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Home My WebLink About20251452.tiffCont-frac-1-04(1�6co BOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW PASS -AROUND TITLE: Professional Services Agreement Amendment #1 with Shiloh Home, Inc. DEPARTMENT: Human Services DATE: August 12, 2025 PERSON REQUESTING: Jamie Ulrich, Director, Human Services Brief description of the problem/issue: On May 28, 2025, the Department entered into a Professional Services Agreement with Shiloh Home, Inc., known to the Board as Tyler ID# 2025-1452 and is associated with the Invitation for Bid (IFB) #62500040. The Department is now requesting approval of Amendment #1 to the Professional Services Agreement. This amendment updates Exhibit C, Rate Schedule, to reflect a revised service location for Intensive Family Physical Therapy In -Office — Moderate and includes a rate adjustment for Intensive Family Therapy In -Home — Low, increasing the monthly rate from $1,235.00 to $1,560.00, effective June 1, 2025. What options exist for the Board? Approval of Amendment #1 with Shiloh Home, Inc. Deny approval of Amendment #1 with Shiloh Home, Inc. Consequences: The Department will not enter into an amendment to update rates. Impacts: Provider may not provide needed services to Department of Human Services clients. Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years): Fees for Services Rate $3,120.00 Unit Type Service Name Month Intensive Family Therapy In -Home - Moderate $1,560.00 Month Intensive Family Therapy In -Home - Low Funded through Core/Non-Core Child Welfare funding. Pass -Around Memorandum; August 12, 2025 — CMS ID 9836 0,0ns-en+ cc. OhbaSt (MS) 2025 1452_ R /3/25 9/3/25 N2-009-1 Recommendation: • Approval of Amendment #1 with Shiloh Home, Inc. 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 443 V� a- untid Pass -Around Memorandum; August 12, 2025 - CMS ID 9836 Karla Ford From: Sent: To: Subject: I support — thanks ; (�-sc 'a. COUNTY, CO Scott James Wednesday, August 13, 2025 10:55 AM Karla Ford Re: Please Reply - PA FOR ROUTING: CW Shiloh Home, Inc. Amendment #1 (CMS 9836) Scott K. James Weld Cony Commissioner Office: 970-400-4200/Ceti : 970-381-7496 P.O. Box 758, 1150 O St., Greeley, CO 80632 0 0 Join Our Team IMPORTANT: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Karla Ford <kford@weld.gov> Date: Wednesday, August 13, 2025 at 10:47 AM To: Scott James <sjames@weld.gov> Subject: Please Reply - PA FOR ROUTING: CW Shiloh Home, Inc. Amendment #1 (CMS 9836) Please advise if you support recommendation and to have department place on the agenda. ,ht,: ti COUNTY, CO Karla Ford Office Manager & Executive Assistant Board of Weld County Commissioners Desk: 970-400-4200/970-400-4228 P.O. Box 758, 1150 O St., Greeley, CO 80632 AGREEMENT AMENDMENT BETWEEN WELD COUNTY AND SHILOH HOME, INC. This Agreement Amendment made and entered into 7 "d Jday of -errnhcv 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 Shiloh Home, Inc., hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Child Welfare Various Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2025-1452, approved on May 28, 2025. 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 July 31, 2028. This Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement as of June 1, 2025: 1. Exhibit C, Rate Schedule, is hereby amended as attached. All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: BY: V.0610A) Clerk to the Board COUNTY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO eputy Cle to the Boa ck, Chair NTRACTOR: Shiloh Home, Inc. 6558 West Ottawa Avenue Littleton, Colorado 80218 Steven RAMIREz StI) 0 3 2325 Steven Ramirez, Chief Executive Officer 08/24/202E Date: n7_5 -1 LISL EXHIBIT C RATE SCHEDULE 1 Funding and Method of Payment The County 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 County expenditures and shall not be reimbursed by the County. 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 County, 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 County, the County may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Rate $ 90.00 Unit Type Hour Service Name Aftercare ,try-Office/Video $ 115.00 Hour Aftercare: In Home or Community AND with Transportation $ 90,00'. Hour Aftercare: FTM TDM, Prof Staffing $ 90.00 Each Aftercare: No Show $ 0.59 Mile Home -Based Services: Mileage $ 7,800.00 Month Mental Health Services In -Home Therapy - Intensive $ 4,680.00 ` Month Mental Health Services in -Home Therapy - High; $ 3,120.00 Month Mental Health Services In -Home Therapy - Moderate $1,560.00 Month Mental Health Services In -Home Therapy - Low Rate $ 6,175.00 Unit Type Month Service Name Mental Health Services In -Office Therapy - Intensive $ 3.705 .00 ,AAonth' : Mental Health Services In -Office Therapy - High $ 2,470.00 Month Mental Health Services In -Office Therapy - Moderate $1,235.00 Month Mental Health Services In -Office Therapy - Low $ 7,800.00 Month Intensive Family Therapy In -Home - Intensive $ 4,680.00 Month Intensive Family Therapy In -Home - High $ 3,120.00 Month Intensive Family Therapy In -Home - Moderate $1,560.00 AAonth Intensive Family Therapy In -Home - ' Low $ 6,175.00 Month Intensive Family Therapy In -Office - Intensive $ 4,680.00 Month Intensive Family Therapy In -Office --- High $ 2,470.00 Month Intensive Family Therapy In -Office - Moderate $ 1,235.00 Month Intensive Family Therapy In -Office - Low $ 95.00 Hour Sex Abuse Individual and Family Therapy: In-OfficeNideo $ 130.00 Hour Sex Abuse Individual and Family. Therapy. In Home or Cprnmunity AND with Transportation $ 95.00 Hour Sex Abuse Treatment: FTM, TDM, Professional Staffing $ 95.00. ' Each Sex Abuse Treatment: ;No Show $ 0.59 Hour Sex Abuse Treatment: Mileage $ `95.00 Hour = FP & KP Training: In-Office/Video $ 120.00 Hour FP & KP Training: In -Home or Community AND with Transportation $ 05.00 Hour FP & KP Training: FTM, TDM, Prof. Staffing $ 95.00 Hour FP & KP Training: No Show $ I20:g0 Hour FP '& KP Training: In -Home or Camman'ifiy AND with Transpodation $ 5,525.00 Month Life Skills and Family Coaching - Intensive $ 3,315.00 Month Life Skills and Family Coaching- High $ 2,210.00 Month Life Skills and Family Coaching- Moderate $ 1,105.00 Month Life Skills and Family Coaching- Low $ 1,115.00 Month Beyond the Walls $ ` 300.00 Each Informed Supervision $ 4,225.00 Month Youth Mentoring - Intensive: In-OfficeNideo $ 2,535:00 Month Youth Mentoring - High: In-Office/Video $ 1,690.00 Month Youth Mentoring - Moderate: In-OfficeNideo $ 845.00 Month Youth Mentoring - Low: In-Office/Video Rate $ 5,525.00 Unit Type Month Service Name Youth Mentoring - Intensive: In -Home or Community $ 3,315.00, Month Youth Mentoring = High h i=Horne or Community $ 2,210.00 Month Youth Mentoring - Moderate: In -Home or Community $ ;'l 105.00 Month Youth Mentoring -.Low: 1"n -Home or Community $ 4,875.00 Month Youth Intervention Therapy - High: In -Home $ 3;250.00 Month Youth Intervention Therapy - Moderate: In -Home $ 1,625.00 Month Youth Intervention Therapy - Low: In -Home $ 3,705.00 Month Youth Intervention Therapy - High: In -Office $ 2,470.00 Month Youth Intervention Therapy - Moderate: In -Office $1,040.00 Month Youth Intervention. Therapy- Low: In -Office $ 95.00 Hour FP and KP Consultation: In-Office/Video $ 120.00 ` Hour FP and KP Consultation: In -Home or Community $ 0.59 Mile FP and KP Consultation: Mileage $ 320.00 Hour The Truth About Sexually Abuse Youth: In-OfficeNideo $ 2,125.00 Month Day Treatment $ 2,054.00 Month Supervised Family/Sibling Time - High: In -Office $ 1,027.00 Month Supervised Family/Sibling Time - Moderate: In -Office $ 342.00 Month Supervised Family/Sibling Time - Low: In -Office' $ 95.00 Hour Therapeutic Family/Sibling Time: In -Office $ 120.00 Hour Therapeutic Family/Sibling Time: In- Home or Community AND with Transportation,. $ 95 .00 Hour Therapeutic Family/Sibling Time: FTM, TDM, Professional Staffing 95.00 hour Therapeutic Family/Sibling Time: No Show $ 0.59 Hour Therapeutic Family/Sibling Time: Mileage $ 342.00 Month Therapeutic Family/Sibling Time - Low: In -Office $ 600.00 Each Parents as Teachers: In -Office or In -Home or Community. Price per child. $ : 0.59 `. Mileage Parents as Teachers: Mileage *Mileage rate is paid after 30 roundtrio miles from the nearest office or staff location. Staff members operate from mobile offices. 3. Request for Reimbursement and Supporting Documentation Contractor shall submit all Requests for Reimbursement and supporting documentation to the County 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 County's online reporting system, unless otherwise directed or agreed to by the County. 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 temiination of the Agreement. 4. Payment The County 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 County funds can be accessed for services. Exceptions to this Paragraph may include, if approved by the County, 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 County 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. to the amount of work or deliverables lost to the County. 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 County and Contractor, or by the County as a debt due to the County 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. ACORM, Client#: 2047745 SHILOHOMI CERTIFICATE OF LIABILITY INSURANCE IDATE (MM/DDYY) 2/27/2025/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 holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: T Breanna Bucklin _ USI Insurance Services, LLC PHONE _------- 303 837-85050 T 0 (A/C, No, Ext) � (AIC, No): - 4600 South Ulster Street Mass; breanna.bucklin@usi.com Denver, CO 80237 INSURERS) AFFORDING COVERAGE NAIC It 303 837-8500 INSURER A : Philadelphia Indemnity Insurance Co. i 18058 INSURED ' INSURER B : Plnnacol Assurance Company 41190 Shiloh Home Inc. dba Shiloh Home INSURER C ; At -Bay Specialty Insurance Company 19607 dba Shiloh Home6588 W. Ottawa Avenue I INSURER D Littleton, CO 80128-4572 I INSURER E : . INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE IADDL LTR '{INSR SUER WVD POLICY NUMBER POLICY EFF POLICY EXP /YYYY) ;ANI /YYYY) LIMITS .06_7g 01/01/2025I01/01/2026 I ($1,000,000 A X COMMERCIAL GENERAL UABIUTY j I CLAIMS -MADE IX OCCUR PHPK2640802 EEAp1C�IH�OEC7C�URRENCE PREMISES (EaEoNccTuE ence) I $100,000 MED EXP (Any one person) ':. $20,000 PERSONAL & ADV INJURY I $1,000,000 GEN'L _ AGGREGATE LIMIT APPLIES PER: I PRO- I POLICY I !IT& LOC I OTHER: GENERAL AGGREGATE I $ 3,000,000 PRODUCTS - COMP/OP AGG I $ 3,000,000 ! $ AUTOMOBILE A _ X r-- X LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOS ONLY I I SCHEDULED I AUTOS I X NON-OOSWNED I AUTONLY PHPK2640802 01/01/2025 01/01/2026 I I I COMBINED SINGLE LIMIT (Ea accident) �$1,000,000 BODILY INJURY (Per person) I $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ A X I--- UMBRELLAUAB EXCESS LIAB X OCCUR , CLAIMS -MADE I PHUB895673 01/01/2025;01/01/2026 EACH OCCURRENCE I $9,000,000 AGGREGATE I $9,000,000 $ DED I X, RETENTION $15000 { B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N I OFFICER/MEMBER EXCLUDED? (� I N, A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below I 1705662 01/01/2025101/01/2026 I X PER grr �.STASUTE ! ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT j $500,000 C Cyber Liabil IAB660364006 A Fidelity Liab A Professional Liab PHSD1849310 PHPK2640802 01/01/2025,01/01/2026 01/01/2025 01/01/2026 01/01/2025 01/01/2026 $2M/2M per occ/agg $1M limit/$5,000 ret $1M/$3M per occ/agg DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, are included as Additional Insured with respect to General Liability as required by written contract or agreement per the attached form.60 day Notice of Cancellation is provided for Weld County. CERTIFICATE HOLDER CANCELLATION Weld County, Colorado SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 315 N. 11th Avenue, Bldg A ACCORDANCE WITH THE POLICY PROVISIONS. Greeley, CO 80631 AUTHORIZED REPRESENTATIVE Oii © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S48296751 /M47948705 MXRBP o tract F Entity Information Entity Name* SHILOH HOUSE, INC Entity ID* @00035732 Contract Name* SHILOH HOUSE, INC. (PSA AMENDMENT #1) Contract Status CTB REVIEW Contract ID 9836 Contract Lead* WLUNA New Entity? Parent Contract ID 20251452 Requires Board Approval YES Contract Lead Email Department Project # wluna@weld.gov;cobbxxl k@weld.gov Contract Description* (CONSENT) SHILOH HOUSE, INC. PROFESSIONAL SERVICES AGREEMENT AMENDMENT #1 RELATED TO CHILD WELFARE VARIOUS SERVICES IFB #B2500040, TO UPDATE RATE. TERM: JUNE 1, 2025 THROUGH JULY 31, 2028. Contract Description 2 PA WILL ROUTE WITH THIS ENTRY. ETA TO CTB 08/15/25. Contract Type* Department Requested BOCC Agenda Due Date AMENDMENT HUMAN SERVICES Date* 08/16/2025 08/20/2025 Amount* Department Email $0.00 CM- Will a work session with BOCC be required?* HumanServices@weld.gov NO Renewable* YES 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 Contact Info Review Date 05/31/2028 Renewal Date 05/01/2026 Committed Delivery Date Expiration Date Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date CONSENT 08/27/2025 Approval Process Department Head JAMIE ULRICH DH Approved Date 08/27/2025 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 09/03/2025 Finance Approver CONSENT Legal Counsel CONSENT Finance Approved Date Legal Counsel Approved Date 08/27/2025 08/27/2025 Tyler Ref # AG 090325 Originator WLUNA Corti/ad-049509 PROFESSIONAL SERVICE AGREEMENT BETWEEN WELD COUNTY AND SHILOH HOME, INC. THIS AGREEMENT is made and entered into this ZSThday of , 2025 by and between the Board of Weld County Commissioners, on behalf of th eld County Department of Human Services, hereinafter referred to as "County," and Shiloh Home, Inc., 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 Services funding to the Department. 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 be based upon order of attachment. Exhibit A consists of the HIPAA Business Associates Agreement. Exhibit B consists of the Scope of Services. Exhibit C consists of the Rate Schedule. Exhibit D consists of County's Invitation for Bid (IFB) as set forth in Bid Package No. B2500040 which is incorporated into this agreement by reference and will be provided upon request to the Department. Exhibit E consists of Contractor's Bid Response to County's Invitation. 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 Cun-en+- Arend.k- siz$i2s 1 CC-. GhbaY CD -S) 5/2/25 2025-1452 Exhibits. Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibits B, Scope of Services, and Exhibit E, Contractor's Bid Response to County's Invitation. 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, 2025 through July 31, 2028 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 not covered in the compensation and time provisions of this Agreement, unless approved and documented otherwise by the County Representative. 6. Compensation. County agrees to pay Contractor through an invoice process during the course of this Agreement in accordance with the Rate Schedule as described as Exhibit C. Contractor agrees to submit invoices which detail the work completed by Contractor. 2 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 termin tion or expiration of this Agreement, County reasonably determines that any payment m de by County to Contractor was improper because the service for which payment w s made did not perform as set forth in this Agreement, then upon written notice of su h determination and request for reimbursement from County, Contractor shall forthwith ret rn 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. Any provisions in this Contract that may appear to give the County the right to direct contractor as to details of doing work or to exercise a measure of control over the work mean that Contractor shall follow the direction of the County as to end results of the work only. The Contractor is obligated to pay all federal and state income tax on any moneys earned or paid pursuant to this contract. 8. Subcontractors. Contractor acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of the Work without County's prior written consent, which may be withheld in County's sole discretion. County shall have the right in its reasonable discretion to approve all personnel assigned to the Work during the performance of this Agreement and no personnel to whom County has an objection, in its reasonable discretion, shall be assigned to the Work. Contractor shall require each subcontractor, as approved by County and to the extent of the Work to be performed b 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, y this Agreement, assumes toward County. County shall have the right (but not the obligation) to enforce the provisions of this Agreement against any subcontractor 3 hired by Contractor and Contractor shall cooperate in such process. The Contractor shall be responsible for the acts and omissions of its agents, employees and subcontractors. 9. Ownership. All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of County. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contractor in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the County. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of County. 10. Confidentiality. Confidential information of the Contractor should be transmitted separately from non -confidential information, clearly denoting in red on the relevant document at the top the word, "CONFIDENTIAL." However, Contractor is advised that as a public entity, Weld County must comply with the provisions of the Colorado Open Records Act (CORA), C.R.S. 24-72-201, et seq., with regard to public records, and cannot guarantee the confidentiality of all documents. Contractor agrees to keep confidential all of County's confidential information. Contractor agrees not to sell, assign, distribute, or disclose any such confidential information to any other person or entity without seeking written permission from the County. Contractor agrees to advise its employees, agents, and consultants, of the confidential and proprietary nature of this confidential information and of the restrictions imposed by this Agreement. 11. Warranty. Contractor warrants that the Work performed under this Agreement will be performed in a manner consistent with the standards governing such services and the provisions of this Agreement. Contractor further represents and warrants that all Work shall be performed by qualified personnel in a professional manner, consistent with industry standards, and that all services will conform to applicable specifications. 12. Acceptance of Services Not a Waiver. Upon completion of the Work, Contractor shall submit to County originals of all test results, reports, etc., generated during completion of this work. Acceptance by County of reports and incidental material(s) furnished under this Agreement shall not in any way relieve Contractor of responsibility for the quality and accuracy of the project. In no event shall any action by County hereunder constitute or be construed to be a waiver by County of any breach of this Agreement or default which may then exist on the part of Contractor, and County's action or inaction when any such breach or default exists shall not impair or prejudice any right or remedy available to County with respect to such breach or default. No assent expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the County of, or payment for, the Work completed under this Agreement shall 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 4 term of the greement, or any extension thereof, and during any warranty period. For all coverages, ontractor's insurer shall waive subrogation rights against County. Contractor shall provide coverage with limits of liability no less than those stated below. An excess liability policy or urribrella liability policy may be used to meet the minimum liability requirements provided that the coverage is written on a "following form" basis. Acceptability, of Insurers: Insurance is to be placed with insurers duly licensed or authorized to do business in the state of Colorado and with an "A.M. Best" rating of not less than A -VIII. The County in no way warrants that the above -required minimum insurer rating is sufficient to protect the Contractor from potential insurer insolvency. Required Types of Insurance Workers' Compensation and 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. Minimum Limits: Coverage A (Workers' Compensation) Coverage B (Employers Liability) Commercial General Liability Insurance - Occurrence Form. Statutory $ 100,000 $ 100,000 $ 500,000 Policy shall include bodily injury, property damage, liability assumed under an Insured Contract. The policy shall be endorsed to include the following additional insured language: "Weld County, its elected officials, employees, associated and/or affiliated entities, successors, or assigns, agents, and volunteers shall be named as additional insureds with respect to liability arising out of the activities performed by, or on behalf of the Contractor." Such policy shall include Minimum Limits as follows: General Aggregate $ 1,000,000 Products/Completed Operations Aggregate $ 1,000,000 Each Occurrence Limit $ 1,000,000 Personal/Advertising Injury $ 1,000,000 Automobile Liability Insurance Bodily Injury and Property Damage for any owned, hired, and non -owned vehicles used in the performance Of this Contract. Such policy shall maintain Minimum Limits as follows: Bodily Injury/Property Damage (Each Accident) $ 1,000,000 5 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: Per Loss Aggregate $ 1,000,000 $ 2,000,000 14. Proof of Insurance. Upon County's request, Contractor shall provide to County, for examination, a policy, endorsement, or other proof of insurance as determined in County's sole discretion. Provided information for examination shall be considered confidential, and as such, shall be deemed not subject to Colorado Open Records Act (CORA) disclosure. All insurers must be licensed or approved to do business within the State of Colorado, and unless otherwise specified, all policies must be written on a per occurrence basis. The Contractor shall provide the County with a Certificate of Insurance evidencing required coverages, before commencing work or entering the County premises. The Contractor shall furnish the County with certificates of insurance (ACCORD) form or equivalent approved by the County as required by this Contract. The certificates for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The Contractor shall name on the Certificate of Insurance "Weld County, its successors or assigns; its elected officials, employees, agents, affiliated entities, and volunteers as Additional Insureds" for work that is being performed by the Contractor. On insurance policies where Weld County is named as an additional insured, the County shall be an additional insured to the full limits of liability purchased by the Contractor even if those limits of liability are in excess of those required by this Contract. Each insurance policy required by this Agreement must be in effect at or prior to commencement of work under this Agreement and remain in effect for the duration of the project, and for a longer period of time if required by other provisions in this Agreement. Failure to maintain the insurance policies as required by this Agreement or to provide evidence of renewal is a material breach of contract. All certificates and any required endorsement(s) shall be sent directly to the County Department Representative's Name and Address. The project/contract number and 6 project des ription shall be noted on the Certificate of Insurance. The County reserves the right to require complete, certified copies of all insurance policies required by this Agreement 7t any time, and such shall also be deemed confidential. Any modification or variation from the insurance requirements in this Agreement shall be made by the County Attorney's Office, whose decision shall be final. Such action will not require a formal contract amendment but may be made by administrative action. 15. Additional Insurance Related Requirements. The County requires that all policies of insurance be written on a primary basis, non-contributory with any other insurance coverages and/or self-insurance carried by the County. The Contractor shall advise the County in the event any general aggregate or other aggregate limits are reduced below the required per occurrence limit. At their own expense, the Contractor will reinstate the aggregate limits to comply with the minimum requirements and shall furnish the County with a new certificate of insurance showing such coverage is in force. Commercial General Liability Completed Operations coverage must be kept in effect for up to three (3) years after completion of the project. Contractors Professional Liability (Errors and Omissions) policy must be kept in effect for up to three (3) years after completion of the project. Certificates of insurance shall state that on the policies that the County is required to be named as an Additional Insured, the insurance carrier shall provide a minimum of 30 days advance written notice to the County for cancellation, non -renewal, suspension, voided, or material changes to policies required under this Agreement. On all other policies, it is the Contractor's responsibility to give the County 30 days' notice if policies are reduced in coverage or limits, cancelled or non -renewed. However, in those situations where the insurance carrier refuses to provide notice to County, the Contractor shall notify County of any cancellation, or reduction in coverage or limits of any insurance within seven (7) days of receipt of insurer's notification to that effect. The Contractor agrees that the insurance requirements specified in this Agreement do not reduce the liability Contractor has assumed in the indemnification/hold harmless section of this Agreement. Failure of the Contractor to fully comply with these requirements during the term of this Agreement may be considered a material breach of contract and may be cause for immediate termination of the Agreement at the option of the County. The County reserves the right to nDgotiate additional specific insurance requirements at the time of the contract award. 16. Subcontractor Insurance. Contractor hereby warrants that all subcontractors providing services under this Agreement have or will have the above -described insurance prior to their commencement of the Work, or otherwise that they are covered by the Contractor's 7 policies to the minimum limits as required herein. Contractor agrees to provide proof of insurance for all such subcontractors upon request by the County. 17. No limitation of Liability. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor. The County in no way warrants that the minimum limits contained herein are sufficient to protect the Contractor from liabilities that might arise out of the performance of the Work under by the Contractor, its agents, representatives, employees, or subcontractors. The Contractor shall assess its own risks and if it deems appropriate and/or prudent, maintain higher limits and/or broader coverages. The Contractor is not relieved of any liability or other obligations assumed or pursuant to the Contract by reason of its failure to obtain or maintain insurance in sufficient amounts, duration, or types. The Contractor shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. 18. 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. 19. Mutual Cooperation. The County and Contractor shall cooperate with each other in the collection of any insurance proceeds which may be payable in the event of any loss, including the execution and delivery of any proof of loss or other actions required to effect recovery. 20. Indemnity. The Contractor shall indemnify, hold harmless and, not excluding the County's right to participate, defend the County, its officers, officials, agents, and employees, from and against any and all liabilities, claims, actions, damages, losses, and expenses including without limitation reasonable attorneys' fees and costs, (hereinafter referred to collectively as "claims") for bodily injury or personal injury including death, or loss or damage to tangible or intangible property caused, or alleged to be caused, in whole or in part, by the negligent or willful acts or omissions of Contractor or any of its owners, officers, directors, agents, employees or subcontractors. This indemnity includes any claim or amount arising out of or recovered under Workers' Compensation Law or arising out of the failure of the Contractor to confomi to any statutes, ordinances, regulation, judicial decision, or other law or court decree. It is the specific intention of the parties that the County shall, in all instances, except for claims arising solely from the negligent or willful acts or omissions of the County, be indemnified by Contractor from and against any and all claims. It is agreed that the Contractor will be responsible for primary loss investigation, defense, and judgment costs where this indemnification is applicable. In consideration of the award of this contract, the Contractor agrees to waive all rights of subrogation against the County, its officers, officials, agents, and employees for losses arising from the work performed by the Contractor for the County. The Contractor shall be fully responsible and liable for any and all injuries or damage received or sustained by any person, persons, or property on account 8 of its performance under this Agreement or its failure to comply with the provisions of the Agreement. A failure of Contractor to comply with these indemnification provisions shall result in County's right but not the obligation to terminate this Agreement or to pursue any other lawful remedy. 21. 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. 22. Examination of Records. To the extent required by law, the Contractor agrees that a duly authorized representative of County, including the County Auditor, shall have access to and the right to examine and audit any books, documents, papers and records of Contractor, involving all matters and/or transactions related to this Agreement. Contractor agrees to maintain these documents for three years from the date of the last payment received. 23. 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. 24. 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 9 Either party may change its notice address(es) by written notice to the other. Notice may be sent to: TO CONTRACTOR: Name: Austin Topolnicki Position: Executive Consultant Address: 5688 West Ottawa Avenue Address: Littleton, Colorado 80218 E-mail: atopolnicki@shilohhouse.net Phone: (303) 933-1393 TO COUNTY: Name: Jamie Ulrich Position: Director Address: P.O. Box A Address: Greeley, Colorado 80632 E-mail: ulrichjj(a�weld.gov Phone: (970) 400-6510 25. 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. 26. Health Insurance Portability & Accountability Act of 1996 ("HIPAA"). 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 A is a HIPAA Business Associate Agreement for HIPAA compliance. 27. 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. 28. 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. 29. 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. 30. 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 10 which is the subject matter of this Agreement. Contractor agrees that if Contractor was a former employee of the Department of Human Services, or employs a former employee of the Department of Human Services, that Contractor will also abide by applicable requirements under C.R.S. 24-18-201 et seq. 31. 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. 32. 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. 33. Non -Waiver. The parties hereto understand and agree that the County is relying on, and does not waive or intend to waive by any provision of this Contract, the monetary limitations or any other rights, immunities, and protections provided by the Colorado Governmental Immunity Act, §§24-10-101 et seq. as from time to time amended, or otherwise available to the County, its subsidiary, associated and/or affiliated entities, successors, assigns; or its elected officials, employees, agents, and volunteers. 34. 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 or results from acts beyond the impacted Party's reasonable control, including without limitation, the following "force majeure" events that frustrate the purpose of this Agreement: 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, government order or law, action by any governmental authority, and other similar events beyond the reasonable control of the impacted party, 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. However, if force majeure occurs after the party delays performance, the party shall not be exempted from liability. The Party affected by the force majeure shall make reasonable efforts to reduce the consequences caused by the force majeure. If the force majeure affects the performance of the contract, the party that is subject to force majeure shall promptly notify the other party and submit to the other party a sufficient and valid proof of force majeure within a reasonable period of time. Otherwise, the corresponding liability shall not be waived. 35. 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 11 any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 36. 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. 37. 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. 38. No Employment of Unauthorized Aliens. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an unauthorized alien who will perform work under this Agreement (see 8 U.S.C.A. §1324a and (h)(3)), nor enter into a contract with a subcontractor that employs or contracts with an unauthorized alien to perform work under this Agreement. Upon request, contractor shall deliver to the County a written notarized affirmation that it has examined the legal work status of an employee and shall comply with all other requirements of federal or state law, including employment verification requirements contained within state or federal grants or awards funding public contracts. Contractor agrees to comply with any reasonable request from the Colorado Department of Labor and Employment in the course of any investigation. If Contractor fails to comply with any requirement of this provision, County may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. 39. 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. 40. 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. 41. Acknowledgment. County and Contractor acknowledge that each has read this Agreement, understands it and agrees to be bound by its terms. Both parties further agree that this Agreement, with the attached Exhibits, is the complete and exclusive statement of agreement between the parties and supersedes all proposals or prior agreements, oral or written, and any other communications between the parties relating to the subject matter of this Agreement. 12 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: BY: d.arrhAi Clerk to the Board BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Deputy Jerk to the Boa �: ,' ��. '' �� L.:' ck, Chair MAY 2 8 2025 CTOR: hiloh Home, Inc. 6558 West Ottawa Avenue Littleton, Colorado 80218 ft6V6h nwitez By: s[even ramirez(May21, 202521:45 MDT) Steven Ramirez, Chief Executive Officer Date: °5/2,12°25 13 Z025-I4SSZ Exhibit A 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. 14 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. ny 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 f oher 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 receivedby 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, including the consequences for violation of such obligations. Business Associate shall take appropriate disciplinary action against any member of its workforce who uses or discloses 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 applicabl# law. 9. Business Associate agrees to maintain a record of its disclosures of PHI, including disclosur#s 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 t"ie 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 15 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 16 of a wri ien 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 permiss'on 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. In 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 ter ination of this BAA for any reason, Business Associate, with respect to PHI received rom County, or created, maintained, transmitted, or received by Business AssociatEi on behalf of County, shall: a. Retain only that PHI which is necessary for Business Associate to continue its 17 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. 18 EXHIBIT B SCOPE OF SERVICES Contractor will provide Services as referred by the County. 1. Aftercare Services a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Office -Based Family Therapy. ii. Community -Based Family Therapy. iii. In -Home Family Therapy. iv. Office -Based Individual Therapy. v. Community -Based Individual Therapy. vi. In -Home Individual Therapy. vii. Community -Based Family Support Services (i.e., Life Skills and/or Parent Coaching). viii. In -Home Family Support Services b. Anticipated Frequency of Services: i. Frequency dependent on the type of aftercare service chosen. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Treat emotional and behavioral symptoms associated with trauma and mental health disorders. ii. Educate families about trauma and mental health issues. iii. Help children, adolescents, and their families develop healthy coping tools. iv. Equip caretakers with knowledge and methods to provide trauma - informed parenting. v. Improve parenting skills including the ability to develop, implement, and reinforce appropriate behavior expectations and consequences. vi. Provide intensive psychoeducation that increases each family member's understanding of their own unhealthy interaction patterns and how to change them. vii. Reduce conflict between family members by teaching them positive communication skills that foster empathy between them. viii. Facilitate communication between family members about emotional, behavioral, and relational issues. ix. Assist caretakers in creating a nurturing and healthy home environment which will enable the children to successfully progress in their development and academic achievement. x. Practical implementation of parenting skills learned in therapy (e.g., creating chore charts, homework charts). xi. Practical implementation of life skills e. Outcomes of Services: i. Improved individual and family functioning. ii. Alleviation or reduction of mental health symptoms. iii. Completion of treatment goals. f. Target Population: i. Children and adolescents in the process of reunifying with their families or transitioning to another permanent placement. ii. Children, adolescents, and families who are struggling with issues related to mental health, trauma, and difficult family dynamics that compromise individual and family functioning and lead to placement disruptions. iii. All genders. g. Language: i. English. h. Medicaid Eligibility: i. Services may be Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. ii. In -Home or Community AND with Transportation. 2. Mental Health Services Therapy - Intensive, High, Moderate and Low a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Mental health assessment. ii. Behavior Therapy principles/interventions (including communication skills training). iii. Parent management training techniques. iv. Trauma Focused -Cognitive Behavioral Therapy (TF-CBT). v. Play therapy. vi. Family Systems interventions. vii. Dialectical Behavior Therapy (DBT) techniques. b. Anticipated Frequency of Services: i. Intensive — ten (10) to fifteen (15) hours per week. ii. High - seven (7) to nine (9) hours per week. Moderate — four (4) to six (6) hours per week. iv. Low — two (2) to three (3) hours per week. c. Anticipated Duration of Services: i. Three (3) to nine (9) months. d. Goals of Services: i. Reduce problematic symptoms and behaviors associated with mental health disorders and trauma. ii. To help children, adolescents, and their families develop healthy coping tools to manage their unpleasant thoughts and emotions. iii. Equip caretakers with knowledge and methods to provide trauma - informed parenting and meet the unique needs of their children. iv. Improve parenting skills including the ability to develop, implement, and reinforce appropriate behavior expectations and consequences. v. Reduce conflict within families by teaching and guiding family members in the use of positive communication skills that foster empathy between them. vi. Facilitate communication between family members to address therapy issues. e. Outcomes of Services: i. Improved Mental Health. ii. Improved Individual Functioning. iii. Improved Family Functioning. iv. Educating children, adolescents, and families about issues associated with trauma and mental health, including identifying how they impact functioning f. Target Population: i. Children, adolescents, and families who are struggling with mental health issues and difficult family dynamics. g. Language: i. English. h. Medicaid Eligibility: i. Services may be Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. ii. In -Home or Community 3. Intensive Family Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. A combination of individual therapy and family therapy in home, community, or office locations. ii. Therapeutic services. iii. Evidence -based services include Trauma -Focused Cognitive Behavioral Therapy (TF-CBT). iv. Motivational Interviewing. Services are solutions Focused, and Person Centered. v. Engagement Techniques. vi. Provide recommendations for individual community -based services and other community resources/services. b. Anticipated Frequency of Services: i. Intensive — ten (10) to fifteen (15) hours per week ii. High - seven (7) to nine (9) hours per week. iii. Moderate — four (4) to six (6) hours per week. iv. Low — two (2) to three (3) hours per week. c. Anticipated Duration of Services: i. Three (3) to nine (9) months. d. Goals of Services: i. Create healthy patterns for interaction between family members. ii. Resolve presenting problems identified by the family. iii. Increase trustworthiness in relationships between family members. e. Outcomes of Services: i. Improved family dynamics. ii. Completion of treatment goals. iii. Family will continue to demonstrate safety and stability in the home environment, reducing the risk for out of home placement or future Human Services involvement. f. Target Population: i. Families who are struggling with mental health issues (often related to trauma) and difficult family dynamics g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. ii. In -Home or Community. 4. Sex Abuse Individual and Family Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Emphasizes implementation of evidence -based treatment practices. ii. Colorado Sex Offender Management Board (SOMB) guidelines and standards. iii. Risk assessment. iv. Evidence -based services include Trauma -focused Cognitive Behavioral Therapy (TF-CBT). v. Cognitive Behavioral Therapy (CBT). vi. Psychoeducation and Family Systems Therapy. vii. Safety planning. viii. Informed Supervision training. ix. Relapse prevention planning. b. Anticipated Frequency of Services: i. Typically, two (2) to four (4) hours per week. c. Anticipated Duration of Services: i. Three (3) to nine (9) months. d. Goals of Services: i. To gain understanding of abusive dynamics. ii. Increase healthy boundaries related to sex and sexuality. iii. Adherence to SOMB guidelines. e. Outcomes of Services: i. Completion of the treatment plan. ii. The youth contribute to community safety by maintaining healthy boundaries and accountability. iii. Prevent out of home placement. iv. Reduced risk of offending as measured by the Juvenile Sex Offender Assessment Protocol -II (JSOAP). v. Demonstration of improved mental health as demonstrated by observation and assessments vi. To help youth and families increase pro -social behaviors and protective factors; develop a nurturing, healthy home environment; eliminate all illegal behaviors by family members. vii. Provide participants with an understanding of their family and personal cycle of abuse, while increasing their ability to interrupt this cycle. viii. Help clients identify and address safety concerns for all family members. ix. Promote disclosure of abusive behaviors and address any victimization the client has experienced. x. Assist in the development of empathy for persons victimized. xi. Establish healthy coping skills and tools (self-control, and rehearsal of corrected cognitions). f. Target Population: i. Families with youth who experience issues and behaviors related to sexual abuse victimization, sexual dysfunction, sexual abuse perpetration ii. To prevent further sexual abuse and victimization. g. Language: i. English. h. Medicaid Eligibility: i. Services may be Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. ii. In -Home or Community AND with Transportation. 5. Foster Parent and Kinship Provider Training a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Review of the grief and loss that occurs in transitions. ii. View and discus dramatic videos that portray the impact. iii. Teach foster parents how to support foster children in transitions. iv. Step-by-step guide of navigating the mental health system, including accessing services, counseling and psychiatric services, initial assessments and first contacts, making appointments. v. How to support the child before and after mental health appointments and/or hospitalizations. vi. communication with the therapist, and problem -solving real -life roadblocks. vii. A thorough review of children's complex feelings toward their families and the best strategies for supporting the child in all steps of the family reunification process. viii. The foster parents will be provided the opportunity to explore their own feelings about family reunification. ix. Teach the value of developmentally appropriate daily routine and consistency with children -Home Based family support professionals will help parents establish a daily routine by using schedules and meal planning menus. x. Assist parents with household rules, rewards and consequences and are given resources such as age -appropriate chore charts to help parents with consistency. xi. Provide services that protect the child. b. Anticipated Frequency of Services: i. Therapy - Approximately one (1) to two (2) hours per week. ii. Coaching - Approximately two (2) to four (4) hours per week. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Enable the family to function in a safe manner. ii. Address concerns through education, role modeling, providing information for community resources, and providing effective parenting training. iii. Promote stable placement and/or reunification. e. Outcomes of Services: i. Increase foster parent competency and confidence. ii. Significantly reduce placement disruption. iii. Increase formal and informal supports such as community, family, and friends. iv. Increase foster parents understanding of the impact of trauma. v. Help foster parents to have realistic child expectations. vi. Improve foster parenting, relationship, and social skills. vii. Return children in placement to their own home. viii. Prevent out of home placement. ix. Facilitate the successful return of youth to the home and community. x. Unite children with their permanent families. f. Target Population: i. Foster and Kinship providers. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. ii. In -Home or Community AND with Transportation. 6. Life Skills and Family Coaching a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Provide information regarding community resources, employment, occupational training, education, and health care options. ii. Provide support services to assist families with accessing resources and employment. iii. Provide families with assistance with household budgeting. iv. Provide help with household management. v. Help families identify and establish appropriate boundaries and limits. vi: Provide tools to improve family functioning, including behavior management, conflict management, communication, and problem - solving tools. vii. Support development of parent/child relationships. viii. Teach appropriate discipline techniques. ix. Family Support Professionals utilize a variety of techniques with parents to increase awareness, skill, and management of child behavior, including but not limited to. 1. Trust -Based Relational Intervention (TBRI). 2. No Drama Discipline. 3. Whole Brain Child. 4. Love and Logic. x. Role modeling positive interaction with children. xi. Family Support Professionals use activities to model how to positively interact with children. 1. Books, games, crafts, and creative play to teach clients. 2. This includes recognition of children's needs, nurturing interactions, appropriate responses to the child's cues, as well as stepping in to model age- appropriate discipline and consequences. b. Anticipated Frequency of Services: i. Frequency of service is determined by the level of services purchased. 1. Intensive: ten (10) to fifteen (15) hours per week. 2. High: seven (7) to nine (9) hours per week. 3. Moderate: four (4) to six (6) hours per week. 4. Low: two (2) to three (3) hours per week. c. Anticipated Duration of Services: i. Three (3) to nine (9) months. d.', Goals of Services: i. To Increase awareness of children's basic needs. ii. Increase value of consistency and routine within the household. iii. Improve global family functioning to reduce the risk of further Department involvement. iv. Provide supports that can strengthen the family. v. Provide guidance and information to allow self-sufficiency, and create a safe, nurturing environment for children, thereby increasing the likelihood of long-term family preservation. vi. Provide information regarding community resources, employment, occupational training, education, and health care options. vii. Provide support services to assist families with accessing resources and employment. viii. Provide families with assistance with household budgeting. ix. Provide help with household management. x. Help families identify and establish appropriate boundaries and limits. xi. Provide tools to improve family functioning, including behavior management, conflict management, communication, and problem - solving tools. xii. Support development of parent/child relationships. xiii. Teach appropriate discipline techniques. xiv. Role modeling positive interaction with children. xv. Activities to model how to positively interact with children. e. Outcomes of Services: i. Increase level of family functioning. ii. Eliminate child protection issues in the home. iii. Increase formal and informal supports such as community, family, and friends. iv. Increase parents understanding of their parenting role. v. Help parents have realistic child expectations. vi. Improve parenting, relationship, and social skills f. Target Population: i. Families with children under the age of eighteen (18) involved in or at risk of becoming involved in a dependency and neglect case. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. ii. In -Home or Community AND with Transportation. 7. Beyond the Walls a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Assemble the circle of support and network of resources that exists naturally in local communities. ii. Youth will build a plan by assessing their current skills and their goals for the future. iii. Work with a life transitions coach to identify their needs, set goals, and connect them with our community partners' network. iv. Amplify the ability for each youth to have caring adults working alongside as they journey towards their future. v. Workshops such as financial literacy. vi. Reality tours at local colleges and businesses, and mentoring relationships on a one-on-one (1:1) level or in Circles of support. vii. Focus on the areas of education, housing, job skills, faith -based connections, business engagement, and community skills. viii. Hands-on assistance that are proven tools to assist young people in gaining vital confidence and support as they transition into young adulthood. b. Anticipated Frequency of Services: i. Approximately six (6) hours per week. ii. Twenty-five (25) hours per month. c. Anticipated Duration of Services: i. Service can continue as needed between ages 16-26. d. Goals of Services: i. Identify goals specific to their needs. ii. Youth will participate in hands-on activities that will assist them in the transition into young adult life. iii. Build supports who can provide guidance, promote continued growth, and help them create stability in their early adult lives. e. Outcomes of Services: i. Youth will be aware of educational opportunities that may be useful to them. ii. Youth will be exhibit understanding of rudimentary financial and household management skills. iii. Youth will demonstrate skills to build and maintain circles of support. f. Target Population: i. Youth ages sixteen (16) to twenty-six (26) who have had involvement in the Child Welfare system. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. ii. In -Home or Community. 8. Informed Supervision a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Trained Bachelor of Arts (BA) or Master of Arts (MA) level coaches and clinicians. ii. Informed Supervision training consistent with (Sex Offender Management Board) SOMB Standards and Guidelines. iii. History of SOMB Principles of SOMB treatment with emphasis on community safety. iv. Training for why Informed Supervision is necessary. v. Victim Confidentiality. vi. Sexual Offending Behaviors overview. vii. Current laws that relate to juvenile sexual offending. viii. Seriousness of Juvenile Offending, impact, and priorities. ix. Dynamic patterns (cycles) associated with abusive behavior. x. The role of the MDT in all decisions. xi. Safety Plans. xii. High Risk patterns. xiii. Community Supervision and Treatment. b. Anticipated Frequency of Services: i. One (1) session. ii. Three (3) hour class. c. Anticipated Duration of Services: i. One (1) session. ii. Three (3) hour class. d. Goals of Services: i. Participants will understand why, how, and when Informed Supervision applies to a youth in their care. ii. Participants will understand the requirements established by the SOMB for the supervision of juveniles who have committed a sexual offense. iii. Participants will understand how to create safety plans with youth in their care that adequately address needs specific to the youth. e. Outcomes of Services: i. Parent/Caregiver will gain understanding of Informed Supervision standards and guidelines. ii. Parent/Caregiver will demonstrate both willingness and ability to provide Informed Supervision as evidenced by participation in the class. iii. Acknowledgement of the impact of abusive behavior, and demonstration of knowledge through completion of a post test. iv. Decreased risk, and improved personal health v. Community Safety. f. Target Population: i. Caregiving adults of youth between ten (10) to eighteen (18) who have engaged in unsafe sexualized behaviors and are or are at -risk for adjudication. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 9. Youth Mentoring a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Mentor meets with the family for an initial family driven, strength - based assessment. ii. Work with the young person and his or her family to create a plan that clearly outlines the areas to be addressed with measurable goals. iii. Family Support Paraprofessional (Mentor) can provide support to youth and their families in school and other educational settings. iv. Work with therapists, staff or foster parents, parents, and other siblings to make the transition home smoother and safer by addressing barriers that might exist in reconnecting as a family v. Trust Based Relational Interventions (TBRI) vi. Casey Life Skills Assessment vii. Strengthening Protective Factors Foundation. b. Anticipated Frequency of Services: i. Frequency of service is determined by the level of services. 1. Intensive: ten (10) to fifteen (15) hours per week. 2. High: seven (7) to nine (9) hours per week. 3. Moderate: four (4) to six (6) hours per week. 4. Low, two (2) to three (3) hours per week. c. Anticipated Duration of Services: i. Three (3) to nine -(9) months. d. Goals of Services: i. Smoother, safer reunification process. ii. Help youth with court ordered community service find appropriate opportunities to complete volunteer work. iii. Improved communication with teachers. iv. Parents learn how to access the school's parent portal. v. Establish shared expectations for school attendance and homework completion. e. Outcomes of Services: i. Reduced risks for legal involvement or improved compliance with probation requirements. ii. Increased communication between school and parents. iii. Increased pro -social activity and school engagement. iv. Help parents or guardians improve communication with teachers and learn to access school resources like the parent portal. v. Promote long term pro -social engagement with the young person. vi. Provide resources to help identify those opportunities. vii. Help youth find volunteer opportunities when there is court ordered community service as part of probation. viii. Help youth in the development of pro -social relationships and introduce them to a range of pro -social activities. ix. Help youth and their families find community resources that will provide cost effective options for ongoing mental health care, medical, dental, and vision care. x. Help families identify the culturally responsive service providers and cultural education opportunities. xi. Work with therapists, staff or foster parents, parents, and other siblings to make the transition home smoother and safer by addressing barriers that might exist in reconnecting as a family. f. Target Population: i. Youth ages ten (10) to eighteen (18). g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. ii. In -Home or Community. 10. Youth Intervention a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Work with the young person and his or her family to create a plan that clearly outlines the areas to be addressed with measurable goals. ii. Work with therapists, staff or foster parents, parents, and other siblings to make the transition home smoother and safer by addressing barriers that might exist in reconnecting as a family. iii. Motivational Interviewing. iv. Strengthening protective factors foundations, v. Trauma Focused -Cognitive Behavioral Therapy (TF-CBT). vi. Dialectical Behavioral Therapy (DBT). vii. Trust Based Relational Interventions (TBRI) and utilization of the Casey Life Skills Assessment. viii. Seek direct input from clients on the needs they identify for their families. b. Anticipated Frequency of Services: i. Frequency of service is determined by the level of services. 1. Intensive: ten (10) to fifteen (15) hours per week. 2. High: seven (7) to nine (9) hours per week. 3. Moderate: four (4) to six (6) hours per week. 4. Low, two (2) to three (3) hours per week. c. Anticipated Duration of Services: i. Three (3) to nine (9) months. ii. Recommendations to be reviewed every 30 days. d. Goals of Services: i. With supports in place to maintain family functioning, the youth will remain at home successfully. ii. Provide information regarding community resources, mental health, education, and health care options. iii. Provide services to enable the family to function in a safe manner, by addressing the concerns through education, role modeling, and providing information for community resources. iv. Help families create and implement safety plans. v. Help families create short term goals to transition to appropriate ongoing providers to support maintenance of goals. vi. Provide tools to improve family functioning, including behavior management, conflict management, communication, and problem - solving tools. vii. Support development of parent/child relationships. viii. Teaching appropriate discipline techniques. e. Outcomes of Services: i. Reduced risks for legal involvement or improved compliance with probation requirements. ii. Increased communication between school and parents. iii. Increased pro -social activity and school engagement. iv. Help parents or guardians improve communication with teachers and learn to access school resources like the parent portal. v. Help parents or guardians gain access to needed educational services for children and teens. vi. Promote long term pro -social engagement with the young person. vii. Help youth in the development of pro -social relationships and introduce them to a range of pro -social activities. Target Population: i. Youth ages twelve (12) to eighteen (18). g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. In-OfficeNirtual. ii. In -Home or Community. 11. Foster Parent and Kinship Provider Consultation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Provide psychoeducation for foster parents regarding the impact of trauma and abuse and neglect. ii. Provide support services to assist the foster family with child specific consultation. iii. Provide families with assistance with household family functioning. iv. Provide phone consultation in crisis situations. v. Provide a supportive and non -judgmental relationship for the foster child and foster parents. vi. Assist families with skill development to ensure that families can establish appropriate relationship development, structure, boundaries and limits, with the goal of proactively preventing family conflict, and/or to decrease conflict that may already exist vii. Provide tools to improve family functioning, including behavior management, conflict management, communication, and problem - solving tools. viii. Support the development of foster parent/child relationships. b. Anticipated Frequency of Services: i. Eight (8) hours. c. Anticipated Duration of Services: i. Typically, two (2) months. d. Goals of Services: i. To increase foster parent confidence. ii. Teach value of daily routine and consistency with children. iii. Focus on the family strengths by directing intensive services that support and strengthen the family and protect the child. iv. Enable the family to function in a safe manner, by addressing the concerns through education, role modeling, providing information for community resources, and providing effective parenting training. e. Outcomes of Services: i. Prevent placement disruption. ii. Increase formal and informal supports such as community, family, and friends. iii. Increase foster parents understanding of the impact of trauma. iv. Help foster parents to have realistic child expectations. v. Improve foster parenting, relationship, and social skills. vi. Provide rapid crisis consultation and support for foster parents experiencing challenges with their foster child. vii. Help the family build skills, relationships and have fun together. viii. Help foster parents' recognition of children's needs, nurturing interactions, appropriate responses to the child's cues, as well as stepping in to model age -appropriate discipline and consequences. ix. Return children in placement to their own home. x. Unite children with their permanent families. xi. Provide services that protect the child. f. Target Population: i. Foster and Kinship providers. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. I. Service Access and Transportation: i. In-OfficeNideo. ii. In -Home or Community. 12. The Truth About Sexually Abusive Youth a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Provide education. b. Anticipated Frequency of Services: i. Two (2) hours per class. c. Anticipated Duration of Services: i. One (1) time class. d. Goals of Services: i. Provide information about normative, concerning, and problematic sexual behavior. ii. Dispel the "myths" that many people often believe regarding sexually abusive and sexually reactive youth. iii. Provide accurate information about what is actually required when providing care for sexually abusive and/or sexually reactive youth. e. Outcomes of Services: i. Community Safety. ii. Preserved foster placement to minimize disruption for children and families. iii. Increased willingness and ability of foster parents to care for sexually abusive or sexually reactive youth. iv. Diverted entry into residential placement, or support step-down from residential placement into foster care. f. Target Population: i. Foster and Kinship caregivers. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 13. Day Treatment a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Special education services. ii. Transportation to/from school. iii. In -home service/per case need. iv. Community activities. v. Twenty-four (24) hour on -call assistance. b. Anticipated Frequency of Services: i. During established school hours. c. Anticipated Duration of Services: i. Typically, one semester. d. Goals of Services: i. Youth will gain emotional and behavioral stability. ii. Improve school attendance. iii. Prepare for return to a public -school setting. e. Outcomes of Services: i. Recovery of school credits. ii. Improved school emotional and behavioral functioning. iii. Return to home school prepared for academic and interpersonal success. iv. Maintain positive home and community relationships. f. Target Population: i. Males. ii. Ages twelve (12) to eighteen (18). g. Language: i. English. h. Medicaid Eligibility: i. Services may be Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 14. Supervised Family and Sibling Time a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Parent education regarding the developmental needs of the children. ii. Parent skill development. b. Anticipated Frequency of Services: i. Frequency of service is determined by the level of services. 1. Intensive: ten (10) to fifteen (15) hours per week. 2. High: seven (7) to nine (9) hours per week. 3. Moderate: four (4) to six (6) hours per week. 4. Low, two (2) to three (3) hours per week. c. Anticipated Duration of Services: i. One (1) to three (3) months. d. Goals of Services: i. Maintain permanent connections between children and parents. ii. Strengthen the bond between parents and children. iii. Strengthen the bond between siblings. iv. Help the parent or caregiver improve the ability to interact with the child or youth in developmentally appropriate ways. v. Assist in establishing healthy boundaries and communication between the parent and child. vi. Ensure healthy and developmentally appropriate interactions between siblings. vii. Assist in establishing healthy boundaries and communication between siblings. e. Outcomes of Services: i. Increased safe and healthy interactions between parents and their children. ii. The parent will gain skills needed to succeed in a lower level of supervised interaction or in unsupervised interactions with children. iii. Increased ability by the parent to recognize cues provided by the child. iv. Increased safe and healthy interactions between siblings. v. Preservation of sibling relationships when siblings are not placed together in out of home care. vi. Prepare siblings for a lower level of supervision when appropriate. f. Target Population: i. Parents with children ages birth (0) to eighteen (18) years. ii. Any gender. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. ii. In -Home or Community AND with Transportation. 15. Therapeutic Family and Sibling Time a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. initial assessment meeting and observation ii. Review skills. iii. Discuss the goals of the session. iv. Plan the specific tasks. v. Engage in a natural interaction time between the parent and child. vi. Provide feedback vii. Discuss frustrations or skills that the parent has identified as needing and establish a plan for the next session. b. Anticipated Frequency of Services: i. One session per week. ii. Two (2) to four (4) hours per session. c. Anticipated Duration of Services: i. Eight (8) to sixteen (16) weeks. d. Goals of Services: i. Strengthen the bond between parents and children. ii. Help the parent or caregiver improve the ability to interact with and care for the child or youth in developmentally appropriate ways. iii. Assist in establishing safety, healthy boundaries and communication between the parent and child. iv. Maintain or build sibling bonds. v. Create or enhance safety and healthy boundaries between siblings. vi. Help children interact in safe and developmentally appropriate ways. e. Outcomes of Services: i. Improvement of a healthy parent -child relationship. ii. Increased child safety. iii. Increased ability by the parent to recognize cues provided by the child iv. To gain skills identified through assessment and be able to succeed in a lower level of supervised interaction with children. v. Children will become more adept at healthy, age -appropriate sibling interaction. vi. Children will maintain permanent connections with siblings. vii. Increased safety and reduced anxiety around sibling contact. f. Target Population: i. Children ages birth (0) to eighteen (18). ii. Any gender. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. I n-OfficeNideo. ii. In -Home or Community AND with Transportation. 16. Parents as Teachers a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Parents as Teachers Evidence -based Home Visiting Model ii. Personal Visits. iii. Group Connections. iv. Provide a resource network. v. Child Screening. b. Anticipated Frequency of Services: i. Sessions may be up to one (1) time per week. ii. Group connections once (1) per month. c. Anticipated Duration of Services: i. Age birth (0) to five (5) years. d. Goals of Services: i. Increase parent knowledge of early childhood development and improve parent practices. ii. Provide early detection of developmental delays and health issues. iii. Prevent child abuse and neglect iv. Increase children's school readiness and success. e. Outcomes of Services: i. Parents will be better prepared to identify and help children meet developmental milestones. ii. Parents will have increased understanding of how to address early childhood needs. Parents will be aware of community -based resources. f. Target Population: i. Parents of children age birth (0) to five (5) years. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. ii. In -Home or Community AND with Transportation Terms 1. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the County. 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 County. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. 3. Contractor will respond to the Mental Health and Support Services Team (HS- CWServiceReferralaweld.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-CWServiceReferralCv�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(aNeld.gov. No other County 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 County will not reimburse for "no-shows". Contractor understands that the County 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- CWServiceReferralAweld.gov within three (3) days of when the client is placed on a behavioral plan or discharged. 7. Contractor understands that the County 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 County 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-CWServiceReferralAweld.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 County, unless otherwise directed by the County. 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- CWServiceReferraleNeld.gov immediately AND on the required monthly report. 11. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator or any member of the Mental Health and Support Services Team. Any changes to Family Time referrals will be approved by a new referral signed by the Child Welfare Supervisor. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 12. Contractor agrees to attend meetings when available and as requested by the County. Such meetings include Court Facilitations, Bid Meetings, Professional Staffings, Family Team Meetings and/or Team Decision Making meetings. The County 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 County. 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 County. 13.On a monthly basis, the Contractor will notify the Mental Health and Support Services Team HS-CWServiceReferral(aweld.gov of new staff who will manage and/or administer the services with the following information: a. Staff member name and contact information b. Education level/degree (if applicable) c. Licensure/credentials (if applicable) d. Department of Regulatory Authority (DORA) number (if applicable) e. Supervisor name and contact information The County reserves the right to decline the new staff members managing and/or administering services to County 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 County by the Contractor prior to the start of any Agreement. 16.12 Contractor may be required to attend training at the request of the County specific to services provided under this Agreement. The County 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 County. 17.Subgoenas 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 County agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the County. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the County, and the Contractor. Contractor will collaborate in a timely manner with the County 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 County will not reimburse for services rendered to County clients until releases of information are obtained. Contractor shall permit the County, 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. 19. Credentialing Criteria Contractor and its employee(s) and sub-contractor(s) shall remain in good standing with the Colorado Department of Regulatory Affairs (DORA) and may not, at any time during the term of this contract, be listed as excluded or debarred in the System for Award Management (SAM). Contractor shall ensure that all employees/subcontractors who provide services to clients under this contract meet the credentials/qualifications specific to the County's identified Credentialing standards and C.R.S Title 12, Article 43 and in the Social Services Manual Volume 7.000.6(M) (12 CCR 2509-4). The County has the right to approve Contractor's employees/subcontractors who will be performing services under this contract prior to the commencement of the work and shall have the right to review the employee(s)'/subcontractor(s)' employment files prior to granting approval. Contractor must retain copies of employee credentialing qualifications and background checks in personnel files and make such records available to the County Representative upon request. Contractor shall obtain reference and background checks, including fingerprint - based police (CBI and/or FBI) checks (if required by statute or regulation or if there will be unsupervised contact with children), checks of County records, and Sexual Offender Registry checks and receive, at minimum, preliminary results before assigning/hiring employees/subcontractors to perform under this contract. If the County becomes dissatisfied with Contractor's employee(s)/subcontractor(s), the County will notify Contractor of its concerns about the employee(s)/subcontractor(s). Disciplinary measures, if any, will be the sole responsibility of Contractor. However, if the concerns/issues cannot resolve to the County's satisfaction, Contractor's employee(s)/subcontractor(s) may not be allowed to provide services under this contract. The County reserves the right to review all Contractor's or Sub -Contractors background checks. It is the responsibility of the Contractor to notify the County of results of background checks. EXHIBIT C RATE SCHEDULE 1. Funding and Method of Payment The County 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 County expenditures and shall not be reimbursed by the County. 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 County, 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 County, the County may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Rate $ 90.00 Unit Type Hour Service Name Aftercare: In-OfficeNldeo $ 115.00 Hour Aftercare: In Home or Community AND with Transportation $ 90.00 Hour Aftercare: FTM, TDM, Prof Staffing $ 90.00 Each Aftercare: No Show $ 0.59 Mlle Home -Based Services: Mileage $ 7,800.00 Month Mental Health Services In -Home Therapy - Intensive $ 4,680.00 Month Mental Health Services In -Home Therapy - High $ 3,120.00 Month Mental Health Services In -Home Therapy - Moderate $1,560.00 Month Mental Health Services In -Home Therapy - Low Rate $ 6,175.00 Unit Type Month Service Name Mental Health Services In -Office Therapy - Intensive $ 3,705.00 Month Mental Health Services M -Office Therapy - High $ 2,470.00 Month Mental Health Services In -Office Therapy - Moderate $1,235.00 Month Mental Health Services In -Office Therapy - Low $ 7,800.00 Month Intensive Family Therapy In -Home - Intensive $ 4,680.00 Month Intensive Family Therapy In -Horne - High $ 3,120.00 Month Intensive Family Therapy In -Office - Moderate $1,235.00 Month Intensive Family Therapy In -Home - Low $ 6,175.00 Month Intensive Family Therapy In -Office - Intensive $ 4,680.00 Month Intensive Family Therapy In -Office - High $ 2,470.00 Month Intensive Family Therapy In -Office - Moderate $1 235.06 ` Month Intensive Family Therapy In -Office- Low $ 95.00 Hour Sex Abuse Individual and Family Therapy: In-Office/Video $ L3(t.00 '. Hour Sex Abase Individual and Family Therapy: In Home or Community AND with Transportation $ 95.00 Hour Sex Abuse Treatment: FTM, TDM, Professional Staffing 95.00 Each Sex Abuse Treatment: No Show $ 0.59 Hour Sex Abuse Treatment: Mileage $ 95.04 " Hour FP & KP Training: In-OfFceNideo $ 120.00 Hour FP & KP Training: In -Home or Community AND with Transportation $ 95.00 Hour FP & KP Training: FTM, TDM, Prof. Staffing $ 95.00 Hour FP & KP Training: No Show $ 120:00 Hour FP & KP Training: In -Horne or Community AND with Transportation $ 5,525.00 Month Life Skills and Family Coaching - Intensive $ 3,315.00! Month Life Skills and Family Coaching- High $ 2,210.00 Month Life Skills and Family Coaching- Moderate $1,105.00 Month Life Skills and Family Coaching- Low $ 1,115.00 Month Beyond the Walls $ 300.001 ' Each Informed Supervision $ 4,225.00 Month Youth Mentoring - Intensive: In-OfficeNideo $ 2,535.00 Month Youth Mentoring - High: In-OfficeNideo' $ 1,690.00 Month Youth Mentoring - Moderate: In-OfficeNideo $ 845.001 Month Youth Mentoring - Low: In-QfficeNideo Rate $ 5,525.00 Unit Type Month Service Name Youth Mentoring - Intensive: In -Home or Community $ 3,315.00 Month Youth Mentoring - High: In -Home or Community $ 2,210.00 Month Youth Mentoring - Moderate: In -Home or Community $ 1,105.00 Month Youth Mentoring - Low: In -Home or Community $ 4,875.00 Month Youth Intervention Therapy - High: In -Home $ 3,250.00 Month Youth Intervention Therapy - Moderate: In -Home $ 1,625.00 Month Youth Intervention Therapy - Low: In -Home $ 3,705.00 Month Youth Intervention Therapy - High: In -Office $ 2,470.00 Month Youth Intervention Therapy - Moderate: In -Office $ 1,040.00 Month Youth Intervention Therapy — Low: In -Office $ 95.00 Hour FP and KP Consultation: In-OfficeNideo $ 120.00 Hour FP and KP Consultation: In -Home or Community $ 0.59 Mile FP and KP Consultation: Mileage $ 320.00 Hour The Truth About Sexually Abuse Youth: In-OfficeNideo $ 2,125.00 Month Day Treatment $ 2,054.00 Month Supervised Family/Sibling Time - High: In -Office $ 1,027.00 Month Supervised Family/Sibling Time - Moderate: In -Office $ 342.00 Month Supervised Family/Sibling Time - Low. In -Office $ 95.00 Hour Therapeutic Family/Sibling Time: In -Office $ 120.00 Hour Therapeutic Family/Sibling Time: In- Home or Community AND with Transportation $ 95 .00 Hour Therapeutic Family/Sibling Time: FTM, TDM, Professional Staffing $ 95.00 Hour Therapeutic Family/Sibling Time: No Show $ 0.59 Hour Therapeutic Family/Sibling Time: Mileage $ 342.00 Month Therapeutic Family/Sibling Time - Low: In -Office $ 600.00 Each Parents as Teachers: In -Office or In -Home or Community. Price per child. $ 0.59 Mileage; Parents as Teachers: Mileage *Mileaae rate is paid after 30 roundtrio miles from the nearest office or staff location. Staff members operate from mobile offices. 3. Request for Reimbursement and Supporting Documentation Contractor shall submit all Requests for Reimbursement and supporting documentation to the County 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 County's online reporting system, unless otherwise directed or agreed to by the County. 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 County 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 County funds can be accessed for services. Exceptions to this Paragraph may include, if approved by the County, 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 County 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. to the amount of work or deliverables lost to the County. 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 County and Contractor, or by the County as a debt due to the County 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 D WELD COUNTY'S INVITATION FOR BID (Weld County's Invitation for Bid is incorporated into this agreement by reference and will be provided upon request to the Department.) This page is intentionally left blank Exhibit E Contractor's response to the Invitation for Bid Exhibit E contains the following documents: • Attachment 1 — Bid Attestation • Attachment 2 — Bid Form • Attachment 3 — Provider Information Form (PIF) • Attachment 4 — Staff Data Sheet • Certificate of Insurance (COI) ATTACHMENT 1 BID ATTESTATION Failure to include a signed Attestation upon submittal of your bid may result in your bid being incomplete, non -responsive, and your bid being rejected. If there are any exclusions or contingencies submitted with your bid it may be disqualified. Bidder's Legal Name as reflected on W-9: Shiloh Home, Inc. Address: 6588 W. Ottawa Avenue, Littleton, CO 80128 Phone Number: 303-933-1393 Email: atopolnicki�shilohhouse.net FEIN/Federal Tax ID # or SS#: 84-0978992 The undersigned, by his or her signature, hereby acknowledges and represents that: 1. The bid proposed herein meets all the conditions, specifications and special provisions set forth in the Invitation for Bid for Request No. #B2500040. 2. The quotations set forth herein are exclusive of any federal excise taxes and all other state and local taxes. 3. He or she is authorized to bind the below -named bidder for the amount shown on the accompanying bid sheets. 4. Acknowledgement of Schedule E — Insurance and Bond 5. Acknowledgment of Schedule F — Weld County Contract 6. By submitting a responsive bid or proposal, the supplier agrees to be bound by all terms and conditions of the solicitation as established by Weld County. 7. Weld County reserves the right to reject any and all bids, to waive any informality in the bids, and to accept the bid that, in the opinion of the Board of County Commissioners, is to the best interests of Weld County. The bid(s) may be awarded to more than one vendor. CONTRACTOR: Name: Steven Ramirez Title: Chief Executive Officer By: 171 Recoverable Signature X Steven Ramirez Signed by: trust_Od870fe9-8d26-4d72-8aa8-c7b8a939cdOd (Double Click in box to sign electronically) 12/3/2024 ADA ATTACHMENT 2 BID FORM Please complete the following: N umber of services offered on this Attachment 2 (max 5): 5 You may complete another Attachment 2 if you have more than 5 services. Service #1 S ervice Name: Aftercare P rogram Area: Home -Based Intervention 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) 1.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Shiloh House will provide individual and family therapy and support services to allow for the reunification of the child with his or her family where feasible. These services will promote the successful transition of children to their home (or another permanent placement) from a higher level of care and are aimed at preventing out of home placements. Aftercare services are especially appropriate when the child is transitioning from a Shiloh House residential program to home or another permanent placement, as Shiloh House providers can communicate with each other and work together to facilitate a seamless transition. Shiloh House offers the following Aftercare Services: • Office -Based Family Therapy • Community -Based Family Therapy • In -Home Family Therapy • Office -Based Individual Therapy • Community -Based Individual Therapy • In -Home Individual Therapy • Community -Based Family Support Services (i.e., Life Skills and/or Parent Coaching) • In -Home Family Support Services 1.02 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: The frequency of direct service depends on the type of aftercare service chosen. 1.03 Anticipated duration of service (i.e. 3-4 months): 3-6 months 1.04 Three (3), or more, specific goals of the service (DO use bullet points): • Treating emotional and behavioral symptoms associated with trauma and mental health disorders • Educating families about trauma and mental health issues • Helping children, adolescents, and their families develop healthy coping tools • Equipping caretakers with knowledge and methods to provide trauma -informed parenting Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM • Improving parenting skills including the ability to develop, implement, and reinforce appropriate behavior expectations and consequences • Providing intensive psychoeducation that increases each family member's understanding of their own unhealthy interaction patterns and how to change them • Reducing conflict between family members by teaching them positive communication skills that foster empathy between them • Facilitating communication between family members about emotional, behavioral, and relational issues • Assisting caretakers in creating a nurturing and healthy home environment which will enable the children to successfully progress in their development and academic achievement • Practical implementation of parenting skills learned in therapy (e.g., creating chore charts, homework charts) • Practical implementation of life skills 1.05 Three (3), or more, specific outcomes of service: • Improved individual and family functioning • Alleviation or reduction of mental health symptoms • Completion of treatment goals. 1.06 Target population of the service, including age and gender: The target population of Aftercare Services is children and adolescents in the process of reunifying with their families or transitioning to another permanent placement. The target population often includes children, adolescents, and families who are struggling with issues related to mental health, trauma, and difficult family dynamics that compromise individual and family functioning and lead to placement disruptions. Aftercare services can be provided to all genders. 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English 1.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Therapy services are eligible for Medicaid reimbursement. Coaching services are not eligible. 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): in -home, 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 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM • 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 $90 Per Hour Community $115 Per Hour 1.10b In -Home or 1.10c Service with Transportation Provided $115 Per Hour Hour 1.10d FTM, TDM, Prof. Staffing $90 Per 1.10e No show $90 Per No Show 1.10f Mileage rate* $0.59 Per Mile * If applicable — Mileage rate is paid after 30 roundtrip miles. 1.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level Rate Month per Minimum of Service: Hours $ 1.11a 1.11b $ 1.11c $ 1.11d $ 1.11e $ 1.11f $ 1.118 $ 1.11h $ 1.111 $ 1.11j $ 1.12 Home Study Providers - List your rates in the box below. 1.13 Monitored Sobriety Providers - List your rates in the box below. 1.14 Additional Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Hourly service rate mentioned above is for therapy Coaching services are $80 00/hour Revised 12/3/2024 ADA ATTACHMENT BB FORM Weld County Use Only Service #1 Imbal Proposal Determination: Date: Reason for follow up or negotiation' List specific item(s) needing follow up or discussion Changes approved to proposal. List specific item(s) that were changed Changes approved by: Name of Authonzed Representative for Bidder Date Method changes were approved Final Proposal Determination Comments Date* Revised 12/3/2024 ADA I ATTACHMENT 2 BID FORM Service #2 S ervice Name: Mental Health Services P rogram Area: Mental Health Services Scope of Work Please Note: If the service is a monthly package, different levels should be indicated. All monthly packages must state a specific minimum number of direct service hours. (Please address each line item below using bulleted points) 2.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Outpatient or in -home individual and family therapy services provided to children, adolescents, and families who are struggling with mental health issues (often related to trauma) and difficult family dynamics. Assessments Utilized A mental health assessment is used to determine the therapeutic needs of the individual and family. Further assessments may be administered if indicated (e.g., trauma symptom checklists, family relationship questionnaires, etc.). Focus of Mental Health Services Areas targeted by therapy services include: • Reducing problematic symptoms and behaviors associated with mental health disorders and trauma • Educating children, adolescents, and families about issues associated with trauma and mental health, including identifying how they impact functioning • Helping children, adolescents, and their families develop healthy coping tools to manage their unpleasant thoughts and emotions • Equipping caretakers with knowledge and methods to provide trauma -informed parenting and meet the unique needs of their childrenoG • Improving parenting skills including the ability to develop, implement, and reinforce appropriate behavior expectations and consequencesG • Increasing each family member's understanding of their own unhealthy interaction patterns and how to change theme • Reducing conflict within families by teaching and guiding family members in the use of positive communication skills that foster empathy between them • Facilitating communication between family members to address therapy issues Mental Health Services Methodologies All treatment interventions used by Shiloh Home, Inc. are trauma -informed, evidence -based, and focus on individual and family strengths. Mental Health Treatment services may include Behavior Therapy principles/interventions (including communication skills training), Parent Management Training techniques, Trauma Focused -Cognitive Behavioral Therapy (TF-CBT) play therapy, Family Systems interventions, and DBT techniques. , Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Engagement Techniques: Clinicians work as closely as possible with the family to schedule services for times and locations that are most convenient for the family to ensure ongoing success after a youth returns home. Therapeutic services are trauma informed, strength -based and are designed to meet the needs of each client. 2.02 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: • Four treatment packages are available: Intensive, 10-15 hours per week; High, 7-9 hours per week; Moderate, 4-6 hours per week; and Low, 2-3 hours per week. • Treatment Packages include 75% face to face with family and 25°/0 other duties including, but not limited to, Team Decision Making (TDM) Meetings, Administrative Review Conferences, Case Management, resource and community support building and MDT related activities. 2.03 Anticipated duration of service (i.e. 3-4 months): 3-9 months 2.04 Three (3), or more, specific goals of the service (DO use bullet points): • Reduce problematic symptoms and behaviors associated with mental health disorders and trauma • Improve parenting skills including the ability to develop, implement, and reinforce appropriate behavior expectations and consequences • Reduce conflict within families by teaching and guiding family members in the use of positive communication skills that foster empathy between them 2.05 Three (3), or more, specific outcomes of service: • Improved Mental Health • Improved Individual Functioning • Improved Family Functioning 2.06 Target population of the service, including age and gender: children, adolescents, and families who are struggling with mental health issues (often related to trauma) and difficult family dynamics 2.07 Languages service is available in (please list proficiency and if interpreter services are available): English 2.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Individual and Family Therapy are Medicaid eligible services. 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): In -home or in -office. Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM All rates should be per hour unless service is for evaluations/assessments, Horne 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 * If applicable - Mileage rate is paid after 30 roundtrip miles. 2.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level Rate Month per Minimum of Service: Hours 2.11a In -home therapy Intensive $7800 40 2.11b In -home therapy High $4680 28 2.11c In -home therapy Moderate $3120 16 2.11d In -home therapy Low $1560 8 2.11e In -office therapy Intensive $6175 40 2.11f In -office therapy $3705 28 High 2.11g In -office therapy Moderate $2470 16 2.11h In -office therapy Low $1235 8 2.111 $ 2.11j $ 2.12 Home Study Providers - List your rates in the box below. Revised 12/3/2024 ADA TTACHMENT 2 BID FORM 2.13 Monitored Sobriety Providers — List your rates m the box below. 2.14 Additional Comments. Minimum hours of service in monthly packages include both individual and family therapy Revised 12/3/2024 ADA ATI Ci ' ,ENT 2 DID FORM Weld County Use Only Service #2 Initial Proposal Determination. Date: Reason for follow up or negotiation' List specific item(s) needing follow up or discussion Changes approved to proposal. List specific item(s) that were changed Changes approved by. Name of Authorized Representative for Bidder Date Method changes were approved: Final Proposal Determination: Date: Comments• Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #3 Service Name: Intensive Family 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) 3.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Intensive Family Therapy is a short-term, family -centered therapeutic process used to focus on disruptive familial relationship patterns and define new healthy patterns for interaction between family members. Family therapy is often a solution -based treatment concentrating on resolving presenting problems identified by the family. Treatment includes a combination of individual therapy and family therapy in home, community, or office locations. Intensive Services are to be individualized to each individual and family and should incorporate measurable goals/anticipated outcomes. If the youth or family are involved in DHS or DYC services, the treatment plan will collaborate with and include goals consistent with the Human Services Family Service Plan. Delivery Methods: Therapeutic services can be provided in the office, community or in the home. Evidence -based services include TF-CBT, Motivational Interviewing. Services are solutions Focused, and Person Centered. Services range from 2-15 hours weekly, based on the referring request and outcome of family assessment. ** Cancellations may occur up to 24 hours prior to a scheduled appointment. Appointments canceled within 24 hours of scheduled appointments are subject to billing for the service. Engagement Techniques: Clinicians work as closely as possible with the family to schedule services for times and locations that are most convenient for the family to ensure ongoing success after a youth returns home. Therapeutic services are strength -based and are designed to meet the needs of each client. Clinicians can conduct an in-depth family assessment to provide recommendations for any of Shiloh's treatment packages, individual community -based services, and other community resources/services. 3.02 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: • Four treatment packages are available: Intensive, 10-15 hours per week; High, 7-9 hours per week; Moderate, 4-6 hours per week; and Low, 2-3 hours per week. • Treatment Packages include 75% face to face with family and 25°/0 other duties including, but not limited to, Team Decision Making (TDM) Meetings, Administrative Review Conferences, Case Management, resource and community support building and MDT related activities. 3.03 Anticipated duration of service (i.e. 3-4 months): 3-9 months 3.04 Three (3), or more, specific goals of the service (DO use bullet points): Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM • Create healthy patterns for interaction between family members. • Resolve presenting problems identified by the family. • Increase trustworthiness in relationships between family members. 3.05 Three (3), or more, specific outcomes of service: • Improved family dynamics • Completion of treatment goals • Family will continue to demonstrate safety and stability in the home environment, reducing the risk for out of home placement or future Human Services involvement. 3.06 Target population of the service, including age and gender: Families who are struggling with mental health issues (often related to trauma) and difficult family dynamics 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English 3.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Therapy services are eligible for Medicaid reimbursement. 3.09 Service location — list where the service will take place (i.e. client's home, in -office, other): In -home or 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 3.10b i 3.10c 3.10d 3.10e 3.10f Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM * If applicable — Mileage rate is paid after 30 roundtrip miles. 3.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level Rate Month per Minimum of Service: Hours 3.11a In -home Intensive $7800 40 3.11b In -home $4680 28 High 3.11c In -home Moderate $3120 16 3.11d In -home Low $1560 8 3.11e In -office Intensive $6175 40 3.11f In -office $4680 28 High 3.11g In -office Moderate $2470 16 3.11h In -office Low $1235 8 3.111 $ 3.11j $ 3.12 Home Study Providers - List your rates in the box below. 3.13 Monitored Sobriety Providers - List your rates in the box below. 3.14 Additional Comments: Revised 12/3/2024 ADA ATT'ACHMENT 2 BID FORM Weld County Use Only Service ##3: Initial Proposal Determination: Date: Reason for follow up or negotiation: List specific item(s) needing follow up or discussion Changes approved to proposal: List specific item(s) that were changed Changes approved by: Name of Authonzed Representative for Bidder Date: Method changes were approved: Final Proposal Determination: Date: Comments. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #4 Service Name: Sex Abuse Individual and Family Therapy Program Area: Sexual Abuse Treatment 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) 4.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Trauma Informed Therapeutic intervention designed to address issues and behaviors related to sexual abuse victimization, sexual dysfunction, sexual abuse perpetration, and to prevent further sexual abuse and victimization. Delivery Methods: Shiloh House practices the best standards of care and emphasizes implementation of evidence -based treatment practices. Sex abuse individual and family treatment provides strength based, family focused, accountable, relationship -oriented service which respects the family while ensuring that the goals of treatment are achieved. Shiloh House adheres to the SOMB Guidelines and Standards. Risk assessment will be addressed through empirically guided risk evaluations and clinical insight, ongoing team and family collaboration, treatment progress and team members input, behavioral observation within all arenas of the client's life (home, school, job, social, community). Adjunct referral for polygraphs, arousal measurement, psychological services and psychiatric services are made as deemed necessary and appropriate. Therapy adheres to the Colorado Sex Offender Management Board's Standards and Guidelines for the Evaluation, Assessment, Treatment and Supervision of Juveniles. Shiloh House utilizes TF-CBT, CBT, Psychoeducation and Family Systems Therapy, risk assessment and safety planning, Informed Supervision training, and relapse prevention planning. These services help youth and families increase pro -social behaviors and protective factors; develop a nurturing, healthy home environment; eliminate all illegal behaviors by family members; and provide participants with an understanding of their family and personal cycle of abuse, while increasing their ability to interrupt this cycle.Engagement Techniques: Shiloh House SOMB therapists provide interactive educational and therapeutic tools to help clients identify and address safety concerns for all family members; promote disclosure of abusive behaviors, and address any victimization the client has experienced; assist in the development of empathy for persons victimized; and establish healthy coping skills and tools (self-control, and rehearsal of corrected cognitions). Whenever possible and appropriate, SOMB therapists work directly with the victim therapist(s) to assist the youth and person(s) victimized in the clarification process. 4.02 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: Typically 2-4 hours per week. Revised 12/3/2024 ADA 4.06 4.07 4.08 4.09 ATTACHMENT 2 BID FORM 4.03 Anticipated duration of service (i.e. 3-4 months): 3-9 months 4.04 Three (3), or more, specific goals of the service (DO use bullet points): • Gain understanding of abusive dynamics. • Increase healthy boundaries related to sex and sexuality. • Adherence to SOMB guidelines 4.05 Three (3), or more, specific outcomes of service: • Completion of the treatment plan • The youth contributes to community safety by maintaining healthy boundaries and accountability • Prevent out of home placement • Reduced risk of offending as measured by JSOAP • Demonstration of improved mental health as demonstrated by observation and assessments Target population of the service, including age and gender: Families with youth who experience issues and behaviors related to sexual abuse victimization, sexual dysfunction, sexual abuse perpetration, and to prevent further sexual abuse and victimization. Languages service is available in (please list proficiency and if interpreter services are available): English Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Therapy services may be Medicaid eligible. Service location — list where the service will take place (i.e. client's home, in -office, other): in -office or in -home. 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 Hourlv Service Rates: Service #4 Service $ Amount Unit Type Type 4.10a In-Office/Video $95 4.10b In -Home or Community $130 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 4.10c Service with Transportation Provided $130 4.10d FTM, TDM, Prof. Staffing $95 Per Hour 4.10e No show $95 Per No Show 4.10f Mileage rate'' $0.59 Per Mile * If applicable — Mileage rate is paid after X30) roundtrip miles. 4.11 Monthly Service Rates each level must be listed): If applicable Service Name with -- Level Rate Month per Minimum of Service: Hours -- $ 4.11a 4.11b $ 4.11c $ 4.11d $ 4.11e $ 4.11f $ 4.118 $ 4.11h $ $ 4.111 4.11j $ 4.12 Home Study Providers - List your rates in the box below. 4.13 Monitored Sobriety Providers - List your rates in the box below. 4.14 Additional Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORD Weld County Use Only Service #4: Initial Proposal Determination: Date: Reason for follow up or negotiation: List specific item(s) needing follow up or discussion Changes approved to proposal: List specific item(s) that were changed Changes approved by: Name of Authonzed Representative for Bidder Date: Method changes were approved: Final Proposal Determination' Date. Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #5 Service Name: Foster Parent and Kinship Provider Training 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 iten below using _bulleted_points) 5.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Shiloh will provide psychoeducation for foster parents and kinship providers regarding the impact of trauma, abuse and neglect, transitions impact to foster children, navigation of the mental health system, biological family reunification and developmental expectations. This training will include 11 hours of instruction and practice. The instruction will include the following curriculum topics: 1. It's all about the brain, not the behaviors. 2. The teenage brain is unique, and the teenage, traumatized brain can be healed. 3. Understanding the impact of trauma "it's not defiance, it's learned survival". 4. Effective consequences for teenagers impacted by abuse and neglect. 5. Skills rather than punishment or consequences. 6. Developmental age versus chronological age and reasonable expectations. 7. Resiliency: how to identify the strengths that already exist, and how to build resiliency in every child. Foster parents are the key. 8. Transitions Impact on Foster Children: includes a review of the grief and loss that occurs in transitions, viewing and discussion of dramatic videos that portray the impact, and teaching foster parents how to support foster children in transitions. 9. Navigation of the Mental Health system: our instructors will provide a step-by-step guide of navigating the mental health system, including accessing services, counseling and psychiatric services, initial assessments and first contacts, making appointments, how to support the child before and after mental health appointments and/or hospitalizations, communication with the therapist, and problem solving real life roadblocks. 10. Family Reunification: our instructors will provide a thorough review of children's complex feelings toward their families and the best strategies for supporting the child in all steps of the family reunification process. Real life examples of reunification challenges related to past trauma, and abuse and neglect experiences, as well as positive family experiences, memories, and the ambivalence that children experience. The foster parents will be provided the opportunity to explore their own feelings about family reunification. 5.02 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: Therapy: Approximately 1-2 hours per week. Coaching: Approximately 2-4 hours per week. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 5.03 Anticipated duration of service (i.e. 3-4 months): 3-6 months 5.04 Three (3), or more, specific goals of the service (DO use bullet points): • Enable the family to function in a safe manner • Address concerns through education, role modeling, providing information for community resources, and providing effective parenting training • Promote stable placement and/or reunification 5.05 Three (3), or more, specific outcomes of service: • Increase foster parent competency and confidence • Significantly reduce placement disruption • Increase formal and informal supports such as community, family, and fnends • Increase foster parents understanding of the impact of trauma • Help foster parents to have realistic child expectations • Improve foster parenting, relationship, and social skills • Teach the value of developmentally appropnate daily routine and consistency with children - Home Based family support professionals will help parents establish a daily routine by using schedules and meal planning menus Parents are assisted with household rules, rewards and consequences and are given resources such as age -appropriate chore charts to help parents with consistency • Focus on the family strengths by directing intensive services that support and strengthen the family and protect the child All of Shiloh Home services are provided from a family engagement, strength based, trauma informed basis • Return children in placement to their own home Shiloh Home's home based and foster parent training services are provided as either a prevention of out of home placement, or to facilitate the successful return of youth to the home and community ensuring that the family has the support needed to help the youth be successful post placement • Unite children with their permanent families The Shiloh House home based services strive to ensure the permanency of children with their families • Provide services that protect the child Shiloh Home in -home services ensure that children are protected, and that the well-being of every child is our first pnonty 5.06 Target population of the service, including age and gender: Foster and Kinship providers 5.07 Languages service is available in (please list proficiency and if interpreter services are available): English 5.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or m part: This service is not Medicaid eligible 5.09 Service location — list where the service will take place (i.e. client's home, in -office, other) In -office Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 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 Hourlv Service Rates: Service #5 Service Type $ Amount Unit Type 5.10a In-OfficeNideo $95 Per Hour 5.10b In -Home or Community $120 Per Hour 5.10c Service with Transportation Provided $120 Per Hour 5.10d FTM, TDM, Prof. Staffing $95 Per Hour 5.10e No show $95 Per No Show 5.10f Mileage rate* $0.59 Per Mile * If applicable — Mileage rate is paid after 30 roundtrip miles. 5.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level Rate Month per Minimum of Service: Hours 5.11a $ 5.11b $ 5.11c $ 5.11d $ 5.11e $ 5.11f $ 5.11g $ 5.11h $ 5.111 $ 5.11j $ Revised 12/3/2024 ADA ATTACHMENT Br" FORM 5 12 Home Study Providers — Lost your rates on the box below. 5.13 Monitored Sobriety Providers — List your rates on the box below. 5.14 Additional Comments Revised 12/3/2024 ADA ATTACHMENT 2 BI. FORM I Meld County Use ®nly Service #5 Initial Proposal Determination: Date: Reason for follow up or negotiation. List specific item(s) needing follow up or discussion Changes approved to proposal. List specific item(s) that were changed Changes approved by Name of Authonzed Representative for Bidder Date Method changes were approved* Final Proposal Determination Date Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM P lease complete the following: N umber of services offered on this Attachment 2 (max 5): 5 You may complete another Attachment 2 if you have more than 5 services. Service #1 Service Name: LIFE SKILLS: Life Skills and Family Coaching P rogram Area: Life Skills 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) 1.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): The mission of Shiloh House Life Skills and Family Coaching services is to provide supports that can strengthen the family. Family Support Professionals provide guidance and information to allow self-sufficiency, and create a safe, nurturing environment for children, thereby increasing the likelihood of long-term family preservation. Shiloh House Family Support Professionals focus on the individual needs of the family and the goals set forth in the treatment plan. The BA level Family Support Professional will provide the family with tools to move toward self- confidence and independence. These tools may include but are not limited to the following: • Provide information regarding community resources, employment, occupational training, education, and health care options. • Provide support services to assist families with accessing resources and employment. • Provide families with assistance with household budgeting. • Provide help with household management. • Help families identify and establish appropriate boundaries and limits. • Provide tools to improve family functioning, including behavior management, conflict management, communication, and problem -solving tools. • Support development of parent/child relationships. • Teach appropriate discipline techniques: Family Support Professionals utilize a variety of techniques with parents to increase awareness, skill, and management of child behavior, including but not limited to; TBRI, No Drama Discipline, Whole Brain Child, and Love and Logic. • Role modeling positive interaction with children: Family Support Professionals use activities to model how to positively interact with children. The Family Support Professional will use books, games, crafts, and creative play to teach clients. This includes recognition of children's Revised 12/3/2024 ADA ATTACHMENT 2 RID FORM needs, nurtunng interactions, appropnate responses to the child's cues, as well as stepping in to model age- appropnate discipline and consequences Family Support Professionals seek direct input from clients on the needs they identify for their families The Family Support Professional will keep the family's County case worker and all other involvedly professionals updated on objectives, progress, and issues in the case on a regular basis ,The in -home Family Support Professionals are available on a very flexible schedule including evenings and weekends ** Cancellatiorlis may occur up to 24 hours pnor to a scheduled appointment Appointments canceled within 24 hours of scheduled appointments are subject to billing for the service I 1.02 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: • Frequency of service is determined by the level of services purchased Four treatment packages are available Intensive, 10-15 hours per week, High, 7-9 hours per week, Moderate, 4-6 hours per week, and Low, 2-3 hours per week • Treatment Packages include 75% face to face with family and 25% other duties including but not limited to Team Decision Meetings, Administrative Review Conferences, Case Management, resource and community support budding and MDT related activities 1.03 Anticipated duration of service (i.e. 3-4 months): 3-9 months J 1.04 Three (3), or more, specific goals of the service (DO use bullet points)* • Increase awareness of children's basic needs • Increase value of consistency and routine within the household • Improve global family functioning to reduce the nsk of further DHS involvement 1.05 Three (3), or more, specific outcomes of service: • Increase level of family functioning • Eliminate child protection issues in the home • Increase formal and informal supports such as community, family, and fnends • Increase parents understanding of their parenting role • Help parents have realistic child expectations • Improve parenting, relationship, and social skills 1.06 Target population of the service, including age and gender: Families with children under the age of 18 involved in or at nsk of becoming involved in a dependency rd neglect case 1.07 Languages service is available m (please list proficiency and if interpreter services are available). English 1.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: This service is not eligible for Medicaid reimbursement Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Family home or community locations conducive to providing the service. 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 Hourlv Service Rates: Service #1 $ Amount Unit Type Service Type 1.10a 1.10b 1.10c 1.104 1.10e 1.10f * If applicable — Mileage rate is paid after 30 roundtrip miles. 1.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level Rate Month per Minimum of Service: Hours 1.11a Intensive (min hours 10/week) $5525 40 1.11b (min hours 7/week) $3315 28 High 1.11c Moderate (min hours 4/week) $2210 16 1.11d Low (min hours 2/week) $1105 8 1.11e $ 1.11f $ 1.11g $ Revised 12/3/2024 ADA ATTACHMENT 2 'BID FORM 1 11h $ $ 1 11j 1.12 Home Study Providers — List your rates in the box below. 1.13 Monitored Sobriety Providers — List -your rates in the box below. 1.14 Additional Comments: Revised 12/3/2024 ADA ATTACH@ `:SENT 2 BID FORM Weld County Use Only Service #1 Initial Proposal Determination: Date. Reason for follow up or negotiation' List specific item(s) needing follow up or discussion Changes approved to proposal. List specific item(s) that were changed Changes approved by Name of Authorized Representative for Bidder Date Method changes were approved: Final Proposal Determination' Date Comments' Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #2 Service Name: LIFE SKILLS: Beyond the Walls Program Area: Life Skills 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) 2.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Transitional coaching for youth 16-26: Beyond the Walls assembles the circle of support and network of resources that exists naturally in local communities. Young people build a plan by assessing their current skills and their goals for the future. The youth who participate in Beyond the Walls will have the opportunity to work with a Life Transitions Coach to identify their needs, set goals, and connect them with our Community Partners Network. Our Community Resource Network then links young people to opportunities and experience to help them in reaching their goals. Delivery Method: Each month 25 hours of learning opportunities are available to the youth. This integrated system of resources and connections amplifies the ability for each youth to have caring adults working alongside as they journey towards their future. Engagement Techniques: Each month Beyond the Walls sponsors Workshops such as financial literacy, Reality Tours at local colleges and businesses, and mentoring relationships on a 1: 1 level or in Circles of support. Each learning and support opportunity focuses on the areas of education, housing, job skills, faith -based connections, business engagement, and community skills. Youth are motivated to participate through exposure to a network of activities and hands-on assistance that are proven tools to assist young people in gaining vital confidence and support as they transition into young adulthood. The combination of action learning, mentoring, coaching, and peer mentoring provides young people with a wider source of support and inspiration for idea generation and greater creativity in problem solving during critical times in a young person's life. Specially trained community partners guide each personal growth opportunity which gives young people the chance for experiential learning, and a chance to discuss individual plans, followed by peer support with community partners acting as a sounding board for young people t0 bounce ideas and potential solutions to problems. Beyond the Walls also leverages and builds links to existing resources in the community to ensure young people are able to find what they need to become vibrant members of their local community. 2.02 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: Approximately 6 hours per week, with 25 hours per month of learning opportunities. 2.03 Anticipated duration of service (i.e. 3-4 months): Service can continue as needed between ages 16-26. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2.04 Three (3), or more, specific goals of the service (DO use bullet points): • Youth will work with the Beyond the Walls professional to identify goals specific to their needs • Youth will participate in hands-on activities that will assist them in the transition into young adult life • Youth will build supports who can provide guidance, promote continued growth, and help them create stability in their early adult lives. 2.05 Three (3), or more, specific outcomes of service: • Youth will be aware of educational opportunities that may be useful to them. • Youth will be exhibit understanding of rudimentary financial and household management skills • Youth will demonstrate skills to build and maintain circles of support. 2.06 Target population of the service, including age and gender: Youth ages 16-26 who have had involvement in the Child Welfare system. 2.07 Languages service is available in (please list proficiency and if interpreter services are available): English 2.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: This service is not eligible for Medicaid reimbursement. 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): In -office and in the community. Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 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 Hourlv Service Rates: Service #2 $ Amount Unit Type Service Type 2.10a $ 2.10b $ 2.10c $ 2.104 $ Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2.10e 2.10f $ * If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. 2.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level per Minimum of Service: Hours Rate Month 2.11a Beyond the Walls $1115 25 2.11b $ 2.11c $ 2.11d $ 2.11e $ 2.11f $ 2.11g $ 2.11h $ 2.111 $ 2.11j $ 2.12 Home Study Providers - List your rates in the box below. 2.13 Monitored Sobriety Providers - List your rates in the box below. 2.14 Additional Comments: Revised 12/3/2024 ADA Ate'? CHIME ' T2 p'Meld County Use Only Service #2 Initial Proposal Determination. Date: Reason for follow up or negotiation. List specific items) needing follow up or discussion Changes approved to proposal' List specific item(s) that were changed Changes approved by. Name of Authonzed Representative for Bidder Date Method changes were approved: Final Proposal Determination: Date Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service Name: Informed Supervision Program Area: Sexual Abuse Treatment 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) 3.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): S hiloh Home offers Informed Supervision training consistent with SOMB Standards and Guidelines. The Informed supervision training is provided by a Shiloh staff who is trained in Informed S upervision and supervised by an SOMB qualified supervisor. The Informed supervision training includes at a minimum the following topics: • History of SOMB • Principles of SOMB treatment with emphasis on community safety • Why Informed Supervision is necessary • Victim Confidentiality • Sexual Offending Behaviors overview • Current laws that relate to juvenile sexual offending • Seriousness of Juvenile Offending, impact, and priorities • Dynamic patterns (cycles) associated with abusive behavior • The role of the MDT in all decisions • Safety Plans • High Risk patterns • Community Supervision and Treatment Staff Credentials: Informed Supervision trained BA or MA level coaches and clinicians 3.02 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: Informed Supervision is a one-time, 3 -hour class. 3.03 Anticipated duration of service (i.e. 3-4 months): One-time, 3 -hour class. 3.04 Three (3), or more, specific goals of the service (DO use bullet points): • Participants will understand why, how, and when Informed Supervision applies to a youth in their care. • Participants will understand the requirements established by the SOMB for the supervision of juveniles who have committed a sexual offense. • Participants will understand how to create safety plans with youth in their care that adequately address needs specific to the youth. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 3.05 Three (3), or more, specific outcomes of service: • Community Safety • Parent/Caregiver will gain understanding of Informed Supervision standards and guidelines; and will demonstrate both willingness and ability to provide Informed Supervision as evidenced by participation in the class, acknowledgement of the impact of abusive behavior, and demonstration of knowledge through completion of a post test. • Decreased risk, and improved personal health 3.06 Target population of the service, including age and gender: Caregiving adults of youth between 10-18 who have engaged in unsafe sexualized behaviors, and are or are at -risk for adjudication. 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English 3.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: This service is not eligible for Medicaid reimbursement. 3.09 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 $ 3.10b Community $ In -Home or 3.10c Service with Transportation Provided $ 3.10d FTM, TDM, Prof. Staffing $ Per Hour 3.10e No show $ Per No Show 3.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 3.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level Rate Month per Minimum of Service: Hours 3.11a One-time cost. class/Per Unit (class) $300 3 3.11b $ 3.11c $ 3.11d $ 3.11e $ 3.11f $ 3.11g $ 3.11h $ 3.111 $ 3.11j $ 3.12 Home Study Providers - List your rates in the box below. 3.13 Monitored Sobriety Providers - List your rates in the box below. 3.14 Additional Comments: Revised 12/3/2024 ADA ATT CH ENT 2 BB® F®kg Weld County Use Only Service #3 Initial Proposal Determination: Date. Reason for follow up or negotiation' List specific item(s) needing follow up or discussion Changes approved to proposal. List specific items) that were changed Changes approved by Name of Authonzed Representative for Bidder Date. Method changes were approved: Final Proposal Determination: Date: Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #4 Service Name: Youth Mentoring Program Area: Mentoring 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) 4.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Shiloh House can provide in -home family support services in which a Mentor meets with the family for an initial family driven, strength -based assessment. The Mentor will then work with the young person and his or her family to create a plan that clearly outlines the areas to be addressed with measurable goals. Using measurable goals will allow children and families to see their own progress, increasing the capacity to build on existing strengths, improve self- sufficiency, and establish or maintain permanency. The Family Support Paraprofessional (Mentor) can provide support to youth and their families in school and other educational settings. The Mentor can help parents or guardians improve communication with teachers and learn to access school resources like the parent portal. This simple step of establishing parent/ teacher rapport increases parent engagement in a child's education and provides support to the child by creating standards for academic behaviors like attendance and completion of homework. The Mentor can help parents or guardians gain access to needed educational services for children and teens by showing the parent or guardian how to advocate for the youth in appropriate ways. Mentors will also be able to provide some help for students who need tutoring. In cases where the need for tutoring exceeds the Mentor's comfort with the subject matter, the Mentor can help the student identify tutoring options. Mentors can also routinely check with the youth and his or her family to make sure homework assignments are completed and turned in on time. Mentors can promote long term pro -social engagement with the young person. If a youth or family needs or is interested in volunteer opportunities, the Mentor can provide resources to help identify those opportunities. Mentors can also help youth find volunteer opportunities when there is court ordered community service as part of probation. Mentors can help youth in the development of pro -social relationships and introduce them to a range of pro -social activities. As part of a return -home plan, Mentors can work with therapists, staff or foster parents, parents, and other siblings to make the transition home smoother and safer by addressing barriers that might exist in reconnecting as a family. The Mentor can help youth and their families find community resources that will provide cost effective options for ongoing mental health care, medical, dental, and vision care. They can also help families identify the culturally responsive service providers and cultural education opportunities. Delivery Method: Mentoring is an in-home/community-based service. Family Support Professionals pull from a variety of tools and curriculum to include but not limited to, Motivational Interviewing, the Strengthening Protective Factors foundations, Trust Based Relational Interventions (TBRI) and utilization of the Casey Life Skills Assessment. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Engagement Techniques Family Support Professionals seek direct input from clients on the needs they identify for their families The Family Support Professional will keep the family's County case worker and all other involved professionals updated on objectives, progress, and issues in the case on a regular basis The in -home Family Support Professionals are available ' on a very flexible schedule including evenings and weekends ** Cancellations may occur up to 24 hours pnor to a scheduled appointment Appointments „ canceled within 24 hours of scheduled appointments are subject to billing for the service 4.02' 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. • Four treatment packages are available Intensive, 10-15 hours per week, High, 7-9 hours per week, Moderate, 4-6 hours per week, and Low, 2-3 hours per week u ' • Treatment Packages include 75% face to face with family and 25° other duties including but not limited to Team Decision Meetings, Administrative Review Conferences, Case Management, resource and community support building and MDT related activities 4.03 Anticipated duration of service (i.e. 3-4 months) 3-9 months- Treatment plan and clinical unit recommendations to be reviewed every 30 days, , designed to titrate family level based on progress and clinical need 4.04 Three (3), or more, specific goals of the service (DO use bullet points): • Work with MDT to provide a smoother, safer reunification process • Help youth with court ordered community service find appropnate opportunities to complete ' volunteer work • Help parents or caregivers improve communication with teachers and teach parents how to access the school's parent portal • Establish shared expectations for school attendance and homework completion 4.05 :Three (3), or more, specific outcomes of service: • Reduced nsks for legal involvement or improved compliance with probation requirements • Increased communication between school and parents _ • Increased pro -social activity and school engagement 4.06 Target population of the service, including age and gender. Youth ages 10-18 4.07 Languages service is available in (please list proficiency and if interpreter services are available) English 4.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part' This service is not eligible for Medicaid reimbursement 4.09 Service location — list where the service will take place (i.e. client's home, in -office, other)• `Community and home -based Office based and virtual options are also available Revised° 12/3/2024 ADA ATTACHMENT 2 BID FORM 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 Hourlv Service Rates: Service #4 $ Amount Unit Type Service Type 4.10a 4.10b 4.10c 4.10d 4.10e 4.10f * If applicable — Mileage rate is paid after 30 roundtrip miles. 4.11 Monthly Service Rates each level must be listed: If applicable Service Name with Level per Minimum of Service: Hours Rate Month 4.11a Virtual/In-office Intensive $4225 40 4.11b Virtual/In-office High $2535 28 4.11c Virtual/In-office Moderate $1690 16 4.11d Virtual/In-office Low $845 8 4.11e In-home/Community Intensive $5525 40 4.11f In-home/Community $3315 28 High 4.118 In-home/Community Moderate $2210 16 4.11h In-home/Community Low $1105 8 4.111 $ 4.11j $ Revised 12/3/2024 ADA 17 CHME T2 BID FOR'4 4.112 Home Study Providers — Lost your rates in the box below. 4.13 onitored Sobriety Providers — List your rates in the box below. 4.14 % ddatsonai Comments: Revised 12/3/2024 ADA ATTACHMENT 2 @D FORM Weld County Use Only Service #4: Initial Proposal Determination. Date. Reason for follow up or negotiation: List specific item(s) needing follow up or discussion Changes approved to proposal List specific item(s) that were changed Changes approved by Name of Authonzed Representative for Bidder Date Method changes were approved: Final Proposal Determination Date. Comments Revised 12/3/2024 ADA I ATTACHMENT 2 BID FORM Service #5 Service Name: Youth Intervention Program Area: Mental Health Treatment 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) 5.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Shiloh House offers in -home and out -patient services to reduce risks of out of home placement and increase stability in the home environment. Youth Intervention to divert entry into the child welfare system will provide in -home, office -based, and community -based services to youth 12- 18 years of age and their families when lower levels of intervention are not sufficient, and the family is willing to participate in services to prevent the need for child welfare involvement. Diversion From Entry Into the Child Welfare System: Preventative services are provided to avoid the need for child welfare involvement by establishing stability within the family so that all members of the family are safe and adequately supported through the use of community -based resources. Many families recognize the need for help but are not sure where to find needed supports or cannot afford the available services. Shiloh House offers evidence -based tools and techniques that strengthen the connection between children and parents and address mental health and behavioral issues in the family that may place them at risk for child welfare involvement. Delivery Methods: Therapeutic and Family Coaching services can be provided in the home, office or in the community. For therapeutic services, mental health assessments can be used to determine the therapeutic needs of the individual and family. Further assessments may be administered if indicated (e.g., trauma symptom checklists, family relationship questionnaires, etc ). All treatment interventions used by Shiloh Home, Inc. are trauma -informed, evidence -based, and focus on individual and family strengths. Mental Health Treatment services may include Behavior Therapy principles/interventions (including communication skills training), Parent Management Training techniques, Trauma Focused -Cognitive Behavioral Therapy (TF-CBT), play therapy, Family Systems interventions, and DBT techniques. The therapist and Family Coach will provide monthly documentation to the Department of Human Services, and will collaborate throughout the service period with the Department to ensure that service goals are being met. Engagement Techniques: Clinicians and Family Coaches work as closely as possible with the family to schedule services for times and locations that are most convenient for the family. Interventions Used Revised 12/3/2024 ADA ATTACHMENT 2 RID FORM c1 Immediate screening/contact (phone or in person) — A discussion with the family members regarding their perspective of the challenges that they are facing In the initial contact the Assessment Clinician will offer the following • A crisis assessment is completed, and immediate safety planning will be offered • A Family and individual Biopsychosocial screening will be offered • The Assessment Clinician will review the broad range of possible services in an effort to assist the family in understanding the wide range of hopeful opportunities o The Assessment Clinician will offer a home or office based comprehensive assessment to assist in the service planning • The Assessment Clinician will offer an individual child -based assessment to assist in the service planning 2 Immediate Safety planning 3 Immediate home -based family visit 4 Immediate home or office -based crisis intervention 5 Comprehensive Assessment 6 Consistent phone and email follow up to check in and offer additional services as the family and/or individual situation changes On -going services 1 Individual therapy (home or office based) solution focused sessions aimed at stabilization, improved emotional regulation and problem solving" 2 Family therapy, home and office based, focusing on immediate crisis resolution, improved communication, and relationship restoration 3 Coaching — weekly home -based family support 4 Family Assessment — This assessment is completed at the home unless the family prefers the confidentiality of an office setting • 20 -point family assessment • Screening for mental health concerns o Assessment and recommendations for additional supports and services • When deemed appropriate access to • Child Behavior Checklist (CBCL) • Conners 3 (ADHD screening) • SIB -R developmental assessment • Beck Depression Inventory (BDI-II) • Beck Combination Youth Inventory AnselI — Casey Life Skills Assessment • Mental Status checklist for Adolescents • Trauma Symptom Checklist Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM • Behavior Assessment System for Children (BASC-3) • Resiliency Scales for Children and Adolescents (Strengths profile) 5.02 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 • Three treatment packages are available High, 7-9 hours per week, Moderate, 4-6 hours per week, and Low, 2-3 hours per week • Treatment Packages include 75% face to face with family and 25% other duties including but not limited to Team Decision Meetings, Administrative Review Conferences, Case Management, resource and community support building and MDT related activities 5.03 Anticipated duration of service (i.e. 3-4 months): 3-6 months 5.04 Three (3), or more, specific goals of the service (DO use bullet points): • With supports in place to maintain family functioning, the youth will remain at home successfully • Provide information regarding community resources, mental health, education, and health care options • Provide services to enable the family to function in a safe manner, by addressing the concerns through education, role modeling, and providing information for community resources • Help families create and implement safety plans • Help families create short term goals to transition to appropnate ongoing providers to support maintenance of goals • Provide tools to improve family functioning, including behavior management, conflict management, communication, and problem -solving tools • Support development of parent/child relationships • Teaching appropnate discipline techniques 5.05 , Three (3), or more, specific outcomes of service: • With supports in place to maintain family functioning, the youth will remain at home successfully • Provide -information regarding community resources, mental health, education, and health care options •Provide services to enable the family to function in a safe manner, by addressing the concerns through education, role modeling, and providing information for community resources • Help families create and implement safety plans • Help families create short term goals to transition to appropnate ongoing providers tasupport maintenance of goals • Provide tools to improve family functioning, including behavior management, conflict management, communication, and problem -solving tools • Support development of parent/child relationships • Teaching appropnate discipline techniques Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 5.06 Target population of the service, including age and gender: Youth ages 12-18. 5.07 Languages service is available in (please list proficiency and if interpreter services are available): English 5.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Therapy services are eligible for Medicaid reimbursement. Coaching services are not eligible for Medicaid reimbursement. 5.09 Service location — list where the service will take place (i.e. client's home, in -office, other): In -home or 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 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 * If applicable — Mileage rate is paid after 30 roundtrip miles. 5.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level Rate Month per Minimum of Service: Hours $4875 28 5.11a In -home therapy High 5.11b In -home therapy Moderate $3250 16 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 5 11c In -home therapy Low $1625 8 5 11d In -office therapy High $3705 28 5 11e In -office therapy Moderate $2470 16 5 11f In -office therapy Low , $1235 8 5 11g , In -home coaching High $3120 28 5 11h In -home coaching Moderate - $2080 16 5 11i In -home coaching Low $1040 8 5 11j $ 5.12 ; Home Study Providers — List your rates on the box below. 5.13 Monitored Sobriety Providers — List your rates in the box below. 5.14 Additional Comments' i Revised 12/3/2024 ADA _ ATTACHMENT 2 BID FORM Weld County Use Only Service #5: Initial Proposal Determination: Date. Reason for follow up or negotiation: List specific item(s) needing follow up or discussion Changes approved to proposal: List specific item(s) that were changed Changes approved by: Name of Authonzed Representative for Bidder Date: Method changes were approved: Final Proposal Determination: Date. Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM P lease complete the following: N umber of services offered on this Attachment 2 (max 5): 2 You may complete another Attachment 2 if you have more than 5 services. Service #1 S ervice Name: Foster Parent and Kinship Provider Consultation Program Area: Foster Care/Adoption Support 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) 1.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): 1. Shiloh will provide psychoeducation for foster parents regarding the impact of trauma and abuse and neglect. This training will include 8 hours of instruction and practice. The instruction will include the following curriculum topics: • It's all about the brain, not the behaviors. • The teenage brain is unique, and the teenage, traumatized brain can be healed. • Understanding the impact of trauma "it's not defiance, it's learned survival". • Effective consequences for teenagers impacted by abuse and neglect. • Skills rather than punishment or consequences. • Developmental age vs chronological age and reasonable expectations. • Resiliency: how to identify the strengths that already exist, and how to build resiliency in every child. Foster parents are the key. 2. Shiloh will provide support services to assist the foster family with child specific consultation. 3. Shiloh will provide families with assistance with household family functioning through on -site family support from the Shiloh House Family Support Professionals. 4. Shiloh will provide phone consultation in crisis situations. 5. Shiloh will provide a supportive and non -judgmental relationship for the foster child and foster parents. 6. Shiloh will assist families with skill development to ensure that families can establish appropriate relationship development, structure, boundaries and limits, with the goal of proactively preventing family conflict, and/or to decrease conflict that may already exist. 7. Shiloh will provide tools to improve family functioning, including behavior management, conflict management, communication, and problem -solving tools. 8. Shiloh will support the development of foster parent/child relationships. 9. The goal of Shiloh Home's home -based Foster Parent Consultation services is to enable the family to function in a safe manner, by addressing the concerns through education, role modeling, providing information for community resources, and providing effective parenting training. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 1.02 Anticipated frequency of direct service time with the chent/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: This training Will include 8 hours of instruction and practice 1.03 Anticipated duration of service (i.e. 3-4 months): Typically 2 months 1.04 Three (3), or more, specific goals of the service (DO use bullet points): • Increase foster parent confidence -As the foster parent begins to gain new skills and control in the home, confidence is naturally increased • Teach value of daily routine and consistency with children -Home Based family support professionals will help parents establish a daily routine by using schedules and meal planning menus Parents are assisted with household rules, rewards and consequences and are given resources such as age-appropnate chore charts to help parents with consistency • Focus on the family strengths by directing intensive services that support and strengthen the family and protect the child All of Shiloh Home services are provided from a family engagement, `strength based, trauma informed basis 1.05 Three (3), or more, specific outcomes of service: • Prevent placement disruption • Increase formal and informal supports such as community, family, and fnends • Increase foster parents understanding of the impact of trauma • Help foster parents to have realistic child expectations • Improve foster parenting, relationship, and social skills • Provide rapid crisis consultation and support for foster parents experiencing challenges with their foster child • Role modeling positive interaction with children - The Home -Based family support professional will use a wide vanety of interaction and education -based tools to help the family build skills, relationships and have fun together This includes recognition of children's needs, nurturing interactions, appropnate responses to the child's cues, as well as stepping in to model age-appropnate discipline and consequences • Return children in placement to their own home Shiloh House's home based and foster parent consultation services are provided as either a prevention of out of home placement, or to facilitate the successful return of youth to the home and community ensuring that the family has the support needed to help the youth be successful post placement • Unite children with their permanent families The Shiloh House home based services strive to ensure the permanency of children with their families • Provide services that protect the child Shiloh Home in -home services ensure that children are protected, and that the well-being of every child is our first pnority 1.06 Target popull Lion of the service, including age and gender: Foster and Kinship providers 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 1.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: This service is not Medicaid eligible. 1.09 Service location - list where the service will take place i.e. client's home, in -office, other): In -home or 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 Hourlv Service Rates: Service #1 Service Type $ Amount Unit Type 1.10a In-Office/Video $95 1.10b $120 In -Home or Community 1.10c Service with Transportation Provided $0 1.10d FTM, TDM, Prof. Staffing $ Per Hour 1.10e No show $ Per No Show 1.10f Mileage rate* $0.59 Per Mile * If applicable — Mileage rate is paid after (30) roundtrip miles. 1.11 Monthly Service_ Rates (each level must be listed): If applicable Service Name with Level Rate Month per Minimum of Service: Hours 1.11a $ 1.11b $ 1.11c $ 1.11d $ 1.11e $ Revised 12/3/2024 ADA ATTACHMENT 2 RID FORM 1 11f $ 1 11g $ 1 11h $ 1 11i $ 1 11j $ 1 1.12 Home Study Providers — List your rates m the box below. 1.13 Monitored Sobriety Providers — List your rates m the box below. I 1.14 Additional Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County Use Only Service #1: Initial Proposal Determination: Date: Reason for follow up or negotiation' List specific item(s) needing follow up or discussion Changes approved to proposal: List specific item(s) that were changed Changes approved by: Name of Authonzed Representative for Bidder Date Method changes were approved: 1 Final Proposal Determination. Comments: Date Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM P lease complete the following: N umber of services offered on this Attachment 2 (max 5): 1 You may complete another Attachment 2 if you have more than 5 services. Service #1 Service Name: Day Treatment Program Area: Day Treatment 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) 1.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Shiloh House Day Treatment services are available to youth between 12 to 18 years of age who are proficient in speaking English; and who present with behavioral disorders, mental health issues, and problematic sexual behaviors. The program is specifically designed for those youth who demonstrate a pattern of maladaptive behaviors that interfere with their adaptive community functioning and who are not at greater risk for out -of -home removal. The program focuses on skills development where the youth recognizes his or her maladaptive behaviors and associated thinking errors and where the use of a greater repertoire of positive social skills and adaptive coping skills is supported. Significant considerations for admission include but are not limited to level of risk to family, victim and community, typology of juvenile, level of denial, intellectual functioning, secondary diagnostic features and substance abuse issues Clients with the following issues are generally considered not appropriate for the program: • Severely limited cognitive abilities (IQ below 65) • Ongoing medical issues that cannot be supervised/managed by staff • The inability or significantly impaired ability to understand and/or communicate in English. • Is actively psychotic Delivery Methods: Shiloh Academy offers educational services at five on -site locations. Components of the program include: • Educational, psychological, and clinical assessment services • Offense specific treatment services • Individual, family, group, and milieu therapies (offered on a weekly basis) • Case management • Academic curriculum -credits transferable to public school • Special education services • Transportation to/from school (within 15 -mile radius) • In -home service/per case need • Community activities • 24/hour on -call assistance Revised 12/3/2024 ADA ATTACHMENT 2 BID FO=`:M • Monthly progress reports • On -going assessment of family Transitional services/staffing to public school Engagement Techniques The referred student practices new cognitive and behavioral skills with peers and teachers in,the Shiloh Academy program, in group therapy, with their family at home, and_in the community at large Progression through the program is assisted by a feedback system in which the student's behavior and quality of work on phase projects at Shiloh Academy and at home is tied to student's program privileges Forward movement through the program also involves successful completion of written and behavioral assignments and the development of a relapse prevention plan The focus of treatment sessions is both cognitive (teaching new, healthy, empathic, and reality -based way of thinking) and behavioral (teaching and rehearsing healthy ways to behave when overwhelmed by feeling and perceived needs) 1.02 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: Established school hours 1.03 Anticipated duration of service (i.e. 3-4 months).; Typically one semester 1.04, Three (3), or more, specific goals of the service (DO use bullet points)° • Youth will gain emotional and behavioral stability • Youth will improve school attendance • Youth will prepare for return to a public school setting 1 06 Three (3), or more, specific outcomes of service: • Credit recovery • Improved school emotional and behavioral functioning • Return to home school prepared for academic and interpersonal success • Maintain positive *home and community relationships 1.06 Target population of the service, including age and gender° Male youth, ages 12-18 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English 1.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Therapeutic services are Medicaid eligible Education services are not Medicaid eligible 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): ,m-office/classroom Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 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 $ Select One 1.10b Community $ Select One In -Home or 1.10c Service with Transportation Provided _ $ Select One 1.10d FTM, TDM, Prof. Staffing $ Per Hour 1.10e No show $ Per No Show 1.10f Mileage rate'' $0.59 Per Mile * If applicable — Mileage rate is paid after (30) roundtrip miles. 1.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level Rate Month per Minimum of Service: Hours 1.11a Day and therapy services including education $2125 Treatment 1.11b $ 1.11c $ 1.11d $ 1.11e $ 1.11f $ 1.11g $ 1.11h $ 1.111 $ 1.11j $ 1.12 Home Study Providers - List your rates in the box below. 1.13 Monitored Sobriety Providers - List your rates in the box below. 1.14 Additional Comments: Revised 12/3/2024 ADA ATTACHMENT 2 °ID FORM Weld County Use Only Service #1 Initial Proposal Determination: If Applicable, Select One Date:. Reason for follow up or negotiation: List specific items) needing follow up or discussion Changes approved to proposal: List specific item(s) that were changed Changes approved by. Name of Authonzed Representative for Bidder Date: (Method changes were approved: If Applicable, Select One Final Proposal Determination: Select One Date: Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BI P lease complete the following: D FORM N umber of services offered on this Attachment 2 (max 5): 5 You may complete another Attachment 2 if you have more than 5 services. Service #1 Service Name: Supervised Family and Sibling Time P rogram Area: Life Skills 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) 1.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Supervised family time includes parent education regarding the developmental needs of the children, and parent skill development. Supervised family time may occur in a Shiloh Office or approved community -based locations such as parks, libraries, restaurants, museums and many other approved and appropriate locations, including the client's home. This flexibility allows families to meet in environments that promote bonding and child development. The decision to provide community based, supervised family time is determined by feedback from the multidisciplinary team. All parties in attendance for visits must be pre -approved by the multi -disciplinary team. The family support professional will meet with the visiting parent 15 minutes before and after each visit to discuss goals and provide feedback, making it easier for parents to identify progress and areas for continued support or growth. Supervised family time includes parent education regarding the developmental needs of the children, and parent skill development. A Family Support Professional (FSP) will respond to referrals within 24 hours of assignment and work with the full MDT team to ensure engagement or work to overcome any barriers. Transportation can be added to the treatment package to reduce transportation barriers. Family Support Professionals will remain in sight and hearing of siblings and will engage with children using trauma informed, culturally responsive, age -appropriate techniques to minimize risk and maximize the potential for healthy sibling relationships. • Cancellations may occur up to 24 hours prior to a scheduled appointment. Appointments canceled within 24 hours of scheduled appointments are subject to billing for the service. 'over 2 youth or youth that require more support will require another staff member- additional rate requested 1.02 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: • Four treatment packages are available: Intensive, 7-9 hours per week; High, 4-6 hours per week; moderate; 2-3 hours per week; and low 1 hour per week. Monthly Package Rates In - office: Intensive: $3081/mo, High: $2054/mo, Mod: $1027/mo, Low: $342/mo • Supervised Family Time treatment packages include 75% face to face with family and 25% Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM other duties including but not limited to Team Decision Meetings, Administrative Review Conferences, Case Management, resource development and community support identification, and MDT related activities. 1.03 Anticipated duration of service (i.e. 3-4 months): • Supervised Family Time typically has a duration of 1-3 months. The need for services will be reevaluated every 30 days. 1.04 Three (3), or more, specific goals of the service (DO use bullet points): • Maintain permanent connections between children and parents. • Strengthen the bond between parents and children. • Help the parent or caregiver improve the ability to interact with the child or youth in developmentally appropriate ways. • Assist in establishing healthy boundaries and communication between the parent and child. 1.05 Three (3), or more, specific outcomes of service: • Increased safe and healthy interactions between parents and their children. • The parent will gain skills needed to succeed in a lower level of supervised interaction or in unsupervised interactions with children. • Increased ability by the parent to recognize cues provided by the child. 1.06 Target population of the service, including age and gender: • Supervised Family Time services between parents and children are provided to parents with children between the ages of birth -18 years regardless of gender. 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English 1.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: Family Time services are not eligible for Medicaid reimbursement. 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): In -office, in -home, and in the community. Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 1.10 • For monthly Service rates please complete section 1.11 • For Home Study Providers please complete section 1.12 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM • For monitored Sobriety Providers please complete section 1.13 1.10 Hourly Service Rates: Service #1 Service $ Amount Unit Type Type 1.10a 1.10b 1.10c 1.10d 1.10e 1.10f * If applicable — Mileage rate is paid after 30 roundtrip miles. 1.11 Monthlv Service Rates each level must be listed): If applicable Service Name with Level Rate Month per Minimum of Service: Hours $3081 28 1.11a In Sibling -office Supervised Intensive Family and Time 1.11b In Sibling -office Supervised Family and $2054 16 Time High 1.11c In Sibling -office Supervised Moderate Family and $1027 8 Time 1.11d In Sibling -office Supervised Low and $342 4 Family Time 1.11e $ 1.11f $ $ 1.11g 1.11h $ 1.111 $ 1.11j $ 1.12 Home Study Providers - List your rates in the box below. 1.13 Monitored Sobriety Providers - List your rates in the box below. Revised 12/3/2024 ADA 1.14 Additional Comments. If three or more children are present, the rate is double to accommodate for the additional staff member Revised 12/3/2024 ADA ATTACHMENT 2 ='ID FOR Weld County Use Only Service #1: Initial Proposal Determination. Date. Reason for follow up or negotiation: List specific item(s) needing follow up or discussion Changes approved to proposal. List specific item(s) that were changed Changes approved by Name of Authorized Representative for Bidder Date: Method changes were approved" Final Proposal Determination. Date Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #2 Service Name: Therapeutic Family and Sibling Time (Program Area: Life Skills 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) 2.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Therapeutic Parenting Time provides a goal focused therapeutic time for the parent and child within the supervision and therapeutic intervention, training, and skill building of the MA level parenting therapist. Following an initial assessment meeting, and observation, the parent and parenting therapist collaborate to identify specific skill building areas, as well as develop the goals and tasks for each of the parenting times. Delivery Methods: Following an initial assessment meeting and observation, the parent and parenting therapist collaborate to identify specific skill building areas, as well as develop the goals and tasks for each of the parenting times. Initial observation and collaboration with the parent will assist in creating a culturally responsive plan. Therapeutic Parenting Time will be scheduled in advance, and staff will coordinate with all necessary parties for effective service delivery. Engagement Techniques: In each therapeutic parenting session, the therapist and the parent will review the skills, discuss the goals of the session, plan the specific tasks and then engage in a natural interaction time between the parent and child. During the session if the therapist believes a short helpful intervention or role modeling would be beneficial, they will engage the parent in this learning process. Following the parent -child time together, the therapist and the parent will meet to review the session, provide feedback, discuss frustrations or skills that the parent has identified as needing and establish a plan for the next session. Therapeutic Parenting Time can occur in -home, in -community, or in- office. • Cancellations may occur up to 24 hours prior to a scheduled appointment. Appointments canceled within 24 hours of scheduled appointments are subject to billing for the service. **over 2 youth or youth that require more support will require another staff member- additional rate requested 2.02 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: 2-4 hours per week. 2.03 Anticipated duration of service (i.e. 3-4 months): The Therapeutic Parenting Time ranges from 8-16 weeks on average with 2-4 hours per week. 2.04 Three (3), or more, specific goals of the service (DO use bullet points): • Strengthen the bond between parents and children. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM • Help the parent or caregiver improve the ability to interact with and care for the child or youth in developmentally appropriate ways. • Assist in establishing safety, healthy boundaries and communication between the parent and child 2.05 Three (3), or more, specific outcomes of service: • Improvement of a healthy parent -child relationship • Increased child safety, and increased ability by the parent to recognize cues provided by the child • The parent will gain skills identified through assessment and be able to succeed in a lower level of supervised interaction with children. 2.06 Target population of the service, including age and gender: Therapeutic Family Time services between parents and children are provided to parents with children between the ages of birth -18 years when clinical oversight is needed to promote safety. Services are provided regardless of gender. 2.07 Languages service is available in (please list proficiency and if interpreter services are available): English 2.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Family Time services are not eligible for Medicaid reimbursement. 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Therapeutic Parenting Time can occur in -home, in -community, or in- office. There is an additional mileage fee for visits that are further than 15 miles (or 30 miles round-trip) from our Longmont 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 Hourlv Service Rates: $ Amount Unit Type Service #2 Service Type 2.10a In-Office/Video $95.00 Per Hour 2.10b In -Home or Community $120.00 Per Hour Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2.10c Service with Transportation Provided $120 Per Hour 2.10d FTM, TDM, Prof. Staffing $95 Per Hour 2.10e No show $95 Per No Show 2.10f Mileage rate'' $0.59 Per Mile * If applicable — Mileage rate is paid after (30) roundtrip miles. 2.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level Rate Month per Minimum of Service: Hours $ 2.11a 2.11b $ 2.11c $ 2.11d $ 2.11e $ 2.11f $ 2.11g $ 2.11h $ 2.111 $ 2.11j $ 2.12 Home Study Providers - List your rates in the box below. 2.13 Monitored Sobriety Providers — List your rates in the box below. 2.14 Additional Comments: If three or more children are present, the rate is double to accommodate for the additional staff member. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County Use Only Service #2: Initial Proposal Determination: I Date: Reason for follow up or negotiation' List specific item(s) needing follow up or discussion Changes approved to proposal: List specific item(s) that were changed Changes approved by Name of Authonzed Representative for Bidder Date Method changes were approved f=inal proposal Determination Date' Comments' Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #3 Service Name: Parents as Teachers Program Area: Life Skill's 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) 3.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Evidence -Based Home Visiting Model The Parents as Teachers Evidence -Based Home Visiting Model is the comprehensive home - visiting, parent education model used by Parents as Teachers Affiliates. This model has been identified as swell -supported practice by the Title IV -E Prevention Services Clearinghouse. The model provides services to families with children from prenatal through kindergarten. Four components to the parents as teachers model: • Personal Visits (1-2 visits monthly) • Group Connections (1 per month) • Resource Network • Child Screening 3.02 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: Visits may be up to weekly, depending on identified stressors. Group connections are monthly. 3.03 Anticipated duration of service (i.e. 3-4 months): Services can be available until the children) reach the age of 5 years. 3.04 Three (3), or more, specific goals of the service (DO use bullet points): • Increase parent knowledge of early childhood development and improve parent practices • Provide early detection of developmental delays and health issues • Prevent child abuse and neglect • Increase children's school readiness and success 3.05 Three (3), or more, specific outcomes of service: • Parents will be better prepared to identify and help children meet developmental milestones. • Parents will have increased understanding of how to address early childhood needs. • Parents will be aware of community based resources. 3.06 Target population of the service, including age and gender: Parents of children birth to 5 years old. 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English 3.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM This is not a Medicaid eligible service. 3.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Visits can be in -home. Groups are 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 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 3.10 Hourlv Service Rates: Service #5 Service Type $ Amount Unit Type 3.10a In-OfficeNideo $ 3.10b In -Home or Community $ 3.10c Service with Provided $ Transportation 3.10d FTM, Prof. Staffing $ Per Hour TDM, 3.10e No show $ Per No Show 3.10f Mileage rate* $ Mile Per * If applicable — Mileage rate is paid after 30 roundtrip miles. 3.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level Rate Month per J Minimum of Service: Hours 3.11a Rate is monthly, per youth $600 2 3.11b $ $ 3.11c $ 3.11d • $ 3.11e 3.11f $ $ 3.11g Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 3.11h $ 3.11i $ 3.11j $ 3.12 Home Study Providers — List your rates in the box below. 3.13 Monitored Sobriety Providers — List your rates in the box below. 3.14 Additional Comments: Mileage is .59 cents per mile. The document would not save information on that line. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County Use Onlv Service #5: Initial Proposal Determination: Date: Reason for follow up or negotiation: List specific item(s) needing follow up or discussion Changes approved to proposal: List specific item(s) that were changed Changes approved by: Name of Authorized Representative for Bidder Date: Method changes were approved: Final Proposal Determination: Date: Comments: Revised 12/3/2024 ADA ATTACHMENT 3 WELD COUNTY DEPARTMENT OF HUMAN SERVICES PROVIDER INFORMATION FORM (PIF) Agency Information: As listed on W-9 Agency Name: Shiloh Home, Inc DBA Shiloh House Trails Provider ID (if known): Provider Contact Full Name: Austin T o p o I n i c k i Title: COO Primary Phone Number (10 -digit): 303-933-1393 Ext.: Primary Contact Email: atopolnicki@shilohhouse.net Agency Location Address (Street, city, state, zip): 6 58 8 W. Ottawa Ave Agency Mailing Address (Street, city, state, zip): Littleton, CO 8 0 1 2 8 Agency Type: Private Non -Profit Send Referrals for Service to: Referral Contact Name: Elizabeth M e i s s n e r Title: Intake Clinician Referral Phone Number (10 -digit): 303-932-9599 Ext.: Email: referralsa.shilohhouse.net Billing Contact: Billing Contact Name: Sheila Tabuchi Title: Billing Specialist Billing Phone Number (10 -digit): 303-933-1393 Ext.: 1155 Email: billing shilohhouse.net Revised ADA 12/3/2024 ATTACHMENT 4 - 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: Elizabeth Meissner Shiloh Home, Inc PHONE NUMBER: 303-932-9599 EMAIL: referrals@shilohhouse.net PROPOSED SERVICE(S): Day Treatment Legal Last Name Middle Initial Previous Legal Last Name (If applicable) , Legal First Name Service Type Licensurel Credentials DORA # (if. - applicable) Green A Lawrence Director of SPED Professional Teacher License - and Pmfessinnal Ariministratnr I SPED, Professional Principal License irense - DirPrtnr of SPFn Cherrington D Kevin Paraprofessional Professional Teacher License Davis A Scott Paraprofessional Douglas A Maggie Teacher Initial Teacher License Gladu T Amy SPED Teacher Initial Teacher License - SPED Lawrence Bill Paraprofessional Masby Chris Paraprofessional Donovan Lucie SPED Teacher Alternative Teacher License - SPED, Substitute Teacher Flannigan C Bri SPED Teacher Initial Teacher License - SPED Deisler Olivia Paraprofessional Bennet L Garrison SPED Teacher Alternative Teacher License - SPED, Substitute Teacher Heston Kelsey Paraprofessional Lieberman Katelin Paraprofessional Giddens L Betsy SPED Teacher Professional Teacher License - PE, SPED Garcia M Ibelice Paraprofessional Yu Asensi G Amarylli Teacher Initial Teacher License - ELA, Substitute Authorization Heline R Madison Paraprofessional Young Lexi Paraprofessional Hancock J JoEtta Paraprofessional CHILD WELFARE INVITATION FOR BID 2025-26 - VARIOUS SERVICES ATTACHMENT 4 - 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: Lauren Martinez Shiloh Home, Inc PHONE NUMBER: 720-213-1400 x 1207 EMAIL: Imartinez@shilohhouse.net PROPOSED SERVICE(S): Aftercare, Life Skills, Supervised Family Time. Martinez Lauren LCSW CSW.09925519 Armijo Warren Christine Inskeep Sugar Hufnagel Lindsey Dylan Laura MSW, SWP SWP.0001412 CHILD WELFARE INVITATION FOR BID 2025-26 - VARIOUS SERVICES A CORDTM Client#: 2047745 SHILOHOM1 CERTIFICATE OF LIABILITY INSURANCE DATE (MMtOD/YYYY) 2/27/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER ME: CONTACT Breanna Bucklin I NA_ USI Insurance Services, LLC I Ext): PHONE 303 837-8500 1 FAX . (A/C, No): 4600 South Ulster Street E-MAIL SS breanna.bucklin@usi.com Denver, CO 80237 ._ADDRE@_"___ com INSURER(S) AFFORDING COVERAGE NAIC 0 303 837-8500 INSURER A : Philadelphia Indemnity Insurance Co. 181058 INSURED I INSURER B : Plnnacol Assurance Company 41190 Shiloh Home Inc. dba Shiloh Home INSURER C : At -Bay Specialty Insurance Company 19607 dba Shiloh Home6588 W. Ottawa Avenue INSURER D Littleton, CO 80128-4572 INSURER E : INSURER F : CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR A X TYPE OF INSURANCE IADDL _." _ ..._._IINSR COMMERCIAL GENERAL LIABILITY I CLAIMS -MADE � OCCUR SUER NND - POLICY NUMBER PHPK2640802 POLICY EFF I POLICY EXP (MM/DD/YYYYyMM/DD/YYYY) 01/01/2025•,01/01/2026 ' LIMITS - EACH OCCURRENCE I$1,000,000 DAMAGE T�RENTED PREMISES Ea occurrence�_$100r000 MED EXP (Any one person) j $ 20,000 PERSONAL 8 ADV INJURY I $1,000,000 GEN - _ L AGGREGATE LIMIT APPLIES PER PRO- l POLICY JECT �I LOC OTHER: GENERAL AGGREGATE 1s3,000,000 PRODUCTS - COMP/OP A. I $ 3,000,000 $ A AUTOMOBILE 'i, X !I --� X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY 7SCHEDULED AUTOS �- NON -OWNED � AUTOS ONLY I PHPK2640802 01/01/2025101/01/2026 I COMBINED SINGLE LIMIT (Eaaccicfent) 1$1,000,000 BODILY INJURY (Per person) i $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE I $ (Per accident) $ A L X UMBRELLAUAB I X EXCESS LIAB 7 OCCUR CLAIMS -MADE 1 PHUB895673 01/01/2025101/01/2026 1 EACH OCCURRENCE I $9,000,000 AGGREGATE $9,000,000 Dp_ RETENTION $15000 1705662 01/01/20251,01/01/2026 X .PER OTH STATUTE � __ ER E.L. EACH ACCIDENT $500_,000 -- -""" E.L. DISEASE - EA EMPLOYEE; $500,000 __Al B tWORKERSCOMPENSATION AND EMPLOYERS' LIABILITY I ANY PROPRIETORJPARTNER/EXECUTIVE:Y� _ _ 'I OFFICERlMEMBER EXCLUDED? I7I N 1 A (Mandatory in NH) I If yes, describe under I DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT I $500,000 C I Cyber Liabil A'Fidelity Liab i A (Professional Liab j AB660364006 PHSD1849310 PHPK2640802 01/01/2025'01/01/2026 01/01/2025;01/01/2026 01/01/2025101/01/2026 $2M/2M per occ/agg $1M limit/$5,000 ret $1M/$3M per occ/agg DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, are included as Additional Insured with respect to General Liability as required by written contract or agreement per the attached form.60 day Notice of Cancellation is provided for Weld County. {iGIR 1 Ir IYl11 I. I IVL✓�I, Weld County, Colorado Y 315 N. 11th Avenue, Bldg A Greeley, CO 80631 - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Oibd © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S48296751 /M47948705 MXRBP SIGNATURE REQUESTED: Weld/Shiloh Home, Inc. PSA Final Audit Report 2025-05-22 Created: 2025-05-21 By: Windy Luna (wluna@weld.gov) Status: Signed Transaction ID: CBJCHBCAABAARHzbyfzf plq-xpQYRY2RFu1VRV156sy "SIGNATURE REQUESTED: Weld/Shiloh Home, Inc. PSA" Hist ory 5 Document created by Windy Luna (wluna@weld.gov) 2025-05-21 - 6:33:35 PM GMT- IP address: 204.133.39.9 El Document emailed to sramirez@shilohhouse.net for signature 2025-05-21 - 6:34:30 PM GMT 5 Email viewed by sramirez@shilohhouse.net 2025-05-21 - 6:51:35 PM GMT- IP address: 74.125.214.78 era Signer sramirez@shilohhouse.net entered name at signing as steven ramirez 2025-05-22 - 3:44:59 AM GMT- IP address: 73.243.112.67 6e Document e -signed by steven ramirez (sramirez@shilohhouse.net) Signature Date: 2025-05-22 - 3:45:01 AM GMT - Time Source: server- IP address: 73.243.112.67 © Agreement completed. 2025-05-22 - 3:45:01 AM GMT Dowered by Adobe Acrobat Sign Entity Information Entity Name* SHILOH HOUSE, INC Entity ID* @00035732 Q New Entity? Contract Name* Contract ID SHILOH HOUSE, INC (NEW PROFESSIONAL SERVICES 9509 AGREEMENT RELATED TO BID #B2500040) Contract Status CTB REVIEW Contract Lead WLUNA Contract Lead Email wluna@weld.gov;cobbxxl k@weld.gov Parent Contract ID Requires Board Approval YES Department Project # Contract Description* (CONSENT) SHILOH HOUSE, INC NEW PROFESSIONAL SERVICES AGREEMENT RELATED TO BID #B2500040. Contract Description 2 TEMPLATE APPROVED ON APRIL 23, 2025. THIS WILL BE A CONSENT ITEM. TERM: JUNE 1, 2025 THROUGH JULY 31, 2028. Contract Type* AGREEMENT Amount* $0.00 Renewable* YES Automatic Renewal Grant IGA Department Requested BOCC Agenda Due Date HUMAN SERVICES Date* 05/24/2025 05/28/2025 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* 05/31/2028 Renewal Date* 06/01/2026 Committed Delivery Date Expiration Date Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date Approval Process Department Head JAMIE ULRICH DH Approved Date 05/22/2025 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 05/28/2025 Finance Approver RUSTY WILLIAMS Legal Counsel BYRON HOWELL Finance Approved Date Legal Counsel Approved Date 05/23/2025 05/23/2025 Tyler Ref # AG 052825 Originator WLUNA Hello