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Home My WebLink About20180247.tiffAGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TRANSITIONS PSYCHOLOGY GROUP, LLC This Agreement Amendment, made and entered into �t day of 2018 by and between the Board of Weld County Commissioners, on behalf of the Weld Co ty D artment of Human Services, hereinafter referred to as the "Department", and Transitions Psychology Group, LLC, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Life Skills and Mental Health Services (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2018-0247 approved on January 22, 2018. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on May 31, 2018. • The Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following change is hereby made to the Agreement: 1. WHEREAS, the Colorado Department of Human Services has provided Core Services or other funds to the Department for Life Skills, Mental Health Services, and Teaching Parenting the Positive Discipline Way. 2. Paragraph 1, Term This agreement shall become effective on June 1, 2017, upon proper execution of this Agreement and shall expire May 31, 2019, unless sooner terminated as provided herein. 3. Payment The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. Exceptions to this Paragraph may include, if approved by the Department, the following: i. The service being provided by the contractor is not a Medicaid eligible service; ii. The service is not deemed medically necessary; iii. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; iv. A Medicaid provider is not available to provide the needed service; Cc. 7,/l0-1( V O2v/P- as �7 k/eoa �9 v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. 4. Exhibit C, Scope of Services, amended as attached. 5. Exhibit D, Payment Schedule, amended as attached. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: dirift110/ G J,i0‘"' Weld By: Deputy Clerk t o the Boar Wale 4 he Board )' X1.1. Imo✓4 t per: 1 `r. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Steve Moreno, Chair JUL 16 2D38 ONTRACTOR: Transitions Psychology Group, LLC 7251 West 20th Street, Building M-2 Greeley, Colorado 80634 (970) 336-1123 By: Date: 2yS.reed,COwner..--1--EIC----..---1 By 1/ )-YD..9•LluAs, Norma Alkire, Co -Owner Date: q3/iY EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Life Skills, Mental Health Services and Teaching Parenting the Positive Discipline Way to clients referred by the Department, primarily in the Greeley area. 2. Life Skills services include: a. Family Therapy Visitation — Family contact in the presence of a Master's or Doctoral level therapist to ensure protection of the children emotionally and assist in the healing of the parent - child relationship damaged by severe abuse and/or neglect. b. Therapeutic Visitation —Supervision and evaluation of parent -child interactions for referred clients and their minor children by a Master's or Doctoral level therapist ensuring children remain safe by providing contact with their family members. Child is in the presence of the supervising therapist at all times. All contact between the parent and the child is structured to provide for the safety and well- being of the children while maintaining the continuity of family relationships. Parents are given the opportunity to learn and practice positive parenting. Parents are continually assessed regarding their capacity to appropriately care for their children. Contractor utilizes, as clinically appropriate, the Life Skills Assessment (LSA) tool developed by the Contractor to assess areas of family functioning including household management and environment, parenting styles and capabilities, family interactions and safety, and commitment. A copy of this tool has been provided to the Department. Services are available both in -office and in -home to address the continuum of care issues as the client progresses to a less restrictive setting. c. Life Skills Parent Coaching — Services are designed to address family needs to prevent placement of children or facilitate the reunification process when children return home, and enhance the parent's capacity to provide for their children's needs. Services occur in the client's home and may include individual counseling, family counseling, intensive parenting education and remediation, relapse prevention counseling and referrals to enhance the family's capacity to provide for their children's needs. 3. Mental Health Services include: a. Individual Counseling — Services are available for adults and adolescents and are designed to address a wide variety of issues that impact the individual and family. The goal of the service is to remove any barriers to safety and well-being in the home which may include, but are not limited to, behavior problems, depression, anxiety, stress, trauma, grief and loss, health, self- image, character and treatmentcompliance. b. Family Counseling — Services are available to families to address communication, togetherness, flexibility, family structure, family lifecycle, and multi -generational issues. Family characteristics such as communication, togetherness, flexibility, family structure, family lifecycle, multi - generational issues, interactions and resiliencies also assessed and treated. 1 c. Co -Therapy — Services are provided by two Master's, or higher, level family systems therapists to bridge services between programs and promote change in referred families in complex cases. Services are limited to one (1) to three (3) sessions per referred family and require pre -approval from the Department's Core and Service Contract Coordinator. d. Eye Movement Desensitization and Reprocessing (EMDR) Counseling — EMDR is a recognized, effective form of trauma treatment and is designed to resolve memories of a past difficult emotional experience affecting current functioning. Contractor may use EMDR in conjunction with, or independent of, other services. 4. Teaching Parenting the Positive Discipline Way includes: a. A 7 -week program that utilizes the Positive Discipline curriculum developed by Jane Nelson, Ed.D. Contractor has two certified therapists for this program. The program is designed to assist parents who are in recovery, parenting preschoolers, parenting children and teens to effectively discipline their children in a positive manner. This program can assist families to bridge communication gaps, defuse power struggles, enforce love, build on strengths not weaknesses and utilize a non -punitive approach to parenting. Parents will learn parenting practices that will help them to mitigate and remediate previous methods that likely exacerbated their child/children's traumatic experiences. Each participate will receive a workbook that follows the curriculum: • Week 1— Introduction to the Adlerian Approach based on dignity and respect. The importance of Perception /Interpretation, Belonging/Significance. • Week 2 — Parenting Styles: Kindness and Firmness at the same time, Kindness: Encouragement and Courage, Kindness: Encouragement vs. Praise • Week 3: Purpose of Behavior, Kindness: Mistaken goals, Kindness: Modeling Imperfection, Mutual Respect: Taking care of yourself • Week 4 — Continuum of Change, Firmness: Consequences vs. Punishment vs. Solutions, Firmness: Enabling vs. Empowering, Firmness: Setting Limits • Week 5 - Belonging: Family Meetings, Significance: That ability to contribute (chores), Firmness and Kindness: Making Agreements and Following Through • Week 6: Mutual Respect: Decide what YOU will do, Life Skills: Sibling Issues, Encouragement: What and How questions • Week 7: Encouragement: Listening, Establish and Maintain a routine 5. Contractor retains an office in Greeley, located at 7251 West 20th Street, M-2. 6. All services will be provided by Master's, or higher, level therapists. Contractor has one (1) bilingual (Spanish/English) staffmember. 7. Contractor will utilize a team approach to link mental health services with existing services, such as Life Skills or other community services to ensure a continuum of care. 8. 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 caseworker and the Child Welfare Contract and Services Coordinatorimmediately. 9. Contractor will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 10. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 11. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 13. Contractor understands that the Department will not reimburse Contractor for "no shows" or cancelled appointments, either on the part of the client or the Contractor. 14. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Court Staffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as the meeting is at least one hour in length, participation in the meeting is deemed appropriate and necessary by the Department, and the Contractor obtains the Facilitator's signature on the Client Verification Form at the time of the meeting. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Department. EXHIBIT D PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2019. Expenses incurred by the Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Life Skills: $113.00/Hour (Family Therapy Visitation) $113.00/Hour (Therapeutic Visitation, In -Office) $130.00/Hour (Therapeutic Visitation, In -Home) $130.00/Hour (Life Skills Coaching, In -Home) $130.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) Mental Health Services: $113.00/Hour (Individual Therapy) $113.00/Hour (Family Therapy) $130.00/Hour (Therapy, In -Home) $226.00/Hour (Co -Therapy) $130.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) Teaching Parenting the Positive Discipline Way: $169.50/Episode (1.5 Hour Class/Per Family. Includes workbook.) $130.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) Contractor may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. Contractor will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher, and signed monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. b. For one-time services, proof of services rendered shall be receipt of the completed product. c. For Monitored Sobriety services, proof of services rendered shall be the test result. 2 OP ID: SLS A`cc,,IRO CERTIFICATE OF LIABILITY INSURANCE D05/26ATE /DDIYYYY) 05/2612017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 970-223-1804 Front Range Insurance Group Fax: 1100 Haxton Drive Suite 100 Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI CONTPhone: NAME: PH NN Extl: FAX AXNo): , -- _ . E-MAIL ADDRESS: PRODUCER TRANS6 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Transitions Psychology Group, LLC 7251 W. 20th St, Unit M2 Greeley, CO 80634 INSURER A : Philadelphia Insurance INSURER B : Pinnacol Assurance 41190 INSURER C : - INSURER D : INSURER E : INSURER F: • REVISION NUMBER: vTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR L SUER TYPE OF INSURANCE ADDL. INSR WVD. POLICY NUMBER POLICY EFF IMM/DD/YYYY) POLICY EXP IMM/DDIYTYY1 LIMITS A A A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X I OCCUR X x 'fHPK1658310 05/23/2017 05/23/2017 05/23/2017 05/23/2018 05/23/2018 05/23/2018 EACH OCCURRENCE $ 1,000,000 -DAMAGE TO REN FED I PREMISES (Ea occurrence) j$ 100000 CLAIMS -MADE Iii MED EXP (Any one person) ! $ 5,000 X Prof Liability PERSONAL & ADV INJURY $ 1,000,000 X GEN'L Sexual Abuse GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES POLICY ; VT- PER. LOC PRODUCTS - COMP/OP AGG I $ 2,000,000 X Sexual Ab $ 100,000 A AUTOMOBILE _ X LIABILITY ANY AUTO i ALL OWNED AUTOS I SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X PHPK1658310 05/23/2017 05/23/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X $ A X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE PHUB585149 05/23/2017 05/23/2018 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DEDUCTIBLE X RETENTION $ 10,000 j $ $ B WORKERS COMPENSATION., AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNERIEXECUTIVEY/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS N / A X 4104451 1 05/01/2017 05/01/2018 WC STATU- I OTH- ?_ITORY LIMITS I ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 below EL DISEASE - POLICY LIMIT $ 500,000 A Bus Pers Property PHPK1658310 05/23/2017 05/23/2018 BPP 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Weld County Department of Human Services is named as Additional Insured with respects to General Liability and Automobile Liability policies. A Waiver of Subrogation applies to General Liability policy. A provision that coverage is non-contributory with other coverage or self insurance provided by county. I.GR I Irla.r. I c r7VLIJcrk Weld County Department of Human Services 315 A N. 11th Avenue Greeley, CO 80632 -- ------ ----- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (e -/ G �o,.P,� ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP (Certificate of In5uratter ®HPSO OCCURRENCE POLICY FORM Print Date: 08/24/17 i PRODUCER BRANCH PREFIX POLICY NUMBER 018098 970 Named Insured HPG 0272935313-8 Norma A Alkire 4913 W 12th Street Rd Greeley; CO 80634-2216 Medical Specialty Code Marriage/Family Counselor Professional Liability Your professional liability limits shown above include the following: • Good Samaritan Liability • Malplacement Liability • Personal Injury Liability • Sexual Misconduct included in the PL Limit shown above subject to $25,000 aggregate sublimit 80723 Policy Period: From 12/01/17 to 12/01/18 at 12:01 AM Standard Time Program Administered by: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 19040-1218 1-800-982-9491 www.hpso.com/renew insurance is provided by: American Casualty Company of Reading, Pennsylvania 333 South Wabash Avenue Chicago, Illinois 60604 Coverage Extensions License Protection Defendant Expense Benefit Deposition Representation Assault Includes Workplace Violence Counseling Medical Payments First Aid Damage to Property of Others Information Privacy (HIPAA) Fines & Penalties Workplace Liability $1,000.000 each claim $3,000,000 aggregate 25,000 per proceeding 1,000 per day limit 10,000 per deposition 25,000 per incident 25,000 10,000 10,000 25,000 per person per incident per incident per incident $ 25,000 aggregate $ 25,000 aggregate $ 10,000 aggregate $ 25,000 aggregate $ 100,000 aggregate $ 10,000 aggregate $ 10,000 aggregate $ 25,000 aggregate Workplace Liability Fire and Water Legal Liability Personal Liability Total: $111.00 Included in Professional Liability Limit shown above Included in the PL limit above subject to $150,000 aggregate sublimit $1,000,000 aggregate Premium reflects employed, full-time rate with ACA Membership discount. Policy Forms & Endorsements (Please see attached list for a general description of many common policy forms and endorsements.) G -121500-D G -121501-C G -121503-C CNA82011 G -145184-.A G -147292-A CNA81753 CNA81758 GSL13424 GSL15563 GSL15564 GSL15565 GSL17101 CNA80052 CNA80051 G -123846-005 Chairman of the Board Secretary Keep this Certificate of Insurance in a safe place. This Certificate of Insurance and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full. In order to activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. cnrm 2+• r,-. 1,d1 O 1 R I'21,(14 Conkratuiationsl Below are your electronic wallet cards to use as proof of your license. You can also pons your license at any time by visiting www.cotorado.govidora/DPO_Print_License and following the instructions listed. If you would like a more durable wallet card option, you ca.i order one for a fee by visttius www.nasbastore.org and selecting the "Colorado License Cards" link on the left hand side of the pane. 'i you prefer, you can also contact NASBA by phone at l-8S8-925-5?37 or by email at nasbastore®nasba.org. Should you have questions about you credential, or peed other" information please contact our Customer Service Team at 303-894-7300 or dora_registrations®state.co.us. Colorado Department of Regulatory Agencies Division of Professions and Occupations State Board of Licensed Professional Counselor Examiners Norma Ann Alkire Licensed Professional Counselor LPC.0004453 Number Active Credential Status Verify this credential at: www.colorado.gov!doi !dpo 09/01/2017 Issue Date 08/31/2019 Expire Date Colorado Department of Regulatory Agencies Division of Professions and Occupations State Board of Licensed Professional Counselor Examiners Norma Ann Alkire Licensed Professional Counselor LPC.0004453 Number Active Credential Status Verify this credential at: w 09/01/2017 Issue Date 08/31/2019 Expire Date cnlorado.gov/ o Division Director: Rome Hines Credential Holder Signature Division Director: Ronne Hines CreQential Holder Signature .nn;ratulations! Below are your electronic wallet cards r+3 use as prof of ;cense. YOU can also Orint -,/00r ilcense at any :ime by visiting. www.co(orado.gov/dora/DPO_Print_License and following the is5t r I.ICi.ions risted. II you .would like a fnor.r durable wallet card option, you can order one for a fee by visiting www.nasbastore.org and selecting the "Colorado License Cards" link on the left hand side of the page. cu : refer, you can 0150 contact N; SBA by phone at i -88S-925-5237 or by email at nasbastore@nasba.org. 5houtd o i have questions ,:_cut your credential. Crc he info . ro Service Team at 303-894-7'u''G0 or dora_registrations@state.co.us. or, roa : Colorado Department of Regulatory Agencies Division of Professions and Occupations State Board of Addiction Counselor Examiners Norma Ann Alkire Licensed Addiction Counselor AC0.0000141 09/01/2017 Number Issue Date Actve 08/31/2019 Credential Status Expire Date , Verify this credential at: wwhv cotorado.govrciora dpo L'iii/;,ti ff :+ /A �'�i; Division Director: Ronne Hines Credential Ho er Signature • Colorado Department of Regulatory Agencies Division of Professions and Occupations State Board of Addiction Counselor Examiners Norma Ann Alkire t:censed Addiction Counselor ACD.0000141 09/01/2017 Number Issue Date Active 08/31/2019 Credential Status Expire Date Verify this credential at: wwyy, olurado.g v!ci rtidpo �(r l'lp r ^ .1 ` rr�i V -Q re 'eentiiaa( Ho der Si nature • Division Director: Ronne Hines 'C g Chairman of the Board PRODUCER BRANCH HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP PREFIX Certificate of In urance SO Hra,h, ,, Pwridum tirr.nc hsr,n,..,,.un- OCCURRENCE POLICY FORM POLICY NUMBER 018098 970 Named Insured HPG 0270170686-8 Gregory S Creed 7251 W 20th St Unit M2 Greeley, CO 80634-4626 Medical Specialty Code Clinical Counselor/LPCC Excludes Cosmetic Procedures Professional Liability Your professional liability limits shown above include the following: m Good Samaritan Liability e Malplacement Liability 80723 Policy Period: From 07/04/17 to 07/04/18 at 12:01 AM Standard Time Program Administered by: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 1 9040-1 21 8 1-800-982-9491 www.hpso corn/renew Insurance is provided by: American Casualty Company of Reading, Pennsylvania 333 South Wabash Avenue Chicago, Illinois 60604 $1,000,000 each claim $3,000.000 aggregate m Personal Injury Liability ® Sexual Misconduct included in the PL Limit shown above subject to $25,000 aggregate sublimit Coverage Extensions License Protection Defendant Expense Benefit Deposition Representation Assault Includes Workplace Violence Counseling Medical Payments First Aid Damage to Property of Others Information Privacy (HIPAA) Fines & Penalties Workplace Liability 25,000 per proceeding 1,000 per day limit 10,000 per deposition 25,000 per incident 25,000 per person 10,000 per incident 10,000 per incident 25,000 per incident $ 25,000 aggregate $ 25,000 aggregate $ 10,000 aggregate $ 25,000 aggregate $ 100,000 aggregate $ 10,000 aggregate $ 10,000 aggregate $ 25,000 aggregate Workplace Liability Fire and Water Legal Liability Personal Liability Total: $294.00 Included in Professional Liability Limit shown above Included in the PL limit above subject to $150,000 aggregate sublimit $1,000,000 aggregate Premium reflects self-employed, full-time rate with ACA Membership discount. Policy Forms & Endorsements (Please see attached list for a general description of many cornnwn policy forms and errdorserrlents_) G -121500-D G -121501-C G -121503-C CNA82011 G -145184-A G -147292-A CNA81753 CNA81758 GSL13424 GSL15563 GSL15564 GSL15565 GSL17101 CNA80052 CNA80051 G -123846-005 CNA79575 C6)-44/ilk riAA-4-- Secretary/ Keep this Certificate of insurance in a safe place. This Certificate of Insurance and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full. In order to activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. Form #: G -141241-B (3/2010) Master Policy: 18671 1433 bil.kleckd tLo�i' CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TRANSITIONS PSYCHOLOGY GROUP, LLC This Agreement, made and entered into the°'d o , .21_45, by and between the Board of Weld County Commissioners, on behalf of the Weld County Departme of Human Services, hereinafter referred to as the "Department' and Transitions Psychology Group, LLC, hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and incorporated herein by this reference. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided Core Services funding to the Department for Life Skills and Mental Health Services. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1, 2017, upon proper execution of this Agreement and shall expire May 31, 2018, unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Proposal and Exhibit C, Scope of Services. 3. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Department's Resource Manager, Child Welfare Contract and Services Coordinator, or through a Team Decision Making (TDM) meeting or Family Team Meeting (FTM). No other Department staff or other party to the case may authorize services or modifications to services. 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. Lonsol.* kads040- -04(1- r_aa-if 2018-0247 ti-R(Do 71 d. Contractor agrees to submit a monthly report with the billing statement by the 7th of the month following the month of service for each client receiving ongoing services. One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation). Verification of Monitored Sobriety Services will be the test result. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. 4. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule, attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon, the continuing availability of said funds for the purposes hereof. d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 5. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and 0MG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit an ACH Form for Colorado Providers, which will be provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of 2 Colorado per the directions on the form. Failure to complete and submit this form in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and - Title VII of the Civil Rights Act of 1964; and - the Age Discrimination in Employment Act of 1967; and - the Equal Pay Act of 1963; and the Education Amendments of 1972; and - Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. 3 b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is Core Services. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contract Professional certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contract Professional will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5-102(5)(c). Contract Professional shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contract Professional that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contract Professional shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contract Professional obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contract Professional shall notify the subcontractor and County within three (3) days that Contract Professional has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contract Professional shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. Contract Professional shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contract Professional participates in the State of Colorado program, Contract Professional shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contract Professional has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, 4 and shall comply with all of the other requirements of the State of Colorado program. If Contract Professional fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contract Professional receives federal or state funds under the contract, Contract Professional must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contract Professional operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5-103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR), and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 9. Insurance Requirements Contractor and Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible the insurance provider. a. General Requirements: Contractors/Contract Professionals must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors/Contract Professionals shall keep the required insurance coverage in force at all times during the term of 5 the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non- payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, in the amount of the deductible or self - insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor/Contract Professional. Contractor/Contract Professional shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i.Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii.Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: - $1,000,000 each occurrence; - $2,000,000 general aggregate; - $50,000 any one fire; and $500,000 errors and omissions. iii.Automobile Liability: Contractor/Contract Professional shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County within ten (10) days and reinstate the aggregates required; Unlimited defense costs in excess of policy limits; Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by County. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. c. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance. County reserves the right to require Contractor/Contract Professional to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured as follows: County of Weld 1150 'O' Street Greeley, Colorado 80631 f. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors, subcontractors, independent contractors, sub - vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor/Contract Professional. Contractor/Contract Professional shall include all such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 7 10. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training Contractor may be required to attend training that the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-352-1551, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. 8 - 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: Gregory S. Creed, Co -Owner Norma Alkire, Co -Owner 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: Gregory S. Creed, Co -Owner Norma Alkire, Co -Owner 7251 West 20th Street, Building M-2 Greeley, CO 80634 (970) 336-1123 Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 9 20. No Third -Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall not enter into any third -party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records 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, 10 to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contract Professional agrees that it is an independent Contract Professional and that Contract Professional's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contract Professional shall perform its duties hereunder as an independent Contract Professional. Contract Professional shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contract Professional, its employees and agents are not entitled to unemployment 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 11 coverage is made available by Contract Professional or a third party. Contract Professional shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contract Professional shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contract Professional shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and as set forth in Exhibit A, and provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, 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 12 obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contract Professional's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contract Professional acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contract Professional. Contract Professional shall not enter into any subcontractor agreements for the completion of this project without County's prior written consent, which may be withheld in County's sole discretion. 36. Attorneys Fees/Legal Costs In the event of a dispute between County and Contract Professional, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contract Professional under this Agreement or individual work order shall become or remain (as applicable), the property of County. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contract Professional in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the County. Contract Professional shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of County. 38. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or- Governmental actions. 39. Severabilit 13 If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. 14 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: ‘ t�- Weld County Clerk to the Board WELD COUNTY, COLORADO BOARD OF COUNTY COMMISSIONERS By: Deputy Clerk to t Boar. 15 Steve Moreno, Chair JAN 2 2 2018 CONTRACTOR: Transitions Psychology Group, LLC 7251 West 20`h Street, Building M-2 Greeley, Colorado 80634 (970) 336-1123 By: Date: By: Date: regory S. Creed, Co -Owner Norma,Alkire, Co -Owner ) EXHIBIT A WELD COUNTY'S REQUEST FOR PROPOSAL REQUEST FOR BIDS AND PROPOSALS WELD COUNTY, COLORADO 1150 O STREET GREELEY, CO 80634 DATE: April 3, 2017 BID NUMBER: B1700080 DESCRIPTION: Annual Request for Various Services DEPARTMENT: Human Services MANDATORY PRE -BID CONFERENCE DATE: N/A BID OPENING DATE: APRIL 24, 2017 PAGES 1-9 OF THIS DOCUMENT CONTAINS GENERAL INFORMATION. NOT ALL OF THE INFORMATION CONTAINED IN PAGES 1-9 MAY BE APPLICABLE. THE SCOPE OF WORK AND SPECIFICATIONS UNIQUE TO THIS REQUEST FOR BID FOLLOW PAGE 9. I. NOTICE TO BIDDERS A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the Board of Weld County Commissioners, wishes to purchase the following: VARIOUS ENGLISH AND BILINGUAL (ENGLISH/SPANISH) SERVICES (SERVICE AREAS INCLUDED IN THIS PROPOSAL INCLUDE, BUT ARE NOT LIMITED TO THE BELOW LIST. OTHER SERVICES WILL BE CONSIDERED AND BIDDERS ARE ENCOURAGED TO SUBMIT FOR UNIQUE AND CREATIVE SERVICES.) Violet Services provided to prepare a c other permanent placement and of the child. unification with his/herfa i prevent future out- of -home placement peutiC s ` try assist in t`develop family services plat , to assess and/or` improve familycommunicatior. functioning and relationships, and toprevent further domesticviolence. 1 in- per stir /iris home re h(idren, in y, seven (7) days a week, is furthk r defined., situation or circumstance, nt) in nature, which breaks down the normal functionin; individual and/orfamily, and results in the inability of the individual and/or' amity to resolve the crisis through normal coping behaviors, orwithout y structured 'i ervices th erapy to children and theicfamilies. Services provided to foster and group home families caring for Weld children and youth in their homes to enhance and improve i prov(d sed treat on known ance a at addres ermin ong you pervasive onducf years o s provided primarily in the home of the client that include a which can include therapeutic services, concrete ser terventiao f a ted to rre the nee ..iz» *Crisis Intervention is defined as 24/7 phone access { services In the areas of (3.) consultation and kinship parent aopp specific to a child placed in a kinship home, (2) corrective consultation specific to a child placed Ina kinship home, and (3) critical care consultation specific nship homeChildren placed in kinship areaare. st level of care and least restrictive setting when ou s necessary. Id pia ine brine placeM Visitation (both in -home and in -office) and services provided primarily in the ent, effective accessto roily conflictmanager usehold rrm echniqu Intensive Family Therapeutic intervention typically with all family members to improve � llycommuni on, functioning and relationships. 2 Relinquish merit Counseling Ic and/pr' Rer peutic family services plan, t"o assess a functioning and relationships. to assisi mprove fa vefam ly-and cgmmunity t.ased treatment' program positive changes in the various social systems (home, school, c relations) that contribute to the serious antisocial behaviors of c iolescents who Great risk for t pt -of; home placement. Relinquishment counseling for parents considering relinquishmen children. preventlo rapeutic services to assist in the develop SP),to assess ed/or improved roily con onships, and to prevent further abuse o vices dE sting onal 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: "Iherebywaive 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. 3 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. 4 G. Whenever requested, samples or descriptive matter shall be filed prior to the opening of bids. H. In accordance with Section 14-9(3) of the Weld County Home Rule Charter, the Board of County Commissioners of Weld County will give preference to resident Weld County bidders in all cases where said bids are competitive in price and quality. It is also understood that the Board of County Commissioners of Weld County will give preference to suppliers from the State of Colorado, in accordance with Section 30-11-110, CRS, when it is accepting bids for the purchase of any books, stationery, records, printing, lithographing or other supplies for any officer of Weld County. I. All discounts shall be figured from the date of delivery and acceptance of the articles, or in the case of an incorrect invoice, from the date of receipt of corrected invoice, if this be subsequent to delivery and acceptance. J. Substitutions or modifications to any of the terms, conditions, or specifications of this bid package which are made by Weld County, Colorado, after the bids have been distributed to prospective bidders, and prior to the date and time of bid opening, will be made in writing and signed by the Families, Youth and Children's Commission. No employee of Weld County, Colorado, is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of Families, Youth and Children's Commission. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. K. The successful bidder shall indemnify and hold harmless Weld County, Colorado, against all claims for royalties, for patents or suit for infringement thereon, which may be involved in the manufacture or use of the material to be furnished. L. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5- 101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et seq., Weld County may terminate this Contract for breach and Contractor shall be liable for actual and consequential damages to Contractor. Except where exempted by federal law and except as provided in C.R.S. 24-76.5- 103(3), if Contractor receives federal or state funds under this Contract, Contractor must confirm that any individual natural person eighteen (18) years of age orolder is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of a Contract. M.All goods shall remain the property of the seller until delivered to and accepted by Weld County, Colorado. N. Bids received prior to the time of opening will be kept unopened in a secure place. No responsibility will attach to the Families, Youth and Children Commission, the Weld County Department of Human Services, or the Board of Weld County Commissioners, for the premature opening of a bid not properly addressed and identified. 5 O. In submitting the bid, the bidder agrees that the acceptance of any and all bids by the Board of County Commissioners of Weld County within a reasonable time or period does not constitute a contract. The Board of County Commissioners of Weld County, Colorado, reserves the right to reject any and all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. P. These instructions, the proposal forms, and specifications have been developed with the hope of raising the standard of purchasing negotiations to a level wherein all transactions will be mutually satisfactory. Your cooperation is invited. Q. Substitutions or modifications to any of the terms, conditions, or specifications of this which are made by Weld County after the bids have been distributed to prospective bidders and prior to the date and time of bid opening, will be made in writing. No employee of Weld County is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of said Director of the Weld County Department of Human Services. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. IV.GENERAL SPECIFICATIONS A. Fund Availability: Financial obligations of the Weld County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. By acceptance of the bid, Weld County does not warrant that funds will be available to fund the contract beyond the current fiscal year. B. Governmental Immunity: No term or condition of the contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act §§24- 10-101 et seq., as applicable now or hereafter amended. C. Independent Contractor: The successful bidder shall perform its duties hereunder as an independent contractor and not as an employee. He or she shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to the contract. Neither the successful bidder nor any agent or employee thereof shall be deemed to be an agent or employee of Weld County. The successful bidder and its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through Weld County and Weld County shall not pay for or otherwise provide such coverage for the successful bidder or any of its agents or employees. Unemployment insurance benefits will be available to the successful bidder and its employees and agents only if such coverage is made available by the successful bidder or a third party. The successful bidder shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to the contract. The successful bidder shall not have authorization, express or implied, to bind Weld County to any agreement, liability or understanding, except as expressly set forth in the contract. The successful bidder shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and (b) provide proof thereof when requested to do so by Weld County. D. Compliance with Law: The successful bidder shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established, including without limitation, laws applicable to discrimination and unfair employment practices. E. Choice of Law: Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of the contract. Any provision included or incorporated herein by 6 reference which conflicts with said laws, rules and/or regulations shall be null and void. F. Binding Arbitration Prohibited: Weld County does not agree to binding arbitration by any extra -judicial body or person. Any provision to the contrary in the contract or incorporated herein by reference shall be null and void. G. No Third Party Beneficiary Enforcement: It is expressly understood and agreed that the enforcement of the terms and conditions of the contract, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in the contract shall give or allow any claim or right of action whatsoever by any other person not included in the contract. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under the contract shall be an incidental beneficiary only. H. Attorney Fees/Legal Costs: In the event of a dispute between Weld County and the successful bidder, concerning the contract, the parties agree that Weld County shall not be liable to or responsible for the payment of attorney fees and/or legal costs incurred by or on behalf of the successful bidder. V. Insurance Requirements i. General Requirements: Contractors/Contract Professionals must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant tothis request. Contractors/Contract Professionals shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, during any warranty period, and for three (3) years after termination of the Agreement. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor/Contract Professional. Contractor/Contract Professional shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. ii. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: (a). Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. (b). Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: 7 • $1,000,000 each occurrence; • $2,000,000 general aggregate; • $50,000 any one fire; and • $500,000 errors and omissions. (c). Automobile Liability: Contractor/Contract Professional shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. (d). Additional Provisions: • Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: • If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County within ten (10) days and reinstate the aggregates required; • Unlimited defense costs in excess of policy limits; • Contractual liability covering the indemnification provisions of this Agreement; • A severability of interests provision; • Waiver of exclusion for lawsuits by one insured against another; • A provision that coverage is primary; and • A provision that coverage is non-contributory with other coverage or self- insurance provided by County. (e). For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. iii. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Bid. iv. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance to the County. County reserves the right to require Contractor/Contract Professional to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. v. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured. vi. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. vii. Subcontractors: All subcontractors, subcontractors, independent contractors, sub- vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor/Contract Professional. Contractor/Contract Professional shall include all such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. 8 Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. VI.Warranty. The successful bidder shall warrant that: A. The services to be supplied pursuant to this bid are fit and sufficient for the purpose intended; B. The services sold to Weld County, Colorado pursuant to this bid conform to the minimum Weld County specifications as established herein. VI. CONFIDENTIAL INFORMATION Confidential financial information of the bidder should be transmitted separately from the main bid submittal, clearly denoting in red on the financial information at the top the word, "CONFIDENTIAL." However, the successful bidder is advised that as a public entity, Weld County must comply with the provisions of C.R.S. 24-72-201, et seq., the Colorado Open Records Act (CORA), with regard to public records, and cannot guarantee the confidentiality of all documents. If Weld County receives a CORA request for bid information marked "CONFIDENTIAL", staff will attempt to contact the bidder in order to allow the bidder to seek an appropriate court order preventing disclosure. Without such an order, Weld County will release the requested information in accordance with CORA. 9 SCOPE OF SERVICES PURPOSE: The Weld County Department of Human Services (WCDHS) is seeking qualified English- speaking and bilingual (English/Spanish) providers in various service areas under various funding sources. Service areas include, but are not limited to, Anger Management/Domestic Violence, Day Treatment, Foster Parent Consultation, Foster Parent Training, Functional Family Therapy, Kinship Services (Therapeutic), Home Studies/Relinquishment Counseling, Life Skills, Mediation, Mental Health, Monitored Sobriety, Multi -Systemic Therapy, Home Based Intervention including 24/7 Crisis Intervention, Sexual Abuse Treatment, and Substance Abuse Treatment Services and Aftercare Services. SERVICE AREAS ARE NOTED BEGINNING ON PAGE 1 OFTHIS REQUEST FOR BID, BUT ARE NOT LIMITED TO THOSE LISTED. OTHER SERVICES WILL BE CONSIDERED AND BIDDERS ARE ENCOURAGED TO SUBMIT FOR UNIQUE AND CREATIVESERVICES. Qualifications: To be considered, a bidder must meet the following minimum qualifications: 1) Complete a Provider Information Form (PIF). 2) If submitting to provide bilingual services, a bidder must demonstrate language proficiency at Full Professional Proficiency or higher, as defined by the U.S. Department of State, and as noted below. • Full Professional Proficiency: Able to use and read the language fluently and accurately on all levels pertinent to professional needs • 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 currentlyable 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 staff and/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. W ITN ESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided funding to the Department for NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on , upon proper execution of this Agreement and shall expire , unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Proposal and Exhibit C, Scope of Services. 3. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Department's Resource Manager, Child Welfare Contract and Services Coordinator, or through a Team Decision Making (TDM) meeting or Family Team Meeting (FTM). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit an itemized complete billing statement by the 7th of the month, following the month of service, utilizing billing forms required by the Department. 1 d. Contractor agrees to submit a monthly report with the billing statement by the 7th of the month following the month of service for each client receiving ongoing services. One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation). Verification of Monitored Sobriety Services will be the test result. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. 4. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule, attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon, the continuing availability of said funds for the purposes hereof. d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 5. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services , and Exhibit D, Payment Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit an ACH Form for Colorado Providers, which will be provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of 2 Colorado per the directions on the form. Failure to complete and submit this form in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and - Title VII of the Civil Rights Act of 1964; and - the Age Discrimination in Employment Act of 1967; and - the Equal Pay Act of 1963; and - the Education Amendments of 1972; and Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. 3 b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is Core Services. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contract Professional certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contract Professional will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5-102(5)(c). Contract Professional shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contract Professional that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contract Professional shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contract Professional obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contract Professional shall notify the subcontractor and County within three (3) days that Contract Professional has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contract Professional shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. Contract Professional shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contract Professional participates in the State of Colorado program, Contract Professional shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contract Professional has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, 4 and shall comply with all of the other requirements of the State of Colorado program. If Contract Professional fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contract Professional receives federal or state funds under the contract, Contract Professional must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contract Professional operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5-103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR), and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 9. Insurance Requirements Contractor and Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible the insurance provider. a. General Requirements: Contractors/Contract Professionals must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors/Contract Professionals shall keep the required insurance coverage in force at all times during the term of 5 the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non- payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, in the amount of the deductible or self - insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor/Contract Professional. Contractor/Contract Professional shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: 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 7 Contractor may be required to attend training that the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-352-1551, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 8 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Administrator CONTRACTOR, TITLE 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of 9 any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall not enter into any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 10 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contract Professional agrees that it is an independent Contract Professional and that Contract Professional's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contract Professional shall perform its duties hereunder as an independent Contract Professional. Contract Professional shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contract Professional, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contract Professional or any of its agents or employees. Unemployment insurance benefits will be available to Contract Professional and its employees and agents only if such coverage is made available by Contract Professional or a third party. Contract Professional shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contract Professional shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contract Professional shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law (and as set forth in Exhibit provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in 11 Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflict with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contract Professional's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 12 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contract Professional acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contract Professional. Contract Professional shall not enter into any subcontractor agreements for the completion of this project without County's prior written consent, which may be withheld in County's sole discretion. 36. Attorneys Fees/Legal Costs In the event of a dispute between County and Contract Professional, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contract Professional under this Agreement or individual work order shall become or remain (as applicable), the property of County. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contract Professional in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the County. Contract Professional shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of County. 38. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. 13 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS Weld County Clerk to the Board WELD COUNTY, COLORADO BY: Deputy Clerk to the Board , Chair APPROVED AS TO FUNDING: APPROVED AS TO SUBSTANCE: Controller Elected Official or Department Head APPROVED AS TO FORM: Director of General Services County Attorney CONTRACTOR Contractor, Title 14 EXHIBIT B CONTRACTOR'S PROPOSAL 7251 W 20th Street, Bldg M-2 Greeley, CO 80634 Phone (970)336-1123 Fax (970)351-0182 Transitions PSYCHOLOGY GROUP, LLC■ May 1, 2017 Weld County Department of Human Services RE: Program Proposals for 2017-18 To Whom It May Concern, Transitions Psychology Group, LLC (Transitions) has been providing high quality services to our community since 2001 with our cohesive team of skilled and innovative behavioral health professionals. Over the years, we have built a solid reputation as an agency and we always do our best to maintain that reputation with integrity. We provide ethical and effective psychological services for individuals, couples, families and a variety of human service agencies in Weld County. We developed our Lifeskills and Mental Health programs to serve client populations in Weld County through the Department of Human Services. The Lifeskills program consists of therapeutic visitation and parent coaching for families that have children in foster care or families who are at risk of an out -of - home placement. In this program, we provide services at our offices, in the community and in -home, depending on the needs of the family and the circumstances of each case. We continually assess parent -child interactions, parent capabilities and life skills development with the goal of reunification and preservation of families. In the mental health program, we offer services geared towards helping clients overcome barriers to safe and healthy family interaction and parent -child relationships. Our mental health program is designed to use brief therapies that help clients make the necessary changes in order to reach treatment goals. The mental health program incorporates many modalities of treatment including solution - focused therapy, EMDR, couples therapy, and cognitive behavioral therapy. We provide services to children, adolescents, and adults. Transitions therapists work closely with caseworkers and other providers who are involved in each case in an effort to coordinate care. We use a tailored approach in working with all of our clients that emphasizes their personal goals and the treatment goals set by WCDHS. Transitions has maintained a positive and constructive relationship with the Department over the years. We hope to continue serving Weld County by developing our programs in a way that improve effectiveness, utilization of resources and enhance our community as a whole. Please feel free to contact us with any questions you may have. Thank you for your consideration and we look forward to working with you again in the following program year. Sincerely, Gregory S Creed, PhD Norma Alkire, MA Co -Director Co -Director Enclosures: Provider Information Form, Scope of Services with Rates, Certificates of Insurance, and copies of Resumes and Licensure. Transitions Transitions Psychology Group, LLC LIFESKILLS SCOPE OF SERVICE PSYCHOLOGY GROUP, ICC ■ FY2017-2018. Lifeskills Transitions Psychology Group, LLC (Transitions) is a team of multi -disciplinary professionals working together to provide the highest quality counseling, consulting and assessment services to individuals and families. Transitions provides customized, effective, innovative services to promote human development and address community needs. The agency attracts skilled and experienced professionals who are passionate about helping others. Transitions Lifeskills services are provided by qualified professionals with a minimum of a Master's degree in a human service field. Most providers are Licensed Professional Counselors in Colorado. The Transitions team available for direct services for the Lifeskills program consists of two co -directors, three contracted counselors and one employee at this time. A full-time administrative assistant provides administrative support for the program. Transitions has one Licensed Addiction Counselor (LAC) in order to provide direct service and case consultation to address parent substance abuse issues that impact family functioning. Additionally, we have one Certified Addiction Counselor 2 (CAC 2) professional on staff. Transitions continually strives to maintain current and most effective practices. The Transitions' office is located in Greeley, CO and services are primarily provided in the Greeley area. Bilingual Services Transitions has one therapist that provides services in Spanish, Gregory S. Creed, PhD. He is proficient at a professional level having provided many years of service to Spanish-speaking clients. In addition, he teaches a 20 -hour class at a Hispanic ministries center to couples in paraprofessional training. Our counselor agrees to any necessary testing of proficiency that may be required. References are available upon request. Trauma Informed Care Transitions is committed to providing Trauma Informed Care. We have one therapist that is certified in Trauma Informed Care and trained in EMDR. The other therapists are all registered for training in Trauma Informed Care. Transitions Psychology Group, LLC FY2017-201a Lifeskills Referral Acceptance, Assignment Protocol, Quick Response and Outcome Data Referrals are received by the administrative assistant and program supervisor via email to Transitions. Our administrative assistant immediately sends an email of receipt, prepares a client chart and begins to contact all parties to schedule appointments within one business day upon receipt of the referral. The program supervisor assigns all cases based on needs of the clients and particular skills and availability of our counselors. The Transitions counselor conducts an intake interview prior to the initial visit between the parent(s) and child(ren). In a case where the child(ren) are older and more cognizant, an initial session is also conducted in order to build rapport and a sense of support for the child(ren). Transitions has a good track record of providing organized, responsive and quickly scheduled services. Furthermore, Transitions is willing to track outcome data of all cases received. Supervisory Structure Transitions has two supervisors (Norma Alkire, MA, LPC and Gregory S. Creed, PhD, LPC) for our Mental Health program who work collaboratively with our counselors. Both supervisors are Licensed Professional Counselors. One has a master's degree in community counseling and the other a PhD in Counselor Education and Supervision. Unlicensed master -level therapists on the program receive weekly 1 -hour supervision sessions and have availability for case consultation with supervisors as needed. We have monthly 2 -hour case consultation meetings for all counselors on our Mental Health Program. Transitions counselors work collaboratively on cases, so there is an ongoing process of consultation and supervision. Lifeskills: Therapeutic Visitation and Parent Coaching Transitions has developed and implemented a customized program to address the needs of Weld County parents with children in foster care as well as the needs of the Department of Social Services and the court. The therapeutic visitation program is an enhanced supervised visitation service that incorporates concepts from a variety of therapeutic disciplines: individual therapy, couple's therapy, family therapy, play therapy, Parent -Child Interactional Therapy and parenting skills education are blended to create individualized interventions for each referred family. The contact between parents and children is structured to provide for the safety and well-being of children while maintaining the continuity of family relationships. Therapeutic visitation provides opportunities to learn and practice positive parenting. Additional time is spent with parents outside of and during visits to provide feedback and education and address identified needs. Continuous assessment of the parents' capacity to appropriately care for their children is provided. Transitions utilizes when appropriate for the case the Life Skills Assessment (LSA) tool developed by our team to assess areas of family functioning including household management and environment, parenting styles and capabilities, family interactions and safety, child well- being, support network and community resources, and motivation and commitment. The LSA incorporates solution -focused scaling and offers a pre- and post -assessment of improvement based on a single case research model. The providers are knowledgeable Transitions Psychology Group, LLC FY2017-2018 Lifeskills about child development and able to identify concerns about the physical, emotional, educational and behavioral well-being of the child and make appropriate recommendations to address these concerns. Providers maintain regular contact with the Department of Social Services through online written reports, phone calls, email, staffing of cases and reviews. Transitions believes in providing services in the most natural, least restrictive setting possible that will ensure safety of the children. To this end, services are provided at Transitions' offices, community venues and client homes. Transitions provides both office based and in -home services to address continuum of care issues as clients progress from more restrictive to less restrictive settings. Transitions also provides intensive home -based life skills coaching to address family needs to prevent placement of children in foster care or facilitate the reunification process when children are leaving foster care and returning to their homes. Coaching is provided by Master's level therapists who are skilled at customizing services for each referral. These services may include individual counseling, family counseling, intensive parenting education and remediation, relapse prevention counseling and referrals to enhance the family's capacity to provide for their children's needs. Rates: Family Therapy Visitation: Family contact in the presence of a Master's or Doctoral level therapist. This level of supervision protects the children emotionally and assists in the healing of the parent -child relationship that has been damaged by severe abuse and neglect. $113 per face to face hour Level 3 Therapeutic Visitation: Supervision and evaluation of parent -child interactions for referred clients and their minor children by a Master's or Doctoral level therapist. This level assures that children remain safe by providing contact with their family members in a highly structured and instructional setting. The child is in the presence of the supervisor at all times for families with risk factors and/or moderate to high safety concerns. $113 per face-to-face hour In -Home Therapeutic Visitation/Lifeskills Coaching: $130 per face-to-face hour Team Decision Making (TDM) Meetings: Participation in TDM with DHS staff, multiple providers, and family members. $130 per hour/therapist Transitions Psychology Group, LLC FY2017-201a Lifeskills Court Facilitations: Participation in court facilitations with multiple providers related to current or prior referral for services $ 130 per hour Court Testimony: Preparation and expert testimony for current or prior services provided by Master's or Doctoral level therapist $160 per hour, 1.5 minimum billing for each court appearance Medicaid: The service of the Lifeskills Program are not eligible for reimbursement under Medicaid. Transitions Psychology Group, LLC FY2017-18 Mental Health Services 1 Transi fonS MENTAL HEALTH SERVICES SCOPE OF SERVICE PSKCMOLOG, GROUP, LLCM Transitions Psychology Group, LLC (Transitions) is a team of multi -disciplinary professionals working together to provide the highest quality counseling, consulting and assessment services to individuals and families. Transitions provides customized, effective, innovative services to promote human development and address community needs. The agency attracts skilled and experienced professionals who are passionate about helping others. Transitions Mental Health services are provided by qualified professionals with a minimum of a Master's degree in a human service field. Most providers are Licensed Professional Counselors in Colorado. The Transitions team available for direct services for the Mental Health program consists of two co -directors, three contracted counselors and one employee at this time. A full-time administrative assistant provides administrative support for the program. Transitions has one Licensed Addiction Counselor (LAC) in order to provide direct service and case consultation to address parent substance abuse issues that impact family functioning. Additionally, we have one Certified Addiction Counselor 2 (CAC 2) professional on staff. Transitions continually strives to maintain current and most effective practices. The Transitions' office is located in Greeley, CO and services are primarily provided in the Greeley area. Bilingual Services Transitions has one therapist that provides services in Spanish, Gregory S. Creed, PhD. He is proficient at a professional level having provided many years of service to Spanish-speaking clients. In addition, he teaches a 20 -hour class at a Hispanic ministries center to couples in paraprofessional training. Our counselor agrees to any necessary testing of proficiency that may be required. References are available upon request. Trauma Informed Care Transitions is committed to providing Trauma Informed Care. We have one therapist that is certified in Trauma Informed Care and trained in EMDR. The other therapists are all registered for training in Trauma Informed Care. Transitions Psychology Group, LLC FY2017-18 Mental Health Services 2 Referral Acceptance, Assignment Protocol, Quick Response and Outcome Data Referrals are received by the administrative assistant and program supervisor via email to Transitions. Our administrative assistant immediately sends an email of receipt, prepares a client chart and begins to contact all parties to schedule appointments within one business day upon receipt of the referral. The program supervisor assigns all cases based on needs of the clients and particular skills and availability of our counselors. The Transitions counselor conducts an intake interview prior to the initial visit between the parent(s) and child(ren). In a case where the child(ren) are older and more cognizant, an initial session is also conducted in order to build rapport and a sense of support for the child(ren). Transitions has a good track record of providing organized, responsive and quickly scheduled services. Furthermore, Transitions is willing to track outcome data of all cases received. Supervisory Structure Transitions has two supervisors (Norma Alkire, MA, LPC and Gregory S. Creed, PhD, LPC) for our Mental Health program who work collaboratively with our counselors. Both supervisors are Licensed Professional Counselors. One has a master's degree in community counseling and the other a PhD in Counselor Education and Supervision. Unlicensed master -level therapists on the program receive weekly 1 -hour supervision sessions and have availability for case consultation with supervisors as needed. We have monthly 2 -hour case consultation meetings for all counselors on our Mental Health Program. Transitions counselors work collaboratively on cases, so there is an ongoing process of consultation and supervision. Mental Health Services: Family, Couples and Individual Counseling The Transitions Mental Health Services program offers family, couple and individual counseling services customized to meet the needs of the family as well as the needs of the Department of Human Services and the court. Transitions utilizes our signature team approach to link family, couple and individual services with existing programs such as Transitions Lifeskills and other community services in order to provide a continuum of care delivered at the opportune time and at the most appropriate level of service. Counseling services address family system dynamics and individual issues that impact the safety and well-being of children. Transitions therapists use brief therapy models that are solution oriented and geared towards completing services in a 3-6 month time frame. Services are proactive with the goal of preventing out -of -home placement, during placement to address safety, mental health and relationship issues or during the reunification process in order to promote family stability and permanency. Transitions Psychology Group, LLC FY2017-18 Mental Health Services 3 Transitions believes in using strength based approaches to family counseling designed to enhance the overall functioning of the family. Family characteristics such as communication, togetherness, flexibility, family structure, family lifecycle, multigenerational issues, interactions and resiliencies are assessed and treated. Couples issues and tension often spill over into parenting and can have an impact on behavior in children and overall functioning of the family. Therefore, it is often necessary to address couple issues in order to facilitate long-lasting, systemic change in families. Couples therapy builds on the strengths and resiliency of the couple in order to correct certain deficit areas that undermine the family foundation. Individual counseling services are provided to adults, adolescents and children to address a wide variety of issues that impact the individual and family. The aim of this service is to remove any barriers to safety and well-being in the home which may include but not limited to behavior problems, depression, anxiety, stress, trauma, grief and loss, health, self-image, character and treatment compliance. EMDR (Eye Movement Desensitization and Reprocessing) is a powerful process designed to resolve memories of a past difficult emotional experience affecting current functioning. EMDR is extensively researched and shown to be effective in the treatment of trauma. EMDR is used with children, adolescents and adults and may be used to work through stressors such as abuse, addiction, anxiety, life stress, chronic pain and disturbing memories. EMDR may be used in conjunction with, or independent of, other services. Rates (See below for Medicaid Billing): Family Counseling: Direct counseling services provided by a Master's or Doctoral level family therapist. $105 per face-to-face hour Couples Counseling: Direct counseling services provided to the couple by a Master's or Doctoral level family systems therapist. $105 per face-to-face hour Co -therapy Family/Couples Counseling: Direct counseling services provided by two Master's or Doctoral level family systems therapists. This service is designed to bridge services between programs and to promote change in families in complex cases. Requires pre -approval and is limited to 1-3 sessions per case. $200 per face-to-face hour Individual Counseling: Direct counseling services provided by a Master's or Doctoral level therapist. Transitions Psychology Group, LLC FY2017-18 Mental Health Services 4 $105 per face-to-face hour EMDR Counseling: Direct counseling services provided by a Master's or Doctoral level EMDR certified therapist. Provided in conjunction with or independent from individual of family counseling. $105 per face-to-face hour In -Home Counseling Services: Direct counseling services provided by a Master's or Doctoral level therapist. $120 per face-to-face hour Team Decision Making (TDM) Meetings: Participation in TDM with DHS staff, multiple providers, and family members. $130 per hour/therapist Court Facilitations: Participation in court facilitations with multiple providers related to current or prior referral for services $130 per hour Court Testimony: Preparation and expert testimony for current or prior services provided by Master's or Doctoral level therapist. $160 per hour, 1.5 minimum billing for each court appearance Medicaid Billing_ Medicaid Billing: Transitions is an approved Medicaid Provider in the State of Colorado. We are currently awaiting approval through Colorado Access for Medicaid Billing. Under Medicaid billing of services for any WCDHS client referral additional charges will apply as services are rendered: Case Documentation: A monthly flat fee is applied to case documentation in order to adequately document cases according to the requirements of the WCDHS reporting system. $35 per month billing Case Management: All case management will be billed in increments of 15 minutes. Case management includes communication with caseworkers, Guardian Ad Litum, county attorneys, CASA workers, and any other providers involved in the case. It also includes reading documentation related to the case Transitions Psychology Group, LLC FY2017-18 Mental Health Services 5 including Family Service Plans, psychological reports, lengthy emails, letters, court orders, etc. $105 per hour, billable in .25/hour increments Team Decision Making (TDM) Meetings: Participation in TDM with DHS staff, multiple providers, and family members. $130 per hour/therapist Court Facilitations: Participation in court facilitations with multiple providers related to current or prior referral for services $130 per hour Court Testimony: Preparation and expert testimony for current or prior services provided by Master's or Doctoral level therapist. $160 per hour, 1.5 minimum billing for each court appearance OP ID: SLS kai....----`-' CERTIFICATE OF LIABILITY INSURANCE DATE`MMIDDrYYYY) 05/31/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(k8) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Front Range Insurance Group Phone: 970-223-1804 1100 Heaton Drive Suite 100 Fax- Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI CONTACT tam Nor. PRODUCER TRANS -6 CUSTOMER ID 0: INSURER(S) AFFORDING COVERAGE NAIC S INSURED Transitions Psychology Group, LLC 7281 W. 20th St, Unit M2 Greeley, CO 80634 INSURER A : ThilldelPhla Wigwam* INsuJER 6: Plnnacol Assurance 41190 INSURER c: INSURER D : SOURER E : INSURER F : • • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDCLAIMS. /LEI RR TYPE OF INSURANCE INSa Iwo POLICY NUMBER lIW DEACT1 ntMl IM1 UNITS A A A GENERAL X LIABILITY COMMERCIAL GENERAL X LIABILITY OCCUR PHPK1i00743 05/23f2016 05123/2016 05/23/2016 05/23/2017 05/23/2017 05/23/2017 EACH OCCURRENCE 1 1,000,000, PPEMISES (EsENTED o oe) $ 100,000 CLAIMS -MADE MED EXP (Any one person) $ 5,000 X X Prof Liability PERSONAL a ADV INJURY $ 1,000,000 Sexual Abuse GENERAL AGGREGATE $ 2,000,000 GEM. AGGREGATE LIMIT APPLIES PER: 5i1 pOUCY I I ERc I LaC PRODUCTS - COMP/OP AGG $ 2,000,000 Sexual Ab $ 100,000 A AU'101W8®.E X X LIABILITY ANY AUTO PHPKIS00743 05/23/2016 05/23/2017 COMBINED SINGLE UMIT (Ea oxidant) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per aaidem) $ S $ A X UMBRELLA LIAR EXCESS 'AC X OCCUR CLAIMS -MADE PHUB542077 05/23/2016 06/23/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 X DEDUCTIBLE RETENTION $ 10,000 $ $ -B WORKERS COMPENSATIO END EMPW DIMWIN ANY.PR.I�RIETORIPfiR,fNERJExECUTIVEY/N TX below N / A 4104451 05/01/2016 05/01/2017 I TORYSTILTS OR�LIM TI s I I ER EL EACH ACCIDENT $ 500',000- OFFICERIMEMBER EXCLUDED? (BNrbatoryr(nNH) eyes, dercrPoe under OESCRIPTION OF OPERATIONS E.L DISEASE - EA EMPLOYEE $ 500,000 - E.L DISEASE - POLICY LIMIT $ 500,000 A Sue Para Property PHPK1500743 05/23/2016 05/23/2017 BPP 50,o0p DESCRIPTION OF OPERATIONS/LOCATIONS / VEHICLES (Apacb ACORD 101, Additional Renck* Schedule, Irma* apace IS required) CERTIFICATE HOLDER CANCELLATION DEPTOFH Department of Human Services of Greeley 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. AUTHORIZED REPRESENT/ME ACORD 25 (2009/09) 0)1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Gregory S. Creed, PhD, LPC Transitions Psychology Group, LLC 7251 W 20th Street, Bldg M-2, Greeley, CO 80634 2008A W 120th Avenue, Suite 8, Westminster CO 80234 Tel (970) 336-1123 FAX (970) 351-0182 Cell (970) 590-1424 Email: greg.creed .counselingtransitions.com Website: www.counselingtransitions.com Highlights of Qualifications • Doctoral level marriage & family counselor with over 13 years' experience • Licensed Professional Counselor & National Certified Counselor • Professional training in family systems therapy & couples counseling • Proficient in Spanish and Japanese with highly developed cultural competencies. Sept 1999-Pres Jan 99 -Aug 99 Jan 98 -Dec 98 1996-1998 Relevant Experience Co -Director & Marriage and Family Counselor, Transitions Psychology Group, LLC • Provide high quality individual, couples and family therapy • Supervise counselors on several programs • Perform administrative functions for the agency Counselor/Case Manager,. North Range Behavioral Health, 1306 11th Avenue, Greeley, CO 80631 • Provided in -home therapy services for family preservation referrals from DSS and for an interagency collaborative program • Maintained productive working relationships with caseworkers from DSS • Conducted therapy with Spanish speaking families • Produced positive outcomes with families and individuals Internship, North Range Behavioral Health, 1306 11th Avenue, Greeley, CO 80631 • Family, group and individual therapy with children, adolescents, and adults • Experience with family preservation, Head Start and outreach programs • Case consultation with parents, teachers and program directors. Program Coordinator, Center for International Education, UNC, 1945 10th Avenue, Greeley, CO 80639 • Coordinate cross-cultural programming campus -wide 1994-1996 1990-1996 • Facilitate retention programs for international students • Direct home stay program for Japanese students Assistant Language Teacher, Kyoto City Board of Education, Oike-Teramachi, Nakagyo-ku, Kyoto 616, Japan • Taught English to high school students in team -teaching format wit Japanese teachers • Encouraged Japanese teachers to be model learners of English and to explore new methods of teaching • Designed teaching materials and teaching plans • Helped team to develop new pilot English course Owner & Instructor, Gregory's English School, Kyoto, Japan. • Taught 35 students weekly in small groups, parent/child classes and in individual sessions • Helped demystify the learning process for students and helped them to develop a taste for self -guided learning 1989-1990 Spanish Instructor, Aims Community College, Greeley, CO 1986-1988 Assistant English Teacher, Japan Exchange and Teaching Program, Kyoto Prefectural Research and Training Center, Nishi-machi, Morinagato, Momoyama, Fushimi-ku, Kyoto, Japan • Conducted seminars and training workshops to Japanese educators • Taught English to high school students • Regional representative for Assistant English Teacher Association Education Ph.D., Counselor Education & Supervision, 2006 M.A., Community Counseling, Marriage & Family Emphasis, University of Northern Colorado, 1999 B.A., McPherson College, McPherson, Kansas, Business Management & Spanish, 1986 Junior Year Study Abroad, University of Granada, Granada, Spain, 1983-84 Certification & Licensure Licensed Professional Counselor, #2869 National Certified Counselor Presentations & Professional Instruction Marriage and Family Counseling & Pastoral Counseling Instructor St. John Vianney Theological Seminary, Sept 2008-Pres., 1300 Steele Street, Denver CO Marriage & Family Workshop, Pontifical North American College, Rome, Italy, September 2010 Family and Couple Therapy, Argosy University, Fall 2010, 7600 E. Eastman Avenue, Denver CO Family Systems, University of Northern Colorado, Fall 2010, Greeley CO Pastoral Care with Teens & Adolescent Development, May 31, 2012, Youth Culture & Pastoral Ministry CAYM 606, Augustine Institute, Denver CO Pastoral Care with Teens & Adolescent Development, June 18, 2012, FORMED Youth Ministry, YDisciple, Augustine Institute, Denver CO Counseling Teens and Adolescent Development, Denver Leadership Conference, The Impact Center, St. John Vianney Theological Seminary, August 2010, 1300 Steele Street, Denver CO A School of Love, Life and Learning, Teacher In -Service Training, November 2, 2011, St. Mary's Catholic School, Greeley, CO. Counseling Teens and Adolescent Development, St. John Bosco Youth Ministry Certification Program, April 15-16, 2011, Archdiocese of Kansas City, KS, Marriage Preparation Class: Discipline and Teaching of Children (In Spanish), St. Nicolas Catholic Church, Oct 9, 2009 & 2010, Platteville, CO A Balancing Act: Strengths & Stressors for Families in Cross -Cultural Transitions, FIGT (Families in Global Transitions) Annual Conference, March 29-30, 2007, Houston, Texas The Mystery of Parenting Teens, Parent Training Seminar, St Mary Catholic Church Fall 2004 and St Peter Catholic Church Fall 2005 International Relocation: Implications for Families, Poster Session, Rocky Mountain ACES annual meeting, Oct 5-7, 1998, Jackson, Wyoming Published Dissertation G.S. Creed (2006). Families in cross-cultural transitions: Psychological adjustment, sociocultural adaptation and acculturation strategy. Professional Associations ACA (American Counseling Association) AAMFT (American Association for Marriage and Family Therapy) CPA (Catholic Psychotherapy Association) Child Welfare Collaborative/Model Court Subcommittee on Visitation and Orientation, Weld County 19th Judicial District Academy of Natural Therapy, Advisory Committee Member, Greeley, CO. References Available Upon Request COLORADO Department of Regulatory Agencies sion of Professions and Occupations Congratulations! Below are your electronic wallet cards to use as proof of your license. You can also print your license at any time through your Online Services account by visiting our homepage at www.dora.colorado.gov/professions and clicking on the "Print your License" link under the label "Quick Links". If you would like a more durable wallet card option, you can order one for a fee by visiting www.nasbastore.org and selecting the "Colorado License Cards" link on the left hand side of the page. If you prefer, you can also contact NASBA by phone at 1-888-925-5237 or by email at nasbastore@nasba.org. Should you have questions about your credential, or need other information, please contact our Customer Service Team at 303-894-7800 or dora_registrations@state.co.us. Cut along the line Colorado Department of Regulatory Agencies Division of Professions and Occupations Licensed Professional Counselor Examiners Board Gregory Scott Creed Licensed Professional Counselor LPC.0002869 Number Active Credential Status Verify this credential at: www.dora.colorado.gov/profession s bl4lsion Director: Lauren Larson tEredentiai Holder Signature 09/01/2015 Issue Date 08/31/2017 Expire Date Colorado Department of Regulatory Agencies Division of Professions and Occupations Licensed Professional Counselor Examiners Board Gregory Scott Creed licensed Professional Counselor LPC.0002869 Number Active Credential Status Verify this credential at: www.dora.cotorado.e ov/profession s 09/01/201S Issue Date 08/31/2017 Expire Date ision Director: Lauren Larson dentlal Holder Signature 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 303.894.7693 www.dora.catorado.gov/professions HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP Certif i.catt of 311Orante HP O MI, Pr4,klms 5enise C,�nis„9 PRODUCER I BRANCH I PREFIX 018098 970 HPG Named Insured Gregory S Creed 7251 W 20th St Unit M2 Greeley, CO 80634-4626 Medical Specialty OCCURRENCE POLICY FORM POLICY NUMBER Policy Period: 0270170686-8 Code Clinical Counselor/LPCC Excludes Cosmetic Procedures Professional Liability Your professional liability limits shown above include the following: • Good Samaritan Liability • Malplacement Liability • Personal Injury Liability • Sexual Misconduct included in the PL Limit shown above subject to $25,000 aggregate sublimit 80723 From 07/04/16 to 07/04/17 at 12:01 AM Standard Time Program Administered by: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 19040-1218 1-800-982-9491 www.hpso.com Insurance is provided by: American Casualty Company of Reading, Pennsylvania 333 South Wabash Avenue Chicago, Illinois 60604 $1,000,000 each claim $3,000,000 aggregate -Coverage Extensions License Protection Defendant Expense Benefit Deposition Representation Assault Includes Workplace Violence Counseling Medical Payments First Aid Damage to Property of Others Information Privacy (HIPAA) Fines & Penalties Workplace Liability Workplace Liability Fire and Water Legal Liability Personal Liability Total: $294.00 Premium reflects self-employed, full-time rate with ACA Membership discount. $ 25,000 per proceeding $ 1,000 per day limit $ 10,000 per deposition $ 25,000 per incident $ 25,000 per person $ 10,000 per incident $ 10,000 per incident $ 25,000 per incident $ 25,000 aggregate $ 25,000 aggregate $ 10,000 aggregate $ 25,000 aggregate $ 100,000 aggregate $ 10,000 aggregate $ 10,000 aggregate $ 25,000 aggregate Included in Professional Liability Limit shown above Included in the PL limit above subject to $150,000 aggregate sublimit $1,000,000 aggregate Policy Forms & Endorsements (Please see attached list for a general description of many common policy forms and endorsements.) G -121500-D G -121501-C G -121503-C CNA82011 G -145184-A G -147292-A CNA81753 CNA81758 GSL13424 GSL15563 GSL15564 GSL15565 GSL17101 CNA80052 CNA80051 G -123846-005 CNA79575 ttLviNtier. c !A ` /A Chairman of the Board Secretary Keep this Certificate of Insurance in a safe place. This Certificate of insurance and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full. In order to activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. Form #: G-141241-8 (3/2010) Master Policy: 188711433 Registration has already been confirmed 5/1/17, 8:51 AM NCFY Online Training Home F(SB N Family & Youth National Clearinghouse Services Bureau ; on Families & Youth NCFY Online Training Website Home ► Registration has already been confirmed Thanks, Gregory Creed Registration has already been confirmed Go to course list You are not logged in. (Log in) Home https://ncfy-learn.j bsinternational.com/login/confi rm. php?data=8sam7gBh44TW XJz/greg%2Ecreed Page 1 of 1 NORMA RMA ALKIRE, MA, LPC, LAC EDUCATION 1995 - 1997 Aims Community College Greeley, Colorado AA Degree, Liberal Arts 1997-1998 University of Northern Colorado Greeley, Colorado Bachelor of Arts Degree, Sociology Major, Psychology Minor 1999-2001 University of Northern Colorado Greeley, Colorado Master of Arts Degree, Rehabilitation Counseling/Vocational Evaluation 2002-2004 University of Northern Colorado Greeley, Colorado Masters of Arts Degree, Community Counseling/Marriage & Family Therapy LICENSURES AND CERTIFICATIONS NCC National Certified Counselor #89888 LAC Licensed Addiction Counselor #ACD141 LPC Licensed Professional Counselor #LPC4453 EMDR Certified American Red Cross Disaster Mental Health Trained Value Options Military OneSource Provider PROFESSIONAL EXPERIENCE Exp. 8/31/20 Exp. 8/31/17 Exp. 8/31/17 Exp. 2/01/16 March 2012 May 2012 1999-2000 North Range Behavioral Health Greeley, Colorado Clinical Care Assistant Supervisor, Alice McPherson, MA • Assisted Master's level counselors with the care and treatment of chronic mentally ill adults • Assisted in answering and counseling on a 24 -hour crisis line Nov 2001 -April 2003 Mentoring Coordinator • Mentored TANF clients • Provided encouragement and support to clients re-entering the workplace • Worked with case managers and TANF technicians • Attended staffmgs and other relevant meetings • Completed monthly progress reports Transitions Psychology Group Greeley, Colorado Supervisor, Greg Creed, MA, LPC May 2003 -April 2004 North Range Behavioral Health — Frontier House Greeley, Colorado Rehabilitation Counselor Supervisor, Jennifer Euler, MA • Assisted adults with mental illness in seeking employment • Completed monthly summaries with clubhouse members • Helped clubhouse members in finding community resources • Provided job coaching • Developed jobs in the community for clubhouse members • Attended daily and weekly meetings 4913 12th St Rd. Greeley, Co. 80634 PHONE 970-590-9861 • E-MAIL normaalkire@hotmail.COM Jan 2004 - July 2004 NCMC/Psychcare Greeley, Colorado Therapist (Intern) Supervisor, Stacey Blank, M4, LPC, CAC III • Facilitated and Co -facilitated adult drug and alcohol groups for both in and out patients • Administered Social Assessments to both mental health and substance abuse adult and adolescent inpatients • Attended staffmgs and case conferences with psychiatrists, psychologist and therapists • Completed progress notes and other relevant paper work • Facilitated and Co -facilitated family discharge planning meetings • Taught parenting classes • Co -facilitated continuing care group June 2004 — September 2005 Island Grove Regional Treatment Center Greeley, Colorado Youth & Family Services Counselor/Research Assistant Supervisors, Rochelle Galey, MSW, CAC III Katherine Bryant, MS, CAC II John Wilde, MA, LAC • Facilitated adolescent substance abuse and anger management groups • Conducted substance abuse evaluations, intakes, and discharges • Completed all relevant paperwork ie: progress notes, substance abuse evaluations, intakes, discharge summaries, letters, etc. • Case management • Collaborated with other treatment and community agencies to meet the individual needs of clients • Attended staffings • Participated in community meetings • Attended trainings relevant to certification requirements for Certified Addictions Counselor (CAC) and Clinical Trials Network (CTN) • Administered baseline and follow-up assessments for CTN research protocol • Contacted research participants for follow-up appointments September 2005 - July 2006 Platte Valley Youth Services Center Greeley, Co. 80631 Youth Services Counselor I Supervisor, Gail White, MS' • Provide drug and alcohol treatment for adolescent males committed to DYC • Facilitate drug and alcohol groups • Complete all relevant paperwork including TRAILS documentation • Attend staffings, Parole Board hearings, and other relevant meetings • Provide case management and transitional services as needed • Communicate with Parole Officers/Client Manager's, families, and other counselor's with regard to youth's disposition • Facilitate family therapy • Provide (Eye Movement Desensitization and Reprocessing) EMDR therapy for youth with trauma and substance abuse issues • Supervise CSO I and CSO II (security officers) pod staff • Complete PMAP evaluations • Attend (Sex Offender Management Board)SOMB and other trainings relevant to job duties 4913 12th St Rd. Greeley, Co. 80634 PHONE 970-590-9861 • E-MAIL normaalkire@hotmail.COM July 2006 — January 2007 Platte Valley Youth Services Center Greeley, Co. 80631 Social Work Counselor II Supervisor, Kevin Powell, PhD • Provide drug and alcohol treatment for adolescent males committed to DYC • Facilitate drug and alcohol treatment groups • Complete all relevant paperwork including TRAILS documentation • Attend staffmgs, Parole Board hearings, Community Review Boards (CRB's), and other relevant meetings • Provide case management and transitional services as needed • Communicate with Parole Officers/Client Manager's, families, and other counselor's with regard to youth's disposition • Facilitate family therapy • Provide EMDR therapy for youth with trauma and substance abuse issues • Monitoring and documentation of youth on suicide watch • Attend SOMB and other trainings relevant to job duties • Participate in the hiring process of counseling and other staff • Implement and maintain treatment planning process • Training of staff in utilization of mandated documents • Compliance of audit standards with regard to upkeep and maintenance of clinical records February 2007 — present Transitions Psychology Group, LLC Greeley, Co. 80631 Therapist/Co-Director • Provide Therapeutic Supervision for families involved in the Social Services System • Facilitate family therapy • Help parent's with effective parenting techniques by utilizing the Common Sense Parenting curriculum • Transport children to visitation with their parents • Follow and implement treatment plans created by Social Services caseworker • Attend Case Facilitation meetings with all parties involved in CPS • Teach Life Skills to individuals in need of this service • Provide therapeutic intervention for individual client's either self -referred or referred by Employment Services • Complete drug and alcohol and mental health assessments • Utilize EMDR as a tool to assist individual's in overcoming lifetime trauma • Provide therapy to adolescents committed to DYC PROFESSIONAL MEMBERSHIPS ACA American Counseling Association EMDRIA Eye Movement Desensitization and Reprocessing International Association NAADAC Association for Addiction Professionals 4913 12"' St Rd. Greeley, Co. 80634 PHONE 970-590-9861 • E-MAIL normaalkire@hotmail.COM CONTINUING EDUCATION EMDR: CTN: CAC: SOMB: Part 1 of the Basic Training January 22, 2006 Molly Gierasch, PhD Part 2 of the Basic Training April 23, 2006 Molly Gierasch, PhD Integrating Resource Installation Strategies into your EMDR Practice August 18/19, 2006 Roy Kiessling, LISW Transforming Trauma with EMDR: Advanced Clinical Workshop and Refresher Course October 12-16, 2007 Laurel Parnell, PhD Effectively Utilizing the Eight Phases of EMDR with Any Age Child or Adolescent April 12, 2008 Gregory S. Smith, LISW Advanced EMDR Skills for Strengthening Performance in Executives, Professionals, and Other Adult Clients April 13, 2008 Gregory S. Smith, LISW Mindfulness, Meditation, and EMDR October 24-25, 2009 Julie K. Greene, LPC Through the Eyes of a Child: Using EMDR with Children May 20-21, 2011 Robert Tinker, Ph.D & Sandra Wilson, Ph.D 2012 EMDR International Conference October 4-7, 2012 Feeling State Addiction Protocol — Two day seminar January 19-20, 2013 Robert Miller, PsyD Human Participants Protection Education for Research Teams August 2, 2004 HIV and HCV Reduction Interventions in Drug Detoxification and Treatment Settings June 23-25, 2004 Recruitment, Retention and Return for Follow Up Workshop September 13-14, 2004 Risk Behavior Survey Training July 9, 2004 Biological Measures Training July 9, 2004 Good Research Practices Training July 21, 2004 Composite International Diagnostic Interview (CIDI) July 7-8, 2004 Composite International Diagnostic Interview Post Tmg. October, 8, 2004 CTN0017 Data Management Training November 10, 2004 Addiction Severity Index (ASI) Classroom Training July 20, 2004 Addiction Severity Index (ASI) November 1, 2004 Addiction Counseling Principles of Addiction Treatment Pharmacology I Pharmacology II Client Records Management Motivational Interviewing Infectious Diseases in the Drug and Alcohol Work Setting Ethical Issues in the Drug and Alcohol Work Setting Gender Specific Issues in the Delivery of Treatment Services Adolescent Substance Abuse Issues Clinical Supervision The Culture of Poverty Adolescent Differential Screening Cognitive Behavior SASSI Clinical Interpretation Pathways to Self Discovery Training Advanced Counseling Skills April 14-16, 2004 February 2-4, 2004 June 14-15, 2004 August 16 and 23, 2004 June 7-8, 2004 June 29-29, 2004 September 20-21, 2004 October 18-19, 2004 November 5, 2004 November 1-2, 2004 March 2-4, 2005 November 15-16, 2004 May 20, 2005 May 24-25, 2005 July 20, 2005 July 11-12, 2005 August 14-16, 2005 Understanding the Sexual Behavior of Children, Adolescents, and Adults by Mary Marcantonio, Eileen Courtney and Phil Tedeschi May 9, 2006 Hooks, Hopes, and Healing by Jan Hindman April 18, 2006 4913 12th St Rd. Greeley, Co. 80634 PHONE 970-590-9861 • E-MAIL normaalkire@hotmail.COM Treatment of Sexually Abusive Youth: A Goal Oriented Approach by Gail Ryan, MA April, 2006 (40 hours) Reunification, Contact and Clarification with Victims and Potential Victims by Phil Tedeschi, LCSW May 31, 2006 Sex Offender Registration Training June 23, 2006 Introduction to Supervision and Management of Juveniles Who Commit Sexual Offenses and Introduction to Informed Supervision by Phil Tedeschi June 27, 2006 Understanding Sexually Abusive Youth -New Research and Clinical Direction by John Hunter, PhD October 23, 2006 DYC: DYC Basic Navigation Training in Colorado Trails DYC Super User Training in Colorado Trails DYC Pre -Service DYC Staff Safety Training Phase 1 DYC Supervisory Training and Review Program Instructional Theory Into Practice (16 hrs.) October 18, 2005 May 4, 2006 October 7, 2005 October 13, 2005 May 24, 2006 August 2-3, 2006 Miscellaneous: NAADAC, The Association for Addiction Professionals Annual Conference Atlanta, Georgia October 11-15, 2013 American Psychological Association DSM-5 Field Trials Training Course May 5, 2012 American Counseling Association Conference March 25, 2012 Sexual Compulsivity Clinical Training by Maureen Canning November 4-6, 2009 Aggressive/Impulsive Behavior Workshop by Kevin Powell February 27, 2009 Comprehensive Training for Parenting Coordinators and Decision -Makers by Betsy Barbour Duvall, LCSW and Christine Coates, M. Ed, J.D. December 5-6, 2008 Strategies for Difficult Adolescents by Fred Hanna, PhD October 13, 2006 Developing the Most Effective Systems of Care for People with Co -Occurring Mental Health and Substance Use Disorders: Working Together for Change by Kenneth Minkoff, MD August 30, 2004 The Biosocial Effects of Methamphetamine Abuse by Nicholas Taylor, PhD, CACIII October 8, 2004 Kids Brains May 20-21, 2004 Domestic Violence and Child Abuse Reporting October 27, 2004 Gang Awareness by GPD January 12, 2005 Children from DV Homes and Their Treatment September 15, 2004 Counseling Skills Training Update June 15, 2005 Mindfulness and DBT June 29, 2005 Methamphetamine: Effects of Abuse and Treatment Strategies by Janet Wood July 27, 2006 Substance Abuse Treatment for Medicaid Covered Individuals: A Providers Guide Physical and Emotional Impact of Trauma on the Body 18th Annual COVA Conference Working with GLBTQ Kids Bi-Polar: A New Slant on the Disease Confronting Trauma Related Disorders Trauma Focused Cognitive Behavioral Therapy Training February 23, 2006 November 12, 2006 November 12-15, 2006 December 8, 2006 April 19, 2007 June 15, 2007 April 16-17, 2015 4913 12th St Rd. Greeley, Co. 80634 PHONE 970-590-9861 • E-MAIL normaalkire@hotmail.COM Cut along the line Colorado Department of Regulatory Agencies Division of Professions and Occupations Licensed Professional Counselor Examiners Board Norma Ann Alkire Licensed Professional Counselor LPC.0004453 Number Active Credential Status 09/01/2015 issue Date 08/31/2017 Expire Date Verify this credential at: www.dora colorado.gov/ rofes ions n Director. Lauren Larson Credenfiaal Holder Signature 41 Cut along the line Colorado Department of Regulatory Agencies Division of Professions and Occupations Addiction Counselor Program Norma Ann Alkire Licensed Addiction Counselor ACD.0000141 09/01/2015 Number Issue Date Active 08/31/2017 Credential Status Expire Date Verify this credential at: www.dora.colorado.gov/.r fessi n s*. 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April 16-17, 2015 ~ ► a� —4. ..-----,----7---- -' Laramie, Wyoming E �,p v' Facilitators: Brian Thorn and Amy Oxman r' ' 111-4 \� 11.25 credit hours ►! ,, `�' ':'''�`s 4! �r�� a< t� \fir T;. I'.IT.i II l?_III lit: 41�,� j \ Oil 1 !'ar w Wilene M. Lampert, Ph. D., Executive Director, Western Regional CAC Western Regional CHILDREN'SA CVOCACY CENTER (�Lf 4r7IyYZS1Tt II.TT4:%X .iZ 3.SICZ. '.... -- _t'fpIA-"'r. 2.I i.I1SI Y'i?YS CFSS LT' a SI7`'.T IS I�i:I !. '.S', � S:'.r Cc .r . ar .f► � � �r � i wF. wr �/ , � it 4is �..? �, ,�. wF ice. °G M r`:F.• a r ''` 4 it 4 . `' i r.°•'` w w ♦ r`?:•`' i a, r /I)* r C 1 '` � �I s ✓` �I' off`. ��!'��% ws . V '°S v .�1 s �I � ` � ` v > � ?NA Producer Branch Prefix 018098 970 HPG Named Insured and Address: Norma A Alkire 4913 W 12th Street Rd Greeley, CO 80634-2216 Medical Specialty: Marriage/Family Counselor HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP QCertifitate of 3ngurante OCCURENCE POLICY FORM Policy Number 0272935313 •HPSO Heahhaee Pmvideea Service (hpei Print Date: 4/01/2016 Policy Period from 12/01/15 to 12/01/16 at 12:01 AM Standard Time Program Administered by: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 19040-1218 1-800-982-9491 www.hpso.com Code: Insurance is provided by: 80723 American Casualty Company of Reading, Pennsylvania 333 S. Wabash Avenue, Chicago, IL 60604 Professional Liability $1,000,000 each claim Your professional liability limits shown above include the following: * Good Samaritan Liability * Malplacement Liability * Personal Injury Liability Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit Coverage Extensions License Protection (Defendant Expense Benefit Deposition Representation Assault Includes Workplace Violence Counseling Medical Payments First Aid Damage to Property of Others Information Privacy (HIPAA) Fines and Penalties Workplace Liability Workplace Liability Fins & Water Legal Liability Personal Liability Total: $ 111.00 $ 25,000 $ 1,000 $ 10,000 $ 25,000 $ 25,000 $ 10,000 $ 10,000 $ 25,000 per proceeding per day limit per deposition per incident per person per incident per incident per incident $ 3,000,000 aggregate $ 25,000 aggregate $ 25,000 aggregate $ 10,000 aggregate $ 25,000 aggregate $ 100,000 aggregate $ 10,000 aggregate $10,000 aggregate $ 25,000 aggregate Included in Professional Liability Limit shown above Included in the PL limit shown above subject to $150,000 aggregate sublimit $1,000,000 aggregate Base Premium $111.00 Premium reflects Employed , Full Time , Member Discount Policy forms & Endorsements(Please see attached list for a general description of many common policy forms and endorsements.) G -121500-D GSL15564 G -123846-005 G -121503-C GSL15565 CNA81753 G -141241-B (03/2010) G -121501-C GSL17101 CNA81758 G -145184-A GSL13424 Chairman of the Board Secretary Coverage Change Date: G -147292-A GSL15583 CNA80051 CNA80052 Keep this document in a safe place. it and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in fullin order to activate your coverage, please remit premium in full by the effective date of this Certificate of insurance. Master Policy # 188711433 Endorsement Change Date: Helen A. Frost 317 35"' St., Evans, Co. 80620 970-301-5762(c) Hafrostl @gmail.com Education: • Master of Arts/Social Work *Colorado State University (2010) • Bachelor of Sociology *University of Northern Colorado (1996) • Associate of Arts * Casper Community College (1993) Summary of Professional Qualifications: • Professional advocate for families, youth and aging populations • Skilled Coordinator in locating and maintaining community resources • Accomplished Staff Trainer and community educator • Proficient in Evidence -based Brief Intervention and Crisis Management techniques • Experienced in schedule management and managing staff • Knowledgeable in strategic planning • Proficient in data collection and database management • Strong computer skills: Microsoft Office: Word, Excel, Power Point and Publisher Professional Experience: MSW: Social Worker Fresenius Medical Care, FMC- #1224 2343 W. 27t1 St #501, Greeley, CO. 80631 06/14 -Present Clinic Manager: Paulette O'Brien • Complete Comprehensive Interdisciplinary Needs assessments • Ongoing patient advocacy to support patient autonomy and independence • Implement Brief Interventions based on Evidence -based best practice to assist patients with treatment adjustment related challenges • Collaborate with Financial Coordinators to address and support financial needs of patients • Develop, coordinate and maintain community resources to improve Patient outcomes and maintain independence • Provide support services to client's Health Care partners as appropriate • Provide ongoing collaboration with IDT members to improve patient outcomes as related to disease processes. • Provide Staff education and resources • Maintain CMS standard for documentations and interactions with clients Page I 1 MSW: Social Worker 05/13-6/14 Banner Health Services Ambulatory Case Management 2701 Madison Square Dr., Loveland, CO. 80235, Cindy Reiher 970-350-5686 • Completed Comprehensive Interdisciplinary Needs assessment • Conducted home visits in the community as appropriate • Provided ongoing collaboration with IDT members to address identified patient needs • Provided ongoing patient advocacy as appropriate to client needs • Collaborated with Internal and External agencies to address and support Psych -social needs of patient thru appropriate referrals • Developed, coordinated and maintained community resources to improve Patient outcomes • Actively utilized multiple data systems to conduct research to aid in provision of patient services and ongoing support to increase patient independence • Participated in the development of the program and workflows as applicable to all IDT team members and specifically to Social Work roles. MSW: Social Worker Fresenius Medical Care, FMC -4147 1111 Logan Ave., Cheyenne, WY. 82001, Jane Bowman: 307-632-6457 10/10-5/13 • Completed Comprehensive Interdisciplinary Needs assessment • Provided patient advocacy to support patient autonomy and independence • Initiated Brief Interventions based on Evidence -based best practice • Collaborated with Financial Coordinators to address and support financial needs of patients • Developed, coordinated and maintained community resources to improve Patient outcomes • Provided support services to client's Health Care partners as appropriate • Participated in ongoing collaboration with IDT members • Conducted Staff education and presented professional resources • Maintained CMS standard for documentations and interactions with clients Social Work Intern: Hospice and Bereavement Counselor 08/09-05/10 Pathways Hospice, 305 Carpenter Rd., Fort Collins, CO. 80523, Rick Riddoch/Nancy Jacobsson 970-663-3500 Page 12 • Organized and presented professional development material. • Completed family assessments for hospice and bereavement services. • Connected clients and families with community resources and services. • Facilitated psycho -educational groups for families about grief process and responses. • Delivered individual and family brief therapy utilizing current grief counseling theories. • On -going collaboration with IDT members for provision of services to client and families. Social Work Intern: Family and Consumer Sciences Extension Agent 08/09-05/10 Larimer County Alliance for Grandfamilies (LCAG), CSU-Larimer County Extension Office, 1525 Blue Spruce Road, Fort Collins, CO. 80523, Jacque Miller: 970-498-6000 • Conducted Evaluative research to determine ongoing legal needs of grandparents in Larimer County and developed a Strategic Plan for the Larimer County Alliance for Grandfamilies Leadership Council to address the legal needs of the population. • Developed and maintained professional relationships with community professionals. • Collaborated with community partners for client services and resources. • Conducted research to locate grants to address and support financial needs of the LCAG community collaboration. • Presented grant information to the Larimer County Alliance for Grandfamilies Leadership Council for discussion and follow-up. Social Worker Intern: Systems Navigator 01/09-05/09 Grandparents Raising Grandchildren, Namaqua Center, 404 E. 7th St., Loveland, CO. 80537, Josh Rabe, 970-669-7550 • Conducted community outreach and education to address the needs of grandparent families. • Developed and coordinated resources in the community for grandparent families. • Collaborated with the Inter faith community to develop and link additional available resources within the community. • Targeted outreach to ethnically diverse communities to educate about available services for grandfamilies. • Completed assessments of grandparent families to connect clients to services. • Implemented services and resources that met grand -families needs. • Facilitated support and psycho -educational groups for grandparent families. • Delivered aftercare services to families no longer in the formal child welfare system. Page 13 Corrections Officer I & II 09/97-08/08 Division of Youth Corrections/Platte Valley Youth Services Center (DYC-PVYSC) Greeley, CO. 80634, Brent Nittmann, 970-304-6220 Living Unit Staff: • Facilitated psycho -educational groups and counseling to enhance social and emotional stability, employment opportunities and educational life skills of residents. • Maintained and managed individual caseloads. • Assisted in creating and monitoring resident treatment plans. • Maintained accurate and confidential documentation of client records. Intake and Admission specialist: • Completed Intake and Release process for incoming and outgoing residents. • Completed data entry and retrieved required reports for the unit and facility as assigned. • Monitored admissions records of residents for compliance with juvenile rights and due process as defined by federal and state regulations. • Audit Specialist • DYC-PVYSC Fire Marshal • Safety and Compliance Officer Lead worker for the Admissions and Intake Unit: • Assigned as the building and shift supervisor on designated shifts. • Direct supervision of 10-13 staff. • Mediated conflict between residents, staff, visitors or external agencies. • Monitored shift coverage to ensure staffing levels for oncoming shifts. • Coordinated and facilitated monthly unit meetings. • Monitored Intake and Admissions department workloads to ensure compliance with DYC-PVYSC policy and procedures, federal, state and local regulations, juvenile rights and due process. • Managed and maintained DYC approved data bases for the unit and facility. • Completed data entry and retrieved required reports for the unit and facility. • Division of Youth Corrections Staff Instructor Page 14 Volunteer Experience: MSW Internship Field Supervisor Metro State University of Denver, Aneesha Bharwani-Director of Field Education, 303-556- 3474 • Collaborated with student and Field Liaison to develop a cohesive learning plan that met expectations of MSU, FMC and student for learning opportunities relevant to educational goals • Oriented Intern to agency • Educated MSW Field Intern regarding Agency and Nephrology best practices • Assigned appropriate caseload to MSW Field Intern • Coordinated with MSW Intern appropriate interventions • Incorporated Social Work theories and practices into field learning opportunities for MSW Intern • Provided weekly supervision to MSW Intern to evaluate and synthesize information learned in the field and to improve the application of learned skill sets of Intern • Incorporated outside learning opportunities relevant to Nephrology to MSW as additional learning growth for Intern Executive Director Assistant Kanasita Foundation, P.O. Box 235 Guffey, CO. 80820, Wendy Chunn-Hackwith-Executive Director, 719-285-5240 • Assisted with locating financial resources and in -kind donations to support events and projects. • Assisted with fiscal reporting of resources. • Provided management and coordination of volunteers and resources. • Coordinated annual events and projects. • Maintained professional relationships to support events and projects. • Maintained newsletter and information releases for the foundation's events. Leadership Council Volunteer Larimer County Alliance for Grandfamilies (LCAG) Leadership Council Community Collaboration, Fort Collins, Colorado, Kim Bundy-Fazioli-LCAG Chairperson, 970-491-3012 • Researched grants and correlated grant information to present to the council for potential funding sources. Page 15 • Conducted Needs analysis research for the LCAG Leadership Council and presented research data at the annual Strategic Planning meeting. • Participated in strategic planning of LCAG Leadership Council goals. • Developed and maintained professional relationships to assist LCAG Leadership Council goals. Ongoing Education and Licensing: 02/10/2016 LCSW License March 16/2016 PESI: Managing Challenging Patient and Family Behaviors: 101 Strategies for Healthcare Professionals Denver, Colorado April 18, 2016, 8th Annual Palliative Care Conference: Crafting Courageous Conversations Denver, Colorado November 12, 2015 Explore Transplant Dialysis Provider Training UCH Transplant Center, Aurora Colorado Page 16 COLORADO Department of Regulatory Agencies Division of Professions and Occupations Congratulations! Below are your electronic wallet cards to use as proof of your license. You can also print your license at any time through your Online Services account by visiting our homepage at www.dora.colorado.gov/professions and clicking on the "Print your License" link under the label "Quick Links". If you would like a more durable wallet card option, you can order one for a fee by visiting www.nasbastore.org and selecting the "Colorado License Cards" link on the left hand side of the page. If you prefer, you can also contact NASBA by phone at 1-888-925-5237 or by email at nasbastore@nasba.org. Should you have questions about your credential, or need other information, please contact our Customer Service Team at 303-894-7800 or dora_registrations@state.co.us. Colorado Departmental Regulatory Agencies Division Of Prc essi&nsandOcctipations 4Social Work ExaminersBoard'; Helen. Ann €rast. Licensed Clinics! Social Worker!. CSW.09924261 Number Active Credential Status Verify this credential at: +Fiww.dora. DiOit+tisioDirector:�~�LaurenLaar o . _Cre 02/10/2016 Issue Date 081314017 Expire Date iorado e'dvf rofessions I HJt1 er ignature Cut along the line Colorado Department of Regulatory Agencies Division of Professions:and:Occupations <Social'Work Examiners Board" Helen Ann Frost 'Licensed Clinical Social Worker CSW.09924261' 02/10/2016 Number Issue Date Active 08/31/2017 Credential Status,,,, Expire Date Verify this creetentiaiat: www.dora' •loradoofessions ision Director: Lauren Larson - .Cr n 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 303.894.7693 www.dora.colorado.gov/professions er ig ture CNA PRODUCER I BRANCH 018098 970 Named Insured Helen A Frost 317 35th St Evans, CO 80620-2206 Medical Specialty Social Worker, Clinical Excludes Cosmetic Procedures HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP Certificate of 3kt urance ®HPSO Nmldwar, Pmv61a. Senior Orndutlm- OCCURRENCE POLICY FORM PREFIX I POLICY NUMBER Policy Period: HPG 0642569171-8 Professional Liability Your professional liability limits shown above include the following: • Good Samaritan Liability • Malpiacement Liability • Personal Injury Liability • Sexual Misconduct included in the PL Limit shown above subject to $25,000 aggregate sublimit Coverage Extensions Code 80723 From 09/01/16 to 09/01/17 at 12:01 AM Standard Time Program Administered by: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 19040-1218 1-800-982-9491 www.hpso.com Insurance is provided by: American Casualty Company of Reading, Pennsylvania 333 South Wabash Avenue Chicago, Illinois 60604 License Protection Defendant Expense Benefit Deposition Representation Assault Includes Workplace Violence Counseling Medical Payments First Aid Damage to Property of Others Information Privacy (HIPAA) Fines & Penalties Workplace Liability Workplace Liability Fire and Water Legal Liability Personal Liability Total: $297.00 $1,000,000 each claim $3,000,000 aggregate $ 25,000 per proceeding $ 1,000 per day limit $ 10,000 per deposition $ 25.000 per incident $ 25,000 per person $ 10,000 per incident $ 10,000 per incident $ 25,000 per incident $ 25,000 aggregate $ 25,000 aggregate $ 10,000 aggregate $ 25,000 aggregate $ 100,000 aggregate $ 10,000 aggregate $ 10,000 aggregate $ 25,000 aggregate Included in Professional Liability Limit shown above Included in the PL limit above subject to $150,000 aggregate sublimit $1,000,000 aggregate Premium reflects self-employed, full-time rate. Policy Forms & Endorsements (Please see attached list for a general description of many common policy forms and endorsements.) G -121500-D G -121501-C G -121503-C CNA82011 G -145184-A G -147292-A CNA81753 CNA81758 GSL13424 GSL15563 GSL15564 GSL15565 GSL17101 CNA80052 CNA80051 G -123846-005 CNA79575 Chairman of the Board Secretary Keep this Certificate of Insurance in a safe place. This Certificate of Insurance and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full. In order to activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. Form #: G -141241-B (3/2010) Master Policy: 188711433 HPSn-507-N.Snr..H1 PAWAR A -7s1 Brenda Settgast From: Sent: To: Subject: Helen Frost <hafrostl@gmail.com> Monday, May 01, 2017 9:08 AM Brenda Settgast; Greg Creed Fwd: Welcome to Trauma -Informed Care Forwarded message From: "NCFY"<noreplv@ncfy-learnjbsinternational.com> Date: Apr 27, 2017 5:19 PM Subject: Welcome to Trauma -Informed Care To: "Helen Frost" <hafrost 1 id,gmail.com> Cc: Welcome to Trauma -Informed Care! If you have not done so already, you should edit your profile page so that we can learn more about you: https://ncfy-leam.jbsinternational.com/user/view.php?id= I3566&course=17 i Carole Jean Noblitt, MSW Licensed Clinical Social Worker 4116 W. 15`" Street Greeley, CO 806434 970-397-6503 Career Experience Counselor/consultant: 2001 to present Transitions Psychology Group, PC, Greeley, CO 970-336-1123 Complete Vocational Assessments for Employment Services & family and individual assessments for foster/adopt & kinship SAFE evaluations for Weld County. Also provide therapeutic Life Skills for parents & case management for SS/SSI clients. Work on a contract basis. Counselor/consultant: 1999 to present Adoptions: Advocacy & Alternatives, Ft. Collins, CO Complete family assessments for adoptive parents according to the SAFE Home Study Model. Assist with training, marketing, fundraising, as needed .Work on a contract basis. Medical Social Worker: March 2000 to January 2003 Hospice of Northern Colorado, Greeley, CO 970-352-8487 Provide psycho/social assessment and support services to patients and families in their home, nursing homes and in -patient unit. Work as part of an interdisciplinary team. Crisis & Support Counselor & Education Director: February 1997 to December 1999 Tu Casa, Inc., P.O. Box 473, Alamosa, CO 719-589-5291 Provide individual and group crisis and on -going counseling to victims/survivors of domestic violence and/or sexual assault. Director of grant funded program for violence prevention education in schools & community in all six counties and 14 school districts of the San Luis Valley. Other Work and Volunteer Experience: Field Instruction Supervisor for MSW students through CSU Social Work Department Community Organizer Care Coordinator/Family Caseworker Computer Operator Administrative Assistant Real Estate & Retail Sales Education Masters of Social Work 1996 Colorado State University, Ft. Collins, CO 80523 Post Graduate Course Work - Marriage & Family Therapy Program 1995, 1996, 2000 University of Northern Colorado, Greeley, CO 80639 Bachelor of Science in General Business 1988 University of Northern Colorado, Greeley, CO 80639 Associate of Applied Science in Information Systems 1983 Aims Community College, Greeley, CO 80634 Continuing Education: • How to Help Dying People Attain Dignity and Peace; Douglas Smith, MA, MS, MDiv, 2003. • EMDR Part 1 Basic Training; EMDR Institute, Inc., July 19-21, 2002 • Treating Sexual Abuse: From Victim to Surviving to Creating; Carolyn M. Ball, MA, LPC, 2002 • Grief Counseling & Clinical Practice; John R. Jordan, PhD, 2001 2 • Psychopharmacology Made Simple: The Basics & Beyond; John Preston, PsyD., 2000 • Domestic Violence Risk Assessment Training; Amend, September 11, 1999 • Identification and intervention in Sexually Abusive Behavior; Gail Ryan, MA, Kempe Center, 1997 • Living Well is the Best Revenge: Moving Beyond the Survivor Identity; Yvonne Dolan, MA, 1996 • Evaluation and Treatment of Child Sex Abuse; Richard A. Gardner, MD., 1996 • Why People Don't Heal: Understanding the Intimate Language of Wounds; Carolyn Myss, 1995 • Exploring Psychology, Spirituality, & Creativity; 15th Annual Common Boundary Conference, 1995 • Paralegal Certificate, University of Northern Colorado, Greeley, CO 1993 • Non -Profit Funds Management Certificate Aims Community College, Greeley, CO 1992 References available on request. Cut along the line ColoradoDepartmentof Regulatory Agencies Division of Professions and Occupations Social Work Examiners Board Carole Jean Harrold-Noblitt Licensed Clinical Social Worker CSW.00992962 09/01/2015 Number Issue Date Active 08/31/2017 Credential Status Expire Date Verify this credential at: www.dora.colorado.eov/orofession s /b�f/��_ i kfJitr2Y Glen : f 3i'1 i4 biGision Director: Lauren Larson Credential o er Signature CSW.00992962 Number Active Credential Status Colorado Department of Regulatory Agendes Division of Professions and Occupations Social Work Examiners Board Carole Jean Harrold-Noblitt Licensed Clinical Social Worker 09/01/2015 Issue Date 08/31/2017 Expire Date Verify this credential at: vnvw.dora.colorado.s ov/orofession s "sion Director. Lauren Larson Credentip Holder Signature i560 Broadway, Suite 7350. Denver, CO 50202 P 303.394.7EO -303.89-4.7693 vik.:;.(iora.cotorado.gov/professio,-ts CNA Producer Branch Prefix 018098 970 HPG Named Insured and Address: Carole J Noblitt 4116 W 15th St Greeley, CO 80634-2735 Medical Specialty: Social Worker, Clinical Excludes Cosmetic Procedures HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP Certificate of ifo5uritore OCCURENCE POLICY FORM Policy Number 0411587557 HPSO Healthcare Prnidcn. Scrrkc Organization - Print Date: 10/08/2015 Policy Period from 10/02/15 to 10/02/16 at 12:01 AM Standard Time Program Administered by: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 19040-1218 1-800-982-9491 www.hpso.com Code: Insurance is provided by: 80723 American Casualty Company of Reading, Pennsylvania 333 S. Wabash Avenue, Chicago, IL 60604 Professional Liability $1,000,000 each claim Your professional liability limits shown above include the following: Good• Samaritan Liability * Malplacement Liability * Personal Injury Liability * Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit Coverage Extensions License Protection Defendant Expense Benefit Deposition Representation Assault Includes Workplace Violence Counseling Medical Payments First Aid Damage to Property of Others information Privacy (HIPAA) Fines and Penalties Workplace Liability Workplace Liability Fire & Water Legal Liability Personal Liability Total: $ 148.00 S 25,000 S 1,000 S 10,000 S 25,000 S 25,000 S 10,000 S 10,000 S 25,000 per proceeding per day limit per deposition per incident per person per incident per incident per incident $ 3,000,000 aggregate S 25.000 S 25,000 S 10,000 S 25,000 S 100,000 S 10,000 S 10,000 S 25,000 aggregate aggregate aggregate aggregate aggregate aggregate aggregate aggregate Included in Professional Liability Limit shown above Included in the PL limit shown above subject to $150,000 aggregate sublimit $1,000,000 aggregate Base Premium $148.00 Premium reflects Self Employed , Part Time Policy Forms & Endorsements(Please see attached list for a general description of many common policy forms and endorsements.) G -121500-D G -121503-C GSL15564 GSL15565 G -123846-005 CNA81753 G -121501-C GSL17101 CNA81758 "fke".d°F. .aQ. Chairman of the Board G -141241-B (03/2010) G -145184-A G -147292-A GSL13424 CNA80051 CNA79575 Vid\rik)14.--k Secretary Coverage Change Date: GSL15563 CNA80052 Keep this document in a safe place.lt and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in fain order to activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. Master Policy # 188711433 Endorsement Change Date: I Monday, May 1, 2017 at 8:49:49 AM Mountain Daylight Time Subject: Enrollment in Trauma -Informed Care Date: Sunday, April 30, 2017 at 4:19:19 PM Mountain Daylight Time From: cjn.2010@yahoo.com To: Greg Creed Attachments: 21CBAE8CA604479887EF1C64CEEE6A79.png 1C64CE E E6A79. png Carole Noblitt: Public profile Page path Home / ► My profile / ► View profile Carole Noblitt Yes Transitions Psychology Group Traum -Informed Care Are you a grantee of the Family and Youth Services Bureau? Organization Course profiles Saturday, April 29, 2017, 1:09 AM (1 day 21 hours) Sent from Mail for Windows 10 First access Page 1 of 1 ROSANN M. ROSS, M.A., L.P.C., N.C.C., EAP-1 BUSINESS: Department of Psychological Sciences University of Northern Colorado Greeley, Colorado 80639 (970) 351-2485 Email: rosann.ross(d),unco.edu EDUCATION: HOME: 21490 WCR 78 Eaton, Colorado 80615 (970) 454-1170 Email: ross56aDeoDlepc.com 2002-2005 Ph.D. Student, Counselor Education & Supervision 25 credit hours completed - 4.0 GPA 1994 Master of Arts, Agency Counseling: Marriage and Family Emphasis University of Northern Colorado 1990 CERTIFICATIONS/ 2005 LICENSES 1994-2010 1996 PERSONAL PHILOSOPHY Bachelor of Arts, Psychology University of Northern Colorado Equine Assisted Psychotherapist Certified, Level I Equine Assisted Growth & Learning Association (EAGALA) National Certified Counselor National Board for Certified Counselors Certificate #34131 Licensed Professional Counselor; State of Colorado Regulatory Agency License #1436 - current My philosophy of life as it relates to the work environment stems from the family systems therapeutic perspective which holds that all things are interrelated; what affects one member of the system affects all members of the system. Therefore, the system, which can be a family, a group of individuals or an organization, holds the power for change and has the ability to find solutions to any problems that may arise by examining the relationships within that system. Using this framework, I work to maximize the system's power in its ability to change by looking at the unique web woven by these relationships. As each member's contribution to both the problem and the solution, as well as openness for change are assessed, the system can be brought together in such a way where everyone becomes an active member in searching for, and finding creative answers, for a more permanent change. PROFESSIONAL EXPERIENCE August 1997 - present Position: Full Time Lecturer in Psychology Department of Psychology University of Northern Colorado Primary responsibility: Teaching 15 credit hours each semester, Classes taught: Psy 120 - Introduction to Psychology Psy 255 - Abnormal Psychology Psy 265 - Social Psychology Psy 350 - Theories of Personality Psy 344 - Group Roles & Processes Psy 407 - Introduction to Theories of Counseling ROSANN M. ROSS, M.A., L.P.C., N.C.C., EAP-I PROFESSIONAL EXPERIENCE (continued) Psy 491 - Field Experience Psy 495 - Death & Dying I have developed two online delivery courses in the last academic year (2006-2007) for Theories of Personality and Death & Dying. Additional responsibilities: Minor academic advising of undergraduate psychology majors; promote psychology department to incoming freshmen; providing guidance counseling to graduating seniors regarding graduate school choices; revising & coordinating the undergraduate field experience program (an on -site psychology experience for the student); performing liaison duties with community agencies in placing students at work sites. February 2005 - Present Position: Contract Therapist Transitions Psychology Group, LLC 804 11th Avenue Greeley, Colorado 80631 Counsel individuals and families referred by Social Services; complete vocational assessments for TANF clients; complete home study assessments for Social Services for foster/adopt parents. September 2005 — present January 1996 - April 2000 August 1995 - June 1997 Position: Co-owner Horse Human Reflections Galeton, Colorado Provide Equine Assisted Psychotherapy to individuals, couples and families. Position: Mental Health Therapist Acute Treatment Unit (ATU) North Range Behavioral Health Greeley, Colorado The ATU is a residential treatment facility for persons with chronic mental illness. Duties included the supervision of three to four clinical care assistants and psychiatric nurses; individual and group therapy sessions; crisis intervention; hospital evaluations; managing emergency phone lines for northeastern Colorado; milieu management and supervision of charting and case management. Position: Part Time Instructor Department of Psychology University of Northern Colorado Primary responsibility: Teaching undergraduate courses. Classes taught: Psy 120 - Introduction to Psychology Psy 350 - Theories of Personality Psy 407 - Introduction to Theories of Counseling Psy 455 - Abnormal Psychology -2- ROSANN M. ROSS, M.A., L.P.C., N.C.C., EAP-I PROFESSIONAL EXPERIENCE (continued) July 1994 - Position: Partner in Private Practice December 1996 Counseling Clinic Family Physicians Building 2520 W. 16th Street Greeley, Colorado 80631 I counseled individuals, couples and families facing emotional difficulty arising from a number of diverse life changes. I focused my practice on working with chronic illness, the aging population, the mind -body connection, the final stages of life, and grief and bereavement. January 1995 - Position: Group Co -Facilitator December 1996 Northern Colorado AIDS Project Fort Collins, Colorado As co -facilitator for a heterosexual couples= group living with full-blown AIDS, I addressed the unique and often forgotten issues that these couples face on a day-to-day basis. April 1995 - May 1995 Position: Interim Program Director Greeley Transitional House 1202 6th Street Greeley, Colorado 80631 As interim Program Director, my duties included facilitating interpersonal staff relations, intake interviews and crisis intervention with homeless families, liaison with other community agencies on behalf of the families, and managing the daily affairs of the program. October 1993- Position: August 1994 Intern Therapist Weld Mental Health Center 1306 11th Avenue Greeley, Colorado As part of the externship requirement for my Master's Degree, I worked as an intern therapist at the Mental Health Center seeing individuals and couples. When my externship requirement was completed, I worked pro bono for three months. June 1993 - May 1994 Position: Intern Therapist North Colorado Medical Center Oncology Floor 1801 16th Street Greeley, Colorado As part of the externship requirement for my Master's Degree, I worked on the Oncology Floor at the hospital. My responsibilities included: in- and outpatient counseling, co -facilitator of the Cancer Support Group, and the development of community outreach services. -3- ROSANN M. ROSS, M.A., L.P.C., N.C.C., EAP-I November 1987 - July 1992 Position: Administrative Assistant to the Dean College of Health and Human Sciences University of Northern Colorado Greeley, Colorado Duties included, but certainly were not limited to: Liaison between Dean and five department chairpersons, problem solving with same, managing student complaints, designing and planning college public relations events, college class scheduling, working with Provost=s office in maintaining policy revisions, resource utilization on campus. BOOK REVIEWS August, 2006 November 2006 Allyn & August2007 PRESENTATIONS: March 2005: February 2005: Spring 1999: Fall 1998: Fall 1998: October 1996: October 1995: Allyn & Bacon — Longman Non -clinical Groups in Psychotherapy Bacon — Longman Theories of Counseling Textbook McGraw Hill Exploring Social Psychology "What Dreams May Come" Presentation on the psychology of dreams State Personnel Employees Council University of Northern Colorado Bipolar and Major Depressive Disorders Full day lecture Weld County Sheriffs Office/Weld County Jail Greeley, Colorado Personality and Personal Development: Spirituality in the Classroom Rocky Mountain Psychological Association Fort Collins, Colorado Guest Lecturer - Psy 407: Theories of Counseling AFamily Systems - A Live Role Play@ University of Northern Colorado Guest Lecturer - Psy 240: Maturity and Aging AStress and Its Effect on Health@ University of Northern Colorado Guest Lecturer - Psychology 120: Principles of Psychology ACurrent Views on Death & Dying@ University of Northern Colorado Guest Lecturer - Psychology 407: Theories of Counseling "Family Systems Perspective" University of Northern Colorado -4- ROSANN M. ROSS, M.A., L.P.C., N.C.C., EAP-I PRESENTATIONS (cont): Guest Lecturer - Psychology 450: Abnormal Psychology "The Mind/Body Perspective" University of Northern Colorado Guest Lecturer - Psychology 433: Health Psychology "AIDS and You" University of Northern Colorado March 1995: April 1995: Guest Lecturer - Sociology 221 "Infidelity and Gender Role Differences" University of Northern Colorado Guest Lecturer - Sociology 221 "Religious Institutions and Gender Role Differences" University of Northern Colorado November 1994 Business Aspects of Counseling Full- Day Workshop Presented to Division of Professional Psychology Graduate Student Association University of Northern Colorado ADDITIONAL TRAINING/WORKSHOPS: October, 2006: SAFE Training — three day training program in Home Study Assessment May, 2005: Certified as an equine therapist January, 2005: Completed 24 hours of continuing education — home study program December 2004: Completed 48 hours of continuing education - home study program September 2004: Completed 24 hours of continuing education - home study program Academic Year Supervised Individual Therapy practicum; Supervised Group Facilitation 2003-2004 Practicum; Practicum in Supervision - Ph.D. Program in Counselor Education and Supervision Academic Year Supervised practicum/Advanced practicum - Ph.D. program in Counselor 2002-2003 Education and Supervision January 2002 Aggressive & Defiant Behavior: The Latest Assessment and Treatment Strategies Home Study Course: Compact Clinicals Borderline Personality Disorder: The Latest Assessment & Treatment Strategies Home Study Course: Compact Clinicals December, 2001 PTSD: The Latest Assessment & Treatment Strategies Home Study Course: Compact Clinicals -5 ROSANN M. ROSS, M.A., L.P.C., N.C.C., EAP-I ADDITIONAL TRAINING/WORKSHOPS (continued): Obsessive -Compulsive Disorder: The Latest Assessment & Treatment Strategies Home Study Course: Compact Clinicals April, 1999 Rocky Mountain Psychological Association Regional Conference Fort Collins, Colorado September, 1995 May, 1995: April, 1995: AIDS: The Second Decade Teleconference University of Northern Colorado Alternative Health Care: What is Reasonable? Workshop by Dr. Scott Shannon North Colorado Medical Center Greeley, Colorado Hot Monogamy Workshop by Dr. Patricia Love American Counseling Association National Conference Denver, Colorado April, 1995: American Counseling Association National Conference Denver, Colorado April, 1995: Feb., 1995: Oct., 1994: February 1994 April 1993: April 1992: SERVICE: July, 2005 Chronic Fatigue Syndrome Presentation by Dr. Scott Pace Northern Colorado Mental Health Network How We Choose Our Mates: A Jungian Perspective Workshop by Dr. Neil Scott Mountain Crest Hospital Fort Collins, Colorado Pet Loss and Grief Counseling Mountain Crest Hospital Fort Collins, Colorado Marriages from Hell Workshop by Dr. Frank Pittman Mountain Crest Hospital Fort Collins, Colorado Colorado Association of Marriage & Family Therapists Conference Denver, Colorado Colorado Association of Marriage & Family Therapists Conference Greeley, Colorado Discover UNC -6- ROSANN M. ROSS, M.A., L.P.C., N.C.C., EAP-I SERVICE (continued): September, 2004 Native American Student Services volunteer mentor Spring, 2004 College of Arts & Sciences - Committee to organize undergraduate internships July, 2004 Discover UNC - meeting incoming freshmen and orienting them to the University and helping them build their class schedules June, 2003 Discover UNC - meeting incoming freshmen and orienting them to the University and helping them build their class schedules May 2003 Reviewed proposed Counseling Theory text for Allyn & Bacon Publishers November 2002 General Education Review for PSY 265, Social Psychology February 2002 Participant in the application and selection process for the National Student Exchange Program July 2002 Discover UNC August 2001 Discover UNC November 2001 Presenter: Women & Spirituality Celebrating Women Harrison Residential Hall October 2001 Debriefing in Turner Residential Hall regarding two students' death November 2000 - Committee Member - Community Seminar Planning Committee March 2001 John Fox, Sociology, Chair February 1999 - Faculty Mentor May 2000 McNair Scholarship Program August1998 Faculty Representative May 1999 State Personnel Employees Executive Council University of Northern Colorado February 1996 Volunteer Therapist "Tears for the Children" Sexual Abuse Exhibit University of Northern Colorado March 1995- Pro Bono Therapist December 1996 Pro Bono Project of Weld County Greeley, Colorado October 1995 Intake Interviewer National Depression Disorders Screening Day North Colorado Medical Center Greeley, Colorado -7- ROSANN M. ROSS, M.A., L.P.C., N.C.C., EAP-I SERVICE (continued): May 1995 June 1994 - August 1994 August 1990 - May 1994 Intake Interviewer National Anxiety Disorders Screening Day North Colorado Medical Center Greeley, Colorado Pro Bono Therapist Weld Mental Health 1306 11th Avenue Greeley, Colorado Hospice Volunteer Hospice of Weld County AWARDS/RECOGNITIONS February 2002 April, 2001 February, 2001 February, 2000 April, 1999 February, 1999 February, 1998 REFERENCES: Favorite Professor Distinction - UNC Mortar Board Nominated by Jessica Biel Nominated for Women's Recognition Award Favorite Professor Distinction - UNC Mortar Board Nominated by Shanti Pepper Favorite Professor Distinction - UNC Mortar Board Nominated by Amy Barnett Nominated for Women's Recognition Award Favorite Professor Distinction - UNC Mortar Board Nominated by Lexi Rigg Favorite Professor Distinction — UNC Mortar Board Nominated by Gregg Pederson Vincent A. Scalia, Ed.D. Professor of Rehabilitation Counseling University of Northern Colorado Greeley, Colorado 80639 Chuck Howard, Ph.D. Clinical Director NCMC Behavioral Health Greeley, Colorado 80631 (970) 351-2879 (970) 356-1052 Greg Creed, Ph.D. Transitions Psychology Group, LLC 804 11th Avenue Greeley, Colorado 80631 (970) 336-1123 Congratulations! Below are your electronic wallet cards to use as proof of your license. You can also print your license at any time through your Online Services account by visiting our homepage at www.dora.colorado.gov/professions and clicking on the "Print your License" link under the label "Quick Links". If you would like a more durable wallet card option, you can order one for a fee by visiting www.nasbastore.org and selecting the "Colorado License Cards" link on the left hand side of the page. If you prefer, you can also contact NASBA by phone at 1-888-925-5237 or by email at nasbastore@nasba.org. Should you have questions about your credential, or need other information, please contact our Customer Service Team at 303-894-7800 or dora_registrations@state.co.us. Cut along the tine Colorado Department of Regulatory Agencies Division of Professions and Occupations Licensed Professional Counselor Examiners Board Rosann M. Ross Licensed Professional Counselor LPC.0001436 Number Active Credential Status Verify this credential at: b-Gisio�rector�on Credential Holder Signature 09/01/2015 Issue Date 08/31/2017 Expire Date Colorado Department of Regulatory Agencies Division of Professions and Occupations Licensed Professional Counselor Examiners Board Rosann M. Ross Licensed Professional Counselor LPC.0001436 Number Active Credential Status Verify this credential at: 09/01/2015 Issue Date 08/31/2017 Expire Date vr‘- -iko<4--(1 ision Director Lauren Larson Credential Holder Signature CNA Producer Branch Prefix 018098 970 HPG Named Insured and Address: Rosann M Ross 21490 County Road 78 Eaton, CO 80615-9122 Medical Specialty: Licensed Professional Counselor HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP Certificate of insurance IHPSO Healthcare rm.i&,n &Mite Oilasitadne OCCURRENCE POLICY FORM Print Date: 1/22/2017 Policy Number 0281688374 Policy Period from 02/01/17to 02/01/18 at 12:01 AM Standard Time Program Administered by: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 19040-1218 1-800-982-9491 www.hpso.com Code: Insurance is provided by: 80723 American Casualty Company of Reading, Pennsylvania 333 S. Wabash Avenue, Chicago, IL 60604 Professional Liability $1,000.000 each daim Your professional liability limits shown above include the following: • Good Samaritan Liability * Malplacement Liability * Personal Injury Liability ' Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit Coverage Extensions License Protection $ 25,000 per proceeding $ 25,000 Defendant Expense Benefit $ 1,000 per day limit $ 25,000 Deposition Representation $ 10,000 per deposition $ 10,000 Assault - $ 25,000 per incident $ 25,000 Includes Workplace Violence Counseling Medical Payments $ 25,000 per person $ 100,000 First Aid $ 10,000 per incident $10,000 Damage to Property of Others $ 10,000 per incident $ 10,000 Information Privacy (HIPAA) Fines and Penalties $ 25,000 per incident $ 25,000 Workplace Liability Workplace LiabilIty Fire & Water Legal Liability Personal Liability Total: $ 110.00 $ 3,000,000 aggregate aggregate aggregate aggregate aggregate aggregate aggregate aggregate aggregate Included in Professional Liability Limit shown above Included in the PL limit shown above subject to $150,000 aggregate sublimit $1,000,000 aggregate Base Premium $110.00 Premium reflects Employed , Part Time Policy Forms & Endorsements(Please see endorsements.) G -121500-D G -121503-C G -121501-C GSL15585 GSL17101 GSL13424 CNA81758 CNA82011 L4' Chairman of the Board G -141241-B (03/2010) attached list for a general description of many common policy forms and 0-145184-A G -147292-A CNA80051 CNA80052 AAN Secretary Coverage Change Date: GSL15583 GSL15564 G -123846-005 CNA81753 Keep this document in a safe p/ace./t and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full.in order to activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. Master Policy # 188711433 Endorsement Change Date: Registration has already been confirmed 5/1/17, 8:54 AM NCFY Online Training Home F1'SFamily & Youth National Clearinghouse PP Services Bureau on Families & Youth NCFY Online Training Website Home ► Registration has already been confirmed Thanks, Rosann Ross Registration has already been confirmed Go to course list You are not logged in. (Log in) Home https://ncfy-learn.jbsinternational.com/login/confirm.php?data=1BCEPX2sYLYohgs/rosieross Page 1 of 1 4241 W. 14th St. Ln., Greeley, Colorado 80634'970 381 8935•ktraveler360@aol.com KATHRYN A. NALLY Experience February 2009 -Present North Range Behavioral Health Greeley, CO. Behavioral Health Specialist II/ Back -Up Supervisor • Documentation of patient process in treatment • Assist the therapist with groups • Establish open communication with co-workers and coordinators in a weekly meeting to facilitate successful teamwork and conflict resolution in the work environment. • Provide a safe environment for patients and co-workers • Responsible for the needs of both patients and co-workers • Document, direct, or/and assist After -Hour Emergency phone calls • Monitor various Drug Test for several agencies • Conduct individual therapy sessions with patients • Completed continued education and trainings April 2004 -August 2009 Red Robin Gourmet Burgers and Spirits Hospitality/Server/Mixologist/Certified Designated Trainer • Responsible for meeting the needs of the guest by creating a pleasant dining experience • Expedite proper refreshment presentation and the responsible service of alcohol • Acquired effective time management skills by serving several guest at once • Orient new team members to the Red Robin job design as a Certified Designated Trainer (CDT) • Establish open communication with co-workers and management in biweekly CDT' meetings to facilitate teamwork and conflict resolution September 2004 -January 2008 Administrative Assistant to Pastor • Assist Pastor in daily logistics • Assist Office Manager with daily tasks including food pantry and homeless charitable ministry • Maintained weekly, monthly, and year-end financial records for Office Business Manger • Created Parish Marketing • Document all Sacramental records Greeley, CO. St. Peter Catholic Church Office Greeley, CO. Education May 2014 -December University of Northern Colorado Greeley, CO. 2016 Marriage, Couples and Family Counseling/Therapy • CACREP Accredited Program • A member of the Counseling Academic & Professional Honor Society International, joined in Fall Semester 2014 • Internship at Summit Stone Health Partners, Child and Family Program; Summer and Fall Semester 2016 • Graduated December 2016 December 2008 University of Northern Colorado Greeley, CO. Psychology • Minor in Criminal Justice • The National Honor Society in Psychology Psi Chi, 2006-2008 • Field Research at North Range Behavioral Health at the Acute Treatment Unit, Fall Semester 2008 Fall 2004 -Spring 2006 CO. Psychology Certificates March 2015 CO. Crisis Prevention Intervention • Safely prevent crisis situations from escalating to physical aggression September 2011 North Range Behavioral Health CO. Psychological First Aid and Field Response • Respond to local and neighboring counties after natural disasters • Provide referrals • Crisis Intervention Spring 2007 University of Northern Colorado CO. CPR and First Aid Certification • Renewal 2010, 2014 June 2010 North Range Behavioral Health CO. Qualified Medication Administration Person • Renewal January 2016 Aims Community College Greeley, North Range Behavioral Health Greeley, Community Involvement 2014 -Present Greeley, Greeley, Greeley, United Way of Weld County Greeley, CO. RITE Program • Meet with at -risk students about the importance of education August 2003 -August 2014 St. Peter Catholic Church Cireeley, CO. High School Youth Minister • Serves as a minister for ages 13-18 in St. Peter's Youth Group/Life Teen Program • Assist in lesson plans, personal advisement, facilitation in team building activities • Chaperone on mission trips and pilgrimages Summer 2009-2011 St. Peter Catholic Church Greeley, CO. Summer Festival Coordinators Assistant • Assist Coordinators in Summer Festival logistics References Deborah Hughes, LCSW Summit Stone Health Partners 2001 S. Shields, Blg K, Fort Collins, CO. 80526 970.494.4236 Brandy Simmers, LMFT Program Director of Summit Stone Health Partners for Child and Family Services 2001 S. Shields, Blg K, Fort Collins, CO. 80526 970.494.4200 Father Rocco Porter Pastor of St. John the 23rd Catholic Church 1220 University Ave, Fort Collins, CO 80521 970.484.3356 The gnart of carustrrs for the liniuersity of Northern T oLoreto, upon the rnrnmmrnlatinn of the 'faculty of the 1tniurrsity, has ronfrrrri upon iKntl1rgn Ann Nally the kegrrr of Master of Arts with acknnwtrdgmrnt of major achirurments illarrtagrAtimplesfigamtly (nnunneling with all the rights, privileges and responsibilities thrrrunto appertaining. Given at 6rerley, Colorado, this ninth day of December, two thousand sixteen. frrsiaent of Or 9lnisersity (Chairman of Or iinar? of &mottos HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP ANA Gets of Jourana ffHPSO OCCURRENCE POLICY FORM PRODUCERr_R,ANCH ( PREFIX I POLICY maggot 1J 018008 970 HPG 0646888923.8 Ripped insured Kathryn A Nally 4241 W 14th Street Ln Greeley, CO 80634-1942 Medical Special* Code Marriage/Famlly Counselor 80723 Earl Period: From 08/19/17 to 06/19/18 at 12:0`t AM Standard Time EX2WARAdmInIsteritd by: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 19040-1218 1-800-982-9491 www.hpso.com Insurance is provided by: American Casualty Company of Reertng, Pennsylvania 333 South Wabash Avenue Chicago, Illinois 80604 Protesional Liability $1,000,000 each claim $3,000,000 aggregate Your profewIonel ilebery bets Oxon above include the follovegc • Good Samaritan Liability • Matpiacement Liability • Personal Injury Liability • Sexual Misconduct Included in the PL Limit shown above subject to $25,000 aggregate aublimit Coverage Extensions License Protection $ 26,000 per proceeding Defendant Expanse Darren $ 1,000 per day limit Deposition Representation $ 10,000 per deposition Assault $ 26,000 per incident iticlaidoetWOrfclace Violence Couaselk g Meth* Payments $ 25,000 per person RistAid $ 10,000 per incident Damage to Property of Others $ 10,000 per incident Information Privacy (HIPAA) Fines & Penalties $ 25,000 per Incident Workplace Liability Workplace Liability Fire and Water Legal LiabIity Personal Liability Total: $131.00 25,000 aggregate. 25,000 aggregate 10,000 aggregate 25,000 aggregate 100,000 aggregate 10,000 aggregate 10,000 aggregate 25,000 aggregate Included in Professional Liability Limit shown above Included in the PL limit above subject to $150,000 aggregate subkmit $1,000,000 aggregate Premium reflects self-employed, pert'timre rate with recent graduate discount. Policy Forms A Endorsements IPisase attached fetter a general dandelion of many comlcxxspol oy mne and endosesmerus i G -121500-D 3-121501-C (3-121508-C CNA82011 13-145184-A 61-147292-A CNA81753 CNA81758 38L13424 01.,156$3 38015584 OS1_18565 GSLi7101 CNA80052 CNA8005I G -123948-005 CNA79575 Chairman OM* Board Secretary Keep this Certificate of Insurance In a sake place. This Certificate of Insurance and proof of payment are your proof of coverage. There Is no coverage In force unless the premium is paid in full. In order to activate your coverage, please remit premium In Litt by tie effective date of this Certficate of insurance. Form ti: G -141241-B (3/2010) Master Policy: 188711433 Registration has already been confirmed 5/1/17, 8:50 AM NCFY Online Training Home in, Family & Youth Lig Services Bureau National Clearinghouse on Families & Youth NCFY Online Training Website Home ► Registration has already been confirmed Thanks, Kathryn Nally Registration has already been confirmed Go to course list You are not logged in. (Log in) Home https://ncfy-learn.jbslnternational.com/login/confirm.php?data=VVXS1YgyaHPhbcf/knally Page 1 of 1 EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Life Skills and Mental Health Services to clients referred by the Department, primarily in the Greeley area. 2. Life Skills services include: a. Family Therapy Visitation — Family contact in the presence of a Master's or Doctoral level therapist to ensure protection of the children emotionally and assist in the healing of the parent - child relationship damaged by severe abuse and/or neglect. b. Therapeutic Visitation —Supervision and evaluation of parent -child interactions for referred clients and their minor children by a Master's or Doctoral level therapist ensuring children remain safe by providing contact with their family members. Child is in the presence of the supervising therapist at all times. All contact between the parent and the child is structured to provide for the safety and well- being of the children while maintaining the continuity of family relationships. Parents are given the opportunity to learn and practice positive parenting. Parents are continually assessed regarding their capacity to appropriately care for their children. Contractor utilizes, as clinically appropriate, the Life Skills Assessment (LSA) tool developed by the Contractor to assess areas of family functioning including household management and environment, parenting styles and capabilities, family interactions and safety, and commitment. A copy of this tool has been provided to the Department. Services are available both in -office and in -home to address the continuum of care issues as the client progresses to a less restrictive setting. c. Life Skills Parent Coaching — Services are designed to address family needs to prevent placement of children or facilitate the reunification process when children return home, and enhance the parent's capacity to provide for their children's needs. Services occur in the client's home and may include individual counseling, family counseling, intensive parenting education and remediation, relapse prevention counseling and referrals to enhance the family's capacity to provide for their children's needs. 3. Mental Health Services include: a. Individual Counseling — Services are available for adults and adolescents and are designed to address a wide variety of issues that impact the individual and family. The goal of the service is to remove any barriers to safety and well being in the home which may include, but are not limited to, behavior problems, depression, anxiety, stress, trauma, grief and loss, health, self- image, character and treatment compliance. b. Family Counseling — Services are available to families to address communication, togetherness, flexibility, family structure, family lifecycle, and multi -generational issues. Family characteristics such as communication, togetherness, flexibility, family structure, family lifecycle, multi - generational issues, interactions and resiliencies also assessed and treated. 1 c. Co -Therapy — Services are provided by two Master's, or higher, level family systems therapists to bridge services between programs and promote change in referred families in complex cases. Services are limited to one (1) to three (3) sessions per referred family and require pre -approval from the Department's Core and Service Contract Coordinator. d. Eye Movement Desensitization and Reprocessing (EMDR) Counseling — EMDR is a recognized, effective form of trauma treatment and is designed to resolve memories of a past difficult emotional experience affecting current functioning. Contractor may use EMDR in conjunction with, or independent of, other services. 4. Contractor retains an office in Greeley, located at 7251 West 20th Street, M-2. 5. All services will be provided by Master's, or higher, level therapists. Contractor has one (1) bilingual (Spanish/English) staff member. 6. Contractor will utilize a team approach to link mental health services with existing services, such as Life Skills or other community services to ensure a continuum of care. 7. 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 caseworker and the Child Welfare Contract and Services Coordinator immediately. 8. Contractor will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 9. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 10. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 11. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 12. Contractor understands that the Department will not reimburse Contractor for "no shows" or cancelled appointments, either on the part of the client or the Contractor. 13. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Court Staffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as the meeting is at least one hour in length, participation in the meeting is deemed appropriate and necessary by the Department, and the Contractor obtains the Facilitator's signature on the Client Verification Form at the time of the meeting. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Department. Contractor may appear by phone. Contractor will only charge when the meeting falls within the hours approved for the youth and the youth has not received the full hours for that week. EXHIBIT D PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2018. Expenses incurred by the Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Life Skills: $113.00/Hour (Family Therapy Visitation) $113.00/Hour (Therapeutic Visitation, In -Office) $130.00/Hour (Therapeutic Visitation, In -Home) $130.00/Hour (Life Skills Coaching, In -Home) $130.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) Mental Health Services: $105.00/Hour (Individual Therapy) $105.00/Hour (Family Therapy) $105.00/Hour (Eye Movement Desensitization and Reprocessing) $120.00/Hour (Therapy, In -Home) $200.00/Hour (Co -Therapy) $130.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) 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 1 made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. b. For one-time services, proof of services rendered shall be receipt of the completed product. c. For Monitored Sobriety services, proof of services rendered shall be the test result. 2 OP ID: SLS A 2 RiY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/05/26/22017017 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: 970-223-1804 Front Range Insurance Group Fax' 1100 Haxton Drive Suite 100 Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI CE CT PHONE H N_o E�tt: I FA X, No): X _ E-MAIL ADDRESS: PRODUCER TRANS -6 CUSTOMER lak___ INSURER(S) AFFORDING COVERAGE NAIC # INSURED Transitions Psychology Group, LLC 7251 W. 20th St, Unit M2 Greeley, CO 80634 INSURER A: Philadelphia Insurance INSURER B : Pinnacol Assurance 41190 INSURER C : INSURER D : INSURER E : INSURER F : CERTIFICATE NUMBER: REVISION NUMBER: vTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR r TYPE OF INSURANCE pgR wyQy POLICY NUMBER EFF (MMMIDD/YYYYI DD71 YYY) (MM/Y UNITS A A A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X I OCCUR PHPK1658310 05/23/2017 05/23/2017 05/23/2017 05/23/2018 05/23/2018 05/23/2018 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea n,r $ 100,000 CLAIMS -MADE I MED EXP (My one person) $ 5,000 X Prof Liability PERSONAL &ADV INJURY $ 1,000,000 X Sexual Abuse GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT POLICY 7 PRO- APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X 7 LOC Sexual Ab $ 100,000' A ': AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS PHPK1658310 05/23/2017 05/23/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBREI I A LIAR EXCESS LIAB X OCCUR CLA(MS-MADE PHUB585149 05/23/2017 05/23/2018 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,00 X D DEDUCTIBLE RETENTION $ 10,000 S $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y/N N / A 41O44.51 05/01/2017 05/01/2018 `` WC STATU OTH- X I TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPL0YEE1 500,000 below E.L. DISEASE - POLICY LIMIT $ 500,0001 A Bus Pers Property PHPK1658310 05/23/2017 05/23/2018 BPP 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) V, -,\.O 1•01'4. V ..Vw..• DEPTOFH Department of Human Services of Greeley 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. AUTHORIZED REPRESENTATIVE / G. poi . -2009 ACORD CORPORATION. All rights reserves. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: SLS ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE 05/26/DD/YYYY) 05/26/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: 970-223-1804 FrontRane Insurance on Drive Suite 100 roup Fax: 1 O0Haxt(A/C, Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI CONTACT Flame I FAX (ac No. Exti: i No): E-MAIL : PRODUCER TRANS -6 CUSTOMER ID #: INSURERS) AFFORDING COVERAGE NAIC # INSURED Transitions Psychology Group, LLC 7251 W. 20th St, Unit M2 Greeley, CO 80634 INSURER A: Philadelphia Insurance INSURER B : Pinnacol Assurance 41190 INSURER C : INSURER D : INSURER E : INSURER F : REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L TYPE OF INSURANCE ASR SUBR EFF POLICY NUMBER i (MM/DD/YYYY► M POLICY (MLICY LIMITS A A A GENERAL UABILITY X COMMERCIAL GENERAL LIABILITY OCCUR X ! X IpHPK1658310 i 05/23/2017 05/23/2017 105/23/2018 05/23/2017 05/23/2018 05/23/2018 EACH OCCURRENCE $ 1,000,000 (EaENTED occurrence) $ 100,000 1 CLAIMS -MADE X1 MED EXP (Any one person) $ 5,000 X Prof Liability PERSONAL & ADV INJURY $ 1,000,000 X Sexual Abuse GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY PRO- JECT I I LOC PRODUCTS - COMP/OP AGG $ 2,000,000 X Sexual Ab $ 100,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS i HIRED AUTOS NON -OWNED AUTOS , X j € PHPK1656310 05/23/2017 05/23/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ _ X X $ $ A X UMBRELLA UAB ! X OCCUR CLAIMS -MADE ' PHUB585149 05/23/2017 05/23/2018 EACH OCCURRENCE $ 1,000,000 EXCESS UAB AGGREGATE $ 1,000,000 I DEDUCTIBLE RETENTION $ 10,000 $ X $ B WORKERS COMPENSATION AND EMPLOYERS' UABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes describe under DESCRIPTION OF OPERATIONS N ! A X 1 4104451 05/01/2017 05/01/2018 ! WC STATU- i 0TH - X I TORY LIMIT ER E.L. EACH ACCIDENT $ 500,000 E.L DISEASE - EA EMPLOYE $ 500,000 below E DISEASE - POLICY LIMIT $ 500,000 A Bus Pere Property 1 PHPK1658310 1 05/23/2017 05/23/2018 BPP 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Weld County Department of Human Services is named as Additional Insured with respects to General Liability and Automobile Liability policies. A Waiver of Subrogation applies to General Liability policy. A provision that coverage is non-contributory with other coverage or self insurance provided by county. NOILIMIUV1IAMBLIMOLLP.—ss Weld County Department of Human Services 315 A N. 11th Avenue Greeley, CO 80632 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (�4.-r./ G c.A../��'�� -2009 ACORD CORPORATION. Ail rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD C'NA PRODUCER ( BRANCH 018098 970 Named Insured Norma A Alkire 4913 W 12th Street Rd Greeley, CO 80634-2216 Medical Specialty Marriage/Family Counselor HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP Certificate of 3irrgurance ®HPSO PREFIX OCCURRENCE POLICY FORM IPOLICY NUMBER HPG 0272935313-8 Professional Liability Your professional liability limits shown above include the following • Good Samaritan Liability • Ma'piacement Liability • Personal Injury Liability =.Sexual Misconduct -included -in the -PL -Limit shown above subject-to-$25,000-aggregate-subiirnit Code 80723 Policy Period: From 12/01/16 to 12/01/17 at 12:01 AM Standard Time Program Administered by: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 1 9040-1 21 8 1-800-982-9491 www.hpso.com/renew Insurance is provided by: American Casualty Company of Reading, Pennsylvania 333 South Wabash Avenue Chicago, Illinois 60604 Coverage Extensions License Protection Defendant Expense Benefit Deposition Representation Assault Includes Workplace Violence Counseling Medical Payments first Aid Damage to Property of Others information Privacy (HIPAA) Fines & Penalties Workplace Liability Workplace Liability Fire and Water Legal Liability Personal Liability Total: $111.00 $1,000,000 each claim $3,000,000 aggregate $ 25,000 per proceeding $ 1,000 per day limit $ 10,000 per deposition $ 25,000 per incident $ 25,000 per person $ 10,000 per incident $ 10,000 per incident $ 25,000 per incident $ 25,000 aggregate $ 25,000 aggregate $ 10,000 aggregate $ 25,000 aggregate $ 100,000 aggregate $ 10,000 aggregate $ 10,000 aggregate $ 25,000 aggregate Included in Professional Liability Limit shown above Included in the PL limit above subject to $150,000 aggregate sublimit $1,000,000 aggregate Premium reflects employed, full-time rate with ACA Membership discount Policy Forms & Endorsements (Please see attached list for a general description of many common policy forms and endorsements.) G -121500-D G -121501-C G -121503-C G -145184-A G -147292-A CNA81753 CNA81758 GSL13424 GSL15563 GSL15564 GSL15565 GSL17101 CNA80052 CNA80051 G -123846-005 Chairman of the Board Secretary Keep this Certificate of insurance in a safe place. This Certificate of Insurance and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full. In order to activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. Form #: G -141.241-B (3/2010) Master Policy: 188711433 HPSO-405-R-CON-H1 24161115-065 HEALTHCARE PROVIDERS SERVICE LIHPSO CNA ORGANIZATIONCertificate GROUP f ate of Stt�uraince OCCURRENCE POLICY FORM Producer Branch Prefix 018098 970 HPG Named Insured and Address: Carole J Noblitt 4116 W 15th St Greeley, CO 80634-2735 Medical Specialty: Social Worker, Clinical Excludes Cosmetic Procedures Policy Number 0411587557 Healthcare Providers Scn•ice Otgaai,atioa- Print Date: 5/30/2017 Policy Period from 10/02/16 to 10/02/17 at 12:01 AM Standard Time Program Administered by: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 19040-1218 1-800-982-9491 www.hpso.com Code: Insurance is provided by: 80723 American Casualty Company of Reading, Pennsylvania 333 S. Wabash Avenue, Chicago, IL 60604 Professional Liability $1,000,000 each claim Your professional liability limits shown above include the following: * Good Samaritan Liability * Malplacement Liability * Personal Injury Liability * Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit Coverage Extensions License Protection Defendant Expense Benefit Deposition Representation Assault Includes Workplace Violence Counseling Medical Payments First Aid Damage to Property of Others Information Privacy (HIPAA) Fines and Penalties Workplace Liability Workplace Liability Fire & Water Legal Liability Personal Liability Total: $ 148.00 S 25,000 S 1,000 S 10,000 S 25,000 S 25,000 S 10,000 S 10,000 S 25,000 per proceeding per day limit per deposition per incident per person per incident per incident per incident $ 3,000,000 aggregate $ 25,000 aggregate S 25,000 aggregate S 10, 000 aggregate $ 25,000 aggregate $ 100,000 aggregate $ 10,000 aggregate $ 10,000 aggregate $ 25,000 aggregate Included in Professional Liability Limit shown above Included in the PL limit shown above subject to $150,000 aggregate sublimit $1,000,000 aggregate Base Premium $148.00 Premium reflects Self Employed , Part Time Policy Forms & Endorsements(Please see attached list for a general description of many common policy forms and endorsements.) G -121500-D G -121503-C G -121501-C G -145184-A GSL15565 GSL17101 GSL13424 CNA80051 CNA81758 CNA82011 CNA79575 Chairman of the Board G -141241-B (03/2010) Secretary Coverage Change Date: G -147292-A GSL15563 GSL15564 CNA80052 G -123846-005 CNA81753 Keep this document in a safe place.lt and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full.ln order to activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. Master Policy # 188711433 Endorsement Change Date: Hello