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Home My WebLink About20191899.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 &111"s-eit-t e; 7640--€4)CP) /9, a1 -�j=i9-a-r Page 1 020i9- a.a9 74-620a90 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND JESSICA BRIEN r4- This Agreement Amendment, made and entered into / / day of 2021 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Hum Services hereinafter referred to as the "Department", and Jessica Brien, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Home Studies, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-1899, approved on May 9, 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 2019-1899. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Term This agreement is being renewed for a third and final year, for the period of June 1, 2021 through May 31, 2022. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTES dir4V W' X49; BOARD OF COUNTY COMMISSIONERS Weld ou ty_Clerk a Boar • �� 1'" `�� WELD COUNTY, COLORADO By. Deputy Clereve Moreno, Chair Jessica Brien 800 South Wilson Avenue Loveland, Colorado 80537 By: Date: APR 1 9 2021 JessiBrien (Apr B, 202121:13 MDT) Jessica Brien Apr 8, 2021 ao/9- /1'9 Contract Farm Entity Information Entity Name* BRIEN, JESSICA New Contract Request Contract Nance* JESSICA BRIEN (AGREEMENT AMENDMENT) Contract Status CTB REVIEW Entity ID* 800037375 Contract Description* BID #61900025. TERM= 6'1 /21 - 5,'31/22. Contract Description 2 CONSENT. PA WAS SENT TO CTB ON 3 31 21. Contract Type AGREEMENT Amount* 50.00 Renewable* NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM - H u man Service srroweldgov. co rT} Department Head Email CM-HumanServices- DeptHeadweldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTO RN EY gWELDG OV.COM ❑ New Entity? Contract ID 4644 Contract Lead* APEGG Contract Lead Email apeggC&weldgov.com;cobbx xlkitweldgov.com Requested BOCC Agenda Date* 05 26 2021 Parent Contract ID 20191899 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? li this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Note. the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract [dates Effective Date Review Date 04; 01x2022 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 13?2021 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 04!19; 2021 Originator APEGG Committed Delivery Date Expiration Date 05'31;2022 Contact Type Contact Email Contact Phone i Contact Phone 2 Finance Approver CONSENT Purchasing Approved Date 04; 13 r' 2021 Legal Counsel CONSENT Finance Approved Date Legal Counsel Approved Date 04,13;2021 0413,/2021 Tyler Ref AG 041921 �lingt-�-i 41- 3622 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: April 2, 2020 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Welfare 2020-21 Service Provider Agreement Amendments Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Child Welfare 2020-21 Service Provider Agreement Amendments. The Department entered into agreements with various Child Welfare service providers through the 2019-20 Request for Proposal (RFP), identified as Tyler ID 2019-0707). These agreements were issued for a period of three years with the option to renew annually. The attached list reflects the providers, services and rates, including minor rate changes, the Department wishes to enter into for the period of June 1, 2020 through May 31, 2021. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Upon Board approval of this pass -around, signed agreement amendments will be obtained from providers and submitted to the Board for approval and Chair signature. I do not recommend a Work Session. I recommend approval of these Agreement Amendments. Mike Freeman, Chair Scott James Barbara Kirkmeyer Steve Moreno, Pro-Tem Kevin Ross Approve Recommendation Work Session Schedule Other/Comments: Pass -Around Memorandum; April 2, 2020 — Not in CMS Page 1 f.C 5Pnf',:z(r't� cc : l4 -5P ©,ti�-SPA o5/13/ 03/13/a.0 2.otdt- t odfq ;Moog° VENDOR RENEWALS Vendor Program Area Service Name Family Interactional Evaluation Funding Core Rate $ 375.00 Unit Type Hour lnservice Training for Caseworkers and Foster Parents CW Block $ 175.00 Hour Inservice Training for Caseworkers and Foster Parents CW Block $ 600.00 1/2 Day Mental Health Assessment Gore $ 375.00 Hour Psychological Evaluation Core $ 375.00 Hour Staffing, Family Team Meetings, TDM, Court, etc. Core $' 175.00 Hour Brien, Jessica Home Studies Additional Face -to -Face Time CW Block/Child Welfare Services $ 50.00 Hour Additional Travel Fee CW Block/Child Welfare Services $ 150.00 Episode Extra Adult(s) After First Two (2) CW Block/Child Welfare Services $ 100.00 Each Home Study Update CW Block/Child Welfare Services $ 700.00 Episode Home Study, 2 Adults CW Block/Child Welfare Services $ 1,600.00 Episode Mileage CW Block/Child Welfare Services $ 0.56 Mile Partial Home Study, Denied or Withdrawn CW Block/Child Welfare Services $ 300.00 Episode Centennial Boardof Cooperative Education Services Day Treatment 5er /ices Therapeutic Er Costs Core $' 203.00 Day Therapeutic Costs Core $ 72.00 Day Collaborative Services for Change' Child Mentoring and Family Support Mentoring Core $ 65.00 Hour Mentoring - In Home/Community Core $ 97.50 Hour Mentoring with Animal Assisted Therapy (AAT) Core $ 100.00 Hour Mentoring with Animal Assisted Therapy (AAT) - In Home/Community Core $ 150.00 Hour Transportation Core $ 0.56 Mental Health Services Case Management Core $ 85.00 Hour EMDR 90 -Minute Session Core $ 120.00 Episode Family Therapy Core $ 100.00 Hour Health Sexuality/Boundaries Curriculum Core $ 100.00 Hour Individual Therapy Core $ 100.00 Hour Team Meetings or Staffing Core $ 85,00 Hour Sexual Abuse Treatment Case Management Core $ 85.00 Hour EMDR Therapy Session Core $ 120.00 Episode Family Therapy Core $ 100.00 Hour Health Sexuality/Boundaries Curriculum Core $ 100.00 Hour Individual Therapy Core $ 100.00 Hour Informed Supervision Training Core $ 100.00 Hour MDT, Team Meetings or Staffing Core $ 85.00 Hour Colorado Boys Ranch Home Based Services CBR-HB (Per -Diem) Core $ 54.00 Day CBR-HB, High Package Core $ 1,900.00 Month CBR-H6, Low Package Core $ 900.00 Month CBR-HB, Moderate Package Core $ 1,450.00 Month Community Connections Core $ 55.00 Hour Small Group Options Core $ 48.00 Hour Specialized Mentoring Core $ 55.00 Hour Life Skills Supervised Visitation Core $ 68.00 Hour Transportation for Visitation Core $ 40.00 Hour Crossroads Counseling Sexual Abuse Treatment Sexual Abuse Treatment -Hourly Rate Core $ 80.00 Hour David Kalis, Inc. dba Parker Personal Care Homes Domestic Violence Intervention Anger Management Treatment - In Office CW Block/Child V/elfare Services $ 125.00 Hour WELD COUNTY DEPT. OF HUMAN SERVICES - CHILD WELFARE DIVISION 2020-21 SERVICE VENDORS (CORE/NON-CORE) BID NO.: 82000037 2 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND JESSICA BRIEN This Agreement Amendment, made and entered into ( day of inattr • 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 Jessica Brien, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Home Studies, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-1899, approved on May 20, 2019. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on May 31, 2020. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Term This agreement is being renewed for a second full year term, for the period June 1, 2020 through May 31, 2021. • 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 -4‘011441 gidd4;&i : Weld County Clerk to the Board By: pputy Clerk to the Board C Age.tdoe, ©s 3/A0 COUNTY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Chair MAY 13 2020 CONTRACTOR: Jessica Brien 800 South Wilson Avenue Loveland, CO 80537 By: Date: JessicaBrien (Apr 29, 2020) Jessica Brien Apr 29, 2020 CC t HSO On (reks• O5i t3ta0 20t 1819 1+A00go Contract Form New Contract Request Entity Information Entity Name* BRIEN, JESSICA Entity ID* @00037375 Contract Name* JESSICA BRIEN (NEW AGREEMENT FOR SERVICES) Contract Status CTB REVIEW Contract ID 3622 Contract Lead* CULLINTA Contract Lead Email cullinta@co.weld.co.us New Entity? Parent Contract ID Requires Board Approval YES Department Project # Contract Description* CONSENT. BID NO. 2000037. BOCC APPROVAL 04/15/20_ CHILD PROTECTION AGREEMENT AMENDMENT. TERM: 06/01/20 THROUGH 05/31/21. FUNDING: CORE/OTHER. Contract Description 2 Contract Type* AGREEMENT Amount* $0.00 Renewable* NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanServices@weldgov.com Department Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WELD GOV.COM Requested BOCC Agenda Date* 04115/2020 Due Date 04/11/2020 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept- to be included? If this is a renewal enter previous Contract ID If this is part of a MA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in Onaase Contract Dates Effective Date Review Date* Renewal Date 04101/2021 Termination Notice Period Committed Delivery Date Expiration Date* 05/31/2021 Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JAMIE ULRICH DH Approved Date 05/05/2020 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 05/13!2020 Originator SNYDERKL Contact Type Contact Email Finance Approver BARB CONN©LLY 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 ,D4a57o CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND JESSICA BRIEN This Agreement, made and entered into thay of 2019by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of H an Services, hereinafter referred to as the "Department' and Jessica Brien 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 61900025, 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 Child Welfare Administration or other funding to the Department for Home Studies. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1. 2019, upon proper execution of this Agreement and shall expire May 31,_ 2020, unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Proposal and Exhibit C, Scope of Services. 3. Referrals, Billing and Tracking a. contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit a complete Request for Reimbursement and supporting documentation by the 7th of the month, following the month of service, utilizing billing forms recto droa +h. et: 014-84-sw 04-6D - /9 ,�- 020 -/ g 2019-1899 Pogo 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; iii. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; iv. A Medicaid provider is not available to provide the needed service; v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule, attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon, the continuing availability of said funds for the purposes hereof. 2 d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 5. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit an, which will be provided by the Department, with a voided check. Failure to complete and submit this form and voided check in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This indudes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Cavil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and - Title VII of the Civil Rights Act of 1964; and 3 - the Age Discrimination in Employment Act of 1967; and - the Equal Pay Act of 1963; and - the Education Amendments of 1972; and - Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and subcontractors. 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. e. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this 4 contract. Contractor will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5- 102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contractor participates in the State of Colorado program, Contractor shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contractor has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contractor shall deliver to the Department, a written notarized affirmation that it has examined the legal work status of such employee and shall comply with all of the other requirements of the State of Colorado program. If Contractor fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., the Department, may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 2476.5-103(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. § 2476.5- 103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR), and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 5 9. Insurance Requirements Contractor and the Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible the insurance provider. a. General Requirements: Contractors must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, the Department must be notified by the Contractor. Contractor shall be responsible for the payment of any deductible or self -insured retention. The Department reserves the right to require Contractor to provide a bond, at no cost to the Department, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor. Contractor shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i.Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii.Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, 6 products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: - $1,000,000 each occurrence; $2,000,000 general aggregate; - $50,000 any one fire; and $500,000 errors and omissions. iii.Automobile Liability: Contractor shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: If any aggregate limit is reduced by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify the Department within ten (10) days and reinstate the aggregates required; - Unlimited defense costs in excess of policy limits; - Contractual liability covering the indemnification provisions of this Agreement; - A severability of interests provision; - Waiver of exclusion for lawsuits by one insured against another; - A provision that coverage is primary; and - A provision that coverage is non-contributory with other coverage or self-insurance provided by the Department. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a daims-made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to the Department, whichever is earlier. c. Contractors shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, induding 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 govemmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. The monitoring agency may, if in its sole discretion deems necessary or appropriate, have access to any 8 program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures for purposes of monitoring. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: Heather Walker, Child Welfare Division Head 17. Notice For Contractor: Jessica Brien 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: Jessica Brien 800 South Wilson Avenue Loveland. CO 80537 (970)203-4743 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 §§2410-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall 10 not enter into any third -party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. A conflict of interest or appearance of a conflict of interest may also apply to personal relationships between providers and clients. If a provider has a personal relationship with a 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. Severabilitv 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: Weld By: Deputy Clerk rG�GrLf/1J �/• JdeD:ok. BOARD OF COUNTY COMMISSIONERS ty Clerk to the Board WELD COUNTY, COLORAQO PAr�f.!I/! ,the . •ard / r'r,' 1 15 Barbara Kirkmeyer, it YQj9 CONTRACTOR: Jessica Brien 800 South Wilson Avenue Loveland, CO 80537 (970) 203-4743 By: Jessica B ' n (Apr 4, 2019) Jessica Brien Date: Apr 4, 2019 ,2,o/9-/799 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 CONTRACTORS RESPONSE TO REOEUST FOR PROPOSAL Jessica Brien, MA, LPC 800 S. Wilson Ave. Loveland, CO 805371970-203-4743 I jessicakbrien@gmail.com 1/29/19 Human Services Advisory Commission Weld County 1150 O. Street Greeley, CO 80634 Attention Human Services Advisory Commission: 1 am writing to express my interest in providing home study evaluation services for Weld County DHS. I am trained in the Structured Analysis Family Evaluation (SAFE) and have been providing home study services for 9 years. I have attended SAFE training, SAFE supervisor training, and a SAFE refresher course. My certificates are attached. I am a Licensed Professional Counselor with a master's degree in clinical counseling. I have an office in Loveland, CO where I see clients part time in a private therapy practice. I previously worked in a child placement agency, a mental health center and as a case manager in a homeless shelter. I am able to provide home -based home study services for families of all types and structures throughout Weld and Larimer Counties. I will consider referrals for home studies outside of Weld and Larimer Counties on a case by case basis, for an additional fee. Please contact me with any questions or if you need further information. Sincerely, jes' Ica Brien EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services Jessica Brien, MA, LPC AGENCY OR PRIVATE PRACTICE Jessica Brien PRIMARY CONTACT — FULL NAME ( 970 ) 203-4743 PHONE NUMBER jessicakbrienDiemail. com PRIMARY CONTACT — E-MAIL ADDRESS 8005. Wilson Ave. AGENCY MAILING ADDRESS Unknown TRAILS PROVIDER ID (If Known) Owner/Service Provider PRIMARY CONTACT - TITLE j 970 ) 667-1077 EXT. FAX NUMBER n/a AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) Loveland CITY 80537 ZIP Jessica Brien REFFERAL CONTACT — FULL NAME (970 )203-4743 REFERRAL CONTACT — PHONE NUMBER REFERRAL CONTACT EXT. Owner/Service provider REFERRAL CONTACT - TITLE jessicakbriene8mait.com REFERRAL CONTACT — E-MAIL ADDRESS BIWNG CONTACT Jessica Brien BILLING CONTACT — FULL NAME (970 ) 203-4743 BIWNG CONTACT — PHONE NUMBER EXT. Owner/service provider _ BIWNG CONTACT - TITLE jessicakbrien@gmaitcom BIWNG 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: Date of Signature: f :� - ) 1 Bid No.: B 1900025 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: Jessica Brien Home study 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Structured Analysis Family Evaluation (SAFE) home study evaluation tool. 4. Capacity to Provide Services (ex. 4 hours/week). Up to three home studies at a time. 5. Goals of the service. Determine the appropriateness of a family for children in need of out of home placement/permanent placement. 6. Outcomes of service. Determine if a family should be approved or not approved to provide the desired service (foster care, adoption, or kinship care). 7. Target population for service. Any family determined by WCDHS to be a potential foster care, adoption, or kinship care provider. S. Service access. In person services will be provided in family's homes or in providers office at 1762 Hoffman Dr. Loveland, CO 80538. Willing to travel outside of Greeley/Loveland/Fort Collins area, within Weld and Larimer Counties with additional mileage fee. Referrals outside of those counties will be considered on a case by case basis for an additional fee, plus mileage. Provider also has access for phone conferencing and regular email communication. 9. Languages service is available in. English. 10. Rates of service. • Full home study, up to two adult interviews: $1600/episode. This includes a minimum of 3 face to visits with the family plus phone/email follow up and follow up with 3 references provided by applicants, as needed. • Home study update: $700/episode • Fee per additional adult interview: $100/episode • Partial/incomplete home study (denied or withdrawn after a minimum of 1 face to face contact and 2 phone contacts. Includes brief letter outlining why the study cannot move forward): $300/episode • Mileage outside of Greeley/Loveland/Fort Collins area: Two (2) cents per mile below current Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE IRS mileage/mile rate. • Additional fee outside of Larimer/Weld County: $150, in addition to mileage rate outlined above. • Any additional face to face or phone meetings with Weld County DHS staff throughout home study process will be billed at $50 per hour, plus mileage (if applicable). Bid No.: 1900025 STAFF DATA SHEET DCHIBIT D (Bidder must fist all applicable staff who will menage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services) PROPOSED SERVICE OR SERVICE TYPE: Home study BIDDER LEGAL ENTITY NAME: Brien, MA, LPC, LLC -,APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION _ - .. - 'SUPERVISOR INFORMATION - No. - Last Name - nrst Name. ' . WorkO; . . iNortr EmaB .' Education , level - _ - Devote Focus. Lioermrtc/' Credentials . DORATI (If applicable) 'test Namne . Fast Nana . Work ft r Work Email . 1 Brien Jessica 970-203-4743 jessicakbrierna srr Masters Clinical counsel LPC 6049 Trabelsi Sheila 970-494-4200 sr trabelsi@yahoc 2 3 4 S 6 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 Colorado's Approved Ho me Study Vendor List January Attachment A Individual Contract Workers Tina D. Albert, MA 1087 East 9th Ave. #202 Broomfield, CO 80020 (303) 589-7114 phone TinaAlbert7@aol.com Cheri Barger, MSW, LCSW 812 Grand Ave., Ste. 209 Glenwood Springs, CO 81601 (970) 319-4013 phone cheribarger@mtnsoulonline.com Elizabeth Bryce Beard 7035 Whitebark Ln. Colorado Springs, CO 80927 (719) 694-6581 phone Tibby48egmail.com Bethany L. Blankenheim, MA 29380 East 160th Court Brighton, CO 80603 (720) 232-2303 phone bethany.blankenheimegmail.com Julie Box, MSW 1702 68th Ave. Greeley, CO 80634 (970) 302-1471 phone (970) 339-9036 fax julieebox@comcast.net Jessica R. Brien, MA, LPC 800 S. Wilson Ave. Loveland, CO 80537 (970) 203-4743 phone jessicakbrienagmail.com Kristy Briggs 7478 S. Krameria St. Centennial, CO 80112 (720) 849-0437 kristyrbriggsagmail.com 2019 Patricia M. Chase, ACBSW** 215 Custer St. Brush, CO 80723 (970) 768-7665 phone Foxrizzy2002Oyahoo.com Barb K. D'Albey, Ph.D.** 8308 Everett Way Arvada, CO 80005-2211 (303) 421-0443 phone bkdalbey@comcast.net Jean Davis, MSW, LCSW** 2440 S. Jasmine St. Denver, CO 80222 (720) 810-5071 phone Djd2440Oyahoo.com Renae DellaCroce, LPC 2565 Airport Rd Colorado Springs, CO 80910 (719) 433-8552 phone renaenopendoorwayscolorado.com Amy R. Ferriter, MSW 14134 Blue River Trail Broomfield, CO 80023 (303) 808-1290 phone amyferriteraymail.com Maureen Foley 5059 Morning Glory Place Highlands Ranch, CO 80130 (303) 910-7435 phone MaureenFoleyColoradoegmail.com Kristen Forrest* PO Box 3384 Boulder, CO 80307 (720) 938-4479 phone kristenlives@hotmail.com Spanish Speaking Supervised by Beth Risdon until February 2019 *Vendor requires SAFE supervision **Provides SAFE supervision Colorado's Approved Home Study Vendor List January 2019 Monica Leone 13850 Meadowbrook Dr., Broomfield, CO 80020 224-688-2764 phone rosebean123Ogmail.com Elizabeth Fredrickson 1004 Oxford Ln Colorado Springs, CO 80905 (719) 232-0956 betsifredricksonayahoo.com Kelly Garcia-Brauch 1496 S. Brentwood St. Lakewood, Co. 80232 303-829-7904 kgbtherapy@yahoo.co Danna Gladen, MSW** 6677 Ingalls Ct. Arvada, CO 80003 (303) 940-8605 phone Dino0025@aol.com Adeliada (Lila) Holden, MSW 6594 Diamond Hitch Drive Colorado Springs, CO 80923 (719) 444-5903 phone holdenadel@gmail.com Spanish Speaking Claire Johnston** 3116 S. Glencoe St Denver, CO 80222 574-286-2282 c.viaternyahoo.com Britt Lindell -Colby 715 Smith St Fort Collins, CO 80524 (970) 617-4555 Iindellcolbye..gmail.com Colette B. Lottor* 419 Collyer St. Longmont, CO 80501 (303) 678-1642 phone rejcblamsn.com Rachele Marlette (Physical) 1000 N 9th St. #36 Grand Junction, CO 81501 (Mailing) PO Box 40534 Grand Junction, CO 81504 (970) 314-6675 rachelensmallstepshealing.com Linda Metsger 1493 South Lima Court Aurora, CO 80012 (303) 250-4671 Imetsger33Ogmail.com Supervised by Kathleen Gilmore until September 2020 Lydia W. Moore* 1141 Cottonwood St. Broomfield, CO 80020 (720) 323-4928 Lydiamoore35@gmail.com Supervised by Beth Risdon until October 2019 Sylvia G. Priest, MSW 1751 S. Newport Way Denver, CO 80224 (303) 691-3617 phone Doris Iilliannyahoo.com Marilyn Puryear 13170 Cane Canyon Loop Colorado Springs, CO 80921 (719) 238-7908 mpuryearakairosfamilyservices.com *Vendor requires SAFE supervision **Provides SAFE supervision Colorado's Approved Home Study Vendor List January 2019 Amy Seymour, MaEd P.O. Box 674 Hugo, CO 80821 (719) 760-0766 phone (719) 743-2925 fax caseymour@esrta.com Laurine L. Smith, LCSW 469 E. Maher Dr. Pueblo West, CO 81007 (719) 671-9465 phone (719) 647-2648 fax Laurine42Oyahoo.com Lynn Thayer 1585 S. Garfield St. Denver, CO 80210 (720) 254-1633 phone Lynn thayernmsn.com Spanish Speaking Margaret S. Tibbetts, MSW 712 Cherokee Drive Fort Collins, CO 80525 (970) 988-4173 phone maogiestibbetts aagmail.com Chen A. Van Winkle, MSW 5552 S. Pagosa Ct. Centennial, CO 80015 (303) 204-0572 phone Cheri.vanwinkleagmail.com Stephanie R. Walker 5206 Ironwood Ct.. Johnstown„ CO 80534 (970) 581-2435 phone stephaniejpamsn.com Jeannie S. Webb 5607 North County Road 5 West Del Norte, CO 81132 (719) 850-1881 phone Spottedpony1@msn.com Jennifer Winkelmann, MA, LPC Inward Bound 662 Grant St. Denver, CO 80203 (303) 748-0343 phone Jen@inwardboundco.com Rebecca Wuest 958 Eaton St Lakewood, CO 80214 303-726-4120 beccawuesta..gmai1.com Supervised by Claire Johnston until August 2021 Helene C. Wurth** 4306 Beaver Creek Dr. Fort Collins, CO 80526 (970) 631-6235 phone hwurth@msn.co Attachment B Child Placement Agency Contract Workers Adoption Options 1355 S. Colorado Blvd, Suite 501 Denver, CO 80222 (303) 695-1601 phone (303) 695-1626 fax www.adoption-options.com Approved Staff: Carol Holliday Lawson Leslie Wade Lori Devlyn** Leah Klein *Vendor requires SAFE supervision **Provides SAFE supervision Sarah Olsen Adrienne Elliott** Jacinta Watkins Ashlee Kluth Colorado's Approved Home Study Vendor List January 2019 Courtney Empson-Whaley** Marianne Anderson** Claire Johnston Ariel Clinical Services 2938 North Ave., Suite G Grand Junction, CO 81504 (970) 245-1616 phone (970) 241-8722 fax www.arielcpa.org Approved Staff: Sarah Deforest Tamara Queen Kathy McCoy Amanda Herlo Erika Jordan Denver staff: Shiloh Jones Kelsey Granzen Bridges Child Placement Agency 1225 North Main Street #102 Pueblo, Co 81003 (719) 583-2200 (719) 542- 3412 areahObridgescpa.com Approved Staff: Gregory Hinkle** Bethany Christian Services 3000 S. Race St. Denver, CO 80210 (303) 221-0734 phone (303) 221-0960 fax www.bethany.ora Approved Staff: Cami Haussler Tracy Naviaux Marie Schroeder Shelly Fontera Jaime Buttermore Lacey Jenkins Lori Summers Whitney Shelton Rebecca Ely Taryn Albert Rachel Cisneros Deanna Dingwall Michelle Powner Laurine Smith Jennifer Medina Julie Nehme Jessica Badger Deone Quist *Vendor requires SAFE supervision **Provides SAFE supervision Colorado's Approved Home Study Vendor List January 2019 Catholic Charities of Central Colorado 228 N. Cascade Ave., 1st Floor Colorado Springs, CO 80903 (719) 866-6535 phone (719) 578-5954 fax www.ccharitiescc.orq Approved Staff: Sarah Bidon ** Cyndy Jones Family Resource Network 5360 N. Academy Blvd., Suite 130 Colorado Springs, CO 80918 (719) 227-7477 phone (719) 227-7474 fax www.familyresourcenetworkco.com Kathy Thayer Approved Staff: Shawntel Tucker, MS** Lindsay Callahan Amme Koehler Tara Mitchell Griffith Centers for Children Chins Up Business Office: 1724 Gilpin St. Denver, CO 80218 (303) 237-6865 phone (303) 237-6873 fax Service Location: 3055 Austin Bluffs Parkway Unit C Colorado Springs, CO 80918 (719) 394-4124 phone (719) 368-7678 fax www.griffithcenters.orq Approved Staff: Maggie Petock** Stephanie MacAdam Nicole Korolov Hope and Home 4945 N. 30th Street Colorado Springs, Co 80919 Approved Staff: Melody Reiner Kids Crossing, Inc. 1440 E. Fountain Blvd. Colorado Springs, CO 80910 (719) 632-4569 phone (719) 632-6573 fax Approved Staff: Ben Schoch www.kidscrossing.com *Vendor requires SAFE supervision **Provides SAFE supervision Christine Burcham Colorado's Approved Home Study Vendor List January 2019 Kids Crossing, Inc. 414 Broadway Pueblo, CO 81004 (719) 545-3882 phone (719) 545-4337 fax Approved Staff: David Sanchez Ashton Everly Victoria Romero Kids Crossing, Inc. 14901 E. Hampden Ave., #205 Aurora, CO 80014 (303) 861-8915 phone (303) 861-8976 fax Approved Staff: Lisa Huggins Lutheran Family Services of Colorado 363 S. Harlan, Suite 200 Denver, CO 80226 (303) 922-3433 phone (303) 922-7335 fax www.lfsrm.org Approved Staff: Emily Frank Lutheran Family Services 2032 Lowe St., Ste. 200 Fort Collins, CO 80525 (970) 266-1788 phone (970) 266-1799 fax Jennifer.bohannonelfsrm.org Tahnee.carlson@lfsrm.orq Approved Staff: Jennifer Bohannon** Ashley Shaw Kim Penney** Lutheran Family Services Rocky Mountains 108 E. St. Vrain, #21 Colorado Springs, CO 80903 (719) 227-7571 phone (719) 227-7583 fax Gwendolyn White** Lisa Sauter** Kenicia Hardy Desiree Mayo Autumn Surage *Vendor requires SAFE supervision **Provides SAFE supervision David Williams Shannon Richter Tahnee Carlson** Brittany Foster Marsha Hilty Ashley Campbell Christina Berroa Beth Howes Colorado's Approved Home Study Vendor List January 2019 Maple Star Colorado 2250 S. Oneida St., Ste.100 Denver, CO 80224 (303) 433-1975 phone (303) 433-1980 fax www.maplestar.net Approved Staff: Alice Riley Allison Rodasta Barb D'Albey** Beth Risdon** Caroline Small Christi Beach Emily Tracy Jean Davis Joan Oldenberg Julie Berland** Kathleen Maybury Laura Graber Lindsay Schmidt Maria Bangs Maureen Foley Ronalea Alleman Sarah Cratty Stephanie Walker Sylvia Priest Heather Morris Mt. Saint Vincent 4159 Lowell Blvd Denver, CO 80211 (303) 458-7220 phone (303) 477-7559 fax www.msvhome.orq Approved Staff: Megan Cook Rita Baran *Vendor requires SAFE supervision **Provides SAFE supervision Amita Chugh Ashlie Hovland Brandi Haws Brittany Comelius Cheri Slaughter Elizabeth Sterling Erica Cohen Jennifer Kemp Josh Aevum** Karen Murphy Kristy Briggs** Leanne Figueroa Lori Loretta Maria Hernandez River Holmes -Miller Rosemarie Fritz Sherry Riggs Suzanne Miller Tracy Naviaux Melissa Maile Liesel Scott Colorado's Approved Home Study Vendor List January 2019 Savio House 325 King Street Denver, CO 80219 (303) 225-4100 phone (303) fax http://www.saviohouse.orq Approved Staff: Rebecca Carpenter** Colin Lane Robin Busby WhimSpire Child Placement Agency 9540 E. Jewell Ave. Denver, CO 80247 (303) 912-8954 phone (866) 833-5796 fax www.whimspire.com Approved Staff: Alletta Bode, MSW Rebekah Lansdown, MA Marissa Tabak Tashina Garrett Krista Kent Krystal McManis, MSW Lynnette McKinney Attachment C County Department of Human/Social Services Staff Adams County Department of Human Services 7401 N. Broadway Denver, CO 80601 (303) 412-5030 phone (303) 412-5325 fax Approved Staff: Jennifer McCollum** Jill Schmidt -Love Maria Avila** Alamosa County Department of Human Services PO Box 1310 Alamosa, CO 81101 (719) 589-2581 phone (719) 589-9794 fax Approved Staff: Annette Perea** Matthew Tulley Laurie Rivera Arapahoe County Department of Human Services 14980 E. Alameda Dr. Aurora, CO 80012 (303) 636-1100 phone (303) 636-1628 fax *Vendor requires SAFE supervision **Provides SAFE supervision Sheena Sutter Kathy Suazo** Colorado's Approved Home Study Vendor List January 2019 Approved Staff: None at this time. Archuleta County Department of Human Services PO Box 240 Pagosa Springs, CO 81147 (970) 264-2182 phone (970) 264-2186 fax Approved Staff: Matthew Dodson Baca County Department of Social Services 772 Colorado St. #1 Springfield, CO 81073 (719) 523-4131 phone (719) 523-4820 fax Approved Staff: None at this time. Bent County Department of Social Services 215 — 2nd St_ Las Animas, CO 81054 (719) 456-2620 Approved Staff: Claudia Budd Lacy Brown Boulder County Department of Health and Human Services 3400 N_ Broadway Boulder, CO 80304 (303) 441-1431 phone (303) 441-1289 fax Approved Staff: Bonnie B. Lloyd ** Irene McGaughey Broomfield Health and Human Services 100 Spader Way Broomfield, CO 80020 (720) 887-2269 phone (303) 469-2110 fax Approved Staff: Johnna Shepard Jackeline Sosa Chaffee County Department of Health and Human Services PO Box 1007 Salida, CO 81201 (719) 539-6627 phone (719) 539-6430 fax Approved Staff: Meredith Takacs Keri Vignale Cheyenne County Department of Human Services PO Box 146 *Vendor requires SAFE supervision **Provides SAFE supervision Colorado's Approved Home Study Vendor List January 2019 Cheyenne Wells, CO 80810 (719) 767-5629 phone (719) 767-5101 fax Approved Staff: Jennifer Gribble* Supervised by Patricia Phillips** Clear Creek County Department of Health and Human Services PO Box 2000 Georgetown, CO 80444 (303) 569-3251 x371 phone (303) 679-2443 fax Approved Staff: Sarah Cassano Conejos County Department of Social Services 6683 County Road 13 PO Box 68 Conejos, CO 81129 (719) 376-5455 phone (719) 376-2389 fax Approved Staff: None at this time. Crowley County Department of Human Services 631 Main Street, Ste. 100 Ordway, CO 81063 (719) 267-5248 (719) 267-5296 fax Approved Staff: Tonia Burnett Custer County Department of Human Services PO Box 929 Westcliffe, CO 81252 (719) 783-2371 phone (719) 783-2885 fax Approved Staff: Stacey Schoch Delta County Department of Health and Human Services 560 Dodge St. Delta, CO 81416 (970) 874-2030 phone (970) 874-2068 fax Approved Staff: None at this time. Denver County Department of Human Services 1200 Federal Blvd. Denver, CO 80204 (720) 944-3666 phone (720) 944-1242 fax *Vendor requires SAFE supervision **Provides SAFE supervision Colorado's Approved Home Study Vendor List January 2019 Approved Staff: Peter D. Clarke, MSW** Nichelle Anderson Jeff Veesaert Kristen Bunker Betsy Chanthapaseuth* Steve Griswold Andrea Aragon* Vida Hejazi Kashina Myers Dolores County Department of Social Services 409 N. Main St. P.O. Box 485 Dove Creek, CO 81324 (970) 677-2250 phone (970) 677-2859 Approved Staff: Malynda Evans Douglas County Department of Human Services 4400 Castleton Court Castle Rock, CO 80109 (303) 688-4825 phone (303) 688-0292 fax Approved Staff: None at this time. Eagle County Department of Health and Human Services PO Box 660 Eagle, CO 81631 (970) 328-8840 phone (970) 328-8829 fax Approved Staff: Tracey Branch Elbert County Department of Social Services PO Box 924 Kiowa, CO 80117 (303) 621-3190 phone (303) 621-0122 fax Approved Staff: Kris Johnson El Paso County Department of Human Services 1675 Garden of the Gods Rd. Colorado Springs, CO 80907 (719) 444-5532 phone (719) 444-5597 fax Approved Staff: Yvonne S. Sletta** Adeliada Holden Stephanie Ruiz Alvida Jackson Asmik Manukyan Breanna J. Majors Claire Johnston** Michelle Satchell* Meghan Langfield* Mary Overington Whitney Reeter Annjosiah (Annie) Mace Jamie Heir Tamara Garcia *Vendor requires SAFE supervision **Provides SAFE supervision Colorado's Approved Home Study Vendor List January 2019 Adam Montoya Jessica Hildebran Juli Saiz Brian Allen Jessica Brewster Jin Tassler Bailey Manley Brenda Piatt Stephanie Newton -Keyser Brook Youngberg Katie Wolfe Jillian Stephenson Stacy King Fremont County Department of Human Services 172 Justice Center Rd_ Canon City, CO 81212 (719) 269-2092 phone (719) 275-5206 fax Approved Staff: Barry Acton Linda Potter Garfield County Department of Human Services 195 W. 14"' St. Rifle, CO 81650 (970) 945-9191 phone (970) 928-0465 fax Approved Staff: Susan Garcia Lindsay Zimmer Martha Stanton Grand/Jackson County Department of Social Services PO Box 204 Hot Sulphur Springs, CO 80451 (970) 725-3331 phone (970) 725-3696 fax Approved Staff: Taunia Shipman ** Nichole Fuqua Gunnison/Hinsdale County Departments of Health and Human Services 225 N. Pine, Suite A Gunnison, CO 81230 (970) 641-3244 phone (970) 641-3738 fax Approved Staff: Laura Rascon Selenia Rascon Huerfano County Department of Social Services 121 West 6t' St. Walsenberg, CO 81089 (719) 738-2810 phone (719) 738-2549 fax Approved Staff: V. Anita Cordova Kurt Liebchen Jefferson County Department of Human Services *Vendor requires SAFE supervision **Provides SAFE supervision Colorado's Approved Home Study Vendor List January 2019 900 Jefferson County Parkway Golden, CO 80401 (303) 271-1388 phone (303) 271-4444 fax Approved Staff: None at this time. Kiowa County Department of Social Services 1307 Maine St. PO Box 187, Eads, CO 81036 (719) 438-5541 phone (719) 438-5370 fax Approved Staff: None at this time. Kit Carson County Department of Health and Human Services 252 South 14"' St. PO Box 70 Burlington, CO 80807 (719) 346-8732 phone (719) 346-8066 fax Approved Staff: Tiffany Ramos Lake County Department of Human Services PO Box 884 Leadville, CO 80461 (719) 486-2088 x4145 phone (719) 486-4164 fax Approved Staff: Patricia Gibbons La Plata County Department of Human Services 1060 E. Second Ave. Durango, CO 81301 (970) 382-6150 phone (970) 247-2208 fax Approved Staff: Charmaine Summers** Larimer County Department of Human Services 1501 Blue Spruce Dr. Ft. Collins, CO 80524 (970) 498-6595 phone (970) 498-6988 fax Approved Staff: Katie Kammerzell Amberly Fredrickson Laura Matthews Jay Swope Alexann Worstell Erica Freese Stacie Seim Tiffany Morales Alexa Hilim Brandie Hamig Merrissa Scranton Melanie Law Andrea Mcfarlane *Vendor requires SAFE supervision **Provides SAFE supervision Colorado's Approved Home Study Vendor List January 2019 Addie Killerman Julie Rudley** Las Animas County Department of Human Services 204 S. Chestnut St_ Trinidad, CO 81082 (719) 846-2276 phone (719) 846-4269 fax Approved Staff: Lincoln County Department of Human Services PO Box 37 Hugo, CO 80821 (719) 743-2404 phone (719) 743-2879 fax Approved Staff: Patricia Phillips Amy Seymour Logan County Department of Human Services 508 S. Tenth Ave., Ste. 2 Sterling, CO 80751 (970) 522-2194 phone (970) 521-0853 fax Approved Staff: Peggy Meis Kristen Dempcy Ashley Hays Mesa County Department of Human Services PO Box 20,000 Grand Junction, CO 81502-5035 (970) 241-8480 phone (970) 248-2849 fax Approved Staff: Joni A_ Bedell** Laura Kinson** Caitlin Donohue* Cathy Boutilier Lori Rienstra Nicole Surad Brittany Gardner* Kate Lima* Jeff Sheley* Rory Cornelison* Amanda Pennington* Carrie Hoffman Lindsey Walt Janet Rowland (CASA) Joy Thompson (CASA) Moffat County Department of Social Services 595 Breeze St. Craig, CO 81625 (970) 824-8282 phone (970) 824-9552 fax Approved Staff: Audrey Amedei Montezuma County Department of Social Services *Vendor requires SAFE supervision **Provides SAFE supervision Colorado's Approved Home Study Vendor List January 2019 109 W. Main St., Room 203 Cortez, CO 81321 (970) 564-4126 phone (970) 565-8524 fax Approved Staff: Kelli Jackson Cole McKinney Brenda Jarmon Montrose County Department of Health and Human Services 1845 S. Townsend Ave. Montrose, CO 81401 (970) 252-5000 phone (970) 252-7049 fax Approved Staff: August Martinez Morgan County Department of Human Services PO Box 220 Ft. Morgan, CO 80701 (970) 542-3530 phone/(970) 542-3544 fax Approved Staff: Rachel Free Sheri Armstrong Jennifer Leach Shantel Nelson Otero County Deparhnent of Human Services PO Box 494 La Junta, CO 81050-0494 (719) 383-3168 phone (719) 383-3150 fax Approved Staff: Yolanda Luna** (Note: Otero County only does home studies for their county where the child is in the home and free for adoption) Ouray County Department of Social Services 177 Sherman St., Ste. 104 P.O. Box 530 Ridgway, CO 81432 (970) 626-2299 phone (970) 626-9911 fax Approved Staff: None at this time. Park County Department of Human Services PO Box 1193 Bailey, CO 80421 (303) 816-5939 phone (303) 816-5942 fax Approved Staff: Tammy Taylor Phillips County Department of Human Services *Vendor requires SAFE supervision **Provides SAFE supervision Kim Castellano Colorado's Approved Home Study Vendor List January 2019 127 E. Denver St., Ste. A Holyoke, CO 80734 (970) 854-2280 phone (970) 854-3637 fax Approved Staff: Lori Lundgren Samantha Lightle* Pitkin County Department of Health and Human Services 0405 Castle Creek Road, Ste. 8 Aspen, CO 81611 (970) 920-5235 phone (970) 544-1850 fax Approved Staff: None at this time. Prowers County Department of Human Services 1001 S. Main St. PO Box 1157 Lamar, CO 81052 (719) 336-7486 phone (719) 336-7198 fax Approved Staff: Jona Mills** Donna Guido* Courtney Holt Rogers** Lauri Davidson Pueblo County Department of Social Services 320 W_ 10th St., Ste. 207 Pueblo, CO 81003 (719) 583-6160 phone (719) 583-6377 fax Approved Staff: Amanda Ledbetter Penny Cox Tyra Schroll Julie Hanson Rio Blanco County Department of Human Services 345 Market St. Meeker, CO 81641 (970) 878-9640 phone (970) 878-4893 fax Approved Staff: None at this time. Sabrina Haines Elisa Drouillard Flora LaCrue Rio Grande/Mineral County Departments of Social Services 1015 6th St. Del Norte, CO 81132 (719) 657-3381 phone (719) 657-4013 fax Approved Staff: None at this time. Routt County Department of Human Services *Vendor requires SAFE supervision **Provides SAFE supervision Colorado's Approved Home Study Vendor List January 2019 PO Box 772790 Steamboat Springs, CO 80477 (970) 879-1540 phone (970) 870-5260 fax Approved Staff: Michael Sidinger Saguache County Department of Social Services PO Box 215 Saguache, CO 81149 (719) 655-2537 phone (719) 655-0206 fax Approved Staff: Meryl Tolsma San Miguel County Department of Social Services 333 W. Colorado Ave., 3'd Floor Telluride, CO 81435 (970) 728-4411 phone (970) 728-4412 Approved Staff: None at this time. Sedgwick County Department of Human Services 118 West 3'd St. PO Box 27 Julesburg, CO 80737 (970) 474-3397 x14 phone (970) 474-9881 fax Approved Staff: Natasha Thode Lauren Rising Summit County Department of Health and Human Services PO Box 869 Frisco, CO 80443 (970) 668-9160 phone (970) 668-9724 fax Approved Staff: Ashley Merrill Teller County Department of Social Services PO Box 7245 Woodland Park, CO 80863 (719) 686-5500 phone (719) 687-0429 fax Approved Staff: Linda Arroyo Julie Gilley** Brittany Cornelius Ralph Parson Pauline Knott Mary Longmire** Tisha Montesano Washington County Department of Human Services *Vendor requires SAFE supervision **Provides SAFE supervision Colorado's Approved Home Study Vendor List January 2019 PO Box 395 Akron, CO 80720 (970) 345-2238 phone (970) 345-2237 fax Approved Staff: Pamela McKay Weld County Department of Human Services PO Box A Greeley, CO 80631 (970) 352-1551 phone (970) 353-5215 fax Approved Staff: Veronica Cavazos Toilynn Edwards Jacqui Underwood Tyler Nava John Killen Brent Miller Yuma County Department of Social Services 340 S. Birch St. Wray, CO 80758 (970) 332-4877 phone (970) 332-4978 fax Approved Staff: Hollie A. Hillman *Vendor requires SAFE supervision **Provides SAFE supervision Desiree R. Flores Robin Overmyer Jamie Sanders Kate Jensen Alison Reece CPH & ASSOCIATES Certificate of Liability Insurance Date Issued: 07/03/2018 PHILADELPHIA INSURANCE COMPANIES t ‘h. 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: Jessica Brien 800 S Wilson Ave Loveland, CO 80537 Policy Number: E241641 Policy Term: 08/02/2018 to 08/02/2019 Occupation: Licensed Professional Counselor Covered Locations Professional Liability: Portable coverage, not location specific Coverage Type (Occurrence Form) Professional Liability Supplemental Liability Licensing Board Defense Commercial General Liability o Fire/Water Legal liability Business Personal Property Per Incident (Per individual claim) $ 1,000,000 1,000,000 $ 35,000 tWA NIA WA Aggregate (Total amount per year) $ 5,000,000 $ 5,000,000 S 35,000 N/A WA N/A CommentsfSpecial Descriptions: Certificate Holder Weld County DHS Tobi Vegter P.O. Box A Gneeley, CO 80632 ® Certificate Holder has been added as an additional insured 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 fieu of such endorsemenl(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 IM Auto Insurance Declaration Page FARMERS INSURANCE Policy Number: Effective Expiration Named Insured(s) Underwritten 8y 18816-55-33 1/9/2019 12:01 AM 7/9/2019 12:01 AM Mathew) Brien Jessica Brien 800 S Wilson Ave Loveland, CO 80537 mathewbr,enrryahoo .nom Farmers Insurance Exchange 6301 Owensmouth Ave Woodland Hills, CA 91367 Premiums/Fees Policy Premium Fees ('also see Information on Addit onal Fees beiow) $1,312.40 $1.50 ND' Policy Premium and Fees This is not a bill. Your b l with the amount due will be mailed separately. $1,313.90 Household Drivers Ail persons who drive or will occasionally be driving any of the cars on the policy should be listed below. If anyone is missing or needs to be added, such as a newly licensed driver, you should contact your agent or the company to add that person before they begin to drive any of the cars covered on the policy. Name Mathew) Brien Driver Status Name Covered Jessica Brien Vehicle Information Veh. k Year/Make/Model/VIN 1 1997 Dodge Truck Ram 3500 Club C Pu 4X2 2- 3B7MC33DBVM546672 2 2004 Audi A4 Avant Quattro SW 4Wd 1 WAUVC68E24A130567 2015 Volkswagen New jetta 4D 1 S SE/Spor 3VWD 17Aj6FM221748 Coverage Comprehensive: Collision Uninsured Motorist Property Damage Without Collision: Comprehensive: Collision. Uninsured Mc*cr st Property Damage Without Collision: Comprehensive: Collision: Uninsured Motorist Property Damage Without Collision: Deductible Not Covered Not Covered Not Covered $1,000 $1:000 Covered $1,000 $1,000 Covered Driver Status Covered Limit farmers.com Policy No. 18816-55-33 Questions? ,nwagne.r(4)tarr er,aae„r Manage your account: rrww farm e,y , orn 56-6176 Ist Edition 5-17 11/15/2018 Page 1 of 4 Declaration Page c• Vehic@Level Coverage Items <ovm7 E3.72«72«'A ?:mom 2a- Gzcy 2e s.2<w age tc!--,.-y.erecsve Da —age.± z«2«&y «6�gwe;s� yaw 2zwSe „c: « CaR C2:2a« a(5« $5C3 3CCeas «:os! $50C.00C e« w«o s! a?m ac a� m Policy yLevel Covegets ms taxes e .m«xeacJ� Q E� a c»S,_)0 GJ ac ac». c ax acne / @«aum,m' m@ ellic yavle 2 Verb dea $ m i97 $• 3 $92 3C; 'B « 2 2152 D±m %«� ws: i-13 4,:C' y2 x«29aea $5922 $'«;2 w« yw9= 2=y»e 2w« $ l7 z2 3z 12<9 Per $2.3.C 2C 11"- P■cyPremum Fee Detail Vzew zwwtw we . _ _ _ 50 goo- Fees - - 4°r, V m ,m m e ee: Discounts a72a<m, Other Po�c� Policy Features and Benefits • c;nnec,ti mwdn§g«>,��< • .��..«.. «�0«w> d« >ew,m`:m wsa«aw » w • Dwe2ed •car«<o» as:»« -»-«:a? S1,312.40 Kr»J rotor :» $ 50 S1.50 zl .z ! Jessica Rude Brien, MA, LPC 800 S. Wilson Ave Loveland, CO 80537 Phone: (970) 203-4743 Email: jessicakbrien@gmail.com QUALIFICATIONS: • Nine years of experience performing SAFE home studies. • Licensed Professional Counselor with 9 years of experience in a variety of fields, including trauma, attachment, managing challenging behaviors and parenting support. • Skilled in EMDR, play therapy and family therapy. EMPLOYMENT: September 2015 -present Piivate Practitioner at Jessica Brien, MA, LPC, LLC • Provide individual, family and couples therapy to clients of all ages, • Perform SAFE home studies on a contracted basis. June 2012 present Lutheran Family Services Rocky Mountains Clinician, Foster Care and Family Services • Provided therapy for children in therapeutic foster care, family therapy and parent education for at risk families, and performed SAFE home studies for a variety of families. • Helped children adjust, process grief and loss, and form healthy attachments; instructed parents on how to communicate and build healthy relationships. January 2012 -June 2012 Touchstone Health Partners Outpatient therapist, Child and Family Team • Provided intake, crisis intervention, and ongoing therapy services. • Facilitated healthy communication, anger management, and trauma processing groups. May 2008 -December 2011 Lutheran Family Services of Northern Colorado Clinician, Foster Care and Family Services • Provided therapy for children in therapeutic foster care and family therapy and parent education for at risk families. • Helped children adjust, process grief and loss, and form healthy attachments; instructed parents on how to communicate and build healthy relationships. March 2007 August 2008 The Greeley Transitional House, Inc. Child and Adolescent Program Coordinator • Met weekly with each child and his or her parents to help with adjustment and access to resources. • Assisted clients through brief clinical interventions and crisis management as needed. EDUCATION: August 2006- December 2008 Master of Arts Degree, University of Northern Colorado Clinical Counseling with an emphasis in Couples and Family Therapy August 2002 -May 2006 Bachelor of Arts Degree, University of Northern Colorado Psychology c&ext�e a roc, SAFE - Structured Analysis Family Evaluation 'Maio to certify that TeSSicot. Brien has iosoplrusd site SAFE .1 -dap training mad is eerri6rsi m perform SAFE Mentor Scadict 1?atcisk:CLAApsv it ♦'1 t aciso fit. &muting Memo Gi esettl ns tut Cluldmig nation 'this to certify dt E r 1 i sly I Qom SAFE REFRESHER COURSE - Structured Analysis Family Evaluation This is to certify that ‘)6(*Gr1 DrivA has completed B hours of SAFE Refresher Training Dace(s): athleen Cleary, Executive Director Consortium for Children EXHIBIT C SCOPE OF SERVICES 1. Contractor will conduct Home Studies, for the areas noted below, as referred by the Department. a. Kinship Care b. Foster Care c. Kinship Foster Care d. Parent Care e. Foster -Adoption f. Adoption g. Interstate Compact on the Placement of Children (ICPC) 2. Contractor is certified in Structured Analysis Family Evaluation (SAFE) and is on the State's approved home study vendor list. Contractor also is certified as a SAFE Supervisor. 3. Contractor will utilize the most current Structured Analysis Family Evaluation (SAFE) forms and templates. Contractor will ensure all home studies completed for the Department include, at a minimum, all the following: a. SAFE Home Study template. b. Compatibility Inventory. c. References and documented direct follow-up with references (phone call or meeting). d. Psychosocial Inventory for all applicants. e. Questionnaire I and II for all applicants. f. Indian Child Welfare Act (ICWA)/Indian heritage discovery and documentation. g. All additional collateral information collected from the applicants. h. Urinalysis (UA) result from a certified testing facility, if requested by the Department. A UA will be required for any individual 18 or older residing in the home, when requested by the Department, if substance abuse concerns are noted. The cost of the UA will be responsibility of the applicant. 4. Contractor will meet regularly with Department staff during the home study process. At a minimum, Contractor will meet with Department staff as follows: a. Following completion of individual applicant meetings. b. Three (3) weeks after the completion of individual applicant meetings. c. Prior to the final review with the applicant(s). 5. Contractor understands that reimbursement for partial home studies will only occur after the following: a. At least one (1) face-to-face meeting and two (2) phone contacts, and b. A letter has been submitted to the Department documenting why the study cannot move forward. 6. Capacity: Up to three (3) home studies at a time. 7. Location of Services: In referred family's home or in the Contractor's office at 1762 Hoffman Drive, Loveland, CO 80538. Contractor can travel outside of Greeley/Loveland/Fort Collins area, within Weld and Larimer counties for an additional mileage fee. Referrals outside of those counties will be considered on a case -by -case basis for an additional fee, plus mileage. 8. Language: English only. 9. Contractor will respond to the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400- 6210) within three (3) business days regarding the ability to accept the received referral. 10. Upon acceptance of a referral, Contractor will offer an initial appointment within seven (7) days of receiving the referral. The first attempt to contact the client will occur within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If the client does not respond after three (3) attempts in the first seven (7) days of the referral period, the Contractor will notify the caseworker and the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210). 11. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for visitation services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor 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" on the part of the client per month. After three (3) "no-shows", Contractor will place client on a behavioral plan requiring attendance or discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210). 12. Contractor understands that the Department will not reimburse Contractor for cancelled appointments either on the part of the client or the Contractor. If the cancellation is generated from the Contractor, a "makeup" session/episode, to occur within 30 days of the cancellation, will be offered to the client (excluding session/episodes that fall on holidays). If the cancellation is generated from the client, the Contractor must request a makeup session from the Department prior to the makeup session occurring (excluding session/episodes that fall on holidays). After three (3) cancellations, Contractor will inform the caseworker and the Quality Assurance Team Supervisor (hainlejd@weldgov.com) immediately via email, to discuss service continuation. 13. Contractor will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 14. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 15. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 16. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 17. Contractor will notify the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210) of new staff who will manage and/or administer the services with the following information: a. Staff member name and contact information b. Education level/degree (if applicable) c. Licensure/credentials (if applicable) d. Department of Regulatory Authority (DORA) number (if applicable) e. Supervisor name and contact information The Department reserves the right to decline the new staff members managing and/or administering services to Department clients. EXHIBITD 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 $1,600.00/Episode (Home Study, 2 Adults) $700.00/Episode (Home Study Update) $300.00/Episode (Partial Home Study, denied or withdrawn) $150.00/Episode (Additional Travel Fee) $100.00/Each (Extra Adults(s) after first two (2), per extra adult) $50.00/Hour (Additional Face -to -Face Time) $ .56/Mile (Transportation rate) 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7"' day of the month following the month of service, but no later than 60 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 60 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph .3(d) of this Agreement. For one-time services, proof of services rendered shall be receipt of a Client Verification Form and the completed product. For Monitored Sobriety services, proof of services rendered shall be the test result. Hello