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Home My WebLink About20041744.tiff RESOLUTION RE: APPROVE THIRTY-THREE AGREEMENTS TO PURCHASE RESIDENTIAL CHILD CARE FACILITY 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 thirty-three Agreements to Purchase Residential Child Care Facility Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County,on behalf of the Department of Social Services, and the following providers, commencing July 1, 2004, and ending June 30, 2005, with further terms and conditions being as stated in said agreements, and 1. Alternative Homes for Youth - Greeley 17. Namaqua Center- 7th Street 2. Alternative Homes for Youth - 18. Shiloh House - Estes Emancipation 19. Shiloh House - Denver 3. Alternative Homes for Youth - 20. Shiloh House - Littleton - Portland Longmont 21. Shiloh House - Littleton - Sheridan 4. Children's Ark - Ute Pass 22. Shiloh House - Littleton - Yarrow 5. Children's Ark - Pueblo 23. Third Way Center- Denver - York 6. Children's Ark - Green Mountain 24. Third Way Center- Denver - Pontiac 7. El Pueblo Boys and Girls Ranch 25. Third Way Center- Denver - Lincoln 8. Emily Griffith Center- Colorado 26. Third Way Center- Englewood Springs 27. University of Colorado Health Sciences- 9. Emily Griffith Center- Rifle Synergy 10. Excelsior Youth Centers -Aurora 28. Wingshadow 11. Monarch Youth - Lone Tree Drive 29. Youth Emancipation and Services 12. Monarch Youth - Bryon Grizmore 30. Youthtrack - Excel 13. Monarch Youth - Prairie View 31. Youthtrack - Jeffco 14. Monarch Youth - Wilderness 32. Youthtrack - San Luis Valley 15. Mount St. Vincent Home 33. Youthtrack - Grand Avenue 16. Namaqua Center- 8th Street 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 thirty-three Agreements to Purchase Residential Child Care Facility Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County,on behalf of the Department of Social Services, and the above listed 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. 5:5(6e- d2 ej) 2004-1744 7_ 2.-, ec9y SS0031 AGREEMENT TO PURCHASE RESIDENTIAL CHILD CARE FACILITY SERVICES - VARIOUS PAGE 2 The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 28th day of June, A.D., 2004. BOARD OF COUNTY COMMISSIONERS ! _ 'ai` ///////j�j WELD COUNTTY, COLORAD�O vac i ?,�<VIrA: �( 'i:7,�+• �� 1 Robert D. Masden, Chair 'T . eo9 Clerk to the Board WU � William H. rke, Pro-Tern BY: Deputy Clerk to the Board M. ile AP OV AS TO, • Davi E. Long ur fy Attorney, Gle n Vaa Date of signature: *A y©' 2004-1744 SS0031 DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY, CO. 80632 l6 t iD Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 O • MEMORANDUM COLORADO TO: Robert D. Masden, Chair Date: June 15, 2004 Board of County Commissioners , I' FR: Judy A. Griego, Director, Social Services. ) " V 7V RE: Agreements to Purchase Residential Child Care Facilities'JJ (RCCF) Services Between Weld County Department of Social Services with Various Vendors Enclosed for Board approval are Agreements to Purchase Residential Child Care Facilities (RCCF) Services between the Weld County Department of Social Services with various vendors. These yearly Agreements are in accordance with Board approved policies of Sections 2.320 and 2.902.22 of the Weld County Department of Social Services Operations Manual. These Agreements were reviewed at the Board's Work Session of June 14, 2004. The major provisions of the Agreements are as follows: 1. The term is July 1, 2004 through June 30, 2005. 2. The Department agrees to reimburse vendors at rates that will include room,board, and treatment, as follows: Rate A. Alternative Homes for Youth(Greeley) $83.10 per day B. Alternative Homes for Youth(Emancipation) $83.10 per day C. Alternative Homes for Youth(Longmont) $83.10 per day D. Childrens Ark(Ute Pass) $112.81 per day E. Childrens Ark(Pueblo) $112.81 per day F. Childrens Ark(Green Mountain) $112.81 per day G. El Pueblo Boys' and Girls' Ranch $58.52 per day H. Emily Griffith Center(Colorado Springs) $76.19 per day I. Emily Griffith Center(Rifle) $74.57 per day J. Excelsior Youth Centers(Aurora) $76.27 per day K. Monarch Youth(Lone Tree Drive) $95.48 per day L. Monarch Youth(Bryon Grizmore) $95.48 per day M. Monarch Youth(Prairie View) $95.48 per day N. Monarch Youth(Wilderness) $94.16 per day O. Mount St. Vincent Home $65.08 per day P. Namaqua Center(8'h Street) $76.40 per day Q. Namaqua Center(7i°Street) $76.40 per day R. Shiloh House(Estes) $72.82 per day S. Shiloh House(Denver) $54.21 per day 2004-1744 MEMORANDUM Page 2 Robert D. Masden, Chair, Board of County Commissioners June 15, 2004 T. Shiloh House(Littleton--Portland) $55.56 per day U. Shiloh House(Littleton—Sheridan) $55.56 per day V. Shiloh House(Littleton—Yarrow) $55.56 per day W. Third Way Center(Denver—York) $63.19 per day X. Third Way Center(Denver—Pontiac) $63.19 per day Y. Third Way Center(Denver—Lincoln) $35.65 per day Z. Third Way Center(Englewood) $62.40 per day AA. University of Colorado Health Sciences(Synergy) $71.18 per day BB. Wingshadow $89.35 per day CC. Youth Emancipation& Services $122.28 per day DD. Youthtrack(Excel) $67.22 per day EE. Youthtrack(Jeffco) $71.64 per day FF. Youthtrack(San Luis Valley) $66.47 per day GG. Youthtrack(Grand Avenue) $72.64 per day If you have any questions,please telephone me at extension 6510. Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE • RCCF SERVICES pa THIS AGREEMENT made thisap day of I1(, 2004 between the Board of Weld County Commissioners, sitting as the Board of So al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Alternative Homes For Youth, 700 West 84th Ave, Thornton, CO 80260, 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$83.10 per day for children placed within the Residential Child Care Facility identified as Provider ID#2016. 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 /75/g,a�D S'- 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#: 2016 Alternative Homes For Youth- Greeley 1110 M St 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 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 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? ❑ 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 0 Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care E Substance Abuse Treatment ❑ CORE Services 0 Receiving Home ❑ CPA ❑ RTC ❑ Cty regular Foster Care ❑ Day Treatment 0 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 0 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. AT ELec d � WELD COUNTY BOARD OF SOCIAL 1861 � A' A`sd' SERVICES, ON BEHALF OF THE AAY WELD COUNTY DEPARTMENT ''I OF SOCIAL SERVICES(, p 1, i --N , fp B y ` C z4-2L `C�E7 By: 'yy"l �� -- uty Clerk to the Board )2obert D.Masden,Chair JW4 2 8 2004 APPROVED AS TO FORM. 7----7. CONTRACTOR Coun tto ey \ Alternative Homes For Youth 700 West 84th Ave Thorntpn, CO 80260 \ By:O`fie-.�-a <_ 1-1- ' WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: l�- IC Direct Agreement to Purchase 1O RCCF Services aovz/— /wq Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES n El THIS AGREEMENT made this: day of , 2004 between the Board of Weld County Commissioners, sitting as the Board of S al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Alternative Homes For Youth, 700 West 84th Ave, Thornton, CO 80260, 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$83.10 per day for children placed within the Residential Child Care Facility identified as Provider ID#11677. 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 :ADO 7i--/7 5yq 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 maybe provided for in the treatment/case plan. 5. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall acknowledge their responsibility by signing the treatment/case plan. 6. Contractor will provide the purchased care and services at: Facility ID#: 11677 Alternative Homes For Youth - Emancipation 13435 W 32nd Ave Golden CO 80401 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 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. O 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) ❑ In home services 0 Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care ❑ ❑ Substance r Abuse Treatment CORE Services 0 Receiving Home 0 CPA ❑ RTC ❑ Cty regular Foster Care ❑ 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: ❑ Therapeutic(Behavior Modification) 0 Secure 0 Other(Explain) Appropriate Counseling: ❑ Individual 0 Family ❑ Group Appropriate Treatment: O Sex Offender ❑ Aggressive/Violent 0 Substance Abuse 0 Truancy 0 Victim Behavior 0 Depression 0 Self-destructive 0 Delinquency ❑ Special Medical Needs 0 Behavior Modification 0 Anger Management 0 Other (Explain) Appropriate Educational Services: ❑ Special Ed. 0 Public School 0 Day Treatment O On-grounds School 0 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: 'sa` W oun e to e d ,,\>. ' WELD COUNTY BOARD OF SOCIAL 0 �S. SERVICES,ON BEHALF OF THE WELD COUNTY DEPARTMENT 1861 "� ry„ . a OF SO L SERVICES \ ( t �..,� let z. l,7 By: _n —:eputy Clerk to the :oard Robert . as en, air JUN 2 8 2004 APPROVED AS TO FORM• CONTRACTOR County Att ney Alternative Homes For Youth 700 West 84th Ave Thorn n, CO 80260 Bt 7 WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: irecto Agreement to Purchase 10 RCCF Services moors'- 75/V Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES tt THIS AGREEMENT made this,%may o Litt'. , 2004 between the Board of Weld County Commissioners, sitting as the Board of So llial Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Alternative Homes For Youth, 700 West 84th Ave, Thornton, CO 80260, 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$83.10 per day for children placed within the Residential Child Care Facility identified as Provider ID#67497. 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 moony-,7vy 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#: 67497 Alternative Homes For Youth - Longmont 745 Highway 119 East Longmont CO 80501 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? ❑ 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) ❑ 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: O Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain) Appropriate Counseling: ❑ Individual 0 Family ❑ Group Appropriate Treatment: ❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression O Self-destructive ❑ Delinquency 0 Special Medical Needs ❑ Behavior Modification 0 Anger Management O Other (Explain) Appropriate Educational Services: O Special Ed. ❑ Public School 0 Day Treatment O On-grounds School 0 Additional Tutoring 0 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 0 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-234-RCCF IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: eldCoun e c o e d EL %d0 WELD COUNTY BOARD OF SOCIAL 41 OD SERVICES,ON BEHALF OF THE 1861 WELD COUNTY DEPARTMENT u� OF SOCIAL SERVICES O ,:�,�; , 21 �� . 1c: w- ' C �� '/_7.t � By: puty Clerk to the B and Robert D.Masden, hair JUN 2 8 2004 APPROVED AS TO FO A<...---- CONTRACTOR County Atto ey Alternative Homes For Youth 700 West 84th Ave Thornt , CO 80260 B it ' 1-ri1 WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: Vbf a CDire r Agreement to Purchase RCCF Services 10 &ce 9--/7qy Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES THIS AGREEMENT made this day of �,nt , 2004 between the Board of Weld County Commissioners, sitting as the Board of So@ al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Childrens Ark, Inc, PO Box 1007, Green Mountain Falls, CO 80819, 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$112.81 per day for children placed within the Residential Child Care Facility identified as Provider ID#4261. 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 dGpy1—/79g 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#: 4261 Childrens Ark at Ute Pass 10460 W Hwy 24 Green Mountain Falls CO 80819 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 maybe 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: L 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. ATT T: ,41/2 Weld Coun Clerk to Zriet{ WELD COUNTY BOARD OF SOCIAL SERVICES,ON BEHALF OF THE 1861 tq` WELD COUNTY DEPARTMENT V > h..,2, ,l OF SOC L SERVICES j"e r 7 1' t 1�1 � By: �r �._.___ eputy Clerk to the oarB d Robert D.Masden,Chair JUN 2 8 2004 APPROVED AS TO FORM: ��"Y_, CONTRACTOR County Atto ey Children Ark, Inc PO Box 1007 Green Mountain Falls, CO 80819 //� ,/ BY. , l% h.(c 't', Cc: .S WELD COUNTY DEPARTMENT ( C ci PC.CZ ler-t-t' tatt OF SOCIAL SERVICES By: ,O t. Agreement to Purchase RCCF Services 10 :Ucoy— /?Sig Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES tit THIS AGREEMENT made this, R day of 2004 between the Board of Weld County Commissioners, sitting as the Board of So al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Childrens Ark, Inc, PO Box 1007, Green Mountain Falls, CO 80819, 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$112.81 per day for children placed within the Residential Child Care Facility identified as Provider ID#40322. 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 0?oe,y_/7yy 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#: 40322 Childrens Ark at Pueblo 400 E Routt Ave Pueblo CO 81004 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: I. 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? ❑ 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. ATT.... • ��4�� jC-, Weld County Clerk to the Board !GG((�/�1 , WELD COUNTY BOARD OF SOCIAL ��"� p,� SERVICES, ON BEHALF OF THE ' 1861 i• WELD COUNTY DEPARTMENT a %0 �, OF SOCIAL SERVICES l " ©�AV.. �� / < By ------- - :-puty Clerk to the B and Robert D. asden,Chair JUN 2 8 2004 APPROVED AS TO FO • CONTRACTOR County Atto ey Children Ark, Inc PO Box 1007 Green Mountain Falls, CO 80819 , / BY: /.-2 e_y ^ 4,4 O'.J. WELD COUNTY DEPARTMENT ��'�L/ �f! �f G C"C C lx </ c' t L OF SOCIAL SERVICES G (-LL By: a Q Dire r Agreement to Purchase RCCF Services 10 Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES ffi THIS AGREEMENT made this gday of(frPt _, 2004 between the Board of Weld County Commissioners, sitting as the board of So al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Childrens Ark, Inc, PO Box 1007, Green Mountain Falls, CO 80819, 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$112.81 per day for children placed within the Residential Child Care Facility identified as Provider ID#96480. 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 o7OG y/—/71/N 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#: 96480 Childrens Ark at Green Mountian 10930 Hondo Ave Green Mountain Falls CO 80819 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? ❑ 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 0 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: O Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain) Appropriate Counseling: ❑ Individual ❑ Family 0 Group Appropriate Treatment: ❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑ Truancy 0 Victim Behavior ❑ Depression ❑ Self-destructive ❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification ❑ Anger Management ❑ Other (Explain) Appropriate Educational Services: O Special Ed. ❑ Public School ❑ Day Treatment ❑ On-grounds School ❑ Additional Tutoring ❑ 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) ❑ 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. ATTE : atalc/ ��'�/� f nWeld County Clerk to the Board Elko WELD COUNTY BOARD OF SOCIAL 'a" 0, =' SERVICES,ON BEHALF OF THE 1 WELD COUNTY DEPARTMENT �'4 i OF SOCIAL SERVICES n g .' � ,, B .'�9 ez' B l Y� -- l eputy Clerk to the Board Robert D. asden,Chair JUN 2 8 2004 APPROVED AS TO FORM: CONTRACTOR County 4ttoipey .✓/ Children Ark, Inc PO Box 1007 Green Mountain Falls, CO 80819 t i c2 BY: `%.2".r-t-, .,/� ti/Le, 0(ic WELD COUNTY DEPARTMENT c (z ,,--Ye &*-2-t C�j(/at OF SOCIAL SERVICES C By: L Judi 0_ Dire r Agreement to Purchase RCCF Services 10 art"-/—/75/9 Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES tit THIS AGREEMENT made this'day o1 ,2004 between the Board of Weld County Commissioners, sitting as the Board of So ' 1 Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and El Pueblo Boys' and Girls' Ranch, One El Pueblo Ranch Way, Pueblo, CO 81006, 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$58.52 per day for children placed within the Residential Child Care Facility identified as Provider ID#45146. 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 1D#: 45146 El Pueblo Boys' and Girls' Ranch 1591 Taos Rd. Pueblo CO 81006 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 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? ❑ 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 O Cty regular Foster Care ❑ Day Treatment O Kinship Care O Group Hone O Ind.living O 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 ❑ Family O Group Appropriate Treatment: ❑ Sex Offender O AggressiveNiolent O Substance Abuse O Truancy ❑ Victim Behavior ❑ Depression ❑ Self-destructive ❑ Delinquency O Special Medical Needs O Behavior Modification ❑ Anger Management ❑ Other (Explain) Appropriate Educational Services: ❑ Special Ed. ❑ Public School ❑ Day Treatment ❑ On-grounds School ❑ 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) ❑ 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 El Pueblo Boys and Girls Ranch PO Box A Trails provider ID 45146 Greeley CO 80632 Address 1 El Pueblo Ranch Way City,State,Zip Pueblo,CO 81006 Provider Info: (If applicable) Foster Care Provider Trails provider ID Provider Address Caseworker Signature City,State,Zip (Worker Name) Date c2Q czu c Gloria Romansik,Administrator Signature of PersonJuthorized to Sign Agreement aB-oy 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. ATT • aww//1'!/u �s, eld County Clerk to the Board I I / 4 Jr ,ipw „` WELD COUNTY BOARD OF SOCIAL p�, SERVICES,ON BEHALF OF THE 1261 '��t�p WELD COUNTY DEPARTMENT Or OF SOCIAL SERVICES 8 .,.______ -- l� ' 7-:: By: y,,t,90...,_ _ %II eputy Clerk to the I oard Robert D.Masden, Chair JUN 2 8 2004 APPROVED AS TO FORM: CONTRACTOR ounty El Pueblo Boys' and Girls'Ranch One El Pueblo Ranch Way Pueblo, CO 81006 By: CO f c cwt WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: Di, P f 5 Direct Agreement to Purchase RCCF Services 1O a nos/—173'9 Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES THIS AGREEMENT made this, 0 day of J w , 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 Emily Griffith Center Inc., 14142 Denver West Pkwy, Suite#225, Lakewood, CO 80401-3189, 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$76.19 per day for children placed within the Residential Child Care Facility identified as Provider ID#39212. 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 &efloy_/79 f 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#: 39212 Emily Griffith Center- Colorado Springs 17 N Farragut Colorado Springs CO 80909 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 S 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? ❑ 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 ❑ Day Treatment ❑ Cty regular Foster Care ❑ 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 0 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: �� eld County Clerk to the Board Ica WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE ib61 WELD COUNTY DEPARTMENT àStOF SOCIALSEERVICES4 By: " 'l V `.,�"� L eputy Clerk to the Board Robert D.Masden,Chair JUN 2 8 2004 APPROVED AS TO FO CONTRACTOR County Attorney Emily Griffith Center Inc. 14142 Denver West Pkwy, Suite #225 Lakewd, 01-3 89 WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: / a 7 r ' 'rector Agreement to Purchase RCCF Services 10 aoo�-i7.5/ Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES n tit THIS AGREEMENT made this 77A day o1 mx, 2004 between the Board of Weld County Commissioners, sitting as the Board of So `al Services, on behalf of the Weld County Department of Social Services,hereinafter called "County" and Emily Griffith Center Inc., 14142 Denver West Pkwy, Suite#225, Lakewood, CO 80401-3189,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$74.57 per day for children placed within the Residential Child Care Facility identified as Provider ID#1512515. 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 lD#: 1512515 Emily Griffith Center- Western Academy 1252 CR 294 Rifle CO 81650 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 RCCF Services 5 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? 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 O Shelter Care O Substance Abuse Treatment ❑ CORE Services O Receiving Home ❑ CPA O RTC O Cty regular Foster Care ❑ Day Treatment O Kinship Care ❑ Group Home O Ind.Living ❑ Other(Specify) 5. Services needed within the Initial Treatment Plan. (Mark appropriate box) Appropriate Setting: O Therapeutic(Behavior Modification) O Secure ❑Other(Explain) Appropriate Counseling: ❑ Individual O Family ❑ Group Appropriate Treatment: ❑ Sex Offender O Aggressive/Violent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior O Depression O Self-destructive O Delinquency ❑ Special Medical Needs O Behavior Modification O Anger Management ❑ Other (Explain) Appropriate Educational Services: ❑ Special Ed. ❑ Public School ❑ Day Treatment ❑ On-grounds School O 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) 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 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: ikeietzedi,A, Weld County Clerk to the Board Elle®`` WELD COUNTY BOARD OF SOCIAL SERVICES,ON BEHALF OF THE ?dbd) WELD COUNTY DEPARTMENT 1861` OF SOCIAL SERVICES �I�/uv Y (_ )11,3_ puty Clerk to the oard Robert D.Masden,Chair JUN 282004 APPROVED AS TO FO CONTRACTOR County Attorney Emily Griffith Center Inc. 14142 Denver West Pkwy, Suite#225 Lak o , 0 401 3189 B : WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: \----2(j EP ej kit Directo Agreement to Purchase 0 RCCF Services ,?et,y—i�yy Contrgct No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES 4 THIS AGREEMENT made this, n day oiLQyt, 2004 between the Board of Weld County Commissioners, sitting as the Board of S 'al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Excelsior Youth Centers, 15001 E. Oxford Ave, Aurora, CO 80014, 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$76.27 per day for children placed within the Residential Child Care Facility identified as Provider ID#45243. 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 dinpt/—%7S«% 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#: 45243 Excelsior Youth Centers 15001 E Oxford Ave Aurora CO 80014 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 $ 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. D Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name). D 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 D Shelter Care ❑ CORE Services ❑ Receiving Home ❑ CPA ❑ Cty Substance l r Abuse Treatment ❑ Day Treatment ❑ RTC ❑ Cty regular ) Care ❑ 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 El Other (Explain) El Anger Management 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 Glona 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: iatedeSi' leillaatte`Weld County Clerk to the Board >/ I . WELD COUNTY BOARD OF SOCIAL SERVICES,ON BEHALF OF THE 1661 IC) � WELD COUNTY DEPARTMENT S1� OF SOCIAL SERVICES Prrimay" � By: S≥i≥A\ 1'""' gritty Clerk to the Board Robed D.Masden,Chair 'JUN 2 8 2004 APPROVED AS TO FO • CONTRACTOR County A omey Excelsior Youth Centers 15001 E. Oxford Ave Aurora, CO 880014/r By:WELD COUNTY DEPARTMENT ��f OF SOCIAL SERVICES By: et. 'rector , Agreement to Purchase 10 RCCF Services aooy—i 9, Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES THIS AGREEMENT made thi$-,k? day of< , 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 Monarch Youth, 2695 W Eisenhower Blvd, Ste 208, Loveland, CO 80537-4339,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$95.48 per day for children placed within the Residential Child Care Facility identified as Provider ID#1500261. 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 //. 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#: 1500261 Fox Drive Treatment Center ,I 34(40-Fex-Dr 5 32L' Lvc�L�i e c.titv'� (/Q� Loveland CO 80537 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 R CCc CPrvirrc 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 PCCP Qon,:oo. 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: t. • Legal Status of Child. (Mark appropriate box) D 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) ❑ In home services ❑ Placement with Relative 0 Cty CC Foster Care ❑ Shelter Care ❑ Substance Abuse Treatment ❑ CORE Services ❑ Receiving Home 0 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: O Individual 0 Family 0 Group Appropriate Treatment: O 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. • ilea` eld County Clerk to the Board • 0, \^ 1 i WELD COUNTY BOARD OF SOCIAL 1861 1_ SERVICES, ON BEHALF OF THE � WELD COUNTY DEPARTMENT el`r. 1 OF SOCIAL SERVICES t. L u 6 - / z ri Z /` :49 By: V ^ °U1 Deputy Clerk to the Board Robert D.Masden, ChairJUN 2 8 2004 APPROVED AS TO FORM: — .----'-.7 CONTRACTOR County omey Monarch Youth 2695 W Eisenhower Blvd, Ste 208 Loveland, CO 80537-4339 P ' By: (cl. WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: ftecto1° r Agreement to Purchase RCCF Services 10 Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES 0L THIS AGREEMENT made thisA day of u�2004 between the Board of Weld • County Commissioners, sifting as the Board of Soc al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Monarch Youth, 2695 W Eisenhower Blvd, Ste 208, Loveland, CO 80537-4339, 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$95.48 per day for children placed within the Residential Child Care Facility identified as Provider ID#1503010. 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 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 treatmentcase 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#: 1503010 Byron Grizmore Treatment Center 204 WCR 10E Berthoud CO 80513 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 R rry RP..,irPc 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 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 art 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) ❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care ❑ CORE Services ❑ Receiving Home ❑ CPA ❑ Substance l r Abuse Treatment ❑ Day Treatment ❑ Kinship Care ❑ Group Home ❑ RTC ❑ Cty regular Foster Care ❑ 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 ❑ an Truancy El Self-destructive ❑ Delinquency ❑ Victim Behavior ❑ Depression q y ❑ Special Medical Needs ❑ Behavior Modification ❑ Anger Management ❑ Other (Explain) Appropriate Educational Services: ❑ Special Ed. ❑ Public School El Day Treatment ❑ On-grounds School CIAdditional Tutoring ❑ Independent Living Training ❑ Other (Explain) Estimated date for accomplishing treatment plan goab 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 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. ATT ithet.//4“ Weld County Clerk to the Board WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE 1861 � � WELD COUNTY DEPARTMENT '�n-�- OF SOCIAL SERVICES• By: szsAthD eputy Clerk to the Board Robert D. asden,Chair JUN 2 8 2004 APPROVED AS TO FORM: CONTRACTOR County Attomey Monarch Youth 2695 W Eisenhower Blvd, Ste 208 Loveland, CO 80537-4339 ,q By: l,�l /�1 1 WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: irector Agreement to Purchase RCCF Services r L'9-/z9ii' Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES nt THIS AGREEMENT made thisN day o _. , 2004 between the Board of Weld County Commissioners, sifting as the Board of So al Services, on behalf of the Weld County Department of Social Services,hereinafter called "County" and Monarch Youth, 2695 W Eisenhower Blvd, Ste 208, Loveland, CO 80537-4339, 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$95.48 per day for children placed within the Residential Child Care Facility identified as Provider ID#1510808. 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 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#: 1510808 Prairie View Treatment Center 8233 E County Rd 18 Loveland CO 80537 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 R CCF Servirrc 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 u(-rc can,;,... 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 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? 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? 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 0 CORE Services 0 Receiving Home 0 CPA 0 RTC ❑ Day Treatment0 Cty regular Foster Care ❑ Kinship Care ❑ Group Home 0 Ind.living 0 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: ❑ Individual ❑ Family ❑ Group Appropriate Treatment: ❑ Sex Offender ❑ Aggressive/Violent ❑ Substance Abuse 0 Truancy ❑ Victim Behavior 0 Depression ❑ Self-destructive 0 Delinquency ❑ Special Medical Needs 0 Behavior Modification 0 Anger Management 0 Other (Explain) Appropriate Educational Services: ❑ Special Ed. 0 Public School 0 Day Treatment ❑ On-grounds School ❑ Additional Tutoring ❑ 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) ❑ 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. ATTE • is eld County Clerk to the Board 1G!( WELD COUNTY BOARD OF SOCIAL SERVICES,ON BEHALF OF THE WELD COUNTY DEPARTMENT 1t OF SOCIAL SERVICES ® 3 l By. �! L/� By: �_- _Ddputy Clerk to the Board Robert D. asden,Chair JUN 2 8 2004 APPROVED AS TO FO • - CONTRACTOR County ttomey Monarch Youth 2695 W Eisenhower Blvd, Ste 208 Loveland, CO 80537-43 9 By: WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: Direct° Agreement to Purchase RCCF Services 10 Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES Cl- THIS AGREEMENT made thi f?day of ii,(_,, 2004 between the Board of Weld • County Commissioners, sitting as the Board of So al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Monarch Youth, 2695 W Eisenhower Blvd, Ste 208, Loveland, CO 80537-4339, 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$94.16 per day for children placed within the Residential Child Care Facility identified as Provider ID#1513874. 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 RCrF Servirec OCY —/25/g 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#: 1513874 Wildernes Treatment Center 8-335 Wil&mcos Dr \'Vyj ,, fftrt1 Colorado Springs CO 80908 ( l��y�tu) StS13 , 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 R(Y'F.Qrrvire. 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 ry po thi At. 4. Not se assignices r the vided doe undersgreemen 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? ❑ 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 ❑ Placement with Relative ❑ Cty CC Foster Care O Shelter Care ❑ CORE Services O Receiving Home O CPA ❑ Substance l r Abuse TreatmentC ❑ Day Treatment0 RTC ❑ Cty regular Foster Care O Kinship Care ❑ Group Home O Ind.Living 0 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 ❑ AggressiveNiolent ❑ Substance Abuse sion ❑ Self-destructiveO Truancy ❑ Victim Behavior ❑ Anger Man ❑ Delinquency O Special Medical Needs O Behavior Modification ❑ Other (Explain) ❑ Anger Management Appropriate Educational Services: ❑ Special Ed. O Public School O 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 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 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. • 144/4014444 ATT • 400"-1.3/4"e4. Weld County Clerk to the Board WELD COUNTY BOARD OF SOCIAL IV A�.,,i' SERVICES,ON BEHALF OF THE 196 y� WELD COUNTY DEPARTMENT \ �, OF SO L SERVICES ®� -3( k_ Net �r i....�C� l By: (+V\. ----- Deputy Clerk to the :oard TTT Robert D.Masden,Chair JUN 2 8 2004 APPROVED AS TO FO . CONTRACTOR County Attorney Monarch Youth 2695 W Eisenhower Blvd, Ste 208 Loveland, CO 8053 -W9 WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: • 3ThireZr Agreement to Purchase 1O RCCF Services Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES THIS AGREEMENT made this 15 day of' .,4., 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 Mount St. Vincent Home, 4159 Lowell Blvd, Denver, CO 80211, 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$65.08 per day for children placed within the Residential Child Care Facility identified as Provider ID#45174. 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 RCCP cervirPc c2Oe'9L/797 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. 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#: 45174 Mount St. Vincent Home 4159 Lowell Blvd Denver, CO 80211 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 nerP Qnn,Sao 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 urrF corv:rae 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). ❑ 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 O Cty CC Foster Care ❑ Shelter Care ❑ Substance Abuse Treatment ❑ CORE Services ❑ Receiving Home O CPA ❑ RTC ❑ Cty regular Foster Care ❑ Day Treatment ❑ Kinship Care ❑ Group Home O 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 O 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) 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. ATs : ` )140#446711% � `v E°. p %;ld County Clerk to the Board • �r WELD COUNTY BOARD OF SOCIAL 1861 SERVICES,ON BEHALF OF THE 1 tap SERVICES, WELD COUNTY DEPARTMENT O "7 OF SOCIAL SERVICES Bye A _ ♦ By: Vil.” , ---Deputy Clerk to the Board Robert D.Masden,Chair JUN 2 8 2004 APPROVED AS TO FORM: CONTRACTOR Coun ttorney Mount St. Vincent Home 4159 Lowell Blvd Denver, CO,80211 By:7,', /") WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: Direct Agreement to Purchase RCCF Services 10 /7417 Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES THIS AGREEMENT made thisck day ol)At'_, 2004 between the Board of Weld County Commissioners, sitting as the Board of So al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Namaqua Center, 1327 W Eisenhower Blvd, Loveland, CO 80537,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$76.40 per day for children placed within the Residential Child Care Facility identified as Provider ID#45142. 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 c.,?cc' /2 .11Rrrc Cnnrirnc 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#: 45142 Namaqua Center 549 E 8th St Loveland CO 80537 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 rrc cP.,»PPc 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 IL MEDICAL CARE 1. In accordance with the Weld County Department of Social Services policies (2.710.70, 2.710.71, 2.710.72, 2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy(7.714.131), 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 urrc cpn,,rPc 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 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). 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 DNo 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 O Cty CC Foster Care O Shelter Care ❑ Substance Abuse Treatment ❑ CORE Services ❑ Receiving Home ❑ CPA O RTC ❑ Cty regular Foster Care ❑ Day Treatment ❑ 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) ❑ Secure O Other(Explain) Appropriate Counseling: ❑ Individual ❑ Family O Group Appropriate Treatment: ❑ Sex Offender ❑ AggressiveNiolent O Substance Abuse El 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) 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 ❑ 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. 1.0 •,,,„ Mialt4 ✓ ` I . / 4 `eld County Clerk to the Board ` WELD COUNTY BOARD OF SOCIAL 02'.°O tbl �, ` • tW 01) SERVICES,ON BEHALF OF THE si itg• WELD COUNTY DEPARTMENT •C. t •�I OF SOCIAL SERVICES � r VZ B . w• 176, z By: , - Deputy i eputy Clerk to the Board Robert D.Masden,Chair JUN 2 8 2004 APPROVED AS TO FO • CONTRACTOR County Attorney Namaqua Center 1327 W Eisenhower Blvd Lovel d, CO 805 By: WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: jtjettato hector Agreement to Purchase RCCF Services �coy-i77% Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES THIS AGREEMENT made this day oQ4jt_, 2004 between the Board of Weld County Commissioners, sitting as the Board of Soocial Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Namaqua Center, 1327 W Eisenhower Blvd, Loveland, CO 80537, 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$76.40 per day for children placed within the Residential Child Care Facility identified as Provider ID#100889. 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 f_Qcoci--/-"154 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#: 100889 Namaqua Center 404 E 7th St Loveland CO 80537 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 N, 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? ❑ 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 ❑ Cry 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 ❑ Aggressive/Violent ❑ 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. &ATTE T: ,411 G`".�'� ��Weld County Clerk to the Board E WELD COUNTY BOARD OF SOCIAL 0' SERVICES,ON BEHALF OF THE 1861 _`, �•' WELD COUNTY DEPARTMENT OF SOCIAL SERVICES eye. . - CLcy7 lL By: SW( 6.,%\s.c.)---, "`teputy Clerk to the :oard Robert D.Masden,Chair JUN 2 8 2004 APPROVED AS TO FO . <7.7 ";-----72---L--_ CONTRACTOR County ttorney Namaqua Center 1327 W Eisenhower Blvd Loveland, CO 8ca By: WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: Director Agreement to Purchase RCCF Services 10 a no`/- 1299 Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES • THIS AGREEMENT made this?day o * , 2004 between the Board of Weld County Commissioners, sitting as the Board of So al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Shiloh Home, 6400 W Coal Mine Ave, Littleton, CO 80123, hereinafter called "Contractor". WHEREAS, the Colorado State Department of Social Services,hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and, 'WHEREAS, Contractor is licensed as a Residential Child Care Facility. NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor agree as follows: I. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this Agreement at a rate of$72.82 per day for children placed within the Residential Child Care Facility identified as Provider ID#20335. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. This Agreement shall be in force from July 1, 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 o& y_/7yy 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#: 20335 Shiloh House Estes 7623 S Estes Ct Littleton, CO 80128 7. Contractor shall not charge any additional fees to children or families of children referred by County for services provided under this Agreement. 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 Servirec 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 Servires 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 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: • 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? ❑ 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 ❑ Placement with Relative O Cty CC Foster Care ❑ Shelter Care O Substance Abuse Treatment ❑ CORE Services ❑ Receiving Home O CPA O RTC O Cty regular Foster Care ❑ Day Treatment O Kinship Care O Group Home O Ind.Living 0 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 ❑ Group Appropriate Treatment: ❑ Sex Offender O 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 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 above written. A J�6" 1 /�i(/�/! E°i JJd a eld County Clerk to the Board `' WELD COUNTY BOARD OF SOCIAL MI It."@Z. SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF SOCIAL SERVICES rk)iv/e, <,a K<1/Y By: 0k4 -Deputy Clerk to the Board Robert D. asden,Chair JUN 2 8 2004 APPROVED AS TO FO CONTRACTOR Cozen Attorney Shiloh Home 6400 W Coal Mine Ave Little) , 23 By: WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: irector Agreement to Purchase 10 RCCF Services Q et)y-/7V Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES j THIS AGREEMENT made this 20 day tint 2004 between the Board of Weld County Commissioners, sitting as the Board of So al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Shiloh Home, 6400 W Coal Mine Ave, Littleton, CO 80123, hereinafter called "Contractor". WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, Contractor is licensed as a Residential Child Care Facility. NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor agree as follows: 1. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this Agreement at a rate of$54.21 per day for children placed within the Residential Child Care Facility identified as Provider ID#32567. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. This Agreement shall be in force from July 1, 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 y—/]yy RC CF Servirec 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#: 32567 Shiloh Home 3500 W 55th Ave Denver, CO 80221 7. Contractor shall not charge any additional fees to children or families of children referred by County for services provided under this Agreement. Agreement to Purchase 2 R(Y c Sarvirrc 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. hi 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 rrP 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? ❑ 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 0 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 ❑ Aggressive/Violent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior 0 Depression ❑ Self-destructive 0 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 goats 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. AT gal ��'!/t'Uf d County Clerk to the Board WELD COUNTY BOARD OF SOCIAL 1861if- 8D."- SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF SOCIAL SERVICES het /41:2, By: Ybia k ep uty Clerk to the Board Robert D. Masden, Chair JUN 2 8 2004 APPROVED AS TO FORM: CONTRACTOR un Attorney Shiloh Home 6400 W Coal Mine Ave Littleto �l 3 By: n < C ,„ - WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: • irector Agreement to Purchase RCCF Services 1O ?may—/7V ' Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES THIS AGREEMENT made this day of jg , 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 Shiloh House, 6400 W Coal Mine Ave, Littleton, CO 80123,hereinafter called"Contractor". WHEREAS,the Colorado State Department of Social Services,hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, Contractor is licensed as a Residential Child Care Facility. NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor agree as follows: 1. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this Agreement at a rate of$55.56 per day for children placed within the Residential Child Care Facility identified as Provider ID#54169. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. This Agreement shall be in force from July 1, 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 Poe V— /297 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#: 54169 Shiloh House Portland 6629 W Portland Ave Littleton CO 80123 7. Contractor shall not charge any additional fees to children or families of children referred by County for services provided under this Agreement. 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 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 treatmenticase 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 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 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). 0 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? 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 0 Cty CC Foster Care ❑ CORE Services ❑ Shelter Care 0 Cty regular egu Abuse Treatment 0 Receiving Home 0 CPA 0 RTC 0 Day Treatment 0 Kinship Care 0 Group Home ❑ Cty Foster Care 0 Ind.Living ❑ Other(Specify) 5. Services needed within the Initial Treatment Plan. (Mark appropriate box) Appropriate Setting: ❑ Therapeutic(Behavior Modification) 0 Secure 0 Other(Explain) Appropriate Counseling: ❑ Individual 0 Family 0 Group Appropriate Treatment: ❑ Sex Offender 0 Aggressive/Violent 0 Substance Abuse 0 Truancy ID Self-destructive ❑ Delinquency ❑ Victim Behavior ❑ Depression q cY ❑ Special Medical Needs ❑ Behavior Modification ❑ Anger Management ❑ Other (Explain) Appropriate Educational Services: ❑ Special Ed. ❑ Public School ❑ On-grounds School ❑ Day Independent Lt -grar ❑ Additional Tutoring ❑ Ieenent 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 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 City,State,Zip (Worker Name) Date 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. � /�/IL ATTEST: per Weld County Clerk to the Board ,"JA mei WELD COUNTY BOARD OF SOCIAL SERVICES,ON BEHALF OF THE ' I86I ��"�r'� 1♦ WELD COUNTY DEPARTMENT 3y OF SOCIAL SERVICES Pu IT>:,,,H, By: ill 4 vvy -! Clerk to the Board Robert D.Masden,Chair JUN 2 8 2004 APPROVED AS TO FO • CONTRACTOR County Attorney Shiloh House 6400 W Coal Mine Ave Little , 23 By:. ___ C___ WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: „ 0- 1Director Agreement to Purchase RCCF Services 1O a oc Al- /vvy Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES it THIS AGREEMENT made this 9? day of 'gt , 2004 between the Board of Weld County Commissioners, sitting as the Board of Soc. 1 Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Shiloh House, 6400 W Coal Mine Ave, Littleton, CO 80123, hereinafter called "Contractor". WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, Contractor is licensed as a Residential Child Care Facility. NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor agree as follows: 1. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this Agreement at a rate of$55.56 per day for children placed within the Residential Child Care Facility identified as Provider ID#62291. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. This Agreement shall be in force from July 1, 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#: 62291 Shiloh House Sheridan 7201 S Sheridan Ct Littleton CO 80123 7. Contractor shall not charge any additional fees to children or families of children referred by County for services provided under this Agreement. 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? 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 ❑ CORE services O Receiving Home O CPA O Shelter Care ❑ Substance l r Abuse Treatment ❑ Day Treatment O Kinship Care O Group Home O RTC O Cty regular Foster Care O Ind.Living ❑ Other(Specify) 5. Services needed within the Initial Treatment Plan. (Mark appropriate box) Appropriate Setting: O Therapeutic(Behavior Modification) ❑ Secure O Other(Explain) Appropriate Counseling: ❑ Individual O Family O Group Appropriate Treatment: ❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse Self-destructive Truancy O Victim Behavior ❑ Depression ❑ Self O Delinquency O Special Medical Needs ❑ Behavior Modification O Anger Management ❑ Other (Explain) Appropriate Educational Services: ❑ Special Ed. ❑ Public School ❑ On-grounds School ❑ Day Treatment ❑ 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) 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 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. • IutATTE T: E�' h �'' Weld County Clerk to the Board WELD COUNTY BOARD OF SOCIAL ah ` SERVICES, ON BEHALF OF THE 1861 NN WELD COUNTY DEPARTMENT N�� y 1♦� OF SOCIAL SERVICES • --- eputy Clerk to the Board Robert D. asden,Chair JUN 2 8 2004 APPROVED AS TO FORM: CONTRACTOR County Attorney Shiloh House 6400 W Coal Mine Ave Little ox-Cla-80,k23 By: WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: Director Agreement to Purchase RCCF Services 1O c)ce9--/9 9y/ Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES THIS AGREEMENT made this day o .AL., 2004 between the Board of Weld County Commissioners, sifting as the Board of So `al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Shiloh House, 6400 W Coal Mine Ave, Littleton, CO 80123, hereinafter called "Contractor". WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, Contractor is licensed as a Residential Child Care Facility. NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor agree as follows: 1. County agrees to purchase and Contractor agrees to provide the care and services which are listed in this Agreement at a rate of$55.56 per day for children placed within the Residential Child Care Facility identified as Provider ID#70967. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. This Agreement shall be in force from July 1, 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 (RCVS,—/799 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#: 70967 Shiloh House Yarrow 7227 S Yarrow Ct Littleton CO 80123 7. Contractor shall not charge any additional fees to children or families of children referred by County for services provided under this Agreement. 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.: 1W 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) ❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care 0 Shelter Care ❑ CORE Services ❑ Cty Substance Abuse Treatment ❑ Receiving Home ❑ CPA 0 RTC ❑ Cty regular Foster Care ❑ Day Treatment El Kinship Care ❑ Group Home ❑ Ind.Living ❑ Other(Specify) ( p fy) 5. Services needed within the Initial Treatment Plan. (Mark appropriate box) Appropriate Setting: ❑ Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain) Appropriate Counseling: ❑ Individual ❑ Family 0 Group Appropriate Treatment: ❑ Sex Offender ❑ AggressiveNiolent 0 Substance Abuse 0 Truancy io El Victim Behavior El Depression ❑ Self-destructive ❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification El Anger Management ❑ Other (Explain) Appropriate Educational Services: ❑ Special Ed. ❑ Public School 0 Day Treatment ❑ On-grounds School ❑ Additional Tutoring El 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) 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. A 'aa_ ,66"asc/ ��'//l/U if I /� eld County Clerk to the Board ,',' WELD COUNTY BOARD OF SOCIAL Littf ct"I SERVICES,ON BEHALF OF THE =s WELD COUNTY DEPARTMENT `r # 4' OF SOCIAL SERVICES Ntit � ' � � By\�•. I , �,,z e l By: eputy Clerk to th Board Robert D.Masden,Chair JUN 2 8 2004 APPROVED AS TO F CONTRACTOR County Attorney Shiloh House 6400 W Coal Mine Ave Littlet , rw.. WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: C� Directo Agreement to Purchase RCCF Services 1 cRee4/—/Jyy Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES • THIS AGREEMENT made thist day of VIC, 2004 between the Board of Weld County Commissioners, sitting as the Board of So .al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Third Way Center, PO Box 61385, Denver, CO 80206, 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$63.19 per day for children placed within the Residential Child Care Facility identified as Provider ID#49487. 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 ahoy-/27r 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#: 49487 Third Way Center- York 1295 York St Denver CO 80206 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 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? ❑ 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 ❑ CORE Services ❑ Cty regueAFoser Care nd ❑ Receiving Home ❑ CPA ❑ RTC ❑ Cty regular Foster Care ❑ Day Treatment ❑ Kinship Care ❑ Group Home ❑ Ind.living ❑ Other S if( P� Y) 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 h' ID Victim Behavior 0 Depression ❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification El Other (Explain) El Anger Management Appropriate Educational Services: ❑ Special Ed. ❑ Public School ❑ Day Treatment ❑ On-grounds School ❑ Additional Tutoring ❑ Independent epdent 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 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. A Id County Clerk to the Board /41 WELD COUNTY BOARD OF SOCIAL SERVICES,ON BEHALF OF THE WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: ( 1/-4 / - By: \kin _ _s puty Clerk to th Board Robert D. asden,Chair JUN 2 8 2004 APPROVED AS TO FORM: CONTRACTOR Conn Att ey Third Way Center PO Box 61385 Denver, C 06 By: WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: irector Agreement to Purchase 10 RCCF Services Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES t�a THIS AGREEMENT made this,;.4 day o C'rir , 2004 between the Board of Weld County Commissioners, sitting as the Board of So al Services, on behalf of the Weld County Department of Social Services, hereinafter called "County" and Third Way Center, PO Box 61385, Denver, CO 80206, 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$63.19 per day for children placed within the Residential Child Care Facility identified as Provider ID#65346. 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 07,0eV—��yJ 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#: 65346 Third Way Center- Pontiac 1735 Pontiac St Denver CO 80220 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/OS-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 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? ❑ 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 TreatriRut ❑ CORE Services ❑ Receiving Home ❑ CPA D 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 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. • ` Weld County Clerk to the Board ` WELD COUNTY BOARD OF SOCIAL r�abi 4 `Y �` SERVICES,ON BEHALF OF THE �`.4`t, `•� WELD COUNTY DEPARTMENT 'I OF SOCIAL SERVICES '1YI1uhu^ cs___ Deputy Clerk to the Board Robert D.Masden,Chair JUN 2 8 2004 APPROVED AS TO FORM: CONTRACTOR County Attome Third Way Center PO Box 61 Denver, 206 By: WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: Q irector Agreement to Purchase RCCF Services to L ez,V-/7S«/ Contract No.: PY 04/05-SS-23A-RCCF AGREEMENT TO PURCHASE RCCF SERVICES ork THIS AGREEMENT made this:01(5-day o ; , 2004 between the Board of Weld County Commissioners, sitting as the Board of So 'al Services, on behalf of the Weld County Department of Social Services,hereinafter called "County" and Third Way Center, PO Box 61385, Denver, CO 80206,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$35.65 per day for children placed within the Residential Child Care Facility identified as Provider ID#77810. 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 07co V-i 2yy 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#: 77810 Third Way Center- Lincoln 1133 Lincoln Denver CO 80203 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? ❑ 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 0 Shelter Care Treatment ❑ El Substancel r Abuse CORE Services El 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 ❑ Aggressive/Violent ❑ Substance Abuse 0 Truancy El Self-destructiveEl Victim Behavior 0 Depression ❑ Delinquency 0 Special Medical Needs O Behavior ModificationMan ❑ 0 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 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. A • AL4/14411 1L+ Weld County Clerk to the Board WELD COUNTY BOARD OF SOCIAL SERVICES,ON BEHALF OF THE t1 WELD COUNTY DEPARTMENT r OF SOCIAL SERVICES By I<< < l By: OA -—beputy Clerk to the Board Robert D.Masden,Chair JUN 2 8 2004 APPROVED AS TO FO • CONTRACTOR County Attorney Third Way Center PO Box 6 85 Denver, 80206 By: WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: _c_datt (d1-11f) Director Agreement to Purchase RCCF Services 10 Hello