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Home My WebLink About20193840.tiff2�v-rVCk ttaco ct5 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND HUMAN INTERPERSONAL SERVICES, INC. DBA COLORADO THERAPY HORSES This Agreement, made and entered into theay�of 2019, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department' and Human Interpersonal Services, Inc. dba Colorado Therapy Horses 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 Core Services or other funding to the Department for Mental Health Services and Substance Abuse Treatment. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1, 2019, upon proper execution of this Agreement and shall expire May 31, 2020, unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Proposal and Exhibit C, Scope of Services. 3. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Quality Assurance Team Supervisor (hainleidL weldgov.com, 970-400-6210). No other Department staff or other party to the case may authorize services or modifications to services. �mnFRX1t qsl@Col 2019-3840 S/a..40/ t 9 E-tgoocto 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 home studies and monitored sobriety testing. Contractor agrees that original complete Client Verification Forms are to be submitted with the Request for Reimbursement. Requests for Reimbursement and Client Verification Forms received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet 60 -day deadline may result in termination of the Agreement. d. Contractor agrees to submit a monthly report by the 7th of the month, following the month of service, for each client receiving ongoing services. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. Monthly reports for ongoing services must include the following information, entered in the "Narrative" box for each date of service: a. Date and time of service b. Where the service took place c. Clinician/therapist name d. Clients participating e. What interventions were used, recommendations and/or goals discussed f. Any and all safety concerns One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation, home study). Verification of Monitored Sobriety Services will be the test result. A completed home study may be a full, partial or denied study, as determined by the Department. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. 4. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. Exceptions to this Paragraph may include, if approved by the Department, the following: i. The service being provided by the contractor is not a Medicaid eligible service; ii. The service is not deemed medically necessary; iii. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; iv. A Medicaid provider is not available to provide the needed service; v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule, attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon, the continuing availability of said funds for the purposes hereof. 2 d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 5. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit an, which will be provided by the Department, with a voided check. Failure to complete and submit this form and voided check in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and - Title VII of the Civil Rights Act of 1964; and 3 - the Age Discrimination in Employment Act of 1967; and - the Equal Pay Act of 1963; and - the Education Amendments of 1972; and - Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is determined by the Department. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contractor will confirm the employment eligibility of all employees who are newly hired for 4 employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5- 102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contractor participates in the State of Colorado program, Contractor shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contractor has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contractor shall deliver to the Department, a written notarized affirmation that it has examined the legal work status of such employee and shall comply with all of the other requirements of the State of Colorado program. If Contractor fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., the Department, may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contractor receives federal or state funds under the contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24- 76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5- 103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR), and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 9. Insurance Requirements 5 Contractor and the Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible the insurance provider. a. General Requirements: Contractors must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, the Department must be notified by the Contractor. Contractor shall be responsible for the payment of any deductible or self -insured retention. The Department reserves the right to require Contractor to provide a bond, at no cost to the Department, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor. Contractor shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i.Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii.Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: 6 - $1,000,000 each occurrence; - $2,000,000 general aggregate; $50,000 any one fire; and - $500,000 errors and omissions. iii.Automobile Liability: Contractor shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: If any aggregate limit is reduced by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify the Department within ten (10) days and reinstate the aggregates required; Unlimited defense costs in excess of policy limits; Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by the Department. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to the Department, whichever is earlier. c. Contractors shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor shall provide a copy of this information to its insurance agent or broker and shall have its agent or broker provide proof of Contractor's required insurance. The Department reserves the right to require Contractor to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor's insurer shall name County as an additional insured as follows f. Waiver of Subrogation: For all coverages, Contractor's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors, independent contractors, sub -vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor. Contractor shall include all such subcontractors, independent contractors, sub -vendors, suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors, suppliers or other entities upon request by the Department. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contractor shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 10. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Trainin Contractor may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-400-6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor will collaborate in a timely manner with the Department to resolve issues pertaining to service delivery, service quality, documentation, and invoicing during referral period and after services have concluded. The Contractor will require clients sign releases of information. Contractor understands that the Department will not reimburse for services rendered to Department clients until releases of information are obtained. Contractor shall permit the Department, and any other duly authorized agent or 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. 8 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 Richard C. McMahan, President/Founder 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 400-6510 18. Litigation For Contractor: Richard C. McMahan, President/Founder 5206 West F Street Greeley, CO 80634 (970) 302-5204 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 9 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 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. 10 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. 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 11 information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contractor agrees that it is an independent Contractor and that Contractor's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall perform its duties hereunder as an independent Contractor. Contractor shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contractor, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contractor or any of its agents or employees. Unemployment insurance benefits will be available to Contractor and its employees and agents only if such coverage is made available by Contractor or a third party. Contractor shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contractor shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contractor shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and as set forth in Exhibit A provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 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 12 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. 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 13 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: dea44,1) "eL);tik BOARD OF COUNTY COMMISSIONERS Weld C• • ty Clerk to the Board ��''� WELD COUNTY, COLORADO By: Deputy Clerk tot 'e Board 15 Barbara Kirkmeyer, C air AUG 2G 2019 CONTRACTOR: Human Interpersonal Services, Inc. dba Colorado Therapy Horses 5206 West F Street Greeley, CO 80634 (970) 302-5204 By: Date: Pcldud c. 771 n. Richard C. McMahan, President/Founder Apr 24, 2019 ob t' - 38`10 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 yr Off, SS as jhera 01 tt‘ • N�MP Colorado Therapy Horses by HUMAN INTERPERSONAL SERVICES , Inc. Proposal for Equine -Assisted Therapy To Weld County Department of Human Services In the spirit of our mission to provide a unique service for at -risk youth, adults, veterans, and families that integrate "Natural Humanship" principals while innovatively allowing the human spirit to be renewed by the horse. Program Human Interpersonal Services Story, Purpose, and Plan Colorado Therapy Horses by Human Interpersonal Services is a non -riding horse therapy program, located in Greeley Colorado, Human Interpersonal Services is a nonprofit 501c3 corporation formed in 2012 by Richard McMahan, MA, a CAC III Substance Abuse Counselor, Vocational Evaluator/Counselor and Equine Assisted Psychotherapist. Human Interpersonal Services was created to serve in the Equine Assisted Psychotherapy service that is an emerging form of therapeutic intervention, in which horses are used as tools for clients to gain self - understanding and emotional growth. Equine assisted psychotherapy is a type of animal -assisted therapy, a field of mental health that recognizes the bond between animals and humans, and the potential for emotional healing that can occur when a relationship is formed between the two species. During the process of working with the horse, the therapist and client engage in talk therapy, processing feelings, behaviors, and patterns. The goal is to build skills such as personal responsibility, assertiveness, non-verbal communication, self-confidence, and self-control. In 2014-15, Human Interpersonal Services goal was to enhance the program by providing some comfort for participants. This involved providing a tent for shelter from the elements and a portable toilet donated for Natural Humanship training. In 2014, 925 people visited and benefited from Human Interpersonal Services programs; dramatically increasing in 2015 with 3,250 people visiting the ranch. The upward trend continued with more than 6,889 participants in 2016. Children (<9) and at -risk youth (9-17) represented 3,307 of these participants. The sheer volume demonstrates a great need for these services and the acceptability and willingness of the young client to participate in this program. As Human Interpersonal Services continues to seek alternative and creative funding to support programs and services to meet the growing needs of the community, partnerships continue to develop for 2016-17. The first goal for 2016 was to purchase a permanent home for a new facility that will allow for growth to support new housing for the horses and a new indoor arena for year around therapy programs. December 23, 2016 marked the purchase of 50 acres. This new facility is located just North of Greeley at 14272 WCR 72. The plan for 2017-18 was to build loafing sheds and fences for the horses, and create a temporary office. The 2019 phase will include building the indoor arena and new offices for therapy services. Plans include increasing mental health service programs through the development of a Discovery Ranch that will allow for larger groups, extended stay housing for military families, and treatment for veterans. Additionally, because Richard McMahan, MA is a past Certified Rehabilitation Counselor and Vocational Evaluator, he can coordinate with rehabilitation professionals at the Weld County level and school districts to design a meaningful opportunity. Furthermore, the 50 -acre ranch will have a series of "cottage industries" that will offer job training, job experience and meaningful employment opportunities for those in Weld County Treatment Courts, Veterans in -need and, the special education students that are in the gap and don't fit traditional places like Envision. Examples we are considering; kitchen help in our dining hall, hydroponics crop growing, welding shop, woodworking shop, mechanics shop, logging & milling business, and manufacturing, of items that can be sold over the internet to promote Colorado Therapy Horses and more as the vision takes us. Goals for 2019-2020 included strategically increasing partnerships to address program services and, funding. One major partnership is with Covenant Testing Technologies, LLC. In which we are in the final stages of organizing a "Military Oilwell Watcher Team," which will bring a new way for companies to donate to a non-profit. Our plan is to hire mostly Veterans to provide a "guard duty" service for the oil industry while reducing the production cost and allowing the production company to donate the difference to the Colorado Therapy Horses. The main feature is that the oil companies' giving is tied directly into production, which will be a first of the kind in both the oil industry and among non -profits. Human Interpersonal Services has currently agreed on a deal with PDC Energy and Bill Barrett Company to begin "watching" several of their new production wells as of January 1, 2017, and are in the process of acquiring many other oil and gas companies into the program. These goals are important in supporting the therapeutic goals for Human Interpersonal Services as we endeavor to meet the growing mental health needs of the Weld County Community. Bringing Equine Assisted Psychotherapy to Weld County will provide a unique niche as it will allow the client to open up easier and use all sensory input to activate a different mindset. Equine therapy addresses multiple concerns as participants engage with the horse, and is especially advantageous for clients that struggle with "talk" therapy or the sterile office environment. Generally, Equine therapy takes less time than traditional "talk" therapy as the client is more at ease and able to work through issues at a quicker pace. Scope of Services Target population as it relates to Child Welfare: The target population for CMHTA includes at - risk children, adolescents, youth, parents, and families. Physical location: 14272 WCR 72, Greeley CO. 80631 Hours of Service: o Volunteer and walk-in community service (feeding times)- 8:00 am to 10:00 am & 4 pm to 5:00 pm. o Individual, couple, family by appointment- 10:00 am — 3:30 pm & 5:30 pm. (negotiable) *Individual and family assessment time will be scheduled by the assigned therapist. Staff /Volunteer resources: Richard McMahan, MA, NHTIII, CAC III, Equine Assisted Psychotherapist (also trained in Vocational Rehabilitation Counselor (CRC) and Vocational Evaluator (CVE). Patricia Ferguson, LPC, Therapist Louise Quijano, Ph.D, LCSW, Bilingual Therapist Karizmine Sill, BSW, BSHDFS, Operations Specialist Joni Martin, LPC, volunteer therapist Judy Riba-McMahan, BA, Ranch Manager Jenny Leachman, Equine Specialist Program Goals: Ultimately, the goal of Colorado Therapy Horse program is to increase the human's self- satisfaction, self-control, and self-confidence through enhancing personal power. This empowerment decreases the humans need to seek external means for achieving personal power. When the symptoms of PTSD, depression, anxiety, substance abuse, and other ism's are present, they are indicators of less and less personal power, which causes fear in the human to need to "Control" something. There are only two things that humans can ultimately control and that is what we put in our minds, such as our spiritual values and what we "do" and "put in our" bodies. Human Interpersonal services therapy program focuses on personal fears that lead to a need for control, resulting in out of control behaviors. As clients address fears and learn to "normalize" and manage these feelings, they learn to change thinking, which changes behaviors. Anticipated Outcomes: This therapeutic approach finds roots in Cognitive Behavior Therapy (CBT) as a means of connecting feelings, thoughts, and behaviors to implement change. Furthermore, clients learn to recognize and accept two seemingly opposite ideas as truth, while learning to determine the heathier choice (Dialectical Behavior Therapy-DBT). For example, clients learn to recognize that while they can feel fear and it may seem overwhelming, it is also true that this feeling is "normal" and not something they need to base their behaviors on. This approach on substantiated therapy and techniques allows Human Interpersonal Services to expect a high probability of success in this equine therapy program. Measurable Outcomes: 1. Enhanced personal power as evidenced by positive behaviors, decisions, and relationships with others. 2. Increased use of healthy coping strategies evidenced by decrease behavior escalations. 3. Increased self-awareness as evidenced by the ability to recognize needs and find healthy solutions. 4. The increase in ability to manage or eliminate mental health concerns such as anxiety, panic attacks, depression, and somatic symptoms as evidenced by a decrease in reported symptoms. 5. Possible decrease in need for psychotropic medications as mental health concerns decrease or recede as evidenced by decrease or elimination of symptoms. Behavioral and Mental Health issues addressed: • Post -Traumatic Stress Disorder • Grief • Attention Deficit (ADHD) • Substance Abuse & Chemical Dependency • Anger Management • Relationship issues • Behavioral problems • Depression & Anxiety • Eating disorders • Abuse & Neglect • Lesbian, Gay, Transgender • Attachment issues • Parenting Human Interpersonal Services Approach: This approach follows a ten session weekly program for groups and applies more flexibility to meet the therapeutic needs of individuals and families. The initial session occurs in the office to complete assessment and determine client needs and establish goals. The following sessions start with a teaching/discussion, move to time with the herd, and end with a reflection time to explore session experience. This model is then adapted to specific client populations driven by their unique clinical needs and challenges and does not need to do or complete all of the sessions to be effective for each participant. It is customized for the individual needs of the client. The Colorado Therapy Horses is a `herd' of horses and humans that 'Heal the Hearts' of hurting humans like Wounded Warriors, Veterans, and their families, PTSD. Victims of various kinds of trauma, broken child and family relationships and others, such as those with alcohol and drug additions. Program Descriptions: o Individual- This service is provided to meet needs for participants needing more individual attention or to focus more on in-depth issues a client may struggle to discuss in groups. This program follows the same basic outline for sessions but is tailored to the individual's specific goals. o Families- Focus is on the systems approach to improving relationships and communication in the family. This is tailored to meet the specific needs of the family. o Diversion Programs- This program works with local courts and cities (currently Milliken, Greeley) to provide services for Diversion programs allowing participants to engage in the equine horse experience as a means of creating change. This program follows the group model and meets weekly or bi-weekly based on needs. o Vocational Rehabilitation Program- This program will utilize the daily need to care for the horses and maintain the facility. It can be a type of On the Job Training (OJT) and used to give clients experience and allow staff to monitor emotional, social, work ethics, and experience. We have done this already with adult special education students from Millikan/Johnstown School District and have discussed the opportunity with Greeley School District. o Volunteers- Volunteerism is the means Human Interpersonal Services meets the daily needs of the animals and facilities. Participants arrive during volunteer times and engage in feeding and maintenance chores as a means of experiencing giving back to others (horses), or to fulfill court obligations. Often time therapists are on hand to provide support for those in -need. o Consultations- Richard McMahan, Natural Humanship III (NHTIII), CAC III expert provides psycho -educational consult on Natural Humanship Training Theory and Training, as needed, for services offered. Judy Riba-McMahan, Equine Expert III, provides expert equine information specific to the herd of therapy horses, as well as generalized to the species. o Permanency Service Support Program- Program designed to support other programs offering youth and family coaches the opportunity to bring clients out to experience the benefits of the horse herd. o Parenting Education and Support Program- This program is designed to help parents build healthy parenting skills and gain confidence and empowerment as a parent through relationships with the horse. Parents also learn how to receive and give support for other participants. o Counselor Support Program- This program helps counselors and caseworkers manage self -care and decrease vicarious trauma leading to burnout. Assessments: Participants may receive pre and post -assessments to measure the effectiveness of services. These assessments may include any of the following: (list is not inclusive) o Patient Health Questionnaire (PHQ-9) o Daily Living Assessment (DLA-20) o Generalized Anxiety Disorder (GAD -7) o BECK *Future assessment will include the use of a Cortisol swab to determine the level of anxiety or depression. This will be a part of a future research program. Documentation: The upcoming plan is to use an Instant Collaboration Documentation with I -Pads, and a portal and kiosk for participant pre -registration process. *We will look into possible electronic records system for future. Rate/Unit Schedule: Fees for Service: o Individual $115 per 1.0 hour o Family $150 for 1.5 hours o Intake fee $100 per hour o Case Management (meeting/staffing, phone calls, or in person) fee $100 per hour, ($25 per first 15 minutes, additional $25 for 16-30 minutes, additional $25 for 31-45 minutes, additional $25 for 46-60 minutes, and additional $25 for each 15 minutes over 60 minutes). o Court Testimony $145 per hour with minimum $500 for half day and $1000 for full day. o Permanency Service Support- $50 per day, per individual or family Individual Drug and Alcohol Therapy by Richard McMahan is done at regular Individual Rate. Sincerely, Richard C. McMahan, MA, NHTIII, CACIII President/Founder Colorado Therapy Horses & Wounded Human Project , dba of HUMAN INTERPERSONAL SERVICES , Inc., a501(c)3 non-profit Charitable Foundation richardgcoloradotherapvhorses.com 5206 West F Street, Greeley CO 80634 970-302-5204 EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services HUMAN INTERPERSONAL SERVICE, INC. dba Colorado Therapy Horses AGENCY OR PRIVATE PRACTICE Agency Richard C. McMahan PRIMARY CONTACT — FULL NAME ( 970 PHONE NUMBER 302-5204 richard@ColoradoTherapyHorses.com PRIMARY CONTACT— E-MAIL ADDRESS 14272 County Road 72 AGENCY MAILING ADDRESS TRAILS PROVIDER ID (If Known) CEO PRIMARY CONTACT - TITLE None EXT. FAX NUMBER ColoradoThera pyHorses. corn AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) Greeley CITY 80631 ZIP Richard McMahan OR Kari Sill REFFERAL CONTACT — FULL NAME ( 970 1 302-5204 Kari n;7ColoradoTherapyHorses.com REFERRAL CONTACT — PHONE NUMBER REFERRAL CONTACT CEO and Administrator EXT. REFERRAL CONTACT - TITLE richard@ColoradoTherapyHorses.com & REFERRAL CONTACT — E-MAIL ADDRESS BILLING CONTACT Kart Sill BILLING CONTACT— FULL NAME (970) 302-5204 BILLING CONTACT— PHONE NUMBER EXT. Administrator BILLING CONTACT - TITLE Kari@ColoradoTherapyHorses.com BILLING CONTACT— E-MAIL ADDRESS I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it has so indicated in this bid form. I further affirm intention to enter into an agreement with Weld County, on behalf of the Weld County Department of Human Services, and comply with all requirements of the contract, if awarded. The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are competitive in price and quality. Signature of Authorized Representative: Date of Signature: 01/25/2019 e'�uyac�S:c . Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: BIDDER LEGAL ENTITY NAME: Mental Health Services Human Interpersonal Services dba Colorado Therapy Horses APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION SUPERVISOR INFORMATION No. Last Name First Name Work# i Work Email Education Level Degree Focus Licensure/ Credentials DORA (If applicable) # Last Name First Name Work # Work Email 1 McMahan 4 5 6 7 8 Sill Ferguson Quijano Riba Richard Karizmine Patricia Louise Judy 970-302-5204 970-702-3230 970-817-0092 970-666-1435 970-420-1766 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 richard • color ado MA Psychology MA, CAC III 2040 kari • coloradothe )att a. coloradotl louise coloradot ud a)coloradoth BA MA Ph.D BA Social Work Counseling Social Work Pre -law BASW/BSHDFD LPC Ph.D, LCSW I5 13991 1211 McMahan Richard 970-204-5204' ricr1ardCwcoiurauu i Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) therapyhorses.com Bid No.: B1900025 PINN/ACOL ASSURANCE Human Interpersonal Services Inc 1803 88th Ave Greeley, CO 80634 Insurance Quote January 22, 2019 Application ID: 9405732 LCM: Alliance CINI/Secure American PO Box 350999 Westminster, CO 80035 (303) 500-3386 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com The premium estimate provided expires 30 days from issuance. After expiration of the premium estimate, please contact Pinnacol Assurance for an updated estimate. Quote subject to change based on underwriter analysis and review of all information including classification, payroll, and verification of prior loss data. Coverage Information for 9405732 QUOTED Location: Human Interpersonal Services Inc 14280 Greeley, CO 80631 Period: 01/25/2019 - 02/01/2020 Class RT Description 881005 EM Clerical office employees NOC Total for Human Interpersonal Services Inc Description Ratable Manual Premium Designated Provider Discount Annual Policy Fee Terrorism Insurance Coverage Catastrophe Insurance Coverage Net Estimated Annual Premium Emp Payroll Rate Prem Charge 1.00 $12,230 .145800 $18 $12,230 $18 Period Adjustment Amount 01/25/2019 - 02/01/2020 $18 01/25/2019 - 02/01/2020 .975 $0 01/25/2019 - 02/01/2020 $195 01/25/2019 - 02/01/2020 $1 01/25/2019 - 02/01/2020 $1 01/25/2019 - 02/01/2020 $215 Policyholder Disclosure Notice of Terrorism and Catastrophe Insurance Coverage Coverage for acts of terrorism is included in your policy. Under your existing coverage, any losses resulting from certified acts of terrorism would be partially reimbursed by the United States Government. Beginning January 1, 2016: • The current 85% Federal share of compensation under the TRIPRA decreases by one percentage point per calendar year until it is equal to 80%. • The current program trigger for aggregate industry insured losses to exceed $100 million increases by $20 million per calendar year until it is equal to $200 million. • Notwithstanding above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100 billion. Premium for terrorism is calculated on the basis of total payroll. The total Colorado payroll is divided by $100 and multiplied by the approved terrorism rate, $0.005 per $100 of payroll. The calculation is expressed as (Colorado payroll/$100 X Approved Terrorism Rate = Premium). This premium is not subject to any other modification including, but not limited to, premium discount, experience rating, schedule rating, or retrospective rating. Additionally, all workers' compensation carriers are required to charge premium to cover large losses. Premium Page 1 of 4 P jenniferm@lelandfisher.com - 7501 E. Lowry Blvd Denver. CO 80230-7006 01/22/2019 18:39:20 9405732 53150824 QUO for Catastrophe (other than Certified Acts of Terrorism) is calculated on the basis of total payroll. The total Colorado payroll is divided by $100 and multiplied by the approved Catastrophe (other than Certified Acts of Terrorism) rate, $0.01 per $100 of payroll. The calculation is expressed as (Colorado payroll/ $100 X Catastrophe (other than Certified Acts of Terrorism) Value = Premium). This premium is not subject to any other modifications including, but not limited to, premium discount, experience rating, schedule rating, or retrospective rating. Policy period dates on this quotation are for pricing purposes. This document does not imply insurance coverage. Page 2 of 4 P jenniferm@lelandfisher.com - 7501 E. Lowry Blvd Denver. CO 80230-7006 01/22/2019 18:39:20 9405732 53150824 QUO Make Check or Money Order Payable to: Pinnacol Assurance Human Interpersonal Services Inc 1803 88th Ave Greeley, CO 80634 Application # 9405732 Amount Due $215.00 Quote Issue Date 01/22/2019 Quote Expiration Date 02/22/2019 Page 3 of 4 P jenniferm@lelandfisher.com - Amount Enclosed $ Check Number Pinnacol Assurance PO Box 561434 Denver, CO 80256-1434 7501 E. Lowry Blvd Denver. CO 80230-7006 01/22/2019 18:39:20 9405732 53150824 QUO ACOREP �„� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1i22;2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Secure American Insurance PO Box 350999 Westminster CO 80035 NAME: LI Jennifer Manriquez PHONE (NC, NoEat): (970) 690-1070 I (A' C. No): (888) 874-0969 ADDDREDRE SS: I' mtAcnnife(y leland)iisher.cum INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: UNDERWRITERS AT LLOYDS 32727 INSURED Human Interpersonal Services Inc 1 803 88th Ave Greeley CO 80634 INSURER B INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AUUL4UtUf INSD WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY DIP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y 508298 08/29,2018 08'292019 EACH OCCURRENCE $ 1,000,00(1 X I CLAIMS -MADE OCCURUAIVIAbt I v HEN s to PREMISES tEa occurrence) S 50 000 MED EXP (Any one person) 5 5.000 PERSONAL & ADV INJURY S 1,000.000 GEN'L AGGREGATE I POLICY OTHER: LIMIT APPLIES PER: PRO- GENERAL AGGREGATE S 1.000,000 PRODUCTS - COIv1P%OP AGG S l .000,000 S AUTOMOBILE LIABILITY ANY AUTO OWNED - - _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMbINEU SINGLE LIMI I (Ea accident) S BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPER I Y DAMAGE (Per accident) S S UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR'PARTNER'EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below N /A I PER STATUTE I I ER H- E.L. EACH. ACCIDENT S El. DISEASE - EA EMPLOYEE S El. DISEASE - POLICY LIMIT S A Professional Liability 508298 0829'2018 08.29/2019 Per Claim S1.000.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION County of Weld 1 150 O Street Greeley, CO 80632 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Je -ev fer MoA riq,wez ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Mental Health Services and Substance Abuse Treatment, as referred by the Department. 2. Mental Health Services a. Contractor may utilize any or all of the following pre- and post -assessments to measure the effectiveness of services: i. Patient Health Questionnaire (PHQ-9) ii. Daily Living Assessment (DLA-20) iii. Generalized Anxiety Disorder (GAD -7) iv. BECK b. Behavioral and mental health issues addressed: i. Post -Traumatic Stress Disorder ii. Grief iii. Attention Deficit (ADHD) iv. Substance Abuse and Chemical Dependency v. Anger Management vi. Relationship Issues vii. Behavioral Problems viii. Depression and Anxiety ix. Eating Disorders x. Abuse and Neglect xi. Lesbian, Gay and Transgender xii. Attachment Issues xiii. Parenting c. Capacity for Services: Ten (10) session weekly program for groups through individual, family and Permanency Support. d. Goals of Service: i. Increased self-satisfaction, self-control and self-confidence through enhancing personal power. ii. Decreased need to seek external means for achieving personal power. iii. Ability to address fears and learn to "normalize" and manage these feelings and change thinking, which in turn changes behaviors. e. Outcomes of Service: Clients will learn to recognize and accept two seemingly opposite ideas as truth, while learning the healthier choice through Dialectical Behavior Therapy (DBT). Measurable outcomes include: i. Enhanced personal power as evidenced by positive behaviors, decisions and relationships with others. ii. Increased use of healthy coping strategies evidence by decreased behavior escalations. iii. Increased self-awareness as evidenced by the ability to recognize needs and find healthy solutions. 1 iv. Increased ability to manage or eliminate mental health concerns as anxiety, panic attacks, depression, and somatic symptoms as evidenced by a decrease in reported symptoms. v. Possible decrease in need for psychotropic medications as mental health concerns decrease or recede as evidenced by a decrease or elimination of symptoms. f. Target Population: At -risk children, adolescents, youth, parents and families. g. Service Access: 14272 WCR 72, Greeley, CO 80631, by appointment only, 10:00 a.m. to 3:30 p.m. and 5:30 p.m. (negotiable). 3. Substance Abuse Treatment a. Individual drug and alcohol therapy. b. All services will be provided by Richard McMahan, CACIII. 4. Contractor will respond to the Quality Assurance Team Supervisor (hainlejd@weldgov.com, 970-400- 6210) within three (3) business days regarding the ability to accept the received referral. 5. Upon acceptance of a referral, Contractor will offer an initial appointment within seven (7) days of receiving the referral. The first attempt to contact the client will occur within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If the client does not respond after three (3) attempts in the first seven (7) days of the referral period, the Contractor will notify the caseworker and the Quality Assurance Team Supervisor (hainlejd@weldgov.com, 970-400-6210). 6. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for visitation services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understand that the Department will no reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows" on the part of the client per month. After three (3) "no-shows, "Contractor will place client on a behavioral plan requiring attendance or discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team Supervisor (hainlejdpweldgov.com, 970-400-6210). 7. Contractor understands that the Department will not reimburse Contractor for cancelled appointments either on the part of the client or the Contractor. If the cancellation is generated from the Contractor, a "makeup" session/episode, to occur within 30 days of the cancellation, will be offered to the client (excluding session/episodes that fall on holidays). If the cancellation is generated from the client, the Contractor must request a makeup session from the Department prior to the makeup session occurring (excluding session/episodes that fall on holidays). After three (3) cancellations, Contractor will inform the caseworker and the Quality Assurance Team Supervisor (hainlejd@weldgov.com) immediately via email, to discuss service continuation. 8. Contractor will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 9. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited 2 to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 10. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 11. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 12. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Court Staffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as the meeting is at least one hour in length, the Contractor obtains the Facilitator's signature on the Client Verification Form (if in person) at the time of the meeting and participation in the meeting is deemed appropriate and necessary by the Department. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator. Contractor may participate by phone, if approved by the Department. 13. Contractor will notify the Quality Assurance Team Supervisor (hainlejd@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. 3 EXHIBIT D RATE SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specific in Paragraph 2, below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2020. Expenses incurred by the Contractor prior to the term of this Agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Mental Health Services $100.00/Hour (Case Management, meetings/staffings) $150.00/Episode (Family Equine Therapy, 1.5 hours per episode) $115.00/Hour (Individual Equine Therapy) $100.00/Hour (Intake) $50.00/Day (Permanency Service Support) Substance Abuse Treatment $115.00/Hour (Individual Drug and Alcohol Therapy) 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. A New Contract Form Page 2 of 4 New Contract Request Entity Information Entity Name* Entity ID* HUMAN INTERPERSONAL @00038647 SERVICES INC Contract Name* HUMAN INTERPERSONAL SERVICES INC DBA COLORADO THERAPY HORSES (CHILD PROTECTION AGREEMENT FOR SERVICES) Contract Status CTB REVIEW El New Entity? Contract ID 2645 Contract Lead* CULLINTA Contract Lead Email cullinta@co.weld.co.0 DepartmentProject s Parent Contract ID 20190707 Requires Board Approval YES Contract Description* CONSENT. NEW AGREEMENT FOR SERVCIES. FUNDING: CORE/OTHER. TERM: 06/01/19- 05/31/20. Contract Description 2 BID NO. B1900025. Contract Type * AGREEMENT Amount* $0.00 Renewable * YES Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanServices@weld gov.com Department Head Email CM- Hum an Services- DeptHead@weldgov.c om County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@ WELDGOV.COM Requested BOCC Agenda Date* 05/06/2019 Due Date 05/02/2019 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? http://onbase-app/C M%20-%20AppServer/UnityForm/Form/Http ServiceHandler. ashx?id=... 8/20/2019 A New Contract Form Page 3 of 4 If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Review Date * 04/01/2020 Committed Delivery Date Renewal Date* 06/01/2020 Expiration Date Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Approver CONSENT Approval Process Department Head JUDY GRIEGO DH Approved Date 08/20/2019 Purchasing Approved Date 08/20/2019 Finance Approver CONSENT Finance Approved Date 08/20/2019 Legal Counsel CONSENT Legal Counsel Approved Date 08/20/2019 http://onbase-app/CM%20-%20AppServer/UnityForm/Form/HttpServiceHandler.ashx?id=... 8/20/2019 A New Contract Form Page 4 of 4 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 08/26/2019 Originator CULLINTA Submit Tyler Ref # AG 082619 http://onbase-app/CM%20-%20AppServer/UnityForm/Form/HttpServiceHandler.ashx?id=... 8/20/2019 Hello