HomeMy WebLinkAbout20200017.tiffRESOLUTION
RE: APPROVE AGREEMENT FOR PROFESSIONAL SERVICES FOR PEER SUPPORT
PROJECT AND AUTHORIZE CHAIR TO SIGN - TIMOTHY BROWN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Agreement for Professional Services
for a Peer Support Project between the County of Weld, State of Colorado, by and through the
Board of County Commissioners of Weld County, on behalf of the Department of Human
Resources, and Timothy Brown, commencing January 1, 2020, and ending December 31, 2020,
with further terms and conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Agreement for Professional Services for a Peer Support Project
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Resources, and
Timothy Brown, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 6th day of January, A.D., 2020, nunc pro tunc January 1, 2020.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: deofeiv w a o%el
Weld County Clerk to the Board
c
BY:
Deputy Clerk to the Boar
APPAS
ounty A orney
Date of signature: at /1`F/20
Mike Freeman, Chair
Men-e-/yi-es—
Steve Moreno, Pro-Tem
arbara Kirkmeyer
Cc. . (-t RC PPI/KL)
o f /2.4 /2.0
2020-0017
PE0033
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: Peer Support Contract - Tim Brown
DEPARTMENT: HR DATE: 12/30/19
PERSON REQUESTING: Patti Russell/Kelly Leffler
Brief description of the problem/issue:
We are asking support to contract with Tim Brown for the Peer Support Program we are building for the Sheriff's, Coroner, District Attorney & Dispatch
employees. There was not an RFP for this as Mr. Brown is sole source because of his highly specified requirements. Kelly did meet with two other
counselors, neither of which have developed a Peer Support Program from the ground up, or had near the experience, if any, in peer support. One of
the other counselors she spoke with mentioned doing some hostage negotiation/de-escalation with the SWAT Team, when checked with the Sheriffs
Office, she did not come recommended. Tim has had over 20 years of Peer Support Experience as a Team Member, Team Coordinator & Clinical
Advisor. He has assisted in developing a Peer Support Team for Longmont PD & served as the Clinic Advisor, is the Clinic Advisor for Larimer County
Peer Support, & is certified by Dr. Jack Digliani as a Police Peer Support Team instructor. Not only does he have the Peer Support background, but he
also has 38 years of Law Enforcement Experience working as a Deputy Sheriff, Sergeant, Lieutenant and Captain/Assistant Chief. Time also came
highly recommended by Joanne Rupert, who is the Founder of First Responder Trauma Counselors. I have discussed Tim with Sheriff Reams & Reams
likes the fact that he has the cultural competency down. This contract and exhibit have been approved by the County Attorney's Office and Don Warden
What options exist for the Board? (include consequences, impacts, costs, etc. of options):
1. Approve contract
2. Don't approve contract
If contract not approved, we may have more difficulty starting a robust Peer Support Program as
discussed in our work session a few months ago.
Recommendation:
We recommend approval of the contract.
Sean P. Conway
Mike Freeman, Pro -Tern
Scott K. James
Barbara Kirkmeyer, Chair
Steve Moreno
Approve Schedule
Recommendation Work Session
Other/Comments:
2020-0017
PE,0033
Karla Ford
From:
Sent:
To:
Cc:
Subject:
Approve
Sent from my iPhone
Barbara Kirkmeyer
Tuesday, December 31, 2019 8:49 AM
Steve Moreno
Karla Ford; Mike Freeman
Re: Please Reply - Passaround for HR
On Dec 31, 2019, at 8:45 AM, Steve Moreno <smoreno@weldgov.com>wrote:
Approve
Sent from my iPhone
On Dec 30, 2019, at 4:06 PM, Karla Ford < .fermi (wel ov.co t> wrote:
Please let me know if you approve recommendation. Thanks!
Karla Ford St
Office Manager, Board of Weld County Commissioners
1150 0 Street, P.O. Box 758, Greeley, Colorado 80632
:: 970.336-7204 :: kford a eicgo.v.com •• vww.weidgov.c ors ..
.....,v.........v»..«v ww..u............ w«w.www..ww . v
My working hours are Monday -Thursday 7:00a.m.-4:00 p.m.
Friday 7:00a.m. - Noon
<image002.jpg>
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-
mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the
contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
.....:.V••:1J :•. v t.YJ A\0,* ANv.v... A .A.N.N\.1.0ny 0...JA..1MM nn 'JnwrNJNI.t.nrMM'r. M•.v...m.V r.vM1W. M1 h•nv v •
From: Patti Russell <orusse,Wweldggovxcom>
Sent: Monday, December 30, 2019 3:57 PM
To: Karla Ford <kfordpwel , v.com>
Subject: Passaround for the Board
Hi Karla,
Need the Board to see this Pass Around...
Thank you!
Karla Ford
From:
Sent:
To:
Subject:
Approve
** Sent from my iPhone **
Scott James
Tuesday, December 31, 2O19 1O:25 AM
Karla Ford
Re: Please Reply Passaround for the Board
Scott K. James
Weld County Commissioner, District 2
1.1._5O O Street,
. Box '758 reel yd Colorado 8O632
97O.336.72O4 (Office)
97O.381, 7496 (Cell)
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return
e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the
contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited
On Dec 31, 2O19, at 8:57 AM, Karla Ford <kford@weldgov.com>wrote:
Please let me know if you approve recommendation.
Karla Ford
Office Manager, Board of Weld County Commissioners
1150 O Street, P.O. Box 758, Greeley, Colorado 80632
:: 970.336-7204 :: kford,aweidroy._com :: www w&&drev.com
My working hours are Monday -Thursday 7:00a.m.-4:00 p.m.
Friday 7:00a.m. - Noon
<imageOO2.jpg>
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to
which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received
this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying,
distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named
recipient is strictly prohibited.
.0 .....••:1 4•%%%%v. A. Kn. • MYv.:.v ..... 4 •H . .. L`•J •..•
`IA -• %Al. • a •WV .wp At • •• •• tre. 9• v. 4•••••••• . . -::::w . ......
From: Patti Russell <prussell@weldgov.com>
Sent: Monday, December 3O, 2O19 3:57 PM
To: Karla Ford <kford@weldgov.com>
Subject: Passaround for the Board
1
WELD COUNTY AGREEMENT FOR PROFESSIONAL SERVICES
BETWEEN WELD COUNTY & TIMOTHY BROWN
PEER SUPPORT PROJECT
THIS AGREEMENT is made and entered into this 6th day of January, 2020, by and between the County of Weld,
a body corporate and politic of the State of Colorado, by and through its Board of County Commissioners, whose address
is 1150 "O" Street, Greeley, Colorado 80631 hereinafter referred to as "County," and Timothy Brown, who whose address
is 5009 Meining Road, Berthoud, Colorado 80513-8665, hereinafter referred to as "Contractor".
WHEREAS, County desires to retain Contract Professional as an independent Contract Professional to perform
services as more particularly set forth below; and
WHEREAS, Contract Professional has the ability, qualifications, and time available to timely perform the services,
and is willing to perform the services according to the terms of this Agreement.
WHEREAS, Contract Professional is authorized to do business in the State of Colorado and has the time, skill,
expertise, and experience necessary to provide the services as set forth below;
NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties hereto
agree as follows:
1. Introduction. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A and
Exhibit B which forms an integral part of this Agreement. Exhibit A and B are specifically incorporated herein by this
reference.
2. Service or Work. Contractor agrees to procure the materials, equipment and/or products necessary for the Project and
agrees to diligently provide all services, labor, personnel and materials necessary to perform and complete the Project
described in Exhibit A.
3. Term. The term of this Agreement begins January 1, 2020 and expires on December 31, 2020. This contract may extended
for up to two additional one (1) year terms upon written agreement of both parties.
4. Termination. County has the right to terminate this Agreement, with or without cause on thirty (30) days written notice.
Furthermore, this Agreement may be terminated at any time without notice upon a material breach of the terms of the
Agreement.
5. Extension or Modification. Any amendments or modifications to this agreement shall be in writing signed by both
parties. No additional services or work performed by Contractor shall be the basis for additional compensation unless and
until Contractor has obtained written authorization and acknowledgement by County for such additional services.
6. Compensation/Contract Amount. The County agrees to pay a fixed monthly amount as described in Exhibit B for the
services set forth in Exhibit A. The maximum amount may not exceed $140,000.00. County will not withhold any taxes
from monies paid to the Contractor hereunder and Contractor agrees to be solely responsible for the accurate reporting and
payment of any taxes related to payments made pursuant to the terms of this Agreement.
7. Independent Contractor. Contractor agrees that it is an independent Contractor and that Contractor's officers, agents
or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the
execution of this Agreement. Contractor shall perform its duties hereunder as an independent Contractor. Contractor shall
be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement.
Contractor, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through
County and County shall not pay for or otherwise provide such coverage for Contractor or any of its agents or employees.
8. Subcontractors. Contractor acknowledges that County has entered into this Agreement in reliance upon the particular
reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of
this Project without County's prior written consent, which may be withheld in County's sole discretion.
9. Ownership. All work and information obtained by Contractor under this Agreement or individual work order shall
become or remain (as applicable), the property of County.
10. Confidentiality. Contractor agrees to keep confidential all of County's confidential information. Contractor agrees
not to sell, assign, distribute, or disclose any such confidential information to any other person or entity without seeking
written permission from the County. Contractor agrees to advise its employees, agents, and consultants, of the confidential
and proprietary nature of this confidential information and of the restrictions imposed by this agreement.
11. Warranty_ Contractor warrants that the services performed under this Agreement will be performed in a manner
consistent with the standards governing such services and the provisions of this Agreement. Contractor further represents
and warrants that all services shall be performed by qualified personnel in a professional and workmanlike manner,
consistent with industry standards, and that all services will conform to applicable specifications.
12. Acceptance of Services Not a Waiver. In no event shall any action by County hereunder constitute or be construed
to be a waiver by County of any breach of this Agreement or default which may then exist on the part of Contractor.
Acceptance by the County of, or payment for, the services completed under this Agreement shall not be construed as a
waiver of any of the County's rights under this Agreement or under the law generally.
13. Insurance and Indemnification. Contractor shall procure at least the minimum amount of automobile liability
insurance required by the State of Colorado for the use of any personal vehicle. Proof of said automobile liability insurance
shall be provided to County prior to the performance of any services under this Agreement. Professional Liability (Errors
and Omissions Liability) The policy shall cover professional misconduct or lack of ordinary skill for those positions
defined in the Scope of Services of this contract. Contract Professional shall maintain limits for all claims covering wrongful
acts, errors and/or omissions, including design errors, if applicable, for damage sustained by reason of or in the course of
operations under this Contract resulting from professional services. In the event that the professional liability insurance
required by this Contract is written on a claims -made basis, Contract Professional warrants that any retroactive date under
the policy shall precede the effective date of this Contract; and that either continuous coverage will be maintained or an
extended discovery period will be exercised for a period of two (2) years beginning at the time work under this Contract is
completed.
Minimum Limits:
Per Loss
Aggregate
$ 1,000,000
$ 2,000,000
14. Indemnity. The Contractor shall defend, indemnify and hold harmless County, its officers, agents, and employees,
from and against injury, loss damage, liability, suits, actions, or claims of any type or character arising out of the work done
in fulfillment of the terms of this Contract or on account of any act, claim or amount arising or recovered under workers'
compensation law or arising out of the failure of the Contractor to conform to any statutes, ordinances, regulation, law or
court decree.
15. Non -Assignment. Contractor may not assign or transfer this Agreement or any interest therein or claim thereunder,
without the prior written approval of County.
16. 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.
17. Compliance with Law. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations
in effect or hereafter established, including without limitation, laws applicable to discrimination and unfair employment
practices.
18. Non -Exclusive Agreement. This Agreement is nonexclusive and County may engage or use other Contractors or
persons to perform services of the same or similar nature.
19. Entire Agreement/Modifications. This Agreement including the Exhibits attached hereto and incorporated herein,
contains the entire agreement between the parties with respect to the subject matter contained in this Agreement. This
instrument supersedes all prior negotiations, representations, and understandings or agreements with respect to the subject
matter contained in this Agreement. This Agreement may be changed or supplemented only by a written instrument signed
by both parties.
20. Fund Availability. Financial obligations of the County payable after the current fiscal year are contingent upon funds
for that purpose being appropriated, budgeted and otherwise made available. Execution of this Agreement by County does
not create an obligation on the part of County to expend funds not otherwise appropriated in each succeeding year.
21. Employee Financial Interest/Conflict of Interest — C.R.S. §§24-18-201 et seq. and §24-50-507. The signatories to
this Agreement state that to their knowledge, no employee of Weld County has any personal or beneficial interest
whatsoever in the service or property which is the subject matter of this Agreement.
22. 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.
23. 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 §§24-10-101 et seq., as applicable now or hereafter amended.
24. No Third Party Beneficiary. It is expressly understood and agreed that the enforcement of the terms and conditions
of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties
and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included
in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties
receiving services or benefits under this Agreement shall be an incidental beneficiary only.
25. Board of County Commissioners of Weld County Approval. This Agreement shall not be valid until it has been
approved by the Board of County Commissioners of Weld County, Colorado or its designee.
26. 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.
27. Public Employment Retirement Program. Contractor is responsible for notifying Weld County of any previous
participation in the Colorado Public Employee Retirement Program. Contractor must notify Weld county of the most recent
employment for a PERA contributing employer.
28. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not
knowingly employ or contract with an illegal alien who will perform work under this contract. Contractor will confirm the
employment eligibility of all employees who are newly hired for employment in the United States to perform work under
this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to
C.R.S. §8-17.5-102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall
not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -
Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while
this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the
public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor
and County within three (3) days that Contractor has actual knowledge that a subcontractor is employing or contracting
with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the
illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the
subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an
illegal alien. Contractor shall comply with reasonable requests made in the course of an investigation, undertaken
terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has
not knowingly employed or contracted with an illegal alien. Contractor shall comply with reasonable requests made in the
course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and
Employment. If Contractor participates in the State of Colorado program, Contractor shall, within twenty days after hiring
an 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 County, a written notarized affirmation that it has examined the legal work status
of such employee, and shall comply with all of the other requirements of the State of Colorado program. If Contractor
fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this
Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages.
Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contractor receives federal
or state funds under the contract, Contractor must confirm that any individual natural person eighteen (18) years of age or
older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public
benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty
of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to
federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall
produce one of the forms of identification required by C.R.S. § 24-76.5-103 prior to the effective date of the contract.
29. Acknowledgment. County and Contractor acknowledge that each has read this Agreement, understands it and agrees
to be bound by its terms. Both parties further agree that this Agreement, with the attached Exhibits A and BT, is the
complete and exclusive statement of agreement between the parties and supersedes all proposals or prior agreements, oral
or written, and any other communications between the parties relating to the subject matter of this Agreement.
IN WITNESS WHEREOF, the parties hereto have signed this Agreement this �9 day of Jan .
aOaOL.
CONTRACTOR:
By: Date /".-/Z_,-/
Name:
Title: �: «�, : tr f'- 6..467..
WELD COUNTY:
ATTEST: C./rdrittAi
Weld C. . . n lerk to the Bo
BY:
OARD OF COUNTY COMMISSIONERS
LD COUNTY, COLORADO
Deputy Cler Ito a Boke Freeman, Chair
APPROVED AS TO FUNDING:
�XJ
Controller
APPROVED AS T 0 ORM:
4.
County Attorney
a
JAN 062Q.2'
D AST
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S TANCE:
Elected Official Department Head
EXHIBIT A
SCOPE OF WORK
SERVICES OF THE CONTRACTOR
A. The Contractor shall provide psychological services to Weld County Criminal
Justice Employees, including, but not limited to, individual and group counseling.,
individual assessment, special project work as assigned by Weld County contract
liaison, in-service training, and any other services mutually agreed upon by the
County and the Consultant.
B. The Contractor shall provide intervention/counseling services for all Weld County
Sheriff's Office (WCSO) Sworn Employees, jail staff, Regional
communications/dispatch personnel, members of the Peer Support Team
(including civilian members), employees of the Coroner's Office, and full-time
employees of the Weld County District Attorney.
C. All above -listed counseling services shall also be made available to the spouses
and immediate family members of the eligible employees.
D. The contractor shall provide clinical supervision and training to the Weld County
Sheriff's Peer Support Team and other Peer Support Teams as developed or
expanded. Contractor shall meet monthly (minimum of ten months per year) with
Peer Support Teams in the provision of supervision and training.
E. This agreement does not include "on -call" or "respond to scene" responsibility
except in extreme emergency and by mutual agreement. WCSO agrees to provide
transportation to and from the scene of the incident for the Contractor, for support
of the Sheriff's Office employees, when necessary. Although these services are
not expected except in emergency situations, if provided to employees listed in
Paragraph F, the services are considered part of this scope and are not billed
separately.
F. The contractor agrees to develop and provide additional programming in support of
the Weld County Human Resources' Health and Productivity Program. These
support programs include the Psychological and Training/Recruit Officer Liaison
(P.A.T.R.O.L.) program for new hire personnel in the Weld County Sheriff's Office,
Weld County Jail, Regional Communications Center, Coroner's Office and District
Attorney's Offices as well as other programs as mutually agreed upon by the
Contractor and the Weld County Contract Liaison. Ultimately, programs may
include:
1. Recruit and Training Academy training programs including stress
management training and inoculation,
2. Preemptive programs including the computer crimes child pornography
investigators' quarterly contact support program, Proactive Annual Check -In
(PAC), and the Trauma Intervention program (TIP).
1
3. Development of Critical Incident Management protocols, including but not
limited to Return to Duty (RTD) protocols and Officer Wellness Assessments,
4. In -Service training programs as mutually agreed upon by the Contract
Liaison and the consultant,
5. And Retirement preparation programs in conjunction with Weld County
Human Resources to include:
a. Psychological and emotional issues
b. Departing the Criminal Justice role, and
c. Family and other social issues
G. The Contractor agrees to provide Critical Incident Debriefing Services in
conjunction with the Peer Support Team for Weld County Personnel involved in
traumatic, critical incidents.
H. The Contractor shall be available to present training programs including "Interacting
with Persons with Mental Illness" and within each of the basic skills academies for
Patrol and Jail deputies. The dates of program presentations are to be mutually
agreed upon by the liaison and the Consultant.
I. The Contractor shall be available to present programs of any topic mutually agreed
upon by the County and the Consultant. The Contractor may suggest topics for
continuing or advanced training, including Marriage and Relationships in Law
Enforcement Families, and Advanced Peer Support Team Training, as well as
additional, mutually agreeable training seminars.
J. The Contractor shall obtain, and maintain continuously for the term of this contract,
at his expense, insurance as required by Weld County Risk Management,
incorporated by reference herein (attached). The Contractor is not relieved of any
liability or other obligations assumed pursuant to this contract by reason of its failure
to obtain or maintain insurance or by reason of its failure to procure or maintain
insurance in sufficient amounts, durations, or types.
SECTION II - THE COUNTY'S RESPONSIBILITIES
The County shall:
A. Provide information as to its requirements for the project.
B. Give prompt notice to the Contractor whenever the County observes or otherwise
becomes aware of any deficiency in the project.
C. Assist the Contractor in obtaining approval of all governmental authorities having
jurisdiction over the project and such approvals and consents from such other
individuals or bodies as may be necessary for completion of the project.
D. Provide contractor with a contractor access identity card.
2
E. Provide reasonable access to Weld County buildings as needed to perform
Contractor's duties under this Agreement. Such access may be restricted,
suspended or terminated as deemed necessary for security purposes as
determined in the sole discretion of Weld County.
F. Clinical Records: The parties acknowledge that Contractor shall be performing
psychological services and that documents generated in the performance of
clinical duties under this Agreement are protected by State and Federal Law.
1. Any clinical notes created by the Contractor shall remain the property of the
Contractor and are governed and controlled by the therapist/patient
relationship. Any clinical reports, testing, evaluations, or other formal
documents shall not be deemed a part of any employee's personnel file, but
are separate and independent psychological records, and as such are
governed by state and federal confidentiality laws.
2. Contractor shall not disclose the identity, intervention, process, or case
issues to the County or any other third -party, unless:
i. The client has signed a release as required by state and federal laws,
ii. Confidentiality is otherwise waived by the client,
iii. Client is assessed as unable to safely perform the duties of his or her
position, or
iv. Such information is otherwise ruled releasable by law.
v. Agrees to sign confidentiality statement for limited access to
employees' files.
3
EXHIBIT B
PAYMENT AND FEE SCHEDULE
A. It is understood and agreed by and between the parties hereto, that the County
shall pay the Contractor for services furnished at $11667.00 per month, not to
exceed 140,000.00 in a 12 month period as full payment for services described in
Exhibit A.
B. Invoices will be submitted by the Contractor monthly for services performed
and expenses incurred pursuant to this Agreement during the prior month.
Contractor shall provide a monthly invoice to Weld County. This monthly
statement shall be submitted to the Weld County Director of Human Resources
by the 10th day of each month detailing the previous month.
C. Contractor shall be permitted to create and maintain his work schedule. This
schedule may limit office hours to specific days of the week and hours of the day.
However, Contractor shall ensure he is reasonably available to provide services
as outlined in this Agreement and shall ensure he is available for reasonable
clinical hours each month and is capable of accommodating a variety of the
individual departments personnel schedules, which may include hours outside
normal business hours.
D. Contractor acknowledges that non -clinical hours may be necessary to fulfill
Consultant's duties under this Agreement, and such non -clinical hours shall not
incur additional fees and are included within the amount paid under Paragraph A
above.
E. Contractor acknowledges that this Agreement is not an "hourly" agreement, but is
for services as outlined. There is no minimum or maximum number of hours
required of the Contractor per month or year, but the Contractor must fulfill all
services as outlined in this Agreement.
F. Contractor shall provide in the monthly invoice the specific number of clinical
hours and non -clinical hours provided that month, and the number of personnel
who received services that month.
Tim M. Brown, M.A., L.P.C., Consultant
4
IIIHPSO
01/16/19
Timothy Brown
5009 Meining Rd
Berthoud, CO 80513-8665
1100 Virginia Drive, Suite 250
Fort Washington, PA 19034-3278
Phone:1-800-982-9491 Fax:1-800-758-3635
Website:www. hpso. corn
Dear Timothy Brown:
Enclosed is the replacement certificate of insurance that you requested.
If you have any questions or need assistance, please call us toll free at 1-800-982-9491. Our
Customer Service Representatives are available weekdays from 8:00 a.m. to 6:00 p.m., EST.
Sincerely,
Customer Service
Enclosure
Dedicated To Serving The Insurance Needs of Healthcare Providers
Healthcare Providers Service Organization is a registered trade name of Affinity Insurance Services, Inc.; (AR
244489); in CA 8 MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services Inc.;
in CA, Aon Affinity Insurance Services, Inc., (0G94493), Aon Direct Insurance Administrators and Berkely Insurance
Agency and in NY, AIS Affinity Insurance Agency.
Q032
HEALTHCARE PROVIDERS SERVICE
CNAORGANIZATION PURCHASING GROUP 1 1PSE
Certificate of hi urance
OCCURRENCE POLICY FORM
Producer Branch Prefix
018098 970 HPG
Named Insured and Address:
Timothy Brown
5009 Meining Rd
Berthoud, CO 80513-8665
Medical Specialty:
Mental Health Counselor
Excludes Cosmetic Procedures
Policy Number
0273341612
Print Date: 1/16/2019
Policy Period
from 02/15/19 to 02/15/20 at 12:01 AM Standard Time
Program Administered by:
Healthcare Providers Service Organization
1100 Virginia Drive, Suite 250
Fort Washington, PA 19034
1-800-982-9491
www.hpso.com
Code: Insurance is provided by:
80723
American Casualty Company of Reading, Pennsylvania
333 S. Wabash Avenue, Chicago, IL 60604
Professional Liability $1,000,000 each claim
Your professional liability limits shown above include the following:
Good Samaritan Liability * Malplacement Liability Personal Injury Liability
* Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit
Coverage Extensions
License Protection
Defendant Expense Benefit
Deposition Representation
Assault
Includes Workplace Violence Counseling
Medical Payments
First Aid
Damage to Property of Others
Information Privacy (HIPAA) Fines and Penalties
Workplace Liability
Workplace Liability
Fire & Water Legal Liability
Personal Liability
Total: $ 163.00
$ 3,000,000 aggregate
$ 25,000 per proceeding $ 25,000 aggregate
$ 1,000 per day limit $ 25,000 aggregate
$ 10,000 per deposition $ 10,000 aggregate
$ 25,000 per incident $ 25,000 aggregate
$ 25,000 per person $ 100,000 aggregate
$ 10,000 per incident $ 10,000 aggregate
$ 10,000 per incident $ 10,000 aggregate
$ 25,000 per incident $ 25,000 aggregate
Included in Professional Liability Limit shown above
Included in the PL limit shown above subject to $150,000 aggregate sublimit
$1,000,000 aggregate
Base Premium $163.00
Premium reflects Self Employed , Part Time
Policy Forms
endorsements
G -121500-D
GSL15565
CNA81758
& Endorsements(Please see attached list for a general description
G -121503-C G -121501-C G -145184-A
GSL17101 GSL13424 CNA80051
CNA82011 CNA79575
Chairman of the Board
G -141241-B (03/2010)
Secretary
Coverage Change Date:
of many common policy forms and
G -147292-A GSL15563 GSL15564
CNA80052 G -123846-005 CNA81753
Keep this document in a safe place.lt
and proof of payment are your proof of
coverage. There is no coverage in force
unless the premium is paid in full.ln order
to activate your coverage, please remit
premium in full by the effective date of
this Certificate of Insurance.
Master Policy # 188711433
Endorsement Change Date:
POLICY FORMS & ENDORSEMENTS
The following are the policy forms and endorsements that apply to your current professional liability insurance policy.
COMMON POLICY FORMS& ENDORSEMENTS
FORM # DESCRIPTION
G -121500-D Common Policy Conditions
G -121503-C Workplace Liability Form
G -121501-C Occurrence Policy Form
G -145184-A Policyholder Notice - OFAC Compliance Notice
G -147292-A Policyholder Notice - Silica, Mold & Asbestos Disclosure
GSL15563 Information Privacy Coverage Endorsement HIPAA Fines, Penalties & Notification Costs
GSL15564 Sexual Misconduct Sublimits of Liability Professional Liability & Sexual Misconduct Exclusion
GSL15565 Healthcare Providers Professional Liability Assault Coverage
GSL17101 Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies
GSL13424 Services to Animals
CNA80051 Amended Definition of Personal Injury Endorsement
CNA80052 Distribution or Recording of Material or Information in Violation of Law Exclusion Endorsement
G -123846-005 Colorado Cancellation and Non -Renewal
CNA81753 Coverage & Cap on Losses from Certified Acts Terrorism
CNA81758 Notice - Offer of Terrorism Coverage & Disclosure of Premium
CNA82011 Related Claims Endorsement
CNA79575 Exclusion of Cosmetic Procedures
PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE POLICY FORMS & ENDORSEMENTS SPECIFIC
TO YOUR STATE AND YOUR POLICY PERIOD.
For NJ residents:
The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property & Liability Insurance
Guaranty Association.
For KY residents: The Surcharge shown on the Certificate of Insurance is the KY Firefighters and Law Enforcement
Foundation Program Fund and the KY LGPT is the KY Local Government Premium Tax which
includes charges at a municipality and/or county level.
For WV residents: The surcharge shown on the Certificate of Insurance is the WV Premium Surcharge.
For FL residents:
The FIGA Assessment shown on the Certificate of Insurance is the FL Insurance Guaranty Association
- 2012 Regular Assessment.
Form#: G -141241-B (03/2010)
Named Insured:Timothy Brown
Master Policy#: 188711433 Policy#: 0273341612
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