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Home My WebLink About20251675.tiffCorkva d-i'4c1S(D6 PROFESSIONAL SERVICE AGREEMENT BETWEEN WELD COUNTY AND SAVIO HOUSE THIS AGREEMENT is made and entered into this l Oday of J(�Q, , 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 Savio House, 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. B2500043 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 coo 1 e c : 0h bast 03* co/i (o/25 2025-1675 W-009-1 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 October 31, 2028 unless sooner terminated as provided herein, and is subject to continued budget appropriations. 4. Termination; Breach; Cure. County may terminate this Agreement for its own convenience upon thirty (30) days written notice to Contractor. Either Party may immediately terminate this Agreement upon material breach of the other party, however the breaching party shall have fifteen (15) days after receiving such notice to cure such breach. If this Agreement is terminated by County, Contractor shall be compensated for, and such compensation shall be limited to, (1) the sum of the amounts contained in invoices which it has submitted and which have been approved by the County; (2) the reasonable value to County of the services which Contractor provided prior to the date of the termination notice, but which had not yet been approved for payment; and (3) the cost of any work which the County approves in writing which it determines is needed to accomplish an orderly termination of the work. County shall be entitled to the use of all material generated pursuant to this Agreement upon termination. Upon termination of this Agreement by County, Contractor shall have no claim of any kind whatsoever against the County by reason of such termination or by reason of any act incidental thereto, except for compensation for work satisfactorily performed and/or materials described herein properly delivered. 5. Extension or Amendment. Any amendments or modifications to this agreement shall be in writing signed by both parties. No additional services or work performed by Contractor shall be the basis for additional compensation unless and until Contractor has obtained written authorization and acknowledgement by County for such additional services. Accordingly, no claim that the County has been unjustly enriched by any additional services, whether or not there is in fact any such unjust enrichment, shall be the basis of any increase in the compensation payable hereunder. In the event that written authorization and acknowledgment by the County for such additional services is not timely executed and issued in strict accordance with this Agreement, Contractor's rights with respect to such additional services shall be deemed waived and such failure shall result in non-payment for such additional services or work performed. Any claims by the Contractor for adjustment hereunder must be made in writing prior to performance of any work covered in the anticipated Amendment, unless approved and documented otherwise by the County Representative. Any change in work made without such prior Amendment shall be deemed not covered in the compensation and time provisions of this Agreement, unless approved and documented otherwise by the County Representative. 6. Compensation. County agrees to pay Contractor through an invoice process during the course of this Agreement in accordance with the Rate Schedule as described as Exhibit C. Contractor agrees to submit invoices which detail the work completed by Contractor. 2 The County will review each invoice and if it agrees Contractor has completed the invoiced items to the County's satisfaction, it will remit payment to the Contractor. No payment in excess of that set forth in the Exhibits will be made by County unless an Amendment authorizing such additional payment has been specifically approved by Weld County as required pursuant to the Weld County Code. If, at any time during the term or after 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: Julia Roguski Position: Associate Executive Director Address: 325 King Street Address: Denver, Colorado 80219 E-mail: jroguski@saviohouse.org Phone: (303) 225-4100 TO COUNTY: Name: Jamie Ulrich Position: Director Address: P.O. Box A Address: Greeley, Colorado 80632 E-mail: ulrichjj(ameld.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: ddrif4A) ;t1 BY: Clerk to the Board Deputy Clerk to the Boa BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO uck, Chair JUN 1 6 2025 TRACTOR: avio House 325 King Street Denver, Colorado 80219 n/ema.ileyud .-� By: Norma Aguilar -Dave Executive Director 06/06/2025 Date: 13 20Z5-1co75 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 carry out its legal responsibilities. The provisions of this section shall survive the BAA's termination. 20. The parties agree to amend this Agreement in order to maintain compliance with State or Federal law. County shall provide ten (10) days prior written notice to Business Associate of a need to amend the BAA and propose such amendments for Business Associate's consideration. Upon written agreement between the parties, such amendment shall be binding upon the parties. Either party may elect to terminate the BAA and any underlying service agreement(s) if an amendment is not able to be agreed upon within a reasonable timeframe from an amendment's commencement. All duties hereunder to maintain the security and privacy of PHI shall survive such termination. County and Business Associate may otherwise amend this Agreement by mutual written consent. 21. To the fullest extent permitted by law, each party (the "Indemnifying Party") shall indemnify the other party, and its officers, directors, employees and agents (collectively the "Indemnified Parties"), against any and all claims brought by or directly resulting from third parties, including reasonable attorneys' fees (the "Third Party Losses"), to the extent Third Party Losses are proximately caused by a breach of this BAA by the Indemnifying Party, each by the Indemnifying Party or its employees, directors, officers, subcontractors, and agents. The Indemnifying Party shall have the right to control the defense or settlement of such third -party claim, subject to the reasonable participation of, and approval by, the Indemnified Parties of any such settlement or defense strategy. The foregoing indemnification shall not apply to the extent such claims arise out of (i) the Indemnified Party's negligence or willful misconduct, or (ii) the negligence or willful misconduct of any subcontractor or agent other than Business Associate under the Indemnified Party's control. 18 EXHIBIT B SCOPE OF SERVICES Contractor will provide Services, as referred by the County. 1. Multisystemic Therapy for Problem Sexual Behavior (MST-PSB) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. The Multisystemic Therapy for Problem Sexual Behavior (MST- PSB) model is a total behavioral health care modality that addresses all the needs of each family member. ii. Caregivers are highly involved in the development and implementation of interventions. b. Anticipated Frequency of Services: i. Hours of service are based on what is clinically indicated for the family. ii. Typically, services are more intensive at the beginning and reduce to lower levels as the family works on generalization of skills. c. Anticipated Duration of Services: i. Four (4) to six (6) months. d. Goals of Services: i. Improve family functioning. ii. Improve relationships with peers, school, community. iii. Improve household structure. e. Outcomes of Services: i. Reduced problem sexual behavior. ii. Improved overall functioning of youth. iii. Reduced or eliminated need for out -of -home placement. f. Target Population: i. Youth ages twelve (12) to eighteen (18) with problem sexual behaviors. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. 2. Sexual Abuse Intervention (SAI) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. The Sexual Abuse Intervention (SAI) program utilizes a high level of supervision and involvement and emphasizes community safety and client accountability at all times. ii. The program utilizes this continuum of care to offer more or less restrictive services for clients, as changes in level of care are deemed appropriate to treatment needs. iii. Psychoeducation and skills training. b. Anticipated Frequency of Services: i. SAI Low: one (1) to two (2) hours per week. ii. SAI Moderate: three (3) to four (4) hours per week. iii. SAI Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. Six (6) to nine (9) months. d. Goals of Services: i. Address problem sexual behaviors within a family system. ii. Improve overall family functioning. iii. Increase safety for all children in the home. iv. Improve parental protective capacity. e. Outcomes of Services: i. Reduced or eliminated need for out -of -home placement. ii. Improved caregivers' ability to keep children safe. iii. Increased family access to support systems. f. Target Population: i. Youth ages eleven (11) to eighteen (18) with problem sexual behavior. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. 3. Eye Movement Desensitization and Reprocessing (EMDR) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Eye Movement Desensitization and Reprocessing (EMDR) therapy focuses directly on traumatic memories and is intended to change the way those memories are stored in the brain, thus reducing and eliminating the problematic symptoms. ii. EMDR includes standardized procedures that incorporate the use of eye movements and other forms of rhythmic left -right (bilateral) stimulation (e.g., tones or taps). b. Anticipated Frequency of Services: i. One (1) to two (2) sessions per week. ii. One (1) to one, and one-half (1.5) hour sessions. c. Anticipated Duration of Services: i. Six (6) to twelve (12) sessions. d. Goals of Services: i. Reduce or eliminate Post Traumatic Stress Disorder (PTSD) symptoms. ii. Improve family functioning. iii. Improve youths' regulation skills. e. Outcomes of Services: i. Reduced or eliminated need for out -of -home placement. ii. Improved wellbeing for youth. iii. Reduced or eliminated need for child welfare involvement. f. Target Population: i. Youth ages four (4) to eighteen (18). g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. 4. Trauma Focused Cognitive Behavioral Therapy (TF-CBT) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. An age -appropriate trauma assessment is completed during the intake meeting and includes input from the child and their caretakers. b. Anticipated Frequency of Services: i. One (1) session per week. ii. One (1) to two (2) hour sessions. c. Anticipated Duration of Services: i. Twelve (12) to twenty (20) sessions. d. Goals of Services: i. Reduce or eliminate Post Traumatic Stress Disorder (PTSD) symptoms. ii. Increase parental ability to be tuned into the needs of the child/youth. iii. Increase child/youth regulation skills. e. Outcomes of Services: i. Stabilized placement. ii. Eliminated need for out -of -home placement. iii. Improved child wellbeing. iv. Improved family functioning. f. Target Population: i. Youth ages three (3) to eighteen (18) and their non -offending caregiver(s) who have experienced trauma related difficulties as a result of one or multiple traumatic events. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. 5. Trauma Systems Therapy (TST) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Evidence -based treatment. ii. A phase -based, comprehensive model designed to meet complicated needs of a trauma system defined as the combination of a traumatized child or adolescent, who when exposed to trauma reminders, has difficulty regulating emotions/behavior and a caregiver or system of care that is not able to protect the youth or help manager their dysregulation. iii. Individual and family sessions. b. Anticipated Frequency of Services: i. One (1) to four (4) hours per week. c. Anticipated Duration of Services: i. Nine (9) to twelve (12) months. d. Goals of Services: i. Reduce or eliminate Post Traumatic Stress Disorder (PTSD) within the family system. ii. Improve family functioning. iii. Teach identified family members regulation skills. e. Outcomes of Services: i. Eliminated need for out -of -home placement (stabilize permanent placement). ii. Improved caregivers' ability to be attuned to the needs of the child/youth. iii. Reduced or eliminated future incidents of child maltreatment. iv. Improved child wellbeing. f. Target Population: i. Youth ages five (5) to twenty (20) and their caregivers who have a history of traumatic events. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. 6. MultiSystemic Therapy (MST) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. MultiSystemic Therapy (MST) is an evidence -based intervention model. ii. MST works with juveniles with a mental health diagnosis or who are emotionally disturbed. iii. MST is a highly supervised modality. b. Anticipated Frequency of Services: i. Hours of service are based on what is clinically indicated for the family. c. Anticipated Duration of Services: i. Four (4) to six (6) months. d. Goals of Services: i. Increase youth's connection with positive peers. ii. Improve youth's performance in school. iii. Improve overall family functioning. iv. Develop clear rules and consequences within the family system. v. Improve caregivers' ability to parent youth. e. Outcomes of Services: i. Eliminated need for out -of -home placement. ii. Reduced or eliminated delinquent activity by youth. iii. Successfully reunify youth placed in out -of -home placement. f. Target Population: i. Youth ages eleven (11) to eighteen (18), and their families. ii. Chronic, violent or substance abusing male and female juvenile offenders. iii. Youth and families demonstrating maladaptive behaviors including drug use, truancy, violence, parent -child conflict, youth who have had previous or current episodes of abuse or neglect, and youth who are facing out -of -home placement or are reunifying home. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is Medicaid eligible. . Service Access and Transportation: i. In -Home or Community. 7. MultiSystemic Therapy Contingency Management (MST -CM) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. MultiSystemic Therapy -Contingency Management (MST -CM) includes as standard certain treatment protocols such as. 1. Functional analysis of the substance use. 2. Self -management plans to help the youth avoid substance use. 3. Drug refusal skills. 4. Providing incentives or rewards for not using drugs. 5. Random drug screens. b. Anticipated Frequency of Services: i. Hours of service are based on what is clinically indicated for the family. c. Anticipated Duration of Services: i. Three (3) to five (5) months. d. Goals of Services: i. Decrease or eliminate youth's substance use. ii. Improve structure within the home. iii. Improve parental capacity to set limits. e. Outcomes of Services: i. Eliminated the need for out -of -home placement. ii. Reduced or eliminate youth's involvement with juvenile justice system. iii. Reduce youth's delinquency recidivism. f. Target Population: i. Youth ages twelve (12) to seventeen (17) that present with chronic or severe delinquent behavior and are also abusing drugs and alcohol. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. 8. Functional Family Therapy (FFT) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. The three phases of the Functional Family Therapy (FFT) model include. 1. Engagement and Motivation. 2. Behavior Change. 3. Generalization. b. Anticipated Frequency of Services: i. One (1) to one and one-half (1.5) hours per week. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Target chronic, violent or substance abusing juvenile offenders. ii. Establish household structure. iii. Increase monitoring and supervision. iv. Set clear rules and consequences for the youth. e. Outcomes of Services: i. Reduced or eliminated need for out -of -home placement. ii. Improved family functioning. iii. Reduced parent -child conflict. f. Target Population: i. Youth ages twelve (12) to eighteen (18) and their families demonstrating maladaptive behaviors including truancy, violence, and parent -child conflict. ii. Youth who have had previous or current episodes of abuse or neglect and youth facing out -of -home placement. iii. Youth who are reunifying into the home. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. 9. Functional Family Therapy Gang (FFT-GO) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Functional Family Therapy Gang (FFT-GO) utilizes the core Functional Family Therapy model and has been shown to work with gang -involved or at -risk youth. ii. FFT, FFT-GO specifically targets risk factors relevant to gang - involved youth which may include: 1. Conflictual family relationships. 2. Antisocial behaviors. 3. Impulsivity. 4. Substance use. 5. Lack of supervision. FFT-G® works closely with community partners to support the intervention and help youth and families meet their individual and family goals. b. Anticipated Frequency of Services: i. One (1) to one and one-half hours per week. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Target chronic, violent or substance abusing juvenile offenders. ii. Establish household structure. iii. Increase monitoring and supervision. iv. Set clear rules and consequences for the youth. e. Outcomes of Services: i. Reduced or eliminated substance use for the adolescent. ii. Reduced or eliminated need for out -of -home placement. iii. Improved family functioning. iv. Reduced parent -child conflict. f. Target Population: i. Youth and adolescents ages eleven (11) to eighteen (18) who are currently, at risk of becoming involved, or associated/affiliated with a gang. ii. Families with intergenerational gang involvement and have at least one family member willing to participate. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. 10. Functional Family Therapy Contingency Management (FFT-CM) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Functional Family Therapy Contingency Management (FFT-CM) is an enhancement of Functional Family Therapy (FFT) aimed to specifically reduce substance use among adolescents and family members and to sustain sobriety. ii. This model continues to focus on other risk factors or referring behaviors to the substance use. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) to twenty (20) sessions. ii. Three (3) to six (6) months. d. Goals of Services: i. Decrease or eliminate youth's substance use. ii. Improve structure within the home. iii. Improve parental capacity to set limits. e. Outcomes of Services: i. Eliminated need for out -of -home placement. ii. Reduced or eliminated youth involvement with juvenile justice system. iii. Reduced youth delinquency recidivism. f. Target Population: i. Adolescents between the ages of twelve (12) to eighteen (18) with negative behaviors that appear to be rooted in the relational dynamics of the family system. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. 11. SafeCare for Court Involved Families a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Evidence -based parenting skills intervention. ii. Each module involves the following. 1. Baseline assessment. 2. Intervention. 3. Training. 4. Follow-up assessments to monitor change. b. Anticipated Frequency of Services: i. One (1) to two (2) hours per week. c. Anticipated Duration of Services: i. Sixteen (16) to twenty (20) weeks. d. Goals of Services: i. To increase parental protective capacity in the following areas. 1. Health. 2. Home Safety. 3. Parent-Child/Parent-Infant Interactions. 4. Problem Solving and Communication. e. Outcomes of Services: i. Improved parenting skills. ii. Decreased future incidents of child maltreatment. iii. Increased parent child connection. f. Target Population: i. Families with children age newborn (0) to five (5) with a current dependency and neglect case. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In -Home. 12. Family Coaching a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. The Family Coaching program helps stabilize families struggling with the following: 1. Issues with school. 2. Mental health. 3. Other matters that place the family at risk of becoming further involved with the child welfare system. ii. Psychoeducation and skills training. iii. This service is provided by a Bachelor Level staff. b. Anticipated Frequency of Services: i. Low — one (1) to two (2) hours per week. ii. Moderate — three (3) to four (4) hours per week. iii. Intensive — five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. One (1) to four (4) months. d. Goals of Services: i. Connect the family to needed community resources. ii. Stabilize the family system. iii. Provide coaching and support for parenting. iv. Build caregiver protective factors. e. Outcomes of Services: i. Reduced or eliminated need for child welfare involvement. ii. Reduced or eliminated future incidents of child maltreatment. iii. Increased family functioning. f. Target Population: i. Families with children of all ages. ii. Kinship homes in need of additional support. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service may be Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. 13. Supervised Family Time — Bachelor's Level a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Supervised visitation services include. 1. Family coaching. 2. Intervention. ii. Bachelor's level staff. b. Anticipated Frequency of Services: i. Based on client/family need. c. Anticipated Duration of Services: i. Based on client/family need. d. Goals of Services: i. Improve the parent -child relationship. ii. Increase parenting skills. iii. Provide important parent -child contact. e. Outcomes of Services: i. Based on identified case goals. f. Target Population: i. Families with court ordered parenting time in need of basic coaching during visitation time. 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. 14. Therapeutic Family Time — Master's Level a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Supervised visitation services include family therapeutic/trauma informed intervention. ii. Master's level staff. b. Anticipated Frequency of Services: i. Based on identified case goals. c. Anticipated Duration of Services: i. Based on client/family need. d. Goals of Services: i. Improve parent -child relationship. ii. Increase parenting skills. iii. Provide important parent -child contact. e. Outcomes of Services: i. Based on identified case goals. f. Target Population: i. Families with court ordered parenting time in need of therapeutic interventions during parenting time. 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. 15. Adolescent Skills Coaching a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Bachelor level staff. ii. Adolescent skills coaching is a model which: 1. Builds on the family's strengths. 2. Encourages the development of supportive and sustainable relationships that promote long term resilience. 3. This program can also be an intervention that evaluates the youth's environment and aligns with the parents to establish household structure and supervision. b. Anticipated Frequency of Services: i. Low — one (1) to two (2) hours. ii. Moderate — three (3) to four (4) hours. iii. Intensive — five (5) to six (6) hours. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Assist family to identify and successfully access community resources. ii. Assist youth in building independent living skills. iii. Align with family and youth as an advocate. iv. Support caregiver in establishing household structure. v. Support caregiver in developing rules and consequences. vi. Assist family in establishing support network for long term assistance. e. Outcomes of Services: i. Increased youth and family's ability to access ecological networks of support outside of Savio. ii. Established strong network of support enabling the youth and their family to maintain the skills learned and increases the likelihood of success after discharge. f. Target Population: i. Youth that may have treatment needs in the following program areas. 1. Drug and alcohol services. 2. Tracking. 3. Mentoring. 4. Family intervention. 5. Educational support. 6. Employment/vocational support. 7. Restorative justice. 8. Independent living skills. 9. Crisis intervention. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service may be Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. 16. Community Based Services (CBS) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Community Based Services (CBS) provides in -home therapeutic services to families and children who do not fit into an Evidence - based program. ii. This service includes the following: 1. Therapeutic interventions. 2. Referrals for concrete services. 3. Intensive case management with collateral services. 4. Crisis intervention as needed. 5. Staff are Master's level. b. Anticipated Frequency of Services: i. Low: one (1) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. High: five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. Four (4) to six (6) months. d. Goals of Services: i. To stabilize the home environment. ii. Improve parenting. iii. Provide connection to community resources. iv. Decrease of negative or delinquent behavior. v. Stabilize permanency. e. Outcomes of Services: i. Reduced or eliminated child/youth need for higher level of care. ii. Reduced or eliminated delinquent behavior/involvement with the Juvenile Justice System. iii. Improvement of overall family functioning. iv. Reduced or eliminate future incidents of child maltreatment. f. Target Population: i. Families with children ages birth (0) to eighteen (18). ii. Youth who are in need of therapeutic support and do not fit into another intervention. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In -Home or Community. Terms 1. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the County. Failure to comply with all aspects may result in a forfeiture of payment. 2. Contractor agrees to receive referrals for services through e-mail and will provide an identified e-mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the County. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. 3. Contractor will respond to the Mental Health and Support Services Team (HS- CWServiceReferral(a�weld.gov) within three (3) business days regarding the ability to accept the received referral. 4. Upon acceptance of a referral, Contractor will offer an initial appointment within seven (7) days of receiving the referral. The first attempt to contact the client will occur within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If the client does not respond after three (3) attempts in the first seven (7) days of the referral period, the Contractor will notify the caseworker and the Mental Health and Support Services Team HS-CWServiceReferral(cr�weld.gov. 5. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Mental Health and Support Services Team HS- CWServiceReferral(a�weld.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- CWServiceReferralta'�_weld.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-CWServiceReferralCc�weld.gov immediately via email, to discuss service continuation. 8. Contractor will identify, in detail, areas of continued concern and make recommendations to the caseworker in a monthly report regarding continuation of services and/or the need for additional services. 9. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the 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- CWServiceReferralCa�weld.gov immediately AND on the required monthly report. 11. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator or any member of the Mental Health and Support Services Team. Any changes to Family Time referrals will be approved by a new referral signed by the Child Welfare Supervisor. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 12. Contractor agrees to attend meetings when available and as requested by the County. Such meetings include Court Facilitations, Bid Meetings, Professional Staffings, Family Team Meetings and/or Team Decision Making meetings. The County will reimburse for actual participation in the meeting only so long as there is written authorization from the Mental Health and Support Services Team, and the facilitator documents in the meeting notes the timeframe that the provider attended and when participation in the meeting is deemed appropriate and necessary by the County. The Facilitator will be responsible for filling out the time attended on the meeting notes. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Mental Health and Support Services Team. Contractor may participate by phone or virtually, if approved by the County. 13.On a monthly basis, the Contractor will notify the Mental Health and Support Services Team HS-CWServiceReferral(a�weld.gov of new staff who will manage and/or administer the services with the following information: a. Staff member name and contact information b. Education level/degree (if applicable) c. Licensure/credentials (if applicable) d. Department of Regulatory Authority (DORA) number (if applicable) e. Supervisor name and contact information The County reserves the right to decline the new staff members managing and/or administering services to County clients. 14. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas: Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR) and will address the aforementioned three areas when completing monthly reports as required by Paragraph 9 of this Exhibit. 15. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the County by the Contractor prior to the start of any Agreement. 16.1g 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 $2,896.00 Unit Type Month Service Name MultiSystemic Therapy for Problem Sexual Behavior: In�- Home or Community $2,277.00 Month Sexual Abuse Intervention - Intensive: In -Home or Community $1,812.00 Month Sexual Abuse Intervention - Moderate: In -Home or Community $1,270.00 Month Sexual Abuse Intervention - Low: In -Home or Community $1,228.00 Month EMDR Therapy: In -Home or Community $1,228.00 Month Trauma Focused Cognitive Behavioral Therapy: In -Home or Community $1,919.00 Month Trauma Systems Therapy: In -Home or Community $2,354.00 Month MultiSystemic Therapy: In -Home or Community Rate $2,654.00 Unit Type Month Service Name MultiSystemic Therapy Contingency Management: In - Home or Community $1,350.00 Month Functional Family Therapy: In -Home or Community $1,500.00 Month Functional Family Therapy Gang: In -Home or Community $1,550.00 Month Functional Family Therapy Contingency Management: In - Home or Community $1,070.00 Month SafeCare for Court Involved Families: In -Home or Community $2,350.00 Month Family Coaching - Intensive: In -Home or Community $1,750.00 Month Family Coaching - Moderate: In -Home or Community $1,115.00 Month Family Coaching - Low: In -Home or Community $ 120.00 Hour Supervised. Family Time BA Level English: ln-OfficeNideo and n -Home or Community AND with Transportation $ 132.00 Hour Supervised Family Time BA Level Spanish: In- OfficeNide° and In -Home or Community AND with Transportation $ 120.00 Hour Supervised Family Time BA Level English: FTM, TDM, Prof. Staffing $ 132.00 Hour Supervised Family Time BA Level Spanish: FTM, TDM, Prof. Staffing $ 120.00 Each Supervised Family Time BA Level English: No Show $ 132.00 Each Supervised Family Time BA Level Spanish: No Show $ 140.00 Hour Therapeutic Family Time Master's Level English: In- OffrceNideo AND In -Home or Community AND with Transportation $ 154.00 Hour Therapeutic Family Time Master's Level Spanish: In- OfficeNide° AND In -Home or Community AND with Transportation $ 140.00 Hour Therapeutic Family Time Master's Level English: FTM, TDM, Professional Staffing $ 154.00 Hour Therapeutic Family Time Master's Level Spanish: FTM, TDM, Professional Staffing $ 140.00 Each Therapeutic Family Time Master's Level English: No Show $ 154.00 Each Therapeutic Family Time Master's Level Spanish: No Show $2,350.04 Month Adolescent Skills Coaching - Intensive' In -Home or Community $1,750.00 Month Adolescent Skills Coaching - Moderate: In -Home or Community $1,115.00 Month Adolescent Skills Coaching - Low: In -Home or Community Rate Unit Type Service Name $1,073.00 Month Community Based Services - Low: In -Home or Community $1,850.00 Month Community. Based Services - Moderates in -Home or Community $2,476.00 Month Community Based Services - Intensive: In -Home or Community $ 100.00 Monthcable Monthly Rates for Spanish Interpreter= Appli to Monthly Services Monthly Mileage Rate for Services Outside of the Thirty- $ 500.00 Month five (35) Mile catchment area - Applicable to Monthly Services * Mileage rate is for services 35 miles outside of the catchment area from the home office of the assigned staff — Applicable to Hourly Services. 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 7. 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 3 — Provider Information Form (PIF) • Attachment 4 — Staff Data Sheet • Certificate of Insurance (COI) ATTACHMENT 1 BID ATTESTATION Failure to include a signed Attestation upon submittal of your bid may result in your bid being incomplete, non -responsive, and your bid being rejected. If there are any exclusions or contingencies submitted with your bid it may be disqualified. Bidder's Legal Name as reflected on W-9: Savio House Address: 325 King Street, Denver Co 80219 Phone Number: 303.225.4100 Email: jroguski@saviohouse.org FEIN/Federal Tax ID # or SS#: 84-0570279 The undersigned, by his or her signature, hereby acknowledges and represents that: 1. The bid proposed herein meets all the conditions, specifications and special provisions set forth in the Invitation for Bid for Request No. #B2500043. 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 bids) may be awarded to more than one vendor. CONTRACTOR: Name: Norma Aquilar-Dave Title: Executive Director By: X Norma Aguilar -Dave Signed by S-1.12.1-324579833 12S6091S09 1781211680-214611330,b4b426a-33d1.40a1-9332.1ctikaa504S/ (Double Click in box to sign electronically) 12/3/2024 ADA ATTACHMENT 2 BID FORM Service #1 Service Type $ Amount Unit Type 1.10a In-Office/Video $ Select One 1.10b In -Home or Community $ Select One 1.10c $ Select One Service with Transportation Provided 1.10d FTM, TDM, Prof. Staffing $ Per Hour 1.10e No show $ 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 MultiSystemic Sexual Behavior (MST for Problem $2896 Therapy PSB) 1.11b Services any an the interepreter other monthly provided forgein rate this in language is Spanish in addtion without (or to $100 1.11c Services 35 calculated office where -mile for services catchment for the based families staff will on and area. be outside the the delivered assigned Miles address Savio's are $500 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 =rID FOc:-"! 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: Sexual Abuse Intervention (SAI) 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): The Sexual Abuse Intervention Program works with youth demonstrating problem sexual behaviors and their families to stop sexually abusive behavior and prevent its recurrence through monitoring, education and therapeutic intervention. The program utilizes a high level of supervision and involvement and emphasizes community safety and client accountability at all times. The program primarily serves adolescents who may or may not be adjudicated but are demonstrating problem sexual behaviors. The SAI program can also work with youth who are demonstrating sexually reactive behavior related to trauma. Clients receive services while living in the community at their homes or within out of home placement, depending on the needs of clients and their families. The program utilizes this continuum of care to offer more or less restrictive services for clients, as changes in level of care are deemed appropriate to treatment needs. 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: SA1 Low 1 — 2 hours per week SAI Moderate 3 — 4 hours per week SAI Intensive 5 — 6 hours per week 2.03 Anticipated duration of service (i.e. 3-4 months): 6 - 9 Months 2.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Address problem sexual behaviors within a family system 2. Improve overall family functioning 3. Increase safety for all children in the home 4. Improve parental protective capacity 2.05 Three (3), or more, specific outcomes of service: 1. Reduce or Eliminate the need for out -of -home placement Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2. Improve caregivers' ability to keep children safe 3. Increase family's access to support system 2.06 Target population of the service, including age and gender: Families with histories of problematic sexual behaviors including Intrafamilial sexual abuse, adjudication as a result of sexual abuse, lack of impulse control, lack of supervision, poor social skills, minimizing/justifying abusive behavior (sexual or otherwise). Youth age 11 — 18 with problem sexual behavior 2.07 Languages service is available in (please list proficiency and if interpreter services are available): English S panish (call for availability) 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): Family's home and communty 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 $ Select One 2.10b In Community $ Select One -Home or 2.10c Service with Transportation Provided $ Select One 2.10d $ Per Hour FTM, TDM, Prof. Staffing 2.10e No show $ 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 Sexual Abuse Intervetnion Intensive $2277 5 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2.11b Sexual Moderate Abuse Intervetnion $1812 3 2.11c Sexual Abuse Intervention Low $1270 1 2.11d Services any an the interepreter monthly other provided forgein rate this language in is Spanish in addtion without (or to $100 2.11e Services 35 calculated office where -mile for services catchment for the based families staff will on and area. be outside the the delivered assigned Miles address Savio's are $500 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 } �@D 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: Eye Movement Desensitization and Reprocessing (EMDR) 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): EMDR therapy focuses directly on traumatic memories and is intended to change the way those memories are stored in the brain, thus reducing and eliminating the problematic symptoms. During EMDR therapy, clinical observations suggest that an accelerated learning process is stimulated by EMDR's standardized procedures, which incorporate the use of eye movements and other forms of rhythmic left -right (bilateral) stimulation (e.g., tones or taps). While clients briefly focus on the trauma memory and simultaneously experience bilateral stimulation (BLS), the vividness and emotion of the memory are reduced. Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client's own accelerated intellectual and emotional processes. 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 times per week; 1 - 1.5 hours per session 3.03 Anticipated duration of service (i.e. 3-4 months): 6 - 12 sessions 3.04 Three (3), or more, specific goals of the service (DO use bullet points): Reduce or eliminate PTSD Symptoms 2. Improve family functioning 3. Improve youths regulation skills 3.05 Three (3), or more, specific outcomes of service: 1. Reduce or eliminate the need for out -of -home placement 2. Improve youth's wellbeing 3. Reduce or eliminate the need for child welfare involvement 3.06 Target population of the service, including age and gender: Savio's EMDR services are targeted for clients ages 4-18. EMDR is a psychotherapy technique that addresses maladaptively stored memories that include the thoughts, emotions, and behavioral responses that were experienced at the time of the traumatic event. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Treatment accesses the memories and reprocesses the events to a healthier resolution. 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English 3.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 1o'es 3.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Client's 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 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 $ Select One 3.10b In $ Select One -Home or Community 3.10c Service with Transportation Provided $ Select One 3.10d FTM, TDM, Prof. Staffing $ Per Hour 3.10e No show $ Per No Show 3.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. 3.11 Monthly Service Rates (each level must be listed): If applicable Service Name with Level per J Minimum of Service: Hours Rate Month 3.11a Movement (EMDR) Desenstization and $1228 Eye Reprocessing 3.11b Services any an the interepreter monthly other provided forgein rate this in language is Spanish in addtion without (or to $100 3.11c Services 35 calculated office where -mile for catchment services for the based families staff will on and area. be outside the the delivered assigned Miles address Savio's are $500 Revised '2/3/2024 ADA ATTACHMENT 2 BID FORM 311d $ 311e $ 311f $ 311g $ 311h $ 311i $ 3 111 $ 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 BID FORM !Meld County Use Only Service #3: 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 Service #4 Service Name: Trauma Focused Cognitive Behavioral Therapy (TF CBT) 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): Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is an Evidenced -Based Treatment for children ages 3 — 18 years experiencing trauma -related difficulties as the result of one or multiple traumatic events and their non -offending parent/caretaker. A brief age -specific trauma assessment is completed at the point of intake to determine if the referred child has clinically significant Post Traumatic Stress Disorder (PTSD) or depression symptoms that indicate trauma treatment is needed. The age -appropriate trauma assessment is completed during the intake meeting and includes input from the child and their caretakers. These assessments are brief and used as a tool to determine the need for TF CBT. If it is determined that the child does not have clinically significant symptoms, Savio will make a recommendation for other services. Savio can conduct this brief trauma assessment as a standalone service if there is question with regard to the need TF CBT. 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; 1 - 2 hours per session Anticipated duration of service (i.e. 3-4 months): 12 - 20 sessions Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce or eliminate PTSD symptoms 2. Increase parental ability to be tuned into the needs of the child/youth Increase child/youth regulation skills Three (3), or more, specific outcomes of service: 1. Stabilize placement 2. Eliminate the need for out -of -home placement 3. Improved child well being Improve family functioning Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 4.06 Target population of the service, including age and gender: Children/youth age 3 — 18 experiencing trauma related difficulties as a result of one or multiple t-aumatic events and their non -offending caregiver(s). 4.07 Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) 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): Family's home Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 4.10 • For monthly Service rates please complete section 4.11 • For Home Study Providers please complete section 4.12 • For monitored Sobriety Providers please complete section 4.13 4.10 Hourlv Service Rates: Service #4 $ Amount Unit Type Service Type 4.10a In-Office/Video $ Select One 4.10b In -Home or Community $ Select One 4.10c Service with Transportation Provided $ Select One 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 Focused Therapy Cognitive (TF CBT) $1228 Trauma Behavioral 4.11b Services any an the interepreter other monthly provided forgein rate this in language is Spanish in addtion without (or to $100 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 4.11c Services 35 calculated office where -mile for services catchment for the based families staff will on and area. be outside the the assigned delivered Miles address Savio's are $500 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 items) 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: Trauma Systems Therapy (TST) 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): Trauma Systems Therapy (TST) is evidence -based treatment for children/adolescents who have experienced traumatic events and/or who live in environments where ongoing stress/traumatic reminders are present. Methodology: A phase -based, comprehensive model designed to meet complicated needs of a trauma system defined as the combination of a traumatized child or adolescent, who when exposed to trauma reminders, has difficulty regulating emotions/behavior and a caregiver or system of care that is not able to protect the youth or help manager their dysregulation. Not all families begin at the Safety Focus phase; some begin at a later phase and do not require phase one. 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 - 4 hours per week 5.03 Anticipated duration of service (i.e. 3-4 months): 9 - 12 months 5.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce or eliminate PTSD within the family system 2. Improve family functioning 3. Teach identified family members regulation skills 5.05 Three (3), or more, specific outcomes of service: 1. Eliminate the need for out -of -home placement (stabilize permanent placement) 2. Improve caregivers' ability to be attuned to the needs of the child/youth 3. Reduce or eliminate future incidents of child maltreatment 4. Improve child well being 5.06 Target population of the service, including age and gender: Children, youth age 5 — 20 and their caregivers who have a history of traumatic events. 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 Spanish (call for availability) 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): Family's home and community Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 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 $ Select One 5.10b In -Home or Community $ Select One 5.10c _ $ Select One Service with Transportation Provided 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 Systems Therapy $1919 Trauma 5.11b Services any an the interepreter monthly other provided forgein rate this in language is Spanish in addtion without (or to $100 5.11c Services 35 calculated office where -mile for services catchment for the based families staff will on and area. be outside the the delivered assigned Miles address Savio's are $500 5.11d Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 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 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 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 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: MultiSystemic 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. (Please address each line item below using bulleted points) 1.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): MST is an evidence -based intervention for youth who are chronic, violent or substance abusing juvenile offenders and their families. MST works with juveniles with a mental health diagnosis or who are emotionally disturbed. Youth served are at high risk of out -of -home placement or are transitioning home from residential treatment or correctional care. 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: Hours of service are based on what is clinically indicated for the family. MST is a highly supervised, evidence -based model with internal and external experts who direct service levels and treatment throughout to ensure the most effective, sustainable outcomes. Savio has a 20 plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The model and is not based on set hours of service, rather the family is given the level of service clinically indicated each week. Typically, services are more intensive at the beginning and reduce to lower levels as the family works on generalization of skills. 1.03 Anticipated duration of service (i.e. 3-4 months): 4 - 6 Months 1.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Increase youth's connection with positive peers 2. Improve youth's performance in school 3. Improve overall family functioning Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 4. Develop clear rules and consequences within the family system 5. Improve caregivers ability to parent youth 1.05 Three (3), or more, specific outcomes of service: 1. Eliminate the need for out -of -home placement 2. Reduce or eliminate delinquent activity by youth 3. Successfully reunify youth placed in out -of -home placement 1.06 Target population of the service, including age and gender: The targeted population for MST is chronic, violent or substance abusing male and female juvenile offenders, ages 11-18 and their families. Youth ages 11-18, and their families, demonstrating maladaptive behaviors including drug use, truancy, violence, parent -child conflict, youth who have had previous or current episodes of abuse or neglect and youth who are facing out of home placement or are reunifying home. 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) 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): Family home and community Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 1.10 • For monthly Service rates please complete section 1.11 • For Home Study Providers please complete section 1.12 • For monitored Sobriety Providers please complete section 1.13 1.10 Hourly Service Rates: Service #1 Service Type $ Amount Unit Type 1.10a In-Office/Video $ Select One 1.10b In -Home or Community $ Select One 1.10c Service with Transportation Provided $ Select One 1.10d FTM, TDM, Prof. Staffing $ Per Hour Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 1.10e No show $ 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 MultiSystemic $2354 Therapy 1.11b Services any an the interepreter monthly other provided forgein rate this language in is Spanish in addtion without (or to $100 1.11c Services 35 calculated office where -mile for services catchment the for based families staff will on and area. be outside the the assigned delivered Miles address Savio's are $500 1.11d 1.11e $ 1.11f $ 1.118 $ 1.11h $ 1.111 $ 1.11j $ 1.12 Home Study Providers - List your rates in the box below. 1.13 Monitored Sobriety Providers - List your rates in the box below. 1.14 Additional Comments: Revised 12/3/2024 ADA ATTACHMENT 2 DID 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: MultiSystemic Therapy Contingency Management (MST CM) 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): Multisystemic Therapy -Contingency Management (MST -CM) is an adaptation of Multisystemic Therapy that was developed in order to offer a model specifically focused on addressing substance abuse problems. MST -CM builds upon the "standard" MST model, which is used to treat serious juvenile offenders, by including a contingency management protocol and focusing treatment more specifically on the youth's substance use in cases where such an approach is warranted. MST -CM includes as standard certain treatment protocols to address youth substance use, such as functional analysis of the substance use, self -management plans to help the youth avoid substance use, teaching of drug refusal skills, providing incentives or rewards for not using drugs, and random drug screens. 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: Hours of service are based on what is clinically indicated for the family. MST CM is a highly supervised, evidence -based model with internal and external experts who direct service levels and treatment throughout to ensure the most effective, sustainable outcomes. Savio has a 20 plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The model and is not based on set hours of service, rather the family is given the level of service clinically indicated each week. Typically, services are more intensive at the beginning and reduce to lower levels as the family works on generalization of skills. 2.03 Anticipated duration of service (i.e. 3-4 months): 3 — 5 months 2.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Decrease or eliminate youth's substance use 2. Improve structure within the home 3. Improve parental capacity to set limits Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2.05 Three (3), or more, specific outcomes of service: 1. Eliminate the need for out -of -home placement r, L. Reduce or eliminate youth's involvement with juvenile justice Reduce youth's delinquency recividism 2.06 Target population of the service, including age and gender: MST -CM is intended for youth ages 12-17 that present with chronic or severe delinquent tehavior and are also abusing drugs and alcohol. 2.07 Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability 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): Family's home and community Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 2.10 • For monthly Service rates please complete section 2.11 • For Home Study Providers please complete section 2.12 • For monitored Sobriety Providers please complete section 2.13 2.10 Hourlv Service Rates: Service #2 Service Type $ Amount Unit Type 2.10a In-Office/Video $ Select One 2.10b Community $ Select One In -Home or 2.10c Service with Transportation Provided $ Select One 2.10d FTM, TDM, Prof. Staffing $ Per Hour 2.10e No show $ Per No Show 2.10f Mileage rate* $ Per Mile * If applicable — Mileage rate is paid after ilnsert 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 I Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2.11a MultiSystemic Mangement (MST CM) Contingency $2654 Therapy 2.11b Services any an the interepreter other monthly provided forgein rate this language in is Spanish in addtion without (or to $100 2.11c Services 35 calculated office where -mile for services catchment the for based families staff will on and area. be outside the the delivered assigned Miles address Savio's are $500 2.11d 2.11e $ 2.11f $ 2.118 $ 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 r= 0D 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: Functional Family 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. (Please address each line item below using bulleted points) 3.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Functional Family Therapy is an evidenced -based family therapy model designed to reduce or eliminate problem behaviors by modifying the family relationships that support those behaviors. The three phases of the model include Engagement and Motivation, Behavior Change and Generalization 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 — 1.5 Hours per week (1 family therapy session) 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. Target chronic, violent or substance abusing juvenile offenders ages 12 — 18 2. Establish household structure 3. Increase monitoring and supervision 4. Set clear rules and consequences for the youth 3.05 Three (3), or more, specific outcomes of service: 1. Reduce or eliminate the need for out -of -home placement 2. Improve family functioning 3. Reduce parent -child conflict 3.06 Target population of the service, including age and gender: Youth age 12 — 18 and their families demonstrating maladaptive behaviors including truancy, violence, parent -child conflict Youth who have had previous or current episodes of abuse or neglect and youth facing out -of - home placement or are reunifying home. 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Spanish (call for availability) 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): Family's home and community Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 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 $ Select One 3.10b Community $ Select One In -Home or 3.10c $ Select One Service with Transportation Provided 3.10d FTM, TDM, Prof. Staffing $ Per Hour 3.10e No show $ Per No Show 3.10f Mileage rate" _ $ Per Mile * If applicable — Mileage rate is paid after (Insert Number of miles) roundtrip miles. 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 Family $1350 Functional Therapy 3.11b Services any an the interepreter other monthly provided forgein rate this in language Spanish is in addtion without (or to $100 3.11c Services 35 calculated office where deliveredDrive through 35 -mile mile for services catchment insurance catchment for the based families staff time will on and outside area area. be outside the for the assigned cases Miles address Savio's Savio's paid are $500 3.11d Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 311e $ 311f $ 311g $ 311h $ 311i $ 311j $ 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 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 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: Functional Family Therapy Gang 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): FFT-GOis a family intervention designed to help youth that are gang -involved or at risk for becoming gang involved. FFT-Gutilizes the core Functional Family Therapy model and has been shown to work with gang -involved or atrisk youth. Like FFT, FFT-Go is effective because it specifically targets risk factors relevant to gang - involved youth(conflictual family relationships, antisocial behaviors, impulsivity, substance use, lack of supervision). Treatment is intensive, and all sessions are conducted in the family home or at a location convenient to the youth and family. Family is defined broadly to include individuals that are important to the youth, which may include other members of the youth's gang. FFT-GO works closely with community partners to support the intervention and help youth and families meet their individual and family goals. FFT-Go has demonstrated significant recidivism reductions for drug charges, adjudicated delinquency, property charges, along with reductions in arrests (felony and crimes against persons). 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 — 1.5 Hours per week (1 family therapy session) 4.03 Anticipated duration of service (i.e. 3-4 months): 3 — 6 months 4.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Target chronic, violent or substance abusing juvenile offenders ages 12 — 18 2. Establish household structure 3. Increase monitoring and supervision 4. Set clear rules and consequences for the youth 4.05 Three (3), or more, specific outcomes of service: 1. Reduce or eliminate substance use for the adolescent Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2. Reduce or eliminate the need for out -of -home placement 4.06 4.07 4.08 4.09 3, Improve family functioning 4 Reduce parent -child conflictWho is eligible for FFT-G Youth and adolescents age 11-18 who are: currently gang involved, at risk of becoming involved, youth associated/affiliated with a gang, families with intergenerational gang involvement. must have at least one family member willing to participate. Target population of the service, including age and gender: Who is eligible for FFT-G Youth and adolescents age 11-18 who are: currently gang involved, a~ risk of becoming involved, youth associated/affiliated with a gang, families with intergenerational gang involvement. must have at least one family member willing to participate. Languages service is available in (please list proficiency and if interpreter services are available): E iglish S Danish (call for availability) 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): Family's home and community Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 4.10 • For monthly Service rates please complete section 4.11 • For Home Study Providers please complete section 4.12 • For monitored Sobriety Providers please complete section 4.13 4.10 Hourlv Service Rates: Service #4 $ Amount Unit Type Service Type 4.10a In-Office/Video $ Select One 4.10b In -Home or Community $ Select One 4.10c Service with Transportation Provided $ Select One 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. Revised '2/3/2024 ADA ATTACHMENT 2 BID FORM 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 Functional Family Therapy Gang $1500 4.11b Services any an the interepreter monthly other provided forgein rate this language in is Spanish in addtion without (or to $100 4.11c Services 35 calculated office where -mile for services catchment for the based families staff will on and area. be outside the the assigned delivered Miles address Savio's are $500 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 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: Functional Family Therapy Contingency Mangement (FFT CM) 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): FFT-CM is an enhancement of FFT aimed to specifically reduce substance use among adolescents and family members and to sustain sobriety. This model continues to focus on other risk factors or referring behaviors to the substance use. 1 session per week 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 - 20 sessions 3 — 6 months 5.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Decrease or eliminate youth's substance use 2. Improve structure within the home 3. Improve parental capacity to set limits 5.05 Three (3), or more, specific outcomes of service: 1. Eliminate the need for out -of -home placement 2. Reduce or eliminate youth's involvement with juvenile justice 3. Reduce youth's delinquency recidivism 5.06 Target population of the service, including age and gender: Adolescents between the ages of 12-18, with negative behaviors that appear to be rooted in the relational dynamics of the family system • Substance abuse within family (caregiver or youth) in addition to the referral behaviors for FFT • Runaway behaviors • Defiance and verbal aggression • Physical aggression with people and property • Delinquency and truancy charges Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM • Substance use • Poor school performance • Self -harming behaviors • Most mental health/behavioral disorder 5.07 Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) 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): Family's home and community Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 5.10 • For monthly Service rates please complete section 5.11 • For Home Study Providers please complete section 5.12 • For monitored Sobriety Providers please complete section 5.13 5.10 Hourlv Service Rates: Service #5 Service Type $ Amount Unit Type 5.10a In-OfficeNideo $ Select One 5.10b In -Home or Community $ Select One 5.10c Service with Transportation Provided $ Select One 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 Functional Contingency Family Mangement $1550 Therapy 5.11b Services any other provided forgein language in Spanish without (or $100 Revised 12/3/2024 ADA ATTACHMENT 2 DID FORM an interepreter this is in addtion to the monthly rate 5 11c Services for families outside Savio's 35 -mile catchment area Miles are calculated based on the assigned office for the staff and the address where services will be delivered $500 5 11d 5 11e $ 5 11f $ 5 11g $ 5 11h $ 5 11i $ 5 11j $ 5.12 Horne 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 �9® 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: SafeCare for Court Involved Families 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 lease address each .line vitem below using bulleted,point4 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): SafeCare is an evidence -based parenting skills intervention that reduces future incidents of child maltreatment. The four modules are outlined below. Each module involves baseline assessment, intervention (training) and follow-up assessments to monitor change. Staff members conduct observations of parental knowledge and skills for each module by using a set of observation checklists. The SafeCare training format is based or well -established social learning theory and evidence from previous research. Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1 - 2 hours per week Anticipated duration of service (i.e. 3-4 months): 16 - 20 weeks Three (3), or more, specific goals of the service (DO use bullet points): Increase parental protective capacity in the following areas: 1. Health 2. Home Safety 3. Parent-Child/Parent-Infant Interactions 4. Problem Solving and Communication Three (3), or more, specific outcomes of service: 1. Improved paretning skills Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 2. Decrease furture incidents of child maltreatment 3. Increase parent child connection 1.06 Target population of the service, including age and gender: Families with children age 0 — 5 with an current dependency and neglect case. Families who are NOT court involved should be referred to a prevention providers. 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) 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): Family's 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 Hourlv Service Rates: Service #1 Service Type $ Amount Unit Type 1.10a In-Office/Video $ Select One 1.10b Community $ Select One In -Home or 1.10c Service with Transportation Provided $ Select One 1.10d FTM, TDM, Prof. Staffing $ Per Hour 1.10e No show $ Per No Show 1.10f Mileage rate* $ 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 SafeCare Families for Court Involved $1070 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 1.11b Services any an the interepreter monthly other provided forgein rate this in language is Spanish in addtion without (or to $100 1.11c Services 35 calculated office where -mile for services catchment for the based families staff will on and area. be outside the the delivered assigned Miles address Savio's are $500 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 DID 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 Coaching 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): This Savio Family Coaching Program is an in-home/community-based program designed as an early -intervention service that helps stabilize families struggling with issues with school, mental health and other matters that place the family at risk of becoming further involved with the child welfare system. The Savio Family Coaching Program is available to families with children of all ages. This service is provided by a Bachelor Level staff. 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: Low: 1 -2 Moderate: 3 — 4 Intensive: 5 -6 2.03 Anticipated duration of service (i.e. 3-4 months): 1 - 4 months 2.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Connect family to needed community resources 2. Stabilize family system 3. Provide coaching and support for parenting 4. Build caregiver protective factors 2.05 Three (3), or more, specific outcomes of service: 1. Reduce or eliminate the need for child welfare involvement 2. Reduce or eliminate future incidents of child maltreatment 3. Increase family functioning 2.06 Target population of the service, including age and gender: This service works well with prevention cases prior to court involvement. Families with children of all ages are eligible for this service. This service is also great for kinship homes in need of additional support. 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 Spanish (call for availability) 2.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Typically not. All cases are evaluated for Medicaid eligibility. 2.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Family's home and community Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 2.10 • For monthly Service rates please complete section 2.11 • For Home Study Providers please complete section 2.12 • For monitored Sobriety Providers please complete section 2.13 2.10 H curly Service Rates: Service #2 Service Type $ Amount Unit Type 2.10a In-Office/Video t $ Select One 2.10b In -Home or Community $ Select One 2.10c Service with Transportation Provided $ Select One 2.10d FTM, TDM, Prof. Staffing $ Per Hour 2.10e No show $ 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 Family Coaching Intensive $2350 5 2.11b Family Coaching Moderate $1750 3 2.11c Family Coaching Low $1115 1 2.11d Services any an the interepreter monthly other provided forgein rate this in language is Spanish in addtion without (or to $100 2.11e Services 35 -mile calculated catchment for based families on area. outside the assigned Miles Savio's are $500 Revised ^ 2/3/2024 ADA ATTACHMENT 2 BID FORM office where for services the staff will and be the delivered address 2.11f 2.118 $ 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 I FORM Weld County Use Only Service #2: Initial Proposal Determination: If Applicable, Select One Date: Reason for follow up or negotiation: List specific items) needing follow up or discussion Changes approved to proposal: List specific item(s) that were changed Changes approved by* Name of 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: Supervised Family Time - BA level staff 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): Providing supervised visitation services that includes family coaching and intervention during the session. 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: Based on client/family need 3.03 Anticipated duration of service (i.e. 3-4 months): Based on client/family need 3.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Improve parent -child relationship 2. Increase parenting skills 3. Provide important parent -child contact 3.05 Three (3), or more, specific outcomes of service: Based on identified case goals 3.06 Target population of the service, including age and gender: Families with court ordered parenting time in need of basic coaching during visitation time. 3.07 Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) 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): To be determined based on case need 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 $120/132 Per Hour 3.10b In -Home or Community $120/132 Per Hour 3.10c Service with Transportation Provided $120/132 Per Hour 3.10d FTM, TDM, Prof. Staffing $120/132 Per Hour 3.10e No show $120/132 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 $ 3.118 $ 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: The difference in the rates are for services provided in English first hourly rate second hourly race is for services provided in Spanish. $120 hour English; 132 Spanish Revised `2/3/2024 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 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: Therapeutic Family Time - MA Staff 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): Providing supervised visitation services that includes family therapeutic/trauma informed irtervention during the session. 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: Based on identified case goals 4.03 Anticipated duration of service (i.e. 3-4 months): Based on client/family need 4.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Improve parent -child relationship 2. Increase parenting skills 3. Provide important parent -child contact 4.05 Three (3), or more, specific outcomes of service: Based on identified case goals 4.06 Target population of the service, including age and gender: Families with court ordered parenting time in need of therapeutic interventions during parenting tirne 4.07 Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) 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): To be determined by case need 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 Hours Service Rates: Service #4 Service Type $ Amount Unit Type 4.10a In-Office/Video $140/154 Per Hour 4.10b $140/154 Per Hour In -Home or Community 4.10c Service with Transportation Provided $140/154 Per Hour 4.10d $140/154 FTM, TDM, Prof. Staffing Per Hour 4.10e No show $140/154 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: The difference in the rates are for services provided in English first hourly rate second hourly rate is for services provided in Spanish. $140 English; $154 Spanish 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 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: Adolescent Skills Coaching 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): Short term skills coaching for adolescents and their families to support them in making connections with natural supports in their environment to help meet the family's needs. This service is offered by a Bachelor Level Staff. This model builds on the family's strengths, encourages the development of supportive and sustainable relationships that promote long term resilience. This program can also be an intervention that evaluates the youth's environment and aligns with the parents to establish household structure and supervision. 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: Low: 1 -2 Moderate: 3 — 4 Intensive: 5 -6 5.03 Anticipated duration of service (i.e. 3-4 months): 3 - 6 months 5.04 Three (3), or more, specific goals of the service (DO use bullet points): 1. Assist family to identify and successfully access community resources 2. Assist youth in building independent living skills 3. Align with family and youth as an advocate 4. Support caregiver in establishing household structure 5. Support caregiver in developing rules and consequences 6. Assist family in establishing support network for long term assistance 5.05 Three (3), or more, specific outcomes of service: 1. Increase the youth and their family's ability to access ecological networks of support outside of Savio. 2. Establishing a strong network of support enables the youth and their family to maintain the skills learned and increases the likelihood of success after discharge. Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 5.06 Target population of the service, including age and gender: The youth served may have treatment needs in the following program areas: drug and alcohol services; tracking; mentoring; family intervention; educational support; employment/vocational support; restorative justice; independent living skills; crisis intervention; and aftercare. Specialized services such as mental health treatment is provided either by the Savio CBS VVorker or through linkages with community resources. `kills coaching services begin with the Savio staff being the support system for the youth and their family. 5.07 Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) 5.08 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Typically not. All cases are evaluated for Medicaid eligibility 5.09 Service location — list where the service will take place (i.e. client's home, in -office, other): Client's Home and community Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 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 i Unit Select Type One 5.10a In-Office/Video $ 5.10b Community $ Select One In -Home or 5.10c $ Select One Service with Transportation Provided 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 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 5.11a Adolescent Intensive Skills Coaching $2350 5 5.11b Adolescent Moderate Skills Coaching $1750 3 5.11c Adolescent Skills Coaching Low $1115 1 5.11d Services any an the interepreter monthly other provided forgein rate this language in Spanish is in addtion without (or to $100 5.11e Services 35 calculated office where -mile for services catchment for the based families staff will on and area. be outside the the delivered assigned Miles address Savio's are $500 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 BBD 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): 1 You may complete another Attachment 2 if you have more than 5 services. Service #1 Service Name: Community Based Services Scope of Work Please Note: If the service is a monthly package, different levels should be indicated. All monthly packages must state a specific minimum number of direct service hours. Please address each line item below using bulleted points) 1.01 Modalities, curriculum, tools used in delivery of service (DO NOT list company history): Savio's Community Based Services (CBS) is a flexible intervention that provides in -home therapeutic services to families and children who do not fit into an Evidence -based program. This service can be tailored to meet the specific needs of each family. This service includes therapeutic interventions, referrals for concrete services, intensive case management with collateral services, and crisis intervention as needed. Staff are Master's level. 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: Low: 1 - 2 hours per week Mod: 3 - 4 hours per week High: 5 - 6 hours per week. 1.03 Anticipated duration of service (i.e. 3-4 months): Anticipated length of time to reach stated goal: 4 - 6 months 1.04 Three (3), or more, specific goals of the service (DO use bullet points): Stabilize home environment Improve parenting Connection to community resources Decrease of negative or delinquent behavior Stabilize permanency. 1.05 Three (3), or more, specific outcomes of service: Reduce/eliminate Child/youth need for higher level of care Reduce or eliminate delinquent behavior/involvement with Juvenile Justice Improve overall family functioning Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM Reduce/eliminate future incidents of child maltreatment. 1.06 Target population of the service, including age and gender: Families with children ages birth to 18 in need of in -home services with a specific treatment goal that cannot be met by an evidence -based model. This model may also be utilized with youth who are in need of therapeutic support and do not fit into another intervention. 1.07 Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) 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: Family's home and community Rates Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing). All rates should be per hour unless service is for evaluations/assessments, Home Studies, or Monitored Sobriety. • For hourly Service rates please complete section 1.10 • For monthly Service rates please complete section 1.11 • For Home Study Providers please complete section 1.12 • 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 $ Select One 1.10b In -Home or Community $ Select One 1.10c Service with Transportation Provided $ Select One 1.10d FTM, TDM, Prof. Staffing $ Per Hour 1.10e No show $ Per No Show 1.10f Mileage rate* $ 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 Low 1 - 2 hours per week $1073 1 1.11b Moderate 3 - 4 hours per week $1850 3 1.11c i Intensive 5 - 6 hours per week $2476 5 Revised 12/3/2024 ADA ATTACHMENT 2 BID FORM 1.11d Services any an the interepreter monthly other provided forgein rate this language in is Spanish in addtion without (or to $100 1.11e Services 35 calculated office where -mile for services catchment for the based families staff will on and area. be outside the the delivered assigned Miles address Savio's are $500 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 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 3 WELD COUNTY DEPARTMENT OF HUMAN SERVICES PROVIDER INFORMATION FORM (PIF) Agency Information: As listed on W-9 Agency Name: S a v i o House Trails Provider ID (if known): 0000048170 Provider Contact Full Name:Julia u l i a R o q u s k i Title: Associate Executive Director Primary Phone Number (10 -digit): 303.225.4100 Ext.: Primary Contact Email: jroquski(a�saviohouse.orq Agency Location Address (Street, city, state, zip): 32 5 King Street Denver, CO 80219 Agency Mailing Address (Street, city, state, zip): Same as above Agency Type: Private Non -Profit Send Referrals for Service to: Referral Contact Name:Julia u l i a Rog u s k i Title: Associate Executive Director Referral Phone Number (10 -digit): 303.225.4100 Ext.: Email: jroguski@saviohouse.org Billing Contact: Billing Contact Name: Rob i n Maher Title: Office Manager Billing Phone Number (10 -digit): 303.225.4100 Ext.: Email: rmaherasaviohouse.orq 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): Savio House AGENCY CONTACT: Julia Roguski PHONE NUMBER: 303.225.4100 EMAIL: jroguski@saviohouse.org PROPOSED SERVICE(S):Community Based Services (CBS), MST PSB, SAi, EMDR, TF CBT, TST, MST, MST CM, FFT, FFT G, FFT CM, SAFECARE, FAMILY COACHING, SUPERVISED FAMILY TIME, THERAPEUTIC FAMILY TIME, ADOLESCENT SKILLS COACHING Legal Last Name Middle Initial Previous Legal Last Name (If aoolicable) Legal First Name Service Type Llcensure/ Credentials DORA# (If applicable) BUSH TANYA V\doICBS Licensed Clinical Social Worker CSW.09928684 COLANGELO L ANASTASIA ,Adol CBS Marriage and Family II'herapist MFT.0001530 BAYDUSH DAVID AdoICBS Licensed Clinical Social Worker CSW.09927603 LANE COLIN AdoICBS Licensed Clinical Social Worker CSW.09924088 O'Brien M Kate Adol - DYC ISP/STP Licensed Clinical Social Worker CSW.09924256 MARTINEZ KENNETH Adol - DYC ISP/STP f#N/A #N/A MCALPIN R NATAUE Adol - DYC ISP/STP #N/A #N/A PANTALEO MICHAEL AdoICBS Licensed Clinical :,ocial Worker CSW.09924205 WELK-ROBBINS KAITLYN .Child Placement Unlicensed Psychotherapist NLC.0109942 Shropshire M *Lacey Family Wellness Unlicensed Psychotherapist NLC.0011751 FORD SUSAN Family Wellness Licensed Clinical Social Worker CSW.09930900 STAFFORD :CAROLINA Family Wellness Licensed Clinical Social Worker CSW.09926976 MORRIS KELLY A AdoICBS Unlicensed Psychotherapist NLC.0011735 ROT2 ANDREA MST Licensed Professional Counselor LPC.0012607 NORMAN R AILVIA SafeCare Prevention I#N/A #N/A SPINELLO AMIE AdoICBS Licensed Clinical Social Worker CSW.09926711 RUBENS A LINDSEY Ado! - DYC ISP/STP Licensed Professional Counselor LPC.0014657 WILLOUGHBY AHALEIGH Ado! - DYC ISP/STP Unlicensed Psychotherapist NLC.0008439 Ortiz D effries Mandy Child Placement Licensed Clinical Social Worker CSW.09930632 Brownell C Aophia Ado! - DYC ISP/STP #N/A #N IA McPherson N Pittman Taryn !Add -DYC ISP/STP #N/A #N/A CHILD WELFARE INVITATION FOR BID 2025-26 -VARIOUS SERVICES ATTACHMENT 4 - STAFF DATA SHEET Bidder Must List All Staff Who Will Administer the Proposed Service(s) BIDDER'S LEGAL NAME (As it appears on the W-9):Savio House AGENCY CONTACT: Julia Roguski PHONE NUMBER: 303.225.4100 EMAIL: jroguski@saviohouse.org PROPOSED SERVICE(S): Community Based Services (CBS), MST PSB, SAi, EMDR, TF CBT, TST, MST, MST CM, FFT, FFT G, FFT CM, SAFECARE, FAMILY COACHING, SUPERVISED FAMILY TIME, THERAPEUTIC FAMILY TIME, ADOLESCENT SKILLS COACHING Legal Last Name Middle Initial Previous Legal Last Name (If applicable) Legal First Name Service Type Licensure/ Credentials DORA# (If applicable) Warren D Hargraves-Uribe Aly Child First #N/A #N/A Leal -Tapia A Micheel Child First #N/A #N/A Ramirez Beatriz Child First #N/A #NIA Garcia Sandoval Brian Family Wellness t1=N/A #N/A Walters -Hooey R Quincy Family Wellness #N/A #N/A REASONS RONI Adol CBS Licensed Clinical Social Worker CSW.09927569 If'HORSEN N TAYLORE Child First Licensed Professional Counselor LPC.0020233 Bieltz D Alexis Child First Clinical Social Work Candidate Doryland N Burchfield Anna Child First Licensed Clinical Social Worker CSW.09931017 CARPENTER R REBECCA Child Placement Licensed Clinical Social Worker CSW.00001586 DEHERRERA NICOLE AdoICBS Licensed Professional Counselor LPC.0012385 Englert T Sarah AdoICBS r#N/A #N/A ibril n.. Ladan AdoICBS r#N/A #N/A Moreno Armando Adol CBS #N/A #N/A Guerrero S Alexia Child Placement Marriage and Family MFTC.0014690 Therapy Candidate DONER A ELIZABETH Adol CBS Licensed Professional Counselor LPC.0011414 FIEDLER COURTNEY MST Marriage and Family Therapist MFT.0001051 Barker Hannah Family Wellness #N/A #NIA Bonner F Catie Family Wellness #N/A *N/A Darcey Griffin Family Wellness #N/A #N/A Diaz Flores M ennifer Family Wellness #N/A *N/A McCabe Molly Family Wellness #N/A #N/A Martin S Figueroa ordan Family Wellness Licensed Clinical Social Worker CSW.09931349 WAGNAAR EFFREY Family Wellness Licensed Clinical Social Worker CSW.09931041 PHILLIPS Bob Family Wellness Unlicensed Psychotherapist NLC.0110856 Binns-Calvey F Miranda Family Wellness Clinical Social Work Candidate SWC.0000001476 Caruso Stephanie Family Wellness #N/A ®N/A Duran Kerry Family Wellness Clinical Social Work Candidate SWC.0000001221 Goldstein Micah Family Wellness Clinical Social Work Candidate SWC.0000002403 Hopkinson C Booth Ireland Family Wellness Licensed Professional Counselor *PC.0021667 Osgood E Maddie Family Wellness Licensed Social Worker *SW.0009925777 Salerno N ulianne Family Wellness Clinical Social Work Candidate SWC.0000001700 Sosa-Rivera Ivan Family Wellness Clinical Social Work Candidate SWC.0000001833 Zirbel L Christine Family Wellness Licensed Professional Counselor Candidat LPCC.0023010 Loukaides Eleni AdoICBS Licensed Professional Counselor LPC.0020471 Cummins T Robert AdoICBS Licensed Professional Counselor Candidat LPCC.0021684 Garcia Torres G Chelsey IAdoICBS #N/A fl:N/A HENNESSEY CALLAN IAdoICBS Licensed Professional Counselor Candidat LPCC.0019551 Maestas Anna IAdoICBS Licensed Professional Counselor Candidat LPCC.0021203 Rodriguez M Bella IAdoICBS Clinical Social Work Candidate SWC.0000002183 Dickerson L Ferguson Kelsey MST Licensed Clinical Social Worker CSW.09930672 GUTOWSKI K IAIMEE MST Licensed Clinical Social Worker CSW.09929699 Harrell N ohnson IA.delia MST I#N/A I#N/A Mamola L Chloe MST I#N/A #NIA Ross Olivia MST Unlicensed Psychotherapist NLC.0109573 Fine B Fine Annie MST Clinical Social Work Candidate SWC.0000002142 Goodell Lance MST Licensed Social Worker LSW.0009925421 Molenaar Rebecca MST Licensed Professional Counselor Candidat LPCC.0023267 MORALES L EREMY MST Licensed Clinical Social Worker CSW.09931023 Natalia Corral MST #N/A #N/A Roussos Blair MST Licensed Professional Counselor Thomas P Mary MST Clinical Social Work Candidate SWC.0000001615 Talsma A Cooper Meryl MST Unlicensed Psychotherapist NLC.0103139 Tuttle F Moriah MST Clinical Social Work Candidate SWC.0000002376 Coates B Errin MST Licensed Professional Counselor Candidat LPCC.0022374 Eckberg F O'Malley O'Malley- Wads Woods Apryl MST I#N/A #NIA Habashi S Mariam MST #N/A #N/A Harness L Coral MST I#N/A I#N/A Lee L Riana MST I#N/A I#N/A McConnell IA Higgerson Brooke MST I#N/A I#N/A Pieffer M acob MST I#N/A I#N/A !Trujillo C Maez Sonya MST #N/A #N/A tv'aldez Chavez IV' Flor MST I#N/A I#N/A Paradas L !Andrea MST #NIA I#N/A Ventura M Silvana MST #NIA I#N/A Chavez-Marroquin E Marroquin !Acevedo Erika MST Clinical Social Work Candidate SWC.0000001 81 9 Pena C Wendolly MST Marriage and Family Therapy Candidate MFTC.0014679 CALKINS Calkins HALEY MST Licensed Clinical Social Worker CSW.09929544 Franklin IA Kiaya MST Licensed Professional Counselor Candidat LPCC.0022362 Pensa Pensa Elena MST Clinical Social Work Candidate SWC.0000000886 Maher Robin Administration Wi:N/A #NIA LAY M KRISTY MST Marriage and Family Therapist MFT.0002170 Gomez Pedro AdoICBS Licensed Professional Counselor Candidat LPCC.0023061 Grimste M o IAdoICBS Licensed Social Worker LSW.0009925495 Roberts Heidi IAdoICBS Licensed Professional Counselor Candidat LPCC.0018065 Sheehan L Abigail AdoICBS Licensed Clinical Social Worker CSW.09931080 Saenz E Saenz tv'ictoria (Assessment Program #N/A I#N/A UWUDIA NNEKA IAdoICBS W/:N/A #NIA CHILD WELFARE INVITATION FOR BID 2025-26 -VARIOUS SERVICES ALAT - - ACORO" i`,---- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DOWNY) 5/2/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy((es) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lamb Insurance Services 1385 Hwy 35 PMB 170 Middletown, NJ 07748 CONTACT NAME: PHONE 212 375-3000 I F°'t ) EacA , Ext): ( ) (Alc, No): (888 389-8061 L ADORESs: service@lambis.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Alliance of Nonprofits for Insurance 10023 INSURED Savio House 325 King Street Denver, CO 80219-1326 INSURER B:Pinnacol Assurance 41190 INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL UV INSD WVD POLICY NUMBER POLICY EFF (MMIDDIYYYYI (MAYA% (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X 2025-54986 5/1/2025 5/1 /2026 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occunence) $ 500,000 MED EXP (Any one person) $ 20,000 PERSONAL 8 ADV INJURY $ 1'000'000 GENERAL AGGREGATE $ 3'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JEaT LOC OTHER: PRODUCTS - COMP/OP AGG $ 3,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO OWNED _ AUTOS ONLY ACTOS ONLY SCHEDULED AUTOS EtS ONLDY 2025-54986 5/1/2025 5/1/2026 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (PeOr acclRdentrAGE $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 2025-54986- UMB 5/1/2025 5/1/2026 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5'000'000 $ DED I X I RETENTION $ 10,000 B WORKERS COMPENSATION Virg LIABILITY OFFIC/ng EXLUPROPRIETOR/PARTNER/EXECUTIVE Y / N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 984642 5/1/2025 5/1/2026 X I STATUTE I I EORH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1'000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ A A Professional Liabili Sexual Abuse / Moles 2025-54986 2025-54986 5/1/2025 5/1/2025 5/1/2026 5/1/2026 $1mil/$3mil limits $1 mil/$3mil limits DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Afilid onal Remarks Sohedule, may be attached if more space is required) Board of County Commissioners of Weld County and Its OfficerslEmployees CERTIFICATE HOLDER CANCELLATION Weld Coun ty 1150 O Street Greeley, CO 80634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE it' ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: SAVIHOU-01 ALAT LOC #: 1 ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Lamb Insurance Services NAMED INSURED MII HouStr 325 King se eet POLICY NUMBER Denver, CO 80219-1326 SEE PAGE 1 CARRIER NAIC CODE SEE PAGE 1 SEEP 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance 25-26 Cyber Policy Type: Cyber Liability Policy #: CYB-108245178-00 Policy Carrier: Travelers Excess & Surplus Policy Period: 5/1/2025-2026 Coverage Limit: $1,000,000 each claim/aggregate Retention Limit: $10,000 Loss of Client's Property: $100,000 limit Deductible: $5,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SIGNATURE REQUESTED: Weld/Savio House PSA Final Audit Report 2025-06-06 Created: 2025-06-06 By: Windy Luna (wluna@weld.gov) Status: Signed Transaction ID: CBJCHBCAABAAwSuDJuVyVOWOZu14TUwgdzKcr7lNlcC "SIGNATURE REQUESTED: Weld/Savio House PSA" History t Document created by Windy Luna (wluna@weld.gov) 2025-06-06 - 4:50:26 PM GMT- IP address: 204.133.39.9 Cry Document emailed to Norma Aguilar -Dave (naguilar-dave@saviohouse.org) for signature 2025-06-06 - 4:51:14 PM GMT t Email viewed by Norma Aguilar -Dave (naguilar-dave@saviohouse.org) 2025-06-06 - 7:13:37 PM GMT- IP address: 104.47.73.254 cS© Document e -signed by Norma Aguilar -Dave (naguilar-dave@saviohouse.org) Signature Date: 2025-06-06 - 7:19:06 PM GMT - Time Source: server- IP address: 143.244.115.154 0 Agreement completed. 2025-06-06 - 7:19:06 PM GMT Powered by Adobe Acrobat Sign Entity Information Entity Name* SAVIO HOUSE Entity ID* @00035730 Contract Name* SAVIO HOUSE (NEW PROFESSIONAL SERVICES AGREEMENT RELATED TO BID #B2500043) Contract Status CTB REVIEW New Entity? Contract ID 9563 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) SAVIO HOUSE - NEW PROFESSIONAL SERVICES AGREEMENT RELATED TO BID #B2500043. TERM: JUNE 1 2025 THROUGH OCTOBER 31, 2028. Contract Description 2 (CONSENT) TEMPLATE APPROVED ON APRIL 23, 2025. Contract Type" Department AGREEMENT HUMAN SERVICES Amount* $0.00 Renewable* YES Automatic Renewal Grant IGA 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 THIS WILL BE A CONSENT ITEM. 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* 08/31/2028 Renewal Date* 06/01/2026 Committed Delivery Date Expiration Date Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date Approval Process Department Head JAMIE ULRICH DH Approved Date 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