HomeMy WebLinkAbout20182873.tiffRESOLUTION
RE: APPROVE FOUR (4) STANDARD FORMS OF AGREEMENTS AND RATES FOR
VARIOUS OUT -OF -HOME PLACEMENT SERVICES BETWEEN THE WELD COUNTY
DEPARTMENT OF HUMAN SERVICES AND VARIOUS PROVIDERS ON ATTACHED
LISTS AND AUTHORIZE CHAIR TO SIGN AGREEMENTS CONSISTENT WITH SAID
FORMS
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board, has been presented with four (4) Standard Forms of Agreements
for Various Out -of -Home Placement Services and Rates between the Weld County Department
of Human Services and various providers as shown on the attached provider lists, and
1. Individual Provider Contract for Purchase of Foster Care
Services in a Foster Care Home
2. Exhibit to SS23A - Additional Provisions for Purchase of
Residential Child Care Facility Services
3. Exhibit to SS23A - Additional Provisions for Purchase of Child
Placement Agency Services
4. Exhibit to SS23A - Additional Provisions for Purchase of Group
Home/Group Center Care Services
WHEREAS, after review, the Board deems it advisable to approve the four (4) Standard
Forms of Agreements and Rates for Various Out -of -Home Placement Services, copies of which
are attached hereto and incorporated herein by reference, and to delegate standing authority to
the Chair of the Board of County Commissioners to execute individual agreements between the
Department of Human Services and the individuals identified on the attached provider lists.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that these standard forms and rates between the Weld County Department of
Human Services and various providers be, and hereby are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign any agreements consistent with said forms.
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Iv- It- lS
2018-2873
HR0089
APPROVE FOUR (4) STANDARD FORMS OF AGREEMENTS AND RATES FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND VARIOUS
PROVIDERS
PAGE 2
The above and foregoing Resolution was. on motion duly made and seconded. adopted
by the following vote on the 10th day of September. A.D., 2018.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY. COLORADO
ATTEST: dithA)
Weld County Clerk to the Board
BY
Steve Moreno. Chair
EXCUSED
Barbara Kirkmeyer. Pro-Tem
uty Clerk to the Boar• r , EXCUSED
APPROVED AS
ounty Attorney
Date of signature: 101(-1 ( l
A\Eu
can P. Conway
s A. Cozad
Mike Freeman
2018-2873
HR0089
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: September 4, 2018
TO: Board of County Commissioners — Pass -Around
FR: Judy A. Griego, Director, Human Services
RE: Child Welfare SFY 2018-19 Out -of -Home
(OOH) Placement Templates, Vendors and Rates
Please review and indicate if you would like a work session prior to placing this item on the
Board's agenda.
Request Board Approval of the Department's Child Welfare SFY 2018-19 Out -of -Home
(OOH) Placement Vendors, Templates and Rates (Attached). In June 2018, the BOCC
approved the initial out -of -home (OOH) SFY 2018-19 templates, proposed rates and vendor list,
identified as 2018-1952, based on information received in March 2018 from the Joint Budget
Committee. We requested approval for a 1% rate increase over the previous years' rates,
because at that time, SB 18-254 provided for an increase in provider reimbursement rates, but the
Department had not been notified of the actual amount.
On August 29, 2018, the Department received Information Memorandum IM-CW-2018-0044,
which contained the final provider rate information for SFY 2018-19. The Department is now
seeking approval of the new rates for all OOH providers. Attached are the updated agreement
templates and vendor lists with updated rates, reflecting the newly established State base anchor
rate or grandfathered rates.
These updated templates have been reviewed by Assistant County Attorney, Karin McDougal,
and have been approved for our use for the SFY 2018-2019 contract year, at which time
individual vendor contracts will be submitted through the CMS process. The updated forms are
as follows:
• Individual Provider Contract with Updated Exhibit A to the CWS-7A
• Exhibit A to the SS23A for the Purchase of Child Placement Agency Services
• Exhibit A to the SS23A for the Purchase of Group Home/Group Center Care Services
• Exhibit A to the SS23A for the Purchase of Residential Child Care Facility Services
Pass -Around Memorandum; September 4, 2018 — Not in CMS
Page 1
2018-2873
PRIVILEGED AND CONFIDENTIAL
I do not recommend a Work Session. I recommend approval of the WY 2018-19 templates, State
determined base anchor rates or grandfathered rates, and vendors.
Sean P. Conway
Julie A. Cozad
Mike Freeman
Barbara Kirkmeyer, Pro-Tem
Steve Moreno, Chair
Approve Schedule
Recommendation Work Session
mf
Other/Comments:
Pass -Around Memorandum; September 4, 2018 — Not in CMS
Page 2
COLORADO
I Office of Children,
I Youth & Families
Department of Human Services
INDIVIDUAL PROVIDER CONTRACT
FOR PURCHASE OF FOSTER CARE SERVICES IN A FOSTER CARE HOME
1. THIS CONTRACT AND AGREEMENT, made this date, by and between the Weld County
Department of Human Services, P. O. Box A, Greeley, CO 80632, hereinafter called "County Department" and
«Agency», «Agency_Mailing_Address», «Agency_City_State_Zip», hereinafter called "Provider".
2. This Contract and Agreement shall be effective from July 1, 2018 and continue in force until June 30, 2019 or until
the facility certificate is revoked or surrendered. This contract and agreement may be renewed at any time during
the term of the valid facility certificate. This contract and agreement is in lieu of and supersedes all prior purchase
contracts between the parties hereto and relating to the services herein described.
3. The Provider holds a valid certificateas a: n Foster Care Home or n Kinship Foster Care Home (check
applicable blank). Such certification standards shall be maintained during the term hereof. The provider has
read and is fully familiar with the "Rules Regulating Foster Care Homes" issued by the Colorado Department of
Human Services.
4. The County Department may but shall not be obligated to purchase foster care home services. The County
Department or any duly authorized agent may request such services to be provided to any child or youth at any
time within the limits of the certificate and without prior notice. At such time or as soon as possible after the
acceptance of a child or youth for services, the County Department and the Provider shall verify foster care
placement of each child or youth in writing on the required form, which shall become an addendum to this contract,
subject to all the terms and conditions hereof.
5. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A and Addendum 1
and 2, which form integral parts of this Agreement. Exhibit A and Addendum 1 and 2 are specifically incorporated
herein by this reference.
The Provider agrees:
1. To furnish foster care services to eligible children and youth at the established rate based on the individual
child or youth rates negotiated between the county department and the provider;
2. To safely provide the 24 -hour physical care and supervision of each child or youth until removed or
until the agreement is renewed;
3. To accept a child or youth, only with the approval of the certifying agency;
4. To cooperate fully with the County Department or its representatives, and participate in the
development of the Family Service Plans -for a child or youth in placement, including visits with their
parents, siblings, relatives, or to transition to another foster care facility;
5. To maintain approved standards of care as set by the Colorado Department of Human Services;
6. To maintain the confidentiality of information shared about the child or youth and his/her family;
7. Not to accept money from parents or guardians;
8. Not to make any independent agreement with parents or guardians;
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John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
1876_,
9. Not to release the child or youth to anyone without prior authorization from the County Department;
10. To allow representatives of the County Department to visit the foster care home and to meet with the
child or youth at any reasonable time, including scheduled and unscheduled visits; and,
11. To give the County Department a 30 -day notice, except in an emergency, to remove a child or youth
for placement elsewhere, and to work with the County Department as requested to prepare the child or
youth for another placement.
12. To provide transportation to the child or youth. The amount of transportation to be provided will be
agreed upon at placement and may be changed upon mutual agreement of the provider and the
County Department, as recorded in the Family Service Plan. Transportation must be provided or
arranged:
a. For professional services and/or for school attendance when necessary; and,
b. For children or youth to participate in age or developmentally appropriate extracurricular, enrichment,
cultural, and social activities.
13. To report promptly to the County Department:
a. Any unplanned absence of the child or youth from provider's care;
b. Any major illness of the child or youth;
c. Any serious injury to the child or youth;
d. Any significant change in the sleeping arrangement for the child or youth;
e. Any contemplated change of address or change of household members;
f. Any conflict the child or youth may have with law enforcement, school/school district staff, or other persons
in authority;
g. Any emergency;
h. Any pertinent discussion with parents or guardians about the child or youth or supervising agency; and,
i. Any information received regarding a change of address of the parents or guardians.
14. To comply with the Civil Rights Act of 1964, Section 504, Rehabilitation Act of 1973, and the ADA of 1990, concerning
discrimination on the basis of race, color, sex, age, sexual orientation, expression, or identity, religion, political beliefs,
national origin, or handicapping condition.
15. To complete pre -service training prior to the placement of a child or youth.
16. To annually:
a. Update the Training Development Plan with the County Department;
b. Complete ongoing, quality, and relevant training that will build competencies to meet the needs of the
children and youth served in the foster care home as required by the Colorado Department of Human
Services regulations; and,
c. Obtain certification to use and apply the reasonable and prudent parent standard for each child or youth served
in the foster care home.
17. To attend semi-annual Administrative Reviews for a child or youth in placement.
18. To be knowledgeable of, and comply with the "Rules Regulating Foster Care Homes" and the "General Rules for
Child Care Facilities;
19. Not to enter into any subordinate subcontract hereunder;
20. To keep required and necessary records for audit/review purposes by state and federal personnel. These records
shall document the type of care and dates that care is provided for each child or youth. In addition, medical,
educational, and progress summary records shall be maintained for each child or youth as required pursuant to the
Colorado Department of Human Services' Rules Regulating Family Foster Care Homes.
21. To complete or schedule a medical examination for the child or youth within 14 days after initial placement and a
dental examination within eight weeks of initial placement;
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John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
2
The County Department agrees:
1. To share all available information about the child or youth, including relevant social, medical and educational history,
behavior problems, court involvement, parental, sibling and relative visitation plans, and other specific characteristics
of the child or youth, with the provider before placement and to share additional information when obtained while
the child or youth is in placement.
2. To inform the provider of expectations regarding the care of the child or youth, such as meeting medical needs,
visitation, special psychological needs, trauma and other grief/loss issues, and the child's or youth's identification with
his/her family;
3. To give the provider the written admission record of the child or youth to the foster care home at the time of placement;
4. To give the provider a written procedure or authorization for obtaining medical care for the child or youth;
5. To involve the provider in family service planning for the child or youth as a member of treatment team;
6. To give the provider a copy of the Family Service Plan, as it pertains to their expectations for meeting the needs of the
child or youth in the foster care home, at the time of placement or when it is completed following placement;
7. To give at least a 30 -day notice of plans to remove a child or youth from the foster care home. The 30 -day notice may
be waived by mutual consent to allow and permit immediate removal of a child or youth for placement elsewhere,
or without such waiver in the event of an emergency. An emergency is defined as any situation in which a provider's
inability to provide services threatens the health, safety or welfare of a child or youth.
8. To pay the provider at the rates established by the Colorado Department of Human Services or as authorized and
negotiated between the provider and the County Department:
a. Payment shall be made by electronic banking transfers (EBT) drawn by the duly authorized county officer; and,
b. Provider shall notify the County Department of any payment or billing dispute within 60 days of the month
when service was provided. Failure to do so will result in forfeiture of the payment. The Provider understands
that, pursuant to the Colorado Department of Human Services' Rules for the General Reimbursement for Child
Welfare Services, when reimbursement is warranted current and (2) preceding months.
9. To provide or arrange through statewide contracted training, a minimum of twelve hours of core pre -service
training for foster care homes and 15 hours of pre -service training directed at the needs of the child or youth to be
served in the foster care home.
10. To annually complete the following:
a. Update the Training Development Plan with the provider;
b. Provide or make available quality and relevant training for each foster parent that will build competencies to
meet the needs of the children and youth served in the foster care home;
c. Provide training that prepares each foster parent to use and apply the reasonable and prudent parent
standard; and,
d. Pursuant to the Colorado Department of Human Services' Rules Regulating Family Foster Care Homes,
document that the provider is trained in, and can use and apply the reasonable and prudent parent standard
for each child or youth placed in the foster care home.
11. The County Department is responsible for providing information on county specific procedures.
12. To invite the provider to Administrative Reviews for each child or youth in placement.
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs
John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
3
13. To incorporate provider information in planning for the child or youth placed in the foster care home.
14. To assure that the service described herein has been accomplished and a record made thereof on a case by case
basis.
15. To provide notice of court hearings for each child or youth placed in the foster care home.
County Department (typeor print)
Signature Date
WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above.
COUNTY;
ATTEST: BOARD OF COUNTY COMMISSIONERS
Weld County Clerk to the Board WELD COUNTY, COLORADO
By:
Deputy Clerk to the Board Steve Moreno, Chair
PROVIDER:
Provider (type or print)
Signature Date
Provider (type or print)
Signature Date
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs
John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
4
j;)(j-IIBIT A to the CWS-7A
Additional Provisions for the Agreement to Purchase
Foster Care Services and Foster Care Facility Agreement
CWS-7A
The following additional provisions in this Exhibit A, and Addendum 1 and Addendum 2, apply to the
agreement entitled, "Individual Provider Contract for Purpose of Foster Care Services and Foster Care
Facility Agreement," by and between the Weld County Department of Human Services, hereinafter
referred to as, "County," and «Agency», hereinafter referred to as, "Provider."
GENERAL PROVISIONS
1. Each party shall have the right to terminate this Agreement by giving the other party written notice
received at least thirty (30) days prior to the intended date of termination. If notice is so given,
this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible
child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties
hereunder for further performance of the terms of this Agreement shall thereupon cease;
however, the parties shall not be released from the duty to perform their obligations up to the date
of termination. This provision does not affect removal of a child in an emergencysituation.
2. Provider agrees that Provider is an independent contractor and that neither Provider nor
Provider's agents or employees are, or shall be deemed to be, agents or employees of the
County for any purpose. Provider shall have no authorization, express or implied, to bind the
County to any agreement, liability, or understanding. The parties agree that Provider will not
become an employee of County, nor is Provider entitled to any employee benefits from County as
a result of the execution of this Agreement. Provider shall be solely and entirely responsible for
its acts or of any agent, employee, servants and sub -Providers during the performance of this
Agreement.
3. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in
whole or in part, is subject to and contingent upon the continuing availability of State of Colorado,
county, and federal funds for the purpose thereof.
4. This Amendment is intended to be applied in conjunction with attached Agreement and the Needs
Based Care Addendum as the complete integration of all understandings between theparties.
No prior or contemporaneous addition, deletion or other amendment hereto shall have any force
or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal,
addition, deletion, or other amendment hereto shall have any force or effect unless embodied as
a part of this written Agreement. This section shall not be construed as prohibiting the periodic
amending of this Agreement or the Needs Based Care Addendum in writing, if agreed to by both
parties. The Agreement, this Exhibit A and the Needs Based Care Addendum are intended to be
in lieu of and supersede all prior agreements between the parties hereto and relating to the care
and services herein described.
5. The State of Colorado Department of Human Services and the County shall be and hereby is
permitted to monitor the service program, fiscal and other records sufficiently to assure the
purchase of services in this Agreement are carried out for the benefit of the aforementioned child
or youth. Monitoring may occur through review of program reports, on -site visits where
applicable and other Agreements as deemed necessary. Provider understands that the State
Department and the County may provide consultation to Provider to assure satisfactory
performance in the provision of purchased services under thisAgreement.
6. County shall have access to Provider's service program, financial and other records, which will
sufficiently and properly reflect all direct and indirect costs of any nature incurred in the
performance of this Agreement for purposes of audit. Such records shall be complete and
available for audit 90 days after final payment hereunder and shall be retained and available for
audit purposes for at least five years after final paymenthereunder.
7. Time is of the essence in each and all of the provisions of this Agreement.
Exhibit A to the CWS-7A
5 Revised 5/2018
8. 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.
9. Any notice required to be given under this Agreement shall be in writing and shall be mailed or
delivered to the other party at that party's address as stated in this Agreement.
10. This Agreement is nonexclusive and County may engage or use other Providers or persons to
perform services of the same or similar nature.
11. Provider certifies, warrants, and agrees that it does not knowingly employ or contract with an
illegal alien who will perform work under this contract. Provider 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). Provider shall not knowingly employ
or contract with an illegal alien to perform work under this Agreement or enter into a contract with
a sub -contractor that fails to certify with Provider that the sub -contractor shall not knowingly
employ or contract with an illegal alien to perform work under this Agreement. Provider 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 Provider obtains actual
knowledge that a sub -contractor performing work under the public contract for services knowingly
employs or contracts with an illegal alien Provider shall notify the sub -contractor and County
within three (3) days that Provider has actual knowledge that a sub -contractor is employing or
contracting with an illegal alien and shall terminate the subcontract if a sub -contractor does not
stop employing or contracting with the illegal alien within three (3) days of receiving notice.
Provider shall not terminate the contract if within three days the sub -contractor provides
information to establish that the sub -contractor has not knowingly employed or contracted with an
illegal alien. Provider 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 Provider 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 Provider 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. Provider 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 Provider 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, Provider shall be liable for actual and consequential damages.
Except where exempted by federal law and except as provided in C.R.S. § 24-76.5 103(3), if
Provider receives federal or state funds under the contract, Provider 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 Provider 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.
12. Provider assures and certifies that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, and declared ineligible
or voluntarily excluded from covered transactions by a federal department or agency.
Exhibit A to the CWS-7A
6 Revised 5/2018
B. Have not, within a three-year period of preceding this Agreement, been convicted of or
had a civil judgment rendered against them for commission of fraud or a criminal offense
in connection with obtaining, attempting to obtain, or performing a public (federal, state,
or local) transaction or contract under a 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;
C. Are not presently indicted for or otherwise criminally or civilly charged by agovernment
entity (federal, state, or local) with commission of any of the offenses enumerated in
paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, and local) terminated for cause ordefault.
13. In addition to terminating this Agreement in accordance with the provisions herein, County
may exercise the following remedial actions if the County finds and determines that the
Provider has substantially failed to satisfy the duties found in this Agreement, Exhibit A or the
Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined
to mean incorrect or improper activities or inaction by the Provider. These remedial actions
include, but are not limited to, any one or more of the following:
A. Withhold payment to Provider until the necessary services or corrections in
performance are satisfactorily completed.
B. Deny payment or recover reimbursement for those services or deliverables which have
not been performed and which due to circumstances caused by Provider cannot be
performed or if performed would be of no value to County. Denial of the amount of
payment shall be reasonably related to the amount of work or deliverables lost to County.
C. Recover from Provider any incorrect payment to Provider due to omission, error, fraud,
and/or defalcation by deducting from subsequent payments under this Agreement, or
other agreements between County and Provider, or as a debt to County, or otherwise as
provided by law.
14. 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 or their assignees, and nothing contained 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 or their assignees receiving services or benefits under this Agreement shall be an
incidental beneficiary only.
15. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties
or their officers or employees may possess, nor shall any portion of this Agreement be deemed to
have created a duty of care that did not previously exist with respect to any person not a party to
this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is
intended to circumvent or replace such immunities.
16. Provider shall promptly notify County in the event in which it is a party defendant or respondent in
a case, which involves services provided under the agreement. The Provider, 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 County Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganizations and/or foreclosure.
17. This Agreement and the provision of services hereunder shall be subject to the laws ofColorado
and be in accordance with the policies, procedures, and practices of County. Provider shall
strictly comply with all applicable federal and State laws, rules and regulations in effect or
hereafter established.
18. Financial obligations of the County payable after the current fiscal year are contingent upon funds
Exhibit A to the CWS-7A
7 Revised 5/2018
for that purpose being appropriated, budgeted and otherwise made available. Execution of this
Agreement by County does not create an obligation on the part of County to expend funds not
otherwise appropriated in each succeeding year.
19. County and Provider agree that a child specific Needs Based Care Assessment, designated as
Addendum 1 shall be used to determine the Child Maintenance and Medical Needs, if applicable,
for each child placed with Provider unless otherwise negotiated and approved by the County.
20. County agrees to purchase and Provider agrees to provide the care and services, which are
listed in this Agreement, based on the Needs Based Care Assessment levels determined. The
specific rate of payment will be paid for the Child Maintenance level of service, as indicated by
the Needs Based Care Rate Table, designated as Addendum 2, for children placed within the
Weld County Certified Foster Care Home identified as Provider ID# «Agency_ID».
These services will be for children who have been deemed eligible for social services
under the statutes, rules and regulations of the State of Colorado.
21. All bed hold authorizations and payments are subject to a 7 -day maximum for a child's temporary
absence from a facility, including hospitalization. Bed hold requests must have prior written
authorization from the Department Administrator before payment will be released to Provider.
22. Any additional costs for specialized services, which may include but are not limited to; Co -pays,
deductibles, or services not covered by Medicaid, will need to be authorized, in writing by the
Department Administrator, prior to the service being performed. Any payment for specialized
services not authorized in writing may be denied.
23. All reimbursement requests shall:
A. Be submitted in a format approved by the County. If submitted in an unapproved format
or inadequate documentation is provided, the County reserves the right to deny payment.
B. Be submitted by the 4th of each month following the month of service. If the
reimbursement request is not submitted within twenty-five (25) calendar days ofthe
month following service, it may result in forfeiture ofpayment.
C. Placement service reimbursement shall be paid from the date of placement up to, but not
including the day of discharge.
D. Transportation reimbursement shall be for visitation purposes only. If medical
transportation is needed, Provider will arrange reimbursement through Medicaid. Any
other special requests for transportation reimbursement shall require prior approval by
the Resource Manager or the DepartmentAdministrator.
E. Clothing allowance reimbursement shall be approved and reimbursed as indicated on the
clothing allowance form accessed through the Foster Parents Database On-line System
(FIDOS).
24. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and
protect personal items brought to Provider by the children, Provider shall be released from
responsibility for loss or damage to such personal items.
PROVIDER SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Human
Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State
of Colorado and any applicable federal laws and regulations, as such, which may be amended
from time to time, and shall be binding on Provider and control any disputes in this Agreement.
2. Not charge any fees to children or families of children referred by County for any services
provided under this Agreement.
3. Not assign the obligations under this Agreement nor enter into any sub -Agreement without the
Exhibit A to the CWS-7A
8 Revised 5/2018
express written approval of the Director of the County Department or his/her appointed
designee.
4. Maintain at all times during the term of this Agreement a liability insurance policy of atleast
$25,000 for property damage liability, $150,000 for injury and/or damage to any one person, and
$500,000 for total injuries arising from any one accident. Provider shall provide a certificate of
insurance provided by its insurer upon request by County.
5. Indemnify the County against any and loss against all claims and actions based upon or arising
out of damage or injury, including death, to persons or property caused or sustained in
connection with the performance of this Agreement or by conditions created thereby, or based
upon any violations of any statute, ordinance, or regulation and the defense of any such claims or
actions.
6. Attend or participate in Ice Breaker, Family Engagement or Team Decision making meetings, if
requested by the Department. County staff shall notify the Provider of the dates and times
attendance is requested.
7. Request a staffing if considering giving notice to remove a child, except in emergency situations.
These requests shall be made through the child's caseworker and/or the Provider's FosterCare
Coordinator.
8. Actively participate in achieving the child's permanency goal, cooperate with any contractors
hired by the Weld County Department of Human Services to preserve placement in the least
restrictive placement appropriate, comply with the treatment plan of the child, and attendcourt
hearings as requested.
9. Have physical examinations completed within 14 days and dental examinations completed within
8 weeks of the child being placed with Provider. All documentation of these examinations will be
placed in the foster child's placement binder.
10. Attend all necessary school meetings and support any plan that is developed regarding the child
in order to promote educational success.
11. Immediately report to the County Department and/or local law enforcement any known or
suspected child abuse or neglect as set forth in Section 19-3-304, C.R.S.
12. Maintain, access and review information weekly on FIDOS.
13. Maintain/update information in the foster child's binder. The binder will be reviewed on amonthly
basis and signed off by child's caseworker and/or the Provider's Foster Care Coordinator.
14. Maintain/update medication logs on a daily basis, if child is taking medications.
15. Maintain behavior observation notes as required by the level of care assessed for each child.
16. Comply with all County and State certification requirements as set forth in the State Department
rules, Staff Manual Volume VII and the Weld County Department of Human Services Policy and
Procedure manual.
Exhibit A to the CWS-7A
9 Revised 5/2018
ADDENDUM 1
Needs Based Care Assessment
NBC (NEEDS
Answers
closest
BASED CARE ASSESSMENT)
to the following questions will determine the NBC Care Payment. For each question below please select the
rating for this child. The following seven (7) questions are mutually exclusive.
P1. How often does the child require transportation by the foster care provider for the
following:
Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as
outlined in the treatment plan?
Select One
P2. How often is the foster care provider required to participate in child's therapy or
counseling sessions?
Select One
P3. How much time is the provider required to intervene at home and/or at school with the
child in conjunction with a regular or special education plan?
Select One
P4. How often does the child require special and extensive
scheduling and monitoring of time and/or activities and/or
involvement by the provider in
Select One
crisis management?
P5. How much time is the provider required to assist the child
beyond age appropriate needs with feeding, bathing, grooming,
because of impairments
physical, and/or
Select One
occupational therapy?
Al. How often is CPA/County case management required? (Does not include therapy)
**Please Note: The Case Management level may be assessed on a combined basis
if a sibling group or more than one County foster child is with the same provider.
Select One
T1. How
assessment?
NBC (NEEDS
often are therapy services needed to address child's individual needs per NBC
Select One
BASED CARE ASSESSMENT) — Behavioral Assessment
Assessment Areas:
Comment:
Rating:
❑
Aggression/Cruelty to Animals
Select One
❑
Verbal or Physical Threatening
Select One
❑
Destructive of Property/Fire Setting
Select One
❑
Stealing
Select One
❑
Self -injurious Behavior
Select One
❑
Substance Abuse
Select One
❑
Presence of Psychiatric Symptoms/Conditions
Select One
❑
Enuresis/Encopresis
Select One
❑
Runaway
Select One
❑
Sexual Offenses
Select One
❑
Inappropriate Sexual Behavior
Select One
❑
Disruptive Behavior
Select One
❑
Delinquent Behavior
Select One
❑
Depressive -like Behavior
Select One
❑
Medical Needs - (If condition is rated "severe",
please complete the Medically fragile NBC)
Select One
I
Emancipation
Select One
❑
Eating Problems
Select One
❑
Boundary Issues
Select One
❑
Requires Night Care
Select One
❑
Education
Select One
L.
Involvement with Child's Family
Select One
Addendum 1
10
Revised 5/2018
ADDENDUM 2
Needs Based Care Rate Table
Weld County Department of Human Services
(Effective 7/01/2018)
LEVEL OF .
SERVICE
l
'CHILD
MAINTENANCE
RESPITE
MEDICAL
NEEDS
Level
.
• Daily Rate
Daily Rate _
Daily Rate •
County
Basic
Maintenance
Rate
$35.70
$.66
1
$35.70
e
$.66
$3.54
/2
$35.70
$.66
2
$35.70
$.66
$5.09
2 %
$38.99
$.66
3
$42.28
$.66
$6.66
3 1/2
$45.57
L
$.66
4
Congregate
Care
Drop Down
$48.86
$.66
Negotiated
Assessment/
Emergency
Level Rate
$35.70
7
$.66
Addendum 2
11
Revised 8/2018
WELD COUNTY FOSTER CARE PROVIDERS
July 1, 2018 to June 30, 2019
Foster
.;
Facility Name Facility ID Facility Address Facility City State Zip - Facility Daily Rate.:.
Kin
1
F
Agone, Talia and Emore, Lansing
1694421
833 Columbine Drive
Windsor, CO 80550
Dependant upon child needs - Refer to Needs Based Care Rate TablE
2
F
Anderson, Lauren and Wayne
1717024
8137 22nd Street
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
3
F
Bass, Kayci and Jonathan
1687306
2130 72nd Ave. Ct.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
4
F
Bingley, Anja and Richard
1700655
418 30th Ave. Ct.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
5
K
Bishop, Leilani
1694008
2620 9th Ave.
Greeley, CO 80631
Dependant upon child needs - Refer to Needs Based Care Rate TablE
6
F
Blank, Matthew and Emily
1669654
1251 Vail Ln.
Longmont, CO 80503
Dependant upon child needs - Refer to Needs Based Care Rate TablE
7
F
Braunagel, Karen
1714402
1775 Laurus Ln.
Johnstown, CO 80534
Dependant upon child needs - Refer to Needs Based Care Rate TablE
8
F
Brown, Rachel and Williford, Julie
1640956
7920 West 12th St.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
9
F
Callaway, Christopher and Lisa
1655848
3204 39th Ave.
Evans, CO 80620
Dependant upon child needs - Refer to Needs Based Care Rate TablE
10
K
Carruth, Ashlee B.
1678635
3306 San Marco Ave.
Evans, CO 80620
Dependant upon child needs - Refer to Needs Based Care Rate TablE
11
K
Castaneda, Natalie and Freddy
1678403
6337 W. 28th St.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
12
F
Davidson, Stacey A.
1694419
520 Marquiss Ct.
Dacono, CO 80514
Dependant upon child needs - Refer to Needs Based Care Rate TablE
13
F
Dennis, Esther and Grigsby, Michael
1687385
40818 Jade Drive
Ault, CO 80610
Dependant upon child needs - Refer to Needs Based Care Rate TablE
14
F
Dunn, James and Gari
1714413
413 Ash St.
Kersey, CO 80644
Dependant upon child needs - Refer to Needs Based Care Rate TablE
15
F
Easley, Allison and William Eric
1674424
488 Stonebrook Dr.
Windsor, CO 80550
Dependant upon child needs - Refer to Needs Based Care Rate TablE
16
F
Erickson, Joshuah and Tessa
1716237
2057 26th St. Rd.
Greeley, CO 80631
Dependant upon child needs - Refer to Needs Based Care Rate TablE
17
F
Garcia, Fernando and Aracely
1561879
3919 28th Ave.
Evans, CO 80620
Dependant upon child needs - Refer to Needs Based Care Rate TablE
18
F
Gillette, Michael and Alisyn
1716936
5527 Wilderness Loop
Marysville, CA 95901
Dependant upon child needs - Refer to Needs Based Care Rate TablE
19
F
Gomez, Maira and Ibarra, Eric
1707673
200 N. 35th Ave., #219
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
20
F
Haines, Ryan and Kara
1714134
2737 W. 14th St.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
21
K
Haynes, Donna
1688399
2343 W. 11th St. Rd.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
22
F
Heimer, Sara
1547292
3000 W. 19th St.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
23
K
Hernandez, Keyano and Michael
1702702
5796 E. 129th PI.
Thornton, CO 80602
Dependant upon child needs - Refer to Needs Based Care Rate TablE
24
F
Hidalgo, Maribelle and Daniel
1717718
5025 W 22nd Steet Road
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
25
F
Jeffery, Jamie
1708865
339 Valley Ave.
Lochbuie, CO 80603
Dependant upon child needs - Refer to Needs Based Care Rate TablE
26
F ICPC
Johnston, Loyd and Trisha
1685257
2817 E. Aloma Ct.
Wichita, KS 67211
Dependant upon child needs - Refer to Needs Based Care Rate TablE
27
F ICPC
Kidd, Roger and Michelle
1715791
15182 Oak Knoll
Monroe, MI 48161
Dependant upon child needs - Refer to Needs Based Care Rate TablE
28
F
Klaus, Dawn
1710929
348 Valley Ave.
Lochbuie, CO 80603
Dependant upon child needs - Refer to Needs Based Care Rate TablE
29
F
Korby, Stephanie and Trenton
1659973
3105 70th Ave.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
30
K
Lechman, Pamela & Jay
1587465
5151 W. 29th St., Unit 2004
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
31
F
Lind, Patricia and Dalby, Katherine
1658999
1611 15th Ave.
Greeley, CO 80631
Dependant upon child needs - Refer to Needs Based Care Rate TablE
32
F
Long, Joshua and Jennifer
1712147
2548 Palmer Ave.
Mead, CO 80542
Dependant upon child needs - Refer to Needs Based Care Rate TablE
33
F
Long, Kiley and Cole, Andrew
1687316
1883 Sunset Circle
Milliken, CO 80543
Dependant upon child needs - Refer to Needs Based Care Rate TablE
34
F
Mann, Kristin and Russell
1674765
420 Bobcat Dr.
Milliken, CO 80543
Dependant upon child needs - Refer to Needs Based Care Rate TablE
35
F
Marin, Gilbert and Lazuick-Marin, Justine
1661206
25000 CR 69
Kersey, CO 80644
Dependant upon child needs - Refer to Needs Based Care Rate TablE
36
F
Maronek, Dennis and Patricia
1520627
2929 56th Ave.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
37
F
Martinez, Stacey and Jeremy
1649838
1149 Northview Dr.
Erie, CO 80516
Dependant upon child needs - Refer to Needs Based Care Rate TablE
38
F
Matzke, Michael and Sara
1716250
1949 Cataluna Dr.
Windsor, CO 80550
Dependant upon child needs - Refer to Needs Based Care Rate TablE
39
F
Menzel, Kathrina and Jared
1707638
6025 Lynx Creek Circle
Frederick, CO 80530
Dependant upon child needs - Refer to Needs Based Care Rate TablE
40
F
Moore, Jay and Candice
1692443
7075 19th St., Apt. 5
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
41
K
Olson, Stacey
1698259
1297 Midland Street
Brighton, CO 80601
Dependant upon child needs - Refer to Needs Based Care Rate TablE
WELD COUNTY FOSTER CARE PROVIDERS
July 1, 2018 to June 30, 2019
Foster
„ _ . • ,FaciIity'Narne - :Facility ID, .` Facility.Address; FacilityrCrty:5fate Zip ": ; , ' ,Facility Daily Rate .
Kin
42
F
Purtell, Nicole and Christopher
1708813
2391 Tate Ave.
Ft. Lupton, CO 80620
Dependant upon child needs - Refer to Needs Based Care Rate Table
43
F
Radi, Tera
1683320
501 28th Ave.
Greeley, CO 80634
Dependant.upon child needs - Refer to Needs Based Care Rate Table
44
K
Ritter, Thomas and Deborah
1554009
10151 Devonshire St.
Firestone, CO 80504
Dependant upon child needs - Refer to Needs Based Care Rate Table
45
F
Roderick, Douglas and Kelli
10994
3110 57th Ave.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
46
F
Salazar, Clara and Michael
1663774
1269 49th Ave. Ct.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
47
F
Sanchez, Tracy and Isidro
1687293
423 28th Ave.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
48
F
Scheer, James L. and Elizabeth
1666078
37700 Co. Rd. 23
Severance, CO 80550
Dependant upon child needs - Refer to Needs Based Care Rate Table
49
F
Schmelz, Pamela and Romero, Shane
1694423
411 Pinyon St.
Frederick, CO 80530
Dependant upon child needs - Refer to Needs Based Care Rate Table
50
F
Schmidt, Constance and Donald II
1511343
17900 CR 5
Berthoud, CO 80513
Dependant upon child needs - Refer to Needs Based Care Rate Table
51
F ICPC
Schultz, Alisha
1698304
812 North 6th Street
Manitowoc, WI 54220
Dependant upon child needs - Refer to Needs Based Care Rate Table
52
F
Schulz, Lindsey
1665608
5121 W. 11th St., Apt. 409
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
53
K
Schumaker, Russel and Colleen
1713457
10428 Cherry Vale St.
Firestone, CO 80504
Dependant upon child needs - Refer to Needs Based Care Rate Table
54
F
Schweitzer, Shyanna and Nevin
1686185
1117 Alpine Ct.
Windsor, CO 80550
Dependant upon child needs - Refer to Needs Based Care Rate Table
55
F
Seader, Erin and Ryan
1694425
420 Cottonwood Ave.
Eaton, CO 80615
Dependant upon child needs - Refer to Needs Based Care Rate Table
56
F
Shenk, Christopher and Diaz, Xioma
1715961
709 Keensburg Ct.
Ft. Collins, CO 80525
Dependant upon child needs - Refer to Needs Based Care Rate Table
57
F
Smith, Elizabeth Ann and Sean Michael
1679422
2912 McIntosh Dr.
Longmont, CO 80503
Dependant upon child needs - Refer to Needs Based Care Rate Table
58
F
Tavita, Jacquelyn and Bruce
1680800
6906 23rd Street
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
59
F
Taylor, Jeff and Silva, Alexander
1712176
4943 W. C Street
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate TablE
60
F
Thaden-Fidjeland, Amanda
1676040
537 36th Ave. Ct.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
61
F
Tucker, Tasha and Thomas
1702726
2317 44th Ave.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
62
F
Ulrich, Ross and Kari
1629340
2381 Cedarwood Circle
Lafayette, CO 80026
Dependant upon child needs - Refer to Needs Based Care Rate Table
63
F
Van Den Elzen, Dawn
44282
5819 W. 16th St. Ln.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
64
F
Vance, Morgan and Kindvall, Brandon
1703052
500 Campbell St.
Kersey, CO 80644
Dependant upon child needs - Refer to Needs Based Care Rate Table
65
F
Villa, Jacob and Kati
1712716
14 Rose Ct.
Windsor, CO 80550
Dependant upon child needs - Refer to Needs Based Care Rate Table
66
F
Visser, Ryan and Amanda
1673369
3212 68th Ave. Ct.
Greelen., CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
67
F
Walker, Kayla and Renae
1693525
37077 Northwest Dr.
Windsor, CO 80550
Dependant upon child needs - Refer to Needs Based Care Rate Table
68
F
Walker, Kurt and Jennifer
1546248
7681 Carlson Court
Ft. Collins, CO 80524
Dependant upon child needs - Refer to Needs Based Care Rate Table
69
K
WestHolmes, Liesl and Corey
1667110
2530 Sunstone Dr.
Ft. Collins, CO 80525
Dependant upon child needs - Refer to Needs Based Care Rate Table
70
F
Westra, Michael and Geneva
1696891
1460 Frontier Road
Eaton, CO 80615
Dependant upon child needs - Refer to Needs Based Care Rate Table
71
F
White, Kristen
1711814
1651 Kelmsley Ct.
Windsor, CO 80550
Dependant upon child needs - Refer to Needs Based Care Rate Table
72
F
Williams, Allison and Buddy
1687324
1202 42nd Ave.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
73
F
Winterfeld, Rachel
1712735
1516 44th Ave. Ct.
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
74
F
Wipf, Keith and Bethany
1706601
3266 Cramer Ave.
Evans, CO 80620
Dependant upon child needs - Refer to Needs Based Care Rate Table
75
F
Wright, Jon and Nicole
1639129
3919 W. 22nd Street
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
76
F
Wurtz, Drew and Workman-Wurtz, Kathryn
1633330
1901 15th Street
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
EXHIBIT to the SS23A
Additional Provisions for the Agreement to Purchase
Out -of -Home Placement Services SS23A
For the Purchase of
Residential Child Care Facility Services
The following additional provisions of this Exhibit apply to the agreement entitled, "Agreement
to Purchase Out -of -Home Placement Services SS23A, attached hereto, by and between the Board
of County Commissioners of Weld County, on behalf of the Weld County Department of Human
Services," hereinafter referred to as, "County," and «Agency», hereinafter referred to as,
"Contractor."
1. County agrees to purchase and Contractor agrees to provide the care and services which
are listed in this agreement for Facility ID# «Facility_ID» at the contractor's base
anchor rate of $«Agency_Rate» per day, as outlined in the Colorado Department of
Human Services Informational Memorandum IM-CW-2018-0040, unless for the 2018-
2019 fiscal year the Contractor and County have agreed to a previously negotiated higher
rate based on the significant needs of a specific child. These services will be for children
who have been deemed eligible for social services under the statutes, rules and
regulations of the State of Colorado.
2. All bed hold authorizations and payments are subject to a 7 -day maximum for a child's
temporary absence from a facility, including hospitalization. Bed hold requests must
have prior written authorization from the Department Administrator before payment will
be released to provider. Reimbursement rates for bed hold days may not exceed the state
standard rate for administrative maintenance and administrative services or may be a
reduced rate that is mutually agreed upon.
3. The services purchased under this Agreement as Child Maintenance, Administrative
Maintenance and Services for Residential Child Care Facilities include, but are not
limited to: Food, shelter, clothing, personal needs and allowance, administration,
administrative overhead, support staff, support overhead, sleep -over staff, direct child
care, transportation, therapeutic recreation, service delivery staff, parent training for
teens, independent living training, mentor/advocate, supervised visitation and all other
services as outlined in the Child Specific Addendum. The anticipated minimum
percentage for each item is as follows and will be subject to County monitoring as
outlined in Section VI of this contract:
a. Food, including meals and snacks (25%).
b. Clothing (3%).
c. Shelter, including utilities and use of household furnishing and equipment and daily
supervision, including those activities that a parent would normally carry out to assure
protection, emotional support and care of the child (30%).
d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap,
combs, haircuts, and other essentials (2%).
Exhibit to the SS23A
12 Revised 8/2018
e. Other/miscellaneous items considered usual in the care and supervision of the child,
include, but are not limited to, transportation, recreation and overhead (40%).
4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be
furnished by the Contractor under this contract for facilities that provide sex offender
treatment.
5. Contractor agrees to have appropriate personnel available to attend or participate in
Family Engagement, Team Decision Making meetings or court hearings. Provider shall
be notified by County staff of the dates and times attendance is requested.
6. Contractor agrees to cooperate with any vendors hired by the Weld County Department
of Human Services to shorten the duration of placement.
7. Contractor agrees to have physical examinations scheduled within 14 days and dental
examinations scheduled within 8 weeks of the child being placed with Contractor. All
documentation of these examinations shall be forward to the County.
8. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP)
for youth designated as a Special Education Student every 3 years and coordinate reviews
every year. If the IEP is due while the child is in placement, the Contractor will complete
or obtain a completed IEP. A copy will then be forwarded to the County.
9. Children in Residential Child Care Facilities and Child Placement Agencies are generally
not eligible to receive clothing allowances as outlined in the Weld County Department of
Human Services Policy and Procedure Manual. However, a one-time emergency
clothing allowance may be approved in limited circumstances, with prior written
authorization from County's Department Administrator required before payment will be
released to provider.
10. County shall have access to Contractor's financial records as they relate to this Agreement
for purposes of audit. Such records shall be complete and available for audit 90 days after
final payment hereunder and shall be retained and available for audit purposes for at least
five years after final payment hereunder.
11. Time is of the essence in each and all of the provisions of this Agreement.
12. 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.
13. Any notice required to be given under this Agreement shall be in writing and shall be
mailed or delivered to the other party at that party's address as stated above.
14. This Agreement and the provision of services hereunder shall be subject to the laws of
Colorado and be in accordance with the policies, procedures, and practices of County.
Exhibit to the SS23A
13 Revised 8/2018
15. This Agreement is nonexclusive and County may engage or use other contractors or
persons to perform services of the same or similar nature.
16. 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 an 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 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.
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.
Exhibit to the SS23A
14 Revised 8/2018
17. Contractor assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, and declared
ineligible or voluntarily excluded from covered transactions by a federal
department or agency;
b. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a 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;
c. 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 paragraph (B) above;
d. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
18. In addition to terminating this Agreement, in accordance with the provisions of the
attached Agreement, the County may exercise the following remedial actions County find
and determine that Contractor has substantially failed to satisfy the scope of work found in
the Agreement, any Exhibit, or the child specific addendum SS23B. 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 include, but are not limited to, any one
or more of the following:
a. Withhold payment to Contractor until the necessary services or corrections in
performance are satisfactorily completed.
b. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by Contractor
cannot be performed or if performed would be of no value to County. Denial of
the amount of payment shall be reasonably related to the amount of work or
deliverables lost to County.
c. Recover from Contractor any incorrect payment to Contractor due to omission,
error, fraud, and/or defalcation by deducting from subsequent payments under this
Agreement, or other agreements between County and Contractor, or as a debt to
County, or otherwise as provided by law.
19. 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 or their assignees, and nothing contained 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
Exhibit to the SS23A
15 Revised 8/2018
any entity other than the undersigned parties or their assignees receiving services or
benefits under this Agreement shall be an incidental beneficiary only.
20. No portion of this Agreement shall be deemed to constitute a waiver of any immunity
including those provided by the Colorado Governmental Immunity Act §§24-10-101 et seq.,
as applicable now or hereafter amended, that the parties or their officers or employees may
possess, nor shall any portion of this Agreement be deemed to have created a duty of care
that did not previously exist with respect to any person not a party to this Agreement. The
parties hereto acknowledge and agree that no part of this Agreement is intended to
circumvent or replace such immunities.
21. Contractor shall promptly notify County in the event in which it is a party defendant or
respondent in a case, which involves services provided under the agreement. The
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 County Director. The term
"litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy,
reorganizations and/or foreclosure.
22. Any amendments or modifications to this agreement shall be in writing signed by both
parties.
23. Financial obligations of the County payable after the current fiscal year are contingent
upon funds for that purpose being appropriated, budgeted and otherwise made available.
Execution of this Agreement by County does not create an obligation on the part of
County to expend funds not otherwise appropriated in each succeeding year.
24. Contractor agrees that it is an independent Contractor and that Contractor's officers,
agents or employees will not become employees of County, nor entitled to any employee
benefits from County as a result of the execution of this Agreement. Contractor shall
perform its duties hereunder as an independent Contractor. Contractor shall be solely
responsible for its acts and those of its agents and employees for all acts performed
pursuant to this Agreement. Contractor, its employees and agents are not entitled to
unemployment insurance or workers' compensation benefits through County and County
shall not pay for or otherwise provide such coverage for Contractor or any of its agents or
employees.
25. County reserves the right to require the Contractor to provide a certificate of insurance,
policy, or other proof of insurance at its sole discretion.
Exhibit to the SS23A
16 Revised 8/2018
RESIDENTIAL CHILD CARE FACILITY PROVIDERS
July 1, 2018 to June 30, 2019
A-enc : ; Facili : ID = °Agenc �. Mailing Address `' A g enc 'City State Zip,_
Y tY Y Y tY p
Faci i
Daily Rat`
e.
Exhibit
_
.."..-
1
Alternative Homes for Youth
2016
1110 M St.
Greeley, CO 80631
.
$218.97
A
2
Attention Homes Chase House
11679
1443 Spruce Street
Boulder, CO 80301
$136.79
A
3
Avanti House
1695623
P. O. Box 1938
Broomfield, CO 80023
$155.94
A
4
Dale House Project 24
1502911
24 E. Dale St.
Colorado Springs, CO 80903
$118.91
A
5
Dale House Project 802
1502990
802 N. Tejon St.
Colorado Springs, CO 80903
$118.91
B
6
Denver Children's Home
49551
1501 Albion Street
Denver, CO 80220
$218.97
A
7
Devereux Cleo Wallace
39794
8405 Church Ranch Blvd.
Westminster, CO 80021
$218.97
A
8
Families First Children's Treatment Center
57632
2163 S. Yosemite St.
Denver, CO 80231
$162.42
A
9
Griffith Centers for Children Inc.
39212
1724 Gilpin Street
Denver, CO 80218
$218.97
C
10
Hilltop Residential Youth Services
96474
1331 Hermosa Ave.
Grand Junction, CO 81506
$188.27
A
11
Jefferson Hills Aurora
12284
421 Zang St.
Lakewood, CO 80228
$218.97
A
12
Jefferson Hills Lakewood
88459
421 Zang St.
Lakewood, CO 80228
$218.97
B
13
Midway Youth Services, Inc.
44002
729 Remington
Fort Collins, CO 80524
$155.19
A
14
Mount St. Vincent Home
45174
4159 Lowell Blvd.
Denver, CO 80211
$218.97
A
15
Roundup Fellowship III
45211
3443 South Galena St., Suite 310
Denver, CO 80231
$89.75
A
16
Roundup Fellowship V
45212
3443 South Galena St., Suite 310
Denver, CO 80231
$94.78
B
17
Savio House
48170
325 King St.
Denver, CO 80219
$218.97
F
18
Shiloh House -- Estes
20335
6588 W. Ottawa Ave.
Littleton, CO 80128
$218.97
A
19
Shiloh House -- Portland
54169
6588 W. Ottawa Ave.
Littleton, CO 80128
$218.97
B
20
Shiloh House -- Yarrow
70967
6588 W. Ottawa Ave.
Littleton, CO 80128
$218.97
C
21
Shiloh House -- Adams Campus
1528492
6588 W. Ottawa Ave.
Littleton, CO 80128
$218.97
D
22
Shiloh House -- Longmont
1539982
6588 W. Ottawa Ave.
Littleton, CO 80128
$218.97
E
23
Shiloh House for Youth -- Thornton
1588986
6588 W. Ottawa Ave.
Littleton, CO 80128
$218.97
F
24
Serenity Children's Home - Smith Agency Inc.
96482
15001 E. Tufts Place
Aurora, CO 80014
$162.42
B
25
Serenity II Children's Home - Smith Agency Inc.
6566
14364 E. Evans Ave.
Aurora, CO 80014
$162.42
C
26
Southern Peaks Regional Treatment Center
1526789
700 Four Mile Parkway
Canon City, CO 81212
$218.97
A
27
Springbrook Behavioral Health
1714091
1 Havenwood Lane
Travelers Rest, SC 29690
$589.50
RESIDENTIAL CHILD CARE FACILITY PROVIDERS
July 1, 2018 to June 30, 2019
Agency .: Facility' ID Agency'Mailing Address A t
� y � �ency:City State Zip .
Facility •
. Exhibit
Exhibit
Deily Rate
28
Tennyson Center for Children
1529814
2950 Tennyson St.
Denver, CO 80212-3029
$218.97
A
29
Third Way Center -- York
49487
P. O. Box 61385
Denver, CO 80206
$218.97
A
30
Third Way Center -- Pontiac
65346
P. O. Box 61385
Denver, CO 80206
$218.97
B
31
Third Way Center -- Lincoln
77810
P. O. Box 61385
Denver, CO 80206
$218.97
C
32
Third Way Center -- Bannock
1507881
P. O. Box 61385
Denver, CO 80206
$218.97
D
33
Third Way Center -- Lowry
1547437
P. O. Box 61385
Denver, CO 80206
$218.97
E
34
Turning Point Center for Youth -- Matthews
45179
1644 South College Ave.
Fort Collins, CO 80525
$218.97
A
35
Turning Point Center for Youth -- Prospect
1616504
1644 South College Ave.
Fort Collins, CO 80525
$218.97
B
EXHIBIT A to the SS23A
Additional Provisions for the Agreement to Purchase
Out -of -Home Placement Services SS23A
For the Purchase of
Child Placement Agency Services
The following additional provisions of this Exhibit apply to the agreement entitled, "Agreement to
Purchase Out -of -Home Placement Services SS23A, attached hereto, by and between the Board of
County Commissioners of Weld County, on behalf of the Weld County Department of Human
Services," hereinafter referred to as, "County," and «Agency», hereinafter referred to as,
"Contractor."
1. County agrees to purchase and Contractor agrees to provide the care and services which
are listed in this agreement at the Contractor's base anchor rate of $«Agency_Rate» per day,
as outlined in the Colorado Department of Human Services Informational Memorandum,
IM-CW-2018-0040, unless for the 2018-2019 fiscal year the Contractor and County
have agreed to a previously negotiated higher rate based on the significant needs of a
specific child. These services will be for children who have been deemed eligible
for social services under the statues, rules, and regulations of the State of Colorado.
2. All bed hold authorizations and payments are subject to a 7 -day maximum for a child's
temporary absence from a facility, including hospitalization. Bed hold requests must
have prior written authorization from County's Department Administrator before
payment will be released to provider.
3. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be
furnished by the Contractor under this contract for facilities that provide sex offender
treatment.
4. Contractor agrees to have appropriate personnel available to attend or participate in
Family Engagement, Team Decision Making meetings, or court hearings. Contractor
shall be notified by County staff of the dates and times attendance is requested.
5. Contractor agrees to cooperate with any vendors hired by the County to shorten the
duration of placement.
6. Contractor agrees to have physical examinations completed within 14 days and
dental examinations completed within 8 weeks of the child being placed with
Contractor. All documentation of these examinations shall be forward to County.
7. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP)
for youth designated as a Special Education Student every 3 years and coordinate reviews
every year. If the IEP is due while the child is in placement, the Contractor shall complete
or obtain a completed IEP. A copy will then be forwarded to the County.
Exhibit to the SS23A
1 Revised 8/2018
8. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities
and Child Placement Agencies are generally not eligible to receive clothing allowances as
outlined in the Weld County Department of Human Services Policy and Procedure
Manual. However, a one-time emergency clothing allowance may be approved in limited
circumstances, prior written authorization from the County's Department Administrator is
required before payment will be released to provider.
9. County shall have access to Contractor's financial records as they relate to this Agreement
for purposes of audit. Such records shall be complete and available for audit 90 days after
final payment hereunder and shall be retained and available for audit purposes for at least
five years after final payment hereunder.
10. Time is of the essence in each and all of the provisions of this Agreement.
11. 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.
12. Any notice required to be given under this Agreement shall be in writing and shall be
mailed or delivered to the other party at that party's address as stated above.
13. This Agreement and the provision of services hereunder shall be subject to the laws of
Colorado and be in accordance with the policies, procedures, and practices of County.
14. This Agreement is nonexclusive and County may engage or use other contractors
or persons to perform services of the same or similar nature.
15. 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.
Exhibit to the SS23A
2 Revised 8/2018
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 an 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, 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.
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.
16. Contractor assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, and declared
ineligible or voluntarily excluded from covered transactions by a federal
department or agency;
b. Have not, within a three-year period of preceding this Agreement, been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(federal, state, or local) transaction or contract under a 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;
c. 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 paragraph (B) above;
d. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
Exhibit to the SS23A
3 Revised 8/2018
17. In addition to terminating this Agreement, in accordance with the provisions of the
attached Agreement, the County may exercise the following remedial actions if the
County finds and determines that the Contractor has substantially failed to satisfy the
scope of work found in the Agreement, any Exhibit, or the child specific addendum
SS23B. 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 include, but
are not limited to, any one or more of the following:
a. Withhold payment to Contractor until the necessary services or corrections in
performance are satisfactorily completed.
b. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by Contractor
cannot be performed or if performed would be of no value to County. Denial of
the amount of payment shall be reasonably related to the amount of work or
deliverables lost to County.
c. Recover from Contractor any incorrect payment to Contractor due to omission,
error, fraud, and/or defalcation by deducting from subsequent payments underthis
Agreement, or other agreements between County and Contractor, or as a debt to
County, or otherwise as provided by law.
18. 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 or their assignees, and nothing contained 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 or their assignees receiving services or
benefits under this Agreement shall be an incidental beneficiary only.
19. No portion of this Agreement shall be deemed to constitute a waiver of any immunity
including those provided by the Colorado Governmental Immunity Act §§24-10-101 et
seq., as applicable now or hereafter amended, that the parties or their officers or
employees may possess, nor shall any portion of this Agreement be deemed to have
created a duty of care that did not previously exist with respect to any person not a party to
this Agreement. The parties hereto acknowledge and agree that no part of this Agreement
is intended to circumvent or replace such immunities.
20. Contractor shall promptly notify County in the event in which it is a party defendant or
respondent in a case, which involves services provided under the agreement. The
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 County Director.
The term "litigation" includes an assignment for the benefit of creditors, and filings in
bankruptcy, reorganizations and/or foreclosure.
Exhibit to the SS23A
4 Revised 8/2018
21. Any amendments or modifications to this agreement shall be in writing signed by both
parties.
22. Financial obligations of the County payable after the current fiscal year are contingent
upon funds for that purpose being appropriated, budgeted and otherwise made available.
Execution of this Agreement by County does not create an obligation on the part of
County to expend funds not otherwise appropriated in each succeeding year.
23. Contractor agrees that it is an independent Contractor and that Contractor's officers,
agents or employees will not become employees of County, nor entitled to any employee
benefits from County as a result of the execution of this Agreement. Contractor shall
perform its duties hereunder as an independent Contractor. Contractor shall be solely
responsible for its acts and those of its agents and employees for all acts performed
pursuant to this Agreement. Contractor, its employees and agents are not entitled to
unemployment insurance or workers' compensation benefits through County and County
shall not pay for or otherwise provide such coverage for Contractor or any of its agents or
employees.
24. County reserves the right to require the Contractor to provide a certificate of insurance,
policy, or other proof of insurance at its sole discretion.
Exhibit to the SS23A
5 Revised 8/2018
CPA Foster Care Providers
July 1, 2018 to June 30, 2019
Facility Name-: ; _ I _- Facility lb 4 _ V.:. . . ,; Fauhty.Mailmg-Address',: -., -: * a Ci I iti,k City State'Zip .A -Facility: D`aily.Ratel .Exhibit
1
A New World
1621990
15200 E. Girard Ave.
Aurora, CO 80014
$69.66
A
2
Adoption Options
45078
1355 S. Colorado Blvd., Suite 501
Denver, CO 80222
$69.66
A
3
Ariel Clinical Services
90205
4660 Wadsworth Blvd.
Wheat Ridge, CO 80033
$72.61
A
4
Bethany Christian Services
45514
3000 S. Race St.
Denver, CO 80210
$69.66
A
5
CGL-CPA, LLC
1615382
1420 Kenton Street
Aurora, CO 80010
$103.25
A
6
Denver Area Youth Services
45069
1530 W. 13th Ave.
Denver, CO 80204
$93.42
A
7
Dungarvin Colorado LLC
1547661
4704 Harlan St., Suite 550
Denver, CO 80212
$73.16
A
8
Family Resource Network
1508602
5360 N. Academy Blvd., Suite 130
Colorado Springs, CO 80918
$70.38
A
9
Griffith Centeres for Children, Inc.
1510565
17 N. Farragut
Colorado Springs, CO 80909
$69.66
A
10
Hope & Home
29867
4945 N. 30th Street, Suite 300
Colorado Springs, CO 80919-3152
$69.66
A
11
Kids Crossing
79752
1440 E. Fountain Blvd.
Colorado Springs, CO 80910-3502
$71.91
A
12
Lutheran Family Services Rocky Mountains
45080
363 S. Harlan Street, Suite 200
Denver, CO 80226
$69.66
A
13
Maple Star Colorado
90967
2250 S. Oneida Street, Suite 200
Denver, CO 80224-2557
$69.66
A
14
Nightlight Christian Adoptions
1590226
150 E. 29th Street
Loveland, CO 80538
$69.66
A
15
Parker Personal Care Homes Inc.
1512100
1597 Cole Blvd., Suite 250
Lakewood, CO 80401-3417
$73.16
A
16
Quality Life Services LLC
32066
11975 Reed Street
Broomfield, CO 80020
$92.06
A
17
Rocky Mountain Kids
1593378
2210 E La Salle
Colorado Springs, CO 80909
$71.91
A
18
Sample Supports
1686456
620 Kimbark St.
Longmont, CO 80501
$71.91
A
19
Savio House
37330
325 King St.
Denver, CO 80219
$85.28
A
20
Smith Agency Inc.
44882
14364 E. Evans Ave.
Aurora, CO 80014-1408
$91.43
A
21
Special Kids Special Families
43184
424 W. Pikes Peak Ave.
Colorado Springs, CO 80905
$69.66
A
22
Specialized Alternatives for Families and Youth
1662183
1600 Specht Point Road
Ft. Collins, CO 80525
$138.42
A
23
Strong Foundations, LLC
1594056
1702 68th Ave.
Greeley, CO 80634
$69.66
A
24
Top of the Trail Inc.
28112
301 N. Cascade
Montrose, CO 81401
$69.68
A
25
Whimspire CPA
19562
9540 E. Jewell Ave.
Denver, CO 80247
$75.40
A
EXHIBIT to the SS23A
Additional Provisions for the Agreement to Purchase
Out -of -Home Placement Services SS23A
For the Purchase of
Group Home/Group Center Care Services
The following additional provisions of this Exhibit apply to the agreement entitled, "Agreement
to Purchase Out -of -Home Placement Services SS23A, attached hereto, by and between the Board
of County Commissioners of Weld County, on behalf of the Weld County Department of Human
Services," hereinafter referred to as, "County," and «Agency», hereinafter referred to as,
"Contractor."
1. County agrees to purchase and Contractor agrees to provide the care and services which
are listed in this agreement for Facility ID «Facility_ID» at the contractor's base anchor
rate of $ «Agency_Rate» per day, as outlined in the Colorado Department of Human
Services Informational Memorandum IM-CW-2018-0040, unless for the 2018-2019
fiscal year the Contractor and County have agreed to a previously negotiated higher rate
based on the significant needs of a specific child. These services will be for children
who have been deemed eligible for social services under the statutes, rules and
regulations of the State of Colorado.
2. All bed hold authorizations and payments are subject to a 7 -day maximum for a child's
temporary absence from a facility, including hospitalization. Bed hold requests must
have prior written authorization from the Weld County Department Administrator before
payment will be released to Contractor.
3. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will
be furnished under this contract for facilities that provide sex offender treatment.
4. The services purchased under this Agreement for Group Home/Center services may
include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter,
clothing, educational supplies and allowance), direct child care, transportation,
administrative overhead, support overhead, service delivery staff, which may include but
are not limited to: Parent training for teens, independent living training, and
mentor/advocate services.
5. Contractor agrees to have appropriate personnel available to attend or participate in
Family Engagement, Team Decision Making meetings, or court hearings. Contractor
shall be notified by County staff of the dates and times attendance is requested.
6. Contractor agrees to actively participate in achieving the child's Permanency Goal and
cooperate with any vendors hired by the Weld County Department of Human Services to
shorten the duration of placement.
7. Contractor agrees to have physical examinations completed within 14 days and dental
examinations completed within 8 weeks of the child being placed with Contractor. All
documentation of these examinations shall be forward to the County.
Exhibit to the SS23A
20 Revised 8/2018
8. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP)
for youth designated as a Special Education Student every 3 years and coordinate reviews
every year. If the IEP is due while the child is in placement, the Contractor shall
complete or obtain a completed IEP. A copy will then be forwarded to the County.
9. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities
and Child Placement Agencies are generally not eligible to receive clothing allowances as
outlined in the Weld County Department of Human Services Policy and Procedure
Manual. However, a one-time emergency clothing allowance may be approved in limited
circumstances, with prior written authorization from County's Department Administrator
required before payment will be released to provider.
10. County shall have access to Contractor's financial records as they relate to this
Agreement for purposes of audit. Such records shall be complete and available for audit
90 days after final payment hereunder and shall be retained and available for audit
purposes for at least five years after final payment hereunder.
11. Time is of the essence in each and all of the provisions of this Agreement.
12. 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.
13. Any notice required to be given under this Agreement shall be in writing and shall be
mailed or delivered to the other party at that party's address as stated above.
14. This Agreement and the provision of services hereunder shall be subject to the laws of
Colorado and be in accordance with the policies, procedures, and practices of County.
15. This Agreement is nonexclusive and County may engage or use other contractors or
persons to perform services of the same or similar nature.
16. 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
Exhibit to the SS23A 21
Revised 8;2018
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 an 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, 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.
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.
17. Contractor assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, and declared
ineligible or voluntarily excluded from covered transactions by a federal
department or agency;
b. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a 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;
c. 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 paragraph (B) above;
Exhibit to the SS23A
22 Revised 8/2018
d. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
18. In addition to terminating this Agreement, in accordance with the provisions of the
attached Agreement, the County may exercise the following remedial actions if County
finds and determines that Contractor has substantially failed to satisfy the scope of work
found in the Agreement, any Exhibit, or the child specific addendum SS23B. 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 include, but are not limited
to, any one or more of the following:
a. Withhold payment to Contractor until the necessary services or corrections in
performance are satisfactorily completed.
b. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by Contractor
cannot be performed or if performed would be of no value to County. Denial of the
amount of payment shall be reasonably related to the amount of work or
deliverables lost to County.
c. Recover from Contractor any incorrect payment to Contractor due to omission,
error, fraud, and/or defalcation by deducting from subsequent payments under this
Agreement, or other agreements between County and Contractor, or as a debt to
County, or otherwise as provided by law.
19. 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 or their assignees, and nothing contained 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 or their assignees receiving services or
benefits under this Agreement shall be an incidental beneficiary only.
20. No portion of this Agreement shall be deemed to constitute a waiver of any immunity
including those provided by the Colorado Governmental Immunity Act §§24-10-101 et
seq., as applicable now or hereafter amended, that the parties or their officers or employees
may possess, nor shall any portion of this Agreement be deemed to have created a duty of
care that did not previously exist with respect to any person not a party to this Agreement.
The parties hereto acknowledge and agree that no part of this Agreement is intended to
circumvent or replace such immunities.
21. Contractor shall promptly notify County in the event in which it is a party defendant or
respondent in a case, which involves services provided under the agreement. The
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 County Director. The term -litigation"
includes an assignment for the benefit of creditors, and filings in bankruptcy,
reorganizations and/or foreclosure.
Exhibit to the SS23A
23
Revised 8/2018
22. Any amendments or modifications to this agreement shall be in writing signed by both
parties.
23. Financial obligations of the County payable after the current fiscal year are contingent upon
funds for that purpose being appropriated, budgeted and otherwise made available.
Execution of this Agreement by County does not create an obligation on the part of County
to expend funds not otherwise appropriated in each succeeding year.
24. Contractor agrees that it is an independent Contractor and that Contractor's officers, agents
or employees will not become employees of County, nor entitled to any employee benefits
from County as a result of the execution of this Agreement. Contractor shall perform its
duties hereunder as an independent Contractor. Contractor shall be solely responsible for its
acts and those of its agents and employees for all acts performed pursuant to this
Agreement. Contractor, its employees and agents are not entitled to unemployment
insurance or workers' compensation benefits through County and County shall not pay for
or otherwise provide such coverage for Contractor or any of its agents or employees.
25. County reserves the right to require the Contractor to provide a certificate of insurance,
policy, or other proof of insurance at its sole discretion.
Exhibit to the SS23A
24 Revised 8/2018
CPA Group Home/Center Providers
July 1, 2018 to June 30, 2019
_ cili y Address Facility City:State Zip :.'
Facility
Exhibit
Daily_
3 ;Rate
A New World
1621990
All Hands In
1686513
4291 S. Fundy Way
Aurora, CO 80013
$73.92
B
Ascend
1705635
17905 E. Bails Place
Aurora, CO 80017
$74.95
C
Brighter Pathways
1649791
4006 S. Mission Parkway
Aurora, CO 80013
$74.95
D
Brighter Pathways II
1693759
1697 S. Kenton St.
Aurora, CO 80012
$74.95
E
Candi's House
1652108
1170 Norfolk St.
Aurora, CO 80011
$59.01
F
Cornerstone Specialized G.C.
1707380
3070 S. Quintero Way
Aurora, CO 80013
$74.95
G
Diamonds In The Rough
1686516
322 Lima Street
Aurora, CO 80010
$74.95
H
Gems and Jewels
1639923
5376 S. Truckee Court
Centennial, CO 80015
$74.95
I
House of Healing
1709708
1036 S. Ouray St.
Aurora, CO 80017
$74.95
J
Rocky Mountain Group Home
1701369
16621 E. 107th Ave.
Commerce City, CO 80022
$114.13
K
Turning Lights Group Center
1621806
1365 S. Lewiston St.
Aurora, CO 80017
$116.59
L
Ariel Clinical Services
90205
Ariel Sprite House
1643047
2938 North Ave., Suite G
Grand Junction, CO 81504
$106.07
B
Kismet House
1630179
861 N. Sable Blvd.
Aurora, CO 80011
$63.17
C
Bethany Christian Services
45514
Cortinez Field of Dreams
74864
6137 Kearney St.
Commerce City, CO 80022
$90.32
B
CGL-CPA, LLC
1615382
LGC I - Vine
1620241
2836 Vine Street
Denver, CO 80205
$129.89
B
LGC II - Marion St.
1619053
3659 Marion Street
Denver, CO 80205
$141.90
C
LGC III - Williams ST.
1620076
3025 Williams Street
Denver, CO 80205
$132.48
D
Griffith Center for Children
1510565
Prospect Youth Home
1543863
28 Farragut Ave.
Colorado Springs, CO 80909
$131.18
B
Kids Crossing
79752
A Better Way
1621890
14202 E 24th Ave
Aurora, CO 80011
$103.06
B
Evergreen
61317
1436 Hilltop Dr.
Longmont, CO 80504
$139.29
C
CPA Group Home/Center Providers
July 1, 2018 to June 30, 2019
= = . .
Governing_ CPA Agency,ID- • ,Group Home' Facility Name; =`. Facility ID, ' ,Facility�Addre-ss' Facility: City State Zip =
,Facility
. Exhibit
Daily '
Rate_ -
Helping Hands Group Home
1551132
21622 E Alamo Place
Centennial, CO 80015
$93.94
D
Hudson Group Home
1623469
2060 Bula Dr.
Colorado Springs, CO 80915
$63.17
E
LaMar Place
1534441
3590 LaMar PI.
Colorado Springs, CO 80911
$100.62
F
Robinson
1538302
5082 Tucson Way
Denver, CO 80239
$72.78
G
Safe Landing
1541496
1365 Langness Circle
Ellicott, CO 80808
$99.87
H
Parker Personal Care Homes Inc.
1512100
Saiph Group Center
1666303
1493 S. Wheeling Circle.
Aurora, CO 80012
$114.13
B
Rocky Mountain Kids
1593378
Drew's Place
1613088
65 Diamond Road E
Fountain, CO 80817
$114.13
B
Future Bound
1599810
3101 Palmer Park Blvd.
Colorado Springs, CO 80909
$114.13
C
Jeremiah 29
1619041
4841 Sand Ripples Lane
Colorado Springs, CO 80922
$114.13
D
Nevada House
1599808
2129 N. Nevada Ave.
Colorado Springs, CO 80907
$114.13
E
Savio House
37330
Bridgeway Group Home
1644205
9820 W. 21st Ave.
Lakewood, CO 80215
$114.13
B
Carr Group Center for Girls
1548445
3297 Jasmine Street
Denver, CO 80207
$159.70
C
Carradine Center
1559137
4515 Gibraltar
Denver, CO 80249
$172.72
D
Carradine Center II
1621801
14101 E. 46th Ave.
Denver, CO 80239
$172.72
E
Strong Foundations, LLC
1594056
C & M Group Home
9875
1920 81st Ave.
Greeley, CO 80634
$114.13
B
Marie Alirez Group Home
70335
1405 26th Street
Greeley, CO 80631
$114.13
C
Michael Alirez Group Home
54150
1709 37th Ave.
Greeley, CO 80634
$114.13
D
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