The URL can be used to link to this page

Browse Search

Home My WebLink About20232943.tiffRESOLUTION RE: APPROVE PROFESSIONAL SERVICE AGREEMENT FOR VARIOUS CORE AND NON -CORE CHILD WELFARE SERVICES AND AUTHORIZE CHAIR TO SIGN - LAUREN CITO COUNSELING, LLC WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with a Professional Service Agreement for Various Core and Non -Core Child Welfare Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Lauren Cito Counseling, LLC, commencing August 1, 2023, and ending May 31, 2024, with further terms and conditions being as stated in said agreement, and WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Professional Service Agreement for Various Core and Non -Core Child Welfare Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Lauren Cito Counseling, LLC, be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreement. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 4th day of October, A.D., 2023, nunc pro tunc August 1, 2023. BOARD OF COUNTY COMMISSIONERS WELD COUFY, COLORADO ATTEST: Weld County Clerk to the Board AP .1,Jaka)-,16- Deputy Clerk to the Board F ounty At •rney Date of signature: I DtI a I�3 Scdkt K. James Kevin D. Ross EXCUSED Lori Saine Cc: HSD 10/13/23 2023-2943 HR0095 ContvacF (Dtk-7418' BOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW PASS -AROUND TITLE: Professional Services Agreement with Lauren Cito Counseling, LLC DEPARTMENT: Human Services DATE: September 26, 2023 PERSON REQUESTING: Jamie Ulrich, Director, Human Services Brief description of the problem/issue: The Department is requesting to enter into a Professional Services Agreement for Life Skills and Home Studies Services with Lauren Cito Counseling, LLC. What options exist for the Board? Approval of Lauren Cito Counseling, LLC Professional Services Agreement. Deny approval of Lauren Cito Counseling, LLC Professional Services Agreement. Consequences: New Core/Non-Core Services Provider will not be approved. Impacts: Provider will not provide needed Services to Department of Human Services clients. Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years): o Core/Non-Core Provider funded through Child Welfare. o Term: August 1, 2023 through May 31, 2024. Fees for Services: Program Area Life Skills Rate $100.00 Unit Type Hour Service Name Therapeutic Visitation: In-Office/Video $150.00 Hour Therapeutic Visitation: In -Home or Community $150.00 Hour Therapeutic Visitation: In-Office/Video, In -Home, or Community with Transportation $100.00 Hour Therapeutic Visitation: Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Hour Therapeutic Visitation: No Show (Max of 2 no shows or 2 hours/month/client) $100.00 Hour Parent Coaching: In-OfficeNideo $150.00 Hour Parent Coaching: In -Home or Community $150.00 Hour Parent Coaching: In-OfficeNideo, In -Home, or Community with Transportation $100.00 Hour Parent Coaching: Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $75.00 Hour Parent Coaching: No Show (Max of 2 no shows or 2 hours/month/client) $100.00 Hour Kinship Visitation Supervision Coaching: In-OfficeNideo $150.00 Hour Kinship Visitation Supervision Coaching: In -Home or Community $150.00 Hour Kinship Visitation Supervision Coaching: In-OfficeNideo, In - Home, or Community with Transportation $100.00 Hour Kinship Visitation Supervision Coaching: Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $75.00 Hour Kinship Visitation Supervision Coaching: No Show (Max of 2 no shows or 2 hours/month/client) $800.00 Each Parental Strengths and Needs Assessment: Full Parenting Assessment: In -Home or Community Pass -Around Memorandum; September 26, 2023 — CMS ID 7418 2023-2943 10/4 cc-: hl9O 0, Sc. se- Iotogras i-I-12UU95 Program Area Life Skills Rate $150.00 $100.00 $100 00 $.65 Unit Tyne Each Parental Stren-the and '.edsAssessment: Partial Parenting Assessment In -Home or Community. Service Name Hour Each Mile Parental Strengths and Needs Assessment Family Team Meeting (FTM), Team Decision Making (TOM) Mooting, Professional Staffing Parental Strengths and Needs Assessment: Parenting Assessment No Show (Max of 2 no shows or 2 hours/month/client) Life Skills 'Mileage Home Studies $1,200.00 Each Full SAFE Home Study: Up to two (2) adults. Full SAFE Home Study: Per additional Adult. Partial SAFE Home Study Updated SAFE Home Study All SAFE Home Studies: No Show (Max of 2 no shows or 2 hours/month/client) Home Studies *Mileage $150.00 $400.00 $500.00 Each Each Each $100.00 $.65 Each Mile *Mileage for distances exceeding 20 roundtrip miles from provider's office located at 3620 West 10th Street, Suite B #132, Greeley, Colorado 80634 Recommendation: • Approval of the Professional Services Agreement and authorize the Chair to sign. Support Recommendation Schedule Place on BOCC Agenda Work Session Other/Comments: Perry L. Buck, Pro-Tem Mike Freeman, Chair Scott K. James Kevin D. Ross Lori Saine Pass -Around Memorandum; September 26, 2023 — CMS ID 7418 PROFESSIONAL SERVICE AGREEMENT BETWEEN WELD COUNTY AND LAUREN CITO COUNSELING, ,LLC `f THIS AGREEMENT is made and entered into this 1 day of OU\Obev , 2023, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as "County," and Lauren Cito Counseling, LLC, 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/Non-Core or other funding to the Department for Life Skills and Home Studies. NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties hereto agree as follows: I. Introduction. The terms of this Agreement are contained in the terms recited in this document and in the attached Exhibits, each of which forms an integral part of this Agreement and are incorporated herein. The parties each acknowledge and agree that this Agreement, including the attached Exhibits, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements (the "Work"). If a conflict occurs between this Agreement and any Exhibit or other attached document, the terms of this Agreement shall control, and the remaining order of precedence shall be based upon order of attachment. Exhibit A consists of the Scope of Services. Exhibit B consists 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. Contractor shall further be responsible for the timely completion and acknowledges that a failure o2oa-.2917 3 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 August 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 forth in the Exhibits will be made by County unless an Amendment authorizing such additional 2 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. 8. Subcontractors. Contractor acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of the Work without County's prior written consent, which may be withheld in County's sole discretion. County shall have the right in its reasonable discretion to approve all personnel assigned to the Work during the performance of this Agreement and no personnel to whom County has an objection, in its reasonable discretion, shall be assigned to the Work. Contractor shall require each subcontractor, as approved by County and to the extent of the Work to be performed by the subcontractor, to be bound to Contractor by the terms of this Agreement, and to assume toward Contractor all the obligations and responsibilities which Contractor, by this Agreement, assumes toward County. County shall have the right (but not the obligation) to enforce the provisions of this Agreement against any subcontractor hired by Contractor and Contractor shall cooperate in such process. The Contractor shall be responsible for the acts and omissions of its agents, employees and subcontractors. 9. Ownership. All work and information obtained by Contractor under this Agreement or 3 individual work order shall become or remain (as applicable), the property of County. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contractor in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the County. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of County. 10. Confidentiality. Confidential information of the Contractor should be transmitted separately from non -confidential information, clearly denoting in red on the relevant document at the top the word, "CONFIDENTIAL." However, Contractor is advised that as a public entity, Weld County must comply with the provisions of the Colorado Open Records Act (CORA), C.R.S. 24-72-201, et seq., with regard to public records, and cannot guarantee the confidentiality of all documents. Contractor agrees to keep confidential all of County's confidential information. Contractor agrees not to sell, assign, distribute, or disclose any such confidential information to any other person or entity without seeking written permission from the County. Contractor agrees to advise its employees, agents, and consultants, of the confidential and proprietary nature of this confidential information and of the restrictions imposed by this Agreement. 11. Warranty. Contractor warrants that the Work performed under this Agreement will be performed in a manner consistent with the standards governing such services and the provisions of this Agreement. Contractor further represents and warrants that all Work shall be performed by qualified personnel in a professional manner, consistent with industry standards, and that all services will conform to applicable specifications. 12. Acceptance of Services Not a Waiver. Upon completion of the Work, Contractor shall submit to County originals of all test results, reports, etc., generated during completion of this work. Acceptance by County of reports and incidental material(s) furnished under this Agreement shall not in any way relieve Contractor of responsibility for the quality and accuracy of the project. In no event shall any action by County hereunder constitute or be construed to be a waiver by County of any breach of this Agreement or default which may then exist on the part of Contractor, and County's action or inaction when any such breach or default exists shall not impair or prejudice any right or remedy available to County with respect to such breach or default. No assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the County of, or payment for, the Work completed under this Agreement shall not be construed as a waiver of any of the County's rights under this Agreement or under the law generally. 13. Insurance. Contractor must secure, before the commencement of the Work, the following insurance covering all operations, goods, and services provided pursuant to this Agreement, and shall keep the required insurance coverage in force at all times during the 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. a. Types of Insurance. 4 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 sufficient to protect the Contractor from liabilities that might arise out of the performance 5 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 Contractor and shall, without additional compensation, promptly remedy and correct any errors, 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 County'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 such failure is due to any cause beyond its reasonable control, including but not limited to Acts of 6 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: Lauren Cito Position: Sole Proprietor/Therapist Address: 3620 West 10th Street, Suite B #132 Address: Greeley, Colorado 80634 E-mail: laurencitolpc(a#gmail. com Phone: (970) 599-1034 TO COUNTY: Name: Jamie Ulrich Position: Director Address: P.O. Box A Address: Greeley, Colorado 80632 E-mail: julrich@weld.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, 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 7 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 requirements) 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 without 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 now 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, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contractor agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 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: WL) "t4;eA WELD COUNTY, COLORADOitiBOARD OF COUNTY COMMISSIONERS ATTEST: Clerk to the Board BY: alp., • puty Clerk to the Boar 9 ke Freeman, Chair OCT 0 4 2323 CONTRACTOR: Lauren Cito Counseling, LLC 3620 West 10th Street, Suite B #132 Greeley, Colorado 80634 (970) 559-1034 Laren Cito By: Lauren Oto (Sep 19, 2023 11:10 MDT) Lauren Cito, Sole Proprietor/Therapist Date: Sep 19, 2023 EXHIBIT A SCOPE OF SERVICES Contractor will provide Life Skills and Home Study Services, as referred by the Department. Program Area: Life Skills 1. Therapeutic Visitation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Family engagement. ii. Safe supervision. iii. Parent coaching. iv. Behavior management. v. Family dynamic improvement and bonding and attachment. b. Anticipated Frequency of Services: i. One (1) to three (3) times per week. ii. Three (3) to six (6) hours per week. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Provide safe supervision of parenting time for children and their non -custodial parent while being placed out of the home. ii. Provide intense, moment to moment coaching and intervention as deemed necessary based on the family dynamic, parents' abilities and child's needs. iii. Provide positive parenting time for parent(s) and child(ren). iv. Provide parents the needed skills to help them become more competent and improve upon the bond and attachment of the child(ren) and parent(s) in effort to progress parenting time and work towards family reunification. e. Outcomes of Services: i. Safe and supportive parenting time for children placed out of the home. ii. Improved parenting abilities and improved parent child relationship or bond and attachment. iii. Reunification. f. Target Population: i. Parents of any age, gender, or race, involved with WCDHS. ii. Children of any age, gender or race, involved with WCDHS. iii. Families meeting the level of need of the highest/most restrictive level of visitation. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In office. ii. Video. iii. In -Home. iv. In community. 2. Parent Coaching a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Nurturing Parenting curriculum. ii. Other parent education theories. b. Anticipated Frequency of Services: i. One (1) hour per week. c. Anticipated Duration of Services: i. Two (2) to four (4) months. d. Goals of Services: i. Build upon parental strengths and to help parents learn to develop age -appropriate expectations, promote empathy, promote positive self-image and awareness of the parent and child, reducing the use of physical punishment by promoting dignified discipline, and autonomy and independence. ii. Provide parents the education and tools through one on one coaching to help navigate difficult parenting situations and gain understanding how their own trauma/upbringing impacts their parenting. iii. Provide parents with education and tools to better connect with their child(ren). e. Outcomes of Services: i. Help parents grow and improve in their parenting toolbox and abilities. ii. Improve parent child connection. iii. Provide family reunification and tools to sustain and prevent the cycle of department re - involvement. f. Target Population: i. Parents in need of additional parent education and coaching. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In office. ii. Video. iii. In -Home. iv. In community. 3. Kinship Visitation Supervision Coaching a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Psychoeducation. ii. Boundaries. iii. Family Dynamics. iv. Visitation Coaching. b. Anticipated Frequency of Services: i. Generally, One (1) to six (6) hours, total. c. Anticipated Duration of Services: i. One (1) to two (2) months. d. Goals of Services: i. Coach kinship through the necessary boundaries and support needed to successfully supervise parenting time for child(ren) in their care, or not in their care, for their visiting parent(s). ii. Work with both kinship and the biological parent(s) to best determine a plan that works for all parties that can allow all parties to be on the same page. iii. Help parenting time go successfully when supervised by kinship. e. Outcomes of Services: i. Improve parenting time for children and their non -custodial parent by supporting supervising kinship and the parent. ii. Decrease the need for professionally supervised parenting time for WCDHS families. iii. Support families and reunification of families involved with the child welfare system. f. Target Population: i. Kinship of children involved with WCDHS that the department has determined could benefit from coaching in order to successfully supervise parenting time. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. In office. ii. Video. iii. In -Home. iv. In community. 4. Parenting Strengths and Needs Assessment a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Interview for basic social history, observation of parenting time. ii. Report writing with clinical insight and recommendations. b. Anticipated Frequency of Services: i. One-time assessment. c. Anticipated Duration of Services: i. One-time assessment. d. Goals of Services: i. Gather information about parenting abilities, strengths and areas for growth. ii. Gather information about the relationship between the child(ren) and the non -custodial parent(s). iii. Help the department determine the level of supervision needed for parenting time and provide recommendations about useful interventions and services. e. Outcomes of Services: i. Help WCDHS, the caseworker, and the courts best understand parenting time needs. ii. Improve parenting time for child(ren) and parent(s) by establishing a parenting time road map to include level of supervision needed, parenting/relationship strengths and areas for growth. iii. Provide an assessment that can assist in better relationships between children and parents, bridge gaps between families and WCDHS and courts, and eventually assist in family reunification. f. Target Population: i. Families that the department is struggling to determine the needed level of parenting time intervention that is necessary. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In office. ii. Video. iii. In -Home. iv. In community. Program Area: Home Study Contractor will provide Home Studies, as referred by the Department. 5. Home Studies a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor is certified in Structured Analysis Family Evaluation (SAFE) and is on the State's approved home study vendor list. Contractor also is certified as a SAFE Supervisor. ii. Contractor will conduct the following types of Home Studies: 1. Kinship Care 2. Foster Care 3. Kinship Foster Care 4. Parent Care 5. Foster -Adoption 6. Adoption 7. Interstate Compact on the Placement of Children (ICPC) iii. Contractor will utilize the most current SAFE forms and templates. Contractor will ensure all home studies completed for the Department include, at a minimum, all the following: 1. SAFE Home Study template. 2. Compatibility Inventory. 3. References and documented direct follow-up with references (phone call or meeting). 4. Psychosocial Inventory for all applicants. 5. Questionnaire I and II for all applicants. 6. Indian Child Welfare Act (ICWA)/Indian heritage discovery and documentation. 7. All additional collateral information collected from the applicants. 8. Urinalysis (UA) result from a certified testing facility, if requested by the Department. A UA will be required for any individual 18 or older residing in the home, when requested by the Department, if substance abuse concerns are noted. The cost of the UA will be responsibility of the applicant. iv. Contractor will meet regularly with Department staff during the home study process. At a minimum, Contractor will meet with Department staff as follows: 1. Following completion of individual applicant meetings. 2. Prior to the final review with the applicant(s). b. Anticipated Frequency of Services: i. Minimum of two (2) visits. ii. Three (3) hours, per visit. c. Anticipated Duration of Services: i. Contractor will have a completed, signed home study within sixty (60) days from the referral date. d. Goals of Services: i. To help the Department determine if the applicants are appropriate for foster or kinship care certification, ICPC placement or adoption. e. Outcomes of Services: i. To determine if the character and suitability of the applicant(s) is appropriate to safely care for the children being placed in the home. ii. A written report, using the SAFE model, submitted to the Department. iii. Approve or deny the applicant(s) based on information gathered during the Home Study. f. Target Population: i. All foster, adoption, and kinship applicants, including additional adults, and children within the house. ii. Any gender and age. 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. 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 CWService.Referral(&,weldaov.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(Oveldeov.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(etweldgov.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(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(2weldeov.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)weldeov.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 Staffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as there is written authorization from the 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. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator. Contractor may participate by phone 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(a,weldgov.com) of new staff who will manage and/or administer the services with the following information: a. Staff member name and contact information b. Education level/degree (if applicable) c. Licensure/credentials (if applicable) d. Department of Regulatory Authority (DORA) number (if applicable) e. Supervisor name and contact information The Department reserves the right to decline the new staff members managing and/or administering services to Department clients. 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 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 Ilfe Sk>ros . Rate $100.00 Unit Type Hour " Service Name T'herapeutieVisitation: In e/V' o $150.00 Hour Therapeutic Visitation: In -Home or Community $150.00 Hour Therapeutic Visitata •n: In-OfficeIVklan, In -Home, or Community with Transportation „ " $100.00 Hour Therapeutic Visitation: Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Hour Therapeutic Vs'talion: No Show '(14Iax oft no shows or 2 hours/month./client); $100.00 Hour Parent Coaching: In-Office/Video $150.00 Hour Parent Coaching: In -Home 1st Community $150.00 Hour Parent Coaching: In-Office/Video, In -Home, or Community with Transportation $100.00 Hour Parent Coaching. Family Team Meeting (FTM), Tea.,Deelsion Making (TDM) Meeting, Professional Staffing $75.00 Hour Parent Coaching: No Show (Max oft no shows or 2 hours/month/client) $100.00 Hour Kinship Visitation Supervision Coaching; ht-Dffiee/V Sea $150.00 Hour Kinship Visitation Supervision Coaching: In -Home or Community $150.00 Hour Kinship Visitation Superuision,Coach g: In -O e/Vxleo, Home, or Commuh Trransportation $100.00 Hour Kinship Visitation Supervision Coaching: Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $75.00 Hour: Kinship Vaitation Supervi i ttCoachir : "No. Show (Max oft, no shoves or 2.hours/ mlcn#fi/client ) .. $800.00 Each Parental Strengths and Needs Assessment: Full Parenting Assessment: In -Home or Community Program Area Life Skills Rate $150.00 Unit Type Each Service Name Parental Strengths and Needs Assessment: PartialParentmg Assessment: In -Home or Commusey. $100.00 Hour Parental Strengths and Needs Assessment: Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $ 100.00 Each Parental Strengths and Needs Assessment: Parenting Assessment: No Show (Max of2 no shows or 2 hours/month/client) $.65 Mile Life Skills *Mileage Home Studies $1,200.00 Each Full SAFE Home Study: Up to two (2) adults. $150.00 Each Full SAFE Home Study: Per additional Aduh. $400.00 Each Partial SAFE Home Study $500.00 Each Updated SAFE Home Study $100.00 Each All SAFE Home Studies: No Show (Max of 2 no shows or 2 hours/month/client) $.65 Mile Home Studies *Mileage *Mileage for distances exceeding 20 roundtrip miles from provider's office located at 3620 West 10"' Street, Suite B #132, Greeley, Colorado 80634 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 fora one-time service, the contractor shall submit the first and last page of the evaluation/report to confirm proof of services rendered. The full evaluation/report should be submitted by the contractor to the caseworker. For Monitored Sobriety services, proof of services rendered shall be the test result. Requests for Reimbursement and/or supporting documentation received after the 7`h 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 County'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 Agency Name: Lauren Cito Counseling, LLC Trails Provider ID (if known): Provider Contact Full Name: Lauren Cito Title: Sole proprietor/ Licensed Practicing Counselor Primary Phone Number (10 -digit): 970-599-1034 Ext.: Fax Number (10 -digit): Primary Contact Email: laurencitolpc(Wgmail.com Web Address: Agency Location Address (Street, city, state, zip): 3620 W 10th St. Suite B #132 Greeley Colorado 80634 Agency Mailing Address (Street, city, state, zip): 3620 W 10th St. Suite B #132 Greeley Colorado 80634 Agency Type (pick one): Public Company Send Referrals for Service to: Referral Contact Name: Lauren Cito Title: Sole proprietor/Therapist Referral Phone Number: 970-599-1034 Ext.: Email: laurencitolpc@gmail.comd Billing Contact Referral Contact Name: Lauren Cito Title: Sole proprietor/Therapist Referral Phone Number: 970-599-1034 Ext.: Email: laurencitolpc@gmail.comd CERTIFICATION I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it has so indicated in this bid form. I further affirm intention to enter into an agreement with Weld County, on behalf of the Weld County Department of Human Services, and comply with all requirements of the contract, if awarded. The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are competitive in price and quality. WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES. THE CERTIFICATE OF EXEMPTION NUMBER IS #98-03551-0000. Authorized Rep. Full Name: Lauren Cito Title: Sole proprietor/Therapist Authorized Rep. Email: laurencitolpc@gmail.com Phone (10 -digit): 970-599-1034 Ext.: Authorized Rep. Address (Street, city, state, zip): 3620 W 10th St. Suite B #132 Greeley Colorado 80634 Signature of Authorized Rep.: Date: 7/13/23 ATTACHMENT C - PROPOSAL I I 4.7 Home Study Providers — List your rates in the box below. Full SAFE Home Study- $1200 for up to 2 adults, $150 per additional adult, Partial $400, Updated $500, $100 for no show M nimum 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: -Full Parenting Assessment- $800/hr - Partial Parenting Assessment- $150/hr -No Show -$100 per no show -FTM/TDM/Staffing- $100/hr REV. OCT 2021 6 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) Lauren Cito AGENCY CONTACT Lauren Cito PHONE NUMBER 970-599-1034 EMAIL Iaurencitolpc@gmail com PROPOSED SERVICE(S) Therapeutic Visitation, parent coaching, SAFE Home Studies, Kinship Visitation Supervision Training, Parent Strengths and Needs Assessment Legal Last Name Middle Initial Previous Legal Last Name (If applicable) Legal First Name Service Type Licensure/ Credentials DORA # (If applicable) Cito Lauren LPC 0019141 CHILD WELFARE REQUEST FOR PROPOSAL 2023-24 - VARIOUS SERVICES PROFESSIONAL LIABILITY INSURANCE ENDORSEMENT Agreement to Provide Notice of Cancellation In consideration of the premium paid, it is agreed that if the policy to which this endorsement is attached is cancelled before the expiration date, we will endeavor to mail notice to the person or entity named below. However, failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. Person or Entity Name and Address: Weld County 1150 O St Greely, CO 80631 This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. All other provisions of the policy remain unchanged. Must Be Completed ENDT. NO. POLICY NO. 740788383 G -123828-B (7/2001) Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy ISSUED TO ENDORSEMENT EFFECTIVE DATE Lauren Cito 07/13/2023 Page 1 of 1 HEALTHCARE PROVIDERS PROFESSIONAL LIABILITY COVERAGE PART ENDORSEMENT Additional Insured — Healthcare Professional or Entity In consideration of the additional premium paid, and subject to the Professional Liability limit of liability shown on the certificate of insurance, it is agreed that the PROFESSIONAL LIABILITY COVERAGE PART is amended as follows: The person or entity named below (the "additional insured") is an insured under this Coverage Part but only as respects its liability for your medical incidents and solely to the extent that: 1. a professional liability claim is made against you and the additional insured; and 2. in any ensuing litigation arising out of such claim, you and the additional insured remain as co- defendants. In no event is there any coverage provided under this policy for a medical incident that is the direct liability of the additional insured. Additional Insured: Board of Weld County, Commisioners of of Weld County and its Officers/Employees Weld County 1150O St Greeley, CO 80631 This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. All other provisions of the policy remain unchanged. Must Be Completed ENDT. NO. 01 POLICY NO. 740788383 Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy ISSUED TO ENDORSEMENT EFFECTIVE DATE Lauren Cito 07/13/2023 G -141231-A (07/2001) Page 1 of 1 LHPSO 06/06/23 Lauren Cito 8619 15th Street Rd Greeley, CO 80634-3086 1100 Virginia Drive, Suite 250 Fort Washington, PA 19034-3278 Phone:1-800-982-9491 Fax:1-800-758-3635 Website: www. h pso. com Dear Lauren City: Enclosed is the replacement certificate of insurance that you requested. If you have any questions or need assistance, please call us toll free at 1-800-982-9491. Our Customer Service Representatives are available weekdays from 8:00 a.m. to 6:00 p.m., EST. Sincerely, Customer Service Enclosure Dedicated To Serving The Insurance Needs of Healthcare Providers Healthcare Providers Service Organization is a registered trade name of Affinity Insurance Services, Inc.; (AR 244489); in CA & MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services Inc.; in CA, Aon Affinity Insurance Services, Inc., (0G94493), Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY, AIS Affinity Insurance Agency. Q032 CNA HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP Certificate of 3tt5ttrattce OCCURRENCE PROFESSIONAL LIABILITY POLICY FORM INHPSO Print Date: 6/06/2023 The application for the Policy and any and allsupplementary information, materials, and statements submitted therewith shall be maintained on file by us or our Program Administrator and will be deemed attached to and incorporated into the Policy as if physically attached. PRODUCER BRANCH PREFIX POLICY NUMBER POLICY PERIOD From: 06/06/23 at 08:06 PM ET to 06/06/24 at 12:01 AM Std Time Program Administered by: 018098 970 Named Insured and Address: Lauren Cito 8619 15th Street Rd Greeley, CO 80634-3086 HPG 0740788383 Medical Specialty: Code: Mental Health Counselor 80723 Excludes Cosmetic Procedures Healthcare Providers Service Organization 1100 Virginia Drive, Suite 250 Fort Washington, PA 19034 1-800-982-9491 www. h pso. com Insurance Provided by: American Casualty Company of Reading, Pennsylvania 151 N. Franklin Street Chicago, IL 60606 Professional Liability $ 1,000,000 each claim $ 3,000,000 aggregate Your professional liability limits shown above include the following: * Good Samaritan Liability * Malplacement Liability * Personal Injury Liability * Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit Coverage Extensions License Protection Defendant Expense Benefit Deposition Representation Assault Includes Workplace Violence Counseling Medical Payments First Aid Damage to the Property of Others Information Privacy (HIPAA) Fines and Penalties Media Expense Workplace Liability Workplace Liability Fire & Water Legal Liability Personal Liability Total $ 163.00 $ 25,000 per proceeding $ 25,000 aggregate, $ 1,000 per day limit $ 25,000 aggregate $ 10,000 per deposition $ 10,000 aggregate $ 25,000 per incident $ 25,000 aggregate $ 25,000 per person $ 100,000 aggregate $ 10,000 per incident $ 10,000 aggregate $ 10,000 per incident $ 10,000 aggregate: $ 25,000 per incident $ 25,000 aggregate $ 25,000 per incident $ 25,000 aggregate Included in Professional Liability Limit shown above Included in the PL limit shown above subject to $150,000 aggregate sublimit $1,000,000 aggregate Base Premium $163.00 Premium reflects Self Employed , Part Time Policy Forms and Endorsements (Please see attached list of policy forms and endorsements) Chairman of the Board Secretary Keep this Certificate of Insurance in a safe place. It and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full. To activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. Coverage Change Date: CNA93692 (11-2018) Endorsement Date: Master Policy: 188711433 © Copyright CNA All Rights Reserved. POLICY FORMS & ENDORSEMENTS The following are the policy forms and endorsements that apply to your current professional liability policy. COMMON POLICY FORMS & ENDORSEMENTS FORM # FORM NAME G -121500-D (04-08) Common Policy Conditions G -121503-C (07-01) Workplace Liability Form G -121501-C (07-01) Occurrence Policy Form CNA96097 (06-19) Amended Definition of Policy Period Endorsement CNA94164 (11-18) Amendment Definition of Claim Endorsement G -145184-A (06-03) Policyholder Notice - OFAC Compliance Notice G -147292-A (03-04) Policyholder Notice - Silica, Mold & Asbestos Disclosure GSL15563 (02-10) Information Privacy Coverage Endorsement HIPAA Fines, Penalties & Notification Costs GSL15564 (10-09) Sexual Misconduct Sublimits of Liability Professional Liability & Sexual Misconduct Exclusion GSL15565 (03-10) Healthcare Providers Professional Liability Assault Coverage GSL17101 (02-10) Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies GSL13424 (05-09) Services to Animals CNA80051 (09-14) Amended Definition of Personal Injury Endorsement CNA80052 (09-14) Distribution or Recording of Material or Information in Violation of Law Exclusion Endorsement G -123846-005 (07-01) Colorado Cancellation and Non -Renewal CNA81753 (03-15) Coverage & Cap on Losses from Certified Acts Terrorism CNA81758 (01-21) Notice - Offer of Terrorism Coverage & Disclosure of Premium CNA82011 (04-15) Related Claims Endorsement CNA89027 (10-17) Entity Exclusion Endorsement CNA79575 (07-14) Exclusion of Cosmetic Procedures CNA89026 (05-17) Media Expense Coverage PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE POLICY FORMS & ENDORSEMENTS SPECIFIC TO YOUR STATE AND YOUR POLICY PERIOD. For NJ residents: The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property & Liability Insurance Guaranty Association. For KY residents: The Surcharge shown on the Certificate of Insurance is the KY Firefighters and Law Enforcement Foundation Program Fund and the Local Tax is the KY Local Government Premium Tax. As required by 806 Ky. Admin Regs. 2:100, this Notice is to advise you that a surcharge has been applied to your insurance premium and is separately itemized on the Declarations page or billing instrument attached to your policy, as required KRS. §136.392. For WV residents: The surcharge shown on the Certificate of Insurance is the WV Premium Surcharge. For FL residents: The FIGA Assessment shown on the Certificate of Insurance is the FL Insurance Guaranty Association - 2022 Regular Assessment. Form #:CNA93692 (11-2018) Named Insured: Lauren Cito Master Policy #: 188711433 Policy #: 0740788383 © Copyright CNA All Rights Reserved. SIGNATURE REQUESTED: Weld/Lauren Cito Counseling, LLC PSA Final Audit Report 2023-09-19 Created: 2023-09-18 By: Windy Luna (wluna@co.weld.co.us) Status: Signed Transaction ID: CBJCHBCAABAAbgEQuGDEnlmXhnBOLQY5yJ7OU3XnYgwp "SIGNATURE REQUESTED: Weld/Lauren Cito Counseling, LLC PSA" History t Document created by Windy Luna (wluna@co.weld.co.us) 2023-09-18 - 8:58:45 PM GMT Cry Document emailed to laurencitolpc@gmail.com for signature 2023-09-18 - 9:00:01 PM GMT t Email viewed by laurencitolpc@gmail.com 2023-09-18 - 9:00:28 PM GMT 6® Signer laurencitolpc@gmail.com entered name at signing as Lauren Cito 2023-09-19 - 5:10:40 PM GMT L05 Document e -signed by Lauren Cito (laurencitolpc@gmail.com) Signature Date: 2023-09-19 - 5:10:42 PM GMT - Time Source: server 0 Agreement completed. 2023-09-19 - 5:10:42 PM GMT Powered by Adobe Acrobat Sign Contract For Entity Information Entity Name* Entity ID* LAUREN CITO COUNSELING LLC @00047645 Contract Name LAUREN CITO COUNSELING, LLC (PSA) (POST -BID PROVIDER RELATED TO BID #B2300040( Contract Status CTB REVIEW ❑ New Entity? Contract ID 7418 Contract Lead * WLUNA Contract Lead Email wluna@weldgov.com;cob bxxlk@weldgov.com Parent Contract ID Requires Board Approval YES Department Project # Contract Description LAUREN CITO COUNSELING, LLC PROFESSIONAL SERVICES AGREEMENT (POST -BID PROVIDER RELATED TO BID #B2300040). TERM: AUGUST 1, 2023 THROUGH MAY 31, 2024. Contract Description 2 PA ROUTING THROUGH NORMAL PROCESS. ETA TO CTB 09/28/2023. Contract Type * AGREEMENT Amount* $0.00 Renewable * NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanServices@weldgov. com Department Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WEL DGOV.COM Requested BOCC Agenda Date * 10/11/2023 Due Date 10/07/2023 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 blank if those contracts are not in OnBase Contract Dates Effective Date Termination Notice Period Contact Information Review Date" 03/29/2024 Committed Delivery Date Renewal Date Expiration Date" 05/31/2024 Contact Info Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date Approval Process Department Head Finance Approver Legal Counsel JAMIE ULRICH CHERYL PATTELLI BRUCE BARKER DH Approved Date Finance Approved Date Legal Counsel Approved Date 09/27/2023 09/27/2023 09/28/2023 Final Approval BOCC Approved Tyler Ref # AG 100423 BOCC Signed Date Originator WLUNA BOCC Agenda Date 10/04/2023 Hello