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Home My WebLink About991275.tiff RESOLUTION RE: APPROVE TWO NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR CORE SERVICES FUNDS 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 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 Island Grove Regional Treatment Center, Inc., commencing June 1, 1999, and ending May 31, 2000, 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 Island Grove Regional Treatment Center, Inc., be, and hereby is, 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 2nd day of June, A.D., 1999, nunc pro tunc June 1, 1999. BOARD OF COUNTY COMMISSIONERS _ LD COUNTY, COL RADO /94/ATTEST: a Dale K. Hall, Chair Weld County Clerk to t1: x:45)Q* EXCUSED DATE OF SIGNING (AYE) .� � 1 Barbara J. Kirkmeyer, Pro-Tem BY: 1? Deputy Clerk to the EXCUSED D TE OF SIGNING (AYE) George E. x er ROV D A O FORM: /1111 M. J. eile / (y ty A for Y ,{ 211.( 1174_,/\ Glenn Vaad —=-- 991275 CC . SS SS0026 • 4 DEPARTMENT OF SOCIAL SERVICES PO BOX A GREELEY, CO 80632 Administration and Public Assistance (970)352-1551 Child Support(970)352-6933 O Protective and Youth Services(970) 352-1923 COLORADO MEMORANDUM TO: Dale K. Hall, Chair Date: May 24, 1999 Board of County Commissioners FR: Judy A. Griego, Director, and Social Services 0_11) RE: Core Services Notification of Financial Assista ce Awards between the Weld County Department of Social Services and Island Grove Regional Treatment Center, Inc. Enclosed for Board approval is Core Services Notification of Financial Assistance Awards (NOFFAs)between the Weld County Department of Social Services and Island Grove Regional Treatment Center. The purposes of the NOFAAs are to conclude our Request for Proposal Process for vendors under the Core Services Funds. The Families, Youth, and Children (FYC) Commission has recommended approval of the NOFAAs. 1. The terms of the NOFAAs are from June 1, 1999 through May 31, 2000. 2. The source of funds is Core Services, Family Issues Cash Fund. Social Services agrees to pay Island Grove Regional Treatment Center unit costs as outlined in this Memorandum. 3. Island Grove Regional Treatment Center will provide two programs to families and children in need of child protection services as follows: A. Sex Abuse Treatment: 1) Description: The program will provide treatment for a maximum of forty families per year. The therapy will be at an average of four hours per week for 36 to 52 weeks. 2) Cost Per Unit of Service: according to rate chart. B. Intensive Family Therapy: 1) Description: The program will serve a maximum of 105 families at an average stay in intensive therapy of 25 weeks, one to two hours per week. 2) Cost Per Unit of Service: $97.25. If you have any questions, please telephone me at extension 6510. 991275 1S 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 FY99-PAC-3002 Revision (RFP-FYC-99007) Contract Award Period Name and Address of Contractor Island Grove Regional Treatment Center,Inc. Beginning 06/01/1999 and Individualized Family Systems Sexual Abuse Treatment Ending 05/31/2000 1140 M Street Greeley, CO 80631 Computation of Awards Description Unit of Service This program is to develop a sexual abuse The issuance of the Notification of Financial Assistance treatment program that will address and treat the Award is based upon your Request for Proposal (RFP). individual needs of the entire family. Initial The RFP specifies the scope of services and conditions assessment to determine specific treatment needs of award. Except where it is in conflict with this of the family. Subcontract with professionals in NOFAA in which case the NOFAA governs, the RFP the field who have already established their upon which this award is based is an integral part of the specialty in dealing with victims, non-offending action. parents, and siblings, or adolescent and adult perpetrators. 40 families per year, six monthly Special conditions average capacity, average of four hours per week for 36-52 weeks. 1) Reimbursement for the Unit of Services will be based on a monthly rate per child or per family. Cost Per Unit of Service 2) The hourly rate will be paid for only direct face to face contact with the child and/or family, as evidenced by Hourly Rate Per Unit of Service client-signed verification form, and as specified in the Based on Approved Plan See rate chart unit of cost computation. 3) Unit of service costs cannot exceed the hourly and Enc sur : yearly cost per child and/or family. Signed RFP:Exhibit A 4) Payment will only be remitted on cases open with, and ✓Supp�lemental Narrative to RFP: Exhibit B referrals made by the Weld County Department of t"Recommendation(s) Social Services. c5) Requests for payment must be an original submitted to onditions of Approval the Weld County Department of Social Services by the end of the 25'" 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 royals: Program Official: B By . Dale K. Hall, Chair Judy riego, D ector Board of Weld County Commissioners Weld my 9epartment ofhrvices Date: 6Z.fr/0/O � 9 Date: 5 21/O 99/37S�l �� SEXUAL ABUSE TREATMENT PROGRAM FAMILY PRESERVATION PROGRAM DEPARTMENT OF SOCIAL SERVICES WELD COUNTY 1999/2000 BID PROPOSAL RFP-FYC # 99007 Island Grove Regional Treatment Center, Inc. 1140 M Street Greeley, CO 80631 INVITATION TO BID RFP-FYC 99007 DATE: February 26, 1999 BID NO: RFP-FYC-99007 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-99007) for: Family Preservation Program--Sexual Abuse Treatment Program Family Issues Cash Fund or Family Preservation Program Funds Deadline: March 23, 1999, Tuesday, 10:00 a.m. The Families, Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Statewide Family Preservation Program (C.R.S. 26-5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement (C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1, 1999, through May 31, 2000, at specific rates for different types of service, the County will authorize approved vendors and rates for services only. The Sexual Abuse Treatment Program must provide for therapeutic intervention through one or more modalities to prevent further sexual abuse perpetration or victimization. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date (After receipt of order) BID MUST BE SIGNED IN INK BJ Dean TYPED OR PRINTED SIGNATURE Island Grove Regional VENDOR Treall?Tant Center, Inc. &Ok—" (Name) Han ritten Signature By Authorized Officer or Agent of Vender ADDRESS 1140 M Street TITLE Executive Director Greeley, CO 80631 DATE March 23, 1999 PHONE # (970) 356-6664 The above bid is subject to Terms and Conditions as attached hereto and incorporated. R.FP-FYC-99007 Attached A SEXUAL ABUSE TREATMENT PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING FAMILY PRESERVATION PROGRAM 1999/2000 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1999-2000 BID #RFP-FYC-99007 NAME OF AGENCY: ISLAND GROVE REGIONAL TREATMENT CENTER, INC. ADDRESS: 1140 M Street, Greeley, CO 80631 PHONE: f 970 ) 356-6664 Program Manager of CONTACT PERSON: Robert Keenan TITLE: Family Services DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Sexual Abuse Treatment Program must provide for therapeutic intervention through one or more modalities to event further sexual abuse perpetration or victimization. 12-Month approximate Project Dates: X 12-month contract with actual time lines of Start June 1. 1999 Start June 1, 1999 End May 31,2000 End May 31, 2000 TITLE OF PROJECT: Sexual Abuse Family Therapeutic Interventions (SAFTI) Program ^MOUNT REQUESTED: Roher• D Keenan 3/23/99 ame d Sign ture of Person Preparing Document Date 8c BJ Dean 3/23/99 Nan 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 1998-1999 to Program Fund year 1999-2000. Indicate No Chafe from FY 1998-1999 V'—Project Description slight change r-- -Target/Eligibility Populations no change hypes of services Provided no change V^-- (k --Measurable Outcomes no change P-- -Tr-----Service Objectives 1,&_-Workload Standards no change __,Staff Qualifications no change ?ft-- of Service Rate Computation slight change's--- , regram Capacity per Month no change _-- .Certrficafe of Insurance RFP-FYC-99007 Attached A ----------------------------------------------------------- Date of Meeting(s)with Social Services Division Supervisor: u c Comments by SSD Supervisor: r/C`Ywn-+a-n2 C a:1—n? l" ! < Z q� a-n-4 ,Psc „run, _,. „er-".. ,ate, 7" of_ Name and Signature of SSD Supervisor Date RFP - FYC 99007 Program Category: Sexual Abuse Treatment Program Project Title: Sexual Abuse Family Therapeutic Interventions Vendor: Island Grove Regional Treatment Center, Inc. PROJECT DESCRIPTION Island Grove Regional Treatment Center, Inc. has redesigned and refined a comprehensive, client focused sexual abuse treatment program to address the needs of all family members. Since the family compositions and the sexual abuse situations are so diverse, this program seeks to individualize the components based on the presenting and developing issues of each case. Therefore, key personnel of the new SAFTI Team are grounded in strength- focused systemic family therapy. Current literature reflects how competency-based family therapy is more effective and less time consuming than traditional methods. We have seen the need for this upgrade in the SAFTI Program based on our experience in working with the Weld County Department of Social Services. Based on the initial family assessment and collateral information gathered, the subsequent steps will be determined to acquire additional specialized assessments as needed to engage the family members in the beginning of, as well as throughout, the treatment process. We have hired and subcontracted professionals who specialize in: • The assessment of adult offenders • The assessment and treatment of adolescent offenders • The assessment and treatment of victims • The assessment and treatment of involved families This program will include initial family assessments, offense specific perpetrator assessments, an evaluation of the parents' or non-offending parents' ability to insure the safety of the victim child, and the effects of the sexual abuse on the victim and the rest of the family ecology. This is most critical when the offending adolescent continues to reside in the home with the victim. Following the initial assessments and a consultation with the caseworker, the treatment team will map a treatment strategy for each family. In most cases, family members will begin family therapy immediately. When the offender is the father, his presence in family sessions will be delayed until the time is appropriate for his participation. Some family members will be enrolled with assigned therapists as needed. For example, adolescent offenders will be enrolled in an offender's group while the majority of the non-offending family member work will be performed by family therapy specialists. Some victims as well as other family members may be assigned to specialists as needed. Family therapy will be intensive at the beginning of treatment including two to three in-home sessions per week. Once secrecy and silences are broken and safety is insured by a unanimous agreement of the team and family, family therapy is reduced to once per week. Length of initial treatment will vary on a case by case basis, however, we estimate treatment of the family will take about six to eight months. Monthly "tune-up sessions" are recommended following this initial treatment period. 1 • When the offender of the family is an adolescent, they will participate in the adolescent offender group twice per week. The facilitator, Anne Gleditsch, will author and mail monthly progress reports to case workers, parents, and probation officers alike to keep them informed of any developments in the case. This offense specific group was upgraded following an intensive training presented by Gail Ryan of the Kempe Center, which Anne attended earlier this year. II. TARGET POPULATIONS Island Grove Center will provide services to all appropriate families that may present for the Sexual Abuse Family Therapeutic Interventions (SAFTI) Program, estimating 82 total clients to be served. If we approximate serving 22 total families, we predict, given our trends from previous years, that this will encompass the following sub categories: a. Victims under the age of 18 25 b. Perpetrators under the age of 18 14 c. Non-abusing spouse/ parent 25 d. Other family members in household 10 e. Adult offenders for evaluation only 8 Because of the specialty and recommended intensity of the sexual abuse program, we are not prepared to offer extensive bilingual programming. Consequently, the subtotal of individuals receiving bilingual services will be limited to the assessment phase only with the assistance of a Spanish-speaking interpreter. This may involve only three individuals over the fiscal year. Service to south Weld County will be limited to individuals, estimated at five, who can arrange to access the core of services in Greeley or reasonably be transported by our case manager. All individuals enrolled can have access to 24-hour services through our Acute Care Services unit. If appropriate and necessary, an outpatient counselor can be reached or will return calls within a 24-hour period. Our maximum ongoing program capacity is 12 families, with an average at eight. We know that engaging and maintaining these families in treatment is difficult without effective engagement or consequences. While we would like to recommend at least one year of involvement, we estimate that families will be involved on an average of four hours per week for eight months (if involved with all tracks of the program). III. TYPES OF SERVICES TO BE PROVIDED The SAFTI program will lean heavily on the front-end assessments to determine the initial course of treatment for all involved family members. The first contact will be made by one of the Island Grove Center's family therapists in the SAFTI Program. This first assessment session will determine eligibility, workableness of the referral, determine further specialized assessments, have disclosures signed, and orient the family to the program offerings. This will also be the period where collateral information from the caseworker is gathered that must include the police report of the referring incidents. The most comprehensive assessments involve the perpetrator, whether adult or adolescent. Extensive history-taking and psychometric testing comprise several sessions to gather the necessary information regarding the sex offender. We have found it useful to include 2 polygraph testing periodically for offenders over age fifteen. In some cases, this is done at the beginning, and every three months following. Due to the special nature of this type of testing, we use Amenk and Jenks, Certified Polygraphers in Denver, to administer and interpret the examination results. This has the potential of being somewhat investigative in its content. Any new information will be included and forwarded in the assessment report to the caseworker. It is the most costly component of the program. Without this level of thoroughness, for perhaps the pivotal member of the family, however, effective treatment is not likely. See the Assessment Matrix (Exhibit A) for available assessment instruments useful in working with the offender. When an adult perpetrator has been evaluated and found appropriate for treatment, he/she will be referred to another provider for treatment. The SAFTI Program will no longer provide offense-specific treatment for adult offenders. Involved family members, as a unit, will be evaluated either by the assigned therapist or specialist, depending on the type of evaluation necessary. We have found it useful to have available resources to assess for substance misuse involvement, domestic violence, vocational planning, and neuropsychological issues. Individual families will be seen as a unit. The victim(s), subsystems, or non-offending parent may be seen individually (if coalitions of secrecy are detected between family members) for brief periods. We will use the "Trauma Symptom Inventory" to assess severity of effects on victims, siblings of victims and non-offending parent. As needed, we will assign specific clinicians for certain program functions. One important task of family sessions in early stages, especially when the perpetrator is a youth, will be to educate the families about the effects the perpetration may have had on family members such as the cultivation of secrecy and the hyper-responsibility that many families and victims are recruited into. Once family sessions have progressed so that it is appropriate and safe to do so, the perpetrator will join the sessions. The offending family member will be integrated in the process only if they have progressed sufficiently in their own therapy, so that the victim is not traumatized further. Anne Gleditsch, facilitator of the adolescent offender treatment group, along with the family team, will decide when this would be safe. We will work closely with other providers in deciding a safe transition when the offender is an adult. Throughout the family's involvement, we will have a case manager available to assist the family members in accessing any SAFTI component by providing transportation. To insure a coordinated therapeutic effort, the clinical team will arrange monthly to bimonthly clinical supervision/staffing and additional conferences with the caseworker, the guardian ad litem, attorneys, probation officers, and DSS unit supervisors involved with the family. Through these opportunities, we will stay current on resources and providers, and insure there is no duplication of community services. The assessment matrix and outcome instruments chart, involving the described program components, are included as Exhibits A and B. IV. MEASURABLE OUTCOMES A. Reduced rate of recidivism of sexual abuse perpetration: With a family actively engaged in recommended components for a period of at least seven months. our objective is to track the percent of re-offending at no more than 15%. This will include targeting any victim, in the community or within the home. The scope of victimization also includes any incident report or arrests that are incidents of non-physical sexual misconduct such as 3 indecent exposure or voyeurism. We will use all available information including therapists' reports, DSS reports, polygraphs, and police records, as well as therapeutic disclosures. We will review recidivism on a quarterly basis. B. Decrease in re-victimization: Similar to above, yet focusing on the solution building efforts performed by the victim and other non-offending family members, our objective is to track any further incidents with the identified victim throughout the family's involvement in the program, however lengthy. We propose to limit re-offending to a maximum of 10%. We will review recidivism on a quarterly basis. C. Reduce victim problem behaviors: By providing a range of services to the targeted victim (or potential victims in the home), our objective is to assist in reducing the number of trauma symptoms and decreasing conduct problems. We can only project that aiding in the resolution of the trauma, the victim's responses will not include perpetration in the future. Current research indicates that less than one-third of perpetrators were themselves victims of childhood sexual abuse. Particularly in female victims, they are more likely to harm themselves, rather than to victimize others. Our data will include the observation of indicators, such as self-harming incidents, general misconduct, or sexual acting-out with no targeted victims. D. A percentage of child abuse victims receiving services do not go into placement: Considering all factors, to include the perpetrator's behavior, the non-offending parent's(s') ability to insure safety, and the victim's responses that may effect out-of-home- placement, our objective is to retain 75% of these children safely in the home. E.. Improvement in parental competency as measured by pre and post placement functional test: Our team will use the Browning Outcome Survey Scale (BOSS) upon enrollment and at discharge, which gives overall measures of family functioning. F. More rapid reunification of children with families: Each family will be the subject of our internal clinical staffing, as well as the multi-disciplinary team meetings held to address the progress and difficulties within the course of treatment. If safety-feasible, our objective is to attempt reunification between seven and twelve months if the perpetrator is placed outside the home. G. Gain additional understandings regarding cultural attitudes on childhood sexual abuse in the community: We will gather and compare attitudes about childhood sexual abuse from client interviews. We will then prepare an annual report to the Department of Social Services regarding the information gathered to help us better understand any cultural differences in attitude towards sexual abuse. See attached Assessment and Outcome Matrixes, Exhibits A and B, that list a full range of instruments and measurable components. We need the option of adding or deleting instruments in attempts to provide more useful information regarding the measurable constructs we are tracking. V. SERVICE OBJECTIVES A. Improve Parental Competency: In addition to the instruments mentioned under "Measurable Objectives," our aim is to also increase the participants' ability to be clear in communication, improve a sense of personal agency, build and maintain appropriate connections with other family members and, most importantly, assure safety in the home. Our belief is that healthier relationships make healthier parents. Many of these objectives will intersect and parallel the objectives under"Improve Personal and Relational 4 Competencies." The offender's sexual behavior and related thinking will be the focus of much of his treatment. This can be documented within the therapy session and underscored through the use of periodic polygraph examinations. B. Improve Family Conflict Management: The Browning Outcomes Survey Scale (BOSS) will allow us to measure degrees of family functioning at three intervals; admission, discharge, and six month follow-up. Many of the individual improvements will generalize into better family interaction and problem resolution strategies. When all participants have been evaluated by their respective therapists as to the appropriateness of the offender in joining the family therapy, those sessions will begin. The sessions will continue to reinforce the changes made throughout the family's therapy, such as maintaining the "safety plan," and identifying potential "relapse warning signs." C. Improve Personal and Relational Competencies: Increasing personal efficacy, implementing respectful and sensitive communication, and restoring healthy boundaries will be goals for all participants. For the children, we can also monitor school functioning, a reduction of any trauma symptoms present upon admission, and any acting out or misconduct in response to the abuse. D. Improve Ability to Access Resources: Much of Island Grove's services have included case management and community resource-building specific to substance misuse as an integral part of treatment service delivery. This will be particularly underscored with this high-risk group of families and will include a broad base of needed community links. FOLLOW-UP EVALUATION At six months post-discharge, staff will contact these families in person or by phone to administer the final phase of the BOSS. We will collect data on other life situation demographics, such as placement of children, parental employment, housing, or arrests. We will also provide the agency's Client Satisfaction survey for comments on treatment experiences at Island Grove Regional Treatment Center. VI. WORKLOAD STANDARDS All of the services are on an outpatient basis. The adolescent perpetrator treatment will be provided in group or individual settings at our clinic or at the contractor's site. Family therapy will be provided at the Island Grove Clinic or at the client's home. The maximum caseload per staff will depend on the combinations of family members that are referred, but we are estimating that each therapist will take on 5-7 clients or families. Our clinical Supervisor, Dr. William Walsh, will meet at least once each month with the SAFTI team to strategize optimum interventions. He will be directly supervising the team. Dr. Jack Gardner will continue to provide Offense-Specific Psychological evaluations when requested for by caseworkers and consultants as needed. The Program Manager, Robert Keenan, will oversee the operations of the program, coordinate the participation of the community professionals in the case staffing of the families, monitor budget and billing information, and submit required reports as outlined in the RFP agreement. All contractors have submitted their required insurance to Island Grove Center. The requested verification for Island Grove Regional Treatment Center's coverage is attached at the end of this document. 5 VII. STAFF QUALIFICATIONS All counseling and administrative staff operating independently have at a minimum, a master's degree and numerous years of therapeutic experience. Our subcontractors have all been specifically trained in the treatment of sex offenders or victims of sexual assault. C\KATHRYN\FAMSERVISAFTI Bid Proposal 99-09.doc 6 Wc X x t 7 a CC G V 0 O 01 c X X X X X X et 73 I a y ' r -j E E I 5 • 0 v x x x x x x X LLI )- 03 c v I Q c - c a .J d x x x x 4) 0 x xx x Q 9 1- m r zg a a W ( � V 0 0 it c X X X X X X X X X Q x x x x x W o a x W 0 w m w O co m e a' , 0) > w W ` U, m .4 0 v v 0 { - V E � c a d > . 0 0 = 1 umi 4 w p W C n o m '� m 9 o L y m o z n E 5gc 0 o 3 Z'' c m d, m 4 d p o m 0 W Cr) c 61 2 `o L 0 m s a -0 m ,$ o o E o .n a c 8 E d Z , c ° cp o t mxa� 4 E y mxy m y u 2 a 2 p m = y Q Q m X ? CO N = 0 '0 in N 00 $ N qZ 0. 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H SEXUAL ABUSE FAMILY THERAPEUTIC INTERVENTIONS Island Grove Regional Treatment Center, Inc. Fee Schedule and Direct Service Rates ASSESSMENTS Initial Family Assessment 1 3U�—__ Adult Sex Offender Z5�= Adolescent Sex Offender (in-house) Adolescent Sex Offender contracted) 5 Alcohol and Drug Evaluation Domestic Violence 1 General Psychological Evaluation Vocational Assessment 1 THERAPEUTIC SERVICES Individual Sesslon : 5.. . our Family Sesslon • 1.11 our A o escent er etrator rou .11 •erson ase AI a ervices .11 •erson our ADDITIONAL PROGRAM FEES Plethysmograph* .11 examination Polygraph* 5.11 examination Court Appearance 1 . 1 .11 sta •a Psychiatric Services, if contracted* 1 1 .1 our Training Stipend 11.11 sta Provide DSS Training 51.11 our sta Clinical Supervisor (Dr. William Walsh) : 5.. . our Clinical Supervision/Staffing (Line 1 .11 our sta Staff) *Fees outside of Island Grove Center's contractual arrangements may be subject to change. C\KATHRYN\FAMSERV\9900 SARI Fee Sched.doc BOULDER INS ASSOC PAGE 01 I0.1.12.2/ly7y 16:34 30344973E5 DATE ImMlDmrn re le_wfiliti.. L.cn i irit,f+► i s Vi- uHt31L1 I Y INSURANCE TZSTTTT 3-22-99 _ - PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE IS CERTIFICATE DOES NOT AMEND.'V Lot/Boulder Street A Strr Ins. Associates LTER THE COVERAGE ❑OR COVERAGE AFFORDED BY THE POLICIES BELOW 1 rtC Boulder CO 60301 COMPANIES AFFORDING COVERAGE COMPANY A American Compensation mom No. 303-444-4443 FR.No. INSURED COMPANY B _____ Island Grove Regional Treatment Center COMPANY —F 1140 M Street o ---.--_ _ - Greeley, CO 80631 COMPANY 0 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 OP SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ _- Ca _ DD TYPE Or INSURANCE POLICY NUMBER DATE IMMNOIYYI GATE IMMR)GFYYI POLICY EFFECTIVE POLICY EXPIRATION I LIMITS LTR GENERAL LIMBO., I GENERAL AGGREGATE E ` 1I COMMERCIAL GENERAL AL�LIABILITY PRODUCTS.COMPIOP AGG E I I CLAIMS MADE -;OCCUR PERSONAL A AEA,INJURY , r- OwNER'S EI EACH OCCURRENCE I /CONTRACTOR'S PROT I ---- FIRE DAMAGE[Any one hr.! L I I I MED EXP Any cm oel,Onl I e AUTOMOBILE LIABILITY j COMBINED GINGIL LIMIT I s L� ART AUTO I — --- -- `I ALL OWNED AUTOS BODILY INJUIIY I' F �''IMr SCHEDULED N 1 J SCHEDULED AUTOS -- I I HIRED AUTOS BODILY INJURY I E, -_ I I MriR of it MONO WNED AUTOS 1 PROPERTY DAMAGE I H I GARAGE LIABILITY I AUTO ONLY.EA ACCIDENT Li w ANY AUTO I OTHER THAN AUTO ONLY- I ____I EACH ACCIDENT I$ AGGREGATE I e EXCESS LIABILITY EACH OCCURRENCE IT V AGGREGATE -�1 UMBRELLA FORM OTHER THAN UMBRELLA FORM I 1 WC ,qS`AMU I IIT _LIEU.. WORKERS COMPENSATION AMP ^^ EMPLOYERS'LIABILITY EL EACH ACCIDENT-_11 100.1100. A THEPROFRIETORI ,I„CLI AC000040793 10-1-98 10-1-99 ELOISEASE POLICYLIMIT E 500.000. PAATNERS/EXECVTNE EL DISEASE-EA EMPLOYEE , I OFFICERS ARE: EXCL l .-- OTHER II I I I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLEEISPECIAL ITEMS by and thru the board of County Certificate holder is to read: Weld County Colorado, Commissioners of Weld County, its employees and agents. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE TNF EXPIRATION DATE THEREOF.THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Weld County Colorado 60 OATS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEI T. Greeley. CO 80631 BUT FAILURE TO MAP SUCH NOTICE SMALL nu pp g c NO OAL OITMA OR LIABILITY OF ANY KIND UPON THE COMPANY.ITS AGENTS DR REPRESENTATNEE. WTH RILED REPRESENTATIVE 1 >� O-4L ^i'T AFORD 25.5 11/95) B'ACORQ CORPORATION 1986 FLOOD/PETE EATON ID : 454-3252 MAR 19 '99 16 :04 No . 025 P .04 ACORQ. CERTIFICATE OF LIABILITY INSURANCE DATEommpirn 03/119/99 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. lion, CO 80615 _ 70 454-3381 INSURERS AFFORDING COVERAGE INSURED INSURER A.Frontier Insurance Company, Inc. ISLAND GROVE REGIONAL INgURERB:ST PAUL FIRE & MARINE INSURANCE CC TREATMENT CENTER INC .._._ _..-_____..._.___._--___ -.-_ . _. INSURER C: __ - 1140 M STREET INSURER D: GREELEY, CO 80631 INSURER E. COVERAGES THE POLX;IES OF INSURANCE LISA I) 111 1 OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHBTANDINO ANY REOUIHUMLN1. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICA1t MAY DE ISSUED OR MAY PLHIAIN, THE INSURANCE AFFORDED BT 11 IL POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE 1LHMS,EXCLUSIONS AND CONDITIONS OF SUCH POI CFS. AGGREGATE OMITS SHOWN MAY I IAVF RFFN REDUCED BY PAID CLAIMS. '- -' __ _._ NJ/I'M' ppl,IOY EXPIRATION LIMITS !NOR TYPE OF INSURANCE FOLIOS NUMBER ➢A}E(MIyUp017� OAiP(MM(DO/TTI A GENERAL LIABILITY 'GLSC01013805 04/01/99 04/01/00 EACHCCCUHHENCE 61, 000,,000 000 X COMMERCIAL GENERAL LIADII In ' FIRE DAMAGE(Any one lire' 550-000____ ICLAIM6MADEI X I OCCUR MED F XP(Any one pot con) f5, 000 PERSONAL A ACV INJURY $1, 090, 000_ GENERAL/WORE DATE i3, 000, 000 OE Nt AUUHtUA1E LIMIT APPI_.IFS PUP; PRODUCTS-COMP/OP ADO!33, 000,000 PDUCY[._._i P22.iI r I LOC _.. B AUTOMOBILE LIABILITY FK06602680 ..04/01/99 04/01/00 COMBINED SINGLE LIMIT 'fl, 000, 000 (Ea acclaim/1IX ANY AUTO I ALLOWNLOAUTOS BDDILTINJURY I$ _• (Pp PenalSCHEDULED AUTOS • _. ___ X HIRED AU105 BODILY INJURY S per accident) X NON OWNED AUTOS _-.--- __ I PROPERTY DAMAGE S (Per aoowenn GARAGE LIABILITY AUTOONL Y.EAACCIDENTIS_ ._1 ANY AVIVOTHERIMAN EA ACC '.3 1111 I AUTO ONLY: AUG 1 EXCESS I.IAPILITY EACH OCCURRE NCF f _ OCOLR CLAIM;:MAnI AGGREGATE :S a DEDUCnBLE -- - a RETENTION S WC STATU- OTH- WORXERSCOMPENIATIONANU ITORYLIMITSI ERI .__ __- EMPLOYERB'LIABLITY E.L.EACH ACCIbE NI $ E.L.DISEASE-EAOMPl.OYEC'$ _ ___ 1 E.L.OISEASE•POL ICY LIMIT S A OTHER PROFESSIONAL 1'020000136201 04/01/9904/01/00 $1, 000, 000 PER OCC. LIABILITY I $3, 000, 000 AGGREGATE 1 DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/FXCLUSIONBADOED 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 INSURED. CERTIFICATE HOLDER I Y I AI,VITIONALINSURED;I1laselETTER _N CANCEUATY.DN SHOULDANYOFTHE ABOVE DESONBEDPOLICIES GE CANCELLED BEFORE THE E)rnTION WELD COUNTY, COLORADO DATETH!REOP,THE ISSUING INSURER WILLENDEAVORTOMAI L60 .DAYS WRIITEN BOARD OF COUNTY COMMISSIONERS NOTOETOTHE OERTIFIDATE HOLDER NAMEDTOTHE'EFT.PUTFAILAIR TO DO CO SHALL OF WELD COUNTY IMPOSE NOOSLI N OR UADIUTY OF ANY KIND UPON THE INSURERJTC ADENTE OR n15 - 10 STREET R(PRRBENTA REELEY, CO 80631 AUTHORIZED NTATIVE Y II 4554) ACOR029-S mint Of 2 #125323 G 0 CO O CORPORATION 1955 FLOOD/PETE EATON ID :454-3252 MHR 19 ' 99 16 :05 No .025 P . 05 IMPORTANT If the certificate holder Is an ADDITIONAL INSURED,the policyges)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 en endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such undo!sement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form don 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 atter the coverage afforded by the policies listed thereon. ACORD26-S(7/9712 of 2 41/ 25323 - ; May-17-99 12 :O5P P _ 02 • c ISLAND ` 1t GROVE 114 N0.13•9.•:Lt V:' .,Yllri4ail COMMUNITY COUNSELING CENTER, INC. May.17, 1999 Est. 197.4 David Aldridge Weld Department of Social Services P.O...Box-A-- Greeley, CO 80632 • RF FYC Commission Reconune illations and Conditions Dear Mr. Aldridge: 1 have red the FYC Commission's recommendation and condition for Island Grove's 1999.2000 bid packages(RFP 99008, Intensive Family Therapy and RIFF 99007. Sex Abuse Treatment). ani ple ased-to in brin you that I am in full agreement.to both terms and will execute this condition and recommendation by June 1, 1999. Regarding the conditions that no session will be billed-under 46 .minutes.in length. Y have published a memo to all wr.staff and contractors employed by our agency including administrative departments. 'I'hcy will.be:informed of this condition and no treatment unit will. he billed if under the required length without approval from.the program area supervisor. Regarding to recotnm ndation:to the SAIi•il Program on how evaluations are to be complete l within 45 days of referral, we Will do cur best.to follow this guideline. Occasionally clients hesitate:to tollow through with appointments making timely production of evaluations d.ifticult I I this is the situation in the future,the Case Worker will be informed.and a new.referral may have to be.submitted, Early intervention strategies will also be implemented if clients begin to miss appointments to evaluatory sessions. Thank.you for these recommendations as your feedback: is.always important. Please feel free to c�-tlltile At 392-0261 if you have any questions or further suggestions. Warm Regards, Robe M. Keenan, .A., CAC lll Family Services/Program Manager cc:•II.J. Dean The First Choice to Affordable Alcohol/Drug Services )41)1i) 1513 11th Ave.•Greeley.CO 8176:31 •:9701351-61378•Fax(9"'O)352-745% ,≤ 145 1st St.•Ft Lupton.CO$0621 •303/$57-0365•Fax(303)857.1391 Eatiki (sit ‘ii,"••••,: DEPARTMENT OF SOCIAL SERVICES PO BOX A wil' GREELEY, CO 80632 Administration and Public Assistance(970)352-1551 C Child Suppos (970)352-6933 1 Protective and Youth Services (970)352-1923 COLORADO May 14, 1999 B. J. Dean, Executive Director Island Grove Regional Treatment Center 1140 M Street Greeley, CO 80631 Re: RFP 99008, Intensive Family Therapy RFP 99006, Sex Abuse Treatment Dear Ms. Dean: The purpose of this letter is to outline the results of the RFP Bid process for PY1999-2000 and to request.written information or confirmation from you by May 20, 1999. A. Results of the RFP Bid Process for PY1999-2000 On April 7, 1999, 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 99008, Intensive Family Therapy: Condition: Payment will be denied to Intensive Family Therapy providers for any charge submitted for therapy 45 minutes or less unless cleared by explanation and approved by the program area supervisor. 2. RFP 99007, Sex Abuse Treatment: Recommendation: Offender evaluations are to be completed within 45 days of referral. B. Required Response by RFP Bidders Concerning FYC Commission Recommendations and Conditions The Weld County Department of Social Services is requesting your written response to the FYC Commission's recommendations and conditions. Please respond in writing to David Aldridge, Weld County Department of Social Services, P.O. Box A, Greeley, CO, 80632, by May 20, 1999, close of business, as follows: Page 2 Island Grove Regional Treatment Center, May 14, 1999 RFP 99008, RFP 99006 1. FYC Commission Recommendations: You are requested to review the FYC Commission recommendations and to: a. accept the recommendation(s) as written by the FYC Commission; or b. request alternatives to the FYC Commission's recommendations(s); or c. not accept the recommendation(s) of the FYC Commission. Please provide in writing how you will incorporate recommendation(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. 2. FYC Commission Conditions: All conditions will be incorporated as part of your RFP Bid and Notification of Financial Assistance Award (NOFAA). If you do not accept the condition(s), you will not be authorized as a vendor unless your mitigating circumstances are accepted by the FYC Commission and the Weld County Department of Social Services. If you do not accept the condition, you must provide in writing reasons why. A meeting will be arranged to discuss your response. Your response to the above conditions will be incorporated in the RFP Bid and Notification of Financial Assistance Award. If you wish to arrange a meeting to discuss the above conditions and/or recommendations, please do so through Elaine Furister, 352.1551, extension 6295, and one will be arranged prior to May 20, 1999. Sincerely, } 1d).,' a tJ J y A. �riego, ' irecr ld County Department of Social Services JG:cf cc: Mike Hoover, Chair, FYC Commission David Aldridge, Social Service Manager 11 May-- 17-99 12 : O5P P.O2 ISLAND ,1 ' .:.. GROVE xy M•IMC:AJ.4..VU I...T,tr.4... . • COMMUNITY COUNSELING CENTER, INC. May 17, I999 • - _... ...__._....._ . Est. 1974 David Aidridge Weld Department of Social Services P.O...Box •r1-•- Greeley, CO 80632 • RFFYC Commission Recotri endations and Conditions • Dear Mr. Aldridge: • I have raid the FYC Commission's recommendation and condition for Island Grove's 1999-2000 bid packages(RFP 99008, Intensive Family Therapy,and RIP 99007, Sex Abuse Treatment). I ani':pleased-to inibrrn you that I am in fill]agreement.-to both terms and will execute this condition and recommendation by June I, 1999. Regarding the conditions that no session will be billed under 46 minutes in length. I have published a memo to all IF F staff and contractors employed by our agency including administrative departments. They will.be.infouned of this condition and no treatment unit will he billed if under the required length without approval from-.the program area supervisor. Regarding to recommendation to the SAl*1"I Program on how evaluations are to be complete! within 45 days of referral,we will do our best.to follow this guideline. Occasionally clients -hees�itate to follow through with appointments making timely production of evaluations difficult. If this is the situationin the future,.the Case Worker will be infbrrned.and a new referral may have to be submitted. Early intervention strategies will also.be implemented if clients begin to miss appointments to eval:uatory sessions. - Thank you for these recommendations as your feedback is always'important. Please feel free to call me at 392-t)2(t 1 if you have any.questions or.further suggestions_ Warm Regards, ` Robe • M. `ccnan, '[.A., CAC III Family ScrvicesiProg.ram Manager cc: B.,t. Dean The First Choice in Affordable Alcohol/Drug Services 5A". DAD 1513 11th AVE).•Groaloy.CO(40531 •970:351.6678•Fax(9701 3S2-7457 r•ri F 145. 1 it St.•Ft Lupton.GO 80621 •303(057-636 •Fax(303)857-1391 DEPARTMENT OF SOCIAL SERVICES PO BOX A WAD GREELEY, CO 80632 C Administration and Public Assistance(970)352-1551 O Child Support(970)352-6933 Protective and Youth Services (970)352-1923 COLORADO May 14, 1999 B. J. Dean, Executive Director Island Grove Regional Treatment Center 1140 M Street Greeley, CO 80631 Re: RFP 99008, Intensive Family Therapy RFP 99006, Sex Abuse Treatment . Dear Ms. Dean: The purpose of this letter is to outline the results of the RFP Bid process for PY1999-2000 and to request written information or confirmation from you by May 20, 1999. A. Results of the RFP Bid Process for PY1999-2000 On April 7, 1999, 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 99008, Intensive Family Therapy: Condition: Payment will be denied to Intensive Family Therapy providers for any charge submitted for therapy 45 minutes or less unless cleared by explanation and approved by the program area supervisor. 2. RFP 99007, Sex Abuse Treatment: Recommendation: Offender evaluations are to be completed within 45 days of referral. B. Required Response by RFP Bidders Concerning FYC Commission Recommendations and Conditions The Weld County Department of Social Services is requesting your written response to the FYC Commission's recommendations and conditions. Please respond in writing to David Aldridge, Weld County Department of Social Services, P.O. Box A, Greeley. CO, 80632, by May 20, 1999, close of business, as follows: Page 2 Island Grove Regional Treatment Center, May 14, 1999 RFP 99008, RFP 99006 1. FYC Commission Recommendations: You are requested to review the FYC Commission recommendations and to: a. accept the recommendation(s) as written by the FYC Commission; or b. request alternatives to the FYC Commission's recommendations(s); or c. not accept the recommendation(s) of the FYC Commission. Please provide in writing how you will incorporate recommendation(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. 2. FYC Commission Conditions: All conditions will be incorporated as part of your RFP Bid and Notification of Financial Assistance Award (NOFAA). If you do not accept the condition(s), you will not be authorized as a vendor unless your mitigating circumstances are accepted by the FYC Commission and the Weld County Department of Social Services. If you do not accept the condition, you must provide in writing reasons why. A meeting will be arranged to discuss your response. Your response to the above conditions will be incorporated in the RFP Bid and Notification of Financial Assistance Award. If you wish to arrange a meeting to discuss the above conditions and/or recommendations, please do so through Elaine Furister, 352.1551, extension 6295, and one will be arranged prior to May 20, 1999. Sincerely, 1` Jytdy A. riego, irectfOr- M/ eld County Department of Social Services JG:ef cc: Mike Hoover, Chair, FYC Commission David Aldridge, Social Service Manager Il 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 FY99-PAC-3001 Revision (RFP-FYC-99008) Contract Award Period Name and Address of Contractor Beginning 06/01/1999 and Island Grove Regional Treatment Center Ending 05/31/2000 Intensive Family Therapy Program 1140 M. Street Greeley, CO 80631 Computation of Awards Description The issuance of the Notification of Financial Assistance Unit of Service Award is based upon your Request for Proposal (RFP). The RFP specifies the scope of services and conditions This program is specially designed to assist of award. Except where it is in conflict with this individuals and families with their substance NOFAA in which case the NOFAA governs, the RFP abuse issues. 105 family units over 12 months,45 upon which this award is based is an integral part of the units active at any one time, and estimated action. average stay in intensive therapy to be 25 weeks. (in-home or in-clinic) Special conditions I) Reimbursement for the Unit of Services will be based Cost Per Unit of Service on an hourly rate per child or per family. 2) The hourly rate will be paid for only direct face to face Hourly Rate Per $ 97.25 contact with the child and/or family or as specified in Unit of Service Based on Approved Plan the unit of cost computation. 3) Unit of service costs cannot exceed the hourly and Enclosures: yearly cost per child and/or family. ✓Signed RFP:Exhibit A 4) Payment will only be remitted on cases open with, and ✓Supplemental Narrative to RFP: Exhibit B referrals made by the County Department of Social Recommendation(s) Services. 5) Requests for payment must be an original form and ✓Conditions of Approval submitted to the Weld County Department of Social Services by the end of the 25" 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. Ap royals: Program Official: • • By By Dale K. Hall, Chair Judy . riego irector Board of Weld County Commissioners Weld Ton D partmennt o Social Services Date: p/v/©3-717/ Date:__ 9 7/(973-(.A) INTENSIVE FAMILY THERAPY FAMILY PRESERVATION PROGRAM DEPARTMENT OF SOCIAL SERVICES WELD COUNTY 1999/2000 BID PROPOSAL RFP-FYC # 99008 Island Grove Regional Treatment Center, Inc. 1140 M Street Greeley, CO 80631 INVITATION TO BID DATE: February 26, 1999 BID NO: RFP-FYC-99008 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-99008) for: Family Preservation Program--Intensive Family Therapy Program Family Issues Cash Fund or Family Preservation Program Funds Deadline: March 23, 1999, Tuesday, 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, 1999, through May 31, 2000, 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 U(� VENDOR Treatment Center, Inc. IS-LOAN./ (Name) Han written Signature By Authorized Officer or Agent of Vender ADDRESS 1140 M Street TITLE Executive Director Greeley, CO 80631 DATE March 23, 1999 PHONE # (970) 356-6664 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of35 RFP-FYC-99008 Attached A INTENSIVE FAMILY THERAPY PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 1999/2000 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1999-2000 BID #RFP-FYC-99008 NAME OF AGENCY: ISLAND GROVE REGIONAL TRFATMFNE CENTER, INC. ADDRESS: 1140 M Street. Greeley, CO 80631 PHONE J970 ) 356-6664 Program Manager of CONTACT PERSON: Robert Keenan TITLE: Family Services 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: X 12-month contract with actual time lines of: Start June 1. 1999 Start, June 1, 1999 End May31 1999 End May 31, 2000 TITLE OF PROJECT: Intensive Family Therapy Program .Robert Keenan 3/23/99 Name d S ature o Person Preparing Document Date ( ✓ BJ Dean 3/23/99 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 1998-1999 to Program Fund Year 1999-2000. Indicate No Change from FY 1998-1999 roject Description rip change iR arget/Eligibility Populations no change (t— ypes of services Provided no chan e p3---- easurable Outcomes no char e ervice Objectives no change orkload Standards no chan e taff Qualifications no change\O-_._— S—trait of Service Rate Computation 4% lt`-- li—Program Capacity per Month no chance\F — Certificate of Insurance Page 29 of 35 RFP-FYC-99008 Attached A Jate of Meeting(s) with Social Services Division Supervisor: 3 Lt .( A Comments by.S Supervisor: (� 4fryi s f` C�y,^Il,nn 1 .92 cncM - Y 9 Name and Signature of SSD Supervisor Date Page 30 of 35 RFP - FYC - 99008 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 such as substance misuse by any of its members and the disruption can be so extensive that parents face losing their substance-involved children or children lose their parents to the control of chemicals. These high-risk situations require effective interventions. Island Grove Center's Intensive Family Therapy Program has remained current on developments in Family Therapy to deliver such interventions. The IFT Program is specifically geared to assist substance-involved families in reclaiming their lives from this undermining influence. 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 in-home or in-clinic family sessions. Solution-based models of family therapy have demonstrated success in working with this population 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, play therapy, and case aide support, group therapy and 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 breathalyser 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, substance-involved families within Weld County. Due to proven demand, we are currently capable of carrying an average of 45 family cases at any given time, for a total of 105 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 200 children within these families, from preschool ages on up, within the year. We will also accept referred families where children are at high risk for substance misuse. Length and intensity of treatment vary among the families, depending on the severity of their challenges and their willingness to use the resources available to them- We estimate the average duration of the program to cover a twenty-five-week span, with an average between one to two contacts per week for an estimate of three clock hours of contact at the outset of treatment. Later stages of this time period would typically decrease services to bimonthly contacts. The upper end of the intensity could involve twelve hours of contact per week, for a brief period, in the most extreme cases. Our referred families will be contacted within two business days to arrange for the initial assessment. Depending on the family's schedule, the assessment will occur, typically in- home, within seven business days from the moment of referral. In the event of crisis, all referred family members will have access to 24-hour response through our Acute Care Services unit and available on-call family services counselors. 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 or providing in-home sessions in the further outlying areas such as Dacono, Hudson, or 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 during the initial home visit for all accepted referrals to determine to what extent substance involvement and other factors impact the family's functioning, as well as identifying strengths the family brings to their situation. The Browning Outcomes Survey Sca/e (BOSS) will be used to gather a pre and post treatment measure. 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 partner 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 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 breathalyser 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 not employed indiscriminately, due to the efforts to contain costs and to manage staff time and coverage, yet 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 BOSS, indicates measure of relational skills, family goal attainment, and levels of conflict. IV. MEASURABLE OUTCOMES A. .Children receiving services do not qo 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 BOSS should indicate sustained positive changes. It will be administered by phone six months after the family is discharged. Results will be collected and reported annually. C. Reunification of children with families: The program design for IFT, by its nature, will include, ideally, 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 BOSS 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, recorded in the base file, and data brought together within the submitted quarterly 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 time frame 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 BOSS 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 BOSS 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 arrange for transportation of family members to sessions and other agency or community resources, as it applies to the completion of the treatment plan. As a result, the family may continue these sustaining relationships long after their "treatment" ends. 4 Documentation within the case files will indicate the community net that is being woven with the family that 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. Newly enrolled families will additionally have a case aide contact from .5 to 1 hour per week. 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 12 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 five 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: 6 G. Maximum caseload per supervisor 10 H. Insurance: Flood & Peterson Insurance, Inc. - see attached documentation VII. STAFF QUALIFICATIONS Robert Keenan, Family Services Program Manager M.A. - Agency Counseling, emphasis in Marriage and Family Therapy CAC III Experience: 5 years Intensive Family Therapy 10 years general therapy 5 Anne Gleditsch, Counselor- Family Services M.A. —Agency Counseling, emphasis in Marriage and Family Therapy CAC III Experience: 3 years Family Therapy 8 years general therapy Judi Ashley, Counselor- Family Services, LMFT (Licensed Marriage and Family Therapist) M.A. - Agency Counseling, emphasis in Marriage and Family Therapy CAC III Experience: 4 years Family Therapy 16 years general therapy Adelaide Lopez, Counselor— Family Services B.A. — Bilingual Services Experience: 2 years Family Therapy 4 years general therapy Daniel Sanders, Counselor— Family Services M.S. — Counseling Psychology Experience: 8 years Family Therapy 12 years general therapy 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. Robert Keenan, our Program Manager and contact person for the IFT program, has a large role in the clinical monitoring of the program's daily operation. He interacts with all involved staff numerous times per week and tracks case load, service hours provided, and responds to on-call crises, comprising approximately six hours of his work week. He supplements this ongoing supervision with periodic in-services, presenting alone or with Dr. Walsh. Dr. Walsh meets twice each month with our clinical team for 1.5 to 2 hours each session. Dr. Walsh is a well-respected clinician and scholar of innovative models of family therapies. He is well versed and practiced in the ongoing professional development of the field, in addition to mentoring bright and enthusiastic professionals such as Island Grove's Family Therapy team. C\KATHRVMFAMSERVVFT Bid Proposal 99-00.doc 6 RFP-FYC-99008 ATTACHMENT A Intensive Family Therapy Program Bid Category Intensive Family Therapy - Family Preservation Program Island Grove Regional Treatment Center, Inc. Total Hours of Direct Service per Family Unit 12.4 Hours [A] Total Family Units to be Served 60 Families [B] Total Hours of Direct Service for Year 744 Hours [C] (Line [A] Multiplied by line [B] Cost per Hour of Direct Services $33.86 Per Hour [D] Total Direct Service Costs $25,190.95 [E] (Line [C] Multiplied by Line [D] Administration Costs Allocable to Program $35,748.88 [F] Overhead Costs Allocable to Program $11,411.30 [G] Total Cost, Direct and Allocated, of Program $72,351.13 [H] (Line [E] Plus Line [F] Plus Line [G]) Anticipated Profits Contributed by this Program $0.00 [I) Total Costs and Profits to be Covered $72,351.13 [J] by this Program (Line [H] Plus Line [I]) Total Hours of Direct Service for Year 744 [K] (Must Equal Line [C]) Rate per Hour of Direct, Face-to-Face Service $ 97.25 [L] to be Charged to Weld County Department of Social Services Day Treatment Programs Only: [M] Direct Service Hours Per Client Per Month Monthly Direct Service Rate [N] UJI AA, 1JJJ 1J. J4 J UJ44DfJOD YJUULVLt Sit AS5Ul.' PAGE 01 ^V SF,ILA_ �.cn I irn .44 I C 'V! LI HtSILl I Y INSURANCE cs DATE IMMDD,Ey PRODUCER TISTTTT 1-7�-49 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Talbot/Boulder Ins. Associates 1601 28th Street HOLDER.THIS CERTIFICATE DOES NOT AMEND.EXTEND OR Boulder CO 80301 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Pa NO. 3 03-44 COMPANY —- 4-4943 FE,TIP. A American Compensation no rogUPFD COMPANY Island Grove Regional Treatment Center 1140 M Street COMPANY ^--------- c Greeley, CO 80631 CDMPaxr --- ,------. O 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 CLAIMSCO R TYPE OF INSURANCE I ------- _ POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE IMM/ODEVYI GATEMAN/Dorn) UMITJ GENERAL LIABILITY .y_COMMERCEAL GENERAL LIABILITY (GENERAL AGGREGATE E CLAIMS MADE OCCUR 'PRODUCTS.COMMOP AGG i E OWNER'S S CONTRACTOR'S PROT I PERSONAL I AOY INJURY I I EACH OCCURRENCE T 1 t___ FIRE DAMAGE'Any ono Aryl ' J ,AIITOMDeIII UABIl1TYI ABED EXP ART ORE Mayo, I �~ ANY AUTO L_ COMBINED SINGLE LIMIT �{ All OWNED AUTOS fr.— '_J SCHEDULED AUTOS IBODILY INJURY HIRED AUTOS I .'DB' om I NON.OWNED AUTOS BODILY INJURY I IPFI JCCIOII E M PROPERTY DAMAGE GARAGE tummy ANY AUTO AUTO ONLY EA ACCIDENT $ I OTHER THAN AUTO ONLY: I i EACH ACCIDENT i i EXCESS LIABILITY AGGREGATE I EACH OCCURRENCE I J UMBRELLA FORM OTHER THAN UMBRELLA FORM AGGREGATE ,I� WORKERS COMPENSATION AND I* I EMPLOYERS'LIABILITY WC STATU- II 0TH I TORY LIMIT)I ! ER p' THE PROPRIETOR/ r--. ACC00040793 I EL EACH ACCIDENT I PHETNERS/IETOR,TNF I_ 'NIT' 10-1-98 10-1-99 I- 500,(0�(0�0. _. OFFICERS ARE. 'EXCL 'EL DISEASE POLICY LIMIT L. 50Q,LLV 0. OTHER I EL DISEASE-EA EMPLOYEE IL o 100.000. i DESCRIPTION OF OPERATIONS/LDCATIONSIVEHICLES/SPECIAL ITEMS Certificate holder is to read: Weld County Colorado, by and thru the board of County _ Commissioners of Weld County, its employees and agents. CERTIFICATE HOLDER CANCELLATION `---- SHOULD ANY OF THE ABOVE DESCAIEEO POLICIES BE CANCELLED BEFORE THE Weld County Colorado EXPIRATION DATE THEREOF.THE ISSUING COMPANY WILL ENDEAVOR TO MAR Gres 1 CO 80631 60 DAVE WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO Malt FACIA HOTICK.uKyl Amon NG EN.,on„wN Oa uAPILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES AUTH4WEED RNRESPNTAATTIV1 �I 1J 1/RD 25.5 195) C'r"_�/�W ��/LL�-"'tip --______' � F'ACORD CORPORATION 1988 r LOVV/ rcla [El IUIY ED • 4D4—JLJL PIHIY 1'J 77 10 -U.) ill] .UL7 r .Liz A.GORD,. CERTIFICATE OF LIABILITY INSURANCE ( Lon. lmmru or.T? 03/19/99 PROPUOER THIS CERTIFICATE IS ISSUED AS A MATTER OK INFORMATION Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2n First Street ALTER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 'aton, CO 60615 70 454-3381 INSURERS AFFORDING COVERAGE INSURED INSURER A.Frontier Insurance Company, Inc. ISLAND GROVE REGIONAL INSURERB:ST PAUL FIRE & MARINE INSURANCE CC TREATMENT CENTER INC - INSURERS 1140 M STREET GREELEY, CO 80631 NSURER D. 1 INSURER E: COVERAGES THE POLICIES 01 INSURANCE I ISTFD BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 1[31101)MUICAILU. NOTWITHSTANDING ANY RFOUIRFMF.NT, TERM OR CONDITION DI ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCL Al I OI11)1-II BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS,EXCLUSIONS AND CONDITIONS or SUCI I POLICIES. AOGM_GATF I MRS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. 7�L�p EPlp IyLt ppLl�y��(p�p^ 'p1y ILW! -- TYPE OF INSURANCE POLICY NUMBER pA'(pY(�TAf EIY DAglNZIMITp -- - LIMITS A GENERAL LIABILITY GLSCO1013805 04/01/99 04/01/00 EACH OCCURRENCE {7., 000 ,-000 R CDMMEACRLOENERALLIAWLIIT FIRE DAMAGE(Any one In)$50, 000 GLAIMSMADE XJ OCCUR MED EX.(Any Gniporton) *5, 000 _ - _ PERSONAL 4 A DV INJURY {l, 000, 000 GENERAL AGGREGATE 13,.000, QQQ_ GCN%AGGREGATE LIMIT AI'PLIESPER. PRODUCTS-COMPIOP AGG $3, 000 , 000 POLI CY 3.;_38i IOC y-_ B AUTUMOBILE LIABILITY FK06602680 04/01/99 04/01/00 COMBINED SINGLE LI MIT X ANY AUTO (Eaaccident) ;11, 000, 000 ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Pr,Pe*MI) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Pe tcclasnq S . ._______..... PROPERTY DAMAGE A (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT!, ANT AUTO EA AOC S _._ OTHER THAN _ _ AUTO ONLY! AGO I f . EXCESSUABILITY EACH OCCURRENCE f . I� OCCUR CL AIMS MADE AOBREOATE IS 'S DEDUCTIBLE I I NEIENIION f f f WO/YSERS COMPENSATION AND WCSTATU- OTH- EMPLOYERSLIABILIIY TORY LIMITS ER _.. ,_ E.L.E AC H ACCIDENT ;B E.L.DISEASE-EAFMPI OYCCI/ __.._ __.__ E .DISEASE•POLICY LIMIT;S A IoHERPROFESSIONAL020000136201 04/01/99 04/01/00 $1, 000, 000 PER OCC. ,7.IABILITY $3, 000, 000 AGGREGATE I DESCRIPTION OF OPERATIONSILOCATIONG/VEHICLESIEXCLUSIONS AOD!O BYENDORSEMENT/NEDIALPROVISIONS WELD COUNTY, COLORADO; BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY, ITS EMPLOYEES F. AGENTS, AND THE STATE OF COLORADO ARE NAMED AS ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR IN REGARDS TO THE OPERATIONS OF INSURED. CERTIFICATE HOLDER I Y I AuufIONALIN9UPED;IN9UiERLETTE1t JL jANCELLATION SHOULDANYOF RYE ABOVE DES01V BED POLICIES BE CANCELLED BEFORE THE EXPIRATION WELD COUNTY, COLORADO DATETHEAEOF,THE ISSUING INSURER WILLENDEAVORTOMAIL60 DAYGWRTTEN HOARD OF COUNTY COMMISSIONERS NOTICE TO THE VERO TE HOLDERNAMEDTOTHE LEFT,BUTFAILURE TO DO GO PNALT OF WELD COUNTY IMPOSE NO OOLIO LIABILITY OF ANY KIND UPONTIIE INSURERR9 AGENTS OR 915 - 10 STREET REPREEENTATW REELEY, CO 80637 AUTHORIZED R EISTAT VE s 1 ACORD2S-SgM7n. Of 2 4125323 C co R RATION TSBB fLUVU' rcic CHIUPI 1ll • , J4-JLDZ I'IHK 1i 77 1O •V4 HU .UZD Y .UJ IMPORTANT If the certrticate holder Is an ADDITIONAL INSURED,the colleges)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 Ileu of such endorsement(e). 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 Ii affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. Acme 2s-SI7»R)2 of 2 1t1'2S323 Hello