HomeMy WebLinkAbout20031292.tiff RESOLUTION
RE: APPROVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARD FOR FOSTER
PARENT CONSULTATION PROGRAM AND AUTHORIZE CHAIR TO SIGN -
ACKERMAN AND ASSOCIATES, P.C.
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS,the Board has been presented with a Notification of Financial Assistance Award
for Foster Parent Consultation Program 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 Ackerman and Associates, P.C., commencing June 1, 2003, and ending May 31,
2004, with further terms and conditions being as stated in said award, and
WHEREAS, after review, the Board deems it advisable to approve said award, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, ex-officio Board of Social Services, that the Notification of Financial Assistance
Award for Foster Parent Consultation Program 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 Ackerman and Associates, P.C., be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said award.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 21st day of May, A.D., 2003.
BO OF COUNTY COMMISSIONERS
WEL UNT COLOR q0
ATTEST: tS17Keki ' 11cls
1 vid E. Long, Chair
Weld County Clerk tot !B• er
�ISoI -4
�1 3 ��4 . .� Robert D. s en, Pro-Tem
BY: Co �\�J���rsl�
Deputy Clerk to the B1b:
M. J. Geile
APP D AS TO FOR .
William H.
nty'Att n SaA
Date of signature: may
2003-1292
SS0030
M; Ss 6a 5'')
Weld County Department of Social Services
Notification of Financial Assistance Award
for Families,Youth and Children Commission(Core)Funds
Type of Action Contract Award No.
X Initial Award FY03-CPS-2
Revision (RFP-FYC-PY 03-04 06-000)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2003 and Ackerman and Associates,P.C.
Ending 05/31/2004 Foster Parent Consultation
1750 25th Avenue Suite 101
Greeley, CO 80634
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial
Assistance Award is based upon your Request for
This program provides foster parent consultative Proposal (RFP). The RFP specifies the scope of
services in the areas of(1) consultation and services and conditions of award. Except where it is in
foster parent support, (2)mandated corrective conflict with this NOFAA in which case the NOFAA
action consultation, and(3)mandated critical governs, the RFP upon which this award is based is an
care consultation. Foster Parent Consultation integral part of the action.
will be provided through group consultations for
a maximum of four groups per month, 8-10 Special conditions
participants per group. Individual consultation
services will only be provided when approved 1) Reimbursement for the Unit of Services will be based
by the Resource Services Manager or Child on a per group rate.
Welfare Administrator of Social Services. 2) Payment will only be remitted on foster parents, and
Bilingual-Bicultural services. referrals made by the Weld County Department of
Social Services Certified Foster Parents.
Cost Per Unit of Service 3) Requests for payment must be an original and
submitted to the Weld County Department of Social
Group Rate per 8-10 participants $300.00 Services by the end of the 25th calendar day following
Maximum Allocation for Groups $14,400.00 the end of the month of service. The provider must
Hourly Rate per Individual Consultation $ 80.00 submit requests for payment on forms approved by the
Maximum Allocation for Weld County Department of Social Services.
Individual Consultation $5,600.00 4) Requests for payment must include original client
verification signatures (blue or red ink preferred)and
Based on Approved Plan dates and hours of service.
Enclosures:
X Signed RFP:Exhibit A
Supplemental Narrative to RFP: Exhibit B
Recommendation(s)
Conditions of Approval
Approvals. Program Official:
By By
David E. Long, Chair Judy . rie o, irector
Board of Weld County Com issioners Weld uytt}i Department of Social Services
D Date: r— j— E 3 Date: c7/ 1 03
EXHIBIT A
SIGNED RFP
•
INVITATION TO BID
OFF SYSTEM BID 02-03 RFP-FYC PY 03-04 006-00
DATE:February 19,2003 BID NO: PY02-03 006-00
RETURN BID TO: Pat Persichino,Director of General Services
915 10th Street,P.O.Box 758,Greeley, CO 80632
SUMMARY
Request for Proposal(006-00)for: Colorado Family Preservation Act—Foster Parent
Consultation,Emergency Assistance Program
Deadline:March 14,2003,Friday, 10:00 a.m.
The Families,Youth and Children Commission,an advisory commission to the Weld County Department of
Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of
Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S.26-5.5-101)and
Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act(C.R.S.
26-5.3-101). The Families,Youth and Children Commission wishes to appiove services targeted to run from
June 1,2003,through May 31,2004, at specific rates for different types of service,the county will authorize
approved vendors and rates for services only. The Foster Parent Consultation Program must provide services
that focus on providing psychological consultations and parenting support to foster parents which are
designed to improve foster parent competency, family conflict management, and effectively accessing
community resources. This program announcement consists of five parts, as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work
Delivery Date MQ.rJ (3 94°3
(After receipt of order) BID MUST BE SIGNED IN INK
&0,1/40. h _11e,N-r1)cxn ct.
TYPED bR PRINTED SIGNATURE
VENDOR NM-moth and_ Ft Sa
(Name) Han en Signature By Authorized
,^���y pp Officer or Agent of Vender
ADDRESS �� S aSVn I WQ - S���e.1O I TITLE e�@31 e s\
��@�� LO• b+�bati DATE - ‘Q_
PHONE# cucis 3 — `'S 73
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 29
006-00 Attached A
FOSTER PARENT CONSULTATION PROGRAM BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING
COLORADO FAMILY PRESERVATION ACT
2003-2004 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2003-2004
OFF SYSTEM BID 02-03 RFP-FYC 03-04#006-00
NAME OF AGENCY: Pr N.1.2p exx% ty V
ADDRESS: \\Sr-, - \O\ CA}) ,Cp• cai634
PHONE: (41D ) ‘.=•• -
CONTACT PERSOl4 .hold.--V t-rccca n TITLE: j1*f\t
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Foster Parent Consultation
Program Category must provide services that focus on teaching life skills designed to facilitate implementation of
the case plan by improving household management competency,parental competency, family conflict
management and effectively accessing community resources.
12-Month approximate Project Dates: _ 12-month contract with actual time lines of:
Start June 1. 2003 Start
End May 31. 2004 End
TITLE OF PROJECT: NY4.\%•J\ A:X o r\� 'ggitart>
AMOUNT REQUESTED: I to 1 CO/time 0°
t.Nakjjs. dfl a-\S1—O3
Name 'gnat-tire of Person Preparing Document Date
a- \ Q-43
Name an Si attire Lhief Administrative Officer Applicant Agency Date
MANDATORY PROPOSAL REQUIREMENTS
For both new bids and renewal bids,please initial to indicate that the following required sections are included in
this Proposal for Bid.For renewal bids,please indicate which of the required sections have not changed from
Program Fund Year 2002-2003 to Program Fund Year 2003-2004.
Indicate No Change from FY 2002-2003 to 2003-2004
Project Description Ail MAP
v Target/Eligibility Populations
✓ Types of services Provided
f Measurable Outcomes
Service Objectives
I Workload Standards
Staff Qualifications
_ Unit of Service Rate Computation
I Program Capacity per Month 1
I Certificate of Insurance
,J Assurance Statement
Page 23 of 29
02/26/2003 10:11 FAX 9703535215 SOCIAL SERVICES I002/002
75"
OO640 AttaeLcd A. .
Date of Meeting(s)with Social Services Division Supervisor. ZAIQ 3
Comments by SSD Supervisor i
�..� . le
ot anal
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edint c
pre %2" v 0 3 Li
ame and Si D Supervisor Date
Page 24 of 29
006-00 Attached A
Program Category Foster Parent Consultation
Project Title #lcikar nnert fbos ttr /esc,reAS /rc7re' '
Vendor /4 Cite Af.SSoctart...., AC,
I. PROJECT DESCRIPTION
Provide a brief one-page description of the project.
II. TARGET/ELIGIBILITY POPULATIONS
Provide a one-page brief description of the proposed target/eligibility populations. At a minimum
your description must address:
A. Total number of clients to be sewed.
B. Total family units.
C. Sub-total of individuals who will receive bicultural/bilingual services.
D. Sub-total of individuals who will receive services in South Weld County.
E. The monthly program capacity per group.
F. The monthly average capacity per group.
G. Average stay in the program(weeks).
H. Average groups per week in the program.
III. TYPE OF SERVICES TO BE PROVIDED
Provide a two-page description of the types of services to be provided. Please address if your project
will provide the service minimums as follows:
A. Consultation and Foster Parent Group Support around placement issues,behavioral
management, foster home issues involving biological children in the home,transition and loss
issues,work with foster parents and caseworkers around interpretation and implementation of
treatment plans, discipline in the home,group training for foster parents-access to training
materials,work with foster adopt parents on legal risk and commitment issues,visitation
issues,and solution oriented planning.
B. Individual Foster Parent Consultation on a time-limited basis will be provided only with
approval of the Department.
C. Mandated training for foster parents under corrective action plans and follow-up services
when referred by the Department.
D. Training to satisfy State training requirements for foster parents may be offered though this
program within the following guidelines;
1. One training credit per month will be recorded for each critical care foster parent
participating in the mandated monthly consultation group.
2. All additional foster parent training will be pre approved by Agency staff; i.e.,Foster
Care Coordinators or Resource Services Manager.
All training will be offered to all Weld County foster parents,whether they are
involved in the Consultation Program or not. The flat fee for conducting such training
Page 25 of 29
006-00 Attached A
will be agreed upon between the provider and the Agency on a per event basis.
Contracted individual and group consultation rates cannot be charged for training. It is
expected that post training testing will be part of the training component.
E. Assure the foster parent group consultation will not be provided by a professional staff
member who is providing therapeutic services to foster children in the same home.
F. Assure that all assessments,clinical recommendations, and other opinions derived by the
contractor in the performance of this contract will be shared directly with the assigned
caseworker of the children involved. If there is disagreement over the implementation of the
treatment plan with the caseworker,a meeting shall be held with the contractor,assigned
caseworker, foster parents, and the caseworker's supervisor. The objective will be to
determine a unified departmental response for the court.The contractor will not use the legal
system to oppose the department's recommendations.
G. Agrees to comply with 19-1-120 C.R.S.,which requires that reports of child abuse and any
identifying information in those reports are strictly confidential.
•
Provide your quantitative measures as they directly relate to each service. At a minimum,include a
number to be served in each service component.Describe your internal process to assure that FYC
resources will not supplant existing and available services in the community; e.g.mental health
capitation services,ADAD and professional services otherwise funded.
IV. MEASURABLE OUTCOMES
Provide a two-page description of your expected measurable outcomes of the project. Address the
following measurable outcomes:
A. Improvement of household management competency as measured by pre and post assessment
instruments.
B. Improvement of parental competency as measured by pre and post assessment instruments.
C. Foster parents can independently work with other sources in the community and within the
local,state, and federal governments.
D. Foster parents have demonstrated higher skill and competency levels in fulfilling their
designated function for children in out-of-home placement.
E. Foster parents have positively met the needs of their biological children in adjusting to and
coping with the presence of foster children in the home.
Describe your quantitative measures: Also,describe the methods you will use to measure, evaluate,
and monitor each quantitative measure.
V. SERVICE OBJECTIVES
Provide a one-page description of your expected service objectives and quantitative measures.
Address, at a minimum,the following ways the project will:
A. Improve Household Management Competency-capacity of parents to provide safe
household environment for their children through competent household cleaning and
maintenance,budgeting and purchasing.
Page 26 of 29
006-00 Attached A
B. Improve Parental Competency-capacity of parents to maintain sound relationships with their
children and foster children and provide care,nutrition,hygiene,discipline,protection,
instructions, and supervision.
C. Improve Ability to Access Resources- services shall assist parents to work with other sources
in the community and within the local,state, and federal governments.
Describe the methods you will use to measure,evaluate, and monitor each service objective.
VI. WORKLOAD STANDARDS
Provide a one-page description of the project's workload standards and quantitative measures.
Address,at a minimum,the following areas:
A. Number of groups per month.
B. Number of anticipated requests for individual consultation per month.
C. Number of individuals providing services.
D. Maximum caseload per worker.
E. Modality of treatment
F. Total number of hours per day/week/month.
G. Total number of individuals providing these services.
H. The maximum caseload per supervisor.
I. Insurance.
VII. STAFF QUALIFICATIONS
Provide a one-page description of staff qualifications and address, at a minimum,the following:
A. Will your staff,including supervisors,who are providing direct services have the minimum
qualifications in education and experience as defined in Staff Manual Volume VII, Section
7.303.17, and Section 7.000.6;Q, Colorado Department of Human Services? Describe.
B. Total number of staff, including supervisors,available for the project.
VIII. Unit of Service Rate Computation
The budget form is to be used to provide detailed explanation of the hourly or daily rate your
organization will charge the Core Services Program for the services offered in this Request for
Proposal. This rate may only be used to bill the Weld County Department of Social Services for
direct, face-to-face services provided to clients referred by the Department. Requests for payment
based on units of service such as telephone calls,no shows,travel time,mileage reimbursement,
preparation, documentation, and other costs not involving direct face-to-face services will not be
honored. Likewise,bills must be for hours or days of direct services to the client,regardless of the
number of staff involved in providing those services. Therefore,it is imperative that this rate be
sufficient to cover all costs associated with this client,regardless of the number of staff involved in
providing these services.
There are two different ways to fill out the budget form. The budget can either be done manually or
by computer. Regarding the manual budget, all areas that are required to be filled in are highlighted.
The computerized budget is less work due to predefined calculations,but does require Microsoft
Page 27 of 29
,
PROGRAM BUDGET$ COMPUTERIZED ACTUAL
PROGRAM A°=ba�sfi F— Sexual Abut LMT sI O. 'Paler PrnnP
TOTAL HOURS OR DAYS OF DIRECT SERVICE PER'CLIENT 20 i 5 46 30 1
TOTAL CLIENTS SERVED 120 120 36 _ 120 166
TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) 2400 600 1,620 3,600 166
COST PER HOURS OR DAYS OF DIRECT SERVICES(E 1 C) $48.00 $48.00 $48.00 $46.00 $180.00
TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $115,200 $28,800 $77,760 $172,600 $30,240
ADMINISTRATION COSTS NON-FACE-TO-FACE ALLOCABLE TO PROGRAM $13,440 53,360 $0,074 $20,160 ;5,528
OVERHEAD COSTS ALLOCABLE TO PROGRAM $83,380 $16,840 $42,768 $$8,040 $16,832
TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+0) $1$2,000 $46,000 $128,622 _$268,000 $60,400
PROFITS CONTRIBUTED BY THIS PROGRAM $0 $0 $0 $0 $0
TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) $182,000 $48,000 $128,622 $206,000 $60,400
li TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 2.400 800 1,620 3,800 16$
RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE
(J I IQ $80.00 $80.00 $80.00 $80.00 $300,00
GROUPS
J
SEE BUDGET JUSTIFICATION SECTIONS OF EACH BID FOR EXPLANATIONS
C tion statement
1 ..— declare to the best of my knowledge and belief that the statements
ma this document are true and complete and that the wage rates and other factual unit costs supporting the compensation
paid o to be paid under this contract are accurate, complete and Includes no duplicate costs and that 1 am the CEO or duly authorized agent of
Ackerman and Associates P,C.
Budget justifications to accompany bid worksheet:
The worksheets are based on 2002 income data from Jan 1 2002 through December 31
2002 for Ackerman and Associates P.C. Ackerman and Associates is Category S
Professional Corporation which does not publicly trade stock. As such we will make our
accounting data available to WCDSS services to verify the percentages below upon
written request. Approximate totals can be calculated from data given here.
For 2002 53%of the income of Ackerman and Associates was derived from core services
contracts with WCDSS. 32%was derived from insurance or patient payments, 8%from
mediation and other court related work, 3%from other contracts and 4%from other
sources.
On the expense side salaries of employees totals 23%of expenses and payments to
provider subcontractors total 56%of expenses making salaries and fees for services
rendered by providers 79 percent of expenses. The proportion of provider fees for
services attributable to core social services payments are 57.5%of the subcontractors'
fees. Our formula for paying providers is based upon 60%of the billed fee for all work
done through Ackerman and Associates. The difference represents uncollected billing
from WCDSS based on individual disputed technical issues and items either closed or
under going review.
The remaining 21%of expenses representing slightly more than $100,000 dollars include
heat light, rent, contract labor other than providers, accounting and insurance costs, legal
services, travel,telephone, advertising, mailing supplies and other costs.
Net profits represented less than one half of one percent of gross earnings in 2002.
Do Payments from WCDSS over or under support Ackerman and Associates?
Taking the total income received by Ackerman and Associates as the base and dividing
this into the income produced by all social services core contract work produces a
multiplier of 0.53. This is to say the 0.53 time expenses not otherwise attributable to a
specific program is used to calculate the appropriate attributable expenses assigned to
WCDSS. Call this amount cost A Adding this number with the actual payment to
subcontractors from WCDSS (Cost B) and assigning .53 times salary costs(cost C)
produces a total amount called D where D is the sum of A+B+C
D represents the total amount of expenses that could justifiably be supported by funds
from social services. An amount E is the total actual payment received from WCDSS for
core services.
The ratio of D divided by E tells us if WCDSS payments supported more or less than its
appropriate share of costs of the overall work of Ackerman and Associates P.C.
If DIE is greater than one than more expenses could have been assigned for WCDSS
than money was received from social services,that is to say social services programs
were a potential cost to Ackerman and Associates and fees might be raised. If D/E is less
than one then WCDSS funds are providing additional support for the agency and costs
might be lowered.
For Ackerman and Associates the ratio of D/E is 1.02 for the year 2002 as defined
above. There is no evidence that social services payments are disproportionately
supporting our business activities.Except for a small amount of disputed billing this ratio
would be closer to one.
Ackerman and Associates has never the less elected to reduce or billing fee to $80.00
dollars an hour. MI of this reduced cost comes from a voluntary reduction in direct
service fees paid to our providers. While not all providers have elected to join this
voluntary reduction in payment,the majority of those who previously participated in
specific Services programs have elected to do so again. Our overhead costs are relatively
. fixed or are expected to rise,. However, given the current crisis in state budgetary issues,
we hope these actions by Ackerman and Associates and its providers will provide needed
service for Weld County's residents and children in need of the services of WCDSS.
Current profit margin for 2002 was less than one half of one percent. WCDSS programs
are not expected to produce profit for us given our fee reduction of 23% at anticipated
rates of services. Note that we are offering considerable trcatnient capacity. If we
provided services at that capacity,then economies of scale might become apparent but we
consider this scenario unlikely given current budgetary considerations.
Specific additional information by program
Sexual abuse—The rate provided on the bid sheet is an individual treatment rate. The
group rate is$40 per participant per group session is contained within the proposal.
Foster parent—The rate provided is a group rate. The unit of service is a two hour group
meeting as defined within the bid. Up to 168 groups will be offered. The expected cost
per participant is less than$20 per hour of group time—less if the group is larger as the
groups are being billed at a fixed rate pr group meeting. The rate for individual services if
requested by WCDSS is$80 per hour.
Home Based, IFT and Life skills-no additional budget information is provided beyond
that contained in the bid as only individual or family services are offered at the same rate.
No group services are offered under these proposals.
��L
Project Description 2003-2004
ACKERMAN AND ASSOCIATES' FOSTER PARENT SERVICES
I. Overview: Ackerman and Associates, P.C. has provided Foster Parent
Consultation Services to Weld County over the past six years. We propose to
continue to provide foster parent consultative services in the following areas:
1. Consultation and Foster Parent Support concerning:
a. Placement issues,
b. Behavioral management,
c. Foster home issues involving the biological children in the
home,
d. Transition and loss issues,
e. Assistance in the interpretation and implementation of treatment
plans in coordination with foster parents and caseworkers in
accord with the requirements of the contract.
f. Discipline in the home.
g. Training for foster parents which includes access to training
materials for continuing education credits. Also, in selected
cases, Internet Searches' to help identify resources, such as
support groups for foster parents with children With specific
conditions, provision of in home seminars to deliver workshop
services in an effective manner to foster homes,
h. Work with all foster parents on legal risk and commitment
issues, visitation issues and solution oriented planning.
i. Facilitation of the networking of foster parents particularly in
terms of identified subgroups such as group homes issues,
issues in common to kinship homes, issues for on kinship
homes etc.
We will provide such services to those foster parents who
voluntarily participate in such services for the benefit of
themselves, their children and foster children.
2. Mandated Corrective Action Consultation in the above areas to those
foster parents who are under corrective action orders and to provide
them follow up services as needed. The services listen in No. 1 above
will be provided.
3. Mandated Critical Care Consultation services for identified critical care
foster parents. The services listed in No. 1 above will be provided
We will provide these programs primarily through group services in the home of
the foster parents. Group training will be provided for a maximum of twelve
participants with an average of eight participants per group.
Target/Eligibility Populations
A. Total number of clients to be served in this twelve-month program has
been calculated as follows. There are approximately seventy-five foster
family homes under WCDSS sponsorship. Our past work has reached
about 80 percent of these homes with one or more contacts per year. We
have the capacity to serve more than this number if demand for the
services is there. We projected our maximum capacity for last year as
seventy-five families and expected 60 families to be served. Our capacity
to provide service has exceeded the fund availability for such services in
the past fiscal year.
B. Distribution of clients. We expect to serve about sixty families in the
group consultation format. We expect to serve up to ten families for
corrective action. We also will provide on a limited basis individual
consultation to families with very specific needs when authorized in
advance by the department. These needs will be documented as specific
solution focused treatment aimed at saving a foster placement. All
services for this individual program must be approved in writing by the
DSS supervisors of the foster parents.
C. Families Served. We anticipate serving 60 family units with at least one
contact, based on our use patterns and the level of trust built with foster
families over the past six years.
D. Sub total who will receive biculturaUbilinaual services We anticipate
we can serve 100% of families who need these services in a bilingual
manner. Two of our providers are bilingual. All of the staff have extensive
cross cultural experience.
We have 2 Hispanic members of the staff, Emily Jaramillo, M.A., L.P.C. and
Evelin Gomez, PhD., LPC who are fluent in Spanish. Joyce Ackerman, Ed.
D. has spent several years working in American Indian reservation
populations and with Hispanic mental health in Greeley. She has practiced in
Greeley since 1981. Larry Kerrigan, Ph. D. has more than twenty five years
experience as a therapist in Greeley working with the Hispanic population
through the Weld Mental Health Center. Susan Bromley, M.S.W., Psy.D. is
both a trained social worker and a practicing psychologist with extensive
experience training students in cross cultural sensitivity. Cassie Yaddey M.S.,
L.P.C. and Valerie Larson, M.S.W., L.C.S.W. each has clinical experience
with bicultural families and have worker) in our foster parent program in the
last year. We can provide services in South County if WCDSS can provide a
site to meet at.
E. Accessibility. On weekdays, all providers of Ackerman and Associates
are accessible through our office secretary and through cell phones and
pagers. After hours we maintain a 24 hour answering service and page
system. On weekends, the 24 hour access reaches the provider on call
who is always a licensed Mental Health provider.
F. Maximum per month. The program maximum exceeds the capacity of
funds available from WCDSS is estimated below by program area.
Group Consultation and training for critical care parents 28 hours a month. -
Mandated Training for Corrective Action or individual treatment as needed
16 hours a month.
Monthly patterns are difficult to estimate. The yearly maximum capacity for
the contract is set at 336 group hours at a maximum of$300 per 2 hour
unit for eight people average. The contract billable maximum for any
combination of services is $50,400 per contract year.
The monthly average capacity is 20 hours per month or ten groups per
month.
G. The average stay in the program is expected to be between 10 and 16
hours(five to eight group sessions) over the year period for 60 families.
The maximum expected stay is fifteen group sessions over a one-year
period except in the mandated corrective and critical care programs which
are not limited.
Types of Services Provided
1. Mandated Critical Care Consultation services for identified critical
care foster parents.
2. Consultation and Foster Parent Support concerning:
a. Placement issues,
b. Behavioral management,
c. Foster home issues involving the biological children in the
home,
d. Transition and loss issues,
e. Assistance in the interpretation and implementation of
treatment plans in coordination with foster parents and
caseworkers in accord with the requirements of the
contract.
f. Discipline in the home.
.3
g. Training for foster parents and access to training materials,
including group and individual training(on a very select
short term basis)for continuing education credits,
h. Work with foster parents on legal risk and commitment
issues, visitation issues and solution oriented planning.
Emphasis in this area includes: How to structure your
home to avoid triggering an investigation by preventing
accidents. What to look for in a baby sitter, being a foster
parent in a regulatory world and similar topics.
3. Mandated Corrective Consultation in the above areas will be
provided to those foster parents who are under corrective action
orders. We will provide them follow up services as needed.
A partial list of the types of workshops and seminars we have provided over the
last six years follows:
Separation and Loss, Understanding Prescription Medications, Discipline,
Assertiveness with Systems, Drug Abuse, Eating Disorders, Child Development,
Sexual Abuse and Sexual Behavior-What's Normal With Teens, recovery From
Prenatal Trauma-What to Expect, Anger Management, Stress Reduction,
Parenting Round Tables, Parenting with Love and Logic. We have provided
targeted group services organized around the needs of specific foster parent
group needs and propose to continue to do so.
We have been providing these services for foster parents over the past six years
for Weld County Department of Social Services.
For the mandated programs we have developed response standards to 1) insure
that we deliver services promptly and 2) report to social services if there is any
difficulty in compliance with the corrective actions required. The mandated
consultation programs are analogous to home based delivery of services in
respect to keeping in close contact with the caseworker or in this case the foster
parent supervisor.
The consultants will not serve as advocates for the parents or for social services
in cases of dispute. Our role with the foster parent is to provide consultation not
to conduct assessments to discover the failures of the foster parent or to seek to
alter the treatment plan for the foster child. Neither will the consultants serve as a
conduit primarily for collecting information for the caseworker about the foster
parent in a dispute. As trust is essential to the process, we have worked in and
intended to continue to work in an environment of trust with all parties.
Hopefully, any dispute can be discussed to find common ground in a meeting
with the foster parents, the caseworker, the foster parents supervisor, the case
workers supervisor and the consultant should such instances arise. As
contractors, we will not initiate action with the courts on a consultation case. If
under subpoena for any reason such that we are required to appear before a
court, we will inform the court of this contractual restriction. We will also be
obligated to obey the requirements of the court should such a situation arise.
We also assure WCDSS as we have in the past that no individual working with
Ackerman and Associates and providing therapy to a foster child in a foster home
will concurrently provide consultation in that home, thus avoiding any appearance
of conflict of interest.
We will establish a work plan for consultation and show completion of that work
plan through documented notes. Foster parents will be referred to other
resources in the community for provision of services if they need such resources.
A disclosure stating foster parent agreement to participate in these programs will
be signed by every foster parent prior to treatment.
Measurable Outcomes are of two varieties. One type is termed formative
outcomes and the other type is called summative outcomes. Formative outcomes
measure how the program is preceding while the treatment takes place.
Summative outcomes are the results of the treatment.
In terms of formative measures we have the following...
How did the foster family come into the foster parent support program?
(Voluntary or mandatory)?
Did the family attend what they signed up for?
Did the foster parent need individual consultation?
How many hours of total contact did the foster parent have and how many credits
were earned?
Summative outcomes
For individual consultation, an individual consultation plan will be developed in
the first hour and completed and reviewed in the final hour to see if consultation
goals were met. For groups the group leader will note the group's goals and
evaluate if these were achieved.
C. Were Foster parents enabled to better work with other sources in the
community and the local state and federal government?
Appropriate resources in the community and state and federal resources will be a
component of group sessions as needed.
.s
D. Did foster parents demonstrate higher skills and competency levels in
fulfilling their roles for children in out of home placements?
Individualized treatment will be based on change from the initial to the final
session as documented in a summary of the consultant's notes. The foster
parent's need for information in group will be documented by the group leader.
E. Did foster parents meet the needs of their biological children in
adiustinq to and coping with foster children in their home?
Group leaders will document issues discussed in relation to biological children in
the foster parent home
,Service objectives
We have the following service objectives:
A. Improvement of Household Management Competency By using a
checklist for individual consultation, we will ascertain if the parents are
requesting assistance in relation to issues related to maintaining a safe
household environment. The check list will include the foster parents
assessment is assistance is needed in the following areas- household
cleaning, household maintenance, budgeting or purchasing. We expect
this to be a minor area of work except in families where corrective action
may be needed.
B. Improvement of parental competency We expect this to be a major
area of work with regard to the foster parent's support program. Particular
service goals for each foster parent family will be documented in their
chart.
C. The ability if the familtto access resources The referrals to local and
governmental resources will be documented by group leaders and in
individualized services that are requested.
The methods used to document the service objectives will be a comparison
of the goals of the individual plan for the family with the progress report
completed each month for all families in individual treatment. For those in
group treatment, group leader notes will be used for evaluation.
G
Workload Standards
A. The program has a capacity of 14 groups per month. The total per year
will not exceed 336 hours. At each meeting, one therapist is present. This
represents 336 hours of therapist/client time per year. At our rate of$300 per
group(two hour group at eight hours average per group the cost per
participant per hour is estimated at $18.75, the cost maximum is 50,400 per
year. The monthly average is expected to be eight groups with a yearly cost
estimate of 28,800.
B. There are eight providers—three licensed psychologists, five professional
counselors and a licensed social worker who will provide these services. All
have specific training in helping to assist individuals in behavioral changes. All
have experience in psychoeducational instruction.
C. The maximum caseload is 28 hours.
D. The modality of treatment is exclusively consultation in group settings
Individual consultation must be preauthorized by WCDSS.
E. Hours/month The total number of therapist hours is a maximum of 28 per
month (fourteen groups) and a maximum of 336 hours per year in group
services (168 groups)
F. Staff There are eight individual providers supported by two administrative
professionals in practice.
G. Supervisor This contact would be supervised by Joyce Shohet
Ackerman, Ed. D., who would monitor the project for compliance.
Providers are individually licensed and do not require clinical supervision.
The maximum caseload per supervisor is 60 families per year. Caseload
monitoring would be through tracking of time per foster parent.
H. Insurance All providers carry one million/three million liability policy
Ackerman and Associates carries an additional one million/three million
liability policy on the group and a general liability policy which meets the
required criteria for this application.
7
Staff Qualifications
A. and B. Staff Qualifications Eight staff members are available for the
project. They exceed the minimum qualifications specified as documented
below. The staff are: Joyce Shohet Ackerman, Ed. D., Licensed Psychologist;
Susan Bromley, Psy.D., Licensed Psychologist(and Licensed Social Worker);
Emily Jaramillo MA, L.P.C., Laurence P. Kerrigan, Ph. D., Licensed
Psychologist Karen Bender, M.A., L.P.G., Cassie Yac kley, M.S., L.P.C.,
Evelin Gomez, Ph.D., L.P.C. and Valerie Larson, M.S.W., L.C.S.W.
C. Training The staff has extensive training in family therapy and short term
therapy as documented by their extensive work experience. Resumes are
available upon request.
D. Condnuina education As a part of their work in the private sector all •
providers in this group maintain continuing education programs more than the
minimum eight hours required. They participate in workshops and other
activities. This proposal's continuing education requirements coincide with the
requirements of other contractual arrangements and are being met on an
ongoing basis by members of the group.
E. Supervision All providers are independently licensed and required to have
clinical supervision. All the staff members have advanced skills in family
therapy. The contract supervisor will monitor the specifications made in this
proposal.
F. Supervisor continuing education The supervisor of the project is
involved in ongoing training-to keep current with her profession through
advanced workshops and seminars. Ackerman and Associates, P.G., of
which the supervisor is the president, has more than fifteen years contracting
experience for major managed care companies as short-term, solution-
focused therapy providers in Weld County. Dr. Ackerman maintains ongoing
continuing education activities.
Unit of service rate computation
Group services will be billed at a fixed rate of$300 per group. Individual
services if requested by WCDSS will be billed at $80 per hour. The overall
profit margin for Ackerman and Associates, P.C. for 2002 was 1% of gross
revenues.
Budget Justiflcatloratandards of responsibility for 2003-2004 bids
These rates are reduced for group services and for individual services
compared to prior year contracts. These reductions are a decrease in eleven
8
percent in the individual rate and a switch from an hourly rate to a fixed group
rate for foster parent consultation services in group settings
Ackerman anc$Associates, P.C. is a type S professional corporation and not a
501.c.3.
Resumes are on file with WCDSS
See additional budget justification attached to bid worksheet.
9
BRANCH B/A PRODUCER NUMBER - DATE OF ISSUE PRIOR CERTIFICATE NUMBER
23 A 0004087 04/26/2002 Renewal
PSYCHOLOGISTS PROFESSIONAL LIABILITY
CLAIMS-MADE INSURANCE POLICY
NOTICE:THIS IS A CLAIMS-MADE POUCY, PLEASE.READ THE POUCY CAREFULLY
PURCHASING GROUP POLICY NUMBER: 45-0002000
Item DECLARATIONS CERTIFICATE NUMBER:455 P- 2032570
1 Named Insured JOYCE SHOHETACKERMAN
. _ 175025th Ave
ADDRESS , Greeley.CO 806344943
Number&Street,Town,County,State&Zip No.)
2. Policy Period: 12:01 A.M.Standard Time At From: : To:
Location of Designated Premises.. I 05/01/2002 05/01/2003
3. COVERAGE LIMITS OF LIABILITY PREMIUM
Professional Liability $ 1,000,000 each Incident I S 3,000,000 aggregate $ 1.713.00
4. BUSINESS OF THE INSURED: PSYCHOLOGY
5. The Named Insured is: _ Sole Proprietor(Including indepeedent contactors Partnership X Corporation
_ Other.
6. This policy shall only apply to incidents which happen on or after. a)the policy effective date shown on the
Declarations:or b)the effective date of the earliest claims-made policy issued by the Company to which this
policy is a renewal;or c)the date specified in any endorsement hereto. 05/01/1992
7. This policy is made and accepted subject to the printed conditions in this policy together with the provisions,stipulations
and agreements contained in the following form(s)or endorsement(s).
PLP-2012(06/93),PU-2008(Rev.10/94),,PLE-8035(09/97),PLE-2167(07/00),POE-8004(05/88)(Et'10/93), PLE-2081
Current,PON-2003
CHICAGO INSURANCE COMPANY
55 E. MONROE STREET,CHICAGO,ILLINOIS 60603
Near North Insurance Brokerage
REPRESENTATIVE: Agent or broker. in Association with Trust Risk Management Services
Office address 875 N Michigan Ave
Ste 1900
City, State, Zip:: chicane,it.60611-1803
Toll-Free Number. 1-877-637-9700
PLP-2012(06/93) - APA-
1
BRANCH B/A - PRODUCER NUMBED - DATE OF ISSUE: • PRIOR CERTIFICATE NUMBER
23 A 0004087 `: 03/292002 Renewal
PSYCHOLOGISTS PROFESSIONAL LIABILITY '
CLAIMS-MADE INSURANCE:POLICY
l:
WillIM 716 IS A CLIIIIIIISINKIEPIUGY,,PLF/LSt IEAD H E POET GISIR.LY
PURCI-HASING GROUP POLICY NUNBER: .45-0002000
item DECLARATIONS - ccitFlcw wluosi45P-'2050203 .-
1. Named Insured SUSAN PLOCK BROMLEY
182113th Ave
ADDRESS Creele.Yt 90 80631.5415
Number b Street,Town,County,State&Zip No.),,,2),";2•;..„-'‘,„y r
/.: by 2 ,. )
C
.'l..XvV �,, 1;MYle. -s4 FY`fi: .d >.. i' 4 lJi.T
2 - Polcy Period:12:01 A.M.Standard Tkni At x F '.1"` s T`°- To: ,,-..-,.` J -.:
wcatbn a Daeignited PtaMws ','1'.04/91/2902 -t- '0401/2003
3. COVERAGE i I. LIMITS OF LIABILITY` - PREMIUM
Professional Liability $1,000,000 ' 'each ktddent°I $3,000.000' -•aggregate - : $ 859.00
4. BUSINESS OF THE INSURED: PSYCHOLOGY-t• .-, :'--.5-1-z-,--_ . .:. . .,a1 ., . -.;.
5. The Named Insured is: X Sole Proprietor(Wading Independent contents) _ Partnership Corporation
Other. ' .
6. This policy shall only apply to klddents which happen o)I or after a)the policy edective date shown on the
Declarations:orb)the effective date of 1hq a Zest i a polkyu by the YCompany to which this
policy is a renewak or c)the date spedfiad in atry )tgreb;0MD5/t 996 1 447.4:::','-rt' )1 4M g 3^t}Y' b
vAxe1. L ,? 459'j,+uk
7. This policy is made and accepted subject Id thS Printed G9 4PQn�s3 a policy to9etler wilt the provisions,stipulations
and agreements contained in the,foilowktg forms)oreendorse�nent(�S -e
PLP-2012(06/93),PU-2008(Rev.10/94) PLE-8035 )W97) PLE 2167(07/0)) POE-8004(05/88)(Ed '10/93),PLE-2081
Current,PON-2003
y a qS� 1
d 1
CHICAGO INStIOANCE„C JMPANY . '
55 E.MONROE STREET CHICAGO ILLINOIS 60903 t.
.R 1'^ r^,N407e �j., f 1.;.9 Ppke a9 1t Vfl
REPRESENTATIVE: Agent otbroker luMiT > ,l:St. -a9 Services
i A,'W 975)(= Ave ? A't%
City,State.Zip Chica9 IL 80611-1603 k 4-v? r
Toll-Free Number A
'1S 77:637 9700 ,:
t CY
Vt.
e
i
PLP-2012(06/93) * ---^-5,-i-• A A I t
rte{ � _
Y j A
... Y. s ..
.�.� ?%:„
94 x: ':fe- tC:iu:
..:- .� ^x t�-�>:•� M�: Date Issued
<.Y�`
<.ri=;?> ,�s. G3_. ,joaa<:rA "r=�.,..:., ,YS.`" .� .: `7 .>Sx'.r+.:`�-'>'9•-. >�.,,� ',. tt< <., =P-<- ,>„tk"=:x z*v , A 11/19/2002
�t_<��%z'-'^"T.<'%.6p:. »ivu`...s �::<✓.c1i%Y'x�"s..a. a.:.'- -�'•'�` ..,�^'' Afi 'k
-.:_,Mw;.:.�,�t:<-:k:"xsS.E.��:.:>.�,.:1-:-. �i'a: >..:�"3.'�ls[�ri:C.;...,. X`. `s.�$,"-�.'S�i...`>`.:.�i...a'., �,.:ato^.
Memorandum Holder This memorandum is issued as a matter
of information only and confers no
ACKERMAN & ASSOCIATES ATTN DONNA rights upon the holder. This
SUITE 101 memorandum does not amend, extend
1750 25 AVENUE or alter the coverages afforded by the
GREELEY CO 80634 Certificate listed below.
Producer Company Affording Coverage
Chicago Insurance Company
Seabury & Smith
1776 West Lakes Parkway Covered Person(Status) Owner
West Des Moines, Iowa 50398 EMILY L JARAMILLO-BANSBERG MA x
Employee
This is to certify that the Certificate listed below has been issued to the insured named herein for the policy
period indicated, notwithstanding any requirement,term or condition of any contract or other document with
respect to which this memorandum may be issued or may pertain, the insurance afforded by the Certificate
described herein is subject to all the terms, exclusions and conditions of such Certificate. The limits shown
may have been reduced by paid claims.
Certificate
Type of Insurance Number Effective Date Expiration Date Limits
Professional Liability each incident 1,000,000
or occurrence
Occurrence 80M-4003488 11/01/2002 11/01/2003 3,000,000
in the aggregate
General Liability each incident
or occurrence
Occurrence
in the aggregate
Should the above described Certificate be canceled Insured
before the expiration date thereof, the issuing
company will endeavor to mail written notice to the
named Memorandum Holder, but failure to mail such EMILY L JARAMILLO-BANSBERG MA
notice shall impose no obligation or liabilty of any 183 50 AVENUE PLACE
kind upon the company, its agents or representatives. GREELEY CO 80634
Authorized Representative:
..ft e ofs
Account Number: CO KERL 1750 Date: 1/24/03 Initials: GRETCHEN
CERTIFICATE OF INSURANCE
EXECUTIVE RISK SPECIALTY CO.
C/O: American Professional Agency, Inc.
95 Broadway, Amityville, NY 11701
This is to certify that the insurance policies specified below have been issued by the company indicated
above to the insured named herein and that, subject to their provisions and conditions, such policies afford
the coverages indicated insofar as such coverages apply to the occupation or business of the Named insured(s)
as stated.
THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR
ALTERS THE COVERAGES) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE.
Name and Address of Insured: Additional Named Insureds:
LAURENCE P. KERRIGAN,
PH.D.
1750 25TH AVE.
SUITE 1101 •
GREELEY, CO 80634
Type of Work Covered: PROFESSIONAL PSYCHOLOGIST
Location of Operations: N/A
(If different than address listed above)
Claim History:
Policy Effective Expiration Limits of
Coverages Number Date Date Liability
PROFESSIONAL/ 1,000,000
LIABILITY 008-1766682 12/01/02 12/01/03 3,000,000
NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED ON THIS
POLICY AND HE OR SHE SHALL ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING
OR RECEIVING NOTICE OF CANCELLATION.
Comments:
This Certificate Issued to:
Name: LAURENCE P. KERRIGAN,
PH.D.
Address: 1750 25TH AVE.
SUITE 1101
GREELEY, CO 80634 Au orized Representative
Issue Date: 01/11/02
<SBffa5h1)TOhlPROFESSIONAL LIABILITY OCCURRENCE
e INSURANCE POLICY FOR
Risk Retention Group PROFESSIONAL COUNSELORS AND HUMAN
DEVELOPMENT PRACTITIONERS
ACA Insurance bust,Inc
5999 Stevenson Avenue
Mt
Policy Number: cL13187602 Administered by: Alexandria,VA223043300 TR �
Td freer 1-0003476647 z284
ITEM DECLARATIONS INDIVIDUAL POLICY
1. NAMED INSURED: Evelin D. Gomez
2. ADDRESS:
16593 East Alabama Place
Aurora, CO 80017
3. POUCYPERIOD: From: 01/16/02 To: 01/16/03
1201 A.M.Standard Tine at Location of Designated Premises
4. The insurance afforded is only with respect to such of the following types of insurance as inticated by specific premium charge or charges
COVERAGE PREMIUM
A. PROFESSIONAL LIABIUTY S 136 . 00
B. GENERAL UABIUTY $ 0 .00
TOTAL PREMIUM: $ 136. 00
5. LIMITS OF LIABILITY: $100, 000 each Incident or each Occurrence $100, 000 in the Aggregate
6. THE NAMED INSURED IS: Sole Proprietor(mcL Individual) Partnership
Corporation X Other(refer to Item 7 below)
7. BUSINESS OF THE NAMED INSURED: Employed
(Rating Category) Counselor/Human Development Professional
8. This potty is made and accepted subject to the primed conditions of this poky together with the provisions,stipulations and
agreements contained in the following form(s)or endorsement(s): CPL-0004-0199 CPL-0005-0199 CPL-0006.0199
NOTICE
/THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE
INSURANCE LAWS AND REGULATIONS OF YOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE
FOR YOUR RISK RETENTION GROUP.
CPL•0005-0199.00
CHANGE ENDORSEMENT -
THE RECIPROCAL ALLIANCE(RISK RETENTION GROUP)
This endorsement mollifies insurance provided under the Professional Liability Occurrence Policy for
Professional Counselors and Human Development Practitioners.
The Mowing spaces preceded ky an asterisk%)need not be completed if tin endorsenxmtand the policy have the same inception date.
ATTACHED TO AND FORMING 'EFFECTIVE DATE 'ISSUED TO:
PART OF POLICY NO. OF ENDORSEMENT
Evelin D. Gomez
CL13187602 11/22/02
A. In consideration of the premium charged:(check appropriate box)
❑ 1.The name and address wider items 1.and 2.,Named Insured,on the declarations page is
deleted in its entirety and replaced by the following:
18) 2.Item 5.,Limits of Liability,on the declarations page is deleted in its entirety and replaced by the following:
$1, 000, 000 Emit Incident or Each Occurrence $3, 000, 000 Aggregate
The premium for this change is included in the premiwn shown
on the declarations unless a specific amount is shown here. Additional Premium $27. 00
❑ 3.Coverage and Prenint.Item 4 on the declarations page,is deleted in its entirety and replaced by the following:
Coverage Premm
A:Professional Liabity
B. hi consideration of an ❑ additional pentium ❑ return premium(check appropriate box)of
❑ 1.The policy period,Item 3 on the declarations page,is deleted in its entirety and replaced by the following:
Front To:
12.01 A.M.standard tine at the location of the designated premises.
❑ 2.Coverage B.General liability is O added 0 deleted(check appropriate box).
Nothing herein contained shall be held to vary,alter,waive,or extend any of the terms,conditions,provisions.
agreements,or imitations of the above mentioned policy,other than as above stated.
p
/ 2. 12/13/02
• Authorized Representative Date
CPL-0008-0297 — 2
ALLIED HEALTHCARE PROFESSIONAL AND SUPPLEMENTAL LIABILITY
INSURANCE POLICY DECLARATIONS
Policy Number: PHCP025541 Philadelphia Indemnity Insurance Company
Administered by: CPH&Associates
727 S. Dearborn,Ste. 312
Chicago, IL 60605
Valerie Larson
2500 Haven Court
Evans,CO 80620
Affiliation: AAMFT
Professional Occupation: LCSW
Coverage Term From: (Effective Date)06/27/02 To:(Expiration Date)06/27/03
at 12:01 a.m.Standard Time at the Insured's Mailing Address shown above.
Retroactive Date(if applicable):
COVERAGE A—PROFESSIONAL LIABILITY COVERAGE LIMITS OF PREMIUM
LIABILITY
Individual—Each Incident: $1,000,000 $98.25
Aggregate: $5,000,000
Association, Partnership or Corporation—Each Incident: N/A
Aggregate: N/A
COVERAGE B—SUPPLEMENTAL LIABILITY COVERAGE
Each Incident:: $1,000,000
Aggregate: $5,000,000
COVERAGE C-NON-OWNED AUTOMOBILE(optional)
Each Occurrence:
•
Aggregate:
Premium(including taxes): $98.25
Policy Forms&Endorsements:
PHCP-01(03/01)
tiro RAJ"
Authorized Signature
Call the Administrator to Verify Claims History at 1-800-875-1911
•
Issue Date: 09/21/01
�<N The Reciprocal PROFESSIONAL LIABILITY OCCURRENCE
1�1Alhance INSURANCE POLICY FOR
Risk Retention Group PROFESSIONAL COUNSELORS AND HUMAN
DEVELOPMENT PRACTITIONERS
ACA hwaa shon,4c.
5999 Samna Arum Adl *
Policy Number: CL12494601 Administered by: Watt VA2236433ao TR
Id Fnc 18003474847 x284
ITEM DECLARATIONS INDIVIDUAL POLICY
1. NAMED INSURED: Cathleen Yackley
2. ADDRESS:
2911 12th Road
Greeley, CO 80634
3. POLICY PERIOD: From: 09/05/01 Te:. 09/05/02.
12:01 A.M.Standard Time at Location of Designated Premises
4. The insurance afforded is only with respect to such of the following.tyjes of insurance as inflated by specific premium charge or charges:
COVERAGE PREMIUM
A. PROFESSIONAL LIABILITY S 387 .00
B. GENERAL LIABILITY $ 0.00
TOTAL PREMIUM: S . 387.0 0
5. LIMITS OF LIABILITY: $1, 000, 000 each Incident or each Occurrence $3, 000, 000 in the Aggregate
B. THE NAMED INSURED IS: Sole Proprietor(incl.Individuall Partnership
Corporation X Other!refer to Item 7 below)
7. BUSINESS OF THE NAMED INSURED: Self—Employed
(Rating Category) Counselor/Human Development Professional
IL This policy is made and accepted subject to the prirtedrnnditions of this patty together with the previsions,stipulations and
agreements contained in the following forms)or endorsement(sh CPL-0004O199 CPL-0005-0199 CPL-0006-0199
NOTICE
THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE
INSURANCE LAWS AND REGULATIONS OF YOUR.STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE
FOR YOUR RISK RETENTION GROUP.
CPL-0005-0199-OO
• Issue Date: 11/26/2002
The Reciprocal' PROFESSIONAL LIABILITY OCCURRENCE
's 14,Alliance INSURANCE POLICY FOR
Risk Retention Group PROFESSIONAL COUNSELORS AND HUMAN
DEVELOPMENT PRACTITIONERS
ACA Insurance Trust, Inc
Policy Number: Administered by: 5999 Stevenson Avenue 1R
Alexandria,VA 22304-3300
CL10073403 Toll Free: 1-800-347-6647 x284
ITEM DECLARATIONS RENEWAL CERTIFICATE NUMBER 100734 INDIVIDUAL POLICY
1. NAMED INSURED: Norma Karen Bender
2. ADDRESS: 1001 43rd Avenue#41
Greeley, CO 80634-2405
3. POLICY PERIOD: From 2/4/2003 To: 214/2004
12:01 AM.Standard Time at Location of Designated Premises
4. The insurance afforded is only with respect to such of the following types of insurance as indicated by specific
premium charge or charges
COVERAGE PREMIUM
X PROFESSIONAL LIABILITY $296.40
- GENERAL LIABILITY $0.00
TOTAL PREMIUM: $296.40
5. LIMITS OF LIABILITY: $1,000,000 each Incident or each Occurrence
$3,000•000 in the Aggregate
6. THE NAMED INSURED IS: _ Sole Proprietor(incl. Individual) _ Partnership
_ Corporation X Other(Refer to Item 7 below)
7. BUSINESS OF THE NAMED INSURED: COUNSELOR 0 Full Time
(Rating Category) ® Part Time Part Time(21 -30)
8. This policy is made and accepted subject to the printed conditions of this policy together with the provisions,
stipulations and agreements contained in the following form(s)or endorsement(s):
CPL-0015-0102-00 CPL-0004-0197-00 CPL-0006-0102-00 CPL-0005-0197-00
NOTICE
THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT
BE SUBJECT TO ALL OF THE INSURANCE LAWS AND. REGULATIONS OF YOUR STATE. STATE
INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK RETENTION GROUP.
CPL-005R-1201-00
83/12/2003 11:19 9703536134 PAGE 02
TRUCK INSURANCE EXCHANGE
T1IE�INSURANCE BROUP OF ooWP
ll OM,LOS ANGELES,CAL BN10
POLICY DECLARATIONS
1. • RETAIL SERVICE - PREMIER •
N> • DR JOYCE SHOHETACICERHAN PC
insured - 1750 25TH AVE STE 101 No. Plod Count
Address ,' GItESLEY CO 80631 _07-04-362 04576-38-07
_ Agent Nit Policy Number
The named inured is an Individual unless otherwise statist
OPa nesEp ❑Capondion OJand Venture ❑Organization(Any other)
• Typed Business DOCTOR'S OFFICE •
2.Play Period fiars 07/01/02 (not prior to time angled far)to 07/01/03 12:01 as Standard lime
if this ply replaces otha coverage that ends at noon Siandani time of the same day this poky begins. this policy all not take affect
wiS the other coverage ends. This policy will centime tar successive policy periods as Anon Awe elect to continue this
iauance,we all renew this pokey if you pay the required renewal premium for each successive policy period subject to our premiums,
ivies and tamp then In effect.
S. Inured bamboo same as marling address mdms(Amin staled:
•
4.We pal&insurance only for those coverages described below and for which a specific limit of insurance is shown. •
PROPERTY
COVERAGES AND LIMITS OF INSURANCE
COVERAGES PRE21 NO. 001 001
BUSINESS PERSONAL PROPERTY 854,080
AUTOMATIC
BUILDING INCREASE
PROPERTY DEDUCTIBLE 0500
GLASS DEDUCTIBLE $100
TENANTS EXTERIOR GLASS INCLUDED
OUTDOOR S S COYLRABEA E PLANTS $2,
500
FINE $2,000
•
ADOmORIALODVRRASRu
COVERAGE AS Premises
•
Near 7-N
CUMIN PAGE 1 aFs
At4c E4'108 V
h to 290C.polrcy iiith the' umb same1ner shown on:tFtts endorsement a , !
2nd Edition
Named Insured - . DR JOYCE SHOHET ACZERHAN'PC - Agent Policy Number
Address• 1750. 25TH AVE SUITE 101 07-04-362 04576-38-07
• GREELEY CO 80631
of the Company
designated in the
Declarations -
Insured - -
Location
(Saint as above mess dherwise stared here)
Effective Date 07/31/96 Lim(t.o)Liatsfity.$ 1,000,000 each occurrence
.,,-;-
_ $ 1,000,000 Annual Aggregate
ADDITIONAL INSURED`ENDORSEMENT
(SPECIALSENTINEL) -
In consideration of the premium we agree with you to the following: •
1. The insurance provided by this policy for bodily Injury liability and property damage liability under Coverage ..
D—Business Liability insurance will also apply to the additional insured named below, but only with respect ,
to an occurrence arising out of the ownership, maintenance or use of that part of the Insured location
occupied by you.
2. This insurance does not apply to:
(a) Any occurrence which takes place after you cease to occupy the Insured location.
(b) Any structural alterations, new construction or demolition operations performed by or for any additional
insured named below.
3. The additional insurec4will not be construed or deemed to be a subscriber to the Company issuing this policy..
4. The additional insured will not be or become liable for any premium payments due upon this policy.
5. If this policy ith terminated for any reason we.will give 30 (THIRTY) days notice
in writing to the additional insured named below.
I -
This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise
subject to all other terms of the policy.
STATE OF COLORADO •
Additional . C/0 WELD COUNTY SOCIAL SERVICES DEPT
Insured • ATTN: JUDY GRIECO
PO BOX A
• GREELEY CO 80632 Countersigned
Authorized Representative . :
ILCQI,l
9:"4107 7NO EDITION 69`+ 1501 K 95 1501 . �a-.-:ci_-4
03/12/2003 11:19 9703536134 PA( 03
COMMIE EXTENSIONS - Optional Nigher Limits of Insurance Per Occurrence
;COVERAGE AM Pombes
ACCOUNTS RECEIVABLE 825,000
VALUABLE PAPERS 825,000
OFF PRVIISES PERSONAL PROPERTY $5,000
.OPTIONAL COVERAGES: We provide insurance for these Optional Coverages described below.
COVDIAcE A8 Itxthes
OUTDOOR SIGNS $7,500
EMPLOYEE DISNOIIESTY $10,000 8500 DEDUCTIBLE
MONEY AND sECORITIEs $10,000 8500 DEDUCTIBLE
•
•
LIABILITY AND MEDICAL PAYMENTS - Except ter Fire Legal LIabNlty, each paid claim for the following
coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to
Paragraph 0.4. of the Liability Coverage Form.
ammat
IMIS OF I BOaAIICE
LIABILITY 81,000,000
MEDICAL EXPENSES . *5,000 PER PERSON
TENANTS LIABILITY $75,000 PER OCCCCORRENCE
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03/12/2803 11:19 9703536134 PA( 04
Pa w Manlier: 04576-38-07 Effective Bala 07/01/02
Poky Fame and Endowments attached at Wear
£3452-ED1 BP00021299 SP00060197 DP00090197 DP04170196
BP04340197 DP04390196 BP04550197 E6036-ED1 E0207-ED1
E3342-ED1 25-2110 25-2614 1101690495 I1.02280498
11.02290187 E4009-ED2 8P05110102 DP05130102 25-2880
BP04070187 BP12030689 E6306-ED1 E8162-ED4 87123-ED1
£3020-ED1
Countersigned Ale 2- _ gy a
(Dale) (AuOcuia�d Nepn7aecdalire)
See 7#
COMM PACE • OF E
03/12/2003 11:19 9703536134 PAGE 05
TRUCK INSURANCE EXCHANGE
URANCE GROUP OF COMPANIES
HOME 0 FFi=E:�FARMERS INS
.0010
COMMON POLICY DECLARATIONS
RETAIL SERVICE - PREMIER
1- DR JOYCE SHOHETACICERMAN PC
Named •
• Insured
In - 1750 25TH AVE STE. 101 Eastay Acct.No. Prod.Count
Ad4ps • UREELEY CO 80631•
07-04-362 04576-38,07
Agent No. Paley Number
The tamed band b an Na vidaal unless otherwise state t
a Padnerslup 00 Corporation 0 Joint*ohm D 0rganimfio n (Any
Type of 0usbross DOCTOR'S OFFICE
2.Policy Palled from 07/01/02 (not prior to Time appEed for)to 07/01/03 1221 ea Standard Time
It this policy replaces other coverage that ads at noon standard time of the same day this policy begins, this poky will not take effect
insurance,the will sinewother camp ends. Thispeaty peaty Sr successive policy pellet a bike= N we elect to continue Oils
tiiis policy N you pay the tequkod renewal pianism for each successive policy pedod stilled to our Premiums.
rubs and forms then in effect
•
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS LISTED BELOW AND FOR WINCH A PRftllUM IS INDICATED. TINS
PRIM*MAY 0E SUBJECT TO CHANGE,
Premhu Ater Applicable Olecoad and'44& lie,
BUSINESSOYNERS POLICY 9771.00
TOTAL .. SEE INVOICE ATTACHED
Fonas applies*to all Coverage Pads; •
IL12011185 IL00030498 56-5166 IL00171198
•
•
comtaagrsa •444162_ erj •
( ) (Authorized RepresenlatIve)
SKIN `°' cone, . mw,. 1 •t t
a
414 DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY,CO. 80632
Website:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352.6933
O
•
COLORADO MEMORANDUM
TO: David E. Long, Chair Date: May 14, 2003
Board of County Commissioners
I
FR: Judy A. Griego, Director, Social Services ' � ! , �°
RE: Notifications of Financial Assistance Awards (NOFAAs) with
Vendors—Foster Parent Consultation Program
Enclosed for Board approval are Notifications of Financial Assistance Awards
(NOFAAs) with vendors under the Foster Parent Consultation Program. The Foster
Parent Consultation Program is funded under Core Services. The Families, Youth, and
Children(FYC) Commission completed its Request for Proposal (RFP) process and
recommends that these vendors be funded. The NOFAAs, which were originally drafted
and presented as Agreements, were discussed and reviewed at the Board's Work Session
held on May 12, 2003. All provisions remain the same as discussed at the Work Session,
except funding of the project will be through Core Services, not Child Welfare Funding.
The major provisions of the NOFAAs are as follows:
1. The term of the NOFAAs are June 1, 2003 through May 31, 2004.
2. The recommended vendors are: Lori Kochevar, Ackerman & Associates, and
Lutheran Family Services.
3. The vendors agree to provide psychological consultations and parenting support
to foster parents who are certified by the Department for the purposes of
maintaining positive placement of children in the Department's custody.
4. Each vendor will be reimbursed a maximum of$20,000 that includes $14,400 for
four groups per month at $300 per group, and $5,600 for individual consultation
with County Certified Foster parents at a rate of$80.00.
KO t- IL r .�w- ✓-
If you have any questions, please telephone me at extension 6510. 2.003-1291
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2003-1292
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