HomeMy WebLinkAbout20221339.tiffRESOLUTION
RE: APPROVE INDIVIDUAL PROVIDER CONTRACT FOR PURCHASE OF FOSTER CARE
SERVICES IN A FOSTER CARE HOME AND AUTHORIZE CHAIR TO SIGN -
EDWARD AND RONNETTE SALAZAR
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 an Individual Provider Contract for
Purchase of Foster Care Services in a Foster Care Home between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Human Services, and Edward and Ronnette Salazar, commencing May 2, 2022,
and ending May 1, 2023, with further terms and conditions being as stated in said contract, and
WHEREAS, after review, the Board deems it advisable to approve said contract, 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 Individual Provider Contract for Purchase of Foster Care
Services in a Foster Care Home between the County of Weld, State of Colorado, by and through
the Board of County Commissioners of Weld County, on behalf of the Department of Human
Services, and Edward and Ronnette Salazar, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said contract.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 11th day of May, A.D., 2022, nunc pro tunc May 2, 2022.
BOARD OF COUNTY COMMISSIONERS
WE Lf6 COUTY, COLORADO
ATTEST: dattA) G: •. Cleo;,1
Weld County Clerk to the Board
BY:/UG vvv
Deputy Clerk to the Boar
mes, Chair
—114 Xi. •✓tee
Milo -Freiman, Pro-Tem
AP" �` e :� • FOR ii R "2. �� !(�- /`� L-tw2�%-,.,-r�
ttorney
Date of signature: 5/19 X22
Lori Sai
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5131122
2022-1339
HR0094
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PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: May 3, 2022
TO: Board of County Commissioners — Pass -Around
FR: Jamie Ulrich, Director, Human Services
RE: Individual Provider Contracts for Foster Care
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 Individual Provider Contracts for the Purpose of Foster
Care Services. The major provisions of these contracts are:
CMS ID
Provider/Term
Facility
Type/Location
Daily Rate
5788
Barraza, Josefina
(New Kinship)
May 5, 2022 -May 4, 2023
County Foster Care
Evans, CO
Approved State Rate
5790
Hays, Izzabella and Andrew
(New Foster)
March 1, 2022 -February 28, 2023
County Foster Care
Dacono, CO
Approved State Rate
5789
Rauiston, Seth and Tiffany
(ADDRESS CHANGE)
April 8, 2022 -September 16, 2022
County Foster Care
Greeley, CO
Approved State Rate
5797
Salazar, Ronnette and Edward
(Full Certification)
May 2, 2022 —May_ 1, 2023
County Foster Care
Longmont, CO
Approved State Rate
I do not recommend a Work Session. I recommend approval of these Contracts and authorize the Chair to sign.
Approve Schedule
Recotglrtendation Work Session Other/Comments:
Perry L. Buck
Mike Freeman, Pro-Tem
Scott K. James, Chair
Steve Moreno
Lori Saine
\ie a yemaa
Pass -Around Memorandum; May 3, 2022 — CMS ID Various
Page 1
2022-1339
OS/ i 1 11-12009,-I
COLORADO
Office of Children,
Youth Et Families
Department of Human Services
INDIVIDUAL PROVIDER CONTRACT
FOR PURCHASE OF FOSTER CARE SERVICES IN A FOSTER CARE HOME
1. THIS CONTRACT AND AGREEMENT, made this date, (�� t 1 I UV --by and between theWeld County
Department of Human Services, P. O. Box A, Greeley, CO 8 632,, ereihafter called "County Department" and
Ronnette Salazar and Edward Salazar, 13715 Elmore Road, Longmont, Colorado 80504, hereinafter called
"Provider".
2. This Contract and Agreement shall be effective from May 2, 2022, and continue in force until May 1, 2023 or until
the facility certificate is revoked or surrendered. This contract and agreement may be renewed at any time during
the term of the valid facility certificate. This contract and agreement is in lieu of and supersedes all prior purchase
contracts between the parties hereto and relating to the services herein described.
3. The Provider holds a valid certificateas a Kinship Care home. Such certification standards shall be maintained
during the term hereof. The provider has read and is fully familiar with the "Rules Regulating Foster Care
Homes" issued by the Colorado Department of Human Services.
4. The County Department may but shall not be obligated to purchase foster care home services. The County
Department or any duly authorized agent may request such services to be provided to any child or youth at any
time within the limits of the certificate and without prior notice. At such time or as soon as possible after the
acceptance of a child or youth for services, the County Department and the Provider shall verify foster care
placement of each child or youth in writing on the required form, which shall become an addendum to this contract,
subject to all the terms and conditions hereof.
5. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A and Addendum 1,
which form integral parts of this Agreement. Exhibit A and Addendum 1 are specifically incorporated herein by this
reference.
The Provider agrees:
1. To furnish foster care services to eligible children and youth at the established rate based on the individual
child or youth rates negotiated between the county department and the provider;
2. To safely provide the 24 -hour physical care and supervision of each child or youth until removed or
until the agreement isrenewed;
3. To accept a child or youth, only with the approval of the certifying agency;
4. To cooperate fully with the County Department or its representatives, and participate in the
development of the Family Service Plans -for a child or youth in placement, including visits with their
parents, siblings, relatives, or to transition to another foster care facility;
5. To maintain approved standards of care as set by the Colorado Department of Human Services;
6. To maintain the confidentiality of information shared about the child or youth and his/her family;
7. Not to accept money from parents or guardians;
8. Not to make any independent agreement with parents or guardians;
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs
John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
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9. Not to release the child or youth to anyone without prior authorization from the County Department;
10. To allow representatives of the County Department to visit the foster care home and to meet with the
child or youth at any reasonable time, including scheduled and unscheduled visits; and,
11. To give the County Department a 30 -day notice, except in an emergency, to remove a child or youth
for placement elsewhere, and to work with the County Department as requested to prepare the child or
youth for another placement.
12. To provide transportation to the child or youth. The amount of transportation to be provided will be
agreed upon at placement and may be changed upon mutual agreement of the provider and the
County Department, as recorded in the Family Service Plan. Transportation must be provided or
arranged:
a. For professional services and/or for school attendance when necessary; and,
b. For children or youth to participate in age or developmentally appropriate extracurricular, enrichment,
cultural, and social activities.
13. To report promptly to the County Department:
a. Any unplanned absence of the child or youth from provider's care;
b. Any major illness of the child or youth;
c. Any serious injury to the child or youth;
d. Any significant change in the sleeping arrangement for the child or youth;
e. Any contemplated change of address or change of household members;
f. Any conflict the child or youth may have with law enforcement, school/school district staff, or other persons
in authority;
g. Any emergency;
h. Any pertinent discussion with parents or guardians about the child or youth or supervising agency; and,
i. Any information received regarding a change of address of the parents or guardians.
14. To comply with the Civil Rights Act of 1964, Section 504, Rehabilitation Act of 1973, and the ADA of 1990, concerning
discrimination on the basis of race, color, sex, age, sexual orientation, expression, or identity, religion, political beliefs,
national origin, or handicapping condition.
15. To complete pre -service training prior to the placement of a child or youth.
16. To annually:
a. Update the Training Development Plan with the County Department;
b. Complete ongoing, quality, and relevant training that will build competencies to meet the needs of the
children and youth served in the foster care home as required by the Colorado Department of Human
Services regulations; and,
c. Obtain certification to use and apply the reasonable and prudent parent standard for each child or youth served
in the foster care home.
17. To attend semi-annual Administrative Reviews for a child or youth in placement.
18. To be knowledgeable of, and comply with the "Rules Regulating Foster Care Homes" and the "General Rules for
Child Care Facilities;
19. Not to enter into any subordinate subcontract hereunder;
20. To keep required and necessary records for audit/review purposes by state and federal personnel. These records
shall document the type of care and dates that care is provided for each child or youth. In addition, medical,
educational, and progress summary records shall be maintained for each child or youth as required pursuant to the
Colorado Department of Human Services' Rules Regulating Family Foster Care Homes.
21. To complete or schedule a medical examination for the child or youth within 14 days after initial placement and a
dental examination within eight weeks of initial placement;
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs
John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
2
The County Department agrees:
1. To share all available information about the child or youth, including relevant social, medical and educational history,
behavior problems, court involvement, parental, sibling and relative visitation plans, and other specific characteristics
of the child or youth, with the provider before placement and to share additional information when obtained while
the child or youth is in placement.
2. To inform the provider of expectations regarding the care of the child or youth, such as meeting medical needs,
visitation, special psychological needs, trauma and other grief/loss issues, and the child's or youth's identification with
his/her family;
3. To give the provider the written admission record of the child or youth to the foster care home at the time of placement;
4. To give the provider a written procedure or authorization for obtaining medical care for the child or youth;
5. To involve the provider in family service planning for the child or youth as a member of treatment team;
6. To give the provider a copy of the Family Service Plan, as it pertains to their expectations for meeting the needs of the
child or youth in the foster care home, at the time of placement or when it is completed following placement;
7. To give at least a 30 -day notice of plans to remove a child or youth from the foster care home. The 30 -day notice may
be waived by mutual consent to allow and permit immediate removal of a child or youth for placement elsewhere,
or without such waiver in the event of an emergency. An emergency is defined as any situation in which a provider's
inability to provide services threatens the health, safety or welfare of a child or youth.
8. To pay the provider at the rates established by the Colorado Department of Human Services or as authorized and
negotiated between the provider and the County Department:
a. Payment shall be made by electronic banking transfers (EBT) drawn by the duly authorized county officer; and,
b. Provider shall notify the County Department of any payment or billing dispute within 60 days of the month
when service was provided. Failure to do so will result in forfeiture of the payment. The Provider understands
that, pursuant to the Colorado Department of Human Services' Rules for the General Reimbursement for Child
Welfare Services, when reimbursement is warranted current and (2) preceding months.
9. To provide or arrange through statewide contracted training, a minimum of twelve hours of core pre -service
training for foster care homes and 15 hours of pre -service training directed at the needs of the child or youth to be
served in the foster care home.
10. To annually complete the following:
a. Update the Training Development Plan with the provider;
b. Provide or make available quality and relevant training for each foster parent that will build competencies to
meet the needs of the children and youth served in the foster care home;
c. Provide training that prepares each foster parent to use and apply the reasonable and prudent parent
standard; and,
d. Pursuant to the Colorado Department of Human Services' Rules Regulating Family Foster Care Homes,
document that the provider is trained in, and can use and apply the reasonable and prudent parent standard
for each child or youth placed in the foster care home.
11. The County Department is responsible for providing information on county specific procedures.
12. To invite the provider to Administrative Reviews for each child or youth in placement.
1575 Sherman Street, 2nd Fboor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs
John W. Hickenlooper, Govemor Reggie Bicha, Executive Director
3
13. To incorporate provider information in planning for the child or youth placed in the foster care home.
14. To assure that the service described herein has been accomplished and a record made thereof on a case by case
basis.
15. To provide notice of court hearings for each child or youth placed in the foster care home.
STATE OF COLORADO
WELD COUNTY GOVERNMENT 5%••
County Department
Jam' Ulrich (Apr 30, 2022 05:31 MDT)
Apr 30, 2022
Signature
Date
WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above.
COUNTY:
ATTEST. ..41"At4
Weld •u ty Clerk to the
By:
Deputy
PROVIDER:
Ronnette Salazar
nnette Salazar (Apr 29, 202216:03 MDT)
BOARD F COUNTY COMMISSIONERS
LD �UNTY, COLORADO
James, Chair MAY 1 12022
Apr 29, 2022
Name
Edward Salazar
Signature
6aktfarr7 Sa azar
Edward Salazar (Apr 29, 2022 16:05 MDT)
Date
Apr 29, 2022
Name
Signature
Date
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs
John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
4
/33
EXHIBIT A to the CWS-7q
Additional Provisions for the Agreement to Purchase Foster Care
Services and Foster Care Facility Agreement CWS-7A
The following additional provisions in this Exhibit A and Addendum 1 apply to the agreement entitled, "Individual Provider
Contract for Purpose of Foster Care Services and Foster Care Facility Agreement," by and between the Weld County
Department of Human Services, hereinafter referred to as, "County," and Ronnette Salazar and Edward Salazar,
Provider ID#1760106, hereinafter referred to as, "Provider."
GENERAL PROVISIONS
1. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least
thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon
the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first,
and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon
cease; however, the parties shall not be released from the duty to perform their obligations up to the date of
termination. This provision does not affect removal of a child in an emergency situation.
2. Provider agrees that Provider is an independent contractor and that neither Provider nor Provider's agents or
employees are, or shall be deemed to be, agents or employees of the County for any purpose. Provider shall
have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The
parties agree that Provider will not become an employee of County. Provider shall be solely and entirely
responsible for its acts or of any agent, employee, servants and sub -Providers during the performance of this
Agreement. Provider is not entitled to unemployment insurance or workers' compensation benefits
through Weld County and Weld County shall not pay for or otherwise provide such coverage for Provider.
Unemployment insurance benefits will not be available to Provider for services provided under this
Agreement. Provider shall pay when due any/all applicable employment taxes and income taxes and local
head taxes (if applicable) incurred as a result of the services provided under this Agreement.
3. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the
purpose thereof.
4. This Exhibit A is intended to be applied in conjunction with the attached Agreement as the complete integration of
all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment
hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation,
renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part
of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this
Agreement in writing, if agreed to by both parties. The Agreement, this Exhibit A and the rate Addendums are
intended to be in lieu of and supersede all prior agreements between the parties hereto and relating to the care
and services herein described.
5. The State of Colorado Department of Human Services and the County shall be and hereby is permitted to monitor
the service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are
carried out for the benefit of the aforementioned child or youth. Monitoring may occur through review of program
reports, on -site visits where applicable and other Agreements as deemed necessary. Provider understands that
the State Department and the County may provide consultation to Provider to assure satisfactory performance in
the provision of purchased services under this Agreement.
6. County shall have access to Provider's service program, financial and other records, which will sufficiently and
properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement for
purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder
and shall be retained and available for audit purposes for at least five years after final payment hereunder.
7. Time is of the essence in each and all of the provisions of this Agreement.
8. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to
perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable
control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions.
9. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the
Exhibit A to the CWS-7A
5 Revised 6/2021
other party at that party's address as stated in thisAgreement.
10. This Agreement is nonexclusive and County may engage or use other Providers or persons to perform services of
the same or similar nature.
11. Provider certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will
perform work under this contract. Provider 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). Provider shall
not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a
contract with a sub -contractor that fails to certify with Provider that the sub -contractor shall not knowingly employ
or contract with an illegal alien to perform work under this Agreement. Provider 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 Provider obtains actual knowledge that a sub -contractor performing work under
the public contract for services knowingly employs or contracts with an illegal alien Provider shall notify the sub-
contractor and County within three (3) days that Provider has actual knowledge that a sub -contractor is employing
or contracting with an illegal alien and shall terminate the subcontract if a sub -contractor does not stop employing
or contracting with the illegal alien within three (3) days of receiving notice. Provider shall not terminate the
contract if within three days the sub -contractor provides information to establish that the sub -contractor has not
knowingly employed or contracted with an illegal alien. Provider 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 Provider participates in the State of Colorado program, Contract Professional shall,
within twenty days after hiring a new employee to perform work under the contract, affirm that Provider 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. Provider shall deliver to County, 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 Provider fails to comply with any requirement of this provision or
of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Provider
shall be liable for actual and consequential damages.
Except where exempted by federal law and except as provided in C.R.S. § 24-76.5 103(3), if Provider receives
federal or state funds under the contract, Provider 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 Provider 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.
12. Provider assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily
excluded from covered transactions by a federal department or agency.
b. Have not, within a three-year period of preceding this Agreement, been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting
to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery,
falsification or destruction of records, making false statements, or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a govemment entity (federal, state,
or local) with commission of any of the offenses enumerated in paragraph (B) above.
d. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal,
state, and local) terminated for cause ordefault.
13. In addition to terminating this Agreement in accordance with the provisions herein, County may exercise the
following remedial actions if the County finds and determines that the Provider has substantially failed to satisfy
the duties found in this Agreement and Exhibit A Substantial failure to satisfy the scope of work shall be defined to
mean incorrect or improper activities or inaction by the Provider. These remedial actions include, but are not
limited to, any one or more of the following:
Exhibit A to the CWS-7A
6 Revised 6/2021
a. Withhold payment to Provider until the necessary services or corrections in performance are satisfactorily
completed.
b. Deny payment or recover reimbursement for those services or deliverables which have not been performed
and which due to circumstances caused by Provider cannot be performed or if performed would be of no
value to County. Denial of the amount of payment shall be reasonably related to the amount of work or
deliverables lost to County.
c. Recover from Provider any incorrect payment to Provider due to omission, error, fraud, and/or defalcation by
deducting from subsequent payments under this Agreement, or other agreements between County and
Provider, or as a debt to County, or otherwise as provided by law.
14. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all
rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their
assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by
any other person not included in this Agreement. It is the express intention of the undersigned parties that any
entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement
shall be an incidental beneficiary only.
15. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or
employees may possess, nor shall any portion of this Agreement be deemedto have created a duty of care that
did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge
and agree that no part of this Agreement is intended to circumvent or replace such immunities.
16. Provider shall promptly notify County in the event in which it is a party defendant or respondent in a case, which
involves services provided under the agreement. The Provider, within five (5) calendar days after being served
with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative
agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/orforeclosure.
17. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in
accordance with the policies, procedures, and practices of County. Provider shall strictly comply with all
applicable federal and State laws, rules and regulations in effect or hereafter established.
18. Financial obligations of the County payable after the current fiscal year are contingent upon funds for that purpose
being appropriated, budgeted and otherwise made available. Execution of this Agreement by County does not
create an obligation on the part of County to expend funds not otherwise appropriated in each succeeding year.
19. County agrees to purchase, and Provider agrees to provide the care and services, which are listed in this
Agreement. The State approved rate for Child Maintenance/Respite will be paid for any child placed with the
Provider unless the Inventory for Client and Agency Planning (ICAP) assessment has been completed due to
Intellectual or Developmental Disabilities, intensive medical/physical needs, or limitations that interfere with daily
life functioning. The ICAP assessment will determine the reimbursement rate as specified in Addendum 1.
20. All bed hold authorizations and payments are subject to a 7 -day maximum for a child's temporary absence from a
facility; however, if the absence is a result of hospitalization the maximum bed hold authorization may be up to 14
days. Bed hold requests must have prior written authorization from the Department Administrator or Designee
before payment will be release to Provider.
21. Any additional costs for specialized services, which may include but are not limited to; Co -pays, deductibles, or
services not covered by Medicaid, will need to be authorized, in writing by the Department Administrator, prior to
the service being performed. Any payment for specialized services not authorized in writing may be denied.
22. All reimbursement requests shall:
a. Be submitted in a format approved by the County. If submitted in an unapproved format or inadequate
documentation is provided, the County reserves the right to deny payment.
b. Be submitted by the 4th of each month following the month of service. If the reimbursement request is not
submitted within twenty-five (25) calendar days ofthe month following service, it may result in forfeiture of
payment.
Exhibit A to the CWS-7A
7 Revised 6/2021
c. Placement service reimbursement shall be paid from the date of placement up to, but not including the day of
discharge.
d. Transportation reimbursement shall be for visitation purposes or transportation to school if out of county and
with prior approval only If medical transportation is needed, Provider will arrange reimbursement through
Medicaid. Any other special requests for transportation reimbursement shall require prior approval by the
Resource Manager or the DepartmentAdministrator.
e. Clothing allowance reimbursement shall be approved and reimbursed as indicated on the clothing allowance
form provided by the Foster Care Coordinator.
23. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal
items brought to Provider by the children, Provider shall be released from responsibility for loss or damage to such
personal items.
PROVIDER SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado
Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal
laws and regulations, as such, which may be amended from time to time, and shall be binding on Provider and
control any disputes in this Agreement.
2. Not charge any fees to children or families of children referred by County for any services provided under this
Agreement.
3. Not assign the obligations under this Agreement nor enter into any sub -Agreement without the express written
approval of the Director of the County Department or his/her appointed designee.
4. Maintain at all times during the term of this Agreement a liability insurance policy of atleast $25,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $500,000 for total injuries arising from
any one accident. Provider shall provide a certificate of insurance provided by its insurer upon request by County.
5. Indemnify the County against any and loss against all claims and actions based upon or arising out of damage or
injury, including death, to persons or property caused or sustained in connection with the performance of this
Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation
and the defense of any such claims or actions.
6. Attend or participate in Ice Breaker, Family Engagement or Team Decision making meetings, if requested by the
Department. County staff shall notify the Provider of the dates and times attendance is requested.
7. Request a staffing if considering giving notice to remove a child, except in emergency situations. These requests
shall be made through the child's caseworker and/or the Provider's Foster Care Coordinator.
8. Actively participate in achieving the child's permanency goal, cooperate with any contractors hired by the Weld
County Department of Human Services to preserve placement in the least restrictive placement appropriate,
comply with the treatment plan of the child, and attend court hearings as requested.
9. Have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the
child being placed with Provider. All documentation of these examinations will be placed in the foster child's
placement binder.
10. Attend all necessary school meetings and support any plan that is developed regarding thechild in order to
promote educational success.
11. Immediately report to the County Department and/or local law enforcement any known or suspected child abuse or
neglect as set forth in Section 19-3-304, C.R.S.
12. Maintain, access and review information monthly on Binti.
13. Maintain/update information in the foster child's binder, either hard copy or in Binti. The binder will be reviewed on
a monthly basis and signed off by child's caseworker and/or the Provider's Foster Care Coordinator.
Exhibit A to the CWS-7A
8 Revised 6/2021
14. Maintain/update medication logs on a daily basis, if child is taking medications.
15. Comply with all County and State certification requirements as set forth in the State Department rules, Staff Manual
Volume VII and the Weld County Department of Human Services Policy and Procedure manual.
Exhibit A to the CWS-7A
9 Revised 6/2021
ADDENDUM 1
Inventory for Client and Agency Planning (ICAP) Rates
ICAP IDD Level
Child Maintenance
Daily Rate
Level 1
$97.11
Level 2
$112.64
Level 3
$123.75
Level 4
$134.86
Level 5
$154.94
Level 6
$194.75
Medically Fragile
Level 1
$54.73
Level 2
$110.30
Level 3
$165.88
Level 4
Negotiate up to $200
Exhibit A to the CWS-7A
10 Revised 6/2021
Contract Form
New Contract Request
Entity Name*
SALAZAR, RONNETTE
Entity ID*
'x00045081
Contract Name* Contract ID
SALAZAR, RONNETTE AND EDWARD (INDIVIDUAL PROVIDER 5797
CONTRACT CWS-7A)
Contract Status
CTB REVIEW
Contract Lead*
WLUNA
Contract Lead Email
wlunagweldgov.com
New Entity?
Parent Contract ID
Requires Board Approval
YES
Department Project #
Contract Description*
FULL CERTIFICATION PROVIDER CWS-7A INDIVIDUAL PROVIDER CONTRACT. TERM MAY 2, 2022 TO MAY 1, 2023.
Contract Desorption 2
PA ROUTING THROUGH NORMAL APPROVAL PROCESS. ETA TO CTB 5 5,•2022
Contract Type*
CONTRACT
Amount*
$0.00
Renewable*
NO
Automatic Renewal
Grant
IGA
Department Requested BOCC Agenda Due Date
HUMAN SERVICES Date* 05/14/2022
05/18/2022
Department Email
CM -
H umanServicesPweldgov.co
m
Departrent Head Email
CM-HumanServices-
DeptHeadgweldgov.com
County Attorney
GENERAL COUNTY`
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYA1 iORNEY@NELDG
OV.COM
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 MISA enter WA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in
OnBase
Cunt#t dates
Effective Date
Review Date*
03; 01 ,+2023
Renewal Date
Termination Notice Period
Committed Delivery Date
Expiration Date*
05/0112023
Contact Information
Contact Info
Contact Name
Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing Approver Purdhasing Approved Date
Approval Process
Department Head
JAMIE ULRICH
DH Approved Date
05(03/2022
BOCC Approved
BOCC Signed Date
BOCC Agenda Date
05/11/2022
Originator
WLUNA
Finance Approver
CHERYL PATTELLI
Legal Counsel
CAITLIN PERRY
Finance Approved Date Legal Counsel Approved Date
05/04;2022 05 '04/2022
Tyler Ref #
AG 051122
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