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Home My WebLink About20232038.tiffRESOLUTION RE: APPROVE REVISED ONLINE LICENSE AGREEMENT, ONLINE ORDER FORM, AND CUSTOMER SET-UP FORM FOR CHILD AND ADOLESCENT FUNCTIONAL ASSESSMENT SCALE (CAFAS), AUTHORIZE CHAIR TO SIGN, AND RESCIND RESOLUTION #2023-1827, DATED JUNE 28, 2023 - MULTI -HEALTH SYSTEMS, INC. WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, on the 28th day of June, 2023, by Resolution #2023-1827, the Board approved an Online License Agreement, Online Order Form, and Customer Set -Up Form for the Child and Adolescent Functional Assessment Scale (CAFAS) between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Multi -Health Systems, Inc., and WHEREAS, the Board has been presented with a Revised Online License Agreement, Online Order Form, and Customer Set -Up Form for the Child and Adolescent Functional Assessment Scale (CAFAS) between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Multi -Health Systems, Inc., with further terms and conditions being as stated in said revised agreement and forms, and WHEREAS, after review, the Board deems it advisable to approve said revised agreement and forms, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of Commissioners of Weld County, Colorado, that Resolution #2023-1827, dated June 28, 2023, for an Online License Agreement, Online Order Form, and Customer Set -Up Form for the Child and Adolescent Functional Assessment Scale (CAFAS) between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Multi -Health Systems, Inc., be, and hereby is, rescinded. BE IT FURTHER RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Revised Online License Agreement, Online Order Form, and Customer Set -Up Form for the Child and Adolescent Functional Assessment Scale (CAFAS) between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Multi -Health Systems, Inc., be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said revised agreement and forms. cc:t.-\SD og/Is/23 2023-2038 HR0095 REVISED ONLINE LICENSE AGREEMENT, ONLINE ORDER FORM, AND CUSTOMER SET-UP FORM FOR CHILD AND ADOLESCENT FUNCTIONAL ASSESSMENT SCALE (CAFAS), AND RESCIND RESOLUTION #2023-1827, DATED JUNE 28, 2023 - MULTI- HEALTH SYSTEMS, INC. PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 19th day of July, A.D., 2023. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: Ws.ct4,0 Weld County Clerk to the Board BYti.W hatti 11 • LO 1vizk Deputy Clerk to the Board AP' ' •''' ED O FORM: County ;Vorney Date of signature: r7/Z1 / Z 3 Perry . Bu', Pro-Tem man, Chair ott K. James Saine 2023-2038 HR0095 CUrrhvac4-IDigg PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: July 11, 2023 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child and Adolescent Functional Assessment Scale (CAFAS) User Agreement -Revised 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 and Adolescent Functional Assessment Scale (CAFAS) User Agreement - Revised. On June 28, 2023 the Board approved the request for the Department to enter into an agreement to use the Child and Adolescent Functional Assessment Scale (CAFAS) for assessing a youth's day-to-day functioning and to track changes in functioning over time. This approval is known to the Board as Tyler ID# 2023-1827. The provider of this service, Multi -Health Systems, Inc., has since notified the Department that the cost for using the assessment has increased by $79.00 since the start of the internal approval process: The Department is now requesting to resend the original agreement approval and to enter into a new User Agreement to update the rate. I do not recommend a Work Session. I recommend approval to resend the board approved agreement referenced as Tyler ID# 2023-1827 and approve the Customer Set-up Form, the Online License Agreement, and the revised Online Order Form and authorize the Chair to sign. Approve Recommendation Perry L. Buck, Pro-Tem Mike Freeman, Chair Scott K. James Kevin D. Ross Lori Saine Schedule Work Session Other/Comments: Pass -Around Memorandum; July 11, 2023 - CMS ID 7198 Page 1 2023-2038 7fG 120095 DocuSign Envelope ID: 7302O431-9A2E-4787-6421-56BAC42F94ED IIMHS j FAS Functional Assessment Systems CAFAS• 1 PECFAS' I JIFF. 1 CWO Customer Set-up Form for Multi -Health Systems, Inc. Muhl -Health Systems, Inc (MHS) • P.O. Box 950 • North Tonawanda, NY, 14120-0950 Tel. 1-Slxt-456.3003 or+l-41E492-2627 • Fax 1-BBg-540484 or +1-43Cr492-3343 • mhs.tom Please Fax (an above number) or Email (customerservice@mhs.com) all Pages of this Document to MHS Online Set -Up Contact (This person will setup your organization and create users - i.e., Clinical Director or Manager) Name: Rachel Wisdom Title: Wraparound Supervisor, Family Resource Division Email; wisdomre@weld.gou Phone: 970-400-6765 Liaisoe (The "go to" person at the agency who is responsible for their account with MHS) Same as Information Above? S Yes ❑ No Name: Title: Email: Phone: Name: Julie Witkowski Email: witkowjx©weid goy Any other important contacts? (Required) Thy Division Head. Family Resource Division Phone: 970-400-6777 Organization Information Agency: Weld County Department of Human Services Address: 315 N 11th Ave , Rids A City: _Greeley Phone: 970-352-1551 State:S:O Fax: Zip: 80632 Country: USA Authorized Contract Representative: i esley Cobb Title: Contract Management and Compliance Supervisor Phone: 070-400-6512 Emil: hs-contractmanaaementlOco.weld.co.us Sume: Tammy Maurer Email: maurertk@weld.aov Purchasing/Billing Information Title: Fi¢ral Head Human Services Phone: 970-400-6533 Same as Organization Information? Agency: Weld County Dseartment of Human Services Address: 315 N. 11th Ave.. Bldg A City: Greeley Phone: 970-352-1551 State: CO Fax: Zip: An632 ❑ Yes ❑ No Country: USA Tax Information State Sales Tax Exemption Status: Ilg Exempt ❑ Non -Exempt If Exempt, please fax or email a copy of your State Sales and Use Tax Certificate of Exemption For CAFASs/PECFASe Users Only Name of Reliability Trainer: Title: Email: Phone: Fax: DocuSign Envelope ID: 7302D431-9A2E-4787-6421-56BAC42F94ED 3. MHS FASFunctional Monument systeme CAMS. I MIMS• I IIPP• I CWL• Partin; Patire Contract. This Online Licent Agrccncnt ("Agreemrnt') between MuItFHeahh Syskrm Inc., an Omarq company whh offices at 3770 v re Park Avenue, Tommu:Onarb M2H 7M6. Camda ("MHS'7 and tha cuntamer ("Custovrc� identifad an de "MHS C:olti- Order Fgrtn" ('OMer Fomt'7. The folbwing documents comprise the emba contract bctsvern de parties: (a) Online License Agrccmcnt; (b) Order Form: (c) Terms and Condhbm Regarding c? Ineurer0 Portability and Accountability Acl of 1996, feasted az wwwsnhs.wm, aM (d) sysrcm requircmems and description of Online (euwres (includurg Online security features). furnctions, speeifieations, and kntnmtbm far use, beard az wwwFASonucortamcom ("System Requirements"). sgcpae. MHS provide psychometric azxssmente xala and rods. This Agrcenen[ con[abns tha reran and wdkbm for Castonrer's access m the speck utasmew (sometkrcs rofencd to az'7neazures"1 and taoh spccified in the Order fronn f'ONbne'). [t also gaveros Cusomer s process for renewing tle ()trline Ikeme and for ordering profusional services. arNn az Onlne training ad system intr:gration. Elfaflve Dale; Tenn. 3.1 Acceptance Mrit- This Agrocmem a effective upon ncecipt by MHS of thu Agrcement signed by Customer. Ths Agnxment is "signed" when MHS ncccivcs tha Agreement bearing a signature of Customer's authorized repnasentative az follows: (a) original wpks by M1ad delivery, lust class moil, ovmnight warier; (b) receipt bl' facsimile of a copy of a signed Agrremen[. (c) rccript of [he foregoing u a ecannd document delivered as an email attachment from Customer, or (d) wmplmbn and wbmissbn of a "fit se form' at FASoutwmcs.wm. Term: Renraaf. The rum of this Agreement shall be for ore ( I ) year from tha Eftnxive Date, unless renewed or terminated in accordance with Ills Agreement. Sixty (60) days prior ro tM cspca[bn of the then -current term, MHS shall invoice Cusomer for the Anroal License Fee far the upcoming term. Payment o(wch invoice shall constitute renewnl of this Agnxinent and cntnk Customer ro ougoirng access to the Online. Fees. Customer shall pay MHS an Annual Liccnx Fee far rite right m access ad ut tM Online and "Use Fcns" for rite spccife mcawres licentd m Cuazomcr. Under thu Agreement. a "Use" i. defued az Cusmteer access to a iiccued manure rot a single individual. "Useti' are purcM1asn in groups of at least 100 Usec, Customer may purchaze additbnel Uws from MHS try written request, tncludbg by email. Yearly Annual License Fccs, Usu fen, support frcs. ad other 31 4.2 4,3 Annual Lice. Fees and Use Fees shall aortae increased mom often than once pm calendar year. Chantrs durbg the term of tech year of the Agreement w01 ha effective al the wmmercement of the folbwing mrrewal period. All lees stated are b US. dolun. Timina MPaymenr. The inhiat term of the licence commences on the daze MHS receiro payment of tha Annual Liceme Fcc. MHS shall invoce Cusomer for the fees tt froth on tha initial Order for...alai and fix ...ma for professional services. Payment o due thirty (30) days mounts met a re payvents f -"":::,== d4 Suspenr of overdue aununu. MHS to sucA sutenskn. Cusmt 45 auppon.[raunng. wnsu Ucerrae b Os the Oagne. 5.! Aurhorimrinn m Access Online. Upon rha Effective Dote, pmvidd the MHS has received payment in accordance with this Agrcemem, for the term of mia Agrccmem MHS au[Igrims grccs to pay a laze ile of one ad a half percent ( h 596) pm and all MHS attorncyi fcea and expenses rearing ro bstomer's access ro the Online due ro ronpayment on entice which may ha Irammiud by email, prior twat .. y) prror ro Irving u access to t ual Licenre fee ad Ut Feet do 5.2 nontransferable, and dghu. including inte0ectuel property right, b doeumentaskn, guides. scoring forms. tmirdng Cusbtnur shall ut wmmerci i ad tae ofele Online. Urr MSwfr Scorer. MHS grants Cmtomer a limbed license m copy scale newts gcartated by Uxs of the licrn b measure C incluabn: lo cbniul records of[le imlividaale assessed by Cuamrter. @) in Customer ronpublk busircas recnmds, and (c) in)aretmations given by Curmmcr w omar pmaesabnals. OtMr all uses of scab scores aro expready prohibited. Ail rnxonds,...and wesenu. mini is shall ref idkamr usd, and ""%17:11:7":"=, he "%17d trademark symbo , 52.1 Cusomer may ram extract dctriptan ;!=i".7.= ircms a questbm Scalu4D ('CAFASi Fute[ional Assescmem Scaln� ('Y and JIFT$- luvcnilc nsz,oryF Cusomer may trot ut tha mess" berm) ro state otter mnsusa, o 511 5.3.3 pwtbn of the MHS rnm�surcs rsuch as vcniom. wdcnsatiom. "minf' If Cusroner deigns (w realms a third parry ro design) onlice or other teehrology tits[ accept inputs of sale scores genamscd by the MHS Online and extracted through the export tool or Web Smkes, such teehrology must display the applicable MHS rcgiskrd trademark and rcgiatmd trademark symbol in wnrection with such scores. For the avoidanuc of doubt reithm Cutomer nor coy mks party online developer may subslitule, to sucM1 techrobgy, a diftercnt name for de actual name of tha MHS measure. 52.4 pray use nut cxpncssty authorized h nnicrvd to MHS ad ro rights shall be implied. 5J License to (/re As= Storrs. MHS grams Custaaam a IbNtd license m copy xak xores gereremd by Uses of the Ikemd meuurc for: (a) iaclusiro k the records of me idivimuls assessed by Cusmnrer. @) b Customar rorrptrbik business records, and (c) in pretmatbm given by Custotrcr m other pmhssionals. All reports ad prasemation materials shell refe[encc MHS, the h CAFAS®T IS dby appropriate mcazure, and the tore or indicator uxd. sac az" as core ut permission from Muhi-Hcakh Systems." 5.3 .1 Cusrortcr rmy rot extract dnscripton from tha measures, such as "snub: 'strengms;' w specific items or question Crom the Child and Aiy Childhood Furctional Astssmrnt Scak� C CAFAS®). Rcschool and Early Childhood Functional Astssmcna Scale® ("PECAS®"). Cecgiver Wish Liat® JIFF®-luvenile inventory For Furetiodntt, Custorrcr may nut ut the �uures w any ponbo of iM MHS measures (such u berm) to create miter measures, took. new versin. wsaknatiom, "mini" vo"Mt , w dhcr dcnivativc works. Any ut not exptnely authorized u reserved ro MHS ad ro rights shall he implied. warram0n; Eulusion of Cerlafe Wsrrxtiaa flmired Warranty. oaring tha term of the Agreement, MHS wamnts that the Online will materially perform accortlancc with rite System Requhcments MHS does not warrant that the furetbns contained in the Online will meat Customer's specific reeds, ptofessbnal (a) ro) Cc) 103 rite prior, e Any altcmf 14. Imegn uderab INITIAL HERE ONLINE LICENSE AGREEMENT inch this Ageemcnt without withheld at MHS' sok discrdion DocuSign Envelope ID: 7302D431-9A2E-4787-0421-56BAC42F94ED •MHS ONLINE ORDER FORM F A S Fnnctioaal Assessment Sgstems CAFAs• I t'ECFAS' t IIFP' I CWL• Phone: 1-800-456-3003 or +1-416-492-2627 Fax: 1-888-540-4484 or +1-416-492-3343 Email: customerservice@mhs.eom Item (#) Items Available for purchase I 111 Fee US QTY( #) Total .lss` . m.. .,ts3 � �.. .: tiTY'1�^, _ 4�£��siR �R� . .v :, k? , 'M- a r. -r".� zv�S. ._ FASoutcomes Online Annual Maintenance Fee — FASWMF (per agency. Contact MHS if -you have questions.) $485 1 $485 Assessments: please choose the measure(s) you wish to purchase $371 1 E $371 • Child and Adolescent Functional A«'ssment Scale® (CAFAS.) Per 100 Assessments CAF121 I • Preschool and Early childhood Functional Assessment Scale. (PECFAS•) Per 100 Assessments I PEC107 $371 I 1 , $371 • Caregiver Wish List• (CWL•) Per 100 Assessments CWL100 $371 • JIFF Interviewer. Per 100 Assessments i JIF100 I $697 € Our online platform can communicate with your central information system - i i contact us at support@mhs.com for more information• Total I $1,227 Payment. Please make checks payable to: Multi -Health Systems, Inc. Please mail checks to: Multi -Health Systems, Inc., P.O. Box 950, North Tonawanda, NY, 14120=0950. All prices in U.S. dollars (USD). Effective Date. This Agreement is effective on the date last signed below. Commencement Date of Annual Maintenance. If the commencement of the date of the annual maintenance is different than the Effective Dates: The undersigned Customer(1) accepts and agrees to be bound by the MHS "Online License Agreement," (2) agrees that the online measures licensed to Customer, the additional services (if any) purchased by Customer, and the fees awed to MHS, are accurately set forth, above. AGREED AND ACCEPTED: Signature John Clarke F65B24AA66904DD... Printed Name CRO Multi -Health Systems, Inc. CDocuSigned by: am. Title Jul 31, 2023 I 1:28 PM EDT Date Weld County Government Legal Name of Customer Organization Signature of Au prized Contract Representative Mike Freeman Printed Name Chair, Board of County Commissioners Title JUL 1 9 2023 Date Multi -Health Systems, Inc. (MHS) • P.O. Bar 950 • North Tonawanda, NY, 14120-0950 • Tel.1-8004563003 or+1-416-492-2627 • Fax 1-888-540.4484 or+1-416-492-3343 • mhs.com Contract Form New Contract Request Ent Entity Name* MULTI HEALTH SYSTEMS INC Entity ID* @00047293 Contract Name* MULTI HEALTH SYSTEMS INC (CHILD AND ADOLESCENT FUNCTIONAL ASSESSMENT (CAFAS) LICENSE AGREEMENT) Contract Status CTB REVIEW ❑ New Entity? Contract ID 7198 Contract Lead* COBBXXLK Contract Lead Email cobbxxlk@co.weld.co.us Parent Contract ID Requires Board Approval YES Department Project # Contract Description* NEW LICENSE AGREEMENT FOR THE CHILD AND ADOLESCENT FUNCTIONAL ASSESSMENT (CAFAS) TO BE USED BY THE FAMILY RESOURCE UNIT. COST WAS REVISED TO REFLECT $371.00 PER 100 ASSESSEMENTS. PRIOR BOCC APPROVAL ON 6/2'23 TYLER ID 2023-1827 Contract Description 2 PA ROUTING THROUTH NORMAL APPROVAL PROCESS. ETA TO CTB 7/ 13,=' 2.3. THIS WILL RESEND AND REPLACE TYLER ID#2023-1827 Contract Type* AGREEMENT Amount* $0.00 Renewable* NO Automatic Renewal Department HUMAN SERVICES Department Email CM- HumanServicesweldgov.co Department Head Email CM-HumanServices- DeptHeadt0'weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTORN EYAWELDG OV.COM Requested BOCC Agenda Date* 07 19,2023 Due Date 07,15,2023 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 NSA enter NSA Contract ID Note. the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OWlase Contrac Effective Date Review Date. 04.' 301 2024 Renewal Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Committed Delivery Date Contact Type Contact Email Expiration Date* 06/2812024 Contact Phone 1 Contact Phone 2 Purchasing Approver Purchasing Approved Date Approval Process Department Head JAMIE ULRICH DH Approved Date 07`07/2023 Final Approval BOCC Approved BOCC Signed Date BOCC Agent 07/192023 Originator COBBXXLK Finance Approver CHERYL PATTELLI Legal Counsel BYRON HOWELL Finance Approved Date Legal Counsel Approved Date 07,10/2023 07,10,'2023 Tyler Ref # AG 071923 Cheryl Hoffman From: Sent: To: Cc: Subject: Attachments: Good morning CTB, FAST TRACK ITEM: Sara Adams Wednesday, July 31, 2024 10:28 AM CTB HS -Contract Management FAST TRACK: FR Multi -Health Systems (CMS 8556) EXECUTED - Weld County OHS - CAFAS PECFAS Online License Agreement - 07.31.23 (e).pdf; Invoice 6.7.24.pdf Attached please find the License Agreement between DHS and Multi -Health Systems, Tyler ID# 2023- 2038. The license agreement is renewed with the payment of the annual invoice and there are no changes to the agreement and it is being Fast Track in CMS for tracking purposes only (CMS# 8556). Thank you, Sara Sara Adams Contract Administrative Coordinator Weld County Dept. of Human Services 315 N. 11th Avenue, Building A PO Box A Greeley, CO 80632 (970) 400-6603 sadams@weld.gov 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, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. aos- ao.5g Cheryl Hoffman From: Sent: To: Subject: noreply@weldgov.com Wednesday, July 31, 2024 10:25 AM CM-ClerktoBoard; Sara Adams; Lesley Cobb; CM-HumanServices-DeptHead Fast Tracked Contract ID (8556) Contract # 8556 has been Fast Tracked to CM -Contract Maintenance. You will be notified in the future based on the Contract information below: Entity Name: MULTI HEALTH SYSTEMS INC Contract Name: MULTI HEALTH SYSTEMS INC (CHILD AND ADOLESCENT FUNCTIONAL ASSESSMENT (CAFAS) LICENSE AGREEMENT RENEWAL) Contract Amount: $510.00 Contract ID: 8556 Contract Lead: SADAMS Department: HUMAN SERVICES Review Date: 4/30/2025 Renewable Contract: YES Renew Date: 6/30/2025 Expiration Date: Tyler Ref #: Thank -you Hello