HomeMy WebLinkAbout20221793.tiffRESOLUTION
RE: APPROVE CHILD PROTECTION AGREEMENT FOR SERVICES AND AUTHORIZE
CHAIR TO SIGN - COMMUNITY SAFETY 1ST
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Child Protection Agreement for Services
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services, and Community
Safety 1st, commencing June 1, 2022, and ending May 31, 2023, with further terms and conditions
being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Child Protection Agreement for Services between the County of
Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on
behalf of the Department of Human Services, and Community Safety 1st, be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 22nd day of June, A.D., 2022, nunc pro tunc June 1, 2022.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST:IttAl ;;1
Weld County Clerk to the Board
County orney
Date of signature: 7/7/22
Scott K. James, Chair
cc:I-ISD
7/2.7/22
2022-1793
HR0094
Cuniva
141 s°93
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: June 14, 2022
TO: Board of County Commissioners — Pass -Around
FR: Jamie Ulrich, Director, Human Services
RE: Child Protection Agreement with Community
Safety 15t
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 with Community Safety
1". The Department is requesting to enter into a Child Protection Agreement for Services for Sexual
Abuse Treatment services. The term of the agreement shall be from June 1, 2022 through May 31, 2023.
Fees for Services:
Offense Specific — Juvenile Sexual Offence Management Board (SOMB)
Rate
Unit Type
Service Name
$100.00
Hour
In-officeNideo
$100.00
Hour
Family Team Meeting (FTM), Team Decision Makin (TDM), Professional
Staffing
$50.00
Each
No Show
I do not recommend a Work Session. I recommend approval of this Agreement and authorize the Chair to
sign.
Perry L. Buck
Mike Freeman, Pro -Tern
Scott K. James, Chair
Steve Moreno
Lori Saine
Approve
Recommendation
42 -
Schedule
Work Session Other/Comments:
Pass -Around Memorandum; June 14, 2022 - CMS ID 5993
2022-1793
Oro/zZ N -h bUgg
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND COMMUNITY SAFETY 1ST
This Agreement, made and entered into the today of J Uk_ , 2022, 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 Community Safety 1St, 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, Scope of Services, Exhibit B, Rate Schedule, Exhibit C, Weld County's Request
for Proposal, and Exhibit D, Contractor's Response to Request for Proposal. Exhibit A, B, and D are attached hereto
and incorporated herein by this reference. Exhibit C is Weld County's Request for Proposal Number B2200040 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 Sexual Abuse Treatment.
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, 2022, upon proper execution of this Agreement and shall
expire May31, 2023, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by the Contractor to any person(s) eligible for services in compliance with
Exhibit A Scope of Services, and Exhibit D, Contractor's Response to Request for Proposal.
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(a�weldgov.com). No other
Department staff or other party to the case may authorize services or modifications to services.
c. Contractor agrees to submit a complete Request for Reimbursement and supporting documentation
by the 7th of the month, following the month of service, utilizing billing forms required by the
Department. Requests for Reimbursement Forms received after 45 days from the date of service may
result in delay or forfeiture of payment. Consistent failure to meet 45 -day deadline may result in
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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(s) of service (i.e. two hours or 2-4pm)
b. Location of where the service took place (i.e. clinician's office, client's home, in the
community.)
c. Clinician/therapist name
d. 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, Scope of Services , Exhibit B, Rate
Schedule, Exhibit C, Weld County's Request for Proposal, and Exhibit D, Contractor's Response to
Request for Proposal., attached hereto and incorporated herein by reference, so long as services are
rendered satisfactorily and in accordance with the Agreement.
c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent
upon, the continuing availability of said funds for the purposes hereof.
d. The Department may withhold reimbursement if Contractor has failed to comply with any part of
the Agreement, including the Financial Management requirements, program objectives, contractual
terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal
such circumstance in writing to the Director of Human Services. The decision of the Director of
Human Services shall be final.
5. Financial Management
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At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under this Agreement must conform to the Single Audit Act of 1984 and OMB Circular A-133.
6. Payment Method
Unless otherwise provided in Exhibit A, Scope of Services, Exhibit B, Rate Schedule, and Exhibit D,
Contractor's Proposal:
a. If services are funded through Core Services, Contractor agrees to accept reimbursement through
ACH direct deposit one time per month.
b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor
agrees to complete and submit a State of Colorado direct deposit enrollment form, which will be
provided by the Department, with a voided check. Failure to complete and submit this form and
voided check in a timely and accurate manner may result in a delay of payment.
c. Contractor agrees to accept payment through county warrant when funding source does not allow
for direct deposit.
7. Compliance with Applicable Laws
a. At all times during the performance of this Agreement, Contractor will strictly adhere to all
applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or
guidelines issued pursuant thereto. This includes protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials that have been or may
hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws
and regulations, including, but not limited to the following:
- Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil
Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45
C.F.R. Part 80 et. seq.; and
- all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of
race, creed, color, sex, or national origin, be excluded from participation in, be denied the
benefits of, or be otherwise subjected to discrimination under the approved Agreement.
- Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its
implementing regulations, 45 C.F.R. Part 84; and
- the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its
implementation regulations, 45 C.F.R. Part 91; and
- Title VII of the Civil Rights Act of 1964; and
- the Age Discrimination in Employment Act of 1967; and
- the Equal Pay Act of 1963; and
- the Education Amendments of 1972; and
- Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and
- all regulations applicable to these laws prohibiting discrimination because of race, color,
national origin, sex, religion, and handicap, including Acquired Immune Deficiency
Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the
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Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the
Department will resist in judicial proceedings any efforts to obtain access to client records
except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires
that affirmative steps be taken to assure that small and minority businesses are utilized, when
possible, as sources of supplies, equipment, construction and services. This assurance is
given in consideration of and for the purpose of obtaining any all Federal and/or State
financial assistance.
- Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record
checks for all employees, contractors and sub -contractors.
b. Contractor is further charged with the knowledge that any person who feels that s/he has been
discriminated against has the right to file a complaint either with the Colorado Department of Human
Services or with the United States Department of Health and Human Services, Office for Civil Rights.
c. Contractor assures that it will fully comply with all other applicable Federal and State laws which
may govern the ability of the Department to comply with the relevant funding requirements.
Contractor understands the source of funds to be accessed under the Agreement is determined by the
Department.
d. Contractor assures and certifies that it and its principals:
- Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transaction by a Federal or State department or agency;
and
- have not, within a three-year period preceding this Agreement, been convicted of or had a
civil judgment rendered against them for commission of fraud or criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State or
Local) transaction or contract under public transaction; violation of federal or state antitrust
statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of
records, making false statements, or receiving stolen property; and
- are not presently indicted for or otherwise criminally or civilly charged by a government
entity (federal, state or local) with commission of any of the offenses enumerated in this
certification; and
- have not, within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, or local) terminated for cause or default.
e. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that
it does not knowingly employ or contract with an illegal alien who will perform work under this
contract. Contractor will confirm the employment eligibility of all employees who are newly hired for
employment in the United States to perform work under this Agreement, through participation in the E -
Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5-
102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work
under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor
that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under
this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to
undertake pre -employment screening or job applicants while this Agreement is being performed. If
Contractor obtains actual knowledge that a subcontractor performing work under the public contract for
services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor
and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is
employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does
not stop employing or contracting with the illegal alien within three (3) days of receiving
notice. Contractor shall not terminate the contract if within three days the subcontractor provides
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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 prior to execution of this Agreement.
At a minimum, Contractor shall procure, either personally or through its employer as applicable to the
Contractor's business, at its own expense, and maintain for the duration of the work, insurance coverage
listed in this agreement. The Board of County Commissioners of Weld County and its Officers/Employees
shall be named as additional insured.
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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;
- 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 shall provide the following
coverage:
Professional Liability: Contractor shall maintain limits of $1,000,000 for each claim, and
$2,000,000 aggregate limit for all claims.
10. Certification
Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary
licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by
this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor
prior to the start of any Agreement.
11. Training
Contractor may be required to attend training at the request of the Department specific to services provided
under this Agreement. The Department will not compensate the Contractor for said training in the form of
registration fees, time spent traveling to and from training, attending the training or any other associated
costs unless otherwise agreed to by the Department.
12. Subpoenas
Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the
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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
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s).
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For Department:
Heather Walker, Child Welfare Division Head
17. Notice
For Contractor:
Theresa Weiss, Owner
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:
Theresa Weiss, Owner
8751 East Hampden Avenue #C2
Denver, Colorado 80231
(303) 745-7673
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
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
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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
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
10
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 C, 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
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
11
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, and other similar items, 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. &424-18-201 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:
Weld Coun Clerk to the Board WELL] COUNTY, COLORADO
BOARD OF COUNTY COMMISSIONERS
By:
Deputy Clerk to t
13
K. James, Chair JUN 2 2 2022
CONTRACTOR:
Community Safety 1St
8751 East Hampden Avenue #C2
Denver, Colorado 80231
(303) 745-7673
77ie`era k cr
By: Theresa Weiss (Jun 9,2022 14:53 MOT)
Date:
Theresa Weiss, Owner
Jun 9, 2022
oZo�a_ i7'13
EXHIBIT A
SCOPE OF SERVICES
Contractor will provide Sexual Abuse Treatment Services, as referred by the Department.
1. Offense Specific — Juvenile Sex Offender Management Board (SOMB)
a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services
under this agreement:
i. Cognitive Behavioral Therapy.
ii. Concrete curriculum for Developmental Disabilities (DD)/Intellectual Disabilities (ID)
clients.
b. Anticipated Frequency of Services:
i. Weekly.
c. Anticipated Duration of Services:
i. Twelve (12) to eighteen (18) months.
d. Goals of Services:
i. Help the client learn that abuse is abuse.
ii. Help the client learn the definition of consent.
iii. Help the client learn coping skills to manage emotions and arousal.
e. Outcomes of Services:
i. Client will learn not to cross boundaries.
ii. Client will take responsibility for abusive behaviors.
iii. Client will be able to provide examples of "New Me/Old Me" and coping skills.
iv. Client will complete a clarification letter and/or sessions with victim(s).
f. Target Population:
i. Males, ages twelve (12) to eighteen (18).
g. Language:
i. English only.
h. Medicaid Eligibility:
i. This service is not Medicaid eligible.
i. Service Access and Transportation:
i. In provider's office located at 8751 East Hampden Avenue #C2 Denver, Colorado 80231.
Terms
1. Contractor will respond to the Quality Assurance Team (HS-CWOualitvAssuranceC weldeov.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
1
period, the Contractor will notify the caseworker and the Quality Assurance Team HS -
C WQualityAssurance(a,weldgov.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 discharge the client from services. Contractor
must inform the caseworker and the Quality Assurance Team HS-CWQualityAssurance(a,weldgov.com
within three (3) days of when the client is placed on a behavioral plan or discharged
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 weldgov.com immediately via
email, to discuss service continuation.
5. Contractor will identify, in detail, areas of continued concern and make recommendations to the
caseworker in a monthly report regarding continuation of services and/or the need for additional services.
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 to the
caseworker and the Quality Assurance Team HS-CWQualitvAssurance(&,weldvv.com 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 a new referral signed by the Child Welfare Supervisor. A change is defined as
anything outside of the approved documented service on the initial authorized referral form. This may
include an increase or decrease in services hours, change in frequency, change in location of services,
transportation needs, or any change to the initial referral or subsequent authorizations.
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 facilitator documents in the
meeting notes the timeframe that the provider attended and when participation in the meeting is deemed
appropriate and necessary by the Department. The Facilitator will be responsible for filling out the time
attended on the meeting notes. Staffings and/or meetings other than those listed above are not considered
reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator.
Contractor may participate by phone or virtually, if approved by the Department.
2
10. On a monthly basis, the Contractor will notify the Quality Assurance Team HS-
CWQualitvAssurance(aweldgov.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.
3
EXHIBIT B
RATE SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse the Contractor in consideration of the work and services performed
under this Agreement at the rate specific in Paragraph 2, below.
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
Offense Specific — Juvenile Sexual Offence Management Board (SOMB)
Rate
Unit Type
Service Name
$100.00
Hour
In-office/Video
$100.00
Hour
Family Team Meeting (FTM), Team Decision Makin (TDM), Professional
Staffing
$50.00
Each
No Show
3. Submittal of Vouchers
Contractor shall prepare and submit monthly a Request for Reimbursement and monthly report including
other supporting documentation, if applicable, certifying that services authorized were provided on the
date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 of this
Agreement .
Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department
by the 7th day of the month following the month of service, but no later than 45 days from the date of
service. Requests for Reimbursement and/or supporting documentation received after 45 days from the
date of service may result in delay or forfeiture of payment. Consistent failure to meet the 45 -day deadline
may result in termination of the Agreement.
For ongoing services, proof of services rendered shall be a monthly report submitted in accordance with
Paragraph 3(d) of this Agreement.
When submitting a request for payment for a one-time service, the contractor shall submit the first and last
page of the evaluation/report to confirm proof of services rendered. The full evaluation/report should be
submitted by the contractor to the caseworker.
For Monitored Sobriety services, proof of services rendered shall be the test result.
Exhibit C
WELD COUNTY'S REQUEST FOR PROPOSAL
(Weld County's Request for Proposal is incorporated into this agreement by reference and will
be provided upon request to the Department.)
This page is intentionally left blank
Exhibit D
Contractor's response to the Request for Proposal
Exhibit D contains the following documents:
• Attachment B — Provider Information Form (PIF)
• Attachment C — Proposal
• Attachment D — Staff Data Sheet
• Certificate of Insurance (COI)
ATTACHMENT B
WELD COUNTY DEPARTMENT OF HUMAN SERVICES — PROVIDER INFORMATION FORM (PIF)
AGENCY INFORMATION
Agency Name: Community Safety 1st Trails Provider ID (if known):
Provider Contact Full Name: Theresa Weiss Title: Owner
1517760
3037457673
Primary Phone Number (10 -digit): Ext.: Fax Number (10 -digit):
Primary Contact Email: tweisslmft@gmail.com
Agency Location Address (Street, city, state, zip):
Agency Mailing Address (Street, city, state, zip):
Agency Type (pick one):
Web Address:
3037453489
8751 E. Hampden Ave. #C2 Denver, CO 80231
Public Company [1 Private Non -Profit ri Private for Profit
Send Referrals for Service to:
Referral Contact Name: Theresa Weiss Title: Owner
Referral Phone Number (10 -digit): 3037457673
Ext.:
Email: tweisslmft@gmail.com
Billing Contact
Billing Contact Name: Theresa Weiss
Billing Phone Number (10 -digit):
3037457673
Ext.:
Title: Owner
Email: tweisslmft@gmail.com
r
I
1
CERTIFICATION
I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it
has so indicated in this bid form. I further affirm intention to enter into an agreement with Weld County, on behalf of the Weld County
Department of Human Services, and comply with all requirements of the contract, if awarded.
The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept
the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of
Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are
competitive in price and quality.
tweisslmft@gmail.com
1 Authorized Rep. Email: Phone (10 -digit): 3037457673 Ext.:
IAuthorized Rep. Address (Street, city, ate, zip): 8751 E. Hampden Ave. #C2 Denver CO 80231
I WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES. THE CERTIFICATE OF EXEMPTION NUMBER IS #98-03551-0000.
IAuthorized Rep. Full Name: Theresa Weiss
Title: Owner
Signature of Authorized Rep.:
Date: 5/23/2022 I
REV. DECEMBER 2021
ATTACHMENT C - PROPOSAL
Please type your answers in the boxes below or check the appropriate box.
SECTION 1— Provider and Program Area Information
Bidder's Legal Name:
Program Area:
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.
Theresa Weiss
Sexual Abuse Treatment
Number of services offered on this Attachment C (max 5):
If
Service
2.1a
2.1b
2.1c
2.1d
2.1e
2.1f
2.1g
2.1h
2.1i
Service
2.2a
SECTION 2 - Service Name(s) and Information
the service is a monthly package, please offer different levels. All monthly packages must
state a specific minimum number of direct service hours.
#1 Name: Offense Specific —Juvenile (SOMB)
Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points):
Cognitive Behavioral, concrete curriculum for DD/ID clients
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:
Weekly
Anticipated duration of service (i.e. 3-4 months):
12 -18 months
Three (3), or more, specific goals of the service (DO use bullet points): 1) Abuse is Abuse 2) definition of consent 3) coping
skills to manage emotions and arousal
Three (3), or more, specific outcomes of service: 1) not crossing boundaries 2) taking responsibility for abusive behaviors, 3)
providing examples of New Me/Old Me and coping skills 4) clarification letter and/or sessions with victim(s)
Target population of the service, including age and gender:
Male 12-18
Languages service is available in (please list proficiency and if interpreter services are available):
English
Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
None
Service location — list where the service will take place (i.e. client's home, in -office, other)
In office
#2 Name:
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
2.2i
Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
Service location — list where the service will take place (i.e. client's home, in -office, other)
REV. OCT 2021
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:
2.3i Service location — list where the service will take place (i.e. client's home, in -office, other)
Service #4 Name:
2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points):
2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time,
administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level:
2.4c Anticipated duration of service (i.e. 3-4 months):
2.4d Three (3), or more, specific goals of the service (DO use bullet points):
2.4e Three (3), or more, specific outcomes of service:
2.4f Target population of the service:
2.4g Languages service is available in (please list proficiency and if interpreter services are available):
2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
2.4i Service location — list where the service will take place (i.e. client's home, in -office, other)
Service #5 Name:
2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points):
2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time,
administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level:
2.5c Anticipated duration of service (i.e. 3-4 months):
2.5d Three (3), or more, specific goals of the service (DO use bullet points):
2.5e Three (3), or more, specific outcomes of service:
REV. OCT 2021 2
ATTACHMENT C - PROPOSAL
2.5f
Target population of the service:
2.5g
Languages service is available in (please list proficiency and if interpreter services are available):
2.5h
Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part
2.6i
Service location — list where the service will take place (i.e. client's home, in -office, other)
3.1
3.2
3.3
3.4
3.5
Section 3 — Service Access and Transportation
NO
NO
Will you charge Weld County for transporting clients or mileage? Check one: ■ YES
►5
Will you conduct services in a client's home or in the community? Check one: • YES
O
Miles
Will you transport clients to and/or from services? Check one: • YES ►0 NO
How many miles are you willing to travel round trip? List a specific number of miles.
When you calculate mileage, what is your starting point address?
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:
Offense Specific- Juvenile (SOMB)
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
100
100
Unit Type
per Hour
per Hour
per Hour
per Hour
per No Show
per Mile
No. of roundtrip miles included in rate:
No. of roundtrip miles included in rate:
This is paid after the miles listed above.
miles
miles
4.2 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 roundtrip miles included in rate:
No. of roundtrip 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:
$ Amount
Unit Type
per Hour
per Hour
per Hour
per Hour
No. of roundtrip miles included in rate:
No. of roundtrip miles included in rate:
miles
miles
REV. OCT 2021
3
ATTACHMENT C - PROPOSAL
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 roundtrip miles included in rate:
miles
In -Home or Community:
per Hour No. of roundtrip 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 roundtrip miles included in rate:
miles
4.5c In -Home or Community:
per Hour No. of roundtrip 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. OCT 2021
4
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:Theresa Weiss
Community Safety 1st
PHONE NUMBER: 3037457673
EMAIL:tweisslmft@gmail.com
PROPOSED SERVICE(S): Sex Abuse Treatment - Juvenile SOMB treatment
Legal Last Name `
Middle
Initial
Previous Legal Last
Name (If applicable)
Legal First Name
Service Type
Licensure/
Credentials
DORA # (If applicable)
Weiss
L
Theresa
Individual SOMB
MA, LMFT
654
CHILD WELFARE REQUEST FOR PROPOSAL 2022-23 - VARIOUS SERVICES
A� o® CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
5/23/2022
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 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
CenterPoint Insurance Group
8400 E Prentice Ave Suite 735
Greenwood Village CO 80111
CONTACT Andrea Hunter
NAME:
(ac No.Ext): (303) 333-0375 I (aC No): (3031333-1391
E-MAIL andrea.hunter@cptins.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA:Philadelphia Insurance Companies
006
INSURED COLORADO DUALLY APPOINTED
THERAPIST & REHABILITATION PROVIDERS
C/O COLORADO CARE ASSOCIATION
8400 E. Prentice AVE, SUITE 735
Greenwood Village CO 80111
INSURER B:
INSURER C:
INSURERD:
INSURERE:
INSURERF:
COVERAGES
CERTIFICATE NUMBER:2022-2023 March
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.
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
PPK2385752
3/1/2022
3/1/2023
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO
PREMISES (Ea occurrence)
$ 100 , 000
X I CLAIMS -MADE
OCCUR
MED EXP (Any one person)
$ _ 0
X
Professional Liability
PERSONAL 8.ADV INJURY
$ 1,000,000
*
Sexual Abuse $100,000
GENERALAGGREGATE
$ 5,000,000
GEN'L
X
AGGREGATE
POLICY
OTHER:
LIMIT APPLIES
PRO
JECT
PER:
LOC
PRODUCTS-COMP/OPAGG
$ None
Property Damage Deductible
$ 1,000
AUTOMOBILE
—
LIABILITY
ANY AUTO
ALL OWNED
SCHEDULED
AUTOS
NON -OWNED
AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
—
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
DED I I RETENTION $
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
I PER I 1OTH-
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
A
Privacy Liability/HIPAA
PPK2385752
3/1/2022
3/1/2023
Per Occurence $50,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Board of County Commissioners of Weld County and its Officers/Employees are Listed as Additional Insured
with Respects to Provider:
Theresa Weiss
Community Safety 1st, Inc
8751 E Hampden Ave #C2
Denver, CO 80231
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
Andrea Hunter/ANDREA
ACORD 25 (2014/01)
INS025 (201401)
® 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Contract Form
New Contract Request
Entity Information
Entity Name*
COMMUNITY SAFETY 1ST
Entity ID*
X00045648
❑ New Entity?
Contract Name* Contract ID
COMMUNITY SAFETY 1ST (NEW CHILD PROTECTION 5993
AGREEMENT)
Contract Status
CTB REVIEW
Contract Lead*
APEGG
Contract Lead Email
apeggkwweldgov.com:cobbx
xlkgryveldgov.com
Parent Contract ID
Requires Board Approval
YES
Department Project #
Contract Description*
NEW AGREEMENT. POST -BID PROVIDER RELATED TO BIDS 82200040 TERM JUNE 1, 2022 THROUGH MAY 31, 2023
Contract Description 2
PA IS BEING ROUTED THROUGH THE NORMAL PROCESS. ETA TO CTB 6. 16122.
Contract Type*
AGREEMENT
Amount*
50.00
Renewable*
NO
Automatic Renewal
Grant
IGA
Department
HUMAN SERVICES
Department Email
CM-
HumanServicesC7weldgov.co
m
Department Head Email
CM-HumanServices-
DeptHead2weldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEYaWELDG
OV,COM
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Requested BOCC Agenda
Date*
06, 22; 2022
Due Date
06 18, 2022
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
On Base
Contract Dates
Effective Date
Review Date*
03 31 ,2023
Renewal Date
Termination Notice Period
Contact Information
Contact Info
Contact Name
Purchasing
Committed Delivery Date
Contact Type Contact Email
Expiration Date*
05;3112023
Contact Phone 1 Contact Phone 2
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head
JAMIE ULRICH
DH Approved Date
06,13 r 2022
Final Approval
BOCC Approved
BOCC Signed Date
BOCC Agenda Date
06;'22;2022
Originator
APEGG
Finance Approver
CHERYL PATTELLI
Legal Counsel
BRUCE BARKER
Finance Approved Date Legal Counsel Approved Date
06,r 14; 2022 06:14, 2022
Tyler Ref
AG 062222
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