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PROFESSIONAL SERVICE AGREEMENT BETWEEN WELD COUNTY AND
COLORADO STATE UNIVERSITY
THIS AGREEMENT is made and entered into this ( clay of 3u l.f . , 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 The Board of Governors of the
Colorado State University System, acting by and through Colorado State University, for the
benefit of the department of Human Development & Family Studies, 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.
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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.
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 Mall,.
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.
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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.
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
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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
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
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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
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.
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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
naming Weld County, Colorado, its elected officials, and its employees as an additional
named insured.
c. Subcontractor Insurance. Contractor may require that all subcontractors providing
services under this Agreement will have the above -described insurance prior to their
commencement of the Work.
d. No limitation of Liability. Intentionally left blank.
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. Limitation of Liability. Contractor shall be responsible to the fullest extent allowed
under the law for its own negligence, and the negligence of its employees and authorized
volunteers acting within the scope of their actual authority. It is expressly understood and agreed
that nothing contained in this Agreement shall be construed as an express or implied waiver by
the Contractor of its governmental and sovereign immunities, as an express or implied
acceptance by the Contractor of liabilities arising as a result of actions which lie in tort or could
lie in tort in excess of the liabilities allowable under the Colorado Governmental Immunity Act,
C.R.S. 24-10-101 et seq., as a pledge of the full faith and credit of the State of Colorado, or as the
assumption of any of the parties of a debt, contract or liability of each other in violation of Article
XI, Section 1 of the Constitution of Colorado. As an institution of the State of Colorado,
Contractor is not authorized to indemnify any party, public or private, as against the claims and
demands of third parties and any such indemnification provision in this Agreement shall be null
and void. The Contractor is liable for breach of contract in the same manner as any private party
would be under Colorado law under the same or similar circumstances.
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 a
duly authorized representative of County, including the County Auditor, shall have access to and
the right to examine and audit any books, documents, papers and records of Contractor, involving
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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: Stephanie Seng
Position: Director
Address: 502 West Lake Street
Address: Fort Collins, Colorado 80523-1570
E-mail: sseng@colostate.edu
Phone: (970) 492-4651
With a copy to:
Name: Office of the General Counsel
Position: Attn: Contracting Services
Address: 06 Campus Delivery
Address: Colorado State University
Address: Fort Collins, CO 80523-0006
E-mail: contracts@colostate.edu
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TO COUNTY:
Name: Jamie Ulrich
Position: Director
Address: P.O. Box A
Address: Greeley, Colorado 80632
E-mail: iulrich@weld.gov
Phone: (970) 400-6510
19. Compliance with Law. Contractor shall strictly comply with all applicable federal and
State laws, rules and regulations in effect or hereafter established, including without limitation,
laws applicable to discrimination and unfair employment practices.
20. Non -Exclusive Agreement. This Agreement is nonexclusive, and County may engage or
use other Contractors or persons to perform services of the same or similar nature.
21. Entire Agreement/Modifications. This Agreement including the Exhibits attached
hereto and incorporated herein, contains the entire agreement between the parties with respect
to the subject matter contained in this Agreement. This instrument supersedes all prior
negotiations, representations, and understandings or agreements with respect to the subject
matter contained in this Agreement. This Agreement may be changed or supplemented only by
a written instrument signed by both parties.
22. Fund Availability. Financial obligations of the County payable after the current fiscal
year are contingent upon funds for that purpose being appropriated, budgeted and otherwise
made available. Execution of this Agreement by County does not create an obligation on the part
of County to expend funds not otherwise appropriated in each succeeding year.
23. Employee Financial Interest/Conflict of Interest — C.R.S. §§24-18-201 et seq. and §24-
50-507. The signatories to this Agreement state that to their knowledge, no employee of Weld
County has any personal or beneficial interest whatsoever in the service or property which is the
subject matter of this Agreement. Contractor agrees that if Contractor employs a former
employee of the Department of Human Services, Contractor will notify the County within 30 days
of employment. The Contractor will also abide by applicable requirements under C.R.S. 24-18-
201 et seq.
24. Survival of Termination. The obligations of the parties under this Agreement that by their
nature would continue beyond expiration or termination of this Agreement (including, without
limitation, the warranties, indemnification obligations, confidentiality and record keeping
requirements) shall survive any such expiration or termination.
25. Severability. If any term or condition of this Agreement shall be held to be invalid,
illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed
and enforced without such provision, to the extent that this Agreement is then capable of
execution within the original intent of the parties.
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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 a court of competent jurisdiction in Colorado will 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 anyother communications between the parties relating to the subject matter of this
Agreement.
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IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
COUNTY:
ATTEST: da)f,A)
�• "�t�
Clerk to the Board
BY:
eputy Clerk to the Board
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BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
Kevin D. Ross, Chair
ONTRACTOR:
JUN 1 0 2024
The Board of Governors of the Colorado
State University System, acting by and
through Colorado State University
Colorado State University
CSU Campus Delivery 1570
Fort Collins, Colorado 80523-1570
By: Angela gels a"29! 2024 MDT,
Angela Nielsen
Director, Office of Budgets
Date: May 29, 2024
By:
Dr. Julie Braungart-Rieker
Dept. Head, HDFS
�nian Anolenson
By: Brian Anderson (May 23, 2024 15:54 MDT)
Brian Anderson, Esq.
Assistant Legal Counsel
��� A.1-/
EXHIBIT A
SCOPE OF SERVICES
Contractor will provide Mental Health Services, as referred by the Department.
1. Empower Group
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. I -Empathize Curriculum.
b. Anticipated Frequency of Services:
i. Sixty (60) to ninety (90) minutes per week.
c. Anticipated Duration of Services:
i. Five (5) to eight (8) weeks.
d. Goals of Services:
i. Equip youth with strategies to stay safe from exploitation.
ii. Nurture empathy for others.
iii. Build effective communication skills.
e. Outcomes of Services:
i. Youth will learn language to communicate about empathy, sympathy,
apathy, exploitation.
ii. Youth will gain tools to stay safe from exploitation.
iii. Youth will practice strategies to stay safe from exploitation.
f. Target Population:
i. All genders, ages twelve (12) to eighteen (18).
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service is Medicaid eligible.
Service Access and Transportation:
i. In -Office.
2. High Conflict Couples Therapy
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Domestic Violence Focused Couples Treatment Curriculum: Stith, S.,
McCollum, E., Rosen, K.
ii. Co -Therapy Model allowing for joint and split sessions.
b. Anticipated Frequency of Services:
i. Sixty (60) to ninety (90) minutes per week.
c. Anticipated Duration of Services:
i. Ten (10) to twenty (20) weeks.
d. Goals of Services:
i. The primary goal of treatment is the cessation of all forms of violence in
the relationship.
ii. For some couples the couple intervention may allow partners to
reconsider whether or not the relationship is viable.
iii. The treatment will be considered effective if violence is ended and/or if
the couple separates without a violent incident.
iv. Basic to the approach is a both/and position: Each individual is
responsible for their own behavior and individual behavior affects and is
affected by the behavior of others. That is, although the abuser is held
accountable for their actions, interrupting repetitive patterns of behavior
within the couple system that maintain abuse is viewed as a powerful
tool to deal with the problem.
e. Outcomes of Services:
i. Gain the cooperation and commitment of both partners in making
changes in their relationship.
ii. Assist partners to build on strengths and past successes to develop
solutions to relationship problems.
iii. Identify and support relationship patterns that lead to cooperative
resolution of conflict.
iv. Enhance positive affect between partners.
v. Assist partners in taking responsibility for their own behavior.
vi. Punctuate and solidify positive changes that are made.
f. Target Population:
i. Any gender partner must be 18 years of age or older.
ii. Both partners must participate in couples' treatment.
iii. Both partners must want to try to end the violence and improve the
relationship.
iv. At least one act of physical violence or repeated acts of emotional
violence must have occurred in the past year, however violence cannot
be ongoing, and clients must sign a no -violence agreement.
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service is Medicaid eligible.
i. Service Access and Transportation:
i. In -Office.
3. Individual Therapy
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Solution Focused.
ii. Strategic.
iii. Structural.
iv. Cognitive Behavioral.
v. Internal Family Systems.
vi. Narrative.
vii. Milan.
viii. Transgenerational.
ix. Emotionally Focused.
x. Motivational Interviewing.
xi. Telehealth.
b. Anticipated Frequency of Services:
i. Fifty (50) minutes per week.
c. Anticipated Duration of Services:
i. One (1) to four (4) months.
d. Goals of Services:
i. Develop and maintain healthy boundaries and relationship skills.
ii. Improve communication skills.
iii. Build problem -solving skills.
iv. Build empathy and understanding.
v. Build conflict management skills.
vi. Explore and heal from trauma.
vii. Manage depression, anxiety, and other mental health diagnoses.
e. Outcomes of Services:
i. Clients will be able to successfully complete therapy portion of treatment
plans.
ii. Clients will gain tools to improve functioning related to presenting
problem.
iii. Clients will gain tools to effectively manage conflict and effectively
problem -solve.
f. Target Population:
i. Individuals across the lifespan.
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service is Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
4. Relationship Therapy
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Solution Focused.
ii. Strategic.
iii. Structural.
iv. Cognitive Behavioral.
v. Internal Family Systems.
vi. Narrative.
vii. Milan.
viii. Transgenerational.
ix. Emotionally Focused.
x. Motivational Interviewing.
xi. Telehealth.
b. Anticipated Frequency of Services:
i. Fifty (50) minutes per week.
c. Anticipated Duration of Services:
i. One (1) to four (4) months.
d. Goals of Services:
i. Develop and maintain healthy boundaries.
ii. Facilitate cohesion and communication.
iii. Promote problem -solving by better understanding family dynamics.
iv. Build empathy and understanding.
v. Reduce conflict within the family.
e. Outcomes of Services:
i. Clients will be able to successfully complete therapy portion of treatment
plans.
ii. Clients will gain tools to improve family functioning including
communication and parenting.
iii. Clients will gain tools to effectively manage conflict and effectively
problem -solve.
f. Target Population:
i. Couples, families, other relationships across the lifespan.
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service is Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
5. Social Skills Youth Group
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Motivational Interviewing.
ii. Psychoeducation.
iii. Experiential.
b. Anticipated Frequency of Services:
i. Fifty (50) minutes per week.
c. Anticipated Duration of Services:
i. Eight (8) to ten (10) weeks.
d. Goals of Services:
i. Teach youth about relationships and social skills.
ii. Provide opportunities to practice new skills in a safe social setting.
iii. Create safe setting for group interactions.
e. Outcomes of Services:
i. Learn and practice conversation skills.
ii. Learn and practice friendship skills.
iii. Learn about emotions and practice appropriate emotional expression.
iv. Learn and practice conflict management.
v. Learn about and practice using manners.
f. Target Population:
i. All genders, ages five (5) to eighteen (18).
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service is Medicaid eligible.
i. Service Access and Transportation:
i. In -Office.
6. Transgender Youth Group
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Systemic Therapy Modalities:
1. Attachment, Regulation, and Competency (ARC) Model.
2. Motivational Interviewing.
3. Psychoeducation.
4. Experiential.
b. Anticipated Frequency of Services:
i. Sixty (60) minutes per week.
c. Anticipated Duration of Services:
i. Eight (8) weeks.
d. Goals of Services:
i. Provide a safe and confidential space for youth to share experiences.
ii. Teach and provide opportunity to practice coping skills.
iii. Share resources.
e. Outcomes of Services:
i. Develop safe relationships with peers.
ii. Learn and use tools to cope with difficult emotions, relationships, and
experiences.
iii. Identify and learn to evaluate local and online resources available to
them.
f. Target Population:
i. All genders, ages five (5) to eighteen (18).
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service is Medicaid eligible.
i. Service Access and Transportation:
i. In -Office.
7. Trauma and Resilience Assessment
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Psychosocial interview.
ii. Collateral interviews and surveys.
iii. Cognitive screening and surveys.
iv. Debrief meeting.
v. Telehealth when appropriate.
b. Anticipated Frequency of Services:
i. Three (3) hour assessment.
ii. One (1) to two (2) hour debrief meeting.
c. Anticipated Duration of Services:
i. Four (4) to eight (8) weeks.
d. Goals of Services:
i. Gather information across several key domains of functioning.
ii. Identify the impact of traumatic events on attachment, regulation, and
competency.
iii. Identify needs of children and families exposed to traumatic events,
empowering, and incorporating their voices, and make appropriate
related recommendations.
iv. Summarize information and communicate with families offering
psychoeducation and opportunity for feedback.
e. Outcomes of Services:
i. Build on client resilience in the areas of attachment, regulation, and
competency.
ii. Increase child, family and team understanding of the impact of complex
trauma.
iii. Share client perspective of impact with their family and team.
f. Target Population:
i. Children and families involved in child welfare who have experienced
complex trauma.
ii. All ages.
g. Language:
i. English.
h. Medicaid Eligibility:
i. Not currently Medicaid eligible, contractor is currently negotiating a
Medicaid contract rate.
i. Service Access and Transportation:
i. In-Office/Video.
8. Trauma and Resilience Consultation
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Attachment, Regulation and Competency (ARC) Model.
ii. Community/Trauma Resiliency Model (CRM/TRM).
iii. Telehealth.
b. Anticipated Frequency of Services:
i. One (1) time service.
c. Anticipated Duration of Services:
i. One (1) to two (2) hours.
d. Goals of Services:
i. Provide psychoeducation around impact of trauma for child and family.
ii. Collaborate with the Department team and the family to direct treatment
or support through trauma -informed recommendations.
iii. Provide written report with trauma -informed recommendations.
e. Outcomes of Services:
i. Department employees and family will have a greater understanding
about the impact of trauma.
ii. Department employees and family will incorporate trauma -informed
recommendations.
iii. Client and family's strengths and areas of resilience will be acknowledged
and supported.
f. Target Population:
i. Caseworkers or Caregivers of youth who have experienced trauma.
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service is not Medicaid eligible.
i. Service Access and Transportation:
i. Video.
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 LLS: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
Clinical Care 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
Stuffings, 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. Training
Contractor may be required to attend training at the request of the Department specific
to services provided under this Agreement. The Department will not compensate the
Contractor for said training in the form of registration fees, time spent traveling to and
from training, attending the training or any other associated costs unless otherwise
agreed to by the Department.
17. Subpoenas
Contractor will, on behalf of its employees and/or officers, accept any subpoena for
testimony from the Weld County Attorney's Office by e-mail and will return a waiver of
services within 72 business hours. For this purpose, Contractor will designate an e-mail
address prior to the start of this Agreement. If the Contractor receives a subpoena via
e-mail but will only accept personal service, the Contractor will contact the Weld County
Attorney's Office immediately at (970) 336-7235 and advise that the subpoena must be
personally served.
18. Monitoring and Evaluation
Contractor and the Department agree that monitoring and evaluation of the
performance of this Agreement shall be conducted by the Contractor and the
Department. The results of the monitoring and evaluation shall be provided to the
Board of Weld County Commissioners, the Department, and the Contractor.
Contractor will collaborate in a timely manner with the Department to resolve issues
pertaining to service delivery, service quality, documentation, and invoicing during
referral period and after services have concluded. The Contractor will require clients to
sign releases of information. Contractor understands that the Department will not
reimburse for services rendered to Department clients until releases of information are
obtained.
Contractor shall permit the Department, and any other duly authorized agent or
governmental agency, to monitor all activities conducted by the Contractor pursuant to
the terms of this Agreement. The monitoring agency may, if in its sole discretion deems
necessary or appropriate, have access to any program data, special analyses, on -site
checking, formal audit examinations, or any other reasonable procedures for purposes
of monitoring. All such monitoring shall be performed in a manner that will not unduly
interfere with the work conducted under this Agreement.
EXHIBIT B
RATE SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse the Contractor in consideration of the work and
services performed under this Agreement at the rate(s) specified below in Paragraph 2,
Fees for Services.
Expenses incurred by the Contractor prior to the term of this Agreement are not eligible
Department expenditures and shall not be reimbursed by the Department.
For services funded through Core Services, Contractor agrees to accept reimbursement
through ACH direct deposit one time per month. If Contractor is not currently set up
with the State of Colorado to accept direct deposit, Contractor agrees to complete and
submit a State of Colorado direct deposit enrollment form, which will be provided by
the Department, with a voided check, deposit slip or bank letter. Failure to complete
and submit this form and voided check in a timely and accurate manner may result in a
delay of payment.
For services not funded through Core Services; Contractor agrees to accept payment
through County Warrant when funding source does not allow for direct deposit.
Payment pursuant to this Agreement, whether in whole or in part, is subject to and
contingent upon the continuing availability of said funds for the purposes hereof. In the
event that said funds, or any part thereof, become unavailable as determined by the
Department, the Department may immediately terminate the Agreement or amend it
accordingly.
2. Fees for Services
Program Area
Unit
Rate Type Service Name
0c
Each All Groups: N
S'
35.00
Episode
Empower Group: In-office/Video
75.0O
Episode'
High Conflict Couples Therapy: In-Office/Video
75.00
Each
High Conflict Couples Therapy: No Show
►5.00
Each
Individual or Relationship Therapy: No Show
55.00
Hour
Individual Therapy: In-Office/Video
Program Area
Rate
Unit Type
Service Name
Relationship Therapy (couples, families, other):
Mental Health Services
$ 55.00
Hour
In-Office/Video
$ 35.00
Hour
Social Skills Youth Group: In-Office/Video
$ 35.00
Hour
Transgender Youth Group: In-Office/Video
Trauma and Resilience Assessment: In-
$ 1,900.00
Episode
Office/Video
Trauma and Resilience Consultation: In-'
$ 125.00
Hour
Office/Video
$ 125.00
Each
Trauma and Resilience Consultation: No Show
* Office located at 502 West Lake, Fort Collins, Colorado 80524.
3. Request for Reimbursement and Supporting Documentation
Contractor shall submit all Requests for Reimbursement and supporting documentation
to the Department by the 7th day of the month following the month of service, but no
later than 45 days from the date of service for each client receiving ongoing services.
Contractor shall prepare and submit monthly a Request for Reimbursement and
monthly report including other supporting documentation, if applicable, certifying that
services authorized were provided on the date(s) indicated and the charges were made
pursuant to the terms and conditions of Paragraph 3 of this Agreement. Monthly
reports will be submitted through the Department's online reporting system, unless
otherwise directed or agreed to by the Department. Monthly reports for ongoing
services must include the following information, entered in the "Narrative" box for each
date of service:
a. Time(s) of service (i.e. 2-4pm)
b. Location of where the service took place (i.e. clinician's office, client's home,
in the community.)
c. Clinician/therapist name
d. What interventions were used, recommendations and/or goals discussed,
progressions towards goals, and client engagement.
e. For mileage reimbursement, if applicable, the mileage accumulated minus
roundtrip mileage that is included in the rate, starting location, and ending
location.
f. Any and all safety concerns.
When submitting a Request for Reimbursement for a one-time service, the contractor
shall submit the first and last page of the evaluation/report to confirm proof of services
rendered. The full evaluation/report should be submitted by the contractor to the
caseworker.
For Monitored Sobriety services, proof of services rendered shall be the test result.
Requests for Reimbursement and/or supporting documentation received after the 7th
day of the month may delay payment. Requests for Reimbursement and/or supporting
documentation received after 45 days from the date of service may result in delay or
forfeiture of payment. Consistent failure to meet the 45 -day deadline may result in
termination of the Agreement.
4. Payment
The Department and the Contractor agree that all benefits from private insurance
and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible
provider) or Victim's Compensation must be exhausted before Core Services or other
Department funds can be accessed for services. Exceptions to this Paragraph may
include, if approved by the Department, the following: The service being provided by
the contractor is not a Medicaid eligible service;
a. The service is not deemed medically necessary;
b. The Court with jurisdiction over the case has ordered that a non -Medicaid
provider or service be used;
c. A Medicaid provider is not available to provide the needed service;
d. Medicaid is exhausted for the needed service; or
e. Medicaid denied service.
f. The client is not eligible for Medicaid.
The Department may withhold reimbursement if Contractor has failed to comply with
any part of the Agreement, including the Financial Management requirements, program
objectives, contractual terms, or reporting requirements. In the event of forfeiture of
reimbursement, Contractor may appeal such circumstance in writing to the Director of
Human Services. The decision of the Director of Human Services shall be final.
5. Remedies
The Director of Human Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions
are as follows:
a Withhold payment to the Contractor until the necessary services or
corrections in performance are satisfactorily completed.
b. Deny payment or recover reimbursement for those services or deliverables,
which have not been performed and which due to circumstances caused by
the Contractor cannot be performed or if performed would be of no value to
the Department. Denial of the amount of payment shall be reasonably
related to the amount of work or deliverables lost to the Department.
Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation
shall be recovered from Contractor by deduction from subsequent payments under this
Agreement or other agreements between the Department and Contractor, or by the
Department as a debt due to the Department or otherwise as provided by law.
6. Financial Management
At all times from the effective date of the Agreement until completion of the
Agreement, Contractor shall comply with the administrative requirements, cost
principles and other requirements set forth in the Financial Management Manual
adopted by the State of Colorado. The required annual audit of all funds expended
under this Agreement must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
Exhibit C
WELD COUNTY'S REQUEST FOR PROPOSAL
(Weld County's Request for Proposal is incorporated into this agreement by reference and will
be provided upon request to the Department.)
This page is intentionally left blank
Exhibit D
Contractor's response to the Request for Proposal
Exhibit D contains the following documents:
• Attachment B — Provider Information Form (PIF)
• Attachment C — Proposal
• Attachment D — Staff Data Sheet
• Certificate of Insurance (COI)
ATTACHMENT B
WELD COUNTY DEPARTMENT OF HUMAN SERVICES — PROVIDER INFORMATION FORM (PIF)
AGENCY INFORMATION
Agency Name: Colorado State University
Trails Provider ID (if known): 1562158
Provider Contact Full Name: Stephanie Seng Title: Director
Primary Phone Number (10 -digit): 970-492-4651 Ext.: Fax Number (10 -digit):
Primary Contact Email: sseng@colostate.edu
Web Address:
Agency Location Address (street, city, state, zip): 502 West Lake St., Fort Collins, CO 80523-1570
Agency Mailing Address (Street, city, state, zip):
CSU Campus Delivery 1570, Fort Collins, CO 80523-1570
Agency Type (pick one): Public Company Private Non -Profit ® Private for Profit
Send Referrals for Service to:
Referral Contact Name: Abigail Wiggans
Referral Phone Number (10 -digit): 970-491-5991
Ext.:
Title: Case Manager
Email: cfct@colostate.edu
Billing Contact
Billing Contact Name: Michelle Amundsen
Billing Phone Number (10 -digit): 970-829-1208
Title: Billing Specialist
Ext.: Email:
michelle.amundsen@colostate.edu
-------------------------------------------------------------------------------------------
CERTIFICATION
' I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it
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
Department of Human Services, and comply with all requirements of the contract, if awarded.
The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept
Ithe bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of
Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are
competitive in price and quality.
WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES. THE CERTIFICATE OF EXEMPTION NUMBER IS #98-03551-0000.
Authorized Rep. Full Name: Stephanie Seng Title: Director
Authorized Rep. Email: sseng@colostate.edu Phone (10 -digit): 970-492-4651 Ext.:
Authorized Rep. Address (street, city, state, zip): CSU Campus Delivery 1570, Fort Collins, CO 80523-1570 i
,��j�Q
L ignature of Authorized Rep..: /� ���7 +1�"' `})fj-----)121.1.5.17SEP______ Date: Date: 1/16/2024 I
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)
Colorado State University (DBA Center for Family and Couple Therapy)
Number of services offered on this Attachment C (max 5):
You may complete another Attachment Cif you have more than 5.
5
Service #1
Service Name: High Conflict Couples 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 below using bulleted points)
1.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
High Conflict Couples Therapy
• Domestic Violence Focused Couples Treatment Curriculum: Stith, 5, McCollum, E., Rosen, K.
• Co -Therapy Model allowing for joint and split sessions
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:
60-90 minutes per week
1.3 Anticipated duration of service (i.e. 3-4 months):
10 to 20 weeks
1.4 Three (3), or more, specific goals of the service (DO use bullet points):
• The primary goal of treatment is the cessation of all forms of violence in the relationship.
• For some couples the couple intervention may allow partners to reconsider whether or not the
relationship is viable.
• The treatment will be considered effective if violence is ended and/or if the couple separates without a
violent incident.
• Basic to the approach is a both/and position: each individual is responsible for their own behavior and
individual behavior affects and is affected by the behavior of others. That is, although the abuser is held
accountable for their actions, interrupting repetitive patterns of behavior within the couple system that
maintain abuse is viewed as a powerful tool to deal with the problem.
1.5 Three (3), or more, specific outcomes of service:
• Gain the cooperation and commitment of both partners in making changes in their relationship;
• Assist partners to build on strengths and past successes to develop solutions to relationship problems;
• Identify and support relationship patterns that lead to cooperative resolution of conflict;
• Enhance positive affect between partners;
• Assist partners in taking responsibility for their own behavior;
• Punctuate and solidify positive changes that are made.
•
1.6 Target population of the service, including age and gender:
Any gender partner must be 18 or older. Both partners must participate in couples treatment. Both partners must
want to try to end the violence and improve the relationship. At least one act of physical violence or repeated acts
of emotional violence must have occurred in the past year, however violence cannot be ongoing, and clients must
sign a no -violence agreement.
1.7 Languages service is available in (please list proficiency and if interpreter services are available):
Primarily English
1.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
Eligible for Medicaid in whole
REV. OCT 2023
1
ATTACHMENT C - PROPOSAL
1.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
• In -office
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
#1
Service
Type
$ Amount
Unit Type
1.10a
In-Office/Video
$75.00
Per Episode
1.10b
In -Home or Community
Select
Unit
Type.
1.l0c
Transportation
Service with
Provided
Select
Unit
Type.
1.10d
FTM,
TDM,
Staffing
Prof.
per Hour
1.10e
No
show
$75.00
per
No
Show
1.10f
Mileage
rate
per
Mile
1.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
Mileage rate is
paid after
roundtrip miles.
Rate per Month Minimum Hours of Service:
1.12 Home Study Providers — List your rates in the box below.
1.13 Monitored Sobriety Providers - List your rates in the box below.
Additional Comments
1.14
Weld County Use Only
Service #1:
Proposal Determination: Accept Comments: Approved by team 2/16/24
REV. OCT 2023
2
ATTACHMENT C - PROPOSAL
Service #2
Service Name:
Program Area:
Individual Therapy
Mental Health Services
Scope of Work
Please Note: If the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulleted points)
2.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
Systemic Therapy Modalities:
• Solution Focused
• Strategic
• Structural
• Cognitive Behavioral
• Internal Family Systems
• Narrative
• Milan
• Transgenerational
• Emotionally Focused
• Motivational Interviewing
• Telehealth
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:
2.3
2.4
50 minutes per week
Anticipated duration of service (i.e. 3-4 months):
1-4 months
Three (3), or more, specific goals of the service (DO use bullet points):
• Develop and maintain healthy boundaries and relationship skills
• Improve communication skills
• Build problem -solving skills
• Build empathy and understanding
• Build conflict management skills
• Explore and heal from trauma
• Manage depression, anxiety, and other mental health diagnoses
2.5 Three (3), or more, specific outcomes of service:
• Clients will be able to successfully complete therapy portion of treatment plans
• Clients will gain tools to improve functioning related to presenting problem
• Clients will gain tools to effectively manage conflict and effectively problem -solve
2.6 Target population of the service, including age and gender:
Individuals across the lifespan
2.7 Languages service is available in (please list proficiency and if interpreter services are available):
Primarily English
2.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
Medicaid Eligible in whole
2.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
In -office, tele-health available with safety assessment when appropriate
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
REV. OCT 2023
3
ATTACHMENT C - PROPOSAL
• 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
$55.00
Per
Hour
2.10b
In
-Home or Community
Select
Unit
Type.
2.10c
Service
Transportation
Provided
with
Select
Unit Type.
2.10d
FTM,
Staffing
TDM,
Prof.
per Hour
2.10e
No
show
$55.00
per
No
Show
2.10f
Mileage
rate
per
Mile
2.11 Monthly Service Rates (each level must be listed): If applicable
2.11a
2.11b
2.11c
2.11d
2.11e
2.11f
2.11g
2.11h
2.11i
2.11j
Mileage rate is paid
after
roundtrip miles.
Service
Name
with
Level
Rate
per
Month
Minimum
Hours of
Service:
2.12 Home Study Providers — List your rates in the box below.
2.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
2.14
Weld County Use Only
Service #2:
Proposal Determination: Accept Comments: Approved by team 2/16/24
REV. OCT 2023
4
ATTACHMENT C - PROPOSAL
Service #3
Service Name: Relationship Therapy (couples, families, other)
Program Area:
Mental Health Services
Scope of Work
Please Note: if the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulleted points)
3.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
Systemic Therapy Modalities:
• Solution Focused
• Strategic
• Structural
• Cognitive Behavioral
• Internal Family Systems
• Narrative
• Milan
• Transgenerational
• Emotionally Focused
• Telehealth
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:
50 min/week
3.3 Anticipated duration of service (i.e. 3-4 months):
1-4 months
3.4 Three (3), or more, specific goals of the service (DO use bullet points):
• Develop and maintain healthy boundaries
• Facilitate cohesion and communication
• Promote problem -solving by better understanding family dynamics
• Build empathy and understanding
• Reduce conflict within the family
3.5 Three (3), or more, specific outcomes of service:
• Clients will be able to successfully complete therapy portion of treatment plans
• Clients will gain tools to improve family functioning including communication and parenting
• Clients will gain tools to effectively manage conflict and effectively problem -solve
3.6 Target population of the service, including age and gender:
Couples, families, other relationships across the lifespan
3.7 Languages service is available in (please list proficiency and if interpreter services are available):
Primarily English
3.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
I Medicaid eligibility in whole
3.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
In -office, tele-health available with safety assessment when appropriate
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
1
Service Type
1
$ Amount I
Unit
Type
REV. OCT 2023
5
ATTACHMENT C - PROPOSAL
3.10a
In-Office/Video
$55.00
Per
Hour
3.10b
In
-Home or Community
Select
Unit
Type.
3.10c
Service
Transportation
Provided
with
Select
Unit Type.
3.10d
FTM,
Staffing
TDM,
Prof.
per Hour
3.10e
No
show
$55.00
per
No
Show
3.10f
Mileage
rate
per
Mile
3.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
3.11a
3.11b
3.11c
3.11d
3.11e
3.11f
3.11g
3.11h
3.11i
3.11j
Mileage rate is paid
after
•
roundtrip miles.
Rate per Month Minimum Hours of Service:
•
3.12 Home Study Providers — List your rates in the box below.
3.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
3.14
Weld County Use Only
Service #3:
Proposal Determination: Accept Comments: Approved by team 2/16/24
REV. OCT 2023
6
ATTACHMENT C - PROPOSAL
Service #4
Service Name:
Program Area:
Trauma & Resilience Assessment
Mental Health Services
Scope of Work
Please Note: If the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulleted points)
4.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
• Trauma Assessments include:
• Psychosocial interview
• Collateral interviews and surveys
• Cognitive screening and surveys
• Debrief meeting
• Telehealth when appropriate
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 time service: 3 hour assessment + 1-2 hour debrief meeting
4.3 Anticipated duration of service (i.e. 3-4 months):
4-8 weeks
4.4 Three (3), or more, specific goals of the service (DO use bullet points):
• Gather information across several key domains of functioning
• Identify the impact of traumatic events on attachment, regulation, and competency
• Identify needs of children and families exposed to traumatic events, empowering and incorporating their
voices, and make appropriate related recommendations
• Summarize information and communicate with families offering psychoeducation and opportunity for
feedback
4.5 Three (3), or more, specific outcomes of service:
• Build on client resilience in the areas of attachment, regulation and competency;
• Increase child, family and team understanding of the impact of complex trauma;
• Share client perspective of impact with their family and team
4.6 Target population of the service, including age and gender:
Children and families involved in child welfare who have experienced complex trauma. All ages.
4.7 Languages service is available in (please list proficiency and if interpreter services are available):
Primarily English
4.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
Credentialed with Northeast Health Partners. Currently negotiating contract rate for assessment.
4.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
In -office, tele-health available with safety assessment when appropriate
Rates
Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing).
All rates should be per hour unless service is for evaluations/assessments, Home Studies or Monitored Sobriety.
• For hourly Service rates please complete section 4.10
• For monthly Service rates please complete section 4.11
• For Home Study Providers please complete section 4.12
• For monitored Sobriety Providers please complete section 4.13
4.10 Hourly Service Rates:
Service #4
Service Type
$ Amount
Unit
Type
4.10a
In-Office/Video
$1900.00
Per Episode
4.10b
In
-Home
or Community
Select
Unit
Type.
REV. OCT 2023
ATTACHMENT C - PROPOSAL
4.10c
Transportation
Service
Provided
with
Select
Unit Type.
4.10d
I
FTM,
TDM,
Staffing
Prof.
per Hour
4.10e
No
show
N/A
per
No
Show
4.10f
Mileage
rate
per
Mile
4.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
4.11a
4.11b
4.11c
4.11d
4.11e
4.11f
4.11g
4.11h
4.11i
4.11j
Mileage rate is paid
after
•
roundtrip miles.
Rate per Month Minimum Hours of Service:
4.12 Home Study Providers — List your rates in the box below.
4.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
4.14
Weld County Use Only
Service #4:
Proposal Determination: Accept Comments: Approved by team 2/16/24
REV. OCT 2023
8
ATTACHMENT C - PROPOSAL
Service #5
Service Name: Trauma & Resilience Consultation
Program Area:
Mental Health Services
Scope of Work
Please Note: if the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulleted points)
5.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
• ARC Model
• CRM/TRM (Community/Trauma Resiliency Model)
• Telehealth
5.2 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 -time service
5.3 Anticipated duration of service (i.e. 3-4 months):
1-2 hours
5.4 Three (3), or more, specific goals of the service (DO use bullet points):
• Provide psychoeducation around impact of trauma for child and family
• Collaborate with DHS team and family to direct treatment or support through trauma -informed
recommendations
• Provide written report with trauma -informed recommendations
5.5 Three (3), or more, specific outcomes of service:
• DHS team and family will have a greater understanding about the impact of trauma
• DHS team and family will incorporate trauma -informed recommendations
• Client and family's strengths and areas of resilience will be acknowledged and supported
5.6 Target population of the service, including age and gender:
Caseworkers or Caregivers of youth who have experienced complex trauma
5.7 Languages service is available in (please list proficiency and if interpreter services are available):
Primarily English
5.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
Not Medicaid eligible
5.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
Telehealth
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 5.10
• For monthly Service rates please complete section 5.11
• For Home Study Providers please complete section 5.12
• For monitored Sobriety Providers please complete section 5.13
5.10 Hourly Service Rates:
Service #5
Service
Type
$ Amount
Unit
Type
5.10a
In-Office/Video
$125.00
Per
Hour
5.10b
In
-Home
or Community
Select
Unit
Type.
5.10c
Transportation
Service
Provided
with
Select
Unit
Type.
5.10d
FTM,
TDM,
Staffing
Prof.
per Hour
5.10e
No
show
$125.00
per
No
Show
REV. OCT 2023
9
ATTACHMENT C - PROPOSAL
5.10f
Mileage
rate
per
Mile
5.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
5.11a
5.11b
5.11c
5.11d
5.11e
5.11f
5.11g
5.11h
5.11i
5.11j
Mileage rate is paid
after
roundtrip miles.
Rate per Month Minimum Hours of Service:
5.12 Home Study Providers — List your rates in the box below.
5.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
5.14
Weld County Use Only
Service #5:
Proposal Determination: Accept Comments: Approved by team 2/16/24
REV. OCT 2023
10
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)
Colorado State University (DBA Center for Family and Couple Therapy)
Number of services offered on this Attachment C (max 5):
You may complete another Attachment C if you have more than 5.
5
Service #1
Service Name:
Empower Group
Program Area: Mental Health Services
Scope of Work
Please Note: If the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item `below sing l ui ete poin s)
1.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
• I -Empathize Curriculum
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:
60-90 minutes per week
1.3 Anticipated duration of service (i.e., 3-4 months):
5-8 weeks
1.4 Three (3), or more, specific goals of the service (DO use bullet points):
• Equip youth with strategies to stay safe from exploitation
• Nurture empathy for others
• Build effective communication skills
1.5 Three (3), or more, specific outcomes of service:
• Youth will learn language to communicate about empathy, sympathy, apathy, exploitation.
• Youth will gain tools to stay safe from exploitation
• Youth will practice strategies to stay safe from exploitation
1.6 Target population of the service, including age and gender:
Youth (all genders) ages 12 — 18.
1.7 Languages service is available in (please list proficiency and if interpreter services are available):
Primarily English
1.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
Eligible for Medicaid in whole
1.9 Service location — list where the service will take place (i.e., client's home, in -office, other)
In -office
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
$35.00
Per Episode
REV. OCT 2023 1
ATTACHMENT C - PROPOSAL
1.10b
In -Home
or Community
Select
Unit
Type.
1.10c
Transportation
Service with
Provided
Select
Unit
Type.
1.10d
FTM,
TDM,
Staffing
Prof.
per
Hour
1.10e
No
show
$35.00
per
No
Show
1.10f
Mileage
rate
per
Mile
1.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
Mileage rate is
paid after
roundtrip miles.
Rate per Month Minimum Hours of Service:
I
V
1.12 Home Study Providers — List your rates in the box below.
1.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
1.14
Weld County Use Only
Service #1:
Proposal Determination: Accept Comments: Approved by team 2/16/24
REV. OCT 2023 2
ATTACHMENT C - PROPOSAL
Service #2
Service Name:
Program Area:
Social Skills Youth Group
Mental Health Services
Scope of Work
Please Note: If the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulleted points)
2.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
• Motivational Interviewing
• Psychoeducation
• Experiential
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:
50 minutes per week
2.3 Anticipated duration of service (i.e., 3-4 months):
2.4
2.5
2.6
8-10 weeks
I
Three (3), or more, specific goals of the service (DO use bullet points):
• Teach youth about relationships and social skills
• Provide opportunities to practice new skills in a safe social setting
• Create safe setting for group interactions
Three (3), or more, specific outcomes of service:
• •Youth will learn and practice conversation skills
• Youth will learn and practice friendship skills
• Youth will learn about emotions and practice appropriate emotional expression
• Youth will learn and practice conflict management
• Youth will learn about and practice using manners
Target population of the service, including age and gender:
Youth (all genders) ages 5 - 18
2.7 Languages service is available in (please list proficiency and if interpreter services are available):
Primarily English
2.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
Medicaid Eligible in whole
2.9 Service location — list where the service will take place (i.e., client's home, in -office, other)
In -office
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
$35.00
Per Hour
2.10b
In
-Home
or Community
Select
Unit Type.
2.10c
Service
Transportation
Provided
with
Select
Unit
Type.
2.10d
FTM,
Staffing
TDM,
Prof.
per Hour
2.10e
No
show
$35.00
per
No
Show
REV. OCT 2023
3
ATTACHMENT C - PROPOSAL
2.10f
Mileage
rate
per
Mile
2.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
2.11a
2.11b
2.11c
2.11d
2.11e
2.11f
2.11g
2.11h
2.11i
2.11j
Mileage rate is paid
after
roundtrip miles.
Rate per Month Minimum Hours of Service:
2.12 Home Study Providers — List your rates in the box below.
2.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
2.14
Weld County Use Only
Service #2:
Proposal Determination: Accept Comments: Approved by team 2/16/24
REV. OCT 2023
4
ATTACHMENT C - PROPOSAL
Service Name:
Program Area:
Service #3
Ira nsgender Youth Group
Mental Health Services
Scope of Work
Please Note: If the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulleted points)
3.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
Systemic Therapy Modalities:
• ARC (A-tachment, Regulation, and Competency)
• Motivational Interviewing
• Psychoeducation
• Experiential
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:
Ili
60 min/week
3.3 Anticipated duration of service (i.e., 3-4 months):
8 weeks
3.4 Three (3), or more, specific goals of the service (DO use bullet points):
• Provide a safe and confidential space for youth to share experiences
• Teach and provide opportunity to practice coping skills
• Share resources
3.5 Three (3), or more, specific outcomes of service:
• Youth will develop safe relationships with peers
• Youth will learn and use tools to cope with difficult emotions, relationships, and experiences
• Youth will identify and learn to evaluate local and online resources available to them.
3.6 Target population of the service, including age and gender:
Youth (all genders) ages 5 - 18
3.7 Languages service is available in (please list proficiency and if interpreter services are available):
Primarily English
3.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
Medicaid eligibility in whole
3.9 Service location — list where the service will take place (i.e., client's home, in -office, other)
In -office
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
$35.00
Per
Hour
3.10b
In
-Horne or Community
Select
Unit Type.
3.10c
Transportation
Service
Provided
with
Select
Unit Type.
3.10d
FTM,
Staffing
TDM,
Prof.
per Hour
3.10e
No
show
$35.00
per No
Show
REV. OCT 2023
5
ATTACHMENT C - PROPOSAL
3.10f
Mileage
rate
per
Mile
3.11 Monthly Service Rates (each level must be listed): If applicable
3.11a
3.11b
3.11c
3.11d
3.11e
3.11f
3.11g
3.11h
3.11i
3.11j
Mileage rate is paid
after
roundtrip miles.
Service
Name
with
Level
Rate per
Month
Minimum
Hours of
Service:
3.12 Home Study Providers — List your rates in the box below.
3.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
3.14
Weld County Use Only
Service #3:
Proposal Determination: Accept Comments: Approved by team 2/16/24
REV. OCT 2023
6
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 StepilaIle-Seng -
Colorado State University (DBA Center for Family and Couple Therapy
PHONE NUMBER 97O4924651
EMAIL.
PROPOSED SERVICE(S): High 'Conflict Couples, Individual Therapy, Relationship Therapy, Trauma & Resilience 'Assessment, Trauma and
- Resilience Consultation, Group Therapy - - = - _
Legal Last Name > _r `
Middle=
'_ Initial-
Previous Legal Last
Name (If applicable)
' - ,
; ,_Legal,First,Name
i
,�
, Service Type
=Licensure/ _ ' .
_ Credentials ,
_
, - --DORA # (If applicable) --
Zimmerman '
M ,
' Schindler -'
Toni
Mental Health Services
_ LMFT
MFT 0000150
Seng _
L
Crandall
Stephanie
Mental Health Services
LMFT _
MFT 0000827
Whitney
B
N/A
-_ Shawn -
Mental Health Services
LMFT
-, MFT 00001156', '
Haddock
N/A -
-Shelley -
Mental Health Services
LMFT
MFT 0000148
Chavez
M
Proctor
Candice
Mental Health Services
- LMFT
, MFT 0001856 ,
Kline
L
N/A -
Chelsea
Mental Health Services
- NLC
NLC 0105941'
Young Dusek
R'
Newton
Sydney -
Mental Health Services
LPCC '
_ LPCC 0019249
Winterling
Jessen
Breanne
Mental Health Services
MFTC
MFTC 0014169
Mangen
E - -
- N/A
Kathryn -
Mental Health Services
4 LMFT
MFT 0002426
Belzd
Elizabeth
Mental Health Services
MFTC
MFTC 0014480
- Gaylord
J
N/A'
Joshua
Mental Health Services
MFTC
MFTC 0014514
Ireland
M
Fihn
Gabnelle
Mental Health Services
LMFT -
' MFT 0002380
CHILD WELFARE REQUEST FOR PROPOSAL 2023-24 - VARIOUS SERVICES
.4C'®�®®
CERTIFICATE OF LIABILITY INSURANCE DATo(�o/DOZ YY)
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 hoidens an ADDITIONAL INSURED, the pollcy(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
AonNAME
Risklin TN vicesoffic South, Inc
Franklin
Frank/ i n TN Dffi ce
501 Corporate Centre Drive
Suite 300
Franklin TN 37067 USA
CONTACT
PHONE (880 283-7122 FAX (B00) 363-0105
(A/C No Est) I (AIC No )
EMAIL
ADDRESS
INSURERS) AFFORDING COVERAGE
NAIL #
INSURED
T3lOrado State University
51 Mason Street
Fort COllln5 CO 80523 USA
INSURER The Travelers indemnity Co of CT
25682
INSURERS Safety National Casualty Corp
15105
INSURER united Educators IDS, a Reciprocal RRG
10020
INSURER D
INSURER E
INSURER F
COVERAGES
CERTIFICATE NUMBER 570101027842
REVISION NUMBER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS Limits shown are as requested
LTR TYPE OF INSURANCE
IN'
Ain SUBR
tin WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY11
POLICY AI
1MM/OD/YYYY
LIMBS
C X
COMMERCIAL GENERAL LIABILITY
Y9256u
08/01/2023
08/01/202
EACH OCCURRENCE
S500,000
CLAIMS MADE El OCCUR
SIR applies per poll cy terns
& condi
`ions
300006 LO RENTED
PREMISES (Ea occurrence)
Included
MED EXP (Any one person)
PERSONAL B ADV INJURY
Included
GEN LAGGREGATE LIMITAPPLIES PER
GENERAL AGGREGATE
S2,000,000
1 POLICY El TO LOC
PRODUCTS COMP/OPAGG
Included
OTHER
SIR
5500,000
A AUTOMOBILE LIABILITY
BA -3N543075 -23-14-G
08/01/2023
08/01/2024
COMBINED SINGLE LIMIT
(Ea accident)
51, 000, 000
ANY AUTO
BODILY INJURY ( Per person)
OWNED
X SCHEDULED
AUTOS
BODILY INJURY (Per accident)
>T'
AUTOS ONLY
HIRED AUTOS
ONLY
X NON OWNED
AUTOS ONLY
PROPERTY DAMAGE
(Per accident)
-
_
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
EXCESS LIAR
CLAIMS MADE
AGGREGATE
DED I 'RETENTION
WORKERS COMPENSATION AND
EMPLOYERS LIABILITY
I PER STATUTE I I ORH
y/N
ANYPROPPiTBE/PARLTung EXECUTIVE
EXCLUDED ❑
/ A
N/8
EL EACH ACCIDENT
OFFICER/MEMBER
(Mandatory In NH)
If
E L DISEASE -EA EMPLOYEE
yes describe under
DESCRIPTION OF OPERATIONS below
E L DISEASE POLICY LIMIT
Excess Workers Compensation
SP4067192
siR applies per policy terns
08/01/2023
& conditions
08/01/2024
EL Each Accident
EL Disease - Policy
EL Disease - Ea Emp
51,000,000•
S1,000,000�
51,000,000.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 Additional Remarks Schedule may be attached d more space is required)
Weld County, State of Clorado, by and through the Board of County Commissioners of Weld County, its employees and agents are
in110ded as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability
poll cies, if required by written contract or agreement subject to the policy terms and conditions A waiver of Subrogation is
granted in favor of weld county, Board of County Commissioners, its employees and agents in accordance with the policy
provisions of the General LictOt t Automobile Liability and Excess workers' compensation policies, if required by written
contract or agreement subject to the policy terms and conditions
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS
weld County
1150 o Street
AUTHORIZED REPRESENTATIVE
Greeley CO 80631 USA
(�� ;�!{ � /� /��y� ��//� y/�y
C -Q42 c � Alt Vft,e4.., ti c! 92G1
ACORD 25 (2016/03)
O1988-2015 ACORD CORPORATION All rights reserved
The ACORD name and logo are registered marks of ACORD
Holder Identifier
Certificate No
Contract For
Entity Information
Entity Name" Entity ID"
COLORADO STATE UNIVERSITY @00002340
❑ New Entity?
Contract Name" Contract ID
COLORADO STATE UNIVERSITY (NEW PROFESSIONAL 8286
SERVICES AGREEMENT)
Contract Status
CTB REVIEW
Contract Lead *
WLUNA
Contract Lead Email
wluna@weldgov.com;cob
bxxlk@weldgov.com
Parent Contract ID
Requires Board Approval
YES
Department Project #
Contract Description
COLORADO STATE UNIVERSITY (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.
Contract Type *
AGREEMENT
Amount*
$0.00
Renewable *
YES
Automatic Renewal
Grant
IGA
Department
HUMAN SERVICES
Department Email
CM-
HumanServices@weldgov.
com
Department Head Email
CM-HumanServices-
DeptHead@weldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
DGOV.COM
Requested BOCC Agenda
Date *
06/05/2024
Due Date
06/01/2024
Will a work session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be
included?
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Review Date*
03/31/2025
Renewal Date *
06/01/2025
Committed Delivery Date Expiration Date
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head Finance Approver Legal Counsel
JAMIE ULRICH CHERYL PATTELLI BYRON HOWELL
DH Approved Date Finance Approved Date Legal Counsel Approved Date
05/31/2024 06/03/2024 06/03/2024
Final Approval
BOCC Approved Tyler Ref #
AG 061024
BOCC Signed Date Originator
WLUNA
BOCC Agenda Date
06/10/2024
Houstan Aragon
From:
Sent:
To:
Subject:
noreply@weldgov.com
Friday, April 4, 2025 1:31 PM
CM-ClerktoBoard; Windy Luna; Lesley Cobb; CM-HumanServices-DeptHead
Fast Tracked Contract ID (9294)
Contract # 9294 has been Fast Tracked to CM -Contract Maintenance.
You will be notified in the future based on the Contract information below:
Entity Name: COLORADO STATE UNIVERSITY
Contract Name: COLORADO STATE UNIVERSITY (NEW PROFESSIONAL SERVICES AGREEMENT) Contract Amount:
$0.00 Contract ID: 9294 Contract Lead: WLUNA
Department: HUMAN SERVICES
Review Date: 3/31/2027 CA ' t ',/) C� 1 C(ZC)1 44
Renewable Contract: NO - CY, \2 e ARUjed
Renew Date:
QC"` �V�'"
Expiration Date:5/31/2027
Tyler Ref #:
Thank -you
Houstan Aragon
From:
Sent:
To:
Cc:
Subject:
Sara Adams
Friday, April 4, 2025 1:15 PM
CTB
HS -Contract Management
FAST TRACK - Various Core Agreements (Tyler# Various)
Good afternoon CTB,
FAST TRACK ITEM:
The below list will be Fast Track items in CMS for tracking purposes only to correct the expiration date.
Contractor
CMS # Tyler# New CMS#
APPA THERAPY, PLLC
8150
2023-1434
9290
ASPEN COUNSELING, LLC
BARTGES, ANGELA
8141 2023-1393
9291
8165 2023-1460 9292
CASA OF LARIMER COUNTY
COLORADOSTATE UNIVERSITY
CREATIVE NURSING, LLC
CROSSROACSX COUNSELING
8176 2024-1270
8286 2024-1518
8151
8171
2024-1221
2024-1268
9293
9294
9297
CRUX COUNSELING, LLC
DEEP WATERS PARENTING
KEEP SWIMMING,LLC
KRAFT, DARLA
8132 2023-1396 9300
8734 2024-1264 9`301
8750 2023-1438
8167 2023-1568
9302
MAISHA BORA LLC
NEUROPSYCI-IOLOGICAL SOLUTIONS, LLC
8163 2024-1265
8383 2024=1266
9304
NOCO SPEECH & DIAGNOSTICS
8156 2023-1439
NORTHERN HORIZON BEHAVIORAL HEALTH 8187 2024-1319
POLARIS PARTNERS LLC
RABILLAIRD, APRIL
REACHING HOPE
REECE►,ALIS3�l
RHEGNUMI CONSULTING, LLC
RIGHT ON LEmNING.:.'
SENSITIVE SOLUTIONS BEHAVIORAL HEALTH, LLC
SEVIER, STAGY"C.
SIMPLE ASSENT, LLC
8148 2023-1401
�7 3-1569
8190
8170
8168
8204
8182
8528
2024-1321
2024 1473
2024-1267
X24.1325
2024-1271
3.-1432.
9306
9308
9310
9311
9312
931.3
9314
9315
8215 2024-1416 9323
SOVEREIGNTYSOVEREIGNIY COUNSELING SERVICES PLLC 8193 2024-324 9316
SPECIALTY COUNSELING & CONSULTING LLC 8263 2024-1474 9317
THE HOPE INITIATIVE 8188 2024-1320 9318
UNIVERSITY OF NORTHERN COLORADO 8219 2024-1327 9319
WHICH WAY? LLP 8162 2023-1436 9320
WILLOW COLLECTIVE PLLC
MI YUNGS PRAYER
8192 2024-1323 9321
9015 2023-139/ 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
00 000
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