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Home My WebLink About20241474.tiffCurr}vactlDa31(ov PROFESSIONAL SERVICE AGREEMENT BETWEEN WELD COUNTY AND SPECIALTY COUNSELING & CONSULTING, LLC THIS AGREEMENT is made and entered into this 5"day of ,,Ak , 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 Specialty Counseling & Consulting, LLC, 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. COY1SC"1'} iy4d'1CDL- tc/5l2y /I-6) /5/ag 2024-1474 HP bno 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, 2027, 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. 2 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 3 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 4 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 5 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. 6 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 may be 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 an 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: Daniel Bort Position: M&D, Community Outreach Address: 4025 Rawlins Street Address: Cheyenne, Wyoming 82001 E-mail: dbort@specialtycounseling.com Phone: (970) 942-3031 7 TO COUNTY: Name: Jamie Ulrich Position: Director Address: P.O. Box A Address: Greeley, Colorado 80632 E-mail: julrich@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. 9 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: WI ' ei BY Clerk to the Board Deputy Clerk to the Boar. .,•1R�1 7 La 10 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Kevin D. Ross, Chair CONTRACTOR: JUN 0 5 2024 Specialty Counseling & Consulting, LLC 4025 Rawlins Street Cheyenne, Wyoming 82001 Daniel 'o! - By: DanieiBort(May22, 202414:48 MDT) Daniel Bort, M&D, Community Outreach Date: May 22, 2024 c24 / 7L71 EXHIBIT A SCOPE OF SERVICES Contractor will provide Mental Health Services, as referred by the Department. 1. Individual/Family Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive Behavior Therapy (CBT). ii. Dialectical Behavior Therapy (DBT). iii. Eye Movement Desensitization and Reprocessing (EMDR). iv. Trauma Focused Cognitive Behavior Therapy (TF-CBT). v. Acceptance and Commitment Therapy (ACT). vi. Motivational Interviewing (MI). vii. Family Systems. viii. Person Centered. ix. Brief Solution Focused. x. Rational Emotive Behavior Therapy (REBT). xi. Child Play Therapy. b. Anticipated Frequency of Services: i. One (1) to two (2) hours per week. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Mood Management. ii. Conflict Resolution. iii. Improved Communication. iv. Behavior Modification. e. Outcomes of Services: i. Improved emotion regulation skills. ii. Improved protective factors. iii. Improved awareness/insight, education as needed. f. Target Population: i. Ages four (4) to ninety-nine (99). ii. Any gender/nonbinary. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. ii. In -Home or Community. iii. With Transportation. iv. Contractor is willing to travel up to 30 miles round trip with the starting location of 1910 56th Avenue, Suite B, Greeley Colorado 80634 2. Group Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive Behavior Therapy (CBT). ii. Dialectical Behavior Therapy (DBT). iii. Person Centered. iv. Interactive. v. Expressive therapies. b. Anticipated Frequency of Services: i. One (1) to two (2) hours per week. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Mood Management. ii. Conflict Resolution. iii. Improved Communication. iv. Behavior Modification. e. Outcomes of Services: i. Improved social, interpersonal, and coping skills. ii. Reduction of maladaptive or problematic behaviors. f. Target Population: i. Ages six (6) to ninety-nine (99). ii. Any gender/nonbinary. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. 3. Clinical Intake (Diagnostic Interview) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Conducted upon the first visit of each new referral to gather biopsychosocial history and to determine diagnosis along with medical necessity of services. ii. Level of Care (LOC) is determined along with potential Severe Emotional Disturbance (SED) or Severe and Persistent Mental Illness (SPMI) status. iii. Outcome Measures are conducted. b. Anticipated Frequency of Services: i. One (1) meeting with the client and/or family. ii. Annually, as needed. c. Anticipated Duration of Services: i. One (1) time occurrence. d. Goals of Services: i. Establish Diagnosis. ii. Establish Level of Care. iii. Identify Serious Emotional Disorder (SED)/Severe and Persistent Mental Illness (SPMI) status. iv. Identify Case Management needs. v. Determine therapy course. e. Outcomes of Services: i. Establish baseline for counseling direction. ii. Identification of needs. iii. Develop interventions necessary to meet goals. f. Target Population: i. Ages four (4) to ninety-nine (99). ii. Any gender/nonbinary. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. ii. In -Home or Community. iii. With Transportation. iv. Contractor is willing to travel up to 30 miles round trip with the starting location of 1910 56th Avenue, Suite B, Greeley Colorado 80634. 4. Wrap Around/Support Services a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Support services. ii. Case management. iii. Natural supports. b. Anticipated Frequency of Services: i. One (1) to four (4) hours per week. c. Anticipated Duration of Services: i. One (1) to twelve (12) months. d. Goals of Services: i. Community/Home involvement. ii. Advocacy. iii. Skill Acquisition. iv. Reunification. e. Outcomes of Services: i. Stabilization using both professional and natural supports in the youth's family, home, and community. f. Target Population: i. Ages four (4) to twenty (20). ii. Any gender/transgender. iii. At -Risk youth such as those in out of home placement, returning home from higher level of care, multi -systems, or complex mental health needs. g. Language: i. English. h. Medicaid Eligibility: i. This service is partially Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. ii. In -Home or Community. iii. With Transportation. iv. Contractor is willing to travel up to 30 miles round trip with the starting location of 1910 56th Avenue, Suite B, Greeley Colorado 80634. 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 1-15,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 staff or 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" 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 Family Time 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 Mental Health and Support Services Team. 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. Trainin 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 $ 100.00 Unit Type Hour Service Name Individual & Family Therapy aind Clinical Intakes: FTM, TDM, Professional Staffing $ 150.00 Hour Individual and Family Therapy: In- Home/Community $ 150.00 Hour Individual and Family Therapy: In -Office with Transportation $ 100.00 Hour Individual and Family Therapy: In-Office/Video $ 50.00 Hour Individual & Family Therapy: No Show $ 80.00 Hour Group Therapy: FTM, TDM, Professional Staffing $ 40.00 Hour Group Therapy: In-Office/Video 40.00 Each ' Group Therapy: No Show Program Area Rate $ 150.00 Unit Type Hour Service Name Clinical Intake: In-Home/Community $ 150.00 Hour Clinical Intake: In -Office with Transportation $ 100.00 Hour Clinical Intake: In-Office/Video 50.00 Hour Clinical Intake: No Show $ 80.00 Hour Wraparound/Support Services: FTM, TDM, Professional Staffing $ , 100.00 Hour Wraparound/Support Services: In- Home/Community $ 100.00 Hour Wraparound/Support Services: In -Office with Transportation $ 80.00 Hour Wraparound/Support Services: In-Office/Video $ 50.00 Each Wraparound/Support Services: No Show $ 0.57 Mile Mental Health Services: Mileage 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 Specialty Counseling & Consulting, LLC Agency Name: Provider Contact Full Name: Daniel Bort Trails Provider ID (if known): Title: M&D, Community Outreach 970-942-3031 205 3074264799 Primary Phone Number (10 -digit): Ext.: Fax Number (lo -digit): Primary Contact Email: dbort@specialtycounseling.com Web Address: www.specialtycounseling.c 3257 W. 20th Street, Suite 200, Greeley CO 80634 Agency Location Address (street, city, state, zip): 4025 Rawlins St., Cheyenne, WY 82001 Agency Mailing Address (Street, city, state, zip): Agency Type (pick one): El Public Company El Private Non -Profit El Private for Profit Send Referrals for Service to: Loren Ledall Referral Contact Name: 970-672-4667 Referral Phone Number (10 -digit): Ext.: Office Coordinator Title: lledall@specialtycounseling., Email: Billing Contact Sasha Baker Billing Contact Name: 307-426-4797 Billing Phone Number (lo -digit): 106 Ext.: Office Manager Title: sbaker@specialtycounseling Email: CERTIFICATION 1 ' I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it i i 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 iDepartment 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. Daniel Bort M&D, Community Outreach j I Authorized Rep. Full Name: Title: I I dbort@specialtycounseling.com 970-942-3031 205 j Authorized Rep. Email: Phone (10 -digit): Ext.: 2550 Stover Street, Building C, Fort Collins 80525 Authorized Rep. Address (street, city, state, zip): j Enid EoF 5/22/24 j signature of Authorized Rep.: Daniel Bort (May 22, 2024 14:48 MDT) Date: 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) Specialty Counseling & Consulting, LLC Number of services offered on this Attachment C (max 5): You may complete another Attachment Cif you have more than 5. 4 Service #1 Service Name: Individual/Family Therapy Program Area: Mental Health Services 1.1 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) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): CBT, DBT, EMDR, TF-CBT, ACT, MI, Family Systems, Person Centered, Brief Solution Focused, REBT, Child Play Therapy 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: 1-2 hours per week 1.3 Anticipated duration of service (i.e. 3-4 months): 3-6 months 1.4 Three (3), or more, specific goals of the service (DO use bullet points): Mood Management, Conflict Resolution, Improved Communication, and Behavior Modification 1.5 Three (3), or more, specific outcomes of service: Improved emotion regulation skills, improved protective factors, improved awareness/insight, education as needed 1.6 Target population of the service, including age and gender: 4 to 99, any gender/nonbinary 1.7 Languages service is available in (please list proficiency and if interpreter services are available): English and Spanish 1.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Yes, in network with NEHP and other RAE's 1.9 Service location — list where the service will take place (i.e. client's home, in -office, other) In -Office, Tele-therapy 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 100 Per Hour REV. OCT 2023 1 ATTACHMENT C - PROPOSAL 1.10b In -Home or Community 150 Per Hour 1.10c Transportation Service Provided with 150 Per Hour 1.10d FTM, TDM, Staffing Prof. 100 per Hour 1.10e No show 50 per No Show 1.10f Mileage rate .57 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 30 roundtrip miles. Minimum Hours of Service: N/A 1.12 Home Study Providers — List your rates in the box below. N/A 1.13 Monitored Sobriety Providers — List your rates in the box below. N/A Additional Comments 1.14 N/A Weld County Use Only REV. OCT 2023 2 ATTACHMENT C - PROPOSAL Service #2 Service Name: Group Therapy 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 be ow using bullefed points) 2.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): CBT, DBT, Person Centered, Interactive, Expressive Therapies 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 hours per week 2.3 Anticipated duration of service (i.e. 3-4 months): 3-6 months 2.4 Three (3), or more, specific goals of the service (DO use bullet points): Mood Management, Conflict Resolution, Improved Communication, and Behavior Modification 2.5 Three (3), or more, specific outcomes of service: Improved social, interpersonal, and coping skills. Reduction of maladaptive or problematic behaviors. 2.6 Target population of the service, including age and gender: 6 to 99, any gender/non-binary 2.7 Languages service is available in (please list proficiency and if interpreter services are available): English and Spanish 2.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Yes, in network with NEHP and other RAE's 2.9 Service location — list where the service will take place (i.e. client's home, in -office, other) In -Office, Teletherapy 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 40 Per Hour 2.10b In -Home or Community N/A Select Unit Type. 2.10c Transportation Service Provided with N/A Select Unit Type. 2.10d FTM, TDM, Staffing Prof. 80 per Hour 2.10e No show 40 per No Show 2.10f Mileage rate N/A per Mile 2.11 Monthly Service Rates (each level must be listed): If applicable Service Name with Level 2.11a Mileage rate is paid after N/A roundtrip miles. Rate per Month Minimum Hours of Service: REV. OCT 2023 3 ATTACHMENT C - PROPOSAL 2.11b 2.11c 2.11d 2.11e 2.11f 2.11g 2.11h 2.111 2.11j • 2.12 Home Study Providers — List your rates in the box below. N/A 2.13 Monitored Sobriety Providers — List your rates in the box below. N/A Additional Comments 2.14 N/A Weld County Use Only REV. OCT 2023 4 ATTACHMENT C - PROPOSAL Service #3 Service Name: Program Area: Clinical Intake (Diagnostic Interview) M ,nta! Llealth 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): Conducted upon the first visit of each new referral to gather biopsychosocial history and to determine diagnosis along with medical necessity of services. Also, Level of Care is determined along with potential SED or SPMI status. Outcome Measures are also conducted 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: Only first meeting with client and/or family, and then annually as needed 3.3 Anticipated duration of service (i.e. 3-4 months): One time occurrence 3.4 Three (3), or more, specific goals of the service (DO use bullet points): Establish Diagnosis, Level of Care, SED/SPMI status, Case Management needs, and Therapy Course 3.5 Three (3), or more, specific outcomes of service: Establish baseline for counseling direction, identification of needs, interventions necessary to meet goals 3.6 Target population of the service, including age and gender: 4 to 99, any gender/non-binary 3.7 Languages service is available in (please list proficiency and if interpreter services are available): English and Spanish 3.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Yes, in network with NEHP and other RAE's 3.9 Service location — list where the service will take place (i.e. client's home, in -office, other) In -Office, Teletherapy 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 100 Per Hour 3.10b In -Home or Community 150 Per Hour 3.10c Service Transportation Provided with 150 Per Hour 3.10d FTM, Staffing TDM, Prof. 100 per Hour 3.10e No show 50 per No Show 3.10f Mileage rate S7 per Mile 3.11 Monthly Service Rates (each level must be listed): If applicable Service Name with Level Mileage rate is paid after 30 roundtrip miles. Rate per Month Minimum Hours of Service: REV. OCT 2023 5 ATTACHMENT C - PROPOSAL 3.11a 3.11b 3.11c 3.11d 3.11e 3.11f 3.11g 3.11h 3.11i 3.11j N/A 3.12 Home Study Providers — List your rates in the box below. N/A 3.13 Monitored Sobriety Providers List your rates in the box below. N/A Additional Comments 3.14 Clinical Intakes are 2 hours long, 1 hour for the Interview, 1 hour for the Report Writing Weld County Use Only REV. OCT 2023 6 ATTACHMENT C - PROPOSAL Service #4 Service Name: Program Area: Wraparound/Support Services Mental NpRIth 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 ierg.-11S 4.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Support Services, Case Management, Natural Supports 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 levels, be specific for each level: 1-4 hours per week 4.3 Anticipated duration of service (i.e. 3-4 months): 1-12 months 4.4 Three (3), or more, specific goals of the service (DO use bullet points): Community/Home involvement, Advocacy, Skill Acquisition, Reunification 4.5 Three (3), or more, specific outcomes of service: Stabilization using both professional and natural supports in the youth's family/home/community 4.6 Target population of the service, including age and gender: 4 to 20, any gender/transgender At -Risk Youth (out of home placement, returning home from higher LOC, multi -systems, complex mental health needs) 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: Yes, in network with NEHP and other RAE's 4.9 Service location — list where the service will take place (i.e. client's home, in -office, other) Office, Home, School, Community 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 I $ Amount Unit Type 4.10a In-Office/Video 80 Select Unit Type. 4.10b In -Home or Community 100 Select Unit Type. 4.10c Service Transportation Provided with 100 Select Unit Type. 4.10d FTM, TDM, Staffing Prof. 80 per Hour 4.10e No show 50 per No Show 4.10f Mileage rate S7 per Mile 4.11 Monthly Service Rates (each level must be listed): If applicable Service Name with Level 4.11a Mileage rate is paid after 30 roundtrip miles. Rate per Month Minimum Hours of Service: REV. OCT 2023 7 ATTACHMENT C - PROPOSAL 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. N/A 4.13 Monitored Sobriety Providers List your rates in the box below. N/A Additional Comments 4.14 N/A 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 Daniel'Bort Specialty Counseling & Consulting, LLC PHONE NUMBER 970-67214p7,' EMAIL dbort@specialtycounseling corn' PROPOSED SERVICE(S). Individual, Family, Group Therapy, Clinical Intakes, WRAP around support services, ; . ,i `,+.., _ ,} 'F •r ~�Ls�� I-.s i`4Y4 -_ ,� „, 'r Legal Last ame , _ S, ;^` 4" �� Middles, Initial: °i :�aY ��, �{i �� L �, previous Legal L`ast3 Name,(If applicable) „�t�zx ��nt �t 'r�t�'{^' �� ,i�_ ,, �•�'y �� Syr �, Legal First Name" = z- 1 rya ';�, \ ..E �� 'M . , �,, , �z' - - Service Type_ ,F"zr r,- ,A ;jam b�,�I ' r �-. Licensure/�. Credentials = ` ;;.�.." ,r�`,'s. - `�Y. "'—sfi_•,.TY +FF ��C}A � `'nC��' '" E �r _e, , ' ��f ' DORA # (If applicable)' Bort , Daniel Therapy LPC/LAC Jostad Brooke Therapy LCSW/LAC '„ Malone '' ' , , , , Elise' Therapy , LPC '', Eid , ; Manna' Therapy LPCC - Andnng - Stephanie Therapy SWC Rodriguez " Andrea Therapy MFTC Martin , i - = Corey Therapy LPCC -� Elwood ,'' , '' ; , ,, , Valerie - Therapy -, , LPCC , = 8 ` ; ' - Waterman Katie , Therapy ' LPC -Pettilohn ` ' _ Annie Support Services - Stoll ' Rachel Support Services ._ S CHILD WELFARE REQUEST FOR PROPOSAL 2023-24 - VARIOUS SERVICES SPECCOU-02 CSPANGLER2 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYY`n 5/17/2024 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(les) 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 rights to the certificate holder in lieu of such endorsement(s) PRODUCER License # 6024 CONTACT NAME Cindy Spangler HUB International Mountain States Limited (a/O I o 03) (307) 823-6131 I j,vC No) (307) 632-6447 1620E Pershing Blvd, Suite 100 Cheyenne, WY 82001 EMAIL AD DRESS cindy Spangler@hubinternational coin INSURERS) AFFORDING COVERAGE NAIL # INSURER Employers Mutual Casualty Company 21415 INSURED INSURERS Transportation Insurance Company 20494 Specialty Counseling & Consulting, LLC 4025 Rawlins St INSURER C Hudson Excess Insurance Company 14484 INSURER D Cheyenne, WY 82001 INSURER E 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 POLIO ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE LTR ADD,- VIE INSD VIE POLICY NUMBER POLICY EFF (MMIDDIYYYYI POLICY EXP (MMIpplYY1'Yl LIMITS A X COMMERCIAL GENERAL LIABILITY I CLAIMS MADE OCCUR X BBB4729 3/26/2024 3/26/2025 EACH OCCURRENCE $ 1,000,000 pREM SES (Ea oNc ED nce) $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN X L AGGREGATE LIMIT APPLIES PER POLICY D Ter L. OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS COMP/OP AGG $ 2,000,000 WY STOP GAP EMP $ 1,000,000 A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOS ONLY SCHEDULED AUTOS _ AUOTOS ONLY 6E63697 3/26/2024 3/26/2025 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (PenccidentDAMAGE $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERlMEMBER EXCLUDED (Mandatory in NH) descnbe under DESCRIPTION OF OPERATIONS below Da N / A WC714898763 6/3/2023 6/3/2024 X I STATUTE I I ERH E L EACH ACCIDENT 100,000 $ E L DISEASE EA EMPLOYEE $ 100,000 E L DISEASE POLICY LIMIT 500,000 $ C Professional Liab C Professional Liab X AAHC9897 AAHC9897 4/27/2024 4/27/2024 3/26/2025 3/26/2025 Per Claim Aggregate 1,000,000 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 Additional Remarks Schedule, may be attached d more space is required) Workers' Comp LLC Members Excluded Robert A Logan Additional Insured Board of County Commissioners of Weld County and its Officers/Employees General Liability Additional Insured, Primary and Non -Contributory, and Waiver of Subrogation form CG7578 0219 (General Liability Elite Extension) CERTIFICATE HOLDER CANCELLATION Weld Coun tY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS 1150 O ST Greeley, CO 80631 AUTHORIZED REPRESENTATIVE tIr ILL ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION All rights reserved The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY ELITE EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to include the following clarifications and extensions of coverage. The provisions of the Coverage Form apply unless modified by endorsement. A. EXPECTED OR INTENDED INJURY Section I — Coverage A, Exclusion a. is amended as follows: a. "Bodily injury" or "property damage" expected or intended from the standpoint of an insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. B. NON -OWNED WATERCRAFT Section I — Coverage A, Exclusion g.(2) is amended as follows: (2) A watercraft you do not own that is: (a) Less than 60 feet long; and (b) Not being used to carry person(s) or property for a charge; C. EXTENDED PROPERTY DAMAGE COVERAGE Section I — Coverage A, Exclusions j.(3) and (4) is amended to add the following: Paragraphs (3) and (4) of this exclusion do not apply to tools or equipment loaned to you, provided they are not being used to perform operations at the time of loss. SCHEDULE Limits Of Insurance Deductible $5,000 Each Occurrence $250 Per Claim $10,000 Annual Aggregate a. The each occurrence limit listed above is the most we will pay for all damages because of "property damage" to property in the care, custody and control of or property loaned to an insured as the result of any one "occurrence", regardless of the number of: (1) insureds; (2) claims made or "suits" brought; (3) persons or organizations making claims or bringing "suits". The aggregate limit listed above is the most we will pay for all damages because of "property damage" to property in the care custody and control of or property loaned to an insured during the policy period. Any payment we make for damages because of "property damage" to property in the care, custody and control of or property loaned to an insured will apply against the General Aggregate Limit shown in the declarations. b. Our obligation to pay damages on your behalf applies only to the amount of damages in excess of the deductible amount listed above. We may pay any part or all of the deductible amount listed above. We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and upon notification by us, you will promptly reimburse us for that part of the deductible we paid. If two or more coverages apply under one "occurrence", only the highest per claim deductible applicable to these coverages will apply. d. Insurance provided by this provision is excess over any other insurance, whether primary, excess, contingent or any other basis. Since insurance provided by this endorsement is excess, we will have no duty to defend any claim or "suit" to which insurance provided by this endorsement applies if any other insurer has a duty to defend such a claim or "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. D. PROPERTY DAMAGE — ELEVATORS Section I — Coverage A.2. Exclusions paragraphs j.(3), j.(4), j.(6) and k. do not apply to use of elevators. This insurance afforded by this provision is excess over any valid and collectible property insurance (including any deductible) available to the insured and Section IV — Commercial General Liability Conditions Paragraph 4. Other Insurance is changed accordingly. C07578(2-19) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 1 of 6 E. FIRE, LIGHTNING OR EXPLOSION DAMAGE Except where it is used in the term "hostile fire", the word fire includes fire, lightning or explosion wherever it appears in the Coverage Form. Under Section I — Coverage A, the last paragraph (after the exclusions) is replaced with the following: Exclusions c. through n. do not apply to damage by fire, smoke or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III - Limits of Insurance. F. MEDICAL PAYMENTS If Section I — Coverage C. Medical Payments Coverage is not otherwise excluded from this Coverage Form: The requirement, in the Insuring Agreement of Coverage C., that expenses must be incurred and reported to us within one year of the accident date is changed to three years. G. SUPPLEMENTARY PAYMENTS Supplementary Payments — Coverages A and B Paragraphs 1.b. and 1.d. are replaced by the following: 1.b. Up to $5,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 1.d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. H. SUBSIDIARIES AS INSUREDS Section II — Who Is An Insured is amended to add the following: 1.f. Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date of this policy. However, insured does not include any subsidiary that is an insured under any other general liability policy, or would have been an insured under such a policy but for termination of that policy or the exhaustion of that policy's limits of liability. I. BLANKET ADDITIONAL INSUREDS - AS REQUIRED BY CONTRACT 1. Section II — Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) subject to provisions in Paragraph 2. below, (hereinafter referred to as additional insured) when you and such person(s) or organization(s) have agreed in a written contract or written agreement that such person(s) or organization(s) be added as an additional insured on your policy provided that the written contract or agreement is: a. Currently in effect or becomes effective during the policy period; and b. Executed prior to an "occurrence" or offense to which this insurance would apply. However, the insurance afforded to such additional insured: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured; and c. Applies only if the person or organization is not specifically named as an additional insured under any other provision of, or endorsement added to, Section II — Who Is An Insured of this policy. 2. As provided herein, the insurance coverage provided to such additional insureds is limited to: Any Controlling Interest, but only with respect to their liability arising out of their financial control of you; or premises they own, maintain, or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. b. Any architect, engineer, or surveyor engaged by you but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (1) In connection with your premises; or (2) In the performance of your ongoing operations. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. CG7578(2-19) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 2 of 6 This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional services by or for you. c. Any manager or lessor of a premises leased to you, but only with respect to liability arising out of the ownership, maintenance or use of that part of a premises leased to you, subject to the following additional exclusions: This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to be a tenant in that premises. (2) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. d. Any state or governmental agency or subdivision or political subdivision, subject to the following: (1) This insurance applies only with respect to the following hazards for which any state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; or (b) The construction, erection or removal of elevators; or The ownership, maintenance or use of any elevators covered by this insurance. (2) This insurance applies only with respect to operations performed by you or on your behalf for which any state or governmental agency or subdivision or political subdivision has issued a permit or authorization. (c) This insurance does not apply to: (a) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or (b) "Bodily injury" or "property damage" included within the "products - completed operations hazard". Any vendor, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business. With respect to the insurance afforded to these vendors, the following additional exclusions apply: (1) The insurance afforded any vendor does not apply to: (a) "Bodily injury" or "property damage" for which any vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that any vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by any vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as any vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at any vendor's premises in connection with the sale of the product; (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for any vendor; or CG7578(2-19) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 3 of 6 (h) "Bodily injury" or "property damage" arising out of the sole negligence of any vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) The exceptions contained in Subparagraphs (d) or (f); or (ii) Such inspections, adjustments, tests or servicing as any vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. f. Any Mortgagee, Assignee Or Receiver, but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of the premises by you. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. Any Owners Or Other Interests From Whom Land Has Been Leased, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land leased to you. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: (1) This insurance does not apply to: (a) Any "occurrence" which takes place after you cease to lease that land; or (b) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. h. Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). g. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. i. Any Owners, Lessees, or Contractors for whom you are performing operations, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: (1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. (2) "Bodily injury" or "property damage" occurring after: CG7578(2-19) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 4 of 6 (a) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (b) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Any Grantor of Licenses to you, but only with respect to their liability as grantor of licenses to you. Their status as additional insured under this endorsement ends when: 1. The license granted to you by such person(s) or organization(s) expires; or 2. Your license is terminated or revoked by such person(s) or organization(s) prior to expiration of the license as stipulated by the contract or agreement. k. Any Grantor of Franchise, but only with respect to their liability as grantor of a franchise to you. I. Any Co-owner of Insured Premises, but only with respect to their liability as co- owner of any insured premises. m. Any Concessionaires Trading Under Your Name, but only with respect to their liability as a concessionaire trading under your name. 3. Any insurance provided to any additional insured does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the sole negligence or willful misconduct of the additional insured or its agents, "employees" or any other representative of the additional insured. 4. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits of Insurance: If coverage provided to any additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. J. COVERAGE FOR INJURY TO CO -EMPLOYEES AND/OR YOUR OTHER VOLUNTEER WORKERS Section II — Who is an Insured, Paragraph 2.a. (1) is amended to add the following: e. Paragraphs (a), (b), and (c) do not apply to your "employees" or "volunteer workers" with respect to "bodily injury" to a co -"employee" or other "volunteer worker". Damages owed to an injured co -"employee" or "volunteer worker" will be reduced by any amount paid or available to the injured co - "employee" or "volunteer worker" under any other valid and collectible insurance. K. HEALTH CARE SERVICE PROFESSIONALS AS INSUREDS - INCIDENTAL MALPRACTICE Section II — Who is an Insured, Paragraph 2.a. (1) (d) is amended as follows: This provision does not apply to Nurses, Emergency Medical Technicians, or Paramedics who provide professional health care services on your behalf. However this exception does not apply if you are in the business or occupation of providing any such professional services. L. NEWLY FORMED OR ACQUIRED ORGANIZATIONS Section II — Who Is An Insured, Paragraph 3.a. is replaced by the following: 3.a. Coverage under this provision is afforded until the end of the policy period. This provision does not apply if newly formed or acquired organizations coverage is excluded either by the provisions of the Coverage Form or by endorsements. M. DAMAGE TO PREMISES RENTED TO YOU Section III — Limits of Insurance, Paragraph 6. is replaced by the following: Subject to 5.a. above, the Damage To Premises Rented To You Limit, or $500,000, whichever is higher, is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, smoke or leakage from automatic protection systems, while rented to you or temporarily occupied by you with permission of the owner. N. MEDICAL PAYMENTS - INCREASED LIMITS Section III — Limits of Insurance, Paragraph 7. is replaced by the following: 7. Subject to Paragraph 5. above, $10,000 is the Medical Expense Limit we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person, unless the amount shown on the Declarations of this Coverage Part for Medical Expense Limit states: CG7578(2-19) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 5 of 6 (a) No Coverage; or (b) $1,000; or (c) $5,000; or (d) A limit higher than $10,000. O. DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT Section IV — Commercial General Liability Conditions Paragraph 2. is amended to add the following: e. The requirement in Condition 2.a. that you must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim, applies only when the "occurrence" or offense is known to: (1) You, if you are an individual or a limited liability company; (2) A partner, if you are a partnership; (3) A member or manager, if you are a limited liability company; (4) An "executive officer" or insurance manager, if you are a corporation; or (5) A trustee, if you are a trust. f. The requirement in Condition 2.b. that you must see to it that we receive notice of a claim or "suit" as soon as practicable will not be considered breached unless the breach occurs after such claim or "suit" is known to: (1) You, if you are an individual or a limited liability company; (2) A partner, if you are a partnership; (3) A member or manager, if you are a limited liability company; (4) An "executive officer" or insurance manager, if you are a corporation; or (5) A trustee, if you area trust. P. PRIMARY AND NONCONTRIBUTORY ADDITIONAL INSURED EXTENSION Section IV — Commercial General Liability Conditions Paragraph 4. Other Insurance is amended to add the following: This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. However, if the additional insured has been added as an additional insured on other policies, whether primary, excess, contingent or on any other basis, this insurance is excess over any other insurance regardless of the written agreement between you and an additional insured. Q. UNINTENTIONAL FAILURE TO DISCLOSE EXPOSURES Section IV — Commercial General Liability Conditions Paragraph 6. Representations is amended to add the following: If you unintentionally fail to disclose any exposures existing at the inception date of your policy, we will not deny coverage under the Coverage Form solely because of such failure to disclose. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non - renewal. This provision does not apply to any known injury or damage which is excluded under any other provision of this policy. R. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Section IV — Commercial General Liability Condition Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us is amended to add the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: 1. Your ongoing operations; or 2. "Your work" included in the "products - completed operations hazard". However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1. Is in effect or becomes effective during the term of this policy; and 2. Was executed prior to loss. S. MENTAL ANGUISH Section V — Definition 3. is replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish or death resulting from bodily injury, sickness or disease. T. LIBERALIZATION If we revise this endorsement to provide greater coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. C07578(2-19) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 6 of 6 SIGNATURE REQUESTED: Weld/Specialty Counseling PSA Final Audit Report 2024-05-22 Created: 2024-05-22 By: Windy Luna (wluna@weld.gov) Status: Signed Transaction ID: CBJCHBCAABAA-CIPGga2jSMKk2JYU_XvCVO93LvUz-2A "SIGNATURE REQUESTED: Weld/Specialty Counseling PSA" History ,t Document created by Windy Luna (wluna@weld.gov) 2024-05-22 - 5:57:04 PM GMT- IP address: 204.133.39.9 D, Document emailed to dbort@specialtycounseling.com for signature 2024-05-22 - 5:58:04 PM GMT ,t Email viewed by dbort@specialtycounseling.com 2024-05-22 - 6:10:11 PM GMT- IP address: 38.15.52.224 da Signer dbort@specialtycounseling.com entered name at signing as Daniel Bort 2024-05-22 - 8:48:20 PM GMT- IP address: 38.15.52.224 do Document e -signed by Daniel Bort (dbort@specialtycounseling.com) Signature Date: 2024-05-22 - 8:48:22 PM GMT - Time Source: server- IP address: 38.15.52.224 O Agreement completed. 2024-05-22 - 8:48:22 PM GMT Powered by Adobe Acrobat Sign Fon Entity Information Entity Name * SPECIALTY COUNSELING & CONSULTING LLC Entity ID* @00042405 Contract Name * SPECIALTY COUNSELING & CONSULTING LLC (NEW PROFESSIONAL SERVICES AGREEMENT) Contract Status CTB REVIEW Contract ID 8263 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 * SPECIALTY COUNSELING & CONSULTING LLC - 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 04/10/2024. j Contract Type * AGREEMENT Amount* 00.00 Renewable * YES Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanServices@weldgov. corn 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 * 06/03/2024 Due Date 05/30/2024 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 Committed Delivery Date Renewal Date* 06/01/2025 Expiration Date Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Approval Process Department Head JAMIE ULRICH DH Approved Date 05/24/2024 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 06/05/2024 Purchasing Approved Date 05/24/2024 Finance Approver CONSENT Finance Approved Date 05/24/2024 Tyler Ref # AG 060524 Originator WLUNA Legal Counsel CONSENT Legal Counsel Approved Date 05/24/2024 Houstan Aragon From: Sent: To: Subject: noreply@weldgov.com Friday, April 4, 2025 1:36 PM CM-ClerktoBoard; Windy Luna; Lesley Cobb; CM-HumanServices-DeptHead Fast Tracked Contract ID (9317) Contract # 9317 has been Fast Tracked to CM -Contract Maintenance. You will be notified in the future based on the Contract information below: Entity Name: SPECIALTY COUNSELING & CONSULTING LLC Contract Name: SPECIALTY COUNSELING & CONSULTING LLC (NEW PROFESSIONAL SERVICES AGREEMENT) Contract Amount: $0.00 Contract ID: 9317 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 Con\-vo.e4- ko# G3n aciV 'TY GCS v2--Em-ewea 2o74--m-IL4 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, PL 8150 2023.1434 9290 ASPEN COUNSELING, LLC BARTGES, ANGELA 8141 2023-1393 9291 8165 2023-1460 9292 CASA OF LARIMER COUNTY COLORADO STATE UNIVERSITY CREATIVE NURSING, LLC CROSSROADSX COUNSELING CRUX COUNSELING, LLC DEEP WATERS PARENTING KEEP SWIMMING,LLC KRAFT, DARLA MAISHA BORA LLC NEUROPSfCHOLOGICAL SOLUTIONS, LLC NOCO SPEECH & DIAGNOSTICS NORTHERN HORIZO E -IAVIORAL HEALTH POLARIS PARTNERS LLC RABILLARD, APRIL REACHING HOPE REECE, ALISON RHEGNUMI CONSULTING, LLC RIGHT ON LEARNING SENSITIVE SOLUTIONS BEHAVIORAL HEALTH, LLC S 8176 2024-1270 9293 8286 2024-1518 9294 8151 8171 2024-12! 8132 8734 2024-1264 8750 2023-1438 8167 2023-1568 8163 2024-1265 8383 2024-1266 2024-1221 2023-1396 9297 9300 9301 9302 9303 9304 9305 8156 2023-1439 9306 8187 2024.1319 r 9307 8148 2023-1401 8397 2023-1569 8190 2024-1321 8170 2024-1473 8168 2024-1267 8204 20224-1,325 8182 28 2024-1271 2i 9308 9309 9310 9311. 9312 9313 9314 15 SIMPLE ASSENT, LLC VER IGNTY COUNSELING SERVICES RLLC 8215 8193 2024-1416 2024 '14 9323 9316 SPECIALTY COUNSELING & CONSULTING LLC THE -HOPE INITIAT& 8263 2024-1474 8188 2024-1320 9318 9317 UNIVERSITY OF NORTHERN COLORADO WHICH WAY? LI-P 8219 2024-1327 9319 8162 2023-1436 9320 WILLOW COLLECTIVE PLLC MI YUNGS PRAYER 8192 2024-1323 9321 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 ONO ®O Join Our Team Important: 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. 2 Hello