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Home My WebLink About20251677.tiffCun-hvac+-11)0501 PROFESSIONAL SERVICE AGREEMENT BETWEEN WELD COUNTY AND LIFELONG, INC. II 1 THIS AGREEMENT is made and entered into this l (Othday of UTA. LC , 2025 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as "County," and Lifelong, 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 C omcrrF nctildo— wA co/Z5' CC:OnbaSe 0)43) /I /2 2025-1677 Ae0051-1 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 April 30, 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 termination or expiration of this Agreement, County reasonably determines that any payment made by County to Contractor was improper because the service for which payment was made did not perform as set forth in this Agreement, then upon written notice of such determination and request for reimbursement from County, Contractor shall forthwith return such payment(s) to County. Upon termination or expiration of this Agreement, unexpended funds advanced by County, if any, shall forthwith be returned to County. County will not withhold any taxes from monies paid to the Contractor hereunder and Contractor agrees to be solely responsible for the accurate reporting and payment of any taxes related to payments made pursuant to the terms of this Agreement. Unless expressly enumerated in the attached Exhibits, Contractor shall not be entitled to be paid for any other expenses (e.g. mileage). Notwithstanding anything to the contrary contained in this Agreement, County shall have no obligations under this Agreement after, nor shall any payments be made to Contractor in respect of any period after December 31 of any year, without an appropriation therefore by County in accordance with a budget adopted by the Board of County Commissioners in compliance with Article 25, Title 30 of the Colorado Revised Statutes, the Local Government Budget Law (C.R.S. 29-1-101 et. seq.) and the TABOR Amendment (Colorado Constitution, Article X, Sec. 20). 7. Independent Contractor. Contractor agrees that it is an independent contractor and that Contractor's officers, agents or employees will not become employees of County, nor entitled to any employee benefits (including unemployment insurance or workers' compensation benefits) from County as a result of the execution of this Agreement. Contractor shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. 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 by the subcontractor, to be bound to Contractor by the terms of this Agreement, and to assume toward Contractor all the obligations and responsibilities which Contractor, by this Agreement, assumes toward County. County shall have the right (but not the obligation) to enforce the provisions of this Agreement against any subcontractor 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 Agreement, or any extension thereof, and during any warranty period. For all coverages, Contractor'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 umbrella 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 -VII. 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 Products/Completed Operations Aggregate Each Occurrence Limit Personal/Advertising Injury Automobile Liability Insurance $ 1,000,000 $ 1,000,000 $ 1,000,000 $ 1,000,000 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 description 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 at 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 negotiate 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 conform 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: Lindsey Spraker Position: Director of Operations Address: 750 West Hampden Avenue, Suite 450 Address: Englewood, Colorado 80110 E-mail: referrals(a�lifelonginc.com Phone: (720) 582-3086 TO COUNTY: Name: Jamie Ulrich Position: Director Address: P.O. Box A Address: Greeley, Colorado 80632 E-mail: ulrichij 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: S..�eit1 'ok Clerk to the Board BY: Deputy Clerk to the B BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ck, Chair JUN 1 6 2025 RACTOR: Lifelong, Inc. 750 West Hampden Avenue, Suite 450 Englewood, Colorado 80110 (303) 573-0839 Erika Sptaket By: Erika Spraker(Juii 9, 202512:53 MDT) Erika Spraker, Executive Director 06/09/2025 Date: 13 2 025 - 1(61-1 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. Any disclosure is required by law; or b. Business Associate obtains reasonable assurances from the person to whom the PHI is disclosed that (i) the PHI will be held confidentially and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person; and (ii) the Business Associate will be notified of any instances of which the person is aware in which the confidentiality of the information is breached. 5. Business Associate hereby agrees to maintain the security and privacy of all PHI in a manner consistent with state and federal laws and regulations, including HIPAA, HITECH, 42 CFR Pt. 2 if applicable, and all other applicable laws. 6. Business Associate shall ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of the Business Associate agree to the same restrictions, conditions, and requirements that apply to the Business Associate with respect to such information. Business Associate shall not disclose PHI created or received by Business Associate on behalf of County to a person, including any agent or subcontractor of Business Associate but not including a member of Business Associate's own workforce, until such person agrees in writing to be bound by provisions not less restrictive than this BAA and applicable state or federal law. 7. Business Associate shall not disclose PHI to any member of its workforce unless Business Associate has advised such person of Business Associate's privacy and security obligations under this Agreement, 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 applicable law. 9. Business Associate agrees to maintain a record of its disclosures of PHI, including disclosures not made for the purposes of this Agreement. Such record shall include the date of the disclosure, the name and, if known, the address of the recipient of the PHI, the name of the individual who is the subject of the PHI, a brief description of the PHI disclosed, and the purpose of the disclosure consistent with enabling County to meet its 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 written request by County, and to make such amendment as directed by County. Business Associate shall forward any request for amendment by an individual to County promptly upon receipt thereof. 15. County shall notify Business Associate of any changes in, or revocation of, the permission by an individual to use or disclose his or her PHI, to the extent that such changes may affect Business Associate's use or disclosure of PHI. 16. 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 termination of this BAA for any reason, Business Associate, with respect to PHI received from County, or created, maintained, transmitted, or received by Business Associate on behalf of County, shall: a. Retain only that PHI which is necessary for Business Associate to continue its 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 cant' 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. Domestic Violence Evaluation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Clinical assessment interview. ii. Domestic Violence Risk and Needs Assessment (DVRNA). iii. Spousal Assault Risk Assessment Guide — 3 (SARA — 3) iv. Clut down — Annoyed — Guilty - Eye-opener (CAGE -AID) substance abuse screening tool. v. Alcohol Use Disorders Identification Test (AUDIT). vi. Scoring the States of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A/8D). vii. Ohio State University Traumatic Brain Injury Identification Method (OSU-TBI). viii. Mini -Mental State Examination (MMSE). ix. Brief Resiliency Scale (BRS) x. Beck Anxiety Inventory (BAI). xi. Beck Depression Inventory (BDI) xii. Level two (2) - Anger — Adult. xiii. Substance Abuse Subtle Screening Inventory (SASSI). xiv. Personality Inventory for DSM-5 — Brief Form (PID-BF) — Adult. xv. World Health Organization Disability Assessment Schedule (WHODAS) 2.0. xvi. Personality Assessment Screener (PAS). xvii. Adverse Childhood Experiences (ACE) Questionnaire. b. Anticipated Frequency of Services: i. Three (3) to seven (7) hours. c. Anticipated Duration of Services: i. Until the completion of the evaluation. d. Goals of Services: i. To assess and identify treatment needs of the client. ii. Determine the level of treatment intensity required for domestic violence services. iii. Establish recommendations for immediate and long-term safety planning. e. Outcomes of Services: i. Completion of the evaluation. f. Target Population: i. Persons identified as at risk of or known domestic violence involvement with or without police contact or child welfare involvement. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. 2. Family Violence Reduction Program Intake a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Dependent on service referral type. 1 May include Domestic Violence Offender Management Board (DVOMB) approved intake and assessment materials. 2. Biopsychosocial. 3. Conflict screens. 4. Behavior and risk assessments. 5. Required intake paperwork. a. Disclosures. b. Release of Information (ROI). c. Rights and responsibilities. b. Anticipated Frequency of Services: i. Two (2) to five (5) hours. c. Anticipated Duration of Services: i. One (1) to two (2) sessions. d. Goals of Services: i. Completion of the Intake. e. Outcomes of Services: i. Completion of intake so client eligible to begin any of the identified treatments, including. 1. Domestic Violence (DV) Treatment. 2. Caring Dads. 3. Foundations for Family Safety. 4. High Conflict Co -Parenting. 5. Building Treatment Pathways. 6. Victim -Survivor Advocacy. 7. Loved Ones of Survivors Psychoeducation. 8. Loved Ones of Survivors Support Group. 9. Therapeutic Peer Support Group for Survivors. 10. Building Treatment Pathways. 11. Intake to cover future individual and groups added in the Family Violence Reduction Program service offerings. f. Target Population: i. Persons identified as at risk of or known domestic violence involvement with or without police contact or child welfare involvement. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 3. Domestic Violence Group Treatment a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive behavioral therapy (CBT). ii. Dialectical behavioral therapy (DBT). iii. Trauma focused behavioral therapy (TF-CBT). iv. Motivational interviewing (MI). v. Duluth model. vi. Multimodal approaches. b. Anticipated Frequency of Services: i. One (1) group meeting per week. c. Anticipated Duration of Services: i. Case specific, ranges for each case needs. ii. Sixteen (16) weeks to fifty-two (52) weeks. d. Goals of Services: i. To reduce and manage mental health triggers. ii. Increase the ability to demonstrate understanding of cycle of violence, power and control. iii. Increase ability to demonstrate self-awareness and identify triggers. iv. Increase ability to reflect on self in the group setting. v. Interact with peers in the group setting, demonstrating accountability, competency achievement, and vulnerability. vi. Identify precursors to violence and engage in preventive strategies to self -regulate and manage impulses. e. Outcomes of Services: i. Successful engagement in the group therapy dynamic. ii. Successful daily practice of self -care and coping skills. iii. Successful use of coping skills during conflict or crisis. iv. Successful reunification or other successful case closure. f. Target Population: i. Persons identified as at risk of or known domestic violence involvement with or without police contact or child welfare involvement. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 4. Domestic Violence Individual Treatment a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive behavioral therapy (CBT). ii. Dialectical behavioral therapy (DBT). iii. Trauma focused behavioral therapy (TF-CBT). iv. Motivational interviewing (MI). v. Duluth model. vi. Multimodal approaches. b. Anticipated Frequency of Services: i. One (1) to two (2) sessions per week, depending on individual's needs. c. Anticipated Duration of Services: i. Case specific, ranges for each case needs. ii. Generally, sixteen (16) to fifty-two (52) weeks. d. Goals of Services: i. To reduce and manage mental health triggers. ii. Increase the ability to demonstrate understanding of cycle of violence, power and control. iii. Increase ability to demonstrate self-awareness and identify triggers. iv. Increase ability to reflect and self -evaluate, identify precursors to violence, and engage in preventive strategies to self -regulate and manage impulses. v. Increase ability to identify criteria for safe and healthy interactions and relationships. vi. Increase ability to demonstrate protective skills of self and dependents e. Outcomes of Services: i. Successful engagement in the group therapy dynamic. ii. Successful daily practice of self -care and coping skills. iii. Successful use of coping skills during conflict or crisis. iv. Successful reunification or other successful case closure. f. Target Population: i. Persons identified as at risk of or known domestic violence involvement with or without police contact or child welfare involvement. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 5. Caring Dad's Group a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. The Caring Dads parenting group is a curriculum driven and facilitated opportunity for men to obtain and practice parenting skills and connect with other men as fathers. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Seventeen (17) weeks. d. Goals of Services: i. To improve and strengthen the father/child relationship. ii. Learn child centered parenting skills and strategies to manage stress and frustration. iii. Identify and self -reflect on the impact of previous conflictual strategies on familial relationships. e. Outcomes of Services: i. Reduced recidivism of child welfare contacts for participating families. ii. Successful case closure via reunification or maintenance of custody or in -home placement. iii. To create community connections and relationships for fathers. f. Target Population: i. Parents with children. ii. Fathers who have demonstrated parenting challenges that resulted in child protection concerns. iii. Fathers struggling with parenting children with challenging behaviors or special behavioral needs. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 6. Caring Dad's Individual Treatment a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. The Caring Dads curriculum. 1. A driven curriculum facilitated to provide the opportunity for men to obtain and practice parenting skills and connect with other men as fathers. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Seventeen (17) weeks. d. Goals of Services: i. To improve and strengthen the father/child relationship. ii. Learn child centered parenting skills and strategies to manage stress and frustration. iii. Identify and self -reflect on the impact of previous conflictual strategies on familial relationships. e. Outcomes of Services: i. Reduced recidivism of child welfare contacts for participating families. ii. Successful case closure via reunification or maintenance of custody or in -home placement. iii. Create community connections and relationships for fathers. f. Target Population: i. Parents with children, fathers who have demonstrated parenting challenges that resulted in child protection concerns. ii. Fathers struggling with parenting children with challenging behaviors or special behavioral needs. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 7. High Conflict Co -Parenting Group a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Group therapy. ii. Curriculum driven and skill acquisition focused. iii. Skills focused on conflict resolution, communication skills, stress management, and protection of involved children. iv. Parents in high -conflict separations, child welfare cases, divorces, or requiring mediation attend the groups separately. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) weeks. d. Goals of Services: i. To provide a safe environment for parents to connect, reflect, and learn ways to manage co -parenting challenges. ii. Parents will develop skills to co -parent and communicate effectively, minimizing conflict. iii. Parents will learn strategies to mediate stress and implement protective strategies to reduce emotional harm to involved children. e. Outcomes of Services: i. To reduce occurrences of severe conflictual parenting interactions that result in violence, child protection involvement, and/or police contact. ii. Support parents to resolve contentious custody battles and resolve disagreements independently after supports fade. iii. Reduce emotional/physical harm to involved children f. Target Population: i. Parents identified as having co -parenting conflict that is unable to resolved without proper supports. g. Language: i. English. h. Medicaid Eligibility: ii. This service is not Medicaid eligible. i. Service Access and Transportation: In-OfficeNideo. 8. High Conflict Co -Parenting Individual Treatment a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Individual treatment sessions. ii. Curriculum driven and skill acquisition focused. iii. Parents in high -conflict separations, child welfare cases, divorces, or requiring mediation attend the groups separately. iv. Skills focused on conflict resolution, communication skills, stress management, and protection of involved children. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) weeks. d. Goals of Services: i. To provide a safe environment for parents to connect, reflect, and learn ways to manage co -parenting challenges. ii. Parents will develop skills to co -parent and communicate effectively, minimizing conflict. iii. Parents will learn strategies to mediate stress and implement protective strategies to reduce emotional harm to involved children. e. Outcomes of Services: i. Reduced the occurrence of severe conflictual parenting interactions that result in violence, child protection involvement, and/or police contact. ii. Parents are supported as they resolve contentious custody battles and resolve disagreements independently after supports fade. iii. Reduce emotional / physical harm to involved children. f. Target Population: i. Parents identified as having co -parenting conflict that is unable to resolved without proper supports. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. 9. Foundations for Family Safety Group a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. To provide psychoeducation. ii. Processing and support around family violence. iii. Intimate partner violence education. iv. Victim and offender issues. v. Developmental neglect and harm. vi. The impact on children. vii. Indicators of family violence. viii. Case planning. ix. Continuity of care. x. Connection to resources, safety planning, and repairing harm. xi. Parents and caregivers of shared children attend separate groups. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) weeks. d. Goals of Services: i. To educate caregivers on the impact of unsafe experiences for children. ii. Increase the ability to demonstrate understanding of impact of violence on children. iii. Increase ability to demonstrate self-awareness and identify triggers. iv. Increase ability to reflect and self -evaluate. v. Identify precursors to violence. vi. Engage in preventive strategies to self -regulate and manage impulses. vii. Increase ability to identify criteria for safe and healthy interactions and relationships. viii. Increase ability to demonstrate protective skills of self and dependents. e. Outcomes of Services: i. To reduce the occurrence of severe conflictual parenting interactions that result in violence, child protection involvement, and/or police contact. ii. Support parents to resolve contentious custody battles and resolve disagreements independently after supports fade. iii. Reduced emotional/physical harm to involved children. f. Target Population: i. Persons identified as at risk of or known family safety concerns. ii. Child welfare involvement due to caregiver safety decisions. iii. Family violence. iv. High conflict. v. Neglect. vi. Victimization or suspected intimate partner violence in front of children or in the home. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. 10. Foundations for Family Safety Individual Treatment a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. To provide psychoeducation. ii. Processing and support around family violence. iii. Intimate partner violence education. iv. Victim and offender issues. v. Developmental neglect and harm. vi. The impact on children. vii. Indicators of family violence. viii. Case planning. ix. Continuity of care. x. Connection to resources, safety planning, and repairing harm. xi. Parents and caregivers of shared children attend separate groups. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) weeks. d. Goals of Services: i. To educate caregivers on the impact of unsafe experiences for children. ii. Increase the ability to demonstrate understanding of impact of violence on children. iii. Increase ability to demonstrate self-awareness and identify triggers. iv. Increase ability to reflect and self -evaluate, identify precursors to violence, and engage in preventive strategies to self -regulate and manage impulses. v. Increase ability to identify criteria for safe and healthy interactions and relationships. vi. Increase ability to demonstrate protective skills of self and dependents. e. Outcomes of Services: i. To reduce the occurrence of severe conflictual parenting interactions that result in violence, child protection involvement, and/or police contact. ii. Support parents to resolve contentious custody battles and resolve disagreements independently after supports fade. iii. Reduced emotional/physical harm to involved children. f. Target Population: i. Persons identified as at risk of or known family safety concerns. ii. Child welfare involvement due to caregiver safety decisions. iii. Family violence. iv. High conflict. v. Neglect. vi. Victimization or suspected intimate partner violence in front of children or in the home. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. 11. Building Treatment Pathways Groups a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Psychoeducation surrounding the stages of change. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) weeks. d. Goals of Services: i. To promote client self -reflection of behavior impacts and outcome results. ii. To identify client indicators of accountability and repair efforts. iii. To support client emergence through the contemplation and reparation stages. e. Outcomes of Services: i. Client indicates readiness for next treatment steps and requirements. ii. Client has established foundation of accountability reflections. iii. Client completion of treatment assignments f. Target Population: i. Caregivers in pre -contemplation stages of accountability, denial, or refusal to engage in other treatment modalities. ii. This service is additionally appropriate for clients with Domestic Violence (DV) charges pending. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 12. Building Treatment Pathways Individual Sessions a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Psychoeducation surrounding the stages of change. b. Anticipated Frequency of Services: i. One session (1) per week. c. Anticipated Duration of Services: i. Six (6) to twelve (12) weeks, depending on client progress. d. Goals of Services: i. To promote client self -reflection on the impacts of their behavior and resulting outcomes. ii. To identify client indicators of accountability and efforts toward repair. iii. Support client progression into the Contemplation and Preparation stages of change. e. Outcomes of Services: i. Client shows readiness for next treatment steps and requirements. ii. Client has established a foundation of accountability reflections. iii. Client completion of treatment assignments. f. Target Population: i. Caregivers in pre -contemplation stages of accountability, denial, or refusal to engage in other treatment modalities. ii. Additionally appropriate for clients with Domestic Violence (DV) charges pending. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 13. Anger Regulation/Affective Education Groups a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Curriculum driven and skill acquisition focused curriculum. ii. Substance Abuse and Mental Health Services Administration (SAMHSA) guidelines for addiction counseling. iii. To teach skills focused on. 1. Conflict resolution. 2. Safe emotion expression. 3. Communication skills. 4. Stress management. 5. The protection of involved children. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) weeks. d. Goals of Services: i. To establish amenability and accountability surrounding safe expression of emotions. ii. Identify and understand intent versus impact. iii. Understand and practice safe emotions of self, secondary emotions, and communication strategy. e. Outcomes of Services: i. Client shows a reduced occurrences of aggression versus safe expressions of high emotion. ii. Established empathy of the experiences of others based on intent and impact. iii. Client is able to translate thoughts of experiences into matched expressions of emotion. f. Target Population: i. Parents identified as having difficulty with safe emotion expression. ii. This service is for caregivers who do not have an identified victim as a romantic partner. iii. Parents expressing high emotion and dysregulation. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfflceNideo. 14. Anger Regulation/Affective Education Individual Sessions a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Curriculum driven and skill acquisition focused curriculum. ii. Substance Abuse and Mental Health Services Administration (SAMHSA) guidelines for addiction counseling - anger management for substance abuse disorder for mental health clients. iii. To teach skills focused on. 1. Conflict resolution. 2. Safe emotion expression. 3. Communication skills. 4. Stress management. 5. The protection of involved children. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) weeks. d. Goals of Services: i. Client establishes amenability and accountability surrounding safe expression of emotions. ii. Identifies and understands intent versus impact. iii. Understands and practices safe emotions of self, secondary emotions, and communication strategies. e. Outcomes of Services: i. Client shows reduction in occurrences of aggression, demonstrating safe expression of intense emotions. ii. Development of empathy through understanding the experiences of others, focusing on both intent and impact. iii. Improved ability to translate thoughts of experiences into appropriately matched emotional expressions. f. Target Population: i. Parents identified as having difficulty with safe emotion expression. ii. This service is for caregivers who do not have an identified victim as a romantic partner. iii. Parents expressing high emotion and dysregulation. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. 15. Acceptance and Commitment Therapy Groups a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive diffusion curriculum. ii. Personal responsibility. iii. Embodying and living by personal values. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) weeks. d. Goals of Services: i. To educate caregivers on connection between difficult thoughts and emotions in alignment with behavior choices. ii. Identify deeper feelings connected to behavior choices. iii. Reduce psychological suffering by addressing complex thoughts and emotions. e. Outcomes of Services: i. Client has identified relief and repair of complex experiences. ii. Established personal responsibility of attitudes that condone problematic behavior. iii. Evident committed action by client in behavior that is guided by safe values. f. Target Population: i. Clients with various diagnosed or suspected disabilities. ii. Ages birth (0) to one hundred (100). g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 16. Acceptance and Commitment Therapy Individual a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive diffusion curriculum. ii. Personal responsibility. Imbodying and living by personal values. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) weeks. d. Goals of Services: i. To educate caregivers on connection between difficult thoughts and emotions in alignment with behavior choices. ii. Identify deeper feelings connected to behavior choices. iii. Reduce psychological suffering by addressing complex thoughts and emotions. e. Outcomes of Services: i. Client identified relief and repair of complex experiences. ii. Established personal responsibility of attitudes that condone problematic behavior. iii. Evident committed action by client in behavior that is guided by safe values. f. Target Population: i. Clients with various diagnosed or suspected disabilities. ii. Ages birth (0) to one hundred (100). g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNirtual. 17. Rock and Roll Recovery Individual Sessions a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. To provide a visceral approach to treatment versus intellectual treatment. ii. Tuning into different neurological pathway for treatment to support individual who may not be able to process traditional treatment approaches iii. Incorporates substance abuse disorder and stages of change Model. iv. Using music to process. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) weeks, depending on client progress. d. Goals of Services: i. To establish nontraditional treatment pathways of progress. ii. Identify connections to substance use and behavior change requirements. iii. Establish sobriety as part of a collaborative treatment effort. e. Outcomes of Services: i. Client establishment of sobriety efforts and outcomes. ii. Client connections to music modalities for treatment gains. iii. Client compensatory strategies developed surrounding misuse and abuse of substances. f. Target Population: i. Clients that show past difficulties with success in prior treatment experiences. ii. Prior nonsuccess with traditional treatment modalities. g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 18. Rock and Roll Recovery Groups a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: ii. Visceral approach to treatment vs. intellectual treatment. iii. Tuning into different neurological pathway for treatment to support individual who may not be able to process traditional treatment approaches. iv. Incorporates substance abuse disorder and stages of change model using music to process. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) weeks d. Goals of Services: i. To establish nontraditional treatment pathways of progress. ii. Identify connections to substance use and behavior change requirements. iii. Establish sobriety as part of a collaborative treatment effort. e. Outcomes of Services: i. Client establishment of sobriety efforts and outcomes. ii. Client connections to music modalities for treatment gains. iii. Client compensatory strategies developed surrounding misuse and abuse of substances f. Target Population: i. Clients that have experienced past difficulties with success in prior treatment experiences. g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-OfFiceNideo. 19. Substance Abuse Treatment - Groups a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Interlock Enhancement Counseling (IEC). ii. Relapse prevention. iii. Strategies for Self -Improvement and Change (SSIC). iv. Single Session Consultation (SSC). v. Cognitive behavioral therapy (CBT). vi. Dialectical behavioral therapy (DBT). vii. Trauma focused behavioral therapy (TF-CBT). viii. Motivational interviewing (MI). ix. Curriculum driven multimodal approaches. b. Anticipated Frequency of Services: i. One (1) to two (2) groups per week. c. Anticipated Duration of Services: i. Sixteen (16) to fifty-two (52) weeks, depending on clients' need. d. Goals of Services: i. To reduce and manage substance use or substance misuse. ii. Reach a goal of being alcohol or substance use free. iii. Maintain abstinence from all substances. e. Outcomes of Services: i. Successful daily practice of self -care and coping skills. ii. Successful establishment and maintenance of pro -social relationships. iii. Successful reunification or other successful case closure f. Target Population: i. Clients seeking safety. ii. With codependency. iii. Driving Under the Influence (DUI). iv. Veterans. v. Client with various diagnosed or suspected disabilities/brain injury. vi. Ages twelve (12) to one hundred (100). g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 20. Substance Abuse Treatment Individual Sessions a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive behavioral therapy (CBT). ii. Dialectical behavioral therapy (DBT). iii. Trauma focused behavioral therapy (TF-CBT). iv. Motivational interviewing (MI). v. Curriculum driven multimodal approaches. b. Anticipated Frequency of Services: i. One (1) to two (2) groups per week. c. Anticipated Duration of Services: i. Sixteen (16) to fifty-two (52) weeks, depending on clients' need. d. Goals of Services: i. Reduced and managed substance use or substance misuse. ii. Client has reached a goal of being alcohol or substance use free. iii. Maintain abstinence from all substances. e. Outcomes of Services: i. Successful daily practice of self -care and coping skills. ii. Successful establishment and maintenance of pro -social relationships. iii. Successful reunification or other successful case closure. f. Target Population: i. Clients with various diagnosed or suspected disabilities/brain injury. ii. Ages twelve (12) to one hundred (100). g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 21. Victim -Survivor Advocacy - Individual a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Psychoeducation. ii. Processing skills. iii. Supports surrounding interpersonal and family violence. b. Anticipated Frequency of Services: i. One (1) to two (2) sessions per week. c. Anticipated Duration of Services: i. Six (6) to nine (9) weeks. d. Goals of Services: i. To educate victim -survivors on connection between intimate partner violence, victimization issues, and parenting outcomes. ii. Resource provision and communication connections established. iii. Reduce psychological suffering. e. Outcomes of Services: i. Client identified outcomes related to ongoing community supports. ii. Established safety plan. iii. Evident committed action by client related to prior experiences of victimization and impact to child(ren). f. Target Population: i. Clients with various diagnosed or suspected disabilities. ii. Ages birth (0) to one hundred (100). 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. 22. Victim -Survivor Advocacy - Group a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Psychoeducation. ii. Processing skills. iii. Supports surrounding interpersonal and family violence. b. Anticipated Frequency of Services: i. One (1) to two (2) sessions per week. c. Anticipated Duration of Services: i. Six (6) to nine (9) weeks. d. Goals of Services: i. To educate victim -survivors on connection between intimate partner violence, victimization issues, and parenting outcomes. ii. Resource provision and communication connections established. iii. Reduce psychological suffering. e. Outcomes of Services: i. Client will have identified outcomes related to ongoing community supports. ii. Established safety plan. iii. Evident committed action by client related to prior experiences of victimization and impact to child(ren). f. Target Population: i. Clients that have had prior nonsuccess with traditional treatment modalities. g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. 23. Bilingual Services — Add On a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Bilingual Professional services. b. Anticipated Frequency of Services: i. As needed for client service. c. Anticipated Duration of Services: i. As needed for client service. d. Goals of Services: i. To provide client support or treatment services in their preferred in clients' language. e. Outcomes of Services: i. Provided support to clients. f. Target Population: i. Clients with various diagnosed or suspected disabilities. ii. Ages birth (0) to one hundred (100). g. Language: i. Spanish. ii. Arabic. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. ii. In -Home or Community. 24. Drug Screens a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Secure and protected drug panel screening tools ii. Substances tested for: 1. Amphetamine (AMP). 2. Barbiturates (BAR). 3. Buprenorphine (BUP). 4. Benzodiazepine (BZO). 5. Cocaine (COC). 6. Creatinine (CR). 7. Ethyl glucuronide (ETG). 8. Fentanyl (FEN). 9. Multi drug test (MTD). 10. Morphine/Codeine (OPI). 11.Oxycodone (OXY). 12.Tetrahydrocannabinol (THC). 13. Tramadol. b. Anticipated Frequency of Services: i. As needed or required. c. Anticipated Duration of Services: i. As needed. d. Goals of Services: i. To successfully complete sobriety testing. e. Outcomes of Services: i. Provide negative sobriety test results. f. Target Population: i. Youth or adults with concerns of substance misuse. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In -Office. 25. Substance Treatment Intake a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: ii. Intake assessment. iii. Screening tools. b. Anticipated Frequency of Services: i. One (1) to two (2) sessions. c. Anticipated Duration of Services: i. Thirty (30) days. d. Goals of Services: i. To complete substance intake. e. Outcomes of Services: i. Competed substance abuse disorder intake report generated and released. f. Target Population: i. Client with various diagnosed or suspected disabilities or brain injuries. ii. Ages twelve (12) to one hundred (100). g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 26. Substance Treatment Evaluation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Intake assessment. ii. Screening tools. b. Anticipated Frequency of Services: i. One (1) to two (2) sessions. c. Anticipated Duration of Services: i. Thirty (30) days. d. Goals of Services: i. To complete substance intake. e. Outcomes of Services: ii. Competed Substance Abuse Report intake report generated and released. f. Target Population: i. Client with various diagnosed or suspected disabilities or brain injuries. ii. Ages twelve (12) to one hundred (100). g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: In-OfficeNideo. 27. Home -Based Intervention - Intensive a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Individual and/or family therapy. ii. Therapeutic life skills. iii. Applied Behavior Analysis (ABA). iv. Modality for therapeutic interventions determined by clinician and based on clients' individual needs and abilities. v. Skills assessments may be utilized to determine curriculum and programming b. Anticipated Frequency of Services: i. Three (3) to eight (8) hours per week, based on individual needs. c. Anticipated Duration of Services: i. Minimum of twelve (12) weeks, based on individual needs. d. Goals of Services: i. To provide accessible therapeutic level interventions in client home. ii. Individuals will engage in skill acquisition and therapy with opportunity to demonstrate and maintain skills in their home environment. iii. Individuals will reflect on and process stressors, traumatic experiences, and associated emotions and behaviors. iv. Individuals will develop and maintain self -care and coping practices. e. Outcomes of Services: i. Increased ability to generalize and maintain learned skills over time in their home environments. ii. Reduce likelihood of out -of -home placement and court involvement for child protection concerns. iii. Reduce recidivism for child welfare contact and involvement. f. Target Population: i. Clients with various diagnosed or suspected disabilities. ii. Ages birth (0) to one hundred (100). iii. Individuals. iv. Dyads. v. Families. g. Language: i. English. ii. Arabic proficient. h. Medicaid Eligibility: i. This service may be Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. 28. Home -Based Intervention - High a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Individual and/or family support. ii. Life skills. Mentorship. iv. Modality for interventions and supports determined by professional and based on clients' individual needs and abilities. v. Skills assessments may be utilized to determine curriculum and programming. b. Anticipated Frequency of Services: i. Three (3) to six (6) hours per week. c. Anticipated Duration of Services: i. Minimum of eight (8) weeks, based on individual needs or goals. d. Goals of Services: i. To provide most accessible therapeutic level interventions in client home. ii. Individuals will engage in skill acquisition and therapy with opportunity to demonstrate and maintain skills in their home environment. iii. Individuals will develop and maintain self -care and coping practices. e. Outcomes of Services: i. Increased ability to generalize and maintain learned skills over time in their home environments. ii. Reduce likelihood of out -of -home placement and court involvement for child protection concerns. iii. Reduce recidivism for child welfare contact and involvement. f. Target Population: i. Clients with various diagnosed or suspected disabilities. ii. Ages birth (0) to one hundred (100). iii. Individuals. iv. Dyads. v. Families. g. Language: i. English. ii. Spanish proficient. h. Medicaid Eligibility: i. This service may be Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. 29. Therapeutic Life Skills a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Approaches are highly individualized and dependent on the specific skill deficits and goals of the individual. ii. May include, but not limited to 1. Role play practice of skills. 2. Direct support. 3. Prompting and prompt fading strategies. 4. Naturalistic in -situation instruction. b. Anticipated Frequency of Services: i. Minimum of two (2) hours per week. ii. One (1) to three (3) sessions. c. Anticipated Duration of Services: i. Case specific. ii. Approximately sixteen (16) weeks to fifty-two (52) weeks. d. Goals of Services: i. To provide skill acquisition training to individuals. ii. Provide safe therapeutic support in which clients social/emotional needs are respected and addressed in ways that will allow learning of skills and processing the emotions related to their challenges. iii. Individuals will increase their independence to the maximum potential possible for their abilities. iv. Individuals will secure and maintain resources that will allow them to meet their court ordered treatment goals. v. Individuals will improve the quality of their relationships, develop leisure skills that are healthy and sustainable. vi. Successful mental health management during stressful or triggering life skill activities. e. Outcomes of Services: i. Successful reunification or other successful case closure. ii. Increased ability to access home and community resources. iii. Increased independence and ability to establish and maintain meaningful healthy relationships. iv. Increased ability to identify and maintain healthy supports and leisure skills that contribute to stable and predictable parenting. f. Target Population: i. Individuals with various diagnosed or suspected disabilities. ii. All ages. iii. Individuals. iv. Dyads. v. Families. g. Language: i. English. ii. Arabic. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. ii. In -Home or Community. 30. Life Skills a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Approaches are highly individualized and dependent on the specific skill deficits and goals of the individual. ii. May include, but not limited to 1. Role play practice of skills. 2. Direct support. 3. Prompting and prompt fading strategies. 4. Naturalistic in -situation instruction. b. Anticipated Frequency of Services: i. Minimum two (2) hours per week. ii. One (1) to three (3) sessions, depending on client needs. c. Anticipated Duration of Services: i. Client specific range. ii. Approximately sixteen (16) to fifty-two (52) weeks. d. Goals of Services: i. To provide skill acquisition training to individuals. ii. Individuals will increase their independence to the maximum potential possible for their abilities. iii. Individuals will secure and maintain resources that will allow them to meet their court ordered treatment goals. e. Outcomes of Services: i. Successful reunification or other successful case closure. ii. Increased ability to access home and community resources. iii. Increased independence and ability to establish and maintain meaningful healthy relationships. iv. Increased ability to identify and maintain healthy supports and leisure skills that contribute to stable and predictable parenting. f. Target Population: i. Clients with various diagnosed or suspected disabilities. ii. All ages. iii. Individuals. iv. Dyads. v. Families. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. ii. In -Home or Community. 31. Therapeutic Family Time a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Approaches are highly individualized and dependent on the specific skill deficits and goals of the individual regarding 1. Parenting needs. 2. Trauma responses. 3. Triggers, and other evidence -informed assessment and treatment approaches. ii. May include but not limited to. 1. Role play practice of parenting skills. 2. Direct support. 3. Prompting and prompt fading strategies. 4. Redirection. 5. Bonding. 6. Abuse intervening. 7. Structure. 8. Education. 9. Repeat instruction. b. Anticipated Frequency of Services: i. As determined by the Department. c. Anticipated Duration of Services: i. As determined by the Department. d. Goals of Services: i. To strengthen parent -child bond. ii. Assess for trauma responses. iii. Develop a family structure that is predictable with protective parenting and safe behaviors. e. Outcomes of Services: i. Increased parenting time for the identified parent. ii. Increased independent parenting. iii. Increased structure during visitation f. Target Population: i. Clients with various diagnosed or suspected disabilities. ii. All ages. iii. Individuals. iv. Dyads. v. Families. g. Language: i. English. ii. Arabic. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. ii. In -Home or Community. 32. Supervised Family Time a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Approaches are highly individualized and dependent on the specific skill deficits and goals of the individual regarding parenting needs, trauma responses, triggers, and other evidence - informed assessment and treatment approaches. ii. May include but not limited to 1. Role play practice of parenting skills. 2. Direct support. 3. Prompting and prompt fading strategies. 4. Redirection. 5. Bonding 6. Structure. 7. Education. 8. Repeat instruction. b. Anticipated Frequency of Services: i. As determined by the Department. c. Anticipated Duration of Services: i. As determined by the Department. d. Goals of Services: i. Strengthen parent -child bond. ii. Assess for triggers. iii. Develop a family structure that is predictable, with protective parenting, and safe behaviors. e. Outcomes of Services: i. Increased parenting time for the identified parent. ii. Increased independent parenting. iii. Increased structure and initiative during visitation. f. Target Population: i. Clients with various diagnosed or suspected disabilities. ii. All ages. iii. Individuals. iv. Dyads. v. Families. g. Language: i. English. ii. Spanish. 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. 33. Specialized Mentorship a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Curriculum may include, but not limited to, 1. Adventure based activities. 2. Participation and engagement in community activities 3. Modeling. 4. Skill acquisition. 5. Role playing. 6. Development of hobbies and interests. b. Anticipated Frequency of Services: i. Minimum of two (2) hours per week. ii. Typically, three (3) sessions per week. c. Anticipated Duration of Services: i. Typically, six (6) to twelve (12) months. d. Goals of Services: i. Provide a safe, stable and consistent connection to individuals. ii. Individuals will develop and maintain skills that promote stability, independence, and physical/mental wellbeing. iii. Individuals will develop and maintain healthy leisure skills and increase self-worth and self-confidence by reducing risk taking behavior, acting out, substance use, and negative self -statements. e. Outcomes of Services: i. Reduced future police contact or juvenile justice system involvement. ii. Maintained placement in home or current stable living situation. iii. Increased school attendance and completion. iv. Increased awareness of mental health and resources to secure supports necessary to maintain wellbeing. v. Increased social/emotional skills and self -management. vi. Increased ability to advocate for self. vii. Increased communication skills. viii. Reduced symptoms of anxiety and depression. ix. Reduced self -harm. f. Target Population: i. Youth ages eight (8) to twenty-one (21). g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNirtual. ii. In -Home or Community AND with Transportation. 34. Mental Health Therapy - Individual a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive Behavioral Therapy (CBT). ii. Dialectical Behavior Therapy (DBT). iii. Trauma -Focused Cognitive Behavioral Therapy (TF-CBT). iv. Attachment -Based Therapy (ABT). v. Animal -assisted therapy (AAT). vi. Marriage and Family Therapist (MFT). vii. Motivational Interviewing (MI). viii. Acceptance and Commitment Therapy (ACT). ix. Internal Family Systems Model (IFS). b. Anticipated Frequency of Services: i. Case specific, depending on the severity of client need. c. Anticipated Duration of Services: i. Case specific with recommendations based on assessment, client goals, abilities and level of engagement. d. Goals of Services: i. To reduce and manage mental health triggers. ii. Reduce skill deficits within emotional regulation and coping practices. iii. Increase self-awareness and self -management skills. iv. Process traumatic experiences and develop understanding of their impact on current functioning and relationships. v. Increase the ability of the client to identify emotional, mental, and ' physical needs and advocate for themselves. e. Outcomes of Services: i. Successful use of coping skills during day-to-day interactions, conflict or crisis. ii. Increased independence in accessing community activities, resources, and services. iii. Increased ability to demonstrate independent engagement in pro - social and safe leisure skills. iv. Ability to establish and maintain healthy and safe relationships. v. Successful achievement of court recommended goals. vi. Successful reunification or other successful case outcome. f. Target Population: i. Clients with various diagnosed or suspected disabilities. ii. All ages. iii. Individuals. g. Language: i. English. ii. Arabic. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. ii. In -Home or Community. 35. Mental Health Therapy - Family a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive Behavioral Therapy (CBT). ii. Dialectical Behavior Therapy (DBT). iii. Trauma -Focused Cognitive Behavioral Therapy (TF-CBT). iv. Attachment -Based Therapy (ABT). v. Animal -assisted therapy (AAT). vi. Marriage and Family Therapy (MFT). vii. Motivational Interviewing (MI). viii. Acceptance and Commitment Therapy (ACT). ix. Internal Family Systems Model (IFS). b. Anticipated Frequency of Services: i. Case specific, depending on the severity of client need. c. Anticipated Duration of Services: i. Case specific with recommendations based on assessment, client goals, abilities and level of engagement. d. Goals of Services: i. Reduce and manage mental health triggers. ii. Reduce skill deficits within emotional regulation and coping practices. iii. Increase self-awareness and self -management skills. iv. Ability to process traumatic experiences and develop understanding of their impact on current functioning and relationships. v. Increase ability of the client to identify emotional, mental, and physical needs and advocate for themselves. e. Outcomes of Services: i. Successful use of coping skills during day-to-day interactions, conflict or crisis. ii. Increased independence in accessing community activities, resources, and services. iii. Increased ability to demonstrate independent engagement in pro - social and safe leisure skills. iv. Ability to establish and maintain healthy and safe relationships. v. Successful achievement of court recommended goals. vi. Successful reunification or other successful case outcome. f. Target Population: i. Clients with various diagnosed or suspected disabilities. ii. All ages. iii. Individuals. iv. Dyads. v. Families. g. Language: i. English. ii. Arabic. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. ii. In -Home or Community. 36. Psychological Evaluation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Diagnostic tools, screeners, and assessments as determined by psychologist. b. Anticipated Frequency of Services: i. Ten (10) to twelve (12) hours total. c. Anticipated Duration of Services: i. One (1) to three (3) sessions. d. Goals of Services: i. To generate accurate assessment of clients' diagnosis, strengths, needs, and areas of skill deficits. ii. Generate a complete report of specialized recommendations for treatment and services tailored to the social/emotional, mental health, and learning needs of the individual. iii. Identify and determine course of treatment, treatment goals, and modality that is best suited for the individual. e. Outcomes of Services: i. Evaluation will provide data, summary, and outcome suggestions for client's learning, developmental, and mental health needs. f. Target Population: i. Ages four (4) to one hundred (100). g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 37. Neuropsychological Evaluation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Diagnostic tools, testing, screeners, and assessments as determined by the psychologist. b. Anticipated Frequency of Services: i. Ten (10) to fifteen (15) hours total. c. Anticipated Duration of Services: i. One (1) to three (3) sessions. d. Goals of Services: i. Assess clients' strengths and areas of skill deficits. ii. Conduct neuropsychological testing as prescribed. iii. Accurately test clients' current functioning and gather full history of the whole person. iv. Generate tailored recommendations for specialized services and modalities that will best support the client. e. Outcomes of Services: i. Accurate holistic understanding of client needs, diagnosis, and abilities. ii. Provide recommendations for specialized services through an individualized and thorough report. f. Target Population: i. Ages four (4) to one hundred (100). g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In -Office. 38. Diagnostic Evaluation — Autism Evaluation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. The diagnostic evaluation consists of 1. Systematic observations. 2. Assessments. 3. Collateral documentation review. 4. Testing that will yield evidence to support a diagnosis of an autism spectrum diagnose or another disorder. b. Anticipated Frequency of Services: i. Ten (10) to fifteen (15) hours. c. Anticipated Duration of Services: i. One (1) to three (3) sessions. d. Goals of Services: i. Obtain or rule out a diagnosis of a developmental disorder. ii. Procure a thorough assessment of where a child falls along the Autism Spectrum. iii. Gain an understanding of a child's intellectual potential. e. Outcomes of Services: i. Provide a treatment and education plan specifically geared towards the child's needs. ii. Provide education and resources to those providing care for the child. iii. Identify and connect the family with specialized support services and treatment options. f. Target Population: i. Clients with suspected developmental disabilities or autism spectrum disorder. ii. Ages four (4) to one hundred (100). g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 39. Parent Child Interaction Assessment a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Parent child interaction assessment utilizes prescribed evidence - based tools, observation techniques, and structured play scenarios based on the assessors training and current research. b. Anticipated Frequency of Services: i. Two (2) to three (3) sessions. c. Anticipated Duration of Services: i. Ten (10) to twelve (12) hours total. d. Goals of Services: i. Gather data about parental attunement, attachment, relationship dynamics between parent and child. ii. Identify harmful or dysfunctional parenting attributes. iii. Present a thorough representation of the parent child relationship. e. Outcomes of Services: i. Generate specialized recommendations for therapeutic supports to improve the quality of the parent/child relationship. ii. Reduce the likelihood of future child welfare contact. iii. Predict likelihood of potential for future abuse and neglect. f. Target Population: i. Individuals with various diagnosed or suspected intellectual/developmental disabilities. ii. Individuals. iii. Dyads. iv. Families. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 40. Mental Health Services Intake a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Clinical assessment, need, or referral reason. ii. Adverse Childhood Experiences (ACE). iii. Brief Resilience Scale (BRS). iv. Ohio State University (OSU) Traumatic Brain Injury (TBI) assessment. v. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). vi. Trauma Symptom Inventory -2 (TSI). vii. Mental status exam. viii. Others as determined during interview. b. Anticipated Frequency of Services: i. Two (2) to three (3) hours total. c. Anticipated Duration of Services: i. One (1) to two (2) sessions. d. Goals of Services: i. Intake client for mental health treatment enrollment. ii. Identify individuals' current mental functioning and mental health diagnosis if indicated. iii. Assist individual in identifying areas of strength and need with regard to their mental/emotional health. e. Outcomes of Services: i. Mental health treatment services begin. f. Target Population: i. Individuals with various diagnosed or suspected intellectual/developmental disabilities. ii. Ages six (6) to one hundred (100). iii. Individuals exhibiting challenges with mental or behavioral health. g. Language: i. English. ii. Arabic. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: ii. In-Office/Video. iii. In -Home or Community. 41. Mental Health Evaluation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Clinical Interview. ii. Adverse Childhood Experiences (ACE). iii. Brief Resilience Scale (BRS). iv. Ohio State University (OSU) Traumatic Brain Injury (TBI) assessment. v. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). vi. Minnesota Multiphasic Personality Inventory (MMPI). vii. Trauma Symptom Inventory (TSI). viii. Mental status exam. ix. Others as determined during interview. b. Anticipated Frequency of Services: i. Three (3) to five (5) hours total. c. Anticipated Duration of Services: i. One (1) to two (2) sessions. d. Goals of Services: i. Conduct a thorough assessment of individuals' mental status, social/emotional skills and deficits, and adaptive functioning. ii. Identify individuals' current mental functioning and mental health diagnosis if indicated. iii. Assist individual in identifying areas of strength and need with regard to their mental/emotional health. e. Outcomes of Services: i. Provide client and authorized service providers with a comprehensive assessment summary. ii. Provide client and authorized service providers with specialized treatment recommendations for modalities and treatment options that are most effective for client's abilities and needs. iii. Provide psychoeducation to the client and/ or guardian regarding client's mental status, symptomology, and diagnosis. iv. Connect client with resources which can meet their needs. f. Target Population: i. Individuals with various diagnosed or suspected intellectual/developmental disabilities exhibiting challenges with mental or behavioral health. ii. Ages six (6) to one hundred (100). g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 42. Case Consultation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Case consult, document review, etc. b. Anticipated Frequency of Services: i. As needed. c. Anticipated Duration of Services: i. As needed. d. Goals of Services: i. Identify correct course for client treatment. e. Outcomes of Services: i. Successful direction of services achieved. f. Target Population: i. All ages. 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. 43. Securis, iWeb, Virtual Fees a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: ii. Fees required during virtual sessions for clients experiencing incarceration. b. Anticipated Frequency of Services: iii. As needed. c. Anticipated Duration of Services: i. As needed. d. Goals of Services: i. Facility fees related to professionals being able to access clients experiencing incarceration. e. Outcomes of Services: i. Success in facilitation of services. f. Target Population: i. Clients experiencing incarceration. g. Language: i. Program fee. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Video. 44. Domestic Violence Case Support (All Domestic Violence Services) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Due to the abundance of administrative, risk reduction, and monitoring requirements for Domestic Violence Treatment Services, this fee is required. b. Anticipated Frequency of Services: i. Duration of each domestic violence treatment. c. Anticipated Duration of Services: i. Throughout the duration of domestic violence treatment. d. Goals of Services: i. Due to the abundance of administrative, risk reduction, and monitoring requirements for Domestic Violence Treatment Services, this fee is required. e. Outcomes of Services: i. Due to the abundance of administrative, risk reduction, and monitoring requirements for Domestic Violence Treatment Services, this fee is required. . Target Population: i. Clients receiving domestic violence treatment services. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 45. Victim Advocate Case Support (Fee for domestic violence victim advocate cases) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Due to the abundance of administrative, risk reduction, and monitoring requirements for Domestic Violence Treatment Services, this fee is required for support by the Victim Advocate to survivors. b. Anticipated Frequency of Services: i. Duration of each domestic violence victim advocate service. c. Anticipated Duration of Services: i. Duration of each domestic violence victim advocate service. d. Goals of Services: i. Due to the abundance of administrative, risk reduction, and monitoring requirements for domestic violence treatment services, this fee is required for support by the victim advocate to survivors. e. Outcomes of Services: i. due to the abundance of administrative, risk reduction, and monitoring requirements for domestic violence treatment services, this fee is required for support by the victim advocate to survivors. f. Target Population: i. Clients receiving domestic violence victim advocate services on top of fees already charged for this service. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In -Office. 46. Applied Behavior Analysis a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Applied Behavior Analysis (ABA) as primary modality. ii. Trauma —informed assessments including but not limited to: 1. Functional Behavior Assessment (FBA). 2. Functional Assessment Screening Tools (FAST). 3. Functional Analysis, only when clinically indicated. 4. Skills assessments. 5. Adaptive functioning scales. 6. Vineland III (Vineland Adaptive Behavior Scale) 7. Developmental assessments. 8. Autism screening tools. 9. Verbal Behavior Milestones Assessment and Placement Program (VBMAPP). 10.Assessment of Basic Language and Living Skills (ABLLS). 11.Assessment of functional living skills (AFLS). 12. Essentials for Living (EFLS). iii. All assessments are used to allocate baseline data, identify skill deficits and drive curriculum for treatment goals. iv. Assessment is ongoing and all treatment decisions are driven by data collected in every session reflecting progress on each goal and behavior. b. Anticipated Frequency of Services: i. Depending on a through individualized assessment and recommendations. ii. Approximately one (1) to forty (40) hours per week. c. Anticipated Duration of Services: i. Approximately six (6) months or until completion of treatment services. d. Goals of Services: i. To identify skill deficits and develop skill acquisition programming to be taught using the principles of Applied Behavioral Analysis (ABA). ii. Mediate and reduce the negative effects of challenging behaviors on the individual and caregivers. iii. Develop and implement behavior intervention strategies to reduce behaviors targeted for reduction. iv. Conduct ongoing parent/caregiver required training on skill teaching and behavior intervention strategies using a trauma- informed/preventative approach. e. Outcomes of Services: i. To prevent or reduce behaviors that put individuals or their caregivers/family members at risk of harm. ii. Prevent or reduce behaviors that limit an individual's ability to access their home, school, community, and establish and maintain meaningful relationships. iii. Increase communication and social skills. iv. Increase independence to the highest level possible and establish skills that contribute to mental and physical health and hygiene. f. Target Population: i. All ages. ii. All abilities and diagnoses. iii. Unless clinically contraindicated or involves a symptomology that requires medical intervention as the primary treatment. g. Language: i. English. ii. Arabic. h. Medicaid Eligibility: i. This service may be Medicaid eligible. i. Service Access and Transportation: i. In-Office/Video. ii. In -Home or Community. 47. Trauma Processing - Group a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Trauma informed approaches and materials ii. Depression and anxiety scales. iii. Post -Traumatic Stress Disorder (PTSD) assessments as prescribed by the group facilitators, as needed. iv. All assessments are used to allocate baseline data, identify skill deficits and drive curriculum for treatment goals. b. Anticipated Frequency of Services: i. One (1) session per week. ii. One (1) to two (2) hours. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. To provide a safe setting for individuals who have been assessed and identified as a candidate and determine which group processing may be beneficial. ii. Facilitate the development of a supportive working group in which individuals can share, relate to others and process traumatic experiences. iii. Provide psychoeducation to group members to promote skill development for management of symptoms of Post -Traumatic Stress Disorder and other trauma related behaviors and symptomology. e. Outcomes of Services: i. Individuals are able to access opportunities to process trauma and begin a healing process in a safe and supportive group that is goal oriented and facilitated. ii. Individuals demonstrate the ability to establish and maintain self - care and coping practices while sharing connection and accountability with their group peers. f. Target Population: i. Youth and adults that have been assessed and identified as a candidate for group processing. 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. 48. Social Skills Group a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Social skills checklists are utilized to assess skills and identify pairs of individuals in the group who would work effectively together on mutual goals that are appropriate for their age and development. b. Anticipated Frequency of Services: i. One (1) to two (2) sessions per week. ii. One (1) or more hours per session, depending on size of the group. c. Anticipated Duration of Services: i. Eight (8) weeks. d. Goals of Services: i. To identify individuals who could benefit from facilitated social skills practice in a group setting. ii. Provide safe, monitored, and facilitated activities that support individuals' social skills practice in a group setting. iii. Provide peer modeling opportunities for individuals with social skills deficits. iv. Promote the development of necessary social skills and safe ways to connect and interact with peers. e. Outcomes of Services: i. To increase clients' access to safe opportunities to practice social skills and develop meaningful relationships. ii. Increase clients' ability to generalize social skills to new individuals in a new setting. iii. Increase the connections and opportunities to create a community for individuals with intellectual disabilities. f. Target Population: i. Children and adults with specialized social needs, on the Autism Spectrum, or with intellectual disability or traumatic brain injury. g. Language: ii. English. iii. Arabic. h. Medicaid Eligibility: iv. This service is not Medicaid eligible. i. Service Access and Transportation: v. I n-OfficeNideo. 49. Mental Health Therapy Groups a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive Behavioral Therapy (CBT). ii. Dialectical Behavior Therapy (DBT). iii. Trauma -Focused Cognitive Behavioral Therapy (TF-CBT). iv. Attachment -Based Therapy (ABT). v. Animal -assisted therapy (AAT). vi. Marriage and Family Therapy (MFT). vii. Motivational Interviewing (MI). viii. Acceptance and Commitment Therapy (ACT). ix. Internal Family Systems Model (IFS). b. Anticipated Frequency of Services: i. Case specific, depending on the severity of need/trauma/crisis. c. Anticipated Duration of Services: i. Case specific with recommendations based on assessment, client goals, and abilities in addition to level of engagement. d. Goals of Services: i. To reduce and manage mental health triggers. ii. Reduce skill deficits within emotional regulation and coping practices. iii. Increase self-awareness and self -management skills. iv. Process traumatic experiences and develop understanding of their impact on current functioning and relationships. v. Increase the ability of the client to identify emotional, mental, and physical needs and advocate for themselves. e. Outcomes of Services: i. Successful use of coping skills during day-to-day interactions, conflict or crisis. ii. Increased independence in accessing community activities, resources, and services. iii. Increased ability to demonstrate independent engagement in pro - social and safe leisure skills. iv. Ability to establish and maintain healthy and safe relationships. v. Successful achievement of court recommended goals f. Target Population: i. Clients with various diagnosed or suspected disabilities. ii. Any ages. iii. Individuals. iv. Dyads. v. Families. g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In-OfficeNideo. 50. Reintegration Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Curriculum and Assessment driven. ii. Child led therapy, as best practice, b. Anticipated Frequency of Services: i. One (1) to two (2) sessions per week. c. Anticipated Duration of Services: i. Three (3) months or less. d. Goals of Services: i. To reestablish healthy relationship between parent and child. ii. Establish sustained feelings of safety of child when with caregiver. iii. Parenting skill development through attachment building efforts e. Outcomes of Services: i. Reintegration of child(ren) with caregiver(s). Ceasing reintegration efforts based on child(ren) outcomes and impact f. Target Population: i. All ages. ii. All genders. iii. All abilities and diagnosis. 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. 51. Case Coordination for Securus/iWebNirtual Fees a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Due to abundance of administrative, communication, and ongoing effort to obtain permission for client to receive Securus permissions, this fee is required at the service rate requested. b. Anticipated Frequency of Services: i. Until permissions are granted from facility. c. Anticipated Duration of Services: i. Until permissions are granted from facility. d. Goals of Services: i. To have access to serve incarcerated clients. e. Outcomes of Services: i. Having access to serve incarcerated clients. f. Target Population: i. Clients experiencing incarceration. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Video. Terms 1. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the 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 weld.qov) 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. 5. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Mental Health and Support Services Team HS- CWServiceReferralaweld.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- CWServiceReferraleweld.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-CWServiceReferralCa�weld.gov immediately via email, to discuss service continuation. 8. Contractor will identify, in detail, areas of continued concern and make recommendations to the caseworker in a monthly report reganling 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- CWServiceReferralaweld.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-CWServiceReferralCa�weldmov 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.Trn 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. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at (970) 336-7235 and advise that the subpoena must be personally served. 18. Monitoring and Evaluation Contractor and the 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 .5 Unit Type Service Name restic Volence Evaluati $ 195.00 Hour Domestic Violence Evaluation: FTM, TDM, Prof. Staffing $ 500.00 Episode Domestic Violence Evaluation: i Family Violence Reduction Program Intake: In- OfficeNideo Family Violence Reduction Progra Prof. Staffing $ 195.00 Each Family Violence Reduction Program Intake: No Show nestic Violence Group Treatrt Rate $ 195.00 Unit Type Hour Service Name Domestic Violence Group Treatment: FTM, TDM, Prof. Staffing $ 45.00 Each Domestic Violence Group Treatment: No Show $ 195.00 Hour Domestic Violence Individual Treatment: In-OfficeNide° $195:00 Hour Domestic Violence' Individual Treatment: FTM, TDIVI, Prof. Staffing $ 98.00 Each Domestic Violence Individual Treatment: No Show $ 0. Episode. Garin O Dads Group: In-OffceNideo . $195:00 Hour Caring Dads Group: FTM, TDM, ;Prof. Staffing $ 45.00 Each Caring Dads Group: No Show $195.00 Hour Caring Dads Individual: In-OrficeNideo $ 195.00 hour Caring Dads Individual: FTM, TDM, Prof. Staffing $ 98.0O Each Caring Dads Individual: No Show $ 90.00 Episode High Conflict Co -Parenting Group: In-OfficeNideo $195:00 Hour High Conflict. Co -Parenting Group: FTM, TDM; Pro Staffing $ 45.00 Each High Conflict Co -Parenting Group: No Show $195.00 Hour High Conflict Co -Parenting individual: In-OfficeNideo $ 195.00 Hour High Conflict Co -Parenting Individual: FTM, TDM, Prof. Staffing $ 98.00 Each High Conflict Co -Parenting Individual: No Show $ 90.00 Episode Foundations for Family Safety - Group: In Office/ Video $ 195.00 Hour Foundations for Family Safety - Group: FTM, TDM, Prof, Staffing $ 45.00 Each Foundations for Family Safety - Group: No Show $19.00 Hour Foundations for Family Safety - Individual: in Officef Video $ 195.00 Hour Foundations for Family Safety - Individual: FTM, TDM, Prof. Staffing $ 9 E1 Hour - Foundations for Faiy.efety -.Individual: No Show $ 90.00 Episode Building Treatment Pathways Group: In -Office Video $195.00 Hour Building Treatment Pathways Group: FTM, TDM, Prof. Staffing Rate $ 45.00 Unit Type Hour Service Name Building Treatment Pathways Group: No Show $195.00 Hour Building Treatment Pathways Individual: In -Office Video $ 195.00 Hour Building Treatment Pathways Individual: FTM, TDM, Prof. Staffing $ 98.00 Hour Building Treatment Pathways' Individual: No Show $ 90.00 Episode Anger Regulation/Affective Education Groups: In -Office Video $195.00 Hour ' Anger Regulation/Affective Education Groups: FTM, TDM, Prof. Staffing $ 45.00 Each Anger Regulation/Affective Education Groups: No Show $195,00 Hour Anger Regulation/Affective Education Individual: In- unice Video $ 195.00 Hour Anger Regulation/Affective Education Individual: FTM, TDM, Prof. Staffing 98.00 Hour Anger Regulation/Affective Education Individual: No Show $ 90.00 Episode Acceptance and Commitment Therapy Group: In Office/Video $ 195.00 Hour Acceptance and Commitment Therapy Group and Individual: FTM, TDM, Prof. Staffing $ 45.00 Episode Acceptance and Commitment Therapy Group: No Show $195.00 Hour Acceptance and Commitment Therapy- Individual: In OfficeNideo $ 98.00 Hour Acceptance and Commitment Therapy - Individual: No Show $195.00 Hour Rock and Roll Recovery Individual:In Office/Video $ 195.00 Hour Rock and Roll Recovery Individual: FTM, TDM, Prof. Staffing $ ,98:00 Hour = Rock and Roll Recovery, Individual " N0 Show $ 90.00 Episode Rock and Roll Recovery Group: In Office/Video $195.U0 Hour Rock and Roll Recovery Group: FTM, TDM, Prof. Staffing $ 45.00 Each Rock and Roll Recovery Group: No Show $ 90,00 Episode Substance Abuse Treatment Group: in-Office/Video $ 195.00 Hour Substance Abuse Treatment: FTM, TDM, Professional Staffing Rate $ 45:00 Unit Type Each Service Name Substance Abuse Treatment Group: No Show $ 195.00 Hour Substance Abuse Treatment - Individual: In-OfficeNideo $ 98.00 Each ; .` Substance Abuse Treatment: No Show $ 98.00 Each Victim -Survivor Advocacy Individual: No Show $195.00 Hour Victim -Survivor Advocacy Individual: In Office/ Video' $ 225.00 Hour Victim -Survivor Advocacy Individual: In Home or Community $195.00 Hour Victim -Survivor Advocacy Individual. and Group: FTM, TDM, Prof. Staffing $ 90.00 Episode Victim -Survivor Advocacy, Group: In-Office/Video $ 45.00 Hour Victim -Survivor Advocacy Group: No Show $ 20.00 Hour Bilingual Services $ 20.00 Each Bilingual Services: No Show $195.04 Each Drug Screen: In -Office $ 23.00 Each Drug Screen Urine $ 17.00 Hour '' Drug Screen Confirmation $ 10.00 Each Drug Screen Breath Analyzer $ 175 00 Each Drug Screen Hair Follicle: 5 Panel $ 26.00 Each Drug Screen Oral Swab $ 425.00 Each Drug Screen Hair Follicle: 14 Panel $ 825.00 Each Drug Screen Hair Follicle: 19 Panel $ 375,00 Episode Substance Treatment Intake: In-OfficeNideo $ 195.00 Hour Substance Treatment Intake: FTM, TDM, Prof. Staffing $ 195.00 Each Substance Treatment Intake: No Show $ 575.00 Episode Substance Treatment Evaluation: In-OfficeNideo $195:x0 Hour Substance Treatment Evaluation: FTM, TDM, Prof. Staffing $ 195.00 Each Substance Treatment Evaluation: No Show 225<t)0 Hour Home -Based Intervention - Intensive: In Home or Cbrnnmunity $ 225.00 Hour Home -Based Intervention - Intensive: FTM, TDM, Prof. Staffing Rate $112.00 Unit Type Each ' Service Name ` Home -Based Intervention - Intensive: Pto Show $ 165.00 Hour Home -Based Intervention - High: In Home or Community $165.00 Hour Home -Based Intervention - High: FTM "TDM, ':Prof. . Staffing $ 82.00 Each Home -Based Intervention - High: No Show $ 195.00 Hour Therapeuticl_ife Skills: In OfficeNideo $ 225.00 Hour Therapeutic Life Skills: In Home or Community $195.00 Hour Therapeutic Life Skills: FTM, TDM, Prof. Staffing $ 98.00 Each Therapeutic Life Skills: No Show $135.00 Hour Life Skills: in -Office $ 165.00 Hour Life Skills: in -Home or Community $135.00 Hour Life Skills: FTM, TDM, Prof. Staffing $ 68.00 Each Life Skills: No Show $ 195.00 Hour Therapeutic Family Time: In OfficeNideo $ 225.00 Hour Therapeutic Family Time: In Home or Community $195.00 Hour Therapeutic Family Time: FTM, TDM, Prof. Staffing $ 98.00 Each Therapeutic Family Time: No Show $ 135.00 Hour Supervised Family Time: In OfficeNideo $ 165.00 Hour Supervised Family Time: In Home or Community $ 210.00 Hour Supervised Family Time: Service with Transportation $ 135.00 Hour Supervised Family Time: FTM, TDM, Prof. Staffing 82.00 Each Supervised Family Time: No Show $ 135.00 Hour Specialized Mentorship: In Office/Video $165.00 Hour Specialized Mentorship: In Home or Community $ 210.00 Hour Specialized Mentorship: with Transportation $135.00 Hoar ' Specialized Mentorship: FTM, TDM Prof. Stang $ 82.00 Episode Specialized Mentorship: No Show $195.00 Hour Mental Health Therapy Individual: In OfficeNideo $ 225.00 Hour Mental Health Therapy Individual: In Home or Community $ 195.00 Hour Mental Health Therapy Individual: FTM, TDM, Prof. Staffing Rate $ 98.00 Unit Type Each Service Name Mental Health Therapy Individual: No Show $ 225.00 Hour Mental Health Therapy Family: In OfficeNideo $ 255.00 Hour Mental Health Therapy Family: In -Home and Community $ 225.00 Hour Mental Health Therapy Family: FTM, TOM, Prof. Staffing $ 112.00 Each Mental Health Therapy Family: No Show $2,450:00 Episode Psychological Evaluation: Full $1,225.00 "Episode Psychological Evaluation: Partial $ 250.00 Hour Psychological Evaluation: FTM, TDM, Prof. Staffing $ 250.00 Each Psychological Evaluation: No Show $3,350.00 Episode Neuropsychological Evaluation: Full $1,675.00 Episode Neuropsychological Evaluation: Partial $ 250.00 Hour Neuropsychological Evaluation: FTM, TDM, Professional Staffing $ 250.00 Each Neuropsychological Evaluation: No Show $'3,350.00 Episode Diagnostic Evaluation Autism Evaluation: Full $1,675.00 Episode Diagnostic Evaluation Autism Evaluation: Partial $ 250.00 Hour Diagnostic Evaluation Autism Evaluation: FTM, TDM Prof. Staffing $ 250.00 Each Diagnostic Evaluation Autism Evaluation: No Show $2,750.00 Episode Parent Child Interaction Assessment: Full $1,375.00 Episode Parent Child Interaction Assessment: Partial $ 25:00 Hour Parent Child Interaction. Assessment: FTM, TDM, Prof. Staffing $ 250.00 Each Parent Child Interaction Assessment: No Show $ 500.00 Episode Mental Health Services. intake: In-OfftceNideo $ 625.00 Episode Mental Health Services Intake: In -Home or Community $ 195:00 Hour Mental Health Services Intake: FTM, TOM, Prof. Staffing $ 195.00 Each Mental Health Services Intake: No Show $ 925:00 Episode Mental Health Evaluation• In-OfficeNideo $ 250.00 Hour Mental Health Evaluation: FTM, TDM, Prof. Staffing $ 250.00 Each Mental Health Evaluation: No Show $ 195.00 Hour Case Consultation: In-Office/Video Rate $195.00 Unit Type Hour ' Service Name Case Consultation: FTM, TDM, Prof. Staffing $ 195.00 Each Case Consultation: No Show $ 20:00 Hour Securus; iWeb, Virtual Fees: In-Office/Video $ 20.00 Each Securus, iWeb, Virtual Fees: No Show $ 250.00 Each Domestic Violence Case Support: Additional Fee $ 250.00 Each Victim Advocate Case Support: Additional Fee $ 195.00 Hour Applied Behavior Analysis: In-Office/Video $ 225.00 Hour Applied Behavior Analysis: In -Home or Community $ 195,00 Hour Applied Behavior Analysis: FTM, TDM, Prof. Staffing $ 98:00 Each Applied Behavior Analysis: No Show $ 90.00 Episode Trauma Processing Group:In-Office/Video $ 195.00 Hour Trauma Processing Group: FTM, TDM, Prof. Staffing $ 45.00 Each Trauma Processing Group: No Show $ 90.00 Episode Social Skills Group: In OfficeNideo $ 19500 Hour Social Skills Group: FTM, TDM, Prof. Staffing $ 45.00 Each Social Skills Group: No Show $ 90.00 Episode Mental Health Therapy Group: In-Office/Video $ 195.00 Hour Mental Health Therapy Group: FTM, TDM, Prof. Staffing $ 45:00 Each Mental Health Therapy Group: No Show $ 225.00 Hour Reintegration Therapy: In-OfficeNideo $ 255.00 Hour Reintegration Therapy: In -Home or Community $ 225.00 Hour Reintegration Therapy: FTM, TDM, Prof. Staffing $ 112.00 Each Reintegration Therapy: No Show $ 195.00 Episode Case Coordination - Securus, iWeb, Virtual Fees: In - Case Coordination - Securus, iWeb, Virtual Fees: FTM, TDM, Prof. Staffing $ 98.00 Each Case Coordination - Securus, iWeb, Virtual Fees: No Show 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 7t" 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. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the County. Denial of the amount of payment shall be reasonably related 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 4 — Provider Information Form (PIF) • Attachment 5 — 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: Lifelong, Inc. Address: 750 W. Hampden Avenue, Suite 450, Englewood, CO 80110 Phone Number: 1303)573-0839 Email: Lindsey@lifelongirc.com FEIN/Federal Tax ID # or SS#: 47-5283373 The undersigned, by his c 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: Lindsey Spraker Ti :le: Director of Operations By: X Recoverable Signature Lindsey Spraker Signed by: 1f7697-f-Sdb8-4bee-9039-568bb3731aba (Double Click in box to sign electronically) 12/3/2024 ADA ATTACHMENT 2 BID FORM Please complete the following: Number 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: Domestic Violence Evaluation 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): Clinical Assessment Interview Domestic Violence Risk and Needs Assessment (DVRNA) Spousal Assault Risk Assessment Guide — 3 (SARA - 3) CAGE -AID Substance Abuse Screening Tool Alcohol Use Disorders Identification Test (AUDIT) Scoring the States of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A/8D) Ohio State University Traumatic Brain Injury Identification Method (OSU-TBI) Mini -Mental State Examination (MMSE) Brief Resiliency Scale (BRS) Beck Anxiety Inventory (BAI) Beck Depression Inventory (BDI) Level 2 - Anger — Adult Substance Abuse Subtle Screening Inventory (SASSI) Personality Inventory for DSM-5 — Brief Form (PID-BF) — Adult World Health Organization Disability Assessment Schedule (WHODAS) 2.0 Personality Assessment Screener (PAS) Adverse Childhood Experiences (ACE) Questionnaire 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: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 3-7 hours 1.03 Anticipated duration of service (i.e. 3-4 months): Evaluation and assessment summary with treatment recommendations with a 15-30 day turn around for complete report. 1.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Assess and identify treatment needs of the client. 2. Determine the level of treatment intensity required for domestic violence services. 3. Establish recommendations for immediate and long-term safety planning. 1.05 Three (3), or more, specific outcomes of service: Completion of Evaluation 1.06 Target population of the service, including age and gender: Persons identified as at risk of or known domestic violence involvement with or without police contact or child welfare involvement. 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 1.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual (in some circumstances) 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 In-Office/Video $775 Per Episode 1.10b In Community $ Select One -Home or _ 1.10c Service with Transportation Provided $ Select One 1.10d $195 Per Hour FTM, TDM, Prof. Staffing Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 1.10e No show $195 Per No Show 1.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 1.11g $ 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 B9® FORM Weld County Use Only Service #1 Initial Proposal Determination If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination Select One Date: Comments. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #2 Service Name: Family Violence Reduction Program Intake (see notes) 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 Scope of Work Please Note: If the service is a monthly package, different levels should be indicated. All monthly packages must state a specific minimum number of direct service hours. (Please address each line item below using bulleted points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Dependent on service referral type: May include DVOMB Approved intake and assessment materials, biopsychosocial, conflict screens, behavior and risk assessments, required intake paperwork, disclosures, ROIs, rights and responsibilities. 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: 2-5 hours Anticipated duration of service (i.e. 3-4 months): 1-2 sessions Three (3), or more, specific goals of the service (DO use bullet points): Completion of intake. Three (3), or more, specific outcomes of service: Completion of intake so client eligible to begin any of the identified treatments, including: DV Treatment, Caring Dads, Foundations for Family Safety, High Conflict Co -Parenting, Building Treatment Pathways, Victim -Survivor Advocacy, Loved Ones of Survivors Psychoeducation, Loved Ones of Survivors Support Group, Therapeutic Peer Support Group for Survivors, Gender Identity Based Support Group, and Building Treatment Pathways. Intake to cover future individual and groups added in the Family Violence Reduction Program service offerings. Target population of the service, including age and gender: Persons identified as at risk of or known domestic violence involvement with or without police contact or child welfare involvement. Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 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 2.11 Service #2 Service Type , $ Amount Unit Type 2.10a In-Office/Video $500 Per Episode 2.10b Community $ Per Hour In -Home or 2.10c Service with Transportation Provided $ Select One 2.10d $195 FTM, TDM, Prof. Staffing Per Hour 2.10e No show $195 Per No Show 2.10f Mileage rate'` $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. 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: This intake is for the following group and individual services: 1) Domestic Violence Treatment 2) Caring Dads 3) Foundations for Family Safety Revised 12/3/2024 ADA ATTACHMENT ENT 2 4) High Conflict Co -Parenting 5) Foundations for Family Safety 6) Victim -Survivor Advocacy 7) Loved Ones of Survivors Psychoeducation 8) Loved Ones of Survivors Support Group 9) Therapeutic Peer Support for Survivors 10) Gender Identity Based Support Group 11) Building Treatment Pathways 12) Future individual and group offerings in the Family Violence Reduction Program Revised 12/3/2024 ADA ATTACHMENT 2 r�•> ;,.: Weld County Use Onlv B ,,3 FO Service #2: initial Proposai Determination. If Applicable, Select One 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' If Applicable, Select One Final Proposal Determination' Select One Date: Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #3 Service Name: Domestic Violence Group 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): CBT, DBT, TF-CBT, MI, Duluth model, multimodal approaches 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: One group per week 3.03 Anticipated duration of service (i.e. 3-4 months): Case specific — ranges for each case needs (i.e., 16 weeks to 52 weeks) 3.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce and manage mental health triggers. 2. Increase the ability to demonstrate understanding of cycle of violence, power and control. 3. Increase ability to demonstrate self-awareness and identify triggers. 4. Increase ability to reflect on self in the group setting. 5. Interact with peers in the group setting, demonstrating accountability, competency achievement, and vulnerability. 6. Identify precursors to violence and engage in preventive strategies to self -regulate and manage impulses. 3.05 Three (3), or more, specific outcomes of service: 1. Successful engagement in the group therapy dynamic. 2. Successful daily practice of self -care and coping skills. 3. Successful use of coping skills during conflict or crisis. 4. Successful reunification or other successful case closure. 3.06 Target population of the service, including age and gender: Persons identified as at risk of or known domestic violence involvement with or without police contact or child welfare involvement. 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 3.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No. 3.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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-OfficeNideo $90 Per Episode 3.10b In Community $ Select One -Home or 3.10c Service with Transportation Provided $ Select One 3.10d FTM, TDM, Prof. Staffing $195 Per Hour 3.10e No show $45 Per No Show 3.10f Mileage rate* $ Per Mile " If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 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. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County Use Only Service #3: Initial Proposal Determination. If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination Select One Date: Comments. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #4 Service Name: Domestic Violence Individual 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. Tease address each line item below using bulleted points) 4.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): CBT, DBT, TF-CBT, MI, Duluth model, multimodal approaches 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: 1-2 sessions/week depending on individual's needs. 4.03 Anticipated duration of service (i.e. 3-4 months): Case specific — ranges for each case needs (i.e., 16 weeks to 52 weeks) 4.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce and manage mental health triggers. 2. Increase the ability to demonstrate understanding of cycle of violence, power and control. 3. Increase ability to demonstrate self-awareness and identify triggers. 4. Increase ability to reflect and self -evaluate, identify precursors to violence, and engage it preventive strategies to self -regulate and manage impulses. 5 Increase ability to identify criteria for safe and healthy interactions and relationships. 6 Increase ability to demonstrate protective skills of self and dependents. 4.05 Three (3), or more, specific outcomes of service: 1. Successful engagement in the group therapy dynamic. 2. Successful daily practice of self -care and coping skills. 3. Successful use of coping skills during conflict or crisis. 4. Successful reunification or other successful case closure. 4.06 Target population of the service, including age and gender: Persons identified as at risk of or known domestic violence involvement with or without police cc ntact or child welfare involvement. 4.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 4.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: No. 4.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 Type $ Amount Unit Type 4.10a In-Office/Video $195 Per Hour 4.10b In -Home or Community $ Select One 4.10c $ Select One Service with Transportation Provided 4.10d $195 FTM, TDM, Prof. Staffing Per Hour 4.10e No show $98 Per No Show 4.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after -t 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 $ 4.119 $ 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. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM lfilleld County Use Only Service #4 Initial Proposal Determination: If Applicable, Select One 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' If Applicable, Select One Final Proposal Determination: Select One Date. Comments. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #5 Service Name: Caring Dads Group 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): The Caring Dads parenting group is a curriculum driven and facilitated opportunity for men to obtain and practice parenting skills and connect with other men as fathers. 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: The Caring Dads group takes place 1x per week for 17 weeks. 5.03 Anticipated duration of service (i.e. 3-4 months): 17 weeks 5.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. 17 weeks. Improve and strengthen the father / child relationship. 2. Learn child centered parenting skills and strategies to manage stress and frustration. 3. Identify and self -reflect on the impact of previous conflictual strategies on familial relationships. 5.05 Three (3), or more, specific outcomes of service: 1. Reduce recidivism of child welfare contact for participating families. 2. Successful case closure via reunification or maintenance of custody or in -home placement. 3. Create community connections and relationships for fathers. 5.06 Target population of the service, including age and gender: Parents with children, fathers who have demonstrated parenting challenges that resulted in child protection concerns, fathers struggling with parenting children with challenging behaviors or special behavioral needs. 5.07 Languages service is available in (please list proficiency and if interpreter services are available): English - interpreter services not available 5.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: No 5.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Lifelong, Inc. offices, virtual 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-Office/Video $90 Per Episode 5.10b In -Home or Community $ Select One 5.10c Service with Transportation Provided $ Select One 5.10d $195 FTM, TDM, Prof. Staffing Per Hour 5.10e No show $45 Per No Show 5.10f Mileage rate'` $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 5.118 $ 5.11h $ 5.111 $ 5.11j $ 5.12 Home Study Providers - List your rates in the box below. 5.13 Monitored Sobriety Providers - List your rates in the box below. 5.14 Additional Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County Use Only Service #5: Initial Proposal Determination: If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination: Select One Date' Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Please complete the following: Number 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: Caring Dads Individual 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 nsgiuts) 1.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): The Caring Dads parenting group is a curriculum driven and facilitated opportunity for men to obtain and practice parenting skills and connect with other men as fathers. 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: 1x per week for 17 weeks. 1.03 Anticipated duration of service (i.e. 3-4 months): 17 weeks 1.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. 17 weeks. Improve and strengthen the father / child relationship. 2. Learn child centered parenting skills and strategies to manage stress and frustration. 3. Identify and self -reflect on the impact of previous conflictual strategies on familial relationships. 1.05 Three (3), or more, specific outcomes of service: 1. Reduce recidivism of child welfare contact for participating families. 2. Successful case closure via reunification or maintenance of custody or in -home placement. 3. Create community connections and relationships for fathers. 1.06 Target population of the service, including age and gender: Parents with children, fathers who have demonstrated parenting challenges that resulted in child protection concerns, fathers struggling with parenting children with challenging behaviors or special behavioral needs. 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 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: No 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 $ Amount Unit Type Service Type 1.10a In-Office/Video $195 Per Hour 1.10b In Community $ Select One -Home or 1.10c Service with Transportation Provided $ Select One 1.10d FTM, TDM, Prof. Staffing $195 Per Hour 1.10e No show $98 Per No Show 1.10f Mileage rate* $ Per Mile '` If applicable — Mileage rate is paid after ilnsert Number of miles) 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 $ 1.11g $ 1.11h $ 1.111 $ 1.11j $ 1.12 Home Study Providers - List your rates in the box below. Revised 12/3/2024 ADA ArrAcH ENT 2 BID FORM Weld County Use Only Service #`i Initial Proposal Determination. If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination. Select One Date' Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #2 Service Name: High Conflict Co -Parenting Group 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): • • • Group therapy Curriculum driven and skill acquisition focused Parents in high -conflict separations, child welfare cases, divorces, or requiring mediation attend the groups separately. • Skills focused on conflict resolution, communication skills, stress management, and protection of involved children. 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: Groups take place one time per week. 2.03 Anticipated duration of service (i.e. 3-4 months): 12 weeks 2.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Provide a safe environment for parents to connect, reflect, and learn ways to manage co -parenting challenges. 2. Parents will develop skills to co -parent and communicate effectively, minimizing conflict. 3. Parents will learn strategies to mediate stress and implement protective strategies to reduce emotional harm to involved children. 2.05 Three (3), or more, specific outcomes of service: 1. Reduce the occurrence of severe conflictual parenting interactions that result in violence, child protection involvement, and/or police contact. 2. Support parents to resolve contentious custody battles and resolve disagreements independently after supports fade. 3. Reduce emotional / physical harm to involved children. 2.06 Target population of the service, including age and gender: Parents identified as having co -parenting conflict that is unable to resolved without proper supports. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2.07 Languages service is available in (please list proficiency and if interpreter services are available): English - no interpreter services available 2.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: No 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 Service Type $ Amount Unit Type 2.10a In-Office/Video $90 Per Episode 2.10b Community $ Per Hour In -Home or 2.10c Service with Transportation Provided $ Select One 2.10d $195 Per Hour FTM, TDM, Prof. Staffing 2.10e No show $45 Per No Show 2.10f Mileage rate* $ Per Mile * 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 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. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County Use Only Service #2: Initial Proposal Determination: If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination: Select One Date Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #3 Service Name: High Conflict Co -Parenting Individual 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): • • • Individual Sessions Curriculum driven and skill acquisition focused Parents in high -conflict separations, child welfare cases, divorces, or requiring mediation attend the groups separately. • Skills focused on conflict resolution, communication skills, stress management, and protection of involved children. 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: One session per week 3.03 Anticipated duration of service (i.e. 3-4 months): 12 weeks 3.04 Three (3), or more, specific goals of the service (DO use bullet points): 1 Provide a safe environment for parents to connect, reflect, and learn ways to manage co -parenting challenges. 2. Parents will develop skills to co -parent and communicate effectively, minimizing conflict. 3. Parents will learn strategies to mediate stress and implement protective strategies to reduce emotional harm to involved children. 3.05 Three (3), or more, specific outcomes of service: 1. Reduce the occurrence of severe conflictual parenting interactions that result in violence, child protection involvement, and/or police contact. 2. Support parents to resolve contentious custody battles and resolve disagreements independently after supports fade. 3. Reduce emotional / physical harm to involved children. 3.06 Target population of the service, including age and gender: Parents identified as having co -parenting conflict that is unable to resolved without proper supports. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 3.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No 3.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 $195 Per Hour 3.10b In -Home or Community $ Select One 3.10c Service with Transportation Provided $ Select One 3.10d $195 Per Hour FTM, TDM, Prof. Staffing 3.10e No show $98 Per No Show 3.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after fInsert Number of miles) 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 $ 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. Revised 12/3/2024 ADA BBFOR f Weld County Use WV Service #3 Initial Proposal Determination If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination Select One Date' Comments. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #4 Service Name: Foundations for Family Safety Group 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. 4.01 4.02 4.03 4.04 4.05 4.06 (Please address each line item below using bulleted points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Psychoeducation, processing, and support around family violence, intimate partner violence, victim and offender issues, developmental neglect and harm, impact on children, indications, case planning, continuity of care, connection to resources, safety planning, and repairing harm. Parents and caregivers of shared children attend separate groups. Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1 session/week Anticipated duration of service (i.e. 3-4 months): 12 weeks Three (3), or more, specific goals of the service (DO use bullet points): 1. Educate caregivers on the impact of unsafe experiences for children. 2. Increase the ability to demonstrate understanding of impact of violence on children. 3. Increase ability to demonstrate self-awareness and identify triggers. 4. Increase ability to reflect and self -evaluate, identify precursors to violence, and engage in preventive strategies to self -regulate and manage impulses. 5. Increase ability to identify criteria for safe and healthy interactions and relationships. 6. Increase ability to demonstrate protective skills of self and dependents. Three (3), or more, specific outcomes of service: 1. Reduce the occurrence of severe conflictual parenting interactions that result in violence, child protection involvement, and/or police contact. 2. Support parents to resolve contentious custody battles and resolve disagreements independently after supports fade. 3. Reduce emotional / physical harm to involved children. Target population of the service, including age and gender: Persons identified as at risk of or known family safety conerns, child welfare involvement due to caregiver safety decisions, family violence, high conflict, neglect, victimization, or suspected intimate partner violence in front of children or in the home. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 4.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 4.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No. 4.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 Type $ Amount Unit Type 4.10a In-Office/Video $90 Per Episode 4.10b $ Select One In -Home or Community 4.10c Service with Transportation Provided $ Select One 4.10d FTM, TDM, Prof. Staffing $195 Hour Per 4.10e No show $45 Per No Show 4.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County Use Only Service #4: Initial Proposal Determination. If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination: Select One Date: Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #5 Service Name: Foundations for Family Safety Individual 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. 5.01 5.02 5.03 5.04 5.05 5.06 release address each line item below using bulleted points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Psychoeducation, processing, and support around family violence, intimate partner violence, victim and offender issues, developmental neglect and harm, impact on children, indications, case planning, continuity of care, connection to resources, safety planning, and repairing harm. Parents and caregivers of shared children attend separate sessions. Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1 session per week Anticipated duration of service (i.e. 3-4 months): 12 weeks Three (3), or more, specific goals of the service (DO use bullet points): 1. Educate caregivers on the impact of unsafe experiences for children. 2. Increase the ability to demonstrate understanding of impact of violence on children. 3. Increase ability to demonstrate self-awareness and identify triggers. 4. Increase ability to reflect and self -evaluate, identify precursors to violence, and engage it preventive strategies to self -regulate and manage impulses. 5 Increase ability to identify criteria for safe and healthy interactions and relationships. 6. Increase ability to demonstrate protective skills of self and dependents. Three (3), or more, specific outcomes of service: 1. Reduce the occurrence of severe conflictual parenting interactions that result in violence, child protection involvement, and/or police contact. 2. Support parents to resolve contentious custody battles and resolve disagreements independently after supports fade. 3. Reduce emotional / physical harm to involved children. Target population of the service, including age and gender: Persons identified as at risk of or known family safety conerns, child welfare involvement due to caregiver safety decisions, family violence, high conflict, neglect, victimization, or suspected intimate partner violence in front of children or in the home. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 5.07 Languages service is available in (please list proficiency and if interpreter services are available): English — interpreter services not available 5.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No 5.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 5.10 • For monthly Service rates please complete section 5.11 • For Home Study Providers please complete section 5.12 • For monitored Sobriety Providers please complete section 5.13 5.10 Hourly Service Rates: Service #5 Service Type _ $ Amount Unit Type 5.10a In-Office/Video $195 Per Hour 5.10b In Community $ Select One -Home or 5.10c Service with Transportation Provided $ Select One 5.10d $195 Per Hour FTM, TDM, Prof. Staffing 5.10e No show $98 Per No Show 5.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 5.12 Home Study Providers - List your rates in the box below. Revised 12/3/2024 ADA ATIACYTFJr.. ENT 2 i Weld County Use Oniv -,t 3 FOR Service #5. Initial Proposal Determination. If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination' Select One 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 S ervice Name: Building Treatment Pathways Groups 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. (,lease address each line item below using bulleted points) 1.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Building Treatment Pathways is a treatment for clients in pre -contemplation stages of accountability, denial, or refusal to engage in other treatment modalities (e.g., Domestic Violence treatment). Clients are in early stages of change, experiencing denial, and have not developed the skills of readiness and accountability to move forward in more directive treatment areas. Group is psychoeducational surrounding Stages of Change. 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: 1x per week for 6-12 weeks depending on client progress. 1.03Anticipated duration of service (i.e. 3-4 months): 6-12 weeks depending on client progress. 1.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Client self -reflection of behavior impacts and outcome results. 2. Client indicators of accountability and repair efforts. 3. Client emergence into Contemplation and Preparation stages. 1.05 Three (3), or more, specific outcomes of service: 1. Client readiness for next treatment steps and requirements. 2. Client established foundation of accountability reflections. 3. Client completion of treatment assignments. 1.06 Target population of the service, including age and gender: Caregivers in pre -contemplation stages of accountability, denial, or refusal to engage in other treatment modalities. Additionally appropriate for clients with DV charges pending. 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 1.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No. 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: Lifelong, Inc. offices, virtual 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 $90 Per Hour 1.10b Community $ Select One In -Home or 1.10c Service with Transportation Provided $ Select One 1.10d FTM, TDM, Prof. Staffing $195 Per Hour 1.10e No show $45 Per No Show 1.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. 1.11 Monthly Service Rates each level must be listed): If aaalicable Service Name with Level Rate Month per Minimum of Service: Hours 1.11a $ 1.11b $ 1.11c $ 1.11d $ 1.11e $ 1.11f $ 1.119 $ 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 ATT CH ENT 2 ID FO t :M !!Veld County Use Only Service #1 Initial Proposal Determination If Applicable, Select One 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. If Applicable, Select One Final Proposal Determination Select One Date. Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #2 Service Name: Building Treatment Pathways Individual Sessions 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): Building Treatment Pathways is a treatment for clients in pre -contemplation stages of accountability, denial, or refusal to engage in other treatment modalities (e.g., Caregivers in pre - contemplation stages of accountability, denial, or refusal to engage in other treatment modalities. Additionally appropriate for clients with DV charges pending. 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: lx per week for 6-12 weeks depending on client progress. 2.03 Anticipated duration of service (i.e. 3-4 months): 6-12 weeks depending on client progress. 2.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Client self -reflection of behavior impacts and outcome results. 2. Client indicators of accountability and repair efforts. 3. Client emergence into Contemplation and Preparation stages. 2.05 Three (3), or more, specific outcomes of service: 1. Client readiness for next treatment steps and requirements. 2. Client established foundation of accountability reflections. 3. Client completion of treatment assignments. 2.06 Target population of the service, including age and gender: Caregivers in pre -contemplation stages of accountability, denial, or refusal to engage in other treatment modalities. Additionally appropriate for clients with DV charges pending. 2.07 Languages service is available in (please list proficiency and if interpreter services are available): E �glish — no interpreter services available 2.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 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 $ Amount Unit Type Service Type 2.10a I n-OfficeNideo $195 Per Hour 2.10b Community $ Per Hour In -Home or 2.10c Service with Transportation Provided $ Select One 2.10d $195 Per Hour FTM, TDM, Prof. Staffing 2.10e No show $98 Per No Show 2.10f Mileage rate* $ Per Mile 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 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: Revised 12/3/2024 ADA TTACHMENT 2 BID FORM Weld Countv Use Onlv Service #2' Initial Proposal Determination If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination. Select One Date' Comments• Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #3 Service Name: Anger Regulation/Affective Education Groups 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): • Curriculum driven and skill acquisition focused, SAMHSA - Anger Management for SUD and MH Clients • Parents expressing high emotion and dysregulation • Skills focused on conflict resolution, safe emotion expression, communication skills, stress management, and protection of involved children. 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: One session per week 3.03 Anticipated duration of service (i.e. 3-4 months): 12 weeks 3.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Establish amenability and accountability surrounding safe expression of emotions. 2. Identify and understand intent vs. impact. 3. Understand and practice safe emotions of self, secondary emotions, and communication strategy. 3.05 Three (3), or more, specific outcomes of service: 1. Reduce the occurrence aggression vs. safe expressions of high emotion. 2. Establish empathy of the experiences of others based on intent and impact. 3. Translate thoughts of experiences into matched expressions of emotion. 3.06 Target population of the service, including age and gender: Parents identified as having difficulty with safe emotion expression. This service is for caregivers who do NOT have an identified victim as a romantic partner. 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English - no interpreter services available 3.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No 3.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 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 I n-OfficeNideo $90 Per Episode Community $ Select One 3.10b In -Home or 3.10c Service with Transportation Provided $ Select One 3.10d FTM, TDM, Prof. Staffing $195 Per Hour 3.10e No show $45 Per No Show 3.10f Mileage rate* _ $ Per Mile '` If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. 3.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level per Minimum of Service: Hours Rate Month 3.11a $ 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 ATTACHMENT 2 BAD FORM Weld County Use Only Service #3 Initial Proposal Determination If Applicable, Select One Date Beason 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. If Applicable, Select One Final Proposal Determination• Select One Date. Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #4 Service Name: Anger Regulation/Affective Education Individual Sessions 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. 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 (Please address each line item below using bulleted points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): • Curriculum driven and skill acquisition focused, SAMHSA - Anger Management for SUD and MH Clients • Parents expressing high emotion and dysregulation • Skills focused on conflict resolution, safe emotion expression, communication skills, stress management, and protection of involved children. Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1 session/week Anticipated duration of service (i.e. 3-4 months): 12 weeks Three (3), or more, specific goals of the service (DO use bullet points): 1. Establish amenability and accountability surrounding safe expression of emotions. 2 Identify and understand intent vs. impact. 3 Understand and practice safe emotions of self, secondary emotions, and communication strategy. Three (3), or more, specific outcomes of service: 1 Reduce the occurrence aggression vs. safe expressions of high emotion. 2. Establish empathy of the experiences of others based on intent and impact. 3. Translate thoughts of experiences into matched expressions of emotion. Target population of the service, including age and gender: Parents identified as having difficulty with safe emotion expression. This service is for caregivers wio do NOT have an identified victim as a romantic partner. Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 Service Type $ Amount Unit Type 4.10a In-OfficeNideo $195 Per Hour 4.10b $ Select One In -Home or Community 4.10c Service with Transportation Provided $ Select One 4.10d $195 Per Hour FTM, TDM, Prof. Staffing 4.10e No show $98 Per No Show 4.10f Mileage rate* $ Per Mile If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 4.11g $ 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 BI® FORM Weld County Use Only Service #4 Initial Proposal Determination If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination' Select One Date' Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #5 Service Name: Acceptance and Commitment Therapy Groups 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): Curriculum driven: Cognitive Diffusion, Personal Responsbility, Embodying and living by personal values 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: 1 session per week 5.03 Anticipated duration of service (i.e. 3-4 months): 12 weeks 5.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Educate caregivers on connection between difficult thoughts and emotions in alignment with behavior choices. 2. Identify deeper feelings connected to behavior choices. 3. Reduce psychological suffering by addressing complex thoughts and emotions. 5.05 Three (3), or more, specific outcomes of service: 1. Client identified relief and repair of complex experiences. 2. Established personal responsibility of attitudes that condone problematic behavior. 3. Evident committed action by client in behavior that is guided by safe values. 5.06 Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, ages 0-100 5.07 Languages service is available in (please list proficiency and if interpreter services are available): English — interpreter services not available 5.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No 5.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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, 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 Per Episode Type 5.10a In-Office/Video $90 5.10b In -Home or Community $ Select One 5.10c Service with Transportation Provided $ Select One 5.10d $195 Hour FTM, TDM, Prof. Staffing Per 5.10e No show $45 Per No Show 5.10f Mileage rate* $ Per Mile " If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 5.11i $ 5.11j $ 5.12 Home Study Providers - List your rates in the box below. 5.13 Monitored Sobriety Providers - List your rates in the box below. 5.14 Additional Comments: Revised 12/3/2024 ADA ATTACHMENT 2 = ID FORM !Meld County Use Only Service #5 Initial Proposal Determination: If Applicable, Select One 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• If Applicable, Select One Final Proposal Determination. Select One Date Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Please complete the following: Number 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: Acceptance and Commitment Therapy Individuals 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): Curriculum driven: Cognitive Diffusion, Personal Responsbility, Embodying and living by personal values. 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: lx per week 1.03 Anticipated duration of service (i.e. 3-4 months): 12 weeks 1.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Educate caregivers on connection between difficult thoughts and emotions in alignment with behavior choices. 2. Identify deeper feelings connected to behavior choices. 3. Reduce psychological suffering by addressing complex thoughts and emotions. 1.05 Three (3), or more, specific outcomes of service: 1. Client identified relief and repair of complex experiences. 2. Established personal responsibility of attitudes that condone problematic behavior. 3. Evident committed action by client in behavior that is guided by safe values. 1.06 Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, ages 0-100 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 1.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: YES. 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): Lifelong, Inc. offices, virtual 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 $195 Per Hour 1.10b In $ Select One -Home or Community 1.10c Service with Transportation Provided $ Select One 1.10d $195 FTM, TDM, Prof. Staffing Per Hour 1.10e No show $98 Per No Show 1.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. 1.11 Monthly Service Rates each level must be listedl: If aaalicable Service Name with Level Rate Month per Minimum of Service: Hours 1.11a $ 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. Revised 12/3/2024 ADA ATTACHMENT 2 ID FORM !Meld County Use Only Service #1: Initial Proposal Determination: If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination Select One Date• Comments. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #2 Service Name: Rock and Roll Recovery Individual Sessions 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 bulleied.ppints) 2.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): • • • Past difficulties with success in prior treatment experiences Visceral approach to Treatment vs. intellectual treatment Tuning into different neurological pathway for treatment to support individual who may not be able to process traditional treatment approaches • • Incorporates SUD and Stages of Change Model Using music to process 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: lx per week for 12 weeks depending on client progress. 2.03 Anticipated duration of service (i.e. 3-4 months): 12 weeks depending on client progress. 2.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Establish nontraditional treatment pathways of progress. 2. Identify connections to substance use and behavior change requirements. 3. Establish sobriety as part of a collaborative treatment effort. 2.05 Three (3), or more, specific outcomes of service: 1. Client establishment of sobriety efforts and outcomes. 2. Client connections to music modalities for treatment gains. 3. Client compensatory strategies developed surrounding misuse and abuse of substances 2.06 Target population of the service, including age and gender: Prior nonsuccess with traditional treatment modalities. 2.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 2.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: YES. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 2.10 • For monthly Service rates please complete section 2.11 • For Home Study Providers please complete section 2.12 • For monitored Sobriety Providers please complete section 2.13 2.10 Hourly Service Rates: Service #2 Service Type $ Amount Unit Type 2.10a In-Office/Video $195 Per Hour In Community $ Per Hour 2.10b -Home or 2.10c Service with Transportation Provided $ Select One 2.10d FTM, TDM, Prof. Staffing $195 Per Hour 2.10e No show $98 Per No Show 2.10f Mileage rate* $ Per Mile * 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 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: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM !Meld County Use Only Service #2 Initial Proposal Determination: If Applicable, Select One 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. If Applicable, Select One Final Proposal Determination. Select One Date" Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #3 Service Name: Rock and Roll Recovery Groups 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): • • • Past difficulties with success in prior treatment experiences Visceral approach to Treatment vs. intellectual treatment Tuning into different neurological pathway for treatment to support individual who may not be able to process traditional treatment approaches • • Incorporates SU D and Stages of Change Model Using music to process 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: One session per week 3.03 Anticipated duration of service (i.e. 3-4 months): 12 weeks 3.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Establish nontraditional treatment pathways of progress. 2. Identify connections to substance use and behavior change requirements. 3. Establish sobriety as part of a collaborative treatment effort. 3.05 Three (3), or more, specific outcomes of service: 1. Client establishment of sobriety efforts and outcomes. 2. Client connections to music modalities for treatment gains. 3. Client compensatory strategies developed surrounding misuse and abuse of substances 3.06 Target population of the service, including age and gender: Prior nonsuccess with traditional treatment modalities. 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 3.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: YES. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 3.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 $90 Per Episode 3.10b In -Home or Community $ Select One 3.10c $ Select One Service with Transportation Provided 3.10d $195 Per Hour FTM, TDM, Prof. Staffing 3.10e No show $45 Per No Show 3.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 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 AT1ACHMENT 2 =aID FORM Weld County Use Only Service #3• Initial Proposal Determination: If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination: Select One Date: Comments' Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #4 Service Name: Substance Abuse Treatment Groups (including Relapse Prevention, SSIC/SSC, Seeking Safety, CoDependency, DUI, IEC, Veterans) 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): CBT, DBT, TF-CBT, MI, curriculum driven, multimodal approaches 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: 1-2 groups per week 4.03 Anticipated duration of service (i.e. 3-4 months): Case specific — ranges for each case needs (i.e., 16 weeks to 52 weeks) 4.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce and manage substance use or substance misuse. 2. Reach a goal of being alcohol or substance use free. 3. Maintain abstinence from all substances. 4.05 Three (3), or more, specific outcomes of service: 1. Successful daily practice of self -care and coping skills. 2. Successful establishment and maintenance of pro -social relationships. 3. Successful reunification or other successful case closure. 4.06 Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities/brain injury, ages 12-100 4.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 4.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: YES. 4.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 4.10 • For monthly Service rates please complete section 4.11 • For Home Study Providers please complete section 4.12 • For monitored Sobriety Providers please complete section 4.13 4.10 Hourly Service Rates: $ Amount Unit Type Service #4 Service Type 4.10a In-Office/Video $90 Per Episode 4.10b In -Home or Community $ Select One 4.10c Service with Transportation Provided $ Select One 4.10d FTM, TDM, Prof. Staffing $195 Per Hour 4.10e No show $45 Per No Show 4.10f Mileage rate* $ Per Mile '' If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 4.11g $ 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 FORM Weld County Use Only Service #4: Initial Proposal Determination: If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination: Select One Date. Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #5 Service Name: Substance Abuse Treatment Individual Sessions (including Relapse Prevention, SSIC/SSC, Seeking Safety, CoDependency, DUI, IEC, Veterans) 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. 5.01 5.02 5.03 5.04 (Please address each line item below using bulleted points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): CBT, DBT, TF-CBT, MI, curriculum driven, multimodal approaches Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1-2 groups per week Anticipated duration of service (i.e. 3-4 months): Case specific — ranges for each case needs (i.e., 16 weeks to 52 weeks) Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce and manage substance use or substance misuse. 2. Reach a goal of being alcohol or substance use free. 3. Maintain abstinence from all substances. 5.05 Three (3), or more, specific outcomes of service: 1. Successful daily practice of self -care and coping skills. 2. Successful establishment and maintenance of pro -social relationships. 3. Successful reunification or other successful case closure. 5.06 Target population of the service, including age and gender: Clent with various diagnosed or suspected disabilities/brain injury, ages 12-100 5.07 Languages service is available in (please list proficiency and if interpreter services are available): English — interpreter services not available 5.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: YES. 5.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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, 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 $ Amount Unit Type Service Type 5.10a In-Office/Video $195 Per Hour 5.10b In -Home or Community $ Select One 5.10c Service with Transportation Provided $ Select One 5.10d FTM, TDM, Prof. Staffing $195 Per Hour 5.10e No show $98 Per No Show 5.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 5.12 Home Study Providers - List your rates in the box below. 5.13 Monitored Sobriety Providers - List your rates in the box below. 5.14 Additional Comments: Revised 12/3/2024 ADA ATTACHMENT' 2 BID FORM Weld County Use Only Service #5: Initial Proposal Determination. If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination: Select One Date' Comments' Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Please complete the following: Number 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: Victim -Survivor Advocacy Individuals 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): Sessions held by trained victim advocate, psychoeducation, processing, and support surrounding interpersonal and family violence, and is provided by an expert professional in victim services, support, and advocacy. 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: 1-2 per week 1.03 Anticipated duration of service (i.e. 3-4 months): 6-9 weeks 1.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Educate victim -survivors on connection between intimate partner violence, vicimization issues, and parenting outcomes. 2. Resource provision and communication connections established. 3. Reduce psychological suffering. 1.05 Three (3), or more, specific outcomes of service: 1. Client identified outcomes related to ongoing community supports. 2. Established safety plan. 3. Evident committed action by client related to prior experiences of victimization and impact to child(ren). 1.06 Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, ages 0-100 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English - no interpreter services available 1.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM No. 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual, Weld County DHS, Community, Client 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 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 $195 Per Hour 1.10b $225 In -Home or Community Per Hour 1.10c Service with Transportation Provided $ Select One 1.10d FTM, TDM, Prof. Staffing $195 Per Hour 1.10e No show $98 Per No Show 1.10f Mileage rate'` $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. 1.11 Monthly Service Rates each level must be listed): If aaalicable Service Name with Level Rate Month per Minimum of Service: Hours 1.11a $ 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. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County Use Only Service #1: initial Proposal Determination: If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination: Select One Date. Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #2 Service Name: Victim -Survivor Advocacy Groups 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. 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 (Please address each line item below using bulleted ,points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Groups facilitated by trained victim advocate, psychoeducation, processing, and support surrounding interpersonal and family violence, and is provided by an expert professional in victim services, support, and advocacy. Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1-2 per week. Anticipated duration of service (i.e. 3-4 months): 6-9 weeks Three (3), or more, specific goals of the service (DO use bullet points): 1. Educate victim -survivors on connection between intimate partner violence, vicimization issues, and parenting outcomes. 2. Resource provision and communication connections established. 3. Reduce psychological suffering. Three (3), or more, specific outcomes of service: 1. Client identified outcomes related to ongoing community supports. 2. Established safety plan. 3. Evident committed action by client related to prior experiences of victimization and impact to child(ren). Target population of the service, including age and gender: Prior nonsuccess with traditional treatment modalities. Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: YES. 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 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 Service Type Unit Type 2.10a In-Office/Video $90 Per Episode 2.10b $ Per Hour In -Home or Community 2.10c Service with Transportation Provided $ Select One 2.10d $195 Per FTM, TDM, Prof. Staffing Hour 2.10e No show $45 Per No Show 2.10f Mileage rate* $ Per Mile * 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 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: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County Use Only Service #2: Initial Proposal Determination: If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination: Select One Date: Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #3 Service Name: Bilingual Service - Add On 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 p i�„ts) 3.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Bilingual professional 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: As needed for client service provision 3.03 Anticipated duration of service (i.e. 3-4 months): As needed for client service provision 3.04 Three (3), or more, specific goals of the service (DO use bullet points): Providing client support or treatment services in their preferred language. 3.05 Three (3), or more, specific outcomes of service: Providing client support or treatment services in their preferred language. 3.06 Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, ages 0-100 3.07 Languages service is available in (please list proficiency and if interpreter services are available): Arabic and Spanish 3.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: No. 3.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Any 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 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 3.10 Hour! Service Rates: Service #3 Service Type $ Amount Unit Type 3.10a In-Office/Video $20 Per Hour 3.10b In Community $ Select One -Home or 3.10c Service with Transportation Provided $ Select One 3.10d FTM, TDM, Prof. Staffing $ Per Hour 3.10e No show $20 Per No Show 3.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. 3.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level Rafe Month per Minimum of Service: Hours 3.11a $ 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 FO ikfi Meld County Use Onx Service ##3. Initial Proposal Determination If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination• Select One Date. Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #4 Service Name: Victim -Survivor Groups (including Peer Support, Loved Ones of Survivors, Families Impacted by Intrafamilial Sexual Abuse, Gender Identity) 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): C3T, DBT, TF-CBT, MI, curriculum driven, multimodal approaches 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: 1-2 groups per week 4.03 Anticipated duration of service (i.e. 3-4 months): Case specific — ranges for each case needs (i.e., 12 - 15 weeks) 4.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Education, inform, and integrate victimization issues alongside environment and behavior impacts. 2 Establish resources through development of independence skill building. 3. Create support network. 4.05 Three (3), or more, specific outcomes of service: 1. Expansion of victimization issues understanding. 2. Expansion of natural and community supports. 3. Interruption of cycle of abuse. 4.06 Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities/brain injury, ages 12-100 4.07 Languages service is available in (please list proficiency and if interpreter services are available): English - no interpreter services available 4.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: No 4.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 Type $ Amount Unit Type Service #4 4.10a In-OfficeNideo $90 Per Episode 4.10b In -Home or Community $ Select One 4.10c $ Select One Service with Transportation Provided 4.10d $195 FTM, TDM, Prof. Staffing Per Hour 4.10e No show $45 Per No Show 4.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 4.11g _ $ 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 r eid County Use Only ID FORM Service ##4• Initial Proposal Determination: If Applicable, Select One Date. Reason for follow yap 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: If Applicable, Select One Final Proposal Determination Select One 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: Drug Screens 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): Secure and protected drug panel screening tools S ubstances tested for: AMP,BAR,BUP,BZO,COC,CR,ETG,FEN,MTD,OPI,OXY,THC,TRAMADOL 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: As needed or required by treatment (i.e., 2x/month, 1/x week, et c.) 1.03 Anticipated duration of service (i.e. 3-4 months): Length of SUD treatment 1.04 Three (3), or more, specific goals of the service (DO use bullet points): Complete sobriety testing successfully. 1.05 Three (3), or more, specific outcomes of service: P rovide negative sobriety test results when scheduled. 1.06 Target population of the service, including age and gender: Youth or adults with concerns of substance misuse. 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 1.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: N o 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices 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 $0 Per Episode 1.10b In -Home or Community $ Select One 1.10c Service with Transportation Provided $ Select One 1.10d FTM, TDM, Prof. Staffing $195 Per Hour 1.10e No show $0 Per No Show 1.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 1.11g $ 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. Urine Screen: $23 Confirmation Test: $17 Breathalyzer: $10 Oral Swab: $26 Hair Follicle: 5 panel $175, 14 Panel $425, 19 Panel $825 Revised 12/3/2024 ADA ATTACH ENT 2 I FOR 1.14 Additional Comments Weld County Use WV Service #1. Initial proposal Determination: If Applicable, Select One 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 If Applicable, Select One (Final Proposal Determination. Select One Date: Comments' Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #2 Service Name: Substance Treatment Intake 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): Intake Assessment and Screening Tools 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: 1-2 sessions 2.03 Anticipated duration of service (i.e. 3-4 months): 30 days 2.04 Three (3), or more, specific goals of the service (DO use bullet points): Complete SUD intake 2.05 Three (3), or more, specific outcomes of service: SUD intake report generated and released 2.06 Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, brain injuries, ages 12-100 2.07 Languages service is available in (please list proficiency and if interpreter services are available): English - no interpreter services available 2.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: YES. 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2.10 Hourly Service Rates: Service #2 Service Type $ Amount Unit Type 2.10a In-OfficeNideo $375 Per Episode 2.10b In -Home or Community $ Per Hour 2.10c $ Select One Service with Transportation Provided 2.10d $195 FTM, TDM, Prof. Staffing Per Hour 2.10e No show $195 Per No Show 2.10f Mileage rate* $ Per Mile * 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 Rate Month per Minimum of Service: Hours 2.11a $ 2.11b $ 2.11c $ 2.11d $ 2.11e $ 2.11f $ 2.11g $ 2.11h $ 2.11i $ 2.11j $ 2.12 Home Study Providers - List your rates in the box below. 2.13 Monitored Sobriety Providers - List your rates in the box below. 2.14 Additional Comments: Revised 12/3/2024 ADA ATT CH E T2 Weld County Use Only Service #2. lnataal proposal Determination. If Applicable, Select One Date. Reason for f How 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' If Applicable, Select One Final Proposal Determination Select One Date Comments' Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #3 Service Name: Substance Treatment Evaluation 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 km below using bulleted pmts) 3.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Evaluation Assessment and Screening Tools 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: 1-2 sessions 3.03 Anticipated duration of service (i.e. 3-4 months): 30 days 3.04 Three (3), or more, specific goals of the service (DO use bullet points): Completed SUD evaluation 3.05 Three (3), or more, specific outcomes of service: SUD evaluation report generated and released. 3.06 Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, brain injuries, ages 12-100 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 3.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: YES. 3.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 3.10 Hourlv Service Rates: Service Type $ Amount Unit Type Service #3 3.10a In-Office/Video $575 Per Episode 3.10b In $ Select One -Home or Community 3.10c Service with Transportation Provided $ Select One 3.10d $195 Per Hour FTM, TDM, Prof. Staffing 3.10e No show $195 Per No Show 3.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. 3.11 Monthly Service Rates each level must be listed): If applicable Service Name with Level per Minimum of Service: Hours Rate Month 3.11a $ 3.11b $ 3.11c $ 3.11d $ 3.11e $ 3.11f - - $ 3.11g $ 3.11h $ 3.111 $ 3.11j i $ 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 ATTACHMENT BID FORM Weld County Use Only Service f#3: Initial Proposal Determination: If Applicable, Select One 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 br 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 BID FORM Service #4 Service Name: Home -Based Intervention (Intensive) 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. 4.01 4.02 4.03 4.04 4.05 (Please address each line item below using bulleted points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Individual and / or family therapy, therapeutic life skills, Applied Behavior Analysis, and a variety of our services provided by masters level clinicians in the home environment of the individual. Modality for therapeutic interventions determined by clinician and based on clients' individual needs and abilities. Skills assessments may be utilized to determine curriculum and programming. 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: 3-8 hours per week, based on individual needs and goals. Anticipated duration of service (i.e. 3-4 months): Minimum 12 weeks, based on individual need and goals. Three (3), or more, specific goals of the service (DO use bullet points): 1. Provide most accessible therapeutic level interventions in client home. 2. Individuals will engage in skill acquisition and therapy with opportunity to demonstrate and maintain skills in their home environment. 3. Individuals will reflect on and process stressors, traumatic experiences, and associated emotions and behaviors. 4. Individuals will develop and maintain self -care and coping practices. Three (3), or more, specific outcomes of service: 1. Increased ability to generalize and maintain learned skills over time in their home environments. 2. Reduce likelihood of out of home placement and court involvement for child protection concerns. 3. Reduce recidivism for child welfare contact and involvement. 4.06 Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, ages 0-100, individuals, dyads, or families 4.07 Languages service is available in (please list proficiency and if interpreter services are available): English and Arabic (proficient) — no interpreter services available Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 4.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: Part. 4.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Community, Client 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 Hourly Service Rates: Service #4 Service Type $ Amount Unit Type 4.10a In-Office/Video $ Per Hour 4.10b In Community $225 Per Hour -Home or 4.10c Service with Transportation Provided $ Select One 4.10d FTM, TDM, Prof. Staffing $225 Per Hour 4.10e No show $112 Per No Show 4.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 4.11g $ 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. Revised 12/3/2024 ADA 4.14 A dditoonal Comments Weld County Use Only Service #4 Initial Proposal ;'eterminatoon If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination Select One Date Comments• Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #5 Service Name: Home -Based Interventions (High) 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): Individual and / or family support, life skills, mentorship, and a variety of our services provided by bachelor level professionals in the home environment of the individual. Modality for interventions and supports determined by professional and based on clients' individual needs and abilities. Skills assessments may be utilized to determine curriculum and programming. 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: 3-6 hours per week 5.03 Anticipated duration of service (i.e. 3-4 months): Minimum 8 weeks, based on individual needs and goals. 5.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Provide most accessible therapeutic level interventions in client home. 2. Individuals will engage in skill acquisition and therapy with opportunity to demonstrate and maintain skills in their home environment. 3. Individuals will develop and maintain self -care and coping practices. 5.05 Three (3), or more, specific outcomes of service: 1. Increased ability to generalize and maintain learned skills over time in their home environments. 2. Reduce likelihood of out of home placement and court involvement for child protection concerns. 3. Reduce recidivism for child welfare contact and involvement. 5.06 Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, ages 0-100, individuals, dyads, or families 5.07 Languages service is available in (please list proficiency and if interpreter services are available): English and Spanish (proficient) - no interpreter services available 5.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: No. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 5.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Community, Client 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 5.10 • For monthly Service rates please complete section 5.11 • For Home Study Providers please complete section 5.12 • For monitored Sobriety Providers please complete section 5.13 5.10 Hourly Service Rates: Service #5 Service Type $ Amount Unit Type 5.10a In-OfficeNideo $ Per Hour 5.10b $165 Per Hour In -Home or Community 5.10c Service with Transportation Provided $ Select One 5.10d FTM, TDM, Prof. Staffing $165 Per Hour 5.10e No show $82 Per No Show 5.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 5.12 Home Study Providers - List your rates in the box below. 5.13 Monitored Sobriety Providers - List your rates in the box below. 5.14 Additional Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County Use Only Service #5: Initial Proposal Determination. If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination Select One Date. Comments' Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM fPlease complete the following: Number 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: Therapeutic 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. 1.01 1.02 1.03 1.04 (Please address each line item below using bulleted points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Approaches are highly individualized and dependent on the specific skill deficits and goals of the individual. May include but not limited to role play practice of skills, direct support, prompting and prompt fading strategies, naturalistic in -situation instruction. 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: M nimum 2 hours per week, 1-3 sessions depending on client needs. Anticipated duration of service (i.e. 3-4 months): Case specific — ranges for each case needs (i.e., 16 weeks to 52 weeks) Three (3), or more, specific goals of the service (DO use bullet points): 1. Provide skill acquisition training to individuals. 2. Provide safe therapeutic support in which clients social / emotional needs are respected and addressed in ways that will allow learning of skills and processing the emotions related to their challenges. 3. Individuals will increase their independence to the maximum potential possible for their abilities. 4. Individuals will secure and maintain resources that will allow them to meet their court ordered treatment goals. 5. Individuals will improve the quality of their relationships, develop leisure skills that are healthy and sustainable. 6. Successful mental health management during stressful or triggering life skill activities. 1.05 Three (3), or more, specific outcomes of service: 1. Successful reunification or other successful case closure. 2. Increased ability to access home and community resources. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 3. Increased independence and ability to establish and maintain meaningful healthy relationships. 4. Increased ability to identify and maintain healthy supports and leisure skills that contribute to stable and predictable parenting. 1.06 Target population of the service, including age and gender: Clients with various diagnosed or suspected disabilities, ages (any), individuals, dyads, or families. 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English and Arabic (proficient) — no interpreter services available 1.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Weld County DHS, Lifelong, Inc. offices, community, client's home, virtual 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 Per Type Episode 1.10a In-Office/Video $195 Select One 1.10b Community $225 In -Home or 1.10c Service with Transportation Provided $ Select One 1.10d FTM, TDM, Prof. Staffing $195 Per Hour 1.10e No show $98 Per No Show 1.10f Mileage rate"' $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ Revised 12/3/2024 ADA ATTACHMENT 2 -�ID FORM 111c $ 111d $ 111e - $ 1 11f $ 111g $ 111h $ 111i $ 111j $ 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 Weld County Use Only Service #1: Initial Proposal Determination: If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination: Select One Date: Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #2 Service Name: 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): Approaches are highly individualized and dependent on the specific skill deficits and goals of the individual. May include but not limited to role play practice of skills, direct support, prompting and prompt fading strategies, naturalistic in -situation instruction. 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: M nimum 2 hours per week, 1-3 sessions depending on client needs. 2.03 Anticipated duration of service (i.e. 3-4 months): Case specific — ranges for each case needs (i.e., 16 weeks to 52 weeks) 2.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Provide skill acquisition training to individuals. 2. Individuals will increase their independence to the maximum potential possible for their abilities 3. Individuals will secure and maintain resources that will allow them to meet their court ordered treatment goals. 2.05 Three (3), or more, specific outcomes of service: 1. Successful reunification or other successful case closure. 2. Increased ability to access home and community resources. 3. Increased independence and ability to establish and maintain meaningful healthy relationships. 4. Increased ability to identify and maintain healthy supports and leisure skills that contribute to stable and predictable parenting. 2.06 Target population of the service, including age and gender: Clients with various diagnosed or suspected disabilities, ages (any), individuals, dyads, or families. 2.07 Languages service is available in (please list proficiency and if interpreter services are available): Erglish and Spanish (proficient) — no interpreter services available 2.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM No. 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Weld County DHS, Lifelong, Inc. offices, community, client's home, virtual Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 2.10 • For monthly Service rates please complete section 2.11 • For Home Study Providers please complete section 2.12 • For monitored Sobriety Providers please complete section 2.13 2.10 Hourly Service Rates: Service #2 Service Type $ Amount Unit Type 2.10a In-OfficeNideo $135 Per Hour 2.10b In Community $165 -Home or Per Hour 2.10c Service with Transportation Provided $ Select One 2.10d $135 Per Hour FTM, TDM, Prof. Staffing 2.10e No show $68 Per No Show 2.10f Mileage rate* $ Per Mile * 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 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. Revised 12/3/2024 ADA . BM FORM Weld County Use Only Service #2: Initial Proposal Determination. If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination Select One Date Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #3 Service Name: Therapeutic Family Time 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 Scope of Work Please Note: If the service is a monthly package, different levels should be indicated. All monthly packages must state a specific minimum number of direct service hours. (Please address each line item below using bulleted points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Approaches are highly individualized and dependent on the specific skill deficits and goals of the individual regarding parenting needs, trauma responses, triggers, and other evidence - informed assessment and treatment approaches. May include but not limited to role play practice of parenting skills, direct support, prompting and prompt fading strategies, redirection, bonding, abuse intervening, structure, education, and repeat instruction. 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: As determined by team Anticipated duration of service (i.e. 3-4 months): As determined by team Three (3), or more, specific goals of the service (DO use bullet points): 1. Strengthen parent -child bond. 2. Assess for trauma responses. 3. Develop a family structure that is predictable, with protective parenting, and safe behaviors. Three (3), or more, specific outcomes of service: 1. Increased parenting time for the identified parent. 2. Increased independent parenting. 3. Increased structure during visitation. Target population of the service, including age and gender: Clients with various diagnosed or suspected disabilities, ages (any), individuals, dyads, or families. Languages service is available in (please list proficiency and if interpreter services are available): English and Arabic (proficient) — no interpreter services available Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No 3.09 Service location — list where the service will take place (Le. client's home, in -office, other): Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County DHS, Lifelong, Inc. offices, community, client's home, virtual 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 Service #3 Service Type $ Amount Unit Type 3.10a Hour In-Office/Video $195 Per 3.10b Hour Community $225 Per In -Home or 3.10c Service with Transportation Provided $ Select One 3.10d FTM, TDM, Prof. Staffing $195 Per Hour 3.10e No show $98 Per No Show 3.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 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 ATTACHMENT 2 -ID FORM Weld County Use Only Service #3. Initial Proposal Determination. If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination. Select One Date: Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #4 Service Name: Supervised Family Time 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 Scope of Work Please Note: If the service is a monthly package, different levels should be indicated. All monthly packages must state a specific minimum number of direct service hours. (Please address each line item below using bulleted points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Approaches are highly individualized and dependent on the specific skill deficits and goals of the individual regarding parenting needs, trauma responses, triggers, and other evidence - informed assessment and treatment approaches. May include but not limited to role play practice of parenting skills, direct support, prompting and prompt fading strategies, redirection, bonding, structure, education, and repeat instruction. 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: As determined by team. Anticipated duration of service (i.e. 3-4 months): As determined by team. Three (3), or more, specific goals of the service (DO use bullet points): 1. Strengthen parent -child bond. 2. Assess for triggers. 3. Develop a family structure that is predictable, with protective parenting, and safe behaviors. Three (3), or more, specific outcomes of service: 1. Increased parenting time for the identified parent. 2. Increased independent parenting. 3. Increased structure and initiative during visitation. Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, ages 0-100, individuals, dyads, or families Languages service is available in (please list proficiency and if interpreter services are available): English and Spanish (proficient) — no interpreter services available Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No Service location — list where the service will take place (i.e. client's home, in -office, other): Weld County DHS, Lifelong, Inc. offices, community, client's home, virtual 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 Service Type $ Amount Unit Type 4.10a In-OfficeNideo $135 Per Hour 4.10b Community $165 In -Home or Per Hour 4.10c $210 Service with Transportation Provided Per Hour 4.10d FTM, TDM, Prof. Staffing $135 Per Hour 4.10e No show $82 Per No Show 4.10f Mileage rate" $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. 4.11 Monthly Service Rates each level must be listedl: If aaalicable 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 FORM Weld County Use Oniv Service #4. Initial Proposal Determination: If Applicable, Select One Date. Reason for follows 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: If Applicable, Select One Final Proposal Determination: Select One Date: Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #5 Service Name: Specialized Mentorship 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): Based on intake assessment, modalities or curriculum may include but not limited to adventure based activities, participation and engagement in community activities, modeling, skill acquisition, role playing, and development of hobbies and interests. 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: At a minimum 2 hours per week. Typically up to 3 times per week. 5.03 Anticipated duration of service (i.e. 3-4 months): 6-12 months 5.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Provide a safe, stable, consistent connection to individuals. 2. Individuals will develop and maintain skills that promote stability, independence, and physical / mental wellbeing. 3. Individuals will develop and maintain healthy leisure skills and increase self-worth and self-confidence by reducing risk taking behavior, acting out, substance use, and negative self - statements. 5.05 Three (3), or more, specific outcomes of service: 1. Reduce future police contact or juvenile justice system involvement. 2. Maintain placement in home or current stable living situation. 3. Increase school attendance and completion. 4. Increase awareness of mental health and resources to secure supports necessary to maintain wellbeing. 5. Increase social / emotional skills and self -management. 6. Increase ability to advocate for self. 7. Increased communication skills. 8. Reduce symptoms of anxiety and depression. 9. Reduce self harm. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 5.06 Target population of the service, including age and gender: Youth ages 8 to 21 with or without suspected or diagnosed disability, criminal involvement, or child welfare involvement. 5.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 5.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No 5.09 Service location — list where the service will take place (i.e. client's home, in -office, other): We d County DHS, Lifelong, Inc. offices, community, client's home, virtual 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 $ Amount Unit Type Service Type 5.10a In-Office/Video $135 Per Hour 5.10b Community $165 Per Hour In -Home or 5.10c Service with Transportation Provided $210 Per Hour 5.10d $135 FTM, TDM, Prof. Staffing Per Hour 5.10e No show $82 Per No Show 5.10f Mileage rate"` $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 5.11i $ Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 5.11j $ 5.12 Home Study Providers - List your rates in the box below. 5.13 Monitored Sobriety Providers - List your rates in the box below. 5.14 Additional Comments: Revised 12/3/2024 ADA ATTACHMENT 2 Bl a FORM Weld County Use Only Service ##5 Initial Proposal Determination. If Applicable, Select -One 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: If Applicable, Select One Final Proposal Determination Select One Date Comments. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Please complete the following: Number 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: Mental Health Therapy - Individuals 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): CBT, DBT, TF-CBT, ABT, AAT, MFT, MI, ACT, IFT, IFS, etc. 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: Very case specific — some client or families will need 1 hour week, some will need 4, etc., depending on the severity of need/trauma/crisis. 1.03 Anticipated duration of service (i.e. 3-4 months): Very case specific with recommendations based on assessment, client goals, and abilities in addition to level of engagement. 1.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce and manage mental health triggers. 2. Reduce skill deficits within emotional regulation and coping practices. 3. Increase self-awareness and self -management skills. 4. Process traumatic experiences and develop understanding of their impact on current functioning and relationships. 5. Increase the ability of the client to identify emotional, mental, and physical needs and advocate for themselves. 1.05 Three (3), or more, specific outcomes of service: 1. Successful use of coping skills during day-to-day interactions, conflict or crisis. 2. Increased independence in accessing community activities, resources, and services. 3. Increased ability to demonstrate independent engagement in pro -social and safe leisure skills. 4. Ability to establish and maintain healthy and safe relationships. 5. Successful achievement of court recommended goals. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 6. Successful reunification or other successful case outcome. 1.06 Target population of the service, including age and gender: Clients with various diagnosed or suspected disabilities, ages (any), individuals, dyads, or families. 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English and Arabic (proficient) — no interpreter services available 1.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: YES. 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Weld County DHS, Lifelong, Inc. offices, community, client's home, virtual 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-OfficeNideo $195 Per Hour 1.10b In -Home or Community $225 Per Hour 1.10c Service with Transportation Provided $ Select One 1.10d $195 Per Hour FTM, TDM, Prof. Staffing 1.10e No show $98 Per No Show 1.10f Mileage rate"` $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 7s iD FORM 1 11f $ 1 11g $ 1 11h $ 1 11i $ 1 11j $ 1.12 Home Study Providers — List your rates in the box below 1 13 Monitored Sobriety Providers — Lest your rates in the box below. 1.14 Additional Comments Revised 12/3/2024 ADA ATTACHMENT 2 BBD F {RM Weld County Use Only Service #1• Initial Proposal Determination. If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination: Select One Date Comments" Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #2 Service Name: Mental Health Therapy - Family 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 b_ulleted points) 2.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): CBT, DBT, TF-CBT, ABT, AAT, MFT, MI, ACT, I FT, IFS, etc. 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: Very case specific — some client or families will need 1 hour week, some will need 4, etc., depending on the severity of need/trauma/crisis. 2.03 Anticipated duration of service (i.e. 3-4 months): Very case specific with recommendations based on assessment, client goals, and abilities in addition to level of engagement. 2.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce and manage mental health triggers. 2. Reduce skill deficits within emotional regulation and coping practices. 3. Increase self-awareness and self -management skills. 4. Process traumatic experiences and develop understanding of their impact on current functioning and relationships. 5. Increase the ability of the client to identify emotional, mental, and physical needs and advocate for themselves. 2.05 Three (3), or more, specific outcomes of service: 1. Successful use of coping skills during day-to-day interactions, conflict or crisis. 2. Increased independence in accessing community activities, resources, and services. 3. Increased ability to demonstrate independent engagement in pro -social and safe leisure skills. 4. Ability to establish and maintain healthy and safe relationships. 5. Successful achievement of court recommended goals. 6. Successful reunification or other successful case outcome. 2.06 Target population of the service, including age and gender: Clients with various diagnosed or suspected disabilities, ages (any), individuals, dyads, or families. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2.07 Languages service is available in (please list proficiency and if interpreter services are available): English and Arabic (proficient) - no interpreter services available 2.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: YES. 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Weld County DHS, Lifelong, Inc. offices, community, client's home, virtual Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 2.10 • For monthly Service rates please complete section 2.11 • For Home Study Providers please complete section 2.12 • For monitored Sobriety Providers please complete section 2.13 2.10 Hourly Service Rates: Service #2 Service Type $ Amount Unit Type 2.10a In-Office/Video $225 Per Hour 2.10b In Community $255 Per Hour -Home or 2.10c Service with Transportation Provided $ Select One 2.10d FTM, TDM, Prof. Staffing $225 Per Hour 2.10e No show $112 Per No Show 2.10f Mileage rate* $ Per Mile * 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 -- $ - 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. Revised ' 2/3/2024 ADA ATTACHMENT 2 DID FORD Meld County Use Only Service #2 Initial Proposal Determination: If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination* Select One Date. Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #3 Service Name: Psychological Evaluation 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): Diagnostic tools, screeners, and assessments as determined by psychologist. 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: 10-12 hours total including report preparation and feedback session. 3.03 Anticipated duration of service (i.e. 3-4 months): 1-3 appointments 3.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Generate accurate assessment of clients' diagnosis, strengths, needs, and areas of skill deficits. 2. Generate a complete report of specialized recommendations for treatment and services tailored to the social/emotional, mental health, and learning needs of the individual. 3. Identify and determine course of treatment, treatment goals, and modality that is best suited for the individual. 3.05 Three (3), or more, specific outcomes of service: Evaluation will provide data, summary, and outcome suggestions for client's learning, developmental, and mental health needs. 3.06 Target population of the service, including age and gender: Clients age 4-100 . 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 3.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No. 3.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices 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, 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 $2450 Per Episode 3.10b In -Home or Community $ Select One 3.10c Service with Transportation Provided $ Select One 3.10d $250 Per Hour FTM, TDM, Prof. Staffing 3.10e No show $250 Per No Show 3.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 3.11b $ 3.11c $ 3.11d $ 3.11e $ 3.11f $ 3.11g $ 3.11h $ 3.11i $ 3.11j $ 3.12 Home Study Providers - List your rates in the box below. 3.13 Monitored Sobriety Providers — List your rates in the box below. 3.14 Additional Comments: Partial Evaluation - $1225 Revised 12/3/2024 ADA ATTACHMENT 2 BAD FOR� Weld County Use Only Service #3 Initial Proposal Determination. If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination Select One Date: Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #4 Service Name: Neuropsychological Evaluation 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): Diagnostic tools, testing, screeners, and assessments as determined by the psychologist. 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: 10-15 hours total for testing and interview 4.03 Anticipated duration of service (i.e. 3-4 months): 1-3 appointments 4.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Assess clients' strengths and areas of skill deficits. 2. Conduct neuropsychological testing as prescribed. 3. Accurately test clients' current functioning and gather full history of the whole person. 4. Generate tailored recommendations for specialized services and modalities that will best support the client. 4.05 Three (3), or more, specific outcomes of service: 1. Accurate holistic understanding of client needs, diagnosis, and abilities. 2. Recommendations for specialized services. 3. Individualized and thorough report. 4.06 Target population of the service, including age and gender: Clients age 4-100 4.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 4.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: No. 4.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices 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 Service Type . $ Amount Unit Type 4.10a In-OfficeNideo $3350 Per Episode 4.10b Community $ Per Hour In -Home or 4.10c Service with Transportation Provided $ Per Hour 4.10d FTM, TDM, Prof. Staffing $250 Per Hour 4.10e No show $250 Per No Show 4.10f Mileage rate'` $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 4.11g $ 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: Partial Evaluation - $1675 Revised 12/3/2024 ADA ATTACHMENT 2 it, Weld County Use Only ID FORM Service #4 Initial Proposal Determination. If Applicable, Select One 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" If Applicable, Select One Final Proposal Determination: Select One Date. Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service tt5 Service Name: Diagnostic Evaluation (Autism Evaluation) 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): The diagnostic evaluation consists of systematic observations, assessments, collateral documentation review, and testing that will yield evidence to support a diagnosis of an autism spectrum diagnose or another disorder. 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: 10-15 hours of observation, interviewing, testing and collateral review. 5.03 Anticipated duration of service (i.e. 3-4 months): 1-3 appointments 5.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Obtain or rule out a diagnosis of a developmental disorder. 2. Procure a thorough assessment of where a child falls along the Autism Spectrum. 3. Gain an understanding of a child's intellectual potential. 5.05 Three (3), or more, specific outcomes of service: 1. Provide a treatment and education plan specifically geared towards the child's needs. 2. Provide education and resources to those providing care for the child. 3. Identify and connect the family with specialized support services and treatment options. 5.06 Target population of the service, including age and gender: Ages 4-100 with suspected developmental disabilities or Autism Spectrum Disorder. 5.07 Languages service is available in (please list proficiency and if interpreter services are available): English - no interpreter services available 5.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: No 5.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices 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 Hours Service Rates: Service #5 Service Type $ Amount Unit Type 5.10a In-Office/Video $3350 Per Episode 5.10b In -Home or Community $ Per Hour 5.10c $ Service with Transportation Provided Per Hour 5.10d $250 Per Hour FTM, TDM, Prof. Staffing 5.10e No show $250 Per No Show 5.10f Mileage rate'` $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 5.12 Home Study Providers - List your rates in the box below. 5.13 Monitored Sobriety Providers — List your rates in the box below. 5.14 Additional Comments: Partial Evaluation - $1675 Revised 12/3/2024 ADA ATTACHMENT 2 AD Fo RM Weld County Use Only Service #5• Initial Proposal Determination. If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination Select One Date' Comments' Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Please complete the following: Number 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: Parent Child Interaction Assessment (including Sibling Interaction Assessment and Caregiver Child Interaction Assessment) 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): Parent child interaction assessment utilizes prescribed evidence based tools, observation techniques, and structured play scenarios based on the assessors training and current research. 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: 2-3 hours of direct observation plus interviews and collateral documentation review 1.03 Anticipated duration of service (i.e. 3-4 months): 10-12 hours including report preparation and feedback session. 1.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Gather data about parental attunement, attachment, relationship dynamics between parent and child. 2. Identify harmful or dysfunctional parenting attributes. 3. Present a thorough representation of the parent child relationship. 1.05 Three (3), or more, specific outcomes of service: 1. Generate specialized recommendations for therapeutic supports to improve the quality of the parent / child relationship. 2. Reduce the likelihood of future child welfare contact. 3. Predict likelihood of potential for future abuse and neglect. 1.06 Target population of the service, including age and gender: Individuals with various diagnosed or suspected intellectual/developmental disabilities, individuals, dyads, and families. 1.07 Languages service is available in (please list proficiency and if interpreter services are available): Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM English — no interpreter services available 1.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No. 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices 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 $2750 Per Episode Community $ Select One 1.10b In -Home or 1.10c Service with Transportation Provided $ Select One $250 1.10d FTM, TDM, Prof. Staffing Per Hour 1.10e No show $250 Per No Show 1.10f Mileage rate* $ Per Mile '' If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. 1.11 Monthly Service Rates each level must be listed): If applicable Name with Level Rate Month per Minimum of Service: Hours Service 1.11a $ 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. Revised 12/3/2024 ADA ATTACHMENT 2 BIEI FORM 1.13 Monitored Sobriety Providers — List your rates in the, box below. 1.14 Additional Comments:, Partial Evaluation - $1375 Revised 12/3/2024 ADA ATTACHMENT 2 BIB? FOR�'�, Weld County Use Only Service #1 Initial Proposal Determination: If Applicable, Select One 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 If Applicable, Select One Final Proposal Determination Select One Date Comments. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #2 Service Name: Mental Heath Services Intake (see notes) 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): Clinical Interview to include based on clinical assessment, need, or referral reason: ACE, BRS, OSU-TBI, DSM-V, TSI, mental status exam, and others as determined during interview. 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: 2-3 hours 2.03 Anticipated duration of service (i.e. 3-4 months): 1-2 appointments 2.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Intake client for mental health treatment enrollment. 2. Identify individuals' current mental functioning and mental health diagnosis if indicated. 3. Assist individual in identifying areas of strength and need with regard to their mental / emotional health. 2.05 Three (3), or more, specific outcomes of service: 1. Mental Health Treatment services begin. 2.06 Target population of the service, including age and gender: Individuals with various diagnosed or suspected intellectual/developmental disabilities, ages 6- 100, exhibiting challenges with mental or behavioral health. 2.07 Languages service is available in (please list proficiency and if interpreter services are available): English and Arabic (proficient) — no interpreter services available 2.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: Yes 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Weld County DHS, Lifelong, Inc. offices, community, client's home, virtual 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, 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 In-Office/Video $500 Per Episode Per Episode 2.10b Community $625 In -Home or 2.10c Service with Transportation Provided $ Select One 2.10d FTM, TDM, Prof. Staffing $195 Per Hour 2.10e No show $195 Per No Show 2.10f Mileage rate* $ Per Mile * 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 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: This intake is for the following group and individual services: 1) Mental Health Individual Therapy, including: DBT, CBT, ACT, Veterans, Trauma Processing, and others. 2) Mental Health Group Therapies, including: DBT, CBT, ACT, Veterans, Trauma Processing, and others. 3) Mental Health Family Therapy Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County Use Only Service #2: Initial Proposal Determination: If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination: Select One Date: Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #3 Service Name: Mental Health Evaluation 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 eachaine item below using bull_eted_points) 3.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Clinical Interview, ACE, BRS, OSU-TBI, DSM-V, MMPI, TSI, mental status exam, or others as determined during interview. 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: 3-5 hours 3.03 Anticipated duration of service (i.e. 3-4 months): 1-2 appointments 3.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Conduct a thorough assessment of individuals' mental status, social / emotional skills and deficits, and adaptive functioning. 2. Identify individuals' current mental functioning and mental health diagnosis if indicated. 3. Assist individual in identifying areas of strength and need with regard to their mental / emotional health. 3.05 Three (3), or more, specific outcomes of service: 1. Provide client and authorized service providers with a comprehensive assessment summary. 2. Provide client and authorized service providers with specialized treatment recommendations for modalities and treatment options that are most effective for client's abilities and needs. 3. Provide psychoeducation to the client and/ or guardian regarding client's mental status, symptomology, and diagnosis. 4. Connect client with resources which can meet their needs. 3.06 Target population of the service, including age and gender: Individuals with various diagnosed or suspected intellectual/developmental disabilities, ages 6-100, exhibiting challenges with mental or behavioral health. 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 3.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: No. 3.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices or virtual when indicated 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-OfficeNideo $925 Per Episode 3.10b Community $ Select One In -Home or 3.10c $ Select One Service with Transportation Provided 3.10d FTM, TDM, Prof. Staffing $250 Per Hour 3.10e No show $250 Per No Show 3.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 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. Revised 12/3/2024 ADA ATTACHMENT 2 Eli's FORM 3.14 Additional Comments* !Meld County Use Only Service #3 Initial Proposal Determination' If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination• Select One Date. Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM complete the following: Number of services offered on this Attachment 2 (max 5): 5 You may complete another Attachment 2 if you have more than 5 services. Service Name: Case Consultation 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): Case consult, document review, etc. 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: As needed 1.03 Anticipated duration of service (i.e. 3-4 months): As needed 1.04 Three (3), or more, specific goals of the service (DO use bullet points): Identify correct course for client treatment, needs, and dynamics. 1.05 Three (3), or more, specific outcomes of service: Successful direction achieved. 1.06 Target population of the service, including age and gender: Any 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 1.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: No 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Virtual 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 Hourlv Service Rates: Service #1 Service Type $ Amount Unit Type 1.10a In-Office/Video $195 Hour Per 1.10b In -Home or Community $ Select One 1.10c Service with Transportation Provided $ Select One 1.10d FTM, TDM, Prof. Staffing $195 Per Hour 1.10e No show $195 Per No Show 1.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. 1.11 Monthlv Service Rates each level must be listed): If applicable Service Name with Level per Minimum of Service: Hours Rate Month 1.11a $ 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 BAD FORM Weld County Use Only Service #1 Initial Proposal Determination: If Applicable, Select One 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' If Applicable, Select One Final Proposal Determination: Select One Date: Comments. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #2 Service Name: SeCurus, iWeb, Virtual Fees 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. 2.01 2.02 (Please address eact,e item below using bulleted points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Fees required during virtual sessions for clients experiencing incarceration 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: as needed for services 2.03 Anticipated duration of service (i.e. 3-4 months): as needed for services 2.04 Three (3), or more, specific goals of the service (DO use bullet points): Facility fees related to professionals being able to access clients experiencing incarceration 2.05 Three (3), or more, specific outcomes of service: Facility fees related to professionals being able to access clients experiencing incarceration 2.06 Target population of the service, including age and gender: clients incarcerated 2.07 Languages service is available in (please list proficiency and if interpreter services are available): n/a 2.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: No. 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): incarceration facilities 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 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2.10 Hourly Service Rates: Service #2 Service Type $ Amount Unit Type 2.10a In-Office/Video $20 Per Episode 2.10b In $ Select One -Home or Community 2.10c $ Select One Service with Transportation Provided 2.10d FTM, TDM, Prof. Staffing $ Per Hour 2.10e No show $20 Per No Show 2.10f Mileage rate* $ Per Mile * 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 Rate Month per Minimum of Service: Hours 2.11a - $ 2.11b $ 2.11c $ 2.11d $ 2.11e $ 2.11f $ 2.119 $ 2.11h $ 2.111 $ 2.11 $ 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 ATTACHMENT 2 BID FORM Weld County Use Only Service #2: Initial Proposal Determination: If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination: Select One Date' Comments: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #4 Service Name: Domestic Violence Case 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.) 4.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Due to abundance of adminstrative, risk reduction, and monitoring requirements for Domestic Violence Treatment Services, this fee is required. 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: Duration of DV Treatment 4.03 Anticipated duration of service (i.e. 3-4 months): Duration of DV Treatment 4.04 Three (3), or more, specific goals of the service (DO use bullet points): Due to abundance of adminstrative, risk reduction, and monitoring requirements for Domestic Violence Treatment Services, this fee is required. 4.05 Three (3), or more, specific outcomes of service: Due to abundance of adminstrative, risk reduction, and monitoring requirements for Domestic Violence Treatment Services, this fee is required. 4.06 Target population of the service, including age and gender: Persons using abuse. 4.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 4.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No. 4.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices 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 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM • For monthly Service rates please complete section 4.11 • For Home Study Providers please complete section 4.12 • For monitored Sobriety Providers please complete section 4.13 4.10 Hourly Service Rates: Service #4 Service Type $ Amount Unit Type 4.10a In-OfficeNideo $250 Per Episode 4.10b In -Home or Community $ Per Hour 4.10c Service with Transportation Provided $ Per Hour 4.10d FTM, TDM, Prof. Staffing $ Per Hour 4.10e No show $ Per No Show 4.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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: This is a one time fee only. Revised 12/3/2024 ADA ATTACHMENT 2 0D FORM a Weld County Use Only Service #4• Initial Proposal Determination" If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination. Select One Date Comments" Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #5 Service Name: Victim Advocate Case 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. 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 (Please address each line item below using bulleted points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Due to abundance of adminstrative, risk reduction, and monitoring requirements for Domestic Violence Treatment Services, this fee is required for support by the Victim Advocate to survivors. 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: Duration of DV Treatment Anticipated duration of service (i.e. 3-4 months): Duration of DV Treatment Three (3), or more, specific goals of the service (DO use bullet points): Due to abundance of adminstrative, risk reduction, and monitoring requirements for Domestic Violence Treatment Services, this fee is required for support by the Victim Advocate to survivors. Three (3), or more, specific outcomes of service: Due to abundance of adminstrative, risk reduction, and monitoring requirements for Domestic Violence Treatment Services, this fee is required for support by the Victim Advocate to survivors. Target population of the service, including age and gender: Victim -Survivors Languages service is available in (please list proficiency and if interpreter services are available): Erglish — no interpreter services available Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: No Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. 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, 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 $ Amount Unit Type Service Type 5.10a In-OfficeNideo $250 Per Episode 5.10b $ Per Hour In -Home or Community 5.10c Service with Transportation Provided $ Per Hour 5.10d FTM, TDM, Prof. Staffing $ Per Hour 5.10e No show $ Per No Show 5.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 5.11i $ 5.11j $ 5.12 Home Study Providers - List your rates in the box below. 5.13 Monitored Sobriety Providers - List your rates in the box below. 5.14 Additional Comments: This is a one time fee only. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld Countv Use Onlv Service #5: Initial Proposal Determination: If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination: Select One Comments: Date: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Please complete the following: Number 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: Applied Behavior Analysis 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): • Applied Behavior Analysis as primary modality • Trauma —informed • Assessments including but not limited to: FBA (Functional Behavior Assessment), FAST (Functional Assessment Screening Tools), Functional Analysis (only when clinically indicated), skills assessments, adaptive functioning scales, Vineland III, developmental assessments, Autism screening tools, VBMAPP (Verbal Behavior Milestones Assessment and Placement Program), ABLLS (Assessment of Basic Language and Living Skills), AFLS (Assessment of functional living skills), EFLS (Essentials for Living). • All assessments are used to allocate baseline data, identify skill deficits and drive curriculum for treatment goals. • Assessment is ongoing and all treatment decisions are driven by data collected in every session reflecting progress on each goal and behavior. 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: Applied Behavior Analysis (ABA) is highly depending on a thorough individualized assessment and recommendations can range from 1 to 40 hours per week of treatment. 1.03 Anticipated duration of service (i.e. 3-4 months): ABA services can range from short term focused treatment for 6 months or less, to several years or lifelong supports depending on the individual's needs and abilities. 1.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Identify skill deficits and develop skill acquisition programming to be taught using the principles of ABA. 2. Mediate and reduce the negative effects of challenging behaviors on the individual and caregivers. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 3. Develop and implement behavior intervention strategies to reduce behaviors targeted for reduction. 4. Conduct ongoing parent / caregiver required training on skill teaching and behavior intervention strategies using atrauma-informed / preventative approach. 1.05 Three (3), or more, specific outcomes of service: 1. Prevent or reduce behaviors that put individuals or their caregivers / family members at risk of harm. 2. Prevent or reduce behaviors that limit an individual's ability to access their home, school, community, and establish and maintain meaningful relationships. 3. Increase communication and social skills. 4. Increase independence to the highest level possible and establish skills that contribute to mental and physical health and hygiene. 1.06 Target population of the service, including age and gender: All ages, genders, abilities and diagnoses. Unless clinically contraindicated or involves a symptomology that requires medical intervention as the primary treatment. 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English and Arabic (proficient) — no interpreter services available 1.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: YES- qualified individuals may access ABA via Medicaid through EPSDT with a doctor's referral prescribing ABA as a medically necessary treatment for individuals' specific diagnosis. Individuals can only access private insurance for ABA funding if they carry an Autism Spectrum Disorder Diagnosis. 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Weld County DHS, Lifelong, Inc. offices, community, client's home (within catchment area), virtual 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 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 1.10 Hourlv Service Rates: Service #1 Service Type $ Amount Unit Type 1.10a In-Office/Video ' $195 Per Hour 1.10b In $225 Per Hour -Home or Community 1.10c Service with Transportation Provided $ Select One $195 Per 1.10d FTM, TDM, Prof. Staffing Hour 1.10e No show $98 Per No Show 1.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after Insert Number of miles) 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 $ 1.11g $ 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 L., !!tl'eld County Use Only ft:1)F NI Service #1. Initial Proposal Determination. If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination. Select One Date Comments Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #3 Service Name: Trauma Processing Group 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. (Plpas..e address each line item below using bulleted points) 3.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Trauma informed approaches and materials, depression and anxiety scales, PTSD assessments as prescribed by the group facilitators as needed. 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: One time per week for 1-2 hours 3.03 Anticipated duration of service (i.e. 3-4 months): 3-6 months 3.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Provide a safe setting for individuals who have been assessed and identified as a candidate for which group processing may be beneficial. 2. Facilitate the development of a supportive working group in which individuals can share, relate to others and process traumatic experiences. 3. Provide psychoeducation to group members to promote skill development for management of symptoms of Post -Traumatic Stress Disorder and other trauma related behaviors and symptomology. 3.05 Three (3), or more, specific outcomes of service: 1. Individuals access opportunities to process trauma and begin a healing process in a safe and supportive group that is goal oriented and facilitated. 2. Individuals demonstrate the ability to establish and maintain self -care and coping practices while sharing connection and accountability with their group peers. 3. Individuals experience safety and acceptance that allows for integration of skills and mental health treatment. 3.06 Target population of the service, including age and gender: Youth and adults that have been assessed and identified as a candidate for group processing. 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 3.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: YES Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 3.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Weld County DHS, Lifelong, Inc. offices, virtual 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 $90 Per Episode 3.10b In -Home or Community $ Select One 3.10c $ Select One Service with Transportation Provided 3.10d FTM, TDM, Prof. Staffing $195 Per Hour 3.10e No show $45 Per No Show 3.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 3.11b $ 3.11c $ 3.11d $ 3.11e $ 3.11f $ 3.11g $ 3.11h $ 3.11i $ 3.11j $ 3.12 Home Study Providers - List your rates in the box below. 3.13 Monitored Sobriety Providers - List your rates in the box below. 3.14 Additional Comments: Revised 12/3/2024 ADA ATTACHMENT 2 RID FORM Weld County Use Only Service #3: Initial Proposal Determination' If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination' Select One Date: Comments' Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #4 Service Name: Social Skills Group 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): Social skills checklists are utilized to assess skills and identify pairs of groups of individuals who would work effectively together on mutual goals that are appropriate for their age and development. 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: Social Skills Group held 1-2 times per week for 1 or more hours depending on size of group and abilities. 4.03 Anticipated duration of service (i.e. 3-4 months): 8 weeks per cohort 4.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Identify individuals who could benefit from facilitated social skills practice in a group setting. 2. Provide safe, monitored, and facilitated activities that support individuals' social skills practice in a group setting. 3. Provide peer modeling opportunities for individuals with social skills deficits. 4. Promote the development of necessary social skills and safe ways to connect and interact with peers. 4.05 Three (3), or more, specific outcomes of service: 1. Increase clients' access to safe opportunities to practice social skills and develop meaningful relationships. 2. Increase clients' ability to generalize social skills to new individuals in a new setting. 3. Increase the connections and opportunities to create a community for individuals with intellectual disabilities. 4.06 Target population of the service, including age and gender: Children and adults with specialized social needs, on the Autism Spectrum , with intellectual disability or traumatic brain injury. 4.07 Languages service is available in (please list proficiency and if interpreter services are available): English and Arabic (proficient) — no interpreter services available Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 4.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: No 4.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Weld County DHS, Lifelong, Inc. offices, virtual 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 Type $ Amount Unit Type 4.10a In-Office/Video $90 Per Episode 4.10b In -Home or Community $ Select One 4.10c Service with Transportation Provided $ Select One 4.10d $195 Per Hour FTM, TDM, Prof. Staffing 4.10e No show $45 Per No Show 4.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 4.119 $ 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. Revised 12/3/2024 ADA ATTACHMENT 2 I® Fit"NI 4.14 additional Comments !field County Use Only Service #4: Initial Proposal Determination If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination Select One Date Comments. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #5 Service Name: Mental Health Therapy Groups 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. 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 (Please address each line .item below using bind points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): CBT, DBT, TF-CBT, ABT, AAT, MFT, MI, ACT, IFT, IFS, etc. 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: Case specific — some client or families will need 1 group/week, some will need 2, etc., depending on the severity of need/trauma/crisis. Anticipated duration of service (i.e. 3-4 months): Very case specific with recommendations based on assessment, client goals, and abilities in addition to level of engagement. Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce and manage mental health triggers. 2. Reduce skill deficits within emotional regulation and coping practices. 3. Increase self-awareness and self -management skills. 4. Process traumatic experiences and develop understanding of their impact on current functioning and relationships. 5. Increase the ability of the client to identify emotional, mental, and physical needs and advocate for themselves. Three (3), or more, specific outcomes of service: 1. Successful use of coping skills during day-to-day interactions, conflict or crisis. 2. Increased independence in accessing community activities, resources, and services. 3. Increased ability to demonstrate independent engagement in pro -social and safe leisure skills. 4. Ability to establish and maintain healthy and safe relationships. 5. Successful achievement of court recommended goals. Target population of the service, including age and gender: Clients with various diagnosed or suspected disabilities, ages (any), individuals, dyads, or families. Languages service is available in (please list proficiency and if interpreter services are available): English - no interpreter services available Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: YES Service location — list where the service will take place (i.e. client's home, in -office, other): Lifelong, Inc. offices, virtual 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 Hourly Service Rates: Service #5 Service Type $ Amount Unit Type 5.10a In-Office/Video $90 Per Episode Community $ Select One 5.10b In -Home or 5.10c Service with Transportation Provided $ Select One 5.10d FTM, TDM, Prof. Staffing $195 Per Hour 5.10e No show $45 Per No Show 5.10f Mileage rate'` $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 5.12 Home Study Providers - List your rates in the box below. 5.13 Monitored Sobriety Providers — List your rates in the box below. 5.14 Additional Comments: Groups include: DBT, ACT, Veterans, Women's Specific, Trauma Processing, Foundation for Family Safety, Building Treatment Pathways, Parenting, and others as added based on referring need. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County Use Only Service #5' Initial Proposal Determination. If Applicable, Select One 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: If Applicable, Select One Final Proposal Determination Select One Date. Comments. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Please complete the following: Number 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 Service Name: Reintegration Therapy 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. 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 (Please address each line item below using bulleted points) Modalities, curriculum, tools used in delivery of service (DO NOT list company history): • Curriculum and Assessment driven, child led as best practice, cannot be ordered for completion if contraindicated based on ongoing clinical assessment during services. Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1-2 times per week Anticipated duration of service (i.e. 3-4 months): 3 months or less. Three (3), or more, specific goals of the service (DO use bullet points): 1. Reestablish healthy relationship between parent and child. 2. Establish sustained feelings of safety of child when with caregiver. 3. Parenting skill development through attachment building efforts. Three (3), or more, specific outcomes of service: 1. Reintegration of children) with caregiver(s). 2. Ceasing reintegration efforts based on children) outcomes and impact. Target population of the service, including age and gender: All ages, genders, abilities and diagnoses. Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No 1.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County DHS, Lifelong, Inc. offices, community, client's home (within catchment area), virtual 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 $225 Per Hour 1.10b In $255 Per Hour -Home or Community 1.10c $ Select One Service with Transportation Provided 1.10d FTM, TDM, Prof. Staffing $225 Per Hour 1.10e No show $112 Per No Show 1.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) 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 $ 1.11g $ 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 jID FORM Weld County Use Only Service #1 Initial Proposal Determination If Applicable, Select One 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. If Applicable, Select One Final Proposal Determination Select One Date Comments. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #2 Service Name: Case Coordination for Securus/iWebNirtual Fees 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): Due to abundance of adminstrative, communication, and ongoing effort to obtain permission for client to receive Securus permissions, this fee is required at the service 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: U ntil permissions granted from facility. 2.03 Anticipated duration of service (i.e. 3-4 months): U ntil permissions granted from facility. 2.04 Three (3), or more, specific goals of the service (DO use bullet points): Due to abundance of adminstrative, communication, and ongoing effort to obtain permission for client to receive Securus permissions, this fee is required at the service rate requested. 2.05 Three (3), or more, specific outcomes of service: Due to abundance of adminstrative, communication, and ongoing effort to obtain permission for client to receive Securus permissions, this fee is required at the service rate requested. 2.06 Target population of the service, including age and gender: Persons experiencing incarceration. 2.07 Languages service is available in (please list proficiency and if interpreter services are available): English — no interpreter services available 2.08 Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: N o 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Incarceration Facility. 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 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM • For monthly Service rates please complete section 2.11 • For Home Study Providers please complete section 2.12 • For monitored Sobriety Providers please complete section 2.13 2.10 Hourly Service Rates: Service #2 Service Type $ Amount Unit Type 2.10a In-Office/Video $195 Per Hour 2.10b In -Home or Community $ Per Hour 2.10c Service with Transportation Provided $ Hour Per 2.10d FTM, TDM, Prof. Staffing $195 Per Hour 2.10e No show $98 Per No Show 2.10f Mileage rate* $ Per Mile '' 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 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: Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Weld County Use Only Service #2' Initial Proposal Determination: If Applicable, Select One Date: Reason for follow up or negotiation' List specific itemfs) 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 3 WELD COUNTY DEPARTMENT OF HUMAN SERVICES PROVIDER INFORMATION FORM (PIF) Agency Information: As listed on W-9 Agency Name: Lifelong, Inc. Trails Provider ID (if known): 1527845 Provider Contact Full Name: Erika S p r a k e r Title: Executive Director Primary Phone Number (10 -digit): (303)573-0839 Ext.: Primary Contact Email: Erika@lifelonginc.com Agency Location Address (Street, city, state, zip): 7 5 0 W . Hampden Avenue , Suite 450, Englewood, CO 801 1 0 Agency Mailing Address (Street, city, state, zip): 7 5 0 W . Hampden Avenue , Suite 450, Englewood, CO 801 1 0 Agency Type: Private for Profit Send Referrals for Service to: Referral Contact Name: Ellie Shepard Title: Referral Coordinator Referral Phone Number (10 -digit): (303)591-0617 Ext.: Email: referralsalifelonainc.com Billing Contact: Billing Contact Name: J a n e e n Puckett Title: Billing Specialist Billing Phone Number (10 -digit): (303)573-0839 Ext.: Email: Janeen@lifelonginc.com 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: Erika Spraker Lifelong, Inc. PHONE NUMBER: (303)573-0839 EMAIL: Erika@Lifelonginc.com PROPOSED SERVICE(S): Anger Management/Domestic Violence Services, Foster Parent Consultation, Foster Parent Training, Home Based intervention, Aftercare Services, Kinship Services (Therapeutic), Life Skills, Mental Health Services, Substance Abuse Treatment Services Legal Last Name Middle Initial Previous Legal Last Name (if _applicable) Legal First Name Service Type Lieensure/ Credentials DORA # (If applicable) Spraker Erika Various LCSW, CAT 9930521, 8035 Spraker Lindsey Various LCSW 2081 Bryne Camryn Various CAS 21020 Fann Jessica Various NLC, TVA 105704 Jorden Jeffrey Various LPC 13469 Murphy Brandon Various LSW, CAT 9925321, 21268 Wilcox Alexa Various LPC 14456 Owen Jesse Various PhD 4340 Quirk Kelley Various PhD 4510 Salisbury Raimee Various BS, TVA Shepard Ellie Various SWC 669 Edwards Amanda Various LSW 9925437 Gutierrez Stephanie Various BS Pallarca Danielle Various SWC 2277 Sydorenko Danielle Various MSW Caraveo Journey Various BS Abda Hesham Various PhD SpEd, LPCC 20531 Puckett Janeen Biller Carter Jessica Office Manager BA Brinker Eric Various BA, MSW Candidate Sekyra Regina Various MA CHILD WELFARE INVITATION FOR BID 2025-26 - VARIOUS SERVICES ACCD aF CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 6/25/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Flood and Peterson PO Box 578 Greeley CO 80632 NAMEACT Allyson Ingram (aa°NN Ext1: (970)356-0123 I(C, No): (970)330-1867 &MAIL SS:AllysonI@FPINSURANCE.COM ADDRE INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : IrWin Siegel Agency Inc. INSURED Lifelong, Inc. 750 W. Hampden Avenue #450 Englewood CO 80110 msuRERB:Berkshire Hathaway Specialty Insurance 22276 INSURER C:Pinnacol Assurance 41190 INSURER D:COalition Insurance Company INSURER E : INSURER F: CERTIFICATE NUMBER:2024-2025 Master 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 AMY 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 TNT OF INSURANCE ADM SUBR INSD WVD POLICY NUMBER POLICY EFF (MMIDDIYYYYI (MM/DDIYx Amax umms A X COMMERCIAL GENERAL LIABILITY I CLAIMS -MADE El OCCUR X Prof. Liability $1101/$3t. 47SPK26317702 7/1/2024 7/1/2025 EACH OCCURRENCE $ 1,000,000 DAMAGETORENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5, 000 PERSONAL BADV INJURY $ 1,000,000 X Sex Abuse $500K/$11e4 GENERAL AGGREGATE $ 3,000,000 GEN'LAGGREGATE LIMITAPPLIESPER: X POLICY JEa LOC OTHER: PRODUCTS - COMP/OPAGG $ 3,000,000 $ B AUTOMOBILE LIABILITY _ ANY AUTO ALL OWNED _ AUTOS X HIRED AUTOS SCHEDULED _ AUTOS NON -OWNED X AUTOS 47RWS26317802 7/1/2024 7/1/2025 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peraccidentl $ Term sm $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED I I RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPR IVBCE' PARTNER/EXECUTIVE ❑ OFFICEtoryin H)EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A 4193499 7/1/2024 7/1/2025 X I STATUTE I I ERH E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 D E Cyber Liability Employee DRshonesty C-4LRV-121171-CYBER-2024 PHSD1863125 7/1/2024 4/17/2024 7/1/2025 4/17/2025 Limit $2,000,000 Limit $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Board of County Commissioners of Weld County and its Officers/Employees are listed as additional insured with regards to Commercial General Liability. CERTIFICATE HOLDER CANCELLATION Weld County 1150 O St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Greeley, CO 80631 AUTHORIZED REPRESENTATIVE I Allyson Ingram/AXI ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD t SIGNATURE REQUESTED: Weld/Lifelong PSA Final Audit Report 2025-06-09 Created: 2025-06-09 By: Windy Luna (wluna@weld.gov) Status: Signed Transaction ID: CBJCHBCAABAAA-1kjk781FIDXjicEPgtllcVofTwl1wX "SIGNATURE REQUESTED: Weld/Lifelong PSA" History t Document created by Windy Luna (wluna@weld.gov) 2025-06-09 - 2:39:09 PM GMT- IP address: 204.133.39.9 C.. Document emailed to Erika Spraker (erika@lifelonginc.com) for signature 2025-06-09 - 2:40:57 PM GMT t Email viewed by Erika Spraker (erika@lifelonginc.com) 2025-06-09 - 6:51:59 PM GMT- IP address: 73.34.187.198 rse Document e -signed by Erika Spraker (erika@lifelonginc.com) Signature Date: 2025-06-09 - 6:53:15 PM GMT - Time Source: server- IP address: 73.34.187.198 O Agreement completed. 2025-06-09 - 6:53:15 PM GMT Powered by Adobe Acrobat Sign Entity Information Entity Name* LIFELONG INC Entity ID* @00045085 Contract Name* LIFELONG INC. (PROFESSIONAL SERVICES AGREEMENT RELATED TO BID #B2500040) Contract Status CTB REVIEW Q New Entity? Contract ID 9567 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) LIFELONG INC. - PROFESSIONAL SERVICES AGREEMENT RELATED TO BID #B2500040. TERM: JUNE 1, 2025 THROUGH APRIL 30, 2028. Contract Description 2 (CONSENT) TEMPLATE APPROVED ON APRIL 23, 2025. THIS WILL BE A CONSENT ITEM. Contract Type* AGREEMENT Amount* $0.00 Renewable* YES Automatic Renewal Grant IGA Department HUMAN SERVICES 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 Requested BOCC Agenda Due Date Date* 06/12/2025 06/16/2025 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* 02/29/2028 Renewal Date* 04/30/2028 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 06/09/2025 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 06/16/2025 Finance Approver CHERYL PATTELLI Legal Counsel BYRON HOWELL Finance Approved Date Legal Counsel Approved Date 06/10/2025 06/10/2025 Tyler Ref # AG 061625 Originator WLUNA Hello