HomeMy WebLinkAbout20223548.tiffRESOLUTION
RE: APPROVE REVISED STANDARD FORM OF AGREEMENT, RATES, AND PROVIDER
LIST FOR INDIVIDUAL PROVIDER CONTRACTS FOR PURCHASE OF FOSTER
CARE SERVICES IN A FOSTER CARE HOME AND AUTHORIZE CHAIR TO SIGN
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 Revised Standard Form of Agreement,
Rates, and Provider List for Individual Provider Contracts for Purchase of Foster Care Services
in a Foster Care Home 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
the various providers as shown on the attached provider list, with further terms and conditions
being as stated in said standard form, and
1. Exhibit A to CWS-7A Individual Provider Contract for Purchase
of Foster Care Services in a Foster Care Home
WHEREAS, after review, the Board deems it advisable to approve said revised standard
form, rates, and provider list, copies of which are attached hereto and incorporated herein by
reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Revised Standard Form of Agreement, Rates, and Provider List
for Individual Provider Contracts for Purchase of Foster Care Services in a Foster Care Home
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, be, and hereby
are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign any contracts consistent with said revised standard form.
Cc:145D, CA Oil ACT(CP/CC'1, CTB(cw)
of /PI /23
2022-3548
HR0094
REVISED STANDARD FORM OF AGREEMENT, RATES, AND PROVIDER LIST FOR
INDIVIDUAL PROVIDER CONTRACTS FOR PURCHASE OF FOSTER CARE SERVICES IN A
FOSTER CARE HOME
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 21st day of December, A.D., 2022.
BOARD OF COUNTY COMMISSIONERS
WELCOUNTY, COLORADO
ATTEST: ddcafoj
Weld County Clerk to the Board
County orney
Date of signature: o f /03 /23
Scott K. James, Chair
Mike Freeman, Pro-Tem
(P A214 SA
Perry C Buck
2022-3548
HR0094
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: November 29, 2022
TO: Board of County Commissioners — Pass -Around
FR: Jamie Ulrich, Director, Human Services
RE: The Weld County Department of Human Services'
Child Welfare SFY 2022-23 Revised Out -of -Home
(OOH) Foster and Kinship Care Provider Contract
Template
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 Weld County Department of Human Services' Child
Welfare SFY 2022-23 Revised Out -of -Home (OOH) Foster and Kinship Care Provider
Contract Template. The State requires Counties to enter into agreements with providers for the
purchase of OOH services and has established the CWS-7A as the State prescribed agreement for
County certified foster and kinship care services. Counties are unable to alter the State CWS-7A
agreement, therefore Weld County has chosen to add County specific requirements for these
providers within the Exhibit A. This Exhibit has been reviewed by Assistant County Attorney,
Caitlin Perry, and approved for use for the 2022-23 contract year. The State has since revised
the CWS-7A effective August 2022 which was reviewed and approved by Caitlin Perry.
I do not recommend a Work Session. I recommend approval of the CWS-7A contract and exhibit
template to be used for the remainder of the 2022-23 contract year.
Perry L. Buck
Mike Freeman, Pro -Tern
Scott K. James, Chair
Steve Moreno
Lori Saine
Approve Schedule
Recomme dation Work Session Other/Comments:
VI 0, Fmatil
Pass -Around Memorandum; November 29, 2022 — CMS (Not in CMS) Page 1
2022-3548
12/21
1-w_oocte-1
Karla Ford
From:
Sent:
To:
Subject:
Yes
Lori Saine
Tuesday, November 29, 2022 2:51 PM
Karla Ford
Re: Please Reply - PA FOR ROUTING: CW Revised Foster and Kinship OOH Template
(Not in CMS)
Sent from my iPhone
On Nov 29, 2022, at 3:05 PM, Karla Ford <kford@weldgov.com>wrote:
Please advise if you approve recommendation. Thank you.
Karla Ford
Office Manager, Board of Weld County Commissioners
1150 0 Street, P.O. Box 758, Greeley, Colorado 80632
:: 970.336-7204 :: kford(weldgov.com :: www.weldyov.com ::
**Please note my working hours are Monday -Thursday 7:00a.m.-5:00p.m.**
<i m age002 . j pg>
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: Windy Luna <wluna@weldgov.com>
Sent: Tuesday, November 29, 2022 11:29 AM
To: Karla Ford <kford@weldgov.com>
Cc: Bruce Barker <bbarker@weldgov.com>; Chris D'Ovidio <cdovidio@weldgov.com>; Cheryl Pattelli
<cpattelli@weldgov.com>; Esther Gesick <egesick@weldgov.com>; Lennie Bottorff
<bottorll@weldgov.com>; HS -Contract Management <HS-ContractManagement@co.weld.co.us>
Subject: PA FOR ROUTING: CW Revised Foster and Kinship OOH Template (Not in CMS)
Good morning Karla,
Please see the attached PA that has been approved for routing to all five Commissioners: CW
Revised Foster and Kinship OOH Template (Not in CMS).
Thank you!
Windy Luna
She/Her/Hers
Contract Management and Compliance Coordinator
Weld County Dept. of Human Services
COLORADO
Office of Children,
Youth & Families
Division of Child Welfare
INDIVIDUAL PROVIDER CONTRACT
FOR PURCHASE OF FOSTER CARE SERVICES IN A FOSTER CARE HOME
1. THIS CONTRACT AND AGREEMENT, made this date, Enter Date by and between
Weld County Department of Human or Social Services, 315 North 11th Avenue, Greeley, Colorado
hereinafter called "County Department" and hereinafter called "Provider," Provider Name at
Address, City, State, Zip Code.
2. This Contract and Agreement shall be effective from Begin Date and continue in force until End Date or until the
facility certificate is revoked or surrendered. This contract and agreement may be renewed at any time during the
term of the valid facility certificate. This contract and agreement is in lieu of and supersedes all prior purchase
contracts between the parties hereto and relating to the services herein described.
3. The Provider holds a valid certificate as a: 0 Foster Care Home or 0 Therapeutic Foster Care Home or 0 Kinship
Foster Care Home -(check appicable blank). Such certification standards shall be maintained during the term hereof.
The provider has read and is fully familiar with the "Rules Regulating Foster Care Homes" issued by the Colorado
Department of Human Services.
4. The County Department may, but shall not be obligated to purchase foster care home services. The County
Department or any duly authorized agent may request such services to be provided to any child or youth at any time
within the limits of the certificate and without prior notice. At such time or as soon as possible after the acceptance of
a child or youth for services, the County Department and the Provider shall verify foster care placement of each child
or youth in writing on the required form, which shall become an addendum to this contract, subject to all the terms and
conditions hereof.
5. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A and Addendum 1,
which form integral parts of this Agreement. Exhibit A and Addendum 1 are specifically incorporated herein by this
reference.
The Provider agrees:
1. To the rates for child placement as set for by the State of Colorado apply to the services contemplated by this
Agreement and that such rates may be negotiated with the Provider individually in cases with exceptional
circumstances as determined by the County Department;
2. To safely provide the 24 -hour physical care and supervision of each child or youth until removed or until the
agreement is renewed;
3. To accept a child or youth, only with the approval of the certifying agency;
4. To cooperate fully with the County Department or its representatives, and participate in the development of the Family
Service Plane for a child or youth in placement, including visits with their parents, siblings, relatives, or to transition to
another foster care facility;
5. To maintain approved standards of care as set by the Colorado Department of Human Services;
6. To maintain the confidentiality of information shared about the child or youth and his/her family;
7. Not to accept money from parents or guardians;
8. Not to make any independent agreement with parents or guardians;
9. Not to release the child or youth to anyone without prior authorization from the County Department ;
10. To allow representatives of the County Department to visit the foster care home and to meet with the child or youth at
any reasonable time, including scheduled and unscheduled visits; and,
11. To give the County Department a 30 -day notice, except in an emergency, to remove a child or youth for placement
elsewhere, and to work with the County Department as requested to prepare the child or youth for another placement.
12. To provide transportation to the child or youth. Transportation to be provided will be agreed upon at placement and
may be changed upon mutual agreement of the provider and the County Department, as recorded in the Family
Service Plan. Transportation must be provided or arranged:
a. For professional services and/or for school attendance when necessary; and,
b. For youth to participate in age or developmentally appropriate extracurricular, enrichment, cultural, and social
activities.
CWS-7A Revised 08/2022
13. To report promptly to the County Department:
a. Any unplanned absence of the child or youth from provider's care;
b. Any major illness of the child or youth;
c. Any serious injury to the child or youth;
d. Any significant change in the sleeping arrangement for the child or youth;
e. Any contemplated change of address or change of household members;
f. Any conflict the child or youth may have with law enforcement, school/school district staff, or other persons in
authority;
g. Any emergency;
h. Any pertinent discussion with parents or guardians about the child or youth or supervising agency; and,
i. Any information received regarding a change of address of the parents or guardians.
14. To comply with the Civil Rights Act of 1964, Section 504, Rehabilitation Act of 1973, and the ADA of 1990,
concerning discrimination on the basis of race, color, sex, age, sexual orientation, expression, or gender identity,
religion, political beliefs, national origin, or handicapping condition.
Pursuant to §19-1-130, C.R.S., a service provider means the state department of human services, a county
department of human or social services, or a child placement agency. This includes a contractor or subcontractor
that provides placement -related services on a service provider's behalf.
A service provider shall provide placement -related services in a manner that is culturally responsive to the complex
social identity of the individual receiving such services. complex social identities include but are not limited to race,
ethnicity, nationality, age, religion, sex, sexual orientation, gender identity, gender expression, socioeconomic status,
physical or cognitive ability, language, beliefs, values, behavior patterns, and customs.
Subjecting a child or youth in foster care or an individual, family, or other service provider to discrimination or
harassment on the basis of actual or perceived disability, race, creed, religion, color, sex, sexual orientation, gender
identity, gender expression, marital status, national origin, ancestry, or any communicable disease, including HIV,
when providing any placement -related service is prohibited.
15. To complete pre -service training prior to the placement of a child or youth.
16. To annually:
a. Update the Training Development Plan with the County Department;
b. Complete ongoing, quality, and relevant training that will build competencies to meet the needs of the children
and youth served in the foster care home as required by the Colorado Department of Human Services regulations
including ongoing training required to use and apply the reasonable and prudent parent standard for each child or
youth served in the foster care home.
17. To attend semi-annual Administrative Reviews for a child or youth in placement.
18. To be knowledgeable of, and comply with the "Rules Regulating Foster Care Homes" and the "General Rules for Child
Care Facilities;
19. Not to enter into any subordinate subcontract hereunder;
20. To keep required and necessary records for audit/review purposes by state and federal personnel. These records
shall document the type of care and dates that care is provided for each child or youth. In addition, medical,
educational, and progress summary records shall be maintained for each child or youth as required pursuant to the
Colorado Department of Human Services' Rules Regulating Foster Care Homes.
21. To complete or schedule a medical examination for the child or youth within 14 days of initial placement and complete
a dental examination within eight weeks of initial placement.
The County Department agrees:
1. To share all available information about the child or youth, including relevant social, medical and educational history,
behavior problems, court involvement, parental, sibling and relative visitation plans, and other specific characteristics
of the child or youth, with the provider before placement and to share additional information when obtained while the
child or youth is in placement.
2. To inform the provider of expectations regarding the care of the child or youth, such as meeting medical needs,
visitation, special psychological needs, trauma and other grief/loss issues, and the child's or youth's identification with
his/her family;
3. To give the provider the written admission record of the child or youth to the foster care home at the time of
placement;
4. To give the provider a written procedure or authorization for obtaining medical care for the child or youth;
5. To involve the provider in family service planning for the child or youth as a member of treatment team;
6. To give the provider a copy of the Family Service Plan, as it pertains to their expectations for meeting the needs of the
child or youth in the foster care home, at the time of placement or when it is completed following placement;
7. To give at least a 30 -day notice of plans to remove a child or youth from the foster care home. The 30 -day notice may
be waived by mutual consent to allow and permit immediate removal of a child or youth for placement elsewhere, or
CWS-7A Revised 08/2022 2
without such waiver in the event of an emergency. An emergency is defined as any situation in which a provider's
inability to provide services threatens the health, safety or welfare of a child or youth.
8. To pay the provider at the rates established by the Colorado Department of Human Services or as authorized and
negotiated between the provider and the County Department:
a. Payment shall be made by electronic banking transfers (EBT) drawn by the duly authorized county officer; and,
b. Provider shall notify the County Department of any payment or billing dispute within 60 days of the month when
service was provided. Failure to do so will result in forfeiture of the payment. The Provider understands that,
pursuant to the Colorado Department of Human Services' Rules for the General Reimbursement for Child Welfare
Services, when reimbursement is warranted the State reimburses for retroactive payments not greater than the
current and (2) preceding months.
9. To provide or arrange through statewide contracted training, a minimum of twelve hours of core pre -service training
for foster care homes and 15 hours of pre -service training directed at the needs of the child or youth to be served in
the foster care home.
10. To annually complete the following:
a. Update the Training Development Plan with the provider;
b. Provide or make available quality and relevant training for each foster parent that will build competencies to meet
the needs of the children and youth served in the foster care home;
c. Provide training that prepares each foster parent to use and apply the reasonable and prudent parent standard;
and,
d. Pursuant to the Colorado Department of Human Services' Rules Regulating Family Foster Care Homes,
document that the provider is trained in and can use and apply the reasonable and prudent parent standard for
each child or youth placed in the foster care home.
11. The County Department is responsible for providing information on county specific procedures.
12. To invite the provider to Administrative Reviews for each child or youth in placement.
13. To incorporate provider information in planning for the child or youth placed in the foster care home.
14. To assure that the service described herein has been accomplished and a record made thereof on a case by case
basis.
15. To provide notice of court hearings for each child or youth placed in the foster care home.
WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above.
COUNTY:
Jamie Ulrich
Weld County Department
of Human Services
Signature Date
ATTEST: BOARD OF COUNTY COMMISSIONERS
BY:
Clerk to the Board WELD COUNTY, COLORADO
Deputy Clerk to the Board Scott K. James, Chair
PROVIDER:
Provider (name)
Provider (name)
Signature Date
Signature Date
CWS-7A Revised 08/2022 3
EXHIBIT A to the CWS-7A
Additional Provisions for the Agreement to Purchase Foster Care
Services and Foster Care Facility Agreement CWS-7A
The following additional provisions in this Exhibit A and Addendum 1 apply to the agreement entitled, "Individual Provider
Contract for Purpose of Foster Care Services and Foster Care Facility Agreement," by and between the Weld County
Department of Human Services, hereinafter referred to as, "County," and <First Name> <Last Name>, Provider
ID#<Provider Number>, hereinafter referred to as, "Provider."
GENERAL PROVISIONS
1. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least
thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon
the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first,
and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon
cease; however, the parties shall not be released from the duty to perform their obligations up to the date of
termination. This provision does not affect removal of a child in an emergencysituation.
2. Provider agrees that Provider is an independent contractor and that neither Provider nor Provider's agents or
employees are, or shall be deemed to be, agents or employees of the County for any purpose. Provider shall
have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The
parties agree that Provider will not become an employee of County. Provider shall be solely and entirely
responsible for its acts or of any agent, employee, servants and sub -Providers during the performance of this
Agreement. Provider is not entitled to unemployment insurance or workers' compensation benefits
through Weld County and Weld County shall not pay for or otherwise provide such coverage for Provider.
Unemployment insurance benefits will not be available to Provider for services provided under this
Agreement. Provider shall pay when due any/all applicable employment taxes and income taxes and local
head taxes (if applicable) incurred as a result of the services provided under this Agreement.
3. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the
purpose thereof.
4. This Exhibit A is intended to be applied in conjunction with the attached Agreement as the complete integration of
all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment
hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation,
renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part
of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this
Agreement in writing, if agreed to by both parties. The Agreement, this Exhibit A and the rate Addendums are
intended to be in lieu of and supersede all prior agreements between the parties hereto and relating to the care
and services herein described.
5. The State of Colorado Department of Human Services and the County shall be and hereby is permitted to monitor
the service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are
carried out for the benefit of the aforementioned child or youth. Monitoring may occur through review of program
reports, on -site visits where applicable and other Agreements as deemed necessary. Provider understands that
the State Department and the County may provide consultation to Provider to assure satisfactory performance in
the provision of purchased services under this Agreement.
6. County shall have access to Provider's service program, financial and other records, which will sufficiently and
properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement for
purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder
and shall be retained and available for audit purposes for at least five years after final paymenthereunder.
7. Time is of the essence in each and all of the provisions of this Agreement.
8. 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.
9. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the
Exhibit A to the CWS-7A
4 Revised 11/2022
other party at that party's address as stated in thisAgreement.
10. This Agreement is nonexclusive and County may engage or use other Providers or persons to perform services of
the same or similar nature.
11. Provider assures and certiies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily
excluded from covered transactions by a federal department or agency.
b. Have not, within a three-year period of preceding this Agreement, been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting
to obtain, or performing a public (federal, state, or local) transaction or contract under a 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;
c. Are not presently indicted for or otherwise criminally or civilly charged by agovernment entity (federal, state,
or local) with commission of any of the offenses enumerated in paragraph (B) above.
d. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal,
state, and local) terminated for cause ordefault.
12. In addition to terminating this Agreement in accordance with the provisions herein, County may exercise the
following remedial actions if the County finds and determines that the Provider has substantially failed to satisfy
the duties found in this Agreement and Exhibit A Substantial failure to satisfy the scope of work shall be defined to
mean incorrect or improper activities or inaction by the Provider. These remedial actions include, but are not
limited to, any one or more of the following:
a. Withhold payment to Provider until the necessary services or corrections in performance are satisfactorily
completed.
b. Deny payment or recover reimbursement for those services or deliverables which have not been performed
and which due to circumstances caused by Provider cannot be performed or if performed would be of no
value to County. Denial of the amount of payment shall be reasonably related to the amount of work or
deliverables lost to County.
c. Recover from Provider any incorrect payment to Provider due to omission, error, fraud, and/or defalcation by
deducting from subsequent payments under thisAgreement, or other agreements between County and
Provider, or as a debt to County, or otherwise as provided by law.
13. 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 or their
assignees, and nothing contained 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 or their assignees receiving services or benefits under this Agreement
shall be an incidental beneficiary only.
14. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or
employees may possess, nor shall any portion of this Agreement be deemedto have created a duty of care that
did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge
and agree that no part of this Agreement is intended to circumvent or replace such immunities.
15. Provider shall promptly notify County in the event in which it is a party defendant or respondent in a case, which
involves services provided under the agreement. The Provider, 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 County Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure.
16. This Agreement and the provision of services hereunder shall be subject to the laws ofColorado and be in
accordance with the policies, procedures, and practices of County. Provider shall strictly comply with all
applicable federal and State laws, rules and regulations in effect or hereafter established.
Exhibit A to the CWS-7A
5 Revised 11/2022
17. Financial obligations of the County payable after the current fiscal year are contingent upon funds for that purpose
being appropriated, budgeted and otherwise made available. Execution of this Agreement by County does not
create an obligation on the part of County to expend funds not otherwise appropriated in each succeeding year.
18. County agrees to purchase, and Provider agrees to provide the care and services, which are listed in this
Agreement. The State approved rate for Child Maintenance/Respite will be paid for any child placed with the
Provider unless the Medically Fragile Tool has been completed due to intensive medical/physical needs, or
limitations that interfere with daily life functioning. The Medically Fragile Tool will be completed every six months
as long as the child remains in care with the Provider. The rate will be adjusted if the Medically Fragile Tool
indicates a change in the level of care. The Medically Fragile Tool will determine the reimbursement rate as
specified in Addendum 1.
19. All bed hold authorizations and payments are subject to a 7 -day maximum for a child's temporary absence from a
facility; however, if the absence is a result of hospitalization the maximum bed hold authorization may be up to 14
days. Bed hold requests must have prior written authorization from the Department Administrator or Designee
before payment will be release to Provider.
20. Any additional costs for specialized services, which may include but are not limited to; Co -pays, deductibles, or
services not covered by Medicaid, will need to be authorized, in writing by the Department Administrator, prior to
the service being performed. Any payment for specialized services not authorized in writing may be denied.
21. All reimbursement requests shall:
a. Be submitted in a format approved by the County. If submitted in an unapproved format or inadequate
documentation is provided, the County reserves the right to deny payment.
b. Be submitted by the 4th of each month following the month of service. If the reimbursement request is not
submitted within twenty-five (25) calendar days ofthe month following service, it may result in forfeiture of
payment.
c. Placement service reimbursement shall be paid from the date of placement up to, but not including the day of
discharge.
d. Transportation reimbursement shall be for visitation purposes or transportation to school if out of county and
with prior approval only If medical transportation is needed, Provider will arrange reimbursement through
Medicaid. Any other special requests for transportation reimbursement shall require prior approval by the
Resource Manager or the DepartmentAdministrator.
e. Clothing allowance reimbursement shall be approved and reimbursed as indicated on the clothing allowance
form provided by the Foster Care Coordinator.
22. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal
items brought to Provider by the children, Provider shall be released from responsibility for loss or damage to such
personal items.
PROVIDER SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado
Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal
laws and regulations, as such, which may be amended from time to time, and shall be binding on Provider and
control any disputes in this Agreement.
2. Not charge any fees to children or families of children referred by County for any services provided under this
Agreement.
3. Not assign the obligations under this Agreement nor enter into any sub -Agreement without the express written
approval of the Director of the County Department or his/her appointed designee.
4. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $500,000 for total injuries arising from
any one accident. Provider shall provide a certificate of insurance provided by its insurer upon request by County.
Exhibit A to the CWS-7A
6 Revised 11/2022
5. Indemnify the County against any and loss against all claims and actions based upon or arising out of damage or
injury, including death, to persons or property caused or sustained in connection with the performance of this
Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation
and the defense of any such claims or actions.
6. Attend or participate in Ice Breaker, Family Engagement or Team Decision making meetings, if requested by the
Department. County staff shall notify the Provider of the dates and times attendance is requested.
7. Request a staffing if considering giving notice to remove a child, except in emergency situations. These requests
shall be made through the child's caseworker and/or the Provider's Foster Care Coordinator.
8. Actively participate in achieving the child's permanency goal, cooperate with any contractors hired by the Weld
County Department of Human Services to preserve placement in the least restrictive placement appropriate,
comply with the treatment plan of the child, and attendcourt hearings as requested.
9. Have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the
child being placed with Provider. All documentation of these examinations will be placed in the foster child's
placement binder.
10. Attend all necessary school meetings and support any plan that is developed regarding the child in order to
promote educational success.
11. Immediately report to the County Department and/or local law enforcement any known or suspected child abuse or
neglect as set forth in Section 19-3-304,C.R.S.
12. Maintain, access and review information monthly on Binti.
13. Maintain/update information in the foster child's binder, either hard copy or in Binti. The binder will be reviewed on
a monthly basis and signed off by child's caseworker and/or the Provider's Foster Care Coordinator.
14. Maintain/update medication logs on a daily basis, if child is taking medications.
15. Comply with all County aryl State certification requirements as set forth in the State Department rules, Staff
Manual Volume VII and the Weld County Department of Human Services Policy and Procedure manual.
Exhibit A to the CWS-7A
7 Revised 11/2022
ADDENDUM 1
Medically Fragile Tool Rates
Child Maintenance
Daily Rate
Medically Fragile
Level 1
$54.73
Level 2
$110.30
Level 3
$165.88
Level 4
Negotiate up to $200
Addendum 1 to Exhibit A CWS-7A
8 Revised 11/2022
Weld County Foster and Kinship Provider
SFY 2022-2023
Provider L_�_
Name2
1 Agorae
Provider Fir st
Naine
Ta0a
Co-Prov'dcr L.-i st
Vame
Ertrore
Co-Prnvid,-
First N,irne
Lan log ; . :
Address Strcees
833,Colu
Address Ci[y/State/Zip
War, Colbrada 80350
I'ro�idrr D
16§4421` ;
Typr
Pfister
2 Aikens
Carly
Aikens
George
22250 County Road 62
Greeley, Colorado 80631
1718610
Foster
3 Andrade
Anfparo
Archuleta _
EBjah '
144324th'Avenue;'
Greelgo,ColoradoSO634
-- 1759768
Foster
4 Arce
Johanna
303817th Street, Apartment B
Greeley, Colorado 80631
1745668
Kinship
5 Armstrong ,
Nicole.
Armstrong
Zachary
108 N.. 50th Avenue
Greeley, Colorado 80634
1723158
Foster
6 Augustin
Le'Andra
5115 West 16th Street
Greeley, Colorado 80634
1752483
Kinship
7 Baldwin
Tierney:
Baldwin
Danny
10377 South Cre9cent
Firestone, Colorado80504:-:
1717778
Foster
8 Barraza
Josephine
4126 Mesquite Lane
Evans, Colorado 80620
1760240
Kinship
9 Bauer
Jennifer
Bauer
Michael
442 La Costa Lane
Johnstown, Colorado80534 .
1733364
Foster
10 Berrelez
Yvette
Berrelez
Matthew
247 63rd Avenue
Greeley, Colorado 80634
1728772
Foster
11 Berry
Cynthia
8390BrendW+imAvenue
Frederickk, Colorado 80504
1734868
Foster
12 Bieber
Dana
Connor
Wade
13611 Wrangler Way
Mead, Colorado 80542
1758807
Kinship
13 8ldcic
Anna' :
Black
Paulo :
1202CrescentOrive
Windsor,,Coforado80550
1745856
Foster
14 Braunagel
Karen
1775 Laurus Lane
Johnstown, Colorado 80534
1714402
Faster
15. 8f[tfkeheif
Satirantha
&Meehofi
2watin;:'
1968: Sweet Pea Drive
Windsor, ,olorado80550
1739843
Foster
16 Brown
Samantha
Brown
Dustin
1114 50th Avenue
Greeley, Colorado 80634
1739396
Foster
17 ,Cali'
Paula
Cell'
Shaun
533 East 28th Street Road .
Greeley, Colorado 80631
3737209
Foster
18 Casey
Robert
Casey
Elyse
2330 6th Avenue
Greeley, Colorado 80631
1734522
Foster
19 Castaneda
Natalie
Castaneda _
Freddy
2837 Avocado Avenue
Greel y, Colorado 80631,
1678403
Foster
20 Chavez
Sonia
10437 Butte Drive
Longmont, Colorado 80504
1748760
Kinship
?,] Clark
toed
Clark
David,
196218th Avenue
Greeley, Colorado 80631
1725980
Foster
22 Collins
Arnie
Collins
Justin
8211 Mentra Street
Anchorage , Alaska 99518
1749447
Kinship
23; Cook '
.antic
Go9k
Jeffrey .
48Coyote7rall -
Greeley,Colorad389634
1756217
Foster.
24 Cowling
Shawn
Cowling
Whitney
253417th Ave Court
Greeley, Colorado 80631
1758324
Foster
25 Crawford
Sassy
Rutledge
Ryan :.
1315 1St Street
Eaton, Colorado 80615
1748633'
Foster
26 Cross
Hannah
Cross
Taylor
22975 County Road 40
LaSalle, Colorado 80645
1739954
Foster
27 Cunliffe
Anne
Cunliffe
Levi
2277 Ptneywoods Street
Ntead, Colorado 80542"
174368
Foster
28 Curley
Brett
Ochoa
Belinda
1117 Nantucket Street
Windsor, Colorado 80550
1745625
Foster
29 Dennis
Esther
Grigsby
Michael
5502 West 3rd Street
Greeley, Colorado 80634
1687385
Foster
30 De5ignori
Melissa
DeSignori
Mclain
2763 Mustang Drive
Oakdale, California 95361
1766212
Kinship
31 Deutsch
Celine
Deetsch
Nicolas
2800 Crescent Cove D.
Evans, totorado 80620
1751838
Foster
32 Dix
Abigail
2182 Skys End Drive qR-4
Windsor, Colorado 80550
1763724
Foster
33 Donn
James -
Dunn
Geri
1I Mcintyrestreet
Kersey,. Colorado,80844 • , ;
1714413_
Foster
34 Erickson
Angela
Erickson
Bradley
223127th Avenue
Greeley, Colorado 80634
1751923
Foster
35:; Ervin
An
Ervin
Jason .
4609 Prattle River Court
Flies ne, Colorado 80504 • :,
1752752-
Foster
36 Fretwell
Crystal
Fretwell
Steven
4121 West 4th Street Road
Greeley, Colorado 80634
1749771
Foster
3'7, yiebet,Emagl ea
Tif8ni.; :
Pager
MBCheet• -- ::
3.4Ealst:Kenv aaa,1
Phoeab A ls0, ilS960 ,
1784721:
..Ki WM,
38 Gonzalez
Cara
Gonzalez
Rafael
167 47th Avenue Court
Greeley, Colorado 80634
1753981
Foster
35 S9gson -
Megan .:
Gtlgsen
Con4fr
2133680s,Avenue ',
Greeleyi Colrado:80634
-- 1749221
: KkrsHtp.--.
40 Gross
Jennifer
Gross
Nathan
1861 12th Avenue
Greeley, Colorado 80631
1718928
Foster
41 Grover
Chelsey
Grover
Andrew
24473Cassia 4trad26
Won. 1 lorad3'81050
1756011
Kinship
Weld County Foster and Kinship Provider
SFy 2022-2023
42 Hamacher
Tara
Purvis
Shaun 7432 Farmdale Street
Frederick, Colorado 80530
1757742
Foster
Fw
Foster
-Foster
Foster
KlnshfR-
Kinship
Foster
Foster
Foster -
Foster
Hansen
Natalie
Betting
Derrick
2771 Dawner Court
Milliken, Colorado 80543
;,17433809.
1753111
46
Hecker
!(elf
Hernandez
Angela
Hecker
,Ahdrew
Kaci
Craiff
Matthew
Mort.
2303 760 Avenue Court
Greeley, Colorado 80634
::;175744
64t 6Wedrl5e.'
1743691
;174az�1.:
1750326
1707¢73
1712735
1763790,
1708865
1723996
1625365
1757039
Shelby
Hernandez II
8823 15th Street
'1q0 04460504 4e640219
4907 West 23rd Street Road
?290 Rsi tdirlyieythhie JIB;4
339 Valley Avenue
19.84thAvenue
9981 Bountiful Street
37125 County... 63
2625 28th Avenue
25000 County Road 69'
501 Dakota Court
2929 56th Avenue
2304 Talon Parkway
102 9th Avenue; Apartment E
4919 St Vrain Road
ea PhteH(461 de.
7428 Ellingwood Circle
1710;GIendereAvenue
6025 Lynx Creek Circle
2813 West 13th Street
2306 Sunset Lane
41,714900.6164
2124 Village Drive
135 Suhtlower-4rlve
708 Moonglow Drive
5810 Graphite;Street
1021019th Street Road
Greeley, Colorado 80634
tireetettnitirede
Greeley, Colorado 80634
Windsor;COlorad400550
Lochbuie, Colorado 80603
Greeley, Wore. 80634
Firestone, Colorado 80504
...ton, Colorado 80622 .,
Greeley, Colorado 80634
'Kersey, Cobra.80644
Windsor, Colorado 80550
Greeley; Colorado 80634.
Greeley, Colorado 80634
Greeley; Colorado 80631
Firestone, Colorado 80504
Wfayette; Colorado'80026
Frederick, Colorado 80504
Casper, Wvomlrlg,82601
Frederick, Colorado 80530
49:
50
51_
52
Jasper
.lion
Jeffery
Rachel
,'�ilinr4t -�-
Jasper
Brandon
Jamie
'lauken>
,Atihnsein Trevor.. Johnson
Johnson
Kelly Slob Kelly
Klein -Troyer Cynthia Troyer
tazukk-Marin Justine Marin
Marcos Shantay Marcos
Moronic : Patricia
Martin Sherry Martin
Meta
McCubbin Crystal Kennedy
Alana
Johnson
3gela
Joshua
Richard
Rodney
Gilbert
Marcel
Foster
Foster
Foster
Foster
Foster
Foster
Foster
KinsMP
Foster
Foster
Foster
Kinship
Foster
Klr4shiP
Foster
56
57
98370
1661206
1732887
1510627"
1746250
1757783
1748208
1727904
1759848
376230
1707638
59
Nicholas
61.
62
Sandra
Jesse
Natalie
n
Mc6ukln
Meier Stephanie
Mendota rYlfrata
Menzel
MoOre
Muth
Kathrina
Rachel
Menzel
Muth
NgUenbslgos
Nix
Jared
Bryan
Ar ieb Cetnrado f6:34.
Greeley, Colorado 80634
Greeiri z64 -
Milliken, Colorado 80543
Wuidaor Colorado 80550
Windsor, Colorado 80550
TMmath, Co8osds 80547
Greeley, Colorado 80634
orielew. Olorida 81634
Greeley, Colorado 80634
trISISten,talteatio130543,
Fort Lupton, Colorado 80620
Windsor Cobredo•550
Frederick, Colorado 80504
.:.175703
1742038
1759081'-
1747311
1758526
1756923
69'
70
71
72
73
74
Niz
Nttrrl4
Dakleaf
Per..
Piccarreto
ratite Iteeta • -Plante JR
Pribble
Amanda
�NOnfs
Randall
1esOn
iter'
Foster
Foster
Foster
Foster
Kinship
Catherine
Timothy
Parrish
Nicholas
,-1634299
1741936
17
1659978
$73000
1708813
76
it
Kelly
decques .
2000 80th Ave Court
1659504th DuldtDrive
2391 Tate Avenue
3281413tage3oarth Road
5938 East Conservation Drive
1713 Mae. Plaza Way
4367 37th Street
:'� KMstilp
Foster
Faster
Foster
Foster
Foster
Foster
Foster
-Ayer:'
Purtell Nicole Punell
79;
Justin'
Christopher
Seth
Jeff
Alberto
Jose
;.�iiltiny `: QfetffSMn
Rickard Carmen Rickard
ttodriBuex-Caro Aslilyn Rodiiguez.Cero
Rojas
1751416
1754586.:
1553794
-Severance, Colerad630550
Kathleen Rojas Munoz
Evans, Colorado 80620
Weld County Foster and Kinship Provider
SFy 2022-2023
Provider Last
Namc•2
Provider Firs
Name
E6Bto , :
CoPr.�v der Last
Name
Medina
Co -Provider
First Name
Esmeralda: ,4315West2163treet-ROW
Addre. ;s Str,�et
-
Ark, . City/, ,,,,,,
WRe 1otteedo:s36315
Provider D
16366678':
Type
Xinship
84 Sanchez
Tracy
Sanchez
Isidro
423 28th Avenue
Greeley, Colorado 80634
1687293
Foster
85 : Sanchez
Stephanie,
135 20th Ave Court
Greeley, Colorado 80631 -
1756851
Kinship
86 Sanchez
87 Santa
Artemisa
Melissa
Perez Cervantes
Mato
Jose Jesus
Richard
3407 Riesling Court
0535Covered 37237Parkway
Evans, Colorado 80634
Windsor, Colorado 80550
1751829
4747566
Foster
Poster
88 Scudder
Mistie
Scudder
Nathan
747 Rock Road
Eaton, Colorado 80615
1521113
Foster
Shlatzaberger
Angela :
Sh6hiaberger :
Shawn
1571 Red Tait Road:.
Eaton, Cotorsda80615
1725981
Foster
90 Skov
Susan
Skov
Terry
461 Stagecoach Drive
Milliken, Colorado 80543
1754279
Kinship
91: Snow
M..
Show-
Austin
1706 Bounty Drive
Windsor, Colorado $0550
1745854 -
Foster
92 Soto -Feliciano
Veronica
Vega-Cuhero
Francisco
6232 Bauer Drive
Frederick, Colorado 80504
1761984
Foster
90 5tumP
Patrick '
SOarmers
Megan
5893 Maidenhead: Drive
Windsor, 630058do 80550
1740805
Foster
94 Thurman
Lauren
Thurman
Joel
4138 West 31st Street
Greeley, Colorado 80634
1708802
Foster
55. Torres
Daniel -'Torres
Jeannie
6756 Sage Avenue
Firestorm, Colorado 80504
1556847
Foster
96 Tupper
Jennifer
Tupper
Donald
6877 St Vrain Ranch Boulevard
Firestone, Colorado 80504
1759758
Kinship
97 Vance
Morgan
61364511
Brandon
5500 Campbell Street
Kersey, Colorada806.44
1703052
Foster.
98 Vandenelzen
Dawn
5819 West 16th Street Lane
Greeley, Colorado 80634
44282
Foster
99. Vargas
Joel
Pena
Marla
70130th Avenue, Apartment
Greeley, Colorado 80634
1757821
Kinship
100 Veyette
Amanda
Veyette
Brandon
316 Cottonwood Avenue
Eaton,Colorado.80615
1733697
Foster
101. Wahr
Laura
Whar
Harold
1740 Ave, Plaza Sneer
Severance, Colorado 80550
1757568
: Foster
102 Walker
108 Walker
Kayla
X.
Walker
Walker
Renee
Jennifer
235 West Shafer Avenue
7681 Carlson Court
Pierce, Colorado 80650
Port Collins, tororado 80524. "
1693525
1546248
Foster
Foster
104 White
Kristen
1651 Kelmsley Court
Windsor, Colorado 80550
1711814
Foster
105 Wlfso o
Shelby
Wilson
Brian ' ,
15670 Havana Way
Brighton, Colorado 80602
1751247
Foster
106 Young
Stephanie
230 Platte Court
Eaton, Colorado 80615
1746103
Foster
-107 Zetye
Rebecca -
Zetye -
Kenneth
2350 Black Duck Avenue -
Johnstown, Colorado 80534
1750254
:Foster
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