HomeMy WebLinkAbout20172330.tiff,tykl-r0,0 IDS 186'1
AGREEMENT AMENDMENT
BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND JESSICA BRIEN
This Agreement Amendment, made and entered into /err ilday of 2018 by and
between the Board of Weld County Commissioners, on behalf of the Weld Cou ty De rtment of Human
Services, hereinafter referred to as the "Department", and Jessica Brien, hereinafter referred to as the
"Contractor".
WHEREAS the parties entered into an Agreement for Home Studies (the "Original Agreement")
identified by the Weld County Clerk to the Board of County Commissioners as document No. 2017-2330
approved on July 17, 2017.
WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with
the terms of the Original Agreement, which is incorporated by reference herein, as well as the terms
provided herein.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
• The Original Agreement will end on June 30, 2018.
• The Amendment, together with the Original Agreement, constitutes the entire understanding
between the parties. The following change is hereby made to the Agreement:
1. WHEREAS, the Colorado Department of Human Services has provided Core Services or other funds
to the Department for Home Studies.
2. Paragraph 1, Term
This agreement shall become effective on July 1, 2017, upon proper execution of this Agreement
and shall expire June 30, 2019, unless sooner terminated as provided herein.
3. Payment
The Department and the Contractor agree that all benefits from private insurance and/or other
funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's
Compensation must be exhausted before Core Services or other Department funds can be accessed
for services. Exceptions to this Paragraph may include, if approved by the Department, the
following:
i. The service being provided by the contractor is not a Medicaid eligible service;
ii. The service is not deemed medically necessary;
iii. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or
service be used;
iv. A Medicaid provider is not available to provide the needed service;
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v. Medicaid is exhausted for the needed service; or
vi. Medicaid denied service.
vii. The client is not eligible for Medicaid.
4. Exhibit C, Scope of Services, amended as attached.
5. Exhibit D, Payment Schedule, amended as attached.
• All other terms and conditions of the Original Agreement remain unchanged.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month,
and year first above written.
COUNTY:
dirityv .1d40;ok.
Weld 'ou ' ty Clerk to the Bo. rd
By:
Deputy Clerk t
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
r
Steve Moreno, Chair JVL 1 8 2Di$
CONTR4CTOfiy
Jessica Brien
138 East 4th Street
Loveland, Colorado 80537
(970) 203-4743
By:
Date:
JeSita Brien
s~ `1--,1?
0.29/7- 02350
EXHIBIT C
SCOPE OF SERVICES
1. Contractor will provide home study services for Weld County families, as referred by the Department.
2. All services will be provided by Jessica Brien, LPC.
3. Contractor will utilize the Structured Analysis Family Evaluation (SAFE) tool developed by the
Consortium of Children. Contractor is SAFE certified and on the State's approved home study vendor
list. Contractor also is under the supervision of SAFE Supervisor, Sheila Trabelsi.
4. Contractor will attend SAFE Refresher training during the term of this contract.
5. Contractor will ensure that all studies are completed utilizing the most up-to-date forms and
templates as found on www.consortforkids.org or www.SAFEhomestudy.org.
Contractor will complete a Department of Motor Vehicle background check at no additional charge.
All CBI, FBI and LexisNexis background check information will be completed by the Department,
unless otherwise directed by the Department.
7. Contractor will submit a completed home study to the Department with their billing within 60 days of
receipt of the home study referral. A complete home study will include the study in SAFE format,
background check information, SAFE questionnaires completed by the applicants, references and all
other original documents submitted by the home study applicant.
Contractor will document in detail any and all observed or verbalized concerns regarding any specific
Weld County home. Areas of concern may include, but are not limited to, any physical, emotional,
educational or behavioral issues. Child abuse must be reported immediately per law.
9. Contractor will offer an initial appointment within seven (7) days of receiving the referral and will
make at least three (3) attempts to contact the client and set up services. The first attempt will occur
within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will
document efforts to engage client in referred services. If after three (3) attempts the client does not
respond the Contractor will notify the caseworker and the Child Welfare Contract and Services
Coordinator immediately.
EXHIBIT D
PAYMENT SCHEDULE
1 Funding and Method of Payment
The Department agrees to reimburse the Contractor in consideration of the work and services performed
under this Agreement at the rate specified in Paragraph 2, below The total amount to be paid to the
Contractor during the term of this Agreement shall be reported by the Department after June 30, 2019
Expenses incurred by the Contractor prior to the term of this agreement are not eligible Department
expenditures and shall not be reimbursed by the Department
Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the
continuing availability of said funds for the purposes hereof In the event that said funds, or any part
thereof, become unavailable as determined by the Department, the Department may immediately
terminate the Agreement or amend it accordingly
2 Fees for Services
$1,600 00/Episode (Home Study, 2 Adults)
$600 00/Episode (Home Study Update)
$50 00/Episode/Per Person (Additional fee per adult after 2 adults)
$300 00/Episode (Partial home study, denied or withdrawn after 1-2 face-to-face contacts Includes brief
written report and all mileage costs within central Larimer and Weld County, include Greeley, Loveland,
Fort Collins and communities located between those three )
After 10 miles outside central Larimer or Weld County, mileage will be reimbursed at two (2) cents under
the current IRS mileage/mile rate Communities included at no mileage charge include Greeley, Loveland,
Fort Collins and communities located between those three Mileage starts at the outer city limit of each
community
Contractor may not attempt to collect co -pays and/or fees for services for which a Department client is
responsible, but which a particular client refuses or fails to pay
Contractor will collect any applicable sliding scale co -pays and credit the Department for any payment
received on the monthly billing
3 Submittal of Vouchers
Contractor shall prepare and submit monthly an itemized voucher, and signed monthly report if
applicable, certifying that services authorized were provided on the date(s) indicated and the charges
made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A
Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the
1
month following the month the cost was incurred Failure to submit by the aforementioned deadline may
result in forfeiture of payment
a For ongoing services, proof of services rendered shall be a Client Verification Form signed by
the client and a monthly report submitted in accordance with Paragraph 3(d) of this
Agreement
b For one-time services, proof of services rendered shall be receipt of the completed product
c For Monitored Sobriety services, proof of services rendered shall be the test result
2
Certificate of Insurance (Proof of Coverage) Date Issued: 06 21 2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER"I !Ft( kTE HOLDER.
THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Insured Name
and Mailing Address*
Program Administrator
Jessica
1
I
108
.���eland,
Brien
Ida Dr
CO 80537
7 i 1
P. 312-987-9823
Philadelphia
Administered By:
CPH and Associates
S. Dearborn, Suite 205
Chicago, IL 60605
F. 312-987-0902
info(a cphins.com
*Additional
one
the
office.
occupation(s)
insured
Your coverage
listed
locations
are often
is portable,
on your policy.
requested
meaning
by individual
that you are covered
business owners who have more than
at any location for practice under
Undem ritten By:
Indemnity Insurance
( onipanv
Coverage
Policy #: [241641
tEffective Date: 08/012017
(Expiration
Date: 08/02, Zia 1
THE
INDICATED.
RESPECT
AGGREGATE
POLICIES
BY
OF INSURANCE
NOTWITHSTANDING
THE
LIMITS
POLICIES DESCRIBED
SHOWN
MAY
LISTED
BELOW
ANY
HAVE
REQUIREMENT,
HEREIN
BEEN
HAVE BEEN
IS SUBJECT
REDUCED
ISSUED TO THE INSURED
TERM OR CONDITION
TO ALL THE TERMS,
BY PAID CLAIMS.
NAMED ABOVE FOR
OF ANY CONTRACT OR
EXCLUSIONS AND CONDITIONS
THE
OTHER
POLICY PERIOD
DOCUMENT
OF SUCH
POLICIFS.
WITH
I . i m its of
Liability
Coverage Part
EACH OCCURRENCE
(Per individual claim)
AGGREGATE
(Total amount per policy
year)
$1,000,000
$5,000,000
Professional Liability
N/A
N/A
Commercial General Liability
I ncludes: General Liability, Fire & w ater Legal Liahilit)
and Personal Liability
N/A
N/A
Property
Coverage
$1,000,000
$5,000,000
Supplemental
I.iahility
Unlimited
Unlimited
Defense Expense
Coverage
$35,000
$35,000
State Licensing Board Investigation Defense Co's erage
$15,000
$15,000
I
Assault Coverage
$10,000
$35,000
Deposition
Expense
Benefit
$5,000/person
$50,000
\ledical Expense
Coverage
$15,000 _
$15,000
First Aid Coverage
Description/Special Provisions:
Certificate Holder
( ancellation
Weld County DHS
Tobi Vegter PO Box A
Greeley, CO 80632
Should any of the above described policies be cancelled before the expiration date thereof.
notice will be delivered in accordance with the policy provisions.
Holder
has also
been added to the policy
[ X Yes/No ]
as an additional insured:*'$
ci
' r
Authorized
C. Philip
)
Hodson
Representative
**1t
endorsed.
the certificate
A statement
holder
on
is
this certificate
in lieu
an ADDITIONAL
of such
INSURED.
does not confer rights
endorsement(s).
the
policy(ies)
to the
must be
certificate holder
DISCLAIMER:The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and
the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon.
Certificate of Insurance (Proof of Coverage) 06/21/2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER"I I F I( kTE HOLDER.
THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Insured Name and \/ailing .Address*
Program Administrator
Jes.vica Brien
1108 Ida Dr
Loveland, CO 80537
*Additional insured locations are often requested by individual business owners who have more
than one office. Your coverage is portable, meaning that you are covered at any location for
practice under the occupation(s) listed on your policy.
Administered By:
CPH and Associates
711 S. Dearborn, Suite 205
Chicago, IL 60605
P. 312-987-9823 F. 312-987-0902
info@cphins.com
Underwritten By:
Philadelphia Indemnity Insurance Company
Coverage
Policy #: E241641
]Effective Date: 08/02/2017 'Expiration Date: 08/02/2018
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH
RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE
BEEN REDUCED BY PAID CLAIMS.
Limits of Liability
EACH OCCURRENCE
(Per individual claim)
AGGREGATE
(Total amount per policy year)
Coverage Part
$1,000,000
$5,000,000
Professional Liability
N/A
Nit k
Commercial General Liability
Includes: General Liability, Fire & Water
Legal Liability, and Personal Liability
Property Coverage
S1,000,000
55,000,000
Supplemental Liability
l nlimited
l nlimited
Defense Expense Coverage
$35,000
S35,000
State Licensing Board Investigation
Defense Coverage
$15,000
$15,000
Assault Coverage
$10,000
$35,000
Deposition Expense Benefit
$5,000/person
$50,000
Medical Expense Coverage
$15,000
$15,000
First Aid Coverage
Description/Special Provisions:
Certificate Holder
Cancellation
PROOF OF COVERAGE
Should any of the above described policy be cancelled before the expiration date thereof, the
issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to
the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer,
its agents or representatives.
Holder has also been added to the policy as an additional insured:*
Yes/XN o
**If the certificate holder is an ADDITIONAL INSURED, the policy(ies)
must be endorsed. A statement on this certificate does not confer rights to
the certificate holder in lieu of such endorsement(s).
/ elar‘r
Authorized Representative
( Philip Hodson
DISCLAIMER: The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and
the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon.
INCIDENT BRIEFING
1 Incident Name
Greeley Stampede 2018
2 Date
June 26, 201.8
3 Time
5 00 pm —12 00 am
4 Map Sketch
Event Maps available at daily briefing
5 Current Organization — On Site Supervisors and Contact Information
Stampede Security
Office (970) 888-3136
Chair Mic Harvey (970) 388-8789
Operations Brian Evans (970) 218-6057
Greeley Fire Department
Battalion Chief On Duty (970) 350-9504
Greeley PD
Substation (970) 353-9998
Sergeant Lobato (970) 371-2790
Sergeant Heck (970) 371-1189
Banner Health Paramedics
Paramedics Supervisor Mitch Wagy (970) 381-2392
Weld County Sheriffs Office
WCSO Supervisor Donnie Patch (970) 518-6542
Weld County Office of Emergency Management
On -Call Merrie Garner (970) 397-1076
Weld County Department of Public Health — Food
Vendor Inspections
On -Call Kristeen Bevel (970) 580-7088
WEATHER FORECAST Sunny with a high of 97 Light winds Partly cloudy Tuesday night, heading to a low around
58 degrees
` , 6 Daily Information Summary & Items for Briefing
Today's Events
College Day
0 ParkOpens500pm
0 Extraction Park Stage 5 15 p m
O 7 00 p m PRCA Extreme Bulls — Stampede Arena
0 Please maintain professional radio etiquette
0 Maintain situational awareness "If you see something say something "
O Attend Briefings 4H building, upstairs, weekdays 1630, weekends 1030
e Provide situation report to Planning Section by 9 00 a.m. each day for previous days' activities
*First Responder Access is on "D" Street
RADIO CHANNELS
NMAT 11— WCSO
NMAT 12 — Security/WCSO
NMAT 13 — Greeley Fire Department (as needed)
NMAT 14 — Banner Paramedics & Greeley Fire Department
GPD TAC 4 — Greeley PD
VHF — Stampede Security
Command Channel to be requested and assigned as needed
Agency/Organization
Position
Name
Phone
Number
City
of
Greeley
Island
Grove Park Manager
Welch
(970) 371-2685
Tom
GPD
GPD
Lt.
Scott
Smith
(970) 371-3929
GPD
GPD
Sgt.
Mike
Heck
(970)371-1
189
GPD
GPD
Sgt.
Dennis Lobato
(970) 371-2790
GPD
GPD Sgt.
Bill
West
(970) 301-3915
GPD
GPD
Sgt.
Zach
St.
Aubyn
(970) 301-0455
Stampede
Security Chair
Mic
Harvey
(970) 388-8789
Stampede
Security
Boss
Brian
Evans
(970) 218-6057
Trail
Stampede
General Manager
Justin
Watada
(303) 885-7804
Stampede
General
Chair
John DeWitt
(970) 302-7104
GFD
On -Duty
BC/Safety
(970) 350-9504
WCSO
Undersheriff
Donnie
Patch
(970) 518-6524
BHPS
Assistant
Chief
Mitch
Wagy
(970) 381-2392
BHPS
EMS
Group
On -Duty Supervisor
(970) 302-2833
Public
Health
Food
Inspections
Kristeen
Bevel
(970) 580-7088
OEM
Logistics/Radio
Roy Rudisill
(970) 381-0417
OEM
Planning Chief
Merrie
Garner
(970) 397-1076
OEM
Dept.
Planning
Chief
Andrew
Glendenning
(970) 590-8429
Security
Office
(970) 888-3136
GPD
Substation
(970) 353-9998
INCIDENT BRIEFING
1 Incident Name
Greeley Stampede 2018
2 Date
June 27, 2018
3 Time
5 00 pm —12 00 am
4 Map Sketch
Event Maps available at daily briefing
5 Current Organization —On Site Supervisors and Contact Information
Stampede Security
Office (970) 888-3136
Chair Mic Harvey (970) 388-8789
Operations Brian Evans (970) 218-6057
Greeley Fire Department
Battalion Chief On Duty (970) 350-5904
Greeley PD
Substation (970) 353-9998
Sergeant West (970) 301-3915
Sergeant St Aubyn (970) 301-0455
Banner Health Paramedics
Paramedics Supervisor Mitch Wagy (970) 381-2392
Weld County Sheriffs Office
WCSO Supervisor Donnie Patch (970) 518-6542
Weld County Office of Emergency Management
On -Call Merrie Garner (970) 397-1076
Weld County Department of Public Health — Food
Vendor Inspections
On -Call Kristeen Bevel (970) 580-7088
WEATHER FORECAST Sunny in the morning, partly cloudy in the afternoon Continued hot, with a high reaching 97-
100 degrees East winds 4-8 mph, possible gusts to around 40 mph between 4-8 p m as a gusty shower passes
overhead Slight chance showers in that time frame, aslo Mostly clear and dry tonight, low around 58 degrees
' 6 Daily Information Summary & Items for Briefing
Today's Events
Tough Enough To Wear Pink (TETWP)
Banner Health Day
o Park Opens 5 00 p m
e Extraction Park Stage 5 15 p m
o 7 00 p m PRCA Pro Rodeo — Stampede Arena
o Please maintain professional radio etiquette
o Maintain situational awareness "If you see something say something "
o Attend Briefings 4H building, upstairs, weekdays 1630, weekends 1030
o Provide situation report to Planning Section by 9 00 a m each day for previous days' activities
*First Responder Access is on "D" Street
RADIO CHANNELS
NMAT 11— WCSO
NMAT 12 — Security/WCSO
NMAT 13 — Greeley Fire Department
NMAT 14 — Banner Paramedics & Greeley Fire Department
GPD TAC 4 — Greeley PD
VHF — Stampede Security
Command Channel to be requested and assigned as needed **Greeley 3 not encrypted if needed
Agency/Organization
Position
Name
Phone
Number
City of Greeley
Island
Grove Park Manager
Tom Welch
(970) 371-2685
GPD
GPD
Lt.
Scott
Smith
(970) 371-3929
GPD
GPD
Sgt.
Mike Heck
(970) 371-1189
GPD
GPD Sgt.
Dennis Lobato
(970) 371-2790
GPI)
PI)
GPD Sgt.
Bill West
(970) 301-3915
GPI)
GPD Sgt.
Zach St.
Aubyn
(970) 301-0455
Stampede
Security
Chair
Mic Harvey
(970) 388-8789
Stampede
Security
Trail Boss
Brian Evans
(970) 218-6057
Stampede
General Manager
Justin Watada
(303) 885-7804
Stampede
General
Chair
John
DeWitt
(970) 302-7104
GFD
On -Duty
BC/Safety
(970) 350-9504
WCSO
Donnie Patch
(970) 518-6524
Undersheriff
BHPS
Assistant
Chief
Mitch
Wagy
(970) 381-2392
BHPS
EMS Group
On -Duty
Supervisor
(970) 302-2833
Public
Health
Food Inspections
Kristeen
Bevel
(970) 580-7088
OEM
Logistics/Radio
Roy Rudisill
(970) 381-0417
OEM
Planning
Chief
Merrie Garner
(970) 397-1076
OEM
Dept.
Planning Chief
Andrew Glendenning
(970) 590-8429
Security
Office
(970) 888-3136
GPD
Substation
(970) 353-9998
/4ts 423
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND JESSICA BRIEN
/K
This Agreement, made and entered into the/ day of
County Commissioners, on behalf of the Weld County Departmenk of 9man Services, hereinafter referred to as
the "Department' and Jessica Brien, hereinafter referred to as the "Contractor".
2017, by and between the Board of Weld
The parties to this Agreement understand and agree that the provisions of this Agreement specifically
include the following documents: Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal,
Exhibit C, Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and
incorporated herein by this reference.
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Home Studies.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This agreement shall become effective on July 1, 2017, upon proper execution of this Agreement and shall
expire June 30, 2018, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by the Contractor to any person(s) eligible for services in compliance Exhibit B,
Contractor's Proposal and Exhibit C, Scope of Services.
3. Referrals, Billing and Tracking
a. Contractor understands and will comply with all aspects of the referral authorization, billing and
tracking requirements as set forth by the Department. Failure to comply with all aspects may result
in a forfeiture of payment.
b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e-mail
address prior to the start of this Agreement. • Contractor acknowledges that services are not
authorized until the Contractor has received an authorized referral form from the Department.
Contractor further acknowledges that services provided prior to the authorized start date or outside
the scope of services on the referral form will not be eligible for reimbursement.
Contractor acknowledges that any and all modifications to an existing referral must be approved
through the Department's Resource Manager, Child Welfare Contract and Services Coordinator, or
2017-2330
i7-/7
ikoati
through a Team Decision Making (TDM) meeting or Family Team Meeting (FTM). No other
Department staff or other party to the case may authorize services or modifications to services.
c. Contractor agrees to submit an itemized complete billing statement by the 7th of the month,
following the month of service, utilizing billing forms required by the Department.
d. Contractor agrees to submit a monthly report with the billing statement by the 7th of the month
following the month of service for each client receiving ongoing services. One-time services will be
verified through receipt of the completed product (ex. psychological evaluation, substance abuse
evaluation). Verification of Monitored Sobriety Services will be the test result.
Contractor will document in detail any and all observed or verbalized concerns regarding any child
whom the Contractor is working with under the Agreement. Areas of concern may include, but are
not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be
reported immediately to the caseworker AND on the required monthly report.
Monthly reports will be submitted through the Department's online reporting system, unless
otherwise directed or agreed to by the Department.
4. Payment
a. The Department and the Contractor agree that all benefits from private insurance and/or other
funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's
Compensation must be exhausted before Core Services or other Department funds can be accessed
for services.
b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B,
Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule, attached hereto
and incorporated herein by reference, so long as services are rendered satisfactorily and in
accordance with the Agreement.
c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon,
the continuing availability of said funds for the purposes hereof.
d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the
Agreement, including the Financial Management requirements, program objectives, contractual
terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may
appeal such circumstance in writing to the Director of Human Services. The decision of the Director
of Human Services shall be final.
5. Financial Management
At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
2
expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133.
6. Payment Method
Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit 0,
Payment Schedule:
a. If services are funded through Core Services, Contractor agrees to accept reimbursement through
ACH direct deposit one time per month.
b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor
agrees to complete and submit an ACH Form for Colorado Providers, which will be provided by the
Department. Contractor is solely responsible to submit the ACH Form to the State of Colorado per
the directions on the form. Failure to complete and submit this form in a timely and accurate manner
may result in a delay of payment.
c. Contractor agrees to accept payment through county warrant when funding source does not allow
for direct deposit.
7. Compliance with Applicable Laws
a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable
Federal and State laws, order, and applicable standards, regulations, interpretations and/or
guidelines issued pursuant thereto. This includes protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials that have been or may
hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws
and regulations, including, but not limited to the following:
Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights
Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R.
Part 80 et. seq.; and
all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race,
creed, color, sex, or national origin, be excluded from participation in, be denied the benefits
of, or be otherwise subjected to discrimination under the approved Agreement.
Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing
regulations, 45 C.F.R. Part 84; and
- the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation
regulations, 45 C.F.R. Part 91; and
- Title VII of the Civil Rights Act of 1964; and
- the Age Discrimination in Employment Act of 1967; and
3
- the Equal Pay Act of 1963; and
- the Education Amendments of 1972; and
Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and
all regulations applicable to these laws prohibiting discrimination because of race, color,
national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome
(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of
1973, as amended, cited above. If necessary, Contractor and the Department will resist in
judicial proceedings any efforts to obtain access to client records except as permitted by 42
C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken
to assure that small and minority businesses are utilized, when possible, as sources of
supplies, equipment, construction and services. This assurance is given in consideration of
and for the purpose of obtaining any all Federal and/or State financial assistance.
- Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for
all employees, contractors and sub -contractors.
b. Contractor is further charged with the knowledge that any person who feels that s/he has been
discriminated against has the right to file a complaint either with the Colorado Department of Human
Services or with the United States Department of Health and Human Services, Office for Civil Rights.
c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may
govern the ability of the Department to comply with the relevant funding requirements. Contractor
understands the source of funds to be accessed under the Agreement is Child Welfare
Administration.
d. Contractor assures and certifies that it and its principals:
Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transaction by a Federal or State department or agency;
and
have not, within a three-year period preceding this Agreement, been convicted of or had a
civil judgment rendered against them for commission of fraud or criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State or
Local) transaction or contract under public transaction; violation of federal or state antitrust
statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction
of records, making false statements, or receiving stolen property; and
are not presently indicted for or otherwise criminally or civilly charged by a government
entity (federal, state or local) with commission of any of the offenses enumerated in this
certification; and
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have not, within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, or local) terminated for cause or default.
e. Contractor certifies that it shall comply with the provision of the Colorado Revised Statutes (C.R.S.) 8-
17.5-101, et. seq. Contractor shall not knowingly employ or contract with an illegal alien to perform
work under this Agreement or enter into a contract with a subcontractor that fails to certify to the
Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to
perform work under this Agreement. Contractor represents, warrants, and agrees that it (a) has
verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment
Verification Program administered by the Social Security Administration and Department of
Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b).
Contractor shall comply with all reasonable requires made in the course of an investigation under
C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If Contractors fails to
comply with any requirement of this provision or C.R.S. 8-17.5-101, et. seq., the Department may
terminate this Agreement for breach and Contractor shall be liable for actual and consequential
damages to the Department.
Except where exempted by Federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Agreement, Contractor must confirm that any individual
natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to
C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If
Contractor operates as a sole proprietor, it hereby affirms under penalty of perjury that s/he (a) is a
citizen of the United States or is otherwise lawfully present in the United State 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 this Agreement.
8. Compliance with Child and Family Services Review
The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas;
Safety, Permanency and Well Being of families. For each outcome, data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance
services to families.
Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well
Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under
this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under
the Child and Family Services Review (CFSR), and will address the aforementioned three areas when
completing monthly reports as required by Paragraph 3(d) of this Agreement.
9. Insurance Requirements
Contractor and Department agree that Weld County, the Board of County Commissioners of Weld County,
its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or
omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing
5
duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County,
the Board of County Commissioners of Weld County, its employees, volunteers and agents.
Contractor shall provide the liability insurances (including professional liability insurances where
necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged
in the performance of this Agreement which are required under Weld County's Request for Proposal, and
required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the
acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement.
At a minimum, Contractor shall procure, either personally or through its employer as applicable to the
Contractor's business, at its own expense, and maintain for the duration of the work, the following
insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners
of Weld County, its employees and agents, shall be named as additional named insured on the insurance,
where permissible the insurance provider.
a. General Requirements: Contractors/Contract Professionals must secure, at or before the time of
execution of any agreement or commencement of any work, the following insurance covering all
operations, goods or services provided pursuant to this request. Contractors/Contract
Professionals shall keep the required insurance coverage in force at all times during the term of
the Agreement, or any extension thereof, during any warranty period, and for three (3) years
after termination of the Agreement. The required insurance shall be underwritten by an insurer
licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each
policy shall contain a valid provision or endorsement stating "Should any of the above -described
policies by canceled or should any coverage be reduced before the expiration date thereof, the
issuing company shall send written notice to the Weld County Director of General Services by
certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to
such cancellation or reduction unless due to non-payment of premiums for which notice shall be
sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, County
must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall
be responsible for the payment of any deductible or self -insured retention. County reserves the
right to require Contractor/Contract Professional to provide a bond, at no cost to County, in the
amount of the deductible or self -insured retention to guarantee payment of claims. The insurance
coverages specified in this Agreement are the minimum requirements, and these requirements do
not decrease or limit the liability of Contractor/Contract Professional. Contractor/Contract
Professional shall maintain, at its own expense, any additional kinds or amounts of insurance that
it may deem necessary to cover its obligations and liabilities under this Agreement.
b. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times
during the term of any Agreement, insurance in the following kinds and amounts:
i. Workers' Compensation Insurance as required by state statute, and Employer's Liability
Insurance covering all of Contractor's Contract Professional's employees acting within
the course and scope of their employment. If Contractor is an Independent Contractor,
as defined by the Colorado Worker's Compensation Act, this requirement shall not apply.
Contractor must submit to the Department a Declaration of Independent Contractor
Status Form prior to the start of this agreement.
ii. Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93
or equivalent, covering premises operations, fire damage, independent Contractors,
products and completed operations, blanket contractual liability, personal injury, and
advertising liability with minimum limits as follows:
- $1,000,000 each occurrence;
- $2,000,000 general aggregate;
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- $50,000 any one fire; and
- $500,000 errors and omissions.
iii. Automobile Liability: Contractor/Contract Professional shall maintain limits of
$1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident,
and $1,000,000 for property damage applicable to all vehicles operating both on County
property and elsewhere.
iv. Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor
liability and pollution liability must provide the following:
If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or
reserved claims, Contractor shall notify County within ten (10) days and
reinstate the aggregates required;
Unlimited defense costs in excess of policy limits;
Contractual liability covering the indemnification provisions of this Agreement;
A severability of interests provision;
Waiver of exclusion for lawsuits by one insured against another;
A provision that coverage is primary; and
A provision that coverage is non-contributory with other coverage or self-
insurance provided by County.
v. For all general liability, excess/umbrella liability, liquor liability, pollution liability and
professional liability policies, if the policy is a claims -made policy, the retroactive date
must be on or before the contract date or the first date when any goods or services were
provided to County, whichever is earlier.
c. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator
("Administrator") at or before the time of execution of this Agreement, and shall keep in force at
all times during the term of the Agreement as the same may be extended as herein provided, a
commercial general liability insurance policy, including public liability and property damage, in
form and company acceptable to and approved by said Administrator, covering all operations
hereunder set forth in the related Bid or Request for Proposal.
d. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to
its insurance agent or broker, and shall have its agent or broker provide proof of
Contractor/Contract Professional's required insurance. County reserves the right to require
Contractor/Contract Professional to provide a certificate of insurance, a policy, or other proof of
insurance as required by the County's Risk Administrator in his sole discretion.
e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor
liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an
additional insured as follows
f. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive
subrogation rights against County.
g.
Subcontractors: All subcontractors, subcontractors, independent contractors, sub -vendors,
suppliers or other entities providing goods or services required by this Agreement shall be subject
to all of the requirements herein and shall procure and maintain the same coverages required of
Contractor/Contract Professional. Contractor/Contract Professional shall include all such
subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds
under its policies or shall ensure that all subcontractors maintain the required coverages.
Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors,
independent contractors, sub -vendors suppliers or other entities upon request by the County.
7
A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage:
Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and
$2,000,000 aggregate limit for all claims.
10. Certification
Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all
necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies
covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any Agreement.
11. Training
Contractor may be required to attend training that the request of the Department specific to services
provided under this Agreement. The Department will not compensate the Contractor for said training in
the form of registration fees, time spent traveling to and from training, attending the training or any other
associated costs unless otherwise agreed to by the Department.
12. Subpoenas
Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the
Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For
this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the
Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will
contact the Weld County Attorney's Office immediately at 970-352-1551, x6503, and advise that the
subpoena must be personally served.
13. Monitoring and Evaluation
Contractor and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners, the Department and the
Contractor.
Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with the work conducted under
this Agreement.
14. Modification of Agreement
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All modifications to this Agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
the Contractor. These remedial actions are as follows:
Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed.
Deny payment or recover reimbursement for those services or deliverables, which have not
been performed and which due to circumstances caused by the Contractor cannot be
performed or if performed would be of no value to the Department. Denial of the amount
of payment shall be reasonably related to the amount of work or deliverables lost to the
Department.
Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall
be recovered from Contractor by deduction from subsequent payments under this
Agreement or other agreements between the Department and Contractor, or by the
Department as a debt due to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s).
For Department:
Heather Walker, Administrator
17. Notice
For Contractor:
Jessica Brien, LPC
All notices required to be given by the parties hereunder shall be given by certified or registered mail to
the individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent.
For Department:
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
(970) 352-1551
9
For Contractor:
Jessica Brien, LPC
138 East 4`h Street
Loveland, CO 80537
(970) 203-4743
18. Litigation
Contractor shall promptly notify the Department in the event that Contractor learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading
which has been filed in any Federal or State court or administrative agency, shall deliver copies of such
document(s) to the Director of Human Services. The term "litigation" includes an assignment for the
benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the
individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an
obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise
appropriated in each succeeding year, as this Agreement is subject to the availability of funding.
Therefore, the Department may terminate this Agreement at any time if the source of funding for the
services made available to the Contractor is no longer available to the Department, or for any other
reason. Contractor reserves the right to suspend services to clients if funding is no longer available.
20. No Third Party Beneficiary Enforcement
It is expressly understood and agreed that the enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned parties and nothing in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties receiving services or benefits
under this Agreement shall be an incidental beneficiary only.
21. Governmental Immunity
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of
any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental
Immunity Act of §§24-10-101 et. seq. as applicable now or hereafter amended.
22. Partial Invalidity of Agreement
If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held
or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions.
The parties hereto declare that they would have entered into this Agreement and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional
or invalid.
23. Improprieties/Conflict of Interest
No officer, member or employee of weld County and no member of their governing bodies shall have any
10
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department
when the Contractor also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the
Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor
know that the two relationships are in opposition. During the term of the Agreement, Contractor shall
not enter into any third party relationship that gives the appearance of creating a conflict of interest.
Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the
Department, a full disclosure statement setting forth the details that create the appearance of a conflict
of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute
grounds for the Department's termination, for cause, of its Agreement with the Contractor.
Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of
Contractor, to any person for influencing or attempting to influence an officer or employee of an agency,
a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contract, the making of any Federal grant, the making of any
Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of an Federal contract, loan, grant, or cooperative agreement.
24. Storage, Availability and Retention of Records
Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during
business hours, have access to inspect and copy records, and shall be allowed to monitor and review
through on -site visits, all activities related to this Agreement, supported with funds under this Agreement,
to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The
results of the monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
All such records, documents, communications, and other materials created pursuant or related to this
Agreement shall be maintained by the Contractor in a central location and shall be made available to the
Department upon its request, for a period of seven (7) years from the date of final payment under this
Agreement, or for such further period as may be necessary to resolve any matters which may be pending,
or until an audit has been completed with the following qualifications: If an audit by or on behalf of the
Federal and/or State government has begun but is not completed at the end of the seven (7) year period,
or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until
the resolution of the audit finding.
25. Confidentiality of Records
Contractor shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Agreement except for purposes directly connected with the
administration of Child Protection. No information about or obtained from any applicant/recipient in
possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's
parent or guardian unless in accordance with the Contractor's written policy governing access to,
11
duplication and dissemination of, all such information, in any form, including social networks. Contractor
shall advise its employees, agents, and subcontractor, if arty, that they are subject to these confidentiality
requirements.
Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written
explanation of these confidentiality requirements before access to confidential data is permitted.
Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality
agreement and shall provide a copy of such agreement to the Department, if requested.
26. Proprietary Information
Proprietary information for the purposes of this Agreement is information relating to a party's research,
development, trade secrets, business affairs, internal operations and management procedures and those
of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third
parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither
party shall use or disclose directly or indirectly without prior written authorization any proprietary
information concerning the other party obtained as a result of this Agreement. Any proprietary
information removed from the Department's site by the Contractor in the course of providing services
under this Agreement will be accorded at least the same precautions as are employed by the Contractor
for similar information in the course of its own business.
27. Independence of Contractor: Not an Employee of Weld County
Contractor agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as
the result of this Agreement.
28. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as state in
Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or
obligations hereunder without the prior consent of both parties.
29. Agreement Nonexclusive
This Agreement does not guarantee any work nor does it create an exclusive agreement for services.
30. Warranty
The Contractor warrants that services performed under this Agreement will be performed in a manner
consistent with the professional standards governing such services and the provisions of this Agreement.
The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training,
diligence and judgment provided by highly competent individuals and entities that perform services of a
similar nature to those described in this Agreement including Exhibits A, B, C and D.
12
31. Acceptance of Services Not a Waiver
Upon completion of the work, the Contractor shall submit to Department originals of all tests and results,
reports, etc., generated during completion of this work. Acceptance by Department of reports and
incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of
responsibility for the quality and accuracy of the services. In no event shall any action by the Department
hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or
default which may then exist on the part of the Contractor, and the Department's action or inaction when
any such breach or default shall exist shall not impair or prejudice any right or remedy available to the
Department with respect to such breach or default; and no assent, expressed or implied, to any breach of
any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a
waiver of any other breach. Acceptance by the Department of, or payment for, any services performed
under this Agreement shall not be construed as a waiver of any of the Department's rights under this
Agreement or under the law generally.
32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507
The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any
personal or beneficial interest whatsoever in the service or property which is the subject matter of this
Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which
would in any manner or degree with the performance of the Contractor's services and the Contractor,
shall not employ any person having such known interests. During the term of this Agreement, the
Contractor shall not engage in any in any business or personal activities or practices or maintain any
relationships which actually conflict with or in any way appear to conflict with the full performance of its
obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may
result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of
the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or
hold any such position which either by rule, practice or action nominates, recommends, supervises
Contract Professional's operations, or authorizes funding to the Contractor.
33. Board of County Commissioners of Weld County Approval
This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld
County, Colorado.
34. Choice of Law/Jurisdiction
Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation,
execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference
which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute
13
between the parties, Contract Professional agrees that the Weld County District Court shall have exclusive
jurisdiction to resolve said dispute.
35. Attorneys Fees/Legal Costs
In the event of a dispute between County and Contract Professional, concerning this Agreement, the
parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs
incurred by or on its own behalf.
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IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and
year first above written.
COUNTY:
ATTEST:
Weld Cou
By:
Deputy Clerk to f e Board
Clerk to the Board
Jicito;eik
15
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
Julie Cozad, Chair
CONTRACTOR:
JUL 17 2017
Jessica Brien, LPC
138 East 4th Street
Loveland, CO 80537
(970) 203-4743
By:
Date:
Jess(cs Brien, LPC
OZoi7- a33O
EXHIBIT A
WELD COUNTY'S REQUEST FOR PROPOSAL
REQUEST FOR BIDS AND PROPOSALS
WELD COUNTY, COLORADO
1150 O STREET
GREELEY, CO 80634
GO N
DATE: April 3, 2017
BID NUMBER: 81700080
DESCRIPTION: Annual Request for Various Services
DEPARTMENT: Human Services
MANDATORY PRE -BID CONFERENCE DATE: N/A
BID OPENING DATE: APRIL 24, 2017
PAGES 1-9 OF THIS DOCUMENT CONTAINS GENERAL INFORMATION. NOT ALL OF THE INFORMATION
CONTAINED IN PAGES 1-9 MAY BE APPLICABLE. THE SCOPE OF WORK AND SPECIFICATIONS UNIQUE TO
THIS REQUEST FOR BID FOLLOW PAGE 9.
I. NOTICE TO BIDDERS
A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of
Human Services, by and through the Board of Weld County Commissioners, wishes to purchase the
following:
VARIOUS ENGLISH AND BILINGUAL (ENGLISH/SPANISH) SERVICES (SERVICE AREAS INCLUDED IN THIS
PROPOSAL INCLUDE, BUT ARE NOT LIMITED TO THE BELOW LIST. OTHER SERVICES WILL BE
CONSIDERED AND BIDDERS ARE ENCOURAGED TO SUBMIT FOR UNIQUE AND CREATIVE SERVICES.)
RIA
Definition
Aftercare Services
Services provided to prepare a child for reunification with his/her family or
other permanent placement and to prevent future out- of -home placement
of the child.
Anger
Management/Domestic
Violence
Diagnostic and/or therapeutic services to assist in the development of the
family services plan, to assess and/or improve familycommunication,
functioning and relationships, and to prevent further domesticviolence.
1
-- _ , - _ -'--- -- -- -
Crisis Intervention and
Stabilization Services
Services that provide an immediate, in- person/in- home response to
families, youth and children, in
*crisis, 24 hours a day, seven (7) days a week.
*A "crisis" is further defined as a situation or circumstance, usually acute
(recent) in nature, which breaks down the normal functioning of an
individual and/or family, and results in the inability of the individual and/or
family to resolve the crisis through normal coping behaviors, orwithout
Day Treatment
Comprehensive, highly structured services that provide education to children
and therapy to children and theirfamilies.
Foster ParentConsultation
Services provided to foster and group home families caring for Weld
County children and youth in their homes to enhance and improve the
quality of care being provided.
Foster ParentTraining
Core training for new Weld County foster parents.
Functional Family Therapy
Intensive family -based treatment that addresses the pervasive patterns of
relational dysfunction known to be determinants of conduct disorder, violent
acting out, and substance abuse among youth 10-18 yearsold.
Home -Based Intervention
Services provided primarily in the home of the client that include a variety of
services which can include therapeutic services, concrete services, collateral
services and *crisis intervention directed to meet the needs of the child and
family.
*Crisis Intervention is defined as 24/7 phone access and in -home
counseling.
Kinship Services
(Therapeutic)
Kinship services in the areas of (1) consultation and kinship parent support
specific to a child placed in a kinship home, (2) corrective consultation specific
to a child placed in a kinship home, and (3) critical care consultation specific
to a child placed in a kinship home. Children placed in kinship care are
maintained in the lowest level of care and least restrictive setting when out -
of -home placement is necessary.
Life Skills
Visitation (both in -home and in -office) and services provided primarily in the
home that teach household management, effective accessto community
resources, parenting techniques and family conflict management.
Mediation/Intensive Family
Therapy
Therapeutic intervention typically with all family members to improve
family communication, functioning and relationships.
2
Mental Health Services
Diagnostic g ostic and/or therapeutic services to assist in the development of
family services plan, to assess and/or improve family communication,
functioning and relationships.
Multi-systemicTherapy
Intensive family -and community -based treatment program designed to make
positive changes in the various social systems (home, school, community, peer
relations) that contribute to the serious antisocial behaviors of children and
adolescents who are at risk for out -of -home placement.
Relinquishment Counseling
Relinquishment counseling for parents considering relinquishment of their
children.
Substance Abuse Treatment
Services
Diagnostic and/or therapeutic services to assist in the development of the
Family Service Plan (FSP), to assess and/or improve family communication,
functioning and relationships, and to prevent further abuse of drugs or
alcohol.
Other
Creative and unique services designed to meet the needs of children,
youth and families interacting with the Child Welfare system through a
prevention or traditional case.
B. Bids for the stated services will be received by the Weld County Department of Human Services, Resource
Unit, Attn: Tobi Vegter, through: MONDAY, APRIL 24, 2017, AT 5:00 P.M. (WELD COUNTY DEPARTMENT OF
HUMAN SERVICES, RESOURCE UNIT TIME CLOCK). Acceptable bid delivery methods are as follows:
Email. Emailed bids are preferred. Bids should be emailed to: vegterta@weldgov.com. Emailed bids must
include the following statement on the email: "I hereby waive my right to a sealed bid". An email
confirmation will be sent when we receive your bid/proposal.
Mail. Mailed bids should be sent in a sealed envelope with the bid title and bid number on it. Bids must include
the following statement on the email: "Ihereby waive my right to a sealed bid". Mailed bids should be
addressed to: Weld County Department of Human Services, Attn: Tobi Vegter, Division of Child Welfare,
Financial Unit, P.O. Box A, Greeley, CO 80632. Please call or email Tobi Vegter at 970-400-6392 or
vegterta@weldgov.com if you have any questions.
Hand Delivery. Hand -delivered bids should be submitted in a sealed envelopewith the bid title and bid number
on it. Bids must include the following statement on the email: "I hereby waive my right to a sealed bid". Hand -
delivered bids can be dropped off at: Weld County Department of Human Services, Attn: Tobi Vegter, Financial
Unit, 822 7th Street, Suite 150, Greeley, CO 80631. Please call or email Tobi Vegter at 970-400-6392 or
vegterta@weldgov.com if you have any questions.
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II. INVITATION TO BID
A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human
Services, by and through the board of Weld County Commissioners requests bids for the purchase of Various
Services (as described above).
B. Bids shall include any and all charges for service(s) applied for by the bidder, and shall, in every way, be the
total net price which the bidder will expect the Board of County Commissioners of Weld County to pay if
awarded the bid.
C. Emailed Bids Are Preferred. Emailed (fully typed) bids are preferred. However, if the bidder is unable to
submit an emailed bid, the bidder must comply with the requirements set forth in Paragraph I, B. An emailed
bid must contain the following statement: "I hereby waive my right to a sealed bid."
D. Unless the Bid is emailed, one original and one copy of the Bid must be submitted. One complete bid
document, which will be the only official copy of the bid, shall be filed at the Weld County Department of
Human Services, Resource Unit. After certification of the bid, the other copy will be routed for applicable
review. An e-mail confirmation will be sent when we receive your bid/proposal.
III.INSTRUCTIONS TO BIDDERS
A. Bids shall be typewritten. Each bid must give the full business address of the bidder and be signed by him
with his usual signature. Bids by partnerships must furnish the full names of all partners and must be signed
with the partnership name by one of the partners of the partnership or by an authorized representative,
followed by the signature and title of the person signing. Bids by corporations must be signed with the legal
name of the corporation, followed by the name of the state of the incorporation and by the signature and
title of the president, secretary, or other person authorized to bind it in this matter. Bids submitted by
limited liability companies must furnish the full names of all members and managers and must be signed by a
manager or by an authorized representative, followed by the signature and title of the person signing. The
name of each person signing shall also be typed or printed below the signature. A bid by a person who affixes
to his signature the word "president," "secretary," "agent," or other title without disclosing his principal, may
be held to be the bid of the individual signing. When requested, satisfactory evidence of the authority of
the officer signing in behalf of a corporation shall be furnished. All corrections or erasures shall be initialed by
the person signing the bid. All bidders shall agree to comply with all of the conditions, requirements,
specifications, and/or instructions of this bid as stated or implied herein. All designations and prices shall be
fully and clearly set forth.
B. Bids may be withdrawn upon written request to the Weld County Department of Human Services received
from bidders prior to the submission deadline. Negligence on the part of bidder in preparing the bid
confers no right for the withdrawal of the bid after it has been opened.
C. Bidders are expected to examine the conditions, specifications, and all instructions contained herein. Failure
to do so will be at the bidder's risk.
D. Bidders shall not stipulate in their proposals any conditions not contained in the instructions and
specifications herein unless specifically requested by the special instructions attached hereto. Any proposal
which fails to comply with the letter of the instructions and specifications herein may be rejected.
E. Late or unsigned bids shall not be accepted or considered. It is the responsibility of the bidder to ensure that
the bid arrives in the Weld County Department of Human Services, Service Utilization Unit, on or prior to the
time indicated in Section I., entitled "Notice to Bidders."
F. When approximate quantities are stated, Weld County reserves the right to increase or decrease quantity
as best fits its needs.
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G. Whenever requested, samples or descriptive matter shall be filed prior to the opening of bids.
H. In accordance with Section 14-9(3) of the Weld County Home Rule Charter, the Board of County
Commissioners of Weld County will give preference to resident Weld County bidders in all cases where
said bids are competitive in price and quality. It is also understood that the Board of County
Commissioners of Weld County will give preference to suppliers from the State of Colorado, in accordance
with Section 30-11-110, CRS, when it is accepting bids for the purchase of any books, stationery, records,
printing, lithographing or other supplies for any officer of Weld County.
I. All discounts shall be figured from the date of delivery and acceptance of the articles, or in the case of
an incorrect invoice, from the date of receipt of corrected invoice, if this be subsequent to delivery and
acceptance.
J. Substitutions or modifications to any of the terms, conditions, or specifications of this bid package which
are made by Weld County, Colorado, after the bids have been distributed to prospective bidders, and prior
to the date and time of bid opening, will be made in writing and signed by the Families, Youth and Children's
Commission. No employee of Weld County, Colorado, is authorized in any way to modify any of the terms,
conditions, or specifications of this bid without written approval of Families, Youth and Children's
Commission. This is not to imply that bids will not be accepted or considered with specifications which are
different from those herein. Any item which does not meet all the terms, conditions, or specifications of this
bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal
sheets and returned with the bid.
K. The successful bidder shall indemnify and hold harmless Weld County, Colorado, against all claims for
royalties, for patents or suit for infringement thereon, which may be involved in the manufacture or use of the
material to be furnished.
L. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the
Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the
requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests made in the
course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If
Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et seq., Weld County may
terminate this Contract for breach and Contractor shall be liable for actual and consequential damages to Contractor.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5- 103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural person
eighteen (18) years of age orolder is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4)
if such individual applies for public benefits provided under this Contract. If Contractor operates as a sole
proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of the United States or
is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms
of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification
required by C.R.S. 24-76.5-103 prior to the effective date of a Contract.
M.All goods shall remain the property of the seller until delivered to and accepted by Weld County, Colorado.
N. Bids received prior to the time of opening will be kept unopened in a secure place. No responsibility will
attach to the Families, Youth and Children Commission, the Weld County Department of Human Services, or
the Board of Weld County Commissioners, for the premature opening of a bid not properly addressed and
identified.
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O. In submitting the bid, the bidder agrees that the acceptance of any and all bids by the Board of County
Commissioners of Weld County within a reasonable time or period does not constitute a contract. The Board
of County Commissioners of Weld County, Colorado, reserves the right to reject any and all bids, to waive any
informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best
interests of the Board and of the County of Weld, State of Colorado.
P. These instructions, the proposal forms, and specifications have been developed with the hope of raising the
standard of purchasing negotiations to a level wherein all transactions will be mutually satisfactory. Your
cooperation is invited.
Q. Substitutions or modifications to any of the terms, conditions, or specifications of this which are made by
Weld County after the bids have been distributed to prospective bidders and prior to the date and time of bid
opening, will be made in writing. No employee of Weld County is authorized in any way to modify any of the
terms, conditions, or specifications of this bid without written approval of said Director of the Weld County
Department of Human Services. This is not to imply that bids will not be accepted or considered with
specifications which are different from those herein. Any item which does not meet all the terms, conditions,
or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid
specification and proposal sheets and returned with the bid.
IV.GENERAL SPECIFICATIONS
A. Fund Availability: Financial obligations of the Weld County payable after the current fiscal year are
contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. By
acceptance of the bid, Weld County does not warrant that funds will be available to fund the contract beyond the
current fiscal year.
B. Governmental Immunity: No term or condition of the contract shall be construed or interpreted as a waiver,
express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado
Governmental Immunity Act §§24- 10-101 et seq., as applicable now or hereafter amended.
C. Independent Contractor: The successful bidder shall perform its duties hereunder as an independent
contractor and not as an employee. He or she shall be solely responsible for its acts and those of its agents and
employees for all acts performed pursuant to the contract. Neither the successful bidder nor any agent or
employee thereof shall be deemed to be an agent or employee of Weld County. The successful bidder and its
employees and agents are not entitled to unemployment insurance or workers' compensation benefits
through Weld County and Weld County shall not pay for or otherwise provide such coverage for the
successful bidder or any of its agents or employees. Unemployment insurance benefits will be available to the
successful bidder and its employees and agents only if such coverage is made available by the successful bidder
or a third party. The successful bidder shall pay when due all applicable employment taxes and income taxes
and local head taxes (if applicable) incurred pursuant to the contract. The successful bidder shall not have
authorization, express or implied, to bind Weld County to any agreement, liability or understanding, except as
expressly set forth in the contract. The successful bidder shall have the following responsibilities with regard to
workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force
workers' compensation and unemployment compensation insurance in the amounts required by law, and (b)
provide proof thereof when requested to do so by Weld County.
D. Compliance with Law: The successful bidder shall strictly comply with all applicable federal and State laws,
rules and regulations in effect or hereafter established, including without limitation, laws applicable to
discrimination and unfair employment practices.
E. Choice of Law: Colorado law, and rules and regulations established pursuant thereto, shall be applied in the
interpretation, execution, and enforcement of the contract. Any provision included or incorporated herein by
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reference which conflicts with said laws, rules and/or regulations shall be null and void.
F. Binding Arbitration Prohibited: Weld County does not agree to binding arbitration by any extra -judicial body
or person. Any provision to the contrary in the contract or incorporated herein by reference shall be null and
void.
G. No Third Party Beneficiary Enforcement: It is expressly understood and agreed that the enforcement of the
terms and conditions of the contract, and all rights of action relating to such enforcement, shall be strictly
reserved to the undersigned parties and nothing in the contract shall give or allow any claim or right of action
whatsoever by any other person not included in the contract. It is the express intention of the undersigned
parties that any entity other than the undersigned parties receiving services or benefits under the contract
shall be an incidental beneficiary only.
H. Attorney Fees/Legal Costs: In the event of a dispute between Weld County and the successful bidder,
concerning the contract, the parties agree that Weld County shall not be liable to or responsible for the
payment of attorney fees and/or legal costs incurred by or on behalf of the successful bidder.
V. Insurance Requirements
i. General Requirements: Contractors/Contract Professionals must secure, at or before the time of execution
of any agreement or commencement of any work, the following insurance covering all operations, goods or
services provided pursuant tothis request. Contractors/Contract Professionals shall keep the required
insurance coverage in force at all times during the term of the Agreement, or any extension thereof, during any
warranty period, and for three (3) years after termination of the Agreement. The required insurance shall be
underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or
better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described
policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing
company shall send written notice to the Weld County Director of General Services by certified mail,
return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or
reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any
policy is in excess of a deductible or self -insured retention, County must be notified by the
Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any
deductible or self -insured retention. County reserves the right to require Contractor/Contract Professional to
provide a bond, at no cost to County, in the amount of the deductible or self -insured retention to guarantee
payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and
these requirements do not decrease or limit the liability of Contractor/Contract Professional.
Contractor/Contract Professional shall maintain, at its own expense, any additional kinds or amounts of
insurance that it may deem necessary to cover its obligations and liabilities under this Agreement.
ii. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the
term of any Agreement, insurance in the following kinds and amounts:
(a). Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance
covering all of Contractor's Contract Professional's employees acting within the course and scope of their
employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation
Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent
Contractor Status Form prior to the start of this agreement.
(b). Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent,
covering premises operations, fire damage, independent Contractors, products and completed operations,
blanket contractual liability, personal injury, and advertising liability with minimum limits as follows:
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• $1,000,000 each occurrence;
• $2,000,000 general aggregate;
• $50,000 any one fire; and
• $500,000 errors and omissions.
(c). Automobile Liability: Contractor/Contract Professional shall maintain limits of
$1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for
property damage applicable to all vehicles operating both on County property and elsewhere.
(d). Additional Provisions:
• Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must
provide the following:
• If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or reserved claims,
Contractor shall notify County within ten (10) days and reinstate the aggregates required;
• Unlimited defense costs in excess of policy limits;
• Contractual liability covering the indemnification provisions of this Agreement;
• A severability of interests provision;
• Waiver of exclusion for lawsuits by one insured against another;
• A provision that coverage is primary; and
• A provision that coverage is non-contributory with other coverage or self- insurance provided by
County.
(e). For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability
policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or
the first date when any goods or services were provided to County, whichever is earlier.
iii. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator
("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times
during the term of the Agreement as the same may be extended as herein provided, a commercial general
liability insurance policy, including public liability and property damage, in form and company acceptable to
and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request
for Bid.
iv. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its
insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract
Professional's required insurance to the County. County reserves the right to require Contractor/Contract
Professional to provide a certificate of insurance, a policy, or other proof of insurance as required by the
County's Risk Administrator in his sole discretion.
v. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability,
and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured.
vi. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation
rights against County.
vii. Subcontractors: All subcontractors, subcontractors, independent contractors, sub- vendors, suppliers or
other entities providing goods or services required by this Agreement shall be subject to all of the
requirements herein and shall procure and maintain the same coverages required of Contractor/Contract
Professional. Contractor/Contract Professional shall include all such subcontractors, independent contractors,
sub -vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors
maintain the required coverages.
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Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors,
independent contractors, sub -vendors suppliers or other entities upon request by the County.
A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage:
Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000
aggregate limit for all claims.
VI.Warranty. The successful bidder shall warrant that:
A. The services to be supplied pursuant to this bid are fit and sufficient for the purpose intended;
B. The services sold to Weld County, Colorado pursuant to this bid conform to the minimum Weld County
specifications as established herein.
VI. CONFIDENTIAL INFORMATION
Confidential financial information of the bidder should be transmitted separately from the main bid submittal,
clearly denoting in red on the financial information at the top the word, "CONFIDENTIAL." However, the
successful bidder is advised that as a public entity, Weld County must comply with the provisions of
C.R.S. 24-72-201, et seq., the Colorado Open Records Act (CORA), with regard to public records, and cannot
guarantee the confidentiality of all documents. If Weld County receives a CORA request for bid information
marked "CONFIDENTIAL", staff will attempt to contact the bidder in order to allow the bidder to seek an
appropriate court order preventing disclosure. Without such an order, Weld County will release the requested
information in accordance with CORA.
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SCOPE OF SERVICES
PURPOSE: The Weld County Department of Human Services (WCDHS) is seeking qualified English-
speaking and bilingual (English/Spanish) providers in various service areas under various funding sources.
Service areas include, but are not limited to, Anger Management/Domestic Violence, Day Treatment,
Foster Parent Consultation, Foster Parent Training, Functional Family Therapy, Kinship Services
(Therapeutic), Home Studies/Relinquishment Counseling, Life Skills, Mediation, Mental Health,
Monitored Sobriety, Multi -Systemic Therapy, Home Based Intervention including 24/7 Crisis Intervention,
Sexual Abuse Treatment, and Substance Abuse Treatment Services and Aftercare Services.
SERVICE AREAS ARE NOTED BEGINNING ON PAGE 1 OFTHIS REQUEST FOR BID, BUT ARE NOT LIMITED
TO THOSE LISTED. OTHER SERVICES WILL BE CONSIDERED AND BIDDERS ARE ENCOURAGED TO SUBMIT
FOR UNIQUE AND CREATIVESERVICES.
Qualifications:
To be considered, a bidder must meet the following minimum qualifications:
1) Complete a Provider Information Form (PIF).
2) If submitting to provide bilingual services, a bidder must demonstrate language proficiency at Full
Professional Proficiency or higher, as defined by the U.S. Department of State, and as noted below.
• Full Professional Proficiency: Able to use and read the language fluently and accurately on all
levels pertinent to professional needs
• Native or Bilingual Proficiency: Equivalent to that of an educated native speaker (both speaking
and reading).
3) A bidder must agree to language proficiency testing that may include assessment of reading, writing
and comprehension of Spanish, as well as a face-to-face conversation with a known native or proficient
Spanish speaker selected by Weld County.
4) A bidder must submit a one page or less cover letter that introduces the bidder, the bidder's
location(s) of practice and target area, his or her experience and qualifications, and staff, if applicable. A
bidder must include current contact information including physical address, mailing address, phone
number, email address and website, if applicable.
5) A bidder must submit sufficient information concerning each proposed service for Weld County to
evaluate whether or not the bidder meets "minimum qualifications" for all bidders. Each service must be
submitted as its own proposal, inclusive of scope of services and rate information. The scope of service
should include at a minimum the following information for each service proposed:
• Detailed description of service components, modalities used, appropriate use of service, etc.
• Target population including age range, specific population characteristics, area of service, etc.
• Whether or not the service is billable to Medicaid and if bidder is currently able to bill Medicaid.
Bidders are strongly encouraged to become Medicaid certified. Medicaid -billable services are •
preferred.
• Clear rate schedule inclusive of all costs bidder wishes to charge for the provision of the service.
6) A bidder should avoid elaborate artwork, graphics, binding, presentation or other artifice that does
not directly address the requirements set forth in this Request for Bid.
7) A bidder must demonstrate the knowledge, training and expertise to conduct the proposed service(s).
8) A bidder must provide a current resume, as well as proof of licensure, for self, staff members and
contractors of the bidder. Additionally, a bidder must include proof of inclusion on State vendor lists if
applicable to the proposed service (ex. Home Study Providers, Sex Offender Management Board
Providers).
9) A bidder should clearly outline the supervisory structure of staff members and/or contractors of the
bidder. This should include the ratio of supervisor to staffand/or contractors, frequency and duration of
supervision, credentials of supervisor and length of time as a supervisor.
10) A bidder should clearly outline the bidder's internal referral acceptance and assignment protocol,
including communication to the referring agency.
11) A bidder must demonstrate familiarity with Trauma Informed Care. Bidder must provide copies of
applicable training certificates, or proof of registration for training, for all staff members who manage
and/or administer services under this proposal.
12) A bidder must demonstrate prior and current capacity to be organized, responsive and to quickly
and successfully schedule services as requested.
13) A bidder must agree to track outcome data related to services proposed if awarded a contract and
report outcomes upon request.
14) A bidder must agree to enter into an agreement, attached as Exhibit A, with the Weld County
Department of Human Services and comply with all requirements of the agreement.
Contract Period and Pricing:
1) The initial contract period is to be determined and shall continue as allowable by the funding source,
so long as both parties are satisfied. The selected vendor(s) will have the opportunity to resubmit
annually.
2) The initial contract will be funded through Core Services Program or other funding, so long as funding
is made available.
3) The selected vendor will bill the Weld County Department of Human Services monthly according to
billing requirements set forth by the Weld County Department of Human Services.
Submittal Requirements for All Proposals:
A bidder must submit according to requirements set forth in this Request for Bid - Qualifications. All
proposals must contain the following specific information:
1) Provider Information Form (PIF).
2) Identification of language(s) and proficiency level, if applying to provide bilingual (English/Spanish)
services.
3) One page or less cover letter that introduces the bidder, the bidder's location(s) of practice, his or her
experience and qualifications, and staff, if applicable.
4) A bidder must submit sufficient information concerning each proposed service for Weld County to
evaluate whether or not the bidder meets"minimum qualifications" for all bidders. Each service must
be submitted as its own proposal, inclusive of scope of services and rate information. The scope of
service should include at a minimum the following information for each service proposed:
• Detailed description of service components, modalities used, appropriate use of service, etc.
• Target population including age range, specific population characteristics, area of service, etc.
• Whether or not the service is billable to Medicaid and if bidder is currently able to bill Medicaid.
Bidders are strongly encouraged to become Medicaid certified. Medicaid -billable services are
preferred.
• Clear rate schedule inclusive of all costs bidder wishes to charge for the provision of the service.
5) Bidders should avoid elaborate artwork, graphics, binding, presentation or other artifice that does not
directly address the requirements set forth in this Request for Bid.
6) Current resume, proof of licensure and copies of applicable training certificates for all staff members
who will manage and/or administer services under this proposal.
7) Supervisory structure of staff members and/or contractors of the bidder. This should include the ratio
of supervisor to staff and/or contractors, frequency and duration of supervision, credentials of supervisor
and length of time as a supervisor.
8) Internal referral acceptance and assignment protocol, including communication to the referring
agency.
9) All proposals must demonstrate the bidder has the ability to deliver the services as proposed, and
comply with the specific requirements set forth by the Weld County Department of Human Services.
10) All proposals must include a clear and concise rate schedule that accurately correlates to the
proposed services and is inclusive of all possible charges related to the proposed service(s). The rate
schedule must demonstrate an exact fee for the described service (s). Approximate rates or a range of
rates for a service will not be accepted.
11) Each bidder must submit a Standard Certificate of insurance, or letter of intent from an insurance
company authorized to do business in the State of Colorado stating its willingness to insure the bidder
pursuant to the terms of this Request for Bid.
Evaluation of Proposals:
All proposals that meet the basic proposal, service and qualification requirements will be reviewed by the
Families, Youth and Children (FYC) Commission. Criteria for review, include but are not limited to the
following:
• Qualifications, appropriate licensure, and experience.
• Cost structure.
• Relationships and collaboration.
• Organizational experience and past performance.
The FYC Commission will make recommendations to the Board of Weld County Commissioners by and
through the Weld County Department of Human Services. The Weld County Department of Human
Services will make its award of contract to the successful bidders upon final approval of the Board of
Weld County Commissioners.
EXHIBIT A
SAMPLE AGREEMENT
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND
This Agreement, made and entered into the _ day of , 2015, by and between the Board of Weld
County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as
the "Department' and «Contractor», hereinafter referred to as the "Contractor".
The parties to this Agreement understand and agree that the provisions of this Agreement specifically
include the following documents: Exhibit A, Weld County's Reuquest for Proposal, Exhibit B, Contractor's Proposal,
Exhibit C, Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and
incorporated herein by this reference.
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Services has provided funding to the Department
for
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This agreement shall become effective on , upon proper execution of this Agreement and shall
expire unless sooner terminated as provided herein. The agreement is for a period of three years.
However, the agreement must be renewed by both parties, in writing, on an annual basis.
2. Scope of Services
Services shall be provided by the Contractor to any person(s) eligible for services in compliance with
Exhibit B, Contractor's Proposal and Exhibit C, Scope of Services.
3. Referrals, Billing and Tracking
a. Contractor understands and will comply with all aspects of the referral authorization, billing and
tracking requirements as set forth by the Department. Failure to comply with all aspects may result
in a forfeiture of payment.
b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e-
mail address prior to the start of this Agreement. Contractor acknowledges that services are not
authorized until the Contractor has received an authorized referral form from the Department.
Contractor further acknowledges that services provided prior to the authorized start date or outside
the scope of services on the referral form will not be eligible for reimbursement.
Contractor acknowledges that any and all modifications to an existing referral must be approved
through the Department's Resource Manager, Child Welfare Contract and Services Coordinator, or
through a Team Decision Making (TDM) meeting or Family Team Meeting (FTM). No other
Department staff or other party to the case may authorize services or modifications to services.
c. Contractor agrees to submit an itemized complete billing statement by the 7th of the month,
following the month of service, utilizing billing forms required by the Department.
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d. Contractor agrees to submit a monthly report with the billing statement by the 7th of the month
following the month of service for each client receiving ongoing services. One-time services will be
verified through receipt of the completed product (ex. psychological evaluation, substance abuse
evaluation). Verification of Monitored Sobriety Services will be the test result.
Contractor will document in detail any and all observed or verbalized concerns regarding any child
whom the Contractor is working with under the Agreement. Areas of concern may include, but are
not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be
reported immediately to the caseworker AND on the required monthly report.
Monthly reports will be submitted through the Department's online reporting system, unless
otherwise directed or agreed to by the Department.
4. Payment
a. The Department and the Contractor agree that all benefits from private insurance and/or other
funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's
Compensation must be exhausted before Core Services or other Department funds can be accessed
for services.
b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit
B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule, attached
hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in
accordance with the Agreement.
c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent
upon, the continuing availability of said funds for the purposes hereof.
d. The Department may withhold reimbursement if Contractor has failed to comply with any part of
the Agreement, including the Financial Management requirements, program objectives, contractual
terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may
appeal such circumstance in writing to the Director of Human Services. The decision of the Director
of Human Services shall be final.
5. Financial Management
At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133.
6. Payment Method
Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services , and Exhibit D,
Payment Schedule:
a. If services are funded through Core Services, Contractor agrees to accept reimbursement
through ACH direct deposit one time per month.
b. If Contractor is not currently set up with the State of Colorado to accept direct deposit,
Contractor agrees to complete and submit an ACH Form for Colorado Providers, which will be
provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of
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Colorado per the directions on the form. Failure to complete and submit this form in a timely and
accurate manner may result in a delay of payment.
c. Contractor agrees to accept payment through county warrant when funding source does not
allow for direct deposit.
7. Compliance with Applicable Laws
a. At all times during the performance of this Agreement, Contractor will strictly adhere to all
applicable Federal and State laws, order, and applicable standards, regulations, interpretations
and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials that have been or may
hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws
and regulations, including, but not limited to the following:
- Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil
Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45
C.F.R. Part 80 et. seq.; and
- all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of
race, creed, color, sex, or national origin, be excluded from participation in, be denied the
benefits of, or be otherwise subjected to discrimination under the approved Agreement.
- Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its
implementing regulations, 45 C.F.R. Part 84; and
- the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its
implementation regulations, 45 C.F.R. Part 91; and
Title VII of the Civil Rights Act of 1964; and
the Age Discrimination in Employment Act of 1967; and
the Equal Pay Act of 1963; and
the Education Amendments of 1972; and
Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and
- all regulations applicable to these laws prohibiting discrimination because of race, color,
national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome
(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of
1973, as amended, cited above. If necessary, Contractor and the Department will resist in
judicial proceedings any efforts to obtain access to client records except as permitted by 42
C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken
to assure that small and minority businesses are utilized, when possible, as sources of
supplies, equipment, construction and services. This assurance is given in consideration of
and for the purpose of obtaining any all Federal and/or State financial assistance.
- Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks
for all employees, contractors and sub -contractors.
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b. Contractor is further charged with the knowledge that any person who feels that s/he has been
discriminated against has the right to file a complaint either with the Colorado Department of Human
Services or with the United States Department of Health and Human Services, Office for Civil Rights.
c. Contractor assures that it will fully comply with all other applicable Federal and State laws which
may govern the ability of the Department to comply with the relevant funding requirements.
Contractor understands the source of funds to be accessed under the Agreement is Core Services.
d. Contractor assures and certifies that it and its principals:
- Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transaction by a Federal or State department or agency;
and
- have not, within a three-year period preceding this Agreement, been convicted of or
had a civil judgment rendered against them for commission of fraud or criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State or
Local) transaction or contract under public transaction; violation of federal or state antitrust
statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction
of records, making false statements, or receiving stolen property; and
- are not presently indicted for or otherwise criminally or civilly charged by a government
entity (federal, state or local) with commission of any of the offenses enumerated in this
certification; and
- have not, within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, or local) terminated for cause or default.
e. Public Contracts for Services C.R.S. §8-17.5-101. Contract Professional certifies, warrants, and
agrees that it does not knowingly employ or contract with an illegal alien who will perform work under
this contract. Contract Professional will confirm the employment eligibility of all employees who are
newly hired for employment in the United States to perform work under this Agreement, through
participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S.
§8-17.5-102(5)(c). Contract Professional shall not knowingly employ or contract with an illegal alien to
perform work under this Agreement or enter into a contract with a subcontractor that fails to certify
with Contract Professional that the subcontractor shall not knowingly employ or contract with an illegal
alien to perform work under this Agreement. Contract Professional shall not use E -Verify Program or
State of Colorado program procedures to undertake pre -employment screening or job applicants while
this Agreement is being performed. If Contract Professional obtains actual knowledge that a
subcontractor performing work under the public contract for services knowingly employs or contracts
with an illegal alien Contract Professional shall notify the subcontractor and County within three (3)
days that Contract Professional has actual knowledge that a subcontractor is employing or contracting
with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or
contracting with the illegal alien within three (3) days of receiving notice. Contract Professional shall
not terminate the contract if within three days the subcontractor provides information to establish that
the subcontractor has not knowingly employed or contracted with an illegal alien. Contract
Professional shall comply with reasonable requests made in the course of an investigation, undertaken
pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contract
Professional participates in the State of Colorado program, Contract Professional shall, within twenty
days after hiring a new employee to perform work under the contract, affirm that Contract Professional
has examined the legal work status of such employee, retained file copies of the documents, and not
altered or falsified the identification documents for such employees. Contract Professional shall deliver
to County, a written notarized affirmation that it has examined the legal work status of such employee,
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and shall comply with all of the other requirements of the State of Colorado program. If Contract
Professional fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq.,
County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be
liable for actual and consequential damages.
f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if
Contract Professional receives federal or state funds under the contract, Contract Professional must
confirm that any individual natural person eighteen (18) years of age or older is lawfully present in
the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits
provided under the contract. If Contract Professional operates as a sole proprietor, it hereby swears
or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully
present in the United States pursuant to federal law, (b) shall produce one of the forms of
identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of
identification required by C.R.S. § 24-76.5-103 prior to the effective date of the contract.
8. Compliance with Child and Family Services Review
The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas;
Safety, Permanency and Well Being of families. For each outcome, data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance
services to families.
Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well
Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under
this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under
the Child and Family Services Review (CFSR), and will address the aforementioned three areas when
completing monthly reports as required by Paragraph 3(d) of this Agreement.
9. Insurance Requirements
Contractor and Department agree that Weld County, the Board of County Commissioners of Weld County,
its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or
omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing
duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County,
the Board of County Commissioners of Weld County, its employees, volunteers and agents.
Contractor shall provide the liability insurances (including professional liability insurances where
necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged
in the performance of this Agreement which are required under Weld County's Request for Proposal, and
required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the
acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement.
At a minimum, Contractor shall procure, either personally or through its employer as applicable to the
Contractor's business, at its own expense, and maintain for the duration of the work, the following
insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners
of Weld County, its employees and agents, shall be named as additional named insured on the insurance,
where permissible the insurance provider.
a. General Requirements: Contractors/Contract Professionals must secure, at or before the
time of execution of any agreement or commencement of any work, the following insurance
covering all operations, goods or services provided pursuant to this request. Contractors/Contract
Professionals shall keep the required insurance coverage in force at all times during the term of
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the Agreement, or any extension thereof, and during any warranty period. The required insurance
shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best
Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating
"Should any of the above -described policies by canceled or should any coverage be reduced
before the expiration date thereof, the issuing company shall send written notice to the Weld
County Director of General Services by certified mail, return receipt requested. Such written
notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-
payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess
of a deductible or self -insured retention, County must be notified by the Contractor/Contract
Professional. Contractor/Contract Professional shall be responsible for the payment of any
deductible or self -insured retention. County reserves the right to require Contractor/Contract
Professional to provide a bond, at no cost to County, in the amount of the deductible or self -
insured retention to guarantee payment of claims. The insurance coverages specified in this
Agreement are the minimum requirements, and these requirements do not decrease or limit the
liability of Contractor/Contract Professional. Contractor/Contract Professional shall maintain, at
its own expense, any additional kinds or amounts of insurance that it may deem necessary to
cover its obligations and liabilities under this Agreement.
b. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all
times during the term of any Agreement, insurance in the following kinds and amounts:
Workers' Compensation Insurance as required by state statute, and Employer's
Liability Insurance covering all of Contractor's Contract Professional's employees acting
within the course and scope of their employment. If Contractor is an Independent
Contractor, as defined by the Colorado Worker's Compensation Act, this requirement
shall not apply. Contractor must submit to the Department a Declaration of Independent
Contractor Status Form prior to the start of this agreement.
ii. Commercial General Liability Insurance written on ISO occurrence form CG 00
01 10/93 or equivalent, covering premises operations, fire damage, independent
Contractors, products and completed operations, blanket contractual liability, personal
injury, and advertising liability with minimum limits as follows:
- $1,000,000 each occurrence;
- $2,000,000 general aggregate;
- $50,000 any one fire; and
$500,000 errors and omissions.
iii. Automobile Liability: Contractor/Contract Professional shall maintain limits of
$1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident,
and $1,000,000 for property damage applicable to all vehicles operating both on County
property and elsewhere.
iv. Additional Provisions: Policies for all general liability, excess/umbrella liability,
liquor liability and pollution liability must provide the following:
If any aggregate limit is reduce by twenty-five percent (25%) or more
by paid or reserved claims, Contractor shall notify County within ten (10) days
and reinstate the aggregates required;
Unlimited defense costs in excess of policy limits;
Contractual liability covering the indemnification provisions of this
Agreement;
A severability of interests provision;
Waiver of exclusion for lawsuits by one insured against another;
A provision that coverage is primary; and
A provision that coverage is non-contributory with other coverage or
self-insurance provided by County.
v. For all general liability, excess/umbrella liability, liquor liability, pollution liability
and professional liability policies, if the policy is a claims -made policy, the retroactive
date must be on or before the contract date or the first date when any goods or services
were provided to County, whichever is earlier.
c. Contractors/Contract Professionals shall secure and deliver to County's Risk
Administrator ("Administrator") at or before the time of execution of this Agreement, and shall
keep in force at all times during the term of the Agreement as the same may be extended as
herein provided, a commercial general liability insurance policy, including public liability and
property damage, in form and company acceptable to and approved by said Administrator,
covering all operations hereunder set forth in the related Bid or Request for Proposal.
d. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this
information to its insurance agent or broker, and shall have its agent or broker provide proof of
Contractor/Contract Professional's required insurance. County reserves the right to require
Contractor/Contract Professional to provide a certificate of insurance, a policy, or other proof of
insurance as required by the County's Risk Administrator in his sole discretion.
e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability,
liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as
an additional insured as follows
f. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer
shall waive subrogation rights against County.
g. Subcontractors: All subcontractors, subcontractors, independent contractors, sub -
vendors, suppliers or other entities providing goods or services required by this Agreement shall
be subject to all of the requirements herein and shall procure and maintain the same coverages
required of Contractor/Contract Professional. Contractor/Contract Professional shall include all
such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds
under its policies or shall ensure that all subcontractors maintain the required coverages.
Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors,
independent contractors, sub -vendors suppliers or other entities upon request by the County.
A provider of Professional Services (as defined in the Bid or RFP) shall provide the following
coverage:
Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and
$2,000,000 aggregate limit for all claims.
10. Certification
Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all
necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies
covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any Agreement.
11. Training
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Contractor may be required to attend training that the request of the Department specific to services
provided under this Agreement. The Department will not compensate the Contractor for said training in
the form of registration fees, time spent traveling to and from training, attending the training or any other
associated costs unless otherwise agreed to by the Department.
12. Subpoenas
Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the
Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For
this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the
Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will
contact the Weld County Attorney's Office immediately at 970-352-1551, x6503, and advise that the
subpoena must be personally served.
13. Monitoring and Evaluation
Contractor and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners, the Department and the
Contractor.
Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with the work conducted under
this Agreement.
14. Modification of Agreement
All modifications to this Agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
the Contractor. These remedial actions are as follows:
- Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed.
- Deny payment or recover reimbursement for those services or deliverables, which have
not been performed and which due to circumstances caused by the Contractor cannot be
performed or if performed would be of no value to the Department. Denial of the amount
of payment shall be reasonably related to the amount of work or deliverables lost to the
Department.
- Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation
shall be recovered from Contractor by deduction from subsequent payments under this
Agreement or other agreements between the Department and Contractor, or by the
Department as a debt due to the Department or otherwise as provided by law.
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16. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s).
For Department: For Contractor:
Heather Walker, Administrator CONTRACTOR, TITLE
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to
the individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent.
For Department:
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
(970) 352-1551
18. Litigation
For Contractor:
Contractor shall promptly notify the Department in the event that Contractor learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading
which has been filed in any Federal or State court or administrative agency, shall deliver copies of such
document(s) to the Director of Human Services. The term "litigation" includes an assignment for the
benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the
individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an
obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise
appropriated in each succeeding year, as this Agreement is subject to the availability of funding.
Therefore, the Department may terminate this Agreement at any time if the source of funding for the
services made available to the Contractor is no longer available to the Department, or for any other
reason. Contractor reserves the right to suspend services to clients if funding is no longer available.
20. No Third Party Beneficiary Enforcement
It is expressly understood and agreed that the enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned parties and nothing in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties receiving services or benefits
under this Agreement shall be an incidental beneficiary only.
21. Governmental Immunity
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of
9
any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental
Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended.
22. Partial Invalidity of Agreement
If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held
or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions.
The parties hereto declare that they would have entered into this Agreement and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional
or invalid.
23. Improprieties/Conflict of Interest
No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department
when the Contractor also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the
Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor
know that the two relationships are in opposition. During the term of the Agreement, Contractor shall
not enter into any third party relationship that gives the appearance of creating a conflict of interest.
Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the
Department, a full disclosure statement setting forth the details that create the appearance of a conflict
of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute
grounds for the Department's termination, for cause, of its Agreement with the Contractor.
Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of
Contractor, to any person for influencing or attempting to influence an officer or employee of an agency,
a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contract, the making of any Federal grant, the making of any
Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of an Federal contract, loan, grant, or cooperative agreement.
24. Storage, Availability and Retention of Records
Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during
business hours, have access to inspect and copy records, and shall be allowed to monitor and review
through on -site visits, all activities related to this Agreement, supported with funds under this Agreement,
to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The
results of the monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
All such records, documents, communications, and other materials created pursuant or related to this
Agreement shall be maintained by the Contractor in a central location and shall be made available to the
Department upon its request, for a period of seven (7) years from the date of final payment under this
Agreement, or for such further period as may be necessary to resolve any matters which may be pending,
or until an audit has been completed with the following qualifications: If an audit by or on behalf of the
Federal and/or State government has begun but is not completed at the end of the seven (7) year period,
or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until
the resolution of the audit finding.
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25. Confidentiality of Records
Contractor shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Agreement except for purposes directly connected with the
administration of Child Protection. No information about or obtained from any applicant/recipient in
possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's
parent or guardian unless in accordance with the Contractor's written policy governing access to,
duplication and dissemination of, all such information, in any form, including social networks. Contractor
shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality
requirements.
Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written
explanation of these confidentiality requirements before access to confidential data is permitted.
Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality
agreement and shall provide a copy of such agreement to the Department, if requested.
26. Proprietary Information
Proprietary information for the purposes of this Agreement is information relating to a party's research,
development, trade secrets, business affairs, internal operations and management procedures and those
of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third
parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither
party shall use or disclose directly or indirectly without prior written authorization any proprietary
information concerning the other party obtained as a result of this Agreement. Any proprietary
information removed from the Department's site by the Contractor in the course of providing services
under this Agreement will be accorded at least the same precautions as are employed by the Contractor
for similar information in the course of its own business.
27. Independence of Contractor: Not an Employee of Weld County
Contract Professional agrees that it is an independent Contract Professional and that Contract
Professional's officers, agents or employees will not become employees of County, nor entitled to any
employee benefits from County as a result of the execution of this Agreement. Contract Professional shall
perform its duties hereunder as an independent Contract Professional. Contract Professional shall be
solely responsible for its acts and those of its agents and employees for all acts performed pursuant to
this Agreement. Contract Professional, its employees and agents are not entitled to unemployment
insurance or workers' compensation benefits through County and County shall not pay for or otherwise
provide such coverage for Contract Professional or any of its agents or employees. Unemployment
insurance benefits will be available to Contract Professional and its employees and agents only if such
coverage is made available by Contract Professional or a third party. Contract Professional shall pay when
due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred
pursuant to this Agreement. Contract Professional shall not have authorization, express or implied, to
bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement.
Contract Professional shall have the following responsibilities with regard to workers' compensation and
unemployment compensation insurance matters: (a) provide and keep in force workers' compensation
and unemployment compensation insurance in the amounts required by law (and as set forth in Exhibit
provide proof thereof when requested to do so by County.
28. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as state in
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Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or
obligations hereunder without the prior consent of both parties.
29. Agreement Nonexclusive
This Agreement does not guarantee any work nor does it create an exclusive agreement for services.
30. Warranty
The Contractor warrants that services performed under this Agreement will be performed in a manner
consistent with the professional standards governing such services and the provisions of this Agreement.
The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training,
diligence and judgment provided by highly competent individuals and entities that perform services of a
similar nature to those described in this Agreement including Exhibits A, B, C, and D.
31. Acceptance of Services Not a Waiver
Upon completion of the work, the Contractor shall submit to Department originals of all tests and results,
reports, etc., generated during completion of this work. Acceptance by Department of reports and
incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of
responsibility for the quality and accuracy of the services. In no event shall any action by the Department
hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or
default which may then exist on the part of the Contractor, and the Department's action or inaction when
any such breach or default shall exist shall not impair or prejudice any right or remedy available to the
Department with respect to such breach or default; and no assent, expressed or implied, to any breach of
any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a
waiver of any other breach. Acceptance by the Department of, or payment for, any services performed
under this Agreement shall not be construed as a waiver of any of the Department's rights under this
Agreement or under the law generally.
32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507
The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any
personal or beneficial interest whatsoever in the service or property which is the subject matter of this
Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which
would in any manner or degree with the performance of the Contractor's services and the Contractor,
shall not employ any person having such known interests. During the term of this Agreement, the
Contractor shall not engage in any in any business or personal activities or practices or maintain any
relationships which actually conflict with or in any way appear to conflict with the full performance of its
obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may
result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of
the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or
hold any such position which either by rule, practice or action nominates, recommends, supervises
Contract Professional's operations, or authorizes funding to the Contractor.
33. Board of County Commissioners of Weld County Approval
This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld
County, Colorado.
12
34. Choice of Law/Jurisdiction
Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation,
execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference
which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute
between the parties, Contract Professional agrees that the Weld County District Court shall have exclusive
jurisdiction to resolve said dispute.
35. Subcontractors
Contract Professional acknowledges that County has entered into this Agreement in reliance upon the
particular reputation and expertise of Contract Professional. Contract Professional shall not enter into any
subcontractor agreements for the completion of this project without County's prior written consent, which
may be withheld in County's sole discretion.
36. Attorneys Fees/Legal Costs
In the event of a dispute between County and Contract Professional, concerning this Agreement, the
parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs
incurred by or on its own behalf.
37. Ownership
All work and information obtained by Contract Professional under this Agreement or individual work order
shall become or remain (as applicable), the property of County. In addition, all reports, documents, data,
plans, drawings, records and computer files generated by Contract Professional in relation to this
Agreement and all reports, test results and all other tangible materials obtained and/or produced in
connection with the performance of this Agreement, whether or not such materials are in completed form,
shall at all times be considered the property of the County. Contract Professional shall not make use of such
material for purposes other than in connection with this Agreement without prior written approval of
County.
38. Interruptions
Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or
otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond
its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or
Governmental actions.
39. Severability
If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of
competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the
extent that this Agreement is then capable of execution within the original intent of the parties.
13
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first
above written.
ATTEST: BOARD OF COUNTY COMMISSIONERS
Weld County Clerk to the Board WELD COUNTY, COLORADO
BY:
Deputy Clerk to the Board , Chair
APPROVED AS TO FUNDING: APPROVED AS TO SUBSTANCE:
Controller Elected Official or Department Head
APPROVED AS TO FORM:
Director of General Services
County Attorney
CONTRACTOR
Contractor, Title
14
EXHIBIT B
CONTRACTOR'S PROPOSAL
PROVIDER INFORMATION FORM (Bid Cover Sheet) Weld
County Department of Human Services
Jessica Brien, MA, LPC
AGENCY OR PRIVATE PRACTICE TRAILS PROVIDER ID (If Known)
Jessica Brien Owner/clinician
PRIMARY CONTACT —FULL NAME PRIMARY CONTACT -TITLE
970 ) 203-4743 1970 ) 593-0264
PHONE NUMBER
EXT. FAX NUMBER
jessicakbrien@gmail.com n/a
PRIMARY CONTACT - E-MAIL ADDRESS
138 E. 4th St.
AGENCY MAILING ADDRESS
same
AGENCY/PRACTICE WEB ADDRESS (IF APPUCABLE)
Loveland 80537
CITY
ZIP
REFFERAL CONTACT- FULL NAME (IF DIFFERENT THAN PRIMARY CONTACT) REFERRAL CONTACT - TITLE
REFERRAL CONTACT - PHONE NUMBER
EXT.
REFERRAL CONTACT - E-MAIL ADDRESS
I certify that the services offered for intended use by Weld County will meet all the specifications it has so indicated
in this bid form. The Board of Weld County Commissioners reserves the right to reject any or all bids, to waive any
informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests
of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give
preference to resident Weld County bidders in all uses where the bids are competitive in price and quality.
Signature of Authorize Re resentative:
Date of Signature: -,'� —17
Jessica Brien, MA, LPC
138 E. 4th Street
Loveland, CO 80537
April 12, 2017
Attention: Tobi Vetger
Child Welfare Contract and Services Coordinator
Weld County Department of Human Services
I am writing to express a continued interest in performing SAFE home studies for Weld County. My
SAFE training and SAFE supervisor training certificates are attached. I have seven years of experience
performing a variety of SAFE home studies, worked in a child placement agency for seven years, and
currently maintain a private therapy practice in Loveland, CO. I have performed home studies as a
contractor for the past two years.
I am interested in serving families of all structures. I have the knowledge, experience and desire to
perform all types of studies (relative care, foster care, parent care, foster -adopt, adoption, and ICPC). I
will accept referrals for families who live in Larimer and Weld counties.
My supervisor is Sheila Trabelsi. Her training certificate is attached. She can be reached at
Sr [I'afleKI [l \anoo.ccin
My rate schedule would be as follows:
$1600 for a foster care or adoption home study report (approved or denied), up to two adults.
$1900 for an ICPC home study report (approved or denied), up to two adults.
$600 for a home study update, up to two adults.
$50 per additional adult beyond two for the services listed above.
$300 for incomplete home study (foster care/adoption or ICPC, denied or family withdrew). This rate
includes one to two face to face contacts, writing a brief report documenting reasons for the decision,
and all mileage and associated costs within central Larimer and Weld County.
$.54 per mile for any home more than 10 miles outside of central Larimer and Weld county
Communities included at no additional charge include Greeley, Fort Collins, and Loveland and
communities located between these three. Mileage starts at the outer edge of each community.
Please contact me with any questions or further information your might require from me. I look
forward to your response.
Sincerely,
Jessica Brien, MA, LPC
jesstcakhrn(:r a aiati.cc.ui
(970) 203-4743
QUALIFICATIONS:
• Seven years of experience performing SAFE home studies.
• Licensed Professional Counselor with 8 years of experience in a variety of fields, including trauma,
attachment, managing challenging behaviors and parenting support.
• Skilled in EMDR, play therapy and family therapy.
Jessica Rude Brien, MA, LPC
138 E. 4th Street
Loveland, CO 80537
Phone: (970) 203-4743
Email: jessicakbrien@gmail.com
EMPLOYMENT:
September 2015 -present
Private Practitioner at Jessica Brien, MA, LPC, LLC
• Provide individual, family and couples therapy to clients of all ages.
• Perform SAFE home studies on a contracted basis.
June 2012 -present
Lutheran Family Services Rocky Mountains
Clinician, Foster Care and Family Services
• Provided therapy for children in therapeutic foster care, family therapy and parent education for at risk
families, and performed SAFE home studies for a variety of families.
• Helped children adjust, process grief and loss, and form healthy attachments; instructed parents on how
to communicate and build healthy relationships.
January 2012 -June 2012
Touchstone Health Partners
Outpatient therapist, Child and Family Team
• Provided intake, crisis intervention, and ongoing therapy services.
• Facilitated healthy communication, anger management, and trauma processing groups.
May 2008 -December 2011
Lutheran Family Services of Northern Colorado
Clinician, Foster Care and Family Services
• Provided therapy for children in therapeutic foster care and family therapy and parent education for at
risk families.
• Helped children adjust, process grief and loss, and form healthy attachments; instructed parents on how
to communicate and build healthy relationships.
March 2007 -August 2008
The Greeley Transitional House, Inc.
Child and Adolescent Program Coordinator
• Met weekly with each child and his or her parents to help with adjustment and access to resources.
• Assisted clients through brief clinical interventions and crisis management as needed.
EDUCATION:
August 2006- December 2008
Master of Arts Degree, University of Northern Colorado
Clinical Counseling with an emphasis in Couples and Family Therapy
August 2002 -May 2006
Bachelor of Arts Degree, University of Northern Colorado
Psychology
C&c/infietio /I/
SAFE - Structured Analysis Family Evaluation
This is to certify that
Tesst co. Brien
has completed the SAFE. 2 -day training and is certified to perform SAFE Home Studies
Date(s)
Its' (t t 19 lam
Kathleen Cleary, Executive Dirccwr
Consortium for Children
■
t:'•
eatPi / &mge&i?/
SAFE FOR SUPERVISORS - Structured Analysis Family Evaluation
This is to certify that
je.ssic&. SY ien
has completed 6 hours of SAFE Training and is certified to supervise SAFE Home Studies
Date(s): 31x0 Qo 14
4
[liken Cleary, Executive Director
Consortium For Children
■
SAFE FOR SUPERVISORS - Structured Analysis Family Evaluation
This is to certify that
Sheik Irtatsi
has complead 6 hoar, of SAFE Training and Is certified to supervise SAFE Home Studio
HMO
shleen Cleary, Ererutive Dranoe
Consortium for Children
Certificate of Insurance (Proof of Coverage)
Date Issued: (8/2/20161
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.
Insured Name and Mailing Address*
Program Administrator
Name Jessica Brien
Street 602 Denali CL
City
State
Zip
Windsor
Colorado
80550
Administered By:
CPH and Associates
711 S. Dearborn, Suite 205
Chicago, IL 60605
P. 312-987-9823 F. 312-987-0902
info@cphins.com
Underwritten By:
Philadelphia Indemnity Insurance Company
*Additional insured locations are often requested by individual business owners who have more than one office.
Your coverageis portable, meaning that you are covered at any location for practice under the occupation(s) listed on your policy.
(Policy #: E241641
Coverage
)Effective Date: (8/2/2016) lExpiration Date: (8/2/2017)
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TILE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Limits of Liability
Each Occurrence
(Per individual claim)
Aggregate
(Total amount per policy year)
Coverage Part
$1,000,000.00
N/A
N/A
$1,000,000.00
Unlimited
$35,000
$15,000
$10,000
S5,000/person
$15,000
Description/Special Provisions:
$5,000,000.00
N/A
Professional Liability
General Liability
Includes: General Liability, Fire & Water Legal Liability and
Personal Liability
N/A Property Coverage
$5,000,000.00 I Supplemental Liability
Unlimited Defense Expense Coverage
$35,000
$15,000
$35,000
$50,000
$15,000
I State Licensing Board Investigation Defense Coverage
Assault Coverage
Deposition Expense Benefit
Medical Expense Coverage
First Aid Coverage
Certificate Holder
Cancellation
Weld County OHS
PO Box A
Greeley, CO 80632
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
Holder has also been added to the policy as an
additional insured:**
XYes/_No/1414‘r
**If the certificate holder is an ADDITIONAL INSURED, the
policy(ies) must be endorsed. A statement on this certificate does
not confer tights to the certificate holder in lieu of such
endorsement(s).
�t
Authorized Representative
C. Philip Hodson
,
e
DISCLAIMER:Tbe Certificate of Insurance does not constitute a contract between the Issuing in (s), authorized representative or producer, and the certificate
holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon.
Auto Insurance Declaration Page
FARMERS
INSURANCE
Policy Number:
Eftect;.,e
Expiration:
Named Insureds:
Underwritten By
18816-55-33
1/24/2017 12:01 AM
7/9/20177/9/201712:01 AM
Matthew) Brien
Jessica Brien
1108 Ida Dr
Loveland, CO 80537-6749
mdt hewbr
Farmers Insurance Exchange
6301 Owensmouth Ave.
Woodland Hills, CA91367
Household Drivers
Name
Matthew.' Brien
Vehicle Information
Veh. it Year/Make/Mode/4PN
1 1997 Dodge Truck Ram 3500 Club C Pu 4X2 2-
3B7MC33D8VM546672
2 2004 Audi A4 Avant Quattro SW 4Wd 1
WAUVC68E24A130567
2015 Volkswagen New Jetta 4D 1.8T SE/Spar
3VWD 17AJ6FM221748
Covered
Premiums
Full -term Premium (excluding fees)
Prorated Premium (1/24/2017 - 7/9/2017)
Total for this Transaction
This is not a bill.
Your bill with the amount due will be mailed separately.
$1,191.90
$0.00
$0.00
Jessica Brien
Comprehensive:
Collision:
Uninsured Motorist
Property Damage
Without Collision:
Comprehensive:
Collision:
Uninsured Motorist
Property Damage
Without Collision:
Comprehensive:
Collision:
Uninsured Motorist
Property Damage
Without Collision:
Not Covered
Not Covered
Not Covered
$1,000
$1,000
Covered
$1,000
$1,000
Covered
Covered
farmers.com Policy No. 18816-55-33
56-6176 1st Edition 4-15 1/25/2017
Questions?
',II your agent Marc Wagner at (970)
1-2050 or email
•
Manage your account:
Go to .: r , , to access
your account any time!
Page 1 of 3
eclaration Page (continued)
Vehicle Level Coverage Items
Limits
Coverage (applicable to all vehicles)
Bodily Injury Liability $500,000 each person
$500,000 each accident
Property Damage Liability $500,000 each accident
Medical Coverage $5,000 each person
Comprehensive
Collision
Uninsured Motorist Property
Damage Without Collision
Towing and Road Service
Glass Deductible Buyback
Policy Level Coverage Items
Coverage
Uninsured Motorist
Limits
(for all vehicles)
$500,000 each person
$500,000 each accident
Premiums by Vehicle
Vehicle 1 Vehicle 2
$157.50 $95.90
$111.50
$90.60 $51.10 $73.70
$7.40 $16.40 $21.20
Not Covered $38.50 $57.10
Not Covered $69.40 $152.50
Not Covered Covered Covered
$7.40 $7.40 $7.40
Not Covered $23.90 $23.90
Per Policy
$179.10
Full -term Premium
Discounts
Discount Type
Auto/Home
Paid In Full
Applies to Vehicle(s) Discount Type
1, 2, 3 Multiple Car
1, 2, 3 Homeownership
Other Policy Features and Benefits
• Accident Forgiveness - prevents one accident from impacting your premium
• Incident Forgiveness - protects your premium from increases due to minor traffic violations
• Guaranteed Renewal -claims activity will not lead to cancellation or nonrenewal
Policy and Endorsements
$1,191.90
Applies to Vehicle(s)
1,2,3
1,2,3
This section lists the policy form number and any applicable endorsements that makeup your insurance contract. Any endorsements
that you have purchased to extend coverage on your policy are also listed in the coverages section of this declarations document:
56-5067 3rd ed.; CO012 1st ed.; CO013 5th ed.; CO023 6th ed.; CO033A 1st ed.; J66741st ed.; J67741st ed.; J6792 1st ed.; J6934
1st ed.; J69561st ed.; CO013A 4th ed.; CO023A 4th ed.; H1171 1st ed.[Veh:2,3 onlvl; J62841st ed.[Veh:2,3 only]; J6683 1st
ed.[Veh:2,3 only]
farmers.com Policy No. 18816-55-33 Questions?
Call your agent Marc Wagner at (970)
391-2050 or email
mwagner@farmersagent.com
56-6176 1st Edition 4-15
Manage your account
Go to www.farmers.com to access
your account any time!
Page 2 of 3
EXHIBIT C
SCOPE OF SERVICES
1. Contractor will provide home study services for Weld County families, as referred by the Department.
2. All services will be provided by Jessica Brien, LPC.
3. Contractor will utilize the Structured Analysis Family Evaluation (SAFE) tool developed by the
Consortium of Children. Contractor is SAFE certified and on the State's approved home study vendor
list. Contractor also is under the supervision of SAFE Supervisor, Sheila Trabelsi.
4. Contractor will attend SAFE Refresher training during the term of this contract.
5. Contractor will ensure that all studies are completed utilizing the most up-to-date forms and
templates as found on www.consortforkids.org or www.SAFEhomestudy.org.
6. Contractor will complete a Department of Motor Vehicle background check at no additional charge.
All CBI, FBI and LexisNexis background check information will be completed by the Department,
unless otherwise directed by the Department.
7. Contractor will submit a completed home study to the Department with their billing within 60 days of
receipt of the home study referral. A complete home study will include the study in SAFE format,
background check information, SAFE questionnaires completed by the applicants, references and all
other original documents submitted by the home study applicant.
8. Contractor will document in detail any and all observed or verbalized concerns regarding any specific
Weld County home. Areas of concern may include, but are not limited to, any physical, emotional,
educational or behavioral issues. Child abuse must be reported immediately per law.
9. Contractor will make at least three (3) attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays).
Contractor will document efforts to engage client in referred services. If after three (3) attempts the
client does not respond the Contractor will notify the referring caseworker and the Child Welfare
Contract and Services Coordinator immediately.
1
EXHIBIT D
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse the Contractor in consideration of the work and services performed
under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to the
Contractor during the term of this Agreement shall be reported by the Department after June 30, 2018.
Expenses incurred by the Contractor prior to the term of this agreement are not eligible Department
expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds, or any part
thereof, become unavailable as determined by the Department, the Department may immediately
terminate the Agreement or amend it accordingly.
2. Fees for Services
$1,600.00/Episode (Home Study, 2 Adults)
$600.00/Episode (Home Study Update)
$50.00/Episode/Per Person (Additional fee per adult after 2 adults)
$300.00/Episode (Partial home study; denied or withdrawn after 1-2 face-to-face contacts. Includes brief
written report and all mileage costs within central Larimer and Weld County, include Greeley, Loveland,
Fort Collins and communities located between those three.)
After 10 miles outside central Larimer or Weld County, mileage will be reimbursed at two (2) cents under
the current IRS mileage/mile rate. Communities included at no mileage charge include Greeley, Loveland,
Fort Collins and communities located between those three. Mileage starts at the outer city limit of each
community.
Contractor may not attempt to collect co -pays and/or fees for services for which a Department client is
responsible, but which a particular client refuses or fails to pay.
Contractor will collect any applicable sliding scale co -pays and credit the Department for any payment
received on the monthly billing.
3. Submittal of Vouchers
Contractor shall prepare and submit monthly an itemized voucher, and signed monthly report if
applicable, certifying that services authorized were provided on the date(s) indicated and the charges
made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A.
Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the
1
month following the month the cost was incurred. Failure to submit by the aforementioned deadline may
result in forfeiture of payment.
a. For ongoing services, proof of services rendered shall be a Client Verification Form signed by
the client and a monthly report submitted in accordance with Paragraph 3(d) of this
Agreement.
b. For one-time services, proof of services rendered shall be receipt of the completed product.
c. For Monitored Sobriety services, proof of services rendered shall be the test result.
2
Certificate of Insurance (Proof of Coverage)
Date Issued: (8/2/20l6)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.
Insured Name and Mailing Address*
Program Administrator
Name
Street
City
State
Zip
Jessica Brien
602 Denali Ct.
Windsor
Colorado
80550
Administered By:
CPH and Associates
711 S. Dearborn, Suite 205
Chicago, IL 60605
P. 312-987-9823 F. 312-987-0902
info®cphins.com
Underwritten By:
Philadel i hia Indemni Insurance Com an
*Additional insured locations are often requested by individual business owners who have more than one office
Your coverageis portable, meaning thatyou are covered at any location for practice under the occupations) listed on your policy.
Coverage
`Policy N: E241641 'Effective Date: (8/2/2016) 'Expiration Date: (8/2/2017)
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Limits of Liability
I.
Each Occurrence
(Per individual claim)
Aggregate
(Total amount per policy year)
Coverage Part
$ 1,000,000.00
N/A
N/A
$ 1,000,000.00
Unlimited
$35,000
515,000
$10,000
S5,000/person
S15,000
Description/Special Provisions:
S5,000,000.00
N/A
N/A
$5,000,000.00
Unlimited
535,000
$15,000
$35,000
S50,000
515,000
Professional Liability
General Liability
Includes: General Liability, Fire & Water Legal Liability and
Personal Liability
Property Coverage
Supplemental Liability
Defense Expense Coverage
State Licensing Board Investigation Defense Coverage
Assault Coverage
Deposition Expense Benefit
Medical Expense Coverage
First Aid Coverage
Certificate Holder
Cancellation
Weld County DHS
PO Box A
Greeley, CO 80632
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
Holder has also been added to the policy as an
additional insured:**
XYes / No
**If the certificate holder is an ADDITIONAL INSURED, thei
policy(ies) must be endorsed. A statement on this certificate does
not confer rights to the certificate holder in lieu of such
endorsement(s).
1° /1/6#10A
Authorized Representative
C. Philip Hodson
DISCLAIMER:The Certincate of Insurance does not constitute a contract between the Issuing insurer(s), authorized representative or prodneer, and the certificate
holder, nor does It affirmatively or negatively amend, eatead, or alter the coverage afforded by the policies listed thereon.
Hello