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Home My WebLink About20211583.tiffCorrFvacf 3q Cbntnf 5/1 0/ PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: March 28, 2023 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Protection Agreement Amendments for 2021-22 Core/Non-Core Contracted Services B2100042 Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Child Protection Agreement Amendments for 2021-22 Core/Non-Core Contracted Services B2100042. The Department entered into Agreements with various Child Welfare Service Providers through the 2021-22 Request for Proposal (RFP), Bid Number: B2100042, identified as Tyler ID 2021-0307. These Agreements were issued for a period of three (3) years with the option to renew annually. The Department is requesting to renew the current Agreements with no changes for twelve (12) Providers reflected in the attached list. Agreements will be renewed for the third and final year, for the period of June 1, 2023 through May 31, 2024. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Upon Board approval of this pass -around, signed Agreement Amendments will be obtained from Providers and submitted to the Board for approval and Chair signature. I do not recommend a Work Session. I recommend approval of these Agreement Amendments and authorize the Chair to sign. Perry L. Buck, Pro -Tern Mike Freeman, Chair Scott K. James Kevin D. Ross Lori Saine Approve Recommendation 114 Schedule Work Session Pass -Around Memorandum; March 28, 2023 — CMS ID Vario s 0A464041 -e 5// 0/25 Other/Comments: Page 1 2o2h 1 5$3 W0CY3 PRIVILEGED AND CONFIDENTIAL - - - - _ NAME --- 7- BID It BiD Y TYLER To Benavior Services of the Rockies B2100042 2021-22 2021-1581 Ceitennial Mental Health Center, Inc. B2100042 2021-22 2021-1579 Cc orado State University B2100042 2021-22 • 2021-1583 Jo ies, Dr. Jacob B2100042 2021-22 2021-1470 62100042 2021-22 2021-1436 Nc-thern Horizon Behavioral Health - Nikki Tolle Reaching Hope B2100042 2021-22 2021-1547 Reece, Alison , 82100042 2021-22 2021-1438 Sc.iereisgnty Counseling - Annette Brown B2100042 2021-22 2021-1439 Specialty Counseling & Consulting B2100042 2021-22 2021-1466 The Hope Initiative B2100042 2021-22 2021-1582 B2100042 2021-22 2021-1469 Vit3lCar e Withers Whisper - Andrea Hall B2100042 2021-22 2021-1471 Pass -Around Memorandum: March 28, 2023 — CMS ID Various Page 2 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND COLORADO STATE UNIVERSITY N' iel This Agreement Amendment, made and entered into I v day of , 2023 by and between the Board of Weld County Commissioners, on behalf of the Weld County Depa ent of Human Services, hereinafter referred to as the "Department", and Colorado State University, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Mental Health Services and Foster Care/Adoption Support, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2021-1583, approved on June 16, 2021. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement was set to end on May 31, 2022. • The Original Agreement was amended on: • May 16, 2022 to extend the term date through May 31, 2023. • The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2021-1583. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Term This agreement is being renewed for the third and final year, for the period of June 1, 2023 through May 31, 2024. • All other terms and conditions of the Original Agreement remain unchanged. W ozi - /.513 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST. BY: BOARD OF COUNTY COMMISSIONERS rk to the Board WELD COUNTY, COLORADO Deputy Cl Ice Freeman, Chair MAY 1 0 2323 NTRACTOR: he Board of Governors of the Colorado State Colorado State University Colorado State University CSU Campus Delivery 1570 Fort Collins, Colorado 80523-1570 A i, NiG.rn By �Ange Nielsen Apr 4, 207318:00 MDT) Angela Nielsen, Director, Office of Budgets Apr 14, 2023 Date: Stephanie Seng, Director, Center for Family and Couple Therapy and Child Trauma and Resilience Assessment Center Apr 16, 2023 Date: LEGAL REVIEW 8rca+z Aitiercatt, By: Brian Anderson (May 3, 2023 08:43 MDT) Brian Anderson, Esq. Assistant Legal Counsel Office of the General Counsel Date: May 3, 2023 coot/- /543 SIGNATURE REQUESTED: Weld/CSU Amendment #2 2023-24 Final Audit Report 2023-05-03 Created: 2023-04-14 By: Windy Luna (wluna@co.weld.co.us) Status: Signed Transaction ID: CBJCHBCAABAA1JiYh-5bxcR8hUdyliL0tat-n6rs6oTd "SIGNATURE REQUESTED: Weld/CSU Amendment #2 2023-2 4" History e Document created by Windy Luna (wluna@co.weld.co.us) 2023-04-14 - 9:22:06 PM GMT Cry Document emailed to Angela Nielsen (angela.nielsen@colostate.edu) for signature 2023-04-14 - 9:23:57 PM GMT t Email viewed by Angela Nielsen (angela.nielsen@colostate.edu) 2023-04-15 - 0:00:38 AM GMT 6Q Document e -signed by Angela Nielsen (angela.nielsen@colostate.edu) Signature Date: 2023-04-15 - 0:00:48 AM GMT - Time Source: server E, Document emailed to Stephanie Seng (stephanie.seng@colostate.edu) for signature 2023-04-15 - 0:00:49 AM GMT '5 Email viewed by Stephanie Seng (stephanie.seng@colostate.edu) 2023-04-15 - 0:56:38 AM GMT d© Document e -signed by Stephanie Seng (stephanie.seng@colostate.edu) Signature Date: 2023-04-17 - 3:04:31 AM GMT - Time Source: server E, Document emailed to Brian Anderson (brian.anderson@colostate.edu) for signature 2023-04-17 - 3:04:32 AM GMT t Email viewed by Brian Anderson (brian.anderson@colostate.edu) 2023-05-03 - 2:42:31 PM GMT t5 Document e -signed by Brian Anderson (brian.anderson@colostate.edu) Signature Date: 2023-05-03 - 2:43:13 PM GMT - Time Source: server Powered by Adobe Acrobat Sign CO Agreement completed. 2023-05-03 - 2:4013PM GMT Contract Form New Contract Request Entity Information Entity Name* Entity ID* COLORADO STATE UNIVERSITY #00002340 Contract Name. COLORADO STATE UNIVERSITY (CHILD PROTECTION AGREEMENT AMENDMENT #21 Contract Status CTB REVIEW ❑ New Entity? Contract ID 69.39 Contract Lead WLUNA Contract Lead Email wlunaLAweldgov.corn;cobbx xlk#weldgov.com Parent Contract ID 20211583 Requires Board Approval YES Department Project I Contract Description. (CONSENT) COLORADO STATE UNIVERSITY (BID #821000421 CHILD PROTECTION AGREEMENT AMENDMENT #2. TERM: 06,01;2023 THROUGH 05;`31 2024, Contract Description 2 PROVIDER WAS LISTED ON APPROVED VENDOR LIST PRESENTED TO THE BOCC ON 03:29; 2023 AND SENT AS A COMMUNICATION ITEM, PA TO CTB ON 03130; 202'3. Contract Type * AGREEMENT Amount. $ 0.00 Renewable. NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanServices#weldgov.co Department Head Email CM-HumanServices- DeptHead#weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTI'ATTORN EY#WELDG OV.COM Requested BOCC Agenda Date. 05/17:2023 Due Date 05;'13;2023 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a MA enter VISA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Review Date. 03 29 2024 Renewal Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Committed Delivery Date Contact Type Contact Email Expiration Date* 05`31:2024 Contact Phone 1 Contact Phone 2 Purchasing Approver Purchasing Approved Date Approval Process Department Head JAMIE ULRICH DH Approved Date 05/03/2023 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 05/1005/10/2023 Originator WLUNA Finance Approver CHERYL PATTELLI Legal Counsel MATTHEW CONROY Finance Approved Date Legal Counsel Approved Date 05/04;2023 05,04/2023 Tyler Ref # AG 051023 PRIVILEGED AND CONFIDENTIAL COYck I r5zsO) MEMORANDUM DATE: March 29, 2022 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Protection Agreement Amendments for 2021-22 Core/Non-Core Contracted Services B2100042 Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Child Protection Agreement Amendments for 2021- 22 Core/Non-Core Contracted Services B2100042. The Department entered into Agreements with various Child Welfare service providers through the 2021-2022 Request for Proposal (RFP), Bid Number: B2100042, identified as Tyler ID 2021-0307. These Agreements were issued for a period of three (3) years with the option to renew annually. The Department is requesting to renew the current Agreements with no changes for sixteen (16) providers reflected in the attached list. Agreements will be renewed for the second year for the period of June 1, 2022 through May 31, 2023. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Upon Board approval of this pass -around, signed Agreement Amendments will be obtained from providers and submitted to the Board for approval and Chair signature. I do not recommend a Work Session. I recommend approval of these Agreement Amendments and authorize the Chair to sign. Perry L. Buck Mike Freeman, Pro -Tern Scott K. James, Chair Steve Moreno Lori Saine Approve Schedule Recommendation Work Session Other/Comments: 6itttui Pass -Around Memorandum; March 29, 2022 - CMS ID — Various Page 1 c&= c�5At'Q/ 2;7_x/61 ov,KR 3 PRIVILEGED AND CONFIDENTIAL CMS Name Behavior Services of the Rockies Bid # B2100042 Bid Year 2021-22 Tyler ID 2021-1581 Centennial Mental Health B2100042 2021-22 2021-1579 Colorado State University B2100042 2021-22 2021-1583 Hartshorn, Mandee dba Creative Nursing LLC B2100042 2021-22 2021-1437 Jones, Dr. Jacob B2100042 2021-22 2021-1470 Northern Colorado Counseling (Rascon, Christina) B2100042 2021-22 2021-1467 Northern Horizon Behavioral Health - Nikki Tolle 62100042 2021-22 2021-1436 Reaching Hope B2100042 2021-22 2021-1547 Reece, Alison B2100042 2021-22 2021-1438 Rocky Mountain Kids B2100042 2021-22 2021-1465 Sovereignty Counseling - Annette Brown B2100042 2021-22 2021-1439 Specialty Counseling & Consulting B2100042 2021-22 2021-1466 The Hope initiative B2100042 2021-22 2021-1582 Tindall and Associates B2100042 2021-22 2021-1606 VitalCare B2100042 2021-22 2021-1469 Withers Whisper - Andrea Hall B2100042 2021-22 2021-1471 Pass -Around Memorandum; March 29, 2022 - CMS ID — Various Page 2 Karla Ford From: Sent: To: Subject: yes Lori Saine Weld County Commissioner, District 3 1150 0 Street PO Box 758 Greeley CO 80632 Phone: 970-400-4205 Fax: 970-336-7233 Email: Isaine@weldgov.com Website: www.co.weld.co.us In God We Trust Lori Saine Tuesday, March 29, 2022 11:34 AM Karla Ford RE: Please Reply - PA FOR ROUTING: CW Core Non -Core 2021-22 Renewals B2100042 (CMS Various) Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confident,al or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Karla Ford <kford@weldgov.com> Sent: Tuesday, March 29, 2022 10:4S AM To: Lori Saine <Isaine@weldgov.com> Subject: Please Reply - PA FOR ROUTING: CW Core Non -Core 2021-22 Renewals B2100042 (CMS Various) Importance: High Please advise if you approve recommendation. Thank you! Karla Ford Executive Assistant & Office Manager, Board of Weld County Commissioners 1150 0 Street, P,O. Box 758, Greeley, Colorado 80632 :: 970.336-7204 :: kfordweldgov.com :: www.weldgov.com **Please note my working hours are Monday -Thursday 7:00a.m.-5:00p.m.** 1 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND COLORADO STATE UNIVERSITY This Agreement Amendment, made and entered into I lnAirk Y day of \Y 1 Cl- , 2022 by and between the Board of Weld County Commissioners, on behalf of the Weld County Depakent of Human Services, hereinafter referred to as the "Department", and Colorado State University, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Mental Health Services and Foster Care/Adoption Support, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2021-1583, approved on June 16, 2021. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on May 31, 2022. • This Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Term This agreement is being renewed for the second year, for the period of June 1, 2022 through May 31, 2023. • All other terms and conditions of the Original Agreement remain unchanged. cot/ - /5g3 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. X140;li ATTEST. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO BY: COUNTY: it K. James, Chair MAY 1 6 2022 CONTRACTOR: 1'I/i The Board of Governors of the Colorado State University System. acting by and through Colorado State University Colorado State University CSU Campus Delivery 1570 Fort Collins, Colorado 80523-1570 By'Oyela N2lreh :Angeo Nielsen (Apr 21, 2022 12:46 MDT) Angela Nielsen, Director, Office of Budgets Apr 21, 2022 Date: By: Shawn Whitney, MS, LMFT, S-PSB Acting Director, Center for Family and Couple Therapy and Child Trauma and Resilience Assessment Center Date: May 4, 2022 LEGAL REVIEW By: Brian Anderson, Esq. Assistant Legal Counsel Office of the General Counsel Date: Apr 21, 2022 Contract Form Entity Information New Contract Request Entity Name* Entity ID* COLORADO STATE UNIVERSITY 10002340 ❑ New Entity? Contract Name* Contract ID COLORADO STATE UNIVERSITY (AGREEMENT AMENDMENT 5800 FY 2022-23) Contract Status CTB REVIEW tract Description * BID# B2100042. TERM 6/1,22-5/31 23. Contract Description 2 CONSENT: PA WAS SENT TO CTB ON: 3,`30,, 2022. Contract Type AMENDMENT Amount * $0.00 Renewable* NO is Renewal Department HUMAN SERVICES Department Email CM- HumanServices weidgov.co n1 Department Head Email CM-HumanServIces- DeptHead �?weldgov,com County Attorney GENERAL COUNT( ATTORNEY EMAIL County Attorney Email CM- COUNTYA I I ORNEYWELDG OV.COM Contract Lead* APEGG Contract Lead Email apegg(_ weldgov.com;cobbx xlkgM eldgov.corn Requested BQCC Agenda Date* 05 25 2022 Parent Contract ID 20211583 Requires Board Approval YES Department Project Due Date 05 21,'2022 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in On Ease Contract Dates Effective Date Review Date* 04=03 2023 Renew Termination Notice Period Contact Information Contact Info Contact Name. Purchasing Purchasing Approver CONSENT Approval Process Department Head JAMIE ULRICH DH Approved Date 05,`10,'2022 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 05;16/2022 Originator APEGG Contact Type Committed Delivery Date Finance Approver CONSENT Expiration Date* 05131/2023 Contact Phone 1 Purchasing 05:10'2022 Finance Approved Date 05,`10'2022 Tyler Ref # AG 051622 d Date Legal Counsel CONSENT Legal Counsel 05'10:2022 Contact Phone 2 d Date //) CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND COLORADO STATE UNIVERSITY This Agreement, made and entered into the /h' ay of 2021, by and between the Board of Weld County Commissioners, on behalf of the Weld Coun epartment of Human Services, hereinafter referred to as the "Department" and Colorado State University, herei after referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule. Exhibit B, C, and D are attached hereto and incorporated herein by this reference. Exhibit A is Weld County's Request for Proposal Number B2100042 which is incorporated into this agreement by reference and will be provided upon request to the Department. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided Core Services or other funding to the Department for Mental Health Services and Foster Care/Adoption Support. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1, 2021, upon proper execution of this Agreement and shall expire May 31, 2022, unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Response to Request for Proposal and Exhibit C, Scope of Services. 3. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Quality Assurance Team(HS-CWOualitvAssurance(a�weldgov.com). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit a complete Request for Reimbursement and supporting documentation by the 7th of the month, following the month of service, utilizing billing forms required by the Department. Contractor agrees to utilize the Client Verification Form for all scheduled and unscheduled face-to-face services with the exception of home studies and monitored sobriety testing. Contractor agrees that original complete Client Verification Forms are to be submitted with the Request for Reimbursement. Requests for Reimbursement and Client Verification Forms received 2021-1583 after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet 60 -day deadline may result in termination of the Agreement. d. Contractor agrees to submit a monthly report by the 7`h of the month, following the month of service, for each client receiving ongoing services. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. Monthly reports for ongoing services must include the following information, entered in the "Narrative" box for each date of service: a. Date and time of service b. Where the service took place c. Clinician/therapist name d. Clients participating e. What interventions were used, recommendations and/or goals discussed f. Any and all safety concerns One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation, home study). Verification of Monitored Sobriety Services will be the test result. A completed home study may be a full, partial or denied study, as determined by the Department. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. 4. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. Exceptions to this Paragraph may include, if approved by the Department, the following: i. The service being provided by the contractor is not a Medicaid eligible service; ii. The service is not deemed medically necessary; iii. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; iv. A Medicaid provider is not available to provide the needed service; v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule, attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. 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. d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 5. Financial Management 2 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 OMG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit a State of Colorado direct deposit enrollment form, which will be provided by the Department, with a voided check. Failure to complete and submit this form and voided check in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and - Title VII of the Civil Rights Act of 1964; and - the Age Discrimination in Employment Act of 1967; and - the Equal Pay Act of 1963; and - the Education Amendments of 1972; and Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the 3 Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is determined by the Department. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contractor will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E - Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5- 102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the subcontractor provides 4 information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contractor participates in the State of Colorado program, Contractor shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contractor has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contractor shall deliver to the Department, a written notarized affirmation that it has examined the legal work status of such employee and shall comply with all of the other requirements of the State of Colorado program. If Contractor fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., the Department, may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contractor receives federal or state funds under the contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24- 76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5- 103 prior to the effective date of the contract. 8. 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 3(d) of this Agreement. 9. Insurance Requirements Contractor and the Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, insurance coverage listed in this agreement. The Board of County Commissioners of Weld County and its Officers/Employees shall be named as additional insured. a. General Requirements: Contractors must secure, at or before the time of execution of any 5 agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, the Department must be notified by the Contractor. Contractor shall be responsible for the payment of any deductible or self -insured retention. The Department reserves the right to require Contractor to provide a bond, at no cost to the Department, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor. 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. b. Types of Insurance: Contractor shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i.Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii.General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: $1,000,000 each occurrence; $2,000,000 general aggregate; $50,000 any one fire; and $500,000 errors and omissions. iii.Automobile Liability: Contractor shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: - If any aggregate limit is reduced by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify the Department within ten (10) days and reinstate the aggregates required; - Unlimited defense costs in excess of policy limits; - Contractual liability covering the indemnification provisions of this Agreement; - A severability of interests provision; - Waiver of exclusion for lawsuits by one insured against another; - A provision that coverage is primary; and - A provision that coverage is non-contributory with other coverage or self-insurance provided by the Department. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to the Department, whichever is earlier. c. Contractors shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor shall provide a copy of this information to its insurance agent or broker and shall have its agent or broker provide proof of Contractor's required insurance. The Department reserves the right to require Contractor to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor's insurer shall name County as an additional insured. f. Waiver of Subrogation: For all coverages, Contractor's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors, independent contractors, sub -vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor. Contractor shall include all such subcontractors, independent contractors, sub -vendors, suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors, suppliers or other entities upon request by the Department. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contractor shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 10. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training Contractor may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. 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 7 the Weld County Attorney's Office immediately at (970) 336-7235 and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor will collaborate in a timely manner with the Department to resolve issues pertaining to service delivery, service quality, documentation, and invoicing during referral period and after services have concluded. The Contractor will require clients sign releases of information. Contractor understands that the Department will not reimburse for services rendered to Department clients until releases of information are obtained. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. The monitoring agency may, if in its sole discretion deems necessary or appropriate, have access to any program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures for purposes of monitoring. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. 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: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Child Welfare Director Stephanie Seng, Director 8 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Jamie Ulrich, Director P.O. Box A Greeley, CO 80632 (970) 400-6510 18. Litigation For Contractor: Stephanie Seng, Director CSU Campus Delivery 1570 Fort Collins, Colorado 80523-1570 (970) 491-5991 With a copy to: Office of the General Counsel 06 Campus Delivery Colorado State University Fort Collins, CO 80523-0006 contractsna,colostate.edu Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third -Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held 9 or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall not enter into any third -party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. A conflict of interest or appearance of a conflict of interest may also apply to personal relationships between providers and clients. If a provider has a personal relationship with a client to whom the Contractor may provide services for, the Contractor must disclose that relationship to the Department. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child 10 Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contractor agrees that it is an independent Contractor and that Contractor's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall perform its duties hereunder as an independent Contractor. Contractor shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contractor, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contractor or any of its agents or employees. Unemployment insurance benefits will be available to Contractor and its employees and agents only if such coverage is made available by Contractor or a third party. Contractor shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contractor shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contractor shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and as set forth in Exhibit A, provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty 11 The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to the Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by the Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and 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 Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflicts with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contractor's operations, or authorizes funding to the Contractor. 33. 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. 34. 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. 35. Subcontractors Contractor acknowledges that the Department has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of this project without the Department's prior written consent, which may be withheld in the Department's sole discretion. 12 36. Attorney's Fees/Legal Costs In the event of a dispute between the Department 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. 37. Ownership All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of the Department. 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 Department. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of the Department. 38. 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. 39. 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. 13 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: Weld Co By: Deputy Clerk to tBoar ddr.{.0) Jeltio;„k, Clerk to the Board 14 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Steve Moreno, Chair JUN 1 6 2021 CONTRACTOR: The Board of Governors of the Colorado State University System. acting by and through Colorado State University Colorado State University CSU Campus Delivery 1570 Fort Collins, Colorado 80523-1570 (970) 491-5991 By: Date: By: Stephanie Seng, Director, Center for Family and Couple Therapy and Child Trauma and Resilience Assessment Center /Ida N%6lI6i1 Ang a Nielsen (Jun 8, 202117:08 MDT) Angela Nielsen, Director, Office of Budgets Jun 8, 2021 Date: Jun 9, 2021 LEGAL REVIEW By: Brian Anderson, Esq. Assistant Legal Counsel Office of the General Counsel ,20,2"-/0-1L5 EXHIBIT A WELD COUNTY'S REQUEST FOR PROPOSAL (Weld County's Request for Proposal is incorporated into this agreement by reference and will be provided upon request to the Department.) This page intentionally left blank. Exhibit B Contractor's response to the Request for Proposal Exhibit B contains the following documents: • Attachment B — Provider Information Form (PIF) • Attachment C — Proposal • Attachment D — Staff Data Sheet • Certificate of Insurance (COI) ATT-:CHMENT B WELD COUNTY DEPARTMENT OF HUMAN SERVICES - PROVIDER INFORMATION FORM (PIF) AGENCY INFORMATION Agency Name: Colorado State University Provider Contact Full Name: Stephanie Seng Primary Phone Number (10 -digit): Primary Contact Email: 970-491-5991 Trails Provider ID (if known): Title: Director 1562158 Ext.: Fax Number (10 -digit): sseng@coiostateeedu Agency Location Address (Street, city, state, zip): Agency Mailing Address (Street, city, state, zip): Agency Type (pick one): Public Company Web Address: https://www.chhs.colostate.edu/cfct 502 West lake St., Fort Collins, CO 80523-1570 CSU Campus Delivery 1570, Fort Collins, CO 80523-1570 Private Non -Profit Private for Profit Referral Contact Name: Send Referrals for Service to: Stephanie Send Referral Phone Number (10 -digit): 970-491-5 91 Ext.: Title: Direct r . cfct@Ctostateeed u Email: Billing Contact Name: Billing Contact Michelle Amundsen Billing Phone Number (10 -digit): 970-829-1208 Title: Billing Specialist Ext.: Email: michelle.amundsen@colostate.edu r a a- a a- a a a s® m a ac a®- !Ma a a s- a a- a a =Ma a s- an a- a a =I= a aalai= a a s- a a- in a CERTIFICATION a a- a a a a a a a a- a s- a a- a a a a - a a IIla GM OS NZ la la til fell I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it has so indicated in this bid form. I further affirm intention to enter into an agreement with Weld County, on behalf of the Weld County Department of Human Services, and comply with all requirements of the contract, if awarded. The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are competitive in price and quality. Authorized Rep. Full Name: Authorized Rep. Email: Stephanie Seng sse @colostatemedu Authorized Rep. Address (street, city, state, zip): Signature of Authorized Rep.: a Angie a a — a- aa-aa-®a-aa-a a-aaaa a a a a a a Title: Director Phone(10-digit): 970-491-5991 Ext.: CSU Campus Delivery 1570, Fort Collins, CO 80523-1570 a a- a a- a s- a a- a a a a - a a Date: a a a- a a a a® a a aas a s- a a 1/23/2021 aa-aa-asSlain asa®a! REV. NOVEMBER 2020 TT CH E T C P P SAL Please type your answers in the boxes bel w r check the apprtspriate box. Bidd :t.is Lt:ga0 Name: Program Area: SECTI N 1— Prvider an " Progr a Nn rmation Colorado State University Mental Health Services Number of services offered ,rt,n this Attachment C (max 5): Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you hove more the n 5. for Proposal starting on page 13. SECTION 2 — Service Name(s) and Information If t e ser ice is a monthly package, please offer different levels. m am _a state a s •aed� c minim num�';�'�er o �:•� irect servic Service #1 Name: • nth ly - ckages urs® Empower Group 2.1a Modalities, curriculum, tools used in deliv ry f service (DO NOT list company hist ryo DO use bullet p hits): ® I -Empathize Curriculum • Telehealth during COVID ® In -person post-COVID 2.1b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 60-90 minutes/week 2.1c Anticipated duration f service (Le. 3-4 months): 5-8 weeks 2.1d Three (3), or more, specific g t�. als of the service (DO use bullet points): Equip youth with strategies to stay safe fr•.m exploitation Nurture empathy f• r others ® Build c•;mmunication skills .2. 2.1e Three (3), or more, specific outcomes of service: Youth will learn language tcommunicate about empathy, sympathy, apathy, exploitation. Youth will gain tools to stay safe from exploitation ® Youth will practice strategies to stay safe from exploitation :S 2.1f Target population of the service, including age and gender: Youth (all genders) ages 12 —18. 2.1g Languages service is available in (please list proficiency and if interpreter services are available): Primarily English. 2.1h Medicaid eligibility — list whether the service k eligible for Medicaid in whole or in part: Eligible for Medicaid in whole Service #2 Name: Social Skills Youth Group 2.2a Modalities, curriculum, t ols used in delivery of service (DO NOT list company history; DO use bullet points): ® Motivational Interviewing ® Psychoeducatisin Experiential 2.2b Anticipated frequency of dir-°ct service time with the client/family per week, n -t including professinal staffing time, administrative time, overhead, or travel time (Le. 4 hours/week). If the service has levels, be specific for each ',van. 50 min/week 2.2c Anticipated duration of service (Le. 3-4 months): 8-10 Weeks 2.2d Three (3), or more, specific goals f the service (DO use bullet p ints): Teach youth about relationships and social skills ® Provide opportunities to practice new skills in a safe social setting ® Create safe setting for group interactions 2.2e Three (3), or more, specific outcomes of service: Youth will learn and practice conversation skills Youth will learn and practice friendship skills REV NOV 2020 1 ACHMENT C P' P SAL Youth will learn about emotions and practice appropriate emotional expression Y*uth will learn and practice conflict management Youth will learn about and practice using manners 2.2f Target population of the service: Youth (all genders) ages 5 - 18 2.2g Languages service is available in (please list proficiency and if interpreter services are available): Primarily English. 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Medicaid Eligible in whole Service #3 Name: Transgender Youth Group 2.3a Modalities, curriculum, t ols used in delivery of service (DO NOT list company history; DO use bullet points): Systemic Therapy Modalities: ARC Motivational Interviewing Psychoeducation Experiential 2.3b Anticipated frequency of direct serice time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 60 min/week 2.3c Anticipated duration of ser .7 ice (i.e. 3-4 months): 8 weeks 2.3d Three (3), or more, specific goals of the service (DO use bullet points): Provide a safe and confidential space for youth to share experiences Teach and provide opportunity to practice coping skills Share resources 2.3e Three(3),orm re, specific outcomes of service: Youth will develop safe relationships with peers Youth will learn and use tools to cope with difficult emtions, relationships and experiences Youth will identify and learn to evaluate local and online resources available ti therm. 2.3f Target population of the service: Youth (all genders) ages 5 - 18 2.3g Languages service is available in (please list proficiency and if interpreter ser ices are available): Primarily English 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole r in part: Medicaid eligible in whole Service #4 Name: Therapy Group for Parents of Juvenile Justice Involved Youth 204a Modalities, curriculum, tools sed in delivery of service (DO NOT list company history; DO use bullet points): ® Systemic Therapy Psychoeducation Trau ra-informed practice 2.4b 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 s:-rvice has levels, be specific for each level: 90 min/week 2.4c Anticipated duration of service (i.e. 3-4 months): 6 weeks 2.4d Three (3), or more, specific goals of the service (DO use bullet points): ® Provide a safe space for parents t : share with peers e Share information and resources about adolescence and how to navigate the juvenile justice system Help participants strengthen family relationships and build resilience 2.4e Three (3), or more, specific outcomes of service: ® Participants will discuss weekly topics with peers Participants will learn about the adolescent brain and practice strategies for responding to their teens ® Participants will learn about the juvenile justice system and gather resources for navigating it. 2.4f Target population of the service: REV. Nov 2020 ATTACHMENT C - PROPOSAL Parents of Juvenile Justice Involved Youth (all genders, all ages as long as a parent) 2.4g Languages service is available in (please list proficiency and if interpreter services are available): Primarily English 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Medicaid eligible in whole Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: 3.2 Will you conduct services in a client's home or in the community? Check one: 3.3 Will you transport clients to and/or from services? Check one: ■ YES 3.4 How many miles are you willing to travel round trip? List a specific number of miles. 3.5 When you calculate mileage, what is your starting point address? ■ ■ YES O NO YES NO 0 Miles NO 0 SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: 4.1a 4.1b 4.1c 4.1d 4.1e REV. NOV 2020 Empower Group In-Office/Video: In -Office with Transportation: In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: $ Amount $35 0 0 0 $35 0 Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: 0 0 This is paid after the miles listed above. miles miles 3 TTACH RENT C R 4.2 H • urly Servic#2 Name: Social Skills Youth Group 402a In-ffice/Video: 4e2b In -Office with Transportation: tic In -H me or Community: 402d FTM, TDM, Prof. Staffing: 402e No show: 402f Mileage rate: $ Amount $35 0 0 0 $35 0 U nit Type per Hour per H:ur per Hour per Hour per N s. Sh per Mile w N o. of miles included in rate: N o..•f miles included in rate: 0 0 This is paid after the miles listed above. miles miles 403 Hurly Service #3 Name: 403a 403b 403c 43d 4.3e 4.3f Transgender Youth Group In-Office/Video: In -Office with Transp trtation: In -Home or Community: FTM, TDM, Prof. Staffing: [Nil* show: Mileage rate: $ Amount $35 0 0 0 $35 0 Unit Type per H*ur per H*ur per Hour per Hour per No Sh per Mile w N o. of miles included in rate: N o. ,itf miles included in rate: 0 0 This is paid after the miles listed above. miles miles 404 Hourly Service #4 Name: Therapy Group for Parents of Juvenile Justice Involved Youth 4.4a In-Office/Video: 4.4b In -Office with Transportation: In -Home or Community: 4.4c FTM, TDM, Pr fo Staffing: 4.4d Nil) show: 4.4e Mileage rate: $ Amount $35 0 0 0 $35 0 U nit Type per Hour per Hour per Hur per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: 0 0 This k paid after the miles listed above. miles miles 4.5 Hourly Service #5 Name: 0 4.5a In-Office/Video: 405b In -Office with Transportation: 405c In -Home or Community: 4.5d FTM, TDM, Prof. Staffing: 405e No show: 4.5f Mileage rate: $ Amount 0 0 0 0 0 0 U nit Type per Hour per Hour per Hour per Hour per No Sh per Mile w No. of miles included in rate: No. of miles included in rate: 0 0 This is paid after the miles listed above. miles miles 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 0 0 0 4.6b 4.6c 4.6d 4.6e 406f 4.6g 4.6h 4.6i 4.6j 4e7 Home Study Providers — List your rates in the b x below. 0 4.8 Monitored Sobriety Providers - List your rates in the box below. 0 REV. NOV 2020 4 ATTACHMENT C - PROPOSAL Provider special notes: 0 REV. NOV 2020 5 ATTACHMENT C ® P L Please type your answers in the bxes below or check the appropria e box. Idder's Legal Name: Program Area: SECTION 1 a Provi r and rogram Area nf patio C. Ilorado State University Foster Parent Training Number of services ifered on this ttac nt C (max 5): Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another ttachment C if you have more than 5. for Proposal starting on purge 13. 2 SECTION 2 — Service Name(s) E nd Information f the service is a monthly package, please offer different leve7so ,ll month state a specific minimum n . mber of direct servic hours. erMoces #1 Name: ckages ust ster Parent Training 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list c mp ny history; D use bullet p * hits): • Psychoeducation Experiential • Trauma -informed practice a ARC • Telehealth during COVI'rf� 2.1b Anticipated frequ ncy f direct service tiny with the client/family per week, not including professional staffing time, administrative time, overhead, r travel time (i.e. 4 hours/week). if the service has levels, be specific for each Berl As directed by the Department 2.1ic Anticipated durati n c•� f service (i.e. 3-4 months): As directed by the Department 2.1d Three (3), or more, specific goals of the service (DO use bullet points): ® Provide training on requested topic t foster parent training group ® Prvide psychoeducation on trauma, resilience, impact of trauma Proide psychreducatin on secondary traumatic stress ,d Lei Three (3), r more, specific utcomes of service: ® Educate and train f*ster parents ® Parents will practice strategies fir supporting youth who have experienced complex trauma • Parents will learn self -care strategies 2.1f Target population of the service, including age and gender: Adult foster parents, any gender 2.1g Languages service is available in (please list proficiency and if interpreter services are available): Primarily English. 2.1h Medicaid eligibility v list hether the service is eligible for Medicaid in whole or in part: N t Eligible for Medicaid Se rvlke #2 Na Therapeutic Foster Parent Training 2.2a Mc.!dalities, curriculum, to Is used in delivery of service (DO NOT list company history; DO use bullet points): Psychoeducation e Experiential Trauma -informed practice • ARC • Telehealth during COVID 2.2b Anticipated fvequency of direct s- rvice time with the client/family per weep, not including professional staffing time, administrative time, .overhead, or travel time (i.e. 4 Inurs/week). If the service has levels, be specific for each level: As directed by the Department 2.2c Anticipated duration of service (i.e. 3-4 months): As directed by the Department 2.2d Three (3), r more, specific goals of the servic (D use bullet points): ® Provide training on requested topic to therapeutic foster parents ® Provide psychoeducation on trauma, resilience, impact of trauma REV. NOV 2020 1 ATTACHMENT C - PROPOSAL O Provide psychoeducation on trauma related behaviors and interventions Provide psychoeducation on secondary traumatic stress 2.2e Three (3), or more, specific outcomes of service: ® Educate and train therapeutic foster parents ® Parents will practice strategies for supporting youth who have experienced complex trauma ® Parents will learn self -care strategies 2.2f Target population of the service: Therapeutic Foster Parents, any gender 2.2g Languages service is available in (please list proficiency and if interpreter services are available): Primarily English 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Not Eligible for Medicaid Service #3 Name: 0 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.3c Anticipated duration of service (Le. 3-4 months): 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 2.3e Three (3), or more, specific outcomes of service: 2.3f Target population of the service: 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #4 Name: 0 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): * 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Anticipated duration of service (i.e. 3-4 months): 2.4d Three (3), or more, specific goals of the service (DO use bullet points): 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list proficiency and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #5 Name: 0 2.Sa Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b 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: REV. NOV 2020 2 ATTACHMENT C - PROPOSAL 2°5c Anticipated duration of service (1e. 3-4 months): 2.5d Thre a; (3), or more, specific goals fth service (DO use bullet p • ints): 2.5e Three (3), or more, specific utcomes of service: 2.Sf Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2°5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part P _ 3d Will y: u c Section 3 — ServIck- Access a arge Weld C#unty for transporting clients or mileage? Chec 3.2 Will you conduct services in a client's h; me or in the community? Ch 33 Will you transp rt clients to and/ r from services? Check nee ■ d Trans r rtation k rse° YES YES ck one: YES 3.4 How many miles are you willing to travel round trip? List a specific numb miles. 3°5 Whin you calculate mileage, what is y ur starting point address? NO 100 ►1 Miles NO NO 502 West Lake Street, Fort Collins, CO80523 SECTION 4 - SERVICE RATES All rates need to include administrative work (ie. scheduliy5g or report writing) and overh Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except fk r t ® For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section o . ® For monitored sobriety testing prviders cornpiet ad. se listed above. section 4.8. 4.1 Hourly Service #1 Name: Foster Parent Training 4.1a ➢n- ffice/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: $ Amount $100 0 0 0 0 $.50 Unit Type per Hour per Hour per Hour per H*ur per No Show per Mile No. of miles included in rate: No. of miles included in rate: 0 0 This is paid after the miles listed above. miles miles 4.2 Hourly Service 2 Name: Therapeutic Foster Parent Training 4.2a I n-Office/V d to: 4.2b In -Office ith Transportation: 4.2c In=l1ome or Community: 4°2d FTM, TDM, Prof. Staffing: 4°2e No show: 4.2f Mileage rate: $ Amount $100 0 0 0 0 $.50 Unit Type per Hour per Hour per Hour per H.:ur per N Show per Mile N N f of 0 a� s included in rate: s included in rate: 0 0 This is paid after the miles listed ab ve. miles miles REV. NOV 2020 3 TTACH ',r f ENT C - PR • P; r 43 Hourly Service #3 Name: 0 4.3a In-Office/Video: 4.3b In -Office with Transportation: 4.3c In -Home or Community: 4.3d FTM, TIM, Prof. Staffing: 4.3e No sh w: 4.3f Mileage rate: $ Am Lint Unit Type per Hour per Hour per Hour per Hour per N. Sh.:,w per Mile No. of miles included in rate: N o. 5•=f miles included in rate: This is paid after the miles listed above. miles miles 4.4 H urly Service #4 Name: 0 4.4a In-Office/Video: 4a4b In -Office with Transportation: In-Hme or Community: FTM, TDM, Prof. Staffing: 4.4c 4.4d 4.4e show: Mile.}ge rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per Nt Shw per Mil N ino zf miles included in rate: No. of miles included in rate: This is paid after the mil miles Iles s listed ab ve. :r 4.5 Hourly Service #5 Name: 0 4.5a In-Office/Vide�: 405b In -Office with Transprtati :•n: 43c In -Home or Community: 4.5d FTM, TDM, Prof. Staffing: 4.5e No shw: 4.5f Mileage rate: Am unt Unit Type per Hour per Hour per Hour per H*ur per N* Shw per Mile No. of miles included in rate: N f mil s incluthd hi rate: This is paid after the miles listed above. miles miles 4.6 M ter; nthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hurs: 4.6a 0 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 43 Home Study Pr viders List your rates in the box below. 0 4.8 Monitored Sobriety Providers — List your rates in the box below. 0 Provider special notes: If training includes creating modules, rate would include prep time. REV. N J V 2020 4 ATTACHMENT C - PROPOSAL Please type your answers in the boxes b low +�l r check the appropriate b Bfidder's Legal Name: P ogram Area: SECTION 1 a Provi er S :gram : \rea nf 0 ! rnat9 n C Irado State University d ental i r alth Services Pr gram Areas Lore listed in column 1 of the t it Request for Proposed starting on page 13. file loc aJ ted an Otero XI of the Number You m t.� f services c. tiered on this ttachent C (max 5)0. y complete another Attachment CC if you have more thy n 50 5 Sepuke 2.1a 2.1b 2.1c Lid Lie 2.1f 2.1g 2.1h S2MCe 2.2a M Modalities, E #1 serolce Name: curriculum, oS a rn st :f Vie n S h y s N l 2 +J Service please li a offer numb,_ Name(s) different ■ a and dal Id c rr eve et servicehours. aSSS s. UU n 4 *nth y ckages must CTI packager ecff 4 o . i L-1 u li 1:1 ■ High Conflict Couples Therapy t oils used in & lir rry of service it t. OT list c*mpany history; D• use bullet punts): High e ® Telehealth Inmp Conflict rson C. uples post-COV Therapy D Anticipated administrative frequency time, of overhead, cirect serice tome? or travel with time (i.e. the 4 client/family h≤.tursbJfeek) l per f the week, service not including has levels, be professional specific for staffing each level: time, 60-90 minutes/week Anticipated durati n of service (i.e. 3-4 months): 10 to 20 weeks Thre;: (3), or morn=, specific gals the service (DO use bullet points): O 0 0 The For The Bask behavior actions, powerful some primary treatment to the interrupting couples affects t approach di g•,al I to will and of deal the treatment be couple cs,nsideraid is is repetitive with affected a both/and the intervention is the by patterns problem. cessation position: behavior of may if behavior of allow viol each all nce of forms individual others. partners within is ended of That the violence is to and/*r responsible is, couple reconsider althcugh in if system the the whether couple for the relatit that their abuser ;ship. separates ,wn maintain or nut is behavior held the abuse relationship without accountable and is a individual viewed violent for is as viable. their incident. a effective the Three (3), or rn re, specific outc.rnes (of service: e , '� ® • ® Gain Assist Identify Enhance Assist Punctuate the partners and partners cooperation positive and support to in solidify build affect taking relationship and positive on between responsibility cci strengths mmitnnent changes patterns partners; and of for that past both that their are successes lead partners own made. to behavior; in to coop- making develop rative changes s restluti*n lutions i, ; their to of r&ationship conflict; relationship; problems; Target p pulation of the service, including age and gender: Any try vi fence gender to end must the partner violence have must be and imprive occurred. 18 in or solder. the the past Both relatizns�hip. year. partners must At least participate one act of in physical couples treatment violence *r repeated Both partners must want acts of emotional to Languages service is a'.tailable in (please list proficiency and if int-iprr rtn serrvic-s are available): Primarily English. I ledicaid eligibility m list wheth r the service is eligible fur Medicaid in whole or in part: Eligible for Medicaid in whole M #2 •-'c elities, Name: curriculum, Individual Therapy tools used in delivery of ser'.<<ice (DO NOT list company histry; DO use bullet points): Systemic e e Solution Strategic Structural Cognitive internal Therapy Focused Family Modalities: Behavioral Systems REV. Nov 2020 1 TT CH E T C ® "ra Narrative Milan Transgenerational Emotionally Focused Motivational Interviewing Telehealth In -person post-COVID 2.2b Anticipated frequency of direct service tin e with the client/family per week, not including pr.fessional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 50 min/week 2.2c Anticipated duration of service (i.e. 3-4 months): 1-4 m • nths 2.2d Three (3), or more, specific goals of the service (DO use bullet points): Develop and maintain healthy boundaries and relationship skills ® Improve communication skills ® Build problem -solving skills ® Build empathy and understanding ® Build conflict management skills ® Manage depression, anxiety, and other mental health diagnoses Fl 2.2e Three (3), r more, specific outcomes of service: • Clients will be able ti successfully complete therapy portion of treatment plans ® Clients will gain tools to improve functioning related to presenting problem Clients will gain tools to effectively manage conflict and effectively problem -solve cb 2.2f Target population of the service: Individuals across the lifespan 2.2g Languages service is available in (please list pr ficiency and if interpreter servic s are available): Primarily English. 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Medicaid Eligible in whole Service #3 Name: Family Therapy (includes couples) 2.3a Modalities, curriculum, tools used in delivery of service (D NOT list company history; DO use bullet points): Systemic Therapy Modalities: Solution Focused Strategic Structural • Cognitive Behavi. ral Internal Family Systems Narrative Milan Transgenerational Emotionally Focused ® Telehealth In -person post-COVID y 203b Anticipated frequency f direct service tim_. with the client/family per w-ek, not including prfessional staffing time, administrative time, ov et, rhead, or tra el time (i.e. 4 hours/week). If the service has levels, be spr:cific fr each level: 50 min/week 2.3c Anticipated duration f service (i.e. 3-4 months): 1-4 months 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 2.3e ® Develop and maintain healthy boundaries ® Facilitate cohesion and communication Prom�.-te problem -solving by better understanding family dynamics • Build empathy and understanding ® Reduce conflict within the family Three (3), r mere, specific ;•.utcmes f service: REV NOV 2020 2 TTACHME E C m °RO3 P • Clients will be able to successfully complete therapy portion of treatment plans O Clients will gain toIs to improve family functioning including communication and parenti * Clients will gain tools to effectively manage conflict and effectively pr*blem-solve g 2.3f Target p pulati n f the servic Couples and families acrss th:t lifespan 2.3g Languages service is available hi (please list proficiency and if int rpreter services ar a :zailable): Primarily English. 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in wh le or in part: Medicaid eligible in whole Service #4 Name: Trauma and Resilience Assessment 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company hist ry; DO use bullet points): Trauma Assessments include: • Psychosocial interview • Collateral interviews and surveys • Cognitive screening and surveys Debrief meeting • Telehealth when appropriate (preference during COVID, available post-COVID • In-pers,+Jn when telehealth is cntraindicated (during and post-COV0)) 2.4b Anticipated frequency of direct service time ith the client/family per oveek, not including pr,,fessit:• nal staffing time, administrative time, overhead, r travel time (i.e. 4 hurs/week)° If the service has levels, be specific for each levrl: 4 1 time service, 20 hours 2.4c .Anticipated duration f service (i.e. 3-4 months): 4-8 weeks 2.4d Three (3), r m re, specific goals f the service (DO use bullet points): • Gather infrmation acroiss several key domains of functioning • Identify the impact of traumatic events on attachment, regulation, and c*mpetency • Identify needs of children and families exp*sed to traumatic events, empowering and inc make appr=•t;priate related recommendations • Summarize infirmation and co :;municate with families offering psychoeducati rporating their voices, and n and opportunity f r feedback 2.4e Three (3), or m re, specific outcomes ti f service: • Build in client resilience in the areas if tachment, regulation and cmpetency; • Incr--ase child, family and team understanding of the impact of complex trauma; Share client perspective of impact with their family and team 2.4f Target population f the servic Children and families involved in child welfare who have experienced complex trauma. All ages. 2.4g Languages service is available in (please list pr * ficiency and if int rpreter services are available): Primarily English. 2.4h `edicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Credentialed with Beac (y n. Currently negotiating Medicaid contract rate. SerM ce #5 Name: Trauma and Resilience Consultation 2.5a M .: dalities, curriculum, tools used in delivery of service (DO NOT list company history; i 0 use bullet p ints): • C Model Telehealth 205b Anticipated frequency of direct service time with the client/family per week, n including pry fssiti•,nal staffin ' time, administrative time, overhead, or travel time (i.e. 4 hours/w e€ ). If the serice has levels, be sp cific for each level: 1 -time service 2.5c Anticipated duration f service (i.e. 3-4 months). 4 -hours (1 -hour prep, 2 -hour consult, 1 -hour pest 2.5d Three (3), or more, specific goals of the servic (D use bullet p hits): • Provide psychoeducation around i, pact of trauma for child and family • Collaborate with DHS team and family to direct tratment .r support through trauma -informed recommendations • Provide written reptrt with trauma -informed recommendations 2.5e Three (3), or m re, specific *utcomes of service: • MIS team and family will have a greater understanding about the i, pact of trauma • DHS team and family will incrporate trauma -informed recommendations REV NOV 2020 3 ATTACHMENT C - PROPOSAL • Client and family's strengths and areas of resilience will be acknowledged and supported 2.5f Target population of the service: English primarily. Spanish available depending on semester 2.5g Languages service is available in (please list proficiency and if interpreter services are available): Primarily English. 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Not Medicaid Eligible Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: 3.2 Will you conduct services in a client's home or in the community? Check one: 3.3 Will you transport clients to and/or from services? Check ■ YES ■ one: 3.4 How many miles are you willing to travel round trip? List a specific number of miles. 3.5 When you calculate mileage, what is your starting point address? YES ■ NO YES NO NO 100 Miles 502 West Lake St., Fort Collins, C) 80524 SECTION 4 SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 N ame: High Conflict Couples Therapy 4.1a In-Office/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: $ Amount $75 0 0 0 $75 0 Unit Type per Hour per Hour per Hour per Hour per No Show per Mile N o. of miles included in rate: N o. of miles included in rate: 0 0 This is paid after the miles listed above. miles miles 4.2 Hourly Service #2 N ame: Individual Therapy 4.2a In-Office/Video: 4.2b In -Office with Transportation: 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $ Amount $55 0 0 0 $50 0 Unit Type per Hour per Hour per Hour per Hour per No Show per Mile N o. of miles included in rate: N o. of miles included in rate: 0 0 This is paid after the miles listed above. miles miles REV. NOV 2020 4 ATTACHMENT C - PROPOSAL 4.3 Hourly Service #3 Name: Family Therapy 4.3a In-Office/Video: 4.3b In -Office with Transportation: 4.3c In -Home or Community: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: 4.3f Mileage rate: $ Amount $55 0 0 0 $50 0 U nit Type per Hour per Hour per Hour per Hour per No Show per Mile N o. of miles included in rate: N o. of miles included in rate: 0 0 This is paid after the miles listed above. miles miles 4.4 Hourly Service #4 Name: Trauma and Resilience Assessment 4.4a In-Office/Video: 4.4b In -Office with Transportation: In -Home or Community: 4.4c FTM, TDM, Prof. Staffing: 4.4d No show: 4.4e Mileage rate: $ Amount 0 0 0 0 0 0 U nit Type per Hour per Hour per Hour per Hour per No Show per Mile N o. of miles included in rate: N o. of miles included in rate: This is paid after the miles listed above. miles miles 4.5 Hourly Service #5 Name: Trauma and Resilience Consultation 4.5a In-Office/Video: 4.5b In -Office with Transportation: 4.5c In -Home or Community: 4.5d FTM, TDM, Prof. Staffing: 4.5e No show: 4.5f Mileage rate: $ Amount $120 0 0 0 $120 .50 U nit Type per Hour per Hour per Hour per Hour per No Show per Mile N o. of miles included in rate: N o. of miles included in rate: 0 0 This is paid after the miles listed above. miles miles 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. Hours: of Direct Service 4.6a Trauma and Resilience Assessment (see special note) $1900/assessment 20 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 0 4.8 Monitored Sobriety Providers — List your rates in the box below. 0 Provider special notes: Trauma & Resilience Assessment - $1900 — full assessment, $100/hour — partial assessment REV. NOV 2020 5 ATTACHMENT D - STAFF DATA SHEET Bidder Must List All Staff Who Will Administer the Proposed Service(s) BIDDER'S LEGAL NAME (As it appears on the W-9): AGENCY CONTACT: Stephanie Seng Colorado State University PHONE NUMBER: 970-491-5991 EMAIL: SSeng a@colostate o ed u PROPOSED SERVICE(S): High Consultation, Conflict Couples, Foster Individual Parent Training, Therapy, Group Family Therapy Therapy, Trauma & Resilience Assessment, Trauma and Resilience -t Legal Last Name Middle initial Previous Legal Last Name (If applicable) Legal First Name Service Type t Licensurei Credentials DORA 1(If applicable) Bechara Shapiro Veronica Mental Health Services/Foster Parent Training LCSW CSW 09925129 Chavez Proctor Candice Mental Health Services/FosterParentTraining LMFT MFT 00001156 Dalager Stephanie Mental Health Servica;/FosterParent Training MFTC MFTC 001369 French Terrio Kate Mental Health Services/FosterParent Training MFTC MFTC.001372 Haddock Shelley Mental Health Services/Foster Parent Training 0 LMFT MFT 0000148 Kline Chelsea Mental Health Services/Foster Parent Training MFTC MFTC 001371 Quirk Crandall Kelley Mental Health Services/Foster Parent Training LP PSY 0004510 Seng Crandall Stephanie Mental Health Services/Foster Parent Training LMFT MFT 0000827 Whitney Shawn Mental Health Services/Foster Parent Training LM FT MFT 00001156 Zimmerman Schindler Toni Mental Health Services/Foster Parent Training LMFT MFT 0000150 CHILD WELFARE REQUEST FOR PROPOSAL 2021-22 - VARIOUS SERVICES BID NO. B2100042 ,4 ci CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/YYW) 03/22/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Services South, Inc. Franklin TN Office 501 Corporate Centre Drive Suite 300 Franklin TN 37067 USA CONTACT NAME: PHONE (NC. No. Ext): FAX (866) 283-7122 I (A/C. No.): (800) 363-0105 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Colorado State University 1251 Mason Street Fort Collins CO 80523 USA INSURERA: Safety National Casualty Corp 15105 INSURERB: The Travelers Indemnity Co of CT 25682 INSURERC: Lloyd's Syndicate No. 2987 Y d's AA1128987 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570086471876 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MMIDDIYYYY) LIMITS C X COMMERCIAL GENERAL LIABILITY PK1033620 SIR applies per policy terms 08/01/2020 & conditions 08/01/2021 EACH OCCURRENCE $5,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) Included II CLAIMS -MADE l X OCCUR MED EXP (Any one person) PERSONAL a ADV INJURY Included GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PEA LOC GENERAL AGGREGATE $5,000,000 PRODUCTS - COMP/OPAGG Included B AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X X _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY BA -3N543075-20-14 08/01/2020 08/01/2021 COMBINED SINGLE LIMIT (Ea accident) S1,000,000 BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED I 'RETENTION WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER (Mandatory in NH) If y describe under DESCRIPTION OF OPERATIONS below YIN I N IA PER STATUTE OTH- I IER E. L. EACH ACCIDENT E.L DISEASE -EA EMPLOYEE E.L DISEASE -POLICY LIMIT A Excess WC SP4061145 SIR applies per policy terms 08/01/2019 & conditions 08/01/2021 EL Each Accident EL Disease - Policy EL Disease - Ea Emil). $1,000,000 $1,000,000 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 Additional Remarks Schedule, may be attached if more space is required) Weld County, State of Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies, if required by written contract or agreement subject to the policy terms and conditions. A Waiver of Subrogation is granted in favor of Weld County Board of County Commissioners, its employees and agents in accordance with the policy provisions of the General Liability, Automobile Liability and Excess Workers' Compensation policies, if required by written contract or agreement subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION Weld County 1150 O Street Greeley CO 80631 USA 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD Holder Identifier : 570086471876 Certificate No : a ,4 .c'® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/22/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AOn Risk Services South, Inc. Franklin TN Office 501 Corporate Centre Drive Suite 300 Franklin TN 37067 USA CONTACT NAME: PHONE Fp,7t (A/c. No. Ext): (866) 283-7122 I (A/c. No.): (800) 363-0105 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Colorado State University 1251 Mason Street Fort Collins CO 80523 USA INSURER A: American Casualty Co. of Reading PA 20427 INSURER B: INSURER C: INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570086472419 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MWDDIYYYY) LIMITS COMMERCIAL GENERAL CLAIMS -MADE l LIABILITY OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL B ADV INJURY GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES PER PRO - JECT LOC GENERAL AGGREGATE PRODUCTS - COMP/OP AGG AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED I (RETENTION EMPLOYERS LIABILITYWORKERS ION AND Y / N ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below N / A I PER STATUTE I 1OTRH- EL EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE EL DISEASE -POLICY LIMIT A E&O-PL-Primary 0127298623 08/22/2020 08/22/2021 Each Claim Aggregate $2,000,000 55,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Holder Identifier : 570086472419 Certificate No : 2 weld County 1150 O Street Greeley CO 80631 USA 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 cYL'�a <<%/c cJst etrez(Q eJ✓nQ ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD EXHIBIT C SCOPE OF SERVICES Contractor will provide Mental Health Services and Foster Care/Adoption Support as referred by the Department. Mental Health Services: 1. High Conflict Couples Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Telehealth therapy. ii. In person (post COVID-19) therapy. b. Anticipated Frequency of Services: i. Sixty (60)-90 minutes per week. c. Anticipated Duration of Services: i. Ten (10) to 20 weeks. d. Goals of Services: i. The primary goal of treatment is the cessation of all forms of violence in the relationship. ii. For some couples the couple intervention may allow partners to reconsider whether or not the relationship is viable. iii. The treatment will be considered effective if violence is ended and/or if the couple separates without a violent incident. iv. Basic to the approach is a both/and position. Each individual is responsible for their own behavior and individual behavior affects and is affected by the behavior of others. That is, although the abuser is held accountable for their actions, interrupting repetitive patterns of behavior within the couple system that maintain abuse is viewed as a powerful tool to deal with the problem. e. Outcomes of Services: i. Gain the cooperation and commitment of both partners in making changes in their relationship. ii. Assist partners to build on strengths and past successes to develop solutions to relationship problems. iii. Identify and support relationship patterns that lead to cooperative resolution of conflict. iv. Enhance positive affect between partners. v. Assist partners in taking responsibility for their own behavior. vi. Punctuate and solidify positive changes that are made. f. Target Population: i. Any gender partner must be 18 years of age or older. ii. Both partners must participate in couples treatment. iii. Both partners must want to try to end the violence and improve the relationship. iv. At least one act of physical violence or repeated acts of emotional violence must have occurred in the past year. g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. 1 i. Service Access and Transportation: i. Services will be conducted in the Contractor's office at 502 West Lake, Fort Collins, Colorado 80524. ii. Virtual services are available via telehealth. iii. Contractor will not transport clients. 2. Individual Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Solution Focused ii. Strategic iii. Structural iv. Cognitive Behavioral v. Internal Family Systems vi. Narrative vii. Milan viii. Transgenerational ix. Emotionally Focused x. Motivational Interviewing xi. Telehealth xii. In -person post COVID-19 b. Anticipated Frequency of Services: i. Fifty (50) minutes per week. c. Anticipated Duration of Services: i. One (1) to four (4) months. d. Goals of Services: i. Develop and maintain healthy boundaries and relationship skills. ii. Improve communication skills. iii. Build problem -solving skills. iv. Build empathy and understanding. v. Build conflict management skills. vi. Manage depression, anxiety, and other mental health diagnoses. e. Outcomes of Services: i. Clients will be able to successfully complete therapy portion of treatment plans. ii. Clients will gain tools to improve functioning related to presenting problem. iii. Clients will gain tools to effectively manage conflict and effectively problem -solve. f. Target Population: i. Individuals across the lifespan. g. Language: i. English h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Services will be conducted in the Contractor's office at 502 West Lake, Fort Collins, Colorado 80524. ii. Virtual services are available via telehealth. iii. Contractor will not transport clients. 2 3. Family Therapy (Includes Couples) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Solution Focused ii. Strategic iii. Structural iv. Cognitive Behavioral v. Internal Family Systems vi. Narrative vii. Milan viii. Transgenerational ix. Emotionally Focused x. Motivational Interviewing xi. Telehealth xii. In -person post COVID-19 b. Anticipated Frequency of Services: i. Fifty (50) minutes per week. c. Anticipated Duration of Services: i. One (1) to four (4) months. d. Goals of Services: i. Develop and maintain healthy boundaries. ii. Facilitate cohesion and communication. iii. Promote problem -solving by better understanding family dynamics. iv. Build empathy and understanding. v. Reduce conflict within the family. e. Outcomes of Services: i. Clients will be able to successfully complete therapy portion of treatment plans. ii. Clients will gain tools to improve family functioning including communication and parenting. iii. Clients will gain tools to effectively manage conflict and effectively problem -solve. f. Target Population: i. Individuals across the lifespan. g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Services will be conducted in the Contractor's office at 502 West Lake, Fort Collins, Colorado 80524. ii. Virtual services are available via telehealth. iii. Contractor will not transport clients. 4. Trauma and Resilience Assessment a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Psychosocial interview. 3 ii. Collateral interviews and surveys. iii. Cognitive screening and surveys. iv. Debrief meeting. v. Telehealth when appropriate (preference during COVID, available post-COVID). vi. In -person when telehealth is contraindicated (during and post-COVID). b. Anticipated Frequency of Services: i. A one (1) time service for twenty (20) hours. c. Anticipated Duration of Services: i. Four (4) to eight (8) weeks. d. Goals of Services: i. Gather information across several key domains of functioning. ii. Identify the impact of traumatic events on attachment, regulation, and competency. iii. Identify needs of children and families exposed to traumatic events, empowering and incorporating their voices, and make appropriate related recommendations. iv. Summarize information and communicate with families offering psychoeducation and opportunity for feedback. e. Outcomes of Services: i. Build on client resilience in the areas of attachment, regulation and competency. ii. Increase child, family and team understanding of the impact of complex trauma. iii. Share client perspective of impact with their family and team. f. Target Population: i. Children and families involved in child welfare who have experienced complex trauma. ii. All ages. g. Language: i. English. h. Medicaid Eligibility: i. Not currently Medicaid eligible, contractor is currently negotiating a Medicaid contract rate. Service Access and Transportation: i. Services will be conducted in the Contractor's office at 502 West Lake, Fort Collins, Colorado 80524. ii. Virtual services are available via telehealth. iii. Contractor will not transport clients. 5. Trauma and Resilience Consultation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Attachment, Regulation and Competency (ARC) Model ii. Telehealth b. Anticipated Frequency of Services: i. One (1) time service c. Anticipated Duration of Services: i. Four (4) hours (one [1] hours prep, two [2] hour consult, one [1] hour post). d. Goals of Services: 4 i. Provide psychoeducation around impact of trauma for child and family. ii. Collaborate with Department employees and family to direct treatment or support through trauma -informed recommendations. iii. Provide written report with trauma -informed recommendations. e. Outcomes of Services: i. Department employees and family will have a greater understanding about the impact of trauma. ii. Department employees and family will incorporate trauma -informed recommendations. iii. Client and family's strengths and areas of resilience will be acknowledged and supported. f. Target Population: i. Child Welfare families who have experienced trauma. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will be conducted in the Contractor's office at 502 West Lake, Fort Collins, Colorado 80524. ii. Virtual services are available via telehealth. iii. Contractor will not transport clients. 6. Empower Group a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. I -Empathize Curriculum ii. Telehealth during COVID-19 pandemic iii. In -person post-COVID-19 pandemic b. Anticipated Frequency of Services: i. Sixty (60)-90 minutes per week. c. Anticipated Duration of Services: i. Five (5) to eight (8) weeks. d. Goals of Services: i. Equip youth with strategies to stay safe from exploitation. ii. Nurture empathy for others. iii. Build communication skills. e. Outcomes of Services: i. Youth will learn language to communicate about empathy, sympathy, apathy, exploitation. ii. Youth will gain tools to stay safe from exploitation. iii. Youth will practice strategies to stay safe from exploitation. f. Target Population: i. All genders, ages 12 to 18. g. Language: i. English 5 h. Medicaid Eligibility: i. This service is Medicaid eligible. Service Access and Transportation: i. Services will be conducted in the Contractor's office at 502 West Lake, Fort Collins, Colorado 80524. ii. Virtual services are available via telehealth. iii. Contractor will not transport clients. 7. Social Skills Youth Group a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Motivational Interviewing ii. Psychoeducation iii. Experiential b. Anticipated Frequency of Services: i. Fifty (50) minutes per week. c. Anticipated Duration of Services: i. Eight (8) to (10) weeks d. Goals of Services: i. Teach youth about relationships and social skills. ii. Provide opportunities to practice new skills in a safe social setting. iii. Create safe setting for group interactions. e. Outcomes of Services: i. Youth will learn and practice conversation skills. ii. Youth will learn and practice friendship skills. iii. Youth will learn about emotions and practice appropriate emotional expression. iv. Youth will learn and practice conflict management. v. Youth will learn about and practice using manners. f. Target Population: i. All genders, ages five (5) to 18. g. Language: i. English h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Services will be conducted in the Contractor's office at 502 West Lake, Fort Collins, Colorado 80524. ii. Virtual services are available via telehealth. iii. Contractor will not transport clients. 8. Transgender Youth Group a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Systemic Therapy Modalities: 1. ARC Model 6 2. Motivational Interviewing 3. Psychoeducation 4. Experiential b. Anticipated Frequency of Services: i. Sixty (60) minutes per week. c. Anticipated Duration of Services: i. Eight (8) weeks. d. Goals of Services: i. Provide a safe and confidential space for youth to share experiences. ii. Teach and provide opportunity to practice coping skills. iii. Share resources. e. Outcomes of Services: i. Youth will develop safe relationships with peers. ii. Youth will learn and use tools to cope with difficult emotions, relationships and experiences. iii. Youth will identify and learn to evaluate local and online resources available to them. f. Target Population: i. All genders, ages five (5) to 18. g. Language: i. English h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Services will be conducted in the Contractor's office at 502 West Lake, Fort Collins, Colorado 80524. ii. Virtual services are available via telehealth. iii. Contractor will not transport clients. 9. Therapy Group for Parents of Juvenile Justice Involved Youth a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Systemic Therapy ii. Psychoeducation iii. Trauma -informed practice b. Anticipated Frequency of Services: i. Ninety (90) minutes per week. c. Anticipated Duration of Services: i. Six (6) weeks. d. Goals of Services: i. Provide a safe space for parents to share with peers. ii. Share information and resources about adolescence and how to navigate the juvenile justice system. iii. Help participants strengthen family relationships and build resilience. 7 e. Outcomes of Services: i. Participants will discuss weekly topics with peers. ii. Participants will learn about the adolescent brain and practice strategies for responding to their teens. iii. Participants will learn about the juvenile justice system and gather resources for navigating it. f. Target Population: i. Parents for Juvenile Justice Involved Youth., all ages and genders. g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. Service Access and Transportation: i. Services will be conducted in the Contractor's office at 502 West Lake, Fort Collins, Colorado 80524. ii. Virtual services are available via telehealth. iii. Contractor will not transport clients. Foster Parent Training 10. Foster Parent Training a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Psychoeducation ii. Experiential iii. Trauma -informed practice iv. ARC v. Training will be conducted via Telehealth during the COVID-19 pandemic. b. Anticipated Frequency of Services: i. As directed by the Department. c. Anticipated Duration of Services: i. As directed by the Department. d. Goals of Services: i. Provide training on requested topic to foster parent training group. ii. Provide psychoeducation on trauma, resilience, impact of trauma. iii. Provide psychoeducation on secondary traumatic stress. e. Outcomes of Services: i. Educate and train foster parents. ii. Parents will practice strategies for supporting youth who have experienced complex trauma. iii. Parents will learn self -care strategies. f. Target Population: i. Foster parents, any gender. g. Language: 8 i. English h. Medicaid Eligibility: i. This service is not eligible for Medicaid. i. Service Access and Transportation: i. Services will be conducted in the Contractor's office at 502 West Lake, Fort Collins, Colorado 80524. ii. Virtual services are available via telehealth. iii. Contractor will not transport clients. 11. Therapeutic Foster Parent Training a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Psychoeducation ii. Experiential iii. Trauma -informed practice iv. ARC v. Training will be conducted via Telehealth during the COVID-19 pandemic. b. Anticipated Frequency of Services: i. As directed by the Department. c. Anticipated Duration of Services: i. As directed by the Department. d. Goals of Services: i. Provide training on requested topic to therapeutic foster parents. ii. Provide psychoeducation on trauma, resilience, impact of trauma. iii. Provide psychoeducation on trauma related behaviors and interventions. iv. Provide psychoeducation on secondary traumatic stress. e. Outcomes of Services: i. Educate and train therapeutic foster parents. ii. Parents will practice strategies for supporting youth who have experienced complex trauma. iii. Parents will learn self -care strategies. f. Target Population: i. Therapeutic Foster Parents, any gender. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will be conducted in the Contractor's office at 502 West Lake, Fort Collins, Colorado 80524. ii. Virtual services are available via telehealth. iii. Contractor will not transport clients. Terms 9 1. Contractor will respond to the Quality Assurance Team(HS-CWQualityAssurance(&,weldgov.com within three (3) business days regarding the ability to accept the received referral. 2. 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 Quality Assurance Team HS- CWQualitvAssurance(a,weldsov.com. 3. 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 D, Rate Schedule, then Contractor understands that the Department will not reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows", or up to two (2) hours, 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 discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team HS-CWQualityAssurance(a,weldgov.com. 4. Contractor understands that the Department will not reimburse Contractor for cancelled appointments either on the part of the client or the Contractor. If the cancellation is generated from the Contractor, a "makeup" session/episode, to occur within 30 days of the cancellation, will be offered to the client (excluding session/episodes that fall on holidays). If the cancellation is generated from the client, the Contractor must request a makeup session from the Department prior to the makeup session occurring (excluding session/episodes that fall on holidays). After three (3) cancellations, Contractor will inform the caseworker and the Quality Assurance Team HS-CWQualitvAssurance(a,weld2ov.com immediately via email, to discuss service continuation. 5. Contractor will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 6. 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 immediately AND on the required monthly report. 7. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 8. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator or any member of the Quality Assurance Team. Any changes to visitation referrals will be approved by the caseworker, their supervisor, or the Family Support and Visitation Center. 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. 9. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Bid Meetings, Professional Staffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as there is written authorization from the Quality Assurance Team, and the Contractor obtains the Facilitator's signature on the Client Verification Form (if in person) at the time of the meeting and 10 participation in the meeting is deemed appropriate and necessary by the Department. The Facilitator will be responsible for filling out the time attended on the Client Verification Form. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator. Contractor may participate by phone, if approved by the Department. 10. Contractor will notify the Quality Assurance Team HS-CWQualitvAssurance(&weldgov.com 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 Department reserves the right to decline the new staff members managing and/or administering services to Department clients. 11 EXHIBIT D RATE SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specific in Paragraph 2, below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2022. Expenses incurred by the Contractor prior to the term of this Agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Foster Care/Adoption Support Rate Unit Type Service Name $100.00 Hour Foster Parent Training $0.50 Mile Mileage $100.00 Hour Therapeutic Foster Parent Training Mental Health Services Rate Unit Type Service Name $35.00 Hour Empower Group $55.00 Hour Family Therapy $75.00 Hour High Conflict Couples Therapy $55.00 Hour Individual Therapy $0.50 Mile Mileage - Trauma and Resilience Consultation $35.00 Each No Show - All Groups $75.00 Each No Show - High Conflict Couples Therapy $50.00 Each No Show - Individual or Family Therapy $120.00 Each No Show - Trauma and Resilience Consultation $35.00 Hour Social Skills Youth Group $35.00 Hour Therapy Group for Parents of Juvenile Justice Involved Youth $35.00 Hour Transgender Youth Group $1,900.00 Episode Trauma and Resilience Assessment $120.00 Hour Trauma and Resilience Consultation $100.00 Hour Trauma and Resilience Partial Assessment 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report 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 and Exhibit A. Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7th day of the month following the month of service, but no later than 60 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 60 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. For one-time services, proof of services rendered shall be receipt of a Client Verification Form and the completed product. For Monitored Sobriety services, proof of services rendered shall be the test result. Contract Form Entity Information New Contract Request Entity Name* Entity ID' COLORADO STATE UNIVERSITY gO0002340 Contract Name* COLORADO STATE UNIVERSITY (CHILD PROTECTION AGREEMENT) Contract Status CTB REVIEW Contract Description* BID# 82100042. TERM_ 6t1 /21-5;31 i22. Contract Description 2 MEMO WAS PRESENTED TO Contract Type AGREEMENT Amount* $0.00 Renewable* YES Automatic Renewal Grant ICA New Entity? Contract ID 4850 Contract Lead* APEGG Contract Lead Email apeggwueldgov.com;cobbx xlkrweidgov.com THE BOCC BY PURCHASING ON 4, 7=2021 TYLER ID: 2021-0307. Department HUMAN SERVICES Department Email CM - H urnanService sweldgov.co m Department Head Email CM-HumanServices- DeptHeadw+eldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY aWELDG OV,COM If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Requested BOCC Agenda Date* 06 ' 16 2021 Parent Contract ID 20210307 Requires Board Approval YES Department Project # Due Date 06x12,`2021 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 Contact Information Contact Info Contact Name Purchasing Purchasing Approver CONSENT Approval Process Department Head JAMIE ULRICH OH Approved Date 06/11/2021 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 06/16;2021 Originator APEGG Review Date 04,01 ,'2022 Committed Delivery Date Contact Type Finance Approver CONSENT Renewal Date 05,`31 x'2022 Expiration Date Contact Phone 1 Purchasing 06, 1 1 ,`2021 Finance Approved Date 06,11[2021 Tyler Ref AG 061621 Legal Counsel CONSENT Contact Phone 2 Legal Counsel Approved Date 06'11=`2021 Hello