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Home My WebLink About20222398.tiffcon}-vae\-tDA 3289 BOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW PASS -AROUND TITLE: Professional Services Agreement Amendments for Core/Non-Core Contracted Services Bid # B22000040 DEPARTMENT: Human Services DATE: April 2, 2024 PERSON REQUESTING: Jamie Ulrich, Director, Human Services Brief description of the problem/issue: The Department entered into Agreements with various Child Welfare Service Providers through Request for Proposal (RFP) Bid #B2200040, identified as Tyler ID 2022-0410. These Agreements were issued for a period of three (3) years,with the option to renew annually. The Department is now requesting to renew the current agreements for eight (8) of these providers with minor changes. The attached list indicates the minor changes in red for each provider. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. What options exist for the Board? • Approval of the eight (8) Child Welfare Core/Non-Core Services Agreement Amendments. • Deny approval of the eight (8) Child Welfare Core/Non-Core Services Agreement Amendments. Consequences: Child Welfare Core/Non-Core Service Agreement Amendments will not be executed. Impacts: Weld County clients will not continue to receive needed services. Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years): • Total Cost = Various depending on services provided. • Funded through Child Welfare Core/Non-Core Service funding. Pass -Around Memorandum; April 2, 2024 - CMS ID ious CUW* CC-`, Ca‘D) (o/5 nei Gi//at Z0ZZ-Z39$ Recommendation: • Approval of the Agreement Amendments and authorize the Chair to sign. Perry L. Buck, Pro -Tern Mike Freeman Scott K. James Kevin D. Ross, Chair Lori Saine Support Recommendation Schedule Place on BOCC Agenda Work Session _cig) r\NF frr \he i Jr Atdi Pass -Around Memorandum; April 2, 2024 - CMS ID Various Other/Comments: Karla Ford From: Sent: To: Subject: yes Lori Saine Weld County Commissioner, District 3 1150 O Street PO Box 758 Greeley CO 80632 Phone: 970-400-4205 Fax: 970-336-7233 Email: Isaine@weldkov.com Website: www.co.weld.co.us In God We Trust Lori Saine Tuesday, April 2, 2024 2:06 PM Karla Ford RE: 9 Please Reply - PA FOR ROUTING: Core/Non Core 2022-23 Minor Changes (CMS Various) Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Karla Ford <kford@weld.gov> @we ld.gov> Sent: Tuesday, April 2, 2024 1:26 PM To: Lori Saine <Isaine@weld.gov> Subject: 9 - Please Reply - PA FOR ROUTING: Core/Non-Core 2022-23 Minor Changes (CMS Various) Importance: High Please advise if you support recommendation and to have department place on the agenda. Karla Ford 1 Minor Core Bid Services Changes Year 2022-23 for Providers 2024-25 Centers, Inc Griffith Program Area Service IIIIISPF Name Rate Milir Unit Type Other Day Treatment Day Treatment $ 1,648.00 Month Address Change Day Treatment Mileage: Day Treatment S 300.00 Month Address Change Home -Based Services Family Community Preservation: In -Home or $ 120.00 Hour Address Change Home -Based Services Family Preservation: In-Office/Video $ 105.00 Hour Address Change Life Skills Life Skills: Mileage $ 0.65 Mile Address Change Life Skills Life Skills: No Show $ 55.00 Each Address Change Mental Health Services Mental Professional Health Staffing Services: TDM, $ 75.00 i Hour Address Change FTM, Mental Health Services Mental Health Services: No Show $ 55.00 Each Address Change Mentoring Mentoring: Mileage $ 0.65 Mile Address Change Mentoring Mentoring: No Show $ 55.00 Each Address Change Life Skills Parenting Community Skills: In -Home or $ 105.00 Hour Address Change Life Skills Parenting Skills: with Transportation $ 110.00 Hour Address Change Life Skills Parenting Skills: In-Office/Video $ 90.00 Hour Address Change Life Skills Supervised Community Visitation: In -Home or $ 110.00 i Hour Address Change Life Skills Supervised Transportation Visitation: with $ 115.00 Hour Address Change Program Area __. Service Name le Rate IMP Unit Type Other Life Skills Supervised Visitation: In-Office/Video $ 100.00 Hour Address Change Life Skills Therapeutic Community Visitation: In -Home or $ 120.00 Hour Address Change Life Skills Therapeutic Transportation Visitation: with $ 125.00 Hour Address Change Life Skills Therapeutic Office/Video Visitation: In - $ 105.00 Hour Address Change Mental Health Services Family Community Therapy: In -Home or $ 130.00 Hour Address Change Mental Health Services gamily Therapy: In-Office/Video $ 125.00 Hour Address Change Mental Health Services Group In -Home Therapy: or Community In-Office/Video AND 5 45.00 Hour Address Change Mental Health Services Individual Community Therapy: In -Home or $ 130.00 Hour Address Change Mental Health Services Individual Therapy: In-Office/Video $ 125.00 Hour Address Change Home -Based Services Family Professional Preservation: Staffing TDM, $ 75.00 Hour Address Change FTM, Home -Based Services Family Preservation: Mileage $ 0.65 Mile Address Change Mental Health Services Mental Health Services: Mileage $ 0.65 Mile Address Change Mental Health Services Therapeutic Community Intake: In -Home or $ 100.00 Hour Address Change Mental Health Services Therapeutic Intake: In-Office/Video $ 90.00 Hour Address Change Mentoring Mentoring/Behavior Home or Community Coaching: In- $ 93.00 Hour Address Change Mentoring Mentoring/Behavior Transportation Coaching: with $ 103.00 Hour Address Change Mentoring Mentoring/Behavior Office/Video Coaching: In- $ 88.00 Hour Address Change Mentoring Mentoring: Staffing FTM, TDM, Professional $ 75.00 Hour Address Change Home -Based Services Family Preservation: No Show $ 55.00 Each Address Change Program Area Service Name Rate Unit Type Other Life Skills Life Staffing Skills: TDM, Professional $ 75.00 Hour Address Change FTM, Foster Support Care/Adoption Foster Professional Parent Staffing Education: FTM, TDM, $ 35.00 Hour Address Change Foster Support Care/Adoption Foster Community Parent Education: In -Home or $ 92.00 Hour Address Change Foster Support Care/Adoption Foster office/Video Parent Education: In - $ 64.00 Hour Address Change Foster Support Care/Adoption Foster Parent Education: No Show $ 30.00 Each Address Change Foster Support Care/Adoption Relinquishment TDM, Professional Counseling: Staffing FTM, $ 75.00 Hour Address Change Foster Support Care/Adoption Relinquishment or Community Counseling: In -Home $ 130.00 Hour Address Change Foster Support Care/Adoption Relinquishment Office/Video Counseling: In - $ 125.00 Hour Address Change Foster Support Care/Adoption Relinquishment Counseling: Mileage $ 0.65 Mile Address Change Foster Support Care/Adoption Relinquishment Counseling: No -Show $ 55.00 Each Address Change Lutheran Family Services Rocky Mountains Program Area Service Name Rate Unit Type Other Life Skills Supervised Community Family Time: In -Home or $ 101.00 Hour Name Change Life Skills Supervised Office/Video Family Time: In - S 90.00 Hour Name Change Life Skills Therapeutic Office/Video Family Time: In - $ 101.00 Hour Name Change Life Skills (Therapeutic Therapeutic Community) Homebased Visitation: Services In -Home or $ 140.00 Hour Name Change Maple Star Colorado Program Area Service Name Rate Unit Type Other Home -Based Services Aftercare Engagement Support Services Team (ASSET) and $ 2,300.00 Month Name Address Change & Change Program Area __ Service Name Rate Unit Type Other Home -Based Services stabilizing (STAY): At Risk teens and Youth in Home $ 1,300.00 Month Name Address Change Change & Home -Based Services Stabilizing (STAY): High Teens Risk and Youth in Home $ 2,600.00 Month Name Address Change Change & Home -Based Services Stabilizing (STAY): Teens Imminent and Risk Youth in Home $ 4,000.00 Month Name Address Change & Change Life Skills Life Staffing Skills: FTM, TDM, Professional $ 93.00 Hour Name Address Change Change & Life Skills Life Skills: Mileage $ 0.65 Mile Name Address Change Change & Life Skills Life Skills: No Show $ 65.00 Each Name Address Change Change & Life Skills RAPT Training or - Community Resilient, (Parent Attuned Coaching): Parent In -Home $ 105.00 Hour Name Address Change Change & Life Skills RAPT Training Office/Video - Resilient, (Parent Attuned Coaching): Parent In- $ 89.00 Hour Name Address Change Change & Life Skills Supervised Community Family AND with Time: In Transportation -Home or $ 120.00 Hour Name Address Change Change & Life Skills Supervised Office/Video Family Time: In- $ 89.00 Hour Name Address Change Change & Life Skills Therapeutic Community Family AND with Time: Transportation In -Home or $ 168.00 Hour Name Address Change Change & Life Skills Therapeutic Office/Video Family Time: In- $ 118.00 Hour Name Address Change Change & Mental Health Services Mental Office/Video Community Health AND Services: In -Home In- or $ 130.00 Hour Name Address Change Change & Mental Health Services Mental Health Services: No Show $ 65.00 Each Name Address Change Change & Mental Health Services Mental Professional Health: Staffing FTM, TDM, $ 93.00 Hour Name Address Change Change & Mental Health Services Mental Health Services: Mileage $ 0.65 Mile Name Address Change Change & Martinez, Tim dba Assurance Therapeutic TM Program g Area ��Serv�ice Name Rate Unit Type Other la Sex Abuse Treatment Offense with Abel Specific Assessment Juvenile Evaluation $ 1,200.00 Episode Program Area Service Name Rate Unit Type Other Sex Abuse Treatment Offense Without Specific Abel Juvenile Assessment Evaluation $ 1,000.00 Episode Sex Abuse Treatment Offense therapy Specific Treatment: Family $ 100.00 Hour Rate Change Sex Abuse Treatment Therapy Offense Specific Treatment: Individual $ 100.00 Hour Rate Change Sex Abuse Treatment Sex Professional Abuse Treatment: Staffing FTM, TDM, $ 75.00 Hour Sex Abuse Treatment Sex Abuse Treatment: Mileage $ 0.33 Mile Northern Colorado Youth for Christ dba Rebalance Program Area Service Name Rate Unit Type Other Mental Health Services Rebalance $ 45.00 Hour Mental Health Services Rebalance: No Show $ 20.00 Each Mentoring Mentoring $ 80.00 Hour Rate Change David Kalis, Inc. dba Parker Personal Care Homes Program Area Service Name Rate Unit Type Other Foster Support Care/Adoption Foster Masters: Staffing Care/Adoption FTM, TDM, Support Professional - $ 200.00 Hour Rate Change Foster Support Care/Adoption Foster Masters' Care/Adoption No Show Support - $ 150.00 Each Rate Change Foster Support Care/Adoption Foster Mileage Care/Adoption Support: $ 0.50 Mile Foster Support Care/Adoption In-Office/Video Foster Community Parent Consultation AND In -Home - Masters: or $ 200.00 Hour Rate Change Foster Support Care/Adoption Foster Office/Video Community Parent AND Training In -Home - Masters: or In - $ 200.00 Hour Rate Change Home -Based Services In Aftercare Masters -Home Therapy Level: or Community In-Office/Video & Consultation AND - $ 200.00 Hour Rate Change Home -Based Services In-Office/Video Home Community Based Intervention AND In -Home - Masters: or $ 200.00 Hour Rate Change Home -Based Services Home FTM, TDM, Based Professional Intervention Staffing - Masters: $ 200.00 Hour Rate Change Program Area IltaService Name Rate Unit i Type Other Home -Based Services Home No Show Based Intervention - Masters: $ 150.00 Each Rate Change Home -Based Services Home -Based Services: Mileage $ 0.50 Mile Life Skills Life Professional Skills - Masters: Staffing FTM, TDM, $ 200.00 Hour Rate Change Life Skills Life Skills - Masters: No Show $ 150.00 Each Rate Change Life Skills Life Skills: Mileage $ 0.50 Mile Life Skills Parent Office/Video Community Coaching AND - Masters: In -Home In- or $ 200.00 Hour Rate Change Life Skills Supervised Office/Video Community Family AND In Time -Home - Masters: or In- $ 200.00 Hour Rate Change Life Skills Therapeutic In-Office/Video Community Family AND Time In -Home - Masters: or $ 200.00 Hour Rate Change Mental Health Services Consultation Office/Video Community - AND Masters: In -Home In- or $ 200.00 Hour Rate Change Mental Health Services Consultation AND In -Home - or PhD: Community In-Office/Video $ 250.00 Hour Rate Change Mental Health Services Counseling/Psychotherapy FTM, TDM, Professional - Staffing Masters: $ 200.00 Hour Rate Change Mental Health Services Counseling/Psychotherapy In-Office/Video Community AND In -Home -Masters: or $ 200.00 Hour Rate Change Mental Health Services Counseling/Psychotherapy Office/Video Community AND In -Home -PhD: or In- $ 250.00 Hour Rate Change Mental Health Services Evaluation & Assessment: No Show $ 500.00 Each Rate Change Mental Health Services In-Office/Video Functional Community Family AND Therapy In -Home - Masters: or $ 200.00 Hour Rate Change Mental Health Services Functional Office/Video Community Family AND Therapy In -Home - PhD: or In- $ 250.00 Hour Rate Change Mental Health Services Mental FTM, TDM, Health Professional Services - Staffing Masters: $ 200.00 Hour Rate Change Program Area Service Name Rate Unit Type Other Mental Health Services Mental Show Health Services - Masters: No $ 150.00 Each Rate Change Mental Health Services Mental TDM, Professional Health Services Staffing - PhD: FTM, $ 250.00 Hour Rate Change Mental Health Services Mental Show Health Services - PhD: No $ 250.00 Each Rate Change Mental Health Services Mental Health Services: Mileage $ 0.50 Mile Mental Health Services Multisystemic Office/Video Community AND Therapy In -Home - Masters: or In- $ 200.00 Hour Rate Change Mental Health Services Parent In-Office/Video Community -Child Interactional AND In -Home Evaluation: or $ 500.00 Hour Rate Change Mental Health Services Psychological Office/Video Community AND Evaluation: In -Home In- or $ 500.00 Hour Rate Change Mental Health Services Trauma AND In -Home Assessment: or Community In-Office/Video $ 500.00 Hour Rate Change N/A Anger Prevention AND In Management -Home - Masters: or Community Treatment/DV In-Office/Video $ 200.00 Hour Rate Change N/A Child FTM, Welfare TDM, Professional Block funded Staffing - Masters: $ 200.00 Hour Rate Change N/A Child No Show Welfare Block Funded - Masters: $ 150.00 Each Rate Change N/A Child Welfare Block Funded: Mileage $ 0.50 Mile N/A Mediation AND In -Home - Masters: or In-Office/Video Community $ 200.00 Hour Rate Change N/A Relinquishment In-Office/Video Community Counseling AND In -Home - Masters: or $ 200.00 Hour Rate Change Sex Abuse Treatment Psychosexual/Sex Evaluation - Masters: Offender In-Office/Video Specific $ 400.00 Hour Rate Change Sex Abuse Treatment Psychosexual/Sex Evaluation: PhD Offender Level testing Specific $ 500.00 Hour Rate Change Sex Abuse Treatment Sexual FTM, TDM, Abuse Treatment Professional - Staffing Masters: $ 200.00 Hour Rate Change Sex Abuse Treatment Sexual No Show Abuse Treatment - Masters: $ 150.00 Each Rate Change Program Area Service Name Rate Unit Type Other Sex Abuse Treatment Sexual Consultation Office/Video Community Abuse - AND Treatment Masters: In -Home In- Therapy or and $ 200.00 Hour Rate Change Sex Abuse Treatment Sexual Abuse Treatment: Mileage $ 0.50 Mile Substance Treatment Abuse Substance Masters: Home Community Abuse In-Office/Video Evaluation AND In - $ 400.00 Hour Rate Change Substance Treatment Abuse Substance Level Testing Abuse Evaluation: PhD $ 500.00 hour Rate Change Substance Treatment Abuse Substance Masters: No Abuse Show Treatment - $ 150.00 Each Rate Change Substance Treatment Abuse Substance Consultation Office/Video Community Abuse - AND Masters: Treatment In -Home In - and or $ 200.00 Hour Rate Change Substance Treatment Abuse Substance FTM, TDM, Abuse Professional Treatment- Staffing Masters: $ 200.00 Hour Rate Change Substance Treatment Abuse Substance Abuse Treatment: Mileage $ 0.50 Mile Therapeutic Services Kinship Therapeutic Masters: Staffing FTM, Kinsnip TDM, Services Professional - $ 200.00 Hour Rate Change Therapeutic Services Kinship Therapeutic Masters: Home In-Office/Video or Community Kinship Services AND - In - $ 200.00 Hour Rate Change Therapeutic Services Kinship Therapeutic Masters: No Kinship Show Services - $ 150.00 Each Rate Change Therapeutic Services Kinship Therapeutic Kinship Services: Mileage $ 0.50 Mile Shiloh Home Program Area Service Name Rate Unit Type Other lasill Day Treatment Day Treatment $ 2,125.00 Month Day Treatment Evening Reporting Center $ 98.50 Day Foster Support Care/Adoption Foster Mileage Care/Adoption Support: $ 0.59 Mile Foster Support Care/Adoption Foster FTM, TDM, Parent Professional Consultation Staffing Coaching: $ 80.00 Hour Program Area Service Name Rate Unit Type Other Foster Support Care/Adoption Foster In -Home Parent Consultation or Community Coaching: $ 80.00 Hour Foster Support Care/Adoption Foster In-Office/Video Parent Consultation Coaching: $ 65.00 Hour Foster Support Care/Adoption Foster No Show Parent Consultation Coaching: $ 60.00 Each Foster Support Care/Adoption Foster FTM, TDM, Parent Professional Consultation Staffing Therapy: $ 95.00 Hour Foster Support Care/Adoption Foster In -Home Parent or Community Consultation Therapy: $ 120.00 Hour Foster Support Care/Adoption Foster In-Office/Video Parent Consultation Therapy: $ 95.00 Hour Foster Support Care/Adoption Foster No Show Parent Consultation Therapy: $ 75.00 Each Foster Support Care/Adoption Foster with Transportation Parent Consultation Therapy: $ 120.00 Hour Home -Based Services Aftercare FTM, TDM, Individual/Family Prof Staffing Therapy: $ 85.00 Hour Home -Based Services Aftercare In Transportation -Home or Individual/Family Community AND Therapy: with $ 115.00 Hour Home -Based Services Aftercare In-Office/Video Individual/Family Therapy: $ 85.00 Hour Home -Based Services Aftercare No Show Individual/Family Therapy: $ 75.00 Each Home -Based Services Aftercare Based TDM, Family Professional In -Home Support and Staffing Services: Community FTM, $ 85.00 Hour Home -Based Services Aftercare Based Office/Video Family In -Home Support and Services: Community In - $ 85.00 Hour Home -Based Services Aftercare Based Show Family In -Home Support and Services: Community No $ 60.00 Each Home -Based Services Home -Based Services: Mileage $ 0.59 Mile Home -Based Services Rapid Staffing Response: FTM, TDM, Prof. $ 95.00 Hour Home -Based Services Rapid Community Response: AND In -Home with or Transportation $ 140.00 Hour Home -Based Services Rapid Response: In-Office/Video $ 95.00 Hour Home -Based Services Rapid Response: No Show $ 75.00 Each Program Area a: Service Name Rate Unit Type Other Home -Based Services Youth FTM, TDM, Intervention Prof.Staffing Family Coaching: $ 65.00 Hour Home -Based Services Youth In -Home Transportation Intervention or Community Family AND Coaching: with $ 80.00 Hour Home -Based Services Youth In-Office/Video Intervention Family Coaching: $ 65.00 Hour Home -Based Services Youth No Show Intervention Family Coaching: $ 60.00 Each Home -Based Services Youth FTM, TDM, Interventions Prof.Staffing Therapy Services: $ 95.00 Hour Home -Based Services Youth In -Home Transportation Interventions or Community Therapy AND Services: with $ 125.00 Hour Home -Based Services Youth In-Office/Video Interventions Therapy Services: $ 95.00 Hour Home -Based Services Youth No Show Interventions Therapy Services: $ 75.00 Each Life Skills Beyond the Walls $ 1,115.00 Month Life Skills Comprehensive TDM, Prof.Staffing Parenting Time: FTM, $ 80.00 Hour Name Change Life Skills Comprehensive Home Transportation or Community Parenting AND Time: with In - $ 85.00 Hour Name Change Life Skills Comprehensive Office/Video Parenting Time: In - $ 80.00 Hour Name Change Life Skills Comprehensive Show Parenting Time: No $ 70.00 Each Name Change Life Skills Life Skills: TDM, Prof.Staffing $ 85.00 Hour FTM, Life Skills Life Skills: In -Home or Community $ 85.00 Hour Life Skills Life Skills: In-Office/Video $ 65.00 Hour Life Skills Life Skills: Mileage $ 0.59 Mile Life Skills Life Skills: No Show $ 60.00 Each Life Skills Parents as Teachers $ 600.00 Month Life Skills Therapeutic Prof.Staffing Family Time: FTM, TDM, $ 95.00 Hour Name Change Life Skills Therapeutic Community AND Family with Time: Transportation In -Home or $ 120.00 Hour Name Change Program Area Service Name Rate Unit Type Other Life Skills Therapeutic Office/Video Parenting Time: In - $ 95.00 Hour Name Change Life Skills Therapeutic Parenting Time: No Show $ 75.00 Each Name Change Mental Health Services Individual TDM, Prof.Staffing and Family Therapy: $ 95.00 Hour FTM, Mental Health Services Individual Home Transportation or and Community Family Therapy: AND with In - $ 120.00 Hour Mental Health Services Individual Office/Video and Family Therapy: In - $ 95.00 Hour Mental Health Services Individual Show and Family Therapy: No $ 75.00 Each Mental Health Services Mental Health Services: Mileage $ 0.59 Mile N/A FP & KP Training - 11 -hour class $ 1,760.00 Each N/A FP & KP Training - 3 -hour class $ 480.00 Each N/A FP Sexually Reactive & KP Training Abusive Youth - The and Truth Sexually about $ 480.00 Each Sex Abuse Treatment Community Youth Conduct Community with Coaching: Based Problematic AND with Treatment In -Home Transportation Sexual or for $ 130.00 Hour Sex Abuse Treatment Community Youth Conduct with Coaching: Based Problematic Treatment In-Office/Video Sexual for $ 95.00 Hour Sex Abuse Treatment Individual Home Transportation or and Community Family AND Treatment: with In - $ 130.00 Hour Sex Abuse Treatment Individual Office/Video and Family Treatment: In - $ 130.00 Hour Sex Abuse Treatment Informed Supervision $ 300.00 Each Sex Abuse Treatment Sex Professional Abuse Treatment: Staffing FTM, TDM, $ 95.00 Hour Sex Abuse Treatment Sex Abuse Treatment: Mileage $ 0.59 Mile Sex Abuse Treatment Sex Abuse Treatment: No Show $ 75.00 Each Transitions Psychology Group Program Area Service Name Rate Unit Type Other Foster Support Care/Adoption Foster Therapeutic TDM, Prof. Parent Staffing Kinship Consultation Services: and FTM, $ 140.00 Hour Foster Support Care/Adoption Foster Therapeutic or Transportation Community Parent Consultation Kinship AND Services: with and In Home $ 188.00 Hour Rate Change roster Support Care/Adoption Foster Therapeutic Office/Video Parent Consultation Kinship Services: and In $ 125.00 Hour Rate Change Foster Support Care/Adoption Foster Therapeutic Parent Consultation Kinship and Services: Mileage $ 0.58 Mile Foster Support Care/Adoption Foster Therapeutic Show Parent Consultation Kinship and Services: No $ 90.00 Each Life Skills In -Home In Transportation Home Family or Community Prevention AND Program: with S 188.00 Hour Rate Change Life Skills In -Home In Office/Video Family Prevention Program: $ 125.00 Hour Rate Change Life Skills LIFE Staffing SKILLS: FTM, TDM, Professional $ 140.00 Hour Life Skills LIFE SKILLS: Mileage $ 0.58 Mile Life Skills LIFE SKILLS: No Show $ 90.00 Each Life Skills Therapeutic Community Visitation: AND with Transportation In Home or $ 188.00 Hour Rate Change Life Skills Therapeutic Office/Video Visitation: In - $ 12C 00 Hour Rate Change N/A Additional Adult $ 300.00 Each N/A Child TDM, Welfare Professional Block Staffing Funded: FTM, $ 140.00 Hour N/A Full Home Study $ 1,350.00 Episode N/A Home Studies: Mileage $ 0.58 Mile N/A Partial Home Study $ 300.00 Episode N/A Relinquishment or Community Counseling: In Home $ 180.00 Hour N/A Relinquishment Office/Video Counseling: In $ 140.00 Hour N/A Updated Home Study $ 700.00 Episode AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND ASSURANCE THERAPEUTIC SERVICES, LTD This Agreement Amendment made and entered into 5thday of 3 u,f iz, , 2024 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department", and Assurance Therapeutic Services, LTD, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Sexual Abuse Treatment, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2022-2398, approved on August 17, 2022. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on May 31, 2023. • The Original Agreement was amended on: • May 3, 2023 to extend the term date through May 31, 2024. • This Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement as of June 1, 2024: 1. Term This agreement is being renewed for the third and final year, for the period Jun.., 2024 through May 31, 2025. 2. Exhibit B, Rate Schedule, is hereby amended as attached. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: "'"1 G: Je""`"':"k BOARD OF COUNTY COMMISSIONERS Clerk to the Boa • WELD COU CO Deputy Clerk to t Kevin D. Ross, Chair CONTRACTOR: JUN 0 5 2024 Assurance Therapeutic Services, LTD 2210 East La Salle Street, Suite 112 Colorado Springs, Colorado 80909 (719) 565-9151 77ni MaYtiPrez By: Tim Martinez {May 15, 2024 11:24 AID, Tim Martinez, LPC/Owner Date: May 15, 2024 LD;A: EXHIBIT B RATE SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specific in Paragraph 2, below. Expenses incurred by the Contractor prior to the term of this Agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Offense Specific Treatment Individual / Family Therapy Rate Unit Type Service Name $100.00 Hour Sex Abuse Treatment: In-Office/Video $100.00 Hour Sex Abuse Treatment: In -Office with Transportation $100.00 Hour In -Home or Community $75.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, and Professional Staffing $0.33 Mile For distances exceeding 30 miles from 2210 East LaSalle Suite 112, Colorado Springs, Colorado 80909 Offense Specific Evaluation Rate Unit Type Service Name $1,200.00 Evaluation Offense Specific Juvenile Evaluation — with Abel Assessment $1,000.00 Evaluation Offense Specific Juvenile Evaluation — without Abel Assessment 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement and monthly report including other supporting documentation, if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 of this Agreement. Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7th day of the month following the month of service, but no later than 45 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 45 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 45 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. When submitting a request for payment for a one-time service, the contractor shall submit the first and last page of the evaluation/report to confirm proof of services rendered. The full evaluation/report should be submitted by the contractor to the caseworker. For Monitored Sobriety services, proof of services rendered shall be the test result. SIGNATURE REQUESTED: Weld/Assurance Amendment #2 Final Audit Report 2024-05-15 Created: 2024-05-14 By: Windy Luna (wluna@weld.gov) Status: Signed Transaction ID: CBJCHBCAABAAi,jzBATS9CIRTMjJkFPiOuSLaDUHnSlb "SIGNATURE REQUESTED: Weld/Assurance Amendment #2" History t Document created by Windy Luna (wluna@weld.gov) 2024-05-14 - 7:53:21 PM GMT- IP address: 204.133.39.9 El Document emailed to Tim Martinez (martineztim@hotmail.com) for signature 2024-05-14 - 7:54:02 PM GMT Email viewed by Tim Martinez (martineztim@hotmail.com) 2024-05-14 - 7:58:51 PM GMT- IP address: 75.70.197.142 5a Document e -signed by Tim Martinez (martineztim@hotmail.com) Signature Date: 2024-05-15 - 5:24:21 PM GMT - Time Source: server- IP address: 75.70.197.142 d Agreement completed. 2024-05-15 - 5:24:21 PM GMT Powered by Adobe Acrobat Sign anti ct For Entity Information Entity Name" MARTINEZ, TIMOTHY Entity ID* @00037114 Contract Name* Contract ID MARTINEZ, TIMOTHY DBA ASSURANCE THERAPEUTIC 8289 SERVICES, LTD (AMENDMENT #2 Contract Status CTB REVIEW Contract Lead * WLUNA New Entity? Parent Contract ID 20222398 Requires Board Approval YES Contract Lead Email Department Project # wluna@weldgov.com;cob bxxlk@weldgov.com Contract Description* (CONSENT) MARTINEZ, TIMOTHY DBA ASSURANCE THERAPEUTIC SERVICES, LTD - AMENDMENT #2. RELATED TO BID #B2200040. TERM: 06/01 /2024 THROUGH 05/31/2025. Contract Description 2 PROVIDER WAS LISTED ON APPROVED VENDOR LIST PRESENTED TO THE BOCC ON 06/1 3/2022. Contract Type* AMENDMENT Amount* $0.00 Renewable* NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanServices@weldgov. com Department Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WEL DGOV.COM Requested BOCC Agenda Date * 06/05/2024 Due Date 06/01/2024 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Termination Notice Period Contact Information Review Date* 03/31/2025 Committed Delivery Date Renewal Date Expiration Date* 05/31/2025 Contact Info Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date CONSENT 05/31 /2024 Approval Process Department Head Finance Approver Legal Counsel JAMIE ULRICH CONSENT CONSENT DH Approved Date Finance Approved Date Legal Counsel Approved Date 05/31/2024 05/31/2024 05/31/2024 Final Approval BOCC Approved Tyler Ref # AG 060524 BOCC Signed Date Originator WLUNA BOCC Agenda Date 06/05/2024 Cori -vac+ ipii-c9n9 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: March 28, 2023 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Protection Agreement Amendments for 2022-23 Core/Non-Core Contracted Services B2200040 Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Child Protection Agreement Amendments for 2022-23 Core/Non-Core Contracted Services B2200040. The Department entered into Agreements with various Child Welfare Service Providers through the 2022-23 Request for Proposal (RFP), Bid Number: B2200040, identified as Tyler ID 2022-0410. These Agreements were issued for a period of three (3) years with the option to renew annually. The Department is requesting to renew the current Agreements with no changes for thirty-one (31) Providers reflected in the attached list. Agreements will be renewed for the second year, for the period of June 1, 2023 through May 31, 2024. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Upon Board approval of this pass -around, signed Agreement Amendments will be obtained from Providers and submitted to the Board for approval and Chair signature. I do not recommend a Work Session. I recommend approval of these Agreement Amendments and authorize the Chair to sign. Approve Recommendation Perry L. Buck, Pro -Tern Mike Freeman, Chair Scott K. James Kevin D. Ross Lori Saine Schedule Work Session Other/Comments: Pass -Around Memorandum; March 28, 2023 — CMS ID Various Page 1 an 4ePifirda-- 5/3/Z3 c&I c74646421. Ulas) 6,) 3/ate %iL% zcr? PRIVILEGED AND CONFIDENTIAL CMS ID _ NAB BID # {BIDYEAR I 'TYLER ID B2200040 2022-23 2022-1543 Mel Clinical Services LA`1er Psychological & Wellness Services B2200040 -23 2 20 2 , 2022-1476 Brads House B2200040 2022-23 4 2022-1537 _ Cer ilei Tiial BOCES B2200040 2022-23 2022-1471 Christiansen, David L B2200040 2022-23 2022-1467 1 DAYS (Denver Area Youth Services) B2200040 2022-23 2022-1539 Ebbinghaus, Krystal 7 B2200040 2022-23 2022-1464 Flynn Counseling, LLC B2200040 2022-23 2022-1466 Garcia Family Guidance Inc. B2200040 2022-23 2022-1592 IDEA Forum, Inc. B2200040 2022-23 2022-1813 Inspired Pathways Counseling Services, LLC B2200040 2022-23 2022-1591 Intervention, Inc. B2200040 2022-23 2022-1540 Jacob Farr _S_ ervices, Inc. DBA The Jacob Center B2200040 2022-23 2022-1538 Lifestance Health B2200040 2022-23 2022-2674 Lutheran Family Services Rocky Mountains 82200040 2022-23 2022-1468 *-- B2200040 2022-23 2022-2398 Martinez, Tim DBA Assurance Therapeutic Services, LTD North Range Behavioral Health B2200040 2022-23 2022-1546 Northern Colorado Youth for Christ B2200040 2022-23 2022-1470 Parker Personal Care Homes, Inc. dba David Kalis B2200040 2022-23 2022-1916 Perkier Center for Psychotherapy B2200040 2022-23 2022-1544 Roundtables Collaborations of Colorado (Rick Hartman) B2200040 2022-23 2022-1541 Sur owl Is, Julie A. - _ - B22UUu4u 2022-23 2022-1533 Smith Agency B2200040 2022-23 2022-1673 B2200040 2022-23 2022-1596 Specialized Coloraco, Inc. Alternatives (SAFY) for Families and Youth of I Strong Foundations, LLC B2200040 2022-23 2022-1597 Swisher. Nathan 22200040 2022-2:3 2022-1474 Tennyson Center for Children B2200040 2022-23 2022-1593 Third Way Center B2200040 2022-23 2022-1477 Transitions Psychology Group, LLC B2200040 2022-23 2022-1542 Turning Inc. Point Center for Youth and Family Development, B2200040 2022-23 2022-1475 I LUABACO LLC B2200040 f 2022-23 1_2022-1728 Pass -Around Memorandum; March 28, 2023 - CMS ID Various Page 2 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND ASSURANCE THERAPEUTIC SERVICES, LTD This Agreement Amendment, made and entered into 3`' day of g 2023 by and between the Board of Weld County Commissioners, on behalf of the Weld County Deparment of Human Services, hereinafter referred to as the "Department", and Assurance Therapeutic Services, LTD, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Sexual Abuse Treatment, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2022- 2398, approved on August 17, 2022. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on May 31, 2023. • This Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1 Term This agreement is being renewed for a second year, for the period of June 1, 2023 through May 31, 2024. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. datziwo • COUNTY: ATTEST: BOARD OF COUNTY COMMISSIONERS rk to the Board ,��, f � ELD COUNTY, COLORADO BY: Deputy Clerk oaFreeman, Chair MAY 0 3 2023 NTRACTOR: Assurance Therapeutic Services, LTD 2210 East La Salle Street, Suite 112 Colorado Springs, Colorado 80909 (719) 565-9151 7Th'r Mout)iez By: Tarn Martinez (Apr 20, 2023 11:12 MDT) Tim Martinez, LPC/Owner Date: Apr 20, 2023 400202_ a 398" SIGNATURE REQUESTED: Weld/Marinez, Tim dba Assurance Amendment #1 2023-24 Final Audit Report 2023-04-20 Created: 2023-04-14 By: Windy Luna (wluna@co.weld.co.us) Status: Signed Transaction ID: CBJCHBCAABAAR9xQtimF-0BeK84fYRHzh-2jwWwWU8wj "SIGNATURE REQUESTED: Weld/Marinez, Tim dba Assurance Amendment #1 2023-24" History n Document created by Windy Luna (wluna@co.weld.co.us) 2023-04-14 - 8:01:49 PM GMT El Document emailed to Tim Martinez (martineztim@hotmail.com) for signature 2023-04-14 - 8:02:45 PM GMT 5 Email viewed by Tim Martinez (martineztim@hotmail.com) 2023-04-14 - 9:03:19 PM GMT ,i°J Email viewed by Tim Martinez (martineztim@hotmail.com) 2023-04-20 - 5:11:59 PM GMT f3© Document e -signed by Tim Martinez (martineztim@hotmail.com) Signature Date: 2023-04-20 - 5:12:44 PM GMT - Time Source: server Q Agreement completed. 2023-04-20 - 5:12:44 PM GMT Names and email addresses are entered into the Acrobat Sign service by Acrobat Sign users and are unverified unless otherwise noted. Powered by Adobe Acrobat Sip Contract Form New Contract Request Entity Information Entity Name" MARTINEZ, TIMOTHY Entity ID. C0003 71 14 Contract Name * MARTINEZ, TIMOTHY DBA ASSURANCE THERAPEUTIC SERVICES, LTD (CHILD PROTECTION AGREEMENT AMENDMENT #2) Contract Status CTB REVIEW Contract ID 6889 Contract Lead WLIJNA ❑ New Entity? Parent Contract ID 20222398 Requires Board Approval YES Contract Lead Email Department Project # wiuna'weidgov.com;cobbx xik.Oweldgov.corn Contract Description * (CONSENT) MARTINEZ, TIMOTHY DBA ASSURANCE THERAPEUTIC SERVICES, LTD (CHILD PROTECTION AGREEMENT AMENDMENT #1). TERM 06 01 2023 THROUGH 05;' 31 ,<2024. Contract Description 2 PROVIDER WAS LISTED ON APPROVED VENDOR LIST PRESENTED TO THE BOCC ON 03 29 2023 AND AS A COMMUNICATION ITEM/PA SENT TO CTB ON 03(30x'2023. Contract Type AGREEMENT Amount" $0.00 Renewable" NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanServicesOweldgov.co Department Head Email CM- Hu man Services- DeptHeadOweldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTO RN EY,WELDG OV.COM Requested BQCC Agenda Date" 05 10x2023 Due Date 05/06;2023 Will a work session with B©CC be required?" NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Review Date'" 03!29:2024 Renewal Date Termination Notice Period Contact Information Committed Delivery Date Expiration Date* 05 31 2024 Contact Info Contact Name Contact Type Contact Email Contact Phone Z Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date Approval Process Department Head Finance Approver Legal Counsel JAMIE ULRICH CHERYL PATTELLI BYRON HOWELL DH Approved Date Finance Approved Date Legal Counsel Approved Date 04.,24: 2023 04;25;'2023 04/25; 2023 Final Approval BOCC Approved Tyler Ref it AG 050323 BOCC Signed Date BOCC Agenda Date 05:`03 2023 Originator WLUNA Co VVaae CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND ASSURANCE THERAPEUTIC SERVICES, LTD —7 This Agreement, made and entered into the 1 day of 4- , 2022, by and between the Board of Weld County Commissioners, on behalf of the Weld County Dep ent of Human Services, hereinafter referred to as the "Department" and Assurance Therapeutic Services, LTD, hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Scope of Services, Exhibit B, Rate Schedule, Exhibit C, Weld County's Request for Proposal, and Exhibit D, Contractor's Response to Request for Proposal. Exhibit A, B, and D are attached hereto and incorporated herein by this reference. Exhibit C is Weld County's Request for Proposal Number B2200040 which is incorporated into this agreement by reference and will be provided upon request to the Department. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided Core Services or other funding to the Department for Sexual Abuse Treatment. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1, 2022, upon proper execution of this Agreement and shall expire May 31, 2023, unless sooner terminated as provided herein. This agreement may be renewed for 2 additional terms by written agreement of both parties. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit A Scope of Services, and Exhibit D, Contractor's Response to Request for Proposal. 3. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Quality Assurance Team(HS-CWQualitvAssurance(a,weldgov.com). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit a complete Request for Reimbursement and supporting documentation by the 7th of the month, following the month of service, utilizing billing forms required by the Department. Requests for Reimbursement Forms received after 45 days from the date of service may ConSe)0+ 'n9d(OWL-, �- pit1t (iiD) ogM122 gi i7iaa 2022-2398 result in delay or forfeiture of payment. Consistent failure to meet 45 -day deadline may result in termination of the Agreement. d. Contractor agrees to submit a monthly report by the 7th of the month, following the month of service, for each client receiving ongoing services. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. Monthly reports for ongoing services must include the following information, entered in the "Narrative" box for each date of service: a. Date and time(s) of service (i.e. two hours or 2-4pm) b. Location of where the service took place (i.e. clinician's office, client's home, in the community.) c. Clinician/therapist name d. Clients participating e. What interventions were used, recommendations and/or goals discussed f Any and all safety concerns One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation, home study). Verification of Monitored Sobriety Services will be the test result. A completed home study may be a full, partial or denied study, as determined by the Department. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. 4. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. Exceptions to this Paragraph may include, if approved by the Department, the following: i. The service being provided by the contractor is not a Medicaid eligible service; ii. The service is not deemed medically necessary; iii. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; iv. A Medicaid provider is not available to provide the needed service; v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. b. Payment shall be made in accordance with Exhibit A, Scope of Services , Exhibit B, Rate Schedule, Exhibit C, Weld County's Request for Proposal, and Exhibit D, Contractor's Response to Request for Proposal., attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon, the continuing availability of said funds for the purposes hereof. d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 2 5. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A, Scope of Services, Exhibit B, Rate Schedule, and Exhibit D, Contractor's Proposal: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit a State of Colorado direct deposit enrollment form, which will be provided by the Department, with a voided check. Failure to complete and submit this form and voided check in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Ad of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Ad of 1964, 42 U.S.C. Sections 2000d-1 et. s and its implementing regulation, 45 C.F.R. Part 80 et. se�C ; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Ad of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. sec and its implementation regulations, 45 C.F.R. Part 91; and Title VII of the Civil Rights Act of 1964; and the Age Discrimination in Employment Act of 1967; and the Equal Pay Act of 1963; and the Education Amendments of 1972; and Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and 3 - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is determined by the Department. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contractor will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E - Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5- 102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is 4 employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contractor participates in the State of Colorado program, Contractor shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contractor has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contractor shall deliver to the Department, a written notarized affirmation that it has examined the legal work status of such employee and shall comply with all of the other requirements of the State of Colorado program. If Contractor fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., the Department, may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contractor receives federal or state funds under the contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24- 76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5- 103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR), and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 9. Insurance Requirements Contractor and the Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect prior to execution of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, insurance coverage 5 listed in this agreement. The Board of County Commissioners of Weld County and its Officers/Employees shall be named as additional insured. a. General Requirements: Contractors must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, the Department must be notified by the Contractor. Contractor shall be responsible for the payment of any deductible or self -insured retention. The Department reserves the right to require Contractor to provide a bond, at no cost to the Department, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor. Contractor shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i.Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii.Commercial General Liability Insurance written on ISO occurrence form CO 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: - $1,000,000 each occurrence; - $2,000,000 general aggregate; $50,000 any one fire; and - $500,000 errors and omissions. iii.Automobile Liability: Contractor shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: If any aggregate limit is reduced by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify the Department within ten (10) days and reinstate the aggregates required; Unlimited defense costs in excess of policy limits; Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; 6 A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by the Department. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to the Department, whichever is earlier. c. Contractors shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor shall provide a copy of this information to its insurance agent or broker and shall have its agent or broker provide proof of Contractor's required insurance. The Department reserves the right to require Contractor to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor's insurer shall name County as an additional insured. f. Waiver of Subrogation: For all coverages, Contractor's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors, independent contractors, sub -vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor. Contractor shall include all such subcontractors, independent contractors, sub -vendors, suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors, suppliers or other entities upon request by the Department. A provider of Professional Services shall provide the following coverage: Professional Liability: Contractor shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 10. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training Contractor may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 7 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at (970) 336-7235 and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor will collaborate in a timely manner with the Department to resolve issues pertaining to service delivery, service quality, documentation, and invoicing during referral period and after services have concluded. The Contractor will require clients sign releases of information. Contractor understands that the Department will not reimburse for services rendered to Department clients until releases of information are obtained. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. The monitoring agency may, if in its sole discretion deems necessary or appropriate, have access to any program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures for purposes of monitoring. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives 8 of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Child Welfare Division Head Tim Martinez, LPC/Owner 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Jamie Ulrich, Director P.O. Box A Greeley, CO 80632 (970) 400-6510 18. Litigation For Contractor: Tim Martinez, LPC/Owner 2210 East La Salle Street, Suite 112 Colorado Springs, Colorado 80909 (719)565-9151 Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third -Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shalt be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. sea., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The 9 parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall not enter into any third -party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. A conflict of interest or appearance of a conflict of interest may also apply to personal relationships between providers and clients. If a provider has a personal relationship with a client to whom the Contractor may provide services for, the Contractor must disclose that relationship to the Department. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall 10 be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contractor agrees that it is an independent Contractor and that Contractor's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall perform its duties hereunder as an independent Contractor. Contractor shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contractor, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contractor or any of its agents or employees. Unemployment insurance benefits will be available to Contractor and its employees and agents only if such coverage is made available by Contractor or a third party. Contractor shall pay when due all applicable employment taxes and income taxes and local bead taxes (if applicable) incurred pursuant to this Agreement. Contractor shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contractor shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and as set forth in Exhibit C, provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner 11 consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to the Department originals of all tests and results, reports, and other similar items, generated during completion of this work. Acceptance by the Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Employee Financial Interest/Conflict of Interest. C.R.S. 5524-18-201 et seq. and 524-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflicts with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contractor's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contractor agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contractor acknowledges that the Department has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of this project without the Department's prior written consent, which may be withheld in the Department's sole discretion. 36. Attorney's Fees/Legal Costs 12 13 In the event of a dispute between the Department and Contractor, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of the Department. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contractor in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the Department. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of the Department. 38. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: Weld , my Clerk to the Boar. WELDOUNTY, COLORADO W..rit„,) Je4,:,,k BOARD OF COUNTY COMMISSIONERS K. James, Chair AUG 1 7 2022 CONTRACTOR: Assurance Therapeutic Services, LTD 2210 East La Salle Street, Suite 112 Colorado Springs, Colorado 80909 (719) 565-9151 e/lia ti;tea By: Tim Martinez (Aug 10, 202210:31 MDT) Tim Martinez, LPC/Owner Date: Aug 10, 2022 2000l - a39,F EXHIBIT A SCOPE OF SERVICES Contractor will provide Sexual Abuse Treatment, as referred by the Department. 1. Sex Abuse Treatment — Individual / Family Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Colorado Sex Offender Management Board approved treatment provider. ii. Cognitive Behavior Therapy (CBT). iii. Trauma Therapy. iv. Family Therapy. v. Various Workbooks. b. Anticipated Frequency of Services: i. One (1) hour per week for individual offence specific therapy, may increase depending on client treatment needs. c. Anticipated Duration of Services: i. Six (6) to nine (9) months. d. Goals of Services: i. Decrease risk to engage in sexual offending behaviors. ii. Increase overall health, strengths, skills and resources relevant to successful functioning. iii. Client accepts responsibility for offending and abusive behaviors. e. Outcomes of Services: i. Client will remain in the least restrictive environment while resolving conflict without becoming abusive. ii. Client will demonstrate pro -social relationship skills and is able to establish closeness, trust and assess trustworthiness of others. iii. Client has an adaptive sense of purpose and future. iv. Client will complete offense specific treatment in compliance with court ordered treatment. f. Target Population: i. Children and adolescents ages ten (10) to eighteen (18). ii. Males and females. iii. Those requiring healthy sexuality treatment, offense specific treatment. g. Language: i. English. h. Medicaid Eligibility: i. Court ordered offense specific treatment is not Medicaid eligible. i. Service Access and Transportation: i. Therapist office. ii. Foster home, group home, or treatment facility. 2. Offense Specific Evaluation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: 1 i. Clinical interview with client. ii. Sentence completion interview. iii. Juvenile sexual history questionnaire. iv. Internet screening test. v. Beck Depression Inventory (BDI). vi. Suicide Probability Scale (SPS). vii. Adverse Childhood Experiences (ACE). viii. Estimate of Adolescent Sexual Offense Recidivism (ERASOR). ix. Juvenile -Sex Offender Assessment Protocol (J -SOAP). x. Millon Adolescent Clinical Inventory (MACI). xi. Montreal Cognitive Assessment (MOCA). xii. Substance Use Survey (SUS). xiii. Additional Review of Collateral Information (Psychological Evaluations/Assessments/Psychosocial history). b. Anticipated Frequency of Services: i. One (1) four (4) to six (6) hour interview. c. Anticipated Duration of Services: i. One-time service d. Goals of Services: i. Assist in determining risk. ii. Assist in treatment planning. iii. Determine amenability to treatment. e. Outcomes of Services: i. Reduce risk to engage in sexual abusive behaviors. ii. Identify dynamic and static risk factors. iii. Provide recommendations of supervision level/management. Target Population: i. Children and adolescents ages ten (10) to eighteen (18). ii. Males and females. iii. Those requiring healthy sexuality treatment, offense specific treatment. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Therapist office. ii. Foster home, group home, or treatment facility. Terms 1. Contractor will respond to the Quality Assurance Team (HS-CWOualitvAssurance(ai/weldeov.com within three (3) business days regarding the ability to accept the received referral. 2. Upon acceptance of a referral, Contractor will offer an initial appointment within seven (7) days of receiving the referral. The first attempt to contact the client will occur within 24 hours of receiving the 2 referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If the client does not respond after three (3) attempts in the first seven (7) days of the referral period, the Contractor will notify the caseworker and the Quality Assurance Team HS - C W QualitvAssurance(&,,weldgov.com . 3. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understands that the Department will not reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows", or up to two (2) hours, on the part of case participants who cancel without 24 hour notice. After three (3) "no-shows", Contractor will place client on a behavioral plan requiring attendance or discharge the client from services. Contractor must inform the caseworker and the Quality Assurance Team HS-CWQualitvAssurance/d/weldgov.com within three (3) days of when the client is placed on a behavioral plan or discharged. 4. Contractor understands that the Department will not reimburse Contractor for cancelled appointments either on the part of the client or the Contractor. If the cancellation is generated from the Contractor, a "makeup" session/episode, to occur within 30 days of the cancellation, will be offered to the client (excluding session/episodes that fall on holidays). If the cancellation is generated from the client, the Contractor must request a makeup session from the Department prior to the makeup session occurring (excluding session/episodes that fall on holidays). After three (3) cancellations, Contractor will inform the caseworker and the Quality Assurance Team HS-CWQualitvAssurance(a,weldgov.com immediately via email, to discuss service continuation. 5. Contractor will identify, in detail, areas of continued concern and make recommendations to the caseworker in a monthly report regarding continuation of services and/or the need for additional services. 6. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported to the caseworker and the Quality Assurance Team HS-CWQualitvAssurance(a,weldgov.com immediately AND on the required monthly report. 7. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 8. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator or any member of the Quality Assurance Team. Any changes to visitation referrals will be approved by a new referral signed by the Child Welfare Supervisor. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 9. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Bid Meetings, Professional Staffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as there is written authorization from the Quality Assurance Team, and the facilitator documents in the meeting notes the timeframe that the provider attended and when participation in the meeting is deemed appropriate and necessary by the Department. The Facilitator will be responsible for filling out the time attended on the meeting notes. Stuffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator. Contractor may participate by phone or virtually, if approved by the Department. 3 10. On a monthly basis, the Contractor will notify the Quality Assurance Team HS- CWQualitvAssurance(al/weldeov.com of new staff who will manage and/or administer the services with the following information: a. Staff member name and contact information b. Education level/degree (if applicable) c. Licensure/credentials (if applicable) d. Department of Regulatory Authority (DORA) number (if applicable) e. Supervisor name and contact information The Department reserves the right to decline the new staff members managing and/or administering services to Department clients. 4 EXHIBIT B RATE SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specific in Paragraph 2, below. Expenses incurred by the Contractor prior to the term of this Agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Offense Specific Treatment Individual / Family Therapy Rate Unit Type Service Name $75.00 Hour In-officeNideo $75.00 Hour In -office with Transportation $75.00 Hour In -home or community $75.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, and Professional Staffing $0.33 Mile For distances exceeding 30 miles from 2210 East LaSalle Suite 112, Colorado Springs, Colorado 80909 Offense Spe Rate cific Evaluati $1,200.00 $1,000.00 Unit Type Evaluation Service Name Offense Specific Juvenile Evaluation — with Abel Assessment Offense Specific Juvenile Evaluation — without Abel Assessment Evaluation 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement and monthly report including other supporting documentation, if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 of this Agreement . Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7. day of the month following the month of service, but no later than 45 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 45 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 45 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. When submitting a request for payment for a one-time service, the contractor shall submit the first and last page of the evaluation/report to confirm proof of services rendered. The full evaluation/report should be submitted by the contractor to the caseworker. For Monitored Sobriety services, proof of services rendered shall be the test result. Exhibit C WELD COUNTY'S REQUEST FOR PROPOSAL (Weld County's Request for Proposal is incorporated into this agreement by reference and will be provided upon request to the Department.) This page is intentionally left blank Exhibit D Contractor's response to the Request for Proposal Exhibit D contains the following documents: • Attachment B — Provider Information Form (PIF) • Attachment C — Proposal • Attachment D — Staff Data Sheet • Certificate of Insurance (COI) ATTACHMENT B WELD COUNTY DEPARTMENT OF HUMAN SERVICES — PROVIDER INFORMATION FORM (PIF) AGENCY INFORMATION Agency Name: Assurance Therapeutic Servicdes, LTD Trails Provider ID (if known): Provider Contact Full Name: Tim Martinez Title: LPC / Owner 719 565 9151 Primary Phone Number (10 -digit): Ext.: Fax Number (10 -digit): Primary Contact Email: martineztim@hotmail.coom WebAddress: Agency Location Address (street, city, state, zip): 2210 E. La Salle St., Suite 112, Coloado Springs, CO 80909 Agency Mailing Address (Street, city, state, zip): Agency Type (pick one): n Public Company El Private Non -Profit ID Private for Profit Send Referrals for Service to: Referral Contact Name: Tim Martinez Title: LPC / Owner Referral Phone Number (10 -digit): 719 565 9151 Ext.: Email: martineztim@hotmail.com Billing Contact Billing Contact Name: Tim Martinez Billing Phone Number (10 -digit): 719 565 9151 Ext.: Title: LPC / Owner Email: martineztim@hotmail.com I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it has so indicated in this bid form. I further affirm intention to enter into an agreement with Weld County, on behalf of the Weld County Department of Human Services, and comply with all requirements of the contract, if awarded. The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept Ithe bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are competitive in price and quality. WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES, THE CERTIFICATE OF EXEMPTION NUMBER IS 098-03551-0000. Authorized Rep. Full Name: Tim Martinez jAuthorized Rep. Email: martineztim a► hotmal.com jAuthorized Rep. Address ( rest, ci Late, zip): 2210 E La Salle St., Suite 112, Colorado Springs CO 80909 i Signature of Authorized Rep.: Title: LPC / Owner Phone (10 -digit): 719 565 9151 Ext.: Date:[ ---------------------- REV. DECEMBER 2021 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Tim Martinez, LPC — DBA Assurance Therapeutic Services LTD Program Area: Sexual Abuse Treatment Number of services offered on this Attachment C (max 5): Program Areas are listed in column 1 of the table located in Item Xl of the Request You may complete another Attachment C If you have more than 5. for Proposal starting on page 13. SECTION 2 - Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: ISex Abuse Treatment — Individual / Family Therapy 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Colorado Sex Offender Management Board Approved Treatment Provider, CBT, Trauma Therapy, Family Therapy, Various Workbooks 2.1b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: I 1 hour per week for individual offense specific therapy, may increase depending on client treatment needs. 2.1c Anticipated duration of service (i.e. 3-4 months): I 6 — 9 months 2.1d Three (3), or more, specific goals of the service (DO use bullet points): 1. Decrease risk to engage in sexual offending behaviors. 2. Increase overall health, strengths, skills and resources relevant to successful functioning. 3. Client accepts responsibility for offending and abusive behaviors. 2.1e Three (3), or more, specific outcomes of service: 1. Client will remain in the least restrictive environment while resolving conflict without becoming abusive. 2. Client will demonstrate pro -social relationship skills and is able to establish closeness, trust and assess trustworthiness of others. 3. Client has an adaptive sense of purpose and future. 4. Client will complete offense specific treatment in compliance with court ordered treatment. 2.1f Target population of the service, including age and gender: Children and Adolescents age 10 —18, males and females, requiring healthy sexuality treatment, offense specific treatment. 2.1g Languages service is available in (please list proficiency and if interpreter services are available): I English 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Court ordered offense specific treatment is not Medicaid eligible 2.1i Service location — list where the service will take place (i.e. client's home, in -office, other) I Therapist Office, Foster Home, Group Home, Treatment Facility Service #2 Name: IOffense Specific Evaluation 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Clinical Interview with Client Sentence Completion Interview Juvenile Sexual History Questionnaire Internet Screening Test Beck Depression Inventory (BDI) Suicide Probability Scale (SPS) Adverse Childhood Experiences (ACE) Estimate of Adolescent Sexual Offense Recidivism (ERASOR) Juvenile -Sex Offender Assessment Protocol (J -SOAP) Millon Adolescent Clinical Inventory (MACI) REV. OCT 2021 1 ATTACHMENT C - PROPOSAL Montreal Cognitive Assessment (MOCA) Substance Use Survey (SUS) Additional Review of Collateral Information (Psych Evaluations / Assessments / Psychosocial History, etc.) 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1 time —4 - 6 hour direct face to face interview 2.2c Anticipated duration of service (i.e. 3-4 months): 1 time per month 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 1. Assist in determining risk. 2. Assist in treatment planning. 3. Determine amenability to treatment. 2.2e Three (3), or more, specific outcomes of service: 1. Reduce risk to engage in sexual abusive behaviors. 2. Identify dynamic and static risk factors. 3. Provide recommendations of supervision level / management. 2.2f Target population of the service: Children and Adolescents age 10 —18, males and females, requiring healthy sexuality treatment, offense specific treatment. 2.2g languages service is available in (please list proficiency and if interpreter services are available): English 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Medicaid does not fund psychosexual evaluation. 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Office, Group Home, Treatment Facility Service #3 Name: 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.3c Anticipated duration of service (i.e. 3-4 months): 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 2.3e Three (3), or more, specific outcomes of service: 2.3f Target population of the service: 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Anticipated duration of service (i.e. 3-4 months): REV. OCT 2021 ATTACHMENT C - PROPOSAL 2.4d Three (3), or more, specific goals of the service (DO use bullet points): 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list proficiency and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.4i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: ® YES 0 NO 3.2 Will you conduct services in a client's home or in the community? Check one: ® YES 0 NO 3.3 Will you transport clients to and/or from services? Check one: ® YES 0 NO 3.4 How many miles are you willing to travel round trip? List a specific number of miles. 3.5 When you calculate mileage, what is your starting point address? 30 Miles I 2210 E La Salle Suite 112 CO Springs CO 80909 SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. REV. OCT 2021 ATTACHMENT C - PROPOSAL • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: I Offense Specific Treatment Individual / Family Therapy 4.1a In-Office/Video: 4.1b in -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: $ Amount 75.0O 75.00 75.00 75.00 0 .33 Unit Type per Hour per Hour No. of roundtrip miles included in rate: per Hour No. of roundtrip miles included in rate: per Hour per No Show per Mile This is paid after the miles listed above. 3O 3O miles miles 4.2 Hourly Service #2 Name: 4.2a In-Office/Video: 4.2b In -Office with Transportation: 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $ Amount Unit Type per Hour per Hour No. of roundtrip miles included in rate: per Hour No. of roundtrip miles included in rate: per Hour per No Show per Mile This is paid after the miles listed above. miles miles 4.3 Hourly Service #3 Name: 4.3a In-Office/Video: 4.3b In -Office with Transportation: 4.3c In -Home or Community: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: 4.3f Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: This is paid after the miles listed above. miles miles 4.4 Hourly Service #4 Name: 4.4a In-Office/Video: 4.4b In -Office with Transportation: In -Home or Community: 4.4c FTM, TDM, Prof. Staffing: 4.4d No show: 4.4e Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of roundtrip miles included in rate: 1 miles No. of roundtrip miles included in rate: miles This is paid after the miles listed above. 4.5 Hourly Service #5 Name: 4.5a In-Office/Video: 4.5b In -Office with Transportation: 4.5c In -Home or Community: 4.5d FTM, TDM, Prof. Staffing: 4.5e No show: 4.5f Mileage rate: $ Amount Unit Type per Hour per Hour No. of roundtrip miles included in rate: per Hour No. of roundtrip miles included in rate: per Hour per No Show per Mile This is paid after the miles listed above. miles miles 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month I No. of Direct Service Hours: 4.6a Offense Specific Juvenile Evaluation with Abel Assessment 1200.00 12 4.6b Offense Specific Juvenile Evaluation without Abel Assessment 1000.00 10 4.6c 4.6d 4.6e REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: REV. OCT 2021 ATTACHMENT D - STAFF DATA SHEET Bidder Must List All Staff Who Will Administer the Proposed Service(s) BIDDER'S LEGAL NAME (As it appears on the W-9): Tim Martinez DBA - Assurance Therapeutic Services, LTD PROPOSED SERVICE(S): Juvenile Offense Specific Treatment Juvenile Offense Specific Treatment AGENCY CONTACT: Tim Martinez PHONE NUMBER: 719 565 9151 EMAIL: martineztim@hotmail.com Legal Last Name Middle Initial Previous Legal Last Name (if applicable), Legal First°Name. Martinez J Tim Service Type Offense Specific Treatment Licensure/ Credentials LPC D SOME Full Level Provider Ifs 0011275 bid) CHILD WELFARE REQUEST FOR PROPOSAL 2022-23 - VARIOUS SERVICES ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 7/27/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. 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 tights to the certificate holder in lieu of such endorsement(s). PRODUCER Affinity Insurance Service, Inc. 1100 Virginia Drive, Suite 250 Fort Washington, PA 19034-3278 CONTACT Carl Messmer PHONE I FAX Extl: 1-888-288-3534 (ac, No): Ewa La, ADDREss: customer.service@hpsocover.com INSURER(S) AFFORDING COVERAGE NAIL # INSURER A : INSURED Assurance Therapeutic Services 2210 E La Salle St Ste 112 Colorado Springs, CO 80909 INSURER B INSURER C : INSURER D : INSURER E : American Casualty Company of Reading, PA 20427 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. TV TV TYPE OF INSURANCE ADDL SUER INSD WIND POLICY NUMBER ATM; (MM/DD/Y; POLICY EXP (gags= LIMITS B X COMMERCIAL GENERAL LIABILITY ICLAIMS -MADE EI OCCUR )( X 6025243631 07/23/2022 07/23/2023 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Anyone person) $ 10,000 PERSONAL&AD, INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENII AGGREGATE LIMIT APPLIES PER: X POLICY ❑ Te- D LOC OTHER: 19066079-6051:01680 $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) B X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE X X 6025243659 07/23/2022 07/23/2023 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED I X I RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LUIBILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER 2,1". I STATUTE E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Professional Liability X 0666079058 08/03/2022 08/03/2023 Liability (Each claim) 2,000,000 Liability (Aggregate) 4,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Board of County Commissioners of Weld County and its Officers/Employees are listed as additional insured, per the policies' terms and conditions. CERTIFICATE HOLDER CANCELLATION County of Weld SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE /150 O Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Greeley, CO 80631 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SIGNATURE REQUESTED:Weld/Assurance Therapeutic Services LTD CPA 2022-23 (f) Final Audit Report 2022-08-10 Created: 2022-08-04 By: Alison Pegg (apegg@co.weld.co.us) Status: Signed Transaction ID: CBJCHBCAABAAAmXFjPEVjpb2tZBLvrdYpf3xVl5leDPH "SIGNATURE REQUESTED:Weld/Assurance Therapeutic Servi ces LTD CPA 2022-23 (f)" History t Document created by Alison Pegg (apegg@co.weld.co.us) 2022-08-04 - 3:37:38 PM GMT- IP address: 204.133.39.9 Cry Document emailed to Tim Martinez (martineztim@hotmail.com) for signature 2022-08-04 - 3:41:01 PM GMT 5 Email viewed by Tim Martinez (martineztim@hotmail.com) 2022-08-04 - 4:43:22 PM GMT- IP address: 98.38.37.9 t Email viewed by Tim Martinez (martineztim@hotmail.com) 2022-08-10 - 4:30:12 PM GMT- IP address: 98.38.37.9 156 Document e -signed by Tim Martinez (martineztim@hotmail.com) Signature Date: 2022-08-10 - 4:31:18 PM GMT - Time Source: server- IP address: 98.38.37.9 0 Agreement completed. 2022-08-10 - 4:31:18 PM GMT Powered by Adobe Acrobat Ego New Contract Request Entity Information Entity Name* MARTINEZ, TIMOTHY Entity ID* 10037114 New Entity? Contract Name* Contract ID MARTINEZ, TIMOTHY DCA ASSURANCE THERAPEUTIC 6209 SERVICES (NEW CHILD PROTECTION AGREEMENT) Contract Status CTB REVIEW Contract Lead* APEGG Contract Lead Email apeggbtweldgov. corn; cobbx xlk@weldgov.com Contract Description* CONSENT BIDtt 62200040 TERM: JUNE 1, 2022 THROUGH MAY 31, 2023 Parent Contract ID 20220410 Requires d YES Department Project Contract Description 2 PROVIDER WAS LISTED ON APPROVED VENDOR LIST PRESNETED TO THE BOCC ON 04,06/22 AND AS A COMMUNICATION ITEM 'PA SENT TO CTB ON 05'10,'2022. Contract Type* AGREEMENT Amount* 90.00 Renewable* YES Automatic Renewal ICA Department HUMAN SERVICES Department Email CM - Human Service sr +eldgov. co m Department Head Email CM -Human Servic_es- C>eptHeadweldgov,cam County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM - COO NTYATTO RN EY:OWELDG OV.COM Requested BQCC Agenda Date* 00 r' 17/2022 Due Date 08x' 1 3 2022 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a MESA enter NSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Review Date 03 31 2023 Renewal Date 05, 31x2023 Termination Notice Period Contact Information Contact Info Contact Name Purchasing Purchasing CONSENT Approval Process Department Head JAMIE ULRICH DH Approved Date 08,15/2022 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 08'17 2022 Originator APEGG Committed Delivery Date Expiration Date Contact Type Contact Email Contact Phone 1 Contact Phone 2 Finance Approver CONSENT Purchasing Approved Date 08,:x 15 2022 Legal Counsel CONSENT Finance Approved Date Legal Counsel Approved Date 08/15/2022 0815,2022 Tyler Ref AG 081 722 Hello