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Home My WebLink About20210619.tiffRESOLUTION RE: APPROVE AGREEMENT FOR PROFESSIONAL SERVICES FOR HOME -BASED INTERVENTION AND CASE CONSULTATION AND AUTHORIZE CHAIR TO SIGN - AMANDA HARTSHORN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with an Agreement for Professional Services for Home -Based Intervention and Case Consultation between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Amanda Hartshorn, commencing February 1, 2021, and ending May 31, 2021, with further terms and conditions being as stated in said agreement, and WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Agreement for Professional Services for Home -Based Intervention and Case Consultation between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Amanda Hartshorn, be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreement. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 3rd day of March, A.D., 2021, nunc pro tunc February 1, 2021. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: dcith/t) k Weld County Clerk to the Board ou Attorney Date of signature: 3 /t 7/2 Steve oreno, Chair S ;s, ames, Pro -T cc.. HS iD 3/I I(/.2 I 2021-0619 HR0093 C,sV -i-rC -CA-- * PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE; February 9, 2021 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Agreement for Professional Services with Amanda Hartshorn Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Agreement for Professional Services with Amanda Hartshorn. The Department has entered into an Agreement for Professional Services with Amanda Hartshorn for nursing consultation, case management, and Home -Based Services. All services will be provided by Amanda Hartshorn, an experienced Registered Nurse (RN). Ms. Hartshorn will have regular office hours for consultation services and will be located within the Division of Child Welfare.. She will also conduct services in client homes when referred to by the Department for Home Based Services. The term of this Agreement is February 1, 2021 through May 31, 2021. $105.00/Hour (Case consultation) $105.00/Hour (Case management) $130.00/Hour (Home -Based Services) $95,00/Hour (FTM, TDM, Prof. Staffing) $75.00/Hour (No show) $00.55/Mile (Mileage) For distance exceeding twenty (20) miles, one-way, from practitioner's office. Pass -Around Memorandum; February 9, 2021 — ID 4452 Page 1 2021-0619 d3/o 3 AF\Xg3 PRIVILEGED AND CONFIDENTIAL I do not recommend a Work Session. I recommend approval of this Agreement and authorize the chair to sign. Perry L. Buck Mike Freeman Scott K. James, Pro-Tem Steve Moreno, Chair Lori Saine Aggrove Schedule Recommendation Work Session Other/Comments; Pass -Around Memorandum; February 9, 2021- ID 4452 Page 2 WELD COUNTY AGREEMENT FOR PROFESSIONAL SERVICES BETWEEN WELD COUNTY AND AMANDA HARTSHORN THIS AGREEMENT is made and entered into this 3� day of March , 2021, by and between the County of Weld, a body corporate and politic of the State of Colorado, by and through its Board of County Commissioners, whose address is 1150 "O" Street, Greeley, Colorado 80631 hereinafter referred to as "County," and Amanda Hartshorn, who whose address is 820 Ponderosa Court, Eaton, Colorado 80615, hereinafter referred to as "Contractor". WHEREAS, County desires to retain Contractor as an Independent Contractor to perform services as more particularly set forth below; and WHEREAS, Contractor has the ability, qualifications, and time available to timely perform the services, and is willing to perform the services according to the terms of this Agreement. WHEREAS, Contractor is authorized to do business in the State of Colorado and has the time, skill, expertise, and experience necessary to provide the services as set forth below; NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties hereto agree as follows: 1. Introduction. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, Scope of Services and Rate of Services, which forms an integral part of this Agreement. Exhibits A and B are specifically incorporated herein by this reference. 2. Service or Work. Contractor agrees to provide the materials, equipment and/or products necessary for the outlined Scope of Work and further agrees to diligently provide all services and labor, as set forth in Exhibits A and B. 3. Term. The term of this Agreement shall be from February 1, 2021, through May 31, 2021, or Contractor's completion of the responsibilities described in Exhibit A. 4. Termination. County has the right to terminate this Agreement, with or without cause on thirty (30) days written notice. Furthermore, this Agreement may be terminated at any time without notice upon a material breach of the terms of the Agreement. 5. Extension or Modification. Any amendments or modifications to this agreement shall be in writing signed by both parties. No additional services or work performed by Contractor shall be the basis for additional compensation unless and until Contractor has obtained written authorization and acknowledgement by County for such additional services. 6. Compensation/Contract Amount. County agrees to pay an amount no greater than the amount set forth in Exhibit B for the term of this Agreement. County agrees to pay Contractor through an invoice process during the course of this Agreement in accordance with the Rate Schedule as described in Exhibit B. Contractor agrees to submit invoices which detail the work completed by Contractor. The County will review each invoice and if it agrees Contractor has completed the invoiced items to the County's satisfaction, it will remit payment to Contractor. Contractor agrees to work within the confines of the Scope of Services outlined in Exhibit A. 1 County will not withhold any taxes from monies paid to the Contractor hereunder and Contractor agrees to be solely responsible for the accurate reporting and payment of any taxes related to payments made pursuant to the terms of this Agreement. 7. Independent Contractor. 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. 8. Subcontractors. Contractor acknowledges that County 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 County's prior written consent, which may be withheld in County's sole discretion. 9. Ownership. All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of County. 10. Confidentiality. Contractor agrees to keep confidential all of County's confidential information. Contractor agrees not to sell, assign, distribute, or disclose any such confidential information to any other person or entity without seeking written permission from the County. Contractor agrees to advise its employees, agents, and consultants, of the confidential and proprietary nature of this confidential information and of the restrictions imposed by this agreement. 11. Warranty. Contractor warrants that the services performed under this Agreement will be performed in a manner consistent with the standards governing such services and the provisions of this Agreement. Contractor further represents and warrants that all services shall be performed by qualified personnel in a professional and workmanlike manner, consistent with industry standards, and that all services will conform to applicable specifications. 12. Acceptance of Services Not a Waiver. In no event shall any action by County hereunder constitute or be construed to be a waiver by County of any breach of this Agreement or default which may then exist on the part of Contractor. Acceptance by the County of, or payment for, the services completed under this Agreement shall not be construed as a waiver of any of the County's rights under this Agreement or under the law generally. 13. Insurance and Indemnification. Contractor shall procure at least the minimum amount of automobile liability insurance required by the State of Colorado for the use of any personal vehicle. Proof of said automobile liability insurance shall be provided to County prior to the performance of any services under this Agreement. 14. Professional Liability (Errors and Omissions Liability). The policy shall cover professional misconduct or lack of ordinary skill for those positions defined in the Scope of Services of this contract. Contractor shall maintain limits for all claims covering wrongful acts, errors and/or omissions, including design errors, if applicable, for damage sustained by reason of or in the course of operations under this Contract resulting from professional services. In the event that the professional liability insurance required by this Contract is written on 2 a claims -made basis, Contractor warrants that any retroactive date under the policy shall precede the effective date of this Contract; and that either continuous coverage will be maintained or an extended discovery period will be exercised for a period of two (2) years beginning at the time work under this Contract is completed. Minimum Limits: Per Loss Aggregate $ 1,000,000 $ 2,000,000 15. Indemnity. The Contractor shall defend, indemnify and hold harmless County, its officers, agents, and employees, from and against injury, loss damage, liability, suits, actions, or claims of any type or character arising out of the work done in fulfillment of the terms of this Contract or on account of any act, claim or amount arising or recovered under workers' compensation law or arising out of the failure of the Contractor to conform to any statutes, ordinances, regulation, law or court decree. 16. Non -Assignment. Contractor may not assign or transfer this Agreement or any interest therein or claim thereunder, without the prior written approval of County. 17. 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. 18. Compliance with Law. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established, including without limitation, laws applicable to discrimination and unfair employment practices. 19. Non -Exclusive Agreement. This Agreement is nonexclusive, and County may engage or use other Contractors or persons to perform services of the same or similar nature. 20. Entire Agreement/Modifications. This Agreement including the Exhibits attached hereto and incorporated herein, contains the entire agreement between the parties with respect to the subject matter contained in this Agreement. This instrument supersedes all prior negotiations, representations, and understandings or agreements with respect to the subject matter contained in this Agreement. This Agreement may be changed or supplemented only by a written instrument signed by both parties. 21. Fund Availability. Financial obligations of the County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. Execution of this Agreement by County does not create an obligation on the part of County to expend funds not otherwise appropriated in each succeeding year. 22. Employee Financial Interest/Conflict of Interest — C.R.S. §§24-18-201 et seq. and §24-50-507. The signatories to this Agreement state 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. 23. 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. 24. Governmental Immunity. No term or condition of this contract shall be construed or interpreted as a waiver, 3 express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 25. Force Majeure. Neither the Contractor nor the County shall be liable for any delay in, or failure of performance of, any covenant or promise contained in this Agreement, nor shall any delay or failure constitute default or give rise to any liability for damages if, and only to extent that, such delay or failure is caused by "force majeure." As used in this Agreement, "force majeure" means acts of God, acts of the public enemy, unusually severe weather, fires, floods, epidemics, quarantines, strikes, labor disputes and freight embargoes, to the extent such events were not the result of, or were not aggravated by, the acts or omissions of the non- performing or delayed party. 26. No Third -Party Beneficiary. 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. 27. 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 or its designee. 28. 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. 29. Public Employment Retirement Program. Contractor is responsible for notifying Weld County of any previous participation in the Colorado Public Employee Retirement Program. Contractor must notify Weld county of the most recent employment for a PERA contributing employer. 30. 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 County 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. Contractor 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 4 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 County, a written notarized affirmation that it has examined the legal work status of such employee and shall comply with all of the other requirements of the State of Colorado program. If Contractor fails to comply with any requirement of this provision or of C.R.S. §8-17.5- 101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if 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. 31. Acknowledgment. County and Contractor acknowledge that each has read this Agreement, understands it and agrees to be bound by its terms. Both parties further agree that this Agreement, with the attached Exhibits A and B, is the complete and exclusive statement of agreement between the parties and supersedes all proposals or prior agreements, oral or written, and any other communications between the parties relating to the subject matter of this Agreement. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTESTS W""°Jei1;t1 BOARD OF COUNTY COMMISSIONERS Weldty Clerk to the Board WELD COUNTY, COLORADO Deputy Clei Steve Moreno, Chair ONTRACTOR: Amanda Hartshorn 820 Ponderosa Court Eaton, Colorado 80615 By: Date: 5 MAR 0 3 2021 hiveda blaeihnni, /FA/11SN Amanda Hartshorn, RN MSN (Feb 4, 202108:00 MST) Amanda Hartshorn, RN Feb 4, 2021 0,240,OW? EXHIBIT A SCOPE OF SERVICES 1. Contractor will provide Home Based Intervention, as referred by the Department, and Case Consultation to Department staff, as needed. 2. All services will be provided by Mandee Hartshorn, an experienced Registered Nurse (RN). 3. Contractor will provide case consultation services and case management to the Department. Services will include: i. Evidence Based Research, and professional experience. ii. Education regarding medical diagnosis and treatment. Utilization of credible resources such as Children's Hospital Online and Mayo Clinic as needed to enhance education. iv. Setup and facilitation of home visit or medical appointments and record reviews. v. Meeting with Department staff and caseworkers regarding specific cases to determine needs and goals. vi. Ongoing documentation and/or communication of objective observations and interactions with the client to the caseworker via phone or email. vii. Contractor will serve as a liaison between the client, caregiver and the Department for the purpose of setting up and/or attending medical appointments. viii. Health Service Plan. Contractor will work with Department, other professionals, client, and caregiver to create an initial Health Service Plan, and will obtain current provider and service information pertinent to medical and mental needs. b. Anticipated Frequency of Services: i. Established ongoing office hours at the Department as needed. c. Anticipated Duration of Services: i. Services shall be for the term of the Agreement unless otherwise modified per Paragraph five (5) of the Agreement. d. Goals of Services: i. Collaboration with Department staff to meet established goals. ii. Education of Department staff to gain a better understanding of medical information and needs of identified clients. iii. Education of Department staff and caregivers to better assist caregivers in navigating the healthcare system and understanding medical information. iv. Case management support to the Department and client. e. Outcomes of Services: i. Assessment of case -specific medical issues that may be creating child protection issues. ii. Establishment of short-term and long-term goals for each identified case. iii. Increased understanding of medical information and healthcare system by Department staff, allowing Department staff to better assist caregivers in mitigating or eliminating child protection issues. f. Target Population: i. All Department staff. ii. All clients as referred by Department. g. Language: i. English. 1 h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Contractor does not provide transportation. ii. Services will be primarily accessed onsite at the Department but may also be accessed outside of the Department at a mutually agreed upon location. Contractor may also be accessed via phone, email, and virtual platform. 4. Contractor will provide Home -Based Services, as referred by the Department, to include Education, Nursing Assessments and/or Observation. Services will include: i. Information gathering. Information will be collected from the Department, other professionals, the client, and the caregivers to the determine medical and mental health care needs of the client. Contractor will work collaboratively with all parties to gather and review all necessary information. ii. Goal setting. Short-term and long-term goals will be established pertinent to medical and mental health needs. iii. Health Service Plan. Contractor will work with Department, other professionals, client, and caregiver to create an initial Health Service Plan, and will obtain current provider and service information pertinent to medical and mental needs. iv. Hands-on Demonstration. Contractor will provide skilled hands-on demonstration to caregivers regarding performance of ordered medical tasks in a safe and competent manner. Demonstration will include skilled nursing education around ordered interventions. Contractor will not provide ongoing nursing support such as Home Health Care Services. v. Contractor will provide hands on nursing skilled education by directing and educating caregivers on ordered interventions. Contractor will not provide ongoing nursing support such as Home Health Care Services. b. Anticipated Frequency of Services: i. Two (2) to ten (10) hours per week, based on needs of client. c. Anticipated Duration of Services: i. One (1) to ninety (90) days with option to extend upon request by either party and with approval of the Department. d. Goals of Services: i. Education of client and/or caregiver regarding client specific medical information to promote increased understanding and knowledge of information and needs. ii. Hands-on skilled nursing demonstration of ordered medical interventions to promote understanding and competency by client and/or caregiver. iii. Hands-on education of client and/or caregiver regarding navigation of the healthcare system to promote confidence and increase ability to navigate the system successfully. e. Outcomes of Services: i. Client and/or caregiver will demonstrate: 1. Increased knowledge and understanding of the client's medical information and needs, including self -care, ongoing medical needs and requirements for a safe environment. 2. Increased understanding and competency regarding ordered medical interventions through hands-on performance of interventions. Client will demonstrate safe, accurate and confident performance of interventions. 2 3. Increased confidence and ability to navigate the healthcare system independently and successfully, and confidence accessing additional resources as needed. 4. Decreased child protection issues mitigated through increased knowledge, understanding of client's medical issues, needs and ordered interventions. f. Target Population: All ages and genders. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Contractor does not provide transportation. ii. Services will be provided in person in the client's home, unless otherwise approved by the Department. Terms 1. Contractor will respond to the Quality Assurance Team (HS-CWQualityAssurance &weldgov.com within three (3) business days regarding the ability to accept the received referral. 2. 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 HS- CW OualitvAssurance(&,weldgov.com. 3. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understands that the Department will not reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows", or up to two (2) hours, on the part of case participants who cancel without 24 -hour notice. 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 HS-CWQualitvAssurance(aweldgov.com. 4. 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 HS-CWQualityAssurance(aweldgov.com immediately via email, to discuss service continuation. 5. 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. 3 6. 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 concem 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. 7. 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. 8. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator or any member of the Quality Assurance Team. Any changes to visitation referrals will be approved by the caseworker, their supervisor, or the Family Support and Visitation Center. 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. 9. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Bid Meetings, Professional Staffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as there is written authorization from the Quality Assurance Team, and the Contractor obtains the Facilitator's signature on the Client Verification Form (if in person) at the time of the meeting and participation in the meeting is deemed appropriate and necessary by the Department. The Facilitator will be responsible for filling out the time attended on the Client Verification Form. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator. Contractor may participate by phone, if approved by the Department. 10. Contractor will notify the Quality Assurance Team HS-CWOualitvAssurance(aweldgov.com 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. 4 EXHIBIT RATE B SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specific in Paragraph 2, below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2021. Expenses incurred by the Contractor prior to the term of this Agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services List the Name of the Service Here $105.00/Hour (Case consultation) $105.00/Hour (Case management) $130.00/Hour (Home -Based Services) $95.00/Hour (FTM, TDM, Prof. Staffing) $75.00/Hour (No show) $00.55/Mile (Mileage) — For distance exceeding twenty (20) miles, one-way, from practitioner's office located at 928 13th Street, #4C, Greeley, Colorado 80631. 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7th day of the month following the month of service, but no later than 60 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 60 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. For one-time services, proof of services rendered shall be receipt of a Client Verification Form and the completed product. For Monitored Sobriety services, proof of services rendered shall be the test result. Contract Farm Requ Entity Name HARTSHORNAMANDA Entity ID* @0©043381 ❑New Entity? Contract Name* Contract ID AMANDA HARTSHORN AGREEMENT FOR PROFESSIONAL 4452 SERVICES Contract Status CTB REVIEW Contract Lead* APEGG Contract Lead Email apegg@weldgov.comcobbx xlkqPweldgov.com Parent Contract ID Requires Board Approval YES Department Project # Contract Description* NEW AGREEMENT FOR NURSING CONSULTATION AND CASE MANAGEMENT. TERM FEBRUARY 1, 2021 THROUGH MAY 31, 2021. Contract Description 2 PA IS BEING ROUTED THROUGH NORMAL PROCESS. ETA TO CTB: 2 i 1 1. Contract Type AGREEMENT Amount S0.00 Renewable* NO Automatic Renewal Department HUMAN SERVICES Department Email CM - H u manServic esPvveldgov. co m nt Head Email CM-HumanServices- De ptHe adgve I dgay.com County Attorney GENERAL COUNTY A! I ORNEY EMAIL County Attorney Email CM- COUNTYA I I ORNEY^ELDG OV.COM If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Requested BOCC Agenda Date* 02 '171.2021 Due Date 02113/2021 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in On Base Effective FIAT. Review Date* 04/01,12021 Renewal Date Termination Notice Period Uinta et tnftkrtnation Con ' Info Contact Name Contact Type PUr rE Approval Prot Department Head JAMIE ULRICH DH Approved Date 02/22/2021 Icfa[ Apprcly BOCC Approved BOCC Signed Date BOCC Agenda Date 03103x,2021 Originator APEGG Committed Delivery Date Finance Approver CHRIS D'©VlDIO Expiration Date* 3112021 Contact Phone 1 Contact Phone 2 Purchasing Approved Date Legal Counsel GABEKAL©USEK Finance Approved Date Legal Counsel Approved Date 021'22;2421 02,'2212021 Tyler Ref AG 030321 Hello