HomeMy WebLinkAbout20022190.tiff RESOLUTION
RE: APPROVE ELEVEN AGREEMENTS TO PURCHASE RESIDENTIAL CHILD CARE
FACILITY SERVICES WITH VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO
SIGN
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 eleven Agreements to Purchase
Residential Child Care Facility 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 the following service providers, with terms commencing July 1, 2002, and
ending June 30, 2003, with further terms and conditions being as stated in said agreements:
1) Shiloh Home, Littleton - Estes
2) Shiloh Home, Denver
3) Shiloh Home, Craig
4) Shiloh House, Littleton - Sheridan
5) Shiloh House, Littleton - Portland
6) Shiloh House, Littleton -Yarrow
7) Devereux Cleo Wallace - Westminster
8) Devereux Cleo Wallace - Colorado Springs
9) Family Pathways of Colorado
10) Courthouse, Inc. - Marilee Center
11) Courthouse, Inc. - Daybreak-Princeton, and
WHEREAS, after review, the Board deems it advisable to approve said agreements,
copies of which are 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 eleven Agreements to
Purchase Residential Child Care Facility 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 the above mentioned providers be, and hereby are,
approved.
2002-2190
SS0029
(' r, S C�4)
RE: ELEVEN AGREEMENTS TO PURCHASE RESIDENTIAL CHILD CARE FACILITIES
SERVICES
PAGE 2
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreements.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 12th day of August, A.D., 2002, nunc pro tunc July 1, 2002.
BOARD OF COUNTY COMMISSIONERS
WELD COUN COLORADO
ATTEST: u./�®�k/Q�/ �/�. ��
�� �� Gle aad, Chair
Weld County Clerk to the f. •
r.
yu�
, ; �avid E I ng, Pro-Te
BY: '�LG15E
Deputy Clerk to the B M. J. Geile
AP ED AS TO RM: •
Iliam H. Jerke
ounty Attorne ����
Robert D. Masden
Date of signature: ��2
2002-2190
SS0029
At' •
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
WEBSITE:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
O Child Support(970)352-6933
COLORADO MEMORANDUM
TO: Glenn Vaad, Chair Date: August 5, 2002
Board of County Commissioners
FR: Judy A. Griego,Director, Social Services //tab C l (Acs, ,
RE: Agreements to Purchase Residential Child(are Facilities (RCCF)
Services Between Weld County Department of Social Services with
Various Vendors
Enclosed for Board approval are Agreements to Purchase Residential Child Care Facilities
(RCCF) Services between the Weld County Department of Social Services with various vendors.
These yearly Agreements are in accordance with Board approved policies of Sections 2.320 and
2.902.22 of the Weld County Department of Social Services Operations Manual. These
Agreements were reviewed at the Board's Work Session of August 5, 2002.
The major provisions of the Agreements are as follows:
1. The term is July 1,2002 through June 30, 2003.
2. The Department agrees to reimburse vendors at rates that will include room, board, and
treatment, as follows:
A. Shiloh Homes*: (Littleton—Estes) $72.82 per day
B. Shiloh Homes*: (Denver) $54.21 per day
C. Shiloh Homes*: (Craig) $55.56 per day
D. Shiloh Homes*: (Littleton—Sheridan) $55.56 per day
E. Shiloh Homes*: (Littleton—Portland) $55.56 per day
F. Shiloh Homes*: (Littleton—Yarrow) $55.56 per day
G. Devereux Cleo Wallace—Westminster: $76.04 per day
H. Devereux Cleo Wallace—Colorado Springs: $71.91 per day
I. Family Pathways of Colorado: $71.35 per day
J. Courthouse,Inc.—Marilee Center: $81.17 per day
�J.K Courthouse,Inc.—Daybreak-Princeton: $81.33 per day
*Shiloh will not provide psychological,neuropsychological,neurological,or sex offender
evaluations,polygraphs,plethysmograph, or mentoring services within their rate. These services
and their rates would have to be negotiated separately if requested by the Department.
If you have any questions,please telephone me at extension 6510.
2002-2190
Contract No.: PY 02/03-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this 1st day of July, 2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and Shiloh Home, 6400
W Coal Mine Ave, Littleton, CO 80123, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this
Agreement at a rate of $72.82 per day for children placed within the Residential Child Care Facility
identified as Provider ID#20335. These services will be for children who have been deemed eligible for
social services under the statutes,rules and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2002, until the end of the Colorado fiscal year, June 30,
2003; or until the child is removed by the County; or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees, in writing, to
terminate this Agreement, whichever event occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 2 above, either party shall have the right to terminate this contract by giving the other party thirty
(30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall
terminate on the expiration of the thirty(30) days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease,but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
4. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agreement to Purchase
RCCF Services Rev 06/11/02
-Contract No.: PY 02/03-SS-23A-RCCF
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services and may include,
but are not limited to: Basic 24-hour care and child maintenance (food, shelter, clothing, educational
supplies and allowance), Direct Child Care, Transportation, Administrative Overhead, Support Overhead,
Therapeutic Recreation, Service delivery Staff, Direct therapy and evaluation, which may include but are
not limited to: PsyOlogical,NeurO>e l Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex O er valuation and/or Sex Offender Treatment as prescribed by the Sex
Offender Management Board olicy, Paph, Plettiograph, Parent Training for Teens, Independent
Living Training, Men,Xcivocate, and Supervised Visitation. See ndeldiM
2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility, the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 20335
Shiloh House Estes
7623 S Estes Ct
Littleton, CO 80128
7. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase 2
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70, 2.710.71, 2.710.72,
2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131), the contractor may obtain: 1) Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between regular work hours, the Contractor will make every effort to notify the assigned caseworker,
supervisor, or Intake Screener of any emergency medical, surgical or dental issues prior to granting
authorization. During non-regular work hours, weekends and holidays, the Contractor will contact the
Emergency Duty Worker at the pager number(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County, the
parent(s)must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening, Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor, including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven(7) days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure, where possible, permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status, which comes to their attention.
Agreement to Purchase 3
RCCF Services Rev 06/11/02
—Contract No.: PY 02/03-SS-23A-RCCF
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological (mental and behavioral) or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30) intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress, significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services, the
State of Colorado and any federal laws and regulations, as such, which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
4. Maintain during the term of this Agreement a liability insurance policy of at least $400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $400,000 for total injuries
arising from any one accident.
5. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross
receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts, omissions, or any other defalcations of the Contractor.
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death, to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase A
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
7. Maintain service program records, fiscal records, documentation and other records, which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered, using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received, payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2)weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held, participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education
Students will be conducted every 3 years and reviewed every year. If the IEP is due while the child is in
placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the
County.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
1. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
2. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein, when
Provider Rosters are submitted as described in Section IV, Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual, Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
Agreement to Purchase 5
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee, or servant of Contractor shall be deemed
to be an employee, agent, or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds,whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
1. In the event this contract is terminated, final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado, Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
2. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,
and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or
their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties or their assignees receiving services
or benefits under this Agreement shall be an incidental beneficiary only.
Agreement to Purchase 6
RCCF Services Rev 06/11/02
•
Contract No.: PY 02/03-SS-23A-RCCF
3. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a
duty of care which did not previously exist with respect to any person not a party to this Agreement. The
parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace
such immunities.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
/1
ATTEST: Montt y � 'tr G"�e,�(
Weld County Clerk WELD COUNTY BOARD OF SOCIAL SERVICES,
,4, OF SOCIAL SERVICES
CES WELD COUNTY DEPARTMENT
By ' `� •�. 1 ` " ,/ " W, By: ,j,//� j"
Deputy Clerk to the Bo. '+ 3 I �Gle , hair
APPROVED AS TO FORM:
7-27
CONTRACTOR
County Attorney
Shiloh Home
6400 W Coal Mine Ave
.n, CO 80123
By: R.w,,.` 6 Q°U L
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: {, (1
Direc .'
Agreement to Purchase
RCCF Services Rev 06/11/02
SHILOH HOME, INC.
Addendum A
Shiloh Home offers a range of therapeutic services, and we strive to meet the diverse
treatment needs of youth referred for services. While most often successful in addressing
complex treatment needs, Shiloh Home's lower rate of Medicaid reimbursement, relative
to many other treatment providers, generally does not provide the funding to allow some
services requested by county caseworkers. In addition, it appears that Medicaid
reimbursement does not cover some of the services outlined in the Weld County
"Agreement to Purchase Residential Treatment Center Services".
Please understand that the services outlined below are typically not available at Shiloh
Home. If any of the services outlined below are requested by a county caseworker or
other external member of the treatment team, Shiloh staff will help coordinate completion
of the service with an outside contractor. Payment of the service will be the
responsibility of the county. Shiloh Home is open to assuming responsibility for
providing extra services outlined below, and this can be negotiated with the county on a
case-by-case basis.
Services typically not provided by Shiloh Home include:
> Psychological evaluations
> Neuropsychological evaluations
> Neurological evaluation
> Sex offender evaluation
> Polygraph
> Plethysmograph
➢ Mentoring Services
With regard to medical care, it is not possible to guarantee that a physical examination
will be completed within 14 days of placement due to the limited number of medical
providers accepting Medicaid. A physical exam for youth placed at Shiloh Home will be
scheduled within 14 days of placement. A physical examination is scheduled to ensure
that a youth has obtained a routine medical exam at least once a year.
With regard to dental care, Shiloh Home has no control over the scheduling of dentists
who accept Medicaid. Effort will be made to secure a dental appointment within 60 days
of placement and at a minimum a dental appointment will be scheduled within 60 days of
placement at Shiloh Home.
With regard to annual and triennial reviews of Individual Education Plans (IEP), Shiloh
Home assumes responsibility for completion of annual IEP reviews. However, initial
evaluations used to determine special education eligibility and triennial reviews of IEP's
are the responsibility of the youth's home school district. Shiloh Home will coordinate
with the home school district and will provide support so that the youth's home school
district may complete the initial staffing or triennial review.
SHILOH HOME,INC.
Addendum B
Populations Served by Shiloh Home:
> Male, 7 to 17 years
> Sexually abusive youth
> Youth with conduct issues and significant mental illness
> Traumatized youth and youth with attachment issues
Outline of Treatment Services offered to referred youth based on assessed need:
> 24 hour awake staff offering supervision, counseling, and structured programming
> enrichment experiences provided through both on-grounds and off-grounds activities
> independent living support
> a staff client ratio of 1:5 during awake hours and not exceeding 1:10 during overnight
hours
➢ a comprehensive psychosocial intake completed as part of the admission process
➢ an initial staffing scheduled within 10 days of placement
> monthly treatment staffings to review progress and needs
> a monthly report summarizing treatment progress and ongoing needs
> Specialized treatment for sexually abusive youth, 12 to 17 years
> Specialized programming for young boys, 7 to 12 years
> Substance abuse counseling, individual and group, when necessary
> Structured programming for youth with significant conduct issues
> Individual, group and family therapy up to weekly, as needed
> Ongoing case management
> Medication evaluations and medication management
> Education provided through an on-grounds school
Contract No.: PY 02/03-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this 1st day of July, 2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and Shiloh Home, 6400
W Coal Mine Ave, Littleton, CO 80123, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this
Agreement at a rate of$54.21 per day for children placed within the Residential Child Care Facility
identified as Provider ID#32567. These services will be for children who have been deemed eligible for
social services under the statutes, rules and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2002, until the end of the Colorado fiscal year, June 30,
2003; or until the child is removed by the County; or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees, in writing, to
terminate this Agreement, whichever event occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 2 above, either party shall have the right to terminate this contract by giving the other party thirty
(30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall
terminate on the expiration of the thirty(30) days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease,but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
4. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agreement to Purchase
1
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services and may include,
but are not limited to: Basic 24-hour care and child maintenance (food, shelter, clothing, educational
supplies and allowance), Direct Child Care, Transportation, Administrative Overhead, Support Overhead,
Therapeutic Recreation, Service delive Staff, Direct therapy and evaluation, which may include but are
not limited to: PsychKgical,Neur gical Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offe r Evaluation and/or Sex Offender Treatment as prescribed by the Sex
Offender Management Bo Policy, Polph, Plethys graph, Parent Training for Teens, Independent
Living Training, Mento dvocate, and Supervised Visitation. See A'id c. d-"— A-
2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility, the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 32567
Shiloh Home
3500 W 55th Ave
Denver, CO 80221
7. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase
2
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70, 2.710.71, 2.710.72,
2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131), the contractor may obtain: 1) Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between regular work hours, the Contractor will make every effort to notify the assigned caseworker,
supervisor, or Intake Screener of any emergency medical, surgical or dental issues prior to granting
authorization. During non-regular work hours,weekends and holidays, the Contractor will contact the
Emergency Duty Worker at the pager number(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County, the
parent(s)must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening, Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor, including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven (7) days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure, where possible, permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status, which comes to their attention.
Agreement to Purchase
3
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological (mental and behavioral) or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30) intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress, significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services, the
State of Colorado and any federal laws and regulations, as such, which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
4. Maintain during the term of this Agreement a liability insurance policy of at least$400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $400,000 for total injuries
arising from any one accident.
5. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2)months gross
receipts,whichever is greater, covering the activities of any of its officers, agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts, omissions, or any other defalcations of the Contractor.
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death, to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase
4
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
7. Maintain service program records, fiscal records, documentation and other records, which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection,review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered, using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received, payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2) weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held,participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan(IEP) for youth designated as a Special Education
Students will be conducted every 3 years and reviewed every year. If the IEP is due while the child is in
placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the
County.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
1. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
2. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein,when
Provider Rosters are submitted as described in Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual, Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
Agreement to Purchase
5
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee, or servant of Contractor shall be deemed
to be an employee, agent, or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
1. In the event this contract is terminated, final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado, Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
2. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,
and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or
their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties or their assignees receiving services
or benefits under this Agreement shall be an incidental beneficiary only.
Agreement to Purchase
6
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
3. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a
duty of care which did not previously exist with respect to any person not a party to this Agreement. The
parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace
such immunities.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST: Don, �►�.� „
Weld County Cl. S o ��
I� . ... , 3 WELD COUNTY BOARD OF SOCIAL SERVICES,
: : % ON BEHALF OF THE WELD COUNTY DEPARTMENT
1861 OF SOCIAL SERVICE
/� .. n1
By: l t ./c\- o, 'a'L uUN-\\
�Jp " _q, , By:
Deputy Clerk to the Board�� 4: N 5,,. Glenn as ,Chair
(Si/217A4
APPROVED AS TO FORM:
CONTRACTOR
ou A mey
Shiloh Home
' 6400 W Coal Mine Ave
1 e o , CO 80123
By: 4u... - ^016 op—
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES 1(By: 1.� Oo��
Ijll�ector
Agreement to Purchase
RCCF Services Rev 06/11/02
SHILOH HOME, INC.
Addendum A
Shiloh Home offers a range of therapeutic services, and we strive to meet the diverse
treatment needs of youth referred for services. While most often successful in addressing
complex treatment needs, Shiloh Home's lower rate of Medicaid reimbursement, relative
to many other treatment providers, generally does not provide the funding to allow some
services requested by county caseworkers. In addition, it appears that Medicaid
reimbursement does not cover some of the services outlined in the Weld County
"Agreement to Purchase Residential Treatment Center Services".
Please understand that the services outlined below are typically not available at Shiloh
Home. If any of the services outlined below are requested by a county caseworker or
other external member of the treatment team, Shiloh staff will help coordinate completion
of the service with an outside contractor. Payment of the service will be the
responsibility of the county. Shiloh Home is open to assuming responsibility for
providing extra services outlined below, and this can be negotiated with the county on a
case-by-case basis.
Services typically not provided by Shiloh Home include:
> Psychological evaluations
> Neuropsychological evaluations
) Neurological evaluation
> Sex offender evaluation
> Polygraph
> Plethysmograph
> Mentoring Services
With regard to medical care, it is not possible to guarantee that a physical examination
will be completed within 14 days of placement due to the limited number of medical
providers accepting Medicaid. A physical exam for youth placed at Shiloh Home will be
scheduled within 14 days of placement. A physical examination is scheduled to ensure
that a youth has obtained a routine medical exam at least once a year.
With regard to dental care, Shiloh Home has no control over the scheduling of dentists
who accept Medicaid. Effort will be made to secure a dental appointment within 60 days
of placement and at a minimum a dental appointment will be scheduled within 60 days of
placement at Shiloh Home.
With regard to annual and triennial reviews of Individual Education Plans(IEP), Shiloh
Home assumes responsibility for completion of annual IEP reviews. However, initial
evaluations used to determine special education eligibility and triennial reviews of IEP's
are the responsibility of the youth's home school district. Shiloh Home will coordinate
with the home school district and will provide support so that the youth's home school
district may complete the initial staffing or triennial review.
SHILOH HOME,INC.
Addendum B
Populations Served by Shiloh Home:
> Male, 7 to 17 years
> Sexually abusive youth
> Youth with conduct issues and significant mental illness
> Traumatized youth and youth with attachment issues
Outline of Treatment Services offered to referred youth based on assessed need:
> 24 hour awake staff offering supervision, counseling, and structured programming
> enrichment experiences provided through both on-grounds and off-grounds activities
> independent living support
> a staff:client ratio of 1:5 during awake hours and not exceeding 1:10 during overnight
hours
➢ a comprehensive psychosocial intake completed as part of the admission process
➢ an initial staffing scheduled within 10 days of placement
> monthly treatment staffings to review progress and needs
➢ a monthly report summarizing treatment progress and ongoing needs
> Specialized treatment for sexually abusive youth, 12 to 17 years
> Specialized programming for young boys, 7 to 12 years
> Substance abuse counseling, individual and group, when necessary
> Structured programming for youth with significant conduct issues
> Individual, group and family therapy up to weekly, as needed
> Ongoing case management
> Medication evaluations and medication management
> Education provided through an on-grounds school
•
Contract No.: PY 02/03-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this 1st day of July, 2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and Shiloh Home, 6400
W Coal Mine Ave, Littleton, CO 80123, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services,hereinafter called "State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this
Agreement at a rate of $55.56 per day for children placed within the Residential Child Care Facility
identified as Provider ID#1500860. These services will be for children who have been deemed eligible for
social services under the statutes, rules and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2002, until the end of the Colorado fiscal year, June 30,
2003; or until the child is removed by the County; or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees, in writing, to
terminate this Agreement,whichever event occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 2 above, either party shall have the right to terminate this contract by giving the other party thirty
(30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall
terminate on the expiration of the thirty(30) days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
4. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agreement to Purchase
RCCF Services 1 Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services and may include,
but are not limited to: Basic 24-hour care and child maintenance (food, shelter, clothing, educational
supplies and allowance), Direct Child Care, Transportation, Administrative Overhead, Support Overhead,
Therapeutic Recreation, Service delivery Staff, Direct therapy and evaluation, which may include but are
not limited to: Psyclgical, Neuroll Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offen Evaluation and/or Sex Offender Treatment as prescribed by the Sex
Offender Management Boar Policy, Poly$h, Plethy+iraph, Parent Training for Teens, Independent
Living Training, Mentor/ vocate, and Supervised Visitation. ,S-ee A ddc.cJ e-
2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility, the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 1500860
Shiloh Home, Inc.
1324 E Victory Way
Craig, CO 81625
7. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase
RCCF Services 2 Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70, 2.710.71, 2.710.72,
2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131), the contractor may obtain: 1) Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between regular work hours, the Contractor will make every effort to notify the assigned caseworker,
supervisor, or Intake Screener of any emergency medical, surgical or dental issues prior to granting
authorization. During non-regular work hours, weekends and holidays, the Contractor will contact the
Emergency Duty Worker at the pager number(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County, the
parent(s) must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening, Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor, including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven (7) days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure, where possible, permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status,which comes to their attention.
Agreement to Purchase
3
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological (mental and behavioral) or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30) intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress, significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services, the
State of Colorado and any federal laws and regulations, as such, which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
4. Maintain during the term of this Agreement a liability insurance policy of at least $400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $400,000 for total injuries
arising from any one accident.
5. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross
receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts, omissions, or any other defalcations of the Contractor.
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death, to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase
4
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
7. Maintain service program records, fiscal records, documentation and other records,which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered, using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received, payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2)weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held, participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education
Students will be conducted every 3 years and reviewed every year. If the IEP is due while the child is in
placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the
County.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
1. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
2. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein,when
Provider Rosters are submitted as described in Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual, Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
Agreement to Purchase
5
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee, or servant of Contractor shall be deemed
to be an employee, agent, or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
1. In the event this contract is terminated, final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado, Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
2. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,
and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or
their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties or their assignees receiving services
or benefits under this Agreement shall be an incidental beneficiary only.
Agreement to Purchase
6
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
3. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a
duty of care which did not previously exist with respect to any person not a party to this Agreement. The
parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace
such immunities.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
Air,
ATTEST: i Tj/.�f- '
Weld County Cler - t•. • WELD COUNTY BOARD OF SOCIAL SERVICES,
ON BEHALF OF THE WELD COUNTY DEPARTMENT
aI OF SOCIAL SERVICES
By: G7i1/ “e< , • .� ci ,W111? g By:
Deputy Clerk to the Board % �y , hair
(8,42°64
APPROVED AS TO FORM:
CONTRACTOR
Co�uhty A om
Shiloh Home
6400 W Coal Mine Ave
Littleton, CO 80123
By: b 1 6-oZ
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: •_y fCk0
irector
J Atit��JJJJJ
Agreement to Purchase
RCCF Services Rev 06/11/02
SHILOH HOME, INC.
Addendum A
Shiloh Home offers a range of therapeutic services, and we strive to meet the diverse
treatment needs of youth referred for services. While most often successful in addressing
complex treatment needs, Shiloh Home's lower rate of Medicaid reimbursement, relative
to many other treatment providers, generally does not provide the funding to allow some
services requested by county caseworkers. In addition, it appears that Medicaid
reimbursement does not cover some of the services outlined in the Weld County
"Agreement to Purchase Residential Treatment Center Services".
Please understand that the services outlined below are typically not available at Shiloh
Home. If any of the services outlined below are requested by a county caseworker or
other external member of the treatment team, Shiloh staff will help coordinate completion
of the service with an outside contractor. Payment of the service will be the
responsibility of the county. Shiloh Home is open to assuming responsibility for
providing extra services outlined below, and this can be negotiated with the county on a
case-by-case basis.
Services typically not provided by Shiloh Home include:
> Psychological evaluations
> Neuropsychological evaluations
> Neurological evaluation
> Sex offender evaluation
> Polygraph
> Plethysmograph
> Mentoring Services
With regard to medical care, it is not possible to guarantee that a physical examination
will be completed within 14 days of placement due to the limited number of medical
providers accepting Medicaid. A physical exam for youth placed at Shiloh Home will be
scheduled within 14 days of placement. A physical examination is scheduled to ensure
that a youth has obtained a routine medical exam at least once a year.
With regard to dental care, Shiloh Home has no control over the scheduling of dentists
who accept Medicaid. Effort will be made to secure a dental appointment within 60 days
of placement and at a minimum a dental appointment will be scheduled within 60 days of
placement at Shiloh Home.
With regard to annual and triennial reviews of Individual Education Plans (PEP), Shiloh
Home assumes responsibility for completion of annual IEP reviews. However, initial
evaluations used to determine special education eligibility and triennial reviews of IEP's
are the responsibility of the youth's home school district. Shiloh Home will coordinate
with the home school district and will provide support so that the youth's home school
district may complete the initial staffing or triennial review.
SHILOH HOME,INC.
Addendum B
Populations Served by Shiloh Home:
> Male, 7 to 17 years
> Sexually abusive youth
> Youth with conduct issues and significant mental illness
> Traumatized youth and youth with attachment issues
Outline of Treatment Services offered to referred youth based on assessed need:
> 24 hour awake staff offering supervision, counseling, and structured programming
➢ enrichment experiences provided through both on-grounds and off-grounds activities
> independent living support
➢ a staff:client ratio of 1:5 during awake hours and not exceeding 1:10 during overnight
hours
> a comprehensive psychosocial intake completed as part of the admission process
➢ an initial staffing scheduled within 10 days of placement
> monthly treatment staffings to review progress and needs
> a monthly report summarizing treatment progress and ongoing needs
> Specialized treatment for sexually abusive youth, 12 to 17 years
> Specialized programming for young boys, 7 to 12 years
> Substance abuse counseling, individual and group, when necessary
> Structured programming for youth with significant conduct issues
> Individual, group and family therapy up to weekly, as needed
> Ongoing case management
> Medication evaluations and medication management
> Education provided through an on-grounds school
Contract No.:•PY 02/03-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this 1st day of July, 2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and Shiloh House, 6400
W Coal Mine Ave, Littleton, CO 80123, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this
Agreement at a rate of $55.56 per day for children placed within the Residential Child Care Facility
identified as Provider ID#62291. These services will be for children who have been deemed eligible for
social services under the statutes, rules and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2002, until the end of the Colorado fiscal year, June 30,
2003; or until the child is removed by the County; or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees, in writing, to
terminate this Agreement, whichever event occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 2 above, either party shall have the right to terminate this contract by giving the other party thirty
(30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall
terminate on the expiration of the thirty(30) days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
4. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agreement to Purchase
RCCF Services 1 Rev 06/11/02
•
Contract No.:•PY 02/03-SS-23A-RCCF
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services and may include,
but are not limited to: Basic 24-hour care and child maintenance (food, shelter, clothing, educational
supplies and allowance), Direct Child Care, Transportation, Administrative Overhead, Support Overhead,
Therapeutic Recreation, Service delivery Staff, Direct therapy and evaluation, which may include but are
not limited to: Psychhpgical,Neuro gical Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offe valuation and/or Sex Offender Treatment as prescribed by the Sex
Offender Management Bo Policy, Polaph, Pleth graph, Parent Training for Teens, Independent
Living Training, Ment dvocate, and Supervised Visitation. S'e e A d ck 4'N. A
2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility, the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 62291
Shiloh House Sheridan
7201 S Sheridan Ct
Littleton CO 80123
7. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase
2
RCCF Services Rev 06/11/02
•
Contract No.: PY 02/03-SS-23A-RCCF
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70, 2.710.71, 2.710.72,
2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131), the contractor may obtain: 1) Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between regular work hours, the Contractor will make every effort to notify the assigned caseworker,
supervisor, or Intake Screener of any emergency medical, surgical or dental issues prior to granting
authorization. During non-regular work hours, weekends and holidays, the Contractor will contact the
Emergency Duty Worker at the pager number(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County, the
parent(s) must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening, Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor, including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven (7) days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure, where possible,permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status, which comes to their attention.
Agreement to Purchase
RCCF Services 3 Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological (mental and behavioral) or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30) intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress, significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services, the
State of Colorado and any federal laws and regulations, as such, which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
4. Maintain during the term of this Agreement a liability insurance policy of at least $400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $400,000 for total injuries
arising from any one accident.
5. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross
receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts, omissions, or any other defalcations of the Contractor.
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death, to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase
4
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
7. Maintain service program records, fiscal records, documentation and other records, which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered, using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received, payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2) weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held, participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education
Students will be conducted every 3 years and reviewed every year. If the IEP is due while the child is in
placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the
County.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
1. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
2. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein, when
Provider Rosters are submitted as described in Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual, Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
Agreement to Purchase
RCCF Services 5 Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee, or servant of Contractor shall be deemed
to be an employee, agent, or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
1. In the event this contract is terminated, final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado, Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
2. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,
and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or
their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties or their assignees receiving services
or benefits under this Agreement shall be an incidental beneficiary only.
Agreement to Purchase 6
RCCF Services Rev 06/11/02
Contract NG.: PY 02/03-SS-23A-RCCF
3. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a
duty of care which did not previously exist with respect to any person not a party to this Agreement. The
parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace
such immunities.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
Pi
ATTEST: a .
Weld Weld County Cl: �d`t{1c oMrd' ;y WELD COUNTY BOARD OF SOCIAL SERVICES,
r ON BEHALF OF THE WELD COUNTY DEPARTMENT
' OF SOCIAL SERVICES
1861 \q V'"`� p
7 o 4''I
t`ve, i> -� i y� YK/lU//n{/, (////.//
Deputy Clerk to the Boar. e , Glenn a , air
�r� (SJt2]2Wz)
APPROVED AS TO FORM:
/' CONTRACTOR
ountratt m
Shiloh House
6400 W Coal Mine Ave
Lit CO 80123
By: tun, C CPO i'ab-Oa.
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: -
irector
Agreement to Purchase
RCCF Services Rev 06/11/02
SHILOH HOME, INC.
Addendum A
Shiloh Home offers a range of therapeutic services, and we strive to meet the diverse
treatment needs of youth referred for services. While most often successful in addressing
complex treatment needs, Shiloh Home's lower rate of Medicaid reimbursement, relative
to many other treatment providers, generally does not provide the funding to allow some
services requested by county caseworkers. In addition, it appears that Medicaid
reimbursement does not cover some of the services outlined in the Weld County
"Agreement to Purchase Residential Treatment Center Services".
Please understand that the services outlined below are typically not available at Shiloh
Home. If any of the services outlined below are requested by a county caseworker or
other external member of the treatment team, Shiloh staff will help coordinate completion
of the service with an outside contractor. Payment of the service will be the
responsibility of the county. Shiloh Home is open to assuming responsibility for
providing extra services outlined below, and this can be negotiated with the county on a
case-by-case basis.
Services typically not provided by Shiloh Home include:
> Psychological evaluations
> Neuropsychological evaluations
> Neurological evaluation
> Sex offender evaluation
> Polygraph
> Plethysmograph
> Mentoring Services
With regard to medical care, it is not possible to guarantee that a physical examination
will be completed within 14 days of placement due to the limited number of medical
providers accepting Medicaid. A physical exam for youth placed at Shiloh Home will be
scheduled within 14 days of placement. A physical examination is scheduled to ensure
that a youth has obtained a routine medical exam at least once a year.
With regard to dental care, Shiloh Home has no control over the scheduling of dentists
who accept Medicaid. Effort will be made to secure a dental appointment within 60 days
of placement and at a minimum a dental appointment will be scheduled within 60 days of
placement at Shiloh Home.
With regard to annual and triennial reviews of Individual Education Plans (IEP), Shiloh
Home assumes responsibility for completion of annual IEP reviews. However, initial
evaluations used to determine special education eligibility and triennial reviews of IEP's
are the responsibility of the youth's home school district. Shiloh Home will coordinate
with the home school district and will provide support so that the youth's home school
district may complete the initial staffing or triennial review.
SHH,OH HOME,INC.
Addendum B
Populations Served by Shiloh Home:
> Male, 7 to 17 years
> Sexually abusive youth
> Youth with conduct issues and significant mental illness
> Traumatized youth and youth with attachment issues
Outline of Treatment Services offered to referred youth based on assessed need:
> 24 hour awake staff offering supervision, counseling, and structured programming
> enrichment experiences provided through both on-grounds and off-grounds activities
> independent living support
➢ a staff client ratio of 1:5 during awake hours and not exceeding 1:10 during overnight
hours
➢ a comprehensive psychosocial intake completed as part of the admission process
> an initial staffing scheduled within 10 days of placement
> monthly treatment staffings to review progress and needs
➢ a monthly report summarizing treatment progress and ongoing needs
> Specialized treatment for sexually abusive youth, 12 to 17 years
> Specialized programming for young boys, 7 to 12 years
> Substance abuse counseling, individual and group, when necessary
> Structured programming for youth with significant conduct issues
> Individual, group and family therapy up to weekly, as needed
> Ongoing case management
> Medication evaluations and medication management
> Education provided through an on-grounds school
Contract 310.: PY 02/03-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this 1st day of July, 2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and Shiloh House, 6400
W Coal Mine Ave, Littleton, CO 80123, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this
Agreement at a rate of $55.56 per day for children placed within the Residential Child Care Facility
identified as Provider ID#54169. These services will be for children who have been deemed eligible for
social services under the statutes, rules and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2002, until the end of the Colorado fiscal year, June 30,
2003; or until the child is removed by the County; or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees, in writing, to
terminate this Agreement, whichever event occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 2 above, either party shall have the right to terminate this contract by giving the other party thirty
(30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall
terminate on the expiration of the thirty(30) days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
4. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agreement to Purchase 1
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services and may include,
but are not limited to: Basic 24-hour care and child maintenance (food, shelter, clothing, educational
supplies and allowance), Direct Child Care, Transportation, Administrative Overhead, Support Overhead,
Therapeutic Recreation, ervice delivery Staff, Direct therapy and evaluation, which may include but are
not limited to: Psychical, Neuro cal Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offe r r valuation and/or Sex Offender Treatment as prescribed by the Sex
Offender Management Boar Policy, Porgy aph, Plethy ograph, Parent Training for Teens, Independent
Living Training, Ment vocate, and Supervised Visitation. See q dc)4d:,-, ,1--
2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility, the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 54169
Shiloh House Portland
6629 W Portland Ave
Littleton CO 80123
7. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase 2
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70, 2.710.71, 2.710.72,
2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131), the contractor may obtain: 1) Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between regular work hours, the Contractor will make every effort to notify the assigned caseworker,
supervisor, or Intake Screener of any emergency medical, surgical or dental issues prior to granting
authorization. During non-regular work hours, weekends and holidays, the Contractor will contact the
Emergency Duty Worker at the pager number(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County, the
parent(s) must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening, Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor, including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven (7) days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure, where possible, permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status, which comes to their attention.
Agreement to Purchase
3
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological (mental and behavioral) or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30) intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress, significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services, the
State of Colorado and any federal laws and regulations, as such, which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
4. Maintain during the term of this Agreement a liability insurance policy of at least $400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $400,000 for total injuries
arising from any one accident.
5. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2)months gross
receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts, omissions, or any other defalcations of the Contractor.
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death, to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase
4
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
7. Maintain service program records, fiscal records, documentation and other records, which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered, using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received, payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2) weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held, participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan(IEP) for youth designated as a Special Education
Students will be conducted every 3 years and reviewed every year. If the IEP is due while the child is in
placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the
County.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
1. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
2. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein, when
Provider Rosters are submitted as described in Section IV, Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual, Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
Agreement to Purchase 5
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee, or servant of Contractor shall be deemed
to be an employee, agent, or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
1. In the event this contract is terminated, final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado, Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
2. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,
and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or
their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties or their assignees receiving services
or benefits under this Agreement shall be an incidental beneficiary only.
Agreement to Purchase 6
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
3. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a
duty of care which did not previously exist with respect to any person not a party to this Agreement. The
parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace
such immunities.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
Weld County Cle fo .3rd'.'% WELD COUNTY BOARD OF SOCIAL SERVICES,
i ON BEHALF OF THE WELD COUNTY DEPARTMENT
1861 I OF SOCIAL SERVICES
By: 41 4A �: 1�_� V�J p �P` �,I By:
Deputy Clerk to the Board �� lu' j U e � �'�*'! it
�-►� (8//2/2o3L)
APPROVED AS TO FORM:
CONTRACTOR
oun tto ney
Shiloh House
6400 W Coal Mine Ave
ton,/CO 80123
BY: JLw� (/Ct�) .6J `I-a - a.
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
Director
Agreement to Purchase
RCCF Services Rev 06/11/02
SHILOH HOME,INC.
Addendum A
Shiloh Home offers a range of therapeutic services, and we strive to meet the diverse
treatment needs of youth referred for services. While most often successful in addressing
complex treatment needs, Shiloh Home's lower rate of Medicaid reimbursement, relative
to many other treatment providers, generally does not provide the funding to allow some
services requested by county caseworkers. In addition, it appears that Medicaid
reimbursement does not cover some of the services outlined in the Weld County
"Agreement to Purchase Residential Treatment Center Services".
Please understand that the services outlined below are typically not available at Shiloh
Home. If any of the services outlined below are requested by a county caseworker or
other external member of the treatment team, Shiloh staff will help coordinate completion
of the service with an outside contractor. Payment of the service will be the
responsibility of the county. Shiloh Home is open to assuming responsibility for
providing extra services outlined below, and this can be negotiated with the county on a
case-by-case basis.
Services typically not provided by Shiloh Home include:
> Psychological evaluations
> Neuropsychological evaluations
> Neurological evaluation
> Sex offender evaluation
> Polygraph
> Plethysmograph
> Mentoring Services
With regard to medical care, it is not possible to guarantee that a physical examination
will be completed within 14 days of placement due to the limited number of medical
providers accepting Medicaid. A physical exam for youth placed at Shiloh Home will be
scheduled within 14 days of placement. A physical examination is scheduled to ensure
that a youth has obtained a routine medical exam at least once a year.
With regard to dental care, Shiloh Home has no control over the scheduling of dentists
who accept Medicaid. Effort will be made to secure a dental appointment within 60 days
of placement and at a minimum a dental appointment will be scheduled within 60 days of
placement at Shiloh Home.
With regard to annual and triennial reviews of Individual Education Plans(IEP), Shiloh
Home assumes responsibility for completion of annual IEP reviews. However, initial
evaluations used to determine special education eligibility and triennial reviews of IEP's
are the responsibility of the youth's home school district. Shiloh Home will coordinate
with the home school district and will provide support so that the youth's home school
district may complete the initial staffing or triennial review.
SHH.OH HOME,INC.
Addendum B
Populations Served by Shiloh Home:
> Male, 7 to 17 years
> Sexually abusive youth
> Youth with conduct issues and significant mental illness
> Traumatized youth and youth with attachment issues
Outline of Treatment Services offered to referred youth based on assessed need:
> 24 hour awake staff offering supervision, counseling, and structured programming
> enrichment experiences provided through both on-grounds and off-grounds activities
> independent living support
➢ a staff:client ratio of 1:5 during awake hours and not exceeding 1:10 during overnight
hours
➢ a comprehensive psychosocial intake completed as part of the admission process
➢ an initial staffing scheduled within 10 days of placement
> monthly treatment staffings to review progress and needs
➢ a monthly report summarizing treatment progress and ongoing needs
> Specialized treatment for sexually abusive youth, 12 to 17 years
> Specialized programming for young boys, 7 to 12 years
> Substance abuse counseling, individual and group, when necessary
> Structured programming for youth with significant conduct issues
> Individual, group and family therapy up to weekly, as needed
> Ongoing case management
> Medication evaluations and medication management
> Education provided through an on-grounds school
Contract Na.: PY 02/03-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this 1st day of July, 2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and Shiloh House, 6400
W Coal Mine Ave, Littleton, CO 80123, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this
Agreement at a rate of $55.56 per day for children placed within the Residential Child Care Facility
identified as Provider ID#70967. These services will be for children who have been deemed eligible for
social services under the statutes, rules and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2002, until the end of the Colorado fiscal year, June 30,
2003; or until the child is removed by the County; or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees, in writing, to
terminate this Agreement, whichever event occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 2 above, either party shall have the right to terminate this contract by giving the other party thirty
(30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall
terminate on the expiration of the thirty(30) days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
4. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agreement to Purchase
1
RCCF Services Rev 06/11/02
•
Contract Na.: PY 02/03-SS-23A-RCCF
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services and may include,
but are not limited to: Basic 24-hour care and child maintenance (food, shelter, clothing, educational
supplies and allowance), Direct Child Care, Transportation, Administrative Overhead, Support Overhead,
Therapeutic Recreation, Service delive Staff, Direct therapy and evaluation,which may include but are
not limited to: Psyc logical, Neur gical Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as prescribed by the Sex
Offender Management Board Policy, PolyWiph, Plethypktfigraph, Parent Training for Teens, Independent
Living Training, Ment dvocate, and Supervised Visitation. See Add iJcn . /}
2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility, the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation maybe provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 70967
Shiloh House Yarrow
7227 S Yarrow Ct
Littleton CO 80123
7. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase
2
RCCF Services Rev 06/11/02
•
Contract No.: PY 02/03-SS-23A-RCCF
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70, 2/10.71, 2.710.72,
2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131), the contractor may obtain: 1) Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between regular work hours, the Contractor will make every effort to notify the assigned caseworker,
supervisor, or Intake Screener of any emergency medical, surgical or dental issues prior to granting
authorization. During non-regular work hours, weekends and holidays, the Contractor will contact the
Emergency Duty Worker at the pager number(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County, the
parent(s) must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening, Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor, including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven (7) days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure, where possible, permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status, which comes to their attention.
Agreement to Purchase
3
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological (mental and behavioral) or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30) intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress, significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services, the
State of Colorado and any federal laws and regulations, as such, which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
4. Maintain during the term of this Agreement a liability insurance policy of at least $400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $400,000 for total injuries
arising from any one accident.
5. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross
receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts, omissions, or any other defalcations of the Contractor.
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death, to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase
4
RCCF Services Rev 06/11/02
•
Contract No.: PY 02/03-SS-23A-RCCF
7. Maintain service program records, fiscal records, documentation and other records, which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered, using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received,payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2)weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held, participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan(IEP) for youth designated as a Special Education
Students will be conducted every 3 years and reviewed every year. If the IEP is due while the child is in
placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the
County.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
1. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
2. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein, when
Provider Rosters are submitted as described in Section IV, Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual, Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
Agreement to Purchase
5
RCCF Services Rev 06/11/02
•
Contract No.: PY 02/03-SS-23A-RCCF
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee, or servant of Contractor shall be deemed
to be an employee, agent, or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
1. In the event this contract is terminated, final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado, Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
2. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,
and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or
their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties or their assignees receiving services
or benefits under this Agreement shall be an incidental beneficiary only.
Agreement to Purchase
6
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
3. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a
duty of care which did not previously exist with respect to any person not a party to this Agreement. The
parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace
such immunities.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
-�
ATTEST: 140
a/ttitiY.a/ / r
Weld County Cle tht o ` WELD COUNTY BOARD OF SOCIAL SERVICES,
44, tit ` ON BEHALF OF THE WELD COUNTY DEPARTMENT
1861 kite OF SOCIAL SERVICES
i - W
By: ' /J . • � �J aQ�, By:
Deputy Cleric lL{'to the Board � UN'S Glenn aa�au
(SI)212CX14
APPROVED AS TO FORM:
CONTRACTOR
my Att ney
Shiloh House
6400 W Coal Mine Ave
ton, CO 80123
By: _ -Oa
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: , j ` i% Ci Oituyeti
Irector C
Agreement to Purchase
RCCF Services Rev 06/11/02
SHILOH HOME, INC.
Addendum A
Shiloh Home offers a range of therapeutic services, and we strive to meet the diverse
treatment needs of youth referred for services. While most often successful in addressing
complex treatment needs, Shiloh Home's lower rate of Medicaid reimbursement, relative
to many other treatment providers, generally does not provide the funding to allow some
services requested by county caseworkers. In addition, it appears that Medicaid
reimbursement does not cover some of the services outlined in the Weld County
"Agreement to Purchase Residential Treatment Center Services".
Please understand that the services outlined below are typically not available at Shiloh
Home. If any of the services outlined below are requested by a county caseworker or
other external member of the treatment team, Shiloh staff will help coordinate completion
of the service with an outside contractor. Payment of the service will be the
responsibility of the county. Shiloh Home is open to assuming responsibility for
providing extra services outlined below, and this can be negotiated with the county on a
case-by-case basis.
Services typically not provided by Shiloh Home include:
> Psychological evaluations
> Neuropsychological evaluations
➢ Neurological evaluation
> Sex offender evaluation
> Polygraph
> Plethysmograph
> Mentoring Services
With regard to medical care, it is not possible to guarantee that a physical examination
will be completed within 14 days of placement due to the limited number of medical
providers accepting Medicaid. A physical exam for youth placed at Shiloh Home will be
scheduled within 14 days of placement. A physical examination is scheduled to ensure
that a youth has obtained a routine medical exam at least once a year.
With regard to dental care, Shiloh Home has no control over the scheduling of dentists
who accept Medicaid. Effort will be made to secure a dental appointment within 60 days
of placement and at a minimum a dental appointment will be scheduled within 60 days of
placement at Shiloh Home.
With regard to annual and triennial reviews of Individual Education Plans (IEP), Shiloh
Home assumes responsibility for completion of annual IEP reviews. However, initial
evaluations used to determine special education eligibility and triennial reviews of MP's
are the responsibility of the youth's home school district. Shiloh Home will coordinate
with the home school district and will provide support so that the youth's home school
district may complete the initial staffing or triennial review.
•
SHILOH HOME,INC.
Addendum B
Populations Served by Shiloh Home:
➢ Male, 7 to 17 years
> Sexually abusive youth
> Youth with conduct issues and significant mental illness
> Traumatized youth and youth with attachment issues
Outline of Treatment Services offered to referred youth based on assessed need:
➢ 24 hour awake staff offering supervision, counseling, and structured programming
> enrichment experiences provided through both on-grounds and off-grounds activities
> independent living support
➢ a staff:client ratio of 1:5 during awake hours and not exceeding 1:10 during overnight
hours
➢ a comprehensive psychosocial intake completed as part of the admission process
➢ an initial staffing scheduled within 10 days of placement
> monthly treatment staffings to review progress and needs
➢ a monthly report summarizing treatment progress and ongoing needs
> Specialized treatment for sexually abusive youth, 12 to 17 years
> Specialized programming for young boys, 7 to 12 years
> Substance abuse counseling, individual and group, when necessary
> Structured programming for youth with significant conduct issues
> Individual, group and family therapy up to weekly, as needed
> Ongoing case management
> Medication evaluations and medication management
> Education provided through an on-grounds school
Contract No.: PY 02/03-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this 1st day of July, 2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and Devereux Cleo
Wallace, 7100 E Belleview Ave, Suite 210, Lakewood, CO 80111, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this
Agreement at a rate of $76.04 per day for children placed within the Residential Child Care Facility
identified as Provider ID#39794. These services will be for children who have been deemed eligible for
social services under the statutes, rules and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2002, until the end of the Colorado fiscal year, June 30,
2003; or until the child is removed by the County; or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees, in writing, to
terminate this Agreement, whichever event occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 2 above, either party shall have the right to terminate this contract by giving the other party thirty
(30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall
terminate on the expiration of the thirty(30) days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease,but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
4. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agreement to Purchase 1
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services and may include,
but are not limited to: Basic 24-hour care and child maintenance (food, shelter, clothing, educational
supplies and allowance), Direct Child Care, Transportation, Administrative Overhead, Support Overhead,
Therapeutic Recreation, Service delivery Staff, Direct therapy and evaluation,which may include but are
not limited to: Psychological,Neurological Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as prescribed by the Sex
Offender Management Board Policy, Polygraph, Plethysmograph, Parent Training for Teens, Independent
Living Training, Mentor/Advocate, and Supervised Visitation.
2. Payment for a child's temporary absence from the facility, including absence due to hospitalization,will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility, the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 39794
Devereux Cleo Wallace
8405 Church Ranch Blvd
Westminster, CO 80021
7. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase 2
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70, 2.710.71, 2.710.72,
2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131), the contractor may obtain: 1) Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between regular work hours, the Contractor will make every effort to notify the assigned caseworker,
supervisor, or Intake Screener of any emergency medical, surgical or dental issues prior to granting
authorization. During non-regular work hours, weekends and holidays, the Contractor will contact the
Emergency Duty Worker at the pager number(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective,non-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County, the
parent(s) must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening, Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor, including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven(7) days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure, where possible, permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status, which comes to their attention.
Agreement to Purchase 3
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological (mental and behavioral) or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30) intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress, significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services, the
State of Colorado and any federal laws and regulations, as such, which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
4. Maintain during the term of this Agreement a liability insurance policy of at least $400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $400,000 for total injuries
arising from any one accident.
5. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2)months gross
receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts, omissions, or any other defalcations of the Contractor.
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death, to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase 4
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
7. Maintain service program records, fiscal records, documentation and other records, which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered, using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received,payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2) weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held,participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education
Students will be conducted every 3 years and reviewed every year. If the IEP is due while the child is in
placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the
County.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
1. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
2. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein, when
Provider Rosters are submitted as described in Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual, Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
Agreement to Purchase 5
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee, or servant of Contractor shall be deemed
to be an employee, agent, or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds,whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
1. In the event this contract is terminated, final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado, Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
2. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,
and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or
their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties or their assignees receiving services
or benefits under this Agreement shall be an incidental beneficiary only.
Agreement to Purchase 6
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
3. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a
duty of care which did not previously exist with respect to any person not a party to this Agreement. The
parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace
such immunities.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST: Pan
Weld County Cl f FA +^, J% WELD COUNTY BOARD OF SOCIAL SERVICES,
f. ,;%'''``, % BEHALF
SOF THE
WELD COUNTY DEPARTMENT
OF SOCIAL O CE
By, � �, �f e rj2l� p By:
�,P �p Deputy Clerk to the Boar�� � G a , it
•.iAv�I (412-12042)
APPROVED AS TO FORM:
CONTRACTOR
C un Attorney
Devereux Cleo Wallace
7100 E elleview Ave, Suite 210
L d, CO 80111
By: `7
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: ka
irector
Agreement to Purchase
'
RCCF Services Rev 06/11/02
Addendum(A)to the Agreement to Purchase
Residential Treatment Center Services and RCCF Services
between
Devereux Cleo Wallace
and
Weld County Department of Social Services
This addendum is made and entered into as of the 1St day of July 2002 by and between
Weld County Department of Social Services "County" and Devereux Cleo Wallace
"Contractor".
In reference to Section IV,provision#12 of the Agreements, language shall be revised to
read"Contractor agrees to make reasonable efforts to obtain Dental examinations within
60 days of placement and forward all appropriate information to the County".
The undersigned individuals represent that they are fully authorized to execute this
addendum on behalf of the respective parties.
Weld County Department
Devereux Wallace of Social Services
By C/L 7--"c59 B
]r/"TIt--tiF si+ lSk�f Lt k7 r O
Print Name Print Name (,F
2N cm 's.- or Pr.ir,cc ti i'e c-FOC
Title Title
7/'2-9 /O'>^ g7/s/0 Z
Date Date 1
Contract No.: PY 02/03-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this 1st day of July, 2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and Devereux Cleo
Wallace, 7100 E Belleview Ave, Suite 210, Englewood, CO 80111, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this
Agreement at a rate of $71.91 per day for children placed within the Residential Child Care Facility
identified as Provider ID#39796. These services will be for children who have been deemed eligible for
social services under the statutes, rules and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2002, until the end of the Colorado fiscal year, June 30,
2003; or until the child is removed by the County; or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees, in writing, to
terminate this Agreement,whichever event occurs first.
3. This Agreement maybe renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 2 above, either party shall have the right to terminate this contract by giving the other party thirty
(30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall
terminate on the expiration of the thirty(30) days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
4. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agreement to Purchase
1
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services and may include,
but are not limited to: Basic 24-hour care and child maintenance (food, shelter, clothing, educational
supplies and allowance), Direct Child Care, Transportation, Administrative Overhead, Support Overhead,
Therapeutic Recreation, Service delivery Staff, Direct therapy and evaluation, which may include but are
not limited to: Psychological, Neurological Medication and follow-up, Family Therapy, Individual
Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as prescribed by the Sex
Offender Management Board Policy, Polygraph, Plethysmograph, Parent Training for Teens, Independent
Living Training, Mentor/Advocate, and Supervised Visitation.
2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility, the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 39796
Devereux Cleo Wallace
430 Gold Pass Heights
Colorado Springs CO 80906
7. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase
2
RCCF Services Rev 06/11/02
•
Contract No.: PY 02/03-SS-23A-RCCF
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70, 2.710.71, 2.710.72,
2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131), the contractor may obtain: 1) Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between regular work hours, the Contractor will make every effort to notify the assigned caseworker,
supervisor, or Intake Screener of any emergency medical, surgical or dental issues prior to granting
authorization. During non-regular work hours, weekends and holidays, the Contractor will contact the
Emergency Duty Worker at the pager number(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County, the
parent(s) must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening, Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor, including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven (7) days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure, where possible, permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status,which comes to their attention.
Agreement to Purchase
3
RCCF Services Rev 06/11/02
•
Contract No.: PY 02/03-SS-23A-RCCF
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological (mental and behavioral) or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30) intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress, significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services, the
State of Colorado and any federal laws and regulations, as such, which maybe amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
4. Maintain during the term of this Agreement a liability insurance policy of at least $400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $400,000 for total injuries
arising from any one accident.
5. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross
receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts, omissions, or any other defalcations of the Contractor.
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death, to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase
4
RCCF Services Rev 06/11/02
•
Contract No.: 1W 02/03-SS-23A-RCCF
7. Maintain service program records, fiscal records, documentation and other records, which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered, using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received, payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2) weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held, participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan(IEP) for youth designated as a Special Education
Students will be conducted every 3 years and reviewed every year. If the IEP is due while the child is in
placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the
County.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
1. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
2. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein, when
Provider Rosters are submitted as described in Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which maybe amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual, Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
Agreement to Purchase
5
RCCF Services Rev 06/11/02
Contract•No.: PY 02/03-SS-23A-RCCF
6: Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee, or servant of Contractor shall be deemed
to be an employee, agent, or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
1. In the event this contract is terminated, final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado, Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
2. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,
and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or
their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties or their assignees receiving services
or benefits under this Agreement shall be an incidental beneficiary only.
Agreement to Purchase
6
RCCF Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RCCF
3. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a
duty of care which did not previously exist with respect to any person not a party to this Agreement. The
parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace
such immunities.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST: 'mooL* �'_ '.b�
Weld Coun .tler o WELD COUNTY BOARD OF SOCIAL SERVICES,
i , `, .' ON BEHALF OF THE WELD COUNTY DEPARTMENT
1861 �j[' (� . OF SOCIAL SERVICES
Ce .1 s4/ , O (ik-7t id A
By: ! Li. , JO. By:
Deputy Clerk to the Boar Glenn Glenn Vaad, Chair
(1g11412004
APPROVED AS TO FO •
-----,7'
i
CONTRACTOR
ouinty Attorney
Devereux Cleo Wallace
7100 E Belleview Ave, Suite 210
Engle 0000d, CO 8011
By: ,/ Y c
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
u
Dir ctor (
Agreement to Purchase
7
RCCF Services Rev 06/11/02
Addendum (A) to the Agreement to Purchase
Residential Treatment Center Services and RCCF Services
between
Devereux Cleo Wallace
and
Weld County Department of Social Services
This addendum is made and entered into as of the 1st day of July 2002 by and between
Weld County Department of Social Services "County" and Devereux Cleo Wallace
"Contractor".
In reference to Section IV,provision #12 of the Agreements, language shall be revised to
read"Contractor agrees to make reasonable efforts to obtain Dental examinations within
60 days of placement and forward all appropriate information to the County".
The undersigned individuals represent that they are fully authorized to execute this
addendum on behalf of the respective parties.
Weld County Department
Devereux Cleo Wallace
� of Social Services7�
By i��' / B L
r3lrs"re/ F snZT7� t o ,
Print Name Print Name
,5)T2C—cTD2 OF Fr-rvs oci= :1 i c i d2
Title Title
Date Date
07/22/02 10:36 FAX 970 346 7691 WELD CTY S0C SERVICES Ii 010
Contract No-: PY 02103-SS-23A-RCCP
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this 1st day of July,2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called"County" and Family Pathways of
Colorado,PO Box 3398,Idaho Springs,CO 80452, hereinafter called"Contractor".
WHEREAS,the Colorado State Department of Social Services,hereinafter called"State Department" is
authorized to provide social services to individuals and families of individuals through its agents,Count,
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE,it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this
Agreement at a rate of$71.35 per day for children placed within the Residential Child Care Faciity
identified as Provider ID#45111. These services will be for children who have been deemed eligible for
social services under the statutes,rules and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2002,until the end of the Colorado fiscal year,June 30,
2003;or until the child is removed by the County;or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees,in writing,to
terminate this Agreement,whichever event occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 2 above, either party shall have the right to terminate this contract by giving the other party thirty
(30)days notice by registered mail,return receipt requested. If notice is so given,this contract shall
terminate on the expiration of the thirty(30)days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the tetras of
this Agreement shall thereupon cease,but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
4. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agiec,.wm to Purchase 1 Rev 06'11/02
RCCF Scrvices
07/22/02 10:36 FAX 970 346 7691 WELD CTY SOC SERVICES x¢.;011
Contract No.: PY 02/03-SS-23A-RCCF
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services and mot include,
but are not limited to:Basic 24-hour care and child maintenance(food,shelter,clothing, educational
supplies and allowance),Direct Child Care,Transportation,Administrative Overhead, Support Overhead,
Therapeutic Recreation, Service delivery Staff,Direct therapy and evaluation,which may include but are
not limited to: Psychological,Neurological Medication and follow-up,Family Therapy,Individual
Therapy,Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as prescribed by the Sex
Offender Management Board Policy,Polygraph,Plethysmograph,Parent Training for Teens,Independent
Living Training,Mentor/Advocate, and Supervised Visitation.
2. Payment for a child's temporary absence from the facility,including absence due to hospitalization,will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility,the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negctiated.
between County and Contractor and are not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#:45111
Family Pathways of Colorado
984 Hwy 103
Idaho Springs CO 80452
7. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contacts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase 2
R CCF Services Rev 06;11;02
07/22/02 10:36 FAX 970 346 7691 WELD CTY S0C SERVICES Ef 012
Contract No.: PY 02/03-SS-23A-RCCF
SECTION IL MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies(2.710.70,2.710.71,2.710.72,
2.710.73,2.710.74)and Colorado Department of Human Services Child Care Licensing Divisior policy
(7.714.131),the contractor may obtain; 1)Ordinary medical care,and 2)Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between regular work hours,the Contractor will make every effort to notify the assigned caseworker,
supervisor, or Intake Screener of any emergency medical,surgical or dental issues prior to granting
authorization. During non-regular work hours,weekends and holidays,the Contractor will contact the
Emergency Duty Worker at the pager number(970)350-8389.
4. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective,non-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s)and the Cour ty,the
parent(s)must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report,including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening.Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor,including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven(7)days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure,where possible,permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status,which comes to their attention.
Agreement to Purchase 3
RCCF Services Rev 06'11/02
07/22/02 10:37 FAX 970 346 7691 WELD CTY SOC SERVICES Z013
Contract No_: PY 02103-SS-23A-RCCF
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological(mental and behavioral)or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor ar d shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30)intervals after placement,Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress,significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL;
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services,the
State of Colorado and any federal laws and regulations, as such,which may be amended from tine to time,
and chill be binding on Contractor and control any disputes in this Agreement_
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973,Title XX of the Social Security Act of 1975 as revised,and provide.
confidentiality of information concerning the child and the child's family.
4_ Maintain during the term of this Agreement a liability insurance policy of at least$400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and$400,000 for total injuries
arising from any one accident.
5. Maintain during the terms of this Agreement a fidelity bond of at least S25,000 or two(2)months gross
receipts,whichever is greater,covering the activities of any of its officers,agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts, omissions,or any other defalcations of the Contractor.
6. Indemnify County,the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury,including death,to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby,or based upon any violations of any statute, ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase 4 Rev 06'11/02
RCCF Services
07/22/02 10:37 FA% 970 346 7691 WELD CTY SOC SERVICES 1014
Contract No-! PY 02/03-SS-23A-RCCF
7. Maintain service program records, fiscal records,documentation and other records,which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection,review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered,using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received,payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days,and any
subsequent appeal process,for children in placement with the Contractor pursuant to two (2)weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held,participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan(IEP) for youth designated as a Special Education
Students will be conducted every 3 years and reviewed every year. If the IEP is due while the child is in
placement,the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the
County.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
1. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
2. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein, when
Provider Rosters are submitted as described in Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services,federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual,Volume VII,and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
Agreement to Purchase 5 Rev 06/1 1/02
RCCF Services
07/22/02 10:38 FAX 970 346 7691 WELD CTY SOC SERVICES l? 015
Contract No.: PY 07103-SS-23A-RCCF
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
SECTION VI. GENERAL PROVISIONS.
I- The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee,or servant of Contractor shall be deemed
to be an employee,agent,or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement,if in State of Colorado or federal funds,whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal fiords for the
purpose thereof.
3. It is agreed that if,after investigation,it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child,Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation,renewal, addition,deletion,or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
S. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement a:e carrietCt
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
•
1. In the event this contract is terminated, final payment to the Contractor maybe withheld at their di.scretior,
of the County until final audit. Incorrect payments to the Contractor due to omission,error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado,Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
2. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,
and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties or
their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned patties or their assignees receiving services
or benefits under this Agreement shall be an incidental beneficiary only.
Agreement to Purchase 6 Rev 06/11/02
RCCF Services
07/22/02 10:38 FAX 970 346 7691 WELD CIT SOC SERVICES 1]916
Contact No.: PY 02/03-SS-23A-RCCF
3. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,nor shall any portion of this Agreement be deemed to have created a
duty of care which did not previously exist with respect to any person not a party to this Agreemert. The
parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace
such immunities.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,month,and year
first above written.
ATTEST: •
Weld County f.k . 1mM "' \
' , WELD COUNTY BOARD OF SOCIAL SERVICES,
ON BEHALF OF THE WELD COUNTY DEPARTVENT
an '—;\ OF SOCIAL SERVICES
By BY-
Deputy Clerk to the Bo ( 15 � enn V Chair
(81//2/-26412)
APPROVED AS TO FORM:
L
CONTRACTOR
ey
Family Pathways of Colorado
PO Box 3398
Idaho Springs, CO 0452
By: 1/112 14/ y U
WELD COUNTY DEPARTMENTPlifeeJ
��r��—
OF SOCIAL SERVICES 7/x/0
By:c _�
for
Agreement to Purchase 7
RCCF Services Rev 06/.1/02
Jul 30 02 04: 48p COURT HOUSE, INC. 303-781 -0066 p. S
• u u;Druz 14:23 FAX 970 348 7891 WELD CTY SOC SERVICES 4J010
Contract No.: PY 02/03-SS-23A-RCCF
AGREEMENT TO P1JRCAASIE
RCCF SERVICES
TUTS AGREEMENT made this 1st day ofJul y,2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called"Cotuity" and Courthouse Inc., 333
W Hampden Ave, Suite 305,Englewood, CO 80111-2333,hereinafter called "Contractor".
WHEREAS,the Colorado State Department of Social Services,hereinafter called"State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS,county wishes to provide these services by purchasing them from Contractor,and,
WHEREAS,Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1• County agrees to purchase and Contractor agrees to provide the care and services which are listed in this
Agreement at a rate e£$81.17 per day for children placed within the Residential Child Care Facility
identified as Provider ID#45724. These services will be for children who have been deemed eligible for
social services under the statutes,rules and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2002,until the end of the Colorado fiscal year,June 30,
2003; or until the child is removed by the County: or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees,in writing,to
terminate this Agreement,whichever event occurs first.
3. This Agreement maybe renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 2 above, either party shall have the right to terminate this contract by giving the other party thirty
(30)days notice by registered mail,return receipt requested. If notice is so given,this contract shall
terminate on the expiration of the thirty(30)days or until the eligible child can be placed elsewhere,
whichever occurs earlier,and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease,but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
4. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agreement to Purchase
RCCF Services 1
Rev 06/11/02
Jul 30 02 04: 49p COURT HOUSE, INC. 303-791 -0066 p. 10
07/25/02 13:24 FAX 970 348 7891 HELD CD' SOC SERVICES 011
Contract No.; PY 02/03 SS-23A-RCCF
SECTION 1. DESCRIP'T'ION OF SERVICES TO BE PURCHASED,
1. The services purchased under this Agreement are Residential Child Care Facility services and may include,
but are not limited to: Basic 24-hour care and child maintenance(food, shelter, clothing, educational
supplies and allowance),Direct Child Care, Transportation,Administrative Overhead, Support Overhead,
Therapeutic Recreation, Service delivery Staff, Direct therapy and evaluation,which may include but are
not limited to: Psychological,Neurological Medication and follow-up,Family Therapy.Individual
Therapy,Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as prescribed by the Sex
Offender Management Board Policy, Polygraph,Plethysmograph,Parent Training for Teens, Independent
Living Training,Mentor/Advocate,and Supervised Visitation.
2. Payment for a child's temporary absence from the facility,including absence due to hospitalization, will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (}),
3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility,the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
4, All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement, However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are nor a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Facility ID#: 45724
Marilee Center
3864 W Princeton et
Denver CO 80236
7 Contractor shall not charge any additional fees to children or families of children referred by
services provided under this Agreement_ County for
8. Contractor agrees not to assign the obligations wider this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Deparnnent of Social
Services or his appointed designee.
Agreement to Purchase
RCCF Services 2
Rev MI INA
Jul 30 02 04: 48p COURT HOUSE, INC. 303-781 -0066 p. 11
. urrco/oz 1a:z4 FAA 970 346 7691 WELD CT\' SOC SERVICES id 012
Contract No.: PY 02/03-$S-23A-RCCF
SECTION IL MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies(2.710.70,2.710.71,2.710.72,
2.710.73,2.710.74)and Colorado Department of Human Services Child Care Licensing Division policy
(7.714 1 31),the contractor may obtain 1)Ordinary medical care, and 2)Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect thu life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between regular work hours, the Contractor will make every effort to notify the assigned caseworker,
supervisor, or Intake Screener of any emergency medical,surgical or dental issues prior to granting
authorization. During non-regular work hours, weekends and holidays, the Contractor will contact the
Emergency Duty Worker at the pa,et number(970)350-8389.
4. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective,Don-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s)should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County,the
parent(s)must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical,surgical or dental services
provided and the medications administered to the child-
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report,including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening,Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor,including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven(7)days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure,where possible,permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status,wliclr comes to their attention.
Agreement to Nurcllase
RCCF Services 3
Rev 06/11/02
Jul 30 02 04: 49p COURT HOUSE, INC. 303-781 -0066 p. 12
07/25/02 13'25 FAX 970 346 7691 WELD CTX SOC SERVICES Im 01a
Contract No.: PY 02/03SS-23A-RCCF
SECTION III_ REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral fora. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological(mental and behavioral)or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30)intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition,changes in the child's
family situation, education progress, significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL;
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services, the
State of Colorado and any federal laws and regulations, as such,which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973,Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
4. Maintain during the term of this Agreement a liability insurance policy of at least$400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and$400,000 for total injuries
arising from any one accident.
5. Maintain during the terms of this Agreement a fidelity bond of at least$25,000 or two(2)months gross
receipts,whichever is greater,covering the activities of any of its officers, agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts,omissions,or any other defalcations of the Contractor.
6. Indemnify County,the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death,to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby,or based upon any violations of any statute, ordinance,or regulation and the
defense of any such claims or actions.
Agreement to Purchase
RCCF Services 4
Rev 06/11/02
Jul 3O O2 O4: 4Sp COURT HOUSE, INC. 3O3-781 -OO66 p. 13
- 07/25/02 13;25 FAX 970 349 7691 WELD CTY S0C SERVICES 4014
Contact No.: PY 02/03-5S-23A-RCCP
7, Maintain service program records, fiscal records, documentation and other records, which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection,review or audit by federal,
State Department or county personnel,and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered,using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received,payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two(2) weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held,participation may be by teleconference.
10 Agrcc to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement.
I l. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan(IEP) for youth designated as a Special Education
Students will be conducted every 3 years and reviewed every year. If the IEP is due while the child is in
placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the
County.
SECTION V. COUNTY SHALL:
I. Determine eligibility of the child under this Agreement for placement and medical coverage.
1. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
2. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein,when
Provider Rosters are submitted as described in Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado,any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Depuuncnt Staff Manual,Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
Agreement to Purchase
RCCF Services S
Rev 06/1 r/U2
Jul 30 02 04: 50p COURT HOUSE, INC. 303-781 -0066 p. 14
. U//ZD/U2 13:23 FAX 970 346 7691 WELD CT1' SOC SERVICES t0�. 015
Contract No.: PY02/03•SS•23A-RCCF
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
SECTION VI_ GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them,contemplated by this Agreement
is that of employer-independent contractor. No agent,employee,or servant of Contractor shall be deemed
to be an employee, agent,or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent,employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement,if in State of Colorado or federal funds,whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof.
3. It is agreed that if, after investigation,it is shown that reasonable care was given to guard and protect
personal items'nought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation,renewal, addition, deletion,or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5, The Contract shall permit the Colorado Department of Social Services to monitor the service program.
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports,on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
1. In the event this contract is terminated,final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error,fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado,Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
2. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,
and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties or
their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
tuidersigned parties that any entity other than the undersigned parties or their assignees receiving services
or benefits under this Agreement shall be an incidental beneficiary only.
Agreement to Purchase
RCCF Services 6
Rev 06/11/02
Jul 3O O2 O4: SOp COURT HOUSE, INC. 3O3-781 -OO66 p, 15
Ufft4foc rs:za FAA 870 348 7891 WELD CIY S0C SERVICES
4010
Contract No,: PY 02/03-SS-23A-RCCF
3. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a
duty of care which did not previously exist with respect to any person not a party to this Agreement. The
parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace
such immunities.
IN WITNESS WIIEREOF, the parties hereto have duly executed the Agreement as of the day,month,and year
first above written.
ATTEST:
Weld Comity Ci@tk t Board
:' WELD coIJNIY BOARD OF SOCIAL SERVICES,
ON BEHALF OF THE WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
Deputy Link t0 the Board nti3s j BY
,F+4, lean Vaal,chat
APPROVED AS TO FORM:
Court none CONTRACTOR
Courthouse Inc.
333 W Hampden Ave, Suite 305
Englewood, CO 80111-2333
By: "
WELD COUNTY DEPARTMRNT
OF SOCIAL SERVICES
By: v l .t,
Dire for
I �
Agreement to Purchase
RCCF Services
Bev 06/11/02
Jul 30 02 04: 47p COURT HOUSE, INC. 303-781 -0066 p. 2
07/25/02 13; 21 FAX 970 346 7891 WELD CTY SOC SERVICES IQ Oo3
Contract NO.: PY 02/03 SS-23A-RCCF
AGREEMENT TO PIJRCI)IASE
RCCF SERVICES
THIS AGREEMENT made this 1st day ofJuly,2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called"County" and Courthouse Inc.,333
W Hampden Ave, Suite 305, Englewood, CO 80110-2333,hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services,hereinafter called"State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children wider State Department Rules,
and
WI-MREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Child Care Facility.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows.
l. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this
Agreement at a rate of$81.33 per day for children placed within the Residential Child Care Facility
identified as Provider ID#46050. These services will be for children who have been deemed eligible for
social services under the statutes,rules and regulations of the State of Colorado.
2. This Agreement shall be in force from July 1, 2002,until the end of the Colorado fiscal year, June 30,
2003;or until the child is removed by the County; or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees, in writing,to
terminate this Agreement,whichever event occurs first.
3. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 2 above, either party shall have the right to terminate this contract by giving the other party thirty
(30) days notice by registered mail,return receipt requested. If notice is so given,this contract shall
terminate on the expiration of the thirty(30) days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease,but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
4. This Agreement is in lieu of and supersedes all prior agreements between the panics hereto and relating to
the care and services herein described.
Agreement to Purchase
RCCF Services 1
Rev G6/11/02
Jul 30 02 04: 47p COURT HOUSE, INC. 303-781 -0066 p. 3
• or/Z ,'U2 17:21 FAX 970 346 7691 WELD CTY SOC SERVICES
IAJ00r
Contract No.: PY 02/03-SS-23A-RCCF
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Residential Child Care Facility services and may include,
but are not limited to:Basic 24-hour care and child maintenance(food, shelter,clothing,educational
supplies and allowance),Direct Child Care, Transportation, Administrative Overhead, Support Overhead,
Therapeutic Recreation,Service delivery Staff,Direct therapy and evaluation, which may include but are
not limited to: Psychological,Neurological Medication and follow-up,Family Therapy,Individual
Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender Treatment as prescribed by the Sex
Offender Management Board Policy, Polygraph, Plethysmograph,Parent Training for Teens,independent
Living Training, Mentor/Advocate, and Supervised Visitation.
2. Payment for a child's temporary absence from the facility, including absence due to hospitalization,will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and Contractor's facility fnr the
initial placement and return atter the treatment plan is completed. If the child runs away from the
Contractor's facility,the County shall provide transportation to either return,the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor_
4. All other transportation associated with the Contractor's proposed set vices will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plats must be negotiated
between County and Contractor and arc not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
S. Any transportation costs to be incurred on behalf of this child which are to be home by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan,and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
6. Contractor will provide the purchased care and services at
Facility ID#: 46050
Daybreak-Princeton
3640 W Princeton Ave
Denver CO 80236-2333
7. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase
RCCF Services 2
Rev 06/11/o2
Jul 30 02 04: 47p COURT HOUSE, INC. 303-781 -0066 p, 4
inn DIV J411 /Ual WELD CTY SOC SERVICES
lQl U06
Contract No.: PY 02/03-SS-23A-RCCF
SECTION II. MEDICAL CARE •
I In accordance with the Weld County Department of Social Services policies(2.710,70,2.710.71, 2.710.72,
2.710.73,2310.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131).the contractor may obtain: I) Ordinary medical care, and 2)Emergency medical,surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as
protect the life end health of a childrecommended delayed
ity a utli laci medical child toriTy to
and treatment cannot be delayed without placing the at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between regular work hours, the Contractor will make every effort to notify the assigned caseworker,
supervisor, or Intake Screener of any emergency medical, surgical or dental issues prior to granting
authorization. During non-regular work hours,weekends and holidays,the Contractor will contact the
Emergency Duty Worker at the pager nunibe, (970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any administration of
emergency medical,surgical or dental services provided under this authorization.
5. Prior to any elective,non-routine or non-emergency medical,surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental lights are intact,
authorization or attempts to obtain authorization from the parent(s)should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County,the
parent(s)must be contacted for authorization. ty
6 The Contractor is required to maintain a complete record of all medical,surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report,including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening, Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor,including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven(7)days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure,where possible, permission from parents or guardians of the child
placed with the Contractor,
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status,which conics to their attention.
Agreemeer to Purchase
RCCF Services g
Rev 06/11/02
Jul 30 02 04: 47p COURT HOUSE, INC. 303-781 -0066 p. 5
07/z5/02 13:22 FAX 970 346 7691 WELD CTY SOC SERVICES
Id 008
Contract No.: PY 02/03-SS-23A-RCCF
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1 Attaclunent A will be designated as the Placement Referral form,This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion.Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological(mental and behavioral)or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30) intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition,changes in the child's
family situation,education progress,significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV, CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services,the
Slate of Colorado and any federal laws and regulations,as such, which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified undor State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title 3Q{of the Social Security ACt of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
4. Maintain during the term of this Agreement a stability insurance policy of at least$400,000 for property
damage liability, SI50,000 for injury and/or damage to any one person, and$400,000 for total injuries
arising from any one accident.
5. Maintain during the terms of this Agreement a fidelity bond of
receipts, whichever is its least 5s agents o two(pl2)months gross
greater,covering the activities of any of officers, or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts, omissions,or any other defalcations of the Contractor.
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death, to
persons or proper ty caused or sustained in connection with the performance of this contract or by
conditions created thereby, or based upon any violations of any statute,ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase
kCCF Services q
Rev 90111/02
Jul 30 02 04: 48p COURT HOUSE, INC. 303-781 -0066 p, 6
o u cJ;UZ AJ=ZZ PAX 870 348 7691 WELD CTX SOC SERVICES
W3007
Cocoact No.; PY 02/03-SS-23A-RCCF
7. Maintain service program records, fiscal records,documentation and other records,which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the perfommucc of this
Agreement. The above shall be subject at all reasonable times to inspection,review or audit by federal,
State Department or county personnel,and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered, using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received, payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days,and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2)weeks written
notice by the County_ If the facility is in a different part of the state from the county in which the review is
held,participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration ofplacemcnt.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan(IEl') for youth designated as a Special Education
Students will be conducted every 3 years and reviewed every year. If the MEP is due while the child is in
placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the
County.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
1. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
2. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein,when
Provider Rosters arc submitted as described in Section IV, Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual, Volume V UI, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
Agreement to Purchase
RCCF Services S
Rev 00/11/02
Jul 30 02 04: 48p COURT HOUSE, INC. 303-781 -0066 p. 7
07/25/02 13:23 FAX 970 346 7691 WELD CTV SOc SERVICES O008
Contract No.: PY 02/03•SS-23A-RCCF
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that thc relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee,or servant of Contractor shall be deemed
to be an employee,agent, or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement,if in State of Colorado or federal finds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof
3. It is agreed that if, after investigation,it is shown that reasonable care was given to g
personal items brought to Contractor by the Child, Contractor will be released from resp responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition,deletion,or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation,renewal, addition,deletion,or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
S. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports,on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactoryperformance
in the provision of purchased services under this Agreement.
In the event this contract is terminated, final payment to thc Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County,as a debt
due to both the State of Colorado,Colorado Department of Social Services and the County,
any violation shall not be construed nt waiver of
i as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
2. It is expressly understood and agreed that the enforcement of the te
rms and conditions of this Agreement,
and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties o,
their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties or their assignees receiving services
or benefits under this Agreement shall be an incidental beneficiary only.
Agreement to Purchase
RCCF Services 6
Rev 06/11/02
Jul 30 02 04: 48p COURT HOUSE, INC. 303-791 -0066 p. 8
• aei VC aa;eJ r4A a'ro 348 7881 WELD CTY SOC SERVICES
X009
Contract No.: PY 02/03-SS•23A•RCCF
3- No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses nor shall any portion of this Agreement be deemed to have created a
duty of care which did not previously exist with respect to any person not a party to this Agreement. The
parties hereto acknowledge and agree that no part of this Agreement is intended to circumventor replace
such immunities.
1N WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year
first above written.
ATTEST:
Weld County CI r WELD COUNTY BOARD OF SOCIAL SERVICES,
v ON BEHALF OF THE WELD COUNTY DEPARTMENT
OF SOCIAL sERvicEs
1861
Deputy Clerk co the Bo By:
Glenn em C it
CC(/I (8ff z)
APPROVED AS TO FORM:
CountyAtiorn y �I - CONTRACTOR
Courthouse Inc.
333 W Hampden Ave, Suite 305
Englewood, CO 80110-2333
By: SledLC -02
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
t for
Agreement to Purchase
RCCF Services 7
Rev 06/11/02
Hello