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Home My WebLink About20194550.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 time (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 - 6T) Page 1 4>2.o AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND THE DAISY CENTER, LLC This Agreement Amendment, made and entered into O�/day of 2021 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of u Services, hereinafter referred to as the "Department", and The Daisy Center, LLC, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Child Mentoring and Family Support, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-4550, approved on October 21, 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: May 13, 2020 to extend the term date through May 31, 2021. The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2019-4550. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Term This agreement is being renewed for a third and final year, for the period of June 1, 2021 through May 31, 2022. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTES .0drAL C/• J6O;6ik. BOARD OF COUNTY COMMISSIONERS Weld ' our , Clerk to the Board ,��,_ WELD COUNTY, COLORADO Steve Moreno, Chair ONTRACTOR: APR 2 12021 The Daisy Center, LLC 643 27-1/2 Road Grand Junction, Colorado 81506 By: Date: /miry b`ieoh jenny br ton (Apr 9, 202112:20 MDT) Jenny Brinton, Director Apr 9, 2021 000/9,. 1.15�1) Contract Form Entity Information Entity Name* BRINTON, JENNY New Contract Request Entity ID* 8O0041279 Contract Name* THE DAISY CENTER (AGREEMENT AMENDMENT) Contract Status CTB REVIEW Contract Description* BID #B1900025 TERM: 6„,'1/21-5/ 31/22. Contract Description 2 CONSENT. PA WAS SENT TO CTB ON 3;'21i21. Contract Type* AMENDMENT Amount* 30.00 Renewable* NO Automatic Renewal Grant Department HUMAN SERVICES Department Email CM- HumanServicesnweldgov.co m Department Head Email CM -Human Services- DeptHeadgweldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTO R N EYPWELDG OV. COM ❑ New Entity? Contract ID 4662 Contract Lead* APEGG Contract Lead Email apeggC weldgov.com;cobbx xlkgweldgov.com Requested BOCC Agenda Date* 05 26 2021 Parent Contract ID 20194550 Requires Board Approval YES Department Project # Due Date 05r22r2021 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 MESA 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* 04.`01;2022 Renewal Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Committed Delivery Date Expiration Date* 05;31,2022 Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Approver Purchasing Approved Date CONSENT 04,;1412021 Approval Process Department Head JAMIE ULRICH DH Approved Date 04,'14/2021 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 04;21;2021 Originator APEGG Finance Approver CONSENT Legal Counsel CONSENT Finance Approved Date Legal Counsel Approved Date 04,14 2021 04;' 14 r' 2021 Tyler Ref # AG 042121 r0 -1* 3605 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 Recommendation Work Session Schedule Other/Comments: Pass -Around Memorandum; April 2, 2020 — Not in CMS Page 1 c : 1159 one 05/13/0 14O.(96b, qo VENDOR RENEWALS Vendor Program Area Home Based Services Service Name Aftercare In Home Coaching Aftercare In Home Therapy' Beyond the Walls Program (Aftercare) LifeSkills Coaching, In Home Supervised Visitation, In Home Mental Health_ Therapy, In Home Mental Health Therapy, Office Psychological Testing (Episode) Psychological Testing (HR) Funding Core Rate 75.00 Unit Type Hour Core Ir Core $ 1,050.00 Month Life Skills Core, 75:00 Hour Core $ 75.00 Hour Mental Healih,Services _ Core 115.00 Hour Core $ 90.00 $ 3,350.00 $ 165.00 Hour Core Episode Core Hour Sexual Abuse Treatment Problematic Sexual Conduct (PSC) Coaching, In Home Sexual Abuse Treatment/Therapy Core 75. Hour, Hour Core $ 125.00 Specialized Alternatives for Families and Youth Horne Base`dSer%nces Multigenerational Treatment Services -High Intensity - No Medicaid Multigenerational Treatment Services -Low Intensity - No Medicaid core Core $ 2,520:00 $ 1,575.00 onth, Month Multiggenerational Treatment Services Medicaid{ Inside Catchment Core $ 40:72 Day Multigenerational Treatment Services -Medicaid - Outside Catchment Core $ 54.97 $ 92.00 $ 92.00 $ 88.80 $ 74.00 $ 22.50 . Day Hour Mental Health Services Psychotherapy Staffing, FTM, TDM, etc. Foster Parent Consultation 2nd Clinician. Foster Parent Consultation Case Collaboration Core Core Hour Trauma- Informed Care/Services Core Hour Core Hour Poster Parent Consultation Daily Rate Foster Parent Consultation Family Support Management Assistance Foster Parent Consultation High Intensity -14o Medicaid Core - Day Core $ 74.00 Hour Core 2,400:00 Month. Foster Parent Consultation Low Intensity - No Medicaid Core $ 1,500.00 $ 0:56 $ 74.00 Month Foster Parent Consultation Mileage Staffing, FTM, TDM, etc. Core. Month Core Hour Strong Foundations Home Studies Additional Fee per Adult, Beyond Two Adults. Cancellation Fee CW Block/Child Welfare Services CW Block/Child Welfare Services $ 250:00 $ 225.00 $ 950.00 $ 300.00 $ 150.00 $ 425.00 Each Episode Episode Episode Episode Episode Full: Home Study Interpretive Services for Family Home Study Interpretive Services for Individual Home Study Updated Home Study CW Block/Child Welfare Services CW Block/Child Welfare Services CW Block/Child Welfare Services CW Block/Child Welfare Services The Daisy Center Child Merit()ring and Family Support Coaching Coaching, Step-down Core $ 65.00 $ 35.00 - Hour Core Hour The Jacob Center Life 5ltilis Intake Cancellation Intake-Larimer County Intake -Outside Larimer County Core $, 25.00 $ 25.00 $ 115.00 Hour Core Hour Core Hour Staffing, FTM, TDM, etc. - Outside Larimer County Core $ 175.00 Hour Staffing, FTM, TDM, etc. - Phone or Larimer County Core 85.00 Hour WELD COUNTY DEPT. OF HUMAN SERVICES - CHILD WELFARE DIVISION 2020-21 SERVICE VENDORS (CORE/NON-CORE) BID NO-: B2000037 12 ,T 36O3 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND THE DAISY CENTER This Agreement Amendment, made and entered into I Q day of 1 � � , 2020 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 The Daisy Center, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Child Mentoring and Family Support (Coaching), (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019- 4550, 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. • 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. • 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. ATTEST: ddrA14) �I• Weld unty Clerk to the Board By: _Alb a. pputy Clerk to the Board / ie*-7 051/320 COUNTY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO � O 0 — Mike Freeman, Chair MAY 1 3 2020 CONTRACI'OR: Jenny Brinton, Director 643 27-1/2 Road Grand Junction, CO 81506 By: Date: c7emiry Jenny Bri on (Apr 23, 2020) Jenny Brinton, Director Apr 23, 2020 cc HS() d n (ae1%-c C-3 ((3Ia0 2ot q- 53O t+-Recgc Contract Form New Contract Request Entity Information Entity Name* BRINTON, JENNY Entity ID* @00041279 Contract Name* THE DAISY CENTER (AGREEMENT AMENDMENT) Contract Status CTB REVIEW ❑ New Entity? Contract ID 3603 Contract Lead* CULLINTA Contract Lead Email cullinta@coweld.co.us Parent Contract ID Requires Board Approval YES Department Project # Contract Description* CONSENT. BID NO. 82000037. BOCC APPROVAL: 04/15/20. CHILD PROTECTION AGREEMENT AMENDMENT. TERM: 06/01/20 THROUGH 05/31121. FUNDING. CORE/OTHER_ Contract Description 2 Contract Type* AGREEMENT Amount* $0.00 Renewable* NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanServices@weldgov.com Department Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL 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 On&ase Contract Dates Effective Date Termination Notice Period Review Date* 04/0112021 Renewal Date Committed Delivery Date Expiration Date* 05/31/2021 Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JAMIE ULRICH DH Approved Date 05/05/2020 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 05/13/2020 Originator SNYDERKL Contact Type Contact Email Finance Approver BARB CONNOLLY Contact Phone 1 Contact Phone 2 Purchasing Approved Date Finance Approved Date 05/06/2020 Tyler Ref # AG 051320 Legal Counsel GABE KALOUSEK Legal Counsel Approved Date 05/06/2020 Submit /0 it- c309e.- CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND THE DAISY CENZ[R This Agreement, made and entered into tF y 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 The Daisy Center, 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 Child Mentoring and Family Support (Coaching). NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1, 2019, upon proper execution of this Agreement and shall expire May 31, 2020, unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Proposal and Exhibit C, Scope of Services. 3. Referrals( Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit a complete Request for Reimbursement and supporting documentation by the 7th of the month, following the month of service, utilizing billing forms required by the cc; 0,G64,1- 0450 /o -O21- i9 2019-4550 4-eipo 90 Department. Contractor agrees to utilize the Client Verification Form for all scheduled and unscheduled face-to-face services with the exception of home studies and monitored sobriety testing. Contractor agrees that original complete Client Verification Forms are to be submitted with the Request for Reimbursement. Requests for Reimbursement and Client Verification Forms received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet 60 -day deadline may result in termination of the Agreement. d. Contractor agrees to submit a monthly report by the 7`h of the month, following the month of service, for each client receiving ongoing services. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. Monthly reports for ongoing services must include the following information, entered in the "Narrative" box for each date of service: a. Date and time of service b. Where the service took place c. Clinician/therapist name d. Clients participating e. What interventions were used, recommendations and/or goals discussed f. Any and all safety concerns One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation, home study). Verification of Monitored Sobriety Services will be the test result. A completed home study may be a full, partial or denied study, as determined by the Department. , Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. 4. 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 - Title VII of the Civil Rights Act of 1964; and 3 - the Age Discrimination in Employment Act of 1967; and - the Equal Pay Act of 1963; and - the Education Amendments of 1972; and - Immigration Reform and Control Act of 1986, P.L. 99-603, 42 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 if and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily, excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or,commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this 4 contract. Contractor will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5- 102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contractor participates in the State of Colorado program, Contractor shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contractor has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contractor shall deliver to the Department, a written notarized affirmation that it has examined the legal work status of such employee and shall comply with all of the other requirements of the State of Colorado program. If Contractor fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., the Department, may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contractor receives federal or state funds under the contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24- 76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5- 103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR) and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 5 9. Insurance Requirements Contractor and the Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible the insurance provider. a. General Requirements: Contractors must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, the Department must be notified by the Contractor. Contractor shall be responsible for the payment of any deductible or self -insured retention. The Department reserves the right to require Contractor to provide a bond, at no cost to the Department, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor. Contractor shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i.Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit'to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii.Commercial General Liability Insurance written on ISO occurrence form CG 00 0110/93 or equivalent, covering premises operations, fire damage, independent Contractors, 6 products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: $1,000,000 each occurrence; $2,000,000 general aggregate; $50,000 any one fire; and $500,000 errors and omissions. iii.Automobile Liability: Contractor shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: - If any aggregate limit is reduced by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify the Department within ten (10) days and reinstate the aggregates required; Unlimited defense costs in excess of policy limits; Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; - A provision that coverage is primary; and - A provision that coverage is non-contributory with other coverage or self-insurance provided by the Department. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a 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 r 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'sOffice by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-400-6503 and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor will collaborate in a timely manner with the Department to resolve issues pertaining to service delivery, service quality,'documentation, and invoicing during referral period and after services have concluded. The Contractor will require clients sign releases of information. Contractor understands that the Department will not reimburse for services rendered to Department clients until releases of information are obtained. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. The monitoring agency may, if in its sole discretion deems necessary or appropriate, have access to any 8 program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures for purposes of monitoring. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Child Welfare Division Head Jenny Brinton, Director 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970)400-6510 9 For Contractor: Jenny Brinton, Director 643 27-1/2 Road Grand Junction, CO 81506 (970) 243-3304 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 (S) 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 andeach 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 A provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 12 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to the Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by the Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflicts with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contractor's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contractor agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contractor acknowledges that the Department has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of this project without the Department's prior written consent, which may be withheld in the Department's sole discretion. 13 36. Attorney's Fees/Legal Costs In the event of a dispute between the Department and Contractor, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of the Department. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contractor in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the Department. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of the Department. 38. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. 14 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: dizA4A) .1d49;‘,k. BOARD OF COUNTY COMMISSIONERS Weld C• nt Clerk to the Board WELD COUNTY, COLORADO By: Deputy Clerk totBoard ] �'`.. / Barbara Kirkmeyer, Chai CONTRACTOR: The Daisy Center 643 27-1/2 Road Greeley, CO 81506 (970)243-3304 �72if� S�reoe By: Jenny Bri on (May 8, 2019) Date: 15 Jenny Brinton, Director May 8, 2019 EXHIBIT B CONTRACTOR'S RESPONSE TO REQUEST FOR PROPOSAL EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services The Daisy Center AGENCY OR PRIVATE PRACTICE Jenny Brinton PRIMARY CONTACT— FULL NAME J 970 ) PHONE NUMBER 243-3304 daisycenter@arielcoa.ore PRIMARY CONTACT — E-MAIL ADDRESS 643 27 h road AGENCY MAILING ADDRESS 1565168 Director TRAILS PROVIDER ID (If Known) PRIMARY CONTACT - TITLE t 1 243-3304 EXT. FAX NUMBER AGENCY/PRACTICE WEB ADDRESS (IF APPUCABLE) Grand !unction 81506 CITY ZIP Jenny Brinton REFFERAL CONTACT —FULL NAME 19701260-9050 REFERRAL CONTACT — PHONE NUMBER REFERRAL CONTACT Director of the Daisy Center DaisyCenter@arielCPA.org EXT. REFERRAL CONTACT - TITLE REFERRAL CONTACT — E-MAIL ADDRESS BILLING CONTACT Telicia Rivera BILLING CONTACT— FULL NAME . 1970)243-3304 BILLING CONTACT— PHONE NUMBER EXT. Assistant Director BILLING CONTACT - TITLE Daisy Centert9arielcoa.orR 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 agreement with Weld County, on behalf of the Weld County Department of Human Services, and comply with all requirements of the contract, if awarded. The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are competitive in price and quality. Signature of Authorized Representative: Electronic Signature: Jenny Brinton Date of Signature: `1/25/19 Bid No.: B1900025 EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services The Daisy Center 1565168 AGENCY OR PRIVATE PRACTICE TRAILS PROVIDER ID (If Known) Jenny Brinton PRIMARY CONTACT— FULL NAME ( 970 ) 243-3304 PHONE NUMBER daisycenter@arielcpa.org PRIMARY CONTACT— E-MAIL ADDRESS 643 27 )5 road AGENCY MAILING ADDRESS Director PRIMARY CONTACT - TITLE J ) 243-3304 EXT. FAX NUMBER AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) Grand Junction 81506 CITY ZIP Jenny Brinton REFFERAL CONTACT— FULL NAME 1970)260-9050 REFERRAL CONTACT — PHONE NUMBER REFERRAL CONTACT Director of the Daisy Center REFERRAL CONTACT - TITLE DaisyCenter@arielCPA.org EXT. REFERRAL CONTACT— E-MAIL ADDRESS BILLING CONTACT Telicia Rivera BILLING CONTACT— FULL NAME (970)243-3304 BILLING CONTACT — PHONE NUMBER EXT. Assistant Director BILLING CONTACT - TITLE Daisy Center@arielcpa.org 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 agreement with Weld County, on behalf of the Weld County Department of Human Services, and comply with all requirements of the contract, if awarded. The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are competitive in price and quality. Signature of Authorized Representative: Electronic Signature: Jenny Brinton Date of Signature: _1/25/19 Bid No.: B1900025 • Bidder's legal entity name: Daisy Center • Program name or service type being proposed: Coaching Time • Modalities, curriculum or tools that will be utilized in the delivery of the service. One on one interaction, recreational activities and therapeutic calming tools such as playdoh or art supplies. • Capacity to Provide Services (ex. 4 hours/week). 18 hours per week of coaching time. • Goals of the service. Goals are to maintain placement, minimize attention seeking behavior and continue educational needs intact. The Coaching staff will also reward positive behavior and try to minimize negative behaviors. • Outcomes of service. Maintaining placement and reunification with parents while working on educational goals. • Target population for service. Teenager girls ages 12-21. • Service access. 643 27'z Road Grand. Junction, CO 81506. All Services will be provided in Grand Junction, Colorado. • Languages service is available in. English • Rates of service. $65 an hour. Stepdown rate is $35 an hour. We will not be asking an additional fee for recreational activities or mileage. 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: Direct support professional-coaching/life skills BIDDER LEGAL ENTITY NAME: Daisy Center •" ' ' 'APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION- ,' ' .. • SUPERVISOR:INFORMATION ' No:; Last Name First. Name: ; Workli `� ';, Work Email •: ' ' ' Education Level . Degree Foals'. cus.. Licen;use/ - Credentials. DORA'# (If applicable) ` Last Name , ,' First Name Work # ` Work. Email 1 Rivera 2 Telicia daisycenter@ariel BA psychology Brinton Jenny daisvicenter@ariel, 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 28 B1800058 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.) cpa.org B1800058 Coloralnl <\grncy. -trT _s.41c_ ela rWJVr c...r ;t•,Vl'1 F.., ISO index This Binder is only a summary of the coverages(s) you have ordered. For a complete description of the terms and conditions of cowerace. please refer to the policy itself including all endorsements. Josh Dewitt Colonial General Insurance Agency. Inc. (Scottsdale) Unified Group Homes of Mesa County Inc 06/16/2016 CO Residential Youth Homes 06/03i2016 to 06/0312017 0007?370-0 Kim Byrd 800-594-8900 801-293-2032 ktb@colgen.com Allied Healthcare James River Insurance Company Unified Group Homes of Nlesa County Inc 1842 V. 7th Street. CO James River Policy Inception 6.43 ?7 I/2 Road. CO James River Policy inception 721 Orchard Ave. CO Jame; River Policy Inception SU4 Glenwood Ave. CO James River Policy Inception 44434 Per Bed 11 Residential Care Facilities (iv Youth (Class I) 444348 Per Bed '1 Residential Care Facilities for Youth (Class II) General Liability including Claims Made X Reported James Ricer Policy Inception S?.500 Professional General Aggregate S3.000.000 Products & Cumpleted Operations A;•greeate Included Personal & Advertising Injury SIA0U,000 Each Occurrence S L000.00U Damatte to Premises Rented to You Si0.000 Medical Expenses Excluded Sexual or Physical Abuse S 1003000 $.00.000 Legal/Media Expense Reimbursement 425.000 525.000 HIPAA Expense Reimbursement S25,000 525,000 Defense Costs are .within the limits of liability Incident Sensitive Tri t eer Punitive damages excluded If ❑ deductible is included. the deductible applies to Indemnity ancCor Expenses. Additional coeerases or enhancements may be available. Please contact your underwriter for details. 1 of 4 inder • This,,inder is only a summary of the coverauests) you have ordered. Fur a complete description of the terns and conditions of coverage. please refer to the policv itself including all endorsements. I? months at I 50 % of annual premium s Extended,Rcponing Period premium is subject to a lower commission rate. Premium Overview Sb.788 S?j0 Please note the premium does not include the company fee Premium: $6,788.00. Supplier Fee: $250.00 10% Policy Fee: $175.00 CO State Tax: $216.39 Total Premium: $7,429.39 •None None The insurance is subject to the term,. conditions and exclusions of the referenced policy. or if no policy is referenced. the policy in current use by the company. This will sere as a notice of premium due to the Company. Remit premiums based on our monthly statement to your office only. This Binder is being offered by a non -admitted insurer subject to 100 "; minimum and deposit premium, with a 25% minimum earned premium. All taxes. fees and filings (if applicable) are the responsibility of the broker. Thank you for your order. \110uit;t ti -07u:; Apljty11 C .\f'? 7(ltll S:0I JIG :1 P' 7t!? t: S-il \11? tL'I_,S_0905 AiI_:it-WS-I-I_I I_ AP2Iri LS-t❑.tt7 A I I _'?0.5 t.'S_09 Commercial General Liability Policy Declarations Schedule A Commercial Ciencral Liability Coverage Fonn -Claims Made General Liability Changes Claims -Made to Claims -Made and Reported Extended Reporting Period Endorsement Physical Abuse or Sexual Misconduct Limits of Liability Endorsement Deductible Endorsement - Damaues and Expenses Minimum Policy Premium Supplementary Payments (Defense Costs) within Limits of Insurance Professional Liability Endorsement (Claims -Made and Reported) Coyem_ye Extension - HIPAA Expense Reimbursement :\I I?7U51 S-li; l' Covenme Extension - Evacuation Expense Reimbursement \P_uulliiS-0-105 Additional Insured Al f___;1 I l IS-Itl tt7 A ('_' 107[; 5-0402 Incident Reponing Endorsement Common Policy Conditions Binding Arbitration Contractual Liability Limitation 2of4 ID' �a finder This Binder is only a summary of the coverages(s) you have ordered_ for a complete description of the terms and conditions of coverage. please refer in the policy itself including all endorsements. _\p._(!?ul. ti-IflII) C(irlilhN-i150,.) COO 14.7- L'n; CC_167-1-'It_l I Eo07.)-(1,111N. Al 12:1O)1'S-0205 AI'2031 CS -0-4 I I Ar.:(Q'l'S._( 111\ \ l"_I1?r, l' S- I '05 \ P'_ I 021 S-040 ArIIthl S-us1? :\P'-'1 I I LIS- I_llli AP5(i:7R_gi A PO I OM 'S-0-10 THE REQUEST FOR REQUEST TO BIND Description of Operations Limitation Recording and Distribution of Material or Information in Violation of the Law Exclusion Exclusion - Coverage C - Medical f aymcnt5 EmployMent-Related Practices Exclusion Fungi or Bacteria Exclusion Nuclear Energy Liability Exclusion Additional General Liability Exclusions Exclusion - Cross Suits Employers Liability - Exclusion Absolute Pollution and Pollution Related Liability - Exclusion Communicable Disease Exclusion Absolute Auto. Aircraft and Watercraft Exclusion Exclusion - Punitive Damages Combined Policy Exclusions Rejection °I -Coverage for Certified Acts of Terrorism Coverage Exclusion of Certified Acts of Terrorism and Exclusion 01Other Acts of Terrorism Committed Outside the United Slates Privacy Policy' TAX PAPER INFORMATION (AP5000) IS ATTACHED AND MUST l3E RETURNED ALONG wrm YOUR . THANK YOU. 3of4 ACC ®d� 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 :EPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. CERTIFICATE OF LIABILITY INSURANCE DATE (MMI0DIYYY ) 06/21/2016 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 JOSHUA DEWITT INSURANCE AGENCY 327 NORTH 7TH STREET UNIT 2 GRAND JUNCTION, CO 81501 CONTACT JOSHUA DEWITT NAME: PHONE E>rtl.. 970-245-1798 I ra , No, 970-257-7858 "AIL JDEWITT@FARMERSAGENT.COM ADDRESS: INSURER(S) AFFORDING COVERAGE INsuRERA: JAMES RIVER INSURANCE COMPANY NAIL S INSURED UNIFIED GROUP HOMES OF MESA COUNTY INC INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE 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 MD POLICY NUMBER POLICY EFF (IN UDDNYYY) POLICY EXP (MMIDD/YYYY) UldlTS A X COMMERCIAL GENERAL LU161LITY X 00072370-0 06/03/2016 06/03/2017 EACH OCCURRENCE 5 1.000,000 DAMAGE r5ES TOoccurrence) $ 50,000 X J CLAIMS -MADE I I OCCUR ?AEI) EJCP (Any one person) s EXCLUDED PERSONAL 8 ADV INJURY S 1.000,000 GENERAL AGGREGATE 5 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER JET L LOC PRODUCTS - COMP/OP AGG 5 INCLUDED $ AUTOMOBILE _ LUUML TY ANY AUTO ALL OWNED AUTOS HIRED AUTOS -- SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE OMIT (Ea accident) 5 BODILY INJURY (Per person) 5 BODILY INJURY (Per accident) 5 PROPERTY DAMAGE (Per accident) 5 $ UMBRELLA LIAB EXCESS LIAR ^— OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE 5 $ DED I I RETENTIONS WORKERS COMPENSATION AND EMPLOYERLIABILRY S ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) D1( ESCRIPTiON dt1Rd[3 PTION OF OPERATIONS below Y I N N / A STAT UTE I W- EL EACH ACCIDENT 5 EL DICFASF - EA EMPLOYEE $ E1 DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 1111, Additional Remarks Schedule, may be attached if more space is remdr'ed) 1842 NORTH 7TH STREET GRAND JUNCTION, CO 81501 721 ORCHARD AVE GRAND JUNCTION, CO 81501 804 GLENWOOD AVE GRAND JUNCTION, CO 81501 , 643 27 1/2 ROAD GRAND JUNCTION, CO 81501 CERTIFICATE HOLDER CANCELLATION HILLTOP 1331 HERMOSA AVE GRAND JUNCTION, CO 81506 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 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AC®R®® CERTIFICATE OF LIABILITY INSURANCE DATE (A4WDD/YYYY) 06/21/2016 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 r-lELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED .EPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed- ff SUBROGATION IS WANED, 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 en iorsement(s). PRODUCER JOSHUA DEWITT INSURANCE AGENCY 327 NORTH 7TH STREET UNIT 2 GRAND JUNCTION, CO 81501 INSURED UNIFIED GROUP HOMES OF MESA COUNTY INC CONTACT JOSHUA DEWITT NAME: PHONE 970-245-1798 4A/C. No. Exit E-MAIL SS: JDEWITT@FARMERSAGENT.COM ADDRE IFAI 970-257-7858 (AM, No): INSURER(S) AFFORDING COVERAGE INSURERA: JAMES RIVER INSURANCE COMPANY INSURER B: NAIC 0 INSURER C : INSURER D : INSURER E : INSURER F : ATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE 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 INS MD SUBR WVD POLICY NUMBER Y (MM/DD /YYY`n (MM/DO/YYYY) UMTIS X COMMERCIAL GENERAL I IARn fly X 00072370-0 06/03/2016 06/03/2017 EACH OCCURRENCE $ 1,000,000 -RENTED DAMAGE TO PREMISES (Ea �ocamenie) 5 50,000 CLAIMS-MADE 1 OCCUR MED EXP (Any one person) $ EXCLUDED pERSONAL a ADV INJURY $ 1,000,000 A GENERAL AGGREGATE $ 3000,000 GEM_ AGGREGATE LIMIT APPLIES I JECTT PER LOC PRODUCTS -COMP/OPAGG 5 INCLUDED T AUTOMOBILE _ _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTO ^ _ SCHEDULED AUTOS AUTOS COMBINED SINGLE UMIT (Ea accident) 5 BODILY INJURY (Per parson) S BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident) S 5 UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S S OED I I RETENTIONS WORKERS COMPENSATION AND EMPLOYERS UABILTrY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS belay Y / N N ! A STAT I PER UTE W- EL. EACH ACCIDENT S EL. DISEASE - EA EMPLOYEE S EL- DISEASE - POLICY LIMIT 5 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule.. may be attached if more space is required). 1842 NORTH 7TH STREET GRAND JUNCTION, CO 81501 721 ORCHARD AVE GRAND JUNCTION, CO 81501 804 GLENWOOD AVE GRAND JUNCTION, CO 81501 643 27 1/2 ROAD GRAND JUNCTION, CO 81501 CERTIFICATE HOLDER 1 CANCELLATION DYC (DEPARTMENT OF YOUTH CORRECTIONS) 801 GRAND AVE GRAND JUNCTION, CO 81501 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 88-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered rrfarks of ACORD EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Coaching, as referred by the Department. 2. Services will encompass one -one -one interaction, recreational activities and therapeutic calming tools such as Playdoh and art supplies. 3. Capacity for Services: 18 hours per week. 4. Goals of Service: a. Maintain placement b. Minimize attention seeking behavior c. Continue education needs intact d. Reward positive behavior e. Minimize negative behaviors 5. Outcomes of Service: a. Maintain placement b. Reunification with parents while working on educational goals 6. Target Population: Females, age 12 to 21 years old. 7. Service Access: 643 27-1/2 Road, Grand Junction, CO 81506. All services will be provided in Grand Junction, 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 1 caseworker and the Quality Assurance Team Supervisor (hainlejd@weldgov.com) immediately via email, to discuss service continuation. 13. Contractor will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 14. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 15. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format requiredby 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. Contractor may participate by phone, if approved by the Department. 18. Contractor will notify the Quality Assurance Team Supervisor (hainlejd@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. 2 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 $65.00/Hour(Coaching) $35.00/Hour (Coaching, Step-down) 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7`h 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. 1 ', P t s� � 4 k"` s ``�.t •`9 s�{ � •1'x �% _. ��.�` } f - ,dwJ L �.' f `C � Y �' �y ; • ..� y T'� 0 nt�r • ct a F o rm k, .r � , I i i New;Contract Request -- - �-• _ - -_ - • . - 1 Entity Information .. -- t 1 ' ---1 - lr Entity Name* Entity ID* ■ New Entity? � BRIM -ON, JENNY @00041279 Contract Name* Contract ID Parent Contract ID DAISY CENTER 3096 20190707 Contract Status Contract Lead* Requires Board Approval CTB REVIEW CULLINTA YES i Contract Lead Email Department Project S cullinta@co.weld.co.us Contract Description* CONSENT. NEW AGREEMENT FOR SERVICES. TERM: 06/01/19-05/31/20. FUNDING: CORE OR OTHER. Contract Description 2 BID NO. 81900025 Contract Type* Department Requested BOCC Agenda Due Date AGREEMENT HUMAN SERVICES Date* 08/24/2019 08/28/2019 Amount* Department Email 50.00 CM- Will a work session with BOCC be required?* HumanServices@weldgov.com NO Renewable* YES Department Head Email Does Contract require Purchasing Dept. to be included? CM-HumanServices- Automatic Renewal DeptHead@weldgov.com County Attorney Grant GENERAL COUNTY ATTORNEY EMAIL i IGA County Attorney Email CM- COUNTYATTORNEY@WELD GOV.COM If this is a renewal enter previous Contract ID i If this is part of a MSA enter MSA Contract ID 1 Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase 1 •.. - { - _ l Contract Dates-, • _ _ . _ _. ...... �-------_._._.._____-._.._ ___ __--�--.-.-_ ; Effective Date Review Date* Renewal Date* 04/01/2020 06/01/2020 Termination Notice Period Committed Delivery Date Expiration Date i-Contact Information -- '; -f Contact Info __ �. ' J _ _ _-------- ----- __ __,_......_ - -_ Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 C Purchasing Purchasing Approver Purchasing Approved Date ; CONSENT 10/16/2019 i Approval Process - _ _ . _ _ .. Department Head Finance Approver Legal Counsel JUDY GRJEGO CONSENT CONSENT DH Approved Date Finance Approved Date Legal Counsel Approved Date 10/162019 10/162019 10/16/2019 - � - - - --- _- Final Approval - _-_ . _.__ — ___ _ _ __._.. BOCC Approved Tyler Ref # AG 102119 BOCC Signed Date BOCC Agenda Date 1D/212019 Originator CULL1 NTA Submit Hello