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Home My WebLink About20211547.tiff(avi+rcci IncTfl PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: March 28, 2023 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Protection Agreement Amendments for 2021-22 Core/Non-Core Contracted Services B2100042 Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Child Protection Agreement Amendments for 2021-22 Core/Non-Core Contracted Services B2100042. The Department entered into Agreements with various Child Welfare Service Providers through the 2021-22 Request for Proposal (RFP), Bid Number: 82100042, identified as Tyler ID 2021-0307. These Agreements were issued for a period of three (3) years with the option to renew annually. The Department is requesting to renew the current Agreements with no changes for twelve (12) Providers reflected in the attached list. Agreements will be renewed for the third and final year, for the period of June 1, 2023 through May 31, 2024. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Upon Board approval of this pass -around, signed Agreement Amendments will be obtained from Providers and submitted to the Board for approval and Chair signature. I do not recommend a Work Session. I recommend approval of these Agreement Amendments and authorize the Chair to sign. Perry L. Buck, Pro -Tern Mike Freeman, Chair Scott K. James Kevin D. Ross Lori Saine Approve Recommendation Schedule Work Session Other/Comments: Pass -Around Memorandum; March 28, 2023 — CMSe&olt0U8 0450) UnsenlePlend niscw-L3 5///c23 Page 1 zoalr t647 tWU0R3 PRIVILEGED AND CONFIDENTIAL S ! NAME I BID I YEAR TYLER ID &BID . Behavior Services of the Rockies + _ l B2100042 2021-22 2021-1581 Centennial Mental Health Center, Inc. 82/00042 2021-22 2021-1579 Colorado State University B2100042 2021-22 2021-1583 Jones, Dr. Jacob B2100042 2021-22 , 2021-1470 Northern Horizon Behavioral Health - Nikki Tolle B2100042 2021-22 2021-1436 Reaching Hope B2100042 2021-22 2021-1547 Reece, Alison B2100042 2021-22 2021-1438 SovereigntyCounselinq - Annette Brown B2100042 2021-22 2021-1439 Specialty Counseling & Consulting B2100042 2021-22 2021-1466 The Hope Initiative _ _T B2100042 2021-22 _ 2021- 1582 v italCare B2100042 2021-22 2021-1469 Withers Whisper - Andrea Hall B2100042 2021-22 2021-1471 Pass-Arourd Memorandum; March 28, 2023 — CMS ID Various Page 2 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND REACHING HOPE This Agreement Amendment, made and entered into 15k day of 1' 1 , 2023 by and between the Board of Weld County Commissioners, on behalf of the Weld County Depn, ent of Human Services, hereinafter referred to as the "Department", and Reaching HOPE, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement to for Foster Parent Consultation, Foster Parent Training, Kinship Services (Therapeutic), Mental Health Services, Sexual Abuse Treatment, and Relinquishment Counseling, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2021-1547, approved on June 14, 2021. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement was set to end on May 31, 2022. • The Original Agreement was amended on: • May 2, 2022 to extend the term date through May 31, 2023. • The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2021-1547. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Term This agreement is being renewed for the third and final year, for the period June 1, 2023 through May 31, 2024. • 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. ATTEST - BY: AfitrAvs AW„ Deputy Cler ,Atilltrectergr valP4r yoth-Bo., COUNTY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ike Freeman, Chair 0 I 2323 NTRACTOR: eaching HOPE 13611 East 104th Avenue, Suite 100 Commerce City, Colorado 80022 Ambra 5cmh By : Ambra Born (Apr 19. 2023 13:40 MDT) Ambra Born, Executive Director Date: Apr 19, 2023 02002/ /641 SIGNATURE REQUESTED: Weld/Reaching HOPE Amendment #2 Final Audit Report 2023-04-19 Created: 2023-04-14 By: Windy Luna (wluna@co.weld.co.us) Status: Signed Transaction ID: CBJCHBCAABAAmk8ova7eAKns1GXgYPYeEWbPykOIxN6P "SIGNATURE REQUESTED: Weld/Reaching HOPE Amendmen t #2" History t Document created by Windy Luna (wluna@co.weld.co.us) 2023-04-14 - 8:27:09 PM GMT + Document emailed to ambra.born@reachinghope.org for signature 2023-04-14 - 8:28:23 PM GMT t Email viewed by ambra.born@reachinghope.org 2023-04-14 - 9:27:18 PM GMT ,t Email viewed by ambra.born@reachinghope.org 2023-04-18 - 3:21:27 AM GMT 64 Signer ambra.born@reachinghope.org entered name at signing as Ambra Born 2023-04-19 - 7:40:04 PM GMT 4, Document e -signed by Ambra Born (ambra.born@reachinghope.org) Signature Date: 2023-04-19 - 7:40:06 PM GMT - Time Source: server Agreement completed. 2023-04-19 - 7:40:06 PM GMT Names and email addresses are entered into the Acrobat Sign service by Acrobat Sign users and are unverified unless otherwise noted. Powered by Adobe Acrobat Sign Contract Form New Contract Request rnxati Entity Name* REACHING HOPE Entity ID* @00042482 Contract Name* REACHING HOPE (CHILD PROTECTION AGREEMENT AMENDMENT #2) Contract Status CTB REVIEW ❑ New Entity? Contract ID 6888 Contract Lead* WLUNA Contract Lead Email wiuna@weldgov.com;cobbx xlk@weldgov.com Parent Contract ID 20211547 Requires Board Approval YES Department Project # Contract Description', (CONSENT) REACHING HOPE (CHILD PROTECTION AGREEMENT AMENDMENT #2). TERM_ 06/01/2023 THROUGH 05/31/2024. Contract Description 2 PROVIDER WAS UTED ON APPROVED VENDOR UST PRESENTED TO THE BOCC ON 03/29/2023 AND AS A COMMUNICATION ITEM/PA SENT TO CTB ON 03/30/2023. Contract Type* AGREEMENT Amount* $0.00 Renewable* NO is Rene Grant Department HUMAN SERVICES Department Email CM- HumanServices@weldgov.co Department Head Email CM-HumanServices- DeptHead#weidgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTORN EY@WELDG OV.COM Requested BOCC Agenda Date* 05/03/2023 Due Date 04/29/2023 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 RSA enter MA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Review Date* 03/29,/2024 Renewal Date Termination Notice Period Contact Information [moll Contact Name Purchasing Purchasing Approver Approval Process Department Head JAMIE ULRICH DH Approved Date 04/20/2023 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 05/01/2023 Originator WLUNA Contact Type Committed Delivery Date Contact Email Finance Approver CHERYL PATTELLI Expiration Date* 05/31/2024 Contact Phone 1 Purchasing Approved Date Finance Approved Date 04/21/2023 Tyler Ref # AG 050123 Legal Counsel BYRON HOWELL Contact Phone 2 Legal Counsel Approved Date 04/21/2023 PRIVILEGED AND CONFIDENTIAL MEMORANDUM Con ck 4- ID 5114 DATE: March 29, 2022 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Protection Agreement Amendments for 2021-22 Core/Non-Core Contracted Services B2100042 Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Child Protection Agreement Amendments for 2021- 22 Core/Non-Core Contracted Services B2100042. The Department entered into Agreements with various Child Welfare service providers through the 2021-2022 Request for Proposal (RFP), Bid Number: B2100042, identified as Tyler ID 2021-0307. These Agreements were issued for a period of three (3) years with the option to renew annually. The Department is requesting to renew the current Agreements with no changes for sixteen (16) providers reflected in the attached list. Agreements will be renewed for the second year for the period of June 1, 2022 through May 31, 2023. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Upon Board approval of this pass -around, signed Agreement Amendments will be obtained from providers and submitted to the Board for approval and Chair signature. I do not recommend a Work Session. I recommend approval of these Agreement Amendments and authorize the Chair to sign. Perry L. Buck Mike Freeman, Pro -Tern Scott K. James, Chair Steve Moreno Lori Saine Annrove Recommendation ymaa. Schedule Work Session Other/Comments: Pass -Around Memorandum; March 29, 2022 - CMS ID — Various Page 1 cones -n -1-i �er� 05/oz/z2_ � 5/02/0209. ab - ► x`-11 N-120TI 3 PRIVILEGED AND CONFIDENTIAL CMS Name Behavior Services of the Rockies Bid # 62100042 Bid Year 2021-22 Tyler ID 2021-1581 Centennial Mental Health B2100042 2021-22 2021-1579 Colorado State University B2100042 2021-22 2021-1583 Hartshorn, Mandee dba Creative Nursing LLC B2100042 2021-22 2021-1437 Jones, Dr. Jacob B2100042 2021-22 2021-1470 Northern Colorado Counseling (Rascon, Christina) B2100042 2021-22 2021-1467 Northern Horizon Behavioral Health - Nikki Tolle B2100042 2021-22 2021-1436 Reaching Hope B2100042 2021-22 2021-1547 Reece, Alison B2100042 2021-22 2021-1438 Rocky Mountain Kids 62100042 2021-22 2021-1465 Sovereignty Counseling - Annette Brown 62100042 2021-22 2021-1439 Specialty Counseling & Consulting B2100042 2021-22 2021-1466 The Hope Initiative B2100042 2021-22 2021-1582 Tindall and Associates B2100042 2021-22 2021-1606 VitalCare B2100042 2021-22 2021-1469 Withers Whisper - Andrea Hall B2100042 2021-22 2021-1471 Pass -Around Memorandum; March 29, 2022 - CMS ID — Various Page 2 Karla Ford From: Sent: To: Subject: yes Lori Saine Weld County Commissioner, district 3 1150 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 Tuesday, March 29, 2022 11:34 AM Karla Ford RE: Please Reply - PA FOR ROUTING: CW Core Non -Core 2O21-22 Renewals B21OOO42 (CMS Various) Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, 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@weldgov.com> Sent: Tuesday, March 29, 2O22 1O:45 AM To: Lori Saine <Isaine@weldgov.com> Subject: Please Reply - PA FOR ROUTING: CW Core Non -Core 2021-22 Renewals B2100042 (CMS Various) Importance: High Please advise if you approve recommendation. Thank you! Karla Ford { Executive Assistant & Office Manager, Board of Weld County Commissioners 1150 O 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 REACHING HOPE r/ d This Agreement Amendment, made and entered into ci day of tA , 2022 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Serlcibes, hereinafter referred to as the "Department", and Reaching HOPE, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Foster Parent Consultation, Foster Parent Training, Kinship Services (Therapeutic), Mental Health Services, Sexual Abuse Treatment, and Relinquishment Counseling, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2021-1547, approved on June 14, 2021. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on May 31, 2022. • This Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Term This agreement is being renewed for the second year, for the period of June 1, 2022 through May 31, 2023. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: BY: dderniti COUNTY: BOA OF COUNTY COMMISSIONERS WELWCOUNTY, COLORADO Deputy Clertt K. James, Chair MAY 0 2 2022 Reaching HOPE 13611 East 104th Avenue, Suite 100 Commerce City, Colorado 80022 Am'bi-a Non,/ By: 'A br r Born (Apr 20, 2022 18)35 MDT) Ambra Born, Co -Executive Director Date: Apr 20, 2022 New Contract Request Entity Information Entity Name* REACHING HOPE Entity ID* g'0OO42482 Contract Name* REACHING HOPE (AGREEMENT AMENDMENT PY 2022-23) Contract Status CT6 REVIEW Contract Description BID# B2100O42. TERM 6/1(22 -5/31x`2.3. Contract Description 2 CONSENT; PA WAS SENT TO CT Contract Type AMENDMENT Amount * $0.00 Renewable* NO Automatic Renewal B ON: 3/3012022. Department HUMAN SERVICES Email CM- HumanServices eldgov.co m Department Head Email CM -Human Services - De ptHeadcwel dgov. co m County Attorney GENERAL COUNTY A I I ORNEY EMAIL County Attorney Email CM- COUNTYATTORNEYPWELDG OV,COM Contract ID 5774 Contract Lead* APEGG Contract Lead Email apegg weldgov.corn:cobbx xlkcwsveldgov.coni Requested BOCC Agenda Date* 05,25/2022 Parent Contract ID 20211547 Requires Board Approval YES Department Project I Due Date 05,?21,2022 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is 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 Review Date* 04/03:2023 Renewal Date Termination Notice Period Contact Information Purchasing CONSENT Approval Department i JAMIE ULRICH DH Approved Date 04/22/2022 BOCC Approved BOCC Signed Date BOCC Agenda Date 05/02/2022 Originator APEGG Committed Delivery Date. Finance Approver CONSENT Finance Appr 04/22/2022 Expiration Date 05, 31 . 2023 Contact Phone 1 Contact Phone 2 Purchasing Approved Date 0422:2022 Tyler Ref # AG 050222 Legal Counsel CONSENT Legal Counsel Approved Date 04,'22;`2022 00)n -tract -r0 Tr --118"7 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND REACHING HOPE th This Agreement, made and entered into the 1 1 d day of Jj nQ, 2021, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department' and Reaching HOPE, hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule. Exhibit B, C, and D are attached hereto and incorporated herein by this reference. Exhibit A is Weld County's Request for Proposal Number B2100042 which is incorporated into this agreement by reference and will be provided upon request to the Department. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided Core Services or other funding to the Department for Foster Parent Consultation, Foster Parent Training, Kinship Services (Therapeutic), Mental Health Services, Sexual Abuse Treatment, and Relinquishment Counseling. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1, 2021, upon proper execution of this Agreement and shall expire May 31, 2022, unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Response to Request for Proposal and Exhibit C, Scope of Services. 3. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Quality Assurance Team(HS-CWOualityAssurance(aweldgov.com). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit a complete Request for Reimbursement and supporting documentation by the 7th of the month, following the month of service, utilizing billing forms required by the Department. Contractor agrees to utilize the Client Verification Form for all scheduled and unscheduled face-to-face services with the exception of home studies and monitored sobriety testing. Contractor agrees that original complete Client Verification Forms are to be submitted with the OfinGe-11-1- ()co/viral e&e,,Azovae( 2021-1547 K Ro©q 3 Request for Reimbursement. Requests for Reimbursement and Client Verification Forms received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet 60 -day deadline may result in termination of the Agreement. d. Contractor agrees to submit a monthly report by the 7th of the month, following the month of service, for each client receiving ongoing services. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. Monthly reports for ongoing services must include the following information, entered in the "Narrative" box for each date of service: a. Date and time of service b. Where the service took place c. Clinician/therapist name d. Clients participating e. What interventions were used, recommendations and/or goals discussed f. Any and all safety concerns One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation, home study). Verification of Monitored Sobriety Services will be the test result. A completed home study may be a full, partial or denied study, as determined by the Department. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. 4. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. Exceptions to this Paragraph may include, if approved by the Department, the following: i. The service being provided by the contractor is not a Medicaid eligible service; ii. The service is not deemed medically necessary; iii. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; iv. A Medicaid provider is not available to provide the needed service; v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule, attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon, the continuing availability of said funds for the purposes hereof. d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 2 5. 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 OMG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit a State of Colorado direct deposit enrollment form, which will be provided by the Department, with a voided check. Failure to complete and submit this form and voided check in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and - Title VII of the Civil Rights Act of 1964; and - the Age Discrimination in Employment Act of 1967; and the Equal Pay Act of 1963; and - the Education Amendments of 1972; and - Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and 3 - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is determined by the Department. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contractor will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E - Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5- 102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is 4 employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contractor participates in the State of Colorado program, Contractor shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contractor has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contractor shall deliver to the Department, a written notarized affirmation that it has examined the legal work status of such employee and shall comply with all of the other requirements of the State of Colorado program. If Contractor fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., the Department, may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contractor receives federal or state funds under the contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24- 76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5- 103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR), and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 9. Insurance Requirements Contractor and the Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, insurance coverage 5 listed in this agreement. The Board of County Commissioners of Weld County and its Officers/Employees shall be named as additional insured. a. General Requirements: Contractors must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, the Department must be notified by the Contractor. Contractor shall be responsible for the payment of any deductible or self -insured retention. The Department reserves the right to require Contractor to provide a bond, at no cost to the Department, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor. Contractor shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i.Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii.Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: - $1,000,000 each occurrence; - $2,000,000 general aggregate; - $50,000 any one fire; and - $500,000 errors and omissions. iii.Automobile Liability: Contractor shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: If any aggregate limit is reduced by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify the Department within ten (10) days and reinstate the aggregates required; Unlimited defense costs in excess of policy limits; Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; 6 A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by the Department. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to the Department, whichever is earlier. c. Contractors shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor shall provide a copy of this information to its insurance agent or broker and shall have its agent or broker provide proof of Contractor's required insurance. The Department reserves the right to require Contractor to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor's insurer shall name County as an additional insured. f. Waiver of Subrogation: For all coverages, Contractor's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors, independent contractors, sub -vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor. Contractor shall include all such subcontractors, independent contractors, sub -vendors, suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors, suppliers or other entities upon request by the Department. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contractor shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 10. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training Contractor may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 7 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at (970) 336-7235 and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor will collaborate in a timely manner with the Department to resolve issues pertaining to service delivery, service quality, documentation, and invoicing during referral period and after services have concluded. The Contractor will require clients sign releases of information. Contractor understands that the Department will not reimburse for services rendered to Department clients until releases of information are obtained. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. The monitoring agency may, if in its sole discretion deems necessary or appropriate, have access to any program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures for purposes of monitoring. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives 8 of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Child Welfare Director Ambra Born, Co -Executive Director 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Jamie Ulrich, Director P.O. Box A Greeley, Colorado 80632 (970) 400-6510 18. Litigation For Contractor: Ambra Born, Co -Executive Director 13611 East 104th Avenue, Suite 100 Commerce City, Colorado 80022 (720) 347-87699 Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third -Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The 9 parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall not enter into any third -party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. A conflict of interest or appearance of a conflict of interest may also apply to personal relationships between providers and clients. If a provider has a personal relationship with a client to whom the Contractor may provide services for, the Contractor must disclose that relationship to the Department. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall 10 be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contractor agrees that it is an independent Contractor and that Contractor's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall perform its duties hereunder as an independent Contractor. Contractor shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contractor, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contractor or any of its agents or employees. Unemployment insurance benefits will be available to Contractor and its employees and agents only if such coverage is made available by Contractor or a third party. Contractor shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contractor shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contractor shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and as set forth in Exhibit A, provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner 11 consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to the Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by the Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Employee Financial Interest/Conflict of Interest. C.R.S. $&24-18-201 et seq. and §24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflicts with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contractor's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contractor agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contractor acknowledges that the Department has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of this project without the Department's prior written consent, which may be withheld in the Department's sole discretion. 36. Attorney's Fees/Legal Costs 12 In the event of a dispute between the Department and Contractor, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of the Department. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contractor in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the Department. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of the Department. 38. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: i� Jd-40 .�� BOARD OF COUNTY COMMISSIONERS Weld C • i n Clerk to the Board �', �1►,�� WELD COUNTY, COLORADO By: Deputy Clerk to t 13 teve Moreno, Chair CONTRACTOR: JUN 1 4 2021 Reaching HOPE 13611 East 104th Avenue, Suite 100 Commerce City, Colorado 80022 (720) 347-8769 Afrfrtbta Nom Am bra Born (May 19, 2021 09:57 MDT) By: Ambra Born, Co -Executive Director Date: May 19, 2021 02,0,4" /544-7 EXHIBIT A WELD COUNTY'S REQUEST FOR PROPOSAL (Weld County's Request for Proposal is incorporated into this agreement by reference and will be provided upon request to the Department.) This page intentionally left blank. Exhibit B Contractor's response to the Request for Proposal Exhibit B contains the following documents: • Attachment B — Provider Information Form (PIF) • Attachment C — Proposal • Attachment D — Staff Data Sheet • Certificate of Insurance (COI) ATTACHMENT B WELD COUNTY DEPARTMENT OF HUMAN SERVICES - PROVIDER INFORMATION FORM (PIF) AGENCY INFORMATION Agency Name: Reaching HOPE Provider Contact Full Name: Ambra Born Primary Phone Number (10 -digit): 720-347-8769 Primary Contact Email: Trails Provider ID (if known): Title: Co -Executive Director Ext.: Fax Number (10 -digit): info@reachinghope.org Web Address: 855-244-7591 www.ReachingHOPE.org Agency Location Address (street, city, state, zip): 13611 E. 104th Ave, Ste 100, Commerce City, CO 80022 Agency Mailing Address (Street, city, state, zip): Agency Type (pick one): Same Public Company VI Private Non -Profit Private for Profit Referral Contact Name: Send Referrals for Service to: Tiffany Brimberry Referral Phone Number (10 -digit): 720-347-8769 Ext.: Title: Staff Psychologist Email: services@reachinghope.org Billing Contact Name: Billing Contact Tiffany Brimberry Title: Staff Psychologist Billing Phone Number (10 -digit): 720-347-8769 Ext.: Email: services@reachinghope.org CERTIFICATION II certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the i 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. IThe Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to l i 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, i iState of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases iwhere the bids are competitive in price and quality. i Authorized Rep. Full Name: Ambra Born Title: Co -Executive Director info@reach i nghope.org 720-347-8769 Authorized Rep. Email: Phone (10 -digit): Ext.: i 13611 E 104th Ave, Ste 100, Commerce City, CO 80022 i I Authorized Rep. Address (Street, city, s ate, zip): I Signature of Authorized Rep.: a -.r. Bor �ay1 , 2109;5 ?) Lf Date: 1/19/2021 i REV. NOVEMBER 2020 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: Reaching HOPE Foster Parent Consultation Number of services offered on this Attachment C (max 5): Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. 1 Service 2.1a 2.1b 2.1c 2.1d 2.1e 2.1f 2.1g 2.1h Service 2.2a 2.2b 2.2c 2.2d 2.2e 2.2f 2.2g 2.2h If the Modalities, #1 service Name: curriculum, is a monthly state SECTION a specific package, 2 - Service please offer number Name(s) different and of direct Information levels. service All monthly hours. packages must minimum Foster Parent Support tools used in delivery of service (DO NOT list company history; DO use bullet points): Parent Mental coaching health and services psychoeducation Anticipated administrative frequency of time, overhead, direct service or time travel with time (i.e. the 4 client/family hours/week). If per the week, service not including has levels, be professional specific for staffing each level: time, 45 minute sessions 1x/week per client Anticipated duration of service (i.e. 3-4 months): 1 day -3 months (depending on modality) Three (3), or more, specific goals of the service (DO use bullet points): Increase Increase Preserve and/or healthy knowledge prepare attachment and understanding for placement and connection of trauma symptoms Three (3), or more, specific outcomes of service: Increased Equip Tools foster for foster knowledge parents parent with and that tools ability are to reduce conflict of foster parent specific to the to needs between meet of the the foster foster trauma child child symptom and foster needs parent of and/or foster child siblings Target population of the service, including age and gender: Foster parents upcoming placement struggling -all with ages currently and genders placed children or in need of additional support to prepare for challenging Languages service is available in (please list proficiency and if interpreter services are available): English, Spanish Medicaid eligibility list whether the service is eligible for Medicaid in whole or in part: — Unknown Modalities, #2 Name: curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Anticipated administrative frequency of time, overhead, direct service or travel time with time (i.e. the client/family 4 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): 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: REV. NOV 2020 1 ATTACHMENT C - PROPOSAL 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: 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): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 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 REV. NOV 2020 2 ATTACHMENT C - PROPOSAL I _ 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 NO YES ►:� NO YES 0 NO 3.4 How many miles are you willing to travel round trip? List a specific number of miles. 3.5 When you calculate mileage, what is your starting point address? N/A Miles N/A 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: Foster Parent Support 4.1a In-Office/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: $ Amount $150 N/A N/A $150 $50 N/A Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: N/a N/A This is paid after the miles listed above. miles miles 4.2 Hourly Service #2 Name: 4.2a In-Office/Video: 4.2b In -Office with Transportation: 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: This is paid after the miles listed above. miles miles 4.3 Hourly Service #3 Name: 4.3a In-Office/Video: 4.3b In -Office with Transportation: 4.3c In -Home or Community: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: 4.3f Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: This is paid after the miles listed above. miles miles 4.4 Hourly Service #4 Name: 4.4a In-Office/Video: $ Amount Unit Type per Hour L REV. NOV 2020 3 ATTACHMENT C - PROPOSAL 4.4b In -Office with Transportation: per Hour No. of miles included in rate: miles In -Home or Cmmunity: per Hour No. of miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.5c In -Home or Community: per Hour No. of miles included in rate: miles 43d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: REV. NOV 2020 4 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: Reaching HOPE Foster Parent Training Number of services offered on this Attachment C (max 5): Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. 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: Foster parenting workshops 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Group training on topics specific to needs of foster parents (e.g. sexual abuse, typical sexual behavior in children, attachment needs of children in foster care, self -care, other topics upon request) 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: 2-8 hours per workshop 2.1c Anticipated duration of service (i.e. 3-4 months): 1 day per workshop 2.1d Three (3), or more, specific goals of the service (DO use bullet points): Prepare foster parents to best meet the needs of children in foster care Prepare foster parents for the emotional drain they can expect and ways to avoid vicarious trauma Connect foster parents as support systems for one another 2.1e Three (3), or more, specific outcomes of service: Equip foster parents with enhanced tools to help foster children Equip foster parents with self -care tools Provide opportunity for foster parents to share ideas and support 2.1f Target population of the service, including age and gender: All foster parents 2.1g Languages service is available in (please list proficiency and if interpreter services are available): English, Spanish 2.1h Medicaid eligibility list whether the service is eligible for Medicaid in whole or in part: Unknown 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. 3-4 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): REV. NOV 2020 1 ATTACHNilii ENi J C p PO SAL 2.2h edicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #3 Name 2.3a Modalities, curriculum, tools used in delivery of service DO NOT Hs company hist DO use bullet points): 203b anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative ti -me, overhead, or travel time (Leo 4 hours/week). Off 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 ullet points): 2.3e Thre (3), or more, specific outcomes of service: 2.3f Target population of the servic 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility m list whether the service is eligible for Medicaid in whole or in p (II rt.: Servke #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 204b Anticipated frequency of direct service time with the client/family per week, not including professional ssaffffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). lff 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 mar specific goals of the service (DO use bullet points): 2.4e Three (3), or more, specific outcomes of service: 2.4ff Targ r.] t population of the service: 2.4g Languages service is available in (please list pr 2.4h ficiency and if interpreter services are availabl ., )a edicaid eligibility list whether t he service is eli ,ible for Medicaid hi whole or in part: Servke #5 Name: 2.5a Modalities, curriculum, tools used in delivery f service (DO NOT list company history; DO use bullet points 205b 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 h:•,urs/week). If the service has levels, he specific for each level: 2.5c Anticipated d ration of service (i.e. 34 months): 2.5d Three (3), or more, specific goals of the service 2.5e DO use bullet points): hree (3), or more, specific outcomes of service: 2.5f Target p pulati n f the service: 2.5g Languages service is available in please list proficiency and if interpreter services are available): REV. NOV 2020 2 ATTACHMENT C - PROPOSAL 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: 3.2 Will you conduct services in a client's home or in the community? Check one: 3.3 Will you transport clients to and/or from services? Check one: ■ YES 3.4 How many miles are you willing to travel round trip? List a specific number of miles. 3.5 When you calculate mileage, what is your starting point address? YES ■ NO YES ■ NO NO 25 Miles 13611 E 104th Ave, Ste 100, Commerce City, CO 80022 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: Foster parenting workshops 4.1a In-Office/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: &1e Mileage rate: $ Amount $10O N/A $125 $0.53 U nit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: N/a 0 This is paid after the miles listed above. miles miles 4.2 Hourly Service #2 Name: 4.2a In-Office/Video: 4.2b In -Office with Transportation: 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $ Amount U nit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: This is paid after the miles listed above. miles miles 4.3 Hourly Service #3 Name: 4.3a In-Office/Video: 4.3b In -Office with Transportation: 4.3c In -Home or Community: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: 4.3f Mileage rate: $ Amount U nit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: This is paid after the miles listed above. miles miles I REV. NOV 2020 3 ATTACHMENT C - PROPOSAL 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of miles included in rate: miles In -Home or Community: per Hour No. of miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.5c Ire -Home or Community: per Hour No. of miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: REV. NOV 2020 4 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: Reaching HOPE Kinship Services (Therapeutic) Number of services offered on this Attachment C (max 5): Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. 2 If Sery 2.1a 2.1b 2.1c 2.1d 2.1e 2.1f 2.1g 2.1h Sery 2.2a 2.2b 2.2c 2.2d ice ice the #1 Modalities, service Name: curriculum, is a monthly state SECTION a specific 2 minimum - Service please offer number Name(s) different and of direct Information levels. service All monthly hours. packages must package, Individual Kinship Consultation tools used in delivery of service (DO NOT list company history; DO use bullet points): Parent Individual Child consultation Interaction sessions Therapy Anticipated administrative frequency time, of overhead, direct service or travel time with time (i.e. the 4 client/family hours/week). If per the week, service not including has levels, professional be specific for staffing each time, level: 45 minute sessions 1x/week per client Anticipated duration of service (i.e. 3-4 months): 3 months -1 year Three (3), or more, specific goals of the service (DO use bullet points): Increase Increase Increase Decrease Decrease safety and and healthy engagement resolve resolve attachment trauma grief with and healthy symptoms loss symptoms community systems Three (3), or more, specific outcomes of service: Increased Increased Increased Increased Increased recognition frequency identification coping ability skills for of caregiver of for family abuse of trauma and and interactions to meet engagement reactions build safety that the needs and in healthy skills grief/loss are of and healthy, the child social, safety safe, following educational/occupational, plan and within utilize trauma individuals effective communication and and family community systems supports Target population of the service, including age and gender: All therapy families involved services to in Child DV or sex Protective assault offenders Services (all unless ages they 2+ and have all successfully genders). Important completed note that offender RH work. does not provide Languages service is available in (please list proficiency and if interpreter services are available): English, Spanish Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: We are not Medicaid providers, but our understanding is that Medicaid does cover individual therapy Modalities, #2 Name: curriculum, Group Kinship Consultation tools used in delivery of service (DO NOT list company history; DO use bullet points): Trauma focused Caregiving support groups groups Anticipated administrative frequency time, of overhead, direct service time or travel with time (i.e. the client/family 4 hours/week). If per the week, service not has including levels, professional be specific for staffing each level: time, 1 hour 1x/week per client Anticipated duration of service (i.e. 3-4 months): 8-16 weeks depending on group Three (3), or more, specific goals of the service (DO use bullet points): Increase Decrease Learn tools coping isolation to support skills children experiencing trauma reaction symptoms and assist with build coping skills REV. NOV 2020 1 ATTACHMENT C - PROPOSAL 2.2e Three (3), or more, specific outcomes of service: Increased coping skills Increased opportunity for connection with safe individuals Increased parenting skills 2.2f Target population of the service: All families involved in Child Protective Services (all ages 2+ and all genders). Important note that RH does not provide therapy services to DV or sex assault offenders unless they have successfully completed offender work. 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English, Spanish 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: We are not Medicaid providers, but our understanding is that Medicaid does cover group therapy 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: Service # 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): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 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): REV. NOV 2020 2 ATTACHMENT C - PROPOSAL 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Section 3 — Service Access Transportation and 3.1 Will you charge Weld County for transporting clients or mileage? Check one: ❑ YES NO 3.2 Will you conduct services in a client's home or in the community? Check one: ❑ YES NO 3.3 Will you transport clients to and/or from services? Check one: ❑ YES NO 3.4 How miles. many miles are you willing to travel round trip? List a specific number of 0 Miles 3.5 When you calculate mileage, what is your starting point address? 13611 E 104th Ave, Ste 100, Commerce City, CO 80022 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: Individual Kinship Consultation 4.1a In-Office/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: $ Amount $150 N/A N.A $150 $50 N/A Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: N/A N/A This is paid after the miles listed above. miles miles 4.2 Hourly Service #2 Name: Group Kinship Consultation (rate is per client) 4.2a In-Office/Video: 4.2b In -Office with Transportation: 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $ Amount $70 N/A N/A $150 $25 N/A Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: N/A N/A This is paid after the miles listed above. miles miles 4.3 Hourly Service #3 Name: $ Amount Unit Type REV. NOV 2020 3 ATTACHMENT C v PROPOSAL 4.3a In-Office/Video: per Hour 4.3b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.3c In -Home or Community: per Hour No. of miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of miles included in rate: miles In -Home or Community: per Hour No. of miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 H curly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.5c In -Home or Community: per Hour No. of miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 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. 4.8 Monitored Sobriety Pr oviders — List your rates in the box below. Provider special notes: REV. NOV 2020 4 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: Reaching HOPE Mental Health Services Number of services offered on this Attachment C (max 5): Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. 5 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: Individual/Family 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Reaching HOPE Model of Treatment for Complex Trauma in Family Systems Parent Child Interaction Therapy Trauma Focused Cognitive Behavioral Therapy *These all include working towards reunification 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: 45 minute sessions 1x/week per client 2.1c Anticipated duration of service (i.e. 3-4 months): 3 months -1 year 2.1d Three (3), or more, specific goals of the service (DO use bullet points): Increase safety Decrease and resolve trauma symptoms Decrease and resolve grief and loss symptoms Increase healthy attachment Increase engagement with healthy community systems 2.1e Three (3), or more, specific outcomes of service: Increased recognition of abuse and build safety skills and safety plan within individuals and family systems Increased coping skills for trauma reactions and grief/loss Increased frequency of family interactions that are healthy, safe, and utilize effective communication Increased ability for caregiver to meet the needs of the child following trauma Increased identification of and engagement in healthy social, educational/occupational, and community supports 2.1f Target population of the service, including age and gender: All families involved in Child Protective Services (all ages 2+ and all genders). Important note that RH does not provide therapy services to DV or sex assault offenders unless they have successfully completed offender work. 2.1g Languages service is available in (please list proficiency and if interpreter services are available): English, Spanish 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: We are not Medicaid providers, but our understanding is that Medicaid does cover individual therapy Service #2 Name: Group Therapy 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Adolescent trauma recovery Adult domestic violence recovery Trauma informed social skills (Elementary aged and Middle School aged) Other trauma focused groups provided upon request or need 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 hour 1x/week per client REV. NOV 2020 1 ATTACHMENT C - PROPOSAL 2.2c Anticipated duration of service (i.e. 3-4 months): 8-16 weeks depending on group 2.2d Three (3), or more, specific goals of the service (DO use bullet points): Increase Safety Decrease isolation Decrease trauma reaction symptoms and build coping Increase coping skills 2.2e Three (3), or more, specific outcomes of service: Increased safety skills for individuals within group Increased coping skills Increased opportunity for connection with safe individuals Increased social skills 2.2f Target population of the service: All families involved in Child Protective Services (all ages 2+ and all genders). Important note that RH does not provide therapy services to DV or sex assault offenders unless they have successfully completed offender work. 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English, Spanish 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: We are not Medicaid providers, but our understanding is that Medicaid does cover group therapy Service #3 Name: Reaching HOPE Multi -Family Intensive Outpatient Programing 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Per week, program includes 3 services per week: A. 1 individual therapy session B. 1 Multi -Family group family session C. 1 age specific group (e.g. adolescent) OR 1 trauma specific group (e.g. sex assault survivor, sibling support, domestic violence support) 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: 2.75 hours per week per person in family 2.3c Anticipated duration of service (i.e. 3-4 months): 12 weeks 2.3d Three (3), or more, specific goals of the service (DO use bullet points): Increase safety Provide psychoeducation on individual and family trauma reaction symptoms and dynamics Decrease trauma symptoms Increase healthy attachment and connection Build support for families and individuals 2.3e Three (3), or more, specific outcomes of service: Increased safety skills and abuse recognition Increased knowledge and understanding of trauma symptoms and family dynamics Increased coping skills for trauma reactions that reduce symptom severity Increase in family report of: Connectedness Feelings of safety Recognition of abusive behaviors 2.3f Target population of the service: Families with a history of abuse and neglect. Caregivers should be non -offending parents and/or permanent caregivers (e.g. adoptive or kinship) who would benefit from additional education, support and safety skill building. Children and adolescents ages 2+ where at least one of the children in the family has a trauma history. 2.3g Languages service is available in (please list proficiency and if interpreter services are available): English, Spanish 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Medicaid does cover individual therapy and group therapy; unknown coverage of Family !OP programing. We are not Medicaid providers REV. NOV 2020 2 ATTACHMENT C - PROPOSAL Service #4 Name: Psychological Testing -Full 2.4a Modalities, curriculum, to Is used in delivery f service (DO NOT list company history; DO use bullet points): A full Psychological Evaluation includes: Assessment/testing of at least 3 areas of functioning: e.g. Cognitive, Adaptive, Personality, Achievement, Trauma symptoms, any necessary screening measures (e.g. Executive Functioning, sensory Profile, etc.) Clinical Interview Records Review Collateral Interviews Full report (summary of client history; assessment results; diagnostic impressions; psychoeducation around trauma symptoms (when appropriate); recommendations (as appropriate) for: psychotherapy treatment, education, s:scial skills, parenting strategies, etc. Feedback Session that includes all pertinent parties (with permission of the client and/or caregiver) 2.4b Anticipated frequency of direct service time with the client/family per week, not including pr,•-fessional staffing time, administrative time, verhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 8-16 hours of face-to-face testing, 1 hour face-to-face feedback session, (20-30 hours of examiner reviewing records, interviewing collaterals if applicable, scoring tests, writing up test results into final report) 2.4c Anticipated durati n of service (i.e. 3-4 months): 1-2 weeks for test administration; 1 month to complete all interviews, write up report, and prvide feedback session 2.4d Three (3), or more, specific goals f the service (DO use bullet points): Assist client, treatment team, and support system with understanding individual's clinical presentation and approach to the world Improve knowledge for caregivers/support system to manage symptom presentation and needs of individual Apprpriate recommendations for presenting concerns Decrease barriers to progress in CPS case 2.4,., Three (3 , or more, specific outcomes of service: Provide cmprehensive written assessment report that includes: Accurate diagnosis to clarify mental health symptoms Personalized, trauma -informed treatment recommendations Recommendations across multiple domains of functioning, as appropriate to presenting issues Provide verbal feedback that helps individual and team better understand the needs of the individual 2.4f Target p pulation of the service: All genders, ages 2+ where concerns exist that there have been inappropriate or incorrect mental health diagnoses, where treatment has been unsuccessful, where the clinical presentation is complex and difficult for the support system to understand and engage in healthy and productive ways. This includes children/youth, biological parents, adoptive parents and kinship providers and others, as appropriate. 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 r in part: Yes, but difficult to get Medicaid approval Service #5 Name: 2.Sa Modalities, curriculum, t ols used in delivery of servic D NOT list company hist ry; DO use bullet points): 2.Sb 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 leels, 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 us bullet points): 2.5e Three (3), r more, specific outcom.s of service: 2.5f Target population of the service: REV. NOV 2020 3 ATTACHMENT C - PROPOSAL 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: 3.2 Will you conduct services in a client's home or in the community? Check one: 3.3 Will you transport clients to and/or from services? Check one: ■ YES 3.4 How many miles are you willing to travel round trip? List a specific number of miles. 3.5 When you calculate mileage, what is your starting point address? ■ ■ YES ►4 NO YES NO NO 0 Miles 13611 E 104th Ave, Ste 100, Commerce City, CO 80022 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: Individual/Family 4.1a In-Office/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: $ Amount $200 N/A N/A $150 $50 N/A U nit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: N/a N/A This is paid after the miles listed above. miles miles 4.2 Hourly Service #2 Name: Group Therapy 4.2a In-Office/Video: 4.2b In -Office with Transportation: 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $ Amount $70 N/A N/A $150 $50 N/A U nit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: N/A N/A This is paid after the miles listed above. miles miles 4.3 Hourly Service #3 Name: 4.3a 4.3b 4.3c 4.3d 4.3e 4.3f REV. NOV 2020 RH !OP In-Office/Video: In -Office with Transportation: In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: $ Amount $100 N/A N/A $150 $50 N/A Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: This is paid after the miles listed above. miles miles 4 ATTACH E T C ® P SAL 4.4 Hourly Service #4 Name: Psychological Assessment -Full 4.4a In-Office/Video: 4.4b In -Office with Transportation: In-Hme ::ar C*mmunity: FTM, TIM, Pr•.f. Staffing: 4.4c 4.4d 4.4e No show: Mileage rate: $ Amount $350 N/A N/A Included $150 N/A Unit Type per Hour per Hour per Htur per H:*ur per N*, Show per Mile N :•. , sf mils included in rate: N o.. f miles included in rate: N/A N/A This is paid after the miles listed above. miles miles 43 Hourly Service #5 Name: 4.5a 4.5b 4.$5-c 4.5d 4.5e 4.5f In-Office/Video: In-Offic-, with Transportation: In -H ,,me *r Community: FTM, TDM, Pr f. Staffing: No show: Mileage rate: $ Amount Unit Type per H ur per Hour per Hour per Hour per No Show per Mile N o. of miles included in rate: No. of miles included in rate: This is paid after the miles listed above. miles miles 4.6 Monthly Service Rates (each level must be listed): 4.6a Service Name with Level 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.61 4.6j Rate per Month No. of Direct Service Hours: 4.7 Home Study Providers — List your rates in the box bel we 4.8 Monitored Sobriety Providers — List your rates in the box belo Provider special notes: REV. NOV 2020 5 ATTACHMENT C - PROPOSAL Please type yur answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Pr®gram Area: Reaching HOPE Sexual Abuse Treatment Number of services offered on this Attachment C (max 5): Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. 5 SECTION 2 — Service Name(s) and Information If the service is a monthly package, please offer different Ie.Os. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: Individual/Family 2.1a Modalities, curriculum, s used in delivery of service (DO NOT list company history; DO use bullet points): Reaching HOPE Model of Treatment for Complex Trauma in Family Systems Parent Child Interaction Therapy Trauma Focused Cognitive Behavi:•;ral Therapy *These all include working towards reunification 2.1b Anticipat- d 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: 45 minute sessions 1x/week per client 2.1c Anticipated durati n of service (i.e. 3-4 months): 3 months -1 year laid Three (3), or more, specific goals f the service (DO use bullet points): Increase safety Decrease and resolve trauma symptoms Decrease and resolve grief and loss symptoms Increase healthy attachment Increase engagement with healthy community systems 2.1e Three (3), or more, sp cific outcomes of service: Increased recognition of abuse and build safety skills and safety plan within individuals and family systems Increased coping skills for trauma reactions and grief/loss Increased frequency ,of family interactions that are healthy, safe, and utilize effective communication Increased ability for caregiver to meet the needs of the child following trauma Increased identification of and engagement in healthy social, educational/occupational, and community supports 2.1f Target p .; pulation of the service, including age and gender: All families involved in Child Protective Services (all ages 2+ and all genders). Important note that RH does not provide therapy services to DV or sex assault :•ffenders unless they have successfully completed offender work. 2.1g Languages service is available in (please list proficiency and if interpreter services are vailable): English, Spanish 2.lh Medicaid Iigibility — list whether the service is eligible for Medicaid in whole or in part: We are not Medicaid prviders, but our understanding is that Medicaid does cover individual therapy Service #2 Name: Group Therapy 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Adolescent trauma recovery Adult dmestic violence recovery Trauma informed social skills (Elementary aged and Middle School aged) Other trauma focused groups provided upon request or need 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrativ time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be sp cific for each level: 1 hour 1x/week per client REV. NOV 2020 1 ATTACHMENT C - PROPOSAL 2.2c Anticipated duration of service (i.e. 3-4 months): 8-16 weeks depending on group 2.2d Three (3), or more, specific goals of the service (DO use bullet points): Increase Safety Decrease isolation Decrease trauma reaction symptoms and build coping Increase coping skills 2.2e Three (3), or more, specific outcomes of service: Increased safety skills for individuals within group Increased coping skills Increased opportunity for connection with safe individuals Increased social skills 2.2f Target population of the service: All families involved in Child Protective Services (all ages 2+ and all genders). Important note that RH does not provide therapy services to DV or sex assault offenders unless they have successfully completed offender work. 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English, Spanish 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: We are not Medicaid providers, but our understanding is that Medicaid does cover group therapy Service #3 Name: Reaching HOPE Multi -Family Intensive Outpatient Programing 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Per week, program includes 3 services per week: A. 1 individual therapy session B. 1 Multi -Family group family session C. 1 age specific group (e.g. adolescent) OR 1 trauma specific group (e.g. sex assault survivor, sibling support, domestic violence support) 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: 2.75 hours per week per person in family 2.3c Anticipated duration of service (i.e. 3-4 months): 12 weeks 2.3d Three (3), or more, specific goals of the service (DO use bullet points): Increase safety Provide psychoeducation on individual and family trauma reaction symptoms and dynamics Decrease trauma symptoms Increase healthy attachment and connection Build support for families and individuals 2.3e Three (3), or more, specific outcomes of service: Increased safety skills and abuse recognition Increased knowledge and understanding of trauma symptoms and family dynamics Increased coping skills for trauma reactions that reduce symptom severity Increase in family report of: Connectedness Feelings of safety Recognition of abusive behaviors 2.3f Target population of the service: Families with a history of abuse and neglect. Caregivers should be non -offending parents and/or permanent caregivers (e.g. adoptive or kinship) who would benefit from additional education, support and safety skill building. Children and adolescents ages 2+ where at least one of the children in the family has a trauma history. 2.3g Languages service is available in (please list proficiency and if interpreter services are available): English, Spanish 2.3h Medicaid eligibility list whether the service is eligible for Medicaid in whole or in part: Medicaid does cover individual therapy and group therapy; unknown coverage of Family lOP programing. We are not Medicaid providers REV. NOV 2020 2 Al D AC {MIEN c o rV� Service #4 Name: Psychological Testing -Full 2.4a Modalities, curriculum, cols used in delivery of service (DO NOT list company history; DO us bullet points): A full Psychol gical Evaluatisen includes: Assessment/testing of at least 3 areas of functioning: e.g. Cognitive, Adaptive, Personality, Achievement, Trauma symptoms, any necessary screening measures (e.g. Executive Functioning, sensory Pr file, etc.) Clinical Interview Records Review Collateral Interviews Full report (summary of client history; assessment results; diagnostic impressions; psychoeducation around trauma symptoms (when appropriate); recommendations (as appropriate) fr: psychotherapy treatment, education, social skills, parenting strategies, etc. Feedback Session that includes all pertinent parties (with permission of the client and/or caregiver) * 2.4b Anticipated frequency of direct service time with the client/family per eek, not including professional staffing time, administrative time, overhead, r travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 346 hours of face-to-face testing, 1 hour face-to-face feedback session, ;20-3o h:•,urs of examiner reviewing records, interviewing collaterals if applicable, scoring tests, writing up test results int, final report) 2.4c Anticipated duration of service (i. 4•1 3-4 months): F2 seeks for test administration; 1 month to complete all interviews, write up report, and provide feedback sessin 2.4d Three (3), or more, specific goals of the service Q D use bullet points): Assist client, treatment team, and support system with understanding individual's clinical presentation and approach t the w•rld Impr• ve knowledge for caregivers/support system to manage symptom presentation and needs of individual Appropriate recommendations for presenting cncerns Decrease barriers to progress in CPS case 2.4e Three 3), or more, specific outcomes of service: Provide comprehensive written assessment report that includes: Accurate diagnosis to clarify mental health symptoms Pers•.nalized, trauma -informed treatment recommendations Recommendations across multiple domains of functioning, as appropriate to presenting issues Provide verbal feedbacK that helps individual and team better underst nd the needs of the individual 2.4f Target p 2.4 pulation of the service: All genders, ages 2+ where concerns exist that there have been inappropriate or incorrect mental health diagnoses, wher treatment has been unsuccessful, where the clinical presentation is complex and difficult for the support system to understand and engage in healthy and productive ways. This includes children/youth, biological parents, adoptive parents and kinship providers and others, as appropriate. Lan Ce) ua es service is available in (please list proficiency and if interpreter services are available): English, Spanish 2.4h edicaid eligibility m list wheth r the service is eligible f edicaid in whole or in part: Yes, but difficult to get Medicaid approval Service #5 Nam 2a5tt. Modalities, curriculum, tools used in delivery f service (DO NOT list company history; DO use bullet prints): 205b 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/weekl 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): REV. NOV 2020 3 ATTACHMENT C - PROPOSAL 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: 3.2 Will you conduct services in a client's home or in the community? Check one: 3.3 Will you transport clients to and/or from services? Check one: YES 3.4 How many miles are you willing to travel round trip? List a specific number of miles. 305 When you calculate mileage, what is your starting point address? ■ YES YES NO 0 Miles NO NO 13611 E 104th Ave, Ste 100, Commerce City, CO 80022 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) ® 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: Individual/Family 4.1a In-Office/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: $ Amount $200 N/A N/A $ 1so $50 N/A U nit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: N/a N/A This is paid after the miles listed above. miles miles 4.2 Hourly Service #2 Name: Group Therapy 4.2a In-Office/Video: 4.2b In -Office with Transportation: 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $ Amount $70 N/A N/A $150 $50 N/A U nit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: N/A N/A This is paid after the miles listed above. miles miles 4.3 Hourly Service #3 Name: RH lOP 4.3a In-Office/Video: 4.3b In -Office with Transportation: 4.3c In -Home or Community: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: 4.3f Mileage rate: $ Amount $100 N/A N/A $150 $50 N/A U nit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: N/A N/A This is paid after the miles listed above. miles miles REV. NOV 2020 4 ATTACHMENT C - PROPOSAL 4.4 Hourly Service #4 Name: Psychological Assessment -Full 4.4a In-Office/Video: 4.4b In -Office with Transportation: In -Home or Community: 4.4c FTM, TDM, Prof. Staffing: 4.4d No show: 4.4e Mileage rate: $ Amount $350 N/A N/A Included $150 N/A Unit Type per service per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: This is paid aft N/A N/A r the miles listed above. miles miles 4.5 Hourly Service #5 Name: 4.5a In-Office/Video: 4.5b In -Office with Transportation: 4.5c In -Home or Community: 4.5d FTM, TDM, Prof. Staffing: 4.5e No show: 4.5f Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of miles included in rate: No. of miles included in rate: N/A N/A This is paid after the miles listed above. miles miles 4.6 Monthly Service Rates (each level must be listed): Service Name with Level 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j Rate per Month No. of Direct Service Hours: 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: REV. NOV 2020 5 A d - ACHMENT C ® PPSAL Please type yur answers in the bxes below or check the appr } priate box. Bidder's Le Program i all Nam rea: SECTI•I 1— Provider and Pr gram Area Infs rim tip zn Reaching HOPE Relinquishment Counseling N Program Areas are listed in c,.>!Limn 1 of the table located in Item XI of the Request Y for Proposal starting on page 13. umber of services offered on this At achment C (max 5): u may complete anther ..tt chment Cif you hove more than S. 1 SECTION 2 — Service rn (s) and Information If the service is a monthly package, please offer different levels. All monthly packa • es must state a s3ecific minimum number of direct service hours. Service #1 Name: Individual Relinquishment Counseling 2.1a Modalities, curriculum, tools used in delivery of sere ice ( 0 NOT list company history; DO use bullet points): Individual therapy including the nec Children's Code ssary requir merits f relinquishment counseling as outlined by the Clorad * 2s1b <nticipat,d frequency administrative time, L.t f direct service time ith the client/family per week, not including professi•nal staffing time, erh:-?ad, or travel time (La, 4 hours/we--k). If the service has levels, be specific fir each Bev l: 45 minute sessi ns ix/week per client 2.1E Anticipated durati n f service (Leo 3-4 months): 1-6 weeks 2.1d Three (3), rm re, specific goals of the service DO use bullet points): 1) Promote child and family safety through relinquishment counseling that includes, but is not limited t following (per the Children's C,de): a) Informatin to the relinquishing parent concerning the permanence of the decision and th decision on the relinquishing parent now and in the future b Informati n concerning each parent's c replete medical and s cial histories the impact -f such c) In the case of pregnancy, referral of the woman for medical care and 'or determination of eligbility f medical assistance d) Information concerning alternatives to relinquishment and referral to private and public resources that may meet the parent's needs e) Relinquishment services necessary to protect the interests and we0fare of a child born in a state institution f) Information to the child's parent that if he or she applies f public assistance for himself or herself and the child, he or she must cooperate with the child supprt enforcement unit for the establishment and enforcement f a child support order" g) the information "obtained by the departent and the child placement agency in the c . urse if relinquishment counseling" is deemed confidential "unless the parent provides written permission or a release of information." Late Three (3), ore, specific outcomes of service: Parent demonstrates empathy for the experiences and needs of his/her child(ren) Parent demonstrates understanding of the permanence of their decision and the impact to him/her now and in the future Parent demonstrates understanding of what a protective parenting, role and related respr•nsibility entails, the c:,nsequences to the children when there is failure to protect, and demonstrates a desire- f*rr the child(ren) t�• be safe and protected 201f Target p 2.1g pulati n of the service, including age and gender: Parents involved Child Prtectiv Services in hich relinquishment of parental rights is being considered. a i gua Ig) �is s servic i is available in (please list proficiency and if interpreter services are available): English, Spanish REV. NOV 2020 �. ATTACHMENT C - PROPOSAL 2.1h Medicaid eligibility list whether the service is eligible for Medicaid in whole or in part: Unknown --We are not Medicaid providers 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. 3-4 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: 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: 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. NOV 2020 2 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: Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: 3.2 Will you conduct services in a client's home or in the community? Check one: 3.3 Will you transport clients to and/or from services? Check one: 3.4 ■ YES How many miles are you willing to travel round trip? List a specific number of miles. 3.5 When you calculate mileage, what is your starting point address? ■ ■ YES NO YES NO NO 0 Miles 13611 E 104th Ave, Ste 100, Commerce City, CO 80022 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 -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: $ Amount $150 N/A N/A $150 $50 Unit Type per Hour per Hour per Hour per Hour per No Show No. of miles included in rate: No. of miles included in rate: N/A N/A miles miles REV. NOV 2020 3 ATTACHMENT C - PROPOSAL 4.1e Mileage rate: N/A per Mile This is paid after the miles listed above. 4,2 Hourly Service #2 Name: $ Amount Unit Type 4.2a In-Office/Video: per Hour 4.2b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.2c In -Home .r Community: per Hour No. of miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: per Hour 4.2e No show: per No Show 4.2f Mileage rate: per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: per Hour 4.3b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.3c In -Home or Community: per Hour No. of miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per H tur 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed ab ve. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In ffice with Transportation: per H,• ur No. of miles included in rate: miles In -Home or Community: per Hour No. of miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.5c In -Home or Community: per Hour No. of miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 43 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. REV. NOV 2020 4 ATTACHMENT C - PROPOSAL Provider special notes: REV. NOV 2020 5 ATTACHMENT D - STAFF DATA SHEET Bidder Must List All Staff Who Will Administer the Proposed Service(s) BIDDER'S LEGAL NAME (As it appears on the W-9): AGENCY CONTACT: Tiffany Brimberry Reaching HOPE PHONE NUMBER: 720-347-8769 EMAIL: services@reachinghope.org PROPOSED SERVICE(S): Foster Parent Training, Foster Parent Consultation, Kinship Relinquishment Counseling Consultation, Mental Health, Sexual Abuse Treatment, Legal Last Name Initial Middle Previous Name Of applicable) Legal Last Legal First Name Service Type Credentials Licensure/ DORA # (If applicable) Born R Ambra All Licensed Psychologist PSY-3519 Austin A Aubrey All Licensed Psychologist PSY-3749 Brimberry Tiffany All Licensed Psychologist PSY-4679 Fishman Loraine I All Psychologist Candidate PSYC-14555 a i v CHILD WELFARE REQUEST FOR PROPOSAL 2021-22 - VARIOUS SERVICES BID NO. B2100042 REACHOP-01 CARYAI 4i,/ -- CERTIFICATE OF LIABILITY INSURANCE ` DATE(MM/DD/YYYY) 11/19/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 0C41366 E -COMP, A Division of Granite Insurance Brokers 6600 Koll Center Parkway #100 Pleasanton, CA 94566 CONTACT Yaneth Carrillo NAME: PHONE FAX (A/C, No, Eat): (A/C, No): nooREss, ycarrillo@goecomp.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Hartford Underwriters Insurance Company 30104 INSURED Reaching HOPE 13611 E 104th Ave Ste 100 Commerce City, CO 80022 INSURER B:Amtrust Ins Co of Kansas Inc. (reports att) 15954 INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 76SBWAHBEJR 11/4/2020 11/4/2021 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) 1,000,000 $ MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE Business LIMIT APPLIES PO - JET Liability General PER: LOC Aggre GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS E�ONLY AUTOS ONLY X SCHEDULED AUTOS AUOTOS ONLYY 76SBWAH8EJR 11/4/2020 11/4/2021 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per PROPERTY DAMAGE $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N /A KWC1230552 1/1/2021 1/1/2022 "y PER STATUTE OH ET E.L. EACH ACCIDENT 100,000 $ E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT 500,000 $ A A Property DataBreach:Ded$2,500 76SBWAH8EJR 76SBWAHBEJR 11/4/2020 11/4/2020 11/4/2021 11/4/2021 BPP R/C Limit-Retro11/4/2020 35,422 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Weld County 1150 O St Greeley, CO 80631 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC RO D® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/09/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Trust Risk Management Services, Inc. doing business in CO as Potomac Risk Management Services, Inc. 1791 Paysphere Circe Chicago, IL 60674 CONTACT NAME: Trust Risk Management Services, Inc PHONE I FAX 877.637.9700 (NC, No): 877 251.5111 EMAIL ADDRESS: °1 tims.com INSURERS) AFFORDING COVERAGE NAIC 0 INSURER A: ACE American Insurance Company 22667 INSURED Reaching HOPE 13611 E 104Th Ave Ste 100Ste 550 Commerce City, CO 80022 INSURER B: INSURER c: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_ NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MISR LTR TYPE OF INSURANCE ADDL. RISK SUER Moo POLICY NUMBER POLICY EFF (YY10mYYYY) POLICY EXP (amDITYYY) LIMITS COPAMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR TO RENTED PREMISES PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENII AGGREGATE LIMIT APPLIES PRO- PER LOC GENERAL AGGREGATE $ PROOUCTS-COMPIOP AGG $ AUTOMOBILE — _ — LIABILITY ANY AUTO ALL D AUTOS HIRED AUTOS — SCHEDULED AUTOS ANON -OWNED ms COMBINED SINGLE LIMIT (Ea accidera) $ BODILY INJURY (Per Person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS UAB OM IR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DM I I RETENTION $ $ SATION AND EMPLOYERSWORKERS �� YIN NIA I ISTATUTE I IER $ ELEACH ACCIDENT S ANY PROPRIETORIPARTNERIEXECUTNE OFFICER/EMBER EXCLUDED? Mandatory in NH)If El. DISEASE -EA EMPLOYEE EL DISEASE - POLICY LIMIT $ yes, describe unde DESCRIPTION of errPERAT1ONs below A Psychologist's Professional Liability Retroactive Date: 11/16/2010 Y 78G26095566 11/16/2020 11/16/2021 Each Incident Annual Aggregate $1,000,000 $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is wed): CERTIFICATE HOLDER CANCELLATION Additional Insured Board of County Commissioners of Weld County and its Officers/ Employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD EXHIBIT C SCOPE OF SERVICES Contractor will provide Foster Parent Consultation, Foster Parent Training, Kinship Services (Therapeutic), Mental Health Services, Sexual Abuse Treatment, and Relinquishment Counseling, as referred by the Department. 1. Foster Parent Support a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Parent coaching and psychoeducation. ii. Mental health services. b. Anticipated Frequency of Services: i. One (1) 45 -minute session per week, per client. c. Anticipated Duration of Services: i. One (1) day to three (3) months depending on modality. d. Goals of Services: i. Preserve and/or prepare client for placement. ii. Increase healthy attachment and connection. iii. Increase knowledge and understanding of trauma symptoms. e. Outcomes of Services: i. Equip foster parents with tools to reduce conflict between foster child and foster parent and/or siblings. ii. Increase the knowledge and ability of a foster parent to meet the trauma symptom needs of the foster child. iii. Equip the foster parent with tools that are specific to the needs of the foster child. f. Target Population: i. All ages and genders. ii. Foster parents who are struggling with child(ren) currently placed in their care or those in need of additional support to prepare for a challenging upcoming placement. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Contractor will not transport clients. ii. Services will be provided at the Contractor's office located at 13611 East 104th Avenue, Suite 100, Commerce City, Colorado 80022. 2. Foster Parenting Workshops a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Group training on topics specific to the needs of foster parents. ii. Example training topics include, but are not limited to, sexual abuse, sexual behavior in children, attachment needs of children in foster care, and self -care. 1 b. Anticipated Frequency of Services: i. Two (2) to eight (8) hours per workshop. c. Anticipated Duration of Services: i. One (1) day per workshop. d. Goals of Services: i. Prepare foster parents to best meet the needs of children in foster care. ii. Prepare foster parents for the emotional drain they can expect and ways to avoid vicarious trauma. iii. Connect foster parents as support systems for one another. e. Outcomes of Services: i. Equip foster parents with enhanced tools to help foster children. ii. Equip foster parents with self -care tools. iii. Provide opportunity for foster parents to share ideas and support one another. f. Target Population: i. All foster parents. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Contractor will not transport clients. ii. Services will be provided at the Contractor's office located at 13611 East 104th Avenue, Suite 100, Commerce City, Colorado 80022. 3. Individual Kinship Consultation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Parent/Child Interaction Therapy. ii. Individual consultation sessions. b. Anticipated Frequency of Services: i. One (1) 45 -minute session per week, per client. c. Anticipated Duration of Services: i. Three (3) months to one (1) year. d. Goals of Services: i. Increase safety between kinship parent and child(ren). ii. Decrease and resolve trauma symptoms. iii. Decrease and resolve grief and loss symptoms. iv. Increase healthy attachment. v. Increase engagement with healthy community systems. e. Outcomes of Services: i. Increase the kinship parent's recognition of abuse and ability to build safety skills and safety plans within the individual and family systems. ii. Kinship parents will have increased coping skills for trauma reactions and grief/loss. 2 iii. Increased frequency of family interactions that are healthy, safe, and utilize effective communication. iv. Increased ability for caregiver to meet the needs of the child following trauma. v. Increased identification of and engagement in healthy social, educational/occupational, and community supports. f. Target Population: i. All families involved in Child Protective Services including all genders and those ages two (2) and older. However, Contractor does not provide therapy services to domestic violence or sexual assault offenders, unless they have successfully completed offender courses. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Contractor will not provide transportation to clients. ii. Services will be provided at the Agency's location at 13611 East 104th Avenue, Suite 100, Commerce City, Colorado 80022. 4. Group Kinship Consultation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Trauma focused groups. ii. Caregiving support groups. b. Anticipated Frequency of Services: i. One (1) hour per week, per client. c. Anticipated Duration of Services: i. Eight (8) to sixteen weeks, total time will depend on the group. d. Goals of Services: i. Decrease isolation among caregivers. ii. Learn tools to support children experiencing trauma reaction symptoms and assist with build coping skills. iii. Increase coping skills. e. Outcomes of Services: i. Increased coping skills. ii. Increased opportunity for connection with safe individuals. iii. Increased parenting skills. f. Target Population: i. All families involved in Child Protective Services including all genders and those ages two (2) and older. However, Contractor does not provide therapy services to domestic violence or sexual assault offenders, unless they have successfully completed offender courses. g. Language: i. English and Spanish. 3 h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Contractor will not transport clients. ii. Services will be provided at the Contractor's office located at 13611 East 104th Avenue, Suite 100, Commerce City, Colorado 80022. 5. Mental Health Services — Individual/Family Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor's model of treatment for complex trauma in family systems includes: 1. Parent/Child interaction therapy. 2. Trauma focused cognitive behavioral therapy. 3. The focus will be working towards reunification. b. Anticipated Frequency of Services: i. One (1) 45 -minutes session per week, per client. c. Anticipated Duration of Services: i. Three (3) months to one (1) year. d. Goals of Services: i. Increase safety. ii. Decrease and resolve trauma symptoms. iii. Decrease and resolve grief and loss symptoms. iv. Increase healthy attachment. v. Increase engagement with healthy community systems. e. Outcomes of Services: i. Increased recognition of abuse and build safety skills and safety plan within individuals and family systems. ii. Increased coping skills for trauma reactions and grief/loss. iii. Increased frequency of family interactions that are healthy, safe, and utilize effective communication. iv. Increased ability for caregiver to meet the needs of the child following trauma. v. Increased identification of and engagement in healthy social, educational/occupational, and community supports. f. Target Population: i. All families involved in Child Protective Services including all genders and those ages two (2) and older. However, Contractor does not provide therapy services to domestic violence or sexual assault offenders, unless they have successfully completed offender courses. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Contractor will not transport clients. 4 ii. Services will be provided at the Contractor's office located at 13611 East 104th Avenue, Suite 100, Commerce City, Colorado 80022. 6. Mental Health Services — Group Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Three focus groups are planned, other trauma focus groups may be provided upon request: 1. Adolescent trauma recovery. 2. Adult domestic violence recovery. 3. Trauma informed social skills for clients who are elementary and middle school aged. b. Anticipated Frequency of Services: i. One (1) hour per week, per group. c. Anticipated Duration of Services: i. Eight (8) to 16 weeks, depending on the group. d. Goals of Services: i. Increase Safety. ii. Decrease isolation. iii. Decrease trauma reaction symptoms and build coping. iv. Increase coping skills. e. Outcomes of Services: i. Increased safety skills for individuals within group. ii. Increased coping skills. iii. Increased opportunity for connection with safe individuals. iv. Increased social skills. f. Target Population: i. All families involved in Child Protective Services including all genders and those ages two (2) and older. However, Contractor does not provide therapy services to domestic violence or sexual assault offenders, unless they have successfully completed offender courses. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Contractor will not transport clients. ii. Services will be provided at the Contractor's office located at 13611 East 104th Avenue, Suite 100, Commerce City, Colorado 80022. 7. Mental Health Services — Reaching HOPE Multi -Family Intensive Outpatient Programming a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Three (3) services are provided per week while participating in this program: 1. One (1) individual therapy session. 2. One (1) multi -family group family session. 5 3. One (1) age specific group such as adolescent or one (1) trauma specific group such as sexual assault survivor, sibling support, or domestic violence support. b. Anticipated Frequency of Services: i. Two and three quarter (2.75) hours per week, per person in the family. c. Anticipated Duration of Services: i. Twelve (12) weeks. d. Goals of Services: i. Increase safety. ii. Provide psychoeducation on individual and family trauma reaction symptoms and dynamics. iii. Decrease trauma symptoms. iv. Increase healthy attachment and connection. v. Build support for families and individuals. e. Outcomes of Services: i. Increased safety skills and abuse recognition. ii. Increased knowledge and understanding of trauma symptoms and family dynamics. iii. Increased coping skills for trauma reactions that reduce symptom severity. iv. Increase in family report of: 1. Connectedness 2. Feelings of safety 3. Recognition of abusive behaviors f. Target Population: i. Families with a history of abuse and neglect. ii. Participating caregivers should be non -offending parents and/or permanent caregivers such as adoptive or kinship families. Specifically, caregivers who would benefit from additional education, support, and safety skill building. iii. Children and adolescents ages two (2) and older where at least one of the children in the family has a history of trauma. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. 1. Service Access and Transportation: i. Contractor will not transport clients. ii. Services will be provided at the Contractor's office located at 13611 East 104th Avenue, Suite 100, Commerce City, Colorado 80022. 8. Mental Health Services — Psychological Full Testing a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Assessment and testing of at least three (3) areas of functioning: Cognitive, Adaptive, Personality, Achievement, and Trauma symptoms, as well as any necessary screening measures such as Executive Functioning and sensory profile. ii. Clinical Interview. iii. Records Review. iv. Collateral Interviews. v. Full report will include a summary of client history, assessment results, diagnostic impressions, psychoeducation around trauma symptoms (when appropriate), 6 recommendations (as appropriate) for: psychotherapy treatment, education, social skills, and parenting strategies. vi. Feedback Session that includes all pertinent parties (with permission of the client and/or caregiver). b. Anticipated Frequency of Services: i. Frequency will vary with each case and is dependent upon the needs of the client and what testing is required. c. Anticipated Duration of Services: i. One (1) to two (2) weeks for test administration. The report will be completed within one (1) month. d. Goals of Services: i. Assist client, treatment team, and support system with understanding a client's individual clinical presentation and approach to the world. ii. Improve knowledge for caregivers and support systems to manage symptom presentation and needs of individual. iii. Provide appropriate recommendations for presenting concerns. iv. Decrease barriers to progress in Child Protective Services case e. Outcomes of Services: i. Provide comprehensive written assessment report that includes: 1. Accurate diagnosis to clarify mental health symptoms. 2. Personalized, trauma -informed treatment recommendations. 3. Recommendations across multiple domains of functioning, as appropriate to presenting issues. ii. Provide verbal feedback that helps individual and team better understand the needs of the individual. f. Target Population: i. All genders and ages two (2) or older where concerns exist that there has been an inappropriate or incorrect mental health diagnoses. ii. In cases where treatment has been unsuccessful, where the clinical presentation is complex and difficult for the support system to understand and engage in healthy and productive ways. This includes children or youth, biological parents, adoptive parents, kinship providers, and others as appropriate. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Contractor will not transport clients. ii. Services will be provided at the Contractor's office located at 13611 East 104th Avenue, Suite 100, Commerce City, Colorado 80022. 9. Sexual Abuse Treatment — Individual/Family Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor's model of treatment for complex trauma in family systems includes: 1. Parent/Child interaction therapy. 2. Trauma focused cognitive behavioral therapy. 7 3. The focus will be working towards reunification. b. Anticipated Frequency of Services: i. One (1) 45 -minutes session per week, per client. c. Anticipated Duration of Services: i. Three (3) months to one (1) year. d. Goals of Services: i. Increase safety. ii. Decrease and resolve trauma symptoms. iii. Decrease and resolve grief and loss symptoms. iv. Increase healthy attachment. v. Increase engagement with healthy community systems. e. Outcomes of Services: i. Increased recognition of abuse and build safety skills and safety plan within individuals and family systems. ii. Increased coping skills for trauma reactions and grief/loss. iii. Increased frequency of family interactions that are healthy, safe, and utilize effective communication. iv. Increased ability for caregiver to meet the needs of the child following trauma. v. Increased identification of and engagement in healthy social, educational/occupational, and community supports. f. Target Population: i. All families involved in Child Protective Services including all genders and those ages two (2) and older. However, Contractor does not provide therapy services to domestic violence or sexual assault offenders, unless they have successfully completed offender courses. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Contractor will not transport clients. ii. Services will be provided at the Contractor's office located at 13611 East 104th Avenue, Suite 100, Commerce City, Colorado 80022. 10. Sexual Abuse Treatment — Group Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Three focus groups are planned, other trauma focus groups may be provided upon request: 1. Adolescent trauma recovery. 2. Adult domestic violence recovery. 3. Trauma informed social skills for clients who are elementary and middle school aged. b. Anticipated Frequency of Services: i. One (1) hour per week, per group. 8 c. Anticipated Duration of Services: i. Eight (8) to 16 weeks, depending on the group. d. Goals of Services: i. Increase Safety. ii. Decrease isolation. iii. Decrease trauma reaction symptoms and build coping. iv. Increase coping skills. e. Outcomes of Services: i. Increased safety skills for individuals within group. ii. Increased coping skills. iii. Increased opportunity for connection with safe individuals. iv. Increased social skills. f. Target Population: i. All families involved in Child Protective Services including all genders and those ages two (2) and older. However, Contractor does not provide therapy services to domestic violence or sexual assault offenders, unless they have successfully completed offender courses. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. Contractor will not transport clients. ii. Services will be provided at the Contractor's office located at 13611 East 104th Avenue, Suite 100, Commerce City, Colorado 80022. 11. Sexual Abuse Treatment — Reaching HOPE Multi -Family Intensive Outpatient Programming a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Three (3) services are provided per week while participating in this program: 1. One (1) individual therapy session. 2. One (1) multi -family group family session. 3. One (1) age specific group such as adolescent or one (1) trauma specific group such as sexual assault survivor, sibling support, or domestic violence support. b. Anticipated Frequency of Services: i. Two and three quarter (2.75) hours per week, per person in the family. c. Anticipated Duration of Services: i. Twelve (12) weeks. d. Goals of Services: i. Increase safety. ii. Provide psychoeducation on individual and family trauma reaction symptoms and dynamics. iii. Decrease trauma symptoms. iv. Increase healthy attachment and connection. v. Build support for families and individuals. 9 e. Outcomes of Services: i. Increased safety skills and abuse recognition. ii. Increased knowledge and understanding of trauma symptoms and family dynamics. iii. Increased coping skills for trauma reactions that reduce symptom severity. iv. Increase in family report of: 1. Connectedness 2. Feelings of safety 3. Recognition of abusive behaviors f. Target Population: i. Families with a history of abuse and neglect. ii. Participating caregivers should be non -offending parents and/or permanent caregivers such as adoptive or kinship families. Specifically, caregivers who would benefit from additional education, support, and safety skill building. iii. Children and adolescents ages two (2) and older where at least one of the children in the family has a history of trauma. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Contractor will not transport clients. ii. Services will be provided at the Contractor's office located at 13611 East 104th Avenue, Suite 100, Commerce City, Colorado 80022. 12. Sexual Abuse Treatment — Psychological Full Testing a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Assessment and testing of at least three (3) areas of functioning: Cognitive, Adaptive, Personality, Achievement, and Trauma symptoms, as well as any necessary screening measures such as Executive Functioning and sensory profile. ii. Clinical Interview. iii. Records Review. iv. Collateral Interviews. v. Full report will include a summary of client history, assessment results, diagnostic impressions, psychoeducation around trauma symptoms (when appropriate), recommendations (as appropriate) for: psychotherapy treatment, education, social skills, and parenting strategies. vi. Feedback Session that includes all pertinent parties (with permission of the client and/or caregiver). b. Anticipated Frequency of Services: i. Frequency will vary with each case and is dependent on the needs of the client and what testing is required. c. Anticipated Duration of Services: i. One (1) to two (2) weeks for test administration. The report will be completed within one (1) month. d. Goals of Services: i. Assist client, treatment team, and support system with understanding a client's individual clinical presentation and approach to the world. 10 ii. Improve knowledge for caregivers and support systems to manage symptom presentation and needs of individual. iii. Provide appropriate recommendations for presenting concerns. iv. Decrease barriers to progress in Child Protective Services case e. Outcomes of Services: i. Provide comprehensive written assessment report that includes: 1. Accurate diagnosis to clarify mental health symptoms. 2. Personalized, trauma -informed treatment recommendations. 3. Recommendations across multiple domains of functioning, as appropriate to presenting issues. ii. Provide verbal feedback that helps individual and team better understand the needs of the individual. f. Target Population: i. All genders and ages two (2) or older where concerns exist that there has been an inappropriate or incorrect mental health diagnoses. ii. In cases where treatment has been unsuccessful, where the clinical presentation is complex and difficult for the support system to understand and engage in healthy and productive ways. This includes children or youth, biological parents, adoptive parents, kinship providers, and others as appropriate. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Contractor will not transport clients. ii. Services will be provided at the Contractor's office located at 13611 East 104th Avenue, Suite 100, Commerce City, Colorado 80022. 13. Individual Relinquishment Counseling a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Individual therapy including the necessary requirements of relinquishment counseling as outlined by the Colorado Children's Code. b. Anticipated Frequency of Services: i. Forty-five (45)minute sessions per week, per client. c. Anticipated Duration of Services: i. One (1) to six (6) weeks. d. Goals of Services: i. Promote child and family safety through relinquishment counseling that includes, but is not limited to the following (per the Colorado Children's Code): 1. Provide information to the relinquishing parent concerning the permanence of the decision and the impact of such a decision on the relinquishing parent now and in the future. 2. Provide information concerning each parent's complete medical and social histories. In the case of pregnancy, referral of the woman for medical care and for determination of eligibility for medical assistance. 11 3. Provide information concerning alternatives to relinquishment and referral to private and public resources that may meet the parent's needs. 4. Provide relinquishment services necessary to protect the interests and welfare of a child born in a state institution. 5. Provide information to the child's parent that if he or she applies for public assistance for himself or herself and the child, he or she must cooperate with the child support enforcement unit for the establishment and enforcement of a child support order. e. Outcomes of Services: i. Parent demonstrates empathy for the experiences and needs of his/her child(ren). ii. Parent demonstrates understanding of the permanence of their decision and the impact to him/her now and in the future. iii. Parent demonstrates understanding of what a protective parenting role and related responsibility entails, as well as the consequences to the children when there is failure to protect and demonstrates a desire for the child(ren) to be safe and protected. f. Target Population: i. Parents involved in Child Protective Services in which relinquishment of parental rights is being considered. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Contractor will not transport clients. ii. Services will be provided at the Contractor's office located at 13611 East 104t Avenue, Suite 100, Commerce City, Colorado 80022. Terms 1. Contractor will respond to the Quality Assurance Team (HS-CWQualityAssurance(aweldgov.com within three (3) business days regarding the ability to accept the received referral. 2. Upon acceptance of a referral, Contractor will offer an initial appointment within seven (7) days of receiving the referral. The first attempt to contact the client will occur within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If the client does not respond after three (3) attempts in the first seven (7) days of the referral period, the Contractor will notify the caseworker and the Quality Assurance Team HS - C W QualityAss u rance(aweldgov.com. 3. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understands that the Department will not reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows", or up to two (2) hours, on the part of case participants who cancel without 24 hour notice. After three (3) "no-shows", Contractor will place client on a behavioral plan requiring attendance or discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team HS-CWQualitvAssurance(a,weldgov.com. 12 4. Contractor understands that the Department will not reimburse Contractor for cancelled appointments either on the part of the client or the Contractor. If the cancellation is generated from the Contractor, a "makeup" session/episode, to occur within 30 days of the cancellation, will be offered to the client (excluding session/episodes that fall on holidays). If the cancellation is generated from the client, the Contractor must request a makeup session from the Department prior to the makeup session occurring (excluding session/episodes that fall on holidays). After three (3) cancellations, Contractor will inform the caseworker and the Quality Assurance Team HS-CWQualitvAssurance(a,weldsov.com immediately via email, to discuss service continuation. 5. Contractor will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 6. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 7. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 8. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator or any member of the Quality Assurance Team. Any changes to visitation referrals will be approved by the caseworker, their supervisor, or the Family Support and Visitation Center. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 9. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Bid Meetings, Professional Staffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as there is written authorization from the Quality Assurance Team, and the Contractor obtains the Facilitator's signature on the Client Verification Form (if in person) at the time of the meeting and participation in the meeting is deemed appropriate and necessary by the Department. The Facilitator will be responsible for filling out the time attended on the Client Verification Form. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator. Contractor may participate by phone, if approved by the Department. 10. Contractor will notify the Quality Assurance Team HS-CWOualitvAssurance(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. 13 EXHIBIT D RATE SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specific in Paragraph 2, below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2022. Expenses incurred by the Contractor prior to the term of this Agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Mental Health Services Rate Unit Type Service Name $150.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $70.00 Hour Group Therapy $200.00 Hour Individual/Family Therapy $50.00 Each No Show $150.00 Each No Show -Psychological Assessment $350.00 Hour Psychological Assessment -Full $100.00 Hour Reaching Hope Intensive Outpatient Programming (RH IOP) Relinquishment Counseling Rate Unit Type Service Name $150.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $50.00 Each No Show $200.00 Hour Relinquishment Counseling Sexual Abuse Treatment Rate Unit Type Service Name $150.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $70.00 Hour Group Therapy $200.00 Hour Individual/Family Therapy $50.00 Each No Show $150.00 Each No Show -Psychological Assessment $350.00 Hour Psychological Assessment -Full $100.00 Hour Reaching Hope Intensive Outpatient Programming (RH IOP) Foster Care Parent Consultation and Training Rate Unit Type Service Name $200.00 Hour Foster Parent Support $125.00 Hour Foster Parenting Workshops, In-Home/Community $100.00 Hour Foster Parenting Workshops, In-OfficeNideo $150.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $70.00 Hour Group Kinship Consultation $200.00 Hour Individual Kinship Consultation $0.53 Mile Mileage - Foster Parenting Workshops $50.00 Each No Show 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7th day of the month following the month of service, but no later than 60 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 60 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. For one-time services, proof of services rendered shall be receipt of a Client Verification Form and the completed product. For Monitored Sobriety services, proof of services rendered shall be the test result. SIGNATURE REQUESTED: Weld/Reaching HOPE CPA (f) Final Audit Report 2021-05-19 Created: 2021-05-19 By: Alison Pegg (apegg@co.weld.co.us) Status: Signed Transaction ID: CBJCHBCAABAAUtPyk3wXSD8T4nZA-62JjiFdBa_zxLJD "SIGNATURE REQUESTED: Weld/Reaching HOPE CPA (f)" Hi story t Document created by Alison Pegg (apegg@co.weld.co.us) 2021-05-19 - 3:08:45 PM GMT- IP address: 204.133.39.9 El Document emailed to Ambra Born (info@reachinghope.org) for signature 2021-05-19 - 3:09:37 PM GMT ,t Email viewed by Ambra Born (info@reachinghope.org) 2021-05-19 - 3:31:49 PM GMT- IP address: 73.34.227.128 5j Document e -signed by Ambra Born (info@reachinghope.org) Signature Date: 2021-05-19 - 3:57:26 PM GMT - Time Source: server- IP address: 73.34.227.128 O Agreement completed. 2021-05-19 - 3:57:26 PM GMT Adobe Sign CARYA1 REACH P-01 ''A��- CERTIFICATE OF LIABILITY INSURANCE DA5/31/20221) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 0C41366 E -COMP, A Division of Granite Insurance Brokers 360 Lindbergh Avenue Livermore, CA 94551 CQNTACT Yaneth Carrillo NnME: PHONE I FAX (A/C, No, Ext): (NC, No): noDREss: Ycarrillo@goecomp.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Hartford Underwriters Insurance Company 30104 INSURED Reaching HOPE 13611 E 104th Ave Ste 100 Commerce City, CO 80022 INSURER B:Amtrust Insurance Company 15954 INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR W JD POLICY NUMBER POLICY EFF IMMIDD/YYYYI POLICY EXP IMMIDD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY 76SBWAH8EJR 11/4/2020 11/4/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 1,000,000 $ I CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY OTHER: Business LIMIT APPLIES j08T Liability General PER: LOC Aggre PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ��ONLY AUTOS ONLY _ X SCHEDULED AUTOS roam 76SBWAH8EJR 11/4/2020 11/4/2021 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ BODILY INJURY (Per person) $ BODILY BODILY INJURY (Per accident) $ ((PPROPERTYrcitDAMAGE $ $ U UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY A�FFI/M, PROPRIETOR/PARTNER/EXECUTIVE (Mandatory m NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N /A KWC1230552 1/1/2021 1/1/2022 X I STATUTE OETH E.L. EACH ACCIDENT 100,000 $ E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 A A Property DataBreach:Ded$2,500 76SBWAH8EJR 76SBWAH8EJR 11/4/2020 11/4/2020 11/4/2021 11/4/2021 BPP R/C Limit-Retro11/4/2020 35,422 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Certificate holder is an additional insured per the Additional Insured - Vendors Form SL3047 attached to this policy. Board of County Commissioners of Weld County and its Officers/Employees CANCELLATION Board of County Commissioners of Weld County and its Officers/Employees 1150O St Greeley, CO 80631 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Contract Form New Contract Request Entity Information Entity Name* REACHING HOPE Entity ID* `00042482 Contract Name* REACHING HOPE (CHILD PROTECTION AGREEMENT) Contract Status CTB REVIEW tract Description* BID# 82100042. TERM: 6/1/21-5/31/22. ❑ New Entity? Contract ID 4787 Contract Lead* APEGG Contract Lead Email apeggg'weldgov.com;cobbx xlkcweldgov.com Contract Description 2 MEMO WAS PRESENTED TO THE BOCC BY PURCHASING ON 4,'7~2021 TYLER ID: 2021-0307. Contract Type* AGREEMENT Amount* $0.00 Renewable NO Automatic Renewal ICA Departrent HUMAN SERVICES Department Email CM - H u man Servicesc'weldgov.co m Department Head Email CM-HumanServices- DeptHeadveldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTO RN EYWELDG OV.COM If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Requested BOCC Agenda Date* 05/26;2021 Parent Contract ID 20210307 Requires Board Approval YES Department Project # Due Date 05;22.2021 Will a work session with BOCC be required? NO Does Contract require Purchasing Dept. to be included? Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Review Date* 04/01;2022 Renewal Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Committed Delivery Date Expiration Date" 05/31/2022 Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Approver Purchasing Approved Date CONSENT 06:09:2021 Approval Process Department Head JAMIE ULRICH DH Approved Date 06/09/2021 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 06`14/2021 Originator APEGG Finance Approver CONSENT Legal Counsel CONSENT Finance Approved Date Legal Counsel Approved Date 06;'09:2021 06 09;'2021 Tyler Ref # AG 061421 Hello