The URL can be used to link to this page

Browse Search

Home My WebLink About20192193.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 c&1ort.46.4.ze-,G ,c -r7-02-1 J Page 1 ozoi 9- �i93 j/-k� e90 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND PARKER PERSONAL CARE HOMES INC. DBA DAVID KALIS, INC. rd This Agreement Amendment, made and entered into / i day of v� 2021 by and between the Board of Weld County Commissioners, on behalf of the Weld County Depar t of Human Services, hereinafter referred to as the "Department", and Parker Personal Care Homes, Inc. DBA David Kalis, Inc., hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Anger Management, Foster Care/Adoption Services, Life Skills, Mental Health Services, Relinquishment Counseling, Sexual Abuse Treatment, and Substance Abuse Treatment, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2193, approved on June 12, 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: November 25, 2019 to amend the Rate Schedule. April 29, 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 2019-2193. • 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 Mav 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: Al I EST: ddrh/t) �/ • �LD; 41 Weld C n Clerk to the Bo By: Deputy Clerk By: BOARD OF. COUNTY COMMISSIONERS WELD COUNTY, COLORADO Steve Moreno, Chair ONTRACTOtt MAY 1 7 2021 arker Personal Care Homes, Inc. DBA David Kalis, Inc. P.O. Box 271167 Louisville, Colorado 80027 Kathryn Schrader, Chief Financial Officer Date: Apr 8, 2021 �oi9- 0/9,3 Contract Form Contract Request Entart tn1 Entity Name* Entity ID* PARKER PERSONAL CARE HOMES INC P00042447 ❑ New Entity? Contract Name* Contract ID PARKER PERSONAL CARE HOMES DBA DAVID KALE, INC;. 4654 (AGREEMENT AMENDMENT) Contract Status CTB REVIEW tract Description* BID #Bl900025 TERM 6J1,f21-5,31122. Contract Description 2 CONSENT. PA WAS SENT TO CTB ON 3/31/21. Contract Type AMENDMENT Amount* 50.00 Renewable NO Automatic Renewal Grant e Department HUMAN SERVICES Department Email CM- HumanServices@weldgov.co m Department Head Email CM-HumanServices- DeptHeadgweldgov.com County Attorney GENERAL COUNTY A 1 i ORNEY EMAIL County Attorney Email CM- COU NTYATTORN EY'WELDG OV.COM us race ID If this is part of a WA enter MSA Contract ID Contract Lead* APEGG Contract Lead Email apegg@weldgov.com; cobbx xlk@weldgov.com Requested B(JCC Agenda Date* 05126; 2021 Parent Contract ID 20192193 Requires Board Approval YES De Due Date 05/22;2021 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? Note: the Previous. Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Termination Notice Period fl IcrformatEon' Con Info Contact Name h1rCfls"i5ing Ptrrchasova CONSENT Approva Pr Department Head JAMIE ULRICH DH Approved Date 04,1412021' BOCC Approved BOCC Signed Date BOCC Agenda Date 05/17/2021 Originator APEGG Contact Type Review date * 04/01,i2022 Committed Del'ivery flafTR Renewal Date Ex A ration Date* 05/31;2022 Contact Email Contact Phone 1 Finance Approver CONSENT Purchasing Approved Date 04/14/2021 I vgal Counsel CONSENT Finance Approved Date Legal Counsel Approved Date 04/14/2021 04.14,E`2021 Tyler Ref # AG 051721 357o 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 0-644 PST a11/2c/ 20 GPI: ®..SA*e, ASP 0ki/2.9720 Page 1 2193 'Pioa90 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 CV/ 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 CW Block/Child Welfare Services $`, ` 700.00 Episode Home Study, 2 Adults CW Block/Child Welfare Services $ 1,600.00 Episode Mileage CW Block/Child Welfare Services $ 0.56 Mile Partial Home Study, Denied or Withdrawn CW Block/Child Welfare Services $ 300.00 Episode Centennial Board of Cooperative Education Services D_y Treatment Services Therapeutic Er Educational Costs Core $ 203.00 Day Therapeutic Costs Core $ 72.00 � Day Collaborative Services for Change Child 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 Services 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 Care $ 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 Home Based 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-CORE) BID NO.: 82000037 2 VENDOR RENEWALS Vendor Program Area Service Name Anger Management Treatment - Out of Office Funding CW Block/Child Welfare Services Rate $ 180.00 Unit Type Hour Staffing, FTM, TDM, etc. CW Block/Child Welfare Services $ 125.00 Hour Foster Care/Adoption Support BCBA Foster Parent Consultation- In Office Core $ 125.00 Hour BCBA Foster Parent Consultation - Out of Office Core $ 180.00 Hour Foster Parent Consultation - In Office Core $ 125.00 Hour Foster Parent Consultation - Out of Office Core $ 180.00 Hour Staffing, FTM, TDM, etc. Core $ 125.00 Hour Life Skills Staffing, FTM, TDM, etc. Core : $ 125.00 Hour Therapeutic Visitation - In Office Core $ 125.00 Hour Therapeutic Visitation '- Out of Office' Core $ 180.00 Hour Mental Health Services Adaptive Behavioral Evaluation Core $ 350.00 Hour BCBA Adaptive Behavioral Evaluation Core $ 350.00 Hour BCBA Behavioral Evaluation Core $ 350.00 Hour BCBA Consultation - In Office Core $ 125.00 Hour BCBA Consultation - Out of Office Core $ 180.00 Hour Behavioral Evaluation Core $ 350.00 Hour Consultation - In Office Core $ 125.00 Hour Consultation - Out of Office Core $ 180:00 Hour Counseling/Psychotherapy - In Office Core $ 125.00 Hour CounselinWPsychotherapy - Out of Office Core $ 180.00 Hour Developmental Disabilities Evaluation Core $ 350.00 Hour Family Therapy - In Office Core $ 125.00 Hour Family Therapy - Out of Office Core $ 180.00 Hour Home Based Therapy Core $ 180.00 Hour Learning Disability/Attention Deficit Disorder Evaluation Core $ 350.00 Hour Psychological Evaluation Core $ 350.00 Hour Psychotherapy for Individuals with Limited Cognitive Abilities - In Office Core $ 125.00 Hour Psychotherapy for Individuals with Limited Cognitive Abilities - Out of Office' Core $ 180.00 Hour Staffing, FTM, TDM, etc. Core $ 125.00 Hour Trauma Informed Assessments/Evaluation Core $ 350.00 Hour Relinquishment Counseling Relinquishment Counseling - In Office CW Block/Child Welfare Services $ 125.00 Hour Relinquishment Counseling - Out of Office CW Block/Child Welfare Services $ 180.00 Hour Staffing, FTM, TDM, etc. CW Block/Child Welfare Services $ 125.00 Hour Sexual Abuse Treatment Sex Offender Specific Evaluation l' Core $ 350.00 Hour Sexual Abuse Counseling - In Office Core $ 125.00 Hour Sexual Abuse Counseling - Out of Office Core $ 180.00 Hour Staffing, FTM, TDM, etc. Core $ 125.00 Hour Substance Abuse Treatment Staffing, FTM, TDM, etc. Core $ 125.00 Hour Substance Abuse Treatment - In Office Core $ 125.00 Hour Substance Abuse Treatment - Out of Office Core $ 180.00 Hour Denver Area Youth Services Home Based Services High Package Core $ 2,275.00 Month Intensive Package Gore $ 2,800.00 Month Low Package Core $ 925.00 Month Moderate Package Core $ 1,700:00 Month Denver Children's Home Child Mentoring and Family Support Behavior Coaching Core $ 48.00 Hour WELD COUNTY DEPT. OF HUMAN SERVICES - CHILD WELFARE DIVISION 2020-21 SERVICE VENDORS (CORE/NON-CORE) BID NO.: 82000037 3 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND PARKER PERSONAL CARE HOMES DBA DAVID KALIS, INC. This Agreement Amendment, made and entered into day of between the Board of Weld County Commissioners, on behalf of the Weld County 2020 by and partment of Human Services, hereinafter referred to as the "Department", and Parker Personal Care Homes dba David Kalis, Inc., hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Anger Management, Foster Care/Adoption Services (Foster parent Consultation), Life Skills, Mental Health Services, Relinquishment Counseling, Sexual Abuse Treatment, and Substance Abuse Treatment, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2193, approved on June 10, 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. • The Original Agreement was amended on November 25, 2019. The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2019-2193. • 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 of 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. ee 011-1&i-a-e9OW �f-.29-ao A/ -O2 � /1E 90 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: .rltritt/1/ �/• Weld Co • ntv - rk t By: Deputy Clerk BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Chair APR 2 9 2020 CONTRACTOR: Parker Personal Care Homes dba David Kalis, Inc. P.O. Box 271168 Louisville, CO 80027 By: Date: katltadiifch a�'e` kathryn sch er(Apr 20, 2020) Kathryn Schrader, CFO Apr 20, 2020 a o /9- 02/93 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 $125.00/hour Staffing/TDM/FTM Attendance — For all program areas and services Anger Management: $125.00/Hour Anger Management Treatment (In Office) $180.00/Hour Anger Management Treatment (Out of Office) Foster Parent Consultation: $125.00/Hour Foster Parent Consultation (In Office) $180.00/Hour Foster Parent Consultation (Out of Office) Life Skills: $125.00/Hour Therapeutic Visitation (In Office) $180.00/Hour Therapeutic Visitation (Out of Office) Mental Health Services: $350.00/Hour -Adaptive Behavioral Evaluation $350.00/Hour BCBA Adaptive Behavioral Evaluation $350.00/Hour BCBA Behavioral Evaluation $350.00/Hour Behavioral Evaluation $350.00/Hour Developmental Disabilities Evaluation $350.00/Hour Learning Disability/Attention Deficit Disorder Evaluation $350.00/Hour Psychological Evaluation $350.00/Hour Trauma Informed Assessments/Evaluation $125.00/Hour Family Therapy (In Office) $180.00/Hour Family Therapy (Out of Office) $125.00/Hour Counseling/Psychotherapy (In Office) $180.00/Hour Counseling/Psychotherapy (Out of Office) $125.00/Hour Psychotherapy for Individuals with limited Cognitive Abilities (In Office) $180.00/Hour Psychotherapy for Individuals with limited Cognitive (Out of Office) $180.00/Hour Home Based Therapy (Out of Office) $125.00/Hour Consultation (In Office) $180.00/Hour Consultation (Out of Office) $125.00/Hour BCBA Consultation (In Office) $180.00/Hour BCBA Consultation (Out of Office) $125.00/Hour BCBA Foster Parent Consultation (In Office) $180.00/Hour BCBA Foster Parent Consultation (Out of Office) Relinquishment Counseling: $125.00/Hour (In Office) $180.00/Hour (Out of Office) Sexual Abuse Treatment: $350.00/Hour Sex Offender Specific Evaluation $125.00/Hour Sexual Abuse Counseling (In Office) $180.00/Hour Sexual Abuse Counseling (Out of Office) Substance Abuse Treatment: $125.00/Hour (In Office) $180.00/Hour (Out of Office) 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 New Contract Request Entity Information Entity Name* DAVID KALIS & ASSOCIATES INC Entity ID* @00035714 Contract Name* DAVID KALIS & ASSOCIATES, INC. {AGREEMENT AMENDMENT} Contract Status CTB REVIEW ❑ New Entity? Contract ID 3570 Contract Lead* CULLINTA Contract Lead Email cullinta@coweld co.us Parent Contract ID Requires Board Approval YES Department Project # Contract Description* CONSENT. BID NO. 2000037. BOCC APPROVAL 04/15/20_ CHILD PROTECTION AGREEMENT AMENDMENT. TERMS: 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@weldgov.com County Attorney Grant GENERAL COUNTY ATTORNEY EMAIL IGA County Attorney Email CM- COUNTYATTORNEY@WELD GOV. COM Requested BOCC Agenda Date* 04/15/2020 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 Review Date* Renewal Date 04/01/2021 Termination Notice Period Committed Delivery Date Expiration Date* 05/3112021 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 04/29/2020 Originator SNYDERKL Contact Type Contact Email Hnance Approver BARB C©NN©LLY Contact Phone 1 Contact Phone 2 Purchasing Approved Date Fnance Approved Date 04/22/2020 Tyler Ref # AG 042920 Legal Counsel GABE KALOUSEK Legal Counsel Approved Date 04/22/2020 Submit Pr 300 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: September 10, 2019 TO: Board of County Commissioners — Pass -Around FR: Judy A. Griego, Director, Human Services RE: Agreement Amendment with Parker Personal Care Homes dba David Kalis, Inc. 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 Agreement Amendment with Parker Personal Care Homes dba David Kalis, Inc. The Department entered into an agreement with Parker Personal Care Homes dba David Kalis, Inc. with a term of June 1, 2019 through May 31, 2020, for Anger Management, Foster Care/Adoption Services, Life Skills, Mental Health Services, Relinquishment Counseling, Sexual Abuse Treatment, and Substance Abuse Treatment. This agreement is identified as 2019-2193, approved on June 12, 2019. The provider is now offering certain services through a Board Certified Behavior Analyst (BCBA). The Department has updated the Rate Schedule to reflect those services, as noted below. • $125,00/hour (Behavioral Evaluation, Ph. D. and BCBA level, up to 12 hours) • $125.00/hour (Adaptive Behavioral Evaluations, Ph. D. and BCBA level, up to 12 hours) • $125.00/hour (Consultation, Ph. D. and BCBA level) • $125.00/hour (Foster Parent Consolation, Ph. D. and BCBA level) i do not recommend a Work Session. I recommend approval of this Amendment. Approve Schedule Recommendation Work Session Sean P. Conway Mike Freeman, Pro-Tem Scott James Barbara Kirkmeyer, Chair Steve Moreno Other/Comments: Pass -Around Memorandum; September 10, 2019 — CMS 3120 Page 1 C6; OgiSaAte9 Cik0-) oZoi9- /fk 60 9e) AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND PARKER PERSONAL CARE HOMES DBA DAVID KALIS, INC. This Agreement Amendment made and entered into gJ day of 2019 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department", and Parker Personal Care Homes dba David Kalis, Inc. hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Anger Management, Foster Care/Adoption Services, Life Skills, Mental Health Services, Relinquishment Counseling, Sexual Abuse Treatment, and Substance Abuse Treatment ("Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2193, approved on June 12, 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. 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: ATTEST: W�I• XL; BOARD OF COUNTY COMMISSIONERS Weld C • n Clerk to the Bo. d." } ) W . D COUNTY, C LORADO By: Deputy Clerk heB.anarbaraKirkmeyer Chair CONTRACTOR: NOV 2 5 2019 Parker Personal Care Homes dba David Kalis, Inc. P.O. Box 271168 Louisville, Colorado 80027 (303)482-7041 katk7`l fat/II/i2` By: kathryn sch ader (Sep 4, 2019) Date: Dr. David Kalis, Director of Clinical and Psychological Services Sep 4, 2019 020/9--Z 13 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 Anger Management: $100.00/Hour (Anger Management, Masters level) $125.00/Hour (Anger Management, Ph.D. level) Foster Parent Consultation: $100.00/Hour (Foster Parent Consultation, Masters level) $125.00/Hour (Foster Parent Consultation, Ph.D. and BCBA level) Life Skills: $100.00/Hour (Therapeutic Visits, Masters level) $125.00/Hour (Therapeutic Visits, Ph.D. level) Mental Health Services: $100.00/Hour (Adaptive Behavior Evaluation, Masters level, up to 3 hours) $125.00/Hour (Adaptive Behavior Evaluation, Ph.D. and BCBA level, up to 3 hours) $100.00/Hour (Behavioral Evaluation, Master level, up to 12 hours) $125.00/Hour (Behavioral Evaluation, Ph.D. and BCBA level, up to 12 hours) $100.00/Hour (Consultation, Masters level) $125.00/Hour (Consultation, Ph.D. and BCBA level) $100.00/Hour (Counseling/Psychotherapy, Masters level) $125.00/Hour (Counseling/Psychotherapy, Ph.D. level) $125.00/Hour (Developmental Disabilities Evaluation, up to 12 hours) $100.00/Hour (Home -Based Therapy, Master level) $125.00/Hour (Home -Based Therapy, Ph.D. level) $125.00/Hour (Learning Disability/Attention Deficit Disorder Evaluation, up to 12 hours) $ .50/Mile (Mileage, outside 25 miles radius DHS) $125.00/Hour (Parent/Child Interactional Evaluation, up to 12 hours) $125.00/Hour (Psychological Evaluation, up to 12 hours) $100.00/Hour (Psychotherapy for individuals with limited cognitive abilities, Masters level) $125.00/Hour (Psychotherapy for individuals with limited cognitive abilities, Ph.D. level) $125.00/Hour (Trauma Informed Assessments/Evaluation — Includes psychological evaluation in addition to trauma assessment, up to 20 hours) Relinquishment Counseling: $100.00/Hour (Relinquishment Counseling, Masters level) $125.00/Hour (Relinquishment Counseling, Ph.D. level) Sexual Abuse Treatment: $125.00/Hour (Sex Offender Specific Evaluation, up to 12 hours) $100.00/Hour (Sexual Abuse Counseling) Substance Abuse Treatment: $100.00/Hour (Substance Abuse Counseling) 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 Farm New Contract Request Entity Information Entity Name* PARKER PERSONAL CARE HOMES INC Entity ID* @00035714 Contract Name* PARKER PERSONAL CARE HOMES DBA DAVID KALIS INC (AGREEMENT AMENDMENT) Contract Status CTB REVIEW Contract ID 3120 Contract Lead* CULLINTA ❑ New Entity? Parent Contract ID 20192193 Requires Board Approval YES Contract Lead Email Department Project * r_ullinta@comeld co.us Contract Description* AMENDMENT OF EXISTING 2019-20 CHILD PROTECTION AGREEMENT FOR SERVICES {ADD BCBA) Contract Description 2 Contract Type* AGREEMENT Amount* $0 00 Renewable* NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanSerOces@weldgov cam Department Head Email CM-HumanServices- DeptHead@weldgov corn County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYA I 1 ORNE'r' ,ArELD aOV.COM Requested BOCC Agenda Date* 09x' 11.x2019 Due Date 09?07/2019 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 PASA 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 Review Date* Renewal Date 04/01!2020 Termination Notice Period Committed Delivery Date Expiration Date's 05(31 2020 Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JUDY GRIEGO DH Approved Date 11/13/2019 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 11/25/2019 Originator CULLINTA Contact Type Contact Email Finance Approver BARB CONNOLLY Contact Phone 1 Contact Phone 2 Purchasing Approved Date F nance Approved Date 111112019 Tyler Ref # AG 112519 Legal Counsel KARIN MCDOUGAL Legal Counsel Approved Date 11;1912019 Submit etfrx,4,0t& /9A4.0.Z‘43 l0- /O2.-i 9 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND PARKER PERSONAL CARE HOJVIES DBA DAVID KALIS, INC. This Agreement, made and entered into th��ida of 019, by and between the Board of Weld County Commissioners, on behalf of the Weld County Departmen f Human Services, hereinafter referred to as the "Department' and Parker Personal Care Homes dba David Kalis, Inc., 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 Anger Management, Foster Care/Adoption Services (Foster Parent Consultation), Life Skills, Mental Health Services, Relinquishment Counseling, Sexual Abuse Treatment, and Substance Abuse Treatment. 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 Response to Request for 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. cc:Q i,betAtx) (�� 2019-2193 kko090 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 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 7th of the month, following the month of service, for each client receiving ongoing services. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. Monthly reports for ongoing services must include the following information, entered in the "Narrative" box for each date of service: a. Date and time 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 befiavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. 4. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. Exceptions to this Paragraph may include, if approved by the Department, the following: i. The service being provided by the contractor is not a Medicaid eligible service; ii. The service is not deemed medically necessary; iii. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; iv. A Medicaid provider is not available to provide the needed service; v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. b. Payment shall be made in accordance with Exhibit A, 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. Payment 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 check in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and 3 - Title VII of the Civil Rights Act of 1964; and the Age Discrimination in Employment Act of 1967; and the Equal Pay Act of 1963; and the Education Amendments of 1972; and - Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is determined by the Department. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. 4 e. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contractor will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5- 102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the subcontractor provides 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 0110/93 6 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: - $1,000,000 each occurrence; - $2,000,000 general aggregate; $50,000 any one fire; and - $500,000 errors and omissions. iii.Automobile Liability: Contractor shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: - If any aggregate limit is reduced by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify the Department within ten (10) days and reinstate the aggregates required; Unlimited defense costs in excess of policy limits; Contractual liability covering the indemnification provisions of this Agreement; - A severability of interests provision; - Waiver of exclusion for lawsuits by one insured against another; A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by the Department. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to the Department, whichever is earlier. c. Contractors shall secure and deliver to County's Risk Administrator ("Administrator') at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor shall provide a copy of this information to its insurance agent or broker and shall have its agent or broker provide proof of Contractor's required insurance. The Department reserves the right to require Contractor to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor's insurer shall name County as an additional insured 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: Heather Walker, Child Welfare Division Head 17. Notice For Contractor: Dr. David Kalis, Director of Clinical and Psychological Services 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. Griego, Director P.O. Box A Greeley, CO 80632 (970)400-6510 9 For Contractor: Dr. David Kalis, Director of Clinical and Psychological Services P.O. Box 271168 Louisville, CO 80027 (303)482-7041 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 foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third -Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more 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 client to whom the Contractor may provide services for, the Contractor must disclose that relationship to the Department. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all 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 J 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: � ;4. BOARD OF COUNTY COMMISSIONERS Weld Cty Clerk to the Board WELD COUNTY, COLORADO By: Deputy Clerk to e Board 15 Ltia-w arbara Kirkmeyer, Cha JUN CONTRACTOR: Parker Personal Care Homes dba David Kalis, Inc. P.O. Box 271168 Louisville, CO 80027 (303)482-7041 ,aat.Grt,Salyir -a/let/at My/Weal/1 By: Kathryn Sch ader for David Kalis (May 2, 2019) Dr. David Kalis, Director of Clinical and Psychological Services Date: May 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 January 12th , 2019 Dear Weld County Department of Human Services and Contract Management Staff: For more than 25 years, Dr. Kalis has been providing services to individuals with mentsi health issues, learning disabilities, and developmental disabilities including autism. He has worked with children, adolescents, and adults in multiple settings including in the home, in the community, and in his offices. Dr. Kalis continues to work with multiple Departments of Human Services throughout Colorado, including those in 'Veld County, Denver, Jefferson County, Boulder County, Arapahoe County, and Pueblo County. The focus of his practice has been on helping families who experience developmental and/or learning disabilities reach their maximum potential and on providing a safe and healthy environment so that families and individuals are able to flourish. Dr. Kalis has a Ph.D. in Clinical Psychology and a Master's Degree in Social Work, and he has conducted numerous seminars and trainings for organizations who work with individuals with disabilities, including government entities at the local, state, and federal level. Dr. Kalis' professional interests include family dynamics, developmental and learning disabilities in the therapeutic setting, and diagnostic and evaluative procedures for individuals with hidden disabilities. Dr. Kalis and his team have been providing services in multiple capacities to individuals with developmental disabilities. There are currently six additional experienced clinicians that support Dr. Kalis. Given Dr. Kalis' training and experience in both social work and psychology, he and his team have a unique perspective in dealing with child protective issues. This broad background gives Dr. Kalis and his team the experience and training to address family issues from a systems approach while also having expertise in individual psychopathology. Dr. Kalis has passed this breadth of knowledge to his team, who is able to work efficiently and effectively with caseworkers, GAL'S, lawyers, and the court system to better support families and children. Parker Personal Care Homes Dba David Kalis, Inc. has offices in Denver, Lakewood, and Louisville. We are additionally able to provide services in the home or community to meet clients' needs. A complete list of available services is included in Exhibit C, attached. As a current Weld County contractor, we are able to seamlessly continue to respond to referrals from the County, and we have the staff capacity and expertise to do so efficiently and thoroughly. Our team continues to meet the requirements of attempting contact with clients within 24 hours and notifying the referring individual if efforts to engage the client are unsuccessful after three attempts, and we continue to be willing to travel to Weld County to provide services through our negotiated travel reimbursement agreement with the Department. Additionally, staff have been trained on the reporting criteria and have been meeting both billing and reporting guidelines. Dr. Kalis and his team are aware that there will not be reimbursement for no-shows. Parker Personal Care Homes Dba David Kalis, Inc. has enjoyed working with Weld County over the past year, and we look forward to continuing our mutually beneficial partnership with your Department of Human Services. EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services Parker Personal Care Homes Dba David Kalis, Inc. ?606658 AGENCY OR PRIVATE PRACTICE Dr. David Kalis TRAILS PROVIDER ID (tf Known) Director of Clinical and Psvcholos?cal Services PRIMARY CONTACT— FULL NAME PRIMARY CONTACT - TITLE 1303 )482-7041 PHONE NUMBER (303 )416-4356 EKT. FAY. NUMBER dawd@kalisandassociates.net www.kalisandassociates.net and www.parkeroch.com PRIMARY CONTACT — E -MA: L ADDRESS AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) P.O. Sox 271168 AGENCY MAILING ADDRESS Louisville, CO 80027 CITY ZIP REFERRAL CONTACT Dr. David Kalis Director of Clinical and Psychological Services REFFERAL CONTACT— FULL NAME REFERRAL CONTACT -TITLE (303 )482-7041 REFERRAL CONTACT— PHONE NUMBER david@kalisandassociates.net EXT. REFERRAL CONTACT — E-MAIL ADDRESS BILLING CONTACT M stlJones Director of Billing Services BILLING CONTACT —FULL NAME SUING CONTACT -TITLE (303 )424-6078 ext, 119 miones@oarkeroch.com BILLING CONTACT— PHONE NUMBER DR, BILLING CONTACT— E-MAIL ADDRESS I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it has so indicated in this bid form. I further affirm intention to enter into an ag,reement 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 a ids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, LTM. the o Mien of the Boar, is ' the be -t interests of the Board and of the County of Weld, Stale of Colorado. The Board Weld C t 'ommiss n s 1 give preference to resident Weld County bidders in all cases where th ds e cc petive in pric q ality. Signature of Authorized Representative: W 1 Date of Signature: ra Bid No.: B1900025 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: Parker Personal Care Homes Dba David Kalis, Inc. Mental Health Services 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Multiple modalities will be utilized to best meet the needs of the client. All services are provided using research -based modalities that have proven efficacy. Our clinicians continue to develop their clinical skills through training and supervision to be on the forefront of the field. Services available under this agreement include: • Aftercare Services, including behavioral management, assistance with the navigation of care systems, psycho -educational information, and therapy to foster bonding and attachment with the goal of supporting permanency and preventing out -of -home placement when possible. • Anger Management/Domestic Violence, including diagnostic and therapeutic services to prevent future violence, foster family communication, improve relationship functioning, and aid in the development of the Family Services Plan when necessary. Attendance at team meetings can also occur. • Foster Parent Consultation, including observation of family functioning, strategies to decrease conflict, build resiliency, and strengthen relationships and, when appropriate, provision of psycho -educational information concerning trauma, abuse, and/or neglect. • Foster Parent Training, including group or individual training sessions concerning the effect of trauma, abuse, neglect, transitions, system of care navigation, and reunification. Additionally, our expertise in developmental development will aid in training providers on appropriate expectations for and behaviors of children being served by the foster care system. • Functional Family Therapy, including intensive treatment services in the home or in the Weld County community to decrease family dysfunction and improve outcomes for the family. • Kinship Services (Therapeutic), including observation of kinship family dynamics and individual functioning as well as provision of psycho -educational information and therapeutic services to ensure positive relationships and decreased conflict. • Life Skills, including therapeutic visitation provided in the home, office, and/or community settings and utilizing interventions to improve household management, improve relationships, reduce family conflict, and teach parenting techniques. We are currently providing these services to clients of the Denver Department of Human Services, Boulder County Housing and Human Services, and other area counties. • Mediation, including meeting with attorneys on D&N cases to assist in resolution of court - related treatment plan issues. • Mental Health Services, including any portion of the following: o Counseling/Psychotherapy, including in the home, office, or community. Child -welfare - specific concerns such as coping with past abuse/neglect and loss/grief will be addressed. When applicable, services are tailored for individuals with limited cognitive abilities. Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE o Consultation, including for child welfare clients and/or caseworkers and department personnel to address cognitive, mental health, and/or developmental issues. o Psychological evaluation, including a thorough evaluation of background, mental health concerns, cognitive abilities and academic skills. o Learning Disability/Attention Deficit Disorder Evaluation, which can include a full psychological (mental health) evaluation including cognitive and academic testing. o Developmental Disabilities Evaluation, which can include a full psychological (mental health) evaluation including cognitive and academic testing. o Behavioral Evaluation, which includes observations, review of records, identification of target behaviors, and recommendations for behavioral modification. o Trauma -Informed Assessment/Evaluation, which includes a psychological evaluation in addition to a full trauma assessment. o Adaptive Behavior Evaluation, which includes an evaluation of skills/abilities versus current daily performance. o Parent/Child Interactional Evaluation, which includes observation of a parent with children) as well as opinions and thorough recommendations. o Sex -Offender -Specific Evaluation, which is completed by a licensed full operating level Sex Offender Management Board (SOMB) professional. Can include other assessments as well, including cognitive, mental health, and developmental. • Relinquishment Counseling, including counseling for parents and their children when age - appropriate. • Sexual Abuse Counseling, including therapeutic intervention provided by a full operating level Sex Offender Management Board (SOMB) professional. Attendance at team meetings can also occur, and psycho -educational information for those impacted by sexual abuse can also be provided. • Substance Abuse Treatment, including diagnostic and therapeutic services to aid in FSP development, improve family functioning, and support future sobriety. 4. Capacity to Provide Services (ex. 4 hours/week). With seven full-time clinicians on staff, we have the ability to provide thorough services to clients rapidly and report back to the Department quickly. 5. Goals of the service. The goals of the services provided are dependent upon the nature of those services. For instance, whether it is an evaluation versus ongoing treatment. Goals are determined with client and team input. Our services include individual, family, and couples therapy, as well as community -type interventions, depending upon the needs of the client. We also provide parent/child interactionals, life skills/parent coaching, and consultation services. We are skilled at administering a full range of psychological and mental health diagnostic measures as well as cognitive and academic testing. We can also provide behavioral evaluations. Testing can include but is not limited to diagnosing: developmental disorders including autism and chronic mental illnesses such as depression, anxiety, schizophrenia and disorders including schizoaffective, bipolar, attachment, and posttraumatic stress. Evaluations often include components involving developmental, cognitive, adaptive behavior, executive functioning, and mental health diagnoses. 6. Outcomes of service. Outcomes are based on goals established with clients and team members and are monitored on an ongoing basis. Monthly reports are submitted to track progress made towards Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE these outcomes. 7. Target population for service. Note: Please include age range, applicable genders, and any specific characteristics/traits/needs. Our clinical specialty is working with individuals with intellectual/developmental disabilities including genetic disorders, developmental disorders including autism, and comorbid mental health and/or substance abuse disorders. We are proud of our commitment to inclusivity and our history of working with individuals regardless of age, gender, or other characteristics/traits. 8. Service access. Note: Bidder must indicate capacity for video conferencing, phone conferencing and in person. If office -based, bidder should provide full physical addresses for all locations. If provided outside the office, bidder should note home -based and/or community -based, and geographical area(s) bidder is willing to travel to. We provide wraparound services that can include in -home, in -community, and in -office settings. Offices addresses are as follows: 1597 Cole Blvd., Suite 250 in Lakewood, 357 S. McCaslin S. McCaslin Blvd., Suite 200 in Louisville; and 950 Cherry Creek Dr. in Denver. Services can also be provided in - home and in -community within Weld County. Because we believe it is beneficial to establishing rapport with our clients and to provide the most thorough care possible, services are provided in - person rather than through teleconferencing or videoconferencing. Our policy is to respond within one business day to schedule services. Clients can access services through Core, Medicaid, some private health insurance carriers, and private pay. 9. Languages service is available in. Note: Bidder should note the language and level of proficiency. Services are provided in English. 10. Rates of service. Note: Bidder should include fee for service, staffing, mileage, and any other applicable costs bidder would like considered. Rates must be an exact amount and must include the unit of cost (i.e., hour, day, month, episode). Approximate rates or a range of rates for a service will not be accepted. SERVICES AND FEES Evaluation Services Fees Psychological (Mental Health) Evaluation — Includes a thorough evaluation of client's background, mental health concerns, cognitive abilities, and academic skills $125/hr. up to 12 hours Learning Disability/Attention Deficit Disorder Evaluation — Can also include full mental health evaluation including cognitive and academic testing $125/hr. up to 12 hours Developmental Disabilities Evaluation — Can also include full mental health evaluation including cognitive and academic testing $125/hr. up to 12 hours Behavioral Evaluation — Includes observations, review of records, $125/hr. up to 12 Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE identification of target behaviors, and recommendations for behavioral modification hours for Ph.D. or $100/hr. up to 12 hours for Masters Trauma -Informed Assessment/Evaluation — Includes a psychological evaluation in addition to a full trauma assessment $125/hr. up to 20 hours Adaptive Behavior Evaluation — Evaluation of skills/abilities versus current daily performance $125/hr. up to 3 hours for Ph.D. or $100/hr. up to 3 hours for Master's Parent/Child Interactional Evaluation — Includes observation of parent with child/children as well as opinions and thorough recommendations $125/hr. up to 12 hours Sex Offender Specific Evaluation by a licensed professional at the full operation level of evaluation. $125/hr. up to 12 hours Counseling/Consultation Services Fees Counseling/Psychotherapy $100/hr. for Master's or $125/hr. for Ph.D. Family Therapy $100/hr. for Master's or $125/hr. for Ph.D. Home -Based Therapy/Therapeutic Visits $100/hr. for Master's or $125/hr. for Ph.D. Psychotherapy for individuals with limited cognitive abilities $100/hr. for Master's or $125/hr. for Ph.D. Consultation $100/hr. for Master's or $125/hr. for Ph.D. Anger Management $100/hr. for Master's or $125/hr. for Ph.D. Foster Parent Consultation $100/hr. for Master's or $125/hr. for Ph.D. Relinquishment Counseling $100/hr. for Master's or $125/hr. for Ph.D. Sexual Abuse Counseling $100/hr. Substance Abuse Counseling $100/hr. Parker Personal Care Homes Dba David Kalis, Inc. charges 50 cents/mile over 25 miles outside of your radius. Bid No.: 1900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Aftercare BIDDER LEGAL ENTITY NAME: Parker Personal Care Homes Dba David Kalis, Inc. APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION SUPERVISOR INFORMATION . _ No. Last Name First Name Worke Work Email Education Level Degree Focus Licensure/ Credentials DORA* llf applicable) test', , First Nsf „ , Work • ilia r Email 1 Kalis David 303.482.7041 david@kalisandas PHD Psychology Licensed Psychologist, LCSW PSY 3755, CSW 077 Walters Jodi 303-424.6078X10 jwalters@parkerpi 2 Bansch-Wickert Julie 303.519.7060 jbansch-wickert@Masters Social Work LCSW CSW 2041 Kalis David 303.482.7041 david@kalisandass 3 Cunningham Shana 216.905.9595 shana@kalisandas Masters Social Administ LCSW CSW 1178 Kalis David 303.482.7041 david@kalisandass 4 Veeder Kate 720.471.9973 kal @kalisandass Masters Social Work LCSW CSW 09925648 Kalis David 303.482.7041 david@kalisandass 5 Read Gretchen 720.936.7645 gretchen@kalisan Masters Social Work LCSW CSW 09924196 Kalis David 303.482.7041 david@kalisandass 6 Pagnotta Jolene 720.335.7332 jpagnotta@parker Masters Marriage and Family Services SOMB, LAC LAC 0000842 Kalis David 303.482.7041 david@kalisandass 7O'Loughlin Abbey 616.340.8877 abbey@kalisanda:Masters Special Education BCBA 1-13-14448 Kalis David 303.482.7041 david@kalisandas! 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 25 26 27 28 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.( sociates.net sociates.net ;ociates.net :ociates.net cociates.net cociates.net Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Anger Management/Domestic Violence BIDDER LEGAL ENTITY NAME: Parker Personal Care Homes Dba David Kalis, Inc. APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION SUPEIVISOR INFORMATION No. Last Name First Name WorkM Work Emall Education Level Degree Focus Lkensure/ Credentials DORA it (If applicable) Last l'il First Work # r (York Emall 1 Kalis David 303.482.7041 david@kalisandas PHD Psychology Licensed Psychologist, LCSW PSY 3755, CSW 077 Walters Jodi 303-424.6078X10 jwalters@parkerpr 2 Bansch-Wickert Julie 303.519.7060 jbansch-wickert@ Masters Social Work LCSW CSW 2041 Kalis David 303.482.7041 david@kalisandas: 3 Cunningham Shana 216.905.9595 shana@kalisandas Masters Social Administ LCSW CSW 1178 Kalis David 303.482.7041 david@kalisandas: 4 Veeder Kate 720.471.9973 kale@kalisandass Masters Social Work LCSW CSW 09925648 Kalis David 303.482.7041 david@kalisandas: 5 Read Gretchen 720.936.7645 Rretchen@kalisan Masters Social Work LCSW CSW 09924196 Kalis David 303.482.7041 david@kalisandas: 6 Pagnotta Jolene 720.335.7332 jpagnotta@parker Masters Marriage and Family Services SOMB, LAC LAC 0000842 Kalis David 303.482.7041 david@kalisandas: 7 O'Loughlin Abbey 616.340.8877 abbey@kalisanda Masters Special Education BCBA 1-13-14448 Kalis David 303.482.7041 david@kalisandas: 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 25 26 27 28 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) iociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net cociates.net Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: BIDDER LEGAL ENTITY NAME: Foster Parent Consultation Parker Personal Care Homes Dba David Kalis, Inc. APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION SUPERVISOR INFORMATION No. Last Name First Name Work# Work Email Education Level Degree Focus Lioensure/ Credentials DORA t inapplicable) Last me First 'NaoNq , World Work Email 1 Kalis David 303.482.7041 david@kalisandas PHD jbansch-wickert@ shana@kalisandas kate@kalisandass gretchen@kalisan Licensed Psychologist, PSY 3755, CSW Psychology LCSW 077 Walters Social Work Jodi 303-424.6078X10 jwalters@parkerpc 303.482.7041 2 3 Bansch-Wickert Cunningham Veeder Julie Shana 303.519.7060 216.905.9595 Masters Masters Social Administ LCSW LCSW CSW 2041 CSW 1178 Kalis Kalis David David 303.482.7041 david@kalisandas≤ david@kalisandas≤ david@kalisandas≤ david@kalisandas≤ 4 5 Read Kate Gretchen 720.471.9973 720.936.7645 Masters Masters Social Work Social Work LCSW LCSW CSW 09925648 CSW 09924196 Kalis Kalis David David 303.482.7041 303.482.7041 6 Pagnotta Jolene 720.335.7332 ipagnotta@parker Masters Marriage and Family Services Special Education SOME, LAC LAC 0000842 Kalis David 303.482.7041 david@kalisandas: 7 8 O'Loughlin Abbey 616.340.8877 abbev@kalisanda Masters BCBA 1-13-14448 Kalis David 303.482.7041 david@kalisandas≤ 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 25 26 27 28 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) ;ociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Foster Parent Training Parker Personal Care Homes Dba David Kalis, Inc. BIDDER LEGAL ENTITY NAME: APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION . SOPERVlsoR INFORMATION No. Last Name First Name Work# Work Email Education Level Degree Focus Licensor*/ Credentials DORA e (IF applicable) Last Name _ First Name :. Work* Work Ewan' 1 Kalis David 303.482.7041 david@kalisandas PHD jbansch-wickert@ shana@kalisandas kate@kalisandass Rretchen@kalisan Psychology Social Work Licensed Psychologist, PSY 3755, CSW LCSW 077 Walters Jodi 303-424.6078X10 jwalters@parkerpc 303.482.7041 2 Bansch-Wickert Julie 303.519.7060 Masters LCSW CSW 2041 Kalis David david@kalisandas: david@kalisandas: david@kalisandas: david@kalisandas: 3 Cunningham Veeder Shana 216.905.9595 Masters Social Administ LCSW CSW 1178 Kalis David 303.482.7041 4 Kate 720.471.9973 Masters Social Work LCSW CSW 09925648 Kalis David 303.482.7041 5 Read Gretchen 720.936.7645 Masters Social Work LCSW CSW 09924196 Kalis David 303.482.7041 6 7 Pagnotta O'Loughlin Jolene Abbey 720.335.7332 616.340.8877 jpagnotta@parker abbey@kalisanda, Masters Masters Marriage and Family Services Special Education 5OMB, LAC BCBA LAC 0000842 1-13-14448 Kalis Kalis David David 303.482.7041 303.482.7041 david@kalisandas: david@kalisandas: 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 25 26 27 28 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) ;ociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Functional Family Therapy Parker Personal Care Homes Dba David Kalis, Inc. BIDDER LEGAL ENTITY NAME: APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION " SUPERVINOR INFORMATION No. Last Name First Name Work* Work Email Education Level Degree Focus Ucensure/ Credentials DORA * (if applicable) Last Name First Nate Work If Work Ema6 1 Kalis David 303.482.7041 david@kalisandas PHD jbansch-wckert@ shana@kalisandas kate@kalisandass gretchen@kalisan Psychology Social Work Licensed Psychologist, PSY 3755, CSW LCSW 077 Walters Jodi 303-424.6078X10 jwalters@parkerpi 303.482.7041 2 3 4 5 6 7 8 Bansch-Wickert Cunningham Veeder Read Pagnotta O'Loughlin Julie Shana Kate Gretchen Jolene Abbey 303.519.7060 216.905.9595 720.471.9973 720.936.7645 720.335.7332 616.340.8877 ipagnotta @ parker abbey@kalisanda Masters Masters Masters Masters Masters Masters Social Administ Social Work Social Work Marriage and Family Services Special Education LCSW LCSW LCSW LCSW SOMB, LAC BCBA CSW 2041 CSW 1178 CSW 09925648 CSW 09924196 LAC 0000842 1-13-14448 Kalis Kalis Kalis Kalis Kalis Kalis David David David David David David 303.482.7041 303.482.7041 303.482.7041 303.482.7041 303.482.7041 david@kalisandas: david@kalisandas: david@kalisandas: david@kalisandas: david@kalisandas: david@kalisandas: 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 25 26 27 28 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.( ;ociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Kinship Services (Therapeutic) BIDDER LEGAL ENTITY NAME: Parker Personal Care Homes Dba David Kalis, Inc. APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION SUPERVISOR. INFORMATION ,"` No. Last Name First Name Work* Work Email Education Level Degree Focus Licensure/ Credentials DORA* Ili applicable) Last Name: first Name Wort N, Worit Email 1 Kalis David 303.482.7041 david@kalisandas PHD Psychology Licensed Psychologist, LCSW PSY 3755, CSW 077 Walters Jodi 303-424.6078X10 jwalters@parkerpt 2 Bansch-Wickert Julie 303.519.7060 jbansch-wickert@ Masters Social Work LCSW CSW 2041 Kalis David 303.482.7041 david@kalisandass 3 Cunningham Shana 216.905.9595 shana@kalisandas Masters Social Administ LCSW CSW 1178 Kalis David 303.482.7041 david@kalisandas; 4 Veeder Kate 720.471.9973 kate@kalisandass Masters Social Work LCSW CSW 09925648 Kalis David 303.482.7041 david@kalisandas! 5 Read Gretchen 720.936.7645 Rretchen@kalisan Masters Social Work LCSW CSW 09924196 Kalis David 303.482.7041 david@kalisandas! 6 Pagnotta Jolene 720.335.7332 jpagnotta@parker Masters Marriage and Family Services SOMB, LAC LAC 0000842 Kalis David 303.482.7041 david@kalisandas! 7 O'Loughlin Abbey 616.340.8877 abbey@kalisanda Masters Special Education BCBA 1-13-14448 Kalis David 303.482.7041 david@kalisandas: 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 25 26 27 28 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) iociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Life Skills BIDDER LEGAL ENTITY NAME: Parker Personal Care Homes Dba David Kalis, Inc. APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION SUPERVISOR INFORMATION No. Last Name First Name Work# Work Email Education Level Degree Focus Licensure/ Credentials DORA a (*applicable) Name; Fifa N f tNork iE Work Einar 1 Kalis David Julie 303.482.7041 david@kalisandas PHD jbansch-wckert@ shana@kalisandas kate@kalisandass gretchen@kalisan Psychology Social Work Social Administ Social Work Social Work Licensed Psychologist, PSY 3755, CSW LCSW 077 Walters Jodi 303-424.6078X10 jwalters@ parkerpr 303.482.7041 2 3 4 5 6 7 8 Bansch-Wickert Cunningham Veeder Read Pagnotta O'Loughlin Shana Kate Gretchen Jolene Abbey 303.519.7060 216.905.9595 720.471.9973 720.936.7645 720.335.7332 616.340.8877 jpagnotta@parker abbey@kalisanda Masters Masters Masters Masters Masters Masters Marriage and Family Services Special Education LCSW LCSW LCSW LCSW SOMB, LAC BCBA CSW 2041 CSW 1178 CSW 09925648 CSW 09924196 LAC 0000842 1-13-14448 Kalis Kalis Kalis Kalis Kalis Kalis David David David David David David 303.482.7041 303.482.7041 303.482.7041 303.482.7041 303.482.7041 david@kalisandas: david@kalisandas: david@kalisandas! david@kalisandas: david@kalisandas: david@kalisandas: 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 25 26 27 28 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.( ,ociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Mediation BIDDER LEGAL ENTITY NAME: Parker Personal Care Homes Dba David Kalis, Inc. APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION _ SUPERVISOR INFORMATION No. Last Name First Name Work# Work Email Education Level Degree Focus Measure/ Credentials DORAi (If applicable) Last Name First Nanm Work i Work Email 1 Kalis 4 5 8 Veeder Read David Kate Gretchen 303.482.7041 720.471.9973 720.936.7645 david@kalisandas PHD kate@kalisandass Rretchen@kalisan Masters Masters Psychology Social Work Social Work Licensed Psychologist, PSY 3755, CSW LCSW 077 Walters LCSW LCSW CSW 09925648 CSW 09924196 Kalis Kalis Jodi David David 303-424.6078X10 jwalters@parkerpc 303.482.7041 303.482.7041 david@kalisandass david@kalisandasJ 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) ;ociates.net ;ociates.net Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Mental Health Services BIDDER LEGAL ENTITY NAME: Parker Personal Care Homes Dba David Kalis, Inc. APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION SUPERVISOR INFORMATION 'z No. Last Name First Name Work# Work Email Education Level Degree Focus Ucensure/ Credentials DORA # (if applicable) Last Name First Name Work IE Work EmaR 1 Kalis David 303.482.7041 david@kalisandas PHD jbansch-wickert@ shana@kalisandas kate@kalisandass Rretchen@kalisan Psychology Social Work Social Administ Licensed Psychologist, PSY 3755, CSW LCSW 077 Walters Jodi 303-424.6078X10 jwalters@parkerpr 303.482.7041 2 Bansch-Wickert Julie 303.519.7060 Masters LCSW CSW 2041 Kalis David david@kalisandas! david@kalisandass david@kalisandass david@kalisandas: 3 Cunningham Veeder Shana 216.905.9595 Masters LCSW CSW 1178 Kalis David 303.482.7041 4 Kate 720.471.9973 Masters Social Work LCSW CSW 09925648 Kalis David 303.482.7041 5 Read Gretchen 720.936.7645 Masters Social Work LCSW CSW 09924196 Kalis David 303.482.7041 6 Pagnotta Jolene 720.335.7332 jpaRnotta@parker Masters Marriage and Family Services Special Education SOMB, LAC LAC 0000842 Kalis David 303.482.7041 david@kalisandass 7 O'Loughlin Abbey 616.340.8877 abbey@kalisandas Masters BCBA 1-13-14448 Kalis David 303.482.7041 david@kalisandass 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 25 26 27 28 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) ;ociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Multisystemic Therapy Parker Personal Care Homes Dba David Kalis, Inc. BIDDER LEGAL ENTITY NAME: APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION - - SUPERVISOR INFORMATION No. Last Name First Name Work* Work Email Education Level Degree Focus Ucensure/ Credentials DORA * (If applicable) ta* Name First NagN Work s1 Work Emig 1 Kalis David 303.482.7041 david@kalisandas PHD jbansch-wickert@ shana@kalisanda≤ kate@kalisandass Rretchen@kalisan Psychology Social Work Licensed Psychologist, PSY 3755, CSW LCSW 077 Walters Jodi 303-424.6078X10, jwalte rs@ pa rkerpr 303.482.7041 2 Bansch-Wickert Julie 303.519.7060 Masters LCSW CSW 2041 Kalis Kalis David david@kalisandas: david@kalisandas: david@kalisandas: david@kalisandas: 3 Cunningham Veeder Shana 216.905.9595 Masters Social Administ LCSW CSW 1178 David 303.482.7041 4 Kate 720.471.9973 Masters Social Work LCSW CSW 09925648 Kalis David 303.482.7041 5 Read Gretchen 720.936.7645 Masters Social Work LCSW CSW 09924196 Kalis David 303.482.7041 6 Pagnotta Jolene 720.335.7332 j pagnotta @ pa rker Masters Marriage and Family Services Special Education SOMB, LAC LAC 0000842 Kalis David 303.482.7041 david@kalisandas: 7 O'Loughlin Abbey 616.340.8877 abbey@kalisanda Masters BCBA 1-13-14448 Kalis David 303.482.7041 david@kalisandas: 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 25 26 27 28 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) ;ociates.net :ociates.net ;ociates.net ;ociates.net :ociates.net :ociates.net Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Relinquishment Counseling Parker Personal Care Homes Dba David Kalis, Inc. BIDDER LEGAL ENTITY NAME: APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION _ SUPERVISOR INFORMATION No. Last Name First Name Works Work Email Education Level Degree Focus Ucensure/ Credentials DORAtt (If applicable) Last Name First Name' Work a Work Erne 1 Kalis David 303.482.7041 david@kalisandas PHD Psychology Social Work Licensed Psychologist, PSY 3755, CSW LCSW 077 Walters Jodi 303-424.6078X10 jwalters@ parkerpc 303.482.7041 2 Bansch-Wickert Julie 303.519.7060 jbansch-wickert@ shana@kalisanda≤ kate@kalisandass Rretchen@kalisan Masters LCSW CSW 2041 Kalis David david@kalisandas: david@kalisandas: david@kalisandas: david@kalisandas: 3 Cunningham Veeder Shana 216.905.9595 Masters Social Administ LCSW CSW 1178 Kalis David 303.482.7041 4 5 Read Kate Gretchen 720.471.9973 720.936.7645 Masters Masters Social Work Social Work LCSW LCSW CSW 09925648 CSW 09924196 Kalis Kalis David David 303.482.7041 303.482.7041 6 Pagnotta Jolene 720.335.7332 jpaRnotta@parker Masters Marriage and Family Services Special Education SOMB, LAC LAC 0000842 Kalis David 303.482.7041 david@kalisandas: 7 O'Loughlin Abbey 616.340.8877 abbey@kalisanda: Masters BCBA 1-13-14448 Kalis David 303.482.7041 david@kalisandas! 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 25 26 27 28 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) ;ociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net ;ociates.net Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Sexual Abuse Treatment BIDDER LEGAL ENTITY NAME: Parker Personal Care Homes Dba David Kalis, Inc. APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION SUPERVISOR INFORMATION No. Last Name First Name Work* Work Email Education Level Degree Focus Ucensure/ Credentials DORA * (If applicable) Last Mama -' Fkat NaIFiP -. Works Work Email 1 Pagnotta Jolene 720.335.7332 ipagnotta@parker Masters Marriage and Family Services SOMB, LAC LAC 0000842 Kalis David 303.482.7041 ` david@kalisandas! 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.( 28 Bid No.: 81900025 I STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) ;ociates.net Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Substance Abuse Treatment Services BIDDER LEGAL ENTITY NAME: Parker Personal Care Homes Dba David Kalis, Inc. APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION _ SUPERVISOR INFORIVATtON No. Last Name First Name Work* Work Email Education Level Degree Focus Ucensure/ Credentials DORA* (If applicable) Last Name First Name Work rt Work Email 1 Pagnotta 2 Jolene 720.335.7332 magnotta@parker Masters Marriage and Family Services SOMB, LAC LAC 0000842 Kalis David 303.482.7041 david@kalisandas: 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) L8 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) ;ociates.net Bid No.: B1900025 A� ORO� CERTIFICATE OF LIABILITY INSURANCE 11/29/20118 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-303-534-4567 IMA, Inc. - Colorado Division 17th Street Suite 100 Denver, CO 80202 CONTACT NAME: PHONE FAX (A/C. No. Extl: _ (AIC, No)li E-MAIL DenAccountTechs@imacorp.com ADDRESS: P•com INSURER(S) AFFORDING COVERAGE NAIC# MSURERA: BERKSHIRE HATHAWAY HOMESTATE INS CO(IrAa0044 41190 INSURED Parker Personal Care Homes David Kalis, Inc., dba 357 S McCaslin Blvd #200 LOuisiville, CO 80027 INSURERB: PINNACOL ASSUR INSURERC : INSURERD: INSURER E MSURERF: COVERAGES CERTIFICATE NUMBER: 54648249 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR MDDL!SUBR TYPE OF INSURANCE , INSD ! 4WD POLICY EFF ' POLICY EXP POLICY NUMBER ,(MMIDD/VYYYj F(MM/DDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY X OCCUR ! 47SPK25819802 :07/31/18 '.. 07/31/19 EACH OCCURRENCE '$ 1,000,000 CLAIMS -MADE DAMAGETO RENTED PREMISES (Ea occurrence) !1 $ 1,000,000 MED EXP (Any one person) $ 20, 000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7I POCY, PRO - I JECT LOC OTHER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS-COMP/OPAGG $ 3,000,000 $ A AUTOMOBILELIABILITY X ANY AUTO OWNED AUTOS ONLY X HIRED AUTOS ONLY SCHEDULED AUTOS X • NON -OWNED AUTOS ONLY �'. !! 47RWS25819902 07/31/18 07/31/19 COMBINEDSINGLEUMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLALIAB ! X OCCUR EXCESS LIAB —~. CLAIMS -MADE ! 47SUM25820002 07/31/18 !, 07/31/19 OCCURRENCE $ 1,000,000 _EACH AGGREGATE $ 1, 000, 000 I DED :III X; RETENTION$ 10,000 $ B I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4007978 '12/01/18 12/01/19 j XIPER OTRH I STATUTE E.L. EACH ACCIDENT 500,000 f$ E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT' $ 500, 000 A Professional Liability Coverage 47SPK25819802 07/31/18 107/31/19 Per Occurrence $, 1,000,000 Aggregate 3,000,000 I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Weld County is included as Additional Insured on the General and Umbrella Liability Policies if required by written contract or agreement subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of Additional Insured on the General Liability and Workers Compensation Policies if required by written contract or agreement subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION Weld County Department of Human Services 1150 O STREET GREELEY, CO 80634 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) jculmer 54648249 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO� `� CERTIFICATE OF LIABILITY INSURANCE DATE 11/29/2018 (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. THIS POLICIES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). endorsed. on PRODUCER 1-303-534-4567 IMA, Inc. - Colorado Division 17th Street Suite 100 Denver, CO 80202 CONTACT NAME: PHONE ,FAX (A/C. No, Ext): ILA/C, No): EMAIL DenAccountTechs@imacorp.com ADDRESS: p.com INSURER(S)AFFORDINGCOVERAGE NAIC# INSURER A: BERKSHIRE HATHAWAY HOMESTATE INS CO(Irwir20044 INSURED Go Green, LLP dba Sustainability 1597 Cole Blvd #250 Lakewood, CO 80401 INSURER B: PINNACOL ASSUR 41190 INSURER C INSURER D: INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER: 54648107 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY PERIOD TO WHICH THIS ALL THE TERMS, INSR LTR ADDL SUER TYPE OF INSURANCE INSD WVD POLICY EFF POLICY EXP POLICY NUMBER (MM/DD/YYYY) i (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X OCCUR !. 47SPK25819802 'i, 07/31/18 07/31/19 !. EACH OCCURRENCE !. $ 1,000,000 CLAIMS -MADE DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 GEN'L MED EXP (Any one person) $ 20, 000 PERSONAL 8 ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OPAGG $ 3,000,000 $ A AUTOMOBILE _ X ',. X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY I SCHEDULED AUTOS NON -OWNED X I AUTOS ONLY, 47RWS25819902 '. 07/31/18 07/31/19 COMBINED SINGLE LIMIT (Ea acciden0 _ $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident), $ PROPERTY DAMAGE Per accident) $ $ A X UMBRELLA LIAB X OCCUR _ EXCESS LIAB CLAIMS -MADE 47SUM25820002 07/31/18 07/31/19 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1, 000, 000 DED X IRETENTION$ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below ! NMI 4007978 12/01/18 12/01/19 g 1 PER i OTH- I STATUTE , ER E.L. EACH ACCIDENT $ 500,000 r E.L. DISEASE - EA EMPLOYEE $ 500, 000 E.L. DISEASE - POLICY LIMIT $ 500, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Wewatta and Wynkoop PT, LLC; Wewatta and Wynkoop PT Member, LLC; Wewatta and Wynkoop PT Holdings, LLC; Condominium Association, Inc.; and Crestone Partners, LLC, as Property Management are included as Additional the General Liability Policy if required by written contract or agreement subject to the policy terms and 1400 Wewatta Insureds o: conditions. CERTIFICATE HOLDER CANCELLATION Wewatta and Wynkoop PT, LLC c/o Crestone Partners, LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Delores Frank 1401 Wynkoop Street, Suite Denver, CO 80202 100 USA AUTHORIZED REPRESENTATIVE / / [[ ///►►►,J�A / /`,6'� ACORD 25 (2016/03) jculmer 54648107 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AcD Q® lV(J,R CERTIFICATE OF LIABILITY INSURANCE DATE /2 018 Y) 11/29/2Dls THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-303-534-4567 IMA, Inc. - Colorado Division 1705 17th Street Suite 100 Denver, CO 80202 CONTACT NAME: PHONE FAX (A/C. No. Ext): (A/C, No): E-MAIL DenAccountTechs@imacorp.com ADDRESS: P• INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: BERKSHIRE HATHAWAY HOMESTATE INS CO(Irwi420044 INSURED Parker Personal Care Homes David Kalis, Inc., dba 357 S MCCaslin Blvd #200 Louisiville, CO 80027 INSURER B: PINNACOL ASSUR 41190 INSURER C : INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 54648249 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR rypE OF INSURANCE ADDL�SIll/VD INSDIVD POLICY EFF POLICY NUMBER (MM/DD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY. X OCCUR _ 47SPK25819802 ,07/31/18 ,07/31/19 EACH OCCURRENCE $ 1,000,000 -L- GE CLAIMS -MADE', DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 20,000 PERSONAL B ADV INJURY $ 1,000,000 'L AGGREGATE LIMIT APPLIES PER: i LOC GENERAL AGGREGATE I $ 3,000,000 PRODUCTS - COMP/OPAGG $ 3,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X SCHEDULED AUTOS. NON -OWNED AUTOS ONLY 47RWS25819902 07/ 31/18 1, !, 07/31/19 COMBINEDSINGLE LIMIT (E a accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) _ $ PROPERTY DAMAGE _Per accident) $ $ A X UMBRELLA LIAB X,OCCUR EXCESS LIAB CLAIMS -MADE,!, 47SUM25820002 07/31/18 I07/31/19 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1, 000, 000 i DED I X I RETENTION$ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4007978 12/01/18 li 12/01/19 X ',' PER OTH- ISTATUTE I ER E.L. EACH ACCIDENT I $ 500,000 E.L. DISEASE -EA EMPLOYEE. $ 500,00 0 E.L. DISEASE - POLICY LIMIT $ 500, 000 A ,Professional Liability Coverage 47SPK25819802 07/31/18 •07/31/19 Per Occurrence $', 1,000,000 Aggregate $3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Weld County is included as Additional Insured on the General and Umbrella Liability Policies if required by written contract or agreement subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of Additional Insured on the General Liability and Workers Compensation Policies if required by written contract or agreement subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION Weld County Department 1150 O STREET GREELEY, CO 80634 of Human Services USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE / /!`/�'� ( / ACORD 25 (2016/03) jculmer 54648249 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ® AC IOR0 v CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/29/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-303-534-4567 IMA, Inc. - Colorado Division 17th Street Suite 100 Denver, CO 80202 CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL DenAccountTechs@imacorp.com ADDRESS: P•c om _ INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: BERKSHIRE HATHAWAY HOMESTATE INS CO(Irw#20044 INSURED Go Green, LLP dba Sustainability 1597 Cole Blvd #250 Lakewood, CO 80401 INSURER B: PINNACOL ASSUR 41190 INSURER C : INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 54648107 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE '.ADDL INSD SUBR WVD POLICY EFF POLICY NUMBER (MMIDD/YYYY) POLICY EXP !! LIMITS (MM/DD/YYYY) A IX ICOMMERCIALGENERALLIABILITY X OCCUR 47SPK25819802 i07/31/18 07/31/19 EACH OCCURRENCE $ 1,000,000 I CLAIMS -MADE DAMAGE O RENTED PREMISES (Ea occurrence) $ 1, 000, 000 ' GEN'L MED EXP (Any one person) $ 20, 000 PERSONAL B ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 I PRODUCTS - COMP/OPAGG I $ 3,000,000 $ A AUTOMOBILE X _ X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X SCHEDULED AUTOS NON -OWNED AUTOS ONLY 47RWS25819902 07/31/18 07/31/19 COMBINEDSINGLE LIMIT $ 1,000,000 (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident), $ PROPERTY DAMAGE Leer accident) $ $ A X !UMBRELLALIAB . X OCCUR ~- EXCESS LIAB CLAIMS -MADE '�, 47SUM25820002 07/31/18 07/31/19 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1, 000, 000 DED X , RETENTION$ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4007978 12/01/18 12/01/19 ! X. STATUTE ERH - - E.L. EACH ACCIDENT ' $ 500,000 1 E.L. DISEASE - EA EMPLOYEEI $ 500, 000 E.L. DISEASE - POLICY LIMIT $ 500, 000 Ii DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 707, Additional Remarks Schedule, may be attached if more space is required) Wewatta and Wynkoop PT, LLC; Wewatta and Wynkoop PT Member, LLC; Wewatta and Wynkoop PT Holdings, LLC; 1400 Wewatta Condominium Association, Inc.; and Crestone Partners, LLC, as Property Management are included as Additional Insureds the General Liability Policy if required by written contract or agreement subject to the policy terms and conditions. o CERTIFICATE HOLDER CANCELLATION Wewatta and Wynkoop PT, LLC c/o Crestone Partners, LLC Attn: Delores Frank 1401 Wynkoop Street, Suite 100 Denver, CO 80202 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE //O ACORD 25 (2016/03) jculmer 54648107 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD EXHIBIT C SCOPE OF SERVICE 1. Contractor will provide Anger Management, Foster Care/Adoption Services (Foster Parent Consultation), Life Skills (Therapeutic Visits), Mental Health Services, Relinquishment Counseling, Sexual Abuse Counseling, and Substance Abuse Treatment to children, youth and adults, as referred by the Department. 2. Services available under this agreement include: a. Anger Management: Diagnostic and therapeutic services to prevent future violence, foster family communication, improve relationship functioning, and aid in the development of the Family Services Plan (FSP) when necessary. b. Foster Care/Adoption Services (Foster Parent Consultation): Observation of family functioning, strategies to decrease conflict, build resiliency, and strengthen relationships and, when appropriate, provision of psycho -educational information concerning trauma, abuse, and/or neglect. c. Life Skills: Therapeutic visitation provided in the home, office, and/or community settings and utilizing interventions to improve household management, improve relationships, reduce family conflict, and teach parenting techniques. d. Mental Health Services: i. Counseling/Psychotherapy, including in the home, office, or community. Child -welfare - specific concerns such as coping with past abuse/neglect and loss/grief will be addressed. When applicable, services are tailored for individuals with limited cognitive abilities. ii. Consultation, including for child welfare clients and/or caseworkers and department personnel to address cognitive, mental health, and/or developmental issues. iii. Psychological evaluation, including a thorough evaluation of background, mental health concerns, cognitive abilities and academic skills. iv. Learning Disability/Attention Deficit Disorder Evaluation, which can include a full psychological (mental health) evaluation including cognitive and academic testing. v. Behavioral Evaluation, which includes observations, review of records, identification of target behaviors, and recommendations for behavioral modification. vi. Trauma -Informed Assessment/Evaluation, which includes a psychological evaluation in addition to a full trauma assessment. vii. Adaptive Behavior Evaluation, which includes an evaluation of skills/abilities versus current daily performance. viii. Parent/Child Interactional Evaluation, which includes observation of a parent with child(ren) as well as opinions and thorough recommendations. ix. Sex -Offender -Specific Evaluation, which is completed by a licensed full operating level Sex Offender Management Board (SOMB) professional. Can include other assessments as well, including cognitive, mental health, and developmental. e. Relinquishment Counseling: Counseling for parents and their children when age -appropriate. f. Sexual Abuse Counseling: Therapeutic intervention provided by a full operating level Sex Offender Management Board (SOMB) treatment provider. Psycho -educational information for those impacted by sexual abuse can also be provided. g. Substance Abuse Treatment: Diagnostic and therapeutic services to aid in FSP development, improve family functioning, and support future sobriety. 3. Capacity to Provide Services: Contractor has seven (7) full-time clinicians and will provide thorough services to clients rapidly and report back to the Department quickly. 1 4. Goals of Service: a. Goals depend on the nature of the service such as ongoing or evaluative. b. Goals are determined with client and treatment team input. 5. Outcomes of Service: a. Outcomes are based on goals established through client and team input and monitored on an ongoing basis. 6. Target Population: a. Individuals with intellectual/developmental disabilities including genetic disorders, autism and comorbid mental health and/or substance abuse disorders. 7. Service Access: All services are provided in person and can be conducted in -office at three (3) locations. a. 1597 Cole Boulevard, Lakewood, CO b. 357 South McCaslin, Suite 200, Louisville, CO c. 950 Cherry Creek Drive, Denver, CO 8. 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. 2 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. 3 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 Anger Management: $100.00/Hour (Anger Management, Masters level) $125.00/Hour (Anger Management, Ph.D. level) Foster Parent Consultation: $100.00/Hour (Foster Parent Consultation, Masters level) $125.00/Hour (Foster Parent Consultation, Ph.D. level) Life Skills: $100.00/Hour (Therapeutic Visits, Masters level) $125.00/Hour (Therapeutic Visits, Ph.D. level) Mental Health Services: $100.00/Hour (Adaptive Behavior Evaluation, Masters level, up to 3 hours) $125.00/Hour (Adaptive Behavior Evaluation, Ph.D. level, up to 3 hours) $100.00/Hour (Behavioral Evaluation, Master level, up to 12 hours) $125.00/Hour (Behavioral Evaluation, Ph.D. level, up to 12 hours) $100.00/Hour (Consultation, Masters level) $125.00/Hour (Consultation, Ph.D. level) $100.00/Hour (Counseling/Psychotherapy, Masters level) $125.00/Hour (Counseling/Psychotherapy, Ph.D. level) $125.00/Hour (Developmental Disabilities Evaluation, up to 12 hours) $100.00/Hour (Home -Based Therapy, Master level) $125.00/Hour (Home -Based Therapy, Ph.D. level) $125.00/Hour (Learning Disability/Attention Deficit Disorder Evaluation, up to 12 hours) $ .50/Mile (Mileage, outside 25 miles radius DHS) $125.00/Hour (Parent/Child Interactional Evaluation, up to 12 hours) $125.00/Hour (Psychological Evaluation, up to 12 hours) $100.00/Hour (Psychotherapy for individuals with limited cognitive abilities, Masters level) $125.00/Hour (Psychotherapy for individuals with limited cognitive abilities, Ph.D. level) $125.00/Hour (Trauma Informed Assessments/Evaluation — Includes psychological evaluation in addition to trauma assessment, up to 20 hours) Relinquishment Counseling: $100.00/Hour (Relinquishment Counseling, Masters level) $125.00/Hour (Relinquishment Counseling, Ph.D. level) Sexual Abuse Treatment: $125.00/Hour (Sex Offender Specific Evaluation, up to 12 hours) $100.00/Hour (Sexual Abuse Counseling) Substance Abuse Treatment: $100.00/Hour (Substance Abuse Counseling) 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. Hello