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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND ARIEL CLINICAL SERVICES
This Agreement, made and entered into the
day of ()WV, , 2022, by and between
the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services,
hereinafter referred to as the "Department" and Ariel Clinical Services, hereinafter referred to as the "Contractor".
The parties to this Agreement understand and agree that the provisions of this eement specifically include
the following documents: Exhibit A, Scope of Services, Exhibit B, Rate Schedule, Ex it C, Weld County's Request
for Proposal, and Exhibit D, Contractor's Response to Request oposal. Exhibi , B, and D are attached hereto
and incorporated herein by this reference. Exhibit C is Weld Co' 's Request for ' oposal Number B220040 which
is incorporated into this agreement by reference and will be pro .R, d upon reque to the Department.
WITNES
WHEREAS, required approval, clearance, and coor
appropriate agencies; and
on have b: n accomplished from and with
WHEREAS, the Colorado Department of Human Services has ovided Core Services or other funding to
the Department for Home Studies.
NOW THEREFORE, in considerati
1. Term
premises, th , parties hereto covenant and agree as follows:
This agreement shall become eff o tivv n June 1 21, 2, upon
expire May 31, 2023, unless a rminated as ; ovided
additional terms by wren agr ent of both p. 'ies.
2. Scope of
ution of this Agreement and shall
his agreement may be renewed for 2
Services shall be provide • .y the Contra r to any son s) eligible for services in compliance with
Exhibit A Sco of Sery es, and Exhib; D, Contra oo esponse to Request for Proposal.
3. R
a. Cont
tracki
aforfeit
and Trac
rr understands . 'd will co
equirements as se; `orth by the
payment.
" .. actor agrees
mail aress prior to
authori d until the
Contra or furthe
service
sc
all aspects of the referral authorization, billing and
rtment. Failure to comply with all aspects may result in
receive referr for services through e-mail and will provide an identified e -
e start of this A ment. Contractor acknowledges that services are not
ontractor has received an authorized referral form from the Department.
cknowledges that services provided prior to the authorized start date or outside the
on the referral form will not be eligible for reimbursement.
Contractor a nowledges that any and all modifications to an existing referral must be approved
through the uality Assurance Team(HS-CWOualitvAssurance(a,weldgov.com). No other
Departme staff or other party to the case may authorize services or modifications to services.
c. C• tractor agrees to submit a complete Request for Reimbursement and supporting documentation
by the 7' of the month, following the month of service, utilizing billing forms required by the
Department. Requests for Reimbursement Forms received after 45 days from the date of service may
result in delay or forfeiture of payment. Consistent failure to meet 45 -day deadline may result in
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2022-1590
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