HomeMy WebLinkAbout861021.tiff , 1 mEmoRAn®um
WILD€. Boaaim
Jacrd Johnson, Chairman
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To _._board of County Commissioners on_ers o;,,e __ October 21 _1986
COLORADO From _ Walter J. Speckman, Executive Director, Human Resources
su,,,ec, .Request for Waiver of ApprovaJ Requirements for Weld Co. HRD to
Centennial Developmental Services Inc.
Enclosed for Board approval is a Colorado Department of Institutions Division
for Development Disabilities Request for Waiver of Approval Requirements for
Weld County Division of Human Resources services to Centennial Developmental
Services Inc. (formally known as Weld County Community Center Foundation) .
The Weld County Division of Human Resources has been providing transportation
services for Centennial Developmental Services Inc. for the past ten years.
In August 1986, WC-DHR assumed full responsibilities for Centennial 's
transportation needs. This placed WC-DHR under the authority of the
Department of Institutions.
At this time, the Department of Institutions is asking for certification
of adequate transportation services. Signing this waiver will officially
declare the assurance of quality of WC-DHR transportation services.
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REQUEST FOR WAIVER
OF APPROVAL REQUIREMENTS
FOR SERVICE AGENCIES
(27-10.5-104. CRS)
COLORADO DEPARTMENT OF INSTITUTIONS
DIVISION FOR DEVELOPMENTAL DISABILITIES
Richard D. Lamm,
Governor
Frank A. Traylor, M.D.
Executive Director
Jeffrey A. Sandler
Division Director
Weld Eourty Division of Human Resources
Name of Applicant
Centennial Developmental Services Inc.
Community Centered Board of
Catchment Area
October 22, 1986 - (vg
Date
IDENTIFYING INFORMATION
NAME OF AGENCY APPLYING FOR WAIVER:
Weld County Division of Human Resources
ADDRESS TO BE USED FOR ALL CORRESPONDENCE:
1516 Hospital Road, P.O. Box 1805 Greeley, Colorado 80632
ADDRESS OF PHYSICAL LOCATION OF AGENCY IF DIFFERENT FROM ABOVE:
933 North 11th Ave. , Greeley, Co. 80631
AGENCY PHONE NUMBER(S): Administration - 353-0540 Transp. Office 356-4000
BUSINESS DAYS AND HOURS OF AGENCY ADMINISTRATIVE OFFICE:
Monday through Friday 8:00 a.m. - 5:00 p.m.
NAME AND TITLE OF SERVICE AGENCY DIRECTOR:
Walter J. Speckman
NAME, HOME ADDRESS AND PHONE NUMBER OF BOARD PRESIDENT:
Jackie Johnson, Chairman, Weld County Board of Commissioners
LIST COUNTIES SERVED BY AGENCY APPLYING FOR WAIVER: Weld County
List all Division for Developmental. Disabilities funded services
provided by the service agency (check only those services currently
provided) .
Infant Stimulation Services
Preschool Services
Family Resources Services
Adult Vocational Services (Includes Work Activities)
Community Integrated Employment Services
X State Transportation Services
__ Follow Along Services
Host Home Services
Adult Residential Services
HCB Personal Care Alternatives
HCB Respite Care Services
NCB Residential Group Home Services
FCB Day Program Services
R FCB Transportation
HCB Host Home Services
Cther (Please Describe)
c:iidentify.ms
ASSURANCES (PLEASE SIGN)
Applicant assures compliance with all applicable laws, rules,
regulations, policies and standards set forth by the State of Colorado
and the Federal Government.
Applicant assures cooperation with Quality Assurance onsite surveys and
related activities.
Applicant assures the information provided in this waiver request is
accurate and any changes in this request will be sent to the Division
for Developmental Disabilities.
woo_ �_ October 22, 1986
SLOatur pf Boar resident Date
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k, ; October 22, 1986
Signatyre-`of 5e`�r77vice Agency Director Date‘fritiATTEST: ( 74i,UO4A-Ccrid
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Attachment
Submissions - Part II
o The Weld County Division of Human Resources Transportation Department
operates under the auspices of the Weld County Board of Commissioners
and meets the approval of all its federal and state funding sources,
the primary one being the Community Services Block Grant through the
Colorado Department of Local Affairs.
o The Weld County Board of Commissioners are full-time employed
commissioners whose offices are located at the Weld County
Centennial Center, 915 10th Street, Greeley Colorado. The Board is
comprised of the following Commissioners:
Jacqueline Johnson, Chairman
Gordon E. Lacy
C.W. Kirby
Gene R. Brantner
Frank Yamaguchi
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