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Home My WebLink About20011403.tiff RESOLUTION RE: APPROVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARD FOR OPTION B AND AUTHORIZE CHAIR TO SIGN - ISLAND GROVE REGIONAL TREATMENT CENTER, INC. 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 Option B 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 Island Grove Regional Treatment Center, Inc., 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 Option B 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 Child Advocacy Resource and Education, 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 C UNTY COMMISSIONERS WELD COU Y, COLORADO JEL ATTEST: �� „ a vi-1v M J Bile, Ch it Weld County Clerk tot :'I : ( D ' ,q $ Glenn Vaa , ro- em BY: _-f i • I�`t' ,,or Deputy Clerk to the Boa , __ .1'l ' 17 lam✓ Wi Jerke AP OV AS F RM: avidE. L g ounty ttorn y` p� INLY Robert D. Mas en PC ' S C 2001-1403 SS0028 DEPARTMENT OF SOCIAL SERVICES PO BOX A GREELEY,CO 80632 WEBSITE:www.co.weld.co.us wag C Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 COLORADO MEMORANDUM TO: M. J. Geile, Chair Date: May 23, 2001 Board of County Commissioners FR: Judy Griego, Director a Weld County Departm of$cial rvi s RE: PY 2001-2002 Notification of Financial Assistance Awards (NOFAA) under Core Services Funds-Island Grove Regional Treatment Center 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. Island Grove Regional Treatment Center A. Option B-Home Based Intensive: Capacity to serve 14 Weld County families at any given time,for a total of 60 family units. Capacity to serve 12 bilingual families per year. Average duration of the program is 25 weeks, an average of one to two contacts per week for an estimate of three clock hours of contact at the outset of treatment. The rate is$100/hour. B. Intensive Family Therapy: A maximum of 60,families a year, 14 units active at any one time, with an estimated average stay in intensive therapy of 25 weeks (in- home or in-clinic), an average of one-two contacts per week of three clock hours of contact. Rate is$90.00/hour. If you have any questions, please telephone me at extension 6510. of 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-CORE-0008 _ Revision (RFP-FYC-01010) Contract Award Period Name and Address of Contractor Beginning 06/01/2001 and Island Grove Regional Treatment Center Option B Ending 05/31/2002 1140 M Street Greeley,CO 80631 Computation of Awards Description The issuance of the Notification of Financial Assistance Unit of Service Award is based upon your Request for Proposal(RFP). The RFP specifies the scope of services and conditions Comprehensive assessments and treatment of award. Except where it is in conflict with this planning, therapeutic interventions that may NOFAA in which case the NOFAA governs, the RFP include an array of auxiliary services, co- upon which this award is based is an integral part of the facilitated therapeutic services by qualified family action. therapists, therapy that is designed to dissolve conflicts and restore respeotfulness within the Special conditions family.Average duration of program is 25 weeks, 1) Reimbursement for the Unit of Services will be based with an average of 1-2 contacts per week for an on an hourly rate per child or per family. estimate of 3 clock hours of contact at outset of 2) The hourly rate will be paid for only direct face to face treatment. Capacity to serve 14 families at any contact with the child and/or family or as specified in given time,for a total of 60 family units. Capacity the unit of cost computation. to serve 12 bilingual families per year. 3) Unit of service costs cannot exceed the hourly and yearly cost per child and/or family. Cost Per Unit of Service 4) Payment will only be remitted on cases open with,and referrals made by the County Department of Social Hourly Rate Per $100.00 Services. Unit of Service Based on Approved Plan 5) Requests for payment must be an original form and submitted to the Weld County Department of Social Services by the end of the 25" calendar day following Enclosures: X Signed RFP:Exhibit A the end of the month of service. The provider must Supplemental Narrative to RFP: Exhibit B submit requests for payment on forms approved by Weld County Department of Social Services. Recommendation(s) —Conditions of Approval Approvals: Program Official: By /�/ ed' By # t�s. M. J. Geile, Chair Judy Grio,Dir for Board of Weld County Commissioners Wel ountyVVDepartment of Social Services Date: 65/30/-100 Date: 1231O 2001-1403 Signed RFP: Exhibit A Island Grove Regional Treatment Center RFP: 01010-Option B-Home Based INTENSIVE FAMILY THERAPY FAMILY PRESERVATION PROGRAM DEPARTMENT OF SOCIAL SERVICES WELD COUNTY 2001/2002 BID PROPOSAL RFP-FYC # 01010 Island Grove Regional Treatment Center, Inc. 1 140 M Street Greeley, CO 80631 INVITATION TO BID DATE:February 28, 2001 BID NO: RFP-FYC-01010 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-01010) for:Family Preservation Program--Home Based jtee live Family Intervention 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 competing 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 Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased in intensity, and produce positive change which protects children,prevents or ends placement, and preserves families. 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 BJ Dean TYPED OR PRINTED SIGNATURE Island Grove Regional VENDOR Treatment Center, Inc. kQr,..„ ` (Name) Handwrit n Signature By Authorized Officer or Agent of Vender ADDRESS 1140 M Street TITLE Executive Director Greeley, CO 80631 DATE March 20, 2001 _ PHONE# (970) 356-6664 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 32 RFP-FYC-01010 Attached A HOME BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING FAMILY PRESERVATION PROGRAM 2001-2002 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2001-2002 BID#RFP-FYC-01010 rr NAME OF AGENCY: ItS l a Ak j GraLirc Th C ADDRESS: /IYO M " 'cT G ReExc y , Ca Je / PHONE:(fl ) 3 Z-67,6 e/ CONTACT PERSON: 1/4,5,1// a CtlikfIt TITLE: //er- M DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased intensity,and produce positive change which protects children,prevents or ends placement. and preserves families. 12-Month approximate Project Dates: 12-month contract with actual time lines of: Start June 1. 2001 Start June 1, 2001 End May 31,2002 End May 31, 2002 TITLE OF PROJECT: Home Based Intensive Family Therapy Program ,� K (�/ Scott D. Wykesj Q� Name and Signature-elf Person Preparing Document Date BJ Dean March 20, 2001 Name 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 Proposal 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 2000-2001 to 2001-2002 SAL Project Description new bid SJ Target/Eligibility Populations new bid Sul Types of services Provided new bid sL Measurable Outcomes new bid Sul Service Objectives new bid Sul Workload Standards new bid 50 Staff Qualifications new bid SUl Unit of Service Rate Computation new bid LI Program Capacity per Month new bid ,& Certificate of Insurance Page 26 of 32 RFP-FYC-01010 Attached A Date of Meeting(s)with Social Services Division Supervisor: 3-1) ` 01 comments by SSD Supervisor: ‘g—)61-10/ Name and Signatu of S D Supervisor Date Page 27 of 32 RFP - FYC - 01010 Intensive Family Therapy Program Bid Category Intensive Family Therapy - Family Preservation Program Island Grove Regional Treatment Center, Inc. PROIECT DESCRIPTION Most families face enough challenges to test even the most successful families. Add an accompanying element by any of its members and the disruption can be so extensive that parent's face losing their children or children lose their parents to the control of outside influences. These high-risk situations require effective interventions. Island Grove Center's Intensive Family Therapy Program has remained current on developments in Family Therapy to deliver such interventions. The IFT Program is specifically geared to assist families in reclaiming their lives. Using a Strength based perspective, our staff focuses on building family strengths with the goal of reunifying the family and retaining children safely in their homes. Each referred family is provided with a Solution-based model of family therapy that has demonstrated success in working in a time-efficient, goal-directed manner. The clinical staff has expertise in both couples and family therapy, as well as recent developments in drug and alcohol abuse counseling. This combination of skills provides our staff with the tools to pave opportunities for families to choose more responsible and mutually satisfying ways of living. The frequency of sessions and the duration of the program is assessed and determined by the clinical team, in collaboration with the caseworker and the involved family. In addition to family sessions, case aide support, group therapy, other auxiliary services can be accessed by individual family members. Truly, an individualized and customized family treatment plan can be a reality. The following menu is available to augment and reinforce goal attainment with the approval to bill other authorized funding, such as the ADAD Menu. • Sobriety support groups • Domestic violence education and therapy • Substance abuse education • Women's Therapy Group • Pregnant Women's services • Vocational assessment and planning • Antabuse monitoring • Urinalysis and breathalyzer testing As demonstrated in the past, our family services team will maintain and nurture collaborative relationships with case workers to facilitate timely, flexible, and appropriate services to support the case plan. 1 II. TARGET/ELIGIBILITY POPULATIONS Our Intensive Family Therapy team will serve eligible families within Weld County. Due to proven demand, we are currently capable of carrying an average of 14 family cases at any given time, for a total of 60 family units over the upcoming funding period. We have the flexibility to expand the availability of our team to accommodate additional referrals. This could include more than 150 children within these families, from preschool ages on up, within the year. We will also accept referred families where children are at high risk for substance misuse. Length and intensity of treatment vary among the families, depending on the severity of their challenges and their willingness to use the resources available to them. We estimate the average duration of the program to cover a twenty-five-week span, with an average between one to two contacts per week for an estimate of three clock hours of contact at the outset of treatment. Later stages of this time period would typically decrease services to bimonthly contacts. The upper end of the intensity could involve twelve hours of contact per week, for a brief period, in the most extreme cases. Our referred families will be contacted within two business days to arrange for the initial assessment. Depending on the family's schedule, the assessment will occur, typically in- home, within seven business days from the moment of referral. In case of crisis, all referred family members will have access to 24-hour response through our Acute Care Services unit. Services to south Weld County families have previously comprised approximately one- fourth of our total enrollment. We have been responding to these families through accessing our Ft. Lupton office, reaching families from further outlying areas such as Dacono, Hudson, Firestone, Keenesburg, and Frederick. Recognizing the need for bilingual/bicultural services, we are prepared to serve up to twelve Spanish-speaking families this year. If a family refuses treatment or appears inappropriate for outpatient services, we will immediately contact the caseworker and discuss other referral possibilities. This may include referrals to Intensive Outpatient, residential services, or other special program areas. III. TYPES OF SERVICES TO BE PROVIDED A. Comprehensive assessments and treatment planning:Family services counselors will complete an in-depth family assessment for all accepted referrals to determine to what factors impact the family's functioning, as well as to identify strengths the family brings to their situation. The Family Adaptability and Cohesion Scales(FACES II) will be used to gather pre- and post-treatment measures. The Department of Human Services - Alcohol and Drug Abuse Division requires us to implement the ASAM criterion and ASI instrument to match level of treatment with level of care needed. The family's primary counselor will collaborate with the family to develop a treatment plan that will prioritize and specify measurable objectives. Frequently, families incorporate goals of accessing community resources and other providers. 2 B. Therapeutic interventions that may include an array of auxiliary services: In addition to weekly family therapy sessions and available case management services, individual family members and DSS case workers may find it beneficial to supplement or follow-up the IFT service base with other Island Grove Center offerings or additional community support. The IFT family member could have, at their disposal, therapy groups for women's issues, education and therapy for domestic violence offenders, counseling support and education for pregnant and postpartum women (Medicaid reimbursable), vocational assessment, substance abuse education, detoxification, residential treatment, urinalysis, and breathalyzer monitoring. Virtually every related and necessary service can be accessed within Weld County at Island Grove Center or via the collaborative relationships that Island Grove has with an extensive list of other community providers. There are many caring and competent professionals invested in the families that we share. Other funding streams, such as the ADAD Menu, have been utilized in the past to access existing Island Grove services when authorized by the caseworker. We estimate that 50%of our referred IFT families could benefit from being involved in additional monitored services. C. Co-facilitated therapeutic services by qualified family therapists: Many family sessions are facilitated by pairs of master's level family therapists. This strategy, usually comprised of a male and female team, is utilized when therapeutically beneficial to the family. It is employed discriminately to contain costs and to manage staff time and coverage, yet it may comprise 25% of the family sessions. Other staff combinations such as concurrent individual therapy have been useful in meeting the specific needs of some family members. D. Therapy that is designed to dissolve conflicts and restore respectfulness within the family Family counselors will consistently use solution-based models of family therapy. Solution building and outcome-based strategies have demonstrated success within the brief and managed care models of service provisions. Focusing on a family's strengths, this model integrates well with the services of other providers. The therapy is designed to empower families to implement respectful and responsible conflict skills, restore family boundaries, and discover life without the involvement of drugs and alcohol. The instrument chosen, the FACES//indicates measures of cohesion within the family to bring about successful changes and adaptation to those changes. IV. MEASURABLE OUTCOMES A. Children receiving services do not go into out-of-home placement:We can anticipate that 80% of families completing all recommended treatment will not lose children to placement. Our communication with caseworkers will verify these outcomes. B. Families remain intact: Similarly, we expect that 80% of families completing this program will remain intact and continue to improve. Post-discharge version of the FACES//should indicate sustained positive changes. It will be administered by telephone six months after the family is discharged. It is believed that the use of the FACES//will provide a better indication of each family's success. 3 C. Reunification of children with families:The program design for IFT, by its nature, will include, as many family members in the solution-building process as there are available. Without this involvement, the progress toward goal attainment is slower and much more difficult. Our goal is set at 85% satisfactory completion of all families referred. Satisfactory completion is defined as: All significant family members were included in the treatment plan and completed stated goals prior to discharge. D. Improvements in parental competency, parent/child conflict management: Therapeutically, the focus of much solution building will be in regard to the areas of competency. We feel the FACES//instrument will give us a measure of these areas within the sub-scales. There are desired obvious behavioral outcomes we want to see, such as kids going to school, clean drug screens, etc. All of these incidents will be recorded as the counselor becomes informed, in the base file, and data brought together within the submitted monthly reports. E. Cost efficient lFTservices in comparison to placing the child:We estimate our average monthly treatment costs per family to be under $400. With an average satisfactory completion period of six months, the high end of the total costs would still be at only $2,400.00. F. Therapeutic outcomes include fundamental changes in the family functioning and dynamics:We believe that the regular administration of the pre and post FACES II will indicate improvement in significant family functioning. Other indicators will be recorded such as child's school performance, any out-of-home placement decisions, and observed achievements between sessions. V. SERVICE OBIECTIVES A. Improve Family Conflict manaqement: Family sessions are targeted toward demonstrating family skill building in conflict resolution and sensitive communication. In addition to the instrument mentioned throughout the proposal, the family's individual treatment plan will indicate progress or continued deficits. B. Improve Parental Competency:Instruments such as the FACES//will provide measures of the quality of the relationships within the family. The counselor's home visit reports will also indicate basic safety, supervision, and nutrition needs being met. Additional referrals to participate in other provider's programs will be recommended as needed. Specialized materials will be purchased and utilized to address the impact of substance abuse on parenting abilities. C. Improve Ability to Access Resources: The program's responsibility, in addition to establishing a working, therapeutic atmosphere with the family, is to be a vehicle, literally, at times, to connect families to their communities. Our clinical staff will facilitate the recommendation of family members to other agency or community resources, as they apply to the completion of the treatment plan. Consequently, the family may continue these sustaining relationships long after their treatment ends. 4 Documentation within the case files will indicate that the community net that is being woven with the family is validating their positive directions. Our minimal goal for each family is that one or more of its members establish at least two appropriate community contacts during their course of treatment. These could include such links as peer support groups for sobriety,Job Service, United Way agency volunteering, Food Bank, recreation center involvement, or Sunrise Community Health, etc. VI. WORKLOAD STANDARDS A. Number of hours per day, week, or month: Families are generally involved in one family session per week, 1 to 1 .5 hours in duration. One or more family members may have additional individual sessions of one hour per week and/or auxiliary support services ranging from 1 to 3 hours per week. A minimum average would be 2 hours per week but could range up to 6 hours, if even only periodically. We clearly want the family to have all possible resources and services available to them. On the other hand, we want to individualize the response to the presenting needs, without always assuming that "more is better." B. Number of individuals providing the services: We have access to three deg reed counselors and one case manager. C. Maximum caseload per worker With a staggered caseload, in that families will be at a range of service needs, and with the assistance of our case manager, our counselors can handle a case load of twelve families. Their administrative duties are kept to a minimum so that full attention can be focused on direct services. D. Modality of treatment:All IFT core services will be on an outpatient basis. E. Total number of hours per week:Our Weld County families will be receiving between 1 to 2 hours of service per week/per family (less in later stages of treatment). F. Total number of individuals providing these services: 4 G. Maximum caseload per supervisor: 10 H. Insurance: Flood & Peterson Insurance, Inc. - see attached documentation VII. STAFF QUALIFICATIONS Scott D. Wykes, Youth and Family Services Program Manager Doctoral Candidate, Counselor Education and Supervision emphasis in Marriage and Family Therapy M.A. Pastoral Counseling Licensed Professional Counselor (LPC) Experience: 4 years Intensive Family Therapy 7 years general therapy 5 Fred A. Washington, Counselor - Family Services MA - Agency Counseling, Experience: 2 years Family Therapy 5 years general therapy Bryce Willson, Counselor -Youth and Family Services MA - Agency Counseling, emphasis in Marriage and Family Therapy National Certified Counselor Experience: 4 years Family Therapy 5 years general therapy Kendra Walker, Counselor-Youth and Family Services BS in Psychology Experience: Case Management, Crisis Intervention, and Detox. In addition to this core clinical staff whose education and experience is specifically in family services, we also have available a case manager, clerical assistance, administrative project supervisor, and additional contracted clinical supervisor, Dr. William Walsh, Director of the Marriage and Family Program at the University of Northern Colorado. All staff will have a minimum of 16 clock hours of continuing education annually. Scott D. Wykes, our Program Manager and contact person for the IFT program, has a large role in the clinical monitoring of the program's daily operation. He interacts with all involved staff numerous times per week and tracks case load, service hours provided, and responds to on-call crises, comprising approximately six hours of his work week. He supplements this ongoing supervision with periodic in-services, presenting alone or with Dr. Walsh. Dr. Walsh meets twice each month with our clinical team for 1 .5 to 2 hours each session. Dr. Walsh is a well-respected clinician and scholar of innovative models of family therapies. He is well versed and practiced in the ongoing professional development of the field, in addition to mentoring bright and enthusiastic professionals such as Island Grove's Family Therapy team. K:\HOME\KRUSCH\Kathryn\FAMSERV\DSS 01-02\IFT Bid generic 01-02.doc 6 RFP - FYC - 01010 Intensive Family Therapy Program Bid Category Intensive Family Therapy - Family Preservation Program Island Grove Regional Treatment Center, Inc. Intensive Family Therapy (IFT) Month Week #of Sessions Comments 1 1 2 FACES II, BBB-2, Intake, SASS', etc. 1 2 2 Deconstruct goals, construct case plan 1 3 1 Work toward goals 1 4 1 Work toward goals 2 5 1 Assess goals, scaling, etc., 2 6 1 Work toward goals 2 7 1 Work toward goals 2 8 1 Assess goals, scaling, etc. 3 9 0* Family assesses progress 3 10 1 Summarize goals 3 11 0* Counselor requests renewal if needed, determine if individualized services are needed, or if group therapy is appropriate to meet the needs. 3 12 1 FACES II posttest, Family completes goals, self-assessment. Total 12 @ $100.00= $1200.00 If a renewal is needed then the following will apply: 4 13 1 Deconstruct new goals 4 14 0* Family works on goals 4 15 1 Work toward goals 4 16 0* Family works toward goals 5 17 1 Assess goals 5 18 0* Family works on goals 5 19 1 Assess need to continue therapy 5 20 0* Family works on goals 6 21 0* Family works on goals, assesses needs 6 22 1 FACES II, summary of accomplishments 6 23 0* Therapists recommendations 6 24 0* Closing of referral unless caseworker requests further services. Renewal Total 5@ $100.00= $500.00 24 week Total 17@ $100.00= $1700.00 The referrals are under constant self- assessment, which provides the opportunity for therapy to end successfully at any given week. The Solution Focused model allows families to capitalize upon their strengths and current solutions to maximize their efforts toward their goals. *Indicates times when the therapist will not meet with the family but will be available by phone for consultation to the family at any time. It is during these times that families discover their own ability to effectively apply their own solutions. K:\HOME\KRUSCH\Kathryn\FAMSERV\DSS 01-02\IFT 01010 generic outline.doc RFP-FIT-01014 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) Family Unit Total Hours of Direct Service per 12.4 Hours [A] Families Families Total 09Witiftcto be Served 60 ri)PF [B] Total Hours of Direct Service for Year 744 Hours [C] (Line [A] Multiplied by Line [B] Cost per Hour of Direct Services $ 35.56 Per Hour [D] Total Direct Service Costs $ 26,458.91 [E] (Line [C] Multiplied by Line ID] ) Administration Costs Allocable to Program $ 361161.58 [F] Overhead Costs Allocable to Program $ 11,780.22 [G] Total Cost, Direct and Allocated, of Program$ 74,400.71 [H] Line [E] Plus Line [F] Plus Line [G] ) Anticipated Profits Contributed by this Program $ -0- [I] Total Costs and Profits to be Covered by this Program(Line [H] Plus Line [I] ) $ 74,400.71 [J] Total Hours of Direct Service for Year 744 [K] (Must Equal Line [C] ) Rate per Hour of Direct, Face-to-Face Service to be Charged to Weld County Department of Social Services $ 100.00 [L] Page 31 of 32 RFP-FYC-01010 Attached A Day Treatment Programs Only: Direct Service House Per Client Per Month _ CM] Monthly Direct Service Rate $ [N] IA] 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, 2001. [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 [Hi 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 ACORDA. CERTIFICATE OF LIABILITY INSURANCE DATE(MAVDDIYY) ( 03/20/00 PRODUCER l THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Insurance Inc 1 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 211 Firs S t r@2 t HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Eaton, CO 80615 970 454-1181 INSURERS AFFORDING COVERAGE INSURED I INsuaERA: Frontier Insurance Company, Inc . ISLAND GROVE REGIONAL :,NsuPeRe: ST PAUL FIRE & MARINE INSURANCE CC TREATMENT CENTER INC 1140 M STREET INSURER C GREELEY, CO 60631 !NsuAEA o: i INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 6Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - POIiCY EFFECTVE POUCY EXPIRATION LTfi TYPE OF INSURANCE • POUCY NUMBER : DATE flAWDDMYI • DATE I•AMIODITY) LIMITS A GENERAL LIABILITY ;G20002952200 : 04/01/00i04/01/01 EACH OCCURRENCE '511000, 000 X!COMMERCIAL GENERAL LLABILITY FIRE DAMAGE(MY one I,bl ;S5 0 000 CLAIMS MADE }( OCCUR f + MED EXP(Any ono pw5CA) '55, 000 .- PERSONAL S ADV INJURY i51, 000, 00 0 Ir� , . GENERAL AOOREGATE !s3, 000, 000 1 GEN'L AGGREGATE LIM nT APPLIES PER:I 'PRODUCTS-COMP/QP AGG ;S3, 000, 000 � 7 POLICY PRb I • �- E-�,JFCT �1 LOC i i. B LAUTOMOBiLE LIABILITY I FK0 6 6 0 2 6 8 0 04/01/00 04/01/01 'COMBINED SINGLE LIMIT I r� ��ANY AUTO •(E7 ECCAenI) ,s1, 000, 000 1, 0 0 0, 0 0 0 HALL OWNED AUTOS BODILY INJURY • SCHEDULED AUTOS (Pe,oe,sen) I s iXIHIREDAUTOS _. —I •BODILY INJURY Is •X,NON•OWNEDAUTOS Air icc,O•nl) I I — PROPERTY DAMAGE S (PM accION) GARAGE LIABIUT' ' AUTO ONLY•EA ACCIDENT S --) :ANY AUTO —•-- I I OTHER THAN FA ACC !S AUTO ONLY: AGG S EXCESS LIABILITY EACH OCCURRENCE 5 OCCUR J CLAIMS MADE .AGGREGATE •S IS DEDUCTIBLE I RETENTION S �• • :S WORKERS COMPENSATION AND WC STATU• 0U'• EMPLOYERS'UABILITY L.!70RY�(w11YS • ER E.L.EACH ACCIDENT $ E L.DISEASE•EA EMPLOYEE 5 E.L.DISEASE•POLICY LIMIT $ "A OTHER PROFESSIONAL '020000136202 04/01/00 , 04/01/01i $1, 000, 000 PER OCC. (LIABILITY • $3, 000, 000 AGGREGATE I _ • DESCRIPTION OF OPERATIONS/LOCATIONS/VENICLE9fE7<CLUSIO/JS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS WELD COUNTY, COLORADO, BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY, ITS EMPLOYEES & AGENTS, AND THE STATE OP COLORADO ARE NAMED AS ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR IN REGARDS TO THE OPERATIONS OF THE INSURED. CERTIFICATE HOLDER ! I ADOmONALIPSUR£O:INSUIIERLETTER CANCELLATION SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED inform The ExpoRATON WELD COUNTY COLORADO OATS THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 6D_DAYS WRITTEN BOARD OF COUNTY COMMISSIONERS NOTICETOTHECEIRIFICATSHOLDERNAMEDTOTH5LEFT,BUTFAILURET00090SHALL OF WELD COUNTY IMPOSE NO OBLIGATION OR LIABILITY OP ANY KIND UPON THE INSURER,ITS AGENTS OR 915 - 10 STREET REPRESENTATIVES GREELEY, CO 80631 AUTHORIZED REPRESENTATIVE t______J Food,! Pefe tsarL In.& 4an.ei. -272.C.- "4,CO�(7/97)1 of 2 #148710 CKE o AGGRO CORPORATION INS IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies fisted thereon. \CORD 25-S(7197)2 o f 2 #14 8 710 .CORD. CERTIFICATE OF LIABILITY INSURANCE ► DATE(MWDDIYYI l 03/2_/01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 211 First Street HOLLER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 9Y THE POLICIES BELOW. - Eaton, CO 80615 Y70 0 454-3381 INSURERS AFFORDING COVERAGE INsuREo INSURERA General Ins Company of America ISLAND GROVE REGIONAL - TREATMENT CENTER INC INsunERe• 1140 M STREET rNsURER c: GREELEY, CO 80631 INSURER D I INSURER Et COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REOUTAEMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE NAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCR:9ED HEREIN IS SUBJECT TO AU. THE TERMS,E3(CLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR: IPOLICY EFFECTWE :POLICY EXPIRATION I LTR I TYPE OF INSURANCE POLICY NUMBER ' DATE(MM/DgryYT OATS(MAVDC/YY) LIMITS A GENERAL LIABILITY BINDER182898 !04/01/01 :04/01/02 EACH OCCURRENCE sl, 0.00000 X COMMEACLLGENERA LIABILITYt. FIRE DAMAGE(Any One 6101 's200,,000 CLAIMS MADE i XOCCUR { MEo EXP(Any one Persons :510, O O 0 _ :PERSONAL EADVINJURY 51, 000, 000 _.. _.. I GENERAL AGGREGATE $3, 000, 000 GEN'L AGGRE(GAATTE LIMRAPPLIES PER:, i PRODUCTS -COMP/OP AGG I S 0 0 0, 0 00 I POLICY I I RCT I 7 LOC A AuTOMosILELIABILITY BINDER182898 04/01/01 j 04/01/02 "-1 COMNED SINGLE LIMIT ANY AUTO 1 W UJ CEa acudont) s2 , 000, 000 ALL OWNED AUTOS i • 1 BODILY INJURY X SCHEDULED AUTOS ! I(Por PArlon) S X HIRED AUTOS I BODILY INJURY • X NON-OWNED AUTOS (Peraccidanr) S PROPERTY DAMAGE • I _ .. — I(Per acc.don1) S GARAGE LIABILITY I I AUTO ONLY•EA ACCIDENT !S ANY AUTO I I EA ACC S I t •OTHER THAN :AUTO ONLY: AGO S I EXCESS LIABILITY I :EACH OCCURRENCE S ,iI OCCUR LI CLAIMS MADE AGGREGATE s I DEDUCTIBLE ,_. S RETENTION S .S .. .— WORXERS COMPENSATION AND ` QRV LIMES- E EMPLOYERS'LIABILITY E.L EACH ACCIDENT .S E.L DISEASE•EA£MPLOYEE $ •E.L.DISEASE-POLICY LIMIT S AI (men PROFESSIONAL IBINDER182898 : 04/01/01 '04/01/02 $1, 000,000 Occurrence LIABILITY $3, 000, 000 Aggregate DESCRIPTION OP OPERATIONSILOCATIONSNEMICLESIEYCLU91ONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS WELD COUNTY, COLORADO, BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY, IT' S EMPLOYEES & AGENTS, AND THE STATE OF COLORADO ARE NAMED AS ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR IN REGARDS TO THE OPERATIONS OF THE INSURED. CERTIFICATE HOLDER 'ADOmoNALINSUREO;INSURERLETTER: CANCELLATION SHOULD ANYOFTNE AB Dye 0 ESCRIBED POLICIESBE CANCELLED BEFORE THE EXPIRATION WELD COUNTY COLORADO BOARD OF DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL 1-CL_DAYS WRITTEN COUNTY COMMISSIONERS OF WELD NOTICETOTHE CERTIFICATE NOLDERNAMED TOTHE LEFT,Styr FAILURE TOOOSOSHALL COUNT IN POSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 915 - 10 STREET REPRESENTATIVES, GREELEY, CO 80631 AUTHORIZED T�REPRESENTATIVE I , �IOD,� __ _i15_"-�r►SLo44rtCQ . -2rtC-- ACORD2S-S(7/97)1 of 2 #S179389/M179381 CKE 0ACORD CORPORATION 198B IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,cenain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does h affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AcoRD25-s(7/ 7)2 of 2 #S179369/M179381 ACORD„ CERTIFICATE OF LIABILITY INSURANCE o3ii6/zooi' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 'albot Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 16O1 28th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Boulder, CO 8O3O1 COMPANIES AFFORDING COVERAGE „nAev American Compensation Ins Co A INSURED :Eland E -:Are Regional Treat .ant Center � B :140 I4Street co mPAN" C Creeley CO ©063CC WAN' D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO IYPE OF INSURANCE POI ICY NUMBER POLICY EFFECTIVE POLICY F%PIRATION LIMITS ITR I DAIL IMM!DUIVY) GATE(MMIDDIVY) GENERAL LIABILITY 0ENERAL AGGREGATE S COI'IIMEF.CIAL GENERALLIABILII V PROD.—TS c0 Ali'AGO f CLAMS MADE r 030UN PERSONALS ADV INJURY X NER'S d L. NTRACTC B"E PRO' EACH OCCURRENCE I n RE CAMAGL)Any ens tire' I s � � T YELL LXP'Any ane person) S AUTOMOBILE LIABIIIIY CCc131NE(]SINOLE Jp',:T S A�r'4UT0 H A__OYIM1ED AUTOS Boole/NJ-RI, Pm SCHEDULED AUTOS rP.rl HIREDAHOs (Ps araaena s NonOwNcC AUTOS PROPERTY DA✓ASF ': S GARAGE IABII ITV � A_'O0Jy EA ACCIDENT S A',AU"0 OTFFR FAN 4 IPC Ov . EACH AC,IOFN' S AGGREGATE S -_ I EXCESS LIABILITY SA,H GC':URIP NCnn 5 I_ UMBRELLA UMBRELLA FORM '., /0009 EC ' C004 4 I TIP::Ur,AHRLLLA FORM A WORKERS COMPENSATION AND ACCO0040795 1O/O1/2OOO 11O/O1/2OO1 X TORSTAITS'' EMPLOYERS'LIABILI IY E.LACE Aec.DENI s 100,000 JTHE PROPFEIOR, X , :NCL E.DISEASE 'OLICI"LIMIT 1 5 500,000 'ARTNERS/FxrCI!TVE OE:'CERS ARE ] =_XCL E.DISEASE EA EMe-OYEE S 100,000 OTHER DESCRIPTION OF OPERATIONSIIOCATIONSIVE IICI ES!SPICIAI ITEMS Cer t.rfioate J L shall read, Kerr? I C' y Colorado, by and LU,Tough the hoard of roarLy LTONRTssl oners of Wear' County, ots e -aoyeeE and agLV I' FAX Insured: Kathryn 9/O-'116-',?d9 CERTIFICATE HOLDER CANCELLATION .e1d CcunLy Co 1C_ad0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE JOdrd cc County COTT1G9=Onera EXPIRATION DATE THEREOF, THE ISSUING COMPANY Will ENDEAVOR 10 MAIL 5rYa>r 30 DAYS WRITTEN NOTICE 10 I HE CERIIEICATF HOLDER NAMED ID THE LEFT, 10 rays for con-payment. BUT FAILURE TO MAIL SUCH NOTICE SHAH IMPOSE NO OBLIGATION OR LIABILITY Cree_ey CO BC632 OF ANY KIND UPON THE COMPANY.„Its AGENTS OR REPRESENTATIVES. AUI HONIED REPRESENTATIVE{_ ACQRD 25-11 41(951 " ' �� r'PEA Cq I 908 @dG#2-306911. Hello