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Home My WebLink About20192207.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 CCC". 6n43ta,ig-vC Page 1 �o - �e2o7 ge009O AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TREATMENT AND EVALUATION SERVICES , This Agreement Amendment, made and entered into Q �ay of 2021 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Hum Services, hereinafter referred to as the "Department", and Treatment and Evaluation Services, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Anger Management/Domestic Violence, Mental Health Services, and Sexual Abuse Treatment, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2207, 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: 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 2019-2207. • 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. ATTEST: Weld By: dirifwv .1dio;e1 Clerk to t e Boar Deputy Clergy th - •and / I •� r. COUNTY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ve Moreno, Chair NTRACTOR: APR 2 12021 reatment and Evaluation Services 13693 East Iliff Avenue, Suite 220 Aurora, Colorado 80014 By: Date: Rick May, Psy.d.TApr 10'21.13:54 MDT) Dr. Rick L. May, Owner Apr 11, 2021 020/9--- cz26 Contract Form Entity Information New Contract Request Entity Name* Entity ID* TREATMENT & EVALUATION SERVICES 800028305 Contract Name* TREATMENT AND EVALUATION SERVICES (AGREEMENT AMENDMENT) Contract Status CTB REVIEW Contract Description* BID#B1900025 TERM: 6/1 /21-5/31 122. Contract Description 2 CONSENT. PA WAS SENT TO Contract Type* AMENDMENT Amount* 30.00 Renewable* NO Automatic Renewal Grant CTB ON 3 /31 21. Department HUMAN SERVICES Department Email CM- HumanServicescPweldgov.co m Department Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attomey Email CM- COU NTYATTO RN EYgWELDG OV.COM ❑ New Entity? Contract ID 4664 Contract Lead* APEGG Contract Lead Email apegg@weldgov.com.cobbx xlkOweldgov.com Requested BOCC Agenda Date* 05/26;2021 Parent Contract ID 20192207 Requires Board Approval YES Department Project # Due Date 05/22/2021 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 MA 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 Purchasing Approver CONSENT 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 Contact Type Committed Delivery Date Contact Email Finance Approver CONSENT Expiration Date* 05;31 12022 Contact Phone 1 Purchasing Approved Date 04,14/2021 Finance Approved Date 04/14/2021 Tyler Ref # AG 042121 Legal Counsel CONSENT Contact Phone 2 Legal Counsel Approved Date 04;14.='2021 CO3d-'f - 33$1 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: April 2, 2020 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Welfare 2020-21 Service Provider Agreement Amendments Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Child Welfare 2020-21 Service Provider Agreement Amendments. The Department entered into agreements with various Child Welfare service providers through the 2019-20 Request for Proposal (RFP), identified as Tyler ID 2019-0707). These agreements were issued for a period of three years with the option to renew annually. The attached list reflects the providers, services and rates, including minor rate changes, the Department wishes to enter into for the period of June 1, 2020 through May 31, 2021. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Upon Board approval of this pass -around, signed agreement amendments will be obtained from providers and submitted to the Board for approval and Chair signature. I do not recommend a Work Session. I recommend approval of these Agreement Amendments. Mike Freeman, Chair Scott James Barbara Kirkmeyer Steve Moreno, Pro-Tem Kevin Ross Approve Schedule Recommendation Work Session Other/Comments: Pass -Around Memorandum; April 2, 2020 — Not in CMS Page 1 C...onseof Ar►da- c&: NV anfl� A3/2a hg/ge -131q-22©T ©oqo VENDOR RENEWALS Vendor Program Area Service Name Supervised Visitation -In Office Supervised Visitation-Larimer-County Supervised Visitation -Outside Larimer County Visit Cancellation Funding Core Rate Unit Type $ 116.00 Hour Core Core 140,00 $ 206.00 $ 50.00 Flour,',,; Hour Core Hour The Tennyson Center for Children Day Treatment Services Mileage Special Education - ASPEN Excess Costs' Special Education - ASPEN Therapy Core $ 0.50 $ 161.29 $ 2,820.00 Mile Core Day Core Month SpecialEducation - ASPEN, Therapy ft Excess Costs Special Education - Excess Costs 'Special Education Therapy Special Education - Therapy & Excess Costs Core_ Core $ 6,046.00 $ 96.47 $ 1,770:00 $ 3,700.00 Month Day Core Core Month. Month Third Way Center Home Based Services Next Steps Aftercare Program, Community Based Next Steps Aftercare Program, Home Based Core Core $ .76.00 $ 55.00 Day Day Transitions Psychology Grdup Home Studies Additional Adult(s), After 2 Full SAFE Home study, Up to 2 Adults Mileage Partial Home Study Updated SAFE Home Study, Up to 2 Adults Mileage Parent Coaching, In Office or Video Conferencing Parent Coaching, In -Home Staffing, FTM, TDM, etc. Therapeutic Visitation, In Office or Video Conferencing Therapeutic Visitation,', In -Home Co -Parent Consultation, In Office or Video Conferencing Co -Parent Consultation, In -Home:? Co -Therapy Counseling, In Office CW Block/Child Welfare Services CW Block/Child Welfare Services CW Block/Child Welfare Services CW Block/Child Welfare Services $ 250.00 $ 1,200.00 $ 0.56 $ 250.00 $ 600.00 $ 0.56 $ 118.00 $ 177.00 $ 138.00 Each Episode Milli Episode Episode Life Skills CW Block/Child Welfare Services Core Mile Core Hour Core Hour Core Hour Core $ 118.00 $' 177.00 Hour Core Hour Mental Health Services Core $ 118.00 $ 177.00 $ 236.00 Hour Core Hour Core Hour Couples Therapy, In Office or Video Conferencing Couples Therapy, In -Home Family Therapy, In Office or Video Conferencing Family Therapy, In -Home Core 11.8.00 Hour Core $ 177.00 $ 118:00 $ 177.00 Hour Core Core Hour Hour Individual Therapy, In Office or Video Conferencing Individual Therapy, In -Home Mileage Staffing, FTM, TDM, etc. Core_ Core $ 118.00 $ 177.00 $ 0.56 $ 138.00 Hour Hour Core Mile Core Hour Treatment and Evaluation: services Domestic Violence Intervention Mental Health Services SexualAttuseTreatment DVOMB Evaluation Psychological Evaluation Offense Specific Evaluation CW Block/ChildWelfareServices Core Core 800.00 $ 1,200.00 $ 900.00- Episode Episode Episode UABACO,LLC Monitored Sobriety Services 10 Panel Quick Test 11 Drug Panel (Panel 1709); 5 Panel Quick Test 6.Drug Panel (Panel 33)- 6AM Testing CW Block/Child Welfare Services CW Block/ChildWelfare Services CW Block/Child Welfare Services CV/ Block/Child V%elfare Services CW Block/Child Welfare Services $ 13.00 Test 25.00 $ 10.00 $ 35:00 $ 40.00 Test Test Test Drug WELD COUNTY DEPT. OF HUMAN SERVICES - CHILD WELFARE DIVISION 2020-21 SERVICE VENDORS (CORE/NON-CORE) BID NO.: 62000037 13 cam -,4-,-m..) V AL. 3s Si AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TREATMENT & EVALUATION SERVICES This Agreement Amendment, made and entered into Q day of MAI-- , 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 Treatment & Evaluation Services, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Anger Management/Domestic Violence, Mental Health Services and Sexual Abuse Treatment, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2207, 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. Term This agreement is being renewed for a second full year term, for the period 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: (J-4L4J • `„e:14°, li Weld County Clerk to the Board By ty Clerk to the Boar COUNTY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Chair ONTRACTOR:. MAY 1 31020 Treatment & Evaluation Services 13693 East Iliff Avenue, Ste. 220 Aurora, CO 80014 By: Date: ,Fik/116((y 2:2 0 Rick May, Psy.D. Apr 29, 2 0) Rick L. May, Owner Apr 29, 2020 0343/ 6' GC t (-t SD O n (gal,e o5/13th 20/ 67-.1.2.(37 ktgoe,4a Contract Form New Contract Request Entity Information Entity Name* TREATMENT & EVALUATION SERVICES Entity ID* ra r 0028305 Contract Name* TREATMENT & EVALUATION SERVICES (AGREEMENT AMENDMENT) Contract Status CTB REVIEW Contract ID 3581 Contract Lead* CULLINTA New Entity? Parent Contract ID Requires Board Approval YES Contract Lead Email Department Project # cullinta@comeld.co.us Contract Description* CONSENT. BID NO. 2000037. BOCC APPROVAL 04,115!20. CHILD PROTECTION AGREEMENT AMENDMENT. TERM: 06/01/20 THROUGH 05/31121. FUNDING: COREOTHER 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- COUNTYATTORN EY@WELD GOV.COM Requested BOCC Agenda Date* 04/15/2020 Due Date 04111/2020 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 Base Contract Dates Effective Date Termination Notice Period Review Date* 04/01,12021 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 Dnance 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 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TREATMENT & EVALUATION SERVICES This Agreement, made and entered into they of 2019, by and between the Board of Weld County Commissioners, on behalf of the Weld County Departm t of Human Services, hereinafter referred to as the "Department' and Treatment & Evaluation Services, 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/Domestic Violence (Evaluation), Mental Health Services (Evaluation) and Sexual Abuse Treatment (Evaluation). 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. (r9/t,12-i--A--t- Z,i,2-i9 c: OtZevae-(1450) 2019-2207 c. Contractor agrees to submit a complete Request for Reimbursement and supporting documentation by the 76 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 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; 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. Trainin Contractor may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-400-6503 and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor will collaborate in a timely manner with the Department to resolve issues pertaining to service delivery, service quality, documentation, and invoicing during referral period and after services have concluded. The Contractor will require clients sign releases of information. Contractor understands that the Department will not reimburse for services rendered to Department clients until releases of information are obtained. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. The monitoring agency may, if in its sole discretion deems necessary or appropriate, have access to any 8 program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures for purposes of monitoring. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Child Welfare Division Head Brenna Tindall, Psy.D., 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: Brenna Tindall, Psy.D., Director 13693 East Iliff Avenue, Suite 220 Aurora, CO 80014 (970) 231-9611 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 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: ;e1i BOARD OF COUNTY COMMISSIONERS Weld Co - y Clerk to the Board WELD COUNTY, COLORADO By: Deputy Clerk to t Boar. /� �a P "� Barbara Kirkmeyer, Chair UN 122019 CONTRACTOR: Treatment & Evaluation Services 13693 East Iliff Avenue, Suite 220 Aurora, CO 80014 Si-emea 7iirdaa By: Date: 15 Brenna Tindall (May 10, 2019) Brenna Tindall, Psy.D., Director May 10, 2019 toi-aao-1 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 TREATMENT & EVALUATION SERVICES Rick May, Psy.D., CAC III Pam Hiner Psy.D., CAC III Brenna Tindall, Psy.D., CAC III Jessica Bartels, Psy.D. Licensed Psychologists SOMB Provider/Evaluators DVOMB Provider/Evaluators Certified Addiction Counselors 01/28/2019 Attention: Doug Hainley Quality Assurance Supervisor Weld County Department of Human Services 822 Th St. Ste. 150 Greeley, CO 80632 970-400-6210 Currently, our agency is contracted with your Department to conduct various therapy and evaluation services. Our agency is staffed by four licensed psychologist — two in our Aurora office and two in our Fort Collins and Greeley offices. In addition, we have 4 Master's level clinicians to provide services in our Greeley office, as well as two doctoral interns. All staff are full qualified to provide the following services and our scheduling team of three people can help provide these services quickly. We would like the opportunity to retain and expand our contract with you to include the following services: 1. SOMB approved Psychosexual/sex offense specific evaluations for juveniles and adults. 2. Psychological evaluations (all ages) — We conduct psychological evaluations on all ages to include various pieces of testing. These evaluations are also 4-5 hours of testing and five to six hours of "report writing time." We also have a session after the report is completed to conduct a feedback session to go over the results of the evaluation. We often "piece meal" these evaluations together depending on the referral question. For example, we might conduct an evaluation that focuses more on cognitive and adaptive functioning testing with some personality testing or we may do testing that is more focused on emotional functioning. We typically staff the case with the referral source and figure out what the presenting issue is and then coordinate what testing instruments to use. 3. Anger Management and Domestic Violence Services: Dr. Tindall is a DVOMB approved Full Operating Evaluation. Our office is able to provide diagnostic evaluation services for areas related to intimate partner violence, child abuse, and animal cruelty. The evaluations will assist in the development of the family services plan, to assess and/or improve family communication, functioning and relationships, and to prevent further violence. We also have a staff member who is SOMB-approved who speaks Spanish fluently and is our interpreter. As such, we conduct evaluations in Spanish as well Thank you for your consideration in this matter. If you have other questions, please do not hesitate to call. Everyone on staff at Treatment and Evaluation Services is SOMB-approved. I am a Full Operating SOMB Juvenile and Adult Therapist and Evaluator; Full Operating DVOMB Evaluator; Licensed Psychologist; and Certified Addiction Counselor III. I am also certified through the SOMB and DVOMB to complete evaluations on clients who have Intellectual/Developmental Disabilities (DD/ID. Please feel free to contact this office at 303-369-4200 or 970-231-9611 with any questions. Brenna Tindall, Psy.D., CAC III Licensed Psychologist: CO #: 6943 Certified Addiction Counselor III SOMB Full Operating Evaluator SOMB Certified CCA Evaluator SOTIPS & VASOR-2 Trainer SOMB Full Operating Evaluator —Intellectual Disabilities DVOMB Full Operating Evaluator EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services Treatment & Evaluation Services AGENCY OR PRIVATE PRACTICE TRAILS PROVIDER ID (If Known) Brenna Tindall Licensed Psychologist Director PRIMARY CONTACT— FULL NAME ( 970 )231-9611 PHONE NUMBER b.tindallPtescolorado.com PRIMARY CONTACT— E-MAIL ADDRESS 13693 East Iliff Avenue, Suite 220 Aurora CO 80014 AGENCY MAILING ADDRESS PRIMARY CONTACT - TITLE .( 303 )369-5072 EXT. FAX NUMBER www.tescolorado.com AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) CITY ZIP Carol Kobobel REFERRAL CONTACT REFFERAL CONTACT— FULL NAME (970 )231-9611 REFERRAL CONTACT — PHONE NUMBER EXT. Practice coordinator REFERRAL CONTACT - TITLE scheduling@tescolorado.com REFERRAL CONTACT — E-MAIL ADDRESS BILLING CONTACT Ana Arneros BILLING CONTACT— FULL NAME (303 )369-4200 BILLING CONTACT— PHONE NUMBER EXT. Bookkeeper BILLING CONTACT - TITLE a.arneros@tescolorado.com 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: �� /°'t`/' Date of Signature: _02/08/2019 Bid No.: B1900025 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: Treatment & Evaluation Services DVOMB approved domestic violence evaluations 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Two appointments of 3 hours each to meet with client, family members, etc. Comply with DVOMB Standards related to these evaluations. 4. Capacity to Provide Services (ex. 4 hours/week). Our agency is staffed by four licensed psychologist — two in our Aurora office and two in our Fort Collins and Greeley offices. In addition, we have 4 Master's level clinicians to provide services in our Greeley office, as well as two doctoral interns. All staff are full qualified to provide the following services and our scheduling team of three people can help provide these services quickly. 5. Goals of the service. To provide evaluation services based up the Risk Need Responsivity Principle and implement recommendations for treatment planning around this identified risk -needs. 6. Outcomes of service. Prevention of sexual abuse, domestic violence, and other criminogenic activities typically caused b undiagnosed and untreated mental health. 7. Target population for service. Children, juveniles, adults; adults/minors with intellectual disabilities; GLBTO+ services; 8. Service access. Have capacity to do phone conferencing, video chatting, and in person appointments. 9. Languages service is available in. We have two interpreters —both whom are native speakers (one from Mexico and the other from Venezuela). 10. Rates of service. DVOMB Evaluations -$800 Brenna Tindall, Psy.D., CAC III Licensed Psychologist: CO #: 6943 Certified Addiction Counselor III SOMB Full Operating Evaluator SOMB Certified CCA Evaluator SOTIPS & VASOR-2 Trainer SOMB Full Operating Evaluator —Intellectual Disabilities DVOMB Full Operating Evaluator Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: Treatment & Evaluation Services SOMB approved sex offense specific evaluations/Psychosexual 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Two appointments of 3 hours each to meet with client, family members, etc. Comply with SOMB Standards related to these evaluations. 4. Capacity to Provide Services (ex. 4 hours/week). Our agency is staffed by four licensed psychologist —two in our Aurora office and two in our Fort Collins and Greeley offices. In addition, we have 4 Master's level clinicians to provide services in our Greeley office, as well as two doctoral interns. All staff are full qualified to provide the following services and our scheduling team of three people can help provide these services quickly. 5. Goals of the service. To provide evaluation services based up the Risk Need Responsivity Principle and implement recommendations for treatment planning around this identified risk -needs. 6. Outcomes of service. Prevention of sexual abuse, domestic violence, and other criminogenic activities typically caused b undiagnosed and untreated mental health. 7. Target population for service. Children, juveniles, adults; adults/minors with intellectual disabilities; GLBTQ+ services; 8. Service access. Have capacity to do phone conferencing, video chatting, and in person appointments. 9. Languages service is available in. We have a Spanish speaking SOMB provider who is also a licensed psychologist. We also have two interpreters —both whom are native speakers (one from Mexico and the other from Venezuela). 10. Rates of service. Offense Specific Evaluations -$900 Brenna Tindall, Psy.D., CAC III Licensed Psychologist: CO #: 6943 Certified Addiction Counselor III SOMB Full Operating Evaluator SOMB Certified CCA Evaluator SOTIPS & VASOR-2 Trainer SONIB Full Operating Evaluator Intellectual Disabilities DVOMB Full Operating Evaluator Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: Treatment & Evaluation Services Psychological Evaluations 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Three appointments of 3 hours each to meet with client, family members, etc. Comply with DVOMB Standards related to these evaluations. 4. Capacity to Provide Services (ex. 4 hours/week). Our agency is staffed by four licensed psychologist — two in our Aurora office and two in our Fort Collins and Greeley offices. In addition, we have 4 Master's level clinicians to provide services in our Greeley office, as well as two doctoral interns. All staff are full qualified to provide the following services and our scheduling team of three people can help provide these services quickly. 5. Goals of the service. To provide evaluations that address neurological, cognitive, emotional, and psychological functioning. 6. Outcomes of service. Help identify the mental health problems that are disrupting the client and the client's symptoms and create a treatment plan. 7. Target population for service. Children, juveniles, adults; adults/minors with intellectual disabilities; GLBTQ+ services; 8. Service access. Have capacity to do phone conferencing, video chatting, and in person appointments. 9. Languages service is available in. We have two interpreters —both whom are native speakers (one from Mexico and the other from Venezuela). 10. Rates of service. Psychological Evaluations -$1200 Brenna Tindall, Psy.D., CAC III Licensed Psychologist: CO #: 6943 Certified .-addiction Counselor III SOMB Full Operating Evaluator SOMB Certified CCA Evaluator SOTIPS & VASOR-2 Trainer SOMB Full Operating Evaluator Intellectual Disabilities DVONIB Full Operating Evaluator 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: psychological Evaluations BIDDER LEGAL ENTITY NAME: Treatmerrt & Evaluation Services APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION No. Last Name First Name Work* Work Email Education Level Degree Focus Ucensure/ Credentials 1 Tindall Brenna 970-231-9611 b.tindall@tescolorado.com Doctorate Clinical Psycholgy Licensed Psychologist, Certified Addiction Counselc 2 Bartels Jessica 970-231-9611 j.bartels@tescolorado.com Doctorate Clinical Psycholgy Licensed Psychologist 3 Mendez Vida 970-231-9611 v.mendez@tescolorado.com Masters psychology Social work licensure candidate 4 Fortson Sandra 970-231-9611 s.fortson@tescolorado.com Masters social work Social Work 5 Grego Andrew 970-231-9611 a.Qrego@tescolorado.com Masters psychology psychologist canddiate 6 Parnes Jamie 970-231-9611 j.parnes@tescolorado.com Masters psychology psychologist canddiate 7 8 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.) SUPERVISOR INFORMATION DORA # (If applicable) last Name First Name Work* Work Etna ... 3746 Tindall Brenna 970-231-9611 b.tindall@tescolorado.com Tindall Brenna 970-231-9611 b.tindall@tescolorado.com Tindall Brenna 970-231-9611 b.tindall@tescolorado.com Tindall Brenna 970-231-9611 b.tindall@tescolorado.com 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: psychological Evaluations BIDDER LEGAL ENTITY NAME: Treatment & Evaluation Services APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION No. Last Name First Name Work* Work Email Education Level Degree Focus LIcensure/ Credentials 1 Tindall Brenna 970-231-9611 b.tindall@tescolorado.com Doctorate Clinical Psycholgy Licensed Psychologist, Certified Addiction Counselc 2 Bartels Jessica 970-231-9611 j.bartels@tescolorado.com Doctorate Clinical Psycholgy Licensed Psychologist 3 Mendez Vida 970-231-9611 v.mendez@tescolorado.com Masters psychology Social work licensure candidate 4 Fortson Sandra 970-231-9611 s.fortson@tescolorado.com Masters social work Social Work 5 Grego Andrew 970-231-9611 a.greko@tescolorado.com Masters psychology psychologist canddiate 6 Parnes Jamie 970-231-9611 j.parnes@tescolorado.com Masters psychology psychologist canddiate 7 8 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.) SUPERVISOR INFORIVIATION DORA 8 (If applicable) last Name First Name Work It Work Emall 3746 Tindall Brenna 970-231-9611 b.tindall@tescolorado.com Tindall Brenna 970-231-9611 b.tindall@tescolorado.com Tindall Brenna 970-231-9611 b.tindall@tescolorado.com Tindall Brenna 970-231-9611 b.tindall@tescolorado.com 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: SOMB Evaluations BIDDER LEGAL ENTITY NAME: Treatment & Evaluation Services APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION No. Last Name First Name Worku Work Email Education Level Degree Focus Licensure/ Credentials 1 Tindall Brenna 970-231-9611 b.tindall@tescolorado.com Doctorate Clinical Psycholgy Licensed Psychologist, Certified Addiction Counselc 2 Bartels Jessica 970-231-9611 j.bartels@tescolorado.com Doctorate Clinical Psycholgy Licensed Psychologist 3 Mendez Vida 970-231-9611 v.mendez@tescolorado.com Masters psychology Social work licensure candidate 4 Fortson Sandra 970-231-9611 s.fortson@tescolorado.com Masters social work Social Work 5 Grego Andrew 970-231-9611 a.Rrego@tescolorado.com Masters psychology psychologist canddiate 6 Parnes Jamie 970-231-9611 j.parnes@tescolorado.com Masters psychology psychologist canddiate 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 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.) SUPERVISOR INFORMATION DORA # (If applicable) last Name First Name Work # Work Email 3746 Tindall Brenna 970-231-9611 b.tindall@tescolorado.com Tindall Brenna 970-231-9611 b.tindall@tescolorado.com Tindall Brenna 970-231-9611 b.tindall@tescolorado.com Tindall Brenna 970-231-9611 b.tindall@tescolorado.com Bid No.: B1900025 CPH & ASSOCIATES Certificate of Liability Insurance Date Issued: 07/29/2018 11w1ti �T PHILADELPHIA ►NSERANCI.: COMPANIES Underwritten by: Philadelphia Indemnity Insurance Company • One Bala Plaza, Suite 100 • Bala Cynwyd, PA 19004 NAIC #: 18058 Administered by: CPH & Associates • 711 S. Dearborn St. Ste 205 • Chicago, IL 60605 • P 800.875.1911 • F 312.987.0902 info@cphins.com DISCLAIMER: This certificate is issued as a matter of information only and confers no rights upon the certificate holder. The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon. Insured: Brenna Tindall 13693 E. lliff Ave. Aurora, CO 80014 Policy Number: E54269 Policy Term: 08/10/2018 to 08/10/2019 Occupation: Licensed Psychologist Covered Locations Professional Liability: Portable coverage, not location specific Coverage Type (Occurrence Form) Professional Liability Supplemental Liability Licensing Board Defense Commercial General Liability Fire/Water Legal Liability Business Personal Property Per Incident (Per individual claim) $ 1,000,000 $ 1,000,000 $ 35,000 N/A N/A N/A Aggregate (Total amount per year) $ 3,000,000 $ 3,000,000 $ 35,000 N/A N/A N/A Comments/Special Descriptions: Certificate Holder PROOF OF COVERAGE If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Notice of Cancellation will only be provided to the first named insured in accordance with policy provisions, who shall act on behalf of all additional insureds with respect to giving notice of cancellation. Authorized Representative C. Philip Hodson EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Anger Management/Domestic Violence (Evaluation), Mental Health Services (Evaluation) and Sexual Abuse Treatment (Offense Specific Evaluation), as referred by the Department. 2. Services available under this agreement include: a. Anger Management/Domestic Violence - Domestic Violence Offender Management Board (DVOMB) Evaluation i. Contractor will conduct service per DVOMB standards, and services will be provided by a DVOMB provider. ii. Capacity for Services: 1. Four (4) licensed psychologists 2. Four (4) Master's level clinicians 3. Two (2) doctoral interns Goals of Service: Provide evaluation services based upon the Risk Need Responsivity Principle and implement recommendations for treatment planning around the identified risk needs. iv. Outcomes of Service: Prevention of sexual abuse, domestic violence, and other criminogenic activities typically caused by undiagnosed and untreated mental health. v. Target Population: Children, juveniles, adults, adults/minors with intellectual disabilities, GLBTQ+ services. vi. Service Access: 1. Phone conferencing 2. Video chatting 3. In person appointments vii. Language: English and Spanish. Contractor has two interpreters; both native speakers. b. Mental Health Services - Psychological Evaluation i. Capacity for Services: 1. Four (4) licensed psychologists 2. Four (4) Master's level clinicians 3. Two (2) doctoral interns ii. Goals of Service: Provide evaluation that addresses neurological, cognitive, emotional, and psychological functioning. iii. Outcomes of Service: Help identify mental health problems that are disrupting the client and the client's symptoms and create a treatment plan. iv. Target Population: Children, juveniles, adults, adults/minors with intellectual disabilities, GLBTQ+ services. v. Service Access: 1. Phone conferencing 2. Video chatting 3. In person appointments vi. Language: English and Spanish. Contractor has two interpreters; both native speakers. c. Sexual Abuse Treatment - Offense Specific Evaluation i. Contractor will conduct services per Sex Offender Management Board (SOMB) standards and all services will be conducted by a current SOMB provider. ii. Capacity for Services: 1 1. Four (4) licensed psychologists 2. Four (4) Master's level clinicians 3. Two (2) doctoral interns iii. Goals of Service: Provide evaluation services based upon the Risk Need Responsivity Principle and implement recommendations for treatment planning around the identified risk needs. iv. Outcomes of Service: Prevention of sexual abuse, domestic violence, and other criminogenic activities typically caused by undiagnosed and untreated mental health. v. Target Population: Children, juveniles, adults, adults/minors with intellectual disabilities, GLBTQ+ services. vi. Service Access: 1. Phone conferencing 2. Video chatting 3. In person appointments vii. Language: English and Spanish. Contractor has two interpreters; both native speakers. 3. Contractor will respond to the Quality Assurance Team Supervisor (hainlejd@weldgov.com, 970-400- 6210) within three (3) business days regarding the ability to accept the received referral. 4. 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 (hainlejd@weldgov.com, 970-400-6210). 5. 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 (hainlejd@weldgov.com, 970-400-6210). 6. 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. 7. 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. 8. 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 2 to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 9. 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. 10. 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. 11. 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. 12. 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. 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 $800.00/Episode (DVOMB Evaluation) $1,200.00/Episode (Psychological Evaluation) $900.00/Episode (Offense Specific Evaluation) 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. 1 Hello