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Home My WebLink About20191896.tiffPRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: March 30, 2021 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Protection Agreement Amendments for 2019- 20 Core/Non-Core Contracted 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 Amendments for 2019- 20 Core/Non-Core Contracted Services. The Department entered into Agreements with various Child Welfare service providers through the 2019-2020 Request for Proposal (RFP), Bid Number: B1900025, identified as Tyler ID 2019-0707. These Agreements were issued for a period of three (3) years with the option to renew annually. The Department is requesting to renew the current Agreements with no changes for 34 providers reflected in the attached list. Agreements will be renewed for the third and final year for the period of June 1, 2021 through May 31, 2022. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Upon Board approval of this pass -around, signed Agreement Amendments will be obtained from providers and submitted to the Board for approval and Chair signature. I do not recommend a Work Session. I recommend approval of these Agreement Amendments. Approve Recommendation Perry L. Buck Mike Freeman Scott K. James, Pro-Tem Steve Moreno, Chair Lori Saine Schedule Work Session Other/Comments: Pass -Around Memorandum; March 30, 2021— CMS ID — Various Cc; Page 1 o2a/9.- /,96- 1�D9v AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND BARRY R. LINDSTROM, Ph.D., LLC This Agreement Amendment, made and entered intoLZ day of 2021 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Hum Services, hereinafter referred to as the "Department", and Barry R. Lindstrom, Ph.D., LLC, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Mental Health Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-1896, approved on May 20, 2019. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement was set to end on May 31, 2020. • The Original Agreement was amended on: April 27, 2020 to extend the term date through May 31, 2021 and amend the Rate Schedule. The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2019-1896. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Term This agreement is being renewed for a third and final year, for the period of June 1, 2021 through May 31, 2022. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: `'�j� "'� C►• � BOARD OF COUNTY COMMISSIONERS Weld C. my lerk to the Board _�.� WELD COUNTY, COLORADO By: APR 2 12021 Barry R. Lindstrom, Ph.D., LLC 8217 West 20th Street, Suite A Greeley, Colorado 80634 By: Date: Barry /Tidstr/om�PhD .14 MDT Barry R. Lindstrom, Ph.D. Apr 12, 2021 czo/q /199 Contract Form New Contract Request Entity Information Entity Name* LINDSTROM, BARRY Entity ID* 40000891 Contract Name* BARRY R. LINDSTROM, PH.D., LLC. (AGREEMENT AMEDNMENT) Contract Status CTB REVIEW Contract Description* BID #61900025 TERM 6 1,'21-5/31'22. Contract Description 2 CONSENT. PA WAS SENT Contract Type* AMENDMENT Amount* $0.00 Renewable* NO Automatic Renewal Grant ICA TOCTtiON 3,r 31,21. Department HUMAN SERVICES Department Email CM- HumanServicesOweldgov.co rn Department Head Email CM-HumanServices- DeptHead Qweldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEYgWELDG OV.COM ❑ New Entity? Contract ID 4671 Contract Lead* APEGG Contract Lead Email apegggtweidgov.com; cobbx xlkelweidgov.com Requested BOCC Agenda Date* 05'26'2021 Parent Contract ID 20191896 Requires Board Approval YES Department Project # Due Date 05/22;2021 Will a work session with SOCC 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 RSA enter RSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Review Date* 04;01;2022 Renewal Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Committed Delivery Date Expiration Date* 05x31;2022 Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Approver Purchasing Approved Date CONSENT 04;14;2021 Approval Process Department Head JAMIE ULRICH DH Approved Date 04'14,2021 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 04;21,2021 Originator APEGG Hnance Approver CONSENT Legal Counsel CONSENT Hnance Approved Date Legal Counsel Approved Date 04,'14,2021 04;14,2021 Tyler Ref # AG 042121 60,14 -e - A_&/- x9 35-31 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: April 2, 2020 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Welfare 2020-21 Service Provider Agreement Amendments 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 Welfare 2020-21 Service Provider Agreement Amendments. The Department entered into agreements with various Child Welfare service providers through the 2019-20 Request for Proposal (RFP), identified as Tyler ID 2019-0707). These agreements were issued for a period of three years with the option to renew annually. The attached list reflects the providers, services and rates, including minor rate changes, the Department wishes to enter into for the period of June 1, 2020 through May 31, 2021. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Upon Board approval of this pass -around, signed agreement amendments will be obtained from providers and submitted to the Board for approval and Chair signature. I do not recommend a Work Session. I recommend approval of these Agreement Amendments. Mike Freeman, Chair Scott James Barbara Kirkmeyer Steve Moreno, Pro-Tem Kevin Ross Approve Schedule Recommendation Work Session Other/Comments: Pass -Around Memorandum; April 2, 2020 — Not in CMS Page 1 Goti404- A of -I/7/ o anew.5e, 1.15V og/z7 2O 2©tq- lsg6 oRoolo VENDOR RENEWALS Vendor A New odd Program Area Mentoring Service Name i e avi or Coae ng Funding Core Rate $ 30:00 Unit Type Hour Adoption Options Relinquishment Counseling Relinquishment Counseling CW Block/Child Welfare Services $ 400.00 Episode e Transportation beyond 70 miles - CW Bloc►clChilcf Welfare -Services "$ 0:56 Mile Youth Counseling, 12 yrs. or Older CW Block/Child Welfare Services $ 75.00 Hour Ariel Clinical; Services Home Based Services Behavior Coaching ', Core $ 65.00 Hour Behavior Coaching -Step Down Core $ 40.00 Hour Transportation`, Core $ 0.56 Mile Home Studies Additional Adult(s), After 2 CW Block/Child Welfare Services $ 250.00 Each Cancelled Home Study CW Block/Child Welfare Services $ 225.00 Episode Home Study CW Block/Child Welfare Services $ 1,500.00 Episode Home Study Update CW Block/Child Welfare Services $ 750.00 Episode Incomplete Home Study CW Block/Child Welfare Services $ 750.00 Episode Transportation CW Block/Child Welfare Services $ 0.56 Mile Life Skills Structured Parenting Time Core $ 130.00 Hour Supervised Visitation Core $ 130.00 Hour Mentoring Mentoring Core $ 65.00 Hour Mentoring-Step Down Core.. $ 40.00 Hour Transportation Core $ 0.56 Mile Art Et Soul Care, LLC Home Studies Additional Adult(s), After 2 CW Block/Child Welfare. Services $ 200.00 Each Full Home Study, 2 Adults CW Block/Child Welfare Services $ 1,100.00 Episode Home Study Update CW Block/Child Welfare Services $ 800.00 Episode Mileage CW Block/Child Welfare Services $ 0.56 Mile Partial Home Study CW Block/Child Welfare Services $ " 600.00 Episode Life Skills Mileage Core $ 0.56 Mile Staffing, FTM, TDM, etc. Core. $ 130.00 Hour Therapeutic Visitation, Home/Community Based Core $ 195.00 Hour Therapeutic Visitation, In Office Core $ 130.00 ". Hour Aver Psychological Et Wellness Services, LLC Mental Health Services Brainspotting Individual Session Core $ 85.00 Hour Individual Therapy Gore $ 80.00 Hour Mental Health Evaluation Core $ 450.00 Episode Mental Health Treatment In Home Core $ 120.00 Hour Mindfulness Group Core $ 85.00 Episode Nutrition Group Core $ 85:00 Episode Sexual Abuse Treatment Boundaries Group Core $ 40.00 Episode Boundaries Individual Core $ 80.00 Hour Boundaries Individual In Home Core $ 120.00 Hour _ Concurrent Substance Abuse Group Core $ 45.00 Hour Offense Specific Treatment for Juveniles, High Intensity Core $ 90.00 Hour Offense Specific Treatment for Juveniles, Regular " " Core $ 85.00 Hour Psychosexual Evaluation Core $ 845.00 Episode Sexually Reactive Treatment, High Intensity Core $ 90.00 Hour Sexually Reactive Treatment, Regular Core $ 85.00 Hour Young Adult Sex Offense Treatment, High Intensity Core $ 90.00 Hour Young Adult Sex Offense Treatment, Regular Core $ 85.00 Hour Barry R. Lindstrom, Ph.D., LLC Mental Health Services- Case Consultation Core $ 175.00 Hour WELD COUNTY DEPT. OF HUMAN SERVICES - CHILD WELFARE DIVISION 2020-21 SERVICE VENDORS (CORE/NON-CORE) BID NO.: 82000037 VENDOR RENEWALS Vendor Program Area Service Name Family Interactional Evaluation Funding Core Rate $ 375.00 Unit Type Hour Inservice Training for Caseworkers and Foster Parents CW Block $ 175.00 Hour Inservice Training for Caseworkers and Foster Parents CW Block $ 600.00 1/2 Day Mental Health Assessment Core $ 375.00 Hour Psychological Evaluation Core $ 375.00 Hour Staffing, Family Team Meetings, TDM, Court, etc. Core $ 175.00 Hour Brien, Jessica Home Studies Additional Face -to -Face Time CW Block/Child Welfare Services $ 50.00 Hour Additional Travel Fee CW Block/Child Welfare Services $ 150.00 Episode Extra Adult(s) After First Two (2) CW Block/Child Welfare Services $ 100.00 Each Home Study Update CV/ Block/Child Welfare Services $ 700.00 Episode Home Study, 2 Adults CW Block/Child Welfare Services $ 1,600.00 Episode Mileage CW Block/Child VVelfare Services $ 0.56 Mile Partial Home Study, Denied or Withdrawn CW Block/Child Welfare Services $ 300.00 Episode Centennial Board of Cooperative Education Services Day Treatment Services Therapeutic Et Educational Costs Core $ 203.00 Day Therapeutic Costs Core $ 72.00 Day Collaborative Services forChangeChild Mentoring and Family Support Mentoring Core $ 65.00 Hour Mentoring - In Home/Community Core $ 97.50 Hour Mentoring with Animal Assisted Therapy (AAT) Core $ 100.00 Hour Mentoring with Animal Assisted Therapy (AAT) - In Home/Community Core $ 150.00 Hour Transportation Core $ 0.56 Mental Health 5er/ices Case Management Core $ 85.00 Hour EMDR 90 -Minute Session Core $ 120.00 Episode Family Therapy Core $ 100.00 Hour Health Sexuality/Boundaries Curriculum - Core $ 100.00 Hour Individual Therapy Core $ 100.00 Hour Team Meetings or Staffing Core - $ 85.00 Hour Sexual Abuse Treatment Case Management Core $ 85.00 Hour EMDR Therapy Session Core $ 120.00 Episode Family Therapy Core $ 100.00 Hour Health Sexuality/Boundaries Curriculum Core $ 100.00 Hour Individual Therapy Core $ 100.00 Hour Informed Supervision Training Core $ 100.00 Hour MDT, Team Meetings or Staffing Core $ 85.00 Hour Colorado Boys Ranch HomeBased Services CBR-H6 (Per -Diem) Core $ 54.00 Day CBR-HB, High Package Core $ 1,900.00 Month CBR-HB,Low Package Core $ 900.00 Month CBR-HB, Moderate Package Core $ 1,450.00 Month Community Connections Core $ 55.00 Hour Small Group Options Core $ 48.00 Hour Specialized Mentoring Core $ 55.00 Hour Life Skills Supervised Visitation Core $ 68.00 Hour Transportation for Visitation Core $ 40.00 Hour Crossroads Counseling Sexual Abuse Treatment Sexual Abuse Treatment -Hourly Rate Core $ 80.00 Hour David Kalis, Inc. dba Parker Personal Care Homes Domestic Violence Intervention Anger Management Treatment - In Office CW Block/Child Welfare Services $ 125.00 Hour WELD COUNTY DEPT. OF HUMAN SERVICES - CHILD WELFARE DIVISION 2020-21 SERVICE VENDORS (CORE/NON-COREI BID NO.: 82000037 ,_55541 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND BARRY R. LINDSTROM, Ph.D., LLC This Agreement Amendment, made and entered into 42? 1 day of , 2020 by and between the Board of Weld County Commissioners, on behalf of the Weld County D 1. artment of Human Services, hereinafter referred to as the "Department", and Bany R. Lindstrom, Ph.D., LLC, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Mental Health Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019- 1896, approved on May 20, 2019. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on May 31, 2020. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Term This agreement is being renewed for a second full year term, for the period June 1, 2020 through May 31, 2021. 2. Exhibit D, Rate Schedule, is hereby amended as attached. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTES '✓4‘riteA) BOARD OF COUNTY COMMISSIONERS Weld ' o my Jerk to the Boar • ' �,� �,_ �-` WELD COUNTY, COLORADO Deputy Cler.f o the Board Mike Freeman, Chair CONTRACTOR: APR 2 7 2020 Barry R. Lindstrom, Ph.D., LLC 8217 West 20th Street, Suite A Greeley, CO 80634 By: 02O ,ezi;f 'It`aik Barry R L dstrom, PhD (Apr 17, 2020) Barry R. Lindstrom, Ph.D. Apr 17, 2020 020 /9-/.194 EXHIBIT D 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. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2021. 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 $175.00/Hour (Case Consultation) $375.00/Hour (Evaluation — Psychological, Mental Health Assessment, Interactional) $175.00/Hour (Inservice Training for Caseworkers and Foster Parents) $600.00/Half-Day (Inservice Training for Caseworkers and Foster Parents) $175.00/Hour (Staffing, Family Team Meetings, Team Decision Making Meetings) 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report 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 and Exhibit A. 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 60 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 60 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. For one-time services, proof of services rendered shall be receipt of a Client Verification Form and the completed product. For Monitored Sobriety services, proof of services rendered shall be the test result. Contract Form Entity Information Entity Name* LINDSTROM, BARRY New Contract Request Entity ID* @00000891 Contract Name* BARRY LINDSTROM NEW AGREEMENT AMENDMENT Contract Status CTB REVIEW Contract ID 3554 Contract Lead* CULLINTA Contract Lead Email cullinta@co.weld.co.us New Entity? Parent Contract ID Requires Board Approval YES Department Project # Contract Description* CONSENT. BID NO. 2000037. BOCC APPROVAL 04/15/20. CHILD PROTECTION AGREEMENT AMENDMENT. TERM: 06/01/20 THROUGH 05/31/21. FUNDING CORE/OTHER Contract Description 2 Contract Type* AGREEMENT Amount* $0.00 Renewable* NO Department HUMAN SERVICES Department Email CM- HumanServices@weldgov com Department Head Email CM-HumanServices- Automatic Renewal DeptHead@weldgovcom County Attorney Grant GENERAL COUNTY ATTORNEY EMAIL ICA County Attorney Email CM- COUNTYATTORNEY@WELD GOV.COM Requested BOCC Agenda Date* 04115/2020 Due Date 04/11/2020 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 OnBase Contract Dates Effective Date Termination Notice Penrod Review Date* 04/01/2021 Renewal Date Committed Delivery Date Expiration Date* 05/31/2021 Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JAMIE ULRICH DH Approved Date 04/21/2020 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 04/27/2020 Originator SNYDERKL Contact Type Contact Email Fnance Approver BARB C©NNGLLY Contact Rhone I Contact Phone 2 Purchasing Approved Date Finance Approved Date 04722/2020 Tyler Ref f 042720 Legal Counsel GABE KALUUSEK Legal Counsel Approved Date 04/22/2020 Submit CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND BARRY R. LINDSTROM, PH.D., LLC T� This Agreement, made and entered into thearday of 2019by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of man Services, hereinafter referred to as the "Department' and Barry R. Lindstrom, Ph.D., LLC, hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule. Exhibit B, C, and D are attached hereto and incorporated herein by this reference. Exhibit A is Weld County's Request for Proposal Number B1900025, 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 Mental Health Services. 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, 2019, upon proper execution of this Agreement and shall expire May 31, 2020, unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Proposal and Exhibit C, Scope of Services. 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 Supervisor (hainleid@weldgov.com, 970-400-6210). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit a complete Request for Reimbursement and supporting documentation by the 7th of the month, following the month of service, utilizing billing forms required by the - / 9 (;), 1 (ik ` 19 2019-1896 kheoo90 Department. Contractor agrees to utilize the Client Verification Form for all scheduled and unscheduled face-to-face services with the exception of home studies and monitored sobriety testing. Contractor agrees that original complete Client Verification Forms are to be submitted with the Request for Reimbursement. Requests for Reimbursement and Client Verification Forms received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet 60 -day deadline may result in termination of the Agreement. d. Contractor agrees to submit a monthly report by the 7"' 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 of service b. Where the service took place 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. Pavment 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, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule, 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. 2 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 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 OMG Circular A-133. 6. Pavment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule: 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 an, which will be provided by the Department, with a voided check. Failure to complete and submit this form and voided dieck 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 indudes 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. sec and its implementation regulations, 45 C.F.R. Part 91; and - Title VII of the Civil Rights Act of 1964; and 3 - 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 CF.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 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 govem 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 4 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 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. 5 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 within seven (7) days of the date 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, the following insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible the insurance provider. 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, 6 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 daims-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 as follows 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 (as defined in the Bid or RFP) 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 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 970-400-6503, 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 8 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). For Department: For Contractor: Heather Walker, Child Welfare Division Head Barry R. Lindstrom, Ph.D. 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: Judy A. Grim), Director P.O. Box A Greeley. CO 80632 (970) 400-6510 9 For Contractor: Barry R. Lindstrom, Ph.D. 8217 West 20th Street, Suite A Greeley, CO 80634 (970) 356-3100 18. Litigation 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 foredosure. 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 dients 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 §§2410-101 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 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 10 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 dient 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 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. 11 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 A 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 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. 12 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, etc., 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. 13 36. Attorney's Fees/Legal Costs 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. 14 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY; ATTEST: dialet) v ° ad dl); K• Weld ty Clerk to the Board WELD COUNTY, COLORAD By. Deputy Clerk to 15 BOARD OF COUNTY COMMISSIONERS Barbara Kirkmeyer, • air MAY 2 D 2019 CONTRACTOR: Barry R. Lindstrom, Ph.D., LLC 8217 West 20th Street, Suite A Greeley, CO 80634 (970) 356-3100 flapertraig By: Barry R ddstrom, PhD (Apr 2, 2019) Barry R. Lindstrom, Ph.D. Date: Apr 2, 2019 EXHIBIT A 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 intentionally left blank. EXHIBIT B CONTRACTOR'S RESPONSE TO REQUEST FOR PROPOSAL Barry R. Lindstrom, Ph.D., LLC Licensed Psychologist 8217 W 20th Street, Suite A Greeley, CO 80634 (970) 356-3100 fax (970)356-3100 barrylindstrom@yahoo.com January 25, 2019 TO: Human Services Advisory Commission, Weld County Department of Human Services (WCDHS) 315A North 1 Is' Avenue Greeley, CO 80632 VIA e-mail: HS Contract Management@co.weld.co.us RE: Bid No.: B1900025 WCDHS Core Contract Proposal for Mental Health Services; PY2019-20 Dear Ms. Cullins / Human Services Advisory Commission reviewers: Attached are the CORE Contract Proposal and supporting documents for Barry R. Lindstrom, PhD, LLC, for the 2019-20 contract year. This proposal includes the scope of service and rates for Mental Health Services for evaluation, expert testimony, consultation, and inservice training; and Dr. Lindstrom's license and insurance verifications. Barry R, Lindstrom, PhD, LLC is the private practice of Barry Lindstrom, PhD, Licensed Psychologist in Colorado since 1989_ Dr. Lindstrom has over 30 years of experience in clinical and forensic assessment and intervention, including individual and family psychological evaluations for the Courts. He has demonstrated the knowledge, expertise and training in completing hundreds of evaluations for the Department of Human Services and testifying in Court in several jurisdictions. He has studied, used and presented on a Trauma -informed model throughout his practice; integrating neuro-developmental, trauma -focused, and multigenerational family systems emphases in his evaluations and clinical work. Barry R. Lindstrom, PhD, LLC will provide contracted Mental Health Services including: A. Evaluation Services: Mental Health Assessments and Psychological Evaluations for children, adolescents and adults; and Parent Child Interactional, (PCT), and Sibling Interactional assessments; B. Consultation at Family Engagement Meetings (FEM, TDM & FTM) and Court Facilitation as requested; C. Expert Testimony in Court, when subpoenaed; D. Case consultation for Caseworkers and Foster Parents; and E. Inservice training for Caseworkers and Foster Parents. Dr. Lindstrom has demonstrated ability and reliability in providing these services over many years and in compliance with the provisions outlined in Exhibit A, the Child Protection Agreement. Dr_ Lindstrom places a priority on providing appointment times for the clients and staff of WCDHS. I look forward, if accepted, to entering into a contract for another year of working with you and your staff. Sincerely, /24,,,,dsi,_ Barry R. Lindstrom, PhD Licensed Psychologist EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services Barry R Lindstrom, PhD. LLC 1526711 AGENCY OR PRIVATE PRACTICE Barry Lindstrom PRIMARY CONTACT —FULL NAME 19701356-3100 PHONE NUMBER barrylindstromPyahoo com PRIMARY CONTACT— E-MAIL ADDRESS 8217 W 20th Street, Suite A AGENCY MAILING ADDRESS TRAILS PROVIDER ID (If Known) Psychologist PRIMARY CONTACT -TITLE (970) 356-48271 EXT. FAX NUMBER pathwaysgreeley.com AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) Greeley 80634 CITY ZIP REFERRAL CONTACT same as above REFFERALODNTACF—FULL NAME REFERRAL CONTACT— PHONE NUMBER EXT. REFERRAL CONTACT - TITLE REFERRAL CONTACT— E-MAIL ADDRESS BILLING CONTACT Jolene Johnson BILLING CONTACT— FULL NAME W70) 356-3100 BILLING CONTACT— PHONE NUMBER Office Manager BILLING CONTACT -TITLE pathwaysjotkomcast.net EXT. BILLING CONTACT— E-MAIL ADDRESS I certify that the services proposed for intended use by the Weld County Department of Hunan Services will meet all the specifications it has so indicated in this bid form. I further affirm intention to enter into an agreement with Weld County, on behalf of the Weld County Department of Human Services, and comply with all requirements of the contract, if awarded_ The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado_ The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are competitive in price and quality. Signature of Authorized Representative: Date of Signature: _January 25, 2019 Bid No.: B1900025 EXHIBIT C 1. Bidder's legal entity name: 2. Program name or service type being proposed: Barry R Lindstrom, PhD, LLC Mental Health Services A. Evaluation Services including: Mental Health Assessments and Psychological Evaluations for children, adolescents and adults; and Parent Child Interactional, (PCI), and Sibling Interactional assessments; B. Consultation at Family Engagement Meetings (FEM, TDM & FTM) and Court Facilitations; C. Expert Testimony in Court; D. Case consultation for Caseworkers and Foster Parents; and E. Inservice training for Caseworkers and Foster Parents. 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. A. Evaluation Servkes: Mental Health Assessments are a brief assessment of an individual's mental health functioning to answer diagnostic questions outlined by the Department and to provide treatment recommendations. Mental Health Assessments will typically include two, one -hour interviews approximately 2 weeks apart. Mental Health Assessments will include a review of WCDHS social history and family services plans, but limited outside collateral information. Psychological screening instruments (*listed below) will be completed, but no formal Psychological testing. If psychological testing is indicated, further Psychological Evaluation will be recommended and completed if approved. Individual Psychological Evaluations provide more thorough intellectual and diagnostic assessment and treatment recommendations. Specific referrals for intellectual and adaptive behavior assessment for disability determination are also accepted. Individual Psychological Evaluations will address referral questions regarding clients' diagnoses and their impact on attachment and parenting, placement and visitation needs, and treatment recommendations. This proposal does not include Psychosexual or Sexual Offender evaluations. Evaluations will typically include: Interviews to obtain relevant psychosocial history and mental status evaluation (1 to 3 hours). Psychological Testing (4 to 6 hours): Adults: Wechsler Abbreviated Scale of Intelligence (WASI); Wide Range Achievement Test -Fourth Edition (WRAT-5); Behavior Rating Inventory of Executive Function, Adult Version (BRIEF A; Self -Report and Informant forms as indicated); Minnesota Multiphasic Personality Inventory-2-Restructered Format (MMPI-2-RF); Millon Clinical Multiaxial Inventory -IV (MCMI-IV); Vineland Adaptive Behavior Scales - Third Edition (Vineland -3) or Adaptive Behavior Assessment System (Second Edition, ABAS-II) if needed for determination of intellectual or developmental disability; Thematic Apperception Test (TAT), Projective Drawings; *Beck Depression Inventory, Beck Anxiety Inventory, Penn Inventory for PTSD, Adult Self - Report Scale (for ADHD), Stressful Life Events Questionnaire, Mood Disorder Questionnaire, Rotter Incomplete Sentences. Children and Adolescents (4 to 6 hours): Wechsler Abbreviated Scale of Intelligence (WASI); Wide Range Achievement Test -Fourth Edition (WRAT-5); Behavior Rating Inventory of Executive Function, Second Edition (BRIEF -2 Self -Report, Parent and Teacher forms as indicated); Minnesota Multiphasic Personality Inventory for Adolescents -Restructured Format (MMPI-A RF); Millon Adolescent or Pre - Adolescent Clinical Inventory, (MACI, M -PACT); Behavioral Assessment System for Children -3`d Edition (BASC-3) completed by the child, parents, foster parents, and teachers; Conners Rating scales, developmental history forms and other non - standardized behavioral assessments completed by parents, foster parents, and teachers; Children's Apperception Test (CAT), Projective Drawings; Vineland Adaptive Behavior Scales Third Edition (Vineland -3; Caregiver and Educator forms). Family (Interactional) evaluations are provided as Parent -Child Interactional (PCI) or Sibling Interactional evaluations. PCI evaluations can include birth, adoptive and foster parents, and kinship providers as referred. Interactional evaluations will address referral questions regarding clients' diagnoses; attachment and interaction patterns; placement and visitation needs; and treatment recommendations. Family evaluations will assess risk factors from the Kempe Family Stress Inventory. Family Evaluations can also assess level and intensity of visitation, including issues related to visitation between children and their incarcerated parents. Interactional evaluations will address the relative contributions of the child(ren), the parent(s), and their interaction and attachment patterns to the problems that led to the Department's involvement. As such, interactional evaluations will include a brief mental health assessment of each individual in addition to an assessment of family interaction patterns and January 25, 2019 Bid No.: B1900025 EXHIBIT C Vendor: Barry R. Lindstrom, PhD, LLC Program Category: Mental Health Services Page 2 attachment behaviors. Interactional evaluations will typically include: Interviews (3-10 hours): Individual interviews to obtain relevant psych000cial history and mental status evaluation with each referred family member; Conjoint interviews with all family members (including marital, parent -child, and sibling subsystems); and Conjoint interview/ consultation with child and current caregivers (e.g., foster parent, kinship, relative) if child is in out of home placement at the time of evaluation. Psychological Screening/Testing: Adults (1 to 2 hours): Milton Clinical Multiaxial Inventory -IV (MCMI-IV) or Minnesota Multiphasic Personality Inventory-2- Restructered Format (MMPI-2-RF) as indicated and screening instruments*. Children and Adolescents (1 hour): BASC-3 completed by the child, parents, foster parents, and teachers; Conners Rating scales; developmental history forms and other non -standardized behavioral assessments. B. Family Engagement Meetings (FEM, FTM & TDM) and Court Facilitation Stallings Family Engagement Meetings and Court facilitation staffings with the client's participation will be attended before, during or after evaluation or treatment as requested by the Caseworker, GAL, County Attorney or Court facilitator to provide information and input regarding the evaluation process, findings and recommendations; treatment progress and outcomes; and case consultation regarding treatment, visitation and permanency planning. Consultation can also include attendance at Clinical, Psychiatric or Educational (IEP) Stafngs as approved by the Department. C. Expert Testimony Expert testimony regarding the evaluation process, findings and recommendations; treatment progress and outcomes; and treatment, visitation and permanency planning will be provided as requested by the County Attorney via subpoena. Expert testimony to provide information to the Court regarding abuse, attachment or other psychological topics on cases not seen for evaluation or treatment can also be provided. D. Case Consultation for Caseworkers & Foster Parents Consultation regarding specifically referred cases will be provided to caseworkers or foster parents in order to help foster children preserve or maintain placement in a clinically appropriate level of care, to minimize the number of changes or transitions, and to meet permanency goals. This is a brief consultation and not intended to replace formal evaluation of an individual or family. If requested, a report can be prepared summarizing recommendations. E. Inservice training for Caseworkers & Foster Parents Dr. Lindstrom has presented numerous times on Trauma, PTSD, Vicarious Trauma and Compassion Fatigue in caseworkers, foster parents, CASAs, therapists, attomeys and judicial officers. He can provide Inservice training or workshops for Caseworkers or Foster Parents on these and other topics as requested (e.g., specific diagnoses or interventions). 4. Capacity to Provide Services (ex. 4 hours/week). 10-20 hours/week or as needed. Mental Health Assessments can be completed in a month or less. Psychological and Interactional Evaluations take from one to three months to complete, unless expedited to meet Court deadlines. 5. Goals of the service. To provide individual and family diagnostic evaluations to assess individual functioning, family structure, communication, and attachment relationships to assist in the development of family services plans and provide treatment recommendations in support the permanency goals established by the Court and in the child(ren)'s best interests for safety, permanence and well-being; and the prognosis for change within a developmentally meaningful timeframe. 6. Outcomes of service. A final diagnostic feedback session is offered to the dient as part of each evaluation to discuss psychological test results, and the findings and recommendations of the evaluation. A written report will be provided for all evaluations summarizing the CORE Services referral questions; brief case and social history; evaluation course, methods and procedures; assessment findings; collateral contacts; limitations; analysis; and Bid No.: 1900025 January 25, 2019 Bid No.: 81900025 EXHIBIT C Vendor: Barry R. Lindstrom, PhD, LLC Program Category: Mental Health Services Page 3 conclusions and recommendations for visitation, treatment, medication evaluations or further psychological evaluation. Evaluations will include a review of WCDHS social history, family services plans and case records; consultation with collateral sources; previous evaluations and treatment records. Evaluation reports will address strengths and protective factors as well as risk factors or problems related to the child's Safety, Permanence, and Well Being. Incomplete evaluations will be documented in writing to the extent possible, outlining the limitations and impact of any missing information. Case management will include regular email or telephone communication with caseworkers at the time of referral and after each appointment to update on the progress of the evaluation, discuss concerns and meet deadlines. Communication with and Guardians ad Litem and treating professionals will obtain collateral information as needed. All evaluations will be completed following the Guidelines for Psychological Evaluations in Child Protection Matters as published by the American Psychological Association (2013, APA) and the Ethical Principles of the American Psychological Association (APA). 7. Target population for service. Mental Health Assessments and Psychological Evaluations are provided by Dr. Lindstrom for Children (Birth through 12 years), Adolescents (13 through 18 years), and Adults over 18 years . Family/ Interactional evaluations are provided by Dr. Lindstrom for clients of any age, including the child and parents, foster parents or caregivers (kin, special respondents, intervenors) and/or siblings. 8. Service access. Referrals can be sent directly to Dr. Lindstrom via email: barrylindstrom@yahoo.com. He will respond to the referring caseworker within two business days. Unless otherwise indicated or arranged, evaluation services will be provide at the office of Pathways at 8217 W 20"' St., Suite A, Greeley, CO 80634. Psychological evaluations can be completed with locally incarcerated clients as needed. Dr. Lindstrom can attend family visitation at the Family Services and Visitation Center in Greeley, or Del Camino as needed to complete portions of Parent -Child or Sibling Interactional Assessments. Dr. Lindstrom will attend Family team meetings at the Department, and attend Court Facilitations and provide expert testimony at the Court house, as requested. Dr. Lindstrom will provide consultation and in-service training at the requested location(s). 9. Languages service is available in. English. 10. Rates of service. A. Evaluations, with written report by Barry R. Lindstrom, PhD (Per hour of interviews and psychological testing) B. TDM, FTM, FEM, and Court Facilitator Staffings (excluding travel) Clinical or Educational Staffings (as authorized) C. Expert Testimony with subpoena. Court preparation, and travel (portal a portal) D. Case Consultation for Caseworkers and foster parents E. Inservice training for Caseworkers or foster parents Respectfully submitted, Barry R. Lindstrom, PhD Licensed Psychologist Bid No.: 1900025 Rate / Hour $375 $150 (1 hr. minimum) $150 $175 (2 hr. minimum) $150 $175/hr $600 (per 1/2 day) STAFF DATA SHEET EXHIBIT D (Bidder mast ust alt applicable stag who will manage acrd/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Mental Health: Psychological & interactional Evaluation BIDDER LEGAL ENTITY NAME: Barry R Lindstrom, PhD, LLC APPLICABLE STAFF IVIEMBEB OR. CONTRACTOR INFORMATION SUPE„RVISDR INFORMATION No. Last Name First Name Work# Worts Email Education Level Degree Focus Eicensurej Credentials DORA. (If applicable) Last 'Name � First Name �� for. mail 1 Lindstrom Barry 9703563100 harrylindstromP\ Pala Psychology CO #1303 NA 2 3 4 5 6 7 i 8 • 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Bid No.: B1900025 'COLORADO Department of i Regulatory Agencies ' Dvts:on of Professions any Occupattons Congratulations! Below are your electronic wallet cards to use as proof of your license. You can also print your license at any time by visiting www.colorado.gov/dora/DPO_Print_License and following the instructions listed. If you would like a more durable wallet card option, you can order one for a fee by visiting www.nasbastore.org and selecting the "Colorado License Cards" link on the left hand side of the page. If you prefer, you can also contact NASBA by phone at 1-888-925-5237 or by email at nasbastore@nasba.org. Should you have questions about your credential, or need other information please contact our Customer Service Team at 303-894-7800 or dora_registrations@state.co.us. Colorado Department of Regulatory Agencies Division of Professions and Occupations State Board of Psychologist Examiners Barry Richard Lindstrom Licensed Psychologist PSY.0001303 Number Active Credential Status Verify this credential at: { /11; . Division Directory Ronne Hines 09/01/2017 Issue Date 08/31/2019 Expire Date ov/dora/dpo al Holder Signature 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 Colorado Department of Regulatory Agencies Division of Professions and Occupations State Board of Psychologist Examiners Barry Richard Lindstrom Licensed Psychologist PSY.0001303 Number Active Credential Status Verify this credential at: www Divisiorector3�Ronne Hfnes 09/01/2017 Issue Date /31/2019 Expire Date oora/dpo ntial Holler Signature F 303.894.7693 www.colorado.gov/dora/dpo ra rfi CPHCCPHC PHILADELPHIA INSURANCE COMPANIES Certificate of Liability Insurance Date Issued: 08/08/2018 Underwritten by: Philadelphia Indemnity Insurance Company One Bala Plaza, Suite 100 Bala Cynwyd, PA 19004 - NAIC #: 18058 Administered by: CPH & Associates 711 S. Dearborn St. Ste 205 Chicago, IL 60605 • P 800.875.1911 F 312.987.0902 info@cphins.com DISCLAIMER: This certificate is issued as a matter of information only and confers no rights upon the certificate holder. The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend. extend, or alter the coverage afforded by the policies listed thereon. Insured: Barry R. Lindstrom PhD, LLC Barry Lindstrom 8217 W 20th Street, Ste A Greeley, CO 80634 Policy Number: 072277 Policy Term: 10/04/2018 to 10/04/2019 Covered Locations Professional Liability: Portable coverage, not location specific Coverage Type (Occurrence Form) Professional Liability Supplemental Liability Licensing Board Defense Commercial General Liability Fire/Water Legal Liability Business Personal Property Per Incident (Per individual claim) $ 1,000,000 $ 1,000,000 $ 100,000 N/A N/A N/A Aggregate (Total amount per year) $ 3,000,000 $ 3,000,000 $ 100,000 N/A N/A N/A Comments/Special Descriptions: Certificate Holder PROOF OF COVERAGE If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Notice of Cancellation will only be provided to the first named insured m accordance with policy provisions, who shall act on behalf of all additional insureds with respect to giving notice of cancellation. 6194.11044\• 44' Authorized Representative C. Philip Hodson TRAVELERS One Tower Square, Hartford, Connecticut 06183 COMMON POLICY DECLARATIONS OFFICE PAC BUSINESS: PHYSICIANS AND RENEWAL CERTIFICATE POLICY NO.: 680-390N4113-18-42 ISSUE DATE: 09/07/2018 INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT 1. NAMED INSURED AND MAILING ADDRESS: PATHWAYS MANAGEMENT 3211 20TH STREET SUITE D GREELEY CO 80634 2. POLICY PERIOD: From 11/01/2018 to 11/01/2019 12:01 A.M. Standard Time at your mailing address. 3. LOCATIONS: PREM. BLDG. NO. NO. 001 001 OCCUPANCY ADDRESS s(same as Mailing Address unless PHYSICIANS AND 3211 20TH STREET SUITE D GREELEY CO 80634 4. COVERAGE PARTS AND SUPPLEMENTS FORMING PART OF THIS POLICY AND INSURING COMPANIES COVERAGE PARTS AND SUPPLEMENTS INSURING COMPANY Businessowners Coverage Part TCT 5. The COMPLETE POLICY consists of this declarations and all other declarations, and the forms and endorse - ments for which symbol numbers are attached on a separate listing. 6. SUPPLEMENTAL POLICIES: POLICY DIRECT BILL 7. PREMIUM SUMMARY: Provisional Premium Due at Inception Due at Each Each of the following is a separate policy containing its complete provisions. POLICY NUMBER INSURING COMPANY $ $ $ 1,125.00 NAME AND ADDRESS OF AGENT OR BROKER COUNTERSIGNED BY: FLOOD & PETERSON INS INC XY235 PO BOX 578 GREELEY IL TO 25 08 01 (Page 1 of 01) Office: ELMIRA NY SRV CTR DOWN Authorized Representative CO 80632-0578 09/07/2018 DATE: TRAVELERS One Tower Square, Hartford, Connecticut 06183 BUSINESSOWNERS COVERAGE PART DECLARATIONS OFFICE PAC POLICY NO.: 680-390N4113-18-42 ISSUE DATE: 09/07/2018 INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT POLICY PERIOD: From 11-01-18 to it -01-19 12:01 A.M. Standard Time at your mailing address FORM OF BUSINESS: PARTNERSHIP COVERAGES AND LIMITS OF INSURANCE: Insurance applies only to an item for which a "limit" or the word "included" is shown. COMMERCIAL GENERAL LIABILITY COVERAGE OCCURRENCE FORM LIMITS OF INSURANCE General Aggregate (except Products -Completed Operations Limit) $ 2,000,000 Products -completed Operations Aggregate Limit $ 2,000,000 Personal and Advertising Injury Limit $ 1,000,000 Each Occurrence Limit $ 1,000,000 Damage to Premises Rented to You $ 300,000 Medical Payments Limit (any one person) $ 5,000 BUSINESSOWNERS PROPERTY COVERAGE DEDUCTIBLE AMOUNT: Businessowners Property Coverage: $ 250 per occurrence. Building Glass: $ 250 per occurrence. BUSINESS INCOME/EXTRA EXPENSE LIMIT: Actual loss for 12 consecutive months Period of Restoration -Time Period: Immediately ADDITIONAL COVERAGE: Fine Arts: $ 25,000 Other additional coverages apply and may be changed by an endorsement. Please read the policy. SPECIAL PROVISIONS: COMMERCIAL GENERAL LIABILITY COVERAGE IS SUBJECT TO A GENERAL AGGREGATE LIMIT MP TO 01 02 05 (Page 1 of 2) COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 680-390N4113-18-42 ISSUE DATE: 09/07/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of person or organization: STATE OF COLORADO, WELD COUNTY, COLORADO BY AND THROUGH THE BOARD OF PO BOX A CO 80632 WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your acts or omissions. CG T4 91 11 88 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 GENERAL PURPOSE ENDORSEMENT POLICY NUMBER: 680-390x4113-18-42 OFFICE PAC ISSUE DATE: 09/07/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MANUSCRIPT ENDORSEMENT This endorsement modifies insurance provided under the following: THE NAME FOR THE ADDITIONAL INSURED DESIGNATED PERSON ORGANIZATION, (CG T4 91), THE NAME OF THE PERSON OR ORGANIZATION IS AMENDED TO READ: STATE OF COLORADO, WELD COUNTY, COLORADO, BY AND THROUGH THE BOARD OF COUNTY COMMISSIONERS CF WELD COUNTY, ITS EMPLOYEES ANC AGENTS ATTN: TOBY VETTER PO BOX A GREELEY, CO 80632 CG T8 01 11 18 Page 1 of 1 EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Mental Health Services. as referred by the Department. The following services are available under this Agreement: a. Case Consultation: Consultation regarding specifically referred cases will be provided to caseworkers or foster parents in order to help foster children preserve or maintain placement in a clinically appropriate level of care, to minimize the number of changes or transitions, and to meet permanency goals. This is a brief consultation and not intended to replace formal evaluation of an individual or family. If requested, a report can be prepared summarizing recommendations. b. Evaluations: i. Individual Psychological Evaluation: A thorough intellectual and diagnostic assessment and treatment recommendations. Specific referrals for intellectual and adaptive behavior assessment for disability determination are also accepted. Individual Psychological Evaluations will address referral questions regarding clients' diagnoses and their impact on attachment and parenting, placement and visitation needs, and treatment recommendations. 1. Psychological Testing (Adults): Wechsler Abbreviated Scale of Intelligence (WASI); Wide Range Achievement Test -Fourth Edition (WRAT-5); Behavior Rating Inventory of Executive Function, Adult Version (BRIEF -A; Self -Report and Informant forms as indicated); Minnesota Multiphasic Personality Inventory-2- Restructered Format (MMPI-2-RF); Millon Clinical Multiaxial Inventory -IV (MCMI-IV); Vineland Adaptive Behavior Scales -Third Edition (Vineland -3) or Adaptive Behavior Assessment System (Second Edition, ABAS-II) if needed for determination of intellectual or developmental disability; Thematic Apperception Test (TAT), Projective Drawings; *Beck Depression Inventory, Beck Anxiety Inventory, Penn Inventory for PTSD, Adult Self -Report Scale (for ADHD), Stressful Life Events Questionnaire, Mood Disorder Questionnaire, Rotter Incomplete Sentences. 2. Psychological Testing (Children): Wechsler Abbreviated Scale of Intelligence (WASI); Wide Range Achievement Test -Fourth Edition (WRAT-5); Behavior Rating Inventory of Executive Function, Second Edition (BRIEF -2 Self -Report, Parent and Teacher forms as indicated); Minnesota Multiphasic Personality Inventory for Adolescents -Restructured Format (MMPI-A-RF); Millon Adolescent or Pre -Adolescent Clinical Inventory, (MACI, M-PACI); Behavioral Assessment System for Children -3"I Edition (BASC-3) completed by the child, parents, foster parents, and teachers; Conners Rating scales, developmental history forms and other non -standardized behavioral assessments completed by parents, foster parents, and teachers; Children's Apperception Test (CAT), Projective Drawings; Vineland Adaptive Behavior Scales -Third Edition (Vineland -3; Caregiver and Educator forms). c. Mental Health Assessment (MHA): A brief assessment of an individual's mental health functioning to answer diagnostic questions outlined by the Department and to provide treatment recommendations. Mental Health Assessments will typically include two, one -hour interviews approximately 2 weeks apart. Mental Health Assessments will include a review of WCDHS social history and family services plans but limited outside collateral information. Psychological screening instruments (*listed below) will be completed, but no formal Psychological testing. If psychological testing is indicated, further Psychological Evaluation will be recommended and completed if approved. d. Interactional Evaluation: A Parent -Child Interactional (PCI) or Sibling Interactional evaluation. PCI evaluations can include birth, adoptive and foster parents, and kinship providers as referred. Interactional evaluations will address referral questions regarding clients' diagnoses; attachment and interaction patterns; placement and visitation needs; and treatment recommendations. Family evaluations will assess risk factors from the Kempe Family Stress Inventory. Family Evaluations can also assess level and intensity of visitation, including issues related to visitation between children and their incarcerated parents. Interactional evaluations will address the relative contributions of the child(ren), the parent(s), and their interaction and attachment patterns to the problems that led to the Department's involvement. As such, interactional evaluations will include a brief mental health assessment of each individual in addition to an assessment of family interaction patterns and attachment behaviors. i. Interviews: Individual interviews to obtain relevant psych000ccal history and mental status evaluation with each referred family member; Conjoint interviews with all family members (including marital, parent -child, and sibling subsystems); and Conjoint interview / consultation with child and current caregivers (e.g., foster parent, kinship, relative) if child is in out of home placement at the time of evaluation. ii. Psychological Screening/Testing (Adults): Millon Clinical Multiaxial Inventory -IV (MCMI- IV) or Minnesota Multiphasic Personality Inventory-2-Restructered Format (MMPI-2-RF) as indicated and screening instruments. iii. Psychological Screening/Testing (Children): BASC-3 completed by the child, parents, foster parents, and teachers; Conners Rating scales; developmental history forms and other non -standardized behavioral assessments. e. Inservice Training for Caseworkers and Foster Parents: Contractor can provide Inservice training or workshops for caseworkers or foster parents on various topics as requested (e.g., specific diagnoses or interventions). 2. Capacity: Ten (10) to 20 hours per week, or as needed. Mental Health Assessments (MHA) can be completed in one month or less. Psychological and Interactional Evaluations take from one (1) to three (3) months to complete, unless expedited. 3. Goals of Service: a. Provide individual and family diagnostic evaluations to assess individual functioning, family structure, communication and attachment relationships to assist in the development of Family Service Plans and provide treatment recommendations. b. Support the goals established by the Court and in the child(ren)'s best interests for safety, permanency and well-being, and the prognosis to change within a developmentally meaning 4. Outcomes of Service: a. A final diagnostic feedback session will be offered to the client to discuss psychological test results, findings and recommendations of the evaluation. b. A written report will be provided for all evaluations summarizing the referral questions, brief case and social history, evaluation course, methods and procedures, assessment findings, collateral contacts, limitations, analysis, and conclusions and recommendations for visitation, treatment, medication evaluation or future psychological evaluation. i. Incomplete evaluations will be documented to the extent possible, and will outline the limitations and impact of any missing information. 5. Target Population: a. Mental Health Assessments and Psychological Evaluations: i. Children, ages birth to 12 years. ii. Adolescents, ages 13 to 18 years. iii. Adults, over the age of 18 years. b. Interactional Evaluations: i. All ages/genders, including child(ren), parents, foster parents or caregivers (kin, special respondents, intervenors) and/or siblings. 6. Access to Services: a. 8217 West 20th Street, Suite A, Greeley, CO 80634. b. Psychological evaluations can be completed for locally incarcerated clients as needed. c. Contractor can attend family visitation at the Department's Family Support Visitation Center as needed to complete portions of any Interactional Evaluation. d. Consultation and In-service Training will be provided at the requested location(s). 7. Language: English only. 9. Contractor will respond to the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400- 6210) within three (3) business days regarding the ability to accept the received referral. 10. 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 Supervisor (hainleid@weldgov.com, 970-400-6210). 11. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for visitation services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understand that the Department will no reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows" on the part of the client per month. After three (3) "no-shows, "Contractor will place client on a behavioral plan requiring attendance or discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210). 12. 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 Supervisor (hainleid@weldgov.com) immediately via email, to discuss service continuation. 13. Contractor will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 14. 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 immediately AND on the required monthly report. 15. 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. 16. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. 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. 17. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Court Staffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as the meeting is at least one hour in length, the Contractor obtains the Facilitator's signature on the Client Verification Form (if in person) at the time of the meeting and participation in the meeting is deemed appropriate and necessary by the Department. 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, if approved by the Department. 18. Contractor will notify the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210) 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. EXHIBIT D 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. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2020. 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 $150.00/Hour (Case Consultation) $375.00/Hour (Evaluation — Psychological, Mental Health Assessment, Interactional) $175.00/Hour (Inservioe Training for Caseworkers and Foster Parents) $500.00/Half-Day (Inservrce Training for Caseworkers and Foster Parents) $150.00/Hour (Staffing, Family Team Meetings, Team Decision Malting Meetings) 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report 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 and Exhibit A. Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7* day of the month following the month of service, but no later than 60 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 60 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. For one-time services, proof of services rendered shall be receipt of a Client Verification Form and the completed product. For Monitored Sobriety services, proof of services rendered shall be the test result. Hello