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Home My WebLink About20181526.tiffetitt,r„, /P4t/1 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND PERKLEN INC., DBA PERKLEN CENTER FOR PSYCHOTHERAPY ir This Agreement Amendment, made and entered into /to day of 2018 by and between the Board of Weld County Commissioners, on behalf of the Weld C. nty D -1•artment of Human Services, hereinafter referred to as the "Department", and Perklen Inc., DBA Perklen Center for Psychotherapy, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Sexual Abuse Treatment Services and Anger Management/Domestic Violence Evaluation and Treatement (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2018-1526 approved on May 9, 2018. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on May 31, 2018. • The Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following change is hereby made to the Agreement: 1. WHEREAS, the Colorado Department of Human Services has provided Core Services or other funds to the Department for Sexual Abuse Treatment Services and Anger Management/Domestic Violence Evaluation and Treatement. 2. Paragraph 1, Term This agreement shall become effective on June 1, 2017, upon proper execution of this Agreement and shall expire May 31, 2019, unless sooner terminated as provided herein. 3. Payment 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; �-�-AeAa& kV a6 /,- /5a6 7- /6- /f v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. 4. Exhibit C, Scope of Services, amended as attached. 5. Exhibit D, Payment Schedule, amended as attached. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: dadtteN) •&40•&k. BOARD OF COUNTY COMMISSIONERS Weld ' o my Clerk to the Beard WELD COUNTY, COLORADO By: Deputy Clerk t he Board Steve Moreno, Chair JUL 16 2018 CONTRACTOR: Perklen Inc., DBA Perklen Center for Psychotherapy 1020 8th Street Greeley, Colorado 80631 (970) 353-8171 Kim Ruybal, Director Date: May 25, 2018 020/f /5024. EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Sexual Abuse Treatment Services, and Anger Management and Domestic Violence Evaluation and Treatment Services to male and female, adults and juveniles, including developmentally disabled individuals, in Weld County, who are 10 years of age or older, as referred by the Department. 2. Sexual Abuse Treatment Services: a. Contractor utilizes a non -medical, cognitive behavioral model, which focuses primarily on the treatment of juveniles and adults with sexually abuse behaviors. b. The goal of this program is to reduce recidivism rates by: i. Providing a structured environment for the safety of the client, family and community. ii. Increasing awareness and empathy for the victim and the impact of the offense on the victims and family members. iii. Fostering a family environment to effect positive change. iv. Developing the use of appropriate social/sexual skills and expressions through recognition of situations and stimuli that trigger sexually aggressive behavior. v. Assisting family members to develop the skills necessary to recognize and understand the sexual behavior their family member for the purpose of providing support while the client progresses through treatment. c. The target populations eligible for services under this agreement include: i. Male and female youth 10 to 18 years of age, and male and female adults 18 years of age or older. ii. Youth with current sexual offense adjudications or youth who have admitted guilt and will provide a written letter from a parent or attorney stating they plan to plead guilty. iii. Adults who have been found guilty of a sexual offense or have a written letter form an attorney stating they plan to plead guilty. iv. Adults and youth of average intelligence and those who are developmentally delayed. d. Services available under this agreement include: i. Psychosexual testing and evaluation ii. Offense -specific group therapy iii. Individual or family therapy iv. Informed Supervision Groups — Youth (1.5 Hours/Month or Six Intensive Sessions) v. Chaperones Group —Adults (1.5 Hours/Month Ongoing) vi. Relationship and interpersonal social skills vii. Sex education viii. Interdisciplinary team meetings (monthly as needed) ix. Victim empathy and awareness x. Anger management/impulse control skills xi. Cognitive behavioral modification xii. Self-esteem building xiii. Values clarification and examination xiv. Relapse prevention plan xv. Aftercare services e. Evaluations (assessments) will examine the following areas to determine whether an outpatient program is appropriate: i. The client's potential to reoffend 1 ii. Amenability for treatment iii. Recommended treatment setting iv. Type of treatment needed v. Risk factors/monitoring/potential new victims vi. Psychiatric /substance abuse/individual and family needs vii. Mental health concerns f. Evaluations will include: i. A structured clinical interview ii. Collateral information from schools, caseworkers, probation/parole officers, case managers, therapists, doctors, courts, police reports, or other relevant sources. g. Contractor will utilize a variety of psychometric assessment tools that may include any of the following: i. Hare Psychopathy Checklist -Revised ii. Minnesota Multiphasic Personality Inventory -II (MMPI-II) iii. Jesness Inventory iv. SASSI-Ill Drug and Alcohol Inventory v. Millon Clinical Multiaxial Inventory -Ill (MCMI-III) vi. Shipley Institute of Living Scales vii. State Trait Angry Inventory -II viii. Violence risk Assessment Guide ix. Sex Offender Needs Assessment Guide x. Abel Assessment for Sexual Interests xi. Juvenile Sex Offender Assessment Protocol -II 3. If referred for evaluation or assessment, two (2) to three (3) sessions will be needed to complete the requirements of the evaluation or assessment. 4. Following evaluation sessions, Contractor will pose questions designed to gather basic identifying information, examine the client's mental status/mental health issues, and various history (mental health, family/medical, substance abuse, inpatient/outpatient, current social, and criminal). 5. CONTRACTOR will utilize a variety of psychometric assessment tools that may include the following: - Hare Psychopathy Checklist -Revised Minnesota Multiphasic Personality Inventory -II (MMPI-II) - Jesness Inventory - Multiphasic Sex Inventory Wilson Sex Fantasy Questionnaire - SASSI-III Drug and Alcohol Inventory - Millon Clinical Multiaxial Inventory (MCMI) - Shipley Institute of Living Scale - State Trait Angry Inventory -II - Violence Risk Assessment Guide Millon Clinical Adolescent Inventory Domestic Violence Risk Needs Assessment - Domestic Violence Screening Instrument - Spousal Assault Risk and Assessment - ODARA Domestic Violence Risk Asssessment 6. Contractor will submit a written document outlining client's amenability for treatment, recommendations for treatment, further assessment, and risk to repeat similar behavior. The evaluation will determine the best placement for the client in regards to treatment. Contractor will provide a copy of the evaluation to 2 the caseworker. 3. Anger Management/Domestic Violence Evaluation and Treatment Services: a. Anger Management services will include a minimum of twenty (20) weeks of treatment. b. Contractor will follow the minimum expected requirement for the treatment of male, female, and Gay/Lesbian/Bisexual/Transgendered individuals who have been domestically violent as mandated by the Colorado Domestic Violence Offender Management Board (DVOMB). Level A (Low Risk): Level B (Moderate Risk): Level C (High Risk): - Psycho -educational Treatment — One (1) 90 -minute session per week - 36 -week educational curriculum First treatment plan review within two (2) to three (3) months Second treatment plan review within two (2) to three (3) months of the first review - Open ended psycho -educational treatment — One (1) 90 minutes session per week - 46 week educational curriculum One a month adjunct therapy required; (a) Healthy Relationship Group, (b) DV Education, (c) Caring Dads Group/Mothers Parenting Group, (d) Victim Speaker, (e) Sex Education, (f) HIV/AIDS Education, or (g) Sexual Abuse and Boundaries First treatment plan review within two (2) to three (3) months - Second treatment plan review within two (2) to three (3) months of the first review Open ended psycho -educational treatment — One (1) 90 minutes session per week 46 week educational curriculum One a month adjunct therapy required; (a) Healthy Relationship Group, (b) DV Education, (c) Caring Dads Group/Mothers Parenting Group, (d) Victim Speaker, (e) Sex Education, (f) HIV/AIDS Education, or (g) Sexual Abuse and Boundaries First treatment plan review within two (2) to three (3) months Second treatment plan review within two (2) to three (3) months of the first review c. Contractor offers Caring Dads Parent Education Group. The 17 -week group aims to engage fathers, to help them develop more child -centered fathering, and to take responsibility for ending their abusive behavior towards their children and children' mother. Topics include: Considering Fathering; Developing Discrepancy; Child -centered Fathering; Building Relationships with Our Children; Listing to Children; Fathers as a Part of Families; Eliminating Barriers to Better Relationships; How are Children Different from Adults; Recognizing Unhealthy; Hurtful, Abusive and Neglectful Fathering Behaviors; How Am I Responding to My Children's Needs?; Problem -solving in Difficult Situations; Relationship with My Child's Mother; Decreasing Denial and Minimization; Rebuilding Trust and Healing; and What About Discipline? Participating clients simultaneously attend a men's domestic violence group or have recently graduated from a men's domestic violence program. 3 4. Contractor will submit a discharge summary at the conclusion of services. A standard discharge summary will include the reason the client is being discharged (successful, administrative or negative discharge), treatment history with Contractor, progress or lack of progress, risk to community and any recommendations for future care and/or treatment. 5. Contractor will offer an initial appointment within seven (7) days of receiving the referral and will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the Contractor will notify the caseworker and the Child Welfare Contract and Services Coordinator immediately. 6. 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. 7. 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. 8. 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. 9. 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. 10. Contractor understands that the Department will not reimburse Contractor for "no shows" or cancelled appointments, either on the part of the client or the Contractor. 11. 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. 4 EXHIBIT D PAYMENT 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 specified 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 in Trails after May 31, 2019. 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 Anger Management/Domestic Violence: $210.00/Episode (Anger Management or Domestic Violence Evaluation) $105.00/Hour (Anger Management or Domestic Violence Evaluation) $80.00/Hour (Impact of Domestic Violence on Children and Victims -Minimum 4 Hours) $700.00/Episode (Domestic Violence Assessment) $175.00/Hour (Domestic Violence Assessment -Additional Testing) $25.00/Episode (Domestic Violence Education) $25.00/Episode (Caring Dads Group) $25.00/Episode (Mothers Parenting Group) $38.00/Episode (Standard Group) $80.00/Episode (Individual Session, In -Office) $90.00/Episode (Family Session) Sexual Abuse Treatment: $275.00/Episode (Abel Assessment for Sexual Interests) $137.50/Hour (Abel Assessment for Sexual Interests) $80.00/Episode (Individual Session, In -Office) $100.00/Episode (Individual Session, Out -of -Office) $90.00/Episode (Family Session) $95.00/Episode (Deniers Treatment) $38.00/Episode (Standard Group) $38.00/Episode (Education Group) $38.00/Episode (Non -Offending Partners Group) $38.00/Episode (Phase I Group) $45.00/Episode (Phase III Group) 1 $38.00/Episode (Phase IV Group) $38.00/Episode (Phase II Group) $150.00/Episode (Juvenile Sex Offender Intake) $450.00/Episode (Juvenile Sex Offender Evaluation without Testing, 13 years and younger) $150.00/Hour (All Evaluations) $600.00/Episode (Juvenile Sex Offender Evaluation with Testing and no PPG/Abel, 14 years or older) $600.00/Episode (Adult Sex Offender Updated Evaluation) $800.00/Episode (Adult Sex Offender Evaluation with no PPG/Abel) $900.00/Episode (Juvenile Sex Offender Evaluation with Testing and PPG/Abel) $900.00/Episode (Adult Sex Offender Evaluation with PPG/Abel) $50.00/Episode (Additional fee for jail evaluations) $250.00/Episode (Penile Plethysmograph) $125.00/Hour (Penile Plethysmograph) Contractor may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. Contractor will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher, and signed monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. 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. b. For one-time services, proof of services rendered shall be receipt of the completed product. c. For Monitored Sobriety services, proof of services rendered shall be the test result. 2 AC ao CERTIFICATE OF LIABILITY INSURANCE DATE (MWODIYYYY) 1!912018 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 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 CoBiz Insurance, Inc. - CO 14O1 Lawrence St., Ste. 1200 Denver CO 80202 INSURED Shiloh Home, Inc. 6588 W. Ottawa Avenue Littleton CO 80128 SHILHOM-01 CONTACT NAME: PHONE lore. No. Eu): 3O3 -988-O446 EMAIL COMailebcobizinsurance.com INSURERS) AFFORDING COVERAGE NAIC I ail. No): 303-988-0804 INSURER A : Philadelphia Indemnity Ins. Co 18058 INSURER B : Pinnacol Assurance Company 41190 INSURER C INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 458441956 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MEN LTR , TYPE OF INSURANCE IADDLISUBR j POLICY EFF INSD I veil) , POLICY NUMBER BlIWOOIYYYY) POLICY EXP I IMYDDIYYYY) i LIMITS A i X COMMERCIAL GENERAL LIAMLITY 1 PHPK1755940 1/1/2018 ', 1/112019 ; 1 : EACH OCCURRENCE S 1,000,000 GEM. X �..__ I CLAIMS -MADE X OCCUR i AGGREGATE LIMIT APPUES PER .... PRO' POLICY { -- LOC I JECT J OTHER : DAMAGE TO PR RENTED MISES occurrence) $1,000,000 ' MED EXP (Any one person) 5 5,000 PERSONAL & ADV INJURY GENERAL AGGREGATE S 1,000,000 5 3,000,000 � PRODUCTS - COMPA0P AGG S 3,000,000 f S A I AUTOMOBILE I_ ___ K LYIBNJTY ANY AUTO ALL OWNED I SCHEDULED AUTOS AUTOS _..... NON-0WNED HIRED AUTOS X AUTOS 1 } 1 PHPK1755940 I 1/12018 1/112019 COM SINGLE LIMIT : ( Ea accident) $ 1 000 I BODILY INJURY (Per person) S : BODILY INJURY (Per accident) S PROPERTY DAMAGE Lt accident) ~ �.-_._._.. $ A ! X UMBRELLA LAB I X OCCUR EXCESS LIAR i � CLAIMS-MAOEJ i � PHUB612646 1/112018 1112019 r EACH OCCURRENCE S 3,000,000 AGGREGATE S 3000000 X DED r RETENTIONS 10 000 S B WORKERS COMPENSATION AND EMPLOYERS' LMBLITY Y I N ANY PROPRIETORIPARTNERIEXECUTtVE OFFICER/MEMBER EXCLUDED? L (Mandatory In NN) I yes, describe under. DESCRIPTION OF OPERATIONS below i N / A [ 1705862 1/112018 1712019 I ? 1 I PER I 0TH - L ! STATUTE .I -__-i_ER ' E L. EACH ACCIDENT S 500,000 E.L. DISEASE - EA EMPLOYEE S 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarlu Schedule, may be Matched M more aped le required) Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, are included as Additional Insured with respect to General Liability as required by written contract or agreement per the attached form. 60 day Notice of Cancellation is provided for Weld County. CERTIFICATE HOLDER CANCELLATION Wetd Gotoradt POBox A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU-rHQREEO REPRESENrAT1VE .488. 2114 a:. A'J _:r7F RA riON POLICY NUMBER: PHPK1755940 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Weld County Colorado see 60 Day NOC Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury". "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations: or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law:. and 2. If coverage provided to the additional insured is required by a contract or agreement the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to ;.iovode for such additional insured B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. PI-MANU-1 (09/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY 60 Day Notice of Cancellation effya-cs,„, /p #16,.5 / CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND PERKLEN INC., DBA PERKLEN CENTER FOR PSYCHOTHERAPY N This Agreement, made and entered into the day of , 2018, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of uman Services, hereinafter referred to as the "Department' and Perklen Inc., DBA Perklen Center for Psychothe apy, 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 Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and incorporated herein by this reference. 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, Child Welfare Administration or other applicable funding to the Department for Anger Mangement and Domestic Violence Services and Sexual Abuse Treatment Services. 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, 2017, upon proper execution of this Agreement and shall expire May 31, 2018, 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 Department's Resource Manager, Child Welfare Contract and Services Coordinator, or through a Team Decision Making (TDM) meeting or Family Team Meeting (FTM). No other Department staff or other party to the case may authorize services or modifications to services. 2018-1526 0/: 011(/646,2 /ISD c. Contractor agrees to submit an itemized complete billing statement by the 7th of the month, following the month of service, utilizing billing forms required by the Department. d. Contractor agrees to submit a monthly report with the billing statement by the 7th of the month following the month of service for each client receiving ongoing services. One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation). Verification of Monitored Sobriety Services will be the test result. 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. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. 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. b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment 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. 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 0MG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. 2 b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit an ACH Form for Colorado Providers, which will be provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of Colorado per the directions on the form. Failure to complete and submit this form 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 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. 3 - 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 Core Services. 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. Contract Professional certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contract Professional will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5-102(5)(c). Contract Professional 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 Contract Professional that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contract Professional 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 Contract Professional obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contract Professional shall notify the subcontractor and County within three (3) days that Contract Professional 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. Contract Professional 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. Contract Professional 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 Contract Professional participates in the State of Colorado program, Contract Professional shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contract Professional 4 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. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, and shall comply with all of the other requirements of the State of Colorado program. If Contract Professional fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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 Contractor and 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/Contract Professionals must secure, at or before the 5 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/Contract Professionals 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, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, 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/Contract Professional. Contractor/Contract Professional 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/Contract Professional 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 Contract Professional'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: - $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/Contract Professional 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 reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County 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 County. 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 County, whichever is earlier. c. Contractors/Contract Professionals 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/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance. County reserves the right to require Contractor/Contract Professional 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/Contract Professional's insurer shall name County as an additional insured as follows: County of Weld 1150 'O' Street Greeley, Colorado 80631 f. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors, 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/Contract Professional. Contractor/Contract Professional 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/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 7 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 that 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 970-352-1551, x6503, 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 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. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. 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: 8 - 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, Administrator Jodie Goter, Therapist 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) 352-1551 18. Litigation For Contractor: Kim Ruybal, Director 1020 8th Street Greeley, CO 80631 (970) 353-8171 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 9 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. 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 10 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 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 Contract Professional agrees that it is an independent Contract Professional and that Contract Professional'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. Contract Professional shall perform its duties hereunder as an independent Contract Professional. Contract Professional shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contract Professional, its employees and agents are not entitled to unemployment 11 insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contract Professional or any of its agents or employees. Unemployment insurance benefits will be available to Contract Professional and its employees and agents only if such coverage is made available by Contract Professional or a third party. Contract Professional shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contract Professional shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contract Professional 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, and 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 Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by 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, 12 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 conflict 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 Contract Professional'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, Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contract Professional acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contract Professional. Contract Professional shall not enter into any subcontractor agreements for the completion of this project without County's prior written consent, which may be withheld in County's sole discretion. 36. Attorneys Fees/Legal Costs In the event of a dispute between County and Contract Professional, 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 Contract Professional under this Agreement or individual work order shall become or remain (as applicable), the property of County. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contract Professional 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 County. Contract Professional shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of County. 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 13 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: Weld Co By: Deputy Clerk to th oard Clerk to the Board CONTRACTOR: 15 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO eve Moreno, Chair MAY 092018 Perklen Inc., DBA Perklen Center for Psychotherapy 1020 8th Street Greeley, CO 80631 (970) 353-8171 By: Kim Ruybal, Director Date: 04/04/2018 7o/8 /6240 EXHIBIT A WELD COUNTY'S REQUEST FOR PROPOSAL REQUEST FOR BIDS AND PROPOSALS WELD COUNTY, COLORADO 1150 O STREET GREELEY, E E LEY, CO 80634 DATE: April 3, 2017 BID NUMBER: B1700080 DESCRIPTION: Annual Request for Various Services DEPARTMENT: Human Services MANDATORY PRE -BID CONFERENCE DATE: N/A BID OPENING DATE: APRIL 24, 2017 PAGES 1-9 OF THIS DOCUMENT CONTAINS GENERAL INFORMATION. NOT ALL OF THE INFORMATION CONTAINED IN PAGES 1-9 MAY BE APPLICABLE. THE SCOPE OF WORK AND SPECIFICATIONS UNIQUE TO THIS REQUEST FOR BID FOLLOW PAGE 9. I. NOTICE TO BIDDERS A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the Board of Weld County Commissioners, wishes to purchase the following: VARIOUS ENGLISH AND BILINGUAL (ENGLISH/SPANISH) SERVICES (SERVICE AREAS INCLUDED IN THIS PROPOSAL INCLUDE, BUT ARE NOT LIMITED TO THE BELOW LIST. OTHER SERVICES WILL BE CONSIDERED AND BIDDERS ARE ENCOURAGED TO SUBMIT FOR UNIQUE AND CREATIVE SERVICES.) Program Area Definition AftercareServices Services other of the permanent child. provided placement to prepare a child and to prevent for reunification future with out- of -home his/her placement family or Anger Management/Domestic Violence Diagnostic family functioning services and/or and plan, therapeutic relationships, to assess services and/or and to improve prevent to assist further in family the development communication, domesticviolence. of the Program Area Definition Crisis Stabilization Intervention Services and Services families, *crisis, *A (recent) individual family "crisis" 24 in to that youth resolve hours is nature, and/or further provide and a the family, children, day, which an defined crisis seven immediate, breaks and through in (7) as results days a down situation in- in normal a the the person/in- week. or normal inability coping circumstance, home functioning of behaviors, the response usually individual of orwithout an to acute and/or Day Treatment Comprehensive, and therapy to children highly structured and theirfamilies. services that provide education to children Foster ParentConsultation Services County quality children of provided care and being to foster youth provided. in and their group homes home families to enhance caring and improve for Weld the Foster ParentTraining Core training for new Weld County foster parents. Functional Family Therapy Intensive relational acting out, family dysfunction and -based substance treatment known abuse to be among that determinants addresses youth 10-18 the of conduct pervasive years old. disorder, patterns of violent Home -Based Intervention Services services services family. *Crisis counseling. Intervention and provided which *crisis can primarily include intervention is defined therapeutic in the as directed 24/7 home phone services, of to the client meet access concrete the and that needs in include services, -home of the a variety collateral child of and Kinship (Therapeutic) Services Kinship specific to to maintained of -home a a child child services to placed placed placement a child in the in in in the placed lowest a a is areas kinship kinship necessary. in level a of kinship home, home. (1) of consultation care and Children home, (3) and (2) critical least placed and corrective restrictive care kinship in consultation kinship consultation setting parent care support are when specific specific out - Life Skills Visitation home resources, that (both teach parenting in -home household techniques and in -office) management, and and family services effective conflict provided accessto management. primarily community in the Mediation/Intensive Therapy Family family Therapeutic intervention communication, typically functioning with and all relationships. family members to improve Program Area Definition Mental Health Services Diagnostic family functioning services and/or and plan, relationships. therapeutic to assess services and/or improve to assist in family the development communication, of Multi-systemicTherapy Intensive positive relations) adolescents changes family- that who and in contribute are the community at various risk to for the -based social serious out -of systems -home treatment antisocial (home, placement. behaviors program school, designed community, of children to make and peer Relinquishment Counseling Relinquishment children. counseling for parents considering relinquishment of their Substance Services Abuse Treatment Diagnostic Family functioning alcohol. Service and/or and Plan relationships, therapeutic (FSP), to services assess and and/or to prevent to assist improve in further the development family abuse communication, of drugs of or the Other Creative youth prevention and and families or unique traditional services interacting case. designed with the to Child meet Welfare the needs system of children, through a B. Bids for the stated services will be received by the Weld County Department of Human Services, Resource Unit, Attn: Tobi Vegter, through: MONDAY, APRIL 24, 2017, AT 5:00 P.M. (WELD COUNTY DEPARTMENT OF HUMAN SERVICES, RESOURCE UNIT TIME CLOCK). Acceptable bid delivery methods are as follows: Email. Emailed bids are preferred. Bids should be emailed to: vegterta@weldgov.com. Emailed bids must include the following statement on the email: "I hereby waive my right to a sealed bid". An email confirmation will be sent when we receive your bid/proposal. Mail. Mailed bids should be sent in a sealed envelope with the bid title and bid number on it. Bids must include the following statement on the email: "thereby waive my right to a sealed bid". Mailed bids should be addressed to: Weld County Department of Human Services, Attn: Tobi Vegter, Division of Child Welfare, Financial Unit, P.O. Box A, Greeley, CO 80632. Please call or email Tobi Vegter at 970-400-6392 or vegterta@weldgov.com if you have any questions. Hand Delivery. Hand -delivered bids should be submitted in a sealed envelope with the bid title and bid number on it. Bids must include the following statement on the email: "I hereby waive my right to a sealed bid". Hand - delivered bids can be dropped off at: Weld County Department of Human Services, Attn: Tobi Vegter, Financial Unit, 822 7th Street, Suite 150, Greeley, CO 80631. Please call or email Tobi Vegter at 970-400-6392 or vegterta@weldgov.com if you have any questions. II INVITATION TO BID A The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the board of Weld County Commissioners requests bids for the purchase of Various Services (as described above) B Bids shall include any and all charges for service(s) applied for by the bidder, and shall, in every way, be the total net price which the bidder will expect the Board of County Commissioners of Weld County to pay if awarded the bid C Emailed Bids Are Preferred Emailed (fully typed) bids are preferred However, if the bidder is unable to submit an emailed bid, the bidder must comply with the requirements set forth in Paragraph I, B An emailed bid must contain the following statement "I hereby waive my right to a sealed bid " D Unless the Bid is emailed, one original and one copy of the Bid must be submitted One complete bid document, which will be the only official copy of the bid, shall be filed at the Weld County Department of Human Services, Resource Unit After certification of the bid, the other copy will be routed for applicable review An e-mail confirmation will be sent when we receive your bid/proposal III INSTRUCTIONS TO BIDDERS A Bids shall be typewritten Each bid must give the full business address of the bidder and be signed by him with his usual signature Bids by partnerships must furnish the full names of all partners and must be signed with the partnership name by one of the partners of the partnership or by an authorized representative, followed by the signature and title of the person signing Bids by corporations must be signed with the legal name of the corporation, followed by the name of the state of the incorporation and by the signature and title of the president, secretary, or other person authorized to bind it in this matter Bids submitted by limited liability companies must furnish the full names of all members and managers and must be signed by a manager or by an authorized representative, followed by the signature and title of the person signing The name of each person signing shall also be typed or printed below the signature A bid by a person who affixes to his signature the word "president," "secretary," "agent," or other title without disclosing his principal, may be held to be the bid of the individual signing When requested, satisfactory evidence of the authority of the officer signing in behalf of a corporation shall be furnished All corrections or erasures shall be initialed by the person signing the bid All bidders shall agree to comply with all of the conditions, requirements, specifications, and/or instructions of this bid as stated or implied herein All designations and prices shall be fully and clearly set forth B Bids may be withdrawn upon written request to the Weld County Department of Human Services received from bidders prior to the submission deadline Negligence on the part of bidder in preparing the bid confers no right for the withdrawal of the bid after it has been opened C Bidders are expected to examine the conditions, specifications, and all instructions contained herein Failure to do so will be at the bidder's risk D Bidders shall not stipulate in their proposals any conditions not contained in the instructions and specifications herein unless specifically requested by the special instructions attached hereto Any proposal which fails to comply with the letter of the instructions and specifications herein may be rejected E Late or unsigned bids shall not be accepted or considered It is the responsibility of the bidder to ensure that the bid arrives in the Weld County Department of Human Services, Service Utilization Unit, on or prior to the time indicated in Section I , entitled "Notice to Bidders " F When approximate quantities are stated, Weld County reserves the right to increase or, decrease quantity as best fits its needs 1 4 G Whenever requested, samples or descriptive matter shall be filed prior to the opening of bids H In accordance with Section 14-9(3) of the Weld County Home Rule Charter, the Board of County Commissioners of Weld County will give preference to resident Weld County bidders in all cases where said bids are competitive in price and quality It is also understood that the Board of County Commissioners of Weld County will give preference to suppliers from the State of Colorado, in accordance with Section 30-11-110, CRS, when it is accepting bids for the purchase of any books, stationery, records, printing, lithographing or other supplies for any officer of Weld County I All discounts shall be figured from the date of delivery and acceptance of the articles, or in the case of an incorrect invoice, from the date of receipt of corrected invoice, if this be subsequent to delivery and acceptance J Substitutions or modifications to any of the terms, conditions, or specifications of this bid package which are made by Weld County, Colorado, after the bids have been distributed to prospective bidders, and prior to the date and time of bid opening, will be made in writing and signed by the Families, Youth and Children's Commission No employee of Weld County, Colorado, is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of Families, Youth and Children's Commission This is not to imply that bids will not be accepted or considered with specifications which are different from those herein Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid K The successful bidder shall indemnify and hold harmless Weld County, Colorado, against all claims for royalties, for patents or suit for infringement thereon, which may be involved in the manufacture or use of the material to be furnished L Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C R S ) 8-17 5- 101, et seq Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C R S 8-17 5-102(2)(b) Contractor shall comply with all reasonable requests made in the course of an investigation under C R S 8-17 5-102 by the Colorado Department of Labor and Employment If Contractor fails to comply with any requirement of this provision or C R S 8-17 5-101, et seq , Weld County may terminate this Contract for breach and Contractor shall be liable for actual and consequential damages to Contractor 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 this Contract, Contractor must confirm that any individual natural person eighteen (18) years of age orolder 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 this 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 a Contract M All goods shall remain the property of the seller until delivered to and accepted by Weld County, Colorado N Bids received prior to the time of opening will be kept unopened in a secure place No responsibility will attach to the Families, Youth and Children Commission, the Weld County Department of Human Services, or the Board of Weld County Commissioners, for the premature opening of a bid not properly addressed and identified 5 O In submitting the bid, the bidder agrees that the acceptance of any and all bids by the Board of County Commissioners of Weld County within a reasonable time or period does not constitute a contract The Board of County Commissioners of Weld County, Colorado, reserves the right to reject any and 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 P These instructions, the proposal forms, and specifications have been developed with the hope of raising the standard of purchasing negotiations to a level wherein all transactions will be mutually satisfactory Your cooperation is invited Q Substitutions or modifications to any of the terms, conditions, or specifications of this which are made by Weld County after the bids have been distributed to prospective bidders and prior to the date and time of bid opening, will be made in writing No employee of Weld County is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of said Director of the Weld County Department of Human Services This is not to imply that bids will not be accepted or considered with specifications which are different from those herein Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid IV GENERAL SPECIFICATIONS A Fund Availability Financial obligations of the Weld County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available By acceptance of the bid, Weld County does not warrant that funds will be available to fund the contract beyond the current fiscal year B Governmental Immunity No term or condition of the contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act §§24- 10-101 et seq , as applicable now or hereafter amended C Independent Contractor The successful bidder shall perform its duties hereunder as an independent contractor and not as an employee He or she shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to the contract Neither the successful bidder nor any agent or employee thereof shall be deemed to be an agent or employee of Weld County The successful bidder and its employees and agents are not entitled to unemployment Insurance or workers' compensation benefits through Weld County and Weld County shall not pay for or otherwise provide such coverage for the successful bidder or any of its agents or employees Unemployment insurance benefits will be available to the successful bidder and its employees and agents only if such coverage is made available by the successful bidder or a third party The successful bidder shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to the contract The successful bidder shall not have authorization, express or implied, to bind Weld County to any agreement, liability or understanding, except as expressly set forth in the contract The successful bidder 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 (b) provide proof thereof when requested to do so by Weld County D Compliance with Law The successful bidder shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established, including without limitation, laws applicable to discrimination and unfair employment practices E Choice of Law Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of the contract Any provision included or incorporated herein by 6 reference which conflicts with said laws, rules and/or regulations shall be null and void F Binding Arbitration Prohibited Weld County does not agree to binding arbitration by any extra -judicial body or person Any provision to the contrary in the contract or incorporated herein by reference shall be null and void G No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of the contract, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in the contract shall give or allow any claim or right of action whatsoever by any other person not included in the contract It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under the contract shall be an incidental beneficiary only H Attorney Fees/Legal Costs In the event of a dispute between Weld County and the successful bidder, concerning the contract, the parties agree that Weld County shall not be liable to or responsible for the payment of attorney fees and/or legal costs incurred by or on behalf of the successful bidder V Insurance Requirements i General Requirements Contractors/Contract Professionals 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 tothis request Contractors/Contract Professionals shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, during any warranty period, and for three (3) years after termination of the Agreement 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, County must be notified by the Contractor/Contract Professional Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, 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/Contract Professional Contractor/Contract Professional 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 ii Types of Insurance Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts (a) Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional'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 (b) 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 7 ® $1,000,000 each occurrence, • $2,000,000 general aggregate, • $50,000 any one fire, and • $500,000 errors and omissions (c) Automobile Liability Contractor/Contract Professional 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 (d) Additional Provisions • Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following ® If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County 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 County (e) 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 County, whichever is earlier iii Contractors/Contract Professionals 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 Bid iv Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance to the County County reserves the right to require Contractor/Contract Professional 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 v Additional Insureds. For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured vi Waiver of Subrogation. For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County vii Subcontractors All subcontractors, 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/Contract Professional Contractor/Contract Professional 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 8 Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage. Professional Liability Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims VI Warranty The successful bidder shall warrant that A The services to be supplied pursuant to this bid are fit and sufficient for the purpose intended, B The services sold to Weld County, Colorado pursuant to this bid conform to the minimum Weld County specifications as established herein VI. CONFIDENTIAL INFORMATION Confidential financial information of the bidder should be transmitted separately from the main bid submittal, clearly denoting in red on the financial information at the top the word, "CONFIDENTIAL" However, the successful bidder is advised that as a public entity, Weld County must comply with the provisions of C R S 24-72-201, et seq , the Colorado Open Records Act (CORA), with regard to public records, and cannot guarantee the confidentiality of all documents If Weld County receives a CORA request for bid information marked "CONFIDENTIAL", staff will attempt to contact the bidder in order to allow the bidder to seek an appropriate court order preventing disclosure Without such an order, Weld County will release the requested information in accordance with CORA 9 SCOPE OF SERVICES PURPOSE. The Weld County Department of Human Services (WCDHS) is seeking qualified English- speaking and bilingual (English/Spanish) providers in various service areas under various funding sources Service areas include, but are not limited to, Anger Management/Domestic Violence, Day Treatment, Foster Parent Consultation, Foster Parent Training, Functional Family Therapy, Kinship Services (Therapeutic), Home Studies/Relinquishment Counseling, Life Skills, Mediation, Mental Health, Monitored Sobriety, Multi -Systemic Therapy, Home Based Intervention including 24/7 Crisis Intervention, Sexual Abuse Treatment, and Substance Abuse Treatment Services and Aftercare Services SERVICE AREAS ARE NOTED BEGINNING ON PAGE 1 OFTHIS REQUEST FOR BID, BUT ARE NOT LIMITED TO THOSE LISTED. OTHER SERVICES WILL BE CONSIDERED AND BIDDERS ARE ENCOURAGED TO SUBMIT FOR UNIQUE AND CREATIVESERVICES. Qualifications: To be considered, a bidder must meet the following minimum qualifications 1) Complete a Provider Information Form (PIF) 2) If submitting to provide bilingual services, a bidder must demonstrate language proficiency at Full Professional Proficiency or higher, as defined by the U S Department of State, and as noted below • Full Professional Proficiency Able to use and read the language fluently and accurately on all levels pertinent to professional needs a Native or Bilingual Proficiency Equivalent to that of an educated native speaker (both speaking and reading) 3) A bidder must agree to language proficiency testing that may include assessment of reading, writing and comprehension of Spanish, as well as a face-to-face conversation with a known native or proficient Spanish speaker selected by Weld County 4) A bidder must submit a one page or less cover letter that introduces the bidder, the bidder's location(s) of practice and target area, his or her experience and qualifications, and staff, if applicable A bidder must include current contact information including physical address, mailing address, phone number, email address and website, if applicable 5) A bidder must submit sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets "minimum qualifications" for all bidders Each service must be submitted as its own proposal, inclusive of scope of services and rate information The scope of service should include at a minimum the following information for each service proposed O Detailed description of service components, modalities used, appropriate use of service, etc ® Target population including age range, specific population characteristics, area of service, etc O Whether or not the service is billable to Medicaid and if bidder is currently able to bill Medicaid Bidders are strongly encouraged to become Medicaid certified Medicaid -billable services are preferred e Clear rate schedule inclusive of all costs bidder wishes to charge for the provision of the service 6) A bidder should avoid elaborate artwork, graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Bid 7) A bidder must demonstrate the knowledge, training and expertise to conduct the proposed service(s) 8) A bidder must provide a current resume, as well as proof of licensure, for self, staff members and contractors of the bidder Additionally, a bidder must include proof of inclusion on State vendor lists if applicable to the proposed service (ex Home Study Providers, Sex Offender Management Board Providers) 9) A bidder should clearly outline the supervisory structure of staff members and/or contractors of the bidder This should include the ratio of supervisor to staffand/or contractors, frequency and duration of supervision, credentials of supervisor and length of time as a supervisor 10) A bidder should clearly outline the bidder's internal referral acceptance and assignment protocol, including communication to the referring agency 11) A bidder must demonstrate familiarity with Trauma Informed Care Bidder must provide copies of applicable training certificates, or proof of registration for training, for all staff members who manage and/or administer services under this proposal 12) A bidder must demonstrate prior and current capacity to be organized, responsive and to quickly and successfully schedule services as requested 13) A bidder must agree to track outcome data related to services proposed if awarded a contract and report outcomes upon request 14) A bidder must agree to enter into an agreement, attached as Exhibit A, with the Weld County Department of Human Services and comply with all requirements of the agreement Contract Period and Pricing 1) The initial contract period is to be determined and shall continue as allowable by the funding source, so long as both parties are satisfied The selected vendor(s) will have the opportunity to resubmit annually 2) The initial contract will be funded through Core Services Program or other funding, so long as funding is made available 3) The selected vendor will bill the Weld County Department of Human Services monthly according to billing requirements set forth by the Weld County Department of Human Services Submittal Requirements for All Proposals A bidder must submit according to requirements set forth in this Request for Bid - Qualifications All proposals must contain the following specific information 1) Provider Information Form (PIF) 2) Identification of language(s) and proficiency level, if applying to provide bilingual (English/Spanish) services 3) One page or less cover letter that introduces the bidder, the bidder's location(s) of practice, his or her experience and qualifications, and staff, if applicable 4) A bidder must submit sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets"minimum qualifications" for all bidders Each service must be submitted as its own proposal, inclusive of scope of services and rate information The scope of service should include at a minimum the following information for each service proposed O Detailed description of service components, modalities used, appropriate use of service, etc e Target population including age range, specific population characteristics, area of service, etc ® Whether or not the service is billable to Medicaid and if bidder is currently able to bill Medicaid Bidders are strongly encouraged to become Medicaid certified Medicaid -billable services are preferred ® Clear rate schedule inclusive of all costs bidder wishes to charge for the provision of the service 5) Bidders should avoid elaborate artwork, graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Bid 6) Current resume, proof of licensure and copies of applicable training certificates for all staff members who will manage and/or administer services under this proposal 7) Supervisory structure of staff members and/or contractors of the bidder This should include the ratio of supervisor to staff and/or contractors, frequency and duration of supervision, credentials of supervisor and length of time as a supervisor 8) Internal referral acceptance and assignment protocol, including communication tothe referring agency 9) All proposals must demonstrate the bidder has the ability to deliver the services as proposed, and comply with the specific requirements set forth by the Weld County Department of Human Services 10) All proposals must include a clear and concise rate schedule that accurately correlates to the proposed services and is inclusive of all possible charges related to the proposed service(s) The rate schedule must demonstrate an exact fee for the described service (s) Approximate rates or a range of rates for a service will not be accepted 11) Each bidder must submit a Standard Certificate of Insurance, or letter of intent from an insurance company authorized to do business in the State of Colorado stating its willingness to insure the bidder pursuant to the terms of this Request for Bid I I Evaluation of Proposals All proposals that meet the basic proposal, service and qualification requirements will be reviewed by the Families, Youth and Children (FYC) Commission Criteria for review, include but are not limited to the following • Qualifications, appropriate licensure, and experience • Cost structure O Relationships and collaboration • Organizational experience and past performance The FYC Commission will make recommendations to the Board of Weld County Commissioners by and through the Weld County Department of Human Services The Weld County Department of Human Services will make its award of contract to the successful bidders upon final approval of the Board of Weld County Commissioners EXHIBIT A SAMPLE AGREEMENT CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND This Agreement, made and entered into the_ day of , 2015by 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 «Contractor», 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 Reuquest for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule Each of these documents is attached hereto and incorporated herein by this reference 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 funding to the Department for NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows 1 Term This agreement shall become effective on , upon proper execution of this Agreement and shall expire 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 Department's Resource Manager, Child Welfare Contract and Services Coordinator, or through a Team Decision Making (TDM) meeting or Family Team Meeting (FTM) No other Department staff or other party to the case may authorize services or modifications to services c Contractor agrees to submit an itemized complete billing statement by the 7th of the month, following the month of service, utilizing billing forms required by the Department 1 d Contractor agrees to submit a monthly report with the billing statement by the 7th of the month following the month of service for each client receiving ongoing services One-time services will be verified through receipt of the completed product (ex psychological evaluation, substance abuse evaluation) Verification of Monitored Sobriety Services will be the test result 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 Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department 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 b Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment 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 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, Payment 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 ACH Form for Colorado Providers, which will be provided by the Department Contractor is solely responsible to submit the ACH Form to the State of 2 Colorado per the directions on the form Failure to complete and submit this form 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 - 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 3 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 Core Services 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 Contract Professional certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract Contract Professional will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C R S §8-17 5-102(5)(c) Contract Professional 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 Contract Professional that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement Contract Professional 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 Contract Professional obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contract Professional shall notify the subcontractor and County within three (3) days that Contract Professional 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 Contract Professional 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 Contract Professional 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 Contract Professional participates in the State of Colorado program, Contract Professional shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contract Professional 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 Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, 4 and shall comply with all of the other requirements of the State of Colorado program If Contract Professional fails to comply with any requirement of this provision or of C R S §8-17 5-101 et seq , County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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 Contractor and 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/Contract Professionals 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/Contract Professionals shall keep the required insurance coverage in force at all times during the term of 5 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, County must be notified by the Contractor/Contract Professional Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, 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/Contract Professional Contractor/Contract Professional 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/Contract Professional 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 Contract Professional'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 - $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/Contract Professional 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 reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County 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 County 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 County, whichever is earlier c Contractors/Contract Professionals 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/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance County reserves the right to require Contractor/Contract Professional 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/Contract Professional's insurer shall name County as an addjtional insured as follows f Waiver of Subrogation For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County g Subcontractors All subcontractors, 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/Contract Professional Contractor/Contract Professional 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/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage Professional Liability Contract Professional 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 7 Contractor may be required to attend training that 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 970-352-1551, x6503, 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 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 As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures 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 8 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, Administrator CONTRACTOR, TITLE 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) 352-1551 18 Litigation For Contractor 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 18 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 9 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 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 10 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 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 Contract Professional agrees that it is an independent Contract Professional and that Contract Professional'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. Contract Professional shall perform its duties hereunder as an independent Contract Professional. Contract Professional shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contract Professional, 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 Contract Professional or any of its agents or employees. Unemployment insurance benefits will be available to Contract Professional and its employees and agents only if such coverage is made available by Contract Professional or a third party. Contract Professional shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contract Professional shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contract Professional 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 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 11 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 Department originals of all tests and results, reports, etc , generated during completion of this work Acceptance by 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 conflict 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 Contract Professional'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 12 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, Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute 35 Subcontractors Contract Professional acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contract Professional Contract Professional shall not enter into any subcontractor agreements for the completion of this project without County's prior written consent, which may be withheld in County's sole discretion 36 Attorneys Fees/Legal Costs In the event of a dispute between County and Contract Professional, 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 Contract Professional under this Agreement or individual work order shall become or remain (as applicable), the property of County In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contract Professional 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 County Contract Professional shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of County 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 13 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written ATTEST BOARD OF COUNTY COMMISSIONERS Weld County Clerk to the Board WELD COUNTY, COLORADO BY Deputy Clerk to the Board , Chair APPROVED AS TO FUNDING APPROVED AS TO SUBSTANCE Controller Elected Official or Department Head APPROVED AS TO FORM Director of General Services County Attorney CONTRACTOR Contractor, Title 14 EXHIBIT B CONTRACTOR'S PROPOSAL Perklen Center for Psychotherapy A Journey to Integrity Through Self-awareness April 20, 2017 Weld County Department of Human Services 915 10th Street Greeley, CO 80632 RE: B1700080 To whom it may concern: The Perklen Center for Psychotherapy was first established as a private practice, single owner, for-profit agency in Greeley on February 1, 2001. Currently, Kim R. Ruybal, MA, LPC and Jodie M. Goter, MA, LPC co-own the company. From its inception, this agency has been dedicated to reducing violence in the Weld County community by providing services to those who are on community supervision. We work closely with professionals within the legal system to include the Department of Human Services, Parole, Probation, Community Corrections, the Judicial Bench, and the District Attorney's Office. We provide State approved (DVOMB) domestic violence evaluations, group and individual treatment, in addition to, State approved (SOMB) sex offender evaluations, Abel Assessment for Sexual Interests, and group and individual treatment. Many of the staff of the Perklen Center are approved providers with Parole, the Domestic Violence Offender Management Board, and the Sex Offender Management Board; the governing agencies that provide standards of care for this specific clientele. The individuals we serve include males, females, youth, those with marital discord, families, couples, individuals with developmentally disabilities, and the LGBTQ+ community. We offer mental health, cognitive behavioral group intervention and short-term, intensive, individual treatment. We are contracted with the Department of Youth Corrections to provide offense - specific treatment for youth who have sexually abused. We work closely with Intervention Community Corrections (ICC S) and Foothills Gateway, Inc., a program that supports people with developmental disabilities. We provide a pro -bone service for victims of domestic violence and are providers for clients who have Crime Victim Compensation funding. As a part of a Community Supervision Team (CST), Multi -treatment Team (MTT), and a Multi -discipline Team (MDT), we coordinate the containment of our clients with probation, parole, community corrections, mental health agencies, and polygraphers. 1020 8th Street , Greeley, CO 80631 Phone: 970.353.8171 Fax: 970.353.0371 Page 1 The Perklen Center for Psychotherapy is a protected entity under the provisions of HIPAA and the Regulations Every measure is taken to ensure that the clients Protected Health Information (PHI) is secure and confidential Respectfully submitted, ((AAA - Kim R Ruybal, LPC President 1020 8th Street, Greeley, CO 80631 Phone 970 353 8171 Fax 970 353 0371 Page 2 D PROVIDER INFORMATION FORM (Bid Cover Sheet) Weld County Department of Human Services Periden Inc , dba Perklen Center for Psychotherapy 1529012 AGENCY OR PRIVATE PRACTICE TRAILS PROVIDER ID (II Mown) Ken Ruybal President PRIMARY CONTACT- FULL NAME PRIMARY CONTACT TITLE i 970 1353-8171 / 970 1353-0371 PHONE NUMBER Pertdenkruybai@gwestoffice net EXT FAX NUMBER PRIMARY CONTACT- E MAIL ADDRESS AGENCY/PRACTICE WEB ADDRESS OF APPLICABLE) 1020 8th Street AGENCY MAILING ADDRESS Kelly Gardner Greeley 80631 CITY Agency Manager ZIP REFFERAL CONTACT- FULL NAME (IF DIFFERENT THAN PRIMARY CONTACT) REFERRAL CONTACT -TITLE i 970 i 353-8171 REFERRALCONTACT- PHONE NUMBER perklenkgardner@gwestofflce net EXT REFERRAL CONTACT - E MAIL ADDRESS I certify that the services offered for intended use by Weld County will meet all the specifications it has so indicated in this bid form The Board of Weld County Commissioners reserves 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: 04/20/2017 Perklen Inc., dba Perklen Center for Psychotherapy RFP-FYC 2017 Sexual Abuse Treatment Program for Adults and Juveniles Services Bid Proposal 1. PROJECT DESCRIPTION Perklen Center for Psychotherapy will utilize a non -medical, cognitive behavioral model, focusing primarily on the treatment of juveniles and adults with sexually abusive behavior. This program will focus on providing specialized outpatient services that meet the needs of male and female clients. Adolescent groups will focus on youth between the ages of 10 to 18. Adult groups will accept clients age 18 and older. Both programs will provide education, treatment, and support to ensure a safe and successful integration with the family and community. The mission of the Perklen Center for Psychotherapy outpatient program for sexually abusive youth and sexually violent adults is to reduce recidivism rates by: • Providing a structured environment for the safety of the client, family and community. • Increasing awareness and empathy for the victim and the impact of the offense on the victims and family members. • Fostering a family environment to effect positive change. • Developing the use. of appropriate social/sexual skills and expressions through recognition of situations and stimuli that trigger sexually aggressive behavior. • Assisting family members to develop the skills necessary to recognize and understand the sexual behavior of their family member for the purpose of providing support while the client progresses through treatment. The Perklen Center for Psychotherapy outpatient program for sexually abusive youth will treat: • Male and female youth 10 to 18 years of age. • Youth with current sexual offense adjudications or youth who have admitted guilt and will provide a written letter from a parent or attorney stating they plan to plead guilty. • Youth with both average intelligence and those who are developmentally delayed. The Perklen Center for Psychotherapy outpatient program for sexually aggressive adults will treat: • Male and female adults age 18 and older. • Clients who have been found guilty of a sexual offense or have a written letter from an attorney stating they plan to plead guilty. Program services for clients include: • Psychosexual testing and evaluation. Perklen Center for Psychotherapy SAT Program for Adults and Juveniles Services Bid Proposal - FYC 201 1 o O Offense -specific group therapy o Individual, couples, and/or family therapy ® Informed Supervision groups - youth (1 5 hours/month or six intensive sessions) e Chaperones Group - adults (1 5 hours/month ongoing) e Relationship and interpersonal social skills © Sex education o Interdisciplinary team meetings (monthly or as needed) o Victim empathy and awareness o Anger management/impulse control skills ® Cognitive behavioral modification o Self-esteem building e Values clarification and examination ® Relapse prevention plan o Aftercare services II. TARGET/ELIGIBILITY POPULATIONS Guidelines for conducted offense -specific groups indicate that the ideal number of clients should be approximately eight youth with one therapist and 12 clients with two therapists Total family units will coincide with the number of clients in the offense -specific program Offense -specific services, including individual, group, couples, and family therapy, will be provided at Perklen Center for Psychotherapy All clients and their families will have to arrange transportation to the group location Emergency services are available nights and weekends for all clients or families in crisis Monthly maximum capacity will be limited to 12 youth and their families per group, with monthly average capacity expected at 15 Due to the intensity of the program, youth are expected to complete the program in an average of 18 months to two years Adults can be expected to complete the program in a minimum of three years Average hours per week in the program are expected at approximately 2 5 hours per week for adolescents and 2 5 hours per week for adults HI. TYPE OF SERVICES TO BE PROVIDED A. ADULT AND JUVENILE SEX OFFENSE SPECIFIC EVALUATION Before clients can be accepted into the outpatient program, a psychosexual evaluation is required to determine whether an outpatient program will be appropriate Assessment will examine seven areas ® The client's potential to re -offend ® Amenability for treatment o Recommended treatment setting 1 Perklen Center for Psychotherapy SAT Prograin for Adults and Juveniles Services Bid Proposal - FYC 2017 2 of 7 I 1 ® Type of treatment needed © Risk factors/monitoring/potential new victims ® Psychiatric/substance abuse/individual/family needs ® Mental health concerns Evaluations will include o A structured clinical interview o Collateral information from schools, caseworkers, probation/parole officers, case managers, therapists, doctors, courts, police reports, or other relevant sources Other assessment tools may include (depending on the age of the offender and circumstances of the case) ® Hare Psychopathy Checklist -Revised o Minnesota Multiphasic Personality Inventory -II o Jessness Inventory o SASSI Drug and Alcohol Inventory © Millon Clinical Multiaxial Inventory 6 Shipley Institute of Living Scales o State Trait Angry Expression Inventory © Violence Risk Assessment Guide o Sex Offender Needs Assessment Guide o Abel Assessment for Sexual Interests m Juvenile Sex Offender Assessment Protocol Assessments may reveal the need for additional treatment, such as a medication evaluation, psychiatric evaluation, monitoring of substance abuse, and/or substance abuse treatment Referrals will be made to the appropriate agencies to address these treatment needs Results of the initial assessment will indicate what treatment goals will be addressed Measurable treatment goals will be developed and monitored on a monthly basis B GROUP AND INDIVIDUAL THERAPEUTIC SERVICES Therapy for adolescents and adult sexual abusers consists of a non -medical, cognitive behavioral model Studies have shown that caring confrontation (pointing out client errors in thinking and behavior while treating the client with respect) is the most effective way of motivating the client to make changes This model also focuses on the various types of abuse that clients have committed in addition to their deviant sexual behavior, including physical, emotional, verbal and psychological Understanding of when sexual behavior is abusive will be taught by helping clients understand the concept of consent, victim empathy, responsibility, and relapse prevention An integral part of treatment will include a polygraph during portions of the program, as well as shortly before discharge from the program The purpose of the polygraph includes 1 Per klen Center for Psychotherapy SA7 Pr op am for Adults and Juveniles Services Bid Pi oposal - FYC 2017 3 of 7 • Encouragement of more disclosure of additional victims or other deviant sexual behavior. • Monitoring for honesty to assess progress in treatment and increase containment. Clients will be introduced to the sexual abuse cycle. The cycle will be used throughout group therapy to help youth and adults understand their personal abuse cycle and develop ways they can make their behavioral patterns more functional. Part of the abuse cycle will include how defense mechanisms and cognitive distortions contribute to the continuation of the cycle. Clients will learn Rational Emotive Therapy, which will help them understand how their thoughts and feelings contribute to their behavior, to assist in changing faulty behavior patterns. An important part of group therapy will be addressing victim empathy. Clients will learn to read cues from others, interpret them accurately, and validate what they have heard from others. The goal is for clients to identify an empathic experience or interaction, and eventually develop empathic foresight on how their behavior affects others. An essential part of developing empathy includes addressing the client's own victimization, if applicable, and how it affected their own choices. Since the ultimate goal of offense -specific treatment is to prevent recidivism, clients will focus on developing a comprehensive relapse prevention plan, which will provide them with their own individual guidelines to prevent further deviant sexual behavior. Clients will review their relapse prevention plan during group with therapists and group members who are familiar with the client's offense to assist in developing a plan that will minimize the possibility for re - offense. C. INFORMED SUPERVISION Informed supervision is essential to help the adolescent remain safe at home and in the community and is an ongoing process. The Colorado Sex Offender Management Board (SOMB) require that every juvenile, who is known to have committed a sexual offense, must have an informed supervisor with them at all times until they have successfully completed offense specific treatment. The informed supervisor must be trained by an approved member of the Multidisciplinary Team (MDT). Six hours minimum of training for the informed supervisor is required. The curriculum is to include, but not limited to, reviewing the Colorado Standards and Guidelines for the Treatment of Juveniles Sex Offenders, Goal Orientation, Evaluation Process, Treatment Outcomes Summary, Informed Supervisors Role, Types of Illegal Sexual Behavior, Defense Mechanisms, Cycle of Sexual Offending, Universal Goals, Safety Planning, MDT Supervision Protocol, Informed Supervision Initial Care -giver Juvenile Supervision Plan, and Therapeutic Care Protocol. Informed supervision groups provide three essential elements: • Improve parental understanding of the pattern of sexual abuse. • Increase containment in the community to maximize a successful outcome in treatment. • Develop a support group with other parents to gain acknowledgment from others about their experiences as parents of sexually reactive youth. Perklen Center for Psychotherapy SAT Program for Adults and Juveniles Services Bid Proposal - FYC ?017 4of7 D. FAMILY AND COUPLES SESSIONS Family and/or couples therapy will focus on the situations at home that may have contributed to past abuse, and what interventions would be necessary in order to provide a safe home environment for all family members This may include sorting out feelings for each family member about the abuse, reunifying family members, and assessing how families can contribute to improving safety in the home Family members will also learn how to support the client while he/she completes the therapy process Parenting education and conflict resolution for family members will also be addressed Victims who are part of the family will be included in family therapy when the client has progressed to the point where they are considered to be safe and the victim is ready to have contact Adult offenders are initially not allowed to have contact with anyone under the age of 18, but have the option of attending couples therapy E CHAPERONES PROGRAM Chaperones group is offered for adult family members or spouses to develop the skills necessary to have contact with children under the supervision of trained adults Like the informed supervision group, the purposes of the chaperones group are o Improve understanding of the pattern of sexual abuse for adult offenders o Develop a support group to gain acknowledgment from others about their experiences as significant others with family members who have been sexually aggressive o Increase containment in the community to maximize a successful outcome in treatment F. AFTERCARE FOR ADULTS AND JUVENILES Aftercare will be provided for clients who have successfully completed an offense specific treatment program Adolescent clients will begin attending groups weekly, then reduce to bi-weekly, with the plan of releasing the client from aftercare treatment within six months Aftercare will focus on providing the client with healthy and non -deviant ways of experiencing their sexuality G. COURT TESTIMONY The staff of Perklen Center for Psychotherapy are qualified and experienced in court testimony When given proper notification, the staff of Perklen Center for Psychotherapy is available for court testimony regarding clients with open and/or closed cases IV. MEASURABLE OUTCOMES Upon completion of the program, clients should be able to demonstrate the following o Consistently define all sexually abusive behavior O Acknowledge risk by demonstrating foresight and using safety planning ® Consistently recognize/interrupt sexual abuse cycle Perklen Center for Psychotherapy SAT Program for Adults and Juveniles Services Bid Proposal - FYC 2017 5of7 O Demonstrate new coping skills and develop stress management techniques o Demonstrate victim empathy and understand how his/her behavior effects the victim, family, community, etc O Display accurate attribution of responsibility for offending behavior O Able to manage frustration and unfavorable events e Reject sexually abusive thoughts as dissonant with self image O Demonstrate pro -social relationship skills O Project positive self image o Demonstrate the ability to resolve conflict and make decisions o Celebrate appropriate behavior and experience pro -social pleasure o Delays gratification O Able to communicate assertively O Develop family and/or community support systems O Has an adaptive sense of purpose and future Tracking progress through the program will take place in the following manner O Upon acceptance into group, clients will receive an individualized treatment plan that will outline what the client will accomplish in order to complete treatment Therapists will be assessing the progress each client is making toward their treatment plan Changes and updates will be made to the treatment plan as needed o The therapist will evaluate whether the client is understanding the concepts presented during groups through the use of a Group Note Feedback will be provided at the start of the next group to help the client obtain maximum benefit from groups O Polygraphs will be conducted periodically to determine whether clients are being truthful regarding their referring offense, their current and continued safety in the community, compliance with their terms and conditions of probation, parole plan, or case management plan, and their sexual history O For adult offenders and juvenile offenders, the Abel Assessment for Sexual Interests, will be administered as needed to assist with arousal management and deviant sexual interests o The MDT will meet monthly to discuss client's progress in the program Any major concerns that arise prior to the monthly meeting will be discussed with the case worker, case manager, probation/parole officer within 48 hours V. SERVICE OBJECTIVES The primary objective of the Perklen Center will be to provide safety for the victim and the community, decrease recidivism, and help clients develop healthy sexuality VI. WORKLOAD STANDARDS A Number of hours per day/week/month Day maximum 10 hours Perklen Center for Psychotherdpy SAT Pi ogram for Adults and Juveniles Services Bid Proposal - F YC 2017 6of7 Week maximum 40 hours Month maximum 160 hours B Number of individuals providing treatment Group/individual/family therapists Four Qualified to treat adult and/or juvenile sexual offenders Three C Maximum case load per therapist 30 D Modality of treatment will be cognitive behavioral and will include group, individual, couples, and family therapy E See A above F Total number of individuals providing services Four G Maximum case load per supervisor 30 H See D above I See enclosed Memorandum of Insurance VII. STAFF QUALIFICATIONS A The Perklen Center adolescent and adult program for sexual offenders will meet or exceed the minimum qualifications in education and experience Services will be provided by Masters level counselors who have met the standards of practice to perform mental health intake assessments and reports, as established by the State of Colorado Department of Regulatory Agencies The therapists of Perklen Center are either Licensed Professional Counselors with the State of Colorado or listed on the non -licensed professional database B Total staff available for the project Four C Four therapists is SOMB approved to provide treatment and evaluation for adolescent offenders Three therapists is SOMB approved to provide evaluation and treatment for developmentally delayed offenders Four therapists is approved by the SOMB to provide evaluation and treatment for adult male and female offenders Therapists who are not fully approved have submitted the necessary documentation to the SOMB and are supervised by a licensed Masters level psychotherapist, Jodie M Goter, MA, LPC Perklen Center for Psychotherapy S4T Program for Adult and Juveniles Services Bid Proposal - FYC 2017 7 of 7 Perklen Inc., dba Perklen Center for Psychotherapy RFP-FYC-2017 Mental Health, Anger Management, and Domestic Violence Services Bid Proposal I. PROJECT DESCRIPTION Perklen Center for Psychotherapy will utilize a non -medical, cognitive behavioral model, focusing primarily on the treatment of individuals with mental health, domestic violence, and anger management concerns This program will include evaluation/assessment, and treatment It also includes evaluation and treatment of youth in conflict, and therapy for those involved in dependency and neglect cases Perklen Center for Psychotherapy has the ability to evaluate and treat individuals with high levels of antisocial traits In addition, this program will provide services for victims of sexual abuse, victims of domestic violence, children and extended family members who are secondary victims of crime The mission of Perklen Center for Psychotherapy is to continue to offer services which reflect our care and interest in our clients, and to provide useful services to the community By doing so we will ® Provide a structured program and environment for the safety of the client, family, and community O Increase awareness and empathy for family members, victims, and the community regarding the impact of crime ® Foster a family environment to effect positive change O Develop the use of appropriate cognitive, social, and communication skills to reduce reactive and concerning behaviors The Perklen Center for Psychotherapy outpatient treatment program will treat ® Male and female clients, ages 10 and older ® Individuals with power and control, anger management, domestic violence, and mental health concerns ® Individuals who are developmentally delayed Program Services for the targeted population include o Mental health testing and evaluation, Domestic Violence Offender Management Board approved offense specific assessments and evaluations, anger management evaluations, and mental health evaluations e Domestic violence individual sessions e Domestic violence treatment and education groups 1 I • Anger management individual sessions. • Anger management treatment and education groups. • Group and/or individual anger management, and cognitive restructuring. • Individual and/or family therapy for general mental health concerns. • Family education/support groups. • Victim education and support groups. • Victim empathy and awareness. • Anger management/impulse control skills. • Cognitive behavioral modification. • Self esteem building. • Values clarification and examination. • Personal change plan for domestic violence clients. • After care services for domestic violence and general mental health clients. • Relationship and interpersonal social skills for general mental health clients. • Caring Dads Group for men who have been domestically violent. • Mothers Parenting Group for women who are in, or have been in, domestic violence relationships. • Non -offending partner group therapy for victims and family members of domestic violence. • Emergency services will be available nights and weekends for clients in crisis. II. TARGET / ELIGIBILITY POPULATIONS Clients of the Perklen Center for Psychotherapy's outpatient treatment program include male and female clients 10 years of age and older. Average stay in the program varies, depending on the individual treatment plan. For example, if an individual is referred for domestic violence treatment, there is no minimum number of weeks in the program, as mandated by the Domestic Violence Offender Management Board. Regarding general mental health and anger management, an individual may attend anywhere from one therapy session to an unlimited amount of therapy services, with the average stay in the program of 12 weeks. Clients will need to attend an average of two hours per week. The Caring Dads Program and the Mothers Parenting Group is 17 weeks. III. TYPE OF SERVICES TO BE PROVIDED A. EVALUATION AND/OR ASSESSMENT FOR MENTAL HEALTH, ANGER MANAGEMENT, AND DOMESTIC VIOLENCE To begin the evaluation/assessment process, an initial appointment is scheduled between the client and the evaluator. Two or three sessions will be necessary to accomplish all requirements for evaluation/assessment. The next step of the process includes a question and answer interview designed to gather basic identifying information, mental status examination, the client's mental health issues, mental health history, family and medical history, substance abuse history, inpatient and outpatient history, current social situation, and criminal history Next, the clinician gathers collateral information from agencies noted by the client and/or supervising agency At times, requests of the supervising agency will be made to assist in gathering collateral data The last phase of the process includes psychometric testing, which may include any number of the following psychometric instruments, including o Hare Psychopathy Checklist -Revised o Minnesota Multiphasic Personality Inventory -II o Jessness Inventory o SASSI Drug and Alcohol Inventory o Millon Clinical Multiaxial Inventory -III 9 Shipley Institute of Living Scales o State Trait Angry Inventory • Violence Risk Assessment Guide o Millon Clinical Adolescent Inventory o Domestic Violence Risk Needs Assessment ® Domestic Violence Screening Instrument o Spousal Assault Risk Assessment s ODARA Domestic Violence Risk Assessment After all phases of the evaluation/assessment have been completed, the evaluator then combines all the information from the clinical interview, collateral data, and testing summaries in order to ascertain the client's amenability for treatment and risk level In addition, treatment recommendations will be included This recommendation will be in written format at the conclusion of the evaluation/assessment B. DOMESTIC VIOLENCE EVALUATION To begin the evaluation process, an initial appointment is scheduled between the client and the evaluator The next step of the process includes a question and answer interview designed to gather basic identifying information, mental status examination, the client's mental health issues, mental health history, family and medical history, substance abuse history, inpatient and outpatient history, current social situation, and criminal history Next, the clinician gathers collateral information from agencies noted by the client and/or supervising agency At times, requests of the supervising agency will be made to assist in gathering collateral data The last phase of the process includes any number of the following Perklen Center for Psychotherapy M11 AM DV Services Bid Proposal - HC 2017 3of9 ) • SASSI Drug and Alcohol Inventory • Domestic Violence Risk Needs Assessment • Domestic Violence Screening Instrument • Spousal Assault Risk Assessment • ODARA Domestic Violence Risk Assessment After all phases of the evaluation have been completed, the evaluator then combines all the information from the clinical interview, collateral data, and testing summaries in order to ascertain the client's amenability for treatment and risk level. In addition, treatment recommendations will be included. This recommendation will be in written format at the conclusion of the evaluation. A treatment plan is then established. A standard treatment plan will include: • Short or long term goals. • Measurable objectives relating to the achievement of the established goals. • Type and frequency of services the client will be receiving. • Specific criteria for treatment completion. • Any recommendations as mandated by the Domestic Violence Offender Management Board. • Level of Risk. The therapist will document treatment plan reviews. Monthly progress reports will be provided to the referring agency to inform caseworkers on client's progress. There will be at least two treatment plan reviews in the clients first six months of treatment to determine level of risk. C. DOMESTIC VIOLENCE TREATMENT Perklen Center for Psychotherapy will follow the minimum expected requirement for the treatment of male, female, and Gay/Lesbian/Bisexual/Transgendered individuals who have been domestically violent as mandated by the Colorado Domestic Violence Offender Management Board. Domestic violence treatment is open ended. There are three levels of risk requiring three different levels of care. Low Risk: Level A ■ Psychoeducational treatment: one 90 minute session once weekly. • Weekly educational curriculum is included. • First treatment plan review within two to three months. ■ Second treatment plan review within two to three months of the first treatment plan review. Moderate Risk: Level B ■ Open ended psychoeducational treatment: one 90 minute session once Perklen Center for Psychotherapy MIL AM, Dr: Services Bid Proposal - PVC 2017 4 of 9 weekly ® Weekly educational cumculum is included © Once a month adjunct therapy is required (a) Substance abuse treatment (b) Individual session (c) Skills group (d) Healthy relationship group (e) DV Education (f) Caring Dads group/Mothers Parenting (g) Victim speaker (h) Sex education (i) HIV/AIDS education (1) Sexual abuse and boundaries • First treatment plan review within two to three months • Second treatment plan review within two to three months of the first treatment plan review High Risk: Level C ® Open ended psychoeducational treatment one 90 minute session once weekly ® One weekly educational group ® One weekly skills group (a) Healthy relationship group (b) Caring Dads/Mothers Parenting group (described below) (c) Victim speaker (d) Sex education (e) HIV/AIDS education (f) Sexual abuse and boundaries (g) DV Education (described below) ® First treatment plan review within two to three months • Second treatment plan review within two to three months of the first treatment plan review At the conclusion of services received by a client of Perklen Center for Psychotherapy, a discharge summary will be submitted A standard discharge summary will include the reason the client is being discharged, treatment history with Perklen Center for Psychotherapy, progress or lack of progress following the care of Perklen Center for Psychotherapy, and any recommendations made for future care Risk to the community will also be included The discharge summary will clearly delineate the client's status at discharge, which may include a successful, administrative, or negative discharge Perklen Center for Psychotherapy A'1H, AM D k Services Bid Proposal - FYC 2017 5of9 1). CARING DADS PARENT EDUCATION GROUP: Helping Fathers Value their Children Caring Dads is a 17 week group intervention program that aims to engage fathers, to help them develop more child -centered fathering, and to take responsibility for ending their abusive behavior towards their children and their children's mothers. The Caring Dads' curriculum provides "powerful incentive for men to recognize, without being lectured or shamed, the importance of setting a more positive example for their children." The curriculum not only "helps men to recognize the effects of domestic violence on their children but also provides them with positive and concrete ways to become more responsible co -parents." There is an emphasis on "helping men recognize the importance as well as the key aspects of supporting their children's mother, whether as custodial or non -custodial fathers." The fathers who attend the program are simultaneously attending a men's domestic violence program or have just graduated from such a program. The curriculum consists of 17 sessions that can be pared down to 14-15 groups. It begins with an orientation group followed by: considering fathering, developing discrepancy, child -centered fathering, building relationships with our children, listening to children, fathers as a part of families, eliminating barriers to better relationships, how are children different from adults, recognizing unhealthy, hurtful, abusive and neglectful fathering behaviors, how am I responding to my children's needs?, problem -solving in difficult situations, relationship with my child's mother, decreasing denial and minimization, rebuilding trust and healing, and what about discipline? This program was developed by Katreena Scott, Ph.D. C. Psych, Karen Francis, Ph.D., Claire Crooks, Ph.D C. Psych, and Tim Kelly, Executive Director, Changing Ways. E. MOTHERS PARENTING GROUP: The Mother's Parenting Group is loosely designed around the Caring Dads program. There is an emphasis around mother's also being the victim in a relationship and how this impacts parenting. Please see above for a more specific description. F. DOMESTIC VIOLENCE EDUCATION: According to the Domestic Violence Offender Management Board (DVOMB) Standards and Guidelines, many offenders are required to have two clinical contacts per week. In order to meet this need Perklen Center developed a cost effective educational program designed only for this population. G. THE IMPACT OF DOMESTIC VIOLENCE ON CHILDREN AND VICTIMS: In order to accommodate Weld County Department of Human Services' need for a program Perklen Center for Psychotherapy AM, .441, DV Services Bid Proposal - PVC 2017 6of9 to educate adults on how domestic violence effects children and victims we provide a program titled, The Impact of Domestic Violence on Children and Victims A four to six hours is required to complete The Impact of Domestic Violence on Children and Victims course The sessions consist of educating the client about the cycle of abuse, types of abuse, impact of the family, a short social history, and collateral review This is a multi -media group using, lecture, DVD's and videos H. GROUP AND INDIVIDUAL SESSIONS Individual counseling includes one client and one therapist Group counseling would include one therapist and two or more clients It is a policy of the Perklen Center for Psychotherapy to limit the ratio to one therapist per eight clients and 12 clients with two therapists, with the exception of educational settings Family counseling will include at least one therapist and at times may include a second therapist In addition, at least one client and one or more family members will attend a family counseling session I. CLINICAL CONSULTATION Clinical consultation will include an individual or group session with the Department of Human Services to discuss mental health/domestic violence supervision issues for the purpose of aiding and identification of risk management and treatment issues This may include a review of pre - sentence reports/police reports, pnor psychological reports, and other existing information to identify the need for continued mental health/domestic violence services When applicable, a written report will be submitted, which will include the mental status of the client, diagnostic impression, current psycho -social stressors, and obvious indicators of decompensation, recommended treatment activities, and report or record analysis J. COURT TESTIMONY The staff of Perklen Center for Psychotherapy are qualified and experienced in court testimony When given proper notification, the staff of Perklen Center for Psychotherapy is available for court testimony regarding clients with open and/or closed cases IV. MEASURABLE OUTCOMES Upon successful completion of a mental health/domestic violence program, clients should be able to demonstrate the following behaviors o Consistently define all types of abuse ® Acknowledge risk in the future, and demonstrate the ability for safety planning ® Consistently recognize and interrupt the domestic violence cycle and/or anger management cycle o Demonstrate new coping skills o Demonstrate empathy o Display accurate attribution of responsibility and does not try to control the behavior of others e Able to manage frustration and unfavorable events in reference to anger management Perklen Center for Psychotherapy MH, AM, DV Services Bid Proposal - FYC 2017 7of9 and self protection o Reject abusive thoughts as dissident and incongruent with self image o Demonstrate pro -social relationship skills, such as closeness, trust, and trustworthiness o Project positive self image o Demonstrate the ability to resolve conflict and make decisions through assertive communication, tolerance, forgiveness, cooperation, and is able to negotiate and compromise o Celebrate accomplishments, experience pleasure, and is able to relax and socialize © Work toward achieving delayed gratification and is persistent in the pursuit of goals and submissive to reasonable authority o Able to think and communicate effectively through rational cognitive processing, demonstrate adequate verbal skills, and is able to concentrate ® Develop a family and or community support system ® Adapt a sense of purpose and future m Understand that he/she is prohibited from purchasing, possessing, or using firearms or ammunition if convicted of a domestic violence offense Tracking progress through the program will take place in the following manner o Clients attending group therapy will receive feedback weekly from their therapist in the form of a "Group Note The purpose of the group note is to monitor progress on treatment goals Group notes will be compiled by the therapist after each group The therapist will evaluate whether the client is learning during group sessions Feedback will be provided to help the individual obtain maximum benefit from their treatment modality o Staff will also discuss the progress of the individual and indicate whether or not he/she is on track o A compilation of these reports will be available to the Department of Human Services as requested o Anytime there is contact made with members of the treatment team documentation will be made o With regard to general mental health/domestic violence issues, the caseworker will be contacted any time a team meeting involving the client is needed These meetings should take place in the therapeutic environment which is most comfortable for the client V SERVICE OBJECTIVES The primary objective of Perklen Center for Psychotherapy is to offer services, which reflect our care and interest in our clients, victim safety, decrease recidivism, and to provide useful services Perklen Center for Psychotherapy MH, AM DV Services Bid Proposal - FYC 2017 8 of 9 to the community VI WORKLOAD STANDARDS A Number of hours per day/week/month Day maximum 10 hours Week maximum 40 hours Month maximum 160 hours B Number of individuals providing treatment Group/individual/family therapists four to five (applications are being accepted for a new hire) Qualified to treat domestic violence offenders two C Maximum case load per therapist 30 D Modality of treatment will be cognitive behavioral and will include group, individual, and family therapy E See A above F Total number of individuals providing services four to five (applications are being accepted for a new hire) G Maximum case load per supervisor 25 H See D above I See enclosed Memorandum of Insurance VII. STAFF QUALIFICATIONS A The Perklen Center for Psychotherapy's mental health/domestic violence outpatient treatment program will meet or exceed the minimal qualifications in education and experience Services will be provided by four to five Masters level counselors who have met the standards of practice to perform mental health intake assessments and reports, as established by the State of Colorado Department of Regulatory Agencies and/or the Domestic Violence Offender Management Board Three therapists are Licensed Professional Counselors for the State of Colorado The remaining therapists have completed all course work requirements and are under the direct supervision of a licensed Masters level psychotherapist, Kim R Ruybal, MA, LPC, NCAC II and Jodie M Goter, MA, LPC All practitioners who are not licensed with the state of Colorado are listed with the Department of Regulatory Agencies in the non -licensed data base B Total staff available four plus two support staff and an agency manager C Perklen Center for Psychotherapy employees are not required to attend mandated new caseworker training D All therapists at Perklen Center for Psychotherapy have received extensive risk assessment training through various workshops provided by the Colorado Domestic Violence and Perklen Center for Psychotherapy MN AM DV Services Bid Proposal - FYC 2017 9of9 Sex Offender Management Boards Perklen Center for Psychotherapy MH, AM, DV Services Bid Proposal - FYC 2017 10of9 Education Group $38 Juvenile Sex Offender Evaluation without testing $600 13 years and younger Hourly Rate $200 Juvenile Sex Offender Evaluation with testing and no Abel $700 14 years and older Hourly Rate $175 Juvemle Sex Offender Evaluation with testing and a Abel $985 Hourly Rate $164 Jail Evaluations additional $50 Mental Health Individual Session $80 Group $38 Mental Health Evaluation $700 Additional testing HARE, PCLR, VRAG Hourly Rate $175 Jail Evaluations additional $50 Minnesota Miltiphasic Personality Inventory -2 (MMPI) Testing MMPI testing with no write-up $200 MMPI testing with write-up $250 Non -Offending Partners Group $38 Penile Plethysmograph (PPG) Penile Plethysmograph $250 Hourly Rate $125 Sex Offender Intake $100 Education Group $38 Demers Treatment $100 Phase I $38 Phase H $45 Phase III $38 Phase W $38 Sanctions $85 Aftercare $15 Sex Offender Evaluation for Adults with no Abel and no testing $700 Perklen Center for Psychotherapy 1020 86 Street, Greeley, Colorado 80631 / Telephone — 970-353-8171 / Fax — 970-353-0371 Page 2 of 3 erklen Center for "sych®therapy A Journey to Integrity Through Self Awareness Abel Assessment Abel Assessment for Sexual Interests $275 Hourly Rate $137 50 Agency Documents Copies of Agency Documents $ 30 per page Anger Management / Domestic Violence AM/DV Intake $80 AM/DV Evaluation $210 Hourly Rate $105 DV Assessment $700 Additional testing HARE, PCLR, VRAG Hourly Rate $175 Group $38 DV Education $25 Caring Dads $25 Mothers Parenting Group $25 The Impact of DV on Children and Victims — four hrs required (1-2 indv) $80 Community Support Group (forsexual offender clients only) Group for two people (ongoing for duration of treatment) $38 Individual $80 Child Contact Assessment (CCA) Child Contact Assessment $985 Hourly Rate $164 Couples/Family Couples Session $90 Family Session $90 Individual Sessions Individual sessions at Agency $80 Individual sessions off site $100 Informed Supervision Group for two people $38 Individual $80 Juvenile Sex Offender Intake ) $150 Group $3 8 Hourly Rate $150 Sex Offender Evaluation for Adults with Abel $985 Hourly Rate $164 Sex Offender Evaluation for Adults with no Abel $900 Hourly Rate $180 , Sex Offender Updated Evaluation $985 Hourly Rate $164 Jail Evaluations additional $50 Miscellaneous Fees Present / No Credit $38 No Show / No Call %2 of service fee Non Medical Absence %2 of service fee Court Testimony Hourly Rate $100 Perklen Center for Psychotherapy 1020 8th Street, Greeley, Colorado 80631 / Telephone — 970-353-8171 /Fax — 970-353-0371 Page 3 of 3 Client # 9105743 °! EMORANDUM OF INSURANCE !II ate Issued 04/13/2017 ` rod ucer Mercer Consumer, a service of Mercer Health & Benefits Administration LLC P O Box 14576 Des Moines, IA 50306-3576 1-800-503-9230 is memorandum is issued as a matter of informant) •nly and confers no rights upon the holder Thi' emorandum does not amend, extend or alter th- overages afforded by the Certificate listed below ompany Affording Coverage Liberty Insurance Underwriters Inc rl nsured Perklen Inc 1020 8th Street Greeley CO 80631 his is to certify that the Certificate listed below has been issued to the insured named above for the policy penod indicated not withstanding any requirement, term or condition of any contract or other document with respect to which thi emorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the erms, exclusions and _of such Certificate The limits shown ma_ have been reduced b . aid claims1. "~Type _conditions . of Insurance Certificate Number Effective Date Expiration Date Limits Professional Liability MentalHS Fm Counselor AHZ-103018006 04/01/2017 04/01/2018 Per Incident/ Occurrence Annual Aggregate $1,000,000 $3,000,000 I r Memorandum Holder is added as an Additional Insured but only as respects to claims arising out of the sole t negligence of the named insured subject to the terms and provisions of the policy r kl emorandum Holder Weld County Dept of Human Servicesill 915 10th Street PO Box 758 Greeley CO 80632 i. Should the above describe Certificate be cancelle• •efore the expiration date thereof, the issumg compan . endeavor to mail 30 days written notice to th Memorandum Holder named to the left, but failure t•� ail such notice shall impose no obligation or liabili • f any kind upon the company, its agents o epresentatives • uthonzed Representative Mark Brostowitz AtZek..a /cts V i Mercer Consumer a service of Mercer Health & Benefits Administration LLC In CA d/b/a Mercer Health & Benefits Insurance Services LLC CA Ins Lic #0G39709 1 eAveg INSURANCE COMPANY 16144 6101 ANACAPRI BLVD , LANSING, MI 48917-3999 AGENCY GLEN WALL INSURANCE 32-0070-00 MKT TERR 100 INSURED PERKLEN INC ADDRESS 1020 8TH ST GREELEY CO 80631-1101 Page 1 27777 (10-88) Issued 01-13-2017 (970) 353-2020 WORKERS' COMPENSATION & EMPLOYERS' LIABILITY INFORMATION PAGE -RENEWAL AGREEMENT Renewal Effective 03-01-2017 POLICY NUMBER 111732 74020233 Company Use 74 -17 -CO -0311 Company Bill POLICY PERIOD 1201A.M 1201AM 03-01-2017 to 03-01-2018 ITEM 1. INSURED. PERKLEN INC 1020 8TH ST GREELEY, CO 80631-1101 INSURED IS' Corporation ITEM 2. POLICY PERIOD 03-01-2017 (12 01 AM ) to 03-01-2018 (12 01 AM ) (Based on the insured's address shown in Item 1 ) ITEM 3 A. WORKERS' COMPENSATION INSURANCE Part One of the policy applies to Workers' Compensation Law of the states listed here CO B. EMPLOYERS LIABILITY INSURANCE' Part Two of the policy applies to work in each state listed in ITEM 3 The limits of our liability under Part Two are Bodily Injury by Accident Bodily Injury by Disease Bodily Injury by Disease $100,000 $100,000 $500,000 Each Accident Each Employee Policy Limit C. OTHER STATES INSURANCE. Part Three of the policy applies to the states, if any, listed here AL, AZ, AR, CO, FL, GA, ID, IL, IN, IA, KS, KY, MI, MN, MO, NE, NC, PA, SC, SD, TN, UT, VA, & WI unless already listed in ITEM 3A ITEM 4. The premium for this policy will be determined by our manuals of rules, classifications, rates and rating plans All information required below is subject to venfication and change by audit "CLASSIFICATION OF OPERATIONS , PREMIUM BASIS, , RATES STATE OF COLORADO ID# 0010 PHYSICIAN & CLERICAL DESC 001 CLASS CODE ESTIMATED ANNUAL REMUNERATION RATE PER $100 ESTIMATED ANNUAL PREMIUM 8832 84,670 70 593 COLORADO PREMIUM SUMMARY TOTAL I 593 POLICE PREMIUM SUMMARY 2% MULTI -POLICY DISCOUNT EXPENSE CONSTANT TERRORISM -SEE FORM 27317 CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) SEE FORM 27322 TOTAL ESTIMATED ANNUAL PREMIUM 27777 (10-88) (WC000001A) 12- 195 15 15 581 776 791 806 806 Page 2 AUTO -OWNERS INS CO AGENCY- GLEN -WALL INSURANCE 32-0070-00 MKT TERR 100 INSURED PERKLEN INC 27777 (10-88) Issued Q1-13-4017 Company POLICY NUMBER 111732 ;4020233 Bill Company Use 74 -17 -CO -0311 Term 03-01-2017 to 03-01-2018 FEDERAL ID. COUNTY* MINIMUM PREMIUM. CO NUMBER OF EMPLOYEES AUDIT IS 271178648 123 $300 COLORADO 6 ANNUAL A 2% Cumulative Multi -Policy Discount applies Supporting policies are marked with an (X) Comm Umb( ) Comm Prop/Comm Liab(X) Comm Auto( ) Life( ) Personal( ) Farm( ) The Paid in Full Discount does not apply to fixed expense fees, statuary charges or minimum premiums Your policy qualifies for the Paid in Full Discount if you choose to pay your premium in full Your Paid in Full Discount may change as a result of policy changes These changes will be reflected in a future invoice TOTAL ESTIMATED ANNUAL PREMIUM 806 SAVINGS IF PAID IN FULL 43 - TOTAL POLICY PREMIUM IF PAID IN FULL 763 ENDORSEMENTS 14019 (02-08)C 27256 (06-99)A 27320 (03-06)A 27395 (10-14)A(WC000000C) 59270 (02-97) 27777 (10-88) (WC000001A) 27011 (04-84)A(WC000308 ) 27279 (07-03)A(WC000419 ) 27322 (01-15)B(WC000421D) 27942 (11-90)A(WC000414 ) 27252 (06-99)A(WC050402 ) 27317 (01-15)B(WC000422B) 27392 (07-12) 27990 (05-01)A(WC000404 ) AC®h®® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOWYYTY) 04/21/2017 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 Advantage 1 Insurance 13762 Colorado Blvd Ste 124-56 Thornton, CO 80602 CONTACT Sandra Martinez NAME PHONE IA/C. R Eat). 720-370-2833 1NC, No 720-370.2866 AIL ADDRESS info@advantageoneins com INSURER(S AFFORDING COVERAGE NAIC I INSURERA Owners Insurance Company 32700 INSURED PERKLEN INC 1020 8TH ST GREELEY, CO 80631-1101 INSURER B INSURER C INSURERD INSURER INSURER F COVERAGES CERTIFICATE NUMBER 00000000-33693 REVISION NUMBER 3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE SUBR INSD INI WVD POLICY NUMBER POLICY EFF (MMIDDIYYYYI POLICY EXP [MMIDDlYYYY) YYY LIMITS A X COMMERCIAL GENERAL LIABILITY i I 74318448 02/01/2017 02/01/2018 EACH OCCURRENCE 5 1,000,000 $ 300,000 AGE TO RENTED PREM SES Ea occurrence) I CLAIMS -MADE xl OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY S GENERAL AGGREGATE 5 2,000,000 GEN X L AGGREGATE LIMIT APPLIES POLICY LJ ER& OTHER PER LOC PRODUCTS COMP/OPAGG $ 2,000,000 S AUTOMOBILE _ _ LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY I I COMBINED SINGLE LIMIT (Ea acadenl) S BODILY INJURY (Per person) S BODILY INJURY (Per &cadent) a PROPERTY DAMAGE (Per accident) $ S UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE I EACH OCCURRENCE $ AGGREGATE S S DED I RETENTIONS WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTNE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes doscnbe under DESCRIPTION OF OPERATIONS below N I A I PER S µ TATUTE ER E L EACH ACCIDENT S E L DISEASE EA EMPLOYEE S E L DISEASE POLICY LIMIT S I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 AddPoonal Remarks Schedule may be attached if mom space Is required) CERTIFICATE HOLDER CANCELLATION Weld County Dept of Human Services 822 7th St. Suite 150 GREELEY, CO 80631 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS A 42x1.1,« (SAM) ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION All rights reserved The ACORD name and logo are registered marks of ACORD Printed by SAM on April 21 2017 at 09 36AM EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Anger Management and Domestic Violence Evaluation and Treatment Services, and Sexual Abuse Treatment Services, to male and female, adults and juveniles, including developmentally disabled individuals, in Weld County, who are 10 years of age or older, as referred by the Department. 2. Sexual Abuse Treatment Services: a. Contractor utilizes a non -medical, cognitive behavioral model, which focuses primarily on the treatment of juveniles and adults with sexually abuse behaviors. b. The goal of this program is to reduce recidivism rates by: i. Providing a structured environment for the safety of the client, family and community. ii. Increasing awareness and empathy for the victim and the impact of the offense on the victims and family members. iii. Fostering a family environment to effect positive change. iv. Developing the use of appropriate social/sexual skills and expressions through recognition of situations and stimuli that trigger sexually aggressive behavior. v. Assisting family members to develop the skills necessary to recognize and understand the sexual behavior their family member for the purpose of providing support while the client progresses through treatment. c. The target populations eligible for services under this agreement include: i. Male and female youth 10 to 18 years of age, and male and female adults 18 years of age or older. ii. Youth with current sexual offense adjudications or youth who have admitted guilt and will provide a written letter from a parent or attorney stating they plan to plead guilty. iii. Adults who have been found guilty of a sexual offense or have a written letter form an attorney stating they plan to plead guilty. iv. Adults and youth of average intelligence and those who are developmentally delayed. d. Services available under this agreement include: i. Psychosexual testing and evaluation ii. Offense -specific group therapy iii. Individual or family therapy iv. Informed Supervision Groups — Youth (1.5 Hours/Month or Six Intensive Sessions) v. Chaperones Group — Adults (1.5 Hours/Month Ongoing) vi. Relationship and interpersonal social skills vii. Sex education viii. Interdisciplinary team meetings (monthly as needed) ix. Victim empathy and awareness x. Anger management/impulse control skills xi. Cognitive behavioral modification xii. Self-esteem building xiii. Values clarification and examination xiv. Relapse prevention plan xv. Aftercare services e. Evaluations (assessments) will examine the following areas to determine whether an outpatient program is appropriate: i. The client's potential to reoffend 1 ii. Amenability for treatment iii. Recommended treatment setting iv. Type of treatment needed v. Risk factors/monitoring/potential new victims vi. Psychiatric /substance abuse/individual and family needs vii. Mental health concerns f. Evaluations will include: i. A structured clinical interview ii. Collateral information from schools, caseworkers, probation/parole officers, case managers, therapists, doctors, courts, police reports, or other relevant sources. g. Contractor will utilize a variety of psychometric assessment tools that may include any of the following: i. Hare Psychopathy Checklist -Revised ii. Minnesota Multiphasic Personality Inventory -II (MMPI-II) iii. Jesness Inventory iv. SASSI-Ill Drug and Alcohol Inventory v. Millon Clinical Multiaxial Inventory -III (MCMI-III) vi. Shipley Institute of Living Scales vii. State Trait Angry Inventory -II viii. Violence risk Assessment Guide ix. Sex Offender Needs Assessment Guide x. Abel Assessment for Sexual Interests xi. Juvenile Sex Offender Assessment Protocol -II 3. If referred for evaluation or assessment, two (2) to three (3) sessions will be needed to complete the requirements of the evaluation or assessment. 4. Following evaluation sessions, Contractor will pose questions designed to gather basic identifying information, examine the client's mental status/mental health issues, and various history (mental health, family/medical, substance abuse, inpatient/outpatient, current social, and criminal). 5. CONTRACTOR will utilize a variety of psychometric assessment tools that may include the following: Hare Psychopathy Checklist -Revised Minnesota Multiphasic Personality Inventory -II (MMPI-II) - Jesness Inventory - Multiphasic Sex Inventory - Wilson Sex Fantasy Questionnaire - SASSI-III Drug and Alcohol Inventory Millon Clinical Multiaxial Inventory (MCMI) - Shipley Institute of Living Scale State Trait Angry Inventory -II - Violence Risk Assessment Guide - Millon Clinical Adolescent Inventory - Domestic Violence Risk Needs Assessment Domestic Violence Screening Instrument - Spousal Assault Risk and Assessment ODARA Domestic Violence Risk Asssessment 6. Contractor will submit a written document outlining client's amenability for treatment, recommendations for treatment, further assessment, and risk to repeat similar behavior. The evaluation will determine the best placement for the client in regards to treatment. Contractor will provide a copy of the evaluation to 2 the caseworker. 3. Anger Management/Domestic Violence Evaluation and Treatment Services: a. Anger Management services will include a minimum of twenty (20) weeks of treatment. b. Contractor will follow the minimum expected requirement for the treatment of male, female, and Gay/Lesbian/Bisexual/Transgendered individuals who have been domestically violent as mandated by the Colorado Domestic Violence Offender Management Board (DVOMB). Level A (Low Risk): Level B (Moderate Risk): Level C (High Risk): Psycho -educational Treatment — One (1) 90 -minute session per week 36 -week educational curriculum - First treatment plan review within two (2) to three (3) months Second treatment plan review within two (2) to three (3) months of the first review Open ended psycho -educational treatment — One (1) 90 minutes session per week 46 week educational curriculum One a month adjunct therapy required; (a) Healthy Relationship Group, (b) DV Education, (c) Caring Dads Group/Mothers Parenting Group, (d) Victim Speaker, (e) Sex Education, (f) HIV/AIDS Education, or (g) Sexual Abuse and Boundaries First treatment plan review within two (2) to three (3) months Second treatment plan review within two (2) to three (3) months of the first review - Open ended psycho -educational treatment — One (1) 90 minutes session per week 46 week educational curriculum One a month adjunct therapy required; (a) Healthy Relationship Group, (b) DV Education, (c) Caring Dads Group/Mothers Parenting Group, (d) Victim Speaker, (e) Sex Education, (f) HIV/AIDS Education, or (g) Sexual Abuse and Boundaries - First treatment plan review within two (2) to three (3) months - Second treatment plan review within two (2) to three (3) months of the first review c. Contractor offers Caring Dads Parent Education Group. The 17 -week group aims to engage fathers, to help them develop more child -centered fathering, and to take responsibility for ending their abusive behavior towards their children and children' mother. Topics include: Considering Fathering; Developing Discrepancy; Child -centered Fathering; Building Relationships with Our Children; Listing to Children; Fathers as a Part of Families; Eliminating Barriers to Better Relationships; How are Children Different from Adults; Recognizing Unhealthy; Hurtful, Abusive and Neglectful Fathering Behaviors; How Am I Responding to My Children's Needs?; Problem -solving in Difficult Situations; Relationship with My Child's Mother; Decreasing Denial and Minimization; Rebuilding Trust and Healing; and What About Discipline? Participating clients simultaneously attend a men's domestic violence group or have recently graduated from a men's domestic violence program. 3 EXHIBIT D PAYMENT 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 specified 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 in Trails after May 31, 2018. 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 Anger Management/Domestic Violence: $210.00/Episode (Anger Management or Domestic Violence Evaluation) $105.00/Hour (Anger Management or Domestic Violence Evaluation) $80.00/Hour (Impact of Domestic Violence on Children and Victims -Minimum 4 Hours) $700.00/Episode (Domestic Violence Assessment) $175.00/Hour (Domestic Violence Assessment -Additional Testing) $25.00/Episode (Domestic Violence Education) $25.00/Episode (Caring Dads Group) $25.00/Episode (Mothers Parenting Group) $38.00/Episode (Standard Group) $80.00/Episode (Individual Session, In -Office) $90.00/Episode (Family Session) Sexual Abuse Treatment: $275.00/Episode (Abel Assessment for Sexual Interests) $137.50/Hour (Abel Assessment for Sexual Interests) $80.00/Episode (Individual Session, In -Office) $100.00/Episode (Individual Session, Out -of -Office) $90.00/Episode (Family Session) $95.00/Episode (Deniers Treatment) $38.00/Episode (Standard Group) $38.00/Episode (Education Group) $38.00/Episode (Non -Offending Partners Group) $38.00/Episode (Phase I Group) $45.00/Episode (Phase III Group) 1 $38.00/Episode (Phase IV Group) $38.00/Episode (Phase II Group) $150.00/Episode (Juvenile Sex Offender Intake) $450.00/Episode (Juvenile Sex Offender Evaluation without Testing, 13 years and younger) $150.00/Hour (All Evaluations) $600.00/Episode (Juvenile Sex Offender Evaluation with Testing and no PPG/Abel, 14 years or older) $600.00/Episode (Adult Sex Offender Updated Evaluation) $800.00/Episode (Adult Sex Offender Evaluation with no PPG/Abel) $900.00/Episode (Juvenile Sex Offender Evaluation with Testing and PPG/Abel) $900.00/Episode (Adult Sex Offender Evaluation with PPG/Abel) $50.00/Episode (Additional fee for jail evaluations) $250.00/Episode (Penile Plethysmograph) $125.00/Hour (Penile Plethysmograph) Contractor may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. Contractor will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher, and signed monthly report if applicable, certifying that servicesauthorized were provided on the date(s) indicated and the charges made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. b. For one-time services, proof of services rendered shall be receipt of the completed product. c. For Monitored Sobriety services, proof of services rendered shall be the test result. 2 CERTIFICATE OF LIABILITY INSURANCE DATE IM*D StYY I 1/912016 _ TillCERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE Arronout BY THE POLICIES BELOW. THIS CE=RTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT RETWEEN THE S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THECIRTIFWATE HOLDER. IMPORTANT: if the cartes hailer Is an ADOMONALWhat the softy** must be endorsed. If SUBROGATION 1$ WAIVED, .. to the terms and conditl~One of the poitcy, Miele Mrs may nun** an endorsement. A statement, on tilt certificate does not der rtie to the settiteate holder Ih Ileu of such er semaktE(r1�. loRCPIATII COBlz Insurance, Inc. - CO 1401 Lawrence St,, Ste. 1200 Denver CO 80202 CERTIFICATE NUMBER: 45@1441956 Nio.• E11f: •�u u-VR go • coMetwomensuummeom estaant0:_ tea: Mime F AX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P0UCSi' INDICATED. NOTMTHSTANPING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO POCH THI'S CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN Reduce tof PAID MAIMS. 11Te0F JRANCE A X COIrMBNCIM GENERAL LIABa.ITY [ X ) OCCUR PHPK1755840 1/12010 1/02019 EACH I CLAIMS -MADE MED EX? (Arly penwn S 5000 PERSONAL S:ADM R JUR Y $1 Doll 09Et GENt AGGREGATE LIMIT APPLIES PER. POLICY Flo [ LOC OT ER GE5ERALAf GATE It3000R0 X PRGO( TS-COMP,pPACSB 3 800004: . $ A AUTOMOBI a LIABILITY SCHEDULED MIT AUr PHPK1755940 1/1/2018 1/1/2019 COMBINED 1MGLE LIMIT $ BODILY INJURY {Per perm) $ 800ILY INJURY $ r _ : _ . 9 3_ A X tlft I119 LAUAe i X OCCUR CLAIMS=MADE PHUBBI2S46 1 2018 1/1/2119 Er,CH AGGREGATE ? ANY 'OFPI II k ` r�IPTIDN PRC1PRIETCIR/PARTNER/E%ECU E31CLUDED1 YYnNH) rieuruba r . OF 1 RERAT ONS Y/'N N / A 1/11"20`18 1/1/2619 E.L. EACH ACCIDENT r 6011,uk14 rli/E below EDI$E/ •EAEI ICS FE ED Il40 .. EL DISEArSE • PDLICY U IT . F 0 erllgalticwla / 1Neld Countyi Coloradoc by and through the Board of respect to General Liability as required by written contract , RwuteYu a MT rtinbgl a o. M MOW) County i of W Id crud r. alai &1ctu ded as Insured vAtP or agreement per the atta N form. 64 Noticeof ancella n is prDV tOr WiNd CouDity CERTIFICATE HOLDER CANCELLATION Weld County, Colorado PO Box A Greeley CO 80632 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICES DE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHDRREDREPRESENTA1riE ACORD 25 (2014101) 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER; PHPK1755940 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Weld County Colorado see 60 Day NOC Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional required by a contract or agreement, the malt We will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement;; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 0413 © Insurance Services Office, Inc.. 2012 Page 5 of 5 PI-MANU-1 (09/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY 60 Day Notice of Cancellation :n t.ne ci cancel on, wii!ltoa._,..b0 days ot _,.. (t canehlo:ior trke f___ .v_na entity, liniesse z iiis ca..__lcad __x non-payment: d ... r.t.y 'oloradc; P.U. ^c:.; A Greeley, >. CE3<_ All other terms and conditions of this Policy remain unchanged. Page 1 of 1 Hello