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Home My WebLink About20231433.tiffLnvcC} ID*Iztao ConVP4- e,ncro- 7/3/Z3 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: July 25, 2023 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Amendment #1 with kpj FIRST Services, llc 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 kpj FIRST Services, lie. The Department entered into a Professional Services Agreement with kpj FIRST Services, llc for Home -Based Intervention, Home Studies, Life Skills, Mentoring, and Relinquishment Counseling Services. This agreement is known as Tyler ID# 2023-1433. The Agreement is now being amended to make changes to Exhibit B Rate Schedule, as noted below. Rate Schedule Changes: • Update the Program Area Life Skills to add the rate of $95.00 per hour for Supervised Visitation: In-OfficeNideo, In -Home, or Community with Transportation, and to add $115.00 per hour for Therapeutic Supervised Visitation: In-OfficeNideo, In -Home, or Community with Transportation. Fees for Services: Home Based Intervention $130.00 Hour Home Based Intervention $85.00 Hour Home Based Intervention: Virtual Visits $65.00 Hour Home Based Intervention: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing, $65.00 Each Home Based Intervention: No Show (Max of 2 no shows or 2 hours/month/client) $0.55 Mile Home Based Intervention: Mileage. Home Studies $1,250.00 Episode Full Home Study $1.400.00 Episode Full Home Study: Spanish $225.00 Each Full Home Study: Additional Adult- Full $600.00 Episode Full Home Study: Updated $700.00 Episode Full Home Study: Updated, Spanish Pass -Around Memorandum; July 25, 2023 - CMS ID 72607/3#3 Page 1 2023-1433 Ro0q5 PRIVILEGED AND CONFIDENTIAL Home Studies $125.00 Each Full Home Study: Additional Adult - Updated $65.00 Hour Full Home Study: Cancelled Home Study or Partial $0.55 Mile Full Home Study: Mileages Life Skills $85.00 Hour Supervised Visitation: In-Office/Video $110.00 Hour Supervised Visitation: Out -of -Office $95.00 Hour Supervised Visitation: In-OfficeNideo, In -Home or Community with Transportation $65.00 Hour Supervised Visitation: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $65.00 Each Visitation Services: No Show (Max of2 no shows or 2 hours/month/client) Life Skills $0.55 Mile Life Skills: Mileage* $105.00 Hour Therapeutic Supervision: In- OfficeNirtual $130.00 Hour Therapeutic Supervision: Out -of -Office $115.00 Hour Therapeutic Supervision: In - OfficeNirtua, In -Home or Community with Transportation $10.00 Hour Life Skills: Spanish Interpreter Mentoring $70.00 Hour Mentoring $10.00 Hour Mentoring: Spanish Intergpreter $65.00 Hour Mentoring: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $65.00 Each Mentoring: No Show (Max of 2 no shows or 2 hours/month/client) $0.55 Mile Mentoring: Mileage* Relinquishment Counseling $105.00 Hour Relinquishment Counseling: In -Office $ 150.00 Hour Relinquishment Counseling: In -Home or Community $35.00 Hour Relinquishment Counseling: Spanish Interpreter $65.00 Hour Relinquishment Counseling: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $0.55 Mile Relinquishment Counseling: Mileages *Mileage for distances exceeding 30 roundtrip miles from 928 13° Street, Greeley, Colorado 80631. Pass -Around Memorandum; July 25, 2023 - CMS ID 7260 Page 2 PRIVILEGED AND CONFIDENTIAL I do not recommend a Work Session. I recommend approval of this Amendment #1 and authorize the Chair to sign. Approve Recommendation Perry L. Buck, Pro -Tern Mike Freeman, Chair Scott K. James Kevin D. Ross Lori Saine Schedule Work Session Other/Comments: Pass -Around Memorandum; July 25, 2023 - CMS ID 7260 Page 3 Karla Ford From: Sent: To: Subject: yes Lori Saine Weld County Commissioner, District 3 1150 O 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 Wednesday, July 26, 2023 10:00 AM Karla Ford RE: Please Reply - PA FOR ROUTING: kpj FIRST Services, Mc Amendment #1 (CMS TBD) 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. From: Karla Ford <kford@weld.gov> Sent: Tuesday, July 25, 2023 1:59 PM To: Lori Saine <lsaine@weld.gov> Subject: Please Reply - PA FOR ROUTING: kpj FIRST Services, llc Amendment #1 (CMS TBD) Importance: High Please advise if you approve recommendation. Thank you. Karla Ford Office Manager, Board of Weld County Commissioners 1150 0 Street, P.O. Box 758, Greeley, Colorado 80632 :: 970.336-7204 :: kford(@_weldgov.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 KPJ FIRST SERVICES, LLC This Agreement Amendment, made and entered into v I54- day of 2023 by and between the Board of Weld County Commissioners, on behalf of the Weld County epartment of Human Services, hereinafter referred to as the "Department", and kpj FIRST Services,11c., hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Home -Based Intervention, Home Studies, Life Skills, Mentoring, and Relinquishment Counseling, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2023-1433, approved on May 22, 2023. 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 30, 2024. This Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement as of June 1, 2023: 1. Exhibit B, Rate Schedule, is hereby amended as attached. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: ^"� ;41 Clerk to the Board BY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Chair JUL 3 12023 Kpj FIRST Services, 11c. 928 13th Street, #4A Greeley, Colorado 80631 (970)405-7716 ICS. Wawi t n ak By: K.p w wrzyn iak (Jul 26, 20 22:02 MDT) Keith P. Wawrzyniak Jr., Owner Jul 26, 2023 Date: O2t 2a-/ '5o EXHIBIT A SCOPE OF SERVICES Contractor will provide Home -Based Intervention, Home Studies, Life Skills, Mentoring, and Relinquishment Counseling, as referred by the Department. Program Area: Home -Based Intervention 1. Home -Based Intervention a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor's staff will utilize a Solution -Focused approach with the families based on the identified needs of the Department, and concurrently, assess for additional needs of the family. ii. Assist the family member with utilizing different skills and tools to address these immediate and ongoing identified issues and concerns. iii. Contractor's staff will respond in a timely manner to help the family deescalate any crisis situation in the home. iv. Contractor's staff will be available by phone twenty-four seven (24/7) to help deescalate crisis situations needing immediate response. v. Contractor's staff will be available to provide around the clock supervision for youth in crisis situations. vi. Contractor's staff will provide parent coaching and education to help parents to develop stronger and more effective parenting skills. vii. Contractor's staff will collaborate with other professionals involved to better meet the needs of the family. viii. Contractor's staff will maintain ongoing communication with the Department to ensure the alignment of goals for the family. b. Anticipated Frequency of Services: i. Two (2) to ten (10) hours per week. ii. As needed to meet the needs identified by Department. c. Anticipated Duration of Services: i. Thirty (30) to one hundred eighty (180) days. d. Goals of Services: i. Respond to families who are in crisis in a timely manner and be available twenty-four seven (24/7). ii. Support families in difficult circumstances and help them identify and mitigate immediate existing concerns. iii. Work with families to strengthen parenting skills. iv. Establish structure in the home. v. Establish clear expectations and boundaries. vi. Maintain a safe environment. vii. Collaborate with all professionals involved with the family to ensure all the needs of the family are being met. viii. Encourage and prompt family member to reach out to their support system to avoid crisis. e. Outcomes of Services: i. Establish healthy, trusting, and supportive relationships with the family. ii. The family will effectively utilize the skills and tools introduced to them to deescalate situations of conflict and chaos. iii. The family will be pro -active and reaches out to current supports to avoid crisis situations. iv. Family members will continue to develop insight to issues and strengthen their family dynamics. v. Parents will demonstrate a strong parental role, maintaining clear expectations and structure in their home. f. Target Population: i. Families that have an open case with the Department. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In home. ii. In community iii. In -Office located at 928 13. Street, #4A, Greeley, Colorado 80631. Program Area: Home Studies 1. Full SAFE Home Study f. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. This service will be provided by utilizing the required format of SAFE, tools provided by the Consortium for Children, and the Department. ii. There will be interaction and observation of each member in any given household. iii. Home Studies will be completed within sixty (60) days of the receipt of the referral from the Department. iv. All required documentation will be delivered to the Department upon completion of the Home Study. v. Home Studies will be completed by a certified SAFE Home Study provider. g. Anticipated Frequency of Services: i. There will be a minimum of three (3) visits for each SAFE Home Study, for a couple. ii. There will be at least two (2) visits for each full SAFE Home Study, for a single parent. iii. Each visit will typically be One (1) to two and a half (2 '/z) hours, per visit. h. Anticipated Duration of Services: i. Home Study will be completed within sixty (60) days upon receipt of the referral. Goals of Services: i. Provide a thorough and complete assessment of a family, their home, and their support systems; through observation and interviews, using the tools required by the Department and the Consortium for Children. ii. Complete Home Study in an objective and professional manner. iii. To be culturally aware, understanding, and respectful. iv. Contractor's staff will complete the Home Study within sixty (60) days of receipt of the referral. v. Contractor and Contractor's staff will help the Department determine if the applicants are appropriate for foster or kinship care certification, ICPC placement, or adoption. j. Outcomes of Services: i. Home Study will be completed and submitted to the Department within sixty (60) days of referral. ii. Mitigation is provided to identified concerns or curiosities during the Home Study. iii. A clear recommendation of approval or denial is provided with the Home Study. k. Target Population: i. ICPC requests, foster care, foster adoption, and kinship placement applicants. 1. Language: i. English. ii. Spanish. m. Medicaid Eligibility: i. This service is not Medicaid eligible. n. Service Access and Transportation: i. In home. 2. Updated SAFE Home Study Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. This service will be provided by utilizing the required format of SAFE, tools provided by the Consortium for Children, and the Department. ii. There will be interaction and observation of each member in any household. iii. Home Studies will be completed within sixty (60) days of the receipt of the referral from the Department. iv. All required documentation will be delivered to the Department upon completion of the Home Study. v. Updated Home Studies will be completed by a certified SAFE Home Study Provider. vi. Contractor's staff will review any previous completed Home Studies. b. Anticipated Frequency of Services: i. There will be a minimum of two (2) visits for each Updated Home Study. ii. Typically, one (1) to two (2) hours, per visit. c. Anticipated Duration of Services: i. To be completed within sixty (60) days of receipt of the Updated Home Study referral. d. Goals of Services: i. Provide a thorough and complete assessment of a family, their home, and their support systems; through observation and interviews, using the tools required by the Department and the Consortium for Children. ii. Complete Home Study in an objective and professional manner. iii. To be culturally aware, understanding, and respectful. iv. Contractor's staff will complete the Home Study within sixty (60) days of receipt of the referral. v. Contractor and Contractor's staff will help the Department determine if the applicants are appropriate for foster or kinship care certification, ICPC placement, or adoption. e. Outcomes of Services: i. Home Study will be completed and submitted to the Department within sixty (60) days of referral. ii. Mitigation is provided to identified concerns or curiosities during the Updated Home Study. iii. A clear recommendation of approval or denial is provided with the Updated Home Study. f. Target Population: ii. ICPC requests, foster care, foster adoption, and kinship placement applicants. g. Language: iii. English. iv. Spanish. h. Medicaid Eligibility: v. This service is not Medicaid eligible. i. Service Access and Transportation: vi. In home. Program Area: Life Skills 1. Supervised Visitation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor's staff will utilize a solution -focused approach in working with individuals and families during visits. ii. Help individuals and families identify strengths and weaknesses. iii. Help strengthen emotional and physical bonds. iv. Provide parenting education and feedback to parents. v. Contractor's staff will help the family set up specific goals to work toward and complete, working toward reunification. vi. Contractor's staff will provide a safe and appropriate location that ensures safety of the children for visits to occur, including basic necessities to meet the needs of the family. vii. Visits will be conducted in -office, in -home, or out in the community, based on approval of the Department. viii. Ongoing communication with Department providing updates with status of visits. ix. Enter frequent and consistent documentation in FIDOS. b. Anticipated Frequency of Services: i. One (1) to fifteen (15) hours a week. ii. As needed to meet the needs identified by the Department. c. Anticipated Duration of Services: i. One (1) to twelve (12) months, based on treatment plan and Court. d. Goals of Services: i. Contractor's staff will provide a safe and appropriate location for visits with basic necessities to meet the needs of the family. ii. Contractor's staff will provide continual observation and supervision of the visit ensuring the safety of all family members. iii. Contractor's staff will provide education and support to parents to develop stronger and more effective parenting skills. iv. Contractor's staff will set goals for the family, helping them meet those goals and adjust as needed along the way. v. Contractor's staff will maintain ongoing communication with the Department to ensure the alignment of goals for the family. vi. Contractor's staff will develop a healthy and trusting relationship with parents which will promote parenting development. vii. Contractor's staff will observe family dynamics, provide education and feedback to parents, and help strengthen emotional and physical bonds between parents and children. e. Outcomes of Services: i. Parent(s) will develop stronger emotional and physical connection with child(ren). ii. Parent(s) will effectively utilize the teamed parenting skills and tools introduced to them during visits to help de-escalate elevated situations, have strong emotional and physical connections with their child(ren), and re-establish appropriate family dynamics. iii. Parent(s) will demonstrate insight to current daily problems and family issues and successfully utilize their coping skills. iv. Parent(s) will complete their established goals with this Contractor and treatment plan with the Department. f. Target Population: i. Families with an open case at the Department. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. In home. ii. In community. iii. In -Office located at 928 13th Street, #4A, Greeley, Colorado 80631. 2. Therapeutic Supervised Visits a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor's staff will utilize a solution -focused and Cognitive Behavior approach in working with individuals and families during visits. ii. Contractor's staff will help the family identify strengths and weaknesses. iii. Contractor's staff will help strengthen emotional and physical bonds and provide parenting education and feedback to parents. iv. Contractor's staff will help the family set up specific goals to work toward, and complete, working toward reunification. v. Contractor's staff will provide a safe and appropriate location for visits to occur that ensures the safety of the children, to include basic necessities to meet the needs of the family. vi. Ongoing communication with Department to provide updates with status of visits. b. Anticipated Frequency of Services: i. One (1) to fifteen (15) hours, weekly. ii. As needed to meet the needs identified by the Department. c. Anticipated Duration of Services: i. One (1) to twelve (12) months, based on treatment plan and Court orders. d. Goals of Services: i. Contractor's staff will provide a safe and appropriate location for visits with basic necessities to meet the needs of the family. ii. Contractor's staff will provide continual observation and supervision of the visits, ensuring the safety of all family members. iii. Contractor's staff will provide education and support to parent to develop stronger and more effective parenting skills. iv. Contractor's staff will set goals for the family, help them meet those goals, and adjust the goals as needed. v. Contractor's staff will maintain ongoing communication with the Department to ensure the alignment of goals for the family. vi. Contractor's staff will provide continuous observation and supervision of the visit to ensure the safety of all family members. vii. Contractor's staff will develop a healthy and trusting relationship with parents which will promote parenting development. viii. Contractor's staff will observe family dynamics, provider education and feedback to parents, and help strengthen emotional and physical bonds between parents and children. e. Outcomes of Services: i. Parent(s) will develop stronger emotional and physical connection with child(ren). ii. Parent(s) will effectively utilize the learned parenting skills and tools introduced to them during visits to help de-escalate elevated situations. iii. Parent(s) will have strong emotional and physical connections with their child(ren) and re-establish appropriate family dynamics. iv. Parent(s) will demonstrate insight to current daily problems and family issues and successfully utilize their coping skills. v. Parent(s) will complete their established goals with this provider and treatment plan with the Department. f. Target Population: i. Families with an open case at the Department. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In home. ii. In -Office located at 928 13. Street, #4A, Greeley, Colorado 80631. Program Area: Mentoring 1. Mentoring a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor's staff will utilize a solution -focused approach in working with the youth and families. ii. Contractor's staff will establish a rapport with youth to determine the needs of the youth(s). iii. Contractor's staff will utilize community resources and activities for youth to engage in. iv. Contractor's staff will collaborate with the Department. v. Contractor's staff will respond in a timely manner, via phone or in person, to help the family deescalate any crisis situation in the home. vi. Contractor's staff will work with parents to understand their needs with their youth and provide that support as needed. b. Anticipated Frequency of Services: i. One (1) to five (5) visits, weekly. ii. One (1) to twenty (20) hours, weekly. iii. As needed to meet the needs identified by the Department. c. Anticipated Duration of Services: i. One (1) to six (6) months. d. Goals of Services: i. Establish rapport with youth. ii. Determine the needs of the youth through conversations with youth and parents. iii. Help youth develop personal insight, coping skills and social skills. iv. Help youth advocate for self and communicate needs in a positive manner. v. Provide respite for parents or placement providers. vi. Help the youth return home or remain home. vii. Help youth refrain from the use of drugs or alcohol. viii. Help parents identify community resources for support for youth. e. Outcomes of Services: i. Youth will demonstrate positive communication skills and advocate for their own needs. ii. Youth will not demonstrate verbal or physical aggression at home or at school. iii. Youth will demonstrate insight to daily stressors. iv. Youth will remain in the home or return home. f Target Population: i. Youth involved with the Department. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. In home. ii. In community iii. In -Office located at 928 13. Street, #4A, Greeley, Colorado 80631. Program Area: Relinquishment Counseling 1. Relinquishment Counseling a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor's staff will use relevant court documents to complete the paperwork. ii. Contractor's staff will meet with each client to ensure the client understands the finality of his/her decision to relinquish parental rights. iii. Contractor's staff will assess for sobriety or competence of client through observation and conversation at the beginning of the session, and reschedule the session if client is perceived to be under the influence of any substance. iv. Contractor's staff will provide the Department with all completed and signed documents. b. Anticipated Frequency of Services: i. One, one hour in -office visit or out of office visit for a relinquishment counseling session and follow up with the client to read and sign all documents. c. Anticipated Duration of Services: i. Service will be completed within sixty (60) days of receipt of referral from the Department. d. Goals of Services: i. Contractor's staff will thoroughly explain the meaning of "Relinquishment of Parental Rights" to client(s). ii. Ensure client is not under the influence of any substance. iii. Ensure client understands the finality of relinquishing their parental rights. iv. Ensure client understands all of their options regarding custody of the child(ren). e. Outcomes of Services: i. Client will have a complete understanding of the relinquishment process. ii. Client will understand that there are community resources for support should they decide not to relinquish parental rights. iii. Client will understand that once the Court accepts the Petition to Relinquish Parental Rights, the client will no longer have any personal or legal right to contact their child(ren). iv. The Department will receive the required relinquishment counseling paperwork within sixty (60) days of receipt of the referral. f. Target Population: i. Parents. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In home. ii. In community iii. In -Office located at 928 13th Street, #4A, Greeley, Colorado 80631. Terms 1. 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. 2. Contractor agrees to receive referrals for services through e-mail and will provide an identified e-mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the 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. 3. Contractor will respond to the Mental Health and Support Services Team CWServiceReferral(afweldgov.com within three (3) business days regarding the ability to accept the received referral. 4. Upon acceptance of a referral, Contractor will offer an initial appointment within seven (7) days of receiving the referral. The first attempt to contact the client will occur within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If the client does not respond after three (3) attempts in the first seven (7) days of the referral period, the Contractor will notify the caseworker and the Mental Health and Support Services Team (HS- CWServiceReferral(a/weldgov.com) and the Home Study Supervisor. 5. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Mental Health and Support Services Team (HS-CWServiceReferral(a,weldgov.com) and the Home Study Supervisor. No other Department staff or other party to the case may authorize services or modifications to services. 6. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for services. If a rate for "no shows" is not specifically stated in Exhibit 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 discharge the client from services. Contractor must inform the caseworker and the Mental Health and Support Services Team (HS- CWServiceReferral(d/weldgov.com) and the Home Study Supervisor, within three (3) days of when the client is placed on a behavioral plan or discharged 7. 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, Home Study Supervisor, and the Mental Health and Support Services Team (HS- CWServiceReferral(a,weldgov.com) immediately via email, to discuss service continuation. 8. Contractor will identify, in detail, areas of continued concern and make recommendations to the caseworker in a monthly report regarding continuation of services and/or the need for additional services. 9. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 10. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported to the caseworker, Home Study Supervisor, and the Mental Health and Support Services Team HS- CWServiceReferral/h/weldgov.com immediately AND on the required monthly report. 11. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator, Home Study Supervisor, or any member of the Mental Health and Support Services Team. Any changes to visitation referrals will be approved by a new referral signed by the Child Welfare Supervisor. Any changes to home study referrals will be approved by a new referral signed by the Home Study Supervisor. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 12. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Bid Meetings, Professional Stuffings, 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 Mental Health and Support Services Team, and the facilitator documents in the meeting notes the timeframe that the provider attended and when participation in the meeting is deemed appropriate and necessary by the Department. The Facilitator will be responsible for filling out the time attended on the meeting notes. Stuffings 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 or virtually, if approved by the Department. 13. On a monthly basis, the Contractor will notify the Mental Health and Support Services Team (HS- CWServiceReferral(afweldgov.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. 14. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR) and will address the aforementioned three areas when completing monthly or home study reports as required by Paragraph 9 of this Exhibit. 15. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 16. 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. 17. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at (970) 336-7235 and advise that the subpoena must be personally served. 18. Monitoring and Evaluation Contractor and the 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 to 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. EXHIBIT B RATE SCHEDULE 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(s) specified below in Paragraph 2, Fees for Services. 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. For services funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit a State of Colorado direct deposit enrollment form, which will be provided by the Department, with a voided check, deposit slip or bank letter. Failure to complete and submit this form and voided check in a timely and accurate manner may result in a delay of payment. For services not funded through Core Services; Contractor agrees to accept payment through County Warrant when funding source does not allow for direct deposit. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Program Area Home Based Intervention Rate $130.00 Unit Type Hour Service Name Home Based Intervention $85.00 Hour Home Based Intervention: Video Visits $65.00 Hour Home Based Intervention: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $65.00 Each Home Based Intervention: No Show (Max of 2 no shows or 2 hours/month/client) $0.55 Mile Home Based Intervention: Mileage* Home Studies $1,250.00 Episode Full Home Study $1,400.00 Episode Full Home Study, Spanish $225.00 Each Full Home Study: Additional Adult- Full $600.00 Episode Full Home Study: Updated $700.00 Episode Full Home Study: Updated, Spanish $125.00 Each Full Home Study: Additional Adult - Updated $65.00 Hour Full Home Study: Cancelled Home Study or Partial $0.55 Mile Full Home Study: Mileage* Life Skills $85.00 Hour Supervised Visitation: In-OfficeNideo $110.00 Hour Supervised Visitation: Out -of -Office $45.00 Hour Supervised Visitation: In -Office with Transportation $65.00 Hour Supervised Visitation: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $65.00 Each Visitation Services: No Show (Max of 2 no shows or 2 hours/month/client) Program Area Life Skills Rate $0.55 Unit Type Mile Service Name Life Skills: Mileage* $105.00 Hour Therapeutic Supervision: In-Office/Video $130.00 Hour Therapeutic Supervision: Out -of -Office $115.00 Hour Therapeutic Supervision: In -Office with Transportation $10.00 Hour ; Life Skills: Spanish Interpreter Mentoring $70.00 Hour Mentoring $10.00 Hour ° Mentoring: Spanish Interpreter $65.00 Hour Mentoring: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $65.00 Each Mentoring: Na Show (Max of 2 no shows or 2 hours/month/client) $0.55 Mile Mentoring: Mileage* Relinquishment Counseling $105.00 Hour Relinquishment Counseling: In -Office $150.00 Hour Relinquishment Counseling: In -Home or Community $35.0O Hour Relinquishment Counseling: Spanish Interpreter $65.00 Hour Relinquishment Counseling: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $0.55 Mile Relinquishment Counseling: Mileage* *Mileage for distances exceeding 30 roundtrip miles from 928 13`h Street, Greeley, Colorado 80631. 3. Request for Reimbursement and Supporting Documentation 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 45 days from the date of service for each client receiving ongoing services. Contractor shall prepare and submit monthly a Request for Reimbursement and monthly report including other supporting documentation, if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 of this Agreement. Monthly reports will be submitted through the 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. Time(s) of service (i.e. 2-4pm) b. Location of where the service took place (i.e. clinician's office, client's home, in the community.) c. Clinician/therapist name d. What interventions were used, recommendations and/or goals discussed, progressions towards goals, and client engagement. e. For mileage reimbursement, if applicable, the mileage accumulated minus roundtrip mileage that is included in the rate, starting location, and ending location. f. Any and all safety concerns. When submitting a Request for Reimbursement for a one-time service, the contractor shall submit the first and last page of the evaluation/report to confirm proof of services rendered. The full evaluation/report should be submitted by the contractor to the caseworker. For Monitored Sobriety services, proof of services rendered shall be the test result. Requests for Reimbursement and/or supporting documentation received after the 7th day of the month may delay payment. Requests for Reimbursement and/or supporting documentation received after 45 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 45 -day deadline may result in termination of the Agreement. 4. Payment The 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: The service being provided by the contractor is not a Medicaid eligible service; a. The service is not deemed medically necessary; b. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; c. A Medicaid provider is not available to provide the needed service; d. Medicaid is exhausted for the needed service; or e. Medicaid denied service. f. The client is not eligible for Medicaid. The 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. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: a. Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the 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. 6. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMB Circular A-133. SIGNATURE REQUESTED: Weld/kpj FIRST Services, Ilc Amendment #1 Final Audit Report 2023-07-27 Created: 2023-07-26 By: Windy Luna (wluna@co.weld.co.us) Status: Signed Transaction ID: CBJCHBCAABAAUMrUZVrTakMQFluBxh0Ahd5Z0DpfT41b "SIGNATURE REQUESTED: Weld/kpj FIRST Services, Ilc Ame ndment #1" History 5 Document created by Windy Luna (wluna@co.weld.co.us) 2023-07-26 - 7:22:11 PM GMT C'-► Document emailed to kpwawa@kpjfamilyservices.com for signature 2023-07-26 - 7:23:38 PM GMT 5 Email viewed by kpwawa@kpjfamilyservices.com 2023-07-26 - 8:21:58 PM GMT CSa Signer kpwawa@kpjfamilyservices.com entered name at signing as K.p. Wawrzyniak 2023-07-27 - 4:02:48 AM GMT C54 Document e -signed by K.p. Wawrzyniak (kpwawa@kpjfamilyservices.com) Signature Date: 2023-07-27 - 4:02:50 AM GMT - Time Source: server O Agreement completed. 2023-07-27 - 4:02:50 AM GMT Powered by Adobe Acrobat Sign Contract Form New Contract Request Entity information Entity Name * KPJ FIRST SERVICES, LLC Entity ID a 4,00041915 Contract Name* Contract ID KPI FIRST SERVICES. LLC IPSO AMENDMENT 411 (RELATED 7260 TO EID8 B2300040) Contract Status CTB REVIEW Contract Lead * WLUNA Li New Entity? Parent Contract ID 20231433 Reg YES d Contract Lead Email Department Project wluna Eweldgov.com;cobbx xlk.w�weidgov.com Contract Description (CONSENT) EEl FIRST SERVICES, LLC IPSA AMENDMENT 011 (RELATED TO BIDO 823000401. TERM: JUNE 1, 2023 THROUGH MAY 31, 2024. Contract Description 2 PROVIDER WAS ON THE APPROVED PROVIDER LIST PRESENTED TO THE BOCC ON 03 :2B 2023 AND SENT TO CTR ON 03 30 2023. PA FOR THIS AMENDMENT ROUTING THROUGH NORMAL PROCESS. ETA TO CTB 07 27,='2023. Contract Type* AMENDMENT Amount. 90.05 Renewable* NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HurnaoServices/'sveldgov.co rrt Department Head Email CM-Huma0Services- Dept Head 2iweldgos.corn County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM - C O€J NTYATTO F N EY _TW ELDG OV,COM Requested BOCC nda Due Date Date" 07 29.'2023 08 02 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 MSA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blan Ot1Pase Contract Dates hose contracts are not on Effective Date Review Daze'* 03;29; 2024 Renewal Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Approval Process Department Head JAMIE ULRICH DH Approved Date 07'2412023 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 07,`31 2023 Originator WLUNA. Committed Delivery Date Contact Type Contact Email Finance Approver CHERYL P.ATTELLI Expiration Date' 05'31;2024 Contact Phone I Contact Phone 2 Purchasing •t iroved Date Legal Counsel KARIN MC17OUGAL Finance Approved Date Legal Counsel Approved Date 07,`25 2023 07^2512023 Tyler Ref # AG 073123 e�ni'vac- IDth(9995 PROFESSIONAL SERVICE AGREEMENT BETWEEN WELD COUNTY AND KPJ FIRST SERVICES, LLC. ,{ � THIS AGREEMENT is made and entered into this day of I" 1 , 2023, by and between the Board of Weld County Commissioners, on behalf of the Weld Cb{inty Department of Human Services, hereinafter referred to as "County," and kpj FIRST Services, 11c., hereinafter referred to as "Contractor". WHEREAS, County desires to retain Contractor to perform services as required by County and set forth in the attached Exhibits; and WHEREAS, Contractor is willing and has the specific ability, qualifications, and time to perform the required services according to the terms of this Agreement; and WHEREAS, Contractor is authorized to do business in the State of Colorado and has the time, skill, expertise, and experience necessary to provide the services as set forth below; and WHEREAS, the Colorado Department of Human Services has provided Core and Non - Core or other funding to the Department for Home -Based Intervention, Home Studies, Life Skills, Mentoring, and Relinquishment Counseling. NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties hereto agree as follows: 1. Introduction. The terms of this Agreement are contained in the terms recited in this document and in the attached Exhibits, each of which forms an integral part of this Agreement and are incorporated herein. The parties each acknowledge and agree that this Agreement, including the attached Exhibits, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements (the "Work"). If a conflict occurs between this Agreement and any Exhibit or other attached document, the terms of this Agreement shall control, and the remaining order of precedence shall based upon order of attachment. Exhibit A consists of the Scope of Services. Exhibit B consist of the Rate Schedule. Exhibit C consists of County's Request for Proposal (RFP) as set forth in Bid Package No. B2300040 which is incorporated into this agreement by reference and will be provided upon request to the Department. Exhibit D consists of Contractor's Response to County's Request. 2. Service or Work. Contractor agrees to diligently provide all services, labor, personnel and materials necessary to perform and complete the Work described in the attached Exhibits. Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibits A, Scope of Services, and Exhibit D, Contractor's Response to Request for Proposal. cc: 643,,.e -CI -15-D) COYIerl+ i lk' .57a�/a3 i22/z 3 H1wUq S 2023-1433 Contractor shall further be responsible for the timely completion and acknowledges that a failure to comply with the standards and requirements of Work within the time limits prescribed by County may result in County's decision to withhold payment or to terminate this Agreement. 3. Term. The term of this Agreement shall be from June 1, 2023, through May 31, 2024, unless sooner terminated as provided herein. Both of the parties to this Agreement understand and agree that the laws of the State of Colorado prohibit County from entering into Agreements which bind County for periods longer than one year. This Agreement may be renewed for 2 (two) additional one-year terms upon mutual written agreement of the Parties. 4. Termination; Breach; Cure. County may terminate this Agreement for its own convenience upon thirty (30) days written notice to Contractor. Either Party may immediately terminate this Agreement upon material breach of the other party, however the breaching party shall have fifteen (15) days after receiving such notice to cure such breach. If this Agreement is terminated by County, Contractor shall be compensated for, and such compensation shall be limited to, (1) the sum of the amounts contained in invoices which it has submitted and which have been approved by the County; (2) the reasonable value to County of the services which Contractor provided prior to the date of the termination notice, but which had not yet been approved for payment; and (3) the cost of any work which the County approves in writing which it determines is needed to accomplish an orderly termination of the work. County shall be entitled to the use of all material generated pursuant to this Agreement upon termination. Upon termination of this Agreement by County, Contractor shall have no claim of any kind whatsoever against the County by reason of such termination or by reason of any act incidental thereto, except for compensation for work satisfactorily performed and/or materials described herein properly delivered. 5. Extension or Amendment. Any amendments or modifications to this agreement shall be in writing signed by both parties. No additional services or work performed by Contractor shall be the basis for additional compensation unless and until Contractor has obtained written authorization and acknowledgement by County for such additional services. Accordingly, no claim that the County has been unjustly enriched by any additional services, whether or not there is in fact any such unjust enrichment, shall be the basis of any increase in the compensation payable hereunder. In the event that written authorization and acknowledgment by the County for such additional services is not timely executed and issued in strict accordance with this Agreement, Contractor's rights with respect to such additional services shall be deemed waived and such failure shall result in non-payment for such additional services or work performed. Any claims by the Contractor for adjustment hereunder must be made in writing prior to performance of any work covered in the anticipated Amendment, unless approved and documented otherwise by the County Representative. Any change in work made without such prior Amendment shall be deemed covered in the compensation and time provisions of this Agreement, unless approved and documented otherwise by the County Representative. 6. Compensation. County agrees to pay Contractor through an invoice process during the course of this Agreement in accordance with the Rate Schedule as described as Exhibit B. Contractor agrees to submit invoices which detail the work completed by Contractor. The County will review each invoice and if it agrees Contractor has completed the invoiced items to the County's satisfaction, it will remit payment to the Contractor. No payment in excess of that set 2 forth in the Exhibits will be made by County unless an Amendment authorizing such additional payment has been specifically approved by Weld County as required pursuant to the Weld County Code. If, at any time during the term or after termination or expiration of this Agreement, County reasonably determines that any payment made by County to Contractor was improper because the service for which payment was made did not perform as set forth in this Agreement, then upon written notice of such determination and request for reimbursement from County, Contractor shall forthwith return such payment(s) to County. Upon termination or expiration of this Agreement, unexpended funds advanced by County, if any, shall forthwith be returned to County. County will not withhold any taxes from monies paid to the Contractor hereunder and Contractor agrees to be solely responsible for the accurate reporting and payment of any taxes related to payments made pursuant to the terms of this Agreement. Unless expressly enumerated in the attached Exhibits, Contractor shall not be entitled to be paid for any other expenses (e.g. mileage). Notwithstanding anything to the contrary contained in this Agreement, County shall have no obligations under this Agreement after, nor shall any payments be made to Contractor in respect of any period after December 31 of any year, without an appropriation therefore by County in accordance with a budget adopted by the Board of County Commissioners in compliance with Article 25, Title 30 of the Colorado Revised Statutes, the Local Government Budget Law (C.R.S. 29-1-101 et. seq.) and the TABOR Amendment (Colorado Constitution, Article X, Sec. 20). 7. Independent Contractor. Contractor agrees that it is an independent contractor and that Contractor's officers, agents or employees will not become employees of County, nor entitled to any employee benefits (including unemployment insurance or workers' compensation benefits) from County as a result of the execution of this Agreement. Contractor shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. 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. S. Subcontractors. Contractor acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of the Work without County's prior written consent, which may be withheld in County's sole discretion. County shall have the right in its reasonable discretion to approve all personnel assigned to the Work during the performance of this Agreement and no personnel to whom County has an objection, in its reasonable discretion, shall be assigned to the Work. Contractor shall require each subcontractor, as approved by County and to the extent of the Work to be performed by the subcontractor, to be bound to Contractor by the terms of this Agreement, and to assume toward Contractor all the obligations and responsibilities which Contractor, by this Agreement, assumes toward County. County shall have the right (but not the obligation) to enforce the provisions of this Agreement against any subcontractor hired by Contractor and Contractor shall cooperate in such process. The Contractor shall be responsible for the acts and omissions of its agents, employees and subcontractors. 3 9. Ownership. All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of County. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contractor in relation b this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the County. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of County. 10. Confidentiality. Confidential information of the Contractor should be transmitted separately from non -confidential information, clearly denoting in red on the relevant document at the top the word, "CONFIDENTIAL." However, Contractor is advised that as a public entity, Weld County must comply with the provisions of the Colorado Open Records Act (CORA), C.R.S. 24-72-201, et seq., with regard to public records, and cannot guarantee the confidentiality of all documents. Contractor agrees to keep confidential all of County's confidential information. Contractor agrees not to sell, assign, distribute, or disclose any such confidential information to any other person or entity without seeking written permission from the County. Contractor agrees to advise its employees, agents, and consultants, of the confidential and proprietary nature of this confidential information and of the restrictions imposed by this Agreement. 11. Warranty. Contractor warrants that the Work performed under this Agreement will be performed n a manner consistent with the standards governing such services and the provisions of this Agreement. Contractor further represents and warrants that all Work shall be performed by qualified personnel in a professional manner, consistent with industry standards, and that all services wil conform to applicable specifications. 12. Acceptance of Services Not a Waiver. Upon completion of the Work, Contractor shall submit to County originals of all test results, reports, etc., generated during completion of this work. Acceptance by County of reports and incidental material(s) furnished under this Agreement shall not in any way relieve Contractor of responsibility for the quality and accuracy of the project. In no event shall any action by County hereunder constitute or be construed to be a waiver by County of any breach of this Agreement or default which may then exist on the part of Contractor, and County's action or inaction when any such breach or default exists shall not impair or prejudice any right or remedy available to County with respect to such breach or default. No assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the County of, or payment for, the Work completed under this Agreement shall not be construed as a waiver of any of the County's rights under this Agreement or under the law generally. 13. Insurance. Contractor must secure, before the commencement of the Work, the following insurance covering all operations, goods, and services provided pursuant to this Agreement, and shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, and during any warranty period. For all coverages, Contractor's insurer shall waive subrogation rights against County. 4 a. Types of Insurance. Workers' Compensation / Employer's Liability Insurance as required by state statute, covering all of the Contractor's employees acting within the course and scope of their employment. The policy shall contain a waiver of subrogation against the County. This requirement shall not apply when a Contractor or subcontractor is exempt under Colorado Workers' Compensation Act., AND when such Contractor or subcontractor executes the appropriate sole proprietor waiver form. Commercial General Liability Insurance including public liability and property damage, covering all operations required by the Work. Such policy shall include minimum limits as follows: $1,000,000 each occurrence; $1,000,000 general aggregate; $1,000,000 Personal injury; $5,000 Medical payment per person. Automobile Liability Insurance: 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, for vehicles owned, hired, and non -owned vehicles used in the performance of this Contract. Professional Liability (Errors and Omissions Liability). The policy shall cover professional misconduct or lack of ordinary skill for those positions defined in the Scope of Services of this contract. Contractor shall maintain limits for all claims covering wrongful acts, errors and/or omissions, including design errors, if applicable, for damage sustained by reason of or in the course of operations under this Contract resulting from professional services. In the event that the professional liability insurance required by this Contract is written on a claims -made basis, Contractor warrants that any retroactive date under the policy shall precede the effective date of this Contract; and that either continuous coverage will be maintained or an extended discovery period will be exercised for a period of two (2) years beginning at the time work under this Contract is completed. Minimum Limits: $1,000,000 Per Loss; $2,000,000 Aggregate. b. Proof of Insurance. Upon County's request, Contractor shall provide to County a certificate of insurance, a policy, or other proof of insurance as determined in County's sole discretion. County may require Contractor to provide a certificate of insurance naming Weld County, Colorado, its elected officials, and its employees as an additional named insured. c. Subcontractor Insurance. Contractor hereby warrants that all subcontractors providing services under this Agreement have or will have the above described insurance prior to their commencement of the Work, or otherwise that they are covered by the Contractor's policies to the minimum limits as required herein. Contractor agrees to provide proof of insurance for all such subcontractors upon request by the County. d. No limitation of Liability. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor. The County in no way warrants that the minimum limits contained herein are 5 sufficient to protect the Contractor from liabilities that might arise out of the performance of the Work under by the Contractor, its agents, representatives, employees, or subcontractors. The Contractor shall assess its own risks and if it deems appropriate and/or prudent, maintain higher limits and/or broader coverages. The Contractor is not relieved of any liability or other obligations assumed or pursuant to the Contract by reason of its failure to obtain or maintain insurance in sufficient amounts, duration, or types. The Contractor shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. e. Certification of Compliance with Insurance Requirements. The Contractor stipulates that it has met the insurance requirements identified herein. The Contractor shall be responsible for the professional quality, technical accuracy, and quantity of all services provided, the timely delivery of said services, and the coordination of all services rendered by the Contactor and shall, without additional compensation, promptly remedy and correct any error, omissions, or other deficiencies. 14. Indemnity. The Contractor shall defend, indemnify and hold harmless County, its officers, agents, and employees, from and against any and all injury, loss, damage, liability, suits, actions, claims, or willful acts or omissions of any type or character arising out of the Work done in fulfillment of the terms of this Agreement or on account of any act, claim or amount arising or recovered under workers' compensation law or arising out of the failure of the Contractor to conform to any statutes, ordinances, regulation, judicial decision, or other law or court decree. The Contractor shall be fully responsible and liable for any and all injuries or damage received or sustained by any person, persons, or property on account of its performance under this Agreement or its failure to comply with the provisions of the Agreement. It is agreed that the Contractor will be responsible for primary loss investigation, defense and judgment costs where this contract of indemnity applies. In consideration of the award of this contract, the Contractor agrees to waive all rights of subrogation against the County its associated and/or affiliated entities, successors, or assigns, its elected officials, trustees, employees, agents, and volunteers for losses arising from the work performed by the Contractor for the County. A failure to comply with this provision shall result in Coanty's right to immediately terminate this Agreement. 15. Non -Assignment. Contractor may not assign or transfer this Agreement or any interest therein or claim thereunder, without the prior written approval of County. Any attempts by Contractor to assign or transfer its rights hereunder without such prior approval by County shall, at the option of County, automatically terminate this Agreement and all rights of Contractor hereunder. Such consent may be granted or denied at the sole and absolute discretion of County. 16. Examination of Records. To the extent required by law, the Contractor agrees that an duly authorized representative of County, including the County Auditor, shall have access to and the right to examine and audit any books, documents, papers and records of Contractor, involving all matters and/or transactions related to this Agreement. Contractor agrees to maintain these documents for three years from the date of the last payment received. 17. 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 6 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. 18. Notices. County may designate, prior to commencement of Work, its project representative ("County Representative") who shall make, within the scope of his or her authority, all necessary and proper decisions with reference to the project. All requests for contract interpretations, change orders, and other clarification or instruction shall be directed to County Representative. All notices or other communications made by one party to the other concerning the terms and conditions of this contract shall be deemed delivered under the following circumstances: (a) personal service by a reputable courier service requiring signature for receipt; or (b) five (5) days following delivery to the United States Postal Service, postage prepaid addressed to a party at the address set forth in this contract; or (c) electronic transmission via email at the address set forth below, where a receipt or acknowledgment is required and received by the sending party; or Either party may change its notice address(es) by written notice to the other. Notice may be sent to: TO CONTRACTOR: Name: Keith P. Wawrzyniak Jr. Position: Owner Address: P.O. Box 761 Address: Eaton, Colorado 80631 E-mail: kpwawakpjfamilyservices.com Phone: (970) 405-7716 TO COUNTY: Name: Jamie Ulrich Position: Director Address: P.O. Box A Address: Greeley, Colorado 80632 E-mail: julrich(afweld.gov Phone: (970) 400-6510 19. Compliance with Law. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established, including without limitation, laws applicable to discrimination and unfair employment practices. 20. Non -Exclusive Agreement. This Agreement is nonexclusive and County may engage or use other Contractors or persons to perform services of the same or similar nature. 21. Entire Agreement/Modifications. This Agreement including the Exhibits attached hereto and incorporated herein, contains the entire agreement between the parties with respect to the subject matter contained in this Agreement. This instrument supersedes all prior negotiations, 7 representations, and understandings or agreements with respect to the subject matter contained in this Agreement. This Agreement may be changed or supplemented only by a written instrument signed by both parties. 22. Fund Availability. Financial obligations of the County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. Execution of this Agreement by County does not create an obligation on the part of County to expend funds not otherwise appropriated in each succeeding year. 23. Employee Financial Interest/Conflict of Interest — C.R.S. §§24-18-201 et seq. and §24- 50-507. The signatories to this Agreement state that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. 24. Survival of Termination. The obligations of the parties under this Agreement that by their nature would continue beyond expiration or termination of this Agreement (including, without limitation, the warranties, indemnification obligations, confidentiality and record keeping requirement) shall survive any such expiration or termination. 25. 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 wlhout such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. 26. Governmental Immunity. No term or condition of this Agreement 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 §§24-10-101 et seq., as applicable rmw or hereafter amended. 27. No Third Party Beneficiary. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 28. Board of County Commissioners of Weld County Approval. This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado or its designee. 29. Choice of Law/Jurisdiction. Colorado law, and rules and regulations established pursuant thereto, shal 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. 8 30. Attorney's Fees/Legal Costs. In the event of a dispute between County and Contractor concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 31. Binding Arbitration Prohibited. Weld County does not agree to binding arbitration by any extra judicial body or person. Any provision to the contrary in this Agreement or incorporated herein by reference shall be null and void. 32. Acknowledgment. County and Contractor acknowledge that each has read this Agreement, understands it and agrees to be bound by its terms. Both parties further agree that this Agreement, with the attached Exhibits, is the complete and exclusive statement of agreement between the parties and supersedes all proposals or prior agreements, oral or written, and any other communications between the parties relating to the subject matter of this Agreement. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: -'.4 " " JC/44;&k. k to the Board BY: Deputy Cler �i to di: Bo.4' ' t r' t 9 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Chair MAY 2 2 2323 CONTRACTOR: kpj FIRST Services, llc. 928 13th Street #4A Greeley, Colorado 80631 faith Wawrihiak,7r R�l'KeithPWawrzvniaklrlMavll. ]314:UStAOT) Keith P. Wawrzyniak Jr., Owner Date: May 11, 2023 o2Da,3- / 5 EXHIBIT A SCOPE OF SERVICES Contractor will provide Home -Based Intervention, Home Studies, Life Skills, Mentoring, and Relinquishment Counseling, as referred by the Department. Program Area Home -Based Intervention 1. Home -Based Intervention Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor's staff will utilize a Solution -Focused approach with the families based on the identified needs of the Department, and concurrently, assess for additional needs of the family. ii. Assist the family member with utilizing different skills and tools to address these immediate and ongoing identified issues and concerns. iii. Contractor's staff will respond in a timely manner to help the family deescalate any crisis situation in the home. iv. Contractor's staff will be available by phone twenty-four seven (24/7) to help deescalate crisis situations needing immediate response. v. Contractor's staff will be available to provide around the clock supervision for youth in crisis situations. vi. Contractor's staff will provide parent coaching and education to help parents to develop stronger and more effective parenting skills. vii. Contractor's staff will collaborate with other professionals involved to better meet the needs of the family. viii. Contractor's staff will maintain ongoing communication with the Department to ensure the alignment of goals for the family. b. Anticipated Frequency of Services: i. Two (2) to ten (10) hours per week. ii. As needed to meet the needs identified by Department. c. Anticipated Duration of Services: i. Thirty (30) to one hundred eighty (180) days. d. Goals of Services: i. Respond to families who are in crisis in a timely manner and be available twenty-four seven (24/7). ii. Support families in difficult circumstances and help them identify and mitigate immediate existing concerns. iii. Work with families to strengthen parenting skills. iv. Establish structure in the home. v. Establish clear expectations and boundaries. vi. Maintain a safe environment. vii. Collaborate with all professionals involved with the family to ensure all the needs of the family are being met. viii. Encourage and prompt family member to reach out to their support system to avoid crisis. e. Outcomes of Services: i. Establish healthy, trusting, and supportive relationships with the family. ii. The family will effectively utilize the skills and tools introduced to them to deescalate situations of conflict and chaos. iii. The family will be pro -active and reaches out to current supports to avoid crisis situations. iv. Family members will continue to develop insight to issues and strengthen their family dynamics. v. Parents will demonstrate a strong parental role, maintaining clear expectations and structure in their home. f. Target Population: i. Families that have an open case with the Department. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In home. ii. In community iii. In -Office located at 928 13. Street, #4A, Greeley, Colorado 80631. Program Area: Home Studies 1. Full SAFE Home Study a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. This service will be provided by utilizing the required format of SAFE, tools provided by the Consortium for Children, and the Department. ii. There will be interaction and observation of each member in any given household. iii. Home Studies will be completed within sixty (60) days of the receipt of the referral from the Department. iv. All required documentation will be delivered to the Department upon completion of the Home Study. v. Home Studies will be completed by a certified SAFE Home Study provider. b. Anticipated Frequency of Services: i. There will be a minimum of three (3) visits for each SAFE Home Study, for a couple. ii. There will be at least two (2) visits for each full SAFE Home Study, for a single parent. iii. Each visit will typically be One (1) to two and a half (2 'H) hours, per visit. c. Anticipated Duration of Services: i. Home Study will be completed within sixty (60) days upon receipt of the referral. d. Goals of Services: i. Provide a thorough and complete assessment of a family, their home, and their support systems; through observation and interviews, using the tools required by the Department and the Consortium for Children. ii. Complete Home Study in an objective and professional manner. iii. To be culturally aware, understanding, and respectful. iv. Contractor's staff will complete the Home Study within sixty (60) days of receipt of the referral. v. Contractor and Contractor's staff will help the Department determine if the applicants are appropriate for foster or kinship care certification, ICPC placement, or adoption. e. Outcomes of Services: i. Home Study will be completed and submitted to the Department within sixty (60) days of referral. ii. Mitigation is provided to identified concerns or curiosities during the Home Study. iii. A clear recommendation of approval or denial is provided with the Home Study. • Target Population: i. ICPC requests, foster care, foster adoption, and kinship placement applicants. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. L Service Access and Transportation: i. In home. 2. Updated SAFE Home Study Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. This service will be provided by utilizing the required format of SAFE, tools provided by the Consortium for Children, and the Department. ii. There will be interaction and observation of each member in any household. iii. Home Studies will be completed within sixty (60) days of the receipt of the referral from the Department. iv. All required documentation will be delivered to the Department upon completion of the Home Study. v. Updated Home Studies will be completed by a certified SAFE Home Study Provider. vi. Contractor's staff will review any previous completed Home Studies. b. Anticipated Frequency of Services: i. There will be a minimum of two (2) visits for each Updated Home Study. ii. Typically, one (1) to two (2) hours, per visit. c. Anticipated Duration of Services: i. To be completed within sixty (60) days of receipt of the Updated Home Study referral. cL Goals of Services: i. Provide a thorough and complete assessment of a family, their home, and their support systems; through observation and interviews, using the tools required by the Department and the Consortium for Children. ii. Complete Home Study in an objective and professional manner. iii. To be culturally aware, understanding, and respectful. iv. Contractor's staff will complete the Home Study within sixty (60) days of receipt of the referral. v. Contractor and Contractor's staff will help the Department determine if the applicants are appropriate for foster or kinship care certification, ICPC placement, or adoption. e. Outcomes of Services: i. Home Study will be completed and submitted to the Department within sixty (60) days of referral. ii. Mitigation is provided to identified concerns or curiosities during the Updated Home Study. iii. A clear recommendation of approval or denial is provided with the Updated Home Study. f. Target Population: ii. ICPC requests, foster care, foster adoption, and kinship placement applicants. g. Language: iii. English. iv. Spanish. h. Medicaid Eligibility: v. This service is not Medicaid eligible. i. Service Access and Transportation: vi. In home. Program Area: Life Skills 1. Supervised Visitation Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor's staff will utilize a solution -focused approach in working with individuals and families during visits. ii. Help individuals and families identify strengths and weaknesses. iii. Help strengthen emotional and physical bonds. iv. Provide parenting education and feedback to parents. v. Contractor's staff will help the family set up specific goals to work toward and complete, working toward reunification. vi. Contractor's staff will provide a safe and appropriate location that ensures safety of the children for visits to occur, including basic necessities to meet the needs of the family. vii. Visits will be conducted in -office, in -home, or out in the community, based on approval of the Department. viii. Ongoing communication with Department providing updates with status of visits. ix. Enter frequent and consistent documentation in FIDOS. b. Anticipated Frequency of Services: i. One (1) to fifteen (15) hours a week. ii. As needed to meet the needs identified by the Department. c. Anticipated Duration of Services: i. One (1) to twelve (12) months, based on treatment plan and Court. d. Goals of Services: i. Contractor's staff will provide a safe and appropriate location for visits with basic necessities to meet the needs of the family. ii. Contractor's staff will provide continual observation and supervision of the visit ensuring the safety of all family members. iii. Contractor's staff will provide education and support to parents to develop stronger and more effective parenting skills. iv. Contractor's staff will set goals for the family, helping them meet those goals and adjust as needed along the way. v. Contractor's staff will maintain ongoing communication with the Department to ensure the alignment of goals for the family. vi. Contractor's staff will develop a healthy and trusting relationship with parents which will promote parenting development. vii. Contractor's staff will observe family dynamics, provide education and feedback to parents, and help strengthen emotional and physical bonds between parents and children. Outcomes of Services: i. Parent(s) will develop stronger emotional and physical connection with child(ren). ii. Parent(s) will effectively utilize the learned parenting skills and tools introduced to them during visits to help de-escalate elevated situations, have strong emotional and physical connections with their child(ren), and re-establish appropriate family dynamics. iii. Parent(s) will demonstrate insight to current daily problems and family issues and successfully utilize their coping skills. iv. Parent(s) will complete their established goals with this Contractor and treatment plan with the Department. E Target Population: i. Families with an open case at the Department. 8. Language: i. English. ii. Spanish. I. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. In home. ii. In community. iii. In -Office located at 928 13. Street, #4A, Greeley, Colorado 80631. 2. Therapeutic Supervised Visits a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor's staff will utilize a solution -focused and Cognitive Behavior approach in working with individuals and families during visits. ii. Contractor's staff will help the family identify strengths and weaknesses. iii. Contractor's staff will help strengthen emotional and physical bonds and provide parenting education and feedback to parents. iv. Contractor's staff will help the family set up specific goals to work toward, and complete, working toward reunification. v. Contractor's staff will provide a safe and appropriate location for visits to occur that ensures the safety of the children, to include basic necessities to meet the needs of the family. vi. Ongoing communication with Department to provide updates with status of visits. b- Anticipated Frequency of Services: i. One (1) to fifteen (15) hours, weekly. ii. As needed to meet the needs identified by the Department. c. Anticipated Duration of Services: i. One (1) to twelve (12) months, based on treatment plan and Court orders. d- Goals of Services: i. Contractor's staff will provide a safe and appropriate location for visits with basic necessities to meet the needs of the family. ii. Contractor's staff will provide continual observation and supervision of the visits, ensuring the safety of all family members. iii. Contractor's staff will provide education and support to parent to develop stronger and more effective parenting skills. iv. Contractor's staff will set goals for the family, help them meet those goals, and adjust the goals as needed. v. Contractor's staff will maintain ongoing communication with the Department to ensure the alignment of goals for the family. vi. Contractor's staff will provide continuous observation and supervision of the visit to ensure the safety of all family members. vii. Contractor's staff will develop a healthy and trusting relationship with parents which will promote parenting development. viii. Contractor's staff will observe family dynamics, provider education and feedback to parents, and help strengthen emotional and physical bonds between parents and children. e. Outcomes of Services: i. Parent(s) will develop stronger emotional and physical connection with child(ren). ii. Parent(s) will effectively utilize the learned parenting skills and tools introduced to them during visits to help de-escalate elevated situations. iii. Parent(s) will have strong emotional and physical connections with their child(ren) and re-establish appropriate family dynamics. iv. Parent(s) will demonstrate insight to current daily problems and family issues and successfully utilize their coping skills. v. Parent(s) will complete their established goals with this provider and treatment plan with the Department. f. Target Population: i. Families with an open case at the Department. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In home. ii. In -Office located at 928 13. Street, #4A, Greeley, Colorado 80631. Program Area: Mentoring 1. Mentoring Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor's staff will utilize a solution -focused approach in working with the youth and families. ii. Contractor's staff will establish a rapport with youth to determine the needs of the youth(s). iii. Contractor's staff will utilize community resources and activities for youth to engage in. iv. Contractor's staff will collaborate with the Department. v. Contractor's staff will respond in a timely manner, via phone or in person, to help the family deescalate any crisis situation in the home. vi. Contractor's staff will work with parents to understand their needs with their youth and provide that support as needed. la. Anticipated Frequency of Services: i. One (1) to five (5) visits, weekly. ii. One (1) to twenty (20) hours, weekly. iii. As needed to meet the needs identified by the Department. a. Anticipated Duration of Services: i. One (1) to six (6) months. d. Goals of Services: i. Establish rapport with youth. ii. Determine the needs of the youth through conversations with youth and parents. iii. Help youth develop personal insight, coping skills and social skills. iv. Help youth advocate for self and communicate needs in a positive manner. v. Provide respite for parents or placement providers. vi. Help the youth return home or remain home. vii. Help youth refrain from the use of drugs or alcohol. viii. Help parents identify community resources for support for youth. Outcomes of Services: i. Youth will demonstrate positive communication skills and advocate for their own needs. ii. Youth will not demonstrate verbal or physical aggression at home or at school. iii. Youth will demonstrate insight to daily stressors. iv. Youth will remain in the home or return home. £ Target Population: i. Youth involved with the Department. g. Language: i. English. ii. Spanish. 11. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. In home. ii. In community iii. In -Office located at 928 13th Street, #4A, Greeley, Colorado 80631. Program Area Relinquishment Counseling 1. Relinquishment Counseling a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor's staff will use relevant court documents to complete the paperwork. ii. Contractor's staff will meet with each client to ensure the client understands the finality of his/her decision to relinquish parental rights. iii. Contractor's staff will assess for sobriety or competence of client through observation and conversation at the beginning of the session, and reschedule the session if client is perceived to be under the influence of any substance. iv. Contractor's staff will provide the Department with all completed and signed documents. b. Anticipated Frequency of Services: i. One, one hour in -office visit or out of office visit for a relinquishment counseling session and follow up with the client to read and sign all documents. c. Anticipated Duration of Services: i. Service will be completed within sixty (60) days of receipt of referral from the Department. d. Goals of Services: i. Contractor's staff will thoroughly explain the meaning of "Relinquishment of Parental Rights" to client(s). ii. Ensure client is not under the influence of any substance. iii. Ensure client understands the finality of relinquishing their parental rights. iv. Ensure client understands all of their options regarding custody of the child(ren). e. Outcomes of Services: i. Client will have a complete understanding of the relinquishment process. ii. Client will understand that there are community resources for support should they decide not to relinquish parental rights. iii. Client will understand that once the Court accepts the Petition to Relinquish Parental Rights, the client will no longer have any personal or legal right to contact their child(ren). iv. The Department will receive the required relinquishment counseling paperwork within sixty (60) days of receipt of the referral. f. Target Population: i. Parents. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. In home. ii. In community iii. In -Office located at 928 13th Street, #4A, Greeley, Colorado 80631. Terms 1. 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. 2. Contractor agrees to receive referrals for services through e-mail and will provide an identified e-mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the 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. 3. Contractor will respond to the Mental Health and Support Services Team CWServiceReferral(a,weldeov.com within three (3) business days regarding the ability to accept the received referral. 4. Upon acceptance of a referral, Contractor will offer an initial appointment within seven (7) days of receiving the referral. The first attempt to contact the client will occur within 24 hours of receiving the refewal (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If the client does not respond after three (3) attempts in the first seven (7) days of the referral period, the Contractor will notify the caseworker and the Mental Health and Support Services Team (HS- CWServiceReferral(a,weldgov.com) and the Home Study Supervisor. 5. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Mental Health and Support Services Team (HS-CWServiceReferral(a�weldnov.com) and the Home Study Supervisor. No other Department staff or other party to the case may authorize services or modifications to services. 6. Contactor 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 Contactor 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 discharge the client from services. Contractor must inform the caseworker and the Mental Health and Support Services Team (HS- CWServiceReferral(a/weldgov.com) and the Home Study Supervisor, within three (3) days of when the client is placed on a behavioral plan or discharged 7. 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, Home Study Supervisor, and the Mental Health and Support Services Team (HS- CWServiceReferral(diweldgov.com) immediately via email, to discuss service continuation. 8. Contractor will identify, in detail, areas of continued concern and make recommendations to the caseworker in a monthly report regarding continuation of services and/or the need for additional services. 9. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 10. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported to the caseworker, Home Study Supervisor, and the Mental Health and Support Services Team HS- CWServiceReferral(a)weldgov.com immediately AND on the required monthly report. 11. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator, Home Study Supervisor, or any member of the Mental Health and Support Services Team. Any changes to visitation referrals will be approved by a new referral signed by the Child Welfare Supervisor. Any changes to home study referrals will be approved by a new referral signed by the Home Study Supervisor. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 12. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Bid Meetings, Professional Stuffings, 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 Mental Health and Support Services Team, and the facilitator documents in the meeting notes the timeframe that the provider attended and when participation in the meeting is deemed appropriate and necessary by the Department. The Facilitator will be responsible for filling out the time attended on the meeting notes. Stuffings 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 or virtually, if approved by the Department. 13. On a monthly basis, the Contractor will notify the Mental Health and Support Services Team (HS- CWServiceReferraldweldeov.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. 14. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR) and will address the aforementioned three areas when completing monthly or home study reports as required by Paragraph 9 of this Exhibit. 15. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 16. 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. 17. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at (970) 336-7235 and advise that the subpoena must be personally served. 18. Monitoring and Evaluation Contractor and the 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 shallbe 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 to 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. EXHIBIT B 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(s) specified below in Paragraph 2, Fees for Services. 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. For services funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit a State of Colorado direct deposit enrollment form, which will be provided by the Department, with a voided check, deposit slip or bank letter. Failure to complete and submit this form and voided check in a timely and accurate manner may result in a delay of payment. For services not funded through Core Services; Contractor agrees to accept payment through County Warrant when funding source does not allow for direct deposit. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Program Area 4 r e a 4 �er ent F rr., Rated SS Type '' ouC Service Name `. Hame B � � tion m $85.00 Hour HomeBased Intervention:Virtual Visits rA un� 3 e � J-ntervent.4 . X1 earn � ing eatn eeIrlg f'rlessnalt g $65.00 Each Home Based Intervention: No Show (Max of 2 no shows or 2 hours/month/client) ers ention«,>Mile ge* Home Studies $1,250.00 Episode Full Home Study 4S .S0_: Episode 'Full s St s SparrIsh $225.00 Each Full Home Study: Additional Adult- Full $ 0 00 .Episad ;` Z pal H me Slt dy pdated, $700.00 Episode Full Home Study: Updated, Spanish 1,5,00 > ;aE h tt Ho St dy :Additional Adult $65.00 Hour Full Home Study: Cancelled Home Study or Partial rle `` Fall H er to y 1Viileage* Life Skills $85.00 Hour Supervised Visitation: In-Office/Video :Hoerr 'Supervised :V,Wt4lon :Out -b $65.00 Hour Supervised Visitation: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing � r ae st tr r S ices: N Show Ma of 2 00 1.�.',�� ,. $0.55 Mile Life Skills: Mileage* a11 is e isi0lt_ in Program Area Life Skills Rate $130.00 Un�e Type P Hour Service Name Therapeutic Supervision: Out -of -Office $10.00 = Hour Life Skills: Spanish Interpreter Mentoring $70.00 Hour Mentoring $10O0 . Hour Mentorring: Spanish Interpreter $65.00 Hour Mentoring: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $65:00 Each Mentoring: No Show (Ma' oft iio sli0ws or hourshrionth/client) $0.55 Mile Mentoring: Mileage's Relinquishment Counseling $105.00 Hour Relinquishment Counseling: In -Office $150.00 Hour Relinquishment Counseling: In -Home or Community $: 5;00 llour Pelir ati Smori Cowls g. Spsi�ish Interpreter _. $65.00 Hour Relinquishment Counseling: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $0.55 Mile . Relinquishment Counseling: Mileage.•;; .. _. *Mileage for distances exceeding 30 roundtrip miles from 928 13"' Street, Greeley, Colorado 80631. 3. Request for Reimbursement and Supporting Documentation Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7. day of the month following the month of service, but no later than 45 days from the date of service for each client receiving ongoing services. Contractor shall prepare and submit monthly a Request for Reimbursement and monthly report including other supporting documentation, if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 of this Agreement. Monthly reports will be submitted through the 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. Time(s) of service (i.e. 2-4pm) b. Location of where the service took place (i.e. clinician's office, client's home, in the community.) c. Clinician/therapist name d. What interventions were used, recommendations and/or goals discussed, progressions towards goals, and client engagement. e. For mileage reimbursement, if applicable, the mileage accumulated minus roundtrip mileage that is included in the rate, starting location, and ending location. f. Any and all safety concerns. When submitting a Request for Reimbursement for a one-time service, the contractor shall submit the first and last page of the evaluation/report to confirm proof of services rendered. The full evaluation/report should be submitted by the contractor to the caseworker. For Monitored Sobriety services, proof of services rendered shall be the test result. Requests for Reimbursement and/or supporting documentation received after the 70 day of the month may delay payment. Requests for Reimbursement and/or supporting documentation received after 45 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 45 -day deadline may result in termination of the Agreement. 4. Payment The 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: The service being provided by the contractor is not a Medicaid eligible service; a. The service is not deemed medically necessary; b. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; c. A Medicaid provider is not available to provide the needed service; d. Medicaid is exhausted for the needed service; or e. Medicaid denied service. f. The client is not eligible for Medicaid. The 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. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: a. Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the 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. 6. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMB Circular A-133. Exhibit C WELD COUNTY'S REQUEST FOR PROPOSAL (Weld Cointy's Request for Proposal is incorporated into this agreement by reference and will be provided upon request to the Department.) This page is intentionally left blank Exhibit D Contractor's response to the Request for Proposal Exhibit D contains the following documents: • Attachment B — Provider Information Form (PIF) • Attachment C — Proposal • Attachment D — Staff Data Sheet • Certificate of Insurance (COI) ATTACHMENT B WELD COUNTY DEPARTMENT OF HUMAN SERVICES — PROVIDER INFORMATION FORM (PIF) AGENCY INFORMATION kpj FIRST Services, Ilc° Agency Name: Trails Provider ID (if known): Provider Contact Full Name: Keith (KP) Wawrzyniak Jr. rtle: Owner Primary Phone Number (10 -digit): (970) 405-7716 Ext.: Fax Number (10 -digit): Primary Contact Email: kpwawa@kpjfamilyservlces,com Web Address: Agency Location Ada.ess (street city, state, zip); 928 13th St. #4A Greeley, CO 80631 Agency Mailing Address (street, city, state, zip): P.O. Box 761 Eaton, CO 80631 Agency Type (pick one): D Public Company El Private Non -Profit Private for Profit Send Referrals for Service to: Referral Contact Name:K.P. Wawrzyniak Title: Owner Referral Phone Number (1O -digit); (970) 405-7716 Ext.: Email: kpwawa@kpjfarnilyservices.com Billing Contact Billing Contact Name: K.P. Wawrzyniak Title: Owner Billing Phone Number (10 -digit): (970 405-7716 Ext.: Email: kpwawa@kpjfamilyservices.com r..,_,._,._.._.._.._.,-.._.._.._.._.._.CERTIFICATION._.._.._.._.._.._.._.._.._.._.._.._.._.. I certify that the services proposed for intended use by the Weld County Department of Human Services will meet ail the specifications it has so indicated in thls 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 I 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 I. competitive in price and quality. ( WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES, THE CERTIFICATE OF EXEMPTION NUMBER IS t19O-03551-0000. l Authorized Rep. Full Same: Keith P. Wawrzyniak Jr. Title: Owner Authorized Rep. Email: Phone Phone (10 -digit): (970) 405-7716 Ext.: i 1626 Plains Dr. Eaton, CO 80615 Authorized Rep. Addles (street, city, state, zip): • �/ / � -�.. �- 12/20/23 Signature of Authorized Rep.: _ Date: REV. DECEMBER 2021 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1- Provider and Program Area Information Bidder's Legal Name: Program Area: kpj FIRST Services, Life Skills Program Areas are listed in column I of the table located in Item XI of the Request for Proposal starting on page 13. Number of services offered on this Attachment C (max 5): You may complete another Attachment C If you have more than 5. 4 SECTION 2 Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages p ges must state a specific minimum number of direct service hours. Service #1 Name: [ Supervised visitations 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): - kpj FIRST staff will utilize a solution -focused approach in working with individuals and families during visits, help them identify strengths and weaknesses, help strengthen emotional and physical bonds, and provide parenting education and feedback to parents. - kpj FIRST staff will help family set up specific goals to work toward and complete, working toward reunification. -kpj FIRST staff will provide a safe and appropriate location for visits to occur, that ensures the safety of the children, to include basic necessities, to meet the needs of the family. -Visits will be conducted in -office, in -home, or out in the community, based on approval of WCDHS. -Ongoing communication with WCDHS caseworkers providing updates with status of visits. -Frequent and consistent documentation in FIDOS. 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: [1-15 hours a week, or to meet the needs identified by the Department 2.1c Anticipated duration of service (i.e. 34 months): 1-12 months, based on treatment plan and Court 2.1d Three (3), or more, specific goals of the service (DO use bullet points): - kpj FIRST Staff to provide a safe and appropriate location for visits with basic necessities to meet the needs of the family. 2.1e 2.1f 2.1g 2.1h 2.1i REV. OCT 2021 - kpj FIRST Staff to provider continual observation and supervision of the visit ensures the safety of all family members -kpj FIRST Staff will provide education and support to parents to develop stronger and more effective parenting skills. -kpj FIRST Staff will set goals for family, help them meet those goals and adjust them as needed along the way. -kpj FIRST Staff will maintain ongoing communication with Caseworker to ensure the alignment of goals for the family. -kpj FIRST Staff will provide continuous observation and supervision of the visit to ensure the safety of all family members -kpj FIRST Staff will develop a healthy and trusting relationship with parents which will promote parenting development. -kpj FIRST Staff will observe family dynamics, provide education and feedback to parents, and help strengthen emotional and physical bonds between parents and children. Three (3), or more, specific outcomes of service: -Parent(s) -The -Parent(s) -Parents elevated family parents dynamics. develop situations, demonstrate complete effectively stronger their have utilize strong insight established emotional the to emotional current learned goals and physical parenting and daily with this problems physical provider connection skills and connections and family and with tools treatment child(ren). introduced issues with their and plan to child(ren) successfully with them WCDHS. during and utilize visits re-establish their to coping help appropriate de-escalate skills. Target population of the service, including age and gender: Families open with the Department. No perceived limitation s __ Languages service is available in (please list proficiency and if interpreter services are available): English and Spanish r Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: NA Service location list where the service will take place (i.e. client's home, in -office. other) — 1 ATTACHMENT C - PROPOSAL In -home, in -community, in -office Service #2 Name: Masters Level Therapeutic Visits _ 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): -kpj FIRST staff will utilize a solution -focused and cognitive behavior approach in working with individuals and families during visits, help them identify strengths and weaknesses, help strengthen emotional and physical bonds, and provide parenting education and feedback to parents. -kpj FIRST staff will help family set up specific goals to work toward and complete, working toward reunification. -kpj FIRST staff will provide a safe and appropriate location for visits to occur, that ensures the safety of the children, to include basic necessities, to meet the needs of the family. -Visits will be conducted in -office, in -home, or out in the community, based on approval of WCDHS. -Ongoing communication with WCDHS caseworkers providing updates with status of visits. -Frequent and consistent documentation in FIDOS. - 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1-15 hours a week, or to meet the needs identified by the Department. 2.2c 2.2d 2.2e Anticipated duration of service (i.e. 3-4 months): 1-12 months, based on treatment plan and Court Three (3), or more, specific goals of the service (DO use bullet points): - kpj FIRST Staff to provide a safe and appropriate location for visits with basic necessities to meet the needs of the family. - kpj FIRST Staff to provider continual observation and supervision of the visits, ensuring the safety of all family members -kpj FIRST Staff will provide education and support to parents to develop stronger and more effective parenting skills. -kpj FIRST Staff will set goals for family, help them meet those goals and adjust them as needed along the way. -kpj FIRST Staff will maintain ongoing communication with caseworker to ensure the alignment of goals for the family. -kpj FIRST Staff will provide continuous observation and supervision of the visit to ensure the safety of all family members -kpj FIRST Staff will develop a healthy and trusting relationship with parents which will promote parenting development. -kpj FIRST Staff will observe family dynamics, provide education and feedback to parents, and help strengthen emotional and physical bonds between parents and children. Three (3), or more, specific outcomes of service: -Parent(s) develop stronger emotional and physical connection with child(ren). -The parents effectively utilize the learned parenting skills and tools introduced to them during visits to help de-escalate elevated situations, have strong emotional and physical connections with their child(ren) and re-establish appropriate family dynamics. -Parent(s) demonstrate insight to current daily problems and family issues and successfully utilize their coping skills. -Parents complete their established goals with this provider and treatment plan with WCDHS. 2.2f Target population of the service: Families open with the Department. No perceived limitations 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English and Spanish 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: NA 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) In -office or in -home i Service #3 Name: Licensed Therapeutic Visits 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): -kpj FIRST staff will utilize a solution -focused and cognitive behavior approach in working with individuals and families during visits, help them identify strengths and weaknesses, help strengthen emotional and physical bonds, and provide parenting education and feedback to parents. -kpj FIRST staff will help family set up specific goals to work toward and complete, working toward reunification. -kpj FIRST staff will provide a safe and appropriate location for visits to occur, that ensures the safety of the children, to include basic necessities, to meet the needs of the family- -Visits will be conducted in -office, in -home, or out in the community, based on approval of WCDHS. -Ongoing communication with WCDHS caseworkers providing updates with status of visits. -Frequent and consistent documentation in FIDOS. 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: REV. OCT 2021 ATTACHMENT C - PROPOSAL 1-10 hours a week, or to meet the needs identified by the Department. 2.3c Anticipated duration of service (i.e. 3-4 months): _ 1-12 months, based on treatment plan and Court 2.3d Three (3), or more, specific goals of the service (DO use bullet points): -kpj FIRST Staff to provide a safe and appropriate location for visits with basic necessities to meet the needs of the family. Y -kpj FIRST Staff to provider continual observation and supervision of the visit ensures the safety of all family members -kpj FIRST Staff will provide education and support to parents to develop stronger and more effective parenting skills. -kpj FIRST Staff will set goals for family, help them meet those goals and adjust them as needed along the way. -kpj FIRST Staff will maintain ongoing communication with Caseworker to ensure the alignment of goals for the family. -kpj FIRST Staff will provide continuous observation and supervision of the visit to ensure the safety of all family members -kpj FIRST Staff will develop a healthy and trusting relationship with parents which will promote parenting development. -kpj FIRST Staff will observe family dynamics, provide education and feedback to parents, and help strengthen emotional and physical bonds between parents and children. 2.3e Three (3), or more, specific outcomes of service: -Parent(s) develop stronger emotional and physical connection with child(ren) -The family effectively utilizes the taught parenting skills and tools introduced to them to help de-escalate elevated situations, have strong emotional and physical connections with their child(ren) and re-establish appropriate family dynamics. -Parent(s) establish stronger insight to current problems and utilize their new parenting skills to avoid crisis situations. -Parents demonstrate a strong parental role, maintaining clear expectations and structure in their home. 2.3f Target population of the service: Families open with the Department. No perceived limitations 2.3g Languages service is available in (please list proficiency and if interpreter services are available): English and Spanish 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: NA 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) in -home or In -office Service #4 Name: Mentoring 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): -kpj FIRST Staff will utilize a Solution -Focused approach in working with the youth and families. -kpj FIRST Staff will establish a rapport with you and determine needs of youth. -kpj FIRST staff will utilize community resources and activities for youth to engage in. -kpj FIRST Staff will collaborate with -kpj FIRST Staff will respond in a timely manner, via phone or in person to help the family deescalate any crisis situation in the home. -kpj FIRST Staff will work with parents to understand their needs with their youth and provide that sunnort as nppripr1_ 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: 1-5 visits a week, 1-20 hours a week, or to meet the needs identified by the Department. 2.4c Anticipated duration of service (i.e. 3-4 months): [1-6 months 2.4d Three (3), or more, specific goals of the service (DO use bullet points): -To establish rapport with youth. -To determine the needs of the youth through conversations with youth and parents. -To help youth develop personal insight, coping skills and social skills. -To help youth advocate for self and communicate needs in a positive manner. -To provide respite for parents or placement providers. -To help the youth return home or remain home. -To help youth refrain from the use of drugs or alcohol. - Help parents identify community resources for support for youth. 2.4e Three (3), or more, specific outcomes of service: - Youth will demonstrate positive communication skills and advocate for own needs. -Youth will not demonstrate verbal or physical aggression at home or at school. -Youth will demonstrate insight to daily stressors. -Youth will remain in the home or return home. REV. OCT 2021 3 ATTACHMENT C - PROPOSAL -Parents utilize community resources for support. 2.4f Target population of the service: Youth 10-17 years of age 2.4g Languages service is available in (please list proficiency and if interpreter services are available): English Spanish 2,4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: NA 2.41 Service location — list where the service will take place (i.e. client's home, in -office, other) In -office, in -home, in -community Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b administrative Anticipated frequency of time, overhead, direct service time or travel with time (i.e. the 4 client/family hours/week). per If the week, service not including has levels, professional be specific for staffing each level: time, 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 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) Section 3 Service Access Transportation — and 3.1 Will you charge Weld County for transporting clients or mileage? Check one: ►I4 YES ❑ NO 3.2 Will you conduct services in a client's home or in the community? Check one: Z YES ❑ NO 3.3 Will you transport clients to and/or from services? Check one: ►a YES ❑ NO 3.4 How many miles are you willing to travel round trip? List a specific number of miles. 60 1 Miles 3.5 When you calculate mileage, what is your starting point address? t_928 13th St. Greeley, CO 80631 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: Supervised Visitation $ Amount 4.1a In-Office/Video: $85/h Unit Type Select Unit Type. REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.1b In -Home or Community: 4.1c In-Office/Video, In -Home, or Community with Transportation: 4.1d FTt, TDM, Prof. Staffing: 4.1e No show: 4.1f Mileage rate: 5110.00/h r +510.00 $65.00 $65.00 .55 Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: 30 30 This is paid after the miles listed above. miles miles 4.2 Hourly Service #2 Name: Master's Level Therapeutic Supervised visit $ Amount 4.2a In-Office/Video: 4.2b In -Home or Community: 4.2c in-Office/Video, In -Home, or Community with Transportation: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $105.00 $130.00 +510.00 $65.00 $65.00 5.55 Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: 30 30 miles miles This is paid after the miles listed above. 4.3 Hourly Service #3 Name: Licensed Therapeutic Supervised visits. 4.3a In-Office/Video: 4.3b In -Home or Community: 4.3c In-Office/Video, In -Home, or Community with Transportation: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: 4.3f Mileage rate: $ Amount Unit Type $115.00 $135.00 +510.00 $65.00 $65.00 5.55 Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrlp miles included in rate: 30 30 miles miles This is paid after the miles listed above. 4.4 Hourly Service #4 Name: Mentor 4.4a In-Office/Video: 4.4b In -Home or Community: 4.4c In-Office/Video, In -Home, or Community with Transportation: 4.4d FTM, TDM, Prof. Staffing: 4.4e No show: 4.4f Mileage rate: $ Amount $70.00 $70.00 $ 70.00 $65 .55 Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: 30 30 miles miles This is paid after the miles listed above. 4.5 Hourly Service #5 Name: 4.5a In-Office/Video: 4.5b In -Home or Community: 4.5c 4.5d 4.5e In-Office/Video, In -Home, or Community with Transportation: FTM, TDM, Prof. Staffing: No show: $ Amount Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: miles miles REV. OCT 2021 S ATTACHMENT C - PROPOSAL 4.Sf Mileage rate: per Mile This above. is paid after the miles listed 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate Month per Minimum Service: Hours of 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j . 4 4.7 Home Study Providers — List your rates in the box below. Minimum 4.8 Monitored Sobriety Providers — list your rates in the box below. Provider special notes: Spanish Speaking provider to each of these services is Additional $15/hr for therapeutic and supervised visits. Additional $10/hr for mentoring 6 REV. OCT 2021 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. Bidder's Legal Name: Program Area: SECTION 1 Provider and Program Area Information kpj FIRST Services, llc. Home Studies Program Areas are listed in column 1 of the table located in item Xl of the Request for Proposal starting on page 13. Number of services offered on this Attachment C (max 5): You may complete another Attachment C if you hove more than S. SECTION 2 - Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages p c ages must state a specific minimum number of direct service hours. Service #1 Name: [ Full SAFE Home Study 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): -This service will be provided by utilizing the required format of SAFE and tools provided by the Consortium for Children and Weld County Department of Human Services. -There will be interaction and observation of each member in any given household. -Home Studies will be completed within 60 days of the receipt of the referral from the Department. -All required documentation will be delivered to the Department upon completion of the Home Study. -Home Studies will be completed by a certified SAFE Home Study provider. 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: -There will be a minimum of 3 visits for each Safe Home Study (Couple), and at least 2 visits for each Full Home Study (single parent). -Each visit will typically be 1-2.5 hours per visit. 2.1c Anticipated duration of service (i.e. 3-4 months): Home Study will be completed within 60 days upon receipt of referral. 2.1d Three (3), or more, specific goals of the service (DO use bullet points): -To provide a thorough and complete assessment of a family, their home and their support systems, through observation 2.1e 2.1f 2.1g 2.1h 2.11 and interviews, using the tools required by Weld County DHS and the Consortium for Children. -To complete Home Study in an objective and professional manner. - To be culturally aware, understanding and respectful. - To complete the Home Study within 60 days of receipt of referral. -To help the Department determine if the applicants are appropriate for foster or kinship care certification, ICPC placement or adoption. 1 Three (3), or more, specific outcomes of service: -Home -Mitigation -A clear Study recommendation completed is provided to and submitted any identified of approval or to concerns denial Weld is County or curiosities provided DHS within identified with the 60 days Home during of Study. receipt the of Home referral. Study. Target population of the service, including age and gender: ICPC requests, foster care, foster adopt and kinship placement applicants Languages service is available in (please list proficiency and if interpreter services are available): English or Spanish Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: NA Service location — list where the service will take place (i.e. client's home, in -office, other) Client's homes. Service #2 Name: Updated SAFE Home Study 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): -This service will be provided by utilizing the required format of SAFE and tools provided by the Consortium for Children and Weld County DHS REV. OCT 2021 ATTACHMENT C - PROPOSAL - There will be interaction and observation of each member in any give household. - Home Studies will be completed within 60 days of the receipt of the referral from Weld County DHS. -All required documentation will be delivered to Weld County DHS upon completion of the Home Study. -Updated Home Studies will be completed by a certified SAFE Home Study provider. -kpj FIRST staff will review any previous completed home studies. 2.2b 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: -There will be a minimum of 2 visits for each Updated Home Study. -Each visit will typically be 1-2 hours per visit. 2.2c Anticipated duration of service (i.e. 3-4 months): To be completed within 60 days of receipt of Updated Home Study referral 2.2d Three (3), or more, specific goals of the service (DO use bullet points): -To provide a thorough and complete assessment of a family, their home and their support systems, through observation and interviews, using the tools required by Weld County DHS and Consortium for Children. - To complete Updated Home Study in an objective and professional manner. -To be culturally aware, understanding and respectful. -To complete the Home Study within 60 days of receipt of referral. - To help the Department determine if the applicants are appropriate for foster or kinship care certification, ICPC placement or adoption. 2.2e Three (3), or more, specific outcomes of service: _ - Updated Home Study completed and submitted to Weld County DHS within 60 days of receipt of referral. -Mitigation is provided to any identified concerns or curiosities identified during the Home Study. -A clear recommendation of approval or denial is provided with the Home Study. 2.2f Target population of the service: ricc requests, foster care, foster adopt and kinship placement applicants _ 2,2g Languages service is available in (please list proficiency and if interpreter services are available): English and Spanish 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: ANA 2.2i Servi 2.3a 2.3b 2.3c 2.3d 2.3e Service location — list where the service will take place (i.e. client's home, in -office, other) Client's home ce #3 Name: Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Anticipated administrative frequency of time, overhead, direct service time or travel with the time (i.e. 4 client/family hours/week). If per the week, service not including has levels, professional be specific for staffing each level: time, Anticipated duration of service (i.e. 3-4 months): Three (3), or more, specific goals of the service (DO use bullet points): --- ------ - - outcomes of service: Three (3), or more, specific 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: _ 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): REV. OCT 2021 ATTACHMENT C - PROPOSAL 2.4b 2.4c 2.4d 2.4e 2.4f 2.4g 2.4h 2.41 Sery 2.5a 2.5b 2.5c 2.5d 2.5e 2.5f 2.5g 2.5h 2.61 Anticipated frequency administrative time, of direct overhead, service time or travel with the client/family time (i.e. 4 hours/week). If per week, not including the service has levels, professional be specific for staffing each time, level: L. 1 Anticipated duration of service (i.e. 3-4 months): F Three (3), or more, specific goals of the service (DO use bullet points): Three (3), or more, specific outcomes of service: Target population of the service: 1 Languages service is available in (please list proficiency and if interpreter services are available): Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service location — list where the service will take place (i.e. client's home, in -office, other) I ice #5 Name: Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Anticipated administrative frequency of direct time, overhead, service time or travel with the time (i.e. client/family 4 hours/week). If per week, not including the service has levels, professional be specific for staffing each level: time, Anticipated duration of service (i.e. 3-4 months): I Three (3), or more, specific goals of the service (DO use bullet points): 1 Three (3), or more, specific outcomes of service: Target population of the service: Languages service is available in (please list proficiency and if interpreter services are available): Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part 1 1 Service location — list where the service will take place (i.e. client's home, in -office, other) 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 1,1 if 3.4 How many miles are you willing to travel round trip? List a specific number of miles. ►A' YES ■ NO YES ■ NO NO 70 Miles 3.5 When you calculate mileage, what is your starting point address? r928 13th St Greeley, CO 80631 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. REV. OCT 2021 3 ATTACHMENT C - PROPOSAL • 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 See Additional information In-Office/Video: 4.1b In -Home or Community: 4.1c In-Office/Video, In -Home, or Community with Transportation: 4.1d FTM, TDM, Prof. Staffing: 4.1e No show: 4.1f Mileage rate: $ Amount Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: This is paid after the miles listed above. miles miles I 4.2 Hourly Service #2 Name: 4.2a See Additional information In-Office/Video: 4.2b In -Home or Community: 4.2c In-Office/Video, In -Home, or Community with Transportation: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $ Amount Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: miles miles This is paid after the miles listed above. 4.3 Hourly Service #3 Name: 4.3a In-Office/Video: 4.3b In -Home or Community: 4.3c In-Office/Video, in -Home, or Community with Transportation: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: 4.3f Mileage rate: $ Amount Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: miles miles This is paid after the miles listed above. 4.4 Hourly Service #4 Name: 4.4a In-Office/Video: 4.4b In -Home or Community: 4.4c In-Office/Video, In -Home, or Community with Transportation: 4.4d FTM, TDM, Prof. Staffing: 4.4e No show: 4.4f Mileage rate: $ Amount Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: miles miles This is paid after the miles listed above. 4.5 Hourly Service #5 Name: 4.5a $ Amount Unit Type In-Office/Video: Select Unit Type. REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.5b In -Home or Community: Select Unit Type. No. of roundtrip included in rate: miles miles 4.5c In-Office/Video, Community Transportation: In -Home, or with Select Unit Type. No. of roundtrip miles included in rate: miles 4.5d FTIVM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile above. This is paid after the miles listed 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate Month per Minimum Service: Hours of 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.61 4.6j 4.7 Home Study Providers — List your rates in the box below. Canceled Full Full Updated Updated Home Home Home Home Home Study *each *mileage Study *each *mileage *each *each *mileage *mileage *mileage Study Study(Spanish) Study/Updated additional (Spanish additional additional additional outside outside outside outside outside speaking) adult of adult of adult of adult of of 30 40 40 40 Home 40 miles miles miles miles miles round round round round Study round (canceled) trip(DHS trip(OHS trip trip trip (OHS (DHS (OHS rates) rates) rates) rates) rates) $1,250.00 $ $1,400.00 $ $ $ $ $ $ $0.55/mi 225.00 $0.55/mi 600.00 125.00 $0.55.mi 700.00 125.00 $0.55/mi 65.00/hr $0.55/mi 225.00 I REV. OCT 2021 5 ATTACHMENT C - PROPOSAL Minimum 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: REV. OCT 2021 6 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. Bidder's Legal Name: Program Area: SECTION 1— Provider and Program Area Information Kpj FIRST Services, Ilc. Home -Based Intervention Program Areas are listed in column 1 of the table located in Item XI of the Request for Proposal starting on page 13. Number of services offered on this Attachment C (max 5): You may complete another Attachment Cif you have more than S. 1 SECTION 2 — Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly pg acka es must state a specific minimum number of direct service hours. Service #1 Name: Home -Based Intervention 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): -kpj FIRST Staff will utilize a Solution -Focused approach with the families based on the identified needs of WCDHS, and, concurrently, assess for additional needs of the family. -kpj FIRST Staff will assist the family members with utilizing different skills and tools to address these immediate and ongoing identified issues and concerns. - kpj FIRST Staff will respond in a timely manner to help the family deescalate any crisis situation in the home. - kpj FIRST Staff will be available by phone 24/7 to help deescalate crisis situations needing immediate response. - kpj FIRST Staff will be available to provide around the clock supervision for youth in crisis situations. - kpj FIRST Staff will provide parent coaching and education to help parents to develop stronger and more effective parenting skills. -kpj FIRST Staff will collaborate with other professionals involved to better meet the needs of the family. -kpj FIRST Staff will maintain ongoing communication with Caseworker to ensure the alignment of goals for the family. 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 a specific for each level: IT -10 hours a week, or to meet the needs identified by the Department. 2.1c Anticipated duration of service (i.e. 3-4 months): r30-lsodays - 2.1d Three (3), or more, specific goals of the service (DO use bullet points): -To respond to families who are in crisis in a timely manner and be available for the 24/7. -To support families in difficult circumstances and help them identify and mitigate immediate existing concerns. -Working with families strengthening parenting skills, establishing structure in the home, establishing clear expectations and boundaries and maintaining a safe environment. -Collaborate with all professionals involved with the family to ensure all the needs of the family are being met. -Encourage and prompt family member to reach out to their support system to avoid crisis. Ile Three (3), or more, specific outcomes of service: - To establish healthy, trusting and supportive relationship with the family. - The family effectively utilizes the skills and tools introduced to them to de-esalate situations of conflict and chaos. -The family is proactive and reaches out to current support to avoid crisis situations. -The family members continue to develop insight to issues and strengthen their family dynamics. -Parents demonstrate a strong parental role, maintaining clear expectations and structure in their home. 2.1f Target population of the service, including age and gender: 2.1g 2.1h 2.11 Families open with the Department. No perceived limitations Languages service is available in (please list proficiency and if interpreter services are available): _ English and Spanish Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: FNA Service location — list where the service will take place (i.e. client's home, in -office, other) In -home, in -community, in -office - REV. OCT 2021 1 ATTACHMENT C - PROPOSAL Service #2 Name: 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.2b 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: 2.2c Anticipated duration of service (i.e. 34 months): 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 2.2e Three (3), or more, specific outcomes of service: 2.2f Target population of the service: 2.2g Languages service is available in (please list proficiency and if interpreter services are available): 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #3 Name: 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 (i.e. 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: 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #4 Name: 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: REV. OCT 2021 ATTACHMENT C - PROPOSAL 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: 2.41 Service location — list where the service will take place (i.e. client's home, in -office, other) 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 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) 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: O ►a' YES ❑ NO YES ■ NO YES ■ NO 3.4 How many miles are you willing to travel round trip? List a specific number of miles. 30 1 Miles 3.5 When you calculate mileage, what is your starting point address? 928 13th St. Greeley, CO 80631 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: I Home -Based Intervention 4.1a In-Office/Video: 4.1b In -Home or Community: $ Amount 1 $85.00 $130.00 Unit Type Select Unit Type. Select Unit Type. No. of roundtrip miles included in rate: 30 miles REV. OCT 2021 3 ATTACHMENT C - PROPOSAL 4.1c In-Office/Video, In -Home, or Community with Transportation: 4.1d FTM, TDM, Prof. Staffing: 4.1e No show: 4.1f Mileage rate: $130.00 $65.00 $65.00 .55 Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: • 30 This is paid after the miles listed above. miles 4.2 Hourly Service #2 Name: 4.2a In-Office/Video: 4.2b In -Home or Community: 4.2c In-Office/Video, In -Home, or Community with Transportation: 4.2d FTM, TOM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $ Amount Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: miles miles This is paid after the miles listed above. 4.3 Hourly Service #3 Name: 4.3a j In-Office/Video: 4.3b In -Home or Community: 4.3c In-Office/Video, In -Home, or Community with Transportation: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: 4.3f Mileage rate: $ Amount Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip mites included in rate: miles miles This is paid after the miles listed above. 4.4 Hourly Service #4 Name: 4.4a In-Office/Video: 4.4b in -Home or Community: 4.4c In-Office/Video, In -Home, or Community with Transportation: 4.4d FTM, TDM, Prof. Staffing: 4.4e No show: 4.4f Mileage rate: $ Amount Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: miles miles This is paid after the miles listed above. 4.5 Hourly Service #5 Name: 4.5a In-Office/Video: 4.Sb In -Home or Community: 4.5c In-Office/Video, In -Home, or Community with Transportation: 4.5d FTM, TDM, Prof. Staffing: 4.5e No show: 4.5f Mileage rate: $ Amount Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: This is paid after the miles listed above. miles miles REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate Month per Minimum Service: Hours of 4.6a 4.6b 4.6c 4.6d 4,6e 4.6f 4.6g 4.6h 4.61 4.6j 4.7 Home Study Providers -- List your rates in the box below. Minimum 4.8 Monitored Sobriety Providers -- List your rates in the box below. Provider special notes: REV. OCT 2021 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. Bidder's Legal Name: Program Area: SECTION 1 Provider and Program Area Information Lkpj FIRST Services. Ilc Relinquishment Counseling Program Areas are listed in column 1 of the table located in Item XI of the Request for Proposal starting on page 13. Number of services offered on this Attachment C (max 5): You may complete another Attachment C if you have more than 5. 1 SECTION 2 — Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: ( Relinquishment Counseling 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet ) oints : P -Kpj FIRST staff will use relevant court documents to complete the paperwork. - Kpj FIRST staff will meet with each client for approximately 1 hour, or whatever time is, to ensure the client understands the finality of his/her decision to relinquish parental rights. - Kpj FIRST staff will assess for sobriety or competence of client through observation and conversation at beginning of the session, and reschedule session, if client is perceived to be under the influence of any substance. - Kpj FIRST staff will provide the caseworker with all completed and signed documents. 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: r -This will consist of one, in -office visit or out of office visit for a relinquishment counseling session, ,an d then follow up with the client to read and sign all documents. 2.1c Anticipated duration of service (i.e. 3-4 months): -Service will be completed within 60 days of receipt of referral from the Department. 2.1d Three (3), or more, specific goals of the service (DO use bullet points): -To thoroughly explain the meaning of "Relinquishment of Parental Rights" to client. - To ensure client is not under the influence of any substance. -To ensure client understands the finality of relinquishing their parental rights. - To ensure client understands all their options regarding custody of their child(s). 2.1e Three (3), or more, specific outcomes of service: 2.1f 2.1g 2.1h 2.1i -Client -Client -Client -The rights. have will understands will any Department have understand personal a complete will there or receive that legal understanding are community once right required the Court to contact relinquishment of resources accepts their the child. relinquishment for the support Petition counseling should to process. relinquish paperwork they not decide parental within 60 to rights, days relinquish the of client receipt their will of referral. parental no longer Target population of the service, including age and ---- ---- gender: - --- -- Parents _ Languages service is available in (please proficiency and if interpreter services are available): list English _ - — Medicaid eligibility -- list whether the service is eligible for Medicaid in whole or in part: NA Service location — list where the service will take place (i.e. client's home, in -office, other) In -office or out -of -office. Service #2 Name: 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): REV. OCT 2021 i 1 ATTACHMENT C - PROPOSAL 2.2b 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: 2.2c Anticipated duration of service (i.e. 3-4 months): 2.2d Three (3), or more, specific goals of the service (DO use bullet points): r _ 2.2e Three (3), or more, specific outcomes of service: 2.2f Target population of the service: 2.2g Languages service is available in (please list proficiency and if interpreter services are available): 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #3 Name: 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: J 2.3c Anticipated duration of service (i.e. 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: 2.31 Service location — list where the service will take place (i.e. client's home, in -office, other) Service #4 Name: _ 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): i I REV. OCT 2021 ATTACHMENT C - PROPOSAL 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: L 7 2.41 Service location — list where the service will take place (i.e. client's home, in -office, other) I 1 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 administrative frequency time, of overhead, direct service time or travel with time (i.e. the 4 client/family hours/week). per If the week, service not including has levels, professional be specific for staffing each time, 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: j 2.5f Target _ population of the service: r2.5g 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 2.61 Service location — list where the service will take place (i.e. client's home, in -office, other) Section 3 Service Access Transportation v — and 3.1 Will you charge Weld County for transporting clients or mileage? Check one: ■ YES 0 NO 3.2 Will you conduct services in a client's home or in the community? Check one: 0 YES ❑ NO 3.3 Will you transport clients to and/or from services? Check one: ❑ YES O NO 3.4 How many miles are you willing to travel round trip? List a specific number of miles. L60 Miles 3_S When you calculate mileage, what is your starting point address? 1928 13th St. Greeley, CO 80631 J - 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: Relinquishment Counseling 4.1a In-Office/Video: 4.1b In -Home or Community: &1c In-Office/Video, In -Home, or Community with Transportation: $ Amount $105.00/h r $150.00/hr NA Unit Type Select Unit Type. Select Unit Type. Select Unit Type. No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: 30 30 miles miles REV. OCT 2021 3 ATTACHMENT C - PROPOSAL 4.1d FTM, TOM, Prof. Staffing: 4.1e No show: 4.1f Mileage rate: $65.00 NA $0.55 per Hour per No Show per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: 4.2a In-Office/Video: 4.2b In -Home or Community: 4.2c In-Office/Video, In -Home, or Community with Transportation: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $ Amount Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: miles miles This is paid after the miles listed above. 4.3 Hourly Service #3 Name: 4.3a In-Office/Video: 4.3b In -Home or Community: 4.3c In-Office/Video, In -Home, or Community with Transportation: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: 4.3f Mileage rate: Amount Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: miles miles This is paid after the miles listed above. 4.4 Hourly Service #4 Name: 4.43 In-Office/Video: 4.4b In -Home or Community: 4.4c In-Office/Video, In -Home, or Community with Transportation: 4.4d FTM, TDM, Prof. Staffing: 4.4e No show: 4.4f Mileage rate: $ Amount Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: miles miles This is paid after the miles listed above. 4.5 Hourly Service #5 Name: 4.5a In-Office/Video: 4.Sb In -Home or Community: 4.5c In-Office/Video, In -Home, or Community with Transportation: 4.5d FTM, TOM, Prof. Staffing: 4.5e No show: 4.5f Mileage rate: $ Amount Unit Type Select Unit Type. Select Unit Type. Select Unit Type. per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: 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 Minimum Hours of Service: REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.61 4.6j 4.7 Home Study Providers — List your rates in the box below. j Minimum 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: Spanish Interpreter- $35/hr _ REV. OCT 2021 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: K.P. Wawrzyniak kpj FIRST Services, LLC PHONE NUMBER: (970) 405-7716 EMAIL: kpwawa@kpjfamilyservices.com PROPOSED SERVICE(S): Supervised Visits Therapeutic Supervised Visits(TSV), Home Studies(HS), Home -Based Intervention (HBO) (SV), Facilitator(F). Mentor(M), Relinquishment Counseling(RC), HeartMath(HM), Legal Last Name Middle Initial Previous Name (If applicable) Legal Last legal First Name Service Type Licensure/ Credentials DORA # (If applicable) P Keith All BA -Psych, MSC -Counseling NLC13374 Wawrzyniak Martinson L Joanna HBI, TSV, SV, M, HM RN/BSN license#71246 Williams K Brandon HBI, TSV, SV, M, HS LCSW license#1581 Brucki L Amanda All LCSW license#9926462 Hernandez NA Cavazos Veronica All CAC, MA scnoa counw,�, cw cwt Sol NA Oliva E Wendy BS -Pending NA Jones M Jennifer LPCC, OW -Certified license#0017286 Mckillip L Deborah BA-Socialogy,Mlnor-Psych NA SV, Memtn Saldana G Marcos SV, TSV,HBI, M,F IA.Py,chovg,,.cw..meatteliu*ar NA Saldana I Oliva Karla Mentor iS.+ntomotionai Sluoitot;. Mv..cdattx. GrafOexoir]to NA Hartshorn L Mandee SV, HBI BSN/MSN NAlicense189873 Mena L Marie SV, Ment BA -Sociology, Minor Psych CHILD WELFARE REQUEST FOR PROPOSAL 2022-23 - VARIOUS SERVICES Account Nu er: CO KPJF 1620 Date: 12/06/22 Initials: CA CERTIFICATE OF INSURANCE ALLIED WORLD INSURANCE COMPANY C/O: American Professional Agency, Inc. 95 Broadway, Amityville, NY 11701 800-421-6694 This is to certify that the insurance policies specified below have been issued by the company indicated above to the insured named herein and that, subject to their provisions and conditions, such policies afford the coverages indicated insofar as such coverages apply to the occupation or business of the Named Insured(s) as stated. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE. Name and Address of Named Insured: Additional. Named Insureds: KPJ FIRST SERVICES LLC PO BOX 761 EATON CO 80615 Type of Work Covered: MENTAL HEALTH COUNSELOR Location of Operations: N/A (If different than address listed above) Claim History: Retroactive date is 11/18/2019 KEITH P WAWRZYNIAK JR Coverages Policy Number Effective Date Expiration Date Limits Liability of PROFESSIONAL/ 1,000,000 LIABILITY 5005-4078 11/18/2022 11/18/2023 3,000,000 NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED, WHO SHALL ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF CANCELLATION. Comments: Defense Expense Proceedings Limit is $5,000. 1 ADDL.IN IN BOARD OF COUNTY COMM. OF WELD COUNTY & ITS OFFICERS /EMPLOYEES This Certificate Issued to: Name: KPJ FIRST SERVICES LLC PO BOX 761 Address: EATON CO 80615 Authorized Representative APA 00138 00 (06/2014) Account Number: CO KPJF 1620 Date: 5/09/23 Initials: CA CERTIFICATE OF INSURANCE ALLIED WORLD INSURANCE COMPANY C/O: American Professional Agency, Inc. 95 Broadway, Amityville, NY 11701 800-421-6694 This is to certify that the insurance policies specified below have been issued by the company indicated above to the insured named herein and that, subject to their provisions and conditions, such policies afford the coverages indicated insofar as such coverages apply to the occupation or business of the Named Insured(s) as stated. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE. Name and Address of Named Insured: Additional Named Insureds: KPJ FIRST SERVICES LLC KEITH P WAWRZYNIAK JR PO BOX 761 EATON CO 80615 Type of Work Covered: MENTAL HEALTH COUNSELOR Location of Operations: N/A (If different than address listed above) Claim History: Retroactive date 11/18/2019 Coverages Policy Number Effective Date Expiration Date Limits of Liability PROFESSIONAL/ LIABILITY 5005-4078 11/18/2022 11/18/2023 1,000,000 3,000,000 NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED, WHO SHALL ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF CANCELLATION. Comments: THE COMPANY WILL NOTIFY THE CERTIFICATE HOLDER OF ANY TERMINATION OF COVERAGE AND FAILURE TO RENEW WITHIN 30 DAYS, HOWEVER, FAILURE TO GIVE SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY UPON THE COMPANY OR THE UNDERSIGNED. This Certificate Issued to: Name: WELD COUNTY 1150 O ST Address: GREELEY CO 80631 Authorized Representative APA 00138 00 (06/2014) SIGNATURE REQUESTED: Weld/kpj FIRST Services, Ilc PSA Final Audit Report 2023-05-11 Created: 2023-05-10 By: Windy Luna (wluna@co.weld.co.us) Status: Signed Transaction ID: CBJCHBCAABAA4AT4nR23Z_iKM4TIQiVrrQs4gky8_kC "SIGNATURE REQUESTED: Weld/kpj FIRST Services, Ilc PSA" History t Document created by Windy Luna (wluna@co.weld.co.us) 2023-05-10 - 7:5&22 PM GMT El Document eneiled to kpwawa@kpjfamilyservices.com for signature 2023-05-10 - 7:5518 PM GMT 5 Email viewed by kpwawa@kpjfamilyservices.com 2023-05-10 - 7:5522 PM GMT d© Signer kpwawa@kpjfamilyservices.com entered name at signing as Keith P Wawrzyniak Jr 2023-05-11 - 8:0t31 PM GMT 6p Document e -signed by Keith P Wawrzyniak Jr (kpwawa@kpjfamilyservices.com) Signature Date: 2023-05-11 - 8:01:33 PM GMT - Time Source: server ID Agreement carnpleted. 2023-05-11 - 8:0t33 PM GMT Powered by Adobe Acrobat Sign Contract Form Re Entity Name* KPJ FIRST SERVICES, LLC Entity ID* 600041915 Contract Name* KPJ FIRST SERVICES, LLC (NEW BID #62300040 - PROFESSIONAL SERVICES AGREEMENT) Contract Status CTB REVIEW ❑ New Entity? Contract ID 6995 Contract Lead* WLUNA Contract Lead Email wlana@weldgov.com;cobbx xlk@weldgov.com Parent Contract ID Requires Board Approval YES Department Project # Contract Description* (CONSENT) KPJ FIRST SERVICES, LLC (NEW BID #62300040 - PROFESSIONAL SERVICES AGREEMENT). TERM 06/01/2023 THROUGH 05/31/2024. Contract Description 2 PROVIDER WAS LISTED ON APPROVED PROVIDER VENDOR UST PRESENTED TO THE BOCC ON 03/29/23 AND AS A COMMUNICATION ITEM/PA SENT TO CTB ON 03/30/2023. Contract Type* AGREEMENT Amount* $0.00 Renewable* YES Automatic Renewal Department HUMAN SERVICES Department Email CM- HumanServices@weldgov.co Department Head Email CM-HumanServices- De ptH ead gwel dgov. com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM - C OU NTYATTORN EY#WELDG OV.COM Requested BOCC Agenda Date* 05/24/2023 Due Date 05/20/2023 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept_ to be included? If this is a ren enter _ us Tact ID If this is part of a MSA enter MSA Contract ID Note. the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Effective Date Review Date* 03/29/2024 Renewal Date* 05/31/2024 Termination Notice Period Purchasing Approved Date Approval s Department Head JAMIE ULRICH DH Approved Date 05/15/2023 Final Apprl BOCC Approved BOCC Sig Date BUCC Agenda Date 05/22/2023 Originator WLUNA Committed Delivery Date Finance Approver CHERYL PATTELLI Finance Approved Date 05//17/2023 Tyler Ref # AG 052223 Expiration Date Legal Counsel BYRON HOWELL Legal Counsel Approved Date 05/18/2023 Pr+e Hello