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Home My WebLink About991278.tiff RESOLUTION RE: APPROVE TWO NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR CORE SERVICES FUNDS AND AUTHORIZE CHAIR TO SIGN - LUTHERAN FAMILY SERVICES 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 Lutheran Family Services, 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 Lutheran Family Services 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, CO O /J ATTEST: /O rd// Il��i / Dale all, — y�J " Dale K. Hall, Chair Weld County Clerk to t ; B. • r` % ;=`?� EXCUSED DATE OF SIGNING (AYE) CA 4 Barbara J. Kirkmeyer, Pro-Tem BY: 47r' 1ti Deputy Clerk to the Boar. r� EXCUSED TE OF SIGNING (AYE) George E axter PR!J AS TO FORM: �� . J. peile o nty Attorney / leg , Glenn Vaal 991278 CSSS SS0026 4'\(: DEPARTMENT OF SOCIAL SERVICES PO BOX A IDGREELEY, CO 80632 C D Administration and Public Assistance (970)352-1551 WI O Child Support(970) 352-6933 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 Adel1J 1 RE: Core Services Notification of Financial Assistan e Awards o 11J between the Weld County Department of Social Services and Lutheran Family Services Enclosed for Board approval is Core Services Notification of Financial Assistance Awards (NOFFAs)between the Weld County Department of Social Services and Lutheran Family Services. 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 Lutheran Family Services units cost as outlined in this Memorandum. 3. Lutheran Family Services will provide two programs to families and children in need of child protection services as follows: A. Intensive Family Therapy: 1) Description: The program provides therapy for a maximum of 32 families with children infant to eighteen years of age. The program goal is to improve both individual and family functioning. 2) Cost Per Unit of Service: $100 per hour. B. Home-Based Intensive Family Intervention Program—Option B: 1) Description: The program will serve thirty-two families with children infant to eighteen years of age. The program provides intensive in-home services. 2) Cost Per Unit of Service: $104.00 an hour. If you have any questions,please telephone me at extension 6510. 991278 4 7z 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 99-CORE-002 Revision (RFP-FIX-99010) Contract Award Period Name and Address of Contractor Beginning 06/01/1999 and Lutheran Family Services-Option B (LIFE) Ending 05/31/2000 1212 8 Street Greeley, CO 80631 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance The LIFE program is designed to promote the safety and Award is based upon your Request for Proposal (RFP). well being of children and their family members. The RFP specifies the scope of services and conditions Services will build upon primary family connections and of award. Except where it is in conflict with this to help parents improve their parenting ability, identify NOFAA in which case the NOFAA governs, the RFP parental strengths and support their efforts to provide upon which this award is based is an integral part of the care for their children. The program goal is to improve action. both individual and family functioning. Crisis intervention services will be provided throughout the Special conditions duration of the families' involvement with our agency. Maximum number of families served per year is 32 with 1) Reimbursement for the Unit of Services will be based children 0-18 years, a maximum of eight families at any on an hourly rate per child or per family. given time. of eight families at any given time. 2) The hourly rate will be paid for only direct face to face contact with the child and/or family, as evidenced by Cost Per Unit of Service client-signed verification form, and as specified in the unit of cost computation. Hourly Rate Per $ 104.00 3) Unit of service costs cannot exceed the hourly and Unit of Service Based on Approved Plan yearly cost per child and/or family. 4) Payment will only be remitted on cases open with, and Enclos es: referrals made by the Weld County Department of Signed RFP:Exhibit A Social Services. Supplemental Narrative to RFP: Exhibit B 5) Requests for payment must be an original submitted to Recommendation(s) the Weld County Department of Social Services by the end of the 25'" calendar day following the end of the Conditions of Approval month of service. The provider must submit requests for payment on forms approved by Weld County Department of Social Services. Approvals: Program Official: ByJInt By rt Dale K. Hall, Chair Judy A riego, irector Board of Weld County Commissioners Weld unnty epartment of Social Services Date: (2G-`E /q p Date: 7P y/r[q • Lutheran Family Services • • OF COLORADO --- _4_years. Strengthening individuals and families for over 40 ea March 13, 1999 Weld County Government ATT: Pat Persichino Director of General Services 915 10th Street P.O. Box 758 Greeley, CO 80632 RE: Bid No: RFP-FYC-99010 Home Based Intensive Family Intervention Program Dear Ms. Persichino: Please accept the attached paperwork necessary to renew our contract to provide home based intensive family intervention services (our LIFE program). It is my understanding that I have enclosed the necessary documentation and do not need to submit a new bid if there are not significant changes in the program design and if I am willing to accept a 4% rate increase. As this program is willing to accept these two conditions, I have attached the information necessary for contract renewal. Please do not hesitate to call if I need to provide further information. Thank you for your time and consideration of this matter. Respectfully submitted: 77 Sharon K. Thomas, LCSW Program Director Enc. Signed Invitation to Bid Signed Cover Sheet Division Supervisor Comments Current Certificate of Insurance (970) 266-1788 • Fax 266-1799 3800 Automation Way, Ste. 200 • Fort Collins, CO 8052b Affiliated with The Evangelical Lutheran Church in America and The Lutheran Church-MIf,.4olu 5, INVITATION TO BID DATE: February 26, 1999 BID NO: RFP-FYC-99010 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-99010) for: Family Preservation Program--Home Basedintensive Family Intervention 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 Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited, phased in intensity, and produce positive change which protects children, prevents or ends placement, and preserves families. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B_.Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date i� _ � - '1 P/Itdtc a (After receipt of order) BID MUST BE SIGNED IN INK Chet Evenson _ TYPED OR PRINTED SIGNATURE. VENDOR Lutheran Family Services (Name) Handwritten Signature By Authorized Officer or Agent of Vender ADDRESS 3800 Automation Way #200 TITLE President. and CEO Ft. Collins, CO 80525 DATE 3 J tQ__ PHONE H (970)266-1788 FAX: 266-1799 The above bid is subject to Terms and Conditions as attached hereto and incorporated RFP-FYC-99010 Attached A HOME BASED INTENSIVE FAMILY INTERVENTION 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-99010 NAME OF AGENCY: Lutheran Family Services ADDRESS: 3800 Automation Way #200 Ft. Collins, CO 80525 PHONE: j 970) 266-1788 Fax: (970)266-1799 CONTACT PERSON: Marilyn Welburn TITLE: Program Supervisor DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited.phased intensity, and produce positive change whichprotects children prevents or ends placement and preserves families. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of Start June 1. 1999 Start End May 31.2000 End TITLE OF PROJECT: Lutheran Family Services Empowerment (LIFE) Sharon K. Thomas andittp[,e ' ""A%.Q/ -- Name and Signature of Person Preparing Document Date Chet Evenson 11e, S��!!3S �!t� P44 .& 3'12 4'1 -- Name and Signature Chie dministrative 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�y�FY 1998-1999 Project Description X $t - Target/Eligibility Populations X Types of services Provided _ X _ Measurable Outcomes x Service Objectives X Workload Standards X Staff Qualifications X - Unit of Service Rate Computation X Program Capacity per Month X 5(CT W. Certificate of Insurance J RFP-FYC-99010 Attached A Date of Meeting(s)with Social Services Division Supervisor: - ) , (/7, Comment.s by SSD Su isor: -I-�i P �� //ice —Z�6� .� �zl�a� 1. �� s� (1-'/4_�..:, 1 7 /r 77 Name and Signature of SSD Supervisor Date PRODUCER DATE MMDomn 1-80033121 SEAEURY&SMITH 711{08 THREE EMBARCADERO CENTER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ! /Iw4. BOX 7157 AT ER THE THIS CERTIFICATE AFFORDED BY THOT E POLICIISTBE OW N FRANCISCO,CA 91120 t_ COMPARE'S AFFORDING COVERAGE Cain*" PREFERRED RISK MUTUAL iH WNEO I LUTHERAN FAMILY SERVICES 1 C a'S" WAUSAU INSURANCE COMPANIES Of COLORADO cawnAHY — 363 SOUTH HARLAN C 11 DENVER,CO 80226 ! -- COMPANY D 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 µY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE MSU I OR OTHER DOCUMENT WIUB ECTJECT TO TO T ALL U.THE TERMS. EXCLUSIONSAND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY NAVE BEEN REDUCED BY PA I HEREIN IS SUB ID CLAMS. I LA TYPE Of INSURANCE POLIES MDMBER I PDUCY IMFECTTVE !Patty LOIRATIDN I DAreasceITn DATE NIWOONLT UNITS cc A r OENID1Al LIABILITY 198 II' x I COMMERCIAL,, GENERAL IUEILITY 9618-911 O7R1i 07/yllp� GENERAL AGGREGATE L 3.DDD.DOO.DD CLAIMS MADE ,a OCCUR PRODUCTS COM►gP AGO + 3,000,000.x �i OWMERYI►CONTRACTORS PROS+ PERSONAL L ROY INJURY I 1.000.000.0o ri EACH OCCURRENCE S 1.000.000,00 II FIRE DAAGE IAAT Er iN) i 1,000,000.00 OMOBR.!LYBi1TY I MIND RR CAIN MM pram) 1 5,%Q II AMYAVTO GOWNED EWOLI UMm 5 ALL OWNED AUTOS _ 1 Iii------�!!SCHEDULED AUTOS ' SMELT INJURY HIRED AUTOS Pr PPnml S NON-OWNED AUTOS WOOLY INJURY 5 0401 II PROPERTY DAMAGE IL 16ARAR!LaMar ~ANY AVTO I AUTO ONLY-EA&Weer s F—II OTHER HEW AUTO CMS: `i EACH ACCIDENT I •ESOESS LM4LmY I AGGREGATE i ^`I UMBRELLA FORM ! EACH OCCURRENCE', S ~I OTHER THAN UMBRELLA GOAL AGGREGATE S B jESPUWERV COMPENSATION ANo 0818-00-002041 02/01/98 02/01/99 { ,�MayuiO ai i THE v11M1U[TOb I—I IHCL _EL EACH ACGDEM i /�/{ I PAERNAECUTivE .I �.60 RTN ` `OPfICERi ARl: I EACL'. 4 ORIEASE•POLICY urn' 1 f OTNEII I I eL mess.EA EMPLOYEE I 5 I I DESCRVnON OP OKRA TIONSAOCATIONSAl HCLUISPECWL ITEMS EVIDENCE OF INSURANCE mums ANY OP M ADOBE DYCCEED POLKAS It CANCELLED BORE M •vELD COUNTY LIPMANDN DATE THaEOP. THE la COMPANY W{L ENDEAWYI TO Ea P.O. BOX A own WRLTp ROTNf.TD THE CERTWICATE Mown NAMED TO M Lam GREELEY, CO 80632 RIND tan lianas TO NAIL SUCH NOTCEee SNAIL IMPOSE*0 OMLRA MN OR LWEWM1 Of ANY D WON TM CO ITS OR RPHIeSMfTA1NEi. AUTNORDED RWWSENTA NYE Lutheran Family Services LIFE Program Computation of Direct Service Rate Total Hours of Direct Service Per Client 52 Hours (A) Total Clients to be Served 32 Clients (B) Total Hours of Direct Service for Year 1,664 Hours (C) (Line (A) Multiplied by Line (B)) Cost per our of Direct Services $37 Per Hour (D) Total Direct Service Costs $61,568 (E) (Line (C) Multiplied by Line (D)) Administration Costs Allocable to Program $54,912 (F) Overhead Costs Allocable to Program $56,576 (G) Total Cost, Direct and Allocated, of Program $173,056 (H) (Line (E) Plus Line (F) Plus Line (G)) Anticipated Profits Contributed by this Program $0 (I) Total Costs and Profits to be Covered by this Program $173,056 (J) (Line (H) Plus Line (I)) Total Hours of Direct Service for Year 1,664 (K) (Must Equal Line (C)) Rate per Hour of Direct, Face-to-Face Service $104 (L) to be Charged to Weld County Department of Social Services Lutheran Family Services LIFE Program Computation of Direct Service Rate Total Hours of Direct Service Per Client 52 Hours (A) Total Clients to be Served 32 Clients (B) Total Hours of Direct Service for Year 1,664 Hours (C) (Line (A) Multiplied by Line (B)) Cost per our of Direct Services $37 Per Hour (D) Total Direct Service Costs $61,568 (E) (Line (C) Multiplied by Line (D)) Administration Costs Allocable to Program $54,912 (F) Overhead Costs Allocable to Program $56,576 (G) Total Cost, Direct and Allocated, of Program $173,056 (H) (Line (E) Plus Line (F) Plus Line (G)) Anticipated Profits Contributed by this Program $0 (I) Total Costs and Profits to be Covered by this Program $173,056 (J) (Line (H) Plus Line (I)) Total Hours of Direct Service for Year 1,664 (K) (Must Equal Line (C)) Rate per Hour of Direct, Face-to-Face Service $104 (L) to be Charged to Weld County Department of Social Services Lutheran Family Services LIFE Program Computation of Direct Service Rate Total Hours of Direct Service Per Client 52 Hours (A) Total Clients to be Served 32 Clients (B) Total Hours of Direct Service for Year 1,664 Hours (C) (Line (A) Multiplied by Line (B)) Cost per our of Direct Services $37 Per Hour(D) Total Direct Service Costs _ $61,568 (E) (Line (C) Multiplied by Line (D)) Administration Costs Allocable to Program $54,912 (F) Overhead Costs Allocable to Program $56,576 (G) Total Cost, Direct and Allocated, of Program $173,056 (H) (Line (E) Plus Line (F) Plus Line (G)) Anticipated Profits Contributed by this Program $0 (I) Total Costs and Profits to be Covered by this Program $173,056_ (J) (Line (H) Plus Line (I)) Total Hours of Direct Service for Year 1,664_ (K) (Must Equal Line (C)) Rate per Hour of Direct, Face-to-Face Service $104 (L) to be Charged to Weld County Department of Social Services • Lutheran Family Services LIFE Program Computation of Direct Service Rate Total Hours of Direct Service Per Client _ 52 Hours (A) Total Clients to be Served 32 Clients (B) Total Hours of Direct Service for Year 1,664 Hours (C) (Line (A) Multiplied by Line (B)) Cost per our of Direct Services $37 Per Hour(D) Total Direct Service Costs $61,568 (E) (Line (C) Multiplied by Line (D)) Administration Costs Allocable to Program $54,912 (F) Overhead Costs Allocable to Program $56,576 (G) Total Cost, Direct and Allocated, of Program $173,056 (H) (Line (E) Plus Line (F) Plus Line (G)) Anticipated Profits Contributed by this Program $0 (I) Total Costs and Profits to be Covered by this Program $173,056 (J) (Line (H) Plus Line (I)) Total Hours of Direct Service for Year 1,664 (K) (Must Equal Line (C)) Rate per Hour of Direct, Face-to-Face Service $104 (L) to be Charged to Weld County Department of Social Services Lutheran Family Services LIFE Program Computation of Direct Service Rate Total Hours of Direct Service Per Client 52 Hours (A) Total Clients to be Served 32 Clients (B) Total Hours of Direct Service for Year 1,664 Hours (C) (Line (A) Multiplied by Line (B)) Cost per our of Direct Services $37 Per Hour(D) Total Direct Service Costs $61,568 (E) (Line (C) Multiplied by Line (D)) Administration Costs Allocable to Program $54,912 (F) Overhead Costs Allocable to Program $56,576 (G) Total Cost, Direct and Allocated, of Program $173,056 (H) (Line (E) Plus Line (F) Plus Line (G)) Anticipated Profits Contributed by this Program $0 (I) Total Costs and Profits to be Covered by this Program $173,056 (J) (Line (H) Plus Line (I)) Total Hours of Direct Service for Year 1,664 (K) (Must Equal Line (C)) Rate per Hour of Direct, Face-to-Face Service $104 (L) to be Charged to Weld County Department of Social Services M . . Lutheran Family Services LIFE Program Computation of Direct Service Rate Total Hours of Direct Service Per Client 52 Hours (A) Total Clients to be Served 32 Clients (B) Total Hours of Direct Service for Year 1,664 Hours (C) (Line (A) Multiplied by Line (B)) Cost per our of Direct Services $37 Per Hour(D) Total Direct Service Costs $61,568 (E) (Line (C) Multiplied by Line (D)) Administration Costs Allocable to Program $54,912 (F) Overhead Costs Allocable to Program $56,576 (G) Total Cost, Direct and Allocated, of Program $173,056 (H) (Line (E) Plus Line (F) Plus Line (G)) Anticipated Profits Contributed by this Program _ $0 (I) Total Costs and Profits to be Covered by this Program $173,056 (J) (Line (H) Plus Line (I)) Total Hours of Direct Service for Year 1,664 (K) (Must Equal Line (C)) Rate per Hour of Direct, Face-to-Face Service $104 (L) to be Charged to Weld County Department of Social Services RFP-FYC-98010 Attached A HOME BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING FAMILY PRESERVATION PROGRAM 1998/1999 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1998-1999 BID i/RFP-FYC-98010 NAMEOFAGENCY: Lutheran Family Services ADDRESS: 503 Remington, Ft. Collins, CO 80524 PHONE:J970) 484-5955 CONTACT PERSON: Sharon Thomas _ TITLE: Program Director DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Home Based Intensive Family Intervention Proeram is a family etm+¢th focused home•based seivias n f milirs in crisi ch time l •te D y�� produce positive change which protects childmt prevents or ends placement and preserves families 12-Month approximate Project Dates: I2-month contract with actual time-lines of: Start June 1. 1998 Start End May 31 1999 End TITLE OF PROJECT: Lutheran Family Services ' Intensive Family Empowerment (LIFE ) Program. Sharon Thomas , 2/1ei'l. 40/2166a-li G�KUCCO o�� 9(?) Name and Signature tu of Person Preparing Document Date 049 xJ Pit av st C z= O 3 - z o -9'S 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 1997-1998 to Program Fund year 1998-1999. Indicate No Change from FY 1997-1998 `J�'t Project Description 4 Target/Eligibility Populations Types of services Provided Measurable Outcomes — Service Objectives Workload Standards Staff Qualifications 4,1- t Unit of Service Rate Computation Program Capacity per Month T Certificate of Insurance INVITATION TO BID DATE: February 27, 1998 BID NO: RFP-FYC-98010 RETURN BID TQ Pat Persichino, Director of General Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal (RFP-FYC-98010)for. Family'Preservation Prog ram—Home Based Intensive Family jptervention Program Family I su s C h F ,"d or Family Preservation Program Funds Deadline: March 24, 1998, 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.RS. 26-5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement (C.RS. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1, 1998, through May 31, 1999, at specific rates for different types of service. The County will authorize approved vendors and rates for services only. The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited, phased in intensity, and produce positive change which protects children, prevents or ends placement, and preserves families. This program announcement consists of five parts, as follows: PART A...Administrative Information PART I)...Bidder Response Format PART B...Background, Overview and Goals PART F.....Bid Evaluation Process PART C...Statement of Work Delivery Date (After receipt of order) BID MUST BE SIGNED IN INK Chet Evenson TYPED OR PRINTED SIGNATURE VENDOR Lutheran Family Services (Name) Handwritten Signature By Authorized Officer or Agent of Vender ADDRESS 503 Remington TITLE _ iCaa± CFO Ft . Collins , CO 80524 DATE .2O --9 PHONE it 970-484-5955 The above bid is subject to Terms and Conditions as attached hereto and incorporated RFP-FYC-98008 Attached A Date of Meeting(s)with Social Services Division Supervisor J C-77-70-7:177 io Comments by SSD Supervisor:c 9—HAdt 3 Name and Signature of SSD Supervisor Date March 23, 1998 Core Services Proposal Home Based Intensive Family Intervention Lutheran Family Services of Colorado LIFE Program 1. PROJECT DESCRIPTION Lutheran Family Services of Colorado is a community based agency with an experienced staff that offers a wide range of services to children, families and adults. It is a non-profit agency which has provided human services to Colorado since 1948. Although the agency was established as an affiliate of the Lutheran Church, it is an equal opportunity agency that provides services to all individuals without consideration of religious beliefs, race, ethnicity, sex or economic status. Lutheran Intensive Family Empowerment (LIFE) program is a program component of the LFS Foster Care Program. LFS's Foster Care Program has been providing out of home care services to this region since 1993 and specializes in establishing permanency for children experiencing significant emotional and behavioral impairments. The LIFE program utilizes a comprehensive team approach for families in need of family preservation services. The LFS treatment team will consist of a Program Therapist and a Treatment Coordinator, The LIFE program is designed to promote the safety and well being of children and their families. Services will build upon primary family connections and to help parents improve their parenting abilities, identify parental strengths and support their efforts to provide care for their children. The program will expedite the return of children to their family and assist in creating a stable and nurturing family environment in which children can grow and develop. If children are returning to their permanent home from out of home care we intend to help them reintegrate and stabilize in the family system as soon as possible. The goal is to improve both individual and family functioning We will provide crisis intervention services throughout the duration of the families' involvement with our agency. LIFE program staff will attend formal training in the Family Based Decision Making model and mediation. These intervention tools will be implemented throughout our programs, including the LIFE program. The LIFE program will utilize the Family Risk Assessment Scales to assess the family's nut of home placement risk areas. This will enable the program to individualize services for each family's specific needs. II. TARGET/ELIGIBILITY POPULATIONS: Families considered appropriate for these services are those in which family members are facing problems that have affected their well-being, safety, psychosocial growth and development, and family stability. Families mandated or referred by the courts will be considered for the LIFE program contingent upon their willingness to participate in and ability to profit by participation in such services. Primary caregivers must demonstrate a desire to maintain family relationships and must possess the mental stability to utilize home based services. Eligible families will be screened by the referring DSS worker to insure that they meet the eligibility criteria for Program Areas 4, 5 or 6 target groups. Children will be at imminent risk of out of home placement or have been removed from the home and imminent return is expected. Clients will not be eligible if they can be successfully treated with less intensive service programs and those services have not yet been tried. The provision of services will have a reasonable possibility of diminishing or ameliorating the problematic behaviors/issues in the home. There must be a manageable level of risk of harm to the child and/or among family members. The LIFE program is considered a more intensive level of care than the LFS Intensive Family Therapy program. The LIFE program has the ability to serve 8 families at any given time. If each family is served for the estimated 3 months, we would be able to serve 32 families each year. (8 families x 4 quarters = 32). If family specific time extensions are granted, the overall number of families served would be reduced. If we assume that half the families are two parent families and each family has 2.5 children, we would serve 128 clients. (16 families x 2.5 children and 1 adult = 56 plus 16 families x 2.5 children and 2 adults = 72 for a total of 128). The LIFE program can serve children and their families where children are ages 0-18 although our program's established specialty has been with pre-adolescent children. We currently do not have any bilingual/bicultural staff members, however, we will attempt to recruit a staff member with these attributes if the need presented itself. We are unable to predict the number of individuals who will receive services in South County as we do not know what the referral statistics are. We are willing to travel to South County to provide services when financially feasible (we may need a couple of families at any given time to help minimize the cost of travel). All clients will have access to 24 hour crisis intervention services_ The monthly average capacity is 8 families as this is the ongoing program capacity. The expected length of services is 12 weeks The LIFE program is specifically designed to be short term and time limited in nature, with a length of service of three months or less in order to focus on the priority issues which have placed the 2 family at risk of dissolution. DSS may purchase services for another 1-3 month period of time if the need for services can be clinically justified. III. TYPES OF SERVICES TO BE PROVIDED Intake Assessment The LIFE program staff will be responsible for screening referrals to the program. There will be an acknowledgment of the referral within 4-6 hours with a tentative judgment as to the appropriateness of the family for services. If the initial information from the referring worker is adequate to make initial assessment that the family is appropriate for services, then the family will be contacted within a maximum of 48 hours to set up an appointment for the team to meet with the family team (which will include the family, the LIFE treatment team, significant others in the family's life, the DSS caseworker, etc.). The intent of this initial meeting will be to tentatively evaluate risk factors (Family Risk Assessment Scales), to inform the family of the intervention strategies which the program will implement and to gain beginning agreement to proceed with the services offered. Home Based Therapy The clinical philosophy that drives our practice is that we will provide services in the families environment whenever possible and appropriate. We believe that this treatment approach reduces the stress on the family by reducing the need for the family to adjust to our environment. We believe that we can provide more appropriate treatment in the family's 'natural environment', their home, their church, their school, etc. The second primary philosophy that directs our practice is that we will build on the strengths of the family and will utilize a strength based model of treatment and intervention. In home therapy will be provided by the LFS treatment team (a Program Therapist and a Treatment Coordinator). The treatment team will provide a minimum of 4 hours of direct service to the family per week. Weekly family sessions will be directed at resolving the issues identified in the Family Risk Assessment Scales through utilization of the Family Group Decision Making Model; mediation services; family, individual and conjoint therapy; and support groups. Concrete Services The clinical team will assist the family in identifying and utilizing stress management techniques and will provide individualized instruction in parenting skills with particular attention given to managing any problematic child behaviors. LFS also has a parent education program available which may be accessed by families when appropriate. z Collateral Services The clinical team will assist the family and their support network in accessing and utilizing community resources to deal with particular risk areas identified (ex: access to health care, housing, employment). The family's effective use of community resources is an imperative goal within this program as accessing resources is generally a core issue for families who have achieved a level of stress intensive enough to warrant a referral for family preservation services. Concrete problems frequently lead to stress which concomitantly interferes with resource management and most frequently leads to neglectful or abusive coping behaviors in parenting. Crisis Intervention Services The LIFE program staff will be available on a 24 hour basis. All clinical staff carries pagers and can respond to a crisis within 30 minutes. All families served in the LIFE program will receive services from all four service areas listed above. We believe that the circumstances that are serious enough to warrant referral to family preservation services are multi-faceted and require comprehensive interventions. IV MEASURABLE OUTCOMES (Based in part on county defined objectives) The LIFE program will utilize the Family Risk Scales in measuring the efficacy of the program. The Family Risk Scales were designed as a standardized measure of a child's risk of entering foster care The risk variables measured by the scales are those believed to contribute to or precipitate the need for out of home placement. Changes in a family's risk status may be determined by rating the scales two or more times (pre and post tests). The overall outcome objective of the program is to reduce the risk of the need for out of home placement. The measurement of the achievement of this objective will be obtained through completion of the Family Risk Scales. There are 26 risk factors included in the Family Risk Scales, the scales are: 1. Habitability of Family Residence 2. Suitability of Living Conditions 3. Financial Problems 4. Adult Relationships in Household 5. Family's Social Support 6. Parent's Physical•Health 7. Parent's Mental Health 8. Knowledge of Child Care and Development 9. Parent's Substance Abuse 10. Parent's Motivation for Problem Solving 11. Parent's Attitude to Preventing Placement 12. Client's Cooperation with Agency 13. Preparation for Parenthood 14. Supervision of Child Under Age 10 15. Parenting of Child Age 10 and Over 16. Physical Punishment of Child 17. Verbal Discipline of Child 18. Emotional Care and Stimulation of Infant (Under 2 Years) 19. Emotional Care and Stimulation of child Age 2 and Older 20. Physical Needs of Child 21. Sexual Abuse of Child 22. Child's Physical Health and Disabilities 23. Child's Mental Health 24. Child's School Adjustment 25. Child's Delinquent Behavior 26. Child's Home-Related Behavior. The Family Risk Assessment Scales will be used with the family at the onset of treatment to pinpoint the family's specific intervention needs. The tool may be used throughout the course of treatment to measure the family's movement toward amelioration of the highest risk concerns. The Family Risk Assessment Scales will be completed immediately prior to program completion in order to measure the change in the family's functioning and/or circumstances. The child's living arrangements will be documented at the time the case is closed. (Is the child still in the home?) The LIFE program staff will develop a follow up contact sheet which will include the objectives listed by the department, i.e.: Is the child still in the home? Has there been substantiated abuse/neglect in this family? An aftercare plan for each family will be developed which includes referral to a less intensive family counseling program and/or the use of informal and community resources, such as family self help groups or networks for those who wish such a connection. A system of follow-up at specified points after case closing will also be developed. This system will check that the recommended supports and services which were wanted by the families are in place During the course of the follow up contact, the follow up contact sheet will be used to document the status of the objectives defined by the department V. SERVICE OBJECTIVES The four minimum service objectives that the department would like to have assessed are inherent in the Family Risk Assessment Scales. The Family Risk Assessment Scales provides 5 • more detailed assessment of the family's risk areas and will satisfy this criteria. The risk factors are listed in the section immediately prior to this one. VI. WORKLOAD STANDARDS The LIFE program uses a team approach to the provision of intensive home based services. We will assign two professional staff members to each family. Each staff member has a maximum caseload of eight families. The treatment team will provide a total of four hours of direct services to the family each week, for a total of seventeen hours of direct services per month (4 x 4.3 = 17). We are prepared to offer services to a maximum of eight families at a time. We are willing to expand this program so that we can serve more families if the department presents the need. We currently have ten staff members who are qualified to provide these services. As mentioned earlier, the LIFE program is a program component of the LFS foster care program so the staff may carry foster care cases as well as family preservation cases. Our supervision standard is one FTE supervisor for every six FTE professional staff members. VII. STAFF QUALIFICATIONS Direct service providers assigned to this program are qualified by one of the following: • a master's degree in social work or a master's degree in another human service field and at least two years of pre- or post-master's experience in family and children's services; and/or • a bachelor's degree in social work or a bachelor's degree in another human service field and at least three years' post-degree experience in family and children's services If we are awarded a contract with the department we will secure new caseworker training and the state Home Based Intensive Family Services training. The staff will be trained in the use of the risk assessment scale used by the county department of social services as well as the Family Risk Assessment Scales. We currently have the following staff available to provide direct services in this program: Pam Inberg, BSW Joe Madrid, LCSW Marilyn Welburn, BSW Julie Courtney, LCSW Wynnie Wahlfeldt, MA Kathy McLeod, LCSW Mary Klopfenstein, BSW Randy Mergler, MS Kathy Lees, MSW Candidate Kathy Lerch, MS We also believe that we will be hiring 2-6 new staff members over the next year They MI meet the minimum staff qualifications listed above. a VII. COMPUTATION OF DIRECT SERVICE RATE Direct Time (Per Month) (for 2 full time staff members) Monthly (4 hours/week x 4.3 weeks) 1. Direct client contact 144 Indirect Time 2. Completion of paperwork 32 3. Travel 104 4. Court appointments 8 5. Vacation 8 6. Sick 8 7. Case management 48 8. Other 9. Subtotal 208 10. Total Time per month 352 11. Ratio of direct to total time 40% 40% 7 IX. RATE COMPUTATION Service Costs Monthly Total Total % time Direct Hourly Direct Spent on Time Rate Hourly Program Charge Rate Direct Costs Salary 5,190.00 36.00 100% 36.00 Benefits 1,142.00 8.00 100% 8.00 Subtotal 6,332.00 44.00 100% 44.00 Administrative Costs Supervision Salary 3,083.00 18.00 33% 6.00 Benefits 678.00 4.00 33% 1.00 Clerical Salary 1,557.00 9.00 15% - 1.00 Benefits 343.00 2.00 15% 0 Subtotal 5,661.00 33.00 8.00 Agency Overhead Rent 30,100.00 Utilities 1,440.00 Supplies 6,980.00 Postage 1,720.00 Travel 25,580.00 Telephone 15,500.00 Equipment 12,200.00 Data Processing 0 Other 15,366.00 Total 108,886.00 # of Employees 13 Overhead per Employee 8,376.00 Overhead Per Total Hours 48.00 48.00 Direct Service Rate (Hourly) 100.00 8 W•so JYJ 4019 SEABURT 4 SMITH oo a.. 3 0 /20/98 PHOOIJCER THIS CIfRtIICAIE • If5UIO AS A MATTER OF N ORMAToM LY Sea.+W J cX Smith, RIGHTS UPON THE CERTIFICATE WONDER THIS am-v CATS DOESN NOT AM) CA EAc OR ALTIR TH(COVERAGE ARWIOED ev THE rOucal�EIOW. 0'T P.O. Box 7157 San Francisco, CA 94120 COMPANIES AFFORDING COVERAGE COMPANY • LerTVR A Preferred Risk Mutual Mama) COMPANY --'---�--- LETTER B Waiisall Insurance Companies Lutheran Family Services of Colorado COMPANY C 363 South Harlan LETTEft Denver- CO 80226 CE COMPANYLETTER E — -- �..,y This IS TO ototTrY THAT THE POUCES OF INSURANCE USTIO K1OW HAVE atm ISSUED TO THE IMLUREO NAMED APOVE FOR THE POLICY pERioo INDICATED, NOTNTIHSTAIDIIG ANY REOURE►•MT. TERM OR COMMON Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT To WHICH THIS OURncATE E MAY AIM IR M&!ED OR MAY PERTAIN, 7M Ma3IRANCE A POADED Iv THE rOUCCS oESOUSED HERON IS SUBJECT TO ALL 11E TEPAu cote mONs OF SUOL POLICES. UMRs SHOWN MAY HAVE SEEN REDUCED EY PAD CLARK. D.. SAL MAHAL UmiknY ..•'`'.-• "S 000000-0 A "'''.Clan Hone ]CcOJ` 9618-911 07101/97 07/01/98 'ei-soNK I�AN.AWRY 100_5_,___2.000I) oWHDesa�nNIRAe+are FRDT. E-�'O $1,000.000.0' FIRE o.NAGE w......+ S 1.000.000.0( AUTPW:4112 Warn' ANY AUTO CON NOD SNCI.,UNIT . ALL OWNED AUTOS --- —_—. 8tlOAEJ AuraeaCCYY MARY Iti r0' NSTED AUTOS NONDV/IIm A1111011eoair NAgY I.----- GARAGE UMWI Y ----,—._-- PFeell V flAMiOE ' EstF.a L aauTY - -- ---- Era O'curasiAmor --- E.MeAnLA raRAI ---- --—_-- AGo F4ATE OII®t TNMN WDRBU 1•CWI 4 MMImi,OOeIEI1a*710N STATUR)ry l*IT3 B 1M° Otis-00-002041 02/•01198 02/01/99 `A lAOCCO r 8500,000.00 [&�SCYEII'a Lan 2TPASE POI ay LAC - 5500,000.00 b'- Y OT1♦7l FIT-FAt�EIDVEE 5500,000.00 t.RR3.rnOTT or orEllAT7CM I L ATOTS/vIDMl/MC:W.MikC'. FC._3 a r.:.. •...:',' . . Wdd County SHOULD ANY OF THE mow CF.SCR9Go Pellets lie c.mic uFD SCORE THE P 0 Box-A 07RATION RATE THEREOF, THE msupsa opener WILL ODEAVOR TO*JA. C+EDL1Cy__(�.i•. T2 _ 10 DAYS WIMTIN NOTICE TO THE Celt Ti 3CATE MOLDER NAMED TO TMP trrt. sUT 'frame TO LWL sera, NOTICE SHALL &POSE NO OIUGITIOA Oit LIABILITY OF ANY UPON THE ANY.rrgsu MS OR REPRESENTATMS 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 99-CORE-001 Revision (RFP-FYC-99008) Contract Award Period Name and Address of Contractor Beginning 06/01/1999 and Lutheran Family Services-IFT Ending 05/31/2000 3800 Automation Way, Suite 200 Fort Collins, CO 80525 Computation of Awards Descriutiun Unit of Service The issuance of the Notification of Financial Assistance The IFT program is designed to promote the safety and Award is based upon your Request for Proposal (RFP). well being of children and their family members. The RFP specifies the scope of services and conditions Services will build upon family connections and to help of award. Except where it is in conflict with this parents improve their parenting ability, identify parental NOFAA in which case the NOFAA governs, the RFP strengths and support their efforts to provide care for upon which this award is based is an integral part of the their children. The program goal is to improve both action. individual and family functioning. Crisis intervention services will be provided throughout the duration of the Special conditions families' involvement with our agency. Maximum number of families served per year is 32 with children 1) Reimbursement for the Unit of Services will be based 0-1 8 years, a maximum of eight families at any given on an hourly rate per child or per family. time. 2) The hourly rate will be paid for only direct face to face contact with the child and/or family, as evidenced by client-signed verification form, and as specified in the Cost Per Unit of Service unit of cost computation. 3) Unit of service costs cannot exceed the hourly and Hourly Rate Per $100.00 'yearly cost per child and/or family. Unit of Service Based on Approved Plan 4) Payment will only be remitted on cases open with, and referrals made by the Weld County Department of Enclosures: Social Services. ✓Signed RFP:Exhibit A 5) Requests for payment must be an original submitted to Supplemental Narrative to RFP: Exhibit B the Weld County Department of Social Services by the Recommendation(s) end of the 25`h calendar day following the end of the month of service. The provider must submit requests Conditions of Approval for payment on forms approved by Weld County Department of Social Services. Approvals: Program Official: By%.\----)aBy—t Dale K. Hall, Chair Judy, . riego, Director Board of Weld County Commissioners Weld unty Department of Social Services Date: .c. e,, /oj p Date: 5l/74/Q Cr 9rt.9.4 � ( )3) • • • Lutheran Family Services OF COLORADO Strengthening individuals and families for over 40 years. March 13, 1999 Weld County Government ATT: Pat Persichino Director of General Services 915 10th Street P.O. Box 758 Greeley; CO 80632 RE:-- Bid No: RFP-FYC-99008 Intensive Family Therapy Program Dear Ms. Persichino: Please accept the attached paperwork necessary to renew our contract to provide intensive family therapy services (our IFT program). It is my understanding that I have enclosed the necessary documentation and do not need to submit a new bid if there are not significant changes in the program design and if I am willing to accept a 4% rate increase. As this program is willing to accept these two conditions, I have attached the information necessary for contract renewal. Please do not hesitate to call if I need to provide further information. Thank you for your time and consideration of this matter. Respectfully submitted: Sharon K. Thomas, LCSW Program Director Enc. Signed Invitation to Bid Signed Cover Sheet Division Supervisor Comments Current Certificate of Insurance (970) 266-1788 • Fax 266-1799 3800 Automation Way, Ste. 200 • Fort Collins, CO 80525 Atliliated with The Evangelical Lutheran Church in America and The Lutheran Church-Missouri Sy,. A United Way Agency •l INVITATION TO BID DATE: February 26, 1999 BID NO: RFP-FYC-99008 RETURN BID TO: Pat Persichino, Director of General Semites 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 —d (After receipt of order) BID MUST BE SIGNED IN INK _ Chet Evenson TYPED OR PRINTED SIGNATURE VENDOR Lutheran Family Services (Name) Handwritten Signature By Authorized Officer or Agent of Vender Way ADDRESS 3800 Automation #200 TITLE President and CEO Ft. Collins, CO 80525 DATE .3-/2—44 PHONE 4 (970)266-1788 Fax:266-1799 The above bid is subject to Terms and Conditions as attached hereto and incorporated Page I of 35 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: Lutheran Family Services ADDRESS: 3800 Automation Way #200 PHONE( 970) 266-1788 FAX: 266-1799 CONTACT PERSON: Marilyn Welburn TITLE: Program Supervisor DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists.typically with all family members,to improve family communication,functioning,and relationships 12-Month approximate Project Dates: 12-month contract with actual time lines of: Start June 1 1999 Start End May 31, 1999 End TITLE OF PROJECT: Lutheran Family Services IFT Program Sharon K. Thomas C ,W ,.� kc/tl// may `]///9y Name and Signature of Person Preparing Document Date f at, "3-12 "it Name and Signature Chief Administrative Officer Applicant Agency Date I/ 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 frqn, FY 1998-1999 Project Description x yit Target/Eligibility Populations X _ Types of services Provided X Measurable Outcomes X Service Objectives X Workload Standards x Staff Qualifications Unit of Service Rate Computation X rogram Capacity per Month X gir 'ertificate of Insurance Paon 70 Vic • RFP-FYC-99010 Attached A Date of Meeting(s)with Social Services Division Supervisor Comments by SSD Sypervisor:, y ,r/c, « e' 6 Name and Signature of SSD Supervisor Date 3-89-1999 2-21 Art FROM LUTHERAN FAMILY SRvC 3039227335 R2 rteDingl DATE ryroONrh • PRODUCER 7114198 1400-339-9124 : 1 a •T SEABURY&SMITH ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE THREE EMBARCADERO CENTER HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR THREE 0. BOX 7157 _ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. .N FRANCISCO, CA 94120 _ COMPANIES AFFORDING COVERAGE I COMPANY PREFERRED RISK MUTUAL INSURED - -_- - --� ti I LUTHERAN FAMILY SERVICES COMPANY WAUSAU INSURANCE COMPANIES B OF COLORADO cOMPANv 363 SOUTH HARLAN i c DENVER,CO 80226 ---- 'F — - - COYPANM D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TM' TYPE OF NhIRANCE POLICY NURSER LI I EFFECTIvE EXPIRATION p I DATEIMWOMY) DATEIMWOO/YO f LIMITS,GENERAL LIABILITY 9618-9f1 07/01198 07M-1-J99 +GENERAL AGGREGATE i X I CONMERCLAL GENERALUABILITY tll//�I�/ii!! 1 10003,000,000.00 CLAMS CLAMS MADE X OCCUR IPRooucts•cow CORM*WBIi i 3,000,000.00 PERSONAL LADY INJURY 4 1-OOO S OWNERS•CONTRACTOR'S PROT EACH OCCURRENCE ) 1,•�� .DDD.DD --.j--.jI TIRE DAMAGE(Am in AA) S 1 000.000.0M0 I I MED Sic AUTOMOBILE LIABILITY I I (Arty an paste) j S 5,000 ANY AUTO I COMBINED DINGLE LIMIT i ALL OWNED AUTOS j 1— _ j SIRED SCHEDULED UTOS I BODILY INJURY E PLYNl 'I NONowNEO AUTOS MAI A IRY — I I 1 001, I PROPERTY DAMAGE II ItnGARAGE LIABILITY r jI {AUTO ONLY-EA Att.IDEN T $ ANY AUTO OTHER THAN AUTO ONLY' I-'-+I I EAGN ACCIDENT it 'EXCESS LM)Km EACH AGGREGATE 1 rUMBRELLA FORM AGGREGATE ENCE S ! E ~fl OTHER THAN UMBRELLA FORM AGGREGATE _t g WORKERS COMPENSATION AND 0818-00-002041 r P.TJ ATV• I lug $ (IMR.OYERC LIAagm 02/01/98 02/01/99 ,TORY Lairs; ER --- EL EACH ACCIDENT ME (—, I 411 iii,11 NER62EECUnvE I___, INCL ' El.DISEASE•POLICY UST S PARPHERSBTOAI Oh a4AR2. IEXCl I El.DISEASE-EA EMPLOYEE I HER I OESCRN•T on CS OPERA THONSLOCATON&Yln ctesisPecaL ITEM S EVIDENCE OF INSURANCE MOULD ANY OP THE ADOYE DESCRM ID POLICIES IS DANCELLED WORE TIE WELD VELD COUNTY EIRRATON DATE THEREat TILE ISSUING COMPANY WRl ENOCAVOR TO Na P.O. BOX A In DAYS WRITTEN NOME. T TO 7115 CERTIFICATE MILDER.NAACO TO V LEFT, GREELFV. CO 80632 BUT FAIUYR F_ AMR To MACR NOTICE SHALL 'ARGUE NO OeUOATON OR LYBILAN OF ANY KIND UPON TII! COIF A OR MINIVAN iATTt£b. AUTHORIZED REPRESERTATR2 Lutheran Family Services IFT Program Computation of Direct Service Rate Total Hours of Direct Service Per Client 26 Hours (A) Total Clients to be Served 32 Clients (B) Total Hours of Direct Service for Year 832 Hours (C) (Line (A) Multiplied by Line (B)) Cost per our of Direct Services $37 Per Hour(D) Total Direct Service Costs _ $30,784 (E) (Line (C) Multiplied by Line (D)) Administration Costs Allocable to Program $27,456 (F) Overhead Costs Allocable to Program $24,960 (G) Total Cost, Direct and Allocated, of Program $83,200 (H) (Line (E) Plus Line (F) Plus Line (G)) Anticipated Profits Contributed by this Program _ $0 (I) Total Costs and Profits to be Covered by this Program $83,200 (J) (Line (H) Plus Line (I)) Total Hours of Direct Service for Year 832 (K) (Must Equal Line (C)) Rate per Hour of Direct, Face-to-Face Service $100 (L) to be Charged to Weld County Department of Social Services Lutheran Family Services IFT Program Computation of Direct Service Rate Total Hours of Direct Service Per Client 26 Hours (A) Total Clients to be Served 32 Clients (B) Total Hours of Direct Service for Year 832 Hours (C) (Line (A) Multiplied by Line (B)) Cost per our of Direct Services $37 Per Hour (D) Total Direct Service Costs $30,784 (E) (Line (C) Multiplied by Line (D)) Administration Costs Allocable to Program $27,456 (F) Overhead Costs Allocable to Program $24,960 (G) Total Cost, Direct and Allocated, of Program $83,200 (H) (Line (E) Plus Line (F) Plus Line (G)) Anticipated Profits Contributed by this Program $0 (I) Total Costs and Profits to be Covered by this Program $83,200 (J) (Line (H) Plus Line (I)) Total Hours of Direct Service for Year 832 (K) (Must Equal Line (C)) Rate per Hour of Direct, Face-to-Face Service $100 (L) to be Charged to Weld County Department of Social Services • Lutheran Family Services FT Program Computation of Direct Service Rate Total Hours of Direct Service Per Client 26 Hours (A) Total Clients to be Served 32 Clients (B) Total Hours of Direct Service for Year 832 Hours (C) (Line (A) Multiplied by Line (B)) Cost per our of Direct Services $37 Per Hour(D) Total Direct Service Costs _ $30,784 (E) (Line (C) Multiplied by Line (D)) Administration Costs Allocable to Program $27,456 (F) Overhead Costs Allocable to Program $24,960 (G) Total Cost, Direct and Allocated, of Program $83,200 (H) (Line (E) Plus Line (F) Plus Line (G)) Anticipated Profits Contributed by this Program $0 (I) Total Costs and Profits to be Covered by this Program $83,200 (J) (Line (H) Plus Line (I)) Total Hours of Direct Service for Year 832 (K) (Must Equal Line (C)) Rate per Hour of Direct, Face-to-Face Service $100 (L) to be Charged to Weld County Department of Social Services Lutheran Family Services IFT Program Computation of Direct Service Rate Total Hours of Direct Service Per Client 26 Hours (A) Total Clients to be Served 32 Clients (B) Total Hours of Direct Service for Year 832 Hours (C) (Line (A) Multiplied by Line (B)) Cost per our of Direct Services $37 Per Hour(D) Total Direct Service Costs $30,784 (E) (Line (C) Multiplied by Line (D)) Administration Costs Allocable to Program _ $27,456 (F) Overhead Costs Allocable to Program $24,960 (G) Total Cost, Direct and Allocated, of Program $83,200 (H) (Line (E) Plus Line (F) Plus Line (G)) Anticipated Profits Contributed by this Program $0 (I) Total Costs and Profits to be Covered by this Program $83,200 (J) (Line (H) Plus Line (I)) Total Hours of Direct Service for Year 832 (K) (Must Equal Line (C)) Rate per Hour of Direct, Face-to-Face Service $100 (L) to be Charged to Weld County Department of Social Services Lutheran Family Services IFT Program Computation of Direct Service Rate Total Hours of Direct Service Per Client 26 Hours (A) Total Clients to be Served 32 Clients (B) Total Hours of Direct Service for Year 832 Hours (C) (Line (A) Multiplied by Line (B)) Cost per our of Direct Services $37 Per Hour (D) Total Direct Service Costs $30,784 (E) (Line (C) Multiplied by Line (D)) Administration Costs Allocable to Program $27,456 (F) Overhead Costs Allocable to Program $24,960 (G) Total Cost, Direct and Allocated, of Program _$83,200 (H) (Line (E) Plus Line (F) Plus Line (G)) Anticipated Profits Contributed by this Program $0 (I) Total Costs and Profits to be Covered by this Program $83,200 (J) (Line (H) Plus Line (9) Total Hours of Direct Service for Year 832 (K) (Must Equal Line (C)) Rate per Hour of Direct, Face-to-Face Service $100 (L) to be Charged to Weld County Department of Social Services Lutheran Family Services IFT Program Computation of Direct Service Rate Total Hours of Direct Service Per Client 26 Hours (A) Total Clients to be Served 32 Clients (B) Total Hours of Direct Service for Year 832 Hours (C) (Line (A) Multiplied by Line (B)) Cost per our of Direct Services $37 Per Hour (D) Total Direct Service Costs $30,784 (E) (Line (C) Multiplied by Line (D)) Administration Costs Allocable to Program $27,456 (F) Overhead Costs Allocable to Program $24,960 (G) Total Cost, Direct and Allocated, of Program $83,200 (H) (Line (E) Plus Line (F) Plus Line (G)) Anticipated Profits Contributed by this Program $0 (I) Total Costs and Profits to be Covered by this Program $83,200 (J) (Line (H) Plus Line (I)) Total Hours of Direct Service for Year 832 (K) (Must Equal Line (C)) Rate per Hour of Direct, Face-to-Face Service $100 (L) to be Charged to Weld County Department of Social Services RFP-FYC-98008 ached A INTENSIVE FAMILY THERAPY PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING FAMILY PRESERVATION PROGRAM 1998/1999 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1998-1999 BID#RFP-FYC-98008 NAME OF AGENCY: Lutheran Family Services ADDRESS: 503 Remington, Ft . Collins, CO 80524 PHONE:I970) 484-5955 CONTACT PERSON: Sharon Thomas - TITLE: Program Director DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Intensive Family Therapy Program mint provide for therapeutic intervention through one or more_qtalifed family therapists typically with all family members,to improve family communication-functioning_and relationships 12-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June 1. 1998 Start End May 31. 1999 End TITLE OF PROJECT: Lutheran Family Services ' Intensive Family Therapy ( IFT) Progr. Sharon Thomas r5 A.Qn. a140/JZ4y/ ii 34)3/i( Name and Signature of Person Preparing Document Date P, CEO 3 -2° -7.37 Name and Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL BEOUIJEMENTS 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 1997-1998 to Program Fund year 1998-1999. Indicate No Change from FY 1997-1998 Project Description 't Target/Eligibility Populations Types of services Provided a Measurable Outcomes Service Objectives _ 41 Workload Standards Staff Qualifications Unit of Service Rate Computation Program Capacity per Month _ Al Certificate of Insurance flit INVITATION TO BID DATE: February 27, 1998 BID NO: RFP-FYC-98008 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-98008) for: Family Preservation Program—Intensive Family Therapy Program Family Issues Cash Fund or Family Preservation Program Funds Deadline: March 24, 1998, 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.RS. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1, 1998 through May 31, 1999 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 Chet Evenson - TYPED OR PRINTED SIGNATURE VENDOR Lutheran Family Services ,Y( (Name) Handwritten Signature By Authorized Officer or Agent of Vender p ADDRESS 503 Remington TITLE P >i R cc& Ft . Collins , CO 80524 DATE 3l Zo-`.�8 PHONE # 970-484-5955 The above bid is subject to Terms and Conditions as attached hereto and incorporated 1 RFP-FYC-98010 Attached A Date of Meeting(s)with Social Services Division Supervisor: ---777T-77 Comments by SSD Su or: z 7 62 3 =Z o' Pr Name and Signature of SSD Supervisor Date of March 23, 1998 Core Services Proposal Intensive Family Therapy Lutheran Family Services of Colorado Intensive Family Therapy PROJECT DESCRIPTION Lutheran Family Services of Colorado is a community based agency with an experienced staff that offers a wide range of services to children, families and adults. It is a non-profit agency which has provided human services to Colorado since 1948. Although the agency was established as an affiliate of the Lutheran Church, it is an equal opportunity agency that provides services to all individuals without consideration of religious beliefs, race, ethnicity, sex or economic status. Lutheran Family Services' Intensive Family Therapy (IFT) program is a program component of the LFS Foster Care Program. LFS's Foster Care Program has been providing out of home care services to this region since 1993 and specializes is establishing permanency for children experiencing significant emotional and behavioral impairments. The IFT program is designed to promote the safety and well being of children and their family members. Services will build upon primary family connections and to help parents improve their parenting abilities, identify parental strengths and support their efforts to provide care for their children. The program will expedite the return of children to their family and assist in creating a stable and nurturing family environment in which children can grow and develop. If children are returning to their permanent home from out of home care we intend to help them reintegrate and stabilize in the family system as soon as possible. The program goal is to improve both individual and family functioning. We will provide crisis intervention services throughout the duration of the families' involvement with our agency. IFT staff will attend formal training in the Family Based Decision Making model and mediation. These intervention tools will be implemented throughout our programs, including the IFT program. The IFT program will utilize the Family Risk Assessment Scales to assess the family's out of home placement risk areas, this will enable the program to individualize services for each family's specific needs. Additionally, we will be using the Achenbach Child Behavior Checklists, when appropriate, to assess problematic behaviors, if any, presented by the children in the family. We have the ability to administer the SASSI (substance abuse screening) when warranted. II. TARGET/ELIGIBILITY POPULATIONS: Families considered appropriate for these services are those in which family members are facing problems that have affected their well-being, safety, psychosocial growth and development, and family stability. Families mandated or referred by the courts will be considered for the IFT program contingent upon their willingness to participate in and ability to profit by participation in such services. Primary caregivers must demonstrate a desire to maintain family relationships and must possess the mental stability to utilize home based services. Eligible families will be screened by the referring DSS worker to insure that they meet the eligibility criteria for Program Areas 4, 5 or 6 target groups. Children will be at imminent risk of out of home placement or have been removed from the home and imminent return is expected. Clients will not be eligible if they can be successfully treated with less intensive service programs and those services have not yet been tried. Families appropriate for this program should be able to benefit from services that are primarily therapeutic in nature (vs. concrete and collateral). The provision of services will have a reasonable possibility of diminishing or ameliorating the problematic behaviors/issues in the home. There must be a manageable level of risk of harm to the child and/or among family members. The IFT program is considered a less intensive program than Lutheran's LIFE program. The IFT program has the ability to serve 8 families at any given time. If each family is served for the estimated 3 months, we would be able to serve 32 families each year. (8 families x 4 quarters = 32). If family specific time extensions are granted, the overall number of families served would be reduced. If we assume that half the families are two parent families and each family has 2.5 children, we would serve 128 clients. (16 families x 2.5 children and 1 adult = 56 plus 16 families x 2.5 children and 2 adults = 72 for a total of 128). The IFT program can serve children and their families where children are ages 0-18 although our program's established specialty has been with pre-adolescent children. We currently do not have any bilingual/bicultural staff members, however, we will attempt to recruit a staff member with these attributes if the need presented itself. We are unable to predict the number of individuals who will receive services in South County as we do not know what the referral statistics are. We are willing to travel to South County to provide services when financially feasible (we may need a couple of families at any given time to help minimize the cost of travel). All clients will have access to 24 hour crisis intervention services. The monthly average capacity is 8 families as this is the ongoing program capacity. The expected length of services is 12 weeks. The IFT program is specifically designed to be short term and time limited in nature, with a length of service of three months or less in order to focus on the priority issues which have placed the 2 family at risk of dissolution. DSS may purchase services for another 1-3 month period of time if the need for services can be clinically justified. III. TYPES OF SERVICES TO BE PROVIDED Intake Assessment The IFT program staff will be responsible for screening referrals to the program. There will be an acknowledgment of the referral within 4-6 hours with a tentative judgment as to the appropriateness of the family for services. If the initial information from the referring worker is adequate to make initial assessment that the family is appropriate for services, then the family will be contacted within a maximum of 48 hours to set up an appointment for the therapist to meet with the family team (which will include the family, the IFT therapist, significant others in the family's life, the DSS caseworker, etc.). The intent of this initial meeting will be to tentatively evaluate risk factors (Family Risk Assessment Scales), to inform the family of the intervention strategies which the program will implement and to gain beginning agreement to proceed with the services offered. Home Based Therapy The clinical philosophy that drives our practice is that we will provide services in the families environment whenever possible and appropriate. We believe that this treatment approach reduces the stress on the family by reducing the need for the family to adjust to our environment. We believe that we can provide more appropriate treatment in the family's 'natural environment', their home, their church, their school, etc. The second primary philosophy that directs our practice is that we will build on the strengths of the family and will utilize a strength based model of treatment and intervention. In home therapy will be provided by a Program Therapist. The Program Therapist will provide a minimum of 2 hours of direct service to the family per week. Weekly family therapy sessions will be designed to provide comprehensive, diagnostic and treatment planning with the family and other service providers. Therapeutic interventions will be flexible enough to bring in other service providers, if needed. The preponderance of services provided in this program will fall into this category. Therapy will be designed to resolve conflicts and disagreements within the family and to enhance parenting skills and overall family functioning. 3 Concrete Services The Program Therapist will assist the family in identifying and utilizing stress management techniques and will provide individualized instruction in parenting skills with particular attention given to managing any problematic child behaviors. LFS also has a parent education program available which may be accessed by families when appropriate. Collateral Services The Program Therapist will assist the family and their support network in accessing and utilizing community resources to deal with particular risk areas identified (ex: access to health care, housing, employment). The family's effective use of community resources is an imperative goal within this program as accessing resources is generally a core issue for families who have achieved a level of stress intensive enough to warrant a referral for family preservation services. Concrete problems frequently lead to stress which concomitantly interferes with resource management and most frequently leads to neglectful or abusive coping behaviors in parenting. Crisis Intervention Services The IFT program staff will be available on a 24 hour basis. All clinical staff carries pagers and can respond to a crisis within 1 hour. All families served in the IFT program will receive therapy services and crisis intervention services. As time permits, support and facilitation of concrete and collateral services will be offered. IV MEASURABLE OUTCOMES (Based in part on county defined objectives) The IFT program will utilize the Family Risk Scales and the Achenbach Child Behavioral Check Lists in measuring the efficacy of the program. The Achenbach Child Behavioral Check Lists measures the caregiver's, teacher's and child's assessment of the child's problematic behaviors. The Family Risk Scales were designed as a standardized measure of a child's risk of entering foster care. The risk variables measured by the scales are those believed to contribute to or precipitate the need for out of home placement. Changes in a family's risk status may be determined by rating the scales two or more times (pre and post tests). Changes in the child's functioning may be determined by using the Achenbach two or more times (pre and post tests) The overall outcome objective of the program is to reduce the risk of the need for out of home placement. The measurement of the achievement of this objective will be obtained through completion of the Family Risk Scales. There are 26 risk factors included in the Family Risk Scales, the scales are: 4 1. Habitability of Family Residence 2. Suitability of Living Conditions 3. Financial Problems 4. Adult Relationships in Household 5. Family's Social Support 6. Parent's Physical Health 7. Parent's Mental Health 8. Knowledge of Child Care and Development 9. Parent's Substance Abuse 10. Parent's Motivation for Problem Solving 11. Parent's Attitude to Preventing Placement 12. Client's Cooperation with Agency 13. Preparation for Parenthood 14. Supervision of Child Under Age 10 15. Parenting of Child Age 10 and Over 16. Physical Punishment of Child 17. Verbal Discipline of Child 18. Emotional Care and Stimulation of Infant (Under 2 Years) 19. Emotional Care and Stimulation of child Age 2 and Older 20. Physical Needs of Child 21. Sexual Abuse of Child 22. Child's Physical Health and Disabilities 23. Child's Mental Health 24. Child's School Adjustment 25. Child's Delinquent Behavior 26. Child's Home-Related Behavior. The Family Risk Assessment Scales and the Achenbach Checklists will be used with the family at the onset of treatment to pinpoint the family's specific intervention needs. The tools may be used throughout the course of treatment to measure the family's movement toward amelioration of the highest risk concerns. The Family Risk Assessment Scales and the Achenbach Checklists will be completed immediately prior to program completion in order to measure the expected improvement in the family and child's functioning. The child's living arrangements will be documented at the time the case is closed. (Is the child still in the home?) The IFT program staff will develop a follow up contact sheet which will include the objectives listed by the department, i.e.: is the child still in the home? Has there 5 been substantiated abuse/neglect in this family? An aftercare plan for each family will be developed which includes referral to a less intensive family counseling program and/or the use of informal and community resources, such as family self help groups or networks for those who wish such a connection. A system of follow-up at specified points after case closing will also be developed. This system will check that the recommended supports and services which were wanted by the families are in place. During the course of the follow up contact, the follow up contact sheet will be used to document the status of the objectives defined by the department. V. SERVICE OBJECTIVES The three minimum service objectives that the department would like to have assessed are inherent in the Family Risk Assessment Scales. The Family Risk Assessment Scales provides more detailed assessment of the family's risk areas and will satisfy this criteria. The risk factors are listed in the section immediately prior to this one. VI. WORKLOAD STANDARDS A Program Therapist will be assigned to each family accepted into the program. We are prepared to offer services to a maximum of eight families at a time. We currently have six staff members who are qualified to provide these services. As mentioned earlier, the IFT program is a program component of the LFS foster care program so the staff may carry foster care cases as well as family preservation cases. Our supervision standard is one FTE supervisor for every six FTE professional staff members. VII. STAFF QUALIFICATIONS Direct service providers assigned to this program are qualified by one of the following: • a master's degree in social work or a master's degree in another human service field and at least two years of pre- or post-master's experience in family and children's services; and/or • a bachelor's degree in social work or a bachelor's degree in another human service field and at least six years' post-degree experience in family and children's services. All staff has expertise in family therapy as demonstrated by specialized training and/or experience. All staff in this program will be required to secure a minimum of eight hours per year of continuing education training. All staff will receive weekly supervision from a supervisor experienced in Intensive Family Therapy. The clinical supervisor will be required to secure a minimum of ten hours per year of continuing education training. We currently have the following staff available to provide direct services in this program: Randy Mergler, MS Joe Madrid, LCSW Marilyn Welburn, BSW Julie Courtney, LCSW Kathy McLeod, LCSW Kathy Lorch, MS 6 We also believe that we will be hiring 2-6 new staff members over the next year. They will meet the minimum staff qualifications listed above. VII. COMPUTATION OF DIRECT SERVICE RATE Direct Time (Per Month) weekly monthly (x 4.3) 1. Direct client contact 2 9 Indirect Time 2. Completion of paperwork .5 2 3. Travel 1.5 6.5 4. Court appointments .125 .5 5. Vacation .125 .5 6. Sick .125 .5 7. Case management .625 3 8. Other 9. Subtotal 3 13 10. Total Time per month 5 22 11. Ratio of direct to total time 40% 40% 7 • • IX. RATE COMPUTATION Service Costs Monthly Total Total % time Direct Hourly Direct Spent on Time Rate Hourly Program Charge Rate Direct Costs Salary 2,595.00 15.00 100% 15 00 Benefits 571.00 3.00 100% 3.00 Subtotal 3,166.00 18.00 100% 18.00 Administrative Costs Supervision Salary 3,083.00 18.00 15% 3.00 Benefits 678.00 4.00 15% 0 Clerical Salary 1,557.00 9.00 15% 1.00 Benefits 343.00 2.00 15% 0 Subtotal 5,661.00 33.00 4.00 Agency Overhead Rent 30,100.00 Utilities 1,440.00 Supplies 6,980.00 Postage 1,720.00 Travel 25,580.00 Telephone 15,500.00 Equipment 12,200.00 Data Processing 0 Other 15,366.00 Total 108,886.00 # of Employees 13 Overhead per Employee 8,376.00 Overhead Per Total Hours 48.00 48.00 Direct Service Rate (Hourly) 70.00 (Daily if appropriate) 50.00 (Monthly rate) 1,540.00 8 SO <o 17415 J93 8019 SEABtIRX & SMITE ;nxy.1 �ooi.00_ _ _a • '� r `5 • Sv � v�>4r'A� �' � z 41 o3no/98 PRoour THIS Ctl*TVICATE BI ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Seabury V{, Smith, 111C. RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTTFICATF DOES NOT AMEND,EAT OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. P.O. Box 7157 San Francisco, CA 94120 COMPANIES AFFORDING COVERAGE COMPANY • LETTER A Preferred Risk Mutual COMPANY INSURED LETTER 8 Wausau Insurance Companies Lutheran Family Services of Colorado co&wANY 363 South Harlan ITT C _ Denver CO _80226 a o — — COMPANY LETTER P`�i ;; .�•.1 r..t6ra.Y r 4a S., 0 .n .v >:9 . ...ti.C.�' .. v. `'e . .... � ,..ln!G:1%' �'r Al^.i.•�n �.al.. 1 ./ :.'Mx THIS IS TO MATEY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD PJDICATEo. NOTWITHSTANDING ANY REQUMEMENT. TERM OR CONDITION Of ANY COWmACT OR OTHER DOCUMENT WITH RESPECT TO MINKS THIS CaKt$1CATE MAY BE ISSUED OR MAY PERTAIN. TILE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN BI SUBJECT TO AU. THE TERMS. EXCLUSIONS AND co.cmONS OF SUCH POLICIES. UNITS SHOWN MAY HAVE BEEN REDUCED BY PAM CLAIMS. .. r “v.e a�, t......: "r.,. • II • m r`WT o rY R,� .��, - MORAL NNUT' 4 5 r.•., ODIL3IALAGOREOATE S3.000,000.( MREIe?LTAL GENERAL NAaa PR5ol.Ta °HPIOP Aoa $3000.000.£ CLANS AS AIAoenocoR 9618-911 07/01/97 07/01/98 PEfLTONAIiADV.MAIR1 S1.000.OOO.o OWNER'S IL CONTRACTURE PROT. EACH°COUP PENCE $1.000.000.0 RITE DAMAGE WSow*H 51.000.000.0 - r MEC SOMME Pawn X5.000.0 AMOROUS Liam ANY AUTO CDAmII®swcLe UNIT AIL OWED Mans SCHEDULED AUTOS sooty MAIN PA,woe!) MSC'AUTOS — BODILY MXIRY NDNOMED AUTOS Per,.dr„Q GARASELIAsi Y FRop Rn DAMAGE EXCESS LIABILITY -- '-- EACH DCCIJpRANCE u.mRLqu FORM AGGREGATE aneTHAN WBREUA ROM V M10111IPR'S COMPENSAT1oN STAR:fir LASTS J::.:i B ARO 0818-00-002041 02/01/98 02/01/99 Baal ACtIDpIi. $500,000.00 osLBYors LwAm Don -Pout,'UNIT 5500,000.00 06EASE•EACHt3SYEE 5500,000.00 OTHER reSO TTIOTt of OPERATIONS/LOCATIONS/vaoass/SPSCJAL TI81Q: Weld COpwty SHOUID ANY OF THE ABOVE DESCRIBED POLICIES BE OANCLUID BQORE THE P n,B A BTLgMTCN DATE 11BIEOr, THE ISMANG COMPANY WILL ENDEAVOR To MAL Cues. CQ80612 10 _DAYS W TI*N Horace TO THE CERTFICArt HOLDOl NAMED TO THE LEFT, SOT FAILURE TO MAIL SUCH NOTCE SHALL SI/POSE NO OHUGATION oN LPABIIfTT'BBM�, �A/Ny.rKJLfHPs OR R6Mt[3ENT A OF TtvES. RIR�s 111 li�.��i Hello