HomeMy WebLinkAbout20001539 RESOLUTION
RE: APPROVE TWO NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR CORE
SERVICES FUNDS AND AUTHORIZE CHAIR TO SIGN - CHILD ADVOCACY
RESOURCE AND EDUCATION
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 two Notification of Financial Assistance
Awards for Core Services Funds 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 commencing June 1, 2000, and
ending May 31, 2001, with further terms and conditions being as stated in said awards, and
WHEREAS, after review, the Board deems it advisable to approve said awards, copies
of which are attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, ex-officio Board of Social Services, that the two Notification of
Financial Assistance Awards for Core Services Funds 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
are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said awards.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 26th day of June, A.D., 2000, nunc pro tunc June 1, 2000.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: ,�I/� ,pn L i t- sn
861 Barbara J. Kirkmeyer, Chair
Weld County Clerk to th 'o. r �O
3 EXCUSED re _
r1 4 / M. J. G ile, Pro-Tem
BY: >4 �QI�1��/: N
Deputy Clerk to the Board" z, _
org . Baxter
A7OVED AS TO FOR*—)
_
/ /
Da e K Hall
U Attorndy r EXCUSED _
Glenn Vaad
56 C'//,'/d /Id 117' c! Ge 2000-1539
SS0027
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 FY00-PAC-6000
Revision (RFP-FYC-00005)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2000 and Child Advocacy
Ending 05/31/2001 Resource &Education
(C.A.R.E.)Family Advocate Program
814 9'h Street,P.O. Box 945
Greeley, CO 80632
Computation of Awards Description
The issuance of the Notification of Financial Assistance
Unit of Service Award is based upon your Request for Proposal (RF)).
The RFP specifies the scope of services and conditions
The program is a very intensive home-based of award. Except where it is in conflict with this
intervention program. Each family would be NOFAA in which case the NOFAA governs, the RFI'
provided with 2 to 50 hours per month of Life upon which this award is based is an integral part of the
Skills Training. Approximately 165 clients in the action.
12 month program, 40-50 total family units, 35
families per month, 4-5 hours per week. The Special conditions
average stay in the program is 25 weeks. 1) Reimbursement for the Unit of Services will be based
on an hourly rate per child or per family.
Cost Per Unit of Service 2) The hourly rate will be paid for only direct face to face
contact with the child and/or family or as specified in
Hourly Rate Per $ 42.46 the unit of cost computation.
Unit of Service Based on Approved Plan 3) Unit of service costs cannot exceed the hourly and
yearly cost per child and/or family.
Enclosures: 4) Payment will only be remitted on cases open with, and
X Signed RFP:Exhibit A referrals made by the County Departmeni of Social
_X Supplemental Narrative to RFP: Exhibit B Services.
5) Requests for payment must be an original form and
X Recommendation(s)
submitted to the Weld County Department of Social
Conditions of Approval
Services by the end of the 25th calendar day following
the end of the month of service. 'Be pro'.ider must
submit requests for payment on forms approved by
Weld County Department of Social Services.
Approvals:l� � Program Official:
13yc/a/lG4 _ By
arbara J. Elirkmeyer, Chair Judy . Gri g , Direct
Board of Weld County Commissioners Wel .ou epartment of Social Services
Date: O4 -a& -act) —_ Date: 0/0( i
2000-1539
SIGNED RFP
EXHIBIT A
INVITATION TO BID
RFP-FYC 00005
DATE:February 28, 2000 BID NO: RFP-FYC-00005
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-00005) for:Family Preservation Program--Life Skills Program Family
Issues Cash Fund or Family Preservation Program Funds
Deadline: March 23, 2000, Tuesday, 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 Conunissioners' 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, 2000, through May 31, 2001, at specific rates for different types of service, the county will
authorize approved vendors and rates for services only. The Life Skills Program must provide services that
focus on teaching life skills which are designed to improve household management competency, parental
competency, family conflict management and effectively accessing community resources. This program
announcement consists of five parts, as follows:
PART A....Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work
Delivery Date _
(After receipt of order) B MUST BE SIGNED IN
Gwen Schooley, Executive Director
TYPED OR PRINTED SIGNATURE
VENDOR Child Advocacy Resource and L4 .ti_ a, l —
(Name) Education, Inc. (c.a.r.e. ) Handwritten Signature By Authorized
Officer or Agent of Vender
ADDRESS 814 9th St. Greeley, CO TITLE Board President
80631 March 22, 2000
DATE
PHONE # (970) 356-6751
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 33
RFP-FYC-00005 Attached A
LIFE SKILLS PROGRAM BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING
FAMILY PRESERVATION PROGRAM
2000/2001 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2000-2001
BID#RFP-FYC-00005
NAME OF AGENCY: Child Advocacy Resource and Education, Inc. (c.a.r.e.)
ADDRESS: 814 9th St. Greeley, CO 80631
PHONE: 97q 356-6751
CONTACT PERSON: Rose Francella TITLE: Program Coordinator
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Life Skills Program Category must
provide services that focus on teaching life skills de ietted to facilitate imnlementation of the cage plan by imn own
household management competency.parental competency.family conflict management and effectively accessing
community resources
12-Month approximate Project Dates: _ 12-month contract with actual time lines of:
Start June 1.2000 start June 1, 2000
End May 31. 2001 End May 31, 2001
II_ILE OF PROJECT: Family Advocate Program
AMOUNT REQUESTED:
,--- 3/22/00
Name and Signature of Person Preparin Document Date
12_44A-eft- C . `era 3/22/00
Name and 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 1999-2000 to Program Fund year 2000-2001.
Indicate No Change from FY 1994-2000
Project Description Vivo/
Target/Eligibility Populations O
Types of services Provided lyt.o
Measurable Outcomes /rto
Service Objectives
I -n-c
Workload Standards ,44--oStaff Qualifications /N--o
Unit of Service Rate Computation Al")
Program Capacity per Month ihA
Certificate of Insurance
--
Page 26 of 33
RFIP-FYC-00005 Attached A
Date of Meeting(s) with Social Services Division Supervisor: ,34 C/ C
Comments by SSD Supervisor:
1
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_ Signature of SSD Supervisor Date
Pave 77 of 11
1. Project Description
The Family Advocate Program was developed with the primary purpose of strengthening
and preserving families while protecting children from(re) abuse or neglect; thereby,
preventing out-of-home placement or expediting the return to the home from children
living in foster care.
The Family Advocate Program: Home- Based Parenting and Life Skills Education
Each family that meets the Family Preservation criteria that is referred into the program
would be provided with from 2-50 hours per month of Parenting and Life Skills Training,
enhancing and strengthening the parents' ability to create and maintain stable and
nurturing home environments. Services are designed to promote healthy child
development, assist children and families to resolve crisis, connect with appropriate and
necessary services, and remain safely together in their homes, avoiding unnecessary out-
of-home placement of children and helping children already in out-of-home care to be
returned to and maintained with their families.
The Family Advocate program will also oiler this service to families that are in need of
supervised visitation. While supervising a family visit for safety and parental
appropriateness, the Family Advocate will continue to use that time for parenting and life
skills education. The visits can occur either at the family home, care House ( the c.a.r.e.
supervised visitation facility in Evans) or at another agreed upon location.
H. Target / Eligibility Populations
A. Total number of clients to be served: This depends on the amount of referrals into the
program; however, as stated below, the program has the capacity to serve approximately
35 families per month, or an approximate total of 165 clients per year.
B. Total individual clients and the children's ages: As stated above, there is a total
capacity of 165 clients; this includes parents, plus children aged birth through teens.
Families eligible for this program can vary in age from pregnant/parenting teens through
grandparents or other specific caregivers.
C. Total family units: 40-50 total family units per year.
D. Sub-total of individuals who will receive bicultural/bilingual services: 5-6 families
per year. This can change due to referrals and availability of a bilingual family advocate..
E. Sub-total of individuals who will receive services in South Weld County: 10-12
families per year.
F. The monthly average capacity: 35-40 families
G. The monthly average capacity: 35 families
I I. Average stay in the program: 25 weeks
I. Average hours per week in the program: 4-5 hours per week.
The figures above are approximate. Each family in the program has an individual
service plan depending on the needs of the family and recommendation of the
caseworker. Therefore, not every family utilizes the program for a uniform amount of
hours. The program has the capacity to expand as needed. The above figures are based
on the past year.
III. Type of Service To Be Provided
Each of the following services could be provided to any family enrolled in the program ;
however all families do not need all services. Services provided would be determined by
the program coordinator, family advocate and caseworker.
A. Teaching, modeling, demonstrating and coaching as an interactive process with the
clients:
Home-based parenting and life skills education by a trained family advocate including
role modeling, homework, teaching and coaching of appropriate interactions with the
family.
13. Training in household management, including budgeting, cleaning, maintenance.
purchasing, menu planning, food preparation, etc.:
Intensive home-based training in household management, especially as it pertains to safe
and nurturing child rearing. The goal is to help parents establish appropriate household
environments.
C. Teaching Child-rearing and discipline, parenting:
Provide home-based parent education utilizing ongoing support and encouragement
including but not limited to developmentally based behavior management, problem
solving, conflict resolution, protection and appropriate supervision of children, anger
management and stress management.
D. Teaching how to establish community linkages/ advocacy/and making use of
services.
Provide information, training, and role modeling in accessing community resources, as
well as follow through in using resources.
E. Demonstrating nurturing/ esteem role modeling:
The advocate will model and teach a nurturing parent role with a focus on parent/ child
self esteem. The goal is to increase positive family relationships.
The supervised visitation service offered through this program includes all of the above
activities when appropriate to the goals for the family. This will include parental support
and guidance, help with the use of community resources and ongoing communication and
feedback about parenting progress and goals.
Quantitative Measures: Each service can be offered to each family enrolled in the
program, depending on need. Therefore, there is a.potential for up to 50 families per
year. These figures are estimates, based on the previous year. The program can be
expanded when needed, depending on the number of referrals.
The Family Advocate Program is the only home-based life skills program of its' kind in
Weld County, working with this population of families that are at risk of children's
placement due to abuse or neglect. We do not provide mental health services, substance
abuse treatment or other professional services that are funded by another source.
IV. Measurable Outcomes
All families in the program will be evaluated using the following measures. In some
instances, availability and ability of the clients might affect the program's success in
obtaining outcomes. The average number of families available for measurement of
outcomes is 45.
A. Improvement of household management competency as measured by pre and post test
instruments.
This is measured by advocate report and observation.
B. Improvement of Parental Competency as measured by pre and post assessment
instruments.
This will be measured by advocate report and observation, and pre and post test
scores on the Weld County Referral and Planning Form.
C. Parents can independently work with other sources in the community and within the
local, state, and federal governments.
This will be measured by advocate report and observation of the family's
progress, scores on the Weld County Referral and Planning Form as well as information
obtained through family and community linkages.
D. Families receiving Life Skills services will remain intact six months after discharge of
the services.
Parents will sign a consent to allow c.a.r.e. to do a follow-up contact with
WCDSS six months after completion of the program.
E. Families/ Participants who complete the Life Skills Services will have improved
competency level or reduced risk on the standardized assessment, such as the risk
assessment tool.
Utilizing the Weld County Referral and Planning Form, pre and post test.there
will be documentation of improved competency and/ or reduced risk. This will also be
measured ongoing by advocate report and observation.
V. Service Objectives
A. Improve Household Management Competency:
Intensive home-based household management techniques taught by trained family
advocates to improve the capacity of parents to provide a safe, nurturing environment.
This will include but not be limited to cleaning, budgeting, purchasing, safety, and
maintenance.
This will be measured partly through the Weld County Referral and Planning
Form,as well as advocate report and observation.
B. Improve Parental Competency:
The program will provide home-based parent education including coaching,
instructing, problem-solving, role modeling, and supervision that will help improve the
parent's ability to provide sound relationships within the family. This will include but
not be limited to nutrition, hygiene, discipline and protection.
This will be measured by advocate record and observation; as well as pre and post
scores on the Nurturing Quiz which tests knowledge of parenting and the Weld County
Referral and Planning Form which provides information about strengths and challenges
in the areas of parenting and life skills.
C. Improve Ability to Access Resources
Advocate will provide information,training, and follow-through to families to
enable them to effectively learn to access appropriate community resources, including
those on the local, state, and federal level.
Outcomes will be measured by advocate record and observation as well as
improved scores on the Weld County Referral and Planning Form .
VI. Workload Standards
A. Number of hours per day, week, or month.
From 1-50 hours per month for each family unit. This number changes depending
upon start-up or closure date during the month, contracted hours with the family and any
periodic changes due to the progress and needs of the family.
B. Number of individuals providing services:
1 Full-time Coordinator, 1 half-time Family Advocate and up to 12 part-time
Family Advocates, working with from 40-45 families per year.
C. Maximum caseload per worker:
The half-time Family Advocate will work with up to 4 families. Each part-time
Family Advocate could work with from 1-4 families, depending upon skill level, amount
of contracted hours per family, and personal work preference.
D. Modality of treatment:
Home-based instruction and/or supervision, coaching, role-modeling, practicing,
and support.
E. Total number of hours per day/week/ month:
From 1-50 hours per month, depending upon needs of the family. On the average,
each family works directly with an advocate for 10-15 hours per month in the program.
F. Total number of individuals providing this service:
One Half-time family Advocate, up to 12 part-time Family Advocates, One nth-
time Program Coordinator and One Agency Director providing supervision.
G. The maximum caseload per supervisor:
25-30 families per month.
H. Insurance:
Child Advocacy Resource and Education, Inc. carries a commercial general
liability policy with Non-Profit Mutual Risk Retention Group, Inc.
VII. Staff Qualifications:
A. Yes, the staff that is providing direct services will have the minimum qualifications in
education and experience.
The half-time and part-time Family Advocates will meet the minimum
qualifications of a Case Services Aide II, which includes graduation from High School or
GED equivalent and six months full-time public contact experience. In addition, an
advocate will have had experiences with parenting and/or working with children and
families in environments such as a day care or preschool. Currently, one staff member
has a master's degree, two have high school degrees, and eight have bachelor's degrees in
related fields.
The Coordinator of the Family Advocate Program holds a Bachelor's Degree in
General Studies with an emphasis in Early Childhood Education. She has 2lyears of
experience in the human services field as both a teacher and supervisor.
The Executive Director has a Master's in Agency Counseling with an emphasis in
Marriage and Family Therapy. She has seven years experience as a Family Advocate,
four years experience as a Program Coordinator and has been executive director for 18
months.
B. Total number of staff available for the project:
14-18.
RFP-FYC-00005 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)
Total Hours of Direct Service per Client 55 Hours [A)
Total Clients to be served 40 Clients [B]
Total Hours of Direct Service for Year 2200 Hours (C)
(Line [A] Multiplied by Line [H]
per Hour of Direct Services 19.76
Cost
$ Per Hour [D]
Total Direct Service Costs $ 43,472.00 [E]
(Line (C] Multiplied by Line [D] )
Administration Costs Allocable to Program $ 38,200 [F1
Overhead Costs Allocable to Program $ 11,750.00 [G1
93,422.00
Total Cost, Direct and Allocated, of Program$
Line [E) Plus Line [F1 Plus Line [C1 )
-0-
Anticipated Profits Contributed by this Program $ [I]
Total Costs and Profits to be Covered
by this Program(Line [H] Plus Line (I] ) $ 93,422.00 (J]
2200
Total Hours of Direct Service rc _ear _._ _KI
Page 31 of 33
RFP-FYC-00005 Attached A
(Must Equal Line (C1 )
Rate per Hour of Direct, Face-to-Face Service
to be Charged to Weld County Department of
Social Services $ 42.46 ;L]
Day Treatment Programs Only:
Direct Service House Per Client Per.Month (M)
Monthly Direct Service Rate $ [MI
[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
t::he program.
[B] This is an estimate of the number of clients who will be served during the period
from June 1, 2000, through May 31, 2001.
(DI 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.
[PI 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] :his represents the total amount cf profit your firm expects to realize as a
result of operating this program. :Lilly difference between Lines (HI and [J] must
be substantiated by an amount indicated on this line.
[Li This is the actuai direct, face-to-face hourly service rate at which you will oe
requesting payment for the services provided under the condit'ons of this Recniest
Page 32 of 33
Executive Risk Specialty HomeOffice:
mea
- -A 82w Sreet
Insurance Company Si sbury, do c
Simsbury. Connecticut 06070-7683
NOT-FOR-PROFIT ORGANIZATION
DIRECTORS, OFFICERS AND TRUSTEES LIABILITY INSURANCE POLICY
INCLUDING EMPLOYMENT PRACTICES LIABILITY COVERAGE
DECLARATIONS POLICY NUMBER
751-174767-99
NOTICE: THIS IS A CLAIMS MADE POLICY WHICH APPLIES ONLY TO "CLAIMS" FIRST MADE DURING THE
"POI-ICY PERIOD," OR, IF PURCHASED, THE DISCOVERY PERIOD. THE COVERAGE AFFORDED UNDER THIS
POLICY DIFFERS IN SOME RESPECTS FROM THAT AFFORDED UNDER OTHER POLICIES. PLEASE READ THE
ENTIRE POLICY CAREFULLY.
ITEM 1. PARENT ORGANIZATION - NAME AND PRINCIPAL ADDRESS: ITEM 2. POLICY PERIOD: —�
Child Advocacy Resources & Education dba C.A.R.E. (a) Inception Date: June 1, 1999
P.O.EIox 945 (b) Expiration Date: June 1, 2000
Greeley, CO 80632 at 12:01 a.m. both dates at the Principal
State of Incorporation or Organization: CO Address in ITEM 1.
ITEM 3. LIMIT OF LIABILITY:
$ 1,000,000.00 maximum aggregate limit of liability for all Claims made or deemed made during any Policy Year.
ITEM 4. PREMIUM:
g'. 815.00 total prepaid premium.
ITEM 5. RETENTIONS:
(a) $0.00 each Insured Person each Claim, but only for Loss as to which indemnification by the Insured Entity is not
legally permissible or is not made solely by reason of the Insured Entity's financial insolvency.
(b) $0.00 each Claim, for Loss as to which indemnification by the Insured Entity is legally permissible
(c) $0.00 each Claim under Insuring Agreement C
ITEM 6. ADDITIONAL PREMIUM FOR EXTENDED REPORTING PERIOD:
40% of annual expiring premium, for one (1) year Extended Reporting Period
75% of annual expiring premium, for two (2) year Extended Reporting Period
ITEM 7. NOTICE UNDER CONDITIONS (G)(1) AND (G)(2) MUST BE ADDRESSED TO:
Vice President of Claims
Executive Risk Management Associates
P. O. Box 2002
Simsbury, CT 06070
ITEM 8. ENDORSEMENTS ATTACHED AT ISSUANCE:
B22671
D22983
D23832
D23833
These Declarations, the signed and completed Application and the Policy, with endorsements, will constitute
the entire agreement between the Underwriter, the Insured Entity and the Insured Persons.
XE ECUTIVE RI PEC�BLLINSURANCE COMPANY by (Authorized Representative):
°orm B22211 (9/96 ed.t Cata,og No NFPd-S
NORTH AMERICAN POLICY NUMBER POLICY PERIOD
SPECIALTY INSURANCE COMPANY From To
Manchester,Elm Street AFC 0000549-02 06/01/99 06/01/00
NH 03101-2524 -
(800)542-9200
(12:01 A .Standard arm.at your
mrowa address shown brow(
I
Renewal Of
AFC 0000549-01
Named insured and Mailing Address Agent
Agency Code: 30003-01
CHILD ADVOCACY RESOURCE & EDUCATION, INC. TALBOT/BOULDER INSURANCE ASSOCIATES, INC.
DBA: C.A.R.E. 1601 28TH STREET.
814 9TH STREET. BOULDER, CO. 80301
GREELEY, CO. 80632 Telephone: ( )
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THE EXPIRING
POLICY.. WE AGREE WITH YOU TO EXTEND INSURANCE AS STATED IN THIS CERTIFICATE.
THE RENEWAL CERTIFICATE CONSISTS OF THE FOLLOWING
COVERAGE PARTS AS INDICATED. PREMIUM MAY BE SUBJECT TO
ADJUSTMENT.
Premium
® Commercial Auto Coverage Part $210.
® Commercial Crime Coverage Part $ 100.
® Commercial General Liability Coverage Part $ 1,918.
O Commercial Inland Marine Coverage Part
® Commercial Property Coverage Part $ 370.
PREPAID TOTAL $ 2.598.
O In effect as of the original inception date of the policy (No change).
El As amended by revised schedule(s) attached:
❑ As amended by endorsements issued prior to the effective date of this extension.
El As amended by endorsement(s).
ADDED: IL0017 (11/98), IL0228 (4/98), IL0021 (4/98), NAS-ISC-001 (7/98),
CG0001 (7/98), CG2116 (7/98), CG2021 (7/98), CG2230 (7/98), CG2231 (7/98)
DELETED: IL0017 (11/85), IL0228 (10/89), IL0021 (11/94), NAS-ISC-001 (8/97),
CG0001 (1/96), CG2116 (11/85), CG2021 (1/96), CG2230 (10/93), CG2231 (11/85)
AMENDED:
fl
Countersigned at: This Day of By: c,_ i\-`fir-Cam: A Vz-vim ;
(Authorized Signature)
Issuing Office: Issued Date:
NAS-REN-001 (05/98)
SUPPLEMENTAL NARRATIVE TO RFP:
EXHIBIT B
RECOMMENDATION(S)
rc • a • r • e N LA)Jry
resource pp
Child advocacy and education, Inc.
814 9th Street — P.O. Box 945 — Greeley, Colorado 80632 — (970) 356-6751
Mr. Frank Aaron
Social Services Administrator
P.O. Box A
Greeley, CO 80632
Dear Mr. Aaron,
Child Advocacy Resource and Education, Inc. (c.a.r.e.) is pleased to accept the
results of the RFP Bid Process for PY 2000-2001..
RFP 00005, Parent Advocate Program, Lifeskills:
We accept the recommendation that the program be limited to 55 hours per
family, per approval of Gloria Romansik.
RFP 00005, Visitation, Lifeskills:
Approved as written. We request that requests for this program be addressed to
Annie Goodrick ( not Rose Francella) for more efficient implementation.
Thank you for your consideration and approval of these two programs for
inclusion on your vendor list. We look forward to meeting the needs of families
and children in Weld County during the 2000-2001 year.
Since ly,
Gwen Schooley
Executive Director
rn
(otin
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
CO
GREELEY,C 80832
Administration and Public Assistance(970)352-1551
Child Support(970)352-8933
COLORADO May 10, 2000
Ms. Rose Francella, Coordinator.
Child Advocacy Resource and Education
814 9 Street
Greeley, CO 80631
Re: RFP 99005 Lifeskills
Dear Ms. Francella:
The purpose of this letter is to outline the results of the RFP Bid process for PY2000-2001 and to
request written information or confirmation from you by Wednesday, May 24, 2000.
A. Results of the RFP Bid Process for PY 2000-2001
On April 20, 2000, the Families, Youth and Children (FYC) Commission approved the
RFP(s) listed above for inclusion on our vendor list. The FYC Commission attached the
following recommendations and/or conditions regarding your RFP bid(s).
1. RFP 00005. Parent Advocate Program, Lifeskills:
Recommendation:It is recommended the program be limited to 55 hours per
family, designating the number of hours in part one of the case plan. The end date
will reflect the 55 hours maximum and must be approved by Gloria Romansik.
2. RFP 00005, Visitation, Lifeskills:
Approved for FY2000-2001 with no conditions or recommendations.
B. Required Response by RFP Bidders Concerning FYC Commission
Recommendations
The Weld County Department of Social Services is requesting your written response to
the FYC Commission's recommendations. Please respond in writing to Frank Aaron,
• Social Services Administrator, P.O. Box A, Greeley, CO, 80632, by Wednesday, May 24,
2000, close of business as follows:
Page 2
C.A.R.E., Lifeskills (Parent Advocate Program and Lifeskills)
Results of RFP Bid Process PY 2000-2001
You are requested to review the the recommendation and to:
a. accept the recommendation(s) as written by the FYC Commission; or
b. request alternatives to the FYC Commission's recommendation(s); or
c. not accept the recommendation(s) of the FYC Commission.
Please provide in writing how you will incorporate reconmnendation(s) in your bid. If you
do not accept the recommendation(s), please provide reasons why. All approved
recommendations under the NOFAA will be monitored and evaluated by the FYC
Commission.
If you wish to arrange a meeting to discuss the above recommendation, please do so through
Elaine Furister, 352.1551, extension 6295, and one will be arranged prior to Wednesday, May
24, 2000.
Sincerely,
Ju A. G go, Dir for
W Co y Depart ent o Social Services
JG:ef
cc: Esteban Salazar, Chair, FYC Commission
Frank Aaron, Social Services Administrator
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 FY00-CORE-006
Revision (RFP-FTC-00005)
Contract Award Period Name and Address of Contractor
Child Advocacy
Beginning 06;/01/2000 and Resource& Education
Ending 05/31/2001 (C.A.R.E.) Visitation
Greeley, CO 80631
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial Assistance
Improve parental capacity to keep the children in Award is based upon your Request for Pi oposal (REP).
the home, to reunite the children in the home, to Tie RFP specifies the scope of services:md conditions
reunite the children who are placed in foster care, of award. Except where it is in conflict with his
and sustain the lowest level of care. A maximum NOFAA in which case the NOFAA governs, the REP
of 20 families per month, or an approximate total upon which this award is based is an integral part o1 The
of 90 clients per year. The average stay in the action.
program is 20 weeks, average hours per week is
one hour for exchanges, 3-4 hours for visits. Special conditions
Cost Per Unit of Service 1) Reimbursement for the Unit of Services will be based
on an hourly rate per child or per family.
Hourly Rate Per $ 32.23 2) The hourly rate will be paid for only direct face to titce
Unit of Service Based on Approved Plan contact with the child and/or family, as evidenced by
client-signed verification form, and as specified in the
unit of cost computation.
Enclosures: 3) Unit of service costs cannot exceed the hourly and
_ X Signed RFP:Exhibit A yearly cost per child and/or family.
Supplemental Narrative to RFP: Exhibit B 4) Payment will only be remitted on cases open with, and
Recommendation(s) referrals made by the Weld County Department of
Social Services.
Conditions of Approval
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.
A#b:aJ. rh4hair7
als: Program Official:
B y Judy . Grieg , Direct
Board of Weld County Commissioners Wel ounty Department of Social Services
Date: GYi-A& -"coo Date: (o/ acji 0
boa,--/539
SIGNED REP
EXHIBIT A
INVITATION TO BID
RFP-FYC 00005
DATE:February 28, 2000 BID NO: RFP-FYC-00005
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-00005) for:Family Preservation Program--Life Skills Program Family
Issues Cash Fund or Family Preservation Program Funds
Deadline: March 23, 2000, Tuesday, 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, 2000, through May 31, 2001, at specific rates for different types of service, the county will
authorize approved vendors and rates for services only. The Life Skills Program must provide services that
focus on teaching life skills which are designed to improve household management competency,parental
competency, family conflict management and effectively accessing community resources. This program
announcement consists of five parts, as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work
Delivery Date _
(After receipt of order) BID MUST BE SIGNED IN )�
Gwen Schooley, Executive Director
TYPED OR PRINTED SIGNATURE
Child Advocacy Resource
VENDOR and Frlucation, Inc. (c.a.r.e. ) date-C& 6 . em_42-6±2,.
2-6±2,.
(Name) Handwritten Signature By Authorized
Officer or Agent of Vender
ADDRESS 814 9th St. TITLE Board President
Greeley, CO 80631 3/22/00
DATE
PHONE # (970) 356-6751
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 33
RFP-FYC-00005 Attached A
LIFE SKILLS PROGRAM BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING
FAMILY PRESERVATION PROGRAM
2000/2001 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2000-2001
BID #RFP-FYC-00005
NAME OF AGENCY: Child Advocacy resource and Education, Inc. (c.a.r.e. )
_ADDRESS: 814 9th St. Greeley, CO 80631
PHONE: L270 ) 356-6751
CONTACT PERSON: Suzanne Goodrick 1111E: Program Coordinator
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Life Skills Program Category must
provide servjces that focus on teaching life skills designed to facilitate implementation of the case plan by improving
household management competency parental competency family conflict management and effectively accesging
community'resources
12-Month approximate Project Dates: _ 12-month contract with actual time lines of:
Start June 1. 2000 Start June 1, 2000
End May 31. 2001 End May 31, 2001
lUtE OF PROJECT: Family Visitation and Exchange Program
AMOUNT REQUESTED: $32.23 per hour
_ -- _ 3/22/00
Name and Signature of Person Pr aring Document Date
t.L..4 r-P r ( . _ 3/22/00 _
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
Proposal for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund
Year 1999-2:000 to Program Fund year 2000-2001.
Indicate No Change from FY 1999-2000
1 Project Description -I'" f""
Target/Eligibility Populations
Types of services Provided
Measurable Outcomes
Service Objectives
Workload Standards
Staff Qualifications
Unit of Service Rate Computation
Program Capacity per Month
,UG Certificate of Insurance
Page 26 of 33
RFP-FYC-00005 Attached A
Date of Meeting(s)with Social Services Division Supervisor: 13 /(� — CC
Comments by SSD Supervisor:
7
t,— x-213 ("7/_,,_<; 1 �� .
f t c
_ Signature of SSD Supervisor Date
Page 27 of 33
1. Project Description
Che c.a.r.e. Family Visitation and Exchange Program was developed with the primary
purpose of protecting children from(re) abuse and neglect. It is designed for families in
need of supervised visitation or safe exchanges for children in the case of high conflict
divorce or separation.
Each family that meets the Family Preservation criteria that is referred into the program
would be provided with a safe and nurturing environment for a visit or exchange with a
family member. Services are designed to promote healthy relationships and assist
children and families in maintaining and improving relationships within a structured.
supervised setting.
Visits and exchanges occur at care House, a family visitation and exchange center housed
at the c.a.r.e. facility in Evans. Families are required to adhere to specific guidelines for
use of the center which help to maintain this safe and neutral environment.
II. Target / Eligibility Populations
A. Total number of clients to be served: This depends on the amount of referrals into the
program; however, as stated below, the program has the capacity to serve approximately
20 families per month, or an approximate total of 90 clients per year.
B. Total individual clients and the children's ages: As stated above, there is a total
capacity of 90 clients; this includes parents, plus children aged birth through teens.
Families eligible for this program can vary in age from pregnant /parenting teens through
grandparents or other specific caregivers.
C. Total family units: approximately 25 total family units per year.
D. Sub-total of individuals who will receive bicultural/bilingual services: 4-5 families
per year. This can change due to referrals and availability of a bilingual family advocate.
E. Sub-total of individuals who will receive services in South Weld County: Not
applicable- at this time, families may utilize services only at careHouse in Evans.
F. The monthly maximum program capacity: 10-15 families
G. The monthly average capacity: 10 families
H. Average stay in the program: 20 weeks
I. Average hours per week in the program: 1 hour for exchanges, 3-4 hours for visits.
The figures above are approximate. Each family in the program has an individual
service plan depending on the needs of the family and recommendation of the
caseworker. Therefore, not every family utilizes the program for a uniform amount of
hours. The program has the capacity to expand as needed. The above figures are based
on the past year.
III. Type of Service To Be Provided
Families enrolled in the c.a.r.e. Family Visitation and Exchange Program would receive
a safe and supervised visit or exchange at the c.a.r.e. facility. Families would be required
to go through an application process that will orient families to the guidelines within the
program. Visits and exchanges would be supervised by a c.a.r.e. staff person or a
community volunteer directly supervised by a c.a.r.e. staff person in the facility. When
appropriate, families would be given parenting or community resource information.
A. Teaching, modeling, demonstrating and coaching as an interactive process with
the clients:
When appropriate, there will be limited parent education in the form of coaching.
sharing resources and making referrals to other agencies.
B. Training in household management, including budgeting,cleaning, maintenance,
purchasing, menu planning, food preparation, etc.:
Not applicable except on a limited basis during the clean-up of the visit rooms after a
visit or a meal.
C. Teaching Child-rearing and discipline, parenting:
Ongoing support and encouragement during the visit when applicable.
D. Teaching how to establish community linkages/advocacy/and making use of
services.
Provide information, training, and role modeling in accessing community resources
When applicable on a limited basis.
E. Demonstrating nurturing/esteem role modeling:
When appropriate, the visit supervisor will model a nurturing parent role with a focus
on parent / child self esteem. The goal is to increase positive family interactions.
The c.a.r.e. Family Supervised Visitation Program does not always provide a trained
parent educator during the visit. If parent education or life skills education is needed
during the visit, please refer to the c.a.r.e. Family Advocate Program.
Quantitative Measures: Services can be offered to each family enrolled in the program.
depending on need. Therefore, there is a potential for up to 25 families per year. These
figures are estimates, based on the previous year. The program can be expanded when
needed, depending on the number of referrals.
The c.a.r.e. Family Supervised Visit and Exchange Program is the only service providing
the only exchange services in the Weld County area. There are some supervised visitation
services provided through the Greeley Dream Team, in addition to the in-house services
provided at the Department of Social Services. c.a.r.e. does not provide mental health.
substance abuse or other professional services that are funded by another source.
IV. Measurable Outcomes
All families in the program will be evaluated using the following measures. In some
instances, availability and ability of the clients might affect the program's success in
obtaining outcomes. The average number of families available for measurement of
outcomes is 25.
A. Improvement of household management competency as measured by pre and
post test instruments.
Not applicable.
B. Improvement of Parental Competency as measured by pre and post assessment
instruments.
This will be measured by program documentation as well as pre and post scores
on the Weld County Referral and Planning Form which provides information about
strengths and challenges in the areas of parenting and life skills.
C. Parents can independently work with other sources in the community and within
the local,state and federal governments.
This will be measured by program documentation when applicable.
D. Families receiving Life Skills services will remain intact six months after
discharge of the services.
Parents will sign a consent to allow c.a.r.e. to do a follow-up contact with
WCDSS six months after completion of the program.
E. Families/ Participants who complete the Life Skills Services will have improved
competency level or reduced risk on the standardized assessment, such the risk
assessment tooL
Utilizing the Weld County Referral and Planning Form, pre and post test, there
will be documentation of improved competency and/ or reduced risk. This will also ne
measured ongoing by program documentation.
V. Service Objectives
A. Improve Household Management Competency:
Not applicable.
B. Improve Parental Competency:
The program will provide healthy role modeling and coaching when appropriate
that will increase positive family interactions.
C. Improve Ability to Access Resources
This program can provide limited information to families on community resources
Outcomes will be measured by program documentation as well as improved
scores on the Weld County Referral and Planning Form .
VI. Workload Standards
A. Number of hours per day, week, or month.
From 1-50 hours per month for each family unit. This number changes depending
upon start-up or closure date during the month, contracted hours with the family and any
periodic changes due to the progress and needs of the family.
B. Number of individuals providing services:
1 Full-time Coordinator, 1 part-time manager, and trained community volunteers,
including university interns, working with up to 25 families per year.
C. Maximum caseload per worker:
This would depend on the amount of time each person wanted to work in the
program
D. Modality of treatment:
Center-based supervision of family visits and exchanges.
E. Total number of hours per day/ week/ month:
From 1-50 hours per month, depending upon needs of the family
F. Total number of individuals providing this service:
1 Full-time Coordinator. 1 part-time manager, and trained community volunteers,
including university interns, working with up to 25 families per year, one agency director
providing supervision to the program.
G. The maximum caseload per supervisor:
10-15 families per month.
H. Insurance:
Child Advocacy Resource and Education, Inc. carries a commercial general
liability policy with Non-Profit Mutual Risk Retention Group, Inc.
VII. Staff Qualifications:
A. Yes, the staff that is providing direct services will have the minimum qualifications in
education and experience.
The Program Coordinator and half-time manager will meet the minimum
qualifications of a Case Services Aide II, which includes graduation from High School or
GED equivalent and six months full-time public contact experience. In addition. they
will have had experiences with parenting and / or working with children and families in
environments such as a day care or preschool. The community volunteers will have
appropriate experience with children and families.
The Coordinator of the Family Visitation and Exchange Center holds an
Associate Degree in General Studies. She has 10 years of experience in the human
services field as a family advocate and educator.
The Executive Director has a Master's in Agency Counseling with an emphasis in
Marriage and Family Therapy. She has seven years experience as a Family Advocate.
four years experience as a Program Coordinator and has been executive director for 18
months.
B. Total number of staff available for the project:
6-10.
1tFP-FYC-00005 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)
Total Hours of Direct Service per Client 104 Hours (A]
Total Clients to be Served 25 Clients [B1
Total Hours of Direct Service for Year 2600 Hours [C]
(Line [A] Multiplied by Line [B]
Cost per Hour of Direct Services $ 18.00 Per Hour [D]
Total Direct Service Costs $ 46,800.00 [E1
(Line [C] Multiplied by Line [D] )
Administration Costs Allocable to Program $ 24500.00 D,1
Overhead Costs Allocable to Program $ 12,500.00 [ ]
Total Cost, Direct and Allocated, of Program$ 83,800.00 [l11
Line (E) Plus Line [F) Plus Line [C1 )
Anticipated Profits Contributed by this Program $ [ []
Total Costs and Profits to be Covered
by this Program(Line [H] Plus Line (II ) $ 83'd00.00 [,7]
Total Hours of Direct Service for Year 2600 -,C1
Page 31 of 33
RFP-FYC-00005 Attached A
(Must Equal Line [C] )
Rate per Hour of Direct, Face-to-Face Service
to be Charged to Weld County Department of
Social Services $ 32.23 (L)
Day Treatment Programs Only:
Direct Service House Per Client Per.Month [M)
Monthly Direct Service Rate $ [N]
[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, 2000, through May 31, 2001.
[DI 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 he
requesting payment for the services provided under the conditions of this Request
Page 32 of 33
---A
Executive Risk Specialty Home Office:
82 do Street.
insurance Company Simsbury. Connecticut 06070-7683
NOT-FOR-PROFIT ORGANIZATION
DIRECTORS, OFFICERS AND TRUSTEES LIABILITY INSURANCE POLICY
INCLUDING EMPLOYMENT PRACTICES LIABILITY COVERAGE
DECLARATIONS POLICY NUMBER
751-174767-99
NOTICE: THIS IS A CLAIMS MADE POLICY WHICH APPLIES ONLY TO "CLAIMS" FIRST MADE DURING THE
"POLICY PERIOD," OR, IF PURCHASED, THE DISCOVERY PERIOD. THE COVERAGE AFFORDED UNDER THIS
POLICY DIFFERS IN SOME RESPECTS FROM THAT AFFORDED UNDER OTHER POLICIES. PLEASE READ THE
ENTIRE POLICY CAREFULLY.
ITEM 1. PARENT ORGANIZATION — NAME AND PRINCIPAL ADDRESS: ITEM 2. POLICY PERIOD:
Child Advocacy Resources & Education dba C.A.R.E. (a) Inception Date: June 1, 1999
P.O.Box 945 (b) Expiration Date: June 1, 2000
Greeley, CO 80632 at 12:01 a.m. both dates at the Principal
State of Incorporation or Organization: CO Address in ITEM 1.
ITEM 3. LIMIT OF LIABILITY:
$ 1,000,000.00 maximum aggregate limit of liability for all Claims made or deemed made during any Policy Year.
ITEM 4. PREMIUM:
$ 815.00 total prepaid premium.
ITEM 5. RETENTIONS:
(a) $0.00 each Insured Person each Claim, but only for Loss as to which indemnification by the Insured Entity is not
legally permissible or is not made solely by reason of the Insured Entity's financial insolvency.
(b) $0.00 each Claim, for Loss as to which indemnification by the Insured Entity is legally permissible
(c) $0.00 each Claim under Insuring Agreement C
ITEM 6. ADDITIONAL PREMIUM FOR EXTENDED REPORTING PERIOD:
40%of annual expiring premium, for one (1) year Extended Reporting Period
_ 75% of annual expiring premium. for two (2) year Extended Reporting Period
ITEM 7. NOTICE UNDER CONDITIONS (G)(1) AND (G)(2) MUST BE ADDRESSED TO:
Vice President of Claims
Executive Risk Management Associates
P. O. Box 2002
Simsbury, CT 06070
ITEM 8. ENDORSEMENTS ATTACHED AT ISSUANCE:
B22671
D22983
D23832
D23833
These Declarations,the signed and completed Application and the Policy, with endorsements, will constitute
the entire agreement between the Underwriter, the Insured Entity and the Insured Persons.
EXECUTIVpLy
NSUURRANCE COMPANY by (Authorized Representative):
°orm 822211 (9/96 Cu.) Catalog Na NFPC-3
NORTH AMERICAN POLICY NUMBER POLICY PERIOD
SPECIALTY INSURANCE COMPANY From --a
650 Elm Street AFC 0000549-02 06/01/99 06/01/00
Manchester. NH 03101-2524 -
(800)542-9200 112:01 A .Standard Time.'your
mwllny.Wrw..,wwn b o---]
Renewal Of
AFC 0000549-01
Named Insured and Mailing Address> Agent
Agency Code: 30003-01
CHILD ADVOCACY RESOURCE & EDUCATION, INC. TALBOT/BOULDER INSURANCE ASSOCIATES, INC.
DBA: C.A.R.E. 1601 28TH STREET.
814 9TH STREET. BOULDER, CO. 80301
GREELEY, CO. 80632 Telephone: ( )
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THE EXPIRING
POLICY, WE AGREE WITH YOU TO EXTEND INSURANCE AS STATED IN THIS CERTIFICATE.
THE RENEWAL CERTIFICATE CONSISTS OF THE FOLLOWING
COVERAGE PARTS AS INDICATED. PREMIUM MAY BE SUBJECT TO
ADJUSTMENT.
Premium
® Commercial Auto Coverage Part $210.
® Commercial Crime Coverage Part $ 100.
® Commercial General Liability Coverage Part $ 1,918.
O Commercial Inland Marine Coverage Part
® Commercial Property Coverage Part $ 370.
PREPAID TOTAL S 2.598.
® In effect as of the original inception date of the policy (No change).
❑ As amended by revised schedule(s) attached:
O As amended by endorsements issued prior to the effective date of this extension.
❑ As amended by endorsement(s).
ADDED: IL0017 (11/98), IL0228 (4/98), IL0021 (4/98), NAS-ISC-001 (7/98),
CG0001 (7/98), CG2116 (7/98), CG2021 (7/98), CG2230 (7/98), CG2231 (7/98)
DELETED: IL0017 (11/85), IL0228 (10/89), IL0021 (11/94), NAS-ISC-001 (8/97),
CG0001 (1/96), CG2116 (11/85), CG2021 (1/96), CG2230 (10/93), CG2231 (11/85)
AMENDED:
,.
Countersigned at: This Day of By: —'T C'7-t=- .-.'C
(Authorized Signature)
Issuing Office: Issued Date:
NAS-REN-001 (05/98)
Hello