HomeMy WebLinkAbout20050132.tiff RESOLUTION
RE: APPROVE CHILD PROTECTION AGREEMENT FOR SERVICES AND AUTHORIZE
CHAIR TO SIGN - EDIE ISRAEL
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS,the Board has been presented with a Child Protection Agreement for Services
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Social Services, and Edie Israel,
commencing January 1, 2005 and ending May 31,2005,with further terms and conditions being as
stated in said agreement, and
WHEREAS,after review,the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, ex-officio Board of Social Services, that the Child Protection Agreement for
Services between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Social Services, and Edie Israel,
be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreement.
The above and foregoing Resolution was,on motion duly made and seconded, adopted by
the following vote on the 10th day of January, A.D., 2005, nunc pro tunc January 1, 2005.
BOARD OF COUNTY COMMISSIONERS
os_ WELD COUNTY, COLORADO n ,4044
I, .`a�C: I William H. rke, Chair
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Date of signature: 440_,L-
2005-0132
SS0032
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DEPARTMENT OF SOCIAL SERVICES
' P.O. BOX A
GREELEY, CO. 80632
Website: www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Vilk.
Child Support(970)352-6933
COLORADO MEMORANDUM
TO: William H. Jerke, Chair Date: January 5, 2005
Board of County Commissioners
FR:Judy A.Griego,Director,Social Services((,'�,(,`(i C it
RE: Child Protection Agreement for Services , ween the Weld County
Department of Social Services and Edie Israel, Psy.D.
Enclosed for Board approval is a Child Protection Agreement for Services between the Weld
County Department of Social Services (Department) and Edie Israel, Psy.D. This Agreement
was discussed and reviewed at the Board's Work Session of December 20, 2004.
The major provisions of the Agreement are as follows:
1. The term of the Agreement is January 1, 2005 through May 31, 2005.
2. Edie Israel, Psy.D., will provide psychological evaluations for adults and youth under the
child welfare and youth in conflict systems.
3. The Department agrees to reimburse at rates, not to exceed a maximum reimbursement
level of$1,000 per evaluation,provided below:
Services Provided Rates/Costs
a. Psychological evaluation $120 per hour
b. Interactional evaluation $120 per hour
c. Neuro-psychological and psycho-sexual $120 per hour
evaluation
d. Court preparation/testimony $130 per hour
4. The source of funding is Core Services.
If you have any questions,please telephone me at extension 6510.
2005-0132
Contract No.PY 05-CORE-42
4,
tt
CHILD PROTECTION AGREEMENT FOR SERVICES y
BETWEEN THE WELD COUNTY DEPARTMENT OF SOCIAL SERVIC
AND EDIE ISRAEL,Psy.D 1j ,
This Agreement,made and entered into the day of January,2005 by and between the
�`9
Board of Weld County Commissioners, sitting as the Board of Social Services, on behalf of the
Weld County Department of Social Services,hereinafter referred to as"Social Services,"and Edie
Israel, Psy.D.,hereinafter referred to as the"Contractor".
WITNESSETH
WHEREAS,required approval, clearance, and coordination have been accomplished
from and with appropriate agencies; and
WHEREAS, the Colorado Department of Human Services has provided Core Services
Mental Health funding to Social Services for psychological evaluations and therapy;and
WHEREAS,the Contractor is an academically qualified,post doctorate candidate with
licensure and is able to provide quality psychological evaluations.
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and
agree as follows:
1. Term
This Agreement shall become effective on January 1,2005 upon proper execution of this
Agreement and shall expire May 31,2005,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by the Contractor to any person(s)eligible for child protection
services in compliance with Exhibit A, "Scope of Services,"a copy of which is attached
by reference.
Contractor agrees to provide psychological and interactional consultation and
interpretation of psychological and interactional dynamics related to the cases referred to
Contractor in accordance to the policies and procedures provided by Social Services. In
addition,the Contractor agrees to provide neuro-psychological and psychosexual
evaluations and consultation and interpretation of such dynamics related to cases also
referred to the Contractor in accordance to the policies and procedures provided by Social
Services.
Contractor agrees to provide written reports with evaluation findings, analysis, and
recommendations to Social Services.
2. Payment
a. Payment shall be made on the basis of Exhibit B, "Payment Schedule,"a copy
of which is attached and incorporated by reference. "Payment Schedule"shall
establish the maximum reimbursement,which will be paid from Colorado Core
Services funds during the duration of this Agreement.
Page 1 of 5
Contract No.PY 05-CORE-42
b. Contractor shall submit an itemized monthly bill to Social Services for all costs
incurred and services provided pursuant to Exhibit A, "Scope of Services"of
this Agreement in accordance with criteria established by Social Services. The
Contractor shall submit all itemized monthly billings to Social Services no later
than the twenty-fifth(25)day of the month following the month the cost was
incurred.
Failure to submit monthly billings in accordance with the terms of this
agreement shall result in Contractor's forfeiture of all rights to be reimbursed for
such expenses. In the event of a forfeiture of reimbursement,Contractor may
appeal such circumstance to the Director of Social Services. The decision of the
Director of Social Services shall be final.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent
upon the availability of Colorado Core Services funds to Social Services.
d. Social Services shall not be billed for, and reimbursement shall not be made for
time involved in activities outside of those defined in Exhibit A, "Scope of
Services." Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
3. Financial Management
At all times from the effective date of this Contract until completion of this Contract,
Contractor shall comply with the administrative requirements,cost principles and other
requirements set forth in the Financial Management Manual adopted by the State of
Colorado. The required annual audit of all funds expended under the Colorado Family
Preservation Act must conform to the Single Audit Act of 1984 and OMB Circular A-
128.
4. Payment of Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. Contractor shall provide proper monthly invoices and verification of services
performed for costs incurred in the performance of the agreement.
b. Social Services may withhold any payment if Contractor has failed to comply
with the Financial Management Requirements,program objectives, contractual
terms,or reporting requirements. In the event of a forfeiture of reimbursement,
Contractor may appeal such circumstance to the Director of Social Services.
The decision of the Director of Social Services shall be final.
5. Assurances
Contractor shall abide by all assurances as set forth in the attached Exhibit C,
"Assurances"which is attached hereto and incorporated herein by reference.
6. Compliance with Applicable Laws
At all times during the performance of this contract,the Contractor shall strictly adhere to
all applicable federal and state laws,orders,and all applicable standards,regulations,
Page 2 of 5
Contract No. PY 05-CORE-42
interpretations or guidelines issued pursuant thereto. This includes the protection of the
confidentiality of all applicant/recipient records,papers,documents,tapes and any other
materials that have been or may hereafter be established which relate to this Contract.
Contractor acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-1 et. Seq.
and its implementing regulation,45 C.F.R.Part 80 et. Seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794, and its
implementing regulation,45 C.F.R.Part 84; and
- the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et seq. and its
implementation regulation,45 C.F.R.Part 91; and
Title VII of the civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
Immigration Reform and Control Act of 1986,P.L.99-603;
and all regulations applicable to these laws prohibiting discrimination because of race,
color, national origin,and,sex,religion and handicap, including Acquired Immune
Deficiency Syndrome(AIDS) or AIDS related conditions,covered under Section 504 of
the Rehabilitation Act of 1973, as amended, cited above. Included if 45 C.F.R.part 74
Appendix G 9, which requires that affirmative steps be taken to assure that small and
minority businesses are utilized, when possible, as sources of supplies,equipment,
construction and services. This assurance is given in consideration of and for the purpose
of obtaining any and all federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a
complaint either with the Colorado Department of Social Services or with the U.S.
Department of Health and Human Services,Office for Civil Rights.
8. Certifications
Contractor certifies that,at the time of entering into this Contract,it has currently in
effect all necessary licenses,approvals,insurance, etc.required to properly provide the
services and/or supplies covered by this contract.
9. Monitoring and Evaluation
Contractor and Social Services agree that monitoring and evaluation of the performance
of this Agreement shall be conducted by Contractor and Social Services. The results of
the monitoring and evaluation shall be provided to the Board of Weld County
Commissioners and the Director of Social Services.
Contractor shall permit Social Services,and any other duly authorized agent or
governmental agency,to monitor all activities conducted by the contractor pursuant to the
terms of this Agreement. As the monitoring agency may in its sole discretion deem
necessary or appropriate,such program date, special analyses,on-site checking,formal
audit examinations,or any other reasonable procedures. All such monitoring shall be
performed in a manner that will not unduly interfere with agreement work.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
Page 3 of 5
Contract No. PY 05-CORE-42
11. Remedies
The Director of Social Services or designee may exercise the following remedial actions
should s/he find Contractor substantially failed to satisfy the scope of work found in this
Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by Contractor. These remedial actions are as
follows:
a. Withhold payment to Contractor until the necessary services or corrections in
performance are satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables
which have not been performed and which due to circumstances caused by
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
c. Incorrect payment to Contractor due to omission, error, fraud,and/or defalcation
shall be recovered from Contractor by deduction from subsequent payments
under this Agreement or other agreements between Social Services and
Contractor, or by Social Services as a debt due to Social Services or otherwise
as provided by law.
12. Representatives
For the purpose of this Agreement,the individuals identified below are hereby-designated
representatives of the respective parties. Either party may from time to time designate in
writing a new or substitute representative(s):
For Social Services: For The Contractor:
Lory Secher,Manager 2 Dr.Edie Israel,Psy.D.
Name Title Name Title
13. Notice
All notices required to be given by the parties hereunder shall be given by certified or
registered mail to the individuals at the addresses set forth below. Either party may from
time to time designate in writing a substitute person(s)or address to whom such notices
shall be sent:
To: Social Services To: Contractor
Judy A. Griego,Director Dr.Edie Israel,Psy.D.
P.O.Box A 1500 28th Street
Greeley, CO 80631 Boulder,CO 80302
14. Litigation
Contractor shall promptly notify Social Services in the event that Contractor learns of any
actual litigation in which it is a party defendant in a case,which involves services
provided under this Agreement. Contractor,within five(5)calendar days after being
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Contract No.PY 05-CORE-42
served with a summons,complaint, or other pleading which has been filed in any federal
or state court or administrative agency, shall deliver copies of such document(s)to the
Social Services Director. The term"litigation" includes an assignment for the benefit of
creditors, and filings in bankruptcy,reorganization and/or foreclosure.
15. Termination
This Agreement maybe terminated at any time by either party given thirty(30)days
written notice and is subject to the availability of funding.
16. Entire Agreement
This Agreement, together with all attachments hereto,constitutes the entire understanding
between the parties with respect to the subject matter hereof, and may not be changed or
modified except as stated in Paragraph 10 herein.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year f abo e en. ��
-44 ST: i �"'��/
OUNTY BOARD OF COUNTY COMMISSIONERS
issl I, i RA OTHEBOARD / WELD COUNTY, COLORADO
By: l it,/
^
By: William H. Jerke, Chair 1/10/2005
Deputy C rk
A D AS TO FO
ur ty Attett.
WELD COUNTY DEPARTMENT CONTRACTOR
OF SOCIAL SERVICES �>
✓ ,� V By: ��ck
By: ral(i c .
D. tor Edie Israel,Psy.D.
Page 5 of 5
LCS-C/3
Contract No. PY 05-CORE-42
EXHIBIT A
SCOPE OF SERVICES
1. Target/Eligible Population
Social Services will refer child welfare adult,child,and adolescent family
members/caretakers who are non-Medicaid eligible who are clients of Social Services
and are in need of mental health services. Contractor will be responsible for any servicing
any parents/caretakers on active Dependency and Neglect cases that are referred by
Social Services.
2. Types of Services to be Provided
Services to be provided under the terms of this contract by Contractor who is an
academically qualified,post doctorate candidate with licensure, and shall include the
following:
a. Psychological Evaluation
The Contractor will provide an evaluation that will be available to families,
children and adolescents who are eligible and in need of evaluations,and other
assessment services intended to provide information needed by the staff of
Social Services.The evaluation procedures will be designed to produce useful
responses to specific referral questions mutually developed by Contractor and
Social Services' Caseworker assigned to the case. The parties will also
collaborate with contacts that need to be made prior to the completion of the
evaluation.
Contractor will provide Social Services a written report upon completion of the
evaluation,which clearly states methods used,contacts made,tests
administered,results, and recommendations relevant to the referral questions.
Contractor will administer and interpret tests. The content of this assessment
will be made available to the family and other relevant parties,subject to the
American Psychological Association ethical standards and other legal
considerations. Contractor agrees to produce a written psychological and/or
interactional evaluation within 60 days of the caseworker referral provided that
the client(s)is/are in compliance with keeping scheduled appointments.
Contractor's evaluations can be useful in identifying clinical recommendations
regarding any suggested treatment plan amendment and/or permanency
recommendations for children.
Contractor's evaluations can also be useful in identifying significant mental
health issues and diagnoses,addressing personality issues, addressing
intellectual functioning or the ability to manage emotions that may or may not
hamper a caretaker's ability to safely parent or that may or may not hamper a
child's ability to bond,attach, and cope in a family of origin. The evaluations
may also help in identifying treatment recommendations and determining
whether a caretaker is able to change in a reasonable amount of time for
permanency for a child in the timeframe of a child.
The evaluations may be able to address issues regarding parent/child bonding
and attachment issues;parenting issues;and placement of children with mental
health issues and will consist,at a minimum,as follows:
Page 1 of 2
Contract No. PY 05-CORE-42
Review Social Services case records,prior evaluation and mental
health treatment records,police reports,medical records,records from
other agencies involved in the case, and,
In depth clinical interview; and
Administration of emotional screening instruments,rating scales,
measures of intellectual functioning, and/or personality functioning,
and/or parenting/family functioning as necessary to answer the referral
questions and make appropriate and meaningful recommendations, and
Consultation with collateral sources; and
Feedback given to the client; and
-- Write-up addressing psychosocial history, diagnostic information,all
issues pertinent to the referral questions,and treatment
recommendations.
b. Evaluation Referral
Contractor's evaluations will be assessed by the Social Services' caseworker and
with any other Social Services staff designated by Social Services. If Contractor
and Social Services agree,through its staff,the evaluation requires additional
testing or services resulting in additional expenditures, the Social Services
Manager 4 or his or her designee must expressly authorize in writing to
Contractor to perform such testing or services.
c. Court Testimony
Contractor will be available for court testimony when given proper notification.
Court testimony includes preparation of and actual court testimony.
3. Service Time Frames
a. Evaluations,through a written report,will be completed within sixty(60)days from
the point of receiving the referral letter and referral packet from a caseworker,
provided that the client(s)is/are in compliance with keeping scheduled appointments.
b. Deadlines will be extended by Social Services on behalf of Contractor when clients
cannot be found or reached.
c. If a client partially complies with appointments, Contractor will write the evaluation
based on information obtained up to that date and prorated based on hours performed
by Contractor. If no appointments have been made,the evaluation referral may be
dropped by Contractor due to the client's failure to follow through and Contractor
will not bill Social Services.
d. Contractor will allow a client three appointment absences before the Contractor
drops the referral.
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Contract No.PY 05-CORE-42
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Social Services agrees to reimburse Contractor in consideration for the work and services
performed under Core Services Mental Health or Child Welfare Administration finding.
Expenses incurred by Contractor,in association with said project prior to the term of this
agreement, are not eligible Social Services expenditures and shall not be reimbursed by
Social Services.
Payment pursuant to this Contract, if Core Services Mental Health funds,whether in
whole or in part, is subject to and contingent upon the continuing availability of Core
Services Mental Health funds for the purposes hereof. In the event that said funds, or any
part thereof,become unavailable as determined by Social Services, Social Services may
immediately terminate this Contract or amend it accordingly.
2. Fees for Services
Social Services agrees to reimburse the Contractor as follows:
a. $120 per hour for psychological evaluation.
b. $120 per hour for interactional evaluations.
c. $120 per hour for neuro-psychological and sexual evaluation.
d. $130 per hour for court preparation and testimony
Fees for any evaluation will not exceed$1,000.00 total.
Completed evaluations will be as follows:
a. All evaluations referred to Contractor will result in a write-up addressing
psychosocial history, diagnostic information,personality issues,intellectual
functioning or emotional functioning and regulation abilities, and treatment and
permanency recommendations for caretakers and/or their children
b. Payment cannot be made unless the completed evaluation is attached to the bill
for reimbursement.
3. Standards of Responsibility
a. Social Services agrees to:
1) Contact Contractor in writing for each referral to clarify background
history and referral questions.
2) The written referral by the caseworker will include but may not be
limited to:
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Contract No.PY 05-CORE-42
a) Client's full name, address, and phone number. If the client
does not have an address or phone, other contact information
will be provided.
b) A copy of the Social Services background history report,
Family Services Plan and other documentation providing
details of the case.
c) A copy of a signed release allowing the caseworker to provide
copies of documentation from other agencies with information
pertaining to the case(i.e., substance abuse evaluation and
treatment records,police reports, medical records, school
records,copies of interactional evaluations, copies of prior
mental health evaluations copies of family treatment records,
etc.).
d) Complete copies of all the above as they pertain to the case.
b. Contractor agrees to:
1) Attach copies of the completed evaluation at the time of billing to the
caseworker,at Weld County Department of Social Services,P. O.Box
A, 315 B N 11th Avenue,Greeley,Colorado,80632.
2) A complete and timely billing form is identified by and must include
the following elements.
a) The billing must be an original billing signed by the provider
and/or designee.
b) Evaluations must include the client's full name,beginning and
ending date of the referral,completed or partial evaluation,
hours performed for the partial evaluation,and total billed for
the evaluation.
c) Requests for payment must be an original and submitted to the
Social Services by the end of the 25th calendar day following
the end of the service.The provider must submit requests for
payment on forms,as approved by the Social Services.
Page 2 of 2
Contract No. PY 05-CORE-42
EXHIBIT C
ASSURANCES
1. Contractor agrees he/she is an independent contractor and that its officers and employees
do not become employees of Weld County,nor are they entitled to any employee benefits
as Weld County employees, as the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and
employees,shall not be held liable for injuries or damages caused by any negligent acts
or omissions of Contractor or his employees,volunteers, or agents while performing
duties as described in this Agreement. Contractor shall provide adequate liability and
worker's compensation insurance for all its employees,volunteers, and agents engaged in
the performance of the Agreement upon request,Contractor shall provide Social Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the
parties or their officers or employees may possess,nor shall any portion of this
Agreement be deemed to have treated a duty of care with respect to any persons not a
party to this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the
County of Weld, State of Colorado,to expend funds not otherwise appropriated in each
succeeding year.
5. If any section,subsections,paragraph,sentence,clause,or phase of this Contract is for
any reason held or decided to be unconstitutional,such decision shall not affect the
validity of the remaining portions. The parties hereto declare that they would have
entered into this Contract and each and every section, subsection,paragraph,sentence,
clause,and phrase thereof irrespective of the fact that any one or more sections,
subsections,paragraphs, sentences,clauses,or phrases might be declared to be
unconstitutional or invalid.
6. No officer,member or employee of Weld County and no member of their governing
bodies shall have any pecuniary interest,direct or indirect,in the approved Agreement or
the proceeds thereof.
7. Contractor assures that they will comply with the Title VI of the Civil Rights Act of 1964
and that no person shall,on the grounds of race,creed,color,sex,or national origin,be
excluded from participation in,be denied the benefits of,or be otherwise subjected to
discrimination under this approved Contract.
8. Contractor assures that sufficient,auditable,and otherwise adequate records that will
provide accurate, current,separate,and complete disclosure of the status of the funds
received under the Contract are maintained for three(3)years of the completion and
resolution of an audit. Such records shall be sufficient to allow authorized local,Federal,
and State auditors and representatives to audit and monitor Contractor.
9. All such records, documents, communications,and other materials shall be the property
of Social Services and shall be maintained by Contractor, in a central location and
custodian, in behalf of Social Services, for a period of three(3) years from the date of
final payment under this Contract,or for such further period as may be necessary to
resolve any matters which may be pending,or until an audit has been completed with the
following qualification: If an audit by or on behalf of the federal and/or state government
has begun but is not completed at the end of the three(3)year period, or if audit findings
Page 1 of 3
Contract No. PY 05-CORE-42
have not been resolved after a three(3)year period,the materials shall be retained until
the resolution of the audit finding.
10. Contractor assures that authorized local, federal,and state auditors and representatives
shall, during business hours,have access to inspect any copy records, and shall be
allowed to monitor and review through on-site visits, all contract activities, supported
with funds under this Contract to ensure compliance with the terms of this Agreement.
Contracting parties agree that monitoring and evaluation of the performance of the
Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs,legal
representatives,and assigns. Contractor or Social Services may not assign any of its
rights or obligations hereunder without the prior written consent of both parties.
12. Contractor certifies that Federal appropriated funds have not been paid or will be paid,by
or on behalf of Contractor,to any person for influencing or attempting to influence an
officer or employee of an agency, a Member of Congress, an officer or employee of
Congress,or an employee of a Member of Congress in connection with the awarding of
any Federal contract, the making of any federal grant,the making of any federal loan,the
entering into of any cooperative agreement,and the extension,continuation,renewal,
amendment, or modification of any Federal contract, loan grant, or cooperative
agreement.
13. Contractor assures that it will fully comply with the Children's Code regulations
promulgated,and all other applicable federal and state laws,rules and regulations.
Contractor understands that the source of funds to be used under this Contract is: Core
Services or Child Welfare Administration Funds.
14. Contractor assures and certifies that it and its principals:
a. Is not presently debarred, suspended,proposed for debarment,declared
ineligible,or voluntarily excluded from covered transactions by a federal
department of agency;
b. Has not,within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining,attempting to obtain,or
performing a public(federal,state,or local)transaction or contract under a
public transaction;violation of federal or state antitrust statutes or commission
of embezzlement,theft,forgery,bribery, falsification or destruction of records,
making false statements, or receiving stolen property;
c. Is not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the
offenses enumerated in paragraph 11(b)of this certification; and
d. Has not within a three-year period preceding this Contract,had one or more
public transactions(federal,state,and local)terminated for cause of default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with
Social Services when Contractor also maintains a relationship with a third party and the
two relationships are in opposition. In order to create the appearance of a conflict of
interest, it is not necessary for the contractor to gain from knowledge of these opposing
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Contract No.PY 05-CORE-42
interests. It is only necessary that the contractor know that the two relationships are in
opposition.
16. During the term of the Contract, Contractor shall not enter any third party relationship hat
gives the appearance of creating a conflict of interest. Upon learning of an existing
appearance of a conflict of interest situation,Contractor shall submit to Social Services, a
full disclosure statement setting forth the details that create the appearance of a conflict
of interest. Failure to promptly submit a disclosure statement required by this paragraph
shall constitute grounds for Social Services' termination, for cause, of its contract with
Contractor.
17. Contractor shall protect the confidentiality of all applicant records and other materials
that are maintained in accordance with this Contract. Except for purposes directly
connected the administration of the Child Protection,no information about or obtained
from any applicant/recipient in possession of the Contractor shall be disclosed in a form
identifiable with the applicant/recipient or a minor's parent or guardian. Contractor shall
have written policies governing access to,duplication and dissemination of, all such
information. Contractor shall advise its employees, agents,and subcontractors,if any,
with a copy or written explanation of these confidentiality requirements before access to
confidential data is permitted.
18. Proprietary information for the purposes of this contract is information relating to a
party's research,development,trade secrets,business affairs,internal operations and
management procedures and those of its customers,clients or affiliates,but does not
include information(1)lawfully obtained from third parties, (2)that which is in the
public domain,or(3)that which is developed independently.
Neither party shall use or disclose directly or indirectly without prior written
authorization any proprietary information concerning the other party obtained as a result
of this Contract. Any proprietary information removed from the State's site by
Contractor in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by Contractor for similar information in the
course of its own business.
20. Contractor agrees to provide a written certification to Social Services of its compliance
with Section 26-6-104(7),C.R.S,regarding background checks with current and
prospective employees,contractors and subcontractors whose employees have direct
contact with children.
Page 3 of 3
Contract No. PY 05-CORE-42
310.213 (2/79)
COLORADO STATE DEPARTMENT OF SOCIAL SERVICES
AUTHORIZATION FOR CONTRACTURAL SERVICES
1. WELD COUNTY DATE:
2.
Name of Provider
3.
Address
4.
City, State, Zip
THE DESCRIBED SERVICE IS AUTHORIZED FOR THE CLIENT INDICATED:
5.
Name of Client Household# Cat. Cat.Grp.
6.
Description Sv. Code
7.APPROVAL:
Caseworker Date Co.Director or Supervisor
8. TO BE COMPLETED BY PROVIDER
DATE OF SERVICE
CHARGES$
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE INDICATED
AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN
ME AND THE COUNTY DEPARTMENT OF SOCIAL SERVICES INDICATED.
Provider Signature
Date
Prepare in Triplicate,Original and One copy to Provider, One Copy for Pending File.
Completed Provider's Forms-Original to County Finance Office-Copy to Case Record.
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