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Home My WebLink About20221894.tiffRESOLUTION RE: APPROVE CHILD PROTECTION AGREEMENT FOR SERVICES AND AUTHORIZE CHAIR PRO-TEM TO SIGN - RE, INC., DBA RE SERVICES 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 RE, Inc., dba RE Services, 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 RE, Inc., dba RE Services, be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair Pro-Tem 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 6th day of July, A.D., 2022, nunc pro tunc June 1, 2022. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: d�„.O �!;� EXCUSED Weld County Clerk to the Board BY:. Deoty Clerk to theZoard APP ounty Attorney Date of signature: 1 - (`1 - a a Scott K. James, Chair Mi an, Pro-Tem on Saine cc: HSD 2022-1894 HR0094 zp'cool a PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: June 28, 2022 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Protection Agreement with RE Inc dba RE Services 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 RE Inc dba RE Services. The Department is requesting to enter into a Child Protection Agreement for Services for Life Skills and Home Based Intervention services. The term of the agreement shall be from June 1, 2022 through May 31, 2023. Fees for Services IIIIIIIIIITIIIIIIIMIIIIIIIIM=Rate Unit Type Service Name IIIIIIIIMIIMI Exchange Parent Aid $100.00 Hour In-Office/Video $150.00 Hour In -Office with transportation $125.00 Hour In -Home or Community $50.00 Each No show -• maximum of two (2) no shows or two (2) hours per month per client. $0.65 . Mile Mileage - For distances exceeding fifty (50) miles roundtrip from provider's office or staffs home address. Rate Unit Type Service Name Visit Coaching $ 100.00 Hour In-Office/Video $150.00 Hour in -Office with transportation $150.00 Hour In -Home or Communk. $80.00 flour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $75.00 Each _ No show -- maximum of two (2) no shows or two (2) hours per month per client. $0.65 Mile Mileage - For distances exceeding fifty (50) miles roundtrip from provider's office or staff's home address. Nurturing Parent $100.00 Hour In-Office/Video $150.00 Hour In -Office with transportation $150.00 Hour (n -Home or Community Pass -Around Memorandum; June 28, 2022 CMS ID 6072 Page I 2022-1894 1-IRoo9y PRIVILEGED AND CONFIDENTIAL $80.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $75.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.65 t Mile Mileage - For distances exceeding fitly (50) miles roundtrip from provider's office or staff's home address. I do not recommend a Work Session. I recommend approval of this Agreement and authorize the Chair to sign. Approve Schedule Re mmendation Work Session Perry L. Buck Mike Freeman, Pro -Tern Scott K. James, Chair Steve Moreno Lori Saine Other/Comments: Pass -Around Memorandum; June 28, 2022 - CMS ID 6072 Page 2 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND RE INC. DBA RE SERVICES This Agreement, made and entered into the day of Board of Weld County Commissioners, on behalf of the Weld Coun referred to as the "Department' and RE Inc. dba RE Services, herei , o2 by and between the ent of Human Services, hereinafter erred 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 Life Skills and Home Based Intervention. 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 May 31, 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-CWOualitvAssurance(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 7t' 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 1 02a0201 -1,074 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 2 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 3 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 4 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. 5 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 7 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). 8 For Department: For Contractor: Heather Walker, Child Welfare Division Head Tyson Wilke, Chief Executive Officer 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Jamie Ulrich, Director P.O. Box A Greeley, CO 80632 (970) 400-6510 18. Litigation For Contractor: Tyson Wilke, Chief Executive Officer 11 5th Street North, Suite 201 Great Falls, Montana 59401 (406) 781-7928 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 9 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. &&24-18-201 et seq. and &24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflicts with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contractor's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contractor agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contractor acknowledges that the Department has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of this project without the Department's prior written consent, which may be withheld in the Department's sole discretion. 36. Attorney's Fees/Legal Costs 12 In the event of a dispute between the Department and Contractor, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of the Department. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contractor in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the Department. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of the Department. 38. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: Weld Cou By: Deputy Clerk to t ddt/%tJ Gam. Jelin;e1 Clerk to the Board 13 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO eyys-3, Mike Freeman, Pro-Tem CONTRACTOR: RE Inc. dba RE Services 11 5t' Street North, Suite 201 Great Falls, Montana 59401 (406) 781-7928 By: Date: four Geke JUL 0 6 2022 Tyson Wilke (Jun 23, 202213:20 MDT) Tyson Wilke, Chief Executive Officer Jun 23, 2022 EXHIBIT A SCOPE OF SERVICES Contractor will provide Home -Based Intervention and Life Skills Services, as referred by the Department. Home -Based Intervention 1. Exchange Parent Aid a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Child safety, home support, problem solving, parenting skills and social support and referrals to therapeutic services. ii. Modeling of parenting skills and teaching of child development concerns and milestones. Social emotional development of child is encouraged by strengthening the nurturing capacities of the family in a culturally responsive manner. Family support to discuss problems and define solutions. Connecting families to other community -based services including addiction counseling and parenting groups. iii. 3 modules are implemented 1. Mod 1- Basic needs- Does the family have its basic needs met- food, water, clothing, shelter, or need immediate medical assistances 2. Mod 2- Stabilization of Family- addressing families medical, mental, emotional needs by enrolling them into federal and state assistance programs (Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Medicaid, or other programs) if necessary and making appropriate referrals to Mental Health, Addictions Services, Dentistry, Physical Health, or other services. Continue to work to improve home conditions such as cleanliness, budgeting, secure food allocation, school attendance, etc. 3. Mod 3- Parent Child Interaction & Long -Term Life Skills- Working to build parent child interactions through continued focused efforts of child needs recognition and parent strength building. Build long term habits and abilities within household management such as, budgeting, scheduling, resource allocation and obtainment, gainful employment, continued work and success within substance abuse programs. b. Anticipated Frequency of Services: i. Basic Needs: typically, zero (0) to two (2) months. The length of time is dependent on family situation. ii. Stabilization of family: One (1) to four (4) months for about eight (8) hours. Typically, two (2) to four (4) times per week. iii. Parent Child Interaction: zero (0) to twelve (12) months for about four (4) hours. Typically, two (2) times per week, depending on family need. c. Anticipated Duration of Services: i. Six (6) to twelve (12) months. d. Goals of Services: i. Basic needs: health, food, safety of home, heat, water other household hazards. ii. Home Stabilization: home safety, budgets, health, referral for therapeutics, Substance Use Disorder (SUD) support, mental health appointments, Medicaid, Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and help with scheduling. iii. Parent Child Interaction: parent education, role modeling, child development and increased nurturing capability to strengthen parent child bond, increase needs -based communication, and reduce aggressive behaviors. 1 e. Outcomes of Services: i. Basic Needs: home assessment, treatment plan established, benefits secured, awareness of SUD. ii. Home Stabilization: safety issues addressed, budgets established, referral to services underway. iii. Parent Child Interaction: better communication skills, increased parental mastery, increased support for single parents, reduced maternal stress, reduced psychological aggression and physical assault toward children. iv. The final goal is to eliminate recidivism and Child Protective Services involvement without court involvement f. Target Population: i. Families with children birth through seventeen (17) years of age. g. Language: i. English only. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In the home of the client. ii. In the community. Life Skills 2. Visit Coaching a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Intake/Initial Meeting- Parent intake and explanation of parental requirements, prep for visitations, set the schedule, lay out all the principals of Visit Coaching such as boundaries, strength based, review and modeling oriented. ii. Pre -visit Meeting- Prior to each meeting Contractor meets with the parents before the child arrival. During this meeting Contractor utilizes the "Umbrella Sheet" to identify the parent's problems (and keep them out of the visitation) and the child's needs to address during the visitation. Contractor also uses this time to establish goals for the visit. iii. Visitation- This is the period with the children present, Contractor utilizes several tactics to coach parents the correct skills and reactions to different scenarios of child behavior and reaction. Contractor keeps detailed notes identifying parent weakness and strengths. iv. Post -Visit Meeting- This time is utilized with just the parents present to review the notes taken during the visitation. Contractor utilizes a "Self -Assessment" to have the parent review what their strengths and weaknesses within the visit. All notes are reviewed with the parent, so they know where they need to work and what they do well, continuing to build their skills and furthering the goals of the family b. Anticipated Frequency of Services: i. Depending on the request of the court. Contractor is able to do visitations one (1) to six (6) hours per day and up to twenty-five (25) hours per week. c. Anticipated Duration of Services: i. Zero (0) to twenty-four (24) months. . d. Goals of Services: i. Family Reunification. ii. For the client to learn long term parenting skills. 2 iii. To build appropriate parent -child interactions. iv. For the parent to build upon their ability to recognize child needs. e. Outcomes of Services: i. Family Reunification ii. Client will have positive long-term relationship and parenting skills To eliminate recidivism within the Child Welfare system f. Target Population: i. All genders ages zero (0) to seventeen (17). g. Language: i. English only. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In the home of the client. ii. In the community. 3. Nurturing Parenting a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. The programs feature activities to foster positive parenting skills with nurturing behaviors, promote healthy physical and emotional development, and teach appropriate role and developmental expectations. Nurturing Parenting curriculum is fit to each family's needs and is assessed at the time of intake. ii. Contractor is trained in three (3) additional specialized curriculums focusing on special needs of a family: 1. Parents with Substance Abuse Disorders 2. Child with special needs 3. Single father households b. Anticipated Frequency of Services: i. One (1) to two (2) visits per week, lasting two (2) to four (4) hours per visit. c. Anticipated Duration of Services: i. Three (3) to five (5) months. d. Goals of Services: i. For the client to learn nurturing behaviors. ii. To promote healthy physical and emotional development. iii. To teach appropriate role and developmental expectations. e. Outcomes of Services: i. Client will learn nurturing behavior. ii. Client will understand healthy physical and emotional development. iii. Client will have Long term healthy parent child interactions. iv. Eliminate recidivism within the Child Welfare System. f. Target Population: i. All genders ages zero (0) to seventeen (17). g. Language: i. English only. 3 h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In the home of the client (preferred). ii. In Contractor's office, a location in Northern Colorado that is to be determined. Terms 1. Contractor will respond to the Quality Assurance Team (HS-CWQualityAssurance(a,weldgov.com within three (3) business days regarding the ability to accept the received referral. 2. Upon acceptance of a referral, Contractor will offer an initial appointment within seven (7) days of receiving the referral. The first attempt to contact the client will occur within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If the client does not respond after three (3) attempts in the first seven (7) days of the referral period, the Contractor will notify the caseworker and the Quality Assurance Team HS- CWQualitvAssu rance(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-CWQualityAssurance(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-CWQualityAssurance(aweldgov.com immediately AND on the required monthly report. 4 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. 10. On a monthly basis, the Contractor will notify the Quality Assurance Team HS- CWQualitvAssurance(a,weldgov.com of new staff who will manage and/or administer the services with the following information: a. Staff member name and contact information b. Education level/degree (if applicable) c. Licensure/credentials (if applicable) d. Department of Regulatory Authority (DORA) number (if applicable) e. Supervisor name and contact information The Department reserves the right to decline the new staff members managing and/or administering services to Department clients. 5 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 Rate Unit Type Home -Based Intervention Service Name Exchange Parent Aid $100.00 Hour In-OfficeNideo $150.00 Hour In -Office with transportation $125.00 Hour In -Home or Community $50.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.65 Mile Mileage — For distances exceeding fifty (50) miles roundtrip from provider's office or staffs home address. Rate Unit Type Life Skills Service Name Visit Coaching $100.00 Hour In-OfficeNideo $150.00 Hour In -Office with transportation $150.00 Hour In -Home or Community $80.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $75.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.65 Mile Mileage — For distances exceeding fifty (50) miles roundtrip from provider's office or staffs home address. Nurturing Parent $100.00 Hour In-OfficeNideo $150.00 Hour In -Office with transportation $150.00 Hour In -Home or Community $80.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $75.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.65 Mile Mileage — For distances exceeding fifty (50) miles roundtrip from provider's office or staffs home address. 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) Authorized Rep. Address (Street, city, state, zip): I Signature of Authorized Rep.: ATTACHMENT B WELD COUNTY DEPARTMENT OF HUMAN SERVICES - PROVIDER INFORMATION FORM (PIF) AGENCY INFORMATION Agency Name: RE Inc Provider Contact Full Name: Tyson Wilke Primary Phone Number (10 -digit): 406-781-%928 Ext : _ ityson.wilke@refamilyservices.org Primary Contact Email: Trails Provider ID (if known): Title: CEO Fax Number (10 -digit): Web Address: 406-315-3845 re-services.org Agency Location Address (Street, city, state, zip): 11 5th St N ste 201 Great Falls, MT 59401 Agency Mailing Address (Street, city, state, zip): Same Agency Type (pick one): ri Public Company Private Non -Profit Private for Profit Referral Contact Name: Send Referrals for Service to: Tyson Wilke Referral Phone Number (10 -digit): 406-781-%928 Ext.: Title: CEO Email: tyson.wilke@refamilyservices.org Billing Contact Billing Contact Name: Tyson Wilke Billing Phone Number (10 -digit): 406-781-7928 Title: CEO Ext.: Email: tyson.wilke@refamilyservices.org CERTIFICATION iI 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 0 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 Ithe bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are competitive in price and quality. WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES. THE CERTIFICATE OF EXEMPTION NUMBER IS #98-03551-0000. I Authorized Rep. Full Name: Tyson Wilke Title: CEO Authorized Rep. Email: tyson.wilke@refamilyservices.org Phone (lo -digit): 406-781-7929 Ext.: i I jZl — Date: 5/23/22 i 11 5th SIN ste 201 Great Falls, MT 59401 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 Xl of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. RE Inc. Home -Based Intervention Number of services offered on this Attachment C (max 5): 1 If Service 2.1a 2.1b 2.1c 2.1d 2.1e 2.1f 2.1g 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: Exchange Parent Aide Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Child safety, home support, problem solving, parenting skills and social support and referrals to therapeutic services. Modeling of parenting skills and teaching of child development concerns and milestones. Social emotional development of child is encouraged by strengthening the nurturing capacities of the family in a culturally responsive manner. Family support to discuss problems and define solutions. Connecting families to other community -based services including addiction counseling and parenting groups. 3 modules are implemented • Mod 1- Basic needs- Does the family have its basic needs met- food, water, clothing, shelter, or need immediate medical assistances • Mod 2- Stabilization of Family- addressing families medical, mental, emotional needs by enrolling them into federal and state assistance programs (SNAP, TANF, Medicaid, etc.) if necessary and making appropriate referrals to Mental Health, Addictions Services, Dentistry, Physical Health, etc. Continue to work to improve home conditions such as cleanliness, budgeting, secure food allocation, school attendance, etc. • Mod 3- Parent Child Interaction & Long -Term Life Skills- Working to build parent child interactions through continued focused efforts of child needs recognition and parent strength building. Build long term habits and abilities within household management such as, budgeting, scheduling, resource allocation and obtainment, gainful employment, continued work and success within substance abuse programs, etc. 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: 6 to 12 months 1. Basic Needs 0-2 months, length of time is dependent on family situation. 2. Stabilization of family: 1 to 4 months about 8 hours (2-4 times per week) 3. Parent Child Interaction: 0 to 12 months 4 hours (2 times per week) depending on family need. Anticipated duration of service (i.e. 3-4 months): 6-12 months Three (3), or more, specific goals of the service (DO use bullet points): 1. Basic needs: health, food, safety of home, heat, water other household hazards. 2. Home Stabilization: home safety, budgets, health, referral for therapeutics, SLID support, mental health appointments, Medicaid, SNAP/TAN F, and help with scheduling. 3. Parent Child Interaction: parent education, role modeling, child development and increased nurturing capability to strengthen parent child bond, increase needs -based communication, and reduce aggressive behaviors. Three (3), or more, specific outcomes of service: 1. Basic Needs: home assessment, treatment plan established, benefits secured, awareness of SUD. 2. Home Stabilization: safety issues addressed, budgets established, referral to services underway. 3. Parent Child Interaction: better communication skills, increased parental mastery, increased support for single parents, reduced maternal stress, reduced psychological aggression and physical assault toward children. 4. Final goal to eliminate recidivism and CPS involvement without court involvement Target population of the service, including age and gender: Families with children birth thru 17 years of age. Languages service is available in (please list proficiency and if interpreter services are available): REV. OCT 2021 1 ATTACHMENT C - PROPOSAL 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: This service is not Eligible 2.1i Service location — list where the service will take place (i.e. client's home, in -office, other) In home of client / community Service #2 Name: 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.2c Anticipated duration of service (i.e. 3-4 months): 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 2.2e Three (3), or more, specific outcomes of service: 2.2f Target population of the service: 2.2g Languages service is available in (please list proficiency and if interpreter services are available): 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #3 Name: 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.3c Anticipated duration of service (i.e. 3-4 months): 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 2.3e Three (3), or more, specific outcomes of service: 2.3f Target population of the service: 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Anticipated duration of service (i.e. 3-4 months): 2.4d Three (3), or more, specific goals of the service (DO use bullet points): REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 2.4e 2.4f 2.4g Three (3), or more, specific outcomes of service: Target population of the service: Languages service is available in (please list proficiency and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.4i Service 2.5a Service location — list where the service will take place (i.e. client's home, in -office, other) #5 Name: Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) 3.1 3.2 3.3 3.4 3.5 Section 3 — Service Access and Transportation YES YES NO Will you charge Weld County for transporting clients or mileage? Check one: O • NO Will you conduct services in a client's home or in the community? Check one: @ • NO Miles Will you transport clients to and/or from services? Check one: O YES ■ How many miles are you willing to travel round trip? List a specific number of miles. 50 When you calculate mileage, what is your starting point address? RE Service Office Location / or staff home 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. REV. OCT 2021 3 ATTACHMENT C - PROPOSAL 4.1 Hourly Service #1 Name: Exchange Parent Aid $ Amount Unit Type 4.1a In-Office/Video: 100 per Hour 4.1b In -Office with Transportation: 150 per Hour No. of roundtrip miles included in rate: 50 miles In -Home or Community: 125 per Hour No. of roundtrip miles included in rate: 50 miles 4.1c FTM, TDM, Prof. Staffing: per Hour 4.1d No show: 50 per No Show 4.1e Mileage rate: .65 per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: $ Amount Unit Type 4.2a In-Office/Video: per Hour 4.2b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.2c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: per Hour 4.2e No show: per No Show 4.2f Mileage rate: per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: per Hour 4.3b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.3c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of 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 REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 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 5 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 Xl of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. RE Inc. Life Skills Number of services offered on this Attachment C (max 5): 2 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: Visit Coaching Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): • Intake/Initial Meeting- Parent intake and explanation of parental requirements, prep for visitations, set the schedule, lay out all the principals of Visit Coaching (boundaries, strength based, review and modeling oriented) • Pre -visit Meeting- Prior to each meeting RE meets with the parents before the child arrival. During this meeting we utilize the "Umbrella Sheet" (attached) to identify the parent's problems (and keep them out of the visitation) and the child's needs to address during the visitation. We also use this time to establish goals for the visit. • Visitation- This is the period with the children present, RE utilizes several tactics to coach parents the correct skills and reactions to different scenarios of child behavior and reaction. RE keeps detailed notes (attached) identifying parent weakness and strengths • Post -Visit Meeting- This time is utilized with just the parents present to review the notes taken during the visitation. We utilize a "Self -Assessment" (attached) to have the parent review what their strengths and weaknesses within the visit. All notes are reviewed with the parent, so they know where they need to work and what they do well, continuing to build their skills and further the goals of the family 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: Depends on the request of the court. RE has done visitations from 1-6 hours daily and up to 25 hours a week. Anticipated duration of service (i.e. 3-4 months): 0-24 months depending on need and request of the department Three (3), or more, specific goals of the service (DO use bullet points): • Family Reunification • Long term parenting skills • Building appropriate parent -child interactions • Building parent's ability to recognize child needs Three (3), or more, specific outcomes of service: • Family Reunification • Positive long-term relationship and parenting skills • Elimination of recidivism within the Child Welfare system Target population of the service, including age and gender: 0-17 all genders Languages service is available in (please list proficiency and if interpreter services are available): Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: This service is not Eligible Service location — list where the service will take place (i.e. client's home, in -office, other) Office, Client Home (when approved), Local Community (when approved) #2 Name: Nurturing Parenting Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): The programs feature activities to foster positive parenting skills with nurturing behaviors, promote healthy physical and emotional development, and teach appropriate role and developmental expectations. Nurturing Parenting curriculum is fit REV. OCT 2021 1 ATTACHMENT C - PROPOSAL to each families needs and is assessed at the time of intake. The program runs for 18-20 weeks and is implemented within the client home whenever possible. RE is also trained in 3 additional specialized curriculums focusing on special needs of a family. Thy are: • Parents with Substance Abuse Disorders • Child with special needs • Single father households 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: 2-4 hours (1-2 visits/week) 2.2c Anticipated duration of service (i.e. 3-4 months): 3-5 months 2.2d Three (3), or more, specific goals of the service (DO use bullet points): • Nurturing behaviors • Promote healthy physical and emotional development • Teach appropriate role and developmental expectations 2.2e Three (3), or more, specific outcomes of service: • Nurturing behaviors • Promote healthy physical and emotional development • Teach appropriate role and developmental expectations • Long term healthy parent child interactions • Eliminate recidivism within the Child Welfare System 2.2f Target population of the service: 0-17 all genders 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: This service is not Eligible 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Office, Client Home (preferred) 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: REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 2.4c 2.4d 2.4e 2.4f 2.4g 2.4h 2.4i Service 2.5a Anticipated duration of service (i.e. 3-4 months): Three (3), or more, specific goals of the service (DO use bullet points): Three (3), or more, specific outcomes of service: Target population of the service: Languages service is available in (please list proficiency and if interpreter services are available): Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service location — list where the service will take place (i.e. client's home, in -office, other) #5 Name: Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) 3.1 3.2 3.3 3.4 3.5 Section 3 — Service Access and Transportation YES YES NO Will you charge Weld County for transporting clients or mileage? Check one: ►Za IN NO Will you conduct services in a client's home or in the community? Check one: ►I ■ NO Miles Will you transport clients to and/or from services? Check one: @ YES ■ How many miles are you willing to travel round trip? List a specific number of miles. 50 When you calculate mileage, what is your starting point address? RE Service Office Location / or staff home 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. REV. OCT 2021 3 ATTACHMENT C - PROPOSAL • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: Visit Coaching $ Amount Unit Type 4.1a In-Office/Video: 100 per Hour 4.1b In -Office with Transportation: 150 per Hour No. of roundtrip miles included in rate: 50 miles In -Home or Community: 150 per Hour No. of roundtrip miles included in rate: 50 miles 4.1c FTM, TDM, Prof. Staffing: 80 per Hour 4.1d No show: 75 per No Show 4.1e Mileage rate: .65 per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: Nurturing Parenting $ Amount Unit Type 4.2a In-Office/Video: 100 per Hour 4.2b In -Office with Transportation: 150 per Hour No. of roundtrip miles included in rate: 50 miles 4.2c In -Home or Community: 150 per Hour No. of roundtrip miles included in rate: 50 miles 4.2d FTM, TDM, Prof. Staffing: 80 per Hour 4.2e No show: 75 per No Show 4.2f Mileage rate: .65 per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: per Hour 4.3b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.3c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of 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 REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 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 5 ATTACHMENT D - STAFF DATA SHEET Bidder Must List All Staff Who Will Administer the Proposed Service(s) BIDDER'S LEGAL NAME (As it appears on the W-9): AGENCY CONTACT: Tyson Wilke RE Inc. PHONE NUMBER:406_78 1 _7928 EMAIL: tyson.wilke@refamilyservices.org PROPOSED SERVICE(S): Life Skills: Visit Coaching, Nurturing Parenting Home Based intervention: Exchange Parent Aid Legal Last Name Middle Initial Previous Legal Last Name (If applicable) Legal First Name Service Type Licensure/ Credentials DORA ft (If applicable) Wilke A Tyson Contractor CHILD WELFARE REQUEST FOR PROPOSAL 2022-23 - VARIOUS SERVICES TYSOWIL-01 CBYER ACORL7" CERTIFICATE OF LIABILITY INSURANCE `-►'� DATE D/YYYV) 6 6/1/2/1/2022 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Great Falls Office PayneWest Insurance, a Marsh McLennan Agency LLC Company 405 3rd Street NW, Third Floor Great Falls, MT 59404 NA ME CT PHONE , Ext): (406) 761-1160 FAX(A/C,No):(406) 452-1172 (N, E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :AMCO Insurance Company 19100 INSURED RE Inc., RE Family Services, Inc. 11 5th Street North., Suite 201 Great Falls, MT 59401 INSURER B: Allied Insurance Company of America 10127 INSURER C: Montana State Fund 15819 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X ACP3110323643 2/1/2022 2/1/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR PPAMAGEETOEa RENTED) REMISS (occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE OTHER: LIMIT APPLIES PRPOLICY JECT PER: LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS- COMP/OP AGG $ 3,000,000 $ B AUTOMOBILE X X LIABILITY x S SCHEDULED AUTOS AUUTOS ONLYY ACP3110323643 2/1/2022 2/1/2023 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROTY (Per acEciidentDAMAGE $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 RETENTION $ $ C WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N N / A 034999581 10/1/2021 10/1/2022 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Weld County Department of Human Services 1150 O Street Greeley, CO 80631 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 81 28 01 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY ENHANCEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such other more specific coverage applies, the terms, conditions, and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Coverage Applicable Limit of Insurance Page # Additional Insured — As Required by Contract Included 7 Additional Insured — Broad Form Vendors Included 5 Additional Insured — Funding Source Included 4 Additional Insured — Grantor of Franchise Included 6 Additional Insured — Grantor of Permits Included 4 Additional Insured — Home Care Providers Included 4 Additional Insured — Lessors Of Leased Equipment — Automatic Status When Required In Lease Agreement With You Included 4 Additional Insured — Managers, Landlords, Or Lessors Of Premises Included 4 Additional Insured — Medical Directors And Administrators Included 4 Additional Insured — State Or Political Subdivision Included 5 Broadened Definition Of Bodily Injury Includes Mental Anguish 9 Damage To Premises Rented To You $1,000,000 (Includes Expanded Perils) 8 Damage To Property You Own, Rent, Or Occupy $50,000 2 Duties In The Event Of Occurrence, Claim Or Suit Included 8 Employee Indemnification Defense Coverage For Employee $25,000 3 Extended Property Damage Included 3 Key And Lock Replacement -Janitorial Services Client Coverage $15,000 2 Liberalization Included 8 Limited Rental Lease Agreement Contractual Liability $100,000 3 Medical Payments $20,000 3 Medical Payments — Athletic Activities Amended 3 Medical Payments — Extended Reporting Period 3 Years 3 Named Insured — Broadened Named Insured Included 3 Named Insured — Newly Acquired Included 3 Non -Owned Watercraft Less than 58 feet 2 Personal And Advertising Injury— Includes Abuse Of Process And Discrimination Included 9 Supplementary Payments — Bail Bonds $7,500 3 Supplementary Payments — Loss Of Earnings $1,500 per day 3 Transfer Of Rights Of Recovery Against Other To Us Clarification 8 Unintentional Failure To Disclose A Hazard Included 8 CG 81 28 01 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 9 CG 81 28 01 18 A. Key and Lock Replacement — Janitorial Services Client Coverage 1. We will pay for the cost to replace keys and locks at the "client's" premises due to theft or other loss to keys entrusted to you by your "client", up to a $15,000 limit per occurrence/$15,000 policy aggregate. 2. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers, "employees", "managers", directors, trustees, authorized representatives or any one to whom you entrust the keys of a "client" for any purpose commit, whether acting alone or in collusion with other persons. 3. The following, when used in this coverage only, are defined as follows: a. "Employee" means: (1) Any natural person: (a) While in your services or for 30 days after termination of service; (b) Who you compensate directly by salary, wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent "employee" as defined in Paragraph (1) above, who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. "Employee" does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm, factor, commission merchant, consignee, independent contractor or representative of the same general character; or (b) Any "manager", director or trustee except while performing acts coming within the scope of the usual duties of an "employee". b. "Manager" means a person serving in a directorial capacity for a limited liability company. B. SECTION I - COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions is amended as follows: 1. Exclusion a. Expected or Intended Injury is deleted and replaced with: (3) a. "Bodily injury" or "property damage" expected or intended from the stand point of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 2. Exclusion g. Aircraft, Auto or Watercraft Paragraph (2) is deleted and replaced with: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess, or contingent. 3. Exclusion j. is amended as follows: (a) Exclusion j.(1) is deleted and replaced with: (1) Property you own, rent , or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's' property, unless the damage to property is caused by your "client", in such case we will provide coverage for such "property damage" for which you are legally obligated to pay up to a $50,000 limit per "occurrence". This limit is the only limit of insurance for such "property damage" and will not be combined with the Each Occurrence Limit set for this in Section III — Limits of Insurance and will be included within and not in addition to the Each Occurrence Limit. Any and all damages paid under the terms and condition of this provision will further be applied against and will reduce the Aggregate Limit of Insurance shown on the Declarations page, and as provided in the Commercial General Liability Coverage Form in the same manner and in addition to all other coverages of the Commercial General Liability Coverage Form that are also subject to the Aggregate Limit. 4. The following is added to Paragraph (2) of Exclusion b. Contractual Liability of SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, under Subsection 2. Exclusions: We agree to indemnify the Named Insured for their liability assumed in a contract or agreement Page 2 of 9 Includes copyrighted material of Insurance Services Office, Inc.; CG 81 28 01 18 with its permission. regarding the rental or lease of a premises on behalf of their "client", up to $100,000 per "occurrence". This limit of insurance is the only limit of insurance for your liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of your "client" whether or not such contract qualifies as an "insured contract". This limit will not be combined with the Each Occurrence Limit set forth in Section III — Limits of Insurance and is included within and not in addition to the Each Occurrence Limit. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the "client". Any and all damages paid under the terms and conditions of this provision will further be applied against and will reduce the Aggregate Limit of Insurance shown on the Declarations page, as provided in the Commercial General Liability Coverage Form in the same manner and in addition to all other coverages of the Commercial General Liability Coverage Form that are also subject to the Aggregate Limit. 5. The last Paragraph of Subsection 2. Exclusions is replaced by the following: If damage by fire to premises rented to you is not otherwise excluded, exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III — Limits of Insurance. C. SECTION I - COVERAGES, COVERAGE C - MEDICAL PAYMENTS 1. If COVERAGE C - MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: a. The Medical Expense Limit shown on the Declarations is deleted and replaced by $20,000. $20,000 is the only limit of insurance for Medical Expenses and this limit will not be combined with any other limit of insurance. b. Subsection 1. Insuring Agreement, Paragraph a.(3)(b) is replaced by: (b) The expenses are incurred and reported to us within three years of the date of the accident; and 2. Subsection 2. Exclusions, is amended as follows: a. Exclusion a. Any Insured is deleted and replaced with: a. Any Insured To any insured, except "volunteer workers" or an insured as provided in e. Athletic Activities below. CG 81 28 01 18 CG 81 28 01 18 b. Exclusion e. Athletics Activities is deleted and replaced with: e. Athletics Activities To a person injured while practicing or participating in any physical exercises or games, sports or athletic contests. This exclusion shall not apply to an insured while providing instruction with respect to any of the activities otherwise excluded by this provision. D. SECTION I - COVERAGES, SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is amended as follows: 1. 1. b. is replaced with: b. Up to $7,500 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. 1. d. is replaced with: d. All reasonable expenses incurred by the insured at our request to assist us in the "suit", including actual loss of earnings up to $1,500 a day because of time off from work. 3. The following provision is added: We will reimburse you for defense costs that you incur in the defense of an "employee" who is directly involved in a criminal proceeding that arises out of such "employee's" acts or omissions within the scope of their employment by you or while performing duties related to the conduct of your business and which would otherwise be covered by this insurance. The most we will reimburse you for defense costs that you incur in the defense of an "employee" who is alleged to be directly involved in a criminal proceeding is $25,000, subject to an aggregate limit of $25,000 for all reimbursements that we make during the policy period on behalf of all "employees", regardless of the numbers of "employees", claims or "suits" brought or persons or organizations making claims or bringing "suits". E. SECTION II WHO IS AN INSURED is amended as follows: 1. If coverage for a newly acquired or formed organization is not otherwise excluded from this Coverage Part, Paragraph 3.a. is replaced with: a. Coverage under this provision is until the end of the policy period during which you acquired or formed the organization; 2. The following is also an insured: Broadened Named Insured — Any organization and subsidiary thereof which you control and actively manage (whether through ownership of voting securities, by contract, or otherwise) on the effective date of this policy. However, coverage does not apply to any organization or Includes copyrighted material of Insurance Services Office, Inc.; with its permission. Page 3 of 9 CG 81 28 01 18 subsidiary not named in the Declarations as a Named Insured, if they are also insured under another similar policy, or would have been insured but for such policy's termination or the exhaustion of its limits of insurance. 3. Each of the following is also an additional insured: a. Medical Directors and Administrators — Your medical directors and administrators but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services as a physician or psychiatrist in the treatment of a patient. b. Funding Source — Any person or organization with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to: (a) Any "occurrence" or offense which takes place after you cease to lease or occupy that premises; or (b) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. c. Home Care Providers — At the first Named Insured's option, any person or organization under your direct supervision and control while providing on your behalf private home respite or foster home care for the developmentally disabled. d. Managers, Landlords, or Lessors of Premises — Any person or organization with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to be a tenant in that premises. (2) Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization. e. Lessor of Leased Equipment — Automatic Status When Required in Lease Agreement With You - Any person(s) or organization(s) from whom you lease equipment when you and such person(s) or organization(s) have Page 4 of 9 agreed in writing in a contract or agreement that such person(s) or organization(s) be added as an additional insured on your policy. Such person(s) or organization(s) is an insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). However, the insurance afforded to such additional insured: (1) Only applies to the extent permitted by law; and (2) Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. f. Grantors of Permits — Any state or governmental agency or subdivision or political subdivision granting you a permit in connection with your premises subject to the following additional provision: This insurance applies only with respect to the following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: (1) The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; or (2) The construction, erection or removal of elevators; or The ownership, maintenance or use of any elevators covered by this insurance. However: (1) The insurance afforded to such additional insured only applies to the extent permitted by law; and (3) Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 81 28 01 18 g. (2) If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. State or Political Subdivision — Any state or political subdivision with whom you agreed under a written contract or agreement to add as an additional insured to your policy but only with respect to their liability with respect to on -going operations performed by you or on your behalf for which the state or political subdivision has issued a permit or license. This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or political subdivision; or 2. "Bodily injury" or "property damage" included within the "products -completed operations hazard". The insurance provided to such additional insured state or political subdivision by this endorsement is further limited as follows: 1. The additional insured is covered only for such sums that such additional insured is legally obligated to pay as damages under tort law principles to the injured party because of "bodily injury", "property damage" or "personal and advertising injury" to which this insurance applies, and in accordance with the stated policy limits, exclusions, limitations and conditions except as expressly modified by this endorsement. 2. The limits of insurance are those set forth in the policy Declarations or those specified in the written contract or agreement referenced above, whichever is less. Other Insurance 1. If specifically required by the written contract or agreement referenced above, any coverage provided by this Subsection g. to an additional insured shall be primary and any other valid and collectible insurance available to the additional insured shall be non- contributory with this insurance. If the written contract does not require this coverage to be primary and the additional insured's coverage to be non- contributory, then this insurance will be excess over any other valid and collectible insurance available to the additional insured. CG 81 28 01 18 CG 81 28 01 18 2. Even if the requirements of Paragraph 1. immediately above are met establishing this coverage as primary and the additional insured's coverage as being non-contributory, this coverage will be excess over any other insurance available to the additional insured which is conferred onto said person or organization by a separate additional insured endorsement. h. Broad Form Vendors — Any person(s) or organization(s) which or who is or are a vendor of "your products" with whom you agreed under a written contract or agreement to add as an additional insured to your policy, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: The insurance afforded the vendor does not apply to: 1. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; 2. Any express warranty unauthorized by you; 3. Any physical or chemical change the vendor intentionally made to the product; 4. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; 5. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 6. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; 7. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 9 CG 81 28 01 18 8. "Bodily injury" or "property damage" arising out of the negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf and which was not caused in whole or in part by you or any person or organization acting on your behalf. However, this exclusion does not apply to: (a) The exceptions contained in Subparagraphs 4. or 6.; or (b) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. The insurance provided to such additional insured vendor by this endorsement is further limited as follows: 1. The additional insured is covered only for such sums that such additional insured is legally obligated to pay as damages under tort law principles to the injured party because of "bodily injury", "property damage" or "personal and advertising injury" to which this insurance applies, and in accordance with the stated policy limits, exclusions, limitations and conditions except as expressly modified by this endorsement. 2. The limits of insurance are those set forth in the policy Declarations or those specified in the written contract or agreement referenced above in the first paragraph of this Subsection h., whichever is less. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. Other Insurance 1. If specifically required by the written contract or agreement referenced above in the first paragraph of this Subsection h., any coverage provided by this endorsement to an additional insured shall be primary and any other valid and collectible insurance available to the additional insured shall be non- contributory with this insurance. If the written contract does not require this coverage to be primary and the additional insured's coverage to be non- contributory, then this insurance will be Page 6 of 9 Includes copyrighted excess over any other valid and collectible insurance available to the additional insured. 2. Even if the requirements of Paragraph 1. immediately above are met establishing this coverage as primary and the additional insured's coverage as being non-contributory, this coverage will be excess over any other insurance available to the additional insured which is conferred onto said person or organization by a separate additional insured endorsement. i. Grantor of Franchise — Any person(s) or organization(s) with whom you agreed under a written contract or agreement to add as an additional insured to your policy but only with respect to their liability as grantor of a franchise to you. The insurance provided to such additional insured franchisor by this endorsement is further limited as follows: 1. The additional insured is covered only for such sums that such additional insured is legally obligated to pay as damages under tort law principles to the injured party because of "bodily injury", "property damage" or "personal and advertising injury" to which this insurance applies, and in accordance with the stated policy limits, exclusions, limitations and conditions except as expressly modified by this endorsement. 2. The limits of insurance are those set forth in the policy Declarations or those specified in the written contract or agreement referenced above, whichever is less. Other Insurance 1. If specifically required by the written contract or agreement referenced above in the first paragraph of this Subsection i., any coverage provided by this endorsement to an additional insured shall be primary and any other valid and collectible insurance available to the additional insured shall be non- contributory with this insurance. If the written contract does not require this coverage to be primary and the additional insured's coverage to be non- contributory, then this insurance will be excess over any other valid and collectible insurance available to the additional insured. 2. Even if the requirements of Paragraph 1. immediately above are met establishing this coverage as primary and the additional insured's coverage as being non-contributory, this coverage material of Insurance Services Office, Inc., CG 81 28 01 18 with its permission. will be excess over any other insurance available to the additional insured which is conferred onto said person or organization by a separate additional insured endorsement. j. As Required by Contract — Any person or organization for whom "you" are performing operations, or to whom you are leasing, subleasing or otherwise entrusting the use or occupancy of premises owned by or rented to "you", only as specified under a written contract, lease, sublease or agreement that requires that such person or organization be added as an additional insured on "your" policy. Such person or organization is an additional insured only with respect to liability caused, in whole or in part, by the acts or omissions of the "Named Insured" or the acts the acts or omissions of those acting on your behalf in the performance of the "Named Insured's" ongoing operations for the additional insured or in connection with such premises owned by or rented to a "Named Insured", but in both instances only as specified under the written contract, lease, sublease or agreement. A person's or organization's status as an additional insured under this endorsement ends the earlier of when "your" on -going operations for that additional insured are completed or when "you" no longer are contractually required to include such person or organization as an additional insured under "your" policy. The insurance provided to an additional insured by this endorsement is limited as follows: 1. The additional insured is covered only for such damages which are caused, in whole or in part, by the acts or omissions of the "Named Insured" to which the additional insured is entitled to be indemnified by the "Named Insured" pursuant to the written contract, lease, sublease or agreement referenced in the first paragraph of this subsection i. above and only for those sums that the additional insured is legally obligated to pay as damages under tort law principles to the injured party because of "bodily injury", "property damage" or "personal and advertising injury" to which this insurance applies, and in accordance with the stated policy limits and policy conditions. This coverage does not apply for defense or indemnity of the additional insured if state or federal law does not permit indemnification of the additional insured by the "Named Insured" for the claim of the third party. CG 81 28 01 18 CG 81 28 01 18 2. The limits of insurance are those set forth in the policy and Declarations or those specified in the written contract, lease, sublease or agreement referenced in the first Paragraph of this Subsection j., whichever is less. With respect to the insurance afforded to an additional insured under this Subsection j., the following exclusions are added: 1. This insurance does not apply if the written contract, lease, sublease or agreement referenced in the first Paragraph of this Subsection j. above was not executed by the "Named Insured" prior to the "occurrence" giving rise to the additional insured's potential liability. 2. This insurance does not apply to the additional insured's liability to indemnify, defend or hold harmless a third party. 3. This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" for which the additional insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the additional insured would have in the absence of the contract or agreement. 4. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or, surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (b) Supervisory, inspection, archi- tectural or engineering activities. 5. "Bodily injury" or "property damage" occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (b) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 9 CG 81 28 01 18 subcontractor engaged in performing operations for a principal as a part of the same project. Other Insurance 1. If specifically required by the written contract, lease, sublease or agreement referenced in the first Paragraph of this Subsection j. above, any coverage provided by this endorsement to an additional insured shall be primary and any other valid and collectible insurance available to the additional insured shall be non-contributory with this insurance. If the written contract, lease or sublease does not require this coverage to be primary and the additional insured's coverage to be non-contributory, then this insurance will be excess over any other valid and collectible insurance available to the additional insured. 2. Even if the requirements of Paragraph 1. immediately above are met establishing this coverage as primary and the additional insured's coverage as being non-contributory, this coverage will be excess over other insurance available to the additional insured which is conferred onto said person or organization by a separate additional insured endorsement. Definitions Solely for purposes of the insurance afforded to an additional insured by this endorsement: "Named Insured" is defined as the entity to whom the insurance policy is issued as shown on the Declarations. "You" or "your" means a "Named Insured" as defined above. F. SECTION III - LIMITS OF INSURANCE is amended as follows: 1. Paragraph 6 is replaced with: 6. Subject to 5. above, the Damage To Premises Rented to You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you or in the case of damage by fire while rented to or temporarily occupied by you with permission of the owner. The limit is increased to $1,000,000. However, if damage by fire to premises rented to you is not otherwise excluded, the word fire in the above paragraph is replaced with fire, lightning, explosion, smoke or sprinkler leakage. G. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. Duties In The Event Of Occurrence, Offense, Claim Or Suit is amended as follows: a. The following is added to Paragraph a.: However, this condition only applies when the "occurrence" or offense is known to: i. You, if you are an individual; ii. A partner, if you are a partnership; or iii. An executive officer or insurance manager, if you are a corporation. b. The following is added to Paragraph b.: However, this condition will not be considered breached unless the breach occurs after such claim or "suit" is known to: i. You, if you are an individual; ii. A partner, if you are a partnership; or iii. An executive officer or insurance manager, if you are a corporation. 2. Subsection 4. Other Insurance, Paragraph b. Excess Insurance, Item (1)(a)(ii) is replaced by the following if damage to premises rented to you is not otherwise excluded: (ii) That is fire, lightning, explosion, smoke or sprinkler leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner. 3. Subsection 6. Representations is amended to include: d. Your failure to disclose all hazards or prior "occurrences" or offenses existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior "occurrences" or offenses is not intentional. This provision does not affect our right to collect additional premium or exercise our right of cancellation or nonrenewal. 4. Subsection 8. Transfer of Rights of Recovery Against Others to Us is amended to include: Therefore, the insured can waive the insurer's Rights of Recovery prior to the occurrence of a loss, provided the waiver is made in a written contract. 5. The following condition is added: 10. Liberalization If we revise this coverage form to provide more coverage without additional premium charge, your policy will automatically provide the additional coverage as of the day the revision is effective in your state, provided that this implementation date falls within 45 days prior to or during the policy period stated in the Declarations. Page 8 of 9 Includes copyrighted material of Insurance Services Office, Inc., CG 81 28 01 18 with its permission. H. SECTION V - DEFINITIONS is amended as follows: 1. Paragraph 3. "Bodily Injury" is deleted and replaced with the following: "Bodily Injury": a. Means bodily injury, sickness, or disease sustained by a person and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing (Item a. above) at any time. 2. If damage by fire to premises rented to you is not otherwise excluded, Paragraph 9. "Insured Contract", Item a. is replaced by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owners is not an "insured contract"; 3. Paragraph 14. "Personal and Advertising Injury" is amended as follows: a. Item b. is deleted and replaced with the following: b. Malicious prosecution or abuse of process; b. Item h. is added: h. "Personal and advertising injury" also means injury, including consequential "bodily injury", arising out of discrimination based on race, color, religion, sex, age or national origin, except when: (1) Done intentionally by or at the direction of, or with the knowledge or consent of: CG 81 28 01 18 (a) Any insured; or CG81280118 b. Any executive officer, director, stockholder, partner or member of the insured; or (2) Directly or indirectly related to the employment, former or prospective employment, termination of employment, demotion, failure to promote or application for employment of any person or persons by an insured; or (3) Directly or indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured; or (4) Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling This coverage does not apply to fines or penalties imposed because of discrimination. 4. "Client" as used in this endorsement means: a. An individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services; or b. A person under your direct care and supervision for whom you are providing goods and/or services. All terms and conditions of this policy apply unless modified by this endorsement. Includes copyrighted material of Insurance Services Office, Inc., Page 9 of 9 with its permission. Contract Form New Contract Request Entity Information Entity Name* RE SERVICES Entity 1O * '?'00045650 Contract Name* RE SERVICES (NEW CHILD PROTECTION AGREEMENT) Contract Status CTB REVIEW ❑ New Entity? Contract ID 6072. Contract Lead* APEGG Contract Lead Email apeggc)2 weldgov.coni;cohbx xlk@weldgov.com Parent Contract ID Requires Board YES Department Project # Contract Description NEW AGREEMENT. POST -BID PROVIDER RELATED TO BID* 62200040 TERM. JUNE I, 7022 THROUGH MAY 31 2023 Contract Description 2 PA IS BEING ROUTED THROUGH THE NORMAL PROCESS. ETA TO GTE, 6 3Q 22. Contract Type* AGREEMENT Amount* $0.00 Renewable * NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM - H u m a n Se nj c e s •we l dgov. c o m Department Head Email CM-HumanServ,ces- DeptHead J•weldg©v,corn County Attorney GENERAL COUNTY A I I ORNEY EMAIL County Attorney Email COUNTYAIIORNEY WELDG OV,COM Requested BOCC Agenda Date * 07106 2022 Due Date 07 02 2022 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in On Base Contract Dates Effective Date Review Date* 03 3]]1.E 2023 Renewal Date Termination Notice Period Contact Information Contact Info Contact Name Contact Type Purchasing Approval Process Department Head JAMIE ULRICH DH Approved Date 06 27 2022 Final Approval ROCC Approved ROCC Signed Date ROCC Agenda Date 07, 06 2022 Originator APE0G Committed Delivery Date Finance Approver CHERYL PATTELLI Expiration Date" 05/31 2023 Contact Phone 1 Contact Phone 2 Purchasing Approved Date Legal Counsel CAITLIN PERRY Finance Approved Date Legal Counsel Approved Date 06 28 2022 06 28 2022 Tyler Ref # AG 070622 Hello