HomeMy WebLinkAbout20011399.tiff RESOLUTION
RE: APPROVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARD FOR DAY
TREATMENT AND AUTHORIZE CHAIR TO SIGN -ALTERNATIVE HOMES FOR
YOUTH
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 Day Treatment 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 Alternative Homes for Youth, commencing June 1, 2001, and ending May 31,
2002, 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 Day Treatment 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 Alternative Homes for Youth, 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 30th day of May, A.D., 2001.
BOARD OF COUNTY COMMISSIONERS
WELD CO TY, COLORADO
IE ILa�` �
ATTEST: (' Vii..
■ 1861 ( ;a1 ./` M. J Geile, Ch it
Weld County Clerk to t B.: �� �s
A�
:� ►� �
� pp Glenn Va ,
BY: ' " ' •
Deputy Clerk to the Boar �asi="
Willia . rke
D AS ORM: \\lit
vid E. Lon
ounty Attor ey
Robert D. Masden
p e ; 2001-1399
SS0028
al4
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
WEBSITE:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
111
O Child Support(970)352-6933
COLORADO
MEMORANDUM
TO: M. J. Geile, Chair Date: May 23, 2001
Board of County Commissioners
FR: Judy Griego, Director
Weld County Departmen f S ial S rvic
RE: PY 2001-2002 Notification of Financial Assistance Awards (NOFAA) under Core
Services Funds-Alternative Homes for Youth
Enclosed for Board approval are the PY 2001-2002 Notifications of Financial Assistance
Awards(NOFAA) for Families, Youth, and Children Commission(FYC)Core Services
Funds, which are for the period of June 1, 2001,through May 31, 2002.
The Families, Youth and Children Commission (FYC) reviewed proposals under a
Request for Proposal process and are recommending approval of these bids.
Alternative Homes for Youth
A. Intensive Family Therapy. Multisystemic Therapy (MST): A maximum of 24
clients, an average monthly program capacity of 14,for an average of 20 weeks,
with an average of three hours per week of family preservation services. The
program will serve both males and,females from the ages of 12 to 18, which have
a primary caretaker. Appropriate youth will have one or more issues involving
delinquency, drug and alcohol,family conflict, school issues, or mental health
concerns. Rate is$110.67/hour.
B. Day Treatment: A maximum monthly capacity of 14 youth (12-18 years of age)
per year,five-eight hours of site-based services per day, 40 hours per week for 24
weeks. Rate is$47.12/hour or$1,490.41/month.
Page 1 of 2
MEMORANDUM TO M.J. GEILE, CHAIR
WELD COUNTY BOARD OF COMMISSIONERS
RE: CORE SERVICE NOFAA PY 2001-2002-ALTERNATIVE HOMES FOR YOUTH
C. Sex Abuse Treatment: A maximum of two hours per day,four hours per week, 16
hours per month. Monthly maximum capacity is limited to 12 youth and their
families, monthly average capacity is 10, average length of stay is 32 weeks,
average hours per week is four hours per week. Bilingual services provided for
Spanish-speaking families. Rate is$43.28 per hour.
If you have any questions, please telephone me at extension 6510.
of
Page 2 of 2
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 FY01-PAC-9000
Revision (RFP-FYC-01006)
Contract Award Period Name and Address of Contractor
Alternative Homes for Youth
Beginning 06/01/2001 and Day Treatment
Ending 05/31/2007 9201 W. 44`s Avenue
Wheatridge, CO 80033
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial Assistance
Award is based upon your Request for Proposal(RFP).
This program provides a comprehensive, The RFP specifies the scope of services and conditions
Therapeutic alternative to placement that of award. Except where it is in conflict with this
addresses behavioral,psychological, family NOFAA in which case the NOFAA governs, the RFP
issues and academic enrichment, with a strong upon which this award is based is an integral part of the
emphasis on vocational exploration. A action.
monthly maximum capacity of 14 youths(12-
18), five-eight hours of site-based services per Special conditions
day,40 hours per week for 24 weeks. 1) Reimbursement for the Unit of Services will be based
on a monthly rate per child or per family.
Cost Per Unit of Service 2) The monthly rate will be paid for only direct face to
face contact with the child and/or family or as specified
Monthly $ 1.490.41 in the unit of cost computation.
Hourly Rate Per $ 47.12 3) Unit of service costs cannot exceed the hourly and
Based on Average Capacity yearly cost per child and/or family.
4) Payments will only be remitted on cases open with,and
Unit of Service Based on Approved Plan referrals made by the Weld County Department of
Social Services.
Enclosures: 5) Requests for payment must be an original submitted to
X Signed RFP:Exhibit A the Weld County Department of Social Services by the
Supplemental Narrative to RFP: Exhibit B end of the 25th calendar day following the end of the
Recommendation(s) month of service. The provider must submit requests
_Conditions of Approval for payment on forms approved by Weld County
Department of Social Services.
Approvals: Progra Offici •
By GGv By
M. J. Bile,Chair Ju . G go, Dir for
Board of Weld County Commissioners W County Department of Social Services
Date: 05/3o/,apo/ Date: b/Z3/Of
2001-1399
Signed RFP: Exhibit A
Alternative Homes for Youth
RFP: 01006-Day Treatment
INVITATION TO BID
DATE: February 28, 2001 BID NO: RFP-FYC-01006
RETURN BID TO: Pat Persichino, Director of General Services
915 10th Street,P.O. Box 758, Greeley, CO 80632
SUMMARY
Request for Proposal (RFP-FYC-01006) for:Family Preservation Program--Day Treatment Program Family
Issue's Cash Fund or Family Preservation Program Funds
Deadline: March 23, 2001, 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 Statewide Family Preservation Program (C.R.S. 26-5.5-101) and
Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement(C.R.S. 26-5.3-
101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1,
2001, through May 31, 2002, at specific rates for different types of service,the county will authorize approved
vendors and rates for services only. The Day Treatment Program Category must provide a comprehensive,highly
structured program alternative to placement or more restrictive placement that provides therapy and education
for children. 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
(After receipt of order) BID MUST BE SIGNED IN INK
LOPE&'H -l. coal
TYPED OR PRINTED SIGNATURE
VENDOR qhr PnuE 4mesMr I oUm c r(--1A- 9
(Name) Handwritten Signat e By Authorized
Officer or Agent of Vendor
ADDRESS C/j0/ 441-04 TITLE CK'e l'"°- atilt r2,c&<
War Ze&E, Co &vc33 3
DATE E,/
PHONE # (3t3)9sfv- 55vO
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 32
RFP-FYC-01006 Attached A
DAY TREATMENT PROGRAM BID PROPOSAL
FAMILY PRESERVATION PROGRAM
2001/2001 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2001-2002
BID #RFP-FYC-01006
NAME OF AGENCY: ALTFL2NRrl v liomcz) roe- tloum
_ADDRESS: 90U, GUEST" 441H RVWNOE, WHEAT &ICE t (&0n 8e033
PHONE: (303)940-ssVo
CONTACT PERSON: 8;t.„;- ,TECA ib C 5 /VP TITLE: EbtiCA-nctiALf r'icEDhuAToe
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Day Treatment Program Category must
provide a comprehensive. highly structured program alternative to placement that provides therapy and education for children
12-Month approximate Project Dates: 12-month contract with actual time lines of:
Start June 1. 2001 Start -roue/Zoc
End May 31. 2002 End MfIY 3i 2oc
TITLE OF PROJECT: (otE/EY 2)AY TEERf/yFiJT 1), 96:-EAm
3- .7-C/
Name and Signature erson eparing Document Date
Name and Signature Chief 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 Posposal
for Bid.For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2000-2001
to Program Fund year 2001-2002.
Indicate No Change from FY 2000-2002
Project Description ,.
Target/Eligibility Populations 1Lv
Types of services Provided d
Measurable Outcomes y
Service Objectives
Workload Standards
Staff Qualifications _--_
Unit of Service Rate Computation
Program Capacity per Month
Certificate of Insurance
Page 26 of 32
RFP-FYC-01006 Attached A
Date of Meeting(s)with Social Services Division Supervisor: 13//3/ 9//
Comments b SSD Su.ervisor: :�s (2� � e„ ,• 7r VC
art E . .'R1 C'/ ' ci
C.,
-
ii
,Vi3/o/
Name and ritureiff SSD Supervisor Date
ppie SSCc' y`
Page 27 of 32
RFP-FYC-01006 Attached A
Program Category Day Treatment Program Bid Category
Project Title
Vendor
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 served.
B. Total individual clients and the children's ages.
C. Total family units.
D. Sub-total of individuals who will receive bicultural/bilingual services.
E. Sub-total of individuals who will receive services in South Weld County.
F. The monthly maximum program capacity.
G. The monthly average capacity.
H. Average stay in the program (weeks).
I. Average hours 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. Site based services (The Bidder must state that a minimum of site based services of 5 hours per
day, ages eight through twenty-one (21) and two and one-fourth hours minimum per day for
children ages three to seven) will be provided.
B. Community collaboration efforts. The Bidder must describe its community collaborative efforts
with:
1. The Department of Social Services.
2. The Department of Mental Health.
3. The Department of Education.
4. Others (Please Describe).
C. Program components. The Bidder must describe the program components of:
1. Educational
2. Therapeutic
3. Behavioral
4. Recreational
D. Parental/Caretaker involvement in all program components as indicated in the case plan and as
required.
Page 28 of 32
RFP-FYC-01006 Attached A
E. Assessment and plan to meet the needs of child and family including:
1. Education through a certified teacher.
2. Vocational/Independent living for age appropriate children.
3. Individual and family therapy which includes all family members.
4. Physical health needs, i.e., nutrition, medical, dental, sex education, HIV, contraception,
etc.
5. Mental health needs such as psychotropic medications, etc.
F. Proactive planning for transition to public school setting or independent living:
1. Reintegration into public school.
2. Follow-up for individual and family therapy.
3. Completion of Day Treatment.
4. Identifies progress/outcomes.
5. Reinforces gains.
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. Please address the
following measurable outcomes:
A. The children completing the Day Treatment Program will be residing in their own homes 6
months after discharge from the program.
B. The children will enter public school upon graduation from Day Treatment.
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. The number of children placed within six months of Day Treatment graduation/discharge.
B. The number of children that were enrolled in public school from graduation/discharge from the
Day Treatment Program.
C. Improve ability to access resources - services shall assist parents to work with other sources in
the community and ahead the local, state, and federal governments.
Describe the methods you will use to measure, evaluate, and monitor each service objective.
Page 29 of 32
RFP-FYC-01006 Attached A
VI. WORKLOAD STANDARDS
Provide a one page description of the project's work load standards and quantitative measures. Address,
at a minimum, the following areas:
A. Total number of children and families served.
B. Duration/length of time in program.
C. Total number of hours per day/week/month.
D. Total number of individuals providing these services.
E. Insurance.
VII. STAFF QUALIFICATIONS
Please 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.
C. Total number of counselor and/or treatment leader(s) to the number of children ages 5 years to 13
years. (Minimum expectation is 1 staff member to 8 children.)
D. Total number of counselor and/or treatment leader(s) to the number of children ages 16 years and
over. (Minimum expectation is 1 staff member to 10 children.)
Page 30 of 33
PROGRAM DESCRIPTION
The Greeley Day Treatment Program utilizes a non-medical model of treatment. It is
one of eight programs under the Alternative Homes For Youth umbrella. The Day
Treatment Program has been successfully providing services to youth and families within
the Greeley community since 1994. The program is geared towards providing services that
meet the needs of male and female youth between ages of 12 and 18. The program provides
a comprehensive, highly structured program alternative to placement that addresses
behavioral, psychological, family issues and academic enrichment. There is also a strong
emphasis placed on vocational exploration.
Services are available from 8:00 a.m. - 5:00 p.m. with extended evening and
weekend hours for family therapy and for tracking and support services. Evaluation criteria
measure recidivism, school and/or work attendance and parent satisfaction. The survey is
conducted 6 and 12 months after discharge.
MISSION
The Mission of the Greeley Day Program is to reduce the likelihood of placement
outside the home.
* By providing individual and family opportunities for the development of
effective problem solving skills and constructive communication.
* To help youth in rediscovering how to learn and succeed in school.
* To increase responsibility on part of the youth.
* To develop self-respect through challenging experiences.
* To empower the youth and their families to achieve future goals.
II TARGET/ELIGIBILITY POPULATION
Youth to be Served
A. An average of 14 youth, ages 12 to 18 years, will receive services within
a 12-month period.
B. IQ of 60 or above, non-psychotic, male or female, ages 12-18 years old
(average age has been 15.3), court ordered to the program, and condition of
bond, probation or deferred judgment.
C. An average of 14 family units will be served, involving parents and
siblings.
D. 33% of youth served will receive bicultural/bilingual services.
E. The total number of individuals who receive services in south Weld
County will be determined by referral and transportation.
F. Monthly maximum program capacity is 14 youth.
G. Monthly average capacity is 7 youth.
H. Average stay in program is 24 weeks.
I. Average hours in program per week are 35 hours.
ii
III TYPES OF SERVICES
A. The Greeley Day Treatment Program provides a minimum of 6 hours and maximum of 8
hours of site-based services per day, for ages 12 to 18 years.
Program Services
* Individual, Group and Family Therapy
* Psychological assessments
* Structured level system
* Positive Peer Milieu
* Regular staffing and communication with appropriate agencies, (i.e., social
services probation and public schools)
* Educational services
* Relationship skill building increasing/enhancing self-esteem.
* Basic living skills
* Vocational services
* Drug/Alcohol monitoring and counseling
* Parent and mental health education and support groups
* Transportation within 15 miles
B. Community Collaboration Efforts
1. Weld County Department of Human Services
Referrals and Case Management Services, which include staffing, treatment
planning and discharge.
2. Weld County Department of Mental Health
Case Management/coordination of therapeutic services and testing.
iii
3. Colorado Department of Education
Department of Education: staff certification, training and in-services. Weld
County School District 6: case management, staffing, and testing (IEP).
4. Island Grove
Case Management Services
Group Therapy Services
Drug and Alcohol Assessment and Urinalysis Testing
5. Individual Group Therapy Services (IGTS)
Individual and Family Therapy
C. Program Components
1. Educational
* Approved School Program by the Colorado Department of Education
* 1 - Certified Teacher/1-Counselor
* Vocational/Independent Living Skills (average 1 hour per week)
* Physical health needs (nutrition, medical, sex education, HIV,
contraception, etc.)
* Reintegration into public schools (average 1 hour per week)
* Educational Testing and assessment (as needed)
2. Therapeutic
* Individual counseling services (average 1 hour per week)
* Group counseling services (average 10 hours per week)
* Family counseling services (average 1 hour per week)
* Island Grove-Substance Abuse Group (average I hour per week)
* Psychiatric Consultation (as needed)
* Psychological Testing (as needed)
iv
3. Behavioral
Utilization of Therapeutic Crisis Intervention
* Daily life supervision and interaction
* Peer Dynamics
* Behavioral modification
* Refusal Skills
* Life Skills
4. Recreational
* Wilderness Program (minimum of 2 trips offered per youth)
* Therapeutic Initiatives and Team Building activities (average I hour per
week)
* Team Sports (average I hour per week)
D. Parental/Caretaker Involvement
1. Day Treatment includes parental involvement in all program components as indicated in
the Treatment Plan and as required.
2. Day Treatment advocates family therapy and encourages parents/guardians to participate
in all phases of treatment.
E. Assessment and Plan
1. One certified teacher and 1 counselor provide educational services. Pre-and Post-testing
will be provided using the Woodcock Johnson Assessment Tool.
2. Vocational and Independent living skills are provided by certified teachers and
counselors for age appropriate youth. Experiential activities and job coaching also
provided.
v
3. A contract for therapeutic services is established for every youth and family that outlines
the frequency and level of services needed. This information is documented in the treatment
plan and reviewed on a monthly basis. Individual and Family Therapy will occur weekly.
4. Physical health needs, i.e., sex education, HIV, contraception, nutrition, etc, are covered
within the program's curriculum.
5. Mental health needs such as psychotropic medications and testing are monitored through
the treatment plan and recommendations for these additional services will be coordinated
during case reviews and treatment staffing. The program is capable of administrating
medications and coordinating mental health services.
F. ProActive Planning(transition)
1. The reintegration plan will be outlined and discussed 30 days prior lo discharge. The
program will maintain ongoing communication with the school district to ensure continuity
of care.
2. Monthly staffing will occur between the Greeley Day Treatment staff and the IGTS
therapists to monitor treatment progress. The program will also schedule two follow-up
sessions with the youth and family to further insure family stability.
3. Within 10 days of being discharged from Day Treatment, program Staff will follow-up
with telephone contact to the youth and family to check on progress and offer support.
4. A 6 and 12 month follow-up evaluation will be conducted on all youth and families who
have been discharged from the program. The evaluation will measure client satisfaction, and
progress in school, employment, family dynamics, and recidivism arid stability within the
community.
vi
5. A collaborative effort in utilizing community resources will be established to insure that
personal and family growth is sustained, (i.e., Vocational Rehabilitation Summer Youth
Employment, etc.)-
IV MEASURABLE OUTCOMES
A. 70% of the youth who complete the Day Treatment Program will be residing in their
homes 6 months after being discharged from the program.
B. 70% of the youth will enter public school upon graduation from the program.
Project Monitoring and Evaluation
Internal monitoring/evaluation of the program will include a quarterly review of the
program by Alternative Homes For Youth's Quarterly Assurance Review Team.
The team will ensure compliance with the AHFY Quality Assurance Manual.
Program evaluation will be coordinated at six-month and one-year intervals to
reevaluate youth's successful reintegration into the community. Areas that will be
tracked will be employment, school, illegal activities, and any commitments or new
offenses with the judicial system. The data will be compiled to evaluate the
outcome of the program to prevent imminent placement of children and to reunify
children in placement with their families.
The program will monitor daily, weekly, and monthly services by utilizing the
ESHO Client Record Management System. This computerized data collection
system will provide the project up-to-date information about delivery of services and
the utilization of these services. Each service is documented in quarter hour
increments.
vii
The program will also fill out quarterly client progress reports as prescribed by Weld
County Department of Social Services.
V SERVICE OBJECTIVES
A. Fewer than 30% of the youth will be placed within six months of Day Treatment
graduation/discharge.
B. 70% of the youth discharged from Day Treatment will be enrolled in public school.
C. The Day Treatment Program will assist families in the awareness and identification or
community resources that can be utilized regarding family management issues (i.e., human
services, vocation, housing, medical/health, mental health, education, and legal resources.)
The evaluation methods that will be utilized include the computerized ECHO Client Record
Management System that allows for client follow-up 6 months and 1 year after discharge.
The follow-up procedure is able to quantify service objectives.
The ECHO System will also track client and parental involvement in community and state
sponsored services on a weekly basis.
VI WORKLOAD STANDARDS
A. An average of 14 youth and families will receive
services within a 12-month period.
B. The duration and length of time within the program is an
average 24 weeks.
viii
C. Total number of hours per day/week/month.
Day—minimum 6 hours per day
Week—maximum 40 hours per week
Month - 173 hours per month.
D. We anticipate no more than 14 youth total in Greeley Day Treatment Program. The
Program is staffed with, 1 Tracker/Counselor, 1 Treatment Leader, 1 Counselor/Wilderness
Experience Coordinator and 1 Teacher
VII STAFF QUALIFICATIONS
Day Treatment staff will meet or exceed the minimum Merit System qualifications
in education and experience.
A. Counselors will have a minimum of a Bachelor's degree in Social Work,
Psychology, Sociology or closely related field.
Treatment Leader will have a minimum of a Master's degree of Social Work and
three years of clinical supervision experience.
B. The number of staff at Day Treatment.
1 - Counselor/Wilderness Experience Coordinator
1 - Tracker/Counselor
1 - Treatment Leader
1 - Certified Teacher
C. Staff to youth ratio for youth 12 to 18 years of age.
1 - Counselor to 10 youth
1 - Treatment Leader to 10 youth
ix
VIII COMPUTATION OF DIRECT SERVICE RATE
Direct Time (Per Month) Hours
1 Direct client contact 394
Indirect Time
2 Completion of Paperwork 26
3 Travel 4
4 Court Appointments 2
5 Vacation 32
6 Sick Leave 13
7 Case Management 22
8 Other 52
9 Subtotal 151
10 Total Time Available Per Month 545 (Sum of 1-8)
x
�t `�` /Trr"`4- ,-4/ s1r 4/
RFP-FYC-01006 av/ Attached A
VIII. COMPUTATION OF DIRECT SERVICE RATE
This form is to be used to provide detailed explanation of the hourly 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 for
these services 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, billings must be for hours of direct service 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.
(Explanations for these Lines are Provided on the Following Page)
(y'LLe
Total Hours of Direct Service per Client 3 7 I Hours [A]
Total Clients to be Served / 2- Clients [B]
Total Hours of Direct Service for Year `4' 777 Hours [C]
(Line [A] Multiplied by Line [B]Cost per Hour of Direct Services $ L �/Q•°5 Per Hour [D]
Total Direct Service Costs $ C5� "245 EV [E]
(Line [C] Multiplied by Line [D] ) 2p y
Administration Costs Allocable to Program $ 3/ /g'/ . /s [F]
Overhead Costs Allocable to Program $ o2-/ /59. k51/
/ a [G]
Total Cost, Direct and Allocated, of Program$ /14 5tA 2'7 [H]
Line [E] Plus Line [F] Plus Line [G] )
Anticipated Profits Contributed by this Program $ —V [I]
Total Costs and Profits to be Covered
by this Program(Line [H] Plus Line [I] ) $ In i6Oy. 27 [J]
Total Hours of Direct Service for Year (t 728 [K]
(Must Equal Line [C] )
Rate per Hour of Direct, Face-to-Face Service
to be Charged to Weld County Department of
Social Services $ 3/' (p3 [L]
Page 31 of 32
RFP-FYC-01006 Attached A
Day Treatment Programs Only: mil(•
Direct Service Hou� Per Client Per Month i7/2- [M]
Monthly Direct Service Rate $ /,/ 9O' 5// [NJ
[Al This is an estimate of the total hours of direct, face-to-face service each client will
receive from the time he or she enters the program until completing the program.
[B] This is an estimate of the number of clients who will be served during the period from
June 1, 2001, through May 31, 2002 .
[D] This represents the average hourly salary and benefits that your organization pays its
direct service providers plus any costs which are directly attributable to the face-to-
face session with the client.
[F] This represents the salary and benefits of direct service, supervisory, and clerical
personnel which are not incurred in providing direct, face-to-face service to the
client, but can be allocated to this program for time spent on the program for
activities such as travel, phone conversations, "no-shows, " discussions with involved
parties, meeting preparation, and report completion.
[G] This represents the Agency Overhead costs, such as Rent, Utilities, Supplies, Postage,
Travel Reimbursement, Telephone Charges, Equipment, and Data Processing which are not
incurred in providing direct, face-to-face service to the client, but can be allocated
to this program for time spent on the program for activities such as travel, phone
conversations, "no-shows," discussions with involved parties, meeting preparation, and
report completion.
[H] This represents the Grand Total Costs directly attributable or allocable to this
program. It should be a reasonable assumption that if you decided to discontinue this
program, your agency would realize a reduction in costs approximately equal to this
amount.
[I] This represents the total amount of profit your firm expects to realize as a result of
operating this program. Any difference between Lines [H] and [J] must be substantiated
by an amount indicated on this line.
[L] This is the actual direct, face-to-face hourly service rate at which you will be
requesting payment for the services provided under the conditions of this Request for
Proposal.
[M] To be completed by prospective providers of the Day Treatment Program only, this line
represents the estimated number of hours per month your organization will provide
direct, face-to-face services per client.
[N] To be completed by prospective providers of the Day Treatment Program services only,
this line represents the actual direct, face-to-face monthly service rate at which you
will be requesting payment for the services provided under the conditions of this
Request for Proposal . Calculated by multiplying Line [L] by Line [M] .
Page 32 of 32
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PRODUCERTHIS
no
CERTIFICATEISSUED S A MATTER OF
Riedman Corporation INFORMATION ONLY AND CONF ERS NO RIGHTS UPON
1650 Pennsylvania St THE CERTIFICATE HOLDER. THIS CERTIFICATE
Denver, CO 80203-1390 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
(303) 831-1717 AFFORDED EY THE POLICIES BELOW.
INSURED '' §S�<; iu COMPANIES AFFORDING COVERAGE }} ' { yz }
ALTERNATIVE HOMES FOR YOUTH COMPANY A: GENERAL SECURITY INS. GROUP
ATTN: DENISE DOZEMAN COMPANY B: PINNACOL ....
9201 WEST 44TH AVENUE COMPANY. C:
WHEAT RIDGE, CO 80033 COMPANY D:
I . M c<;.,a `'�� M COVERAGES
w v, tl.,d,.. . . . 9 a %e
T is is to certify that olhc ees of insurance listed below have been iss a Yto t e "i�n'sure r. above e�i r indicated, notwithstanding any requirement, term or condition of any contract or other document with respect to which period
certificate may be issued or may pertain, the insurance afforded by the policies described herein is sub3ect to all the terms,
exclusions and conditions of such olicies. Limits shown may have been reduced bl_paid claims,
'col ' INSURANCE ' MMI POLICY NUMBER & DATES kRomfainf LIMITS ifgranageNNI
A GENERAL LIABILITY 211(330009 $
[X] Comm Gen Liab Eff 09/20/00 Exp 07/01/01 $ 3,000,000 Pro/Co000000 lOps Agg
[ 1 CM EX] Occur $ 1, 000, 000 Pers/Adv Inj
/ / Exp / /
I ] OCP Eff $ 1, 000, 000 Ea Occurrence
I ] $ 50,000 Fire Damage
Eff / / Exp / / $ 5, 000 Medical Exp
A AUTO LIABILITY 21A330009
[ ]Any [ ]All Own Eff 09/20/00 Exp 07/01/01 $ 1, 000, 000 CSL
IX] Schd [X]Hired
[X]Non-Owned Eff / / E $ ST (person)
[ I [ ) "p / / $ SI (accident)
$ Property Dam
GARAGE LIABILITY / / Exp / / $ Auto-Each Acc
[ ]Any Auto Eff
[ ] [ ] Other-Ea ACC
$ -Aggregate
EXCESS LIABILITY $ Occurrence
I ]0 herre1Than Ump Form Eff / / Exp / / $ Aggregate
B WC/EMP LIABILITY 1453282 $[x]WC Stet. Lmts [ IOther-
100000 EL Each[ ] Inc1 [ ]Exel Eff 07/01/00 Exp 07/01/01 $ 500,000 EL Die-Po]. Lmt
Prop/Part/Execs $ 100,000 EL Die-Ea Emp
Eff / / Exp / /
Description of operations/locations/vehicles/special items
REF: 1110 "M" STREET; GREELEY, COLORADO
- CANCELLATION '
` 'r' ' CERTIFICATE HOLDER Imam# a� Should any of the above described policies
be cancelled before the expiration date
thWELD COUNTY DEPT OF SOCIAL SEWS to®mail 30hedayysuiwwrattenpnoanticell toetheavor
ATTN:TONY GROEGER certificate holder named to the left, but
P.O. BOX A failure to mail such notice shall pose no
GREELEY CO 80632 obligation or liability of any kind upon
th C any, its agents or reps .
rized Representative'
I, Department of the Treasuryc------. h' 9 a F . d
IF Internal Revenue Service
600 17th St . M/S 6674 DEN In reply refer to : 8450029352
Denver CO 80202-2490 Mar . 06 , 2000 LTR 1721C
84-0712493 199906 67 000
02960
ALTERNATIVE HOMES FOR YOUTH
9201 W 44TH AVE
WHEAT RIDGE CO 80033-3006016
Taxpayer Identification Number : 84-0712493
Tax Period(s) : June 30 , 1999
Form: 990
Dear Taxpayer :
Thank You for your inquiry of Feb . 29 , 2000 .
. This is to confirm that ALTERNATIVE HOMES FOR YOUTH federal
identification number 84-0712493 now has the following address of
record : 9201 W 44TH AVE WHEAT RIDGE , CO 80033 .
If you have any questions, please call us toll free at 1-800-829-1040 .
If you prefer, you may write to us at the address shown at the top
of the first page of this letter .
R°v \ s SERVICE~----H'EPARTMENT OF THNt • 3.A.P • f
District Director 1100 Commerce 5t. , Dallas, TX 75242
Person to Contact:
Alternative Homes for Youth Mary Smith
3000 Youngfield at 157 Telephone Number:
Lakewood, CO 80215 (214) 767-5023
Refer Reply to:
Mail Code 4940 DAL
Date:
June 13, 1995
Employer Identification Numberr
84-C712493
bear Sir or Madam:
Our records show that Alternative Homes for Youth is exempt from Federal
Income Tax under section 501(c) (3) of the Internal Revenue Code. This
exemption was granted March 1976 and remains in full force and effect.
Contributions to your organization are deductible in the manner and to the
extent provided by section 170 of the Code.
We have classified your organization as one that is not a private foundation
within the meaning of section 509(a) of the Internal Revenue Code because ou '
are an organization described in section 509(a) (2) . y
If we may be of further assistance, please contact the person whose name and
telephone number are shown above.
Sincerely Yours,
7/?Paits a. AO
Mary A. Smith
EP/E0 Correspondence Examiner SAX"
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