HomeMy WebLinkAbout20011404.tiff RESOLUTION
RE: APPROVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARD FOR
INDIVIDUALIZED FAMILY SYSTEMS INTENSIVE FAMILY THERAPY 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 Individualized Family Systems Intensive Family Therapy 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 Individualized Family Systems Intensive Family Therapy 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 COUNTY COMMISSIONERS
�a+` WELD COU COLORADO
ATTEST: a� ,/ ! ;` IE\
�M. J eile, C :ir
Weld County Clerk to th-r - iz�
7 Glenn Vaa., Fro-i em
BY: Yerie C
Deputy Clerk to the Boar%
Willia . Jerke �S
APP D AS To F€ M: 1C_
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Robert D. Masden
2001-1404
e. : 5 S SS0028
sir
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
' WEBSITE:www.co.weld.co.us
VI Administration and Public Assistance(970)352-1551
C
Child Support(970)352-6933
COLORADO
MEMORANDUM
TO: M. J. Geile, Chair Date: May 23, 2001
Board of County Commissioners
FR: Judy Griego, Director 0
Weld County Departm of Jcial 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-PAC-3001
Revision (RFP-FYC-01008)
Contract Award Period Name and Address of Contractor
Island Grove Regional Treatment Center,Inc.
Beginning 06/01/2001 and Individualized Family Systems Intensive Family Therapy
Ending 05/31/2002 1140 M Street
Greeley,CO 80631
Computation of Awards Description
Unit of Service
This program is especially designed to assist The issuance of the Notification of Financial Assistance
individuals and families with their substance Award is based upon your Request for Proposal (RFP).
abuse issues. A maximum of 60 families a year, The RFP specifies the scope of services and conditions
14 units active at any one time,with an estimated of award. Except where it is in conflict with this
average stay in intensive therapy of 25 weeks(in- NOFAA in which case the NOFAA governs, the RFP
home or in-clinic), an average of one-two contacts upon which this award is based is an integral part of the
per week of 3 clock hours of contact. action.
Cost Per Unit of Service Special conditions
Hourly Rate Per Unit of Service 1) Reimbursement for the Unit of Services will be based
Based on Approved Plan $ 90.00 on an hourly rate per child or per family.
2) The hourly rate will be paid for only direct face to face
Enclosures: contact with the child and/or family, as evidenced by
X Signed RFP:Exhibit A client-signed verification form, and as specified in the
Supplemental Narrative to RFP: Exhibit B unit of cost computation.
Recommendation(s) 3) Unit of service costs cannot exceed the hourly and
yearly cost per child and/or family.
Conditions of Approval
4) Payment will only be remitted on cases open with,and
referrals made by the Weld County Department of
Social Services.
5) Requests for payment must be an original submitted to
the Weld County Department of Social Services by the
end of the 25th calendar day following the end of the
month of service. The provider must submit requests
for payment on forms approved by Weld County
Department of Social Services.
Approvals: Program Official:
By By Q 7
M. J.Ge le, Chair Judy ieg Direct r
Board of Weld County Commissioners Weld ounty Department of Social Services
Date: (..)5/3--)4 2-0(3/ Date: 5/23/Q'
2001-1404
Signed RFP: Exhibit A
Island Grove Regional Treatment Center
RFP: 01008-Intensive Family Therapy
INTENSIVE FAMILY THERAPY
FAMILY PRESERVATION PROGRAM
DEPARTMENT OF SOCIAL SERVICES
WELD COUNTY
2001/2002 BID PROPOSAL
RFP-FYC # 01008
Island Grove Regional Treatment Center, Inc.
1140 M Street
Greeley, CO 80631
INVITATION TO BID
DATE:February 28, 2001 BID NO: RFP-FYC-01008
RETURN BID TO: Pat Persichino, Director of General Services Gf
915 10th Street, P.O. Box 758, Greeley, CO 80632 i I '
SUMMARY
Request for Proposal (RFP-FYC-01008) for:Family Preservation Program--Intensive Family Therapy
Program Family Issue's Cash Fund or Family
Preservation Program Funds
Deadline: March 23, 2001, Friday, 10:00 a.m.
The Placement Alternatives 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 Placement Alternatives 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 Intensive Family Therapy Program must provide
for therapeutic intervention through one or more qualified family therapists, typically with all family
members, to improve family communication, function, and relationships. 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 JJ
VENDOR Treatment Center, Inc.
(Name) Handwritten ignature 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-01008 Attached A
INTENSIVE FAMILY THERAPY PROGRAM BID PROPOSAL
FAMILY PRESERVATION PROGRAM
2001-2002 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2001-2002
BID #RFP-FYC-01008
NAME OF AGENCY: 13:5 ItNb 6 ft0 VE RTC
--
_ADDRESS: I(Yn ‘lit" ST GKEEG.E7 , Co gatel
PHONE: (910 ) (3% G(.t(t 4 44- 14
CONTACT PERSON: Sco%!?- ltlyk/A TITLE: eCerVV \ AALvver
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Intensive Family Therapy Program must
provide for therapeutic intervention through one or more qualified family therapists. typically with all family members,to
improve family communication. functioning. and relationships
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: -A4J4 ,S(/G mat /Cur it4r
Sc.ti-7- Vv (-CA--. Scott D. Wykes O37/ 0f
Name and Signature f Person Preparing Document Date
J(,(�t,- BJ Dean March 20, 2001
Name d Signature Chief Administrative Officer Applicant Agency Date
MANDATORY PROPOSAL REOUIREMENTS
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
61d Project Description Silk"-CHrFA6¢
Target/Eligibility Populations Nc aAhA$E
iti Types of services Provided 1O { f-
SDi Measurable Outcomes IJd Cttmtbt
St) Service Objectives NC., CtftW6-f_
si&L Workload Standards 4/ccrm*
S1) Staff Qualifications No at/Wet
' Unit of Service Rate Computation 567iktCHAAFE
_ Program Capacity per Month 5k CttANGG
5LA Certificate of Insurance
Page 26 of 32
RFP-FYC-01008 Attached A
Date of Meeting(s)with Social Services Division Supervisor: /01/-1;
Comments by SSD Supervisor:
Name and Signature o SSD upervisor Date
Page 27 of 32
RFP - FYC -01008
Intensive Family Therapy Program Bid Category
Intensive Family Therapy - Family Preservation Program
Island Grove Regional Treatment Center, Inc.
PROJECT DESCRIPTION
Most families face enough challenges to test even the most successful families. Add an
accompanying element of Substance Abuse by any of its members and the disruption can
be so extensive that parent's face losing their substance abusing children or children lose
their parents to the control substances. These high-risk situations require effective
interventions. Island Grove Center's Intensive Family Therapy Program has remained
current on developments in Substance Abuse and Family Therapy to deliver such
interventions.
The IFT Program is specifically geared to assist families in reclaiming their lives from the
effects of Substance Abuse. 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, and 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 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 11
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 II 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 II 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 II 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 IFT services 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 OBJECTIVES
A. Improve Family Conflict management: 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 II 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
4
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.
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 degreed
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
5
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
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 daily operation of the program. 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\FAMSER\ADSS 01-02VFT Bid Proposal 01-02.doc
6
RFP-FYC-01008 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 Total Hours of Direct Service per 4* Unit 12,4
Hours [Al
F it Unit Families
Total s tote Served 60 V*Telft6 [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 [D] )
Administration Costs Allocable to Program $28,720.87 [F]
Overhead Costs Allocable to Program $11,780.22 [G]
Total Cost, Direct and Allocated, of Program$66,960.00 [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] ) $66,960.00 [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 $ 90.00 [L]
Page 31 of 32
RFP-FYC-01008 Attached A
Day Treatment Programs Only:
Direct Service House Per Client Per Month [M]
Monthly Direct Service Rate $ [N]
[A] 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 [Li by
Line DI] .
Page 32 of 32
03-15-01 13; @1 F ru_'J ,r _ ..._.^. _ •
ACORD. CERTIFICATE OF LIABILITY INSURANCE 1O i o 0
PRODUCER I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
211 First Street I HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
L ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Eaton, CO 80615 ,
970 454-3381 INSURERS AFFORDING COVERAGE
INSURED - INSURER Frontier Insurance Company, Inc .
ISLAND GROVE REGIONAL INSUAERB. ST PAUL FIRE & MARINE INSURANCE CC
TREATMENT CENTER INC 'INsuRERc
1140 M STREET INSURER D'
GREELEY, CO 80631 INSURER E•
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
-� - - POLIO'EFFECTIVE POUCY EXPIRATION
,LSR, TYPE OF INSURANCE POLICY NUMBER OMITS
LIR '� DATE(MMIDDM') DATE(MMADD^M
A IGENERALLIABIUTY IG20002952200 04/01/00 04/01/01 EACHOCEURRENCE S1, 000 000
X ICOMMERCML GENERAL LIASILITY 1 FIREOAMAGE(Any Onelte) 550, 000
TI ICLAIMSMADE 'I X OCCUR MEDEAP(My r Wie
n) x'55, 000
1 _
PERSONAL S ADV INJURY 51, 0 0 0, 000
n _ GENERAL AGGREGATE 'L3, 000, 000
,GEN'L AGGREGATE_ LIM/IAPPLIES PER'. PRODUCTS -COMP/OP AGG 153, 000, 000
GA 1. POLICY i 71g. rT LOC
B AUTOMOBILE LIABILITY IFK06602680 04/01/00 04/01/01 COMBINED SINGLE LIMIT
rr ! (Caacadenp S1, 000 , 000
X)ANY AUTO
ALL OWNED AUTOS BODILY INJURY I$
,SCMEDULEDAUTO5 IPe,WSW)
X HIRED AUTOS I BODILY INJURY $
ri (Per accident)
X,HON-OWNED AUTOS I _
I I '
PROPERTY DAMAGE I$
(Per accidenq
GARAGE LIABWTY AUTOONLY-EA ACCIDENT S _
H ANY AUTO ! I OTHER THAN EA A00 5-
AUTO ONLY. AGG S
EXCESS LIABILITY EACH OCCURRENCE '5
OCCUR JI CLAIMS MADE AGGREGATE S
S
DEDUCTIBLE $I
~I RETENTION $ S
WC STATU- ION/
WORKERS COMPENSATION AND _ 1-0RyytmlYS PR -..
EMPLOYERS'LIABILITY • E.L EACH ACCIDENT 3
:E.L.DISEASE-EA EMPLOYEE S _
• E I. DISEASE•POLICY LIMIT S
-
AIOTHERPROFESSIONAL '020000136202 04/01/00 ' 04/01/011, $1 , 000, 000 PER OCC.
`LIABILITY $3 , 000, 000 AGGREGATE
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCW SIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
WELD COUNTY, COLORADO, BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY,
ITS 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 i ADDP1ONALINSURED:INSURER LETTER: CANCELLATION
SHOULD AHYOF TH E ABOVE DESCRIBED POLICIESDECANCELLED BEFORE THE EXPIRATION
WELD COUNTY COLORADO PATE THEREOF, EWE ISSUING INSURER WILL ENDEAVOR TOMAIL F0 DAYS WRITTEN
BOARD OF COUNTY COMMISSIONERS NOTICE TOTHE CERTIFICATE HOLDER NAMED TOME LEFT,BUT FAILURE TODOSOSHALL
OF WELD COUNTY IMPOSE NO OBLIGATION OR LIABILITY OF ANYKIND UPON THE INSURER,IT5 AGENTS OR
915 - 10 STREET REPRESENTATIVES
GREELEY, CO 80631 AUTHORIZED REPRESENTATIVE
Floor'• 17e>se ison lnscaarcc4 , -L-Ic-
'IORD 25-S(7/97)1 0f 2 #148710 CKE 0 ACORD CORPORATION 1988
@3-16—@1 13n@2 FLOOD h
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 listed thereon.
;ORD 25-S(7/97)2 of 2 #148710
AcoRQIN CERTIFICATE OF LIABILITY INSURANCE DATE(MINDD/vYI
1 03/21/01
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
211 First Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Eaton, CO 80615
)70 454-3381 INSURERS AFFORDING COVERAGE
INSURED T
INSURERA General Ins Company of America
IST.AND GROVE REGIONAL . ..
INSURER B'
TREATMENT CENTER INc NsuRERG
1140 M STREET INSOSER D
GREELEY, CO 80631 INSURER E•
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSIi - (POLICY EFTECTVE POLICY EXPIRATION, OMITS
LTA TYPE OF INSURANCE POLICY NUMBER DATE/MMAJDNYI DATE(MWDDILM
•A GENERAL LIABILITY jBINDER182898 ! 04/01/01 .04/01/02 .EACHOCCURRENCE 51, 0.00 000
X OCCUR
X I COMMERCIAL GENERAL LIABILITY I FIRE DAMAGE(Any ono Ire) '5200, 000
CLAIMS MADE I - ma)EXP(My one person) 510, 000
I
I I i PERSONAL&AOV INJURY 51, 000, 000
' I GENERAL AGGREGATE $3, 000 . 000
G ENE AGGREGATE LIMN APPLIES PER , I PRODUCTS .COMP/OP AGO I S1, 000, 000
1 - -
i.
1.POLICY I f I LCC I
A AUTOMOBILE LIABILITY BINDER18289S 04/01/01 04/01/02 COMBINED SINGLE LIMIT Li , 000, 000
ANY AUTO I I(Ea acc'dom)
_
ALLOWNEDAUTOS BODILY INJURY S
(Po,person)
I X SCHEDULED AUTOS � ',
X HIRED AUTOS BODILY INJURY S
(Per ecc'denr)
X I NON-OWNED AUTOS
- _ PROPERTY DAMAGE S
(Per aCOOMQ
GAR AGE LIABILITY i AUTO ONLY-EA ACCIDENT S
I ANY AUTO OTHER THAN EA ACC $
F !AUTO ONLY: AGO S
I - !EACH OCCURRENCE S
'
EXCESS unea I I - - - -
I I OCCUR CLAIMS MADE AGGREGATE - $
$
I
DEDUCTIBLE ' '— -
I RETENTION $ $
WC STATU•WORKERS COMPENSATOR AND 4QRV LIMSS
EMPLOYERS'LIABILITY E.L EACH ACCIDENT 5
I i EL DISEASE•EAEMPLOYEE$ _.
E.L.DISEASE-POLICY LIMIT $
A . OTHER PROFESSIONAL !BINDER182898 04/01/011. 04/01/02 $1, 000,000 Occurrence
(LIABILITY I $3 , 000, 000 Aggregate
I i I
I
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESliICLUSION$ADDED BY ENDORSEMENT/SPECIAL 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 I ADDmoNALINSURED;IN5uRERLETTER; CANCELLATION
SHOULD ANYOP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
WELD COUNTY COLORADO BOARD OF DATE THEREOF, TIE ISSUING INSURER WILL ENDEAVOR TO MAIL I.0-DAYS WRITTEN
COUNTY COMMISSIONERS OF WELD NORGE TOTHE CERTIFICATE MOLDER NAMED TOTHE LEFT,BUT FAILURE TODOSOSNALL
COUNT IMPOSE HOODLIGATION OR LIABILITY OF ANY KIND UPON THE INSURE R.ITS AGENTS OR
915 - 10 STREET REPRESENTATIVES,
GREELEY, CO 80631 AUTHORIZED REPRESENTATIVE
FloodY- Pe le4Sen InSUAk2YW-1 , 221EL-
ACORD2S-S(797)1 of 2 #S179389/M179381 CKE GACORDCORPORATIONISRR
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 tt
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD25-S(7)97)2 of 2 #S179389/M179381
ACORD CERTIFICATE OF LIABILITY INSURANC ^ rt4 � DATE IMM/DD/YYI
PRODUCER _... _. - "' >: _:03/16/Z OOI
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Talbot Insurance Agency, Inc.
'.601 28th Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
oulder, CO 80301 COMPANIES AFFORDING COVERAGE
COMPANY American Compensation Ins Co
A
INSURED - --
Island Grove Regional Treatment Center COMPANY
1140 M Street
COMPANY
Greeley CO 80631 -_ C
COMPANY
D
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE 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 TYPE OF INSURANCEPOLICY EFFECTIVE POLICY EXPIRATION
LTR POLICY NUMBER PATE IMM/DD/VYI GATE(MM/OD/YYI LIMITS
GENERAL LIABILITY GENERAL AGGREGATE $
COMMERCIAL GENERAL LIABILITY PRODUCTS COMP/OP AGG $
CLAIMS MADE OCCUR --
PERSONAL&ADV INJURY 3
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $
FIRE DAMAGE Any one flrel $
MED EXP(Any one person) 6
AUTOMOBILE LIABILITY
ANY AUTO COMBINED SINGLE LIMIT 5
ALL OWNED AUTOS --
SCHEDULED AUTOS BODILY INJURY 5
(Per person)
HIRED AUTOS - --
�
NON-OWNED AUTOS __ BODILY INJURY 6,...,•�'/(\�\n (Per accident)
PROPERTY DAMAGE 6
GARAGE LIABILITY
AUTO ONLY-EA ACCIDENT 5
ANY AUTO
OTHER THAN AUTO ONLY
EACH ACCIDENT 6
AGGREGATE 5
EXCESS LIABILITY
EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM ---
A WORKERS COMPENSATION AND ACCO0040795 10/01/2000 10/01/2001 X l-ra ilMnsi
EMPLOYERS'LIABILITY
EL EACH ACCIDENT $ 100, 000
THE PROPRIETOR/ X INCL —' - --
PARTNERS/EXECUTIVE - EL DISEASE-POLICY LIMIT 5 500, 000
OFFICERS ARE: EXCL - ---
EL DISEASE EA EMPLOYEE 5100, 000 OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Certificate Holder shall read: Weld County Colorado, by and through the Board of County Commissioners of
Weld County, its employees and agents
FAX Insured: Kathryn 970-356-1349
CERTIFICATE HOLDER CANCELLATION
Weld County Colorado SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
-- Roard of County Commissioners EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
15 10th Street 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
10 days notice for non-Payment
....:.SLIT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Greeley CO 80632 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD zs s I�rs5} &1:12-*- a u at .,G�' t..-7
O ACORD CORPORATION 1988
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