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Home My WebLink About20192481.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 'COrL151,4P-Z Page 1 / oo9D AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND ARIEL CLINICAL SERVICES This Agreement Amendment, made and entered into day of of Weld County Commissioners, on behalf of the Weld County Department of Hum "Department", and Ariel Clinical Services, hereinafter referred to as the "Contractor". 2021 by and between the Board Services, hereinafter referred to as the WHEREAS the parties entered into an Agreement for Home Studies, Life Skills, and Mentoring/Behavior Coaching, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2481, approved on July 1, 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 • December 9, 2019 to amend the Scope of Services and Rate Schedule. • April 29, 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 2019-2481. • 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. ATTES . - "X160�� BOARD OF COUNTY COMMISSIONERS Weld ' ou ty Ierk to the B • . r �� WELD COUNTY, COLORADO COUNTY: By: teve Moreno, Chair APR 2 6 2021 Ariel Clinical Services 4660 Wadsworth Boulevard Wheatridge, Colorado 80033 By: Date: michelle powner 2021 13:14 MDT) Michelle Powner, Program Manager Apr 14, 2021 02.079, 02Val Contract Form Entity Information Entity Name* ARIEL CLINICAL SERVICES New Contract Request Entity ID* @00035654 Contract Name* ARIEL CLINICAL SERVICES (AGREEMENT AMENDMENT} Contract Status CTB REVIEW Contract Description* BID #81900025 TERM: 6; 1 r Contract Description 2 CONSENT. PA WAS SENT TO Contract Type* AMENDMENT Amount* 50.00 Renewable* NO Automatic Renewal Grant 21-5/31I22 CTB ON 3,:31;21. Department HUMAN SERVICES Department Email CM - H u man Servi c e snweldgov. c o m Department Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY WELDG CYil.COM New Entity? Contract ID 4681 Contract Lead* APEGG Contract Lead Email apeggOweldgov.com;cobbx xlk@weldgov.com Requested BOCC Agenda Date* 05:26i2021 Parent Contract ID 20192481 Requires Board Approval YES Department Project # Due Date 05,222021 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 NSA enter NSA 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* 04/0112022 Renewal Date Termination Notice Period Contact Information Committed Delivery Date Expiration Date* 05/'31/2022 Contact Info Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date CONSENT 04/19/2021 Approval Process Department Head JAMIE ULRICH DH Approved Date 04,19x2021 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 04)26)2021 Originator APEGG Finance Approver CONSENT Legal Counsel CONSENT Finance Approved Date Legal Counsel Approved Date 04,1912021 04 19/2021 Tyler Ref #E AG 042621 5555 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 1 CM Approve Recommendation Work Session Schedule Other/Comments: Pass -Around Memorandum; April 2, 2020 — Not in CMS Page 1 H5D' 20tL-JPtsi o l /A q7 VENDOR RENEWALS Vendor A New World Program Area Mentoring Service Name Be avior Coac ing Funding Core Rate $ 30.00 Unit Type Hour Adoption Options Relinquishment Counseling Relinquishment Counseling CW Block/Child Welfare Services $ 400.00 Episode Transportation beyond 70 miles CW Block/Child Welfare Services $ 0.56 Mite Youth Counseling, 12 yrs. or Older CW Block/Child Welfare Services $ 75.00 Hour Ariel Clinical Services Home Based Services Behavior Coaching Core $ 65.00 Hour -. Behavior Coaching -Step Down Core $ 40.00 Hour Transportation Core $ 0.56 Mile Home Studies Additional Adult(s), After 2 CW Block/Child Welfare Services $ 250.00 Each Cancelled Home Study CW Block/Child Welfare Services $ 225.00 Episode Home Study CW Block/Child Welfare Services $ 1,500.00 Episode Home Study Update CW Block/Child Welfare Services $ 750.00 Episode Incomplete Home Study CW Block/Child Welfare Services $ 750.00 Episode Transportation CW Block/Child Welfare Services $`, 0.56 Mile Life Skills Structured Parenting Time Core $ 130.00 Hour Supervised Visitation Core $ 130.00 Hour Mentoring Mentoring Core $ 65.00 Hour Mentoring-Step Down Core $ 40.00 Hour Transportation Core $ 0.56 Mile Art & Soul Care, LLC Home Studies Additional Adult(s), After 2 CW Block/Child Welfare Services $ 200.00 Each Full Home Study, 2 Adults CW Block/Child Welfare Services $ 1,100.00 Episode Home Study Update CW Block/Child Welfare Services $ 800.00 Episode Mileage CW Block/Child Welfare Services $ 0.56 Mile Partial Home Study CW Block/Child Welfare Services $ 600.00 Episode Life Skills Mileage Core $ 0.56 Mile Staffing, FTM, TDM, etc. Core $ 130.00 Hour Therapeutic Visitation, Home/Community Based Core $ 195.00 Hour Therapeutic Visitation, In Office Core $ 130.00 Hour Aver Psychological & Wellness Services, LLC Mental Health Services Brainspotting Individual Session Core $ 85.00 Hour Individual Therapy Core $ 80.00 Hour Mental Health Evaluation Core $ 450.00 Episode Mental Health Treatment In Home Core $ 120.00 Hour Mindfulness Group Core $ 85.00 Episode Nutrition Group Core $ 85.00 Episode Sexual Abuse Treatment Boundaries Group Core $ 40.00 Episode Boundaries Individual Core $ 80.00 Hour Boundaries Individual In Home Core $ 120.00 Hour Concurrent Substance Abuse Group Core $ 45.00 Hour Offense Specific Treatment for Juveniles, High Intensity Core $ 90.00 Hour Offense Specific Treatment for Juveniles, Regular Core $ 85.00 Hour Psychosexual Evaluation Core $ 845.00 Episode Sexually Reactive Treatment, High Intensity Core $ 90.00 Hour Sexually Reactive Treatment, Regular Core $ 85.00 Hour Young Adult Sex Offense Treatment, High Intensity Core $ 90.00 Hour Young Adult Sex Offense Treatment, Regular Core $ 85.00 Hour Barry R. Lindstrom, Ph.D., LLC Mental Health Services Case Consultation Core $ 175.00 Hour WELD COUNTY DEPT. OF HUMAN SERVICES - CHILD WELFARE DIVISION 2020-21 SERVICE VENDORS (CORE/NON-CORE) BID NO-: B2000037 C�-1�-► � ,z'17 # 3353 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND ARIEL CLINICAL SERVICES This Agreement Amendment, made and entered into OG/ day of o4Gt,21,by and between the Board of Weld County Commissioners, on behalf of the Weld County Departm t of Human ervices,1 ereinafter referred to as the "Department", and Ariel Clinical Services, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Coaching and Mentoring Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2481, approved on July 1, 2019. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on May 31, 2020. • The Original Agreement was amended on December 9, 2019. The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2019-2481. • 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. ATTES WAgfrtIftiV Weld ourt(y Cler By: Deputy Clerk ,'. the : oard ke Freeman, Chair COUNTY: BOARD OF COUNTY COMMISSIONERS LD COUNTY, COLORADO Arid Clinical Services 4660 Wadsworth Boulevard Wheatridge, CO 80033 By: APR 2 9 2020 Michelle Powner, Prram Manager Date: L CG: Oh) -a-9-ao �iq zy�i FiRoogD Contract Form Entity Information New Contract Request Entity Name* ARIEL CLINICAL SERVICES Entity ID* @00035654 Contract Name* ARIEL CLINICAL SERVICES (AGREEMENT AMENDMENT FOR SERVIES) Contract Status CTB REVIEW ❑ New Entity? Contract ID 3555 Contract Lead* CULLINTA Contract Lead Email cullinta(aco weld co.us Parent Contract ID Requires Board Approval YES Department Project I Contract Description* CONSENT. BID NO. 2600037. BOCC APPROVAL 04/15/20 CHILD PROTECTION AGREEMENT AMENDMENT. TERM: 06101120 THROUGH 05/31/2021 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@vweldgov corn Department Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY A I I ORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WELD GOV.COM If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Requested BOCC Agenda Date * 04/15/2020 Due Date 04)1112020 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Termination Notice Period Review Date* 04/01/2021 Committed Delivery Date Renewal Date Expiration Date 05/3112021 Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JAMIE ULRICH DH Approved Date 04/21/2020 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 04/29/2020 Originator SNYDERKL Contact Type Contact Email Finance Approver BARB CONNOLLY Contact Phone 1 Contact Phone 2 Purchasing Approved Date Finance Approved Date 04/22/2020 Tyler Ref # AG 042920 Legal Counsel GABE KALOUSEK Legal Counsel Approved Date 04/22(2020 Submit 3Ofro%ct PRIVILEGED AND CONFIDENTIAL #3131 MEMORANDUM DATE: November 20, 2019 TO: Board of County Commissioners — Pass -Around FR: Judy A. Griego, Director, Human Services RE: Agreement Amendment with Ariel Clinical 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 Agreement Amendment with Ariel Clinical Services. The Department entered into an agreement with Ariel Clinical Services with a term of June 1, 2019 through May 31, 2020, for Life Skills. This agreement is identified as 2019-2481, approved on July 1, 2019. The provider has requested to separate Mentoring and Behavior Coaching, previously identified as one single service available under the agreement. The rate per hour remains the same at $65.00 per hour for both services with the addition of a step-down rate of $40.00 per hour, which will be available under both Mentoring and Behavior Coaching. I do not recommend a Work Session. I recommend approval of this Amendment and authorize the Chair to sign. Sean P. Conway Mike Freeman, Pro -Tern Scott James Barbara Kirkmeyer, Chair Steve Moreno Approve Recommendation Work Session Schedule Other/Comments: Pass -Around Memorandum; November 20, 2019 - CMS 3131 Page 1 6e/. ex- 6-34--e (AD) 9 / 9 ()WV io qv AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND ARIEL CLINICAL SERVICES This Agreement Amendment made and entered into K day of L)`'C /'2019 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department", and Ariel Clinical Services hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Home Studies, Life Skills, and Mentoring/Behavior Coaching ("Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2481, approved on July 1, 2019. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on May 31, 2020. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Exhibit C, Scope of Services, is hereby amended as attached. 2. Exhibit D, Rate Schedule, is hereby amended as attached. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. �_- / COUNTY: ATTEST: .0fir 44 `� " ;i1 BOARD OF COUNTY COMMISSIONERS Weld%un C •rktothe B By: Deputy Clerk t; the oard WE D COUNTY, COLORADO arbara Kirkmeyer, Ariel Clinical Services 4660 Wadsworth Boulevard Wheat Ridge, CO 80033 (303) 703-9351 By: Date: michelle 2019) powner ep 12, DECO 9 2019 Michelle Powner, Program Manager Foster Care and Adult Services Sep 12, 2019 020/9- 0?S'/ EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Home Studies, Life Skills and Mentoring/Behavior Coaching, as referred by the Department. 2. Services available under this agreement include: a. Behavior Coaching: One-on-one and group activities with peers weekly for a designated number of hours. i. Capacity for Services: Three (3) to four (4) hours per week, with a maximum of 40 hours per week. ii. Goals of Service: 1. Teach child specific skills. 2. Guide child towards learning a new behavior or replacement behavior so that the child succeeds in changing a behavior which would otherwise prevent him or her for achieving the goal of personal growth or to allow them to be successful in their environment. 3. Support parents and foster parents by spending the time with the child outside their home and offering short-term respite for three (3) to four (4) hours. iii. Outcomes of Service: Improvement in the child's comprehensive health, social skills, coping skills, emotional regulation, and behavioral regulation. iv. Target Population: Any eligible child, age birth to 18 (no specific gender). v. Services Access: Various locations in the Denver Metro area as well as the Grand Junction greater area. vi. Language: English and Spanish. All reports and communication will be in English. b. Mentoring Program: One-on-one and group activities with peers weekly for a designated number of hours. i. Capacity for Services: Three (3) to four (4) hours per week, with a maximum of 40 hours per week. ii. Goals of Service: 1. Development of a healthy relationship with an adult mentor who can model coping skills and self -regulation while assisting the child to improve their self- esteem. 2. Support parents and foster parents by spending the time with the child outside their home and offering short-term respite for three (3) to four (4) hours. iii. Outcomes of Service: Improvement in the child's comprehensive health, social skills, coping skills, emotional regulation, and behavioral regulation. iv. Target Population: Any eligible child, age birth to 18 (no specific gender). v. Service Access: Various locations in the greater Grand Junction area. 1 vi. Language: English and Spanish. All reports and communication will be in English. c. Home Studies i. Contractor will conduct Home Studies, for the areas noted below, as referred by the Department. 1. Kinship Care 2. Foster Care 3. Kinship Foster Care 4. Parent Care 5. Foster -Adoption 6. Adoption 7. Interstate Compact on the Placement of Children (ICPC) ii. 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. iii. 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: 1. SAFE Home Study template. 2. Compatibility Inventory. 3. References and documented direct follow-up with references (phone call or meeting). 4. Psychosocial Inventory for all applicants. 5. Questionnaire I and II for all applicants. 6. Indian Child Welfare Act (ICWA)/Indian heritage discovery and documentation. 7. All additional collateral information collected from the applicants. 8. 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. iv. Contractor will meet regularly with Department staff during the home study process. At a minimum, Contractor will meet with Department staff as follows: 1. Following completion of individual applicant meetings. 2. Three (3) weeks after the completion of individual applicant meetings. 3. Prior to the final review with the applicant(s). v. Contractor defines an incomplete home study as 10 or more hours invested in the home study, contacts and writing time, and the study is not completed due to factors outside of the Contractor's control. Such factors include the applicant stopping the process or a decision of the Department for any reason. vi. Contractor understands that reimbursement for partial home studies will only occur after the following: 1. At least one (1) face-to-face meeting and two (2) phone contacts, and 2. Three and one-half (3-1/2) hours of direct face-to-face contact; 3. A letter has been submitted to the Department documenting why the study cannot move forward. 2 vii. Capacity: Two (2) to four (4) home studies per month. viii. Location of Services: Any home in Greeley, Colorado. ix. Language: English only. d. Structured Parenting Time: Monitoring and hands on modeling, to include direct feedback provided to parent. This will include verbal redirection or verbal prompts to help teach a parent a desired behavior/outcome, or hands-on modeling to allow for feedback in the moment. Guidance will be provided to the parent to teach a skill and to encourage the bond between the parent and child. i. Capacity for Services: Sixty (60) hours per week. ii. Goals of Service: Assist biological parents to learn skills to be able to spend time unsupervised and ultimately reunite with their children. iii. Outcomes of Service: 1. Visit narrative submitted monthly that documents: a. Preparedness of parents for visit b. Responses of children and parents to each other c. Description of activity during the visit d. Observation of parents' ability to interact and redirect their children e. Reactions of the child(ren) at the conclusion of the visit 2. Contractor will redirect parent, as needed, and offer the parent feedback afterwards, as warranted. iv. Target Population: Parents and their children. v. Service Access: 1. 4660 Wadsworth Boulevard, Wheat Ridge, CO 2. Community locations such as libraries, fast food restaurants with play areas, city parks, and Department buildings up to 40 miles one way from 4660 Wadsworth Boulevard, Wheat Ridge, CO vi. Language: English only. e. Supervised Visits: Monitoring and hands on modeling, to include direct feedback provided to parent. This will include verbal redirection or verbal prompts to help teach a parent a desired behavior/outcome, or hands-on modeling to allow for feedback in the moment. Guidance will be provided to the parent to teach a skill and to encourage the bond between the parent and child. i. Capacity for Services: Sixty (60) hours per week. ii. Goals of Service: Assist biological parents to learn skills to be able to spend time unsupervised and ultimately reunite with their children. iii. Outcomes of Service: 1. Visit narrative submitted monthly that documents: a. Preparedness of parents for visit b. Responses of children and parents to each other 3 c. Description of activity during the visit d. Observation of parents' ability to interact and redirect their children e. Reactions of the children) at the conclusion of the visit 2. Contractor will redirect parent, as needed, and offer the parent feedback afterwards, as warranted. iv. Target Population: Parents and their children. v. Service Access: 1. 4660 Wadsworth Boulevard, Wheat Ridge, CO 2. Community locations such as libraries, fast food restaurants with play areas, city parks, and Department buildings up to 40 miles one way from 4660 Wadsworth Boulevard, Wheat Ridge, CO vi. Language: English only. 3. Contractor will transport up to 30 miles one way (inclusive of multiple stops) from 4660 Wadsworth Boulevard, Wheat Ridge, CO, at no additional charge. Transportation beyond 30 miles one way will incur additional charges. Contractor understands that transportation beyond the catchment area must be approved by the Department. 4. Contractor will respond to the Quality Assurance Team Supervisor (hainlejd@weldgov.com, 970-400- 6210) within three (3) business days regarding the ability to accept the received referral. 5. Upon acceptance of a referral, Contractor will offer an initial appointment within seven (7) days of receiving the referral. The first attempt to contact the client will occur within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If the client does not respond after three (3) attempts in the first seven (7) days of the referral period, the Contractor will notify the caseworker and the Quality Assurance Team Supervisor (hainlejd(dweldgov.com, 970-400-6210). 6. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for visitation services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understand that the Department will no reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows" on the part of the client per month. After three (3) "no-shows, "Contractor will place client on a behavioral plan requiring attendance or discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team Supervisor (hainlejdAweldgov.com, 970-400-6210). 7. 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 c(�,weldgov.com) immediately via email, to discuss service continuation. 8. 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. 4 9. 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. 10. 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. 11. 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. 12. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Court Staffings, Family Team Meetings and/or Team Decision Making meetings. Contractor may participate by phone, if approved by the Department. 13. Contractor will notify the Quality Assurance Team Supervisor (hainlejdna,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. 5 EXHIBIT D RATE SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specific in Paragraph 2, below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2020. Expenses incurred by the Contractor prior to the term of this Agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Home Studies: $225.00/Episode (Cancelled home after 3.5 hours of face-to-face contact.) $1,500.00/Episode (Home Study) $750.00/Episode (Home Study Update) $ .56/Mile (Transportation) Life Skills: $130.00/Hour (Structured Parenting Time) $130.00/Hour (Supervised Visitation) Mentoring: $65.00/Hour (Mentoring) $40.00/Hour (Stepdown — Mentoring) Behavior Coaching: $65.00/Hour (Behavior Coaching) $40.00/Hour (Stepdown — Behavior Coaching) 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7th day of the month following the month of service, but no later than 60 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 60 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. For one-time services, proof of services rendered shall be receipt of a Client Verification Form and the completed product. For Monitored Sobriety services, proof of services rendered shall be the test result. Entity Name k ARIEL CLINICAL SERVICES New Contract Requ Entity ID* ii 0035654 tract Marne* ARIEL CLINICAL SERVICES (AGREEMENT AMENDMENT) Contract Status CTB REVIEW tL Description* ❑ New Entity? Contract ID 3131 Contract Lead* CtJLLINTA Contract Lead Email cullinta@coweldca.us AMENDMENT OF 2019-20 CHILD PROTECTION AGREEMENT FOR SERVICES. Contract Description 2 Contract Type "" AGREEMENT Amount* $0.00 Re NO Automatic Renewal If this is a ren . x n HUMAN SERVICES nt Email CM- HurnanServices@weldgovcam rtrnent Head Email CM-HurnanSeryces- DeptHead veidgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WELD GOV. COM nter previous Contract ID If this is part of a MSA enter MSA Contract ID Requested BOCC Agenda Date* 09/25/2019 Parent Contract ID 20192481 Requires d YES Department Project # Due Date 09>r21 /"2019 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Effective Date Termination Notice Period Review Date* 0.01/2020 Committed Delivery Date Renewal Date 2 Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JUDY GRIEGO DH Approved Date 11/13/2019 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 11;27/2019 Originator CULLINTA Contact Type Contact Email Finance Approver BARB CONNOLLY Contact Phone 1 Contact Phone 2 Purchasing Approved Date Finance Approved Date 11/13/2019 Tyler Ref # AG 112719 Legal Counsel KARIN MCDOUGAL Legal Counsel Approved Date 11/21.+2019 Submit '0?(.0•J-IL° CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND ARIEL CLINICAL SERVICES This Agreement, made and entered into the day o , 2019, by and between the Board of Weld County Commissioners, on behalf of the Weld County Departme t of uman Services, hereinafter referred to as the "Department' and Ariel Clinical Services, hereinafter referre to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule. Exhibit B, C, and D are attached hereto and incorporated herein by this reference. Exhibit A is Weld County's Request for Proposal Number B1900025, which is incorporated into this agreement by reference and will be provided upon request to the Department. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided Core Services or other funding to the Department for Home Studies, Life Skills, and Mentoring/Behavior Coaching. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1, 2019, upon proper execution of this Agreement and shall expire May 31, 2020, unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Response to Request for Proposal and Exhibit C, Scope of Services. 3. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210). No other Department staff or other party to the case may authorize services or modifications to services. 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 reauired by the 1 cc. HSD tottici 2019-2481 /-ko09e, 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 includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and - Title VII of the Civil Rights Act of 1964; and 3 - the Age Discrimination in Employment Act of 1967; and - the Equal Pay Act of 1963; and - the Education Amendments of 1972; and - Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is determined by the Department. d. Contractor assures and certifies that 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. § 24-76.5-103(3), if Contractor receives federal or state funds under the contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24- 76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5- 103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor ag•ees 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 claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to the Department, whichever is earlier. c. Contractors shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor shall provide a copy of this information to its insurance agent or broker and shall have its agent or broker provide proof of Contractor's required insurance. The Department reserves the right to require Contractor to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor's insurer shall name County as an additional insured as follows f. Waiver of Subrogation: For all coverages, Contractor's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors, independent contractors, sub -vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor. Contractor shall include all such subcontractors, independent contractors, sub -vendors, suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors, suppliers or other entities upon request by the Department. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contractor shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 10. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. "I -ring Contractor may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-400-6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor will collaborate in a timely manner with the Department to resolve issues pertaining to service delivery, service quality, documentation, and invoicing during referral period and after services have concluded. The Contractor will require clients sign releases of information. Contractor understands that the Department will not reimburse for services rendered to Department clients until releases of information are obtained. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. The monitoring agency may, if in its sole discretion deems necessary or appropriate, have access to any 8 program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures for purposes of monitoring. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Child Welfare Division Head Michelle Powner, Program Manager 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 400-6510 9 For Contractor: Michelle Powner, Program Manager 4660 Wadsworth Boulevard Wheat Ridge, CO 80033 (303) 703-9351 18. Litigation Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third -Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall 10 not enter into any third -party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. A conflict of interest or appearance of a conflict of interest may also apply to personal relationships between providers and clients. If a provider has a personal relationship with a client to whom the Contractor may provide services for, the Contractor must disclose that relationship to the Department. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 11 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contractor agrees that it is an independent Contractor and that Contractor's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall perform its duties hereunder as an independent Contractor. Contractor shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contractor, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contractor or any of its agents or employees. Unemployment insurance benefits will be available to Contractor and its employees and agents only if such coverage is made available by Contractor or a third party. Contractor shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contractor shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contractor shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and as set forth in Exhibit A provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 12 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to the Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by the Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shal 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. §§24-18-2D1 et seq. and §24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflicts with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contractor's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contractor agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contractor acknowledges that the Department has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of this project without the Department's prior written consent, which may be withheld in the Department's sole discretion. 13 36. Attorney's Fees/Legal Costs In the event of a dispute between the Department and Contractor, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of the Department. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contractor in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the Department. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of the Department. 38. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. 14 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: AA) �j�. •4 11.1.44 Weld County Clerk to the Board WELD COUNTY, COLORADO BOARD OF COUNTY COMMISSIONERS By: L/l.• f?"11AS21 Deputy Clerk to the Board 15 Barbara Kirkmeyer, Chair, CONTRACTOR: Ariel Clinical Services 4660 Wadsworth Boulevard Wheat Ridge, CO 80033 (303) 703-9335111.0' michelle powner (2019) By: Date: ._ C _[.pi's$ Michelle Powner, Program Manager Foster Care and Adult Services May 2,2019 049/9 -am EXHIBIT A WELD COUNTY'S REQUEST FOR PROPOSAL (Weld County's Request for Proposal is incorporated into this agreement by reference and will be provided upon request to the Department.) This page intentionally left blank. EXHIBIT B CONTRACTOR'S RESPONSE TO REQUEST FOR PROPOSAL Clinical Services Children g Families A ul January 28, 2019 To: Human Services, Contract Management in Weld County From: Ariel Clinical Services Re: RFP for Home Studies and Supervised Visits Please accept the following proposal for Ariel to provide services to the children and families of Weld County. Ariel is committed to assisting all children and families be safe and successful and we look forward to continue to work with Weld County in these endeavors. Thank you for your consideration, Rebecca A. Hobart CEO 2938 North Avenue Suite G Grand Junction CO 81504 Phone: 970.245.1616 Fax: 970.24'1.8722 4251 Kipling Street, Suite 500 Wheatridge CO 80033 Phone: 303.703.9351 Fax: 3031033.4500 1520 North Union Blvd., Suite 100 Colorado Springs CO 80909 Phone: 719.260.6110 Fax: 719.260.6170 EXHIBIT B Wel Ariel Clinical Services 501.3(c) ] (i PROVIDEINFORMATION FORM County partment of Human Services AGENCY OR PRIVATE PRACTICE TRAILS PROVIDER ID (If Known) Michelle Powner Program Manager, Foster Care and Adult Services PRIMARY CONTACT — FULL NAME PRIMARY CONTACT - TITLE i 03) 703-9351 ( 303 ) 703-4500 PHONE NUMBER m,powner@arielcpa.org PRIMARY CONTACT— E-MAIL ADDRESS 4660 Wadsworth Blvd. AGENCY MAILING ADDRESS EXT. FAX NUMBER www.arielcpa.org AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) Wheat Ridge, CO 80033 CITY ZIP REFERRAL CONTACT Michelle Pawner. MY'R Pro cram Manager. Foster Care and Adult Services REFFERAL CONTACT — FULL NAME REFERRAL CONTACT- TITLE (303) 703^9351 pa mpowner@arielcpa.org REFERRAL CONTACT— PHONE NUMBER EXT REFERRAL CONTACT— E-MAIL ADDRESS Michelle Pawner MSW BILLING CONTACT Program Manager, Foster Care and Adult Services, BILLING CONTACT — FULL NAME BILLING CONTACT - TITLE (3O3j 703-9a51 moowner©arielcua.org BILLING CONTACT— PHONE NUMBER EXT. BILLING CONTACT — E-MAIL ADDRESS I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it has so indicated in this bid form. I further affiirn 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 ids are competitive in price and quality. Signature of Authorized Representative: Date of Signature: 1/28/19 f L' Bid No.: B1900025 ESTERIN ST11A11E Cliii IFGE ('CAL THE TRUSTEES OF THE STATE COLLEGES IN COLORADO UPON THE RECOMMENDATION OF THE FACULTY OF WESTERN STATE COLLEGE HEREBY CONFER UPON DEANNA MAE DINGWALL THE DEGREE OF BACHELOR OF ARTS WITH ALL THE RIGHTS, RESPONSIBILITIES, PRIVILEGES, AND HONORS THEREUNTO APPERTAINING. CONFERRED AT GUNNISON, COLORADO, THIS FIFTH DAY OF MAY, TWO THOUSAND AND ONE. e. 11. P ' PSIDE T OF THE COLLEGE 'f sr_ ACING PRES J T STAI _ E. COLLEGES t 'OLORADC) VI E PRF.IDI~'v'T FOR ACADEMIC AFFAIRS ! RUS I EES OF THE STATE COLLEGES IN COLORADO * StuUS;.'t ND:, em elk 1\ Date Issued: 30-JUL-2009 Record of: Deanna Mae Dingwall Issued To: Leslie Plett HR-Ariel Clinical Services 2938 North Avenue#G Grand Junction, CO 81504 Course Level: Undergraduate Degree Awarded : Bachelor of Arts 05 -MAY -2001 Srr7 NO Major : Emphasis: Major : INSTITUTION CREDIT: Fall Term CORE 197 COTH 119 ENG 099 HIST 126 PSY 151 SOC 168 Ehrs: 1997 14.00 Spring Term BIOL 120 ENG 102 PSY 150 RECR 182 SOC 169 Ehrs: 15.00 Fall Term ANTH 107 COTH 200 ENG 155 MATH 205 PSY 258 1998 Psychology Clinical, Counsel .&School Psych Sociology COURSE TITLE SOW NO. COURSE TITLE OFFC Page: 1 CRED GRD PTS R Institution Information continued: SOC 201 THE SOCIOLOGICAL IMAGINATION 3.00 A- 11.01 Ehrs: 15.00 GPA-Hrs: CRED GRD PTS R Fall US V ST:FRESHMAN FRESHMAN FOCUS DEVELOPMENT OF THEATRE -FILM GRAMMAR & COMPOSITION REVIEW AMERICAN HISTORY TO 1865 GENERAL PSYCHOLOGY AMERICAN SOCIAL PROBLEMS GPA-Hrs: 14.00 Pts: 46.01 1998 ISSUES IN BIO:HUM.AN REPRODUCTN ENGLISH COMPOSITION I GENERAL PSYCHOLOGY INTRODUCTION TO RECREATION GLOBAL SOCIAL PROBLEMS GPA-Hrs: 15.00 Pts: 41.01 GPA: 2.73 2.00 3.00 0.00 3.00 3.00 3.00 GPA: Good Standing A B- S A B B 3.28 Good Standing INTRO TO GENERAL ANTHROPOLOGY PUBLIC SPEAKING & ADVOCACY FRSHMN LIT: THE COLD WAR APPL MATH W/COMPUTER IMPLMNTNS INTRODUCTION TO PERSONALITY Ehts: 15.00 GPA -Hrs : Spring Term POLS 180 PSY 200 PSY 270 PSY 468 1999 AMERICAN FEDERAL GOVT STAT ANAL & EXP METH I /W LAB DEVELOPMENTAL PSYCHOLOGY ABNORMAL PSYCHOLOGY * * * * * * * CONTINUED ON NEXT COLUMN 3.00 B- 3.00 C+ 3.00 B 3.00 B 3.00 B- 15.00 Pts: 45.99 GPA: Good Standing 3.00 B 3.00 B 3.00 B 3.00 Bf 3.00 B 3.06 3,00 B 3.00 B 3.00 A 3.00 A- 8.00 8.01 0,00 12.00 9.00 9.00 8.01 6.99 9.00 9.00 8.01 9.00 9.00 9.00 9.99 9.00 9.00 9.00 12.00 11.01 PSY PSY SOC SOC Term 1999 301 336 460 300 400 Ehrs: 15.00 Spring Term KINS 132 PSY 457 PSY 491 SOC 210 SOC 300 SOC 370 15.00 Pts: 52.02 GPA: 3.46 Good Standing STAT ANAL & EYPER METH 1W IT PSYCHOLOGY OF MOTIVATION PSYCHOLOGICAL TESTING SOC MIST: FAMILY VIOLENCE SOC THEORY:INTERPRETIVE 3 00 u 3.00 C 3.00 A 3.00 A 3.00 A GPA-Hrs: 15.00 Pts: 51.00 GPA: 3.40 Good Standing 2000 WEIGHT TRAINING SOCIAL PSYCHOLOGY HUMAN SEXUALITY RESEARCH DESIGN SOC INST: SOCIAL SERVICES SOCIAL INEQUALITIES: RACE Ehrs: 16.00 GPA-Hrs: 16.00 Pts: 57.01 Fall Term 2000 ART 106 PSY 345 PSY 475 PSY 499 .SEC 453 Ehrs: 16.00 Spring Term PSY SOC .SOC SOC SOC 397 322 350 351 399 1.00 A 3.00 B 3.00 B 3.00 A- 3.00 A 3.00 A GPA: 3.56 Good Standing STUDIO ART FOR NON -ARTIST BIOPSYCHOLOGY CLINICAL PSYCHOLOGY INTERN: PARTNER'S YOUTH PROG CONTEMPORARY THEORY GPA-Hrs: 16.00 Pts: 59.01 3.00 A 4.00 B 3.00 A 3.00 A 3.00 A- GPA: 3.68 Good Standing 2001 ST: HEALTH PSYCHOLOGY MEDICAL SOCIOLOGY DEVIANCE JUVENILE DELINQUENCY INTERN: GUNNISON PARTNERS 3.00 3.00 3.00 3.00 3.00 Ehrs: 15.00 GPA-Hrs: 12.00 Pts: 45.99 GPA: Dean's List Good Standing ********************* CONTINUED ON PAGE 2 B+ A A A S 3.83 9.00 6.00 12.00 12.00 I 12.00 4.00 9.00 9.00 11.01 12.00 I 12.00 12.00 12.00 12.00 12.00 11.01 9.99 12.00 12.00 12.00 0 00 • r r; fr 1 rn 1, 2 a H 11 O O 4,44 !DI 44 1 in 2 t o mmi C) C) a 1rn a PURSUANT TO THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT OF 1974, INFORMATION CONTAINED HEREIN SHALL NOT BE RELEASED TO A THIRD PARTY WITHOUT THE WRITTEN AUTHORIZATION OF THE STUDENT SIT. This officia► document is printed on SCRIP -SAFE" security paper with the name of the institution printed.in white type across, the race tit the document When photocopied, the name of the college and Me word COPY should appear. A BLACK ON WHITE OR A COLOR COPY SHOULD NOT BE ACCEPTED An official signature is white with a red background. L _ Re tra r TRANSCRIPT KEY IS PRINT N REV R E `. 4 5tt,tst'o ' . No;. Date Issued: 30-JUL-2009 Record of: Deanna Mae Dingwall Level: Undergraduate *********************t TRANSCRIPT TOTALS *********************** Earned Hrs GPA Hrs Points GPA TOTAL INSTITUTION 121.00 118.00 398.04 TOTAL TRANSFER OVERALL 0.00 0.00 3.37 0.00 0.00 121.00 118.00 398.04 3.37 OP TPANSCRTPT **********k*++********* OFFC Page: 2 PURSUANT TO THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT OF 1974. INFORMATION CONTAINED HEREIN SHALL NOT BE RELEASED TO A THIRD PARTY WITHOUT TfrE WRITTEN AUTHORIZATION OF THE STUDENT. This official document is printed on SCRIP -SAFE& security paper with the name of the institution printed in, white type across the face of the document, When photocopied. the name of the C.XJliege and the word COPY should appear, A BLACK ON WHITE OR A COLOR COPY SHOULD NOT BE ACCEPTED An official signature is white with a red background. I rn Z m z v -a O v n O No v v z d 0 n O m a TRANSCRIPTKEY IS PRINTED a REVERSE • t tl I C to em ry-I S-1 11 Structured Analysts Family Evaluatton "MOW', 'iu.a?P .,..,r-. 1'.owMH'h5'VR(M'.^+R'R.'.1RAVICHIT' 1 i .•+* fl.utc .wort , a nv`attaM-MYte6AS e0IV -"'.. aa.v..wM'i++r5v^wiuttCv::+utvr..,,•_r aWtxoi___$4166.a•P•.«„,.. x..wn to ce..rs1 rr that has completed the SAFE 2 -day tr�s°m'm arid certirea to iyerform SAFE Hone SuudicS MOCT19i"V'C••-r"..MIta. _ sAN.Y'•'4Y.k.,Y: all03 200iaL411.•=6JYr.r — . S.. - — b use aw.•w flows w.. IN - u r - laafirnodISOMUA twaii.mai re OM -yJ eti Karhken cte r';r 3;;s 'L" ` '.7 ��i CiV�` x.�irCt. rector r Ji^_? i•3_Lil For CyChildren f I •...-,-- ^ ,;ter rd.'. . fl rte. rg Ca I I Cr -4 4-0 Ls) 1 • r O I ••• lid .t6 SvetageStkiihr . p. --.-r.• ..• 5/22/2 J r J Y �\ y ll -^ .y -� ifl3 f tor ,1• Children. & Family Training r Colorado Department of Human Services -.r WESTERN STATE COLLEGE R THE TRUSTEES OF THE STATE COLLEGES IN COLORADO UPON THE RECOMMENDATION OF THE FACULTY OF WESTERN STATE COLLEGE HEREBY CONFER UPON DEANNA MAE DINGWALL THE DEGREE OF BACHELOR OF ARTS WITH ALL THE RIGHTS, RESPONSIBILITIES, PRIVILEGES, AND HONORS THEREUNTO APPERTAINING. CONFERRED AT GUNNISON, COLORADO, THIS FIFTH DAY OF MAY, TWO THOUSAND AND ONE. i(h(-1/)eP ESIDENT OF THE COLLEGE ..e4$074,7 ACTING PRES jj' ` . 'T STATE COLLEGES 'OLORADO VI' E PRESIDENT FOR ACADEMIC AFFAIRS I RUSTEFS OF THE STATE COLLEGES IN COLORADO t Stuei`Snt No ' : Record of: Deanna Mae Dingwall Issued To: Leslie Plett HR-Ari el Clinical Services 2938 North Avenue#G Grand Junction, CO 81504 Course Level: Undergraduate Degree Awarded : Bachelor of Arts 05 -MAY -2001 Major : Psychology Emphasis: CIinical,Counsel.&School Psych Major : Sociology SUar NO. COURSE TITLE INSTITUTION CREDIT: Fall Term CORE 197 COTH 119 ENG 099 HIST 126 PSY 151 SOC 168 Ehrs: 14.00 1997 CRED GRD ST:FRESHMAN FOCUS 2.00 A DEVELOPMENT OF THEATRE -FILM 3.00 B - GRAMMAR & COMPOSITION REVIEW 0.00 S AMERICAN HISTORY TO 1865 3.00 A GENERAL PSYCHOLOGY 3.00 B AMERICAN SOCIAL PROBLEMS 3.00 B GPA-Hrs: 14.00 Pts: 46.01 GPA: 3.28 Good Standing Spring Term 1998 BIOL 120 ISSUES IN BIO:HUMAN REPRODUCTN 3.00 B- ENG 102 ENGLISH COMPOSITION I 3.00 C+ PSY 150 GENERAL PSYCHOLOGY 3.00 B RECR 182 INTRODUCTION TO RECREATION 3.00 B SOC 169 GLOBAL SOCIAL PROBLEMS 3.00 B- Ehrs: 15.00 GPA-Hrs: 15.00 Pts: 41.01 GPA: 2.73 Good Standing Fall Term ANTH 107 COTH 200 ENG 155 MATH 205 PSY 258 Ehrs: 1998 15.00 Spring Term POLS 180 PSY PSY PSY 200 270 468 ********* INTRO TO GENERAL ANTHROPOLOGY PUBLIC SPEAKING & ADVOCACY FRSHMN LIT:THE TIE COLD WAR APPL MATH W/COMPUTER IMPLMNTNS INTRODUCTION TO PERSONALITY 3.00 B 3.00 B 3.00 B 3.00 B+ 3.00 B GPA-Hrs: 15.00 Pts: 45.99 GPA: 3.06 Good Standing 1999 AMERICAN FEDERAL GOVT STAT ANAL & EXP METH I/W LAB DEVELOPMENTAL PSYCHOLOGY ABNORMAL PSYCHOLOGY 3.00 B 3.00 B 3.00 A 3.00 A - .SOW NO. spat*. ett COURSE TITLE Date Issued: 30-JUL-2009 OFFC Page: 1 CRED GRD PTS Institution Information continued: SOC 201 THE SOCIOLOGICAL IMAGINATION 3.00 A- 11.01 Ehrs: 15.00 GPA-Hrs: PTS R Fall PSY 8.00 8.01 0.00 12.00 9.00 9.00 8.01 6.99 9.00 9.00 8.01 9.00 9.00 9.00 9.99 9.00 9.00 9.00 12.00 11.01 ********fl* CONTINUED ON NEXT COLUMN ***r**r********* PURSUANT T TO THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT OF 1974. INFORMATION ' CONTAINED HEREIN SHALL NOT BE RELEASED TO A THIRD PARTY WITHOUT THE WRITTEN AUTHORIZATION OF THE STUDENT. * * * PSY PSY SOC SOC Term 301 336 460 300 400 1999 Ehrs: 15,00 Spring Term KINS 132 PSY 457 PSY 491 SOC 210 SOC 300 SOC 370 Ehrs: 15.00 Pts: 52.02 GPA: 3.46 Good Standing STAT ANAL & EXPER METH Tr PSYCHOLOGY OF MOTIVATION PSYCHOLOGICAL TESTING SOC INST: FAMILY VIOLENCE SOC THEORY:INTERPRETIVE 3 00 u 3.00 C 3.00 A 3.00 A 3.00 A GPA-Hrs: 15.00 Pts: 51.00 GPA: 3.40 Good Standing 2000 WEIGHT TRAINING SOCIAL PSYCHOLOGY HUMAN. SEXUALITY RESEARCH DESIGN SOC INST: SOCIAL SERVICES SOCIAL INEQUALITIES: RACE 16.00 GPA-Hrs: 16.00 Pts: 57.01 Fall Term ART 106 PSY 345 PSY 475 PSY 499 SOC 403 1.00 A 3.00 B 3.00 B 3.00 A- 3.00 A 3.00 A GPA: 3.56 Good Standing 2000 STUDIO ART FOR NON -ARTIST BIOPSYCHOLOGY CLINICAL PSYCHOLOGY INTERN:PARTNER'S YOUTH PROG LONT EMPORARY THEORY Ehrs: 16.00 GPA-Hrs: Spring Term PSY 397 SOC 322 SOC 350 SOC 351 SOC 399 16.00 Pts: 59.01 3.00 A 4.00 B 3.00 A 3.00 A 3.00 A- GFA: 3.68 Good Standing 2001 ST: HEALTH PSYCHOLOGY MEDICAL SOCIOLOGY DEVIANCE JUVENILE DELINQUENCY INTERN: GUNNISON PARTNERS 3.00 B+ 3.00 A 3.00 A 3.00 A 3.00 S Ehrs: 15.00 GPA-Hrs: 12.00 Pts: 45.99 GPA: 3.83 Dean's List Good Standing ********************* CONTINUED ON PAGE 2 This official document is printed on SCRIP -SAFE' security paper with the name of the institution printed.in white type across the face at the document. When photocopied. the name of the college and the word COPY should appear A BLACK ON WHITE OR A COLOR COPY SHOULD NOT BE ACCEPTED An official signature is white with a red background. 9.00 6.00 12.00 12.00 I 12.00 4.00 9.00 9.00 11.01 12.00 I 12.00 12.00 12.00 12.00 12.00 11.01 9.99 12.00 12.00 12.00 0 00 *+r***************** strar 2516 I e Date Issued: 30-JUL-2009 Record of: Deanna Mae Dingwall Level: Undergraduate ***********t* TRANSCRIPT TOTALS *********************** Earned Mrs CPA Firs Points TOTAL INSTITUTION 121.00 118.00 398.04 TOTAL TRANSFER OVERALL 0.00 0.00 GPA 3.37 0.00 0.00 121.00 118.00 398.04 ******t*r*****t******* J?J%7 3.37 OF TRANSCRTPT ***#******k*+**+******* OFFC Page: 2 itt..~.earnibMM^VI YYRYHWKivMAt-Fc�`4+: �YTNY•J-1 `M!N/M\VS.h\Mn AYM\gvl.YMie4.lxG11Vf/YX/B2'/RMfMN/.Y PURSUANT TO THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT OF 1974, INFORMATION CONTAINED HEREIN SHALL NOT BE RELEASED TO A THIRD PARTY WITHOUT THE WRITTEN AUTHORCATION OP THE STUDEaNT. This official document is printed on SCRIP -SAFES security paper with the name of the institution printed in white type across the face of the document. When photocopied. the name of the -Jliege and the word COPY should appear A BLACK ON WHITE OR A COLOR COPY SHOULD NOT BE ACCEPTED, An official signature is white with a rad ba :ground. m 0 C rn a O bti 0 O 0 rn al fit ....y,asua. papayaIttlea :.R^.nronr CCN^d SZ0KFay.".i.:•FJrwngaleur+M,•'Mawpt�!'.Y.WbtN4N:rvNa.N¢ypaA5?`MT5t,9M�G!�M.. a M1 itgiVitSittled.Cortia o, kl:..: ?._�- ...'4A.45k"MPwS�.B.F''dYd+J:GnB'd+A3vw.•. -ss,emnvrwpmxax.•vac^Ctmaac Anal vs is Family Evaluation y i • .} x:Yf:cw.v,pry.MCk`MaPo'awanWaOCtl'ek!G^.'f.',lCik'?.Offn env lAk Y. c_Lired Y • S is to Certifr th0t. rov'+C.'."X„'•p,t.-»...,..y...me a.-.-., .....-.— n . �,,..evG.m u;'% wad..r..,.rrcYly'..a..wm....+..ywbl•s+GYMertee ow <as completed the r J tr•= a and zto pE :. �.,,: �, .r--• �<,.�' ...�1'f.�il� �� _� s'� 1 �;:.A�:.ti'_�. Derform 1 s� ��1`;�'N £ �-�.4?�:�e Studies GentrrM.a.ivevtWaew,^ c' ...YwM^‘"Y7TTL'b.MRa..^..ve.a J3Qt'JWt"ir.1.4'H\Ao':c r..QSt.Ma1$FMY.W ab.�ln ry nY.S1lNryS4Yiearan.Taara.•WK6N.7aG1PW'.J.'.C"'4Jf3J.'Awa.:_SMN.na'.bllaa YN1RY`yT ta—ta-' nran.:Y• •vw. oi@t, Ti4 , ielowe.•,w:rtw4w NO, .w• n4 W d! a*I, Are it f /• Kathleen Cleary, Execusf ivy ConSo?rtium tor Children 4. I K Win' !w'N`Wn elty,t MM..ngg' .ifile IMM„h.MR. .. ..... .... M M'1^!'F.C1M1ir te. , r4:'y.R. nVwrn!901MentaVitt J„. •T!.'�EJr•....w`_.@_iK'.�...`....n.., ., Y"..�..---- .... Y:' ;.. "5T�'1:`1.'::.� X.'n'C.Tvrvn.�. �i t This is te ce Children & Family Training Colorado Department of Human Services 1 ® A 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYW) 10/04/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Rnnacol Assurance 7501 E. Lowry Blvd. Denver, CO 80230-7006 CONTACT NAME: PHONE I FAX Est): (A/C, No): /CLo, ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Pinnacol Assurance 41190 INSURED Niel Clinical Services 2938 North Ave Suite D, F, G, H Grand Junction, CO 81504 INSURER B : INSURER C : INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSO SUER WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I $ DAMAGE TO RENTECLAIMS-MADE PREMISES (Ea occcu ence) i $ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY '', $ GENERAL AGGREGATE I $ GEN'L I AGGREGATE POLICY OTHER: LIMIT APPLIES JECT PER: LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE , ' LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED l RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) ETIO be under DSIf CRIPON OF OPERATIONS below Y/N NIA 3246850 10/01/2018 10/01/2019 PERH STATUTE X ER E.L. EACH ACCIDENT ($1,000,000 E.L. DISEASE - EA EMPLOYEE�I $ 1,000,000 E.L. DISEASE - POLICY LIMIT 5 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Unless otherwise stated in the policy provisions, coverage in Colorado only. For informational purposes CERTIFICATE HOLDER CANCELLATION 1934838 Ariel Clinical Services 2938 North Ave. Ste. G Grand Junction, CO 81504 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Associates Insurance Group ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORDs provided by Forms Boss. www.FormsBoss.com; (c) Impressive Publishing 800-208-1977 CERTIFICATE HOLDER COPY Ariel Clinical Services 2938 North Ave. Ste. G Grand Junction, CO 81504 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form 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. DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT (CONT) AFRO ARIECLI-01 CERTIFICATE OF LIABILITY INSURANCE JCOOPERt DATE (MM/DD/YYYY) 10/01/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER License # 0757776 HUB International Insurance Services (COL) 1125 17th Street, Suite 900 Denver, CO 80202 INSURED Ariel Clinical Services 2938 N Ave Ste G Grand Junction, CO 81504 C NTACT 1 PHONE Eae (303) 893.0300 YrYKtF�ac. IFAX WC, No) (866) 243-0727 INSURERIS) AFFORDING COVERAGE NAIC a INSURER A Alliance of Nonprofits for Insurance, Risk Retention Group (AND 10023 _. INSURERs: Lloyd'sof London 115792 • INSURER C INSURER D INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS INSR LTR IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY ADDLISUBR _.,.,.....-,._. _-...,,... -.._,_ ..,._...,._...�.... ..... ..,11... POLICY EPF TYPE OF INSURANCE POLICY NUMBER f +�I l4SD WVD y (14(►YIIOD/YYYYI TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, PAID CLAIMS. rPOLICY EXP ( 1 LIMITS A X ii [A. ,I COMMERCIAL GENERAL LIABILITY ,. 1 CLAIMS MADE i X I OCCUR { _... ... .......�..._._ __ ._._. ( .-_,-.._._..._....,___.. ...,._..._.. ....,� ._: # AGGREGATE LIMIT APPLIES PER. t# POLICY I 1 LOC ) { OTHER; ( ,(IAMfOD(YYYY1 ! 2018-10702 110/01/20181 10/01/2019 j j - !`: t ( EACH OCCURRENCE $ 1'000,000 I P ES TOEREN@TJED�4iC@1 _ $ 100,000 . MEDEXPIA�io^t.P.grson 5 000 000,000 1 PERSONAL &ADVINJURY l.$ ...... GENERAL AGGREGATE 11__ 3,000,000 - PRODUCTS- C;UMPlOP AGG $ 3,000,000 LIQUOR LIABILIT $ 1,000,000 A AUT_ X L.,.w OMOBILE LIABILITY ANY AUTO OWNED I SCHEDULED AUTOS ONLY , AUTOS pO.� pp A�S ONLY — AU7�Y z }2018-10702AUT ( ; ; 1 10/01/2018 10/01/2019 I # . COMBINED SINGLE LIMIT 1,000,000 ssx4snt) BOoiLV INJURY__ erpersanj, S BODILY INJURY (Per accident r $ PBLTPERTY, GE ... j eta 1..-..._____.__,,..._,. I $ ._.,,,...- _... _..•...„..._„.., .._-- $ A X rl UMBRELLA LIAB ix EXCESS LIAR I DED X RETENTION $ OCCUR CLAIMS -MADE 10,000 I I2018.10702UMB 10/01/2018 10/01/2019 EACH OCCURRENCE $ 2,000,000 AGGREGATE 2,000,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY V / N ANY PROPRIETOR/PARTNER/EXECUTIVE ' ' 0pF�PIg ER/MEMBER EXCLUDED? ` __ anBatory In NH) t --, - If yes, describe under DESCRIPTION OF OPERATIONS below N / A € 1 3 i I ( 1 I j }{ 1 PER I OTH- I ST.ATU.L..1 I ER,..v,.. 1 E.L.-EACH ACCIDENT $ 1...... } ----------- EL DISEASE. EA EMPLOYE E.L.. DISEASE - POLICY LIMIT $ A B ICyberlPrivacy j Professional Liab 1 2018-10702 IWN163621 f 10/01/2018 10/01/2019 10/01/2018 10/01/2019 ELimit Limit 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) This section intentionally left blank. CERTIFICATE HOLDE R CANCELLATION For Informational Purposes Only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Home Studies, Life Skills and Mentoring/Behavior Coaching, as referred by the Department. 2. Services available under this agreement include: a. Coaching/Mentoring Program: One-on-one and group activities with peers weekly for a designated number of hours. i. Capacity for Services: Three (3) to four (4) hours per week, with a maximum of 40 hours per week. ii. Goals of Service: 1. Development of a healthy relationship with an adult mentor who can model coping skills and self -regulation while assisting the child to improve their self- esteem. 2. Support parents and foster parents by spending the time with the child outside their home and offering short-term respite for three (3) to four (4) hours. iii. Outcomes of Service: Improvement in the child's comprehensive health, social skills, coping skills, emotional regulation, and behavioral regulation. iv. Target Population: Any eligible child, age birth to 18 (no specific gender). v. Service Access: Various locations in the greater Grand Junction area. vi. Language: English and Spanish. All reports and communication will be in English. b. Home Studies i. Contractor will conduct Home Studies, for the areas noted below, as referred by the Department. 1. Kinship Care 2. Foster Care 3. Kinship Foster Care 4. Parent Care 5. Foster -Adoption 6. Adoption 7. Interstate Compact on the Placement of Children (ICPC) ii. 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. iii. 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: 1 1. SAFE Home Study template. 2. Compatibility Inventory. 3. References and documented direct follow-up with references (phone call or meeting). 4. Psychosocial Inventory for all applicants. 5. Questionnaire I and II for all applicants. 6. Indian Child Welfare Act (ICWA)/Indian heritage discovery and documentation. 7. All additional collateral information collected from the applicants. 8. 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. iv. Contractor will meet regularly with Department staff during the home study process. At a minimum, Contractor will meet with Department staff as follows: 1. Following completion of individual applicant meetings. 2. Three (3) weeks after the completion of individual applicant meetings. 3. Prior to the final review with the applicant(s). v. Contractor defines an incomplete home study as 10 or more hours invested in the home study, contacts and writing time, and the study is not completed due to factors outside of the Contractor's control. Such factors include the applicant stopping the process or a decision of the Department for any reason. vi. Contractor understands that reimbursement for partial home studies will only occur after the following: 1. At least one (1) face-to-face meeting and two (2) phone contacts, and 2. Three and one-half (3-1/2) hours of direct face-to-face contact; 3. A letter has been submitted to the Department documenting why the study cannot move forward. vii. Capacity: Two (2) to four (4) home studies per month. viii. Location of Services: Any home in Greeley, Colorado. ix. Language: English only. c. Structured Parenting Time: Monitoring and hands on modeling, to include direct feedback provided to parent. This will include verbal redirection or verbal prompts to help teach a parent a desired behavior/outcome, or hands-on modeling to allow for feedback in the moment. Guidance will be provided to the parent to teach a skill and to encourage the bond between the parent and child. i. Capacity for Services: Sixty (60) hours per week. ii. Goals of Service: Assist biological parents to learn skills to be able to spend time unsupervised and ultimately reunite with their children. iii. Outcomes of Service: 2 1. Visit narrative submitted monthly that documents: a. Preparedness of parents for visit b. Responses of children and parents to each other c. Description of activity during the visit d. Observation of parents' ability to interact and redirect their children e. Reactions of the child(ren) at the conclusion of the visit 2. Contractor will redirect parent, as needed, and offer the parent feedback afterwards, as warranted. iv. Target Population: Parents and their children. v. Service Access: 1. 4660 Wadsworth Boulevard, Wheat Ridge, CO 2. Community locations such as libraries, fast food restaurants with play areas, city parks, and Department buildings up to 40 miles one way from 4660 Wadsworth Boulevard, Wheat Ridge, CO vi. Language: English only. d. Supervised Visits: Monitoring and hands on modeling, to include direct feedback provided to parent. This will include verbal redirection or verbal prompts to help teach a parent a desired behavior/outcome, or hands-on modeling to allow for feedback in the moment. Guidance will be provided to the parent to teach a skill and to encourage the bond between the parent and child. i. Capacity for Services: Sixty (60) hours per week. ii. Goals of Service: Assist biological parents to learn skills to be able to spend time unsupervised and ultimately reunite with their children. iii. Outcomes of Service: 1. Visit narrative submitted monthly that documents: a. Preparedness of parents for visit b. Responses of children and parents to each other c. Description of activity during the visit d. Observation of parents' ability to interact and redirect their children e. Reactions of the child(ren) at the conclusion of the visit 2. Contractor will redirect parent, as needed, and offer the parent feedback afterwards, as warranted. iv. Target Population: Parents and their children. v. Service Access: 1. 4660 Wadsworth Boulevard, Wheat Ridge, CO 2. Community locations such as libraries, fast food restaurants with play areas, city parks, and Department buildings up to 40 miles one way from 4660 Wadsworth Boulevard, Wheat Ridge, CO vi. Language: English only. 3 3. Contractor will transport up to 30 miles one way (inclusive of multiple stops) from 4660 Wadsworth Boulevard, Wheat Ridge, CO, at no additional charge. Transportation beyond 30 miles one way will incur additional charges. Contractor understands that transportation beyond the catchment area must be approved by the Department. 4. 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. 5. 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). 6. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for visitation services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understand that the Department will no reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows" on the part of the client per month. After three (3) "no-shows, "Contractor will place client on a behavioral plan requiring attendance or discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210). 7. 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. 8. 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. 9. 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. 10. 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. 11. 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, 4 change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 12. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Court Staffings, Family Team Meetings and/or Team Decision Making meetings. Contractor may participate by phone, if approved by the Department. 13. 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. 5 EXHIBIT D RATE SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specific in Paragraph 2, below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2020. Expenses incurred by the Contractor prior to the term of this Agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Home Studies: $225.00/Episode (Cancelled home after 3.5 hours of face-to-face contact.) $1,500.00/Episode (Home Study) $750.00/Episode (Home Study Update) $ .56/Mile (Transportation) Life Skills: $130.00/Hour (Structured Parenting Time) $130.00/Hour (Supervised Visitation) Mentoring/Behavior Coaching: $65.00/Hour (Mentoring) $ .56/Mile (Transportation) 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7th day of the month following the month of service, but no later than 60 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 60 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. For one-time services, proof of services rendered shall be receipt of a Client Verification Form and the completed product. For Monitored Sobriety services, proof of services rendered shall be the test result. t, ,110,Y1 ft 1,001i Print full name as sia ed full name as si ed Study Vendor list, understand and acknowledge that I cannot and wilt not perform home studies except those that are assigned to me by a County Department of Human/Social Services, or a Cotora©o- licensed Child Ptacement Agency. COLO AD Office of Children, Youth 8- Families Division of Child Welfare ATTESTATION OF UNDERSTANDING , as an approved vendor on Colorado's Approved Home I acknowtedge that any home study that I perform for a family that is not affiliated with a County Department of Human/Social Services, or a Colorado -Licensed C iitd Placement Agency wilt be considered an invalid home study by the State of Colorado and cannot be presented as valid to any other state or organization in the U.S. l acknowledge that, after having signed this attestation, if I complete a home study for a family or individual who is not affiliated with a County Department of Human/Social Services or a Colorado -licensed Child Ptacement agency, I wilt be removed from Colorado's Approved Home Study Vendor List for a period of no less than one year. Signature Date of Si nature v Applied Home Study Vendor 1 ��r _orsworn to before me in the County of - c1`� '\ Subscribed and affirmed, � m� d 5 �� State of rg Joi1/4)Ukrtd � a y Comm iss on Expires: I' Notary Publiputy Cterk , this day of 20 I/ . TAYLOR R. RIVAS Notary Public State of Colorado Notary ID # 20134033523 My Commission Expires 08-21-2022 Attestation for Home Study Vendor List Rev.. 8-18 COLORAD Office of Children, I Youth. 8- Families Division of Child Welfare Ai TESTATI0N OF UNDERSTANDING as an approved vendor on Colorado's Approved -Home Print full name as signed Study Vendor list, understand and acknowledge that I cannot and will not perform home studies except those that are assigned to me by a County Department of Human/Social Services, or a Colorado- licensed Child Placement Agency. I acknowledge that any home study that I perform for a family that is not affiliated with a County Department of Human/Social Services, or a Colorado -Licensed Child Placement Agency will be considered an invalid home study by the State of Colorado and cannot be presented as valid to any other state or organization in the U.S. acknowledge that, after having signed this attestation, if I complete a home study for a family or indivicual who is not affiliated with a County Department of Human/Social Services or a Colorado -licensed Child Placement agency, I wilt be removed from Colorado's Approved Home Study Vendor List for a period of no less than one year. Y' I 4f Signature 17 i L) J Date of Signature Applied Home Study Vendor Subscribed and affirmed, or sworn to before me in the County of t)Q\O n State of \,I)11 CAM , this My Commission Expires: ///7 • Notary Obi cf De ut Clem day ofN moor , 20 IK/ TAYLOR A. RIVAS Notary Public State of Colorado Notary ID # 20184033523 My Commission Expires 08-21-2022 Attccct-211"inn fnr Hrimp Rt•t wit/ Vint-94na- I kJ- R D O Office 1/4..,f Children, Youth Et Fa Gies Division of Child Welfare ATTESTATION OF UNDERSTANDING -lye( ____ as an approved vendor on Colorado's Approved Home Print full name as signed Study Vendor List, understand and acknowledge that I cannot and will not perform home studies except those that are assigned to me by a County Department of Human /Social Services, or a Colorado- Licensed Child Placement Agency. I acknowledge that any home study that I perform for a family that is not affiliated with a County Department of Human/Social Services, or a Colorado -licensed Child Placement Agency will be considered an invalid home study by the State of Colorado and cannot be presented as valid to any other state or organization in the U.S. I acknowledge that, after having signed this attestation, if I complete a home study for a family or individual who is not affiliated with a County Department of Human/Social Services or a Colorado -licensed Child Placement agency, I witt be removed from Colorado's Approved Home Study Vendor List for a period of no tess than one year. I F /17- ;2-7 14/ Date o Signature Applied Home Study Vendor Subscribed and affirmed, or sworn to before me in the County of State of f1 Yw' \f \ f My Commission Expires: , this P�vA\ I i day of Notary Pubr Duty Clerk -usront TAYLOR R, RIVAS Notary Public State of Colorado Notary lD # 20184033523 My Commission Expires 08-21-2022 Attestation for Home Study Vendor List Rev. 8-18 1, IA I oiteUe ORAL' Office of Children, Youth 8- Families Division of auk' Vi elf are ATTESTATION OF UNDERSTANDING )0 1m (10,�as an approved vendor on Colorado's Approved Home — , Print lull name as signed Study Vendor list, understand and acknowledge that I cannot and wilt not perform home studies except those that are assigned to me by a County Department of Human/Social Services, or a Colorado- licensed Child Placement Agency. that any home study that I perform for a family that is not affiliated with a I acknowledge County Department artment of Human/Social Services, or a Colorado -licensed Child Placement Agency will be considered an invalid home study by the State of Colorado and cannot be presented as valid to any other state or organization in the U.S. I acknowledge that, after having signed this attestation, if I complete a home study for a family or individual who is not affiliated with a County Department of Human/Social Services or a Colorado -licensed Child Placement agency, 1 wilt be removed from Colorado's Approved Home Study Vendor List for a period of no less than one year. E-7 C r Signature /2-- /7 — Date of Signature , Applied Home Study Vendor Subscribed and affirmed, or sworn to before me in the County of OQ State of \_,U��'C`C� � , this /71kdayofm\Y My Commission Expires: D Notary ublic r i ty Clerk t -4%za f_Str\A TAYLOR R. R1VAS Notary Public State of Colorado Notary ID # 201 84033523 My Commission Expires 08-21-2022 Attestation for Home Study Vendor List Rev. 8-18 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: Ariel Clinical Services 501 3(c) Child Welfare — Coaching/ Mentoring Program 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Mentoring services provided to children for both one-on-one and group activities with peers weekly for numbers of hours designated. 4. Capacity to Provide Services (ex. 4 hours/week). The average hours, for mentoring, is 3-4 hours per week. The maximum hours are 40 hours per week by contract. 5. Goals of the service. The goals of this service are to develop a healthy relationship with an adult mentor who can model coping skills and self regulation, while assisting the client in self esteem improvement. This also provides support to parents and foster parents by spending time with the child outside their home and offering short term respite for 3-4 hours. 6. Outcomes of service. The outcomes of this service are the improvements in the child's comprehensive health, social skills, coping skills, emotional regulation, and behavioral regulation. 7. Target population for service. Any child who is eligible. Age ranges from birth to age 18 with no specific gender. 8. Service access. Various locations in the Grand Junction greater area. 9. Languages service is available in. Languages provided are English and Spanish. All reports and communication are in English. 10. Rates of service. The rate for this service is $65 per hour. Bid No.: 1900025 19 Bidder's legal entity name: 2® Program name or serice ty beim'.proposed: PR EXHIBIT C POSAL TEMPLATE Ariel Clinical Services 501 3(c) Child Welfare - Home Studies 3m dalities, curriculum or tools that will be utilized in the delivery of the service. Home visit studies utilize the SAFE certification process. We have attached current resumes, SAFE certifications for those who will write Home Studies. Three redacted SAFE studies were included with initial submission as an example. Caacity t Provide Services (ex. 4 hours/week). Our capacity is 2-4 Home Studies per month. 5. Goals , .f the service. To ensure safe kin, adoptive, and foster families and their appropriateness to provide care to children and youth. 6. Outcomes of service. The main outcome is the SAFE Home Study, including approval or denial of the home . Also included are a compatiblity inventory, references for all parties, psychosocial inventory for all parties, and questionnaires one and two for all parties. Additional information will be included as requested. 7. Targ t population for service. The target population is any family who is eligible. 8O S rvice access. We would complete Home Studies for any homes in Greeley. There would be an additional charge 9. Languages service is available in. English. We are native speakers. Rates of service. The charge for a full Home Study is $1,500. There will be a $225 charge as a cancelation fee after 3.5 hrs of direct face-to-face contact, and $250 additional fee per adult, beyond two adults, per home study. An incomplete home study or an update to an existing home study will be a charge of $750. An incomplete home study is one where 10 or more hours is invested into the Home Study (contacts and writing time) and was not completed due to factors out of Ariel's control. This could include a family deciding to stop the process or a decision on Weld County's part for any reason. Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: Ariel Clinical Services 501 3(c) Child Welfare — Structured Parenting Time 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Monitoring and hands-on modeling, to include direct feedback provided to parent. This can include verbal redirection or verbal prompts to help teach a parent a desired behavior/outcome, or hands-on modeling to allow for feedback in the moment. Guidance will be provided to the parent to teach a skill and to encourage the bond between the parent and child. 4. Capacity to Provide Services (ex. 4 hours/week). Sixty hours per month 5. Goals of the service. We work with biological parents to learn skills to be able to spend time unsupervised and ultimately reunite with their children. 6. Outcomes of service. For each visit, a narrative is composed by the supervisor of the visit. Those narratives will be submitted to the county monthly. Narratives document preparedness of parents for the visit, responses of children and parents to each other, description of activity during the visit, observation of parents ability to interact and redirect their children, and reactions of the children at the end of the visit. During the visit, staff will redirect the parent, as needed, and offer the parent feedback afterwards as warranted. 7. Target population for service. Parents and their children. S. Service access. We will provide the service at our office located at 4660 Wadsworth Blvd. Wheat Ridge, Colorado. We will also provide this service in community locations including public libraries, fast food restaurants with play areas, city parks, and county buildings. We are willing to go up to 40 miles one way from the office. 9. Languages service is available in. English. We are native English speakers. 10. Rates of service. The rate for this service is $130 per hour. Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: Ariel Clinical Services 501 3(c) Child Welfare - Supervised Visits 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Monitoring and hands-on modeling, to include direct feedback provided to parent. This can include verbal redirection or verbal prompts to help teach a parent a desired behavior/outcome, or hands-on modeling to allow for feedback in the moment. Guidance will be provided to the parent to teach a skill and to encourage the bond between the parent and child. 4, Capacity to Provide Services (ex. 4 hours/week). Sixty hours per month 5. Goals of the service. We work with biological parents to learn skills to be able to spend time unsupervised and ultimately reunite with their children. 60 Outcomes of service. For each visit, a narrative is composed by the supervisor of the visit. Those narratives will be submitted to the county monthly. Narratives document preparedness of parents for the visit, responses of children and parents to each other, description of activity during the visit, observation of parents ability to interact and redirect their children, and reactions of the children at the end of the visit. During the visit, staff will redirect the parent, as needed, and offer the parent feedback afterwards as warranted. 7. Target population for service. Parents and their children. Ba Service access. We will provide the service at our office located at 4660 Wadsworth Blvd. Wheat Ridge, Colorado. We will also provide this service in community locations including public libraries, fast food restaurants with play areas, city parks, and county buildings. We are willing to go up to 40 miles one way from the office. 9. Languages service is available in. English. We are native English speakers. 10. Rates of service. The rate for this service is $130 per hour. Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: Ariel Clinical Services 501 3(c) Child Welfare —Transportation 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Staff vehicle, gas, time 4. Capacity to Provide Services (ex. 4 hours/week). Sixty hours per month 5. Goals of the service. To allow staff the ability to go to families for various services, such as supervised visitation, completing a home study, or mentoring services. Transportation may allow the service to occur in the family home as staff can be reimbursed for the drive time. Furthermore, it may allow for a staff to work with a family in a larger catchment area if the cost of transportation is reimbursed. Additionally, the transportation of a child to meet with their parent may be a service provided. 6. Outcomes of service. Transportation to be provided to allow the follow-through of an above mentioned service. 7. Target population for service. Parents and their children. 8. Service access. Dependent on the service provided. Services could occur at the Ariel office, in the community, at the county building, or in a family's home. We are willing to go up to 40 miles one way from the office, understanding that transportation beyond the catchment area must be approved by WCDHS. 9. Languages service is available in. English. We are native English speakers. 10. Rates of service. For in -home, community based services transportation that occurs within the catchment area of 30 miles one way (inclusive of multiple stops) is included in the rate; outside of the catchment area, Ariel will be reimbursed at $0.56 per mile. Bid No.: 1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: BIDDER LEGAL ENTITY NAME: Safe Home Studies and Updates APPLICABLE OR CONTRACTOR INFORMATION SU..UPERV) OW R STAFF MEMBER No. Last Name First Name Work# Work Email Education Level Degree Focus Licensure/ Credentials DORA # (If applicable) Est bl First Name x: , _—__. „ .. -Wort Ez q ___._-- '"$%fury, 1 Granzen Kelsey 303-703-9351 kgranzen@arielcp Bachelors Social Work Safe Certified N/A 2 Dingwall Deanna 303-703-9351 ddingwall@arielcp Bachelors BA Safe Certified N/A 3 Shiloh Jones 303-703-9351 siones@arielcpa.c Bachelors BA Safe Certified N/A 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Bid No.: B1900025 Powner Michelle 303-703-9351 mpowner@arielcp Powner Michelle 303-703-9351 mpowner@arielcp Powner Michelle 303-703-9351 mpowner@arielcp 1111 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) Supervised Visitation PROPOSED SERVICE OR SERVICE TYPE: BIDDER LEGAL ENTITY NAME: APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION SUPERVISOR INFORMATION ? No. Last Name First Name Work# Work Email Education Level Degree Focus Licensure/ Credentials DORA # (If applicable) Last Name First Name Work # Work Email I i 1 Dingwall Deanna 303-703-9351 ddingwall@arielcc Bachelors BA Safe Certified N/A Powner Michelle 303-703-9351 mpowner@arielcp 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1111 22 23 24 25 26 27 28 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) Bid No.: B1900025 I . com on 06/08/2015 06:46 PM TRAN000007649121 O s a Ei From Colorado State University to- 9 Registrar's STUDENT NAME: Kelsey Amber Morrell CSUID: BIRTHDATE: 829370235 03/04/XXXX STUDENT LEVEL: Undergraduate COURSE INFORMATION Fall Semester 2011 Freshman Office, Fort Collins, CO 80523-1063 CURRENT NAME:Kelsey Morrell SSN: XXX-XX-0614 DATE/TIME PRINTED: 06/08/2015 16:24 MATH 117 College Algebra in Context I (GT-MA1) MATH 118 College Algebra in Context II (GT-MA1) PHIL 103 Moral and Social Problems (GT- AH3) PSY 100 General Psychology (GT-SS3) SOC 100 General Sociology (GT--SS3) SOWK 150 Term Term Spring Credits Passed: Grade Points: Introduction to Social Work 14.0 43.003 Term GPA: 3.071 1.00 A 1.00 B 3.00 C+ Semester 2012 Freshman CO 150 GEOL 120 GEOL 121 HIST 151 LB 170 MATH 124 MU 100 Term Terra Credits Passed: 17.0 Grade Points: 55.000 Term GPA: Fall Semester 2012 BZ 101 HDFS 101 POLS 103 SOWK 233 SOWK Term Term Sophomore Humans and Other Animals (GT- SC2) Individual and Family Development (GT-SS3) State and Local Government and Politics (GT-SS1) Human Behavior in the Social Environment 371B Social Work with Selected Populations -Juvenile Offenders Credits Passed: 15.0 Grade Points; 3.00 B College Composition (GT-CO2) Exploring Earth: Physical 3.00 B Geology (GT-SC2) Introductory Geology Laboratory 1.00 B (GT-SC1) UPS. History Since 1376 (GT- 3.00 B HI1) 1) World Literatures to 1500 (GT- 3.00 A AH2) Logarithmic and Exponential 1.00 A Functions (GT-MA1) Music Appreciation (GT-AH1) 3.00 B 3.235 3.00 A 3.00 C 3.00 A- 3.00 D 3.00 A 3.00 B- 3.00 B+ 3.00 B 42.003 Term GPA: 2.800 kelsey_morrell@hotmailecom Kelsey Morrell Spring PSY 228 Psychology of Human Sexuality PSY SOWK SPCM STAT STAT Term Term Page: 1 of 2 Semester 2013 Sophomore 3.00 C 315 Social Psychology 3.00 C+ 330 Human Diversity Practice Issues 3.00 B 200 Public Speaking 3.00 B+ 201 General Statistics 3.00 B+ .00 NGC 201 General Statistics - Lecture Credits Passed: 15.0 Grade Points: 42.006 Term GPA: 2.800 Fall Semester 2013 Junior HDFS 311 JTC 300 JTC 300 SOC 330 SOWK 286A SOWK 300 Term Term Adolescent/Early Adult Development in Context Professional and Technical Communication (CT-CO3) Professional and Technical Communication (CT-CO3) Recitation Social Stratification Practicumt I 3.00 B- 3.00 B+ .00 NGC 3.00 B+ 3.00 A Research in Applied Professions 3.00 A Credits Passed: 15.0 Grade Points: Spring Semester 2014 DEAN'S LIST SOWK 286B SOWK 340 S0WK 341 SOWK 3 71D SOWK 371E Term Term Practicurn II 52.005 Term GPA: 3.467 Junior Generalist Practice -Individuals and Families Generalist Practice -Small Groups Social Work with Selected Populations --Substance Abusers Social Work with Selected Populations --Social Gerontology Credits Passed; 15.0 Grade Points: 3.00 A 3.00 A- 3.00 A+ 3.00 A 3.00 A 59.001 Term GPA: 3.933 Chris Seng University Registrar . com on 06/08/2015 06:46 PM TRAN000007649121 R; O CD 2 a 0 From Colorado State University to This PDF document may be validated. A printed copy cannot be validated. See attached cover page for additional information. e University to kelsey morrell From Colorado S Registrar's Office, Fort Collins, CO 80523-1063 STUDENT NAME:Kelsey Amber Morrell CSUID: 829370235 BIRTHDATE: 03/04/XXXX Fall Semester 2014 Senior DEAN'S LIST CURRENT NAME:Kelsey Morrell SSN: XXX-XX-0614 DATE/TIME PRINTED: 06/08/2015 16:24 PSY 320 Abnormal Psychology 3.00 A - SOWN 342 Generalist Practice- 3.00 A- Organizations/Communities SOWN 342 Generalist Practice- .00 NGC Organizations/Communities - Recitation SOWK 384 Supervised College Teaching 4.00 A+ SOWK 410 Social Welfare Policy 3.00 A+ SOWN 410 Social Welfare Policy - .00 NGC Recitation Term Credits Passed: 13.0 Term Grade Points: 50.002 Term SPA: 3.846 Spring Semester 2015 Senior SOWK 384 Supervised College Teaching SOWK 488 Field Placement SOWK 492 Seminar Term Credits Passed: 17.0 Term Grade Points: 28.000 Term GPA; 4,000 CREDITS PASSED: GRADE POINTS: GPA CREDITS: CUMULATIVE SPA: SUMMARY 4.00 A 10.00 S 3.00 A END OF STUDENT LEVEL END OF TRANSCRIPT 121.0 371.020 111.0 3.342 Page: 2 of 2 kelsey_morrell@hotmail.com Kelsey Morrell Chris Seng University Registrar RAN000007649121 .com on 06/08/2015 06:46 PM 2 U) 8) m Colorado S This PDF document may be validated. A printed copy cannot be validated. See attached cover page for additional information. .corn on 06/08/2015 06:46 PM TRAN000007649121 E Go Colorado State University F;.rt Collins, Colorado 80523-1063 (970) 491-4860 egistra.r's ffice Transcript Infn,atin Colorado State University is accredited by The Higher Learning Commission and is also a member of the North Central Association. THIS TRANSCRIPT INCLUDES THE STUDENT'S COMPLETE GRADING SYSTEMS: t ECORD AT COLORADO STATE UNIVERSITY. Effective Fall Semester 2008 to present: STUDENT STATUS: A student's academic status is not posted on Colorado State University transcripts. Confidential information will be furnished to those authorized by State and Federal laws upon written request to the Registrar's Office. Academic Misconduct (AM) is noted on Colorado State University transcripts below the course number. Beginning Fall semester 2010, the description and notation changed from Academic Dishonesty (AD) to Academic Misconduct (AM). U NIVERSITY CREDITS: All credits are expressed in semester values including those credits during the terms when Colorado State U niversity used the quarter system (Summer Session 1945 through Summer Session 1975). On both the quarter and semester systems, one credit is equivalent to one hour of class each week for one term. Three hours of laboratory work with no outside preparation is the usual equivalent of one hour of lecture; two hours of laboratory work with outside preparation is equivalent to one hour of lecture. NUMBERING OF COURSES: Effective Fall Semester 1975 to present: 100-299 300-499 500-599 600-699 700-799 Courses primarily for freshman and sophomore students. Courses primarily for junior and senior students. Acceptable for graduate credit for students holding bachelor's degrees when approved by the students' graduate committees. Courses primarily for students enrolled in master's degree programs or equivalents. Qualified junior and senior students may enroll. Courses primarily for students enrolled in master's degree programs or equivalents. Undergraduate students may not enroll to satisfy undergraduate degree requirements. Courses primarily for students enrolled in Ph.D. level programs or equivalents and professional veterinary medicine courses. Undergraduate students may not enroll. o Prior to Fall Semester 1975: Please see Transcript Information at waregistrar,colostatecedu. 412 a� a 0 E O 2 U - Grade Description A+ A Excellent A- B+ B Good B- C+ C D I F AU H P S U N G N GC Average Poor, but passing Incomplete Failure Withdrawn (without evaluation) Audit Honors Pass Satisfactory Unsatisfactory No Grade Submitted Non -graded Component Grade Points Per Unit 4.000 4.000 3.667 3.334 3.000 2,667 2.334 2.000 1.000 t 0.000 t t t t t t t t 111441tMW. TRANSCRIPT NOTES: Effective Spring Semester 2004 to Summer Session 2008: Please see Transcript Information at www.registrar.colosfate,,edu Effective Fall Semester 1997 to Spring Semester 2004, .33 calculations were used for plus grades and .67 calculations were used for minus grades. Effective Fall Semester 1928 to Fall Semester 1997: Please see Transcript Information at„registrarcclostata.edu t Not used in grade point average calculation. Indicates graduate GPA not necessarily used to meet scholastic standards for graduate students. X Indicates Fresh Start when preceding the grade (see Transcript Information at www,r iptr 3t,E l ; rte.pd ). Credits not used in GPA calculations. R Indicates Repeat/Delete when preceding the grade (see Transcript Information at www.regtstrar.co$ostate.edu). Credits not used in GPA calculations. GT Guaranteed Transfer indicates that the course listed above this code is approved for the statewide general education transfer program used among Colorado public institutions. 0373E-31 09113 AR1 TO TEST FOR AUTHENTICITY: This transcript was delivered through the eSCRIP-SAFEw Global Transcript Delivery Network. The original transcript is in electronic PDF form. The authenticity of the PDF document may be validated at escrip-safe.corn by selecting the Document Validation link. A printed copy cannot be validated. This document cannot be released to a third party without the written consent of the student. This is in accordance with the Family Educational Rights and Privacy Act of 1974. ALTERATION OF THIS DOCUMENT MAY BE A CRIMINAL OFFENSE! r N N- 0 z Q H 2 Era C N 00 C cc 0 0 sci q 0 Lai ca O 2 LL kolsoy_morrel SAFE - Structured Analysis Family Evaluation This is to certify' that has completed 12 hours of S FE Training and is certified. to perform SAFE Home Studies arhleen Cleary, Executive Director rn I I 1 4 .com on 06/08/2015 06:46 PM TRAN000007649121 From Colorado State University to Registrar's STUDENT MANE: Kelsey Amber Morrell CSUID : BIRTHDATE: 829370235 03/04/XXXX STUDENT LEVEL: te n csesi Office, Fort Collins, CO 80523-1063 CURRENT NAME:Kelsey Morrell SSN: XXX-XX-0614 DATE/TIME PRINTED: 06/08/2015 16:24 Page: 1 of 2 Undergraduate COURSE INFORMATION Fall Semester 2011 MATH 117 MATH 118 PHIL 103 PSY 100 SOC 100 SOWK 150 Term Term Credits Passed: Grade Points: Freshman College Algebra in Context I (GT-MA1) College Algebra in Context II (GT-MA1) Moral and Social Problems (GT- AH3) General Psychology (GT-SS3) General Sociology (GT-SS3) Introduction to Social Work 14.0 43.003 Term GPA: 3.071 Spring Semester 2012 Freshman CO 150 GEOL 120 GEOL 121 HIST 151 LB 170 MATH 124 MU 100 College Composition (GT-0O2) Exploring Earth: Physical Geology (GT-SC2) Introductory Geology Laboratory (GT-SC1) U.S. History Since 1876 (GT- HI1) World Literatures to 1500 (GT- AH2) Logarithmic and Exponential Functions (GT-MA1) Music Appreciation (GT-AH1) Term Credits Passed: 17.0 Term Grade Points: 55.000 Term CPA: Fall Semester 2012 BZ 101 HDFS 101 POLS 103 SOWK 233 SOWK 371B Term Term Sophomore Humans and Other Animals (GT- SC2) Individual and Family Development (GT-SS3) State and Local Government and Politics (GT-SS1) Human Behavior in the Social Environment Social Work with Selected Populations -Juvenile Offenders Credits Passed: 15.0 1.00 A 1.00 B 3.00 C+ 3.00 A 3.00 C 3.00 A- 3.00 B 3.00 B 1.00 B 3.00 B 3.00 A 1.00 A 3.00 B 3.235 3.00 D 3.00 A 3.00 B- 3.00 B+ 3.00 B Grade Points: 42.003 Term GPA: 2.800 kelsey morrell@hotmaileaom Kelsey Morrell Spring Semester 2013 Sophomore PSY 228 Psychology of Human Sexuality 3.00 C PSY 315 Social Psychology 3.00 C+ SOWK 330 Human Diversity Practice Issues 3.00 B SPCM 200 Public Speaking 3.00 B+ STAT 201 General Statistics 3.00 B+ STAT 201 General Statistics - Lecture .00 NGC Term. Credits Passed: 15.0 Term Grade Points., 42.006 Term CPA: 2.800 Fall Semester 2013 Junior HDFS 311 JTC 300 JTC 300 Adolescent/Early Adult Development in Context Professional and Technical Communication (CT -0O3) Professional and Technical Communication (CT -0O3) - Recitation Social Stratification 3.00 B- 3.00 B+ .00 NGC SOC 330 3.00 B+ SOWK 286A Practicum I 3.00 A SOWK 300 Research in Applied Professions 3.00 A Term Credits Passed: 15.0 Term Grade Points: 52.005 Term GPA: 3.467 Spring Semester 2014 DEAN'S LIST SOWK 286B SOWK 340 SOWK 341 SOWK 371D SOWK 371E Term Term Practicum II Junior Generalist Practice -Individuals and Families Generalist Practice -Small Groups Social Work with Selected Populations --Substance Abusers Social Work with Selected Populations --Social Gerontology Credits Passed: 15.0 Grade Points: 3.00 A 3.00 A- 3.00 A+ 3.00 A 3.00 A 59.001 Term GPA: 3.933 Chris Seng University Registrar r N e; qzr f�- 0 Ca 0 0 z Ct t- 2 to to C IO 0 c\I co 0 to O C O E O N v From Colorado State University to This PDF document may be validated. A printed copy cannot be validated. See attached cover page for additional information. L O Registrar's Office, Fort Collins, CO 80523-1063 STUDENT NAME:Kelsey Amber Morrell CSUID: 829370235 BIRTHDATE: 03/04/XXXX Fall Semester 2014 Senior DEAN'S LIST PSY 320 Abnormal Psychology 3.00 A- SOWK 342 Generalist Practice- 3.00 A- Organizations/Communities SOWK 342 Generalist Practice- .00 NGC Crganizations/Communities - Recitation SOWK 384 Supervised College Teaching 4.00 A+ SOWK 410 Social Welfare Policy 3.00 A+ SOWK 410 Social Welfare Policy - .00 NGC Recitation Term Credits Passed: 13.0 Term Grade Points: 50.002 Term GPA: 3.846 Spring Semester 2015 Senior SOWK 384 Supervised College Teaching SOWK 488 Field Placement SORE 492 Seminar Term Credits Passed: 17.0 Term Grade Points: 28,000 Term GPA; 4.000 CREDITS PASSED: GRADE POINTS: GPA CREDITS: CUMULATIVE GPA: SUMMARY 4.00 A 10.00 S 3.00 A END OF STUDENT LEVEL END OF TRANSCRIPT 121.0 371.020 111.0 3.342 CURRENT NAME:Kelsey Morrell SSN: XXX-XX-0614 DATE/TIME PRINTED: 06/08/2015 16:24 keleey_morrell@hotmail.com Kelsey Morrell Chris Seng University Registrar Page: 2 of 2 From Colorado State University to kelsey_morrell@hotmail.com on 06/08/2015 06:46 PM TRAN000007649121 This PDF document may be validated. A printed copy cannot be validated. See attached cover page for additional information. .com on 06/08/2015 06A6 PM TRAN0000076r19121 E a) E v a) 0 a) a .C D co -o O U E O u, Colorado State University Fort Collins, Colorado 80523-1063 (970) 491-4860 Registrar's Office Transcript Information Colorado State University is accredited by The Higher Learning Commission and is also a member of the North Central Association. THIS TRANSCRIPT INCLUDES THE STUDENT'S COMPLETE GRADING SYSTEMS: RECORD AT COLORADO STATE UNIVERSITY. Effective Fall Semester 2008 to present: STUDENT STATUS: A student's academic status is not posted on Colorado State University transcripts. Confidential information will be furnished to those authorized by State and Federal laws upon written request to the Registrar's Office. Academic Misconduct (AM) is noted on Colorado State University transcripts below the course number. Beginning Fall semester 2010, the description and notation changed from Academic Dishonesty (AD) to Academic Misconduct (AM). U NIVERSITY CREDITS: All credits are expressed in semester values including those credits during the terms when Colorado State U niversity used the quarter system (Summer Session 1945 through Summer Session 1975). On both the quarter and semester systems, one credit is equivalent to one hour of class each week for one term. Three hours of laboratory work with no outside preparation is the usual equivalent of one hour of lecture; two hours of laboratory work with outside preparation is equivalent to one hour of lecture. N UMBERING OF COURSES: Effective Fall Semester 1975 to present: 100-299 300-499 500-599 600-699 700-799 Courses primarily for freshman and sophomore students. Courses primarily for junior and senior students. Acceptable for graduate credit for students holding bachelor's degrees when approved by the students' graduate committees. Courses primarily for students enrolled in master's degree programs or equivalents. Qualified junior and senior students may enroll. Courses primarily for students enrolled in master's degree programs or equivalents. Undergraduate students may not enroll to satisfy undergraduate degree requirements. Courses primarily for students enrolled in Ph.D. level programs or equivalents and professional veterinary medicine courses. Undergraduate students may not enroll. Prior to Fall Semester 1975: Please see Transcript Information at www.registrar.colostate.edu. Grade A+ A A- B+ B B- C+ C D I F W AU H P S U N G N GC Description Excellent Good Average Poor, but passing Incomplete Failure Withdrawn (without evaluation) Audit Honors Pass Satisfactory Unsatisfactory N o Grade Submitted N on -graded Component Grade Points Per Unit 4.000 4.000 3.667 3.334 3.000 2.667 2.334 2.000 1.000 t 0.000 t t t t t t t t TRANSCRIPT NOTES: Effective Spring Semester 2004 to Summer Session 2008: Please see Transcript Information at www.registrar.colostate.edu Effective Fall Semester 1997 to Spring Semester 2004, .33 calculations were used for plus grades and .67 calculations were used for minus grades. Effective Fall Semester 1928 to Fall Semester 1997: Please see Transcript Information at www.registrar_cotostate.edu t X R GT Not used in grade point average calculation. Indicates graduate GPA not necessarily used to meet scholastic standards for graduate students. Indicates Fresh Start when preceding the grade (see Transcript Information at www.registrar.colbstte.edu). Credits not used in GPA calculations. Indicates Repeat/Delete when preceding the grade (see Transcript Info rm tiorn at www.registrar. colostate.edi). Credits not used in GPA calculations. Guaranteed Transfer indicates that the course listed above this code is approved for the statewide general education transfer program used among Colorado public institutions. 0373E-31 09/13 AR1 TO TEST FOR AUTHENTICITY: This transcript was delivered through the eSCRIP-SAFE') Global Transcript Delivery Network. The original transcript is in electronic PDF form. The authenticity of the PDF document may be validated at escrip-safe.com by selecting the Document Validation link. A printed copy cannot be validated. This document cannot be released to a third party without the written consent of the student. This is in accordance with the Family Educational Rights and Privacy Act of 1974. ALTERATION OF THIS DOCUMENT MAY BE A CRIMINAL OFFENSE! N cp z C I- 2 0 O LU N co O CO 0 rct U .° L cp CD U O L SAFE - Structured Analysis Family Evaluation } s is to cey that has completed 12 hours of SAL Training and is certified to perform SAFE Home Studies Date(s): '-ithlecn Cleary, Executive Director Consortium for Children Official Academic Transcript from: METROPOLITAN STATE UNIVERSITY OF DENVER. OFFICE OF THE REGISTRAR CAMPUS BOX 84 PO BOX 173362 DE1\ VER, CO 80217-3362 TELEPHONE: 303-556-3991 Academic Transcript of: MICHELLE MARIE POWNER Date of Birth: 20-May-xxxx Transcript Created: 26 -Oct -2015 Requested by: MICHELLE MARIE POWNER 1187 S. CLARKSON ST. DENVER, CO 80210-1604 F, -Mail: mrnpowner@gmail.com TranscriptsNetwork Document Type: TURD -PARTY SECURE PDF Intended Recipient: MICHELLE POWNER 1 187 S. CLARKSON ST. 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If you are not the "Intended Recipient", please notify the Office of the Registrar at Metropolitan State University of Denver. You are not permitted to copy or alter this document. You may not forward this document or disclose its contents to any person or organization other than the "Intended Recipient" without the express written permission of the student. If this document is copied or printed, the words "PRINTED COPY" will appear in the replicated transcript image. You may verify the authenticity of this electronic document and have us independently certify that the document has not been altered since its creation by going to https://www.credentials-inc.comicgi-binkicgipdfpg,m?VALID and following the instructions for transcript certification. In the interest of security and privacy, we delete this Official Academic Transcript from our server 48 hours after it is initially downloaded excluding weekends and holidays. If a replacement is subsequently needed, the requesting party must order another transcript from Metropolitan State University of Denver. If you have any questions about this document or require further assistance, please contact Credentials Customer Service at (847) 716-3005. Our operators are available from 7:00 am to 7:00 pm Monday through Thursday and 7:00 am to 5:00 pm on Fridays (Central Time). OFFICIAL TRANSCRIPT Michelle M. Powner r 2480 S Acoma St Denver, CO 80223-4311 Course Level: Graduate Current School: College Letters Arts Sciences Current Major(s): Social Work m MSW Concentration(s): Individuals & Families Degree Awarded . "�.IGi `1,hy Master of Social Work 05/16/2015 Major(s): Social Work - MSW Concentrations): Individuals & Families Course Fall 2013 Title Mx METROPOLITAN MATE UNIVERSITY" OF DENVER Cr Or GT SWKM 5000 SWKM 5050 SWKM 5100 SWKM 5150 Jr Genriist Pract I Multicult Soc 4.00 Social Policy Analysis 3.00 Hum Beh Soc Env I: Prenat-Adol 3.00 Field Experience I 5.00 Attempted: 15.00 Earned: 15.00 Sern gpa: 3.93 Spring 2014 SWKM 5200 Genrlst Pract II Multicult Soc 4.00 SWKM 5250 Research Methods Social Work 3.00 SWKM 5300 Hum Beh Il Young Adult -Old Age 3.00 SWKM 5350 Field Experience II 5.00 Attempted: 15.00 Earned: 15,00 Sem gpa: 3.80 Summer 2014 SWKM 6100 Family Therapy Attempted: 3.00 Earned: 3.00 Sem gpa: 400 A A A- A A A B A+ Fall 2014 SWK\I'1 6002 Direct Practice SWKM 6150 Field Experience III SWKM 6256 Legal Issues in Social Work SWKM 6525 Crisis Intery Trma Disast Resp Attempted: 1200 Earned: 12.00 Sear gpa: 4.00 Spring 2015 SWKM 6050 SWKM 6202 SWKM 6207 SWKM 6250 SWKM 6520 3.00 A 3.00 5.00 1.00 3.00 A A A A Adv Policy and Programming 3.00 Direct Interv:Child Youth Fam 3.00 International Social Work 1.00 Field Experience IV 5.00 Evid-basil Prac in Mental Hlth 3.00 Attempted: 15.00 Earned: 15.00 Sem gpa: 3.93 MICHELLE t NEB, 1187 S. CLA N t REFNUM: 200552243 5 DENVE : GCO 0021'41 This lransrrini nrocBssed and deliverer! by Crcdanania' VA TrensceutsNetwor& A A- A A A Totals Earned Crs. GPA Crs. Grade Points SPA MSU Denver 60.00 60.00 235.02 3.92 Total 60.00 60.00 235.02 3.92' Date Issued: 10/26/2015 SSN: xxx-xx-3394 DOB: 05/20/xxxx Page 1 PabiA E. Paula E Martinez, Registrar OFFICIAL TRANSCRIPT -- icheile2480 S Acorna St Denver, CO 802234311 Course Level: Undergraduate Current School: College Letters Arts Sciences Current Majors}: Undeclared Course Title • METROPOLITAN STATE UNIVERSITY" OF DENVER Cr Gr GT Summer 2013 ENG 390F Prof/Scholarly Writing Workshp 3.00 B PSC 1010 American National Government 3.00 A SS1 SWK 1010 Intro Sac Welfare & Soc Work 3.00 A WMS 3220 Prejdce & Discrmntn Contmp Soc 3.00 A Attempted: 12.00 Earned: 12.00 Sem gpa: 3,75 Totals Earned Crs GPA Crs. Grade Points GPA' MSU Denver 12.00 12.00 45.00 3.75' Total 12.00 12.00 45.00 3.75 MICHELLE POWNER 1187 S. CLARKSON ST. RE F N UM M 20055224305 DENVER, Co 802/01604 This Iransoin{ nrncvtsed mid delivered by Craderstiala' ice:1 Tennecrin2aPietwaa'k Date Issued: 10/26/2015 SSN: xxx-xx-3394 DOB: 05/20/xxxx Page 1 Pad, 6. Paula € Martinez, Registrar METROPOLITAN 5 � STATE UNIVERSITY .. OF DENVER Transcript Guide Metropolitan State University of Denver (MSU Denver) is accredited by the Higher Learning Commission of the North Central Association of Colleges and Schools. Prior to July 2012, the University's name was Metropolitan State College of Denver, and before 1990 it was Metropolitan State College. All credits are articulated in semester hours. Prior to Summer Semester 1976, the University operated on the quarter system. A quarter credit is equivalent to 2/3 of a semester credit_ DICE ID number 001360 COURSE NUMBERING Prior to Spring 1998 Below 100 100-199 200-299 300-399 400-499 500 - Remedial (discontinued Summer 1971) Primarily freshman -level Primarily sophomore -level Primarily junior -level Primarily senior -level Postbaccalaureate Effective Spring 1998 1000-1999 Primarily freshman -level 2000-2999 Primarily sophomore -level 3000-3999 Primarily junior -level 4000-4999 Primarily senior -lever Effective =Fall 410 5000-6999 'Primarily graduate -level i _ Grade A+ A A- B+ B B- C+ C C- D+ D D - F A Bit C# i' F# S u# SP GRADES Grade Quality Points 4.00 4.00 3.67 3.33 3.00 2.67 2.33 2.00 1.67 1.33 1.00 0.67 0 All grades accompanied ; by the # symbol are calculated in the grade point average (GPA.), nor are they counted toward graduation. GT- GUARANTEED TRANSFER This column indicates courses approved for the Statewide General Education Transfer Program among Colorado Public Institutions. ADDITIONAL NOTATIONS IOC S Advanced Placement (AP): Prior to Spring 1998, CEEB high school AP credit appears asNISI) Denver course credit with an AP grade notation. From Spring 1998 forward, Advanced Placement credit appears as a block of transfer credit. College Level Examination Program (CLEP): Prior to Spring 1998, CLEP General and Subiect examination credit appears with a CL grade notation. From Spring 1998 forward, .CLEP credit appears as a block of transcript credit. Departmental Course Examination: Credit by examination for MSU Denver courses appears with an EX grade notation. FYS: First Year Success Course Portfolio Assessment: MSU Denver course credit approved by an academic department and college committee, which appears with a PL grade notation. Proficiency Examination Program (PEP): Prior to Spring 1998, PEP credit appears with a PP grade notation. From Spring 1998 forward, PEP credit appears as a block of transfer credit. SL: Service Learning Course Transfer: The name of the college or other source of credit appears with the years of attendance and total semester credits accepted. Inter -institutional and Study Abroad Programs: MSU Denver participates in programs which allow MSU Denver students to register for courses at participating colleges. The college abbreviation will usually appear in the course title or as the course subject code. However, the subject code and course number of the other college will sometimes appear instead of the course title. The credit and grade for the course count in the MSU Denver totals, except when carrying a # symbol/notation (please see "Grades" above), or a subject code beginning with an X, e.g. XMA 100. Following are abbreviations for the participating colleges and universities: ARC - Arapahoe Community College; ASC - Adams State University; CCD - Community College of Denver; CUA - University of Colorado Study Abroad Program; FRC - Front Range Community College; MSC - Colorado Mesa University; RRC - Red Rocks Community College; STA - Study Abroad; UCD - University of Colorado at Denver; WSC -Western State Colorado University. GRADE NOTATIONS AP = AU AW CC = CL EX I P PL PP S SA SE SN NR U UE w IP NC SP TF WF wp a Advanced Placement Credit Course Audit Administrative Withdrawal Continuing Correspondence Course Only College Level Examination Program Credit Departmental Course Examination Credit incomplete is assigned when the student, in consultation with faculty, has agreed to make up assignments Pass, P is equivalent to the grade of D or better Portfolio Assessment Credit PEP Exam Satisfactory,,, is equivalent to the grade of C or better Study Abroad Satisfactory in Education, SE is equivalent to the grade of B or better Study Abroad, no credit Not Reported Unsatisfactory U is equivalent to the grade of F Unsatisfactory in Education, UE is equivalent to the grade of F Withdrawal In Progress No Credit, this notation is strictly non -punitive and indicates approved withdrawal, course repetition or non -completion of course requirements Self -Paced Technical Failure Withdrew Failing Withdrew Passing This Academic Transcript from Metropolitan State University of Denver located in Denver, CO subject to, the Family Educational Rights and Privacy Act of 1974, Credentials Inc. of Northfield, iL is acting on behalf of Metropolitan State University of Denver in facilitating the delivery of academic transcripts from Metropolitan State University of Denver to other 'colleges, universities and third parties using the 1 Credentials' TranscriptsNetworkTM This secure transcript has been delivered electronically by Credentials Inc. in a Portable Document Format (PDF) file. Please be aware that this layout may be slightly different in look than Metropolitan State University of Denver's printed/mailed copy, however it will contain the identical academic information. Depending on the school and your capabilities, we also can deliver this file as an XML document or an EDi document. Any questions regarding the validity of the information you are receiving should be directed to: Office of the Registrar, Metropolitan State University of Denver, Campus Box 84, P.O. Box 173362, Denver, CO, 80217-3362 Tel: (303) 556-3991. Office of the Registrar 0 Campus Box 84 0 P.O. Box 173362 ® Denver, CO 80217-3362 303-556-3991 s Fax: 303-556-3999 raw Gl OFFICIAL. Plett Ariel Clinical Services ices 2938 Vortia Ave. Suite ,'to G GtatiCt Junction, CO 815-04 eourse Levet rUndergraduate Degrees Awarded ed Bachelor .f ,Science 08 -MAY -2004 br ; 128.00 P -Hrs: 113.00 QPts: 3.4 00 GPA: 3.04 Pr i ma r y Degree Major : : Soola1 Work CPURSE TITLE F TricANSPER CRI tT ACCEPTED ay ergs INSTITUTION' SFSR PSYC 120 $(3CI 11. Tege 101 Austin Omty 'r - Texas Intro. to Psychology Introduction to Socaology Computes Soience TT, Cr. $hrs: 9400 GPI,-.irs: 0.00 OPts: sfe Ta r rn t ENGL 26-3 American Ehra: 3.00 0 A4H2's J NSTXTUt1ON CREDIT: °Mild BIBI 104 CONS 112 EL. EXSC 1.Z 100 Z06 221 Note 001 flint 002 UNIV 1.0 0 Term: . Wars:b t After 1900 0.00 OPts Compos-ition & Rhe .or .c Concepts of Health Fitness 1,00 S SFWrength Training. 1.00 El American HJeto�r'r.y [1. y-+ }�t/Y . r 3� .0t' H.S. 5c7 wince .Requ4r ma.int 0.00 5 }H .. MO? . Language r1� e � u i reue nyt� y.�y �y t 1.00 0.00 j� � 4 �.+r L $+ minacr/•Learning f' 4w"irnl`L41�.ni 1 . 00 A 15.00 (4PA- Ora. 15r 0 Pts: 46.00 P.'+: CRED GRD 3.00 TR 3,00 TR 3,00 TR 0 . 00 GPA: 0.00 �. ,00 TR r-� 0 00 GPA. .00 Pail 2000 W9/01./2000-12/15/2000) LC: Li to & Teach Of Jesus (Ma) or 3,00 LC:Fu d Of COmmf Re .gioua 2mph 3.00 B 00 A *w*".**********w*** t * t * * *•t * * * 4 * t & * * t CONTINUED ON NEXT c:MUNN aft, o.rd of: Student ID: ate issued: 30-SEP-.011 • Page; . 1. S _ Dawn es **-5992 Date. of ;Birth; 21 -Nov NO, C LASE TITLE Institution Information coz msnue : Term: {1BIBD 105 ,ENGL 112 PTS R tEXSW 230 ;MATH 120 iPHYS 101 , SOCW 2 0 9.00 9.0€ 12.00 00 3%00 3.00 6.00 0.00 0.00 * .03 .% 'Term; Ehrs: I' Term: I) B IBL 211 B ? (�L 120 3a_ .r..XSC 111 'SOCW 250 ,:SOCW 325 ,Term: Eh rs Term: ,BLED 380 Iz %. 212 r HIST #22 •� S C I 222 c y�{Vn..T.O �CW 1? 6 Ehrs: +wy '*�F m: .h.rs • Term: BJBM 340 .r tNGL 222 NUSM 230 J C11 416 ,,,OCW 351 CRED ORD . P 49 a Sprig 200? (01/1S/2001-05/11/2001) Acts -Revelation Mp jors } • D A Cornpositio . Lateratut" Scuba Diving Elam t4athemat: ,cal Reasoning Astronomy Intro co Social Wea fa rye 5 0 0 GPr, Hr s : 15g00 0O QPt: ; 3.00 C 1.00 3.000 0 3.00 3.00 S 9.00 GPA: Fall 2001 08/21/200112/14/24101) Message of the Qjd es tauten 3.00 A Biology --Human PerOpectivt 3.00 C Team Sports for Women 1. r 00-A A interpersonal Skills 3.0'0 E, Human Behavior c Soc Bnviran 3upot . 13.00 GPA-Hrs: 13400 QPts: 'Q r . Spring 2002 (01/14/2002-05/11/Z0024 Intro to. Ph i lop{sgoprh yjy �y{ (�.� yy 3.00 f�3 Christianity in Culture jor 3,00 O A r American History 11 3.00 Sooia? Problems 3.00 Human behavior & ..S c Environ I 3.0 C 15.00 GPAOIt4S: 15.00 Q .sa 45.00 GPA: Fall. 2002 (08/26/2002-1-2/13/200:E Foundations of Youth Mln 1 Major British Writers 12 X•.at.roducc' ors co Music Soctaa Stat.i,st.z as Social Work Pra ci e . °a.** k*.+fit*!rA'*Itt3tt*****tt*,***t*'***rkl.* CONtINUED ON PAGE 2 RegiWar 3.00 A 3.00 P1 3.00 3.00 4.00 A It* wt*t* n 2016 6.00 0.0.0 ADO 9.00 [0.0 9 . W ar' 3.60 32,00 6.30 4.00 9 oq. 3.07 9.:00 12.00 9.0 x400 6.00 3.00 1 .00 0.00 : `•. 0 0 6.00 16.00 •nwnp �aw..+T+/.WMa Nn* S44 ..N/MiV1J,WMN+IA.tlAalla P66wAdM!1^ * ri pr. au....wycroceitcoes SUMS No "COURSE TITLE s�ticut ion ::ily»M1 or{yaO;on crOy'ntinu i §` 1y Term: Sb,...s: 13. . OPAL-H:Y6".f'T 13.00 QJ �.f T.F Term: aak 222 'C 212 POLS 226 SOLI 444 SQCt 381 SOCW- 415 - ;WOW "4"t^'� 4"•it 1 Term: t'a *1 's Term: IRM 405 210t4 4.13 POLS 226 PSYC 382 SOC1 442 SOCK 451 Term: 3,'m: Stirs .OFFICIAL TRANSCRIPT cRsD ORD Record of: sh Student l.K.****t9922 Date of Birth: 2 3 -NOV Dawn Jones I 3 a0.11 Paget •2 • •****yr tw**to**w*****.* D` St R.LFL" 3'o';i`ALS **t********4f44.******** .******** . arll htli. Hrs tii A #'!.'' Points SPA PTS R TOTAL INSTITUTION 116.00 113.00 344500 3.04 ¢ITOTAL TRANSFER `.2.00 0'.00 0.0C ,00 43.00 GPA: 3.30 Spring 2003 (01/13/2003-05/09/2003) Malor ant sh Writers II 3.00 C U s-. r :. xn9 1.00 A National Gd r me •' 0 00 Social Group Leadership 3.00 A Yield experience 3 . 0 0 A Social Research 4 . 00 E Social a £att Policy & Ser a e 3.00 B 17.00 GPA4htsi 17.00 Ptris: 55.00 CPA: Fail 2003 t0.8/28/2003-12/12/2003) Women .41 ChristianService' 3 . r 8 Sem in;Adol Moral/Sex Issues 3.00 a States and Federal System 3.00 Abnormal Psychoio y 3.00 Cut ttu.xa l O iness1, ty 3,00 Social Work Practice I3 4.00 19500 -$4trs. 14.00 Ots: 46.00 0 Term: Spring 2004 (01/12/2004-0S/01/2004 SOCW 406 GS: Sbc .a.i. w.`f1 wichldriloamlies 00W 4*S 1 Field E x- er Se ce II SOCW 491 j� r* InrergrJat ivf;e+�v e . a Social ji Wv k Team Ehrs 9500 GPA-iira: 9 00 "} Aies CR A GPA: 2,00 A 6.00 S 1.0.0 A 30.00 GPA; 5 00 4.00 0.00 12.00 12.00 12.00 9.00 3-23 00 .00 6.00 0 00 6 00 16.00 2.87 8.0' 18.00 4.00 T it 3 1 t*'+Y**'****`t'tt.t.**** E' T couno .***44.***********4 5 ru £4*4 OVERALL 128.00 113.00 .344.00 3 _04 *************v******** END OF ' RANsC RXPT ******************A*** Registrar: • -. '.nM;n.:^new+w-+....twk.au .l t. W,' WNAe4wemioenWV.YiP..ari.ih ..\W1n.'t kt.1 ..91VACeetem4artMeseacce.....•.••y.n.PKel.ro aae „Kr 4MY .OFFICIAL TRAK Lestl nett Ariel l nical Services 2na North e , Sae G Gtatid jupction, CO..0 e • .:eve•.«:: Undo rgrad a e epees AwagOded Sa4che/0 • of Science O! -4MAY " 2004 atria 00 flora.: 1i3t00 QPvs: 344.00 RA: imary Eeg'ree .49$4 110.; rftransfer 2& 3 . t1. Work CPUR E TITLE CR DV? ACCEp D BY TKE INSTITUTION: Ault Ca Col:4- Texas 3.04 CRED GRD Intro. o Psychology 3,00 TR 1 oduct cn t,4 ,SOc';tology 3,00 TR Computer Saience Tr. . +Ct. 3,00 TR 00 OPA-Hrs: 0,00 Pts: 0 00 GPA: 0.00 `arrant County College American Lit After 1900 3,00 TR OPA-Hrs: 0.00 OP4s: 0..00 =PA, 00 ION .ReD t: feet IS14 104 M 11'Z 4R),14.14 111 EXSC 100 SC 2'06 yH�1S(�.� .2 //ii��2:yy1 Sprit 00; - .v 100 Term Wars! all 2000 WS 01/2000- nhl5/20,00 Life & Teach t . Jesue (Ma.) or 3 00 LC:Fund Of COmmiReligious Emph 3.00 , COmpOSation et Rhetoric 3.0,0 A Concepts of Health Fitness 1,40 Strength Tra to ng 1.0:0 B American . History I 3.O,0 C H. S.. Science Requirement 0.-0.a H.8, Language Re4u a egnent. 0.00 ti linty . Sent na•r/tearni: ag Communl. 1.00 A .4%00 L4PA,, Hrs : :n. S.00 6 Pts : .46.0Q. WA ' t.' ,:q'***tw,*vP*..a.tw*** CONTINUED CV NEXT COLUMN Record of: Student ; Date of Birth: CSI T 9 w' :ate Issued.. 3 Page- 1 Dawn Ja.4es -*1*_92 2.. COURSE TribE i Institution information cootinued Term: BIBL 105 ENG L 112 PTS R a EX S Wt 230 iMATH 120 .1PHYS 101 :SOCW 230 Term, Ehrs 9 9.00 9„00 1200 3,.00 f 3.00 '6,00 6.00 0.00 4.0.. 3' 91 Term: } BIBL_ 211 ;1 B I O L 120 ;EXSC 111 SOCW 250 .,SOCw 325 :Term: Ehrs Term: 3IBD 380 yl, i. 3j4 212 � 3b2f g' H " .2 SCI 2� SOCW 126 rer : at Txsi fi /DIEM 340 lOta 222 kl-musivi 230 `4 .aF 4 soc1 416 ''Seett: y 35Z rF rjZ Spring 2001 01/15:101-O / 1. Acts -Revelation a ors Composition & Literature attire Scuba Diving Elem Mat.blema ifli Reasoning Astronomy Intro co Social. WeLleare 15.00 GPA- Hrs : 15.00 QPtr , CARD, G,D ,..,PTS ?001 _J^0 A. 12.00 3.00 C •6.00 1.00. W 0.00 3-.04 D 3.00 3.00 0 9%00 3.00 B. 9,00 39,00 GPA: Fall ` ,y 2001 108/21/2001- L2//34/,aaoi.) Message of the Old tesLarnent 3,00 .A 402000 Biology -,Human Perspective 6t000 Team Sports for Wornen , 0; .:A. 4.00 Interpersonal a4110 is 3.00 0 9 : 44 Human �;i,X�t .Yc 3.00 B 0! 13,00 GPA$i s: 13.00 (�o :'0.4-0 GPA 1,07.. ,07.. Spring 2002 C01/14/2002-05/11/2,0024 Intro to Ph o phy 3.00.8 Cbr ist i ast•S t y *n Culture f ta•1Or 3%00 A American History i 3;00 S ial Problems 3.00 Hume Behavior Scc Environ I 3.00 15.00 GPA,K. 71 .y/(�,` 4y 00 S s Fail 2002 �0a/ a6�� 20021- y'fl13/200:2) Foundations of Youth Min ::.. 3.00 A " . 'r Sr ti hWriters Li I; t.r.oc to Music oet S ata.sties Social CONTINUED P" `a .ce ON PAGE t }F� �3 CONTINUED l AGE. *******************************w • � i �tr r< 3.00• . 3.00 C- 4.00 A 9,00 ,0 9.0* •6 •. 00 3.03 12.1.7:0 0..0.0 1(!...00 •6.001 T6.00 ****t**S*****#f'i *fls t I 1k SWIJ NO 'COURSE TITLE OFFICIAL TRANSCRIPT MED ORD ante Issued:. 30 -SE? O ... Page: 2 Record of: Shiloh Dawn Jones Student ID: t* .. * * - s 992 Date of Birth: n --NOV * ******* * *4*tSx*tt*Iirar*ir**tt*t* TRANseRzpoT TOTALS ****,******* *4*w***sv* Earned Mrs GPA Mrs Points OPA PTS R !TOTAL INSTITUTION 116.00 113.00 344.0.0 3,04 ins ].tut iota :nformat lion continued: Tern: Ehrs; < 3.00 fl - tt3: 13.00 QPts: Term: ENGL 222 ' SC 211 LS 22$ SOCI 444 SOCW 302 SGT 415 S W 44.1 erm : Rr s: 43.00 CPA: Spring 2003 tOi/1.3/2OO3-OS/O9/2OO ' MO= British Writer's II cross- ra nl:hg National Government Social Group Leadership Field Sxnerience Social Research Social Welfare Policy & Seate .c 17.00 PA, -Ain: 17,00 opts: 3.00 1.00 0.00 3.00 3.00 4.00 3.00 55.00 3.30 l 6.00 A 4.00 w 0,00 A 12.00 A 12.00 E 12.00 Fi 9.00 CPA: 3 23 Term: Pall 2003 48/2S/zOO3-' •2/12/2003? DIEM 405 Women inChristian Service 3.00 8 BiDM 4.13 Sem in Ado . Moral/Sex Issues 3. 00 B BLS 226 States and Federal System 3.00 C P.SYC 382 Abnormal Psychology 3.00 CR CI 442 av11ura1 Diversity 3.00 C SOCW 4.5.E Socta.•I Work Practice 3S 4.00 A Term: Ehrs : 19.00 GPPmis: 14.00 QPts: 46,00 GP.A: Term: S0CW 400 SOCW *S.I SOCW 491 Term: rs-: Sp:ai;s 2004 col/12/2OO4-O5/O1/2OO4) GS:Social ia,l W 'k w/Ch.idrn&Parn1 .es 2.00 A Field Experience II (yam) ;q��}�(yi}j` 6.00 S In rgrati f e Semi - Social l i!Wk 1.00 A 9,00 GPA-Kra: 9,00 QPts : 30.00 GPA: 00 .00 6_00 0.00 6 00 6.10 2.87 8.00 18.00 T 4 . lV 0 3..33 *****w*w***W'*t***t** CONTINUED QN NEXT coLumN ***********.t*sr*** !TOTAL TRANSFER OVERALL 0'x.00 0.00 0.00 0.00 128.00 113.00 344,00 3.04 * ************v******* END OF TRANSCRIi` ************i****lk***** • TO VERIFY: TRAN$LYCENT ..OBE ICONS Registrar: T'BE VISIBLE WHEW HELD TOWARD. A LIGHTrsS`O l CE Contract Form New Contract Request Entity Information Entity Name* ARIEL CLINICAL SERVICES Entity ID* @44035654 Contract Name* ARIEL CLINICAL SERVICES (CHILD PROTECTION AGREEMENT FOR SERVICES) Contract Status CTB REVIEW ❑ New Entity? Contract ID 2640 Contract Lead* CULLINTA Contract Lead Email cullinta@co weld co us Parent Contract ID 20190707 Requires Board Approval YES Department Project # Contract Description* CONSENT. NEW AGREEMENT FOR SERVCIES. FUNDING: CORE/OTHER. TERM 06/01/19-05/31!2020 Contract Description 2 BID NO. 81900025 Contract Type* AGREEMENT Amount* $0"00 Renewable* YES Automatic Renewal Grant IGA Depar [runt HUMAN SERVICES Department Email CM- HumanSerrices@weldgov corn Department Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYA I I ORNEY@A`ELD GOV. COM Requested BOCC Agenda Date* 05/0612019 Due Date 05;02'2019 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a P4SA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in On Base Contract Dates Effective Date Review Date* 04/41/2020 Termination Notice Period Committed Delivery Date Renewal Date* 06/01/2020 Expiration Date Contact Information Contact Info Contact Name Purchasing Purchasing Approver CONSENT Approval Process Department Head JUDY GRIEGO DH Approved Date 06/24/2019 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 07/01/2019 Originator CULLINTA Contact Type Contact Email Finance Approver CONSENT Contact Phone 1 Purchasing Approved Date 06/24/2019 Finance Approved Date 06/24/2019 Tyler Ref f AG 070119 Legal Counsel CONSENT Contact Phone 2 Legal Counsel Approved Date 06/24.12019 Submit Hello