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Home My WebLink About20241120.tiffBOARD OF COUNTY COMMISSIONERS PASS AROUND REVIEW PASS -AROUND TITLE: Professional Services Agreement Amendment #2 with Various Providers for the Case Management Agency Interim Support Level Assessment (ISLA) DEPARTMENT: Human Services DATE: May 20, 2025 PERSON REQUESTING: Jamie Ulrich, Director, Human Services Brief description of the problem/issue: On March 1, 2024, the Weld County Department of Human Services began serving as the region's Case Management Agency (CMA) as a result of an awarded Request for Proposal (RFP) through the Colorado Department of Health Care Policy & Financing (HCPF). To offer services to clients as the CMA, a Supports Intensity Scale (SIS) assessment is required to be completed to develop an individualized service plan to determine the daily supports a person with intellectual or developmental disabilities may need to live as independently as possible. As a result, in May of 2024, the Department entered into Professional Services Agreements with vendors to perform SIS assessments for clients. On March 17, 2025, the Board approved Amendment #1 that implemented the Interim Support Level Assessment (ISLA) for individuals enrolling in services. The ISLA assessment is required by the State and went into effect on April 1, 2025. The Department is now requesting approval of Amendment #2 to the Professional Services Agreement for the providers listed below. This amendment extends the term(s) of the Agreement through June 30, 2026; updates Exhibit A, Scope of Service and Rate Schedule to remove the SIS assessment and adds Exhibit B, HIPAA Business Associate Agreement. CMS# 9480 Assessment Provider Original Tyler # Alex Turner 2024-1118 9482 Stacey Larrabee 2024-1119 9483 Ayanna Griffin 2024-1120 9484 Micki Schoech 2024-1121 9485 Sulema Saenz Sanchez 2024-1123 9486 Karol Guerrero 2024-1124 What options exist for the Board? • Approval of the Professional Services Agreement Amendment #2. • Deny approval of the Professional Services Agreement Amendment #2. Consequences: WCDHS will not have current agreements in place with providers. Impacts: WCDHS will not be able to conduct the assessments required by the State and DHS clients will not receive needed services. Pass -Around Memorandum; May 20, 2025 - CMS Various CC : ork0a(04S) tort /75 WROCYRD 207- —I 170 Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years): • Total cost = $185.33 per completed ISLA assessment. • Pass-thru funding from the Colorado Department of Health Care Policy & Financing (HCPF). Recommendation: Approval of the Professional Services Agreement Amendment #2 for Various Providers and authorize the Chair to sign. Support Recommendation Schedule Place on BOCC Agenda Work Session Other/Comments: Perry L. Buck Scott K. James Jason S. Maxey Lynette Peppier Kevin D. Ross 69. (7F. Pass -Around Memorandum; May 20, 2025 - CMS Various AGREEMENT AMENDMENT BETWEEN WELD COUNTY AND AYANNA N. GRIFFIN This Agreement Amendment made and entered into Z'day of J UIXIQ, , 2025 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department", and Ayanna N. Griffin, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement to conduct Case Management Agency assessments, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2024-1120, approved on May 6, 2024. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement was set to end on April 30, 2025. • The Original Agreement was amended on: • March 17, 2025 to extend the term date through June 30, 2025 and amend Exhibit A, Scope of Services and Rate Schedule. • The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2024-1120. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement as of July 1, 2025: 1. Paragraph 3. Term is hereby amended as follows: The term of this Agreement shall be from July 1, 2025, through June 30. 2026, or Contractor's completion of the responsibilities described in Exhibit A. This Agreement may be extended annually upon written agreement of both parties. 2. Add Paragraph 29. Health Insurance Portability & Accountability Act of 1996 ("HIPAA") is hereby added as follows: Federal law governing the privacy of certain health information requires a "Business Associate" agreement between Contractor and the County. 45 CFR Section 164.504(e). Attached and incorporated herein by reference as Exhibit B is a HIPAA Business Associate Agreement for HIPAA compliance. 3. Exhibit A, Scope of Services and Rate Schedule is here by amended as attached. 4. Add Exhibit B, HIPAA Business Associate Agreement. All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ��,��,,// /, COUNTY: ATTEST: W� �+'� gie:L ,�. BOARD OF COUNTY COMMISSIONERS BY: Clerk to the Board Deputy Clerk to the Bo WELD COUNTY, COLORADO Act,„A erry L.ck, Chair JUN 0 2 2025 NTRACTOR: Ayanna N. Griffin 12937 East Elgin Place Denver, Colorado 80239 By: Ayanna N. Griffin Date: Z07_44 �l re -0 EXHIBIT A SCOPE OF SERVICES AND RATE SCHEDULE 1) The Contractor will need to complete the deliverables listed below: a. The Interim Support Level (ISLA) Assessor is obligated to maintain current credentials with the Department of Health Care Policy & Financing (HCPF) ISLA Team. b. The Assessor shall provide information regarding their availability to conduct ISLA assessments, whether in -person or virtual. c. When an ISLA assessment needs to be scheduled or completed, the Case Management Agency (CMA) Program Manager will email the Assessor with the following details: d. Name, date of birth, Medicaid number, address, phone number of the member, and a copy of the most recently completed 100.2 assessment. e. Names, email addresses, and phone numbers of respondents. f. Any specific days of the week or times of day preferred or to be avoided for scheduling the ISLA assessment. g. The Assessor will promptly contact the member/respondents to arrange the earliest possible date for the ISLA assessment. If the schedule date is beyond one (1) business day, the Assessor will notify the CMA Program Manager of the date and reason for delay. h. After scheduling, the Assessor will share the most recent versions of the following forms and guides with the member and respondents via email: i. ISLA Response Option Rating Guide ii. HCBS Waiver and ISLA Member and Family Friendly Information Document iii. ISLA Information and Disclosure Document iv. ISLA Complaint Process Document v. Support Level Review Process Document i. On the day of the ISLA assessment, the Assessor will ensure that the ISLA Informed Consent form was signed and returned either electronically or via U.S. Postal mail. j. Upon completion of the ISLA assessment, the Assessor will securely email the signed ISLA Informed Consent (if not already mailed by the Member) and completed Pilot ISLA Excel document to the CMA Program Manager within 3 days business days. The Assessor will attach their invoice to the email. If completing multiple assessments during a calendar month, the Assessor may submit their invoice listing all assessments at the end of the month. k. The Assessor will provide the Member and Respondents with the ISLA Experience Survey link. There are both English and Spanish versions of the survey. ISLA Experience Survey - English Encuesta piloto sobre la experiencia con ISLA 2) Fees for Services: a. Services rendered will be reimbursed at $185.33 per completed ISLA assessment. 3) Invoice and Payment a. Monthly Invoicing: The Contractor shall invoice CMA within four (4) working days of the end of the month in which the services were performed, except at the end of the fiscal year when invoices are due two (2) working days from the end of the fiscal year. b. Invoices should be sent via email to kmorrisonweld.gov c. Vendor must include the following detail on invoices in order to be paid for services: i. Name of member/respondent(s) assessed. ii. Dates of Service. iii. Total Amount Due. d. In order to comply with HCPF State General Funds reporting requirements, no invoices received from the Contractor after July 3, 2026, for Fiscal Year July 1, 2025, thru June 30, 2026, will be accepted or paid by CMA, the date of July 3, 2026 is subject to change pending Fiscal Year 25-26 holiday schedule. e. County shall pay Contractor within thirty (30) days of County's receipt of such invoice. f. The County may also recover, at the County's discretion, payments made to Contractor in error for any reason, including, but not limited to, overpayments or improper payments, by deduction from subsequent payments under this Contract, or by any other appropriate method for collecting debts owed to the County. EXHIBIT B HIPAA BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ("BAA") is entered into by and between the County and the Contractor, referred to as "Business Associate", to set forth the terms and conditions under which protected health information ("PHI"), as defined by the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, Regulations enacted hereunder (HIPAA) , created or received by Business Associate on behalf of County may be used or disclosed. This BAA shall commence on the effective date outlined in Paragraph 3 of the Professional Services Agreement and the obligations herein shall continue in effect so long as Business Associate uses, discloses, creates or otherwise possesses or maintains any PHI created, or received, maintained or transmitted on behalf of County and until all PHI created, received, maintained or transmitted by Business Associate on behalf of County is destroyed or returned to County pursuant to Paragraph 16 herein. 1. The following terms, if and when used in this BAA, shall have the same meaning as those terms in the HIPAA Rules: Breach, Data Aggregation, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Protected Health Information, Required by Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use. a. Business Associate. "Business Associate" shall generally have the same meaning as the term "business associate" at 45 CFR 160.103. b. Covered Entity. "Covered Entity" shall generally have the same meaning as the term "covered entity" at 45 CFR 160.103. c. HIPAA Rules. "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, and Enforcement rules at 45 CFR Part 160 and Part 164. 2. County and Business Associate hereby agree that Business Associate shall be permitted to use and/or disclose PHI created, received, maintained or transmitted on behalf of County in accordance with this BAA. The permitted uses and disclosures, as may be outlined in a contract or Memorandum of Understanding, must be within the scope of, and necessary to achieve, the obligations and responsibilities of the Business Associate in performing on behalf of, or providing services to, County, or as Required by Law. Business Associate may not use or disclose PHI in a manner that would violate Subpart E of 45 CFR Part 164 if done by County except for the specific uses and disclosures set forth herein. 3. Business Associate acknowledges Business Associate is required by law to comply with the HIPAA Security Rule (45 CFR 164.302 through 164.318), the use and disclosure provisions of the HIPAA Privacy Rule and the Health Information Technology for Economic and Clinical Health Act (HITECH). To the extent Business Associate is to carry out one or more of County's obligations under Subpart E of 45 CFR Part 164, Business Associate hereby agrees to comply with the requirements of Subpart E that apply to County in the performance of such obligations. 4. Business Associate may use and disclose PHI created or received by Business Associate on behalf of County if necessary for the proper management and administration of Business Associate or to carry out Business Associate's legal responsibilities, provided that: a Any disclosure is required by law; or b. Business Associate obtains reasonable assurances from the person to whom the PHI is disclosed that (i) the PHI will be held confidentially and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person; and (ii) the Business Associate will be notified of any instances of which the person is aware in which the confidentiality of the information is breached. 5. Business Associate hereby agrees to maintain the security and privacy of all PHI in a manner consistent with state and federal laws and regulations, including HIPAA, HITECH, 42 CFR Pt. 2 if applicable, and all other applicable laws. 6. Business Associate shall ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of the Business Associate agree to the same restrictions, conditions, and requirements that apply to the Business Associate with respect to such information. Business Associate shall not disclose PHI created or received by Business Associate on behalf of County to a person, including any agent or subcontractor of Business Associate but not including a member of Business Associate's own workforce, until such person agrees in writing to be bound by provisions not less restrictive than this BAA and applicable state or federal law. 7. Business Associate shall not disclose PHI to any member of its workforce unless Business Associate has advised such person of Business Associate's privacy and security obligations under this Agreement, induding the consequences for violation of such obligations. Business Associate shall take appropriate disciplinary action against any member of its workforce who uses or disdoses PHI in violations of this Agreement and applicable law, in addition to meeting its reporting obligations owed to County hereunder. 8. Business Associate represents and warrants that it will use and disclose PHI in accordance with the Privacy Rule's "minimum necessary" standards by taking reasonable steps to limit uses and disclosures to the minimum amount of PHI required in accomplishing the intended purpose and consistent with the County's minimum necessary policies and procedures. Business Associate agrees to use appropriate safeguards to prevent use or disclosure of PHI not permitted by this Agreement or applicable law. 9. Business Associate agrees to maintain a record of its disclosures of PHI, including disclosures not made for the purposes of this Agreement. Such record shall include the date of the disclosure, the name and, if known, the address of the recipient of the PHI, the name of the individual who is the subject of the PHI, a brief description of the PHI disclosed, and the purpose of the disclosure consistent with enabling County to meet its accounting of disclosure obligations under the HIPAA Rules. Business Associate shall make such record available to County within thirty (30) days of a request and shall include disclosures made on or after the date which is six (6) years prior to the request. Business Associate shall not be required to maintain a record of disclosures of PHI made for the following purposes, unless such disclosures become mandatory for accounting of disclosure purposes under HIPAA: a For the purpose of treatment, payment or health care operations (as those terms are defined under HIPAA); b. To an individual who is the subject of the PHI; and c. Pursuant to an Authorization which is valid under HIPAA. 10. Business Associate agrees to report to County any unauthorized use or disclosure of PHI by Business Associate or its workforce or subcontractors within ten (10) days and the remedial/mitigating action taken or proposed to be taken with respect to such use or disclosure and account for such disclosure. 11. In the event of a or Security Incident involving the County's PHI, Business Associate shall provide County a report including patient name, contact information, nature/cause of the breach, PHI breached and the date or period of time during which the breach occurred. Business Associate understands that such a report must be provided to County within ten (10) days from the date of the breach or the date the breach should have been known to have occurred, or as soon as possible upon discovery (not to exceed 10 days from the date of the breach/breach discovery). Business Associate is responsible for any actual and direct costs related to notification of individuals or next of kin (if the individual is deceased) of any successful Security Incident or Breach reported or caused by Business Associate to County. 12. Business Associates agrees to make its internal practices, books, and records relating to the use and disclosure of PHI received from County or created or received by Business Associate on behalf of County, available to the Secretary of the United States Department of Health and Human Services, for purposes of determining the County's and/or Business Associate's compliance with HIPAA. 13. Within ten (10) days of a written request by County, Business Associate shall allow a person who is the subject of PHI, such person's legal representative, or County to have access to and to copy such person's PHI maintained by Business Associate. Business Associate shall provide PHI in the format requested by such person, legal representative, or County unless it is not readily producible in such format, in which case it shall be produced in standard hard copy format. Business Associate shall forward any request for access to PHI by an individual to County promptly upon receipt thereof. 14. Business Associate agrees to amend, pursuant to a request by County, PHI maintained and created or received by Business Associate on behalf of County. Business Associate further agrees to complete such amendment within ten (10) days of a written request by County, and to make such amendment as directed by County. Business Associate shall forward any request for amendment by an individual to County promptly upon receipt thereof. 15. County shall notify Business Associate of any changes in, or revocation of, the permission by an individual to use or disclose his or her PHI, to the extent that such changes may affect Business Associate's use or disclosure of PHI. 16.ln the event Business Associate fails to perform its obligations under this Agreement, County may, at its option: a. Require Business Associate to submit to a plan of compliance, including monitoring by County and reporting by Business Associate, as County, in its sole discretion, determines necessary to maintain compliance with this Agreement and applicable law. Such plan shall be incorporated into this Agreement by amendment hereto; b. Require Business Associate to mitigate any loss occasioned by the unauthorized disclosure or use of PHI; and c. Immediately discontinuing providing PHI to Business Associate with or without written notice to Business Associate. 17. County may immediately terminate this and related agreements if County determines that Business Associate has breached a material term of this Agreement. Alternatively, County may choose to: (i) provide Business Associate with ten (10) days written notice of the existence of an alleged material breach and (ii) afford Business Associate an opportunity to cure said alleged material breach to the satisfaction of County within ten (10) days of receipt of notice. Business Associate's failure to cure shall be grounds for immediate termination of this BAA. County's remedies under this BAA are cumulative and the exercise of any remedy shall not preclude the exercise of any other. 18. After termination or expiration of the Underlying Agreement for any reason, Business Associate with respect to PHI received created or maintained from or on behalf County, shall: (i) retain only that PHI which is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities; (ii) destroy (subject to the Underlying Agreement) the remaining PHI that the Business Associate still maintains in any form; and (iii) not use or disclose the PHI retained by Business Associate other than for the purposes for which such PHI was retained and subject to the same conditions set out in this BAA which applied before termination. If the destruction of the PHI is not feasible, in Business Associate's discretion, Business Associate shall notify County of the reasons destruction is not feasible and Business Associate shall continue to for as long as Business Associate retains the PHI. This section shall survive termination of this BAA. 19. Upon termination of this BAA for any reason, Business Associate, with respect to PHI received from County, or created, maintained, transmitted, or received by Business Associate on behalf of County, shall: a. Retain only that PHI which is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities. b. Return to County the remaining PHI that the Business Associate still maintains in any form or destroy said PHI. c. Continue to use appropriate safeguards and comply with Subpart C of 45 CFR part 164 with respect to electronic protected health information to prevent use or disclosure of the PHI, other than as provided for in this Section, for as long as Business Associate retains the PHI. d. Not use or disclose the PHI retained by Business Associate other than for the purposes for which such PHI was retained and subject to the same conditions which applied prior to termination. e. Return to County or destroy the PHI retained by Business Associate when it is no longer needed by Business Associate for its proper management and administration or to carry out its legal responsibilities. The provisions of this section shall survive the BAA's termination. 20. The parties agree to amend this Agreement in order to maintain compliance with State or Federal law. County shall provide ten (10) days prior written notice to Business Associate of a need to amend the BAA and propose such amendments for Business Associate's consideration. Upon written agreement between the parties, such amendment shall be binding upon the parties. Either party may elect to terminate the BAA and any underlying service agreement(s) if an amendment is not able to be agreed upon within a reasonable timeframe from an amendment's commencement. All duties hereunder to maintain the security and privacy of PHI shall survive such termination. County and Business Associate may otherwise amend this Agreement by mutual written consent. 21.To the fullest extent permitted by law, each party (the "Indemnifying Party") shall indemnify the other party, and its officers, directors, employees and agents (collectively the "Indemnified Parties"), against any and all claims brought by or directly resulting from third parties, including reasonable attorneys' fees (the "Third Party Losses"), to the extent Third Party Losses are proximately caused by a breach of this BAA by the Indemnifying Party, each by the Indemnifying Party or its employees, directors, officers, subcontractors, and agents. The Indemnifying Party shall have the right to control the defense or settlement of such third -party claim, subject to the reasonable participation of, and approval by, the Indemnified Parties of any such settlement or defense strategy. The foregoing indemnification shall not apply to the extent such claims arise out of (i) the Indemnified Party's negligence or willful misconduct, or (ii) the negligence or willful misconduct of any subcontractor or agent other than Business Associate under the Indemnified Party's control. SIGANTURE REQUESTED: Weld/Ayanna Griffin Amendment #2 (d) with Exhibits updated 5.22.25 Final Audit Report 2025-05-28 Created: 2025-05-22 By: Sara Adams (sadams@weld.gov) Status: Signed Transaction ID: CBJCHBCAABAAyo9oCDs7OF6_VEE84sZcg6cuR6MWAtSj "SIGANTURE REQUESTED: Weld/Ayanna Griffin Amendment # 2 (d) with Exhibits updated 5.22.25" History ,e Document created by Sara Adams (sadams@weld.gov) 2025-05-22 - 7:36:01 PM GMT- IP address: 204.133.39.9 E Document emailed to ayanna griffin (ayanna_griffin@yahoo.com) for signature 2025-05-22 - 7:36:21 PM GMT t Email viewed by ayanna griffin (ayanna_griffin@yahoo.com) 2025-05-28 - 12:46:53 PM GMT- IP address: 69.147.90.254 d% Document e -signed by ayanna griffin (ayanna_griffin@yahoo.com) Signature Date: 2025-05-28 - 4:06:21 PM GMT - Time Source: server- IP address: 174.16.158.131 O Agreement completed. 2025-05-28 - 4:06:21 PM GMT Powered by Adobe Acrobat Sign Contract For Entity Information Entity Name * GRIFFIN, AYANNA Entity ID* @00048550 Contract Name* Contract ID GRIFFIN, AYANNA - CASE MANAGEMENT AGENCY 9483 (CMA) INTERIM SUPPORT LEVEL ASSESSMENT (ISLA) Contract Lead AMENDMENT #2 SADAMS Contract Status CTB REVIEW Q New Entity? Parent Contract ID 20241120 Requires Board Approval YES Contract Lead Email Department Project # sadams@weld.gov;cobbx xlk@weld.gov Contract Description* (CONSENT) GRIFFIN, AYANNA - CASE MANAGEMENT AGENCY (CMA) INTERIM SUPPORT LEVEL ASSESSMENT (ISLA) AMENDMENT #2 TO ADD EXTEND TERM THROUGH 6/30/2026; UPDATE EXHIBIT A, SCOPE OF SERVICES AND RATE SCHEDULE AND ADD EXHIBIT B, HIPAA BAA. Contract Description 2 PA ROUTING THROUGH THE NORMAL PROCESS. ETA TO CTB IS 5/20/2025. Contract Type* Department Requested BOCC Agenda Due Date AMENDMENT HUMAN SERVICES Date* 05/29/2025 06/02/2025 Amount* Department Email $0.00 CM- Will a work session with BOCC be required?* HumanServices@weld.gov NO Renewable* NO Department Head Email Does Contract require Purchasing Dept. to be CM-HumanServices- included? Automatic Renewal DeptHead@weld.gov Grant County Attorney GENERAL COUNTY ATTORNEY EMAIL IGA County Attorney Email CM- COUNTYATTORNEY@WEL D.GOV 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* 04/30/2026 Committed Delivery Date Renewal Date Expiration Date* 06/30/2026 Contact Info Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date CONSENT 05/28/2025 Approval Process Department Head Finance Approver Legal Counsel JAMIE ULRICH CONSENT CONSENT DH Approved Date Finance Approved Date Legal Counsel Approved Date 05/28/2025 05/28/2025 05/28/2025 Final Approval BOCC Approved Tyler Ref # AG 060225 BOCC Signed Date Originator SADAMS BOCC Agenda Date 06/02/2025 aorfirack- (DU (1 to BOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW PASS -AROUND TITLE: Case Management Agency Supports Intensity Scale (SIS) Agreement for Professional Services Amendment #1 with Various Providers DEPARTMENT: Human Services DATE: March 11, 2025 PERSON REQUESTING: Jamie Ulrich, Director, Human Services Brief description of the problem/issue: On March 1, 2024, the Weld County Department of Human Services began serving as the region's Case Management Agency (CMA) as a result of an awarded Request for Proposal (RFP) through the Colorado Department of Health Care Policy & Financing (HCPF). To offer services to clients as the CMA, a Supports Intensity Scale (SIS) assessment is required to be completed to develop an individualized service plan to determine the daily supports a person with intellectual or developmental disabilities may need to live as independently as possible. As a result, in May of 2024 the Department entered into Agreements for Professional Services with vendors to perform SIS assessments for clients. Effective April 1, 2025, the State has implemented an Interim Support Level Assessment (ISLA) for individuals enrolling in services, which requires the Department to amend the current Agreements for Professional Services in order to align with this implementation. The Department is requesting approval of Amendment #1 to the Agreement for Professional Services for the providers listed below. This amendment updates Exhibit A, Scope of Service and Rate Schedule and extends the term(s) of the Agreement through June 30, 2025. CMS# Assessment Provider Alex Turner Original Tyler # 9193 2024-1118 9200 Sulema Saenz Sanchez 2024-1123 9198 Micki Schoech 2024-1121 9197 Emilia McGinn 2024-1122 4,7 9196 Ayanna Griffin 2024-1120 9199 Stacey Larrabee 2024-1119 9194 Karol Guerrero 2024-1124 What options exist for the Board? • Approval of the Agreement for Professional Services Amendment #1 • Deny approval of the Agreement for Professional Services Amendment #1. Consequences: WCDHS will not have current agreement in place with providers reflecting the new assessment. Impacts: WCDHS will not be in compliance with the State's new assessment requirement. Pass -Around Mem randum; March 11, 2025 — CMS Various Conf - c�c -.0nYx6e Cptks> 3A-1/25 3/ii/Z5 2U2z-1- irm ORcci° Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years): • Total cost = $225.00 per completed SIS assessment $185.33 per completed ISLA assessment • Pass-thru funding from the Colorado Department of Health Care Policy & Financing (HCPF). Recommendation: Approval of the Agreement for Professional Services Amendment #1 for Various Providers and authorize the Chair to sign. Support Recommendation Schedule Place on BOCC Agenda Work Session Other/Comments: Perry L. Buck Scott K. James Jason S. Maxey Lynette Peppier Kevin D. Ross .T744 Pass -Around Memorandum; March 11, 2025 - CMS Various AGREEMENT AMENDMENT BETWEEN WELD COUNTY AND AYANNA GRIFFIN This Agreement Amendment made and entered into ( day of IY (NC ! , 2025 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department", and Ayanna Griffin, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement to conduct Case Management Agency assessments, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2024-1120, approved on May 6, 2024. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on April 30, 2025. This Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement as of April 1, 2025: 1. Paragraph 3. Term is hereby amended as follows: The term of this Agreement shall be from April 1, 2025, through June 30, 2025, or Contractor's completion of the responsibilities described in Exhibit A. This Agreement may be extended annually upon written agreement of both parties. 2. Exhibit A, Scope of Services and Rate Schedule is here by amended as attached. All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: BY: Clerk to the Board BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Deputy Clerk to uck, Chair NTRACTOR: Ayanna Griffin 12937 East Elgin Place Denver, Colorado 80239 By: Ayanna Griffin Date: Mar 6, 2025 MAR 1 7 2325 zo74-070 EXHIBIT A SCOPE OF SERVICES AND RATE SCHEDULE 1) Scope of Services a. The Contractor is obligated to maintain the required current credentials with the Department of Health Care Policy & Financing (HCPF) to conduct Supports Intensity Scale (SIS) assessments and Interim Support Level Assessments (ISLA). b. Contractor will attend a total of three (3) two-hour sessions, in addition to the three training sessions (a total of six hours) for the ISLA. The Contractor will be required to take and pass a competency examination and provide the Certificate of Completion to the CMA Program Manager. c. Pre/during/post ISLA checklists will be provided to the Contractor to complete to ensure the ISLA is implemented in a consistent manner. d. The Contractor shall provide information regarding their availability to conduct SIS and ISLA assessments, whether in -person or virtual. e. When a SIS and ISLA assessment needs to be scheduled or completed, the Case Management Agency (CMA) Program Manager will email the Contractor with the following details: i. Name, date of birth, Medicaid number, address, and phone number of the member. ii. Names, email addresses, and phone numbers of respondents. iii. Any specific days of the week or times of day preferred or to be avoided for scheduling the SIS and, if applicable, the ISLA assessment. f. The Contractor will promptly contact the member/respondents to: iv. Ask if they are willing to participate in both the SIS and ISLA assessment. v. Arrange the earliest possible date for the SIS and, if applicable, the ISLA assessment. g. If the scheduled assessment date is beyond one (1) business day, the Contractor will notify the CMA Program Manager of the date and reason for delay. h. After scheduling, the Contractor will share the most recent versions of the following forms and guides with the member and respondents via email: i. SIS and/or the ISLA Complaint Process ii. ISLA and/or Support Level Review Process iii. ISLA and/or Supports Intensity Scale and Support Level Disclosure forms. iv. SIS-A and/or ISLA Respondent Guide i. On the day of the SIS and, if applicable, the ISLA assessment, the Contractor will review each form with the individual and their guardian, if applicable, and obtain signature(s) on the Disclosure form. j. Upon completion of the SIS and, if applicable, the ISLA assessment, the Contractor will enter the documentation using the prescribed method. k. The Contractor will notify the CMA Program Manager via secure email that the SIS and, if applicable, the ISLA assessment has been entered. The Contractor will attach the signed Disclosure form and their invoice to the email. If completing multiple assessments during a calendar month, the Contractor may submit their invoice listing all assessments at the end of the month. 2) Fees for Services a. Services rendered will be reimbursed at $225.00 per completed SIS assessment. b. Services rendered will be reimbursed at $185.33 per completed ISLA assessment. 1 3) Invoice and Payment a. Monthly Invoicing: The Contractor shall invoice CMA within four (4) working days of the end of the month in which the services were performed, except at the end of the fiscal year when invoices are due two (2) working days from the end of the fiscal year. b. Invoices should be sent via email to wccmabillingweld.gov c. The Contractor must include the following detail on invoices in order to be paid for services: i. Name of member/respondent(s) assessed. ii. Type of assessment completed. iii. Dates of Service. iv. Total Amount Due. d. In order to comply with HCPF State General Funds reporting requirements, no invoices received from the Contractor after July 3, 2025, for Fiscal Year July 1, 2024 thru June 30, 2025 will be accepted or paid by CMA, the date of July 3, 2025 is subject to change pending Fiscal Year 24-25 holiday schedule. e. County shall pay Contractor within thirty (30) days of County's receipt of such invoice and assessment has been approved. In order to comply with HCPF State General Funds reporting requirements, no invoices received from the Contractor after July 3, 2025, for Fiscal Year July 1, 2024 thru June 30, 2025 will be accepted or paid by CMA, the date of July 3, 2025 is subject to change pending Fiscal Year 24-25 holiday schedule. County shall pay Contractor within thirty (30) days of County's receipt of such invoice. 2 SIGNATURE REQUESTED: Weld/Ayanna Griffin Amendment #1 Final Audit Report 2025-03-06 Created: 2025-03-06 By: Sara Adams (sadams@weld.gov) Status: Signed Transaction ID: CBJCHBCAABAAYjTNSDkSDIzd7_19Cmf O_It8nYHYTEr "SIGNATURE REQUESTED: Weld/Ayanna Griffin Amendment # 1" History 5 Document created by Sara Adams (sadams@weld.gov) 2025-03-06 - 3:42:27 PM GMT- IP address: 204.133.39.9 2. Document emailed to ayanna griffin (ayanna_griffin@yahoo.com) for signature 2025-03-06 - 3:43:03 PM GMT ,t Email viewed by ayanna griffin (ayanna_griffin@yahoo.com) 2025-03-06 - 4:21:25 PM GMT- IP address: 69.147.86.72 d© Document e -signed by ayanna griffin (ayanna_griffin@yahoo.com) Signature Date: 2025-03-06 - 5:44:26 PM GMT - Time Source: server- IP address: 71.218.42.18 Agreement completed. 2025-03-06 - 5:44:26 PM GMT Powered by Adobe Acrobat Sign Contract Form Entity Information Entity Name * GRIFFIN, AYANNA Entity ID* @00048550 Contract Name * Contract ID GRIFFIN, AYANNA CASE MANAGEMENT AGENCY (CMA) 9196 SUPPORT INTENSITY SCALE (SIS) AMENDMENT #1 Contract Status CTB REVIEW Contract Lead * SADAMS ❑ New Entity? Parent Contract ID 20241120 Requires Board Approval YES Contract Lead Email Department Project # sadams@weld.gov;cobbx xlk@weld.gov Contract Description * (CONSENT) GRIFFIN, AYANNA - CASE MANAGEMENT AGENCY (CMA) SUPPORT INTENSITY SCALE (SIS) AMENDMENT #1 TO ADD NEW ISLA ASSESSMENT AND EXTEND TERM THROUGH 6/30/2025. Contract Description 2 PA ROUTING THROUGH TH E NORMAL PROCESS. ETA TO CTB IS 3/11/2025. Contract Type* AMENDMENT Amount* $0.00 Renewable* NO Automatic Renewal Grant IGA Department Requested BOCC Agenda Due Date HUMAN SERVICES Date* 03/13/2025 03/17/2025 Department Email CM- HumanServices@weld.gov Department Head Email CM-HumanServices- DeptHead@weld.gov County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WEL D.GOV If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Termination Notice Period Contact Information Contact Info Review Date * 04/30/2025 Committed Delivery Date Renewal Date Expiration Date* 06/30/2025 Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date CONSENT 03/12/2025 Approval Process Department Head JAMIE ULRICH DH Approved Date 03/12/2025 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 03/17/2025 Finance Approver CONSENT Legal Counsel CONSENT Finance Approved Date Legal Counsel Approved Date 03/12/2025 03/12/2025 Tyler Ref # AG 031725 Originator SADAMS ConeS0 WELD COUNTY AGREEMENT FOR PROFESSIONAL SERVICES BETWEEN WELD COUNTY AND AYANNA N. GRIFFIN THIS AGREEMENT is made and entered into this ("' day of 1v \ , 2024, by and between the County of Weld, a body corporate and politic of the State of Colorado, by bid through its Board of County Commissioners, whose address is 1150 "0" Street, Greeley, Colorado 80631 hereinafter referred to as "County," and Avanna N. Griffin, who whose address is 12937 East Elgin Place, Denver, Colorado 80239, hereinafter referred to as "Contractor". WHEREAS, County desires to retain Contractor as an Independent Contractor to perform services as more particularly set forth below; and WHEREAS, Contractor has the ability, qualifications, and time available to timely perform the services, and is willing to perform the services according to the terms of this Agreement. 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; 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 Exhibit A, Scope of Services and Rate Schedule, which forms an integral part of this Agreement. Exhibit A is specifically incorporated herein by this reference. 2. Service or Work. Contractor agrees to provide all services, labor, personnel and materials necessary to perform and complete the work outlined in the Scope of Work, as set forth in Exhibit A. 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 May 1, 2024, through April 30, 2025, or Contractor's completion of the responsibilities described in Exhibit A. This Agreement may be extended annually upon written agreement of both parties. 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 cure is timely accomplished to satisfaction of non -breaching party, then agreement will continue under its current terms and conditions. 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 corw+ 9cakkoot, 5/(0/244 &.071-64-5-D) 2024-1120 41200` to 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 Modification. 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. 6. Compensation/Contract Amount. County agrees to pay Contractor through an invoice process during the course of this Agreement in accordance with the Rate Schedule as described in Exhibit A. 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 Contractor. Contractor agrees to work within the confines of the Scope of Services and Rate Schedule outlined in Exhibit A. 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. 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 from County as a result of the execution of this Agreement. Contractor shall perform its duties hereunder as an independent Contractor. Contractor shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contractor, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contractor or any of its agents or employees. Unemployment insurance benefits will be available to Contractor and its employees and agents only if such coverage is made available by Contractor or a third party. Contractor shall pay when due all applicable employment taxes and income taxes and local 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 this Project without County's prior written consent, which may be withheld in County's sole discretion. 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. 10. Confidentiality. 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. 2 11. Warranty. Contractor warrants that the services 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 services shall be performed by qualified personnel in a professional and workmanlike manner, consistent with industry standards, and that all services will conform to applicable specifications, including all Healthcare Policy and Finance requirements related to SIS Assessment Certification. 12. Acceptance of Services Not a Waiver. 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. Acceptance by the County of, or payment for, the services 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 and Indemnification. Contractor shall procure at least the minimum amount of automobile liability insurance required by the State of Colorado for the use of any personal vehicle. Proof of said automobile liability insurance shall be provided to County prior to the performance of any services under this Agreement. 14. Indemnity. The Contractor shall defend, indemnify and hold harmless County, its officers, agents, and employees, from and against injury, loss damage, liability, suits, actions, or claims of any type or character arising out of the work done in fulfillment of the terms of this Contract or on account of any act, claim or amount arising or recovered under workers' compensation law or arising out of the failure of the Contractor to conform to any statutes, ordinances, regulation, law or court decree. 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. 16. 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. 17. 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. 18. 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. 19. 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. 20. 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. 3 21. 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. 22. 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. 23. Governmental Immunity. No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 24. Force Majeure. Neither the Contractor nor the County shall be liable for any delay in, or failure of performance of, any covenant or promise contained in this Agreement, nor shall any delay or failure constitute default or give rise to any liability for damages if, and only to extent that, such delay or failure is caused by "force majeure." As used in this Agreement, "force majeure" means acts of God, acts of the public enemy, unusually severe weather, fires, floods, epidemics, quarantines, strikes, labor disputes and freight embargoes, to the extent such events were not the result of, or were not aggravated by, the acts or omissions of the non -performing or delayed party. 25. 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. 26. 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. 27. Choice of Law/Jurisdiction. Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contractor agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 28. 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 Exhibit A, is the complete and exclusive statement of agreement between the parties and supersedes all proposals or prior agreements, oral or written, and any other communications between the parties relating to the subject matter of this Agreement. 4 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: '~''''"'`�-'�A) •-kii14;eik BOARD OF COUNTY COMMISSIONERS Clerk to the Board WELD COUNTY, COLORADO B6trdin. GuQ4ur / dL Deputy Clerk to the Board �� +�,� Kevin D. Ross, Chair anna N. Griffin 12937 East Elgin Place Denver, Colorado 80239 MAY 0 6 2D24 A ",9. By: Ayanna N. Griffin Date: Apr 25, 2024 s p2o,7/_ /OZO EXHIBIT A SCOPE OF SERVICES AND RATE SCHEDULE 1) The Contractor will need to complete the deliverables listed below: a. The Support Intensity Scale (SIS) Assessor is obligated to maintain current credentials with the Department of Health Care Policy & Financing (HCPF) SIS Team. b. The Assessor shall provide information regarding their availability to conduct SIS assessments, whether in -person or virtual. c. When a SIS assessment needs to be scheduled or completed, the Case Management Agency (CMA) Program Manager will email the Assessor with the following details: d. Name, date of birth, Medicaid number, address, and phone number of the member. e. Names, email addresses, and phone numbers of respondents. f. Any specific days of the week or times of day preferred or to be avoided for scheduling the SIS assessment. g. The SIS Assessor will promptly contact the member/respondents to arrange the earliest possible date for the SIS assessment. If the schedule date is beyond one (1) business day, the SIS assessor will notify the CMA Program Manager of the date and reason for delay. h. After scheduling, the Assessor will share the most recent versions of the following forms and guides with the member and respondents via email: i. SIS Complaint Process j. Support Level Review Process k. Supports Intensity Scale and Support Level Disclosure forms. I. SIS-A Respondent Guide m. On the day of the SIS assessment, the Assessor will review each form with the individual and their guardian, if applicable, and obtain signature(s) on the Disclosure form. n. Upon completion of the SIS assessment, the Assessor will enter the documentation into SIS Online within 3 days business days. o. The Assessor will notify the CMA Program Manager via secure email that the SIS assessment has been entered. The Assessor will attach the signed Disclosure form and their invoice to the email. If completing multiple assessments during a calendar month, the Assessor may submit their invoice listing all assessments at the end of the month. 2) Fees for Services: a. Services rendered will be reimbursed at $225.00 per completed assessment. 3) Invoice and Payment a. Monthly Invoicing: The Contractor shall invoice CMA within four (4) working days of the end of the month in which the services were performed, except at the end of the fiscal year when invoices are due two (2) working days from the end of the fiscal year. b. Invoices should be sent via email to wccmabilling@weld.gov c. Vendor must include the following detail on invoices in order to be paid for services: i. Name of member/respondent(s) assessed. ii. Dates of Service. iii. Total Amount Due. 6 d. In order to comply with HCPF State General Funds reporting requirements, no invoices received from the Contractor after July 3, 2024, for Fiscal Year July 1, 2023 thru June 30, 2024 will be accepted or paid by CMA, the date of July 3, 2024 is subject to change pending Fiscal Year 24-25 holiday schedule. e. County shall pay Contractor within thirty (30) days of County's receipt of such invoice. 7 SIGNATURE RERQUESTED: Weld/Ayanna Griffin SIS PSA 2024 Final Audit Report 2024-04-26 Created: 2024-04-24 By: Sara Adams (sadams@weld.gov) Status: Signed Transaction ID: CBJCHBCAABAAi_I5NacxRcQBnfOsI8vrEZ75Txl34fcl "SIGNATURE RERQUESTED: Weld/Ayanna Griffin SIS PSA 20 24" History t Document created by Sara Adams (sadams@weld.gov) 2024-04-24 - 10:02:35 PM GMT E Document emailed to ayanna griffin (ayanna_griffin@yahoo.com) for signature 2024-04-24 - 10:04:14 PM GMT 5 Email viewed by ayanna griffin (ayanna_griffin@yahoo.com) 2024-04-25 - 8:29:56 PM GMT Oi Document e -signed by ayanna griffin (ayanna_griffin@yahoo.com) Signature Date: 2024-04-26 - 1:38:53 AM GMT - Time Source: server 0 Agreement completed. 2024-04-26 - 1:38:53 AM GMT Powered by Adobe Acrobat Sign Contract Form Entity Information Entity Name * GRIFFIN, AYANNA Entity ID* @00048550 Contract Name* Contract ID GRIFFIN, AYANNA CASE MANAGEMENT AGENCY (CMA) 8089 SUPPORT INTENSITY SCALE (SIS) PROFESSIONAL * SERVICES AGREEMENT Contract Lead SADAMS Contract Status CTB REVIEW O New Entity? Contract Lead Email sadams@weld.gov;cobbx xlk@weld.gov Parent Contract ID Requires Board Approval YES Department Project # Contract Description (CONSENT) GRIFFIN, AYANNA CASE MANAGEMENT AGENCY (CMA) SUPPORT INTENSITY SCALE (SIS) PROFESSIONAL SERVICES AGREEMENT. TERM 05/01 /24 THROUGH 04/30/25. Contract Description 2 PA ROUTED THROUGH BOCC ON 4/24/2024 AND WAS APPROVED ON 5/1/2024, KNOWN TO CTB AS TYLER# 2024-1053 Contract Type" AGREEMENT Amount* $0.00 Renewable * NO Automatic Renewal Grant IGA Department Requested BOCC Agenda Due Date HUMAN SERVICES Date* 05/02/2024 05/06/2024 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 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 Review Date" Renewal Date 02/28/2025 Termination Notice Period Contact Information Committed Delivery Date Expiration Date* 04/30/2025 Contact Info Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date CONSENT 05/01/2024 Approval Process Department Head Finance Approver Legal Counsel JAMIE ULRICH CONSENT CONSENT DH Approved Date Finance Approved Date Legal Counsel Approved Date 05/01/2024 05/01/2024 05/01/2024 Final Approval BOCC Approved Tyler Ref* AG 050624 BOCC Signed Date Originator SADAMS BOCC Agenda Date 05/06/2024 Hello