HomeMy WebLinkAbout20041948.tiff RESOLUTION
RE: APPROVE TWELVE AGREEMENTS TO PURCHASE RESIDENTIAL CHILD CARE
FACILITIES SERVICES 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 Twelve Agreements to Purchase
Residential Child Care Facilities 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 providers, commencing July 1, 2004, and ending June 30, 2005, with
further terms and conditions being as stated in said agreements, and
1. The Mountain Star Center
2. VisionQuest
3. Kathleen Painter Littler/North Range Behavioral
4. Midway Youth Services, Inc.
5. Turning Point Center for Youth (Mathews Street)
6. Turning Point Center for Youth (Alcohol and Drug)
7. Turning Point Center for Youth (Youth and Family)
8. Colorado Christian Home
9. Family Pathways of Colorado
10. Jefferson Hills (Aurora)
11. Jefferson Hills (Lakewood)
12. Mountain States Children's Home, Inc.
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 Twelve Agreements to Purchase
Residential Child Care Facilities 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 providers be, and hereby are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreements.
2004-1948
E-5- °"/ ss(?t/att. ) SS0031
TWELVE AGREEMENTS TO PURCHASE RESIDENTIAL CHILD CARE FACILITIES
SERVICES
PAGE 2
The above and foregoing Resolution was,on motion duly made and seconded, adopted by
the following vote on the 14th day of July, A.D., 2004, nunc pro tunc July 1, 2004.
BOARD OF COUNTY COMMISSIONERS
�� �/ WELIO N Y, OLORADO-
ATTEST: I '�_ � lv^�- 1,1J
���•1 i% Robert D. Masden, Chair \1
Ile Clerk to the Board
• .���� William H rke, Pro-Tem
g61 �• '�-.0 C•
' ktothe Board
`O M. J. Geile
%c
AS TO !� EXCUSED
Davi. E. Long
!aunty Attor y v .� j
Glenn Vaad
Date of signature: sue-
2004-1948
SS0031
6 ta
DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY, CO. 80632
III Website:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
O
COLORADO
MEMORANDUM
TO: Robert D. Masden, Chair Date: July 12, 2004
Board of County Commissioners
FR: Judy A. Griego,Director, Social Services i .(,((`U (K C 1,c r l
RE: Agreements to Purchase Residential Child CAre Facilities (kCCF) 11
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 July 12, 2004.
The major provisions of the Agreements are as follows:
1. The term is July 1, 2004 through June 30, 2005.
2. The Depatt,nent agrees to reimburse vendors at rates that will include room,board, and
treatment, as follows:
Rate
A. Mountain Star Center $93.28 per day
B. VisionQuest $142.88 per day
C. Kathleen Painter/Littler/North Range $76.18 per day
D. Midway Youth Services, Inc.—Remington House $115.07 per day
E. Turning Point(Mathews Street) $49.39 per day
F. Turning Point(Alcohol and Drug) $75.77 per day
G. Turning Point(Youth and Family) $49.39 per day
H. Colorado Christian Home $76.42 per day
I. Family Pathways of Colorado $71.35 per day
J. Jefferson Hills Aurora $76.16 per day
K. Jefferson Hills Lakewood $76.16 per day
L. Mountain States Children's Home Inc. $33.43 per day
If you have any questions,please telephone me at extension 6510.
•
2004-1948
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE fey untl 16
RCCF SERVICES R/r 10 Sp
THIS AGREEMENT made this%�day of Zig, 2004 between the Board of Weld
County Commissioners, sifting as the Board of Social SUrvices, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and The Mountain Star Center, 3520
W Oxford Ave, Denver, CO 80236,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$93.28 per day for children placed within the
Residential Child Care Facility identified as Provider ID#13363. 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, 2004, until the end of the Colorado fiscal
year, June 30, 2005; 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.
Agreement to Purchase 1
RCCF Services s`C4/-/9414)
Contract No.: PY 04/05-SS-23A-RCCF
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.
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#: 13363
The Mountain Star Center 2 (At Ft. Logan)
4177SKnotCt- Fl d67O GV. 466217,440. -
Denver CO 80236
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 be made in a person-to-person communication, not through phone mail
messages.
3. During 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.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. 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.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90,regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended,proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
•
B. Have not, within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph(B) above.
D. Have not within a three-year period preceding this Agreement,had one or more
public transactions (federal, state, and local)terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
6
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
3. 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.
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 and the County 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.
Agreement to Purchase 7
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. 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.
7. 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.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity 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.
Agreement to Purchase
8
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
I. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
O Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
O Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes O No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation hum facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care O Shelter Care O Substance Abuse Treatment
O CORE Services O Receiving Home O CPA O RTC ❑ Cty regular Foster Care
O Day Treatment O Kinship Care O Group Home ❑ Ind.Living O Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) O Secure O Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family O Group
Appropriate Treatment:
❑ Sex Offender O AggressiveNiolent O Substance Abuse O Truancy O Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency ❑ Special Medical Needs O Behavior Modification O Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. O Public School O Day Treatment
❑ On-grounds School ❑ Additional Tutoring O Independent Living Training O Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Soda!Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
9
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST: 144414471"41
ominew` Weld County Clerk to the Board
, s. ' \ WELD COUNTY BOARD OF SOCIAL
d SERVICES,ON BEHALF OF THE
o?^� 010111
WELD COUNTY DEPARTMENT
1861 tie
VOW' � OF SOCIAL SERVICES
By: ca,...3
sillreputy Clerk to the Board Robert D.Masden,Chair JUL 1 4 2004
APPROVED AS TO FO •
CONTRACTOR
County Atto ey
The Mountain Star Center
3520 W Oxford Ave
Denver,CO 80236
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B� IKSC
WELD COUNTY DEPARTMENT 7
OF SOCIAL SERVICES
By: c c L� LCD
Directo
Agreement to Purchase
1O
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES eooy
vU
THIS AGREEMENT made this; day olkti 2004 between the Board of d
County Commissioners, sitting as the Board of Social S rvices, on behalf of the Weld C' nay
Department of Social Services,hereinafter called "County" and VisionQuest, 5100 Lincoln St,SS'
Denver, CO 80216, 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$142.88 per day for children placed within the
Residential Child Care Facility identified as Provider ID#1511317. 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, 2004, until the end of the Colorado fiscal
year, June 30, 2005; 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.
Agreement to Purchase 1
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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#: 1511317
VisionQuest Residential
5100 Lincoln St.
Denver CO 80216
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 be made in a person-to-person communication, not through phone mail
messages.
3. During 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.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. 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.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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 maybe by
teleconference.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
6
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
3. 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.
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 and the County 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.
Agreement to Purchase
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. 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.
7. 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.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity 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.
Agreement to Purchase
8
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
• FOR RCCF SERVICES
(Attachment A)
• Child's Name: State ID No: Date of Placement:
Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care ❑ Substance Abuse Treatment
❑ CORE Services ❑ Receiving Home ❑ CPA ❑ RTC O Cty regular Foster Care
O Day Treatment ❑ Kinship Care O Group Home ❑ Ind.Living O Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
O Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family O Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification ❑ Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. O Public School O Day Treatment
❑ On-grounds School ❑ Additional Tutoring O Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase 9
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST: latilialetAsi
Weld County Clerk to the Board
V `NJ WELD COUNTY BOARD OF SOCIAL
\�„�` ` SERVICES, ON BEHALF OF THE
1861 t Q g m1 WELD COUNTY DEPARTMENT
%,fir OF SOCIAL SERVICES
`0 . 4
® �Q � ' ' K / By UL 142004
eputy Clerk to the Board Robert D�Masden,Chair
APPROVED AS TO FO
' --7-7 c
�'-- /2_2CONTRACTOR
County orney
VisionQuest
5100 Lincoln St, Bldg 9
Denver, CO 80216
By: 644'd4'9 tC-k
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: �r L1 0l l er
JDirec r
Agreement to Purchase
10
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this/ day oif 2004 between the Board of Weld
County Commissioners, sitting as the Board of Social Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Kathleen Painter Littler/North
Range Behavioral, 2350 3rd St Rd, Greeley, CO 80631, 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$76.18 per day for children placed within the
Residential Child Care Facility identified as Provider ID#6220. 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, 2004, until the end of the Colorado fiscal
year, June 30, 2005; 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.
Agreement to Purchase 1
O7OO V--/94-1,43
Contract No.: PY 04/05-SS-23A-RCCF
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.
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#: 6220
Kathleen Painter Littler
2350 3rd St Rd
Greeley CO 80631
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 be made in a person-to-person communication, not through phone mail
messages.
3. During 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.
Agreement to Purchase 3
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition,psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. 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.
Agreement to Purchase 4
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended,proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local)terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
6
RCCF Services
Contract No.: PIT 04/05-SS-23A-RCCF
3. 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.
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 and the County 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.
Agreement to Purchase
7
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. 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.
7. 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.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity 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.
Agreement to Purchase
$
RCCF Services
•
Contract No.: 1W 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative Involvement? O Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services O Placement with Relative O Cty CC Foster Care O Shelter Care O Substance Abuse Treatment
❑ CORE Services O Receiving Home O CPA O RTC ❑ Cty Cty regular Foster Care
O Day Treatment O Kinship Care O Group Home O Ind.Living D Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
O Therapeutic(Behavior Modification) O Secure O Other(Explain)
Appropriate Counseling:
❑ Individual O Family O Group
Appropriate Treatment:
O Sex Offender ❑ AggressiveNiolent O Substance Abuse O Truancy
O Self-destructive O Delinquency O Special Medical Needs O Victim Behavior O Depression
Man
O Other (Explain) p O Behavior Modification O Anger Management
Appropriate Educational Services:
O Special Ed. O Public School
O Day pendent Lt
O On-grounds School
O Additional Tutoring O Independent Living Training O Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
O It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Sodal Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature
(Worker Name) Date City,State,Zip
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
9
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST: /l t/le(/// j
Weld County Clerk to the Board
WELD COUNTY BOARD OF SOCIAL
SERVICES, ON BEHALF OF THE
w.r WELD COUNTY DEPARTMENT
abl
ar O /J OF SOCIAL SERVICES
Deputy Clerk to the Board By: a 4 2001
P t3 Robert D.Masden,Chair
APPROVED AS TO FORM:
CONTRACTOR
County A omey
Kathleen Painter Littler/North Range
ehavioral
2350 3rd St Rd
Greeley, CO 80631
BY: /.1
WELD COUNTY DEPARTMENT w �Y fre` f"
OF SOCIAL SERVICES
By: z 2/4011 0 U 1.
1 Direc /1
a ,J J
Agreement to Purchase
RCCF Services 10
acs V-/25<i)
' Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this)q-day of 2004 between the Board of Weld
County Commissioners, sitting as the Board of So ial ^ervices, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Midway Youth Services Inc., 729
Remington, Fort Collins CO 80524, 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$115.07 per day for children placed within the
Residential Child Care Facility identified as Provider ID#44002. 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 June 1, 2004, until the end of the Colorado fiscal
year, June 30, 2005; 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.
Agreement to Purchase 1
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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#: 44002
Midway Youth Services -Remington House
1516 Remington
Fort Collins CO 80524
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
' Contract No.: PY 04/05-SS-23A-RCCF
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.
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 be made in a person-to-person communication, not through phone mail
messages.
3. During 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.
Agreement to Purchase 3
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' Contract No.: PY 04/05-SS-23A-RCCF
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.
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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. Contractor shall participate in all
Foster Care Reviews as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
I. 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.
Agreement to Purchase 4
RCCF Services
• Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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
Agreement to Purchase
5
RCCF Services
• ' Contract No.: PY 04/05-SS-23A-RCCF
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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
6
RCCF Services
' Contract No.: PY 04/05-SS-23A-RCCF
3. 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.
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 and the County 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.
Agreement to Purchase
RCCF Services
• ' Contract No.: PY 04/05-SS-23A-RCCF
6. 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.
7. 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.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity 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.
Agreement to Purchase
8
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
D Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes 0 No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? 0 Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services 0 Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care 0 Substance Abuse Treatment
❑ CORE Services 0 Receiving Home 0 CPA 0 RTC ❑ Cty regular Foster Care
❑ Day Treatment 0 Kinship Care 0 Group Home 0 Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
O Therapeutic(Behavior Modification) ❑ Secure 0 Other(Explain)
Appropriate Counseling:
O Individual ❑ Family 0 Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression
❑ Self-destructive 0 Delinquency 0 Special Medical Needs 0 Behavior Modification ❑ Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School ❑ Day Treatment
❑ On-grounds School ❑ Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
9
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST: i tede G
'-_` Weld County Clerk to the Board
t \ /J1`` WELD COUNTY BOARD OF SOCIAL
`�J SERVICES,ON BEHALF OF THE
WELD COUNTY DEPARTMENT
86 { OF SOCIAL SERVICES
�i�Tfa ,
,r .t ay'°1i �.. r n
T(� r '/ By: JUL 14 2004
yr Deputy Clerk to the Board Robert D.Masden, Chair
APPROVED AS TO FORM:
CONTRACTOR
County Atiomey
Midway Youth Services Inc.
729 Remington
Fort Collins CO 805 4
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: kr', P.
Direct
Agreement to Purchase
10
RCCF Services
cCCM/—/9 9c)
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this/t day ofSf, 2004 between the Board of Weld
County Commissioners, sitting as the Board of Social S rvices, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Turning Point Center for Youth,
1644 South College Ave, Fort Collins, CO 80525, 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$49.39 per day for children placed within the
Residential Child Care Facility identified as Provider ID#45179. 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, 2004, until the end of the Colorado fiscal
year, June 30, 2005; 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.
Agreement to Purchase 1
RCCF Services 81V_/;7J)
Contract No.: PY 04/05-SS-23A-RCCF
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.
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#: 45179
Turning Point Mathews St
614 S Mathews St
Fort Collins CO 80521
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 be made in a person-to-person communication, not through phone mail
messages.
3. During 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.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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 maybe 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.
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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. 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.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
•
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended,proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local)terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
6
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
3. 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.
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 and the County 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.
Agreement to Purchase
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. 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.
7. 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.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity 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.
Agreement to Purchase
8
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
•
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
O Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes O No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services O Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care ❑ Substance Abuse Treatment
❑ CORE Services O Receiving Home ❑ CPA ❑ RTC ❑ Cty regular Foster Care
O Day Treatment O Kinship Care ❑ Group Home ❑ Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
O Individual O Family O Group
Appropriate Treatment:
O Sex Offender ❑ AggressiveNiolent O Substance Abuse ❑ Truancy O Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency O Special Medical Needs O Behavior Modification ❑ Anger Management
❑ Other (Explain)
Appropriate Educational Services:
O Special Ed. O Public School ❑ Day Treatment
O On-grounds School O Additional Tutoring O Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
O It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
9
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
•
ATTEST: 1! »titcu1 /ea4r
Weld County Clerk to the Board
�!e�
',st WELD COUNTY BOARD OF SOCIAL
, SERVICES,ON BEHALF OF THE
t4).
�, WELD COUNTY DEPARTMENT
861 =� OF SOCIAL SERVICES
a44 �p1
•r.S t/ / 4:Mt -- �� / By: � 3 11\l—JUL 14 2004
< y.•a Clerk to the Board Robert D. asden,Chair
APPROVED AS TO FO
CONTRACTOR
County Attorney
Turning Point Center for Youth
1644 South College Ave
Fort Collins, CO 80525
1 79
WELD COUNTY DEPARTMENT "�� vie, "'t ice"
OF SOCIAL SERVICES
By: (k,
(, Dire t r
Agreement to Purchase
10
RCCF Services
c.:)/CZ</2/y
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made thisjgaday o4 &/, 2004 between the Board of Weld
County Commissioners, sitting as the Board of Social Sarvices, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Turning Point Center for Youth,
1644 South College Ave, Fort Collins, CO 80525, 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$75.77 per day for children placed within the
Residential Child Care Facility identified as Provider ID#45178. 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, 2004, until the end of the Colorado fiscal
year, June 30, 2005; 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.
Agreement to Purchase 1
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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. My 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. My 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#: 45178
Turning Point For Drugs and Alcohol
640 W Prospect St.
Fort Collins CO 80524
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 be made in a person-to-person communication,not through phone mail
messages.
3. During 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.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. 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.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90,regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended,proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph(B) above.
D. Have not within a three-year period preceding this Agreement,had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase 6
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
3. 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.
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 and the County 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.
Agreement to Purchase
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. 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.
7. 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.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity 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.
Agreement to Purchase
RCCF Services 8
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes O No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services O Placement with Relative O Cty CC Foster Care O Shelter Care O Substance Abuse Treatment
❑ CORE Services O Receiving Home O CPA O RTC ❑ Cty regular Foster Care
❑ Day Treatment O Kinship Care O Group Home O Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) O Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual O Family O Group
Appropriate Treatment:
O Sex Offender O AggressiveNiolent O Substance Abuse ❑ Truancy O Victim Behavior O Depression
O Self-destructive O Delinquency O Special Medical Needs O Behavior Modification O Anger Management
❑ Other (Explain)
Appropriate Educational Services:
O Special Ed. O Public School O Day Treatment
O On-grounds School O Additional Tutoring ❑ Independent Living Training O Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
O It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
9
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
•
ATTEST: 'ad
Weld County Clerk to the Board
teti`� WELD COUNTY BOARD OF SOCIAL
SERVICES,ON BEHALF OF THE
r 1861 Hwy WELD COUNTY DEPARTMENT
� A OF SOCIAL SERVICES
By: Vit �•
W1/44---Deputy Clerk to e Board Robert D.Masden,Chair ��� 1 4 2004
APPROVED AS TO FO •
CONTRACTOR
County A omey
Turning Point Center for Youth
1644 South College Ave
Fort Collins, CO 80525
BY: fh-- 02-a -L-
-
WELD COUNTY DEPARTMENT R� fi ,£-r'
OF SOCIAL SERVICES
jDirectoQr
Agreement to Purchase
1O
RCCF Services
&et) -/wdo
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this/Y day of T' , 2004 between the Board of Weld
County Commissioners, sitting as the Board of Social rvices, on behalf of the Weld County
Department of Social Services,hereinafter called "County" and Turning Point Center for Youth,
1644 South College Ave, Fort Collins, CO 80525, 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$49.39 per day for children placed within the
Residential Child Care Facility identified as Provider ID#100441. 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, 2004, until the end of the Colorado fiscal
year, June 30, 2005; 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.
Agreement to Purchase 1
RCCF Services :9cY'V—/C/5/d9
Contract No.: PY 04/05-SS-23A-RCCF
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.
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
I. 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#: 100441
Turning Point Center for Youth and Family
801 S Shields St
Fort Collins CO 80524
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 be made in a person-to-person communication, not through phone mail
messages.
3. During 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.
Agreement to Purchase 3
R CCP Crrvir-v
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition,psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15)days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. 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.
Agreement to Purchase 4
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90,regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local)transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement,had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
RCCF Services 6
Contract No.: PY 04/05-SS-23A-RCCF
3. 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.
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 and the County 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.
Agreement to Purchase
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. 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.
7. 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.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity 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.
Agreement to Purchase
RCCF Services 8
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS .
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
O Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
O Other (please explain)
2. Reasons for purchasing services for this child are.
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes O No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
O In home services O Placement with Relative O Cty CC Foster Care O Shelter Care
O CORE Services O Receiving Home O CPAO Substance l Abuse Treatment
❑ Day Treatment0 RTC ❑ Cty regular Foster Care
O Kinship Care O Group Home O ma.Living pother(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure O Other(Explain)
Appropriate Counseling:
O Individual O Family O Group
Appropriate Treatment:
O Sex Offender ❑ Aggressive/Violent O Substance Abuse O Truancy O Victim Behavior ❑ Depression
❑ Self-destructive O Delinquency O Special Medical Needs ❑ Behavior Modification O Anger Management
O Other (Explain)
Appropriate Educational Services:
❑ Special Ed. O Public School O Day Treatment
❑ On-grounds School O Additional Tutoring O Independent Living Training O Other (Explain)
Estimated date for accomplishing treatment plan gosh are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child Is In need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
•
If the outcomes are not achieved m the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
9
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST: a ?>tadit,i�y •
�� Weld County Clerk to the oard
E ele o WELD COUNTY BOARD OF SOCIAL
`V SERVICES,ON BEHALF OF THE
`���� WELD COUNTY DEPARTMENT Aititio C / CIerktotheB '
OF SOCIAL SERVICES:AliBy. �� l4 2Q4
utyoard Robert D.Masden,Chau
APPROVED AS TO FORM:
CONTRACTOR
e' County orney
Turning Point Center for Youth
1644 South College Ave
Fort Collins, CO 80525
By:IAA,- tv, g... ..,7,A._____
WELD COUNTY DEPARTMENT 1)6 /r
\O,lent ci74:7
OF SOCIAL SERVICES
By: Jth( t-E/e -
D rector
Agreement to Purchase
10
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this/�day of ` Cy, 2004 between the Board of Weld
County Commissioners, sifting as the Board of Social Services, on behalf of the Weld County
Department of Social Services,hereinafter called "County" and Colorado Christian Home, 2950
Tennyson St, Denver, CO 80212-3029, 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$76.42 per day for children placed within the
Residential Child Care Facility identified as Provider ID#45205. 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 I, 2004, until the end of the Colorado fiscal
year, June 30, 2005; 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.
Agreement to Purchase 1
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 famished 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#: 45205
Colorado Christian Home
2950 Tennyson St
Denver CO 80212-3029
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 be made in a person-to-person communication, not through phone mail
messages.
3. During 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.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. 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.
Agreement to Purchase 4
RCCF Services
Contract No.: IT 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
• • 13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. A full evaluation of an Individualized Educational Plan @EP) 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not,within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph(B) above.
•
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
6
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
3. 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.
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 and the County 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.
Agreement to Purchase
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. 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.
7. 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.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity 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.
Agreement to Purchase 8
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Conant-ids:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services O Placement with Relative O Cty CC Foster Care O Shelter Care O Substance Abuse Treatment
O CORE Services O Receiving Home O CPA O RTC O Cty regular Foster Care
❑ Day Treatment O Kinship Care O Group Home O Ind.Living O Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
O Therapeutic(Behavior Modification) O Secure O Other(Explain)
Appropriate Counseling:
❑ Individual O Family O Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent O Substance Abuse ❑ Truancy O Victim Behavior O D..pression
❑ Self-destructive ❑ Delinquency O Special Medical Needs ❑ Behavior Modification O Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. O Public School O Day Treatment
❑ On-grounds School O Additional Tutoring O Independent Living Training O Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
O It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date `n+
c
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
I3C/C4
Date Date
Agreement to Purchase
9
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
•
ATTEST: MilidAti
Weld County Clerk to the Board
��1
WELD COUNTY BOARD OF SOCIAL
d\ SERVICES,ON BEHALF OF THE
1861 'JN A.o + WELD COUNTY DEPARTMENT
`
1 .1 I s 1 OF SOCIAL SERVICES
J(�/ \^^ By �. °"C---..._
`fir•. ieputy Clerk to the Board JUL 1 4 2004
Robert D.Masden,Chair
APPROVED AS TO FORM:
CONTRACTOR
unty A orney
Colorado Christian Home
2950 Tennyson St
Denver, CO 80212-3029
By: C Vti6e —
WELD COUNTY DEPARTMENT C NW-4 -71- CEO
OF SOCIAL SERVICES
By: —I �i,({4 ( ( ,..,-77
•
7/ J
Dire r
Agreement to Purchase
10
RCCF Services
a'cc4'-/99,
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE MAY 2 4 2004
RCCF SERVICES
THIS AGREEMENT made thisO day o€J ti a 2004 between the Board of Weld
County Commissioners, sitting as the Board of Social Services, on behalf of the Weld County
Department of Social Services, hereinafter 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, 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$71.35 per day for children placed within the
Residential Child Care Facility 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, 2004, until the end of the Colorado fiscal
year, June 30, 2005; 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.
Agreement to Purchase 1
RCCF Services ' m9-/2rcf
Contract No.: PY 04/05-SS-23A-RCCF
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.
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#: 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.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 be made in a person-to-person communication, not through phone mail
messages.
3. During 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.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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 maybe 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.
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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition,psychological and social
functioning,the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. 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.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
• services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended,proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local)transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local)terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
6
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
3. 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.
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 and the County 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.
Agreement to Purchase
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. 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.
7. 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.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity 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.
Agreement to Purchase
RCCF Services 8
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
• Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
O Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services O Placement with Relative ❑ Cty CC Foster Care
O CORE Services ❑ Shelter Care ❑ CrySub regular egul Abuse Treatment
❑ Receiving Home ❑ CPA ❑ RTC
❑ Day Treatment ❑ Kinship Care ❑ Group Home ❑ Cry Foster Care
❑ Ind.Living O Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
O Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
O Individual O Family ❑ Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse O Truancy
uenc ❑ Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency y O Special Medical Needs ❑ Behavior Modification ❑ Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. O Public School
O Day pendent Lt
❑ On-grounds School
❑ Additional Tutoring O Independent Living Training O Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
O It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
CO—7S N—TY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature
(Worker Name) Date City,State,Zip
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date
Date
Agreement to Purchase
RCCF Services 9
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST: ilk a 1. 7
dodoer.% Weld County Clerk to the Board
`N �J
i / �%
at ` WELD COUNTY BOARD OF SOCIAL
Sa SERVICES,ON BEHALF OF THE
uv
I B61 I ie.:A �, WELD COUNTY DEPARTMENT
1 ' OF SOCIAL SERVICES
8 r , ir#
I By: JUL 14 2004
eputy Clerk to the Board Robert D. Masden,Chair
APPROVED AS TO FO
CONTRACTOR
County omey
Family Pathways of Colorado
PO Box 339
Idaho S ri gs, CO 8 52
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
i
By: -__''i/ .; L ,
( ) Direc
Agreement to Purchase
RCCF Services 10
4'c99-/pytt'
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
_"
THIS AGREEMENT made this/q day otpCLt , 2004 between the Board of Weld
County Commissioners, sitting as the Board of Social Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Jefferson Hills, 421 Zang St,
Lakewood, CO 80228, 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$76.16 per day for children placed within the
Residential Child Care Facility identified as Provider ID#12284. 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, 2004, until the end of the Colorado fiscal
year, June 30, 2005; 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.
Agreement to Purchase 1
RCCF Services GeV—/9qp
Contract No.: PY 04/05-SS-23A-RCCF
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.
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#: 12284
Jefferson Hills Aurora
1290 S Patomac
Aurora CO 80012
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 be made in a person-to-person communication, not through phone mail
messages.
3. During 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.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition,psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. 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.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
• 4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90,regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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 maybe by
teleconference.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph(B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase 6
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
3. 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.
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 and the County 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.
Agreement to Purchase
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. 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.
7. 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.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity 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.
Agreement to Purchase
RCCF Services 8
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
I. • Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care ❑ Substance Abuse Treatment
❑ CORE Services ❑ Receiving Home ❑ CPA ❑ RTC ❑ Cty regular Foster Care
❑ Day Treatment ❑ Kinship Care ❑ Group Home ❑ Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family ❑ Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification ❑ Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School ❑ Day Treatment
❑ On-grounds School ❑ Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
9
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
•
ATTEST: attse /i �(.e4
t��a Weld Cou,�fity Clerk to the rd
E La WELD COUNTY BOARD OF SOCIAL
SERVICES, ON BEHALF OF THE
B61 �.� y pJ WELD COUNTY DEPARTMENT
SY OF SOCIAL SERVICES
NNN��� lY
� uiCal
fDeputy Clerk to the Board By: Robert D.Masden, Chair JUL 1 4 2004
APPROVED AS TO FORM:
CONTRACTOR
ounty A omey
Jefferson Hills
421 Zang St
Lakewood, O 80228
By: D.
c.
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: 1- U lP
Directo r
Agreement to Purchase
RCCF Services 10
,?cc4'— /24'
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this N day ofOjjr , 2004 between the Board of Weld
County Commissioners, sitting as the Board of Social Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Jefferson Hills, 421 Zang St,
Lakewood, CO 80228, 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$76.16 per day for children placed within the
Residential Child Care Facility identified as Provider ID#88459. 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, 2004, until the end of the Colorado fiscal
year, June 30, 2005; 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.
Agreement to Purchase 1
RCCF Services
asi—i94(c)
Contract No.: PY 04/05-SS-23A-RCCF
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.
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#: 88459
Jefferson Hills Lakewood
421 Zang St
Lakewood CO 80228
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 be made in a person-to-person communication, not through phone mail
messages.
3. During 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.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. 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.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
• 13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph(B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
6
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
3. 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.
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 and the County 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.
Agreement to Purchase
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. 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.
7. 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.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity 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.
Agreement to Purchase
8
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? 0 Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? 0 Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
O In home services 0 Placement with Relative 0 Cty CC Foster Care ❑ Shelter Care ❑ Substance Abuse Treatment
0 RTC
0 CORE Services 0 Receiving Home 0 CPACtyr❑ Cty regular Foster Care
❑ Day Treatment 0 Kinship Care 0 Group Home 0 Ind.Living
❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
O Therapeutic(Behavior Modification) 0 Secure 0 Other(Explain)
Appropriate Counseling:
O Individual 0 Family ❑ Group
Appropriate Treatment:
❑ Sex Offender 0 AggressiveNiolent ❑ Substance Abuse 0 Truancy 0 Victim Behavior 0 Depression
0 Self-destructive 0 Delinquency 0 Special Medical Needs O Behavior Modification 0 Anger Management
0 Other (Explain)
Appropriate Educational Services:
O Special Ed. ❑ Public School ❑ Day Treatment
O On-grounds School ❑ Additional Tutoring 0 Independent Living Training 0 Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) 0 Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
9
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST:
eld Coun} 1�Tad
L® WELD COUNTY BOARD OF SOCIAL
SERVICES,ON BEHALF OF THE
WELD COUNTY DEPARTMENT
s61 s OF SOCIAL SERVICES
, 1r..t ti
i•., By_
Deputy Clerk to a Board obert . asden,Chair JUL 1 4 2004
APPROVED AS TO FORM:
- CONTRACTOR
ty Att mey
Jefferson Hills
421 Zang St
Lakewood, CO 80228
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: >.
cDirect
Agreement to Purchase
10
RCCF Services
s L.-eV-/2 rf'
Contract No.: PY 04/05-SS-23A-RCCF
AGREEMENT TO PURCHASE
RCCF SERVICES
THIS AGREEMENT made this / day of 74 , 2004 between the Board of Weld
County Commissioners, sitting as the Board of Social/Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Mountain States Children's
Home Inc., PO Box 1097, Longmont, CO 80501, 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$33.43 per day for children placed within the
Residential Child Care Facility identified as Provider ID#45115. 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, 2004, until the end of the Colorado fiscal
year, June 30, 2005; 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.
Agreement to Purchase 1
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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#: 45115
Mountain States Childrens Home
14664 N 107th St
Longmont CO 80504
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
Agreement to Purchase 2
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 be made in a person-to-person communication, not through phone mail
messages.
3. During 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.
Agreement to Purchase 3
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and social
functioning, the child's family situation, educational progress, significant incidents or
disciplinary actions, and progress made to achieve goals specified in the Treatment Plan.
Further, the Contractor agrees to sequence reports to be received by the County fifteen
(15) days prior to judicial or administrative hearings or reviews when provided with thirty
(30) day advance notice of such dates by County. 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.
Agreement to Purchase 4
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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
Agreement to Purchase
5
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement.
14. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph(B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
Agreement to Purchase
6
RCCF Services
•
Contract No.: PY 04/05-SS-23A-RCCF
3. 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.
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 and the County 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.
Agreement to Purchase
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
6. 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.
7. 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.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunity 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.
Agreement to Purchase
8
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RCCF SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? 0 Yes 0 No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
O In home services ❑ Placement with Relative 0 Cty CC Foster Care 0 Shelter Care ❑ Substance Abuse Treatment
O CORE Services 0 Receiving Home 0 CPA 0 RTC ❑ Cty regular Foster Care
O Day Treatment 0 Kinship Care ❑ Group Home ❑ Ind.Living 0 Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
O Therapeutic(Behavior Modification) 0 Secure 0 Other(Explain)
Appropriate Counseling:
❑ Individual 0 Family ❑ Group
Appropriate Treatment:
O Sex Offender 0 AggressiveNiolent 0 Substance Abuse 0 Truancy 0 Victim Behavior 0 Depression
❑ Self-destructive 0 Delinquency ❑ Special Medical Needs 0 Behavior Modification 0 Anger Management
❑ Other (Explain)
Appropriate Educational Services:
O Special Ed. 0 Public School 0 Day Treatment
❑ On-grounds School ❑ Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2005,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
0 It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) 0 Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
9
RCCF Services
Contract No.: PY 04/05-SS-23A-RCCF
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST: iste#D'vv/L� ?
I�
p Weld County Clerk to the Boud
E eta/� WELD COUNTY BOARD OF SOCIAL
SERVICES,ON BEHALF OF THE
,����y� WELD COUNTY DEPARTMENT
1861 OF SOCIAL SERVICES
By: •
eputy Clerk to the Board Robert D.Masden,Chair JUL 14 2004
APPROVED AS TO FORM:
CONTRACTOR
,County Attorney
Mountain States Children's Home
Inc.
PO Box 1097
Longmont, CO 80501
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: l.(' lU
DirecglA.C.1)
U
Agreement to Purchase 10
RCCF Services
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