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Home My WebLink About20200866.tiffRESOLUTION RE: APPROVE CHILD PROTECTION AGREEMENT FOR SERVICES AND AUTHORIZE CHAIR TO SIGN - KPJ FIRST SERVICES, LLC 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 a Child Protection Agreement for Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and KPJ First Services, LLC, commencing March 28, 2020, and ending May 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 Child Protection Agreement for Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and KPJ First Services, LLC, 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 11th day of March, A.D., 2020. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: dittiv •aC L;6k, Weld County Clerk to the Board Deputy Clerk to the Board y Attorney Date of signature: o3/Ictao Mike Freeman, Chair Steve :reno, Pro-Tem . James cc:HSD 04/06/2.0 2020-0866 HR0092 av PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: March 3, 2020 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Protection Agreement for Services with KPJ First Services, LLC for Home Studies 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 for Services with KPJ First Services, LLC. The Department is requesting to enter into an agreement for Home Studies. The major provisions of this Agreement are as follows: Term Service(s) and Funding Rate(s) March 28, 2020 - Home Studies $1,200.00/Episode (Full Home Study) May 31, 2020 CW Admin/Other $200.00/ Each additional adult (Full Home Study) $60.00/Hour (Partial Home Study) $550.00/Episode (Home Study Update) $100.00/Each additional adult (Home Study Update) $.55/Mile (Mileage) — For distance exceeding twenty (20) miles from practitioner's office located at 928 13th Street, Greeley, CO 80631. $200.00/Episode Spanish Interpreter - (Full Home Study) $100.00/Episode Spanish Interpreter - (I-Iome Study Update) Pass -Around Memorandum; March 3, 2020 — CMS 3418 Page 1 2020-0866 ©341 ofoq 2 PRIVILEGED AND CONFIDENTIAL I do not recommend a Work Session. I recommend approval of this Agreement and authorize the Chair to sign. Mike Freeman, Chair Scott James Barbara Kirkmeyer Steve Moreno, Pro -Tern Kevin Ross �1V Approve Schedule Recommendation Work Session Other/Comments: Pass -Around Memorandum; March 3, 2020 — CMS 3418 Page 2 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND KPJ FIRST VICES LLC This Agreement, made and entered into the/ /day of , 2020 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department' and KPJ First Services, LLC, hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule. Exhibit B, C, and D are attached hereto and incorporated herein by this reference. Exhibit A is Weld County's Request for Proposal Number B1900025. which is incorporated into this agreement by reference and will be provided upon request to the Department. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided Child Welfare Administration or other funding to the Department for Home Studies. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on March 28.2020 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. oZ0a2o - 0 efeo, 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 required by the Department. Contractor agrees to utilize the Client Verification Form for all scheduled and unscheduled face-to-face services with the exception of one-time services (ex. home studies, evaluations and monitored sobriety testing). Contractor agrees that original complete Client Verification Forms with original signatures 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. evaluations, 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. 2 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. 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 3 - 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 the Age Discrimination in Employment Act of 1967; and the Equal Pay Act of 1963; and the Education Amendments of 1972; and - Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is determined by the Department. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. 4 e. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contractor will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5- 102(S)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contractor participates in the State of Colorado program, Contractor shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contractor has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contractor shall deliver to the Department, a written notarized affirmation that it has examined the legal work status of such employee and shall comply with all of the other requirements of the State of Colorado program. If Contractor fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., the Department, may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contractor receives federal or state funds under the contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24- 76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5- 103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under 5 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. 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 6 the start of this agreement. ii.Commercial General Liability Insurance written on ISO occurrence form CG 00 0110/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: $1,000,000 each occurrence; $2,000,000 general aggregate; $50,000 any one fire; and $500,000 errors and omissions. iii.Automobile Liability: Contractor shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: If any aggregate limit is reduced by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify the Department within ten (10) days and reinstate the aggregates required; Unlimited defense costs in excess of policy limits; Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by the Department. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to the Department, whichever is earlier. c. Contractors shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor shall provide a copy of this information to its insurance agent or broker and shall have its agent or broker provide proof of Contractor's required insurance. The Department reserves the right to require Contractor to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor's insurer shall name County as an additional insured. 7 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. Training 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 970-336-7235, 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. 8 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 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 Keith P. Wawrzvniak, Jr., Owner 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: Jamie Ulrich, Director P.O. Box A Greeley, CO 80632 (970) 4O0-6581 9 For Contractor: Keith P. Wawrzvniak, Jr., Owner 1626 Plains Drive Eaton, CO 80615 (970) 405-7716 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, 8, C, and D. 12 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to the Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by the Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflicts with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contractor's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contractor agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contractor acknowledges that the Department has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of this project without the Department's prior written consent, which may be withheld in the Department's sole discretion. 13 36. Attorney's Fees/Legal Costs In the event of a dispute between the Department and Contractor, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of the Department. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contractor in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the Department. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of the Department. 38. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. 14 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: .47rA61/ `�' ' BOARD OF COUNTY COMMISSIONERS Weld C. n y Clerk to the Board �� q �� WELD COUNTY, COLORADO By Deputy Clerk to th KPJ First Services, LLC 1626 Plains Drive Eaton, CO 80615 (970) 405-7716 15 e Freeman, Chair MAR 1 12020 CONTRACTOR: By: Date: Keithniak el, 19, 2020 Keith P. Wawrzyniak, Jr., Owner Feb 19, 2020 hoZo - o ffloly 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 KPJ FI ST SERVICES LLC. FAMILY AND INDIVIDUAL RESOURCES, SUPPORT AND TREATMENT 928 131" ST. #4C GREELEY, CO 8O631 (97O) 4O5-7716 KPWAWA@KPJFAMILYSERVICES.COM Introduction Letter Weld County Administration, Keith Paul Wawrzyniak Jr. is the owner of KPJ FIRST Services LLC. and is interested in being a contract provider for the Weld County Department of Human Services. From 2007-2013, Keith Wawrzyniak, under the business name of Dynamic Family Design, LLC. contracted with Weld County to primary do Home Studies and Relinquishment Counseling, probably completing about 2-3 Home Studies a month. Since that time, I have worked in child welfare for Weld County. I have recently completed a Home Study refresher training and a Home Study Supervisor refresher training. I am planning on resigning from the Department, if I am accepted at a contract provider. It is my understanding that there is a significant need for Home Study Providers. Although I understand we are toward the end of the contract cycle, I am requesting and hoping that my request to be a Home Study Contractor, that it be expedited so I can help the Department with the Home Study process. I believe I have completed over 100 Home Studies in the past for Weld County and other Counties together. I am able to complete them in a professional manner, making sure they are thorough and complete prior to submitting them to the Department. I fully understand the new requirements of the providers when it comes to the Home Study process as stated in the RFP and in Exhibit "A", and am able to fulfill each requirement. I am able to work collaboratively with the Department and any other professionals who may be involved with the family of each Home Study. Brandon Williams is an LCSW and Is attending the SAFE Home Study Certification Training at the end of February. He would be assisting me with Home Studies, when needed, under my supervision. KPJ FIRST Services plans to add additional scopes of services for the 2020-21 contract year, but in the mean time will be able to focus soley on Home Studies for Weld County. Sincerely, eith Wawrzyniak, MSC. KPJ FIRST Services, LLC. Owner ATTACHMENT B WELD COUNTY DEPARTMENT OF HUMAN SERVICES - PROVIDER INFORMATION FORM (PIF) Please type your information using the form fields (bores) below. You can press the Tab key to move from field to field. Agency Information Agency Name: KPJ FIRST Services, LLC. Trails Provider ID (If known>: Primary Contact Full Name: Keith Paul Wawrzyniak Jr. Tine: Owner Primary Phone Number Ito digxi: 970)405-7716 Ext.: Fax Number (10 -digit): Primary Contact Email: kpwawa@kpjfamilyservices.com Web Address: Agency Location Address (street, city, state, zip): 928th 13th St. Greeley, CO 80631 Agency Mailing Address (Street,cRy,state, zip): 1626 Plains Dr. Eaton, CO 80615 Agency Type (pick one): [ Private 1 1 Private Non -Profit n Private for Profit OHS service referrals should be sent to whom in your organization: Referral Contact Name: KP Wawrzyniak Tine: Owner Referral Phone Number (10-dipt): (970)405-7716Ext.: Email: kpwawa@kpjfamilyservices.com Billing Contact Billing Contact Name: KP Wawrzyniiak Title: Owner Billing Phone Number 110 -digit): (970) 405-7716 Ext.: Email: kpwawafakpjfamilyservices.com CERTIFICATION I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it has so indicated in this bid form. I further affirm intention to enter into an agreement with Weld County, on I behalf of the Weld County Department of Human Services, and comply with all requirements of the contract, if awarded. I The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and I. r 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 c I Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders In all cases where the bids are competitive in price and quality. j I Authorized Rep. Full Name: Keith Paul Wawrzyniak Jr. Title: Owner Authorized Rep. Email: kpwawa@kpjfamilyservices.com Phone: (970)405-7716 E,n, i Authorized Rep. Address: 1626 Plains Dr. Eaton, CO 80615 Signature of Authorized Rep.: Date: O14 r-cw REV. DEC 2019 EXHIBIT C - PROPOSAL TEMPLATE Please type your answers in the boxes below. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Program Area: KPJ FIRST Services, LLC Home Studies Number of services offered on this Exhibit C (max 5): 3 Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Exhibit C if you have more than 5. for Proposal starting on page 13. Service 2.1a 2.1b 2.1c 2.1d #1 Modalities, Name: curriculum, SECTION 2 Service Name(s) and Information — Full -Home Study tools used in delivery of service (DO NOT list company history; DO use bullet points): -This Consortium -There -The the -All -The -Brandon the Home required supervision service Home Home will Study. Williams for be Studies Studies will documentation interaction Children of be Keith will will and provided Joanna and be be Wawrzyniak. and completed completed by Weld observation will Martinson utilizing be County delivered within primarily the DHS. of will required each 60 to also days by WCDHS member Keith be format of available receipt up Wawrzyniak. in completion of any SAFE of to complete given all and information household of tools the Home provided Home needed Study. Studies by the to start under Anticipated frequency of service per week (i.e. 4 hours/week): -There minimum -There 1/z hours will will per of be 1 be visit. a minimum %z a minimum of hours per visit. of three two visits to visits to the the home home of a "couple" of a "single" Home Home Study, Study each at a minimum at a of 1 Anticipated duration of service (i.e. 3.4 months): To provider be completed within 60 days, barring any unforeseen issues or obstacles outside of the control of this Three (3), or more, specific goals of the service (DO use bullet points): -To observation -To -To provide complete be culturally a thorough and this interviews evaluation aware, and understanding complete using in an the objective assessment tools and required and respectful. of professional a by family the Department and manner. their support and systems, through SAFE. 2.1e Three (3), or more, specific outcomes of service: -Each recommendations Weld FIRST recommendations family County Services will DHS a receive of will recommendation to a fair receive mitigate and a any thoroughly objective of identified the level assessment completed concerns. of appropriateness and Home will Study understand of with placement all the required reason and/or documents. additional for any 2.1f Target population of the service, including age and gender: lCPCs, Kinship homes and foster family candidates 2.1g Languages service is available in (please list proficiency and if interpreter services are available): A Spanish interpreter is available 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: NA REV. NOV 2019 1 EXHIBIT C m PROPOSAL TEMPLATE Service #2 Name: Updated -Home Study 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): -This service will be provided by utilizing the required format of SAFE and tools provided by the Consortium for Children and Weld County DHS. -There will be interaction and observation of each member in any given household -The Home Studies will be completed within 60 days of receipt of all information needed to start the Home Study. - All required documentation will be delivered to WCDHS up completion of the Home Study. -The Home Studies will be completed primarily by Keith Wawrzyniak. -Brandon Williams and Joanna Martinson will also be available to complete Home Studies under the supervision of Keith Wawrzyniak. 2.2b Anticipated frequency of service per week (i.e. 4 hours/week): - There will be a minimum of three visits to the home of a "couple" Home Study, each at a minimum of 1 1/2 hours per visit. -There will be a minimum of two visits to the home of a "single" Home Study at a minimum of 1 1/2 hours per visit. 2.2c Anticipated duration of service (i.e. 3-4 months): To be completed within 60 days, barring any unforeseen issues or obstacles outside of the control of this provider 2.2d Three (3), or more, specific goals of the service (DO use bullet points): -To provide a thorough and complete assessment of a family and their support systems, through observation and interviews using the tools required by the Department and SAFE. - To complete this evaluation in an objective and professional manner. -To be culturally aware, understanding and respectful. 2.2e Three (3), or more, specific outcomes of service: - Each family will receive a fair and objective assessment. -Each family will understand the reason for any recommendations of this provider. -Weld County DHS will receive a thoroughly completed SAFE Home Study with all required documents. 2.2f Target population of the service: ICPCs, Kinship homes and foster family candidates 2.2g Languages service is available in (please list proficiency and if interpreter services are available): A Spanish interpreter is available 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: NA Service #3 Name: Partial Home Study 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): -This service will be provided by utilizing the required format of SAFE and tools provided by the Consortium for Children and Weld County DHS. -There will be interaction and observation of each member in any given household -The Home Studies will be completed within 60 days of receipt of all information needed to start the Home Study. -All required documentation will be delivered to WCDHS up completion of the Home Study. -The Home Studies will be completed primarily by Keith Wawrzyniak. -Brandon Williams and Joanna Martinson will also be available to complete Home Studies under the supervision of Keith Wawrzyniak. REV. NOV 2019 2 EXHIBIT C - PROPOSAL TEMPLATE 2.3b Anticipated frequency of service per week (i.e. 4 hours/week): -There will be a minimum of three visits to the home of a "couple" Home Study, each at a minimum of 11/2 hours per visit. -There will be a minimum of two visits to the home of a "single" Home Study at a minimum of 1 1/2 hours per visit. 2.3c Anticipated duration of service (i.e. 3-4 months): To be completed within 60 days, barring any unforeseen issues or obstacles outside of the control of this provider 2.3d Three (3), or more, specific goals of the service (DO use bullet points): -To provide a thorough and complete assessment of a family and their support systems, through observation and interviews using the tools required by the Department and SAFE. -To complete this evaluation in an objective and professional manner. -To be culturally aware, understanding and respectful. 2.3e Three (3), or more, specific outcomes of service: 2.3f 2.3g 2.3h -Each family will receive a fair and objective assessment. -Each family will understand the reason for any recommendations of this provider. -Weld County DHS will receive a thoroughly completed SAFE Home. Study with all required documents. Target population of the service: ICPCs, Kinship homes and foster family candidates Languages service is available in (please list proficiency and if interpreter services are available): A Spanish Interpreter is available Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: NA Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b Anticipated frequency of service per week (i.e. 4 hours/week): 2.4c Anticipated duration of service (i.e. 3-4 months): 2.4d Three (3), or more, specific goals of the service (DO use bullet points): 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list proficiency and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #5 Name: 1 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of service per week (i.e. 4 hours/week): REV. NOV 2019 3 EXHIBIT C - PROPOSAL TEMPLATE 2.5c 2.5d 2.5e 2.5f 2.5g 2.5h Anticipated duration of service (i.e. 3-4 months): - _ - Three (3), or more, specific goals of the service (DO use bullet points): Three (3), or more, specific outcomes of service: Target population of the service: Languages service is available in (please list proficiency and if interpreter services are available): L Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Section 3.1 Will you conduct services in your 3.1a If yes, office location(s): 3.2 Will you conduct services out 3.2a If yes, how many miles 3.3 Will you transport clients to and 3.3a If yes, what is your staffing 3.3b If yes, how many miles 3 — Service Access and Transportation office? of the will from will I My office is available when needed. 1 928 13th Street. Greeley, CO 80631 office? I you travel services? point address? you travel YES -in -home services 1 from from your office? Weld County, would consider out of County NO 192812th street Greeley, CO 80631 I your starting point address? Up to 60 miles SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. report writing). Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly, daily, or monthly rates will be accepted for services, with the exception those listed above. Home study providers need to list their rates in 4.6. Monitored sobriety testing providers needs to list their rates in 4.7. 4.1 Service #1 Name: 1 4.1a In -Office rate: 4.1b Out -of -office rate: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate after catchment: $ Amount Unit Type per per per per per Mile Catchment area in miles: 4.1f If the rate(s) listed above are a monthly package, complete the boxes below. No. of Face-to-face hours: No. of admin/case management hours: No. of travel hours TOTAL HOURS: per month per month per month per month miles 4.2 Service #2 Name: 4.2a In -Office Rate: 4.2b Out -of -Office Rate: 4.2c FTM, TDM, Prof. Staffing: 4.2d No show: 4.2e Mileage rate after catchment: REV. NOV 2019 $ Amount per per per per per Unit Type Mile Catchment area in miles: 4.2f lithe rate(s) listed above are a monthly package, complete the boxes below. No. of Face-to-face hours: No. of admin/case management hours: No. of travel hours per month per month per month miles 4 EXHIBIT C - PROPOSAL TEMPLATE TOTAL HOURS: per month 4.3 Service #3 Name: r 4.3a In -Office Rate: 4.3b Out -of -Office Rate: 4.3c FTM, TDM, Prof. Staffing: 4.3d No show: 4.3e Mileage rate after catchment: $ Amount per per per per per Mile Unit Type Catchment area in miles: 4.3f If the rate(s) listed above are a monthly package, complete the boxes below. No. of Face-to-face hours: No. of admin/case management hours: No. of travel hours TOTAL HOURS: per month per month per month per month miles 4.4 Service #4 Name: 4.4a In -Office Rate: 4.4b Out -of -Office Rate: 4.4c FTM, TDM, Prof. Staffing: 4.4d No show: 4.4e Mileage rate after catchment: $ Amount per per per per Unit Type per Mile Catchment area in miles: 4.4f If the rate(s) listed above are a monthly package, complete the boxes below. No. of Face-to-face hours: No. of admin/case management hours: No. of travel hours TOTAL HOURS: per month per month per month per month miles 4.5 Service #5 Name: 4.5a In -Office Rate: 4.Sb Out -of -Office Rate: 4.5c FTM, TDM, Prof. Staffing: 4.5d No show: 4.5e Mileage rate after catchment: $ Amount Unit Type per per per per per Mile Catchment area in miles: 4.5f If the rate(s) listed above are a monthly package, complete the boxes below. No. of Face-to-face hours: No. of admin/case management hours: No. of travel hours TOTAL HOURS: per month per month per month per month 4.6 Home Study Providers — List your rates in the box below. miles Full Home Study Home Study (Updated/Addendum) *each additional adult(Full HS) *each additional adult(Updated HS) Partial Home Study Spanish Interpreter, if needed (Full -HS) Spanish interpreter, if needed (Updated -HS) *mileage (outside of a 20 -mile radius from office) $1,200.00 $550.00 $200.00 $100.00 $60.00/hr $ 200.00 $100.00 $0.55/mile 4.7 Monitored Sobriety Providers — List your rates in the box below. REV. NOV 2019 5 EXHIBIT C - PROPOSAL TEMPLATE Provider special notes: L REV. NOV 2019 6 STAFF DATA SHEET Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE BIDDER LEGAL ENTITY NAME: EXHIBIT D Home -Based Services KPJ FIRST Services, LLC. APP,G -AFF MEMBER CONTRACTOR INFORMATION _ -.- --`-- '- - ' _ . ' .,, ±SUPERVI$OR INFORMATIN,O_ .,. ` No, Legal Last Name Legal First Name -- - Workif - - -- -- Work Email - Education Level Degree Focus Licensure/ Credentials, DORM, (If applicable), u�t , LastName--, ,. ir{Y c, blame, ti Wo t #`�.� e , • War_I[EMail1, 1 Wawrzyniak Keith (970)405-7716 kpwawa@nolfamivservices.co Counseling MSC NL13374 2 Williams Brandon (970)301-8214 Bkwsmi70@iclou4LCSW Social Work LCSW1581 _MA Wawrzyniak Keith (970)405-7711Jtpwawa@kplfamil 3 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 81800058 Account Number: CO KPJF 1620 Date: 1/22/20 Initials: CA CERTIFICATE OF INSURANCE ALLIED WORLD INSURANCE COMPANY C/O: American Professional Agency, Inc. 95 Broadway, Amityville, NY 11701 800-421-6694 This is to certify that the insurance policies specified below have been issued by the company indicated above to the insured named herein and that, subject to their provisions and conditions, such policies afford the coverages indicated insofar as such coverages apply to the occupation or business of the Named Insured(s) as stated. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE. Name and Address of Named Insured: KPJ FIRST SERVICES LLC 1626 PLAINS DRIVE EATON CO 80615 Type of Work Covered: MENTAL HEALTH COUNSELOR Location of Operations: N/A (If different thanaddress listed above) Claim History: Retroactive date is 11/18/2019 Additional Named Insureds: KEITH P WAWRZYNIAK JR Coverages Policy Number Effective Date Expiration Date Limits of Liability PROFESSIONAL/ LIABILITY 5005-4078 11/18/19 11/18/20 1,000,000 3,000,000 NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED, WHO SHALL ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF CANCELLATION. Comnents:Defense Reimbursement Proceedings Limit is $5,000. 1 ADDL.INS.BELOW: BOARD OF COUNTY COMM. OF WELD COUNTY & ITS OFFICERS /EMPLOYEES This Certificate Issued to: Name: KPJ FIRST SERVICES LLC 1626 PLAINS DRIVE Address: EATON CO 80615 APA 00138 00 (06/2014) orized Representative EXHIBIT C SCOPE OF SERVICES 1. Contractor will conduct Home Studies, as referred by the Department. 2. Capacity for Services: Varied; approximately four (4) hours per week. 3. Contractor will conduct the following types of Home Studies: i. Kinship Care ii. Foster Care iii. Kinship Foster Care iv. Parent Care v. Foster -Adoption vi. Adoption vii. Interstate Compact on the Placement of Children (ICPC) 4. 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. 5. Contractor will utilize the most current Structured Analysis Family Evaluation (SAFE) forms and templates. Contractor will ensure all home studies completed for the Department include, at a minimum, all the following: a. SAFE Home Study template. b. Compatibility Inventory. c. References and documented direct follow-up with references (phone call or meeting). d. Psychosocial Inventory for all applicants. e. Questionnaire I and II for all applicants. f. Indian Child Welfare Act (ICWA)/Indian heritage discovery and documentation. g. All additional collateral information collected from the applicants. h. Urinalysis (UA) result from a certified testing facility, if requested by the Department. A UA will be required for any individual 18 or older residing in the home, when requested by the Department, if substance abuse concerns are noted. The cost of the UA will be responsibility of the applicant. 6. Contractor will meet regularly with Department staff during the home study process. At a minimum, Contractor will meet with Department staff as follows: a. Following completion of individual applicant meetings. b. Three (3) weeks after the completion of individual applicant meetings. c. Prior to the final review with the applicant(s). 7. Contractor understands that reimbursement for partial home studies will only occur after the following: a. At least one (1) face-to-face meeting and two (2) phone contacts, and b. A letter has been submitted to the Department documenting why the study cannot move forward. 8. Location of Services: • In practitioner's office located at 92813`h Street, Greeley, CO 80631. • In referred applicant's home. • Within Weld County. Consideration will be given to areas outside of Weld County. 9. Language: English. A Spanish speaking interpreter is available upon request. 10. 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. 11. 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). 12. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for visitation services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understands that the Department will not reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows" on the part of the client per month. After three (3) "no-shows", Contractor will place client on a behavioral plan requiring attendance or discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team Supervisor (hainleid@weldgov.com 970-400-6210). 13. 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 dient (excluding session/episodes that fall on holidays). If the cancellation is generated from the client, the Contractor must request a makeup session from the Department prior to the makeup session occurring (excluding session/episodes that fall on holidays). After three (3) cancellations, Contractor will inform the caseworker and the Quality Assurance Team Supervisor (hainleid@weldgov.com) immediately via email, to discuss service continuation. 14. 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. 15. 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. 16. 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. 17. 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 (TOM) 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. 18. 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. 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, 2021. Expenses incurred by the Contractor prior to the term of this Agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $1,200.00/Episode (Full Home Study) $200.00/Each additional adult (Full Home Study) $60.00/Hour (Partial Home Study) $550.00/Episode (Home Study Update) $100.00/Each additional adult (Home Study Update) $ .55/Mile (Mileage) — For distance exceeding twenty (20) miles from practitioner's office located at 928 13th Street, Greeley, CO 80631. $200.00/Episode (Spanish Interpreter Fee — Full Home Study) $100.00/Episode (Spanish Interpreter Fee — Home Study Update) 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7th day of the month following the month of service, but no later than 60 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 60 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. For one-time services, proof of services rendered shall be receipt of a Client Verification Form and the completed product. For Monitored Sobriety services, proof of services rendered shall be the test result. Contract Form Entity Information New Contract Request Entity Name* KPJ FIRST SERVICES. LLC Contract Name* KPJ FIRST SERVICES. LLC Contract Status CTB REVIEW Entity ID* @00041915 ❑ New Entity? Contract ID 3418 Contract Lead* CULLINTA Contract Lead Email cullinta@co.weldCo.us Contract Description * CW AGREEMENT FOR HOME STUDIES. TERM MARCH 28. 2020 THROUGH MAY 31. 2020 Contract Description 2 Contract Type* AGREEMENT Amount* $0.00 Renewable* NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanServices@weldgovcom Department Head Email CM-HurnanSerrices- DeptHead@ eldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email C M- COUNTYATTORNEY@WELD GOV.COM Requested BOCC Agenda Date* 02112/2020 Parent Contract ID Requires Board Approval' YES Department Project # Due Date 02/08/2020 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a NSA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnRase Contract Dates Effective Date Termination Notice Period Review Date* 04/01/2021 Renewal Date Committed Delivery Date Expiration Date* 05/31/2021 Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JAMIE ULRICH DH Approved Date 03/04/2020 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 03/11/2020 Originator SNYDERKL Contact Type Contact Email Finance Approver BARB CONNOLLY Contact Phone 1 Contact Phone 2 Purchasing Approved Date Finance Approved Date 03/05/2020 Tyler Ref # AG 031120 Legal Counsel GABE KALOUSEK Legal Counsel Approved Date 03105/2020 Submit Hello