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PROFESSIONAL SERVICE AGREEMENT BETWEEN WELD COUNTY AND
WILLOW COLLECTIVE FOUNDATION, PLLC
THIS AGREEMENT is made and entered into this Z2 ""day of 2024, by and
between the Board of Weld County Commissioners, on behalf of the Weld County Department
of Human Services, hereinafter referred to as "County," and Willow Collective Foundation, PLLC,
hereinafter referred to as "Contractor".
WHEREAS, County desires to retain Contractor to perform services as required by County
and set forth in the attached Exhibits; and
WHEREAS, Contractor is willing and has the specific ability, qualifications, and time to
perform the required services according to the terms of this Agreement; and
WHEREAS, Contractor is authorized to do business in the State of Colorado and has the
time, skill, expertise, and experience necessary to provide the services as set forth below; and
WHEREAS, the Colorado Department of Human Services has provided Core and Non -
Core or other funding to the Department for Mental Health Services.
NOW, THEREFORE, in consideration of the mutual promises and covenants contained
herein, the parties hereto agree as follows:
1. Introduction. The terms of this Agreement are contained in the terms recited in this
document and in the attached Exhibits, each of which forms an integral part of this Agreement
and are incorporated herein. The parties each acknowledge and agree that this Agreement,
including the attached Exhibits, define the performance obligations of Contractor and
Contractor's willingness and ability to meet those requirements (the "Work"). If a conflict occurs
between this Agreement and any Exhibit or other attached document, the terms of this
Agreement shall control, and the remaining order of precedence shall based upon order of
attachment.
Exhibit A consists of the Scope of Services.
Exhibit B consist of the Rate Schedule.
Exhibit C consists of County's Request for Proposal (RFP) as set forth in Bid Package No.
B2400040 which is incorporated into this agreement by reference and will be provided
upon request to the Department.
Exhibit D consists of Contractor's Response to County's Request.
2. Service or Work. Contractor agrees to diligently provide all services, labor, personnel
and materials necessary to perform and complete the Work described in the attached Exhibits.
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Services shall be provided by the Contractor to any person(s) eligible for services in compliance
with Exhibits A, Scope of Services, and Exhibit D, Contractor's Response to Request for Proposal.
Contractor shall further be responsible for the timely completion and acknowledges that a failure
to comply with the standards and requirements of Work within the time limits prescribed by
County may result in County's decision to withhold payment or to terminate this Agreement.
3. Term. The term of this Agreement shall be from June 1, 2024, through May 31,
21n unless sooner terminated as provided herein, and is subject to continued budget
appropriations.
4. Termination; Breach; Cure. County may terminate this Agreement for its own
convenience upon thirty (30) days written notice to Contractor. Either Party may immediately
terminate this Agreement upon material breach of the other party, however the breaching party
shall have fifteen (15) days after receiving such notice to cure such breach. If this Agreement is
terminated by County, Contractor shall be compensated for, and such compensation shall be
limited to, (1) the sum of the amounts contained in invoices which it has submitted and which
have been approved by the County; (2) the reasonable value to County of the services which
Contractor provided prior to the date of the termination notice, but which had not yet been
approved for payment; and (3) the cost of any work which the County approves in writing which
it determines is needed to accomplish an orderly termination of the work. County shall be
entitled to the use of all material generated pursuant to this Agreement upon termination. Upon
termination of this Agreement by County, Contractor shall have no claim of any kind whatsoever
against the County by reason of such termination or by reason of any act incidental thereto,
except for compensation for work satisfactorily performed and/or materials described herein
properly delivered.
5. Extension or Amendment. Any amendments or modifications to this agreement shall
be in writing signed by both parties. No additional services or work performed by Contractor shall
be the basis for additional compensation unless and until Contractor has obtained written
authorization and acknowledgement by County for such additional services. Accordingly, no
claim that the County has been unjustly enriched by any additional services, whether or not there
is in fact any such unjust enrichment, shall be the basis of any increase in the compensation
payable hereunder. In the event that written authorization and acknowledgment by the County
for such additional services is not timely executed and issued in strict accordance with this
Agreement, Contractor's rights with respect to such additional services shall be deemed waived
and such failure shall result in non-payment for such additional services or work performed. Any
claims by the Contractor for adjustment hereunder must be made in writing prior to performance
of any work covered in the anticipated Amendment, unless approved and documented otherwise
by the County Representative. Any change in work made without such prior Amendment shall
be deemed covered in the compensation and time provisions of this Agreement, unless approved
and documented otherwise by the County Representative.
6. Compensation. County agrees to pay Contractor through an invoice process during
the course of this Agreement in accordance with the Rate Schedule as described as Exhibit B.
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Contractor agrees to submit invoices which detail the work completed by Contractor. The County
will review each invoice and if it agrees Contractor has completed the invoiced items to the
County's satisfaction, it will remit payment to the Contractor. No payment in excess of that set
forth in the Exhibits will be made by County unless an Amendment authorizing such additional
payment has been specifically approved by Weld County as required pursuant to the Weld
County Code. If, at any time during the term or after termination or expiration of this Agreement,
County reasonably determines that any payment made by County to Contractor was improper
because the service for which payment was made did not perform as set forth in this Agreement,
then upon written notice of such determination and request for reimbursement from County,
Contractor shall forthwith return such payment(s) to County. Upon termination or expiration of
this Agreement, unexpended funds advanced by County, if any, shall forthwith be returned to
County. County will not withhold any taxes from monies paid to the Contractor hereunder and
Contractor agrees to be solely responsible for the accurate reporting and payment of any taxes
related to payments made pursuant to the terms of this Agreement. Unless expressly
enumerated in the attached Exhibits, Contractor shall not be entitled to be paid for any other
expenses (e.g. mileage). Notwithstanding anything to the contrary contained in this Agreement,
County shall have no obligations under this Agreement after, nor shall any payments be made to
Contractor in respect of any period after December 31 of any year, without an appropriation
therefore by County in accordance with a budget adopted by the Board of County Commissioners
in compliance with Article 25, Title 30 of the Colorado Revised Statutes, the Local Government
Budget Law (C.R.S. 29-1-101 et. seq.) and the TABOR Amendment (Colorado Constitution, Article
X, Sec. 20).
7. Independent Contractor. 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 (including unemployment insurance or workers' compensation
benefits) from County as a result of the execution of this Agreement. 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 head taxes (if
applicable) incurred pursuant to this Agreement.
8. Subcontractors. Contractor acknowledges that County 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 the Work without
County's prior written consent, which may be withheld in County's sole discretion. County shall
have the right in its reasonable discretion to approve all personnel assigned to the Work during
the performance of this Agreement and no personnel to whom County has an objection, in its
reasonable discretion, shall be assigned to the Work. Contractor shall require each
subcontractor, as approved by County and to the extent of the Work to be performed by the
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subcontractor, to be bound to Contractor by the terms of this Agreement, and to assume toward
Contractor all the obligations and responsibilities which Contractor, by this Agreement, assumes
toward County. County shall have the right (but not the obligation) to enforce the provisions of
this Agreement against any subcontractor hired by Contractor and Contractor shall cooperate in
such process. The Contractor shall be responsible for the acts and omissions of its agents,
employees and subcontractors.
9. Ownership. All work and information obtained by Contractor under this Agreement or
individual work order shall become or remain (as applicable), the property of County. 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 County. Contractor shall not make use of such material for purposes other than
in connection with this Agreement without prior written approval of County.
10. Confidentiality. Confidential information of the Contractor should be transmitted
separately from non -confidential information, clearly denoting in red on the relevant document
at the top the word, "CONFIDENTIAL." However, Contractor is advised that as a public entity,
Weld County must comply with the provisions of the Colorado Open Records Act (CORA), C.R.S.
24-72-201, et seq., with regard to public records, and cannot guarantee the confidentiality of all
documents. Contractor agrees to keep confidential all of County's confidential information.
Contractor agrees not to sell, assign, distribute, or disclose any such confidential information to
any other person or entity without seeking written permission from the County. Contractor
agrees to advise its employees, agents, and consultants, of the confidential and proprietary
nature of this confidential information and of the restrictions imposed by this Agreement.
11. Warranty. Contractor warrants that the Work performed under this Agreement will
be performed in a manner consistent with the standards governing such services and the
provisions of this Agreement. Contractor further represents and warrants that all Work shall be
performed by qualified personnel in a professional manner, consistent with industry standards,
and that all services will conform to applicable specifications.
12. Acceptance of Services Not a Waiver. Upon completion of the Work, Contractor
shall submit to County originals of all test results, reports, etc., generated during completion of
this work. Acceptance by County of reports and incidental material(s) furnished under this
Agreement shall not in any way relieve Contractor of responsibility for the quality and accuracy
of the project. In no event shall any action by County hereunder constitute or be construed to
be a waiver by County of any breach of this Agreement or default which may then exist on the
part of Contractor, and County's action or inaction when any such breach or default exists shall
not impair or prejudice any right or remedy available to County with respect to such breach or
default. 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 County of, or payment for, the Work completed under this Agreement shall
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not be construed as a waiver of any of the County's rights under this Agreement or under the law
generally.
13. Insurance. Contractor must secure, before the commencement of the Work, the
following insurance covering all operations, goods, and services provided pursuant to this
Agreement, and 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. For all coverages,
Contractor's insurer shall waive subrogation rights against County.
a. Types of Insurance.
Workers' Compensation / Employer's Liability Insurance as required by state statute,
covering all of the Contractor's employees acting within the course and scope of their
employment. The policy shall contain a waiver of subrogation against the County. This
requirement shall not apply when a Contractor or subcontractor is exempt under
Colorado Workers' Compensation Act., AND when such Contractor or subcontractor
executes the appropriate sole proprietor waiver form.
Commercial General Liability Insurance including public liability and property damage,
covering all operations required by the Work. Such policy shall include minimum limits as
follows: $1,000,000 each occurrence; $1,000,000 general aggregate; $1,000,000
Personal injury; $5,000 Medical payment per person.
Automobile Liability Insurance: 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, for vehicles owned, hired, and non -owned vehicles used in the performance
of this Contract.
Professional Liability (Errors and Omissions Liability). The policy shall cover professional
misconduct or lack of ordinary skill for those positions defined in the Scope of Services of
this contract. Contractor shall maintain limits for all claims covering wrongful acts, errors
and/or omissions, including design errors, if applicable, for damage sustained by reason
of or in the course of operations under this Contract resulting from professional services.
In the event that the professional liability insurance required by this Contract is written
on a claims -made basis, Contractor warrants that any retroactive date under the policy
shall precede the effective date of this Contract; and that either continuous coverage will
be maintained or an extended discovery period will be exercised for a period of two (2)
years beginning at the time work under this Contract is completed. Minimum Limits:
$1,000,000 Per Loss; $2,000,000 Aggregate.
b. Proof of Insurance. Upon County's request, Contractor shall provide to County a
certificate of insurance, a policy, or other proof of insurance as determined in County's
sole discretion. County may require Contractor to provide a certificate of insurance
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naming Weld County, Colorado, its elected officials, and its employees as an additional
named insured.
c. Subcontractor Insurance. Contractor hereby warrants that all subcontractors
providing services under this Agreement have or will have the above -described insurance
prior to their commencement of the Work, or otherwise that they are covered by the
Contractor's policies to the minimum limits as required herein. Contractor agrees to
provide proof of insurance for all such subcontractors upon request by the County.
d. No limitation of Liability. The insurance coverages specified in this Agreement are the
minimum requirements, and these requirements do not decrease or limit the liability of
Contractor. The County in no way warrants that the minimum limits contained herein are
sufficient to protect the Contractor from liabilities that might arise out of the performance
of the Work under by the Contractor, its agents, representatives, employees, or
subcontractors. The Contractor shall assess its own risks and if it deems appropriate
and/or prudent, maintain higher limits and/or broader coverages. The Contractor is not
relieved of any liability or other obligations assumed or pursuant to the Contract by
reason of its failure to obtain or maintain insurance in sufficient amounts, duration, or
types. The 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.
e. Certification of Compliance with Insurance Requirements. The Contractor stipulates that
it has met the insurance requirements identified herein. The Contractor shall be
responsible for the professional quality, technical accuracy, and quantity of all services
provided, the timely delivery of said services, and the coordination of all services
rendered by the Contractor and shall, without additional compensation, promptly remedy
and correct any errors, omissions, or other deficiencies.
14. Indemnity. The Contractor shall defend, indemnify and hold harmless County, its
officers, agents, and employees, from and against any and all injury, loss, damage, liability, suits,
actions, claims, or willful acts or omissions of any type or character arising out of the Work done
in fulfillment of the terms of this Agreement or on account of any act, claim or amount arising or
recovered under workers' compensation law or arising out of the failure of the Contractor to
conform to any statutes, ordinances, regulation, judicial decision, or other law or court decree.
The Contractor shall be fully responsible and liable for any and all injuries or damage received or
sustained by any person, persons, or property on account of its performance under this
Agreement or its failure to comply with the provisions of the Agreement. It is agreed that the
Contractor will be responsible for primary loss investigation, defense and judgment costs where
this contract of indemnity applies. In consideration of the award of this contract, the Contractor
agrees to waive all rights of subrogation against the County its associated and/or affiliated
entities, successors, or assigns, its elected officials, trustees, employees, agents, and volunteers
for losses arising from the work performed by the Contractor for the County. A failure to comply
with this provision shall result in County's right to immediately terminate this Agreement.
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15. Non -Assignment. Contractor may not assign or transfer this Agreement or any
interest therein or claim thereunder, without the prior written approval of County. Any attempts
by Contractor to assign or transfer its rights hereunder without such prior approval by County
shall, at the option of County, automatically terminate this Agreement and all rights of Contractor
hereunder. Such consent maybe granted or denied at the sole and absolute discretion of County.
16. Examination of Records. To the extent required by law, the Contractor agrees that a
duly authorized representative of County, including the County Auditor, shall have access to and
the right to examine and audit any books, documents, papers and records of Contractor, involving
all matters and/or transactions related to this Agreement. Contractor agrees to maintain these
documents for three years from the date of the last payment received.
17. 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.
18. Notices. County may designate, prior to commencement of Work, its project
representative ("County Representative") who shall make, within the scope of his or her
authority, all necessary and proper decisions with reference to the project. All requests for
contract interpretations, change orders, and other clarification or instruction shall be directed to
County Representative. All notices or other communications made by one party to the other
concerning the terms and conditions of this contract shall be deemed delivered under the
following circumstances:
(a) personal service by a reputable courier service requiring signature for receipt; or
(b) five (5) days following delivery to the United States Postal Service, postage prepaid
addressed to a party at the address set forth in this contract; or
(c) electronic transmission via email at the address set forth below, where a receipt or
acknowledgment is required and received by the sending party; or
Either party may change its notice address(es) by written notice to the other. Notice may be sent
to:
TO CONTRACTOR:
Name: Maddie Darnell
Position: Therapist/Chief Operating Officer
Address: 375 East Horsetooth Road, Building 6-201
Address: Fort Collins, Colorado 80525
E-mail: maddied@willowcollectivefoco.com
Phone: (360) 265-0578
TO COUNTY:
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Name: Jamie Ulrich
Position: Director
Address: P.O. Box A
Address: Greeley, Colorado 80632
E-mail: iulrich@weld.gov
Phone: (970) 400-6510
19. Compliance with Law. Contractor shall strictly comply with all applicable federal and
State laws, rules and regulations in effect or hereafter established, including without limitation,
laws applicable to discrimination and unfair employment practices.
20. Non -Exclusive Agreement. This Agreement is nonexclusive, and County may engage or
use other Contractors or persons to perform services of the same or similar nature.
21. Entire Agreement/Modifications. This Agreement including the Exhibits attached
hereto and incorporated herein, contains the entire agreement between the parties with respect
to the subject matter contained in this Agreement. This instrument supersedes all prior
negotiations, representations, and understandings or agreements with respect to the subject
matter contained in this Agreement. This Agreement may be changed or supplemented only by
a written instrument signed by both parties.
22. Fund Availability. Financial obligations of the County payable after the current fiscal
year are contingent upon funds for that purpose being appropriated, budgeted and otherwise
made available. Execution of this Agreement by County does not create an obligation on the part
of County to expend funds not otherwise appropriated in each succeeding year.
23. Employee Financial Interest/Conflict of Interest — C.R.S. §§24-18-201 et seq. and §24-
50-507. The signatories to this Agreement state 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. Contractor agrees that if Contractor employs a former
employee of the Department of Human Services, Contractor will notify the County within 30 days
of employment. The Contractor will also abide by applicable requirements under C.R.S. 24-18-
201 et seq.
24. Survival of Termination. The obligations of the parties under this Agreement that by their
nature would continue beyond expiration or termination of this Agreement (including, without
limitation, the warranties, indemnification obligations, confidentiality and record keeping
requirements) shall survive any such expiration or termination.
25. 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.
26. Governmental Immunity. No term or condition of this Agreement 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 §§24-10-101 et
seq., as applicable now or hereafter amended.
27. No Third -Party Beneficiary. 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, shall 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.
28. 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 or its designee.
29. 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.
30. Attorney's Fees/Legal Costs. In the event of a dispute between County 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.
31. Binding Arbitration Prohibited. Weld County does not agree to binding arbitration by any
extra -judicial body or person. Any provision to the contrary in this Agreement or incorporated
herein by reference shall be null and void.
32. Acknowledgment. County and Contractor acknowledge that each has read this
Agreement, understands it and agrees to be bound by its terms. Both parties further agree that
this Agreement, with the attached Exhibits, is the complete and exclusive statement of
agreement between the parties and supersedes all proposals or prior agreements, oral or
written, and any other communications between the parties relating to the subject matter of this
Agreement.
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IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
COUNTY:
ATTEST: 4:")
BY:
erk to the Board
Deputy CI ' k to he B
Willow Collective Foundation, PLLC
375 East Horsetooth Road, Building 6-201
Fort Collins, Colorado 80525
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BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
evin D. Ross, Chair
MAY 2 2 2024
ONTRACTOR:
By: Mary Beth swan— (.y8,2024,9,09.,
2024,9,09 MDT)
Maddie Darnell,
Therapist, Chief Operating Officer
Date: May 8, 2024
020 ,1-- /O,23
EXHIBIT A
SCOPE OF SERVICES
Contractor will provide Mental Health Services, as referred by the Department.
1. Caring Dads
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Caring Dads Group curriculum.
b. Anticipated Frequency of Services:
i. One (1) to two (2) times per week.
ii. Up to seventeen (17) weeks.
c. Anticipated Duration of Services:
i. Eight (8) to seventeen (17) weeks.
d. Goals of Services:
i. Help dads understand the impact of controlling, abusive, and neglectful
actions on children.
ii. Help dads learn how to spend time with children in healthy ways.
iii. Increase dad's awareness and application of child -centered fathering.
e. Outcomes of Services:
i. Stop the cross -generational transmission of violence.
ii. Improve awareness of, and responsibility for, abusive and neglectful
fathering behaviors and their impact on children.
iii. To support men in becoming resources rather than risks for their
children.
iv. Improve healthy fathering.
f. Target Population:
i. Fathers who have engaged in intrafamilial violence including domestic
violence and child abuse.
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service may be Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community
2. Child Parent Psychotherapy
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Child parent psychotherapy (Trauma Informed Services).
b. Anticipated Frequency of Services:
i. One (1) time per week.
c. Anticipated Duration of Services:
i. A minimum of sixteen (16) sessions.
ii. Up to eighteen (18) months.
d. Goals of Services:
i. To support and strengthen the relationship between a child and
caregiver.
ii. Restore the child's cognitive, behavioral, and social functioning.
iii. Provide both the child and parent with coping skills that reduce risk
factors for abuse/neglect.
e. Outcomes of Services:
i. Improved quality of attachment between child and caregiver.
ii. Reduction in children's behavioral problems and Post Traumatic Stress
Disorder (PTSD) symptomology.
iii. Reduction in caregiver's symptoms of Post Traumatic Stress Disorder
(PTSD) and depression.
f. Target Population:
i. Caregivers.
ii. Children under the age of six (6).
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service may be Medicaid eligible.
Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community.
3. Circle of Security Parenting Group
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Circle of security parenting group curriculum.
b. Anticipated Frequency of Services:
i. One (1) hour per week.
c. Anticipated Duration of Services:
i. Eight (8) weeks.
d. Goals of Services:
i. Increase caregiver's capacity to identify attachment needs using the
Circle of Security graphic.
ii. Decrease negative attributions of the parent regarding the child's
motivations.
iii. Increase parent's capacity to pause, reflect, and chose security -promoting
caregiving behaviors.
iv. Increase caregiver's ability to recognize ruptures in the relationship and
facilitate repairs.
v. Increase caregiver's ability to read young children's cues.
vi. Increase caregiver's empathy for the child.
e. Outcomes of Services:
i. Children will exhibit increased empathy, greater self-esteem, better
relationships with parents and peers, enhanced school readiness, and an
increased capacity to handle emotions effectively.
ii. Caregivers will increase their awareness of their children's needs and
whether their own responses meet those needs.
iii. Caregivers will increase their capacity to respond in ways that promote
secure attachment and exploration of the environment.
f. Target Population:
i. Caregivers of children seven (7) years of age and under.
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service is Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community.
4. Parent Child Interactional (PCI) Assessments
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Parent Child Interactional (PCI) Assessments for Very Young Children,
under the age of five (5).
ii. Working Model of the Child and Crowell PCI.
iii. Completed by two (2) clinicians.
b. Anticipated Frequency of Services:
i. Two (2) hours per week.
c. Anticipated Duration of Services:
i. One (1) to two (2) months.
d. Goals of Services:
i. Assess the strengths and difficulties in the relationship of young children
and their parents.
ii. Optimize functioning of the parent —child dyad.
iii. Guide treatment decisions to maximize successful repair of parent -child
dyad.
e. Outcomes of Services:
i. Improve infant, toddler, and preschool children's access to permanency.
ii. Decrease the negative impact of early maltreatment on infant, toddler
and preschool children's mental health and behavior.
iii. Improve capacity to devise and implement appropriate dyadic
interventions.
f. Target Population:
i. Children under age five (5) that have been impacted by abuse/neglect,
attachment disruption, and are at risk of out -of -home placement.
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service may be Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community.
Terms
1. 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.
2. 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.
3. Contractor will respond to the Mental Health and Support Services Team HS-
CWServiceReferral@weld.gov) within three (3) business days regarding the ability to
accept the received referral.
4. 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 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 Mental Health and Support Services Team HS-
CWServiceReferral@weld.gov.
5. Contractor acknowledges that any and all modifications to an existing referral must be
approved through the Mental Health and Support Services Team HS-
CWServiceReferral@weld.gov. No other Department staffor other party to the case
may authorize services or modifications to services.
6. 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 B, 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 Mental Health and Support Services Team HS-
CWServiceReferral@weld.gov within three (3) days of when the client is placed on a
behavioral plan or discharged
7. 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 Mental Health and
Support Services Team HS-CWServiceReferral@weld.gov immediately via email, to
discuss service continuation.
8. 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.
9. 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.
10. 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
Mental Health and Support Services Team HS-CWServiceReferral@weld.gov
immediately AND on the required monthly report.
11. Contractor agrees any change to an existing referral must be pre -approved through the
Child Welfare Core Service Coordinator or any member of the Mental Health and
Support Services 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.
12. 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 Mental Health and Support Services 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. Staffings 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.
13. On a monthly basis, the Contractor will notify the Mental Health and Support Services
Team HS-CWServiceReferral@weld.gov of new staffwho 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.
14. 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 9 of this Exhibit.
15. 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.
16. 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.
17. 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.
18. 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 to
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.
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(s) specified below in Paragraph 2,
Fees for Services.
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.
For services funded through Core Services, Contractor agrees to accept reimbursement
through ACH direct deposit one time per month. 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, deposit slip or bank letter. Failure to complete
and submit this form and voided check in a timely and accurate manner may result in a
delay of payment.
For services not funded through Core Services; Contractor agrees to accept payment
through County Warrant when funding source does not allow for direct deposit.
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
Program Area
Mental Health Services
Rate
$ 115.00
Unit
Type
Hour
Service Name
Caring Dad's: In Home or Community
$ 100.00
Hour
Caring Dad's: In Office/Video
200.00
Hour
Child Parent Psychotherapy: In Home or
Community
$ 165.00
Hour
Child Parent Psychotherapy: In Office/Video
115.00
Hour
Circles of Security Parenting Group: In Home
or Community
$ 100.00
Hour
Circles of Security Parenting Group: In
Office/Video
$ 0.67
Mile
Mental Health Service: Mileage
$ 120.00
Hour
Mental Health Services: FTM, TDM,
Professional Staffing
Program Area
Mental Health Services
Rate
Unit
Type Service Name
Each
$ 440.00
Hour
Mental Health Services: No Show
Parent Child Interaction (PCI) Assessments:
In Home or Community
Parelt,Child Interaction (PCI) Assessments:
In Office/Video
3. Request for Reimbursement and Supporting Documentation
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 for each client receiving ongoing services.
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. 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. Time(s) of service (i.e. 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. What interventions were used, recommendations and/or goals discussed,
progressions towards goals, and client engagement.
e. For mileage reimbursement, if applicable, the mileage accumulated minus
roundtrip mileage that is included in the rate, starting location, and ending
location.
f. Any and all safety concerns.
When submitting a Request for Reimbursement 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.
Requests for Reimbursement and/or supporting documentation received after the 7th
day of the month may delay payment. 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.
4. Payment
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: The service being provided by
the contractor is not a Medicaid eligible service;
a. The service is not deemed medically necessary;
b. The Court with jurisdiction over the case has ordered that a non -Medicaid
provider or service be used;
c. A Medicaid provider is not available to provide the needed service;
d. Medicaid is exhausted for the needed service; or
e. Medicaid denied service.
f. The client is not eligible for Medicaid.
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.
5. 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:
a. Withhold payment to the Contractor until the necessary services or
corrections in performance are satisfactorily completed.
b. 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.
6. 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.
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: Willow Collective Foundation Trails Provider ID (if known):
Provider Contact Full Name: Maddie Darnell Title: Therapist/C.O.O.
Primary Phone Number (10 -digit): 360'265'0578 Ext.: Fax Number (lo -digit):
maddied@willowcollectivefoco.com willowcollectivefoco.com
Primary Contact Email: Web Address:
Agency Location Address (Street, city, state, zip): 375 E. Horsetooth Road, Building 6-201
Agency Mailing Address (street, city, state, zip): Fort Collins, CO 80525
Agency Type (pick one): ® Public Company Ei Private Non -Profit EIPrivate for Profit
Send Referrals for Service to:
Referral Contact Name: Andrea Joyce Title: Therapist/Referral coordinator
Referral Phone Number (10 -digit): 970-541-1103 Ext.: Email:
andrea@willowcollectivefoco.com
Billing Contact
Billing Contact Name: Maddie Darnell
Billing Phone Number (10 -digit): 360'265'0578 Ext.:
Title: Therapist/C. O.O
maddied@willowcollectivefoco.com
Email:
CERTIFICATION
I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it
Ihas 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.
i WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES. THE CERTIFICATE OF EXEMPTION NUMBER IS #98-03551-0000.
Maddie Darnell maddied@willowcollectivefoco.com
Authorized Rep. Full Name: Title:
Authorized Rep. Email: maddied@willowcollectivefoco.com Phone (10 -digit,: 360-265-0578 Ext.:
375 E. Horsetooth Road, Building 6-201, Fort Collins, CO 80525
Authorized Rep. Address (street, city, state, zip):
Signature of Authorized Rep.: Mary Beth Swanson (May 8, 202419:09 MDT)
�
Date: 01/25/24
REV. DECEMBER 2021
ATTACHMENT C - PROPOSAL
Please type your answers in the boxes below or check the appropriate box.
Provider Information
Bidder's Legal Name:
(As reflected on W-9)
Willow Collective Foundation
Number of services offered on this Attachment C (max 5):
You may complete another Attachment C if you have more than 5.
Service #1
Service Name:
Program Area:
2/9
Child Parent Psychotherapy
Mental Health Services
Scope of Work
Please Note: if the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulIaWd' p rots)
1.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
Child parent psychotherapy (Trauma Informed Services)
1.2 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:
lx per week
•
1.3 Anticipated duration of service (i.e. 3-4 months):
CPP minimum of 16 sessions often for up to 18 months
1.4 Three (3), or more, specific goals of the service (DO use bullet points):
• To support and strengthen the relationship between a child and caregiver
• To restore the child's cognitive, behavioral, and social functioning
• To provide both the child and parent with coping skills that reduce risk factors for abuse/neglect
1.5 Three (3), or more, specific outcomes of service:
• Improved quality of attachment between child and caregiver
• Reduction in children's behavioral problems and PTSD symptomology
• Reduction in caregiver's symptoms of PTSD and depression
1.6 Target population of the service, including age and gender:
Caregivers and children under age 6
1.7 Languages service is available in (please list proficiency and if interpreter services are available):
English Only
1.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
Individual/Family at times eligible
1.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
Telehealth/Fort Collins office. Potentially community and client's home depending on distance.
Rates
Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing).
All rates should be per hour unless service is for evaluations/assessments, Home Studies or Monitored Sobriety.
• For hourly Service rates please complete section 1.10
• For monthly Service rates please complete section 1.11
• For Home Study Providers please complete section 1.12
• For monitored Sobriety Providers please complete section 1.13
1.10 Hourly Service Rates:
Service
Service
Type
$ Amount
Unit
Type
#1
1.10a
In-Office/Video
165
Per Hour
REV. OCT 2023
1
ATTACHMENT C - PROPOSAL
1.10b
In -Home
Community
or
200
Per Hour
1.10c
Transportation
Service
Provided
with
N/A
Select
Unit Type.
1.l0d
FTM,
TDM,
Staffing
Prof.
120
per Hour
1.10e
No
show
75
per
No
Show
1.10f
Mileage
rate
0.67
per
Mile
1.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
Mileage rate is
paid after
Rate per
Month
10
roundtrip miles.
Minimum Hours of Service:
1.12 Home Study Providers — List your rates in the box below.
1.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
1.14
Weld County Use Only
REV. OCT 2023 2
ATTACHMENT C - PROPOSAL
Service #2
Service Name:
Caring Dad's
Program Area:
Mental Health Services
Scope of Work
Please Note: If the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulleted points)
2.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
Caring Dads Group (Mental Health Services)
2.2 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— 2 times a week for up to 17 weeks
2.3 Anticipated duration of service (i.e. 3-4 months):
8-17 weeks
2.4 Three (3), or more, specific goals of the service (DO use bullet points):
• Help dads understand the impact on children of controlling, abusive, and neglectful actions.
• Helps dads learn how to spend time with children in healthy ways
• Increase dads awareness and application of child -centered fathering.
2.5 Three (3), or more, specific outcomes of service:
• Stop the cross -generational transmission of violence.
• Improve awareness of, and responsibility for, abusive and neglectful fathering behaviors and their
impac: on children.
• Support men to become resources rather than risks for their children.
Improve healthy fathering.
2.6 Target population of the service, including age and gender:
Fathers who have engaged in intrafamilial violence including domestic violence and child abuse
2.7 Languages service is available in (please list proficiency and if interpreter services are available):
English
2.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
Not fully
2.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
Telehealth/Fort Collins office. Potentially community and client's home depending on distance.
Rates
Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing).
All rates should be per hour unless service is for evaluations/assessments, Home Studies or Monitored Sobriety.
• For hourly Service rates please complete section 2.10
• For monthly Service rates please complete section 2.11
• For Home Study Providers please complete section 2.12
• For monitored Sobriety Providers please complete section 2.13
2.10 Hourly Service Rates:
Service #2
Service
Type
$ Amount
Unit
Type
2.10a
In-Office/Video
100
Per Hour
2.10b
In
-Home
or Community
115
Per
Hour
2.10c
Service
Transportation
Provided
with
N/A
Select
Unit
Type.
2.10d
FTM,
Staffing
TDM,
Prof.
120
per Hour
2.10e
No
show
75
per
No
Show
REV. OCT 2023
ATTACHMENT C - PROPOSAL
2.10f
Mileage
rate
per
Mile
0.67
2.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
2.11a
2.11b
2.11c
2.11d
2.11e
2.11f
2.11g
2.11h
2.11i
2.11j
2.12 Home Study Providers — List your rates in the box below.
Mileage rate is paid
after
10
roundtrip miles.
Rate per Month Minimum Hours of Service:
2.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
2.14
Weld County Use Only
REV. OCT 2023
4
ATTACHMENT C - PROPOSAL
Service #3
Service Name:
Circle of Security Parenting Group
Program Area:
Mental Health Services
Scope of Work
Please Note: If the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulleted points)
3.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
Circle of security parenting group curriculum
3.2 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 hour a week
3.3 Anticipated duration of service (i.e. 3-4 months):
8 weeks
3.4 Three (3), or more, specific goals of the service (DO use bullet points):
• Increase caregiver's capacity to identify attachment needs using the Circle of Security graphic
• Decrease negative attributions of the parent regarding the child's motivations.
• Increase parent's capacity to pause, reflect, and chose security -promoting ca-egiving behaviors.
• Increase caregiver's ability to recognize ruptures in the relationship and facilitate repairs.
• Increase caregiver's ability to read young children's cues
• Increase caregiver's empathy for the child.
3.5 Three (3), or more, specific outcomes of service:
• Children exhibit increased empathy, greater self-esteem, better relationships with parents and peers, enhanced
school readiness, and an increased capacity to handle emotions effectively.
• Caregivers increase their awareness of their children's needs and whether their own responses meet those
n eeds
• Caregivers increase their capacity to respond in ways that promote secure attachment and exploration of the
e nvironment.
3.6 Target population of the service, including age and gender:
Caregivers of children 7 and under.
3.7 Languages service is available in (please list proficiency and if interpreter services are available):
English
3.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
Partially covered
3.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
Telehealth/Fort Collins office. Potentially community location
Rates
Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing).
All rates should be per hour unless service is for evaluations/assessments, Home Studies or Monitored Sobriety.
• For hourly Service rates please complete section 3.10
• For monthly Service rates please complete section 3.11
• For Home Study Providers please complete section 3.12
• For monitored Sobriety Providers please complete section 3.13
3.10 Hourly Service Rates:
Service #3
Service
Type
$ Amount
Unit
Type
3.10a
In-Office/Video
i
100
Per
Hour
3.10b
In
-Home
or Community
115
Per
Hour
3.10c
Service
Transportation
Provided
with
N/A
Select
Unit Type.
REV. OCT 2023
ATTACHMENT C - PROPOSAL
3.10d
Staffing
TDM,
Prof.
120
per
Hour
FTM,
3.10e
No
show
75
per
No
Show
3.10f
Mileage
rate
0.67
per
Mile
3.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
3.11a
3.11b
3.11c
3.11d
3.11e
3.11f
3.11g
3.11h
3.11i
3.11j
3.12 Home Study Providers — List your rates in the box below.
Mileage rate is paid
after
10
roundtrip miles.
Rate per Month Minimum Hours of Service:
3.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
3.14
Weld County Use Only
REV. OCT 2023
6
ATTACHMENT C - PROPOSAL
Service #4
Service Name:
Parent Child Interactional Assessments for Very Young Children (under 5) —Working Model of the Child
and Crowell PCI
Program Area:
Mental Health Services
Scope of Work
Please Note: If the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulleted points)
4.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
Parent Child Interactional Assessments for Very Young Children (under 5) —Working Model of the Child and Crowell
PCI. This is completed by two clinicians.
4.2 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 !evels, be specific for each level:
2 hours a week, two clinicians required
4.3 Anticipated duration of service (i.e. 3-4 months):
One - two months, plus report writing
4.4 Three (3), or more, specific goals of the service (DO use bullet points):
• Assess the strengths and difficulties in the relationship of young children and their parents.
• Optimize functioning of the parent —child dyad.
• Guide treatment decisions to maximize successful repair of parent -child dyad.
4.5 Three (3), or more, specific outcomes of service:
• Improve infant, toddler and preschool children's access to permanency.
• Decrease the negative impact of early maltreatment on infant, toddler and preschool children's
mental health and behavior.
• Improve capacity to devise and implement appropriate dyadic interventions.
4.6 Target population of the service, including age and gender:
Children under age 5 impacted by abuse/neglect, attachment disruption, at risk of OOH placement
4.7 Languages service is available in (please list proficiency and if interpreter services are available):
English
4.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
Partially covered by Medicaid (Second clinician not covered by Medicaid)
4.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
Telehealth/Fort Collins office. Potentially community and client's home depending on distance.
Rates
Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing).
All rates should be per hour unless service is for evaluations/assessments, Home Studies or Monitored Sobriety.
• For hourly Service rates please complete section 4.10
• For monthly Service rates please complete section 4.11
• For Home Study Providers please complete section 4.12
• For monitored Sobriety Providers please complete section 4.13
4.10 Hourly Service Rates:
Service #4
Service
Type
$ Amount i
Unit
Type
4.10a
In-Office/Video
360
Per Hour
4.10b
In
-Home or Community
440
Per
Hour
4.10c
Service
Transportation
Provided
with
N/A
Select
Unit Type.
4.10d
FTM,
Staffing
TDM,
Prof.
120
per Hour
REV. OCT 2023
ATTACHMENT C - PROPOSAL
4.10e
No show
75
per
No
Show
4.10f
Mileage
rate
0.67
per
Mile
4.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
4.11a
4.11b
4.11c
4.11d
4.11e
4.11f
4.11g
4.11h
4.11i
4.11j
4.12 Home Study Providers — List your rates in the box below.
Mileage rate is paid
after
10
roundtrip miles.
Rate per Month Minimum Hours of Service:
4.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
4.14
Weld County Use Only
REV. OCT 2023
8
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)•°
_!
AGENCY CONTACT Maddle Darnell
Mary Elizabeth Swanson
PHONE NUMBER 360-265-0578
EMAIL: maddied@wlllowcollectivefoco corn
PROPOSED SERVICE(S): Trauma Informed Care Services (Child 'parent psychotherapy, Circle of Security, Parenting, Individual & Family therapy
[including case staffing, collateral/indirect professional services]) Mental Health Services-(Relinquishment'Counseling),
=Miscellaneous (Travel time -as needed for -meetings) ' -
Zi ' qty- of N �)
--trir2^ `"'
ry, _° -��
r��x �
'" 3 }= 3
-LegalL'ast Name,
` �Y'r
''Midclle,�
Initial
_ r 'iV t1��`k.—r
of ,' fv ur p'
� „ t
Previous Legal Last,
Name (If applicable)
', ,
w, n.
Legal
�i-...'�S..I '� -
<e S. „ ,�'
�.R�M1 �-� ___
; ;e
First,Name
;y,� +. r..- `'
Sy 'tit's �r�
�_,<<
� ��
< � >4
"Service_Type°_ ,
'�t3
«rte,, ` i
,� , t �
; Licensure / ;
r
, ,Credentials
�t rr ; Y�—cM�
Ati{ -�`�` s`yy,� -y--
, . - .K,
�'i�
_,�
�, ',DORA # (If applicable),'
-- Swanson -
E
-
Mary
Mental Health-
LCSW
CSW 00992313 -
, - Schlick , _ _
Madeline
Mental Health
--LPC
LPC 0018901,
' Krug '
Ruth '
Mental Health , -
, LCSW'
CSW 09928865 '
,Tuttle
-Amy
Mental Health
LCSW
- CSW 09929664
Barfuss Egbert_-
_Emily
Mental Health -
SWC
- SWC 0000000742
Darnell
E
Dalton
'Madison
_ - Mental Health
SWC -
_ SWC 00000001578 '
Dayak , - i
A ,
Samantha
_ Mental, Health ,
SWC '
' SWC 00000001606 -
Joyce `
J
, _ - 4
Andrea'
- Mental' Health'
LPCC i'
LPCC 0020718 -
- Haapanen '
_ Bntney
Mental Health
MFT=C '
-
- Davenport ' -
' Kinsey'
- Mental Health -
MSW-C
Lerew
Chloe
- Mental Health
'
- MSW-C _
' Clark
Jenelle
Mental Health
, MSW=C
v
Heinzen ;'
' '
, - , -
'docelyne '
' .,Mental Health
r MSW-C
, '
Swanson
Mary Beth
CHILD WELFARE REQUEST FOR PROPOSAL 2023-24 - VARIOUS SERVICES
Account Number: CO CROS 1450 Date: 4/19/24 Initials: QTMHHTTP
CERTIFICATE OF INSURANCE
ALIZED WORLD INSURANCE COMPANY
C/O: American Professional Agency, Inc.
95 Broadway, Amityville, NY 11701
800-421-6694
This is to certify that the insurance policies specified below have been issued by the company
indicated above to the insured named herein and that, subject to their provisions and conditions,
such policies afford the coverages indicated insofar as such coverages apply to the occupation
or business of the Named Insured(s) as stated.
THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS
THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE.
Name and Address of Named Insured:
CROSSROADSX COUNSELING
PROFESSIONAL LLC
1453 CHERRYWOOD WAY
LONGMONT CO 80504
Type of Work Covered: MENTAL HEALTH COUNSELOR,
Location of Operations: N/A
(If different than address listed above)
Claim History: None
Retroactive date is 03/28/2023
Additional Named Insureds:
ROBERT A DIX
Coverages
Policy
Number
Effective
Date
Expiration
Date
Limits of
Liability
PROFESSIONAL/
LIABILITY
5006-4899
3/28/2024
3/28/2025
1,000,000
1,000,000
NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED, WHO SHALL
ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF
CANCELLATION.
Comments: Defense Reimbursement Proceedings Limit is $5,000. 1 ADDL,INS.BELOW:
BOARD OF COUNTY
COMMISSIONERS OF WELD
COUNTY & ITS OFFICERS/
EMPLOYEES CO 80631
This Certificate Issued to:
Name: Weld County
1150 "O" Street
Address: Greeley, CO. 80631
Authorized Representative
APA 00138 00 (06/2014)
NAME: a -O SSAA) S X Account #: ao GJ0 S' l Lf
S e[:7 REQUEST FOR ADDITIONAL INSURED
Complete the following questionnaire and return to:
American Professional Agency, Inc.
95 Broadway
Amityville, NY 1170
1. Name & Address of proposed Additional Insured*
C
2. Nature of proposed Additional Insureds Businss:
Li) ELA
3. The Additional Insured is my:
Employer [ ] Landlord [ J Professional Corporation [ I
Other K (specify)tif0.4".4^-‘144-14
4. The Additional Insured gives me the following form to file with the IRS:
W-2 [ j 1099
Se-ylric es -
Additional Insured:
Board of County Commissioners of Weld County
and its Officers/Employees
Weld County
1150 O Street
Greeley, CO 80631
Other (specify)
5. Describe relationship between you and the proposed additional insured:
6. Are you requesting that the entity named in Question #1 be added as an additional insured in order to
fulfill a contractual obligation? [ I No [Wes : If yes, give full particulars:
Arr-71-'-,— i" h0.Z.44 ra-Cs legrhA
� J
Signature of Insured: .U/1c 1^/1Z-- Date: 6/23
Signing this form and ten ering premium does not bind the applicant ofthe
9 ng PP Company to adding the
proposed additional insured to the policy. Please make checks payable and mail to the "American
Professional Agency, Inc."
I J DARWIN NATIONAL ASSURANCE COMPANY
I J PLATTE RIVER INSURANCE COMPANY
1 J DARWIN SELECT INSURANCE COMPANY
PRGe2010 ADDINS (3/2006)
SIGNATURE REQUESTED: Weld/Willow PSA
Final Audit Report
2024-05-09
Created: 2024-05-08
By: Windy Luna (wluna@weld.gov)
Statue Signed
Transaction ID: CBJCHBCAABAA2M1A7V—BtL0oNI5HJwis488aoewFibD
"SIGNATURE REQUESTED: Weld/Willow PSA" History
5 Document created by Windy Luna (wluna@weld.gov)
2024-05-08 - 11:16:10 PM GMT- IP address: 204.133.39.9
W. Document emailed to marybeth@willowcollectivefoco.com for signature
2024-05-08 - 11:16:57 PM GMT
5 Email viewed by marybeth@willowcollectivefoco.com
2024-05-08 - 11:36:19 PM GMT- IP address: 74.125.215.66
155 Signer marybeth@willowcollectivefoco.com entered name at signing as Mary Beth Swanson
2024-05-09 - 1:09:52 AM GMT- IP address: 38.15.57.9
d Document e -signed by Mary Beth Swanson (marybeth@willowcollectivefoco.com)
Signature Date: 2024-05-09 - 1:09:54 AM GMT - Time Source: server- IP address: 38.15.57.9
Agreement completed.
2024-05-09 - 1:09:54 AM GMT
Powered by
Adobe
Acrobat Sign
Contract For
Entity Information
Entity Name* Entity ID*
WILLOW COLLECTIVE PLLC @00048009
Contract Name"
WILLOW COLLECTIVE PLLC (NEW PROFESSIONAL
SERVICES AGREEMENT RELATED TO BID #B2400040)
Contract Status
CTB REVIEW
Contract ID
8192
Contract Lead *
WLUNA
Q New Entity?
Parent Contract ID
Requires Board Approval
YES
Contract Lead Email Department Project #
wluna@weldgov.com;cob
bxxlk@weldgov.com
Contract Description *
(CONSENT) WILLOW COLLECTIVE PLLC NEW PROFESSIONAL SERVICES AGREEMENT RELATED TO BID #B2400040.
TERM: 06/01 /2024 THROUGH 05/31/2027.
Contract Description 2
PROVIDER WAS LISTED ON APPROVED VENDOR LIST PRESENTED TO THE BOCC ON 04/10/24.
Contract Type* Department
AGREEMENT HUMAN SERVICES
Amount*
$0.00
Renewable"
YES
Automatic Renewal
Grant
IGA
Department Email
CM-
Human5ervices@weldgov.
com
Department Head Email
CM-HumanServices-
DeptHead@weldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
EY@WEL
DGOV.COM
Requested BOCC Agenda
Date *
05/22/2024
Due Date
05/18/2024
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
Contact Info
Review Date*
03/31/2025
Renewal Date*
06/01/2025
Committed Delivery Date Expiration Date
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver
CONSENT
Approval Process
Department Head
JAMIE ULRICH
DH Approved Date
05/13/2024
Final Approval
BOCC Approved
BOCC Signed Date
BOCC Agenda Date
05/22/2024
Finance Approver
CONSENT
Purchasing Approved Date
05/13/2024
Legal Counsel
CONSENT
Finance Approved Date Legal Counsel Approved Date
05/13/2024
Tyler Ref*
AG 052224
Originator
WLUNA
05/13/2024
Houstan Aragon
From:
Sent:
To:
Subject:
noreply@weldgov.com
Friday, April 4, 2025 1:41 PM
CM-ClerktoBoard; Windy Luna; Lesley Cobb; CM-HumanServices-DeptHead
Fast Tracked Contract ID (9321)
Contract # 9321 has been Fast Tracked to CM -Contract Maintenance.
You will be notified in the future based on the Contract information below:
Entity Name: WILLOW COLLECTIVE PLLC
Contract Name: WILLOW COLLECTIVE PLLC (NEW PROFESSIONAL SERVICES AGREEMENT RELATED TO BID
#B2400040( Contract Amount: $0.00 Contract ID: 9321 Contract Lead: WLUNA
Department: HUMAN SERVICES
Review Date: 3/31/2027
Renewable Contract: NO
Renew Date:
Expiration Date:5/31/2027
Tyler Ref #:
Thank -you
CorVvo.c-V- ‘1),4 g3z1
�aS� Tvack-'R-ev1ewec\
2024- 1323
Houstan Aragon
From:
Sent:
To:
Cc:
Subject:
Sara Adams
Friday, April 4, 2025 1:15 PM
CTB
HS -Contract Management
FAST TRACK - Various Core Agreements (Tyler# Various)
Good afternoon CTB,
FAST TRACK ITEM:
The below list will be Fast Track items in CMS for tracking purposes only to correct the expiration date.
Contractor
CMS#
Tyler# New CMS#
APPA,THERAPY, PLLC
8150
123-1434
9290
ASPEN COUNSELING, LLC
BARTGES, ANGELA
CASA OF LARIMER COUNTY
COLORADO STATE UNIVERSITY
8141 2023-1393 9291
8165 2023-1460 9292
8176 2024-1270 9293
8286 2024-1518
9294
CREATIVE NURSING, LLC
CROSSROADSX COUNSELING
8151 2024-1221
8171 2024-1268 9298
9297
CRUX COUNSELING, LLC
DEEP WATERS PARENTING
KEEP SWIMMING,LLC
8132 2023-1396
9300
8734 2024-1264 9301
8750
2023-1438
9302
K
8167 223-1568 930
MAISHA BORA LLC
NEUROPYCHOLOGIEAL SOLUTIONS, LLC
NOCO SPEECH & DIAGNOSTICS
NOR T N HORIZON BEHAVIORA H LTH
8163
2024-1265
9304
8383 2O24-1266 9305
8156 2023-1439 9306
8187 2'024.1319 9307
POLARIS PARTNERS LLC
RABILLARD, APRIL
REACHING HOPE
REEC5,ISON''.
RHEGNUMI CONSULTING, LLC
RIGHT ON LEARNING
SENSITIVE SOLUTIONS BEHAVIORAL HEALTH, LLC
SES
YG
SIMPLE ASSENT, LLC
SOVEREIGNTY CCOUNSELING SERVICES PLLC
SPECIALTY COUNSELING & CONSULTING LLC
TI NmATIV
UNIVERSITY OF NORTHERN COLORADO
WF
fl? LLP
8148
8397
8190
8168
8204
8182
8215
2023-1401
2023-1569 9309
2024-1321
2424=1473
2024-1267
2k24-1325
2024-1271
•1.
2024-1416
9308
9310
9312
9313
9314
9315
9323
8193 2024-1324 9316
8263
8219
162
2024-1474
2(-1326
2024-1327
-1431
9317
931
9319
9320
WILLOW COLLECTIVE PLLC
8192 2024-1323 9321
ml YON
9015 2023-1397 9322
Thank you,
Sara
COUNTY, CO
Sara Adams
Contract Administrative Coordinator
Department of Human Services
Desk: 970-400-6603
P.O. Box A, 315 N. 11th Ave., Greeley, CO 80632
0 x 00
Join Our Team
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