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Home My WebLink About20173419.tiffAGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND LUTHERAN FAMILY SERVICES ROCKY MOUNTAINS This Agreement Amendment, made and entered into 04, , day of 2018 by and between the Board of Weld County Commissioners, on behalf of the Weld Co ty Department of Human Services, hereinafter referred to as the "Department", and Lutheran Family Services Rocky Mountains, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Life Skills (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2017-3419 approved on October 4, 2017. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on 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. 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: The service being provided by the contractor is not a Medicaid eligible service; The service is not deemed medically necessary; The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; A Medicaid provider is not available to provide the needed service. cc . (-(5 0Co(081 Nieooffg 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: _VjX; Weld County Clerk to the Board By: Deputy lerk to the Board BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO 721-0'7—e2,1--gc Steve Moreno, Chair JUN 2 7 2018 CONTRACTOR: Lutheran Family Services Rocky Mountains 363 South Harlan Street, Suite 200 Denver, Colorado 80226 (303) 922-3433 By: mes Barclay, President/CEO Date:'} EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Monitored Visitation, Supervised Visitation and Safe Exchange under Life Skills to individuals and families, as referred by the Department. 2. Target Population: Families who have had their children removed, or are at risk of having their children removed due to imminent safety concerns, are appropriate for this service. 3. Supervised Visitation: Contractor's visitation supervisor will be physically present with the family at all times, allowing for immediate intervention, coaching and role modeling. The parents are then given the opportunity to practice new skills during the visits with a goal of improving positive family relationships. In order to accomplish parenting instruction without undermining the parental authority in front of the children, some of the education sometimes occurs at a time outside of the scheduled visitation, usually just prior to, or immediately following a visit. 4. Monitored Visitation: Contractor's visitation supervisor will be present at the visit location, within earshot of the visit but not physically supervising the family at all times. Contractor will intervene as necessary. S. Safe Exchanges: Contractor's visitation supervisor is present during the exchange of children for the purpose of parenting time in situations that do not allow for face-to-face contact by the parents. 6. Services will occur at the Contractor's Supervised Visitation and Therapy Program in Greeley, CO, or at the Contractor's Fort Collins office. Services may also occur in appropriate community settings or in the family home if deemed appropriate, and approved by the Department. Contractor will provide day, evening and weekend appointments. 7. Contractor will complete the Weld County Visitation Assessment upon request. 8. Contractor will maintain the technology to record visits upon request. 9. Contractor will ensure visitation supervisors have a minimum of an associate's degree. 10. Contractor will offer an initial appointment within seven (7) days of receiving the referral and will make at least three (3) attempts to contact the client and set up services. The first attempt wilt 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. 11. 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. 12. 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. 13. 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. 1 14. 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 (TOM) 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. 15. 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. 16. 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. Contractor may participate by phone 2 EXHIBIT 0 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 $85.00/Hour (Supervised Visitation) $50.00/Hour (Monitored Visitation and Safe Exchanges) All hourly rates include preparation time, mileage to and from visitation appointments, coordination with parents to schedule appointments, communication with the Department regarding services and staff participation in team meetings, and report writing. 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. 1. 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. CERTIFICATE OF LIABILITY INSURANCE AC/R0� DATE (MMIDD/YYYY) 08/24/2017 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 1-303-534-4567 INA, Inc. - Colorado Division 1705 17th Street CONTACT NAME: PHONE FAX (MC. No. Ext) (AIC, NO)' AOOORRESs- denaccounttechsflimacorp.com Suite 100 INSURER S AFFORDING COVERAGE NAIL I Denver, CO 80202 INSURERA: PHILADELPHIA INS CO 23850 INSURED INSURERS: PINNACOL ASSUR 41190 Lutheran Social Services of CO Lutheran Family Services Rocky Mountain 363 South Harlan, Ste 200 INSURERC: ZURICH AMER INS CO(Pinnacol Assurance) INSURERD. INSURER E : 16535 Denver, CO 80226 INSURERF. COVERAGES CERTIFICATE NUMBER: 50648339 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 LTR TYPE OF INSURANCE ADOL INSD SUER WVO ---------_--- POUCYNUMBER -POLICY Eft (MMIDDIYYYYI POLICY EXP (MMIDDIYYYYI OMITS A X COMMRERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR PHPK1669517 07/01/17 07/01/18 EACH OCCURRENCE _ DAMAGE TO RENTED PREMISES (Ea occurrence)_ MED EXP (Any one person) PERSONAL S ADV INJURY $ 1,000,000 $ 1,000,000 $ 20,000 $1,000,000 GENL AGGREGATE LIMIT APPLIES PER POLICYJECT PRO- X LOC GENERAL AGGREGATE PRODUCTS - COMPIOP AGG $ 3,000,000 S 3.000, 000 S OTHER A AUTOMOBILELIASIUTY X ANY AUTO PHPK1669529 07/01/17 07/01/18 COMBINEDSMGLEL+MIT _(Ea accident SODILY INJURY (Per person) S 1,000,000 $ S S - ALL OWNED AUTOS I- SCHEDULED AUTOS BODILY INJURY (Per acodent) HIRED AUTOS X NX AUUTTtOSWNEO (Pec a identDAMAGE S — UMBRELLA UAB EXCESS LUIS OCCUR CLAIMS -MADE( EACH OCCURRENCE AGGREGATE S S S DED I RETENTION S j B C WORKERS COMPENSATION EMPLOYERS' LIASIUTY 4040538 - CO ONLY 03/01/17 03/01/18 11 - g I H 1 STATUTE 24 ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N N N I A WC969160406 - NM ONLY 03/01/17 03/01/18 E . EACH ACCIDENT 1500,000 $ 500, 000 OFFICER/MEMBER EXCLUDED? (MandatoryInNH) E . DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE -POLICY LIMIT $ 500,000 A Professional Liability PHPK1669517 07/01/17 07/01/18 Each Occurrence $ 1,000,000 Aggregate $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apace is required) County of Weld is included as Additional Insured on the General Liability Policy if required by written contract or agreement subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of Additional Insure! on the General Liability and Workers Compensation Policies if required by written contract or agreement subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION County of Weld 1150 '0' Street Greeley, CO 80631 USA 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 (1/./R ACORD 25 (2014/01) aadie55 50648339 © 1988-2014 ACORD CORPORATION All rights reserved. The ACORD name and logo are registered marks of ACORD CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND LUTHERAN FAMILY SERVICES ROCKY MOUNTAINS This Agreement, made and entered into theTday of , 2017, 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 Lutheran Family Services Rocky Mountains, 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. 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. 2017-3419 /D1 O4/-/ 7 /o- oi---- /7 gepoiS2 d. Contractor agrees to submit a monthly report with the billing statement by the 7th of the month following the month of service for each client receiving ongoing services. One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation). Verification of Monitored Sobriety Services will be the test result. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. 4. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule, attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon, the continuing availability of said funds for the purposes hereof. d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 5. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit an ACH Form for Colorado Providers, which will be provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of 2 Colorado per the directions on the form. Failure to complete and submit this form in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and Title VII of the Civil Rights Act of 1964; and the Age Discrimination in Employment Act of 1967; and the Equal Pay Act of 1963; and the Education Amendments of 1972; and Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. 3 b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is Core Services. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contract Professional certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contract Professional will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5-102(5)(c). Contract Professional shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contract Professional that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contract Professional shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contract Professional obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contract Professional shall notify the subcontractor and County within three (3) days that Contract Professional has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contract Professional shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. Contract Professional shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contract Professional participates in the State of Colorado program, Contract Professional shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contract Professional has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, 4 and shall comply with all of the other requirements of the State of Colorado program. If Contract Professional fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contract Professional receives federal or state funds under the contract, Contract Professional must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contract Professional operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5-103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR), and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 9. Insurance Requirements Contractor and Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible the insurance provider. a. General Requirements: Contractors/Contract Professionals must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors/Contract Professionals shall keep the required insurance coverage in force at all times during the term of 5 the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non- payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, in the amount of the deductible or self - insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor/Contract Professional. Contractor/Contract Professional shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i.Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii.Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: $1,000,000 each occurrence; $2,000,000 general aggregate; $50,000 any one fire; and $500,000 errors and omissions. iii.Automobile Liability: Contractor/Contract Professional shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County within ten (10) days and reinstate the aggregates required; Unlimited defense costs in excess of policy limits; Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by County. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. c. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance. County reserves the right to require Contractor/Contract Professional to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an 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: For Contractor: Heather Walker, Administrator James Barclay, President/CEO 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: James Barclay, President/CEO 363 South Harlan Street, Suite 200 Denver, CO 80226 (303) 922-3433 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. Severability 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: diC/• "id"' 41k. BOARD OF COUNTY COMMISSIONERS Weld C. ' nt Clerk to the Board WELD COUNTY, COLORADO By: Deputy Clerk toth/Boar .' /r/ �� Julie Cozad, RA; OP 6,0 CCT 4 2017 Lutheran Family Services Rocky Mountains 363 South Harlan Street, Suite 200 Denver, Colorado 802 (303) 922-3433 By: Date: 026i7- .54//q 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 PAGE9. 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.) Aftercare Services Services provided to prepare a child for reunification with his/her family or other permanent placement and to prevent future out- of -home placement of the child. Anger Management/Domestic Violence Diagnostic and/or therapeutic services to assist in the development of the family services plan, to assess and/or improve family communication, functioning and relationships, and to prevent further domesticviolence. 1 y I t� ti..a x L " 3 +i vr",y tz ,Sty k Crisis Intervention and Stabilization Services Services that provide an immediate, in- person/in- home response to families, youth and children, in *crisis, 24 hours a day, seven (7) days a week. *A "crisis" is further defined as a situation or circumstance, usually acute (recent) in nature, which breaks down the normal functioning of an individual and/or family, and results in the inability of the individual and/or family to resolve the crisis through normal coping behaviors, orwithout Day Treatment Comprehensive, highly structured services that provide education to children and therapy to children and theirfamilies. Foster ParentConsultation Services provided to foster and group home families caring for Weld County children and youth in their homes to enhance and improve the quality of care being provided. Foster ParentTraining Core training for new Weld County foster parents. Functional Family Therapy Intensive family -based treatment that addresses the pervasive patterns of relational dysfunction known to be determinants of conduct disorder, violent acting out, and substance abuse among youth 10-18 yearsold. Home -Based Intervention Services provided primarily in the home of the client that include a variety of services which can include therapeutic services, concrete services, collateral services and *crisis intervention directed to meet the needs of the child and family. *Crisis Intervention is defined as 24/7 phone access and in -home counseling. Kinship Services (Therapeutic) Kinship services in the areas of (1) consultation and kinship parent support specific to a child placed in a kinship home, (2) corrective consultation specific to a child placed in a kinship home, and (3) critical care consultation specific to a child placed in a kinship home. Children placed in kinship care are maintained in the lowest level of care and least restrictive setting when out - of -home placement is necessary. Life Skills Visitation (both in -home and in -office) and services provided primarily in the home that teach household management, effective accessto community resources, parenting techniques and family conflictmanagement. Mediation/Intensive Family Therapy Therapeutic intervention typically with all family members to improve familycommunication, functioning and relationships. 2 Mental Health Services Diagnostic and/or therapeutic services to assist in the development of family services plan, to assess and/or improve family communication, functioning and relationships. Multi-systemicTherapy Intensive family- and community -based treatment program designed to make positive changes in the various social systems (home, school, community, peer relations) that contribute to the serious antisocial behaviors of children and adolescents who are at risk for out -of -home placement. RelinquishmentCounseling Relinquishment counseling for parents considering relinquishment of their children. Substance Abuse Treatment Services Diagnostic and/or therapeutic services to assist in the development of the Family Service Plan (FSP), to assess and/or improve family communication, functioning and relationships, and to prevent further abuse of drugs or alcohol. Other Creative and unique services designed to meet the needs of children, youth and families interacting with the Child Welfare system through a prevention or traditional case. B. Bids for the stated services will be received by the Weld County Department of Human Services, Resource Unit, Attn: Tobi Vegter, through: MONDAY, APRIL 24, 2017, AT 5:00 P.M. (WELD COUNTY DEPARTMENT OF HUMAN SERVICES, RESOURCE UNIT TIME CLOCK). Acceptable bid delivery methods are as follows: Email. Emailed bids are preferred. Bids should be emailed to: vegterta@weldgov.com. Emailed bids must include the following statement on the email: "I hereby waive my right to a sealed bid". An email confirmation will be sent when we receive your bid/proposal. Mail. Mailed bids should be sent in a sealed envelope with the bid title and bid number on it. Bids must include the following statement on the email: "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," "secretar ," "agent," or other title without disclosing his principal, may Y P p Y 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.AII 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 OF THIS 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 staffand/or contractors, frequency and duration of supervision, credentials of supervisor and length of time as a supervisor. 10) A bidder should clearly outline the bidder's internal referral acceptance and assignment protocol, including communication to the referring agency. 11) A bidder must demonstrate familiarity with Trauma Informed Care. Bidder must provide copies of applicable training certificates, or proof of registration for training, for all staff members who manage and/or administer services under this proposal. 12) A bidder must demonstrate prior and current capacity to be organized, responsive and to quickly and successfully schedule services as requested. 13) A bidder must agree to track outcome data related to services proposed if awarded a contract and report outcomes upon request. 14) A bidder must agree to enter into an agreement, attached as Exhibit A, with the Weld County Department of Human Services and comply with all requirements of the agreement. Contract Period and Pricing: 1) The initial contract period is to be determined and shall continue as allowable by the funding source, so long as both parties are satisfied. The selected vendor(s) will have the opportunity to resubmit annually. 2) The initial contract will be funded through Core Services Program or other funding, so long as funding is made available. 3) The selected vendor will bill the Weld County Department of Human Services monthly according to billing requirements set forth by the Weld County Department of Human Services. Submittal Requirements for All Proposals: A bidder must submit according to requirements set forth in this Request for Bid - Qualifications. All proposals must contain the following specific information: 1) Provider Information Form (PIF). 2) Identification of language(s) and proficiency level, if applying to provide bilingual (English/Spanish) services. 3) One page or less cover letter that introduces the bidder, the bidder's location(s) of practice, his or her experience and qualifications, and staff, if applicable. 4) A bidder must submit sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets"minimum qualifications" for all bidders. Each service must be submitted as its own proposal, inclusive of scope of services and rate information. The scope of service should include at a minimum the following information for each service proposed: • Detailed description of service components, modalities used, appropriate use of service, etc. • Target population including age range, specific population characteristics, area of service, etc. • Whether or not the service is billable to Medicaid and if bidder is currently able to bill Medicaid. Bidders are strongly encouraged to become Medicaid certified. Medicaid -billable services are preferred. • Clear rate schedule inclusive of all costs bidder wishes to charge for the provision of the service. 5) Bidders should avoid elaborate artwork, graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Bid. 6) Current resume, proof of licensure and copies of applicable training certificates for all staff members who will manage and/or administer services under this proposal. 7) Supervisory structure of staff members and/or contractors of the bidder. This should include the ratio of supervisor to staff and/or contractors, frequency and duration of supervision, credentials of supervisor and length of time as a supervisor. 8) Internal referral acceptance and assignment protocol, including communication tothe referring agency. 9) All proposals must demonstrate the bidder has the ability to deliver the services as proposed, and comply with the specific requirements set forth by the Weld County Department of Human Services. 10) All proposals must include a clear and concise rate schedule that accurately correlates to the proposed services and is inclusive of all possible charges related to the proposed service(s). The rate schedule must demonstrate an exact fee for the described service (s). Approximate rates or a range of rates for a service will not be accepted. 11) Each bidder must submit a Standard Certificate of Insurance, or letter of intent from an insurance company authorized to do business in the State of Colorado stating its willingness to insure the bidder pursuant to the terms of this Request for Bid. Evaluation of Proposals: All proposals that meet the basic proposal, service and qualification requirements will be reviewed by the Families, Youth and Children (FYC) Commission. Criteria for review, include but are not limited to the following: • Qualifications, appropriate licensure, and experience. • Cost structure. • Relationships and collaboration. • Organizational experience and past performance. The FYC Commission will make recommendations to the Board of Weld County Commissioners by and through the Weld County Department of Human Services. The Weld County Department of Human Services will make its award of contract to the successful bidders upon final approval of the Board of Weld County Commissioners. EXHIBIT A SAMPLE AGREEMENT CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND This Agreement, made and entered into the _ day of , 2015, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department' and «Contractor», hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Weld County's Reuquest for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and incorporated herein by this reference. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided funding to the Department for NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on , upon proper execution of this Agreement and shall expire , unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Proposal and Exhibit C, Scope of Services. 3. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Department's Resource Manager, Child Welfare Contract and Services Coordinator, or through a Team Decision Making (TDM) meeting or Family Team Meeting (FTM). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit an itemized complete billing statement by the 7th of the month, following the month of service, utilizing billing forms required by the Department. 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 PROVIDER INFORMATION FORM (Bid Cover Sheet) Weld County Department of Human Services Lutheran Family Services Rocky Mountains 45080 AGENCY OR PRIVATE PRACTICE TRAILS PROVIDER ID (II Known) Jim Barclay President and CEO PRIMARY CONTACT — FULL NAME PRIMARY CONTACT • TITLE 303 , 922-3433 f 303 ) 922-7335 PHONE NUMBER EXT. FAX NUMBER kim.penney@Ifsrm.org www.tfsrm.org PRIMARY CONTACT — E-MAIL ADDRESS AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) 363 S. Harlan St. Suite 200 AGENCY MAILING ADDRESS Kim Penney Denver 80226 REFFERAL CONTACT - FULL NAME (IF DIFFERENT THAN PRIMARY CONTACT) i 970 , 232-1156 REFERRAL CONTACT - PHONE NUMBER CITY ZIP Program Director, Foster Care and Family Services North REFERRAL CONTACT -TITLE kim.penney© Ifsrm. org Err REFERRAL CONTACT - E-MAIL ADDRESS I certify that the services offered for intended use by Weld County will meet all the specifications it has so indicated in this bid form. The Board of Weld County Commissioners reserves the right to reject any or all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases w e e bids are • •etitive in pr and quality. Signature of Authorized R pr�es��ntative: Date of Signature: 7 /// 1 Table of Contents Cover Letter 3 Parent Education and Support Program Proposal 4 Certificate of Insurance 7 Resumes, Licenses, and Training Certificates 9 2 EXHIBIT B CONTRACTOR'S PROPOSAL Wig LUTHERAN FAMILY SERVICES Rocky Aloutiroins April 24, 2017 Families, Youth, and Children's Commission Weld County Department of Human Services 315 A. North 11th Ave. Greeley, CO 90631 Dear Commission Members: On behalf of Lutheran Family Services Rocky Mountains (LFS), I am pleased to present the attached proposal in response to the Commission's call for Various English and Bilingual Services. We are applying in order to continue to offer the Life Skills — Supervised Visitation and Safe Exchange Services for the Weld County Department of Human Services for the Program Year 2017-2018. LFS is one of the largest private, nonprofit foster care providers in Colorado. In northern Colorado, LFS serves clients in Weld, Larimer, Morgan and Logan counties. Currently, LFS certifies and supervises approximately 200 children in foster care per night, with 22 foster homes in Weld County. The Supervised Visitation and Safe Exchanges program, located in Greeley, allows for community -based therapy and visitation and exchange services for children and families who live in Weld County. For over a decade, LFS has also provided in -home services for clients of Weld County Department of Human Services living throughout the county, including locations in Greeley, Evans, Eaton, Windsor, Johnstown, Severance, Kersey, Keenesburg, Platteville, Fort Lupton, Nunn, Lochbuie and Firestone. In addition to in -home and community based services, LFS is an accredited provider of Medicaid billable therapy services to authorized clients. LFS is proud to employ highly experienced and dedicated professionals to provide these services to Weld County's most vulnerable families. The LFS Weld County building is located: 800 8w Avenue Suite 225 Greeley, CO 80631 The LFS headquarters and mailing address is: 363 S. Harlan St. Suite 200 Denver, CO 80226 If you have questions or need additional information, please do not hesitate to contact Kim Penney, Foster Care and Prevention Services Director, at 970-232-1156 or kim.penney@lfsrm.org, or visit www.lfsrm.org. Sincerely, ames D. ay President and CEO 3 Supervised Visitation and Safe Exchanges Lutheran Family Services Rocky Mountains April 24, 2017 Description: The Lutheran Family Services Rocky Mountains (LFS) Supervised Visitation and Exchange services are designed to provide an opportunity for children to maintain contact with their parents or other family members in a safe, neutral location. Maintaining contact with parents is paramount to the emotional well-being of a child even when there has been significant family disruption or conflict. Visitation and exchange services provide an important service for parents involved with the child welfare system, divorcing parents and parents in conflict so that they can safely exchange or visit children within the confines of a supervised and closely monitored program. Common reasons for these services are: 1) a proven history of parental abuse and/or neglect, 2) history or allegations of domestic violence, 3) reinstatement of visitation rights after a long absence, 4) a parent's impairment due to mental illness and/or substance abuse, 5) one parent's violation of custody orders, and 6) threats of abduction. When necessary, LFS has the capacity to ensure that parents do not come in contact with one another during visits or exchanges in order to keep children safe. In order to provide the best chance of success, LFS is able to provide visitation services in the structured setting of Supervised Visitation and Therapy Program in Greeley, or in the Fort Collins office. In cases where less structure is required, visitation services can be offered in the community or in the home.. The Supervised Visitation program provides day, evening, and weekend appointments and services are available in Spanish. When requested, the Weld County Visitation Assessment will be completed and the results reported. The Greeley facility is also equipped with the technology necessary to record family visits at the request of the Department. The Visitation and Exchange Program has three service areas: supervised visitation, monitored visitation and safe exchanges. SUPERVISED VISITATION During Supervised Visitation, the visitation supervisor is physically present with the family at all times, allowing for immediate intervention, coaching and role modeling. The parents are then given the opportunity to practice new skills during the visits with a goal of improving positive family relationships. In order to accomplish parenting instruction without undermining the parental authority in front of the children, some of the education sometimes occurs at a time outside of the scheduled visitation, usually just prior to, or immediately following a visit. MONITORED VISITATION In Monitored Visitation, a visitation supervisor is present at the location of the visit, but not physically supervising all interactions. The visitation supervisor is close enough to hear conversations and will verbally intervene for safety when necessary. SAFE EXCHANGES A Safe Exchange is the exchange of children for the purpose of parenting time where each parent/guardian shall have pick up and drop off times that prevent their face to face contact. 4 Target Population: The target population for these services is families involved with Weld County Department of Human Services that have had, or are at risk of having their children removed from the home due to imminent safety concerns. Rate of Schedule: Supervised Visitation will be provided at a rate of $85 per hour for face-to- face contact. Monitored Visitation and Safe Exchanges will be provided at a rate of $50 per hour for face to face contact. All hourly rates include preparation time, mileage to and from visitation appointments, coordination with parents to schedule appointments, communication with OHS regarding services and staff participation in core review team meetings, if requested by OHS, and report writing. A rate of $90 will also be used for staff time waiting at, or testifying in court; for attendance at court facilitation meetings; and for attendance at Team Decision Making Meetings, if attendance is requested by the Caseworker. Expertise of Staff: Visitation supervisors assigned to these services will have a minimum of an associate's degree, but all but one currently have a Bachelor degree. Visitation supervisors will be available, either in person or by phone, for OHS core review team meetings and, under subpoena, for court testimony. In addition, every attempt would be made for the visitation supervisors to be available for court facilitation or Team Decision Making meetings. Monthly reports in the OHS requested format will be submitted and regular communication will be maintained with the OHS Caseworker. LFS requires all eligible staff to be registered with the Colorado Department of Regulatory Agencies. Supervisory Structure:The supervisory structure for the LFS Supervised Visitation and Safe Exchange Program is as follows: The Director of Foster Care, Family Preservation and Prevention North, who is a licensed mental health provider, supervises the Visitation and Exchange Supervisor, who holds a Bachelor degree, and communicates weekly about program needs. The Visitation and Exchange Supervisor meets multiple times a week with a Supervisory Assistant, who also holds a Bachelor degree, as well as all contractors providing visitation. Referral Acceptance: LFS proposes a contract to provide Supervised Visitation and Safe Exchange services for Weld County Department of Human Services (DHS) for the Program Year 2017-2018. Any visitation referral received by LFS will be considered and notified of acceptance or decline within three business days of the referral. If the referral is accepted, an initial contact with the caseworker and family will be made within one week of the acceptance. Trauma Informed Care: LFS is uniquely qualified to apply Trauma Informed Care. LFS North has administered High Level Trauma Assessments conducted to assess for the potential impact of trauma on youth in the region since May of 2015 under the direction of the current Director of Foster Care, Family Preservation and Prevention North. LFS is currently one of only two agencies in the area offering this service, the other being Colorado State University. Licensed mental health professionals who conduct these trauma assessments serve as consultants upon request of the Visitation and Safe Exchange Services staff. As documented through staff training logs, much time and attention has been given to the study of the effects of trauma on brain development, executive functioning and attachment as well as the resulting reenacting of abuse. 5 Children under LFS care, from foster care to preservation to prevention services, are seen not as willfully disobedient but rather exhibiting survival skills once triggered by trauma reminders. Capacity: At any given time, LFS has the capacity to provide services to approximately 15 families through its family preservation service of Supervised Visitation. CORE and other funding sources, it is important to note that this service was provided to over 800 unduplicated individuals at the Greeley Visitation Center in FY 15/16. Objective: It is the objective of LFS to ensure that the continuity and quality of family relationships and connections is improved and preserved for children and that if a child is deemed to be in an unsafe living or visitation situation, that the appropriate Department of Human Service office is contacted as per 26-5.3-103(2), C.R.S. A current success story involves a mom and dad receiving supervised visitation separately with their minor children since August of 2016. Their house burned down, and the children were home alone when the fire started. A month later, DHS received a referral that dad would not stop hitting mom; a D&N was filed, and a restraining order is currently in place between the parents. Mom continues to maintain consistency with visitation, has recently completed a psychological evaluation with Dr. Gardner, and is working through her past trauma. Dad was consistent with his visitation schedule and positively and appropriately demonstrated the nurturing parenting skills he was provided with before and after his supervised visitation. Dad is currently compliant with his treatment plan and has progressed to transition from supervised visitation and begin therapeutic visitation in his home. Data Tracking: Data is tracked electronically in an Efforts to Outcomes (ETO) database and reported to Weld County DHS through their internal FIDOS data reporting system on a monthly basis. Discussion regarding the quality of familial relationships and safety issues regarding all children is provided by the assigned staff while maintaining HIPAA compliance. 6 A Q® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/23/2016 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 ights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-303-534-4567 IMA, Inc. - Colorado Division 1705 17th Street Suite 100 Denver, CO 80202 CONTACT NAME: PHONE IFAX LA/C. No. Ext): i (A/C, No): E-MAIL cor denaccounttechs@ima ADDRESS: P•com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: PHILADELPHIA INS CO 23850 INSURED Lutheran Social Services of CO Lutheran Family Services Rocky Mountain 363 South Harlan, Ste 200 Denver, CO 80226 INSURERB: ZURICH AMER INS CO(Pinn ce) 16535 INSURER C : PINNACOL ASSUR 41190 INSURERD: INSURER E : INSURER F: ICATE NUMBER: 47188534 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT O UMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE PO ' IBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUC =Y PA S. INSR LTR TYPE OF INSURANCE ADM INSD SUER WVD POLICY NUMBER POLIO FF (M DD PO Y EXP (MM/ ,/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY PHPK1507449 k 1/17 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREM IS (EaENTEDoccu ence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 20,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES I PRO- PER: R LOC PRODUCTS-COMP/OPAGG $ 3,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED ^ X SCHEDULED AUTOS AUTOS PHPK150 07/01/16 07/01/17 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ $ (PerPe�acadentPERTY DAMAGE $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE "� 4 31 07/01/16 07/01/17 EACH OCCURRENCE $ 4,000,000 AGGREGATE AGGREGATE $ 4,000,000 $ DED X RETENTON$ 10,000 B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANVPROPRIETOR/PARTNER/EXECUTIVE Y/ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATI be WC969160405 - NM ONLY 4040538 - CO ONLY 03/01/16 03/01/16 03/01/17 03/01/17 X STATUTE E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ 500,000 $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500, 000 A Cyber Liability Privacy Liab' ity Security Costs PHSD1151651 07/01/16 07/01/17 Deductible $10,000 Limit $1,000,000 Limit $500,000 DESCRIPTION OF • '; • TIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ill(<1" CERFICATE HOLDER CANCELLATION For Information Only 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 ACORD 25 (2014/01) ashmcclain 47188534 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 7 SUPPLEMENT TO CERTIFICATE OF INSURANCE NAME OF INSURED: Lutheran Social Services of Co Lutheran Family Services Rocky Mountain Additional Description of Operations/Remarks from Page 1 Additional Information: Professional Liability Coverage: Eff Date: 07/01/16-07/01/17 I $1,000,000 Each Occurrence; $1,000,000 Sexual DATE 06/23/2016 •fk oc)\i o� •s• K1507449 Se Above gregate Limit 1 .`i`=-e Limit(Sexual abuse & Molestation Coverage is not Excluded) SUPP (05/04) 8 Kimberly Penney, LCSW (#992640) 2032 Lowe Street, Suite 200 Fort Collins, CO 80525 970-232-1156 work 970-222-7410 cell kim.penney@lfsrm.org EDUCATION University of Denver —Denver, CO Master of Social Work; Graduated 1996; Emphasis: Mental Health • First year field placement at Colorado Mental Health Institute at Fort Logan: Constructed psychosocial histories including clinical assessment of adolescents with psychiatric diagnoses and provided individual, family and group therapy • Second year field placement at Catholic Charities Samaritan House homeless shelter : Provided case management and counseling services to chronically homeless men, women and families and conducted assessment of mental health /substance abuse University of Missouri -Columbia, MO Bachelor of Arts in Psychology; Graduated 1992; Emphasis: Human Development/Family Services and Educational/Counseling Psychology • Field placements at The Shelter for women who were battered and their children and the Partners in Education Program for developmentally disabled youth WORK HISTORY Lutheran Family Services Rocky Mountains -Fort Collins, CO Director of Foster Care North, Family Preservation and Prevention; 2015 to present • Supervise all Northern Colorado programming for children and families including domestic foster care, unaccompanied refugee minor foster care, family preservation services, a visitation program for families who are DHS-involved or Domestic Relations Court -involved, prevention programs regarding body safety and parenting education, High Level Trauma Assessment Services, Post -Adoption Counseling and therapeutic services through Medicaid • Budget management • Grant management of all funds supporting Northern Colorado LFS programming for children and families and evaluation of each program • Contract negotiation with Denver, Larimer and Weld Counties in addition to smaller Northern Colorado counties • Ongoing training in areas of leadership and trauma -informed care, which are both infused into all areas of practice 9 Kimberly Penney, LCSW (#992640) 2032 Lowe Street, Suite 200 Fort Collins, CO 80525 970-232-1156 work 970-222-7410 cell kim.penney@lfsrm.org Lutheran Family Services Rocky Mountains -Fort Collins, CO Coordinator/Educator for Ready or Not? Teen Pregnancy Prevention; 2012 to 2015 • Schedule over 1,500 students to participate in the program each academic year in Weld and Larimer counties • Develop curriculum appropriate to middle school and high school aged adolescents • Research teen pregnancy and related risk and protective factors • Submit ongoing grant reports to multiple funding sources • Conduct bi-annual program evaluation • Supervise bachelor level interns • Participate in monthly community committee meetings • Conduct weekly group lessons in the classroom regarding the use of infant simulators as an experiential learning tool, pregnancy risk and protective factors, limit setting and parent -child communication techniques WORK HISTORY Arapahoe County Department of Human Services -Littleton, CO Ongoing Social Caseworker; 1996 to 2001 • Provided case management to children, adolescents, and families • Constructed and implemented treatment plans after needs assessment • Secured and supported all treatment and placement • Provided expert documentation and testimonial to the court system • Worked in conjunction with multiple systems, including mental health, educational and criminal justice • Served as lead caseworker and county liaison for the Arapahoe Mental Health Center therapeutic day treatment program, the Adolescent Day Resource Center • Served as lead caseworker and county liaison for the Arapahoe County District Attorney's Office's Serious Habitual Offender Directed Intervention Program with youth engage in criminally delinquent behavior and facing commitments to the Department of Youth Corrections 10 Kimberly Penney, LCSW (#992640) 2032 Lowe Street, Suite 200 Fort Collins, CO 80525 970-232-1156 work Excelsior Youth Center- Aurora, CO Group Living Counselor; 1992 to 1995 970-222-7410 cell kim.penney@lfsrm.org • Supervised in -patient female adolescents with psychiatric diagnoses • Implemented individual treatment plans • Provided individual counseling and group therapy • Coordinated recreational therapy groups • Worked in conjunction with a team of mental health counselors and clinical therapists to meet the mental health needs of residents • Managed acute and unsafe physical behavior of residents through CPI methods LICENSURE I have been a Licensed Clinical Social Worker in the State of Colorado since 2001: License #992640. I received approval for credentialing with Colorado Access in 2015, which allows for Medicaid billing. TRAININGS AND CONFERENCES • Nurturing Parenting Training of Parent Educators, presented by the Family Nurturing Center of Colorado in Boulder on 6-13-12 and 6-14-12 • Child Abuse Symposium, presented by the Child Advocacy Center of Larimer County on 4-18-13 • DSM-5: Understanding and Diagnosing Mental Disorders, presented by Dr. Jean Keim of the University of New Mexico on 1-18-14 • The 12 Core Concepts: Concepts for Understanding Traumatic Stress Responses in Children and Families , presented by Dr. Susan Hansen of The National Child Traumatic Stress Network on 6-19-14 and 6-20-14 • Fundamentals of Trauma Processing, course completed through Continuing Education for Social Workers independent coursework 7-1-14 • Trauma 101, presented by Dr. James Henry of the Southwest Michigan Children's Trauma Assessment Center on 9-4-14 • Trauma Informed Care, presented by Dr. Jerry Yager, childhood trauma expert and fellow with the Child Trauma Academy, in a private LFSRM conference on 9-9-14 11 Kimberly Penney, LCSW (#992640) 2032 Lowe Street, Suite 200 Fort Collins, CO 80525 970-232-1156 work 970-222-7410 cell kim.penney@lfsrm.org • Trauma 201: Resiliency in Case Planning and Trauma -Informed Assessments, presented by Dr. James Henry on 10-20-14 and 10-21-14 • Trauma, Attachment, and Neuroscience: New Psychotherapeutic Treatments, presented by Dr. Bessel van der Kolk, Professor of Psychiatry at Boston University School of Medicine and Medical Director of the Trauma Center, on 11-13-14 • Trauma Assessment, presented by Dr. James Henry, on 1-5-15 and 1-6-15 • Coordinating and Intervening with Trauma Care in the Home and Larger Systems, presented by Dr. James Henry 2/9/16 • Monthly case consults with Dr. Jerry Yager, psychologist and fellow of Dr. Bruce Perry 2016 to present • The Impact of Trauma and Neglect on the Developing Child, Dr. Bruce Perry on 4-11-17 • Animal -assisted Interventions: Enhancing Treatment in Clinical Practice by Brooke Wimer of CMHI-Pueblo Inpatient Forensic Psych Unit on 4/17/17 COMMUNITY COMMITTEE MEMBERSHIP • Larimer County Trauma Practice Group 2015 to present • 7 County Trauma Consortium 2016 to present 12 COLORADO Department of Regulatory Agencies Division of Professions and Occupations ithitVielow 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 Social Work Examiners Board CSW.00992640 Number Active Credential Status Verify this credential at: www.dora.colorado.RovJprofession s Di4ision Director: Lauren Larson Credential Holder Signature Worker °. 09/01/2015 Issue Date Colorado Department of Regulatory Agencies Division of Professions and Occu ations CSW.00992640 Number Active Credential Status Social Work Examiners Board Kimberly A. Penney Licensed Clinical Social Worker 09/01/2015 Issue Date 08/31/2017 Expire Date Verify this credential at: www.dora.colorado.gov/profession s DNislon Director: Lauren Larson Credential Holder Signature 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 303.894.7693 www.dora.colorado.gov/professions 13 J it I Co, ty 64 14, „, ,- -•''' Ill CERTIFICATE OF TRAINING COMPLETION THIS DOCUM CERTIFIES THAT l (L7 HAS SUCCESSFULLY CO LETED THE COORDINATING AND INTERVEN NG WITH TRAUMA CARE IN THE HOME AND LARGER SYSTEMS DESCRIPTION: DR. JAMES HENRY AND AMY PERRICONE'S TRAINING FOR TREAT- MENT PROVIDERS ON TRAUMA TREATMENT COORDINATOR SERVICES. AN IN HOME INTENSIVE SERVICE FOR CHILDREN WHO HAVE HAD A TRAUMA ASSESSMENT AND IMPLEMENTING THE TRAUMA ASSESSMENT RECOMMENDATIONS 3 HOURS OF TRAUMA FOCUSED TRAINING 1 :OO-4:OOPM 2/9/16 ISSUED BY: ANDREA FOTSCH, MSW TRAUMA CARE COORDINATOR LARIMER COUNTY DEPARTMENT OF HUMAN SERVICES SL LARIMER COUNTY DEPARTMENT OF HUMAN SERVICES and Discussion er Tigers Documentar September 19, 2016 - 12:00 - 2:00 (2 hours of trauma training) Andrea Fotsch ca P0 O C a E a C O U g ea 7-1 w U z at 7.V 0J C7 R1 4-1 b 9L I— O bo a) a) a) I. a) a) ea to E co N O u co a .c w F — w 5 a) C a) Q i Pk• J W N W ,16 >1 ad ft Z Certificate of Successful Completion *PES1` *PESI* tiEvu n Ed4Nurses IV Psy0otherupy, , Animal -Assisted Interventions: Integrate Animals to Enhance Treatment in Clinical Practice Speaker(s): BROOKE WIMER, MOT, OTR/L Fort Collins, CO - 4,17:2017 The following participant Kim Penney (License #, if applicable) has completed the above -referenced educational activity in its entirety or as indicated below. This certificate provides sponsor verification of individual attendance and may be used for your records or for any licensing not listed below. We maintain attendance records for 7 years. ADDICTION COUNSELORS: This course has been approved by PES1, Inc., as a NAADAC Approved Education Provider, for 6.0 CE in the Counseling Services skill group. NAADAC Provider #77553. PESI, Inc. is responsible for all aspects of their programming. Full attendance is required; no partial credit will be awarded for partial attendance. COUNSELORS: This intermediate activity consists of≥ock hours of continuing education instruction. Credit requirements and approvals vary per state board regulations. Please save the course outline, the certific o letion you receive from the activity and contact your state board or organization to determine specific filing requirements. EDUCATORS TEACHERS: This course consists of 6.25 clock hours. This certificate is proof of your attendance. Please retain it in your records or use for submission as proof of completion when required. MARRIAGE & FAMILY THERAPISTS: This activity consisted of 380 minutes of continuing education instruction. Credit requirements and approvals vary per state board regulations. Please save the course outline, this certificate of completion and contact your state board or organization to determine specific filing requirements. NURSE/NURSE PRACTI77ONERS CLINICAL NURSE SPECLALISTS: This activity meets the criteria for an American Nurses Credentialing Center (ANCO Activih PES1, Inc, is an approved sponsor by the Amtencan Psychological Association, which is recognized by the ANCC for behavioral health related activities. Full attendance is required; no partial credit will be awarded for partial attendance. This activity qualifies for 6.25 contact hours. NURSING HOME ADMLNISTRATORS. This educational offering has been reviewed by the National Continuing Education Review Service (LACERS) of the National Association of Long Term Care Administrator Boards (NAB) and approved for 6.25 clock hours and 6.25 participant hours. Program Approval Number. 20180305-6.25-SOVI-IN. OCCUPATIONAL THERAPISTS & OCCUPATIONAL THERAPY ASSISTANTS: PESI, Inc. is an AOTA Approved Provider of continuing education. Provider 8: 3322. Full attendance at this course qualifies for 6.0 contact hours or .6 CEUs in the Category of Domain of OT and Occupational Therapy Process. Partial credit will be issued for partial attendance. The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA. Course Level: Intermediate. PHYSICAL THERAPISTS & PHYSICAL THERAPIST ASSISTANTS: This activity consists of 6.25 clock hours of instruction that is applicable for physical therapists. This certificate is proof of your attendance. Please retain it in your records or use for submission as proof of completion when required. PSYCHOLOGISTS: PESI, Inc. is approved by the American Psychological Association to sponsor continuing education for psychologists. PEST maintains responsibility for this program and its content. PEST is offering this activity for 6.25 hours of continuing education credit. Full attendance is required; no partial credits will be offered for partial attendance. SPEECH -LANGUAGE PATHOLOGISTS: This course provided 6.0 contact hours. This certificate neither awards ASHA CEUs nor verifies that ASHA CEUs have been awarded to the person named above. ASHA CEUs are awarded by the ASHA CE Registry upon receipt of the CEU Post Reporting from the ASHA Approved CE Provider. SOCIAL \\'ORKERS: PESI, Inc. Provider #:1062, is approved as a provider for social work continuing education by the Association of Social Work Boards (.AS\\'B), www.aswb.org through the Approved Continuing Education (ACE) Program. PESI, Inc. maintains responsibility for the program. AS VB Approval Penod: January27, 2017 - January 27, 2020. Social workers should contact their regulator)• board to determine course approval for continuing education credits. Social workers participating in this course will recehe 6.25 (Clinical) continuing education clock hours for this intermediate course. The back of this certificate may contain additional information L /2L -camel Kristine Cleasby, Senior Continuing Education Administrator PESI, Inc. 1-800-844-8260 P.O. Box 1000, Eau Claire, WI 54702-1000 17 Certificate of Successful Completion xis xis HeartnCae Rehab HEALTH Ed4Nurses mfg a Psychotheropy, Animal -Assisted Interventions: Integrate Animals to Enhance Treatment in Clinical Practice COLORADO SOCL4L WORKERS: PESI. Inc. is an approved provider with the Colorado Chapter of the National Association of Social Workers. Provider rt1,113. This course has been approved for 6.3 continuing education hours. OTHER PROFESSIONS: This activity qualifies for 380 minutes of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements. DISCLAIMERS: •11 is your ethical responsibility to report accurate hours to your licensing board. If you are in partial attendance a revised certificate will be sent to you, upon your request, after the activity. Please allow 304.5 days. ' 'Even though you have received this Certificate of Attendance, if you have a balance due, the balance must be paid ut full within 30 days, or your hours may be retracted. "All participants are provided a post-test/evaluation form that is to be completed and turned in at the conclusion of the seminar. If you require a copy of the test/evaluation, please have a copy made at the seminar. Or you may call our customer service department and a copy of your test/evaluation will be cmailed to you. Please allow 30-4.5 days. PESI, Inc. offers continuing education programs and products under the brand names PESI, PESI HealthCare, PEST Rehab, MEDS-PDN, HealthEd and Ed.4Nurses. Kristine Cleasby, Senior Continuing Education Administrator PESI, Inc. 1-800-844-8260 P.O Box 1000, Eau Claire, WI 54702-1000 18 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson Date: 4-26-16 Title of Training: TF-CBT, coping skills for hypo -arousal, breathing and relaxation techniques Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant ['Book Audio ❑Video ❑Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. Narratives during TF-CBT 2. Dissociation with hypo -aroused kids and other coping skills 3. Helping increase the capacity to tolerate positive affect What new information did you gain? 1. Kids need repetitive interactions to build capacity to tolerate stress or even positive affect. Our kids externally regulate (with others, not on their own) 2. Always start by validating negative feelings. With TF-CBT narratives, best if co - created with adult but they discover on their own. Okay to give examples and ask "do any of these fit"...even with EMDR and negative cognitions 3. Foster parents need to limit set without shaving. Know that kids wiring to inhibit is not well developed. How will you use it in fostering children? This information was shared in context of case presentation with 2 former foster children who were exposed neglect and domestic violence. Understanding how to set limits without shaming, begin narratives and teach coping skills such as breathing and activity will be useful during psycho -education in therapy sessions and with caregivers. Number of training credit hours granted: Date: Approved by LFS staff member: Signature of staff: H:\Staff Training\Training Documentation 4.26.16 Yager consult.doc In Accordance with Rule #7.708.65.C&D Rev. 9/9/2013 19 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson, Richel Hubbard; Date: 7.19.16 Title of Training: coping with STS Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant ❑Book ❑Audio ['Video ['Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. How to cope with the stress of what we do plus administrative stressors 2. Be realistic about the treatment of children; only a small number of kids are abused 3. How to team build What new information did you gain? 1. There is no way to eliminate stress 2. Stress is tolerated through relationships 3. Build relationships/trust as a team so that you can navigate stressful situations that are a part of life and will never NOT be a part of life How will you use it in fostering children? The better relationships we can build and support as a team, the more we can tolerate stress of jobs and STS that is particular to child welfare. We help foster children when we are regulating our own STS. Number of training credit hours granted: Date: Approved by LFS staff member: Signature of staff: H:\Staff Training\Training Documentation 7.19.16 Yager consult.doc In Accordance with Rule #7.708.65.C&D Rev. 9/9/2013 20 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson Date: 5-17-16 Title of Training: sexual compulsion in abuse victims and windows of tolerance Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant Book Audio Video EWorkshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or .1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. Sexual compulsion v sexual addiction 2. Safety planning for adult victims of sa and their resulting compulsion 3. What to address regarding these issues in family therapy What new information did you gain? 1. We need to honor children for their solutions; they are creative survivors even if we worry about their coping skills 2. Need success experiences; we develop sense of self based on how we are feeling 3. Any type of arousal for sa victims can become sexual in nature How will you use it in fostering children? This information was shared in context of case presentation of a therapy case in which an older teen was developing sexual compulsion and dangerous situations were resulting. We can apply knowledge of how healing occurs in context of present relationships (in home and in tx) and not going back to past relationships. Tips for increasing her ability to ID feelings will be useful to caregivers. Number of training credit hours granted: Date: Approved by LFS staff member: Signature of staff: H:\Staff Training\Training Documentation 5.17.16 Yager consult.doc In Accordance with Rule #7.706 65.C&D Rev. 9/9/2013 21 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson Date: 3-8-16 Title of Training: confidentiality laws, mandatory reporting, executive functioning and trauma Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant ❑Book ❑Audio ❑Video ❑Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. How trauma affects executive functioning in youth. 2. Tips for channeling energy due to sensory issues 3. 1:1 relationships build abilities to navigate social environments What new information did you gain? 1. Education re: children experiencing various levels of arousal, from shut down to high energy and adults needing to help reduce associated stress as kids are unable. 2. Limit setting creates states that the kids cannot tolerate 3. Environments need to be created that help a child learn to self -regulate; these environments establish implantation of neurons that can now be wired into their brains. How will you use it in fostering children? This information was shared in context of case presentation with 2 male children who were exposed to drug use in utero as well as domestic violence. Understanding how to set limits while supporting the children and their inability to tolerate limit setting was discussed. We have concrete ideas re: how to manage sensory overload and complex social environments. Number of training credit hours granted: Date: Approved by LFS staff member: Signature of staff: H:\Staff Training\Training Documentation 3.8.16 Yager consult.doc In Accordance with Rule #7.708.65.C&D Rev. 9/9/2013 22 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson, Richel Hubbard, Julie Robbins, Brittany Foster, McKenzie Gunderson, Ashley Shaw Date: 10-25-16 Title of Training: neglect Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant ['Book ['Audio ❑Video Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. Neglect vs. abuse: Neglect is far worse on the brain and relationships. 2. Skills of the neglected child are very primitive. 3. They may see in you what they can get to meet their own needs and not know how you are feeling 4. There is a push-pull that is innate. They can't tolerate closeness nor can they tolerate being separate from the caregiver. What new information did you gain? See detailed attached notes. How will you use it in fostering children? We presented case of 3 siblings coming from extensive neglect. Knowing that they need repetition and pleasurable experiences in addition to the fact that nothing will be learned or improved in the absence of a relationship with foster parents was good psychoeducation that we can now share with foster parents. Number of training credit hours granted: Date: Approved by LFS staff member: Signature of staff: H:\Staff Training\Training Documentation 10.25.16 Yager consult.doc In Accordance with Rule ri7.708.65.C&D Rev. 9/9/2013 23 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson, Riche! Hubbard, Julie Robbins, Brittany Foster ; Date: 9-6-16 Title of Training: Symptoms of PTSD Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant ❑Book ❑Audio ❑Video ❑Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. Dysregulation as a symptom of PTSD 2. Hospitalizations and how to provide psychoeducation about how they may be unavoidable 3. Why do people do better in school v home? What new information did you gain? See detailed attached notes. How will you use it in fostering children? We presented case of 14 year old URM from Burma. We have approaches we can teach foster parents and know how to look for and plan for dysregulation Number of training credit hours granted: Date: Approved by LFS staff member: Signature of staff: H:1Staff Training\Training Documentation 9.6.16 Yager consult.doc In Accordance with Rule #7.708.65.C&D Rev. 9/9/2013 24 Certificate of Training Completion HR 101 In Depth Supervisor Training for Lutheran Family Services Rocky Mountains Presented by Forte HUMAN RESOURCES The SafeGuard System February 22, 2017 This certificate confirms the employee listed below successfully completed an 8 hour training class named above. Kim Penney Print Name Trainer Signature 25 Tahnee S. Carlson, MS Lutheran Family Services Placement Supervisor 2032 Lowe Street, Suite 200 Fort Collins, CO 80525 EDUCATION Office Phone: 970-232-1144 tahnee.carlson(a lfsrm.orq 1995-1997 1990-1994 Colorado State University Fort Collins, CO Master of Science in Human Development and Family Studies • Specializing in Marriage and Family Therapy • Thesis work on independent living programs for adolescents in the foster care system McPherson College McPherson, KS Bachelor of Art in Psychology • Thesis work on the effects of appearance and justification on sentence severity for juvenile offenders WORK EXPERIENCE December 2002- Lutheran Family Services Fort Collins, CO Present Lead Clinician/Placement Supervisor pursuant to CDHS R & R • Provide therapeutic supervision for court -ordered visitation between foster children and their biological parents • Monitor and provide support to foster families and their foster placements • Provide individual and Family therapy as authorized by Medicaid • Provide supervision to foster care clinicians and case managers January 2000- Presidio, Inc. Fort Collins, CO December 2002 Treatment Coordinator • Monitored and provided support to foster families and their foster placements • Coordinated between members of the treatment team to facilitate appropriate services and treatment to foster children September 1999- Larimer County Clerk and Recorder's Office Fort Collins, CO January 2000 Deputy Clerk • Provided administrative assistance in Elections, Motor -Vehicle, Recording, and Accounting departments • Duties include: data entry and customer service, supervision of season employees, and coordination of special projects February 1996- The Jacob Center Fort Collins, CO August 1997 Alternative Sentencing Proctor Parent • Provided curriculum development and foster care for adjudicated or diversion youth as an alternative to detention • Developed and implemented educational experiences and group discussions 26 WORK EXPIERENCE CONTINUED June 1994 - January 1996 November 1994 - June 1995 The Jacob Center Fort Collins, CO Proctor Parent • Acted as a residential house manager for four adolescents and facilitated their treatment process • Developed and implemented curriculum for teaching youth independent living skills as well as promoting a sense of responsibility to themselves and the community The Jacob Center Fort Collins, CO Case Aid • Facilitated weekly team meetings with foster adolescents, job -retention counseling, academic support, facilitated family visits, and assisted with on - call crisis intervention CLINICAL EXPIERENCE December 2002 - January 2012 July 1996 - December 1997 August 1996 - August 1997 December 1995 - March 1997 Therapist • Provided therapeutic services to individuals, couples and families • 425 hours of client contact and 130 hours of supervision completed Lutheran Family Services Fort Collins, CO Lead Clinician • Provided individual and family therapy to children and families involved in the child welfare system The Family Center Fort Collins, CO Parent Educator • Taught parenting skills to parents of "out -of -control" adolescents Child Safe Fort Collins, CO Intern Therapist • Provided individual and group therapy to child and adolescent victims of sexual abuse and their families • 120 hours of client contact and 75 hours of supervision completed Colorado State University Fort Collins, CO December 1995- Parents Without Partners Fort Collins, CO May 1996 Therapist • Planned and facilitated a group for children (ages 7-13) around divorce and single -parent family issues September 1993- Hutchinson Domestic Violence Shelter Hutchinson, KS May 1994 Intern Therapist • Co -facilitated a group for children (ages 6-15) around issues of domestic violence and child abuse 27 COLORADO Department of Regulatory Agencies DIvis:on 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 Department of Regulatory Agencies Division of Professions and Occupations State Board of Registered Psychotherapists Tahnee Sue Carlson Registered Psychotherapist NLC.0007869 09/01/2015 Number Issue Date Active 08/31/2017 Credential Status Expire Date Verify this credential at www.dora.colorado.s ov/profession s ision Director Lauren Larson Credential Holder Signature Cut along the line Colorado Department of Regulatory Agencies Division of Professions and Occupations State Board of Registered Psychotherapists Tahnee Sue Carlson Registered Psychotherapist NLC.0007869 Number 09/01/2015 Issue Date Active 08/31/2017 Credential Status Expire Date Verfy this credential at. www.dora.colorado.e ov/profession s DiGision Director: Lauren Larson Credential Holder Signature 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 303.894.7693 www.dora.colorado.gov/professions tiOt CO 9 ve 28 O 6Z Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson Date: 3-8-16 Title of Training: confidentiality laws, mandatory reporting, executive functioning and trauma Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant ❑Book ❑Audio ❑Video ❑Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. How trauma affects executive functioning in youth. 2. Tips for channeling energy due to sensory issues 3. 1:1 relationships build abilities to navigate social environments What new information did you gain? 1. Education re: children experiencing various levels of arousal, from shut down to high energy and adults needing to help reduce associated stress as kids are unable. 2. Limit setting creates states that the kids cannot tolerate 3. Environments need to be created that help a child learn to self -regulate; these environments establish implantation of neurons that can now be wired into their brains. How will you use it in fostering children? This information was shared in context of case presentation with 2 male children who were exposed to drug use in utero as well as domestic violence. Understanding how to set limits while supporting the children and their inability to tolerate limit setting was discussed. We have concrete ideas re: how to manage sensory overload and complex social environments. Number of training credit hours granted: L.�'LL2r Date: Approved by LFS staff member: �}—, }� mot Ytl� Signature of staff: 4Ci-r 1. r AMY) H:\Staff Training\Training Documentation 3.8.16 Yager consult.doc In Accordance with Rule #7.708.65.C&D Rev. 9/9/2013 30 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson Date: 4-26-16 Title of Training: TF-CBT, coping skills for hypo -arousal, breathing and relaxation techniques Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant ['Book DAudio ❑Video Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. Narratives during TF-CBT 2. Dissociation with hypo -aroused kids and other coping skills 3. Helping increase the capacity to tolerate positive affect What new information did you gain? 1. Kids need repetitive interactions to build capacity to tolerate stress or even positive affect. Our kids externally regulate (with others, not on their own) 2. Always start by validating negative feelings. With TF-CBT narratives, best if co - created with adult but they discover on their own. Okay to give examples and ask "do any of these fit"...even with EMDR and negative cognitions 3. Foster parents need to limit set without shaving. Know that kids wiring to inhibit is not well developed. How will you use it in fostering children? This information was shared in context of case presentation with 2 former foster children who were exposed neglect and domestic violence. Understanding how to set limits without shaming, begin narratives and teach coping skills such as breathing and activity will be useful during psycho -education in therapy sessions and with caregivers. Number of training credit hours granted: IV/1""1-L\ Date: L{ / 2Li c Lt / ? Approved by LFS staff member: \� 1 r• Signature of staff: 1 HAStaff Training\Tralning Documentation 4.26.16 Yager consult.doc In Accordance with Rule li7 708.65.C&D Rev. 9/9/2013 31 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson Date: 5-17-16 Title of Training: sexual compulsion in abuse victims and windows of tolerance Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant ❑Book ❑Audio ['Video ['Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (A` of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. Sexual compulsion v sexual addiction 2. Safety planning for adult victims of sa and their resulting compulsion 3. What to address regarding these issues in family therapy What new information did you gain? 1. We need to honor children for their solutions; they are creative survivors even if we worry about their coping skills 2. Need success experiences; we develop sense of self based on how we are feeling 3. Any type of arousal for sa victims can become sexual in nature How will you use It in fostering children? This information was shared in context of case presentation of a therapy case in which an older teen was developing sexual compulsion and dangerous situations were resulting. We can apply knowledge of how healing occurs in context of present relationships (in home and in tx) and not going back to past relationships. Tips for increasing her ability to ID feelings will be useful to caregivers. Number of training credit hours granted: ! { Date: t /( ;r Approved by LFS staff member: Signature of staff: \`J H:1Staff Training\Training Documentation 5.17.16 Yager consult.doc In Accordance with Rule #7.708.55.C&D Rev. 9/9/2013 32 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson, Richel Hubbard; Date: 7.19.16 Title of Training: coping with STS Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant Bock DAudio ❑Video Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. How to cope with the stress of what we do plus administrative stressors 2. Be realistic about the treatment of children; only a small number of kids are abused 3. How to team build What new information did you gain? 1. There is no way to eliminate stress 2. Stress is tolerated through relationships 3. Build relationships/trust as a team so that you can navigate stressful situations that are a part of life and will never NOT be a part of life How will you use it in fostering children? The better relationships we can build and support as a team, the more we can tolerate stress of jobs and STS that is particular to child welfare. We help foster children when we are regulating our own STS. Number of training credit hours granted: Date: Approved by LFS staff member: k4 ->-y-\ Signature of staff: eel H:\Staff Training\Training Documentation 7.19.16 Yager consuit.doc In Accordance with Rule #7.708.65.C&D Rev. 9/9/2013 33 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson, Richel Hubbard, Julie Robbins, Brittany Foster ; Date: 9-6-16 Title of Training: Symptoms of PTSD Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant ❑Book ❑Audio (=Video Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. Dysregulation as a symptom of PTSD 2. Hospitalizations and how to provide psychoeducation about how they may be unavoidable 3. Why do people do better in school v home? What new information did you gain? See detailed attached notes. How will you use it in fostering children? We presented case of 14 year old URM from Burma. We have approaches we can teach foster parents and know how to look for and plan for dysregulation C Number of training credit hours granted: Approved by LFS staff member: Date: Signature of staff: % „3 4c/--\ ha/tr--\ , X1%/,,147, 416 H.\Staff Training\Training Documentation 9.6.16 Yager consult.doc In Accordance with Rule #7.708.65.C&D Rev. 9/9/2013 34 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson, Richel Hubbard, Julie Robbins, Brittany Foster , McKenzie Gunderson, Ashley Shaw Date: 10-25-16 Title of Training: neglect Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant EBook EAudio ❑Video ❑Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. Neglect vs. abuse: Neglect is far worse on the brain and relationships. 2. Skills of the neglected child are very primitive 3. They may see in you what they can get to meet their own needs and not know how you are feeling 4. There is a push-pull that is innate. They can't tolerate closeness nor can they tolerate being separate from the caregiver. What new information did you gain? See detailed attached notes. How will you use it in fostering children? We presented case of 3 siblings coming from extensive neglect. Knowing that they need repetition and pleasurable experiences in addition to the fact that nothing will be learned or improved in the absence of a relationship with foster parents was good psychoeducation that we can now share with foster parents. Number of training credit hours granted: Date: Approved by LFS staff member: Signature of staff 'Ai 1 -Si". .1 • i)doikamon 4,44140:61julp, 6 k=--) ,n H \Staff Training\Training Documentation 10.25 16 Yager ccnsult.doc In Accordance with Rule 1#7.7118.65.C&D Rev 9/9/2013 35 Certificate of CornpCetion First Tahnee MI Last Carlson Address City State Zip License # Seminar Date 03/18/2016 Location of Seminar Fort Collins, CO This is to certify that the individual listed above has attended and has met the required standards of completion for continuing education for the seminar entitled: Mastering Sixteen Key Habits of Emotionally Resilient People Presented by Kateri McRae, PhD NURSES: Institute for Brain Potential (IBP) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. IBP is awarded "accreditation with distinction," the highest recognition awarded by the ANCC. This program provides 6 contact hours for nurses. PSYCHOLOGISTS: IBP is approved by the American Psychological Association to sponsor continuing education for psychologists. IBP maintains responsibility for this program and its content. This program provides 6 CE credits. COUNSELORS & MARRIAGE AND FAMILY THERAPISTS: IBP, provider #6342, is an NBCC -Approved Continuing Education Provider (ACEPTM) and may offer NBCC-approved dock hours for events that meet NBCC requirements. IBP solely is responsible for all aspects of the program. This program is 6 dockhours. SOCIAL WORKERS: IBP, provider 1160, is approved as a provider for continuing education by the Association of Social Work Boards (ASWB), 400 South Ridge Parkway, Suite B, Culpeper, VA 22701. www.aswb.org. ASWB Approval Period: 11/11/2014 -11/11/2017. Social workers should contact their regulatory board to determine course approval. Social workers will receive 6 clinical continuing education dock hours for participating in this intermediate -level course. SUBSTANCE ABUSE PROFESSIONALS: IBP is a ppproved by the NAADAC Approved Education Provider Program, Provider #751. This program provides 6 continuing education hours (CEHs). PHARMACISTS AND PHARMACY TECHNICIANS: IBP is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This knowledge -based activity provides 6 contact hours (.6 CEUs). UANs: 0492 -0000 -15 -037 -L04 -P and0492-0000-15-037-L04-T .tic DENTAL PROFESSIONALS: IBP is designated as an Approved PACE Program Provider by the Academy of General Dentistry � (AGD). The formal continuing dental education programs of this provider are accepted by the AGD for Fellowshi /Mastership and — membership maintenance credi t. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval �,extends from 12/01/14 -11/30/18. Provider ID# 312413. Subject Code: 557. This program provides 6 hours of CE credit. Verification `ode: PMCCOS16. OCCUPATIONAL THERAPISTS: IBP is an American Occupational Therapy Association (AOTA) Approved Provider, #6050. The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA. This program provides 0.6 AOTA CEUs or 6 contact hours. Content Level: Intermediate. Content Focus: Domain of OT (Areas of Occupation and Performance Patterns) and Occupational Therapy Process (Intervention). NURSING HOME ADMINISTRATORS: This educational offering has been reviewed by the National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB) and approved for 6.00 dock hours and 6.00 participant hours. Approval# 1922016 -6.00 -15897 -in -s-34390 PHYSICAL THERAPISTS: This certificate of completion signifies that the physical therapist completed this program. BP is approved as a provider of physical therapy continuing education by the CA Physical Therapy Board, IL Department of Professional Regulation, Sponsor #216.000210, and by the NYState Boardof Physical Therapy. This program provides 6 CE hours. SPEECH -LANGUAGE PATHOLOGISTS: This certificate of completion signifies that the SLP completed this Program. IBP is approved as a provider of CE by CA Speech -Language Pathology & Audiology Board (SLPAB), #PDP247, by FL Board of Speech -Language Pathology and Audiology, and by KS Department Of Health and Environment, Provider# LTS S1271. This program provides 6 CE hours. MASSAGE THERAPISTS: BP is approved by NCBTMB as a CE Approved Provider, #450939-09. This course provides 6 CE hours. CASE MANAGERS: This program has been pre -approved by The Commission for Case Manager Certification to provide continuing education credit to CCM® board -certified case managers. The course is approved for 6 CE contact hours. Activity Code: 500019316. Approval# 160000108. To claim these CEs, log into your CE Center account at www.ccmcertification.org. DIETITIANS: IBP is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 6 continuing professional education units (CPEUs) for completion of this program. Continuing Professional Education Provider Accreditation does not constitute endorsement by CDR of a provider, program, or materials. Provider Number: BP001. CPE Level: I. Suggested Learning Codes: 1120, 2060, 2110, and 5190. Activity Number: 1241-48. EDUCATORS: This program provides 7.5 Clock Hours of professional development toward license renewal in CO through a cosponsorship agreement between IBP and A11iant International University, a re onally accredited institution by the Accrediting Commission for Senior Colleges and Universities. Contact your school district if you need prior approval. Retain this certificate for your professional records. Do not send a copy of this certificate to your Board unless specifically requested. INSTITUTE FOR BRAIN POTENTIAL, 245 W Pacheco Blvd, Suite C, Los Banos, CA 93635 36 it�i,.�►Alo it.!1 i►_oLitWit_iti1_itAOL 1 L r/ 4) C . r o • a 1 O` L L r .L� Air te • 4.1 _1 fro COMMUNITY TRAINING CENTER Certificate of Training Awarded to Tahnee Carlson O Trauma Informed Care with Adolescents - 6 hours (72 a I - February 8, 2016 a) 03 0 r r i r L r L _4 L fro / ' k /i —ii /1 'ii /�'ii li_'ii AIL 'ii ;i_ it�i_r4'_ .. _�,ra.��. # � -.- •.�/,olam-�.A ■. 1. 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'�iti /�i-\+ /-I / I . .4iI 4734 DILLON AVE.• LOVELAND, CO 80538 PHONE 970-373-9985 • E-MAIL jennbohannon@skybeam.com JENNIFER BOHANNON EDUCATION 1997-2001 Denver Seminary Littleton, CO M.A., Community Counseling • Cum Laude • GPA 3.68 is Trained in marital and pre -marital counseling, child therapy, group therapy, career counseling, cross-cultural counseling, and psychological testing • Assisted in Student Council and admissions committee (1997-1998) 1991-1995 University of Kansas Lawrence, KS B.A., Psychology • GPA 3.34 • Represented students on a leadership team with Campus Crusade for Christ PROFESSIONAL EXPERIENCE 2012 -Current Lutheran Family Services Rocky Mountains Fort Collins, CO Clinician II/ Clinical Coordinator • Provide case management for foster homes contracted with Lutheran Family Services. This includes home visits and contacts with other supporting agencies involved in a foster child's life. • Conduct therapy for foster children and at risk families through the use of directive and non -directive techniques. • Provide parent coaching and therapeutic visitation services for families who are trying to gain reunification with their children. • Support clinicians in retaining insurance authorizations and billing of insurance. • Review and authorize reports detailing progress and challenges individuals in foster care have experienced each month. • Provide clinical supervision to clinicians working at Lutheran Family Services. • Ensure foster homes are properly reporting changes in their home on a monthly basis. • Conduct trauma assessments using neurodevelopmental testing and interviews. • Write home studies for prospective foster parents desiring to be licensed with Lutheran Family Services. 2007-2011 Bethesda Lutheran Communities Fort Collins, CO Program Manager, Host Home Program • Manage and supervise family homes which provide care and support to people with developmental disabilities. • Provide support to caregivers who have opened their homes as a living environment for people with developmental disabilities. • Act as the instructor for crisis prevention/intervention. 39 • Coordinate care and support services for people with developmental disabilities through working with families, the local community center board, day programs, support providers, therapists, and other environmental systems involved in the person's life. • Develop programs for people with developmental disabilities which help them learn or increase living skills or manage challenging behaviors. • Manage the budget for the host home program. ■ Act as a representative payee for people who receive services through BLC. • Ensure all paperwork is completed to assist in maintaining a person's current programs and services. 2005-2007 Private Practice Loveland, CO Licensed Professional Counselor • Provide individual, couples, and family counseling in the private sector. • Contract with the Department of Human Services, Child, Youth, and Family Division, to offer Intensive Family Therapy to families with at risk (being placed out of the home) children. 2003-2005 Larimer Center for Mental Health Fort Collins, CO Mental Health Therapist III • Provide therapeutic services (individual, couples, family therapy, and play therapy) to children and families involved with the Department of Human Services in Larimer County • Conduct mental health assessments on identified youth that enter through the HUB, Larimer County's Juvenile Assessment Center • Provided 27-10 Assessments on identified youth that have been brought to the HUB ■ Provide expert witness court testimony in applicable cases involved with the Department of Human Services • Participate in intensive supervision in the areas of play therapy and sexual abuse treatment. 2002-2003 Larimer Center for Mental Health Fort Collins, CO Mental Health Therapist 11 • Help stabilize suicidal youth detained at Platte Valley Youth Services Center (PVYSC) • Conduct case management activities (e.g. medication management, contact with case workers, probation officers, and parents) for detained youth from Larimer County at PVYSC. • Maintain an outpatient caseload at Larimer Center for Mental health working with children from ages six to seventeen. • Help detained youth at PVYSC to maintain behavior and remain stable while waiting to return home or go to placement. 2001 Promoting Safe and Stable Families Golden, CO Counseling Intern • Co -facilitated groups for adoptive parents, kinship care, and pre -adoptive parents. • Contacted parents and guardians dealing with adoption issues on a weekly basis 2000 Colorado Community Church Englewood, CO Small Group Intern • Trained in small group dynamics within a church setting. • Developed a program to teach stress management. ■ Developed a support group for people and their families dealing with chronic illness. 1998-1999 Denver Seminary Counseling Clinic Englewood, CO Counseling Intern • Conducted individual therapy with male and female clients. 40 ■ Studied and counseled in the areas of bipolar disorder and sexual abuse. 1998-1999 Denver Seminary Graduate Assistant - Counseling Department • Contacted potential clients and screened them for appropriate services. • Functioned as an advocate for students in the counseling staff meetings. • Performed outreach activities to area churches. Englewood, CO 1995-1997 KANZA Mental Health & Guidance Center Hiawatha, KS Case Manager • Acted as an advocate for severely emotionally disturbed children and their families in cooperation with mental health, schools, and social services. • Developed therapeutic goals and plans to help keep children functioning in the community. ■ Facilitated a psychosocial group in a therapeutic classroom. ■ Wrote occasional articles and presentations for the community. • Trained in recreational therapy, brief solution focused therapy, and in wraparound team meetings. LICENSES/CERTIFICATES Licensed Professional Counselor, #4049, State of Colorado, Expires 8/31/2017 41 COLORADO Department of Regulatory Agencies 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 Department of Regulatory Agencies Division of Professions and Occupations Licensed Professional Counselor Examiners Board Jennifer Christine Bohannon Licensed Professional Counselor LPC.0004049 09/01/2015 Number Issue Date Active 08/31/2017 Credential Status Expire Date Verify this credential at www.dora.colorado.g ov/profession s ision Director: Lauren Larson Credential Holder Signature Cut along the line Colorado Department of Regulatory Agencies Division of Professions and Occupations Licensed Professional Counselor Examiners Board LPC.0004049 Number Jennifer Christine Bohannon Licensed Professional Counselor 09/01/2015 Issue Date Active 08/31/2017 Credential Status Expire Date Verify this credential at: www.dora.colorado.gov/profession s ision Director: Lauren Larson Credential Holder Signature <w o COQ, µ Z �O 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 303.894.7693 www.dora.colorado.gov/professions A2 •187'0• Lutheran Family Services Staff Training Approval Form (Please use ONLY when certificate is not provided) Narne: /ft ,i4Pit AZ Date: '7/b4S) %P/1S, .6/7/ic, 41/45- VV 'bltgh5, ,rI.2/ic1 /fro/s-, /4!1/IS, Title of Book/Training: TF (1-3T- CoYl crf dli (ai22� Name of presenter or author: ❑Book ❑Audio ❑Video Workshop Internet b2144&CARL- Please list number of pages, minutes, or hours of training: AAA - Other (list) of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) What was the training material about? T11:0 ..ttr o I.1iYi epp0'1 1 t * dLDCLC!y7 1F()3 T(AO 7FCi3T c-, t,.Q, t How does this training relate to your position and/ or individual professional goals? 4-tU1J /Tug TFC&T 5Lul!S. �.P Number of training credit hours obtained: q C:1Usersljennfer,bohannon\AppData\LocahMicrosoft\Windows\Temporary Internet Files\Content Outlook \LX8KT5F21Staf Training Approval Fomi.doc In Accordance with Rule #7.708.65.C&D 7/9/2012 43 Foster Family -based Treatment Association a) U as O st p rnA O for attendance at a) a) 0 a) O a) cd •N • F.1 O Q) U • tS aEti• - 0 U (NI a) uS II L O 0x ;.•4's Q U O O U O - W b .g .g s 454 CII Recipient Licensed in State of: CO Recipient License #:0004049 44 ce in )" 0 u, ° w z h U L.,• A I— Z I-> z> re =oW lk A Z QW Wz W W (f)CO 0 et h°Z 66. A 2 = N 0 0 0 0 a QW ww LLU1 ► WA � � m°m awe Q ahh w� a w Z 0 a ► i tiA-� w •� spy ~r h •c X co C� W 1 W'f zpW Z oU� a Z 0 a Q I Z x ° >- —0n I. m � i W 2 hza o 0I-� F' F- w W Q ► A < 0 w �— I- 1g < - c W_ o a a_ a J ~ i N W oNQ o N o A A re IL U ,� I- c� 0 z , III Z 0 0I.' a Z 0 — how I Z V Z 3°> ' ° a , ,► w� L Z � w o ( L _1 1 z c- >. Q °NJ U J = J O I-- ce J zUz w w 0 4, N N z J 0 0 z O ► ii A �? }_ V ~ I.L, 0 W Q Z x U 1- F—° Z n Z zcra Lb.ow A A .� a W 0 CO W O h �, o u) a 2W ua me w L. p Z Q o 45 E co it GJ C _ E O wJg C d O. CO C I- .- Nf i. O N d CU tlp OC Q Cfa L E O C i QJ O C u O •` �VI a i 3 H ` c E a � ~ o V w � y N L y_ f0 O CL E L C1 ? o L C v '_ o ' i Ln u GJ y O. t le O O y LL .5 C O L C N .0 OJ O N w 09 E v o E m. o 46 turningpoint COMMUNITY TRAINING CENTER Certificate of Training Awarded to Jennifer Bohannon for Trauma Informed Care with Adolescents - 6 hours Date(s): February 8, 2016 Trainer: Kim Bappe, LCSW, LAC - �~--�--- 47 Page 1 of 1 The Reasonable and Prudent Parent Standard WBT Review mode COLORADO Office of Children, Child Welfare Training System Youth b Families Certificate of Completion Bohannon, Jennifer has successfully completed the online course, The Reasonable and Prudent Parent Standard and earned 1.5 training credit hours. This course is presented by the Colorado Child Welfare Training System on behalf of the Colorado Department of Human Services. Date of completion: Monday, March 28, 2016 http://lmscloud.cdhsacademy. com/onlinetraining/mod/scorm/player.php 48 3/28/2016 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon. and T. Carlson Date: 3-8-16 Title of Training: confidentiality laws, mandatory reporting, executive functioning and trauma Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant Book ['Audio Video Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. How trauma affects executive functioning in youth. 2. Tips for channeling energy due to sensory issues 3. 1:1 relationships build abilities to navigate social environments What new Information did you gain? 1. Education re: children experiencing various levels of arousal, from shut down to high energy and adults needing to help reduce associated stress as kids are unable. 2. Limit setting creates states that the kids cannot tolerate 3. Environments need to be created that help a child learn to self -regulate; these environments establish implantation of neurons that can now be wired into their brains. How will you use it in fostering children? This information was shared in context of case presentation with 2 male children who were exposed to drug use in utero as well as domestic violence. Understanding how to set limits while supporting the children and their inability to tolerate limit setting was discussed. We have concrete ideas re: how to manage sensory overload and complex social environments. Number of training credit hours granted: I 41--t� jL Date: ;/ 1 -+ Approved by LFS staff member:-,�, ,�t --rt— rt 11 ' -1- z--,:--, Signature of staff: * 1 (- -L ---'-•ti---L--t--i t'/ti ��U - I 1 � O. --t i � Li atLiMrr H:\Staff Training\Training Documentation 3.8.16 Yager consult.doc In Accordance with Rule #7.708.65.C&D Rev. 9/9/2013 49 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson Date: 4-26-16 Title of Training: TF-CBT, coping skills for hypo -arousal, breathing and relaxation techniques Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant ❑Book DAudio Video ['Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. Narratives during TF-CBT 2. Dissociation with hypo -aroused kids and other coping skills 3. Helping increase the capacity to tolerate positive affect What new information did you gain? 1. Kids need repetitive interactions to build capacity to tolerate stress or even positive affect. Our kids externally regulate (with others, not on their own) 2. Always start by validating negative feelings. With TF-CBT narratives, best if co - created with adult but they discover on their own. Okay to give examples and ask "do any of these fit"...even with EMDR and negative cognitions 3. Foster parents need to limit set without shaving. Know that kids wiring to inhibit is not well developed. How will you use it in fostering children? This information was shared in context of case presentation with 2 former foster children who were exposed neglect and domestic violence. Understanding how to set limits without shaming, begin narratives and teach coping skills such as breathing and activity will be useful during psycho -education in therapy sessions and with caregivers. Number of training credit hours granted: Approved by LFS staff member: Signature of sta Date: c..} / �t C HAStaff TrainingiTraining Documentation 4.26.16 Yager consult.doc In Accordance with Rule #7 708.65.C&D Rev. 9/9/2013 1 50 Lutheran Family Services Staff Training Approval Form (Please use ONLY when certificate is not provided) Name: ( ?1 A PA)k t it liGrn Date: 5-110 I to Title of Book/Training:��,,�� , b! . ►: _� .. �. '. Name of presenter or author: p(�R ylle.t� / ❑Book ❑Audio Video (Workshop IgInternet Other (list) Please list number of pages, minutes, or hours of training: (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) What was the training material about? .1,1\4 Lm,p,4_61.-- O i A.L b-GAN0 t '\ Ji How does this training relate to your position and/ or individual professional goals? cur . ..QQru,r\ (yrtils cdr 3lAt m U i tfri...Q/ 1p -\©..gip Number of training credit hours obtained: C:\Users\jennifer.bohannonAppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\.XBKT5F2\Staffi Training Approval Fonn.doc In Accordance with Rule #7 708.65.C&D 7/9/2012 51 Lutheran Fancily Services Staff Training Approval Form (Please use ONLY when certificate is not provided) Name: CJehnI,1 er Boha.nnor, Date: 5)► 1 l i (' Title of Book/Training: \0u Tell Our SI on ; Lai, &a. (3iferns Ekp rP SS \ @u v Ezzr-I es4-- expehev 5of trvyF3orrtfr +DAY ('ul BYd,r, Name of presenter or author: bi cunt (Poole t le r ❑Book ❑Audio ❑Video ['Workshop RI Internet ❑ Other (list) Please list number of pages, minutes, or hours of training: I < < a I�YS (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) What was the training material about? e Z mrnt ,Lrafarnl S*j tec ket24.rsy, d-tfeye,,d$ attar $ S-i jes. 5 k -r& 1Ved abet - hl 4O be tie v Gomm LuV C th w 4 0A+Loy How does this training relate to your position and/ or individual professional goals? ,Ak-* aCkt VI t& 1.5 a Gev\54-eut L,DA-u p 1.44 w Enk. d A_ o aka, y -a re‘ -k So c.rk_o-c -l' (,rcft -Pkrw -i o tit eA. Cem yv uvl.i cafe kY4h o -F a, ,gQpe c QQcc std- 6-Q& Os d p -h Number of training credit hours obtained: 1.5 C:1Users1jennifer.bohannonWppQatalLocahMicrosoft\Windows\Temporary Internet Files1Content.Outlook‘LX8KT5F2lStaff Training Approval Fomt.doc In Accordance with Rule #7.708.65.C&D 7/9/2012 52 Lutheran Family Services Staff Training Approval Form (Please use ONLY when certificate is not provided) Name: Vk h n i f --e 1' Boka v.% rc im Date: 5f I(o Title ofBook/Training:T Evo d1tr\4Practic.e o-Cornpasstor Name of presenter or author: DackQ r ['Book ❑Audio jVideo ❑Workshop PIntemet 1 Other (list) Please list number of pages, minutes, or hours of training: 1.5 (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) What was the training material about? F-ct:W CAvnpa.r' r ,c2ir Q..fy-ck 4- kd ua ara +nari-, I9-eLrrc -'tfh L ar}v e-Lpialzyt.. How does this training relate to your position and/ or individual professional goals?'t r{- 0v c Jitkn 44,p Aw ,w6-Ra0 6-w-4 o.(4 f Cep �3 t_t- /Y)1 2 041(b9401XiId LAP bl B -b nU 6 . eacf� �n� rnty c/t/5 a.o a udaj-tb tLep Lift 4 bez-0 Number of training credit hours obtained: 1.55 C:\Users\Jennifer.bohannontAppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\LX8KT5F2\Staff Training Approval Form.doc In Accordance with Rule #7.708.65.C&D 7/9/2012 53 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson Date: 5-17-16 Title of Training: sexual compulsion in abuse victims and windows of tolerance Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant ❑Book ❑Audio ❑Video ❑Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (A` of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. Sexual compulsion v sexual addiction 2. Safety planning for adult victims of sa and their resulting compulsion 3. What to address regarding these issues in family therapy What new information did you gain? 1. We need to honor children for their solutions; they are creative survivors even if we worry about their coping skills 2. Need success experiences; we develop sense of self based on how we are feeling 3. Any type of arousal for sa victims can become sexual in nature How will you use It in fostering children? This information was shared in context of case presentation of a therapy case in which an older teen was developing sexual compulsion and dangerous situations were resulting. We can apply knowledge of how healing occurs in context of present relationships (in home and in tx) and not going back to past relationships. Tips for increasing her ability to ID feelings will be useful to caregivers. Number of training credit hours granted: Approved by LFS staff member: Signature of staff: H:1Staff Training\Training Documentation 5.17.16 Yager consuit.doc In Accordance with Rule #7.708.65.C&D Rev. 9/9/2013 54 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson, Richel Hubbard; Date: 7.19.16 Title of Training: coping with STS Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant EBook Audio Video ❑Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. How to cope with the stress of what we do plus administrative stressors 2. Be realistic about the treatment of children; only a small number of kids are abused 3. How to team build What new information did you gain? 1. There is no way to eliminate stress 2. Stress is tolerated through relationships 3. Build relationships/trust as a team so that you can navigate stressful situations that are a part of life and will never NOT be a part of life How will you use it In fostering children? The better relationships we can build and support as a team, the more we can tolerate stress of jobs and STS that is particular to child welfare. We help foster children when we are regulating our own STS. Number of training credit hours granted: Date: 2 / Approved by LFS staff member: '.4`). d u�� t,-- ►_ Signature of staff: '--)--11 HAStaft Training\Training Documentation 7.19.16 Yager consult.doc In Accordance with Rule i<7.7o8.65.C&D Rev. 9/9/2013 55 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson, Richel Hubbard, Julie Robbins, Brittany Foster ; Date: 9-6-16 Title of Training: Symptoms of PTSD Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant ❑Book ❑Audio [Video ❑Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. Dysregulation as a symptom of PTSD 2. Hospitalizations and how to provide psychoeducation about how they may be unavoidable 3. Why do people do better in school v home? What new information did you gain? See detailed attached notes. How will you use it in fostering children? We presented case of 14 year old URM from Burma. We have approaches we can teach foster parents and know how to look for and plan for dysregulation Number of training credit hours granted: Date: Approved by LFS staff member: Signature of staff: X D214/7.„ H!.Staff Training\Training Documentation 9.6.16 Yager consult.doc In Accordance with Rule #7.708.65.C&D Rev. 9'9/2013 56 Lutheran Family Services Staff Training Approval Form (Please use ONLY when certificate is not provided) Name: Jennifer Bohannon Date: 9/19/16 Title of Book/Training: Paper Tigers (Movie) Name of presenter or author: Larimer DHS ❑Book ❑Audio ®Video Workshop ❑ Internet ❑ Other (list) Please list number of pages, minutes, or hours of training: 2 (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) What was the training material about? Paper Tigers is a documentary about how a school integrated trauma informed philosophy in approaching its students. It looked at how relationally the teachers and administration changed in approaching youth who come from difficult places and followed several students through the school year to see how they were impacted by this philosophical change. How does this training relate to your position and/ or individual professional goals? As I am trying to be trauma informed in my clinical practice, it is helpful to see how other professionals can incorporate trauma informed practices into their work. I can encourage others to be more trauma informed and direct them to this movie to see first hand the power of approaching kids as not being deliberately rebellious and defiant, but wounded and needing deep connection with trusted people. Number of training credit hours obtained: 2 C:\Users\colleen.finnmanWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\4H0FKP56\Staff Training Approval Form Paper Tigers.doc In Accordance with Rule #7.708.65.C&D 7/9/2012 57 Lutheran Family Services Foster Care Training Documentation and Approval Form (Please use ONLY when certificate is not provided) Name: K. Penney, J. Bohannon, and T. Carlson, Riche! Hubbard, Julie Robbins, Brittany Foster , McKenzie Gunderson, Ashley Shaw Date: 10-25-16 Title of Training: neglect Name of presenter or author: Dr. Jerry Yager, LFS Clinical Consultant ❑Book EAudio ❑Video ❑Workshop ❑ Internet ❑ Other (list) group consultation Please list number of pages, minutes, or hours of training: n/a (# of hours granted will be hour -far -hour, actual workshop length, or 1 hour per 30 pages.) Report Outline (Use back or additional sheets as needed) What was the training material about? 1. Neglect vs. abuse: Neglect is far worse on the brain and relationships. 2. Skills of the neglected child are very primitive. 3. They may see in you what they can get to meet their own needs and not know how you are feeling 4. There is a push-pull that is innate. They can't tolerate closeness nor can they tolerate being separate from the caregiver. What new information did you gain? See detailed attached notes. How will you use it in fostering children? We presented case of 3 siblings coming from extensive neglect. Knowing that they need repetition and pleasurable experiences in addition to the fact that nothing will be learned or improved in the absence of a relationship with foster parents was good psychoeducation that we can now share with foster parents. Number of training credit hours granted: Date: Approved by LFS staff member: Signature of staff: i y l)&1AOY1 �icp ,' At / 6;3 �Jl ��"" ii/C� �I x 12 lJ H:\5W Training1Training Documentation 10.25 16 Yager consuit.doc In Accordance with Rule #7.708.65.O&D Rev. 9/9/2013 58 Lutheran Family Services Staff Training Approval Form (Please use ONLY when certificate is not provided) Name: J-t9V1n►TeY 6ohaMl►1ol', Date: 'lap /11 Title of Book/Training: 11u2 M u64 -h DP S-eJF - - 9 I vine► Ceniniu.nr (-Wes vvety Day Name of presenter or author: a)ktYttc_ gazer ocJ-\l l--i 1,I1iIY Book LjAudio Video 'Workshop n Internet Other (list) Please list number of pages, minutes, or hours of training: l h✓ (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) What was the training material about? LecLS ad- nazi i,Y rGt r4Pi2.v �- reDr,ale, l +, `%Q hni tip o h Q A . L. i 1 v Koote i a ctv-e ,A5-0-Lotpn-� �u-lug��,mi,opk to . 9'1 wa„vi d Q Lkl-tdv\ .6,tua fuitc,. u0-4-00 au.,Q.Fc� How does this training relate to your position and/ or individual professional goals? t1,62,8\\ 6,LM Lcx t t ( *lc 4 Jqc&wYFYt(1GY k- - c�C hvt Qom_ � ►tYC w v e'vv� Sv aS,.6.. 9 rvzs2.6l cerne ct ai - jug) Q, -d-1-, ck-- I--i gr\ Number of training credit hours obtained: I W:tAll Cases\Clinician Forms\Staff Training Approval Form doc In Accordance with Rule #7.708.65.C&D 7/9/2012 59 Lutheran Family Services Staff Training Approval Form (Please use ONLY when certificate is not provided) Name /h itibe(/{11 /U20n Date: a' (v 11-1 Title of Book/Training: —11C rit4 /77a c_,-61(‘ ,i11tc Name of presenter or author: f ? dt;Itez Pa_ 'r p /3v pa Tan ook ❑Audio ❑Video ❑Workshop ❑ Internet ❑ Other (list) Please list number of pages, minutes, or hours of training: c� LLt ea-eQi (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) What was the training material about? JIA_P dart tilt -Fa cDnV 4\4O- pu ra-kv-e . ra c 9 'v) \ 4n IN -Q.94? J-ko atiO 0(94+etir5 �Y&Ly ' cro - .1kt u) can de.velep .s eu.c-i it,nci How does this training relate to your position and/ or individual professional goals? t:aV\ (t `icy n C -a-p ca.An ,Ahouti LU c 1 J-N,rvi Ceti-\ .Q/ (('\ r1 )-per1M�sLQY-) C.(',i (cc .a no Number of training credit hours obtained: R WWII Cases\Clinician Forms\Staff Training Approval Form.doc In Accordance with Rule #7.708.65.C&D 7/9/2012 60 Lutheran Family Services Staff Training Approval Form (Please use ONLY when certificate is not provided) Nam& A l0Aa-ltMfl Date: / /Co 1' 7 Title of Book/Training: 11b (CU, Y Gt1Qe/,u/ l/i9th-/Gi._ Name of presenter or author: gQ&y1 PGyr 9 `. LILA- PcLA m_Q Fp ook Audio ❑Video ❑Workshop ❑ Internet ❑ Other (list) Please list number of pages, minutes, or hours of training: / 3S7pD (# of hours granted will be hour -for -hour, actual workshop length, or 1 hour per 30 pages.) What was the training material about? —rho iiyP-Je bn k j e vic -r - pi.1fs 06 4GtP 4 OC1 �� 1>�1Ce'rcw CLiIYYI �(�CYIA ,�iLe C 1CD J © cam n ' r�i/�dfn tG� r9r� CTh1 kMc /cf*aAAZit5 dN' How does this training relate to your position and/ or individual professional goals? J44i4 Lit beck usia0 AP a wat Jo pn.eltt k.Q Cp L CL Q o L LP A 4)1/119 IAA el A;) (.t t La kyo-van't 19 . Number of training credit hours obtained: 4.5 W:'AII Cases\Clinician Forms\Staff Training Approval Form.doc In Accordance with Rule #7.708.65.C&D 7/9/2012 61 Complex Trauma and Shame: Somatic Interventions with Janina Fisher, Ph.D. Page 1 of 2 Complex Trauma and Shame Somatic Interventions with Janina Fisher, Ph.D. Introduction Course Schedule Forums About Janina Fisher, Ph.D. CE Tests Ton( -Fee" nc5 (in Process The Download rile of the full Somatic Interventions for Treating Complex Trauma seminar can be found under Module 4 - this includes video of Modules 1 - 4 CE details and tests can also be found under Module 4 - this includes the details and test in its entirety for Modules 1-4. Tests can be started at any time during your progress through the modules and you may pick up where you left off during a test attempt Module Title Credit Module 1: Click here for Credit Information Somatic (/Items/GetCertCredttDetail? Interventions ProductlD=17906&DisplayType=1) for Treating Complex Trauma with Janina Fisher, Ph.D. Module 2: Click here for Credit Information Somatic (/Items/GetCertCreditDetait7 Interventions ProductlD=17790&DisplayType=1) for Treating Complex Trauma with Janina Fisher, Ph.D. Duration Tools 2 Hours 57 Minutes Do Launch Viewer (l howTime/367256) 3 Hours 03 Minutes Launch Viewer (/lhowTime/367257) Module 3: Click here for Credit Information 2 Hours 51 Minutes ` Launch Viewer (/ howTime/367258) Somatic (/ltems/GetCertCreditDetall? Interventions ProductiD=17906&DIsplayType=1) for Treating Complex Trauma with Janina Fisher, Ph.D. Module 4: Click here for Credit Information Somatic (/Items/GetCertCreditDetail? Interventions ProductID=19496&DisplayType=1) for Treating Complex Trauma with Janina Fisher, Ph.D. In -Session: Click here for Credit Information Working with (/Items/GetCertCreditOetail? Somatic ProductlD=163038DisplayType=1) Components to Overcome Trauma Related Fears of Feeling Good 2 Hours 56 Minutes is. Launch Viewer t/91awTime/373680) 3 Download seminar (lAccount/DownloadSeminar?products=194961 1 Hour 19 Minutes Launch Viewer (lhowTirne/367253) = Download seminar (/AccounUDownloadSem inar?producIid= 163034 V A https://catalog.pesi.corn/viewer/classroom/365362 64 4/19/2017 Complex Trauma and Shame: Somatic Interventions with Janina Fisher, Ph.D. Page 2 of 2 Module Title In -Session: Steps Toward Healing Traumatic Attachment & Borderline Personality Disorder BONUS: Shame and Self - Loathing in the Treatment of Trauma Credit Click here for Credit Information (/I tems/GetCertC red itD etai I? ProductlD=16308&DisplayType=1) Click here for Credit Information (!items/GetCertCred itDetaii? P roductlD= 16320&O1spiayType=1) Duration Tools 1 Hour 35 Minutes Launch Viewer AllowTime/367254) (.a. Download seminar(/Account/DownloadSeminar'rproducud=163088pn 5 Hours 58 Minutes 11. Launch Viewer (/lhowTime/367255) Total Online Course CE Credit Information (fl t ems/GetCertC red itDetai l? ProductlD=163238.DIsplayType=1) (3 Download seminar(AccounUDownloedSeminar?productid=163208pn C 2017 PESI Inc - Ail rights reserved - Toll Free 866-367-5697 NOTE No additional discounts or coupons may be applied to this course https://catalog.pesi.com/viewer/classroom/365362 65 4/19/2017 Tammy Fisher Greeley, Colorado 80634 *Tel: 970.388.6114'" tammy.fisher@lfsnmorg Career Objective: Continue to maintain a rewarding and challenging position with Lutheran Family Services Rocky Mountain (LFSRM) as well as to better serve the families and enhance the services LFSRM provides. To utilize my education and employment experience to operate effectively while accomplishing job satisfaction, and growing within the company. Summary of Qualifications: More than 18 years of experience interacting with individuals of diverse backgrounds, beliefs and socio-economic status. I am a dedicated, loyal, customer -oriented person and highly motivated to succeed. I have a strong knowledge of practices and principles of employee supervision, including work assignment, planning, review, and training staff in work procedures. Broad knowledge of procedures, policies, curriculums, materials, equipment and supplies related to the operations of Supervised Visitation and Safe Exchanges. I have efficient time management and organizational skills with attention to detail, as well as skilled in problem solving, effective communication skills as well as de- escalating tactics. I am an excellent team player, with the ability to work under pressure and capable of working in emergency and crisis situations. The ability to initiate, develop, and maintain positive program and collaborative relationships. Professional Experience: Supervisor for CareHouse Supervised Visitation and Safe Exchange Program Lutheran Family Services Rocky Mountain (LFSRM) 800 8th Avenue, Suite 209 Greeley, CO970.356.6751 ext. 5212 January 2012 through Present Implement, develop, and coordinate the visitation and exchange programs on -site and home -based services. Recruit, train, and supervise program staff and interns. Prepare program outcome reports used for billing, scheduling, and progress analysis. Outstanding client connections, scheduling, and communication skills. Assist in and perform agency functions such as nurturing parenting curriculum, speaking engagements, community liaison regarding the prevention of child abuse and neglect. Assist with grant applications, contracts, and outcomes. Completion of monthly beneficiary reports and statistics. 66 Tammy Fisher p. 2 On -going collaborations with Judicial Officials to maintain procedures between the 19th Judicial District Courts and CareHouse. Maintain written and verbal communication with Supervisor and other professionals pertinent to the programs. Proactively participate with WCDHS and collaborative agencies in the prevention of child abuse. Coordinator for CareHouse Supervised Visitation and Safe Exchange Program Child Advocacy, Resource & Education, Inc. (C.a.r.e.) 3700 Golden Street Evans, Colorado 80620 1998 to January 2012 Administer and coordinate the Home -Based Program, Young Parent Program, Core Services and Court Ordered Supervised Visitation and Safe Exchange Program. Maintain written and verbal communication with Director and other professionals pertinent to the programs. Implement, develop, and coordinate the visitation and exchange programs on - site and home -based services. Recruit, train, and supervised program staff and interns. Prepare program outcome reports used for billing, scheduling, and progress analysis. Assist in and perform agency functions such as nurturing parenting curriculum, speaking engagements, community liaison on issues of parenting, child abuse and neglect. Assist with grant applications, contracts, and outcomes. Completion of monthly beneficiary reports and statistics, and Core billing. Case management of families involved with Department of Human Services, Adult/Juvenile Probation, Courts, Judge's Advisory Board, Domestic Violence Coalition, Visitation Sub -Committee, Island Grove/North Range, Foster Parent Agencies, Mental Health Professionals, Child Abuse Prevention Team, Colorado Organization of Victims Assistance, Address Confidentiality Program, Behavioral Intervention, Juvenile Assessment Center, and Core Review Team. Education: 2013 B.A. Sociology -Family Studies 1998 AAS Criminal Justice 1981 High School Diploma; Riverton High School Riverton, KS Numerous hours completed in academies, trainings, webinars, classes, and conferences 67 N LL A E rs ti ICS N F— W Z ICe 0 L In 41 .I. v O cc O Z bo . QW0. C a) O 0 ✓ 4:ubo b z d c td W l I- • m Q U ro n w 68 Amber Ellis 475 Knobcone Dr. #303 Loveland, CO 80538 303-704-3414 vballgr1894@aol.com Education • Bachelor's of Arts Degree in Psychology. • Minor in Coaching • Graduation date: May 5, 2012 • GM: 2.76 Work Experience • CareHouse through Lutheran Family Services (May 2012 -Present) Back Up to Coordinator (September 2012 -Present) -Answer questions parents have about scheduling and the visits -At the start and end of visits, take children to and from parents -Assist Program Coordinator with paperwork and stats - Monitor exchanges, return phone calls, confirm visits Visitation Supervisor (Jan. 2011 -Present) -Supervise parents visiting their children - Make sure parents exhibit positive interactions with children -Make sure parents are in an appropriate state of mind throughout the visit -Confirm that the children are comfortable during the visit • Internship at Lutheran Family Services/ careHouse (Jan. 2012 -May 2012) - Answer main telephone Monitor supervised visits with families - Back-up for Coordinator at careHouse (Monitoring exchanges, returning calls, confirming visits, etc.) Supervise children during children's program for Nurturing parenting class • Volunteer at Good Samaritan Society- Bonell Community (Sept. 2011 -Dec. 2011) - Did various activities with senior citizens (play bingo, take to Church, etc.) • Volunteer with Special Olympics (May 2009 -Present) - Volleyball official for the USA National Games in Lincoln, NE in 2010 - Scorekeeper for Special Olympics Volleyball 69 • Volleyball Officiating (August 2008- Present) - Officiate high school, club, and collegiate levels of volleyball Scorekeep club and collegiate levels of volleyball Travel during summers for officiating and scorekeeping • Nanny (June -August 2008-2010) 3 different families with 3 children One family had a child with special needs (minor case of Asperger's syndrome) Took children to sports practice when necessary Disciplined children when appropriate Certifications and Awards • National Scorekeeping Certification (May 2008) • Regional Referee Certification (March 2011) • Selected to be a State Volleyball Official (Nov. 2010 and Nov. 2011) 70 LL Morgan Freed Phone: (719) 353-1235 E-mail: free9305@bears.unco.edu Education Bachelor of Arts in Psychology Minor in Criminal Justice December 2015 University of Northern Colorado Skills Effective in working with a variety of people Able to work under pressure and multi -task Able to type quickly (approx. 62-68 wpm) Professional Lutheran Family Services Rocky Mountains — CareHouse Experience Internship May 2015 —August 2015 Employed August 2015 —Present Visitation Supervisor Supervised client visitations and documented activity Filed documentation, handled payment, answered telephone calls Assisted in facility upkeep (vacuuming, etc.) Academic Support and Advising (ASA) Tutoring Psychology Tutor October 2013 —December 2015 Assisted students with comprehension of class material Provided students with examples and practice problems Advised students: recommended classes and discussed study tips Country Inns & Suites by Carlson Breakfast Attendant November 2014 —August 2015 Prepared and cooked food according to menu Maintained breakfast area and stocked items as necessary Kept kitchen, lounge, and serving areas tidy University of Northern Colorado Phonuthon Caller September 2014 —November 2014 Called alumni and updated contact information Collected donations 72 References Melissa Hoffner Director of Tutorial Services Phone: (970) 351.1904 E-mail: loci u {il it Gilt Tammy Fisher CareHouse Supervisor Phone: (970) 356.6751 E-mail: tammy.fisher@lfsrm org Megan Sjolander National Phonathon Director Phone: (970) 351-4284 E-mail: niet�.ln%��tixti.�tn hellncu.cltnr Betty Powers Country Inns & Suites Night Audit Phone: (970) 352-8986 73 Giselle Marquez —New Hire Contractor with IFS effective 5/1/2017 Current Aspirations 9708882177 I gizzix07@hotmail.com I am looking to broaden her horizons in life, so if that means doing different jobs and experiencing them than I am all in! Currently I am on my last semester at the University of Northern Colorado. It is my fifth year there; I am interested in the inner workings of the mind and am majoring in Psychology. I am interested in working with kids and families, mainly because growing up I did not have a family of my own. Professional Skills Organized, Diligent, Prompt Relevant Experience Swim Instructor Cheyenne Mountain Aquatics Center 2010-2012 • Taught children to swim • Conduct small group discussions • Graded their work and effort on how well they could swim • Have fun! After -School Multicultural Club Dos Rios Elementary School Fall 2012 -Spring 2013 • Watched over children after school has ended • Conducted group games and activities together • Taught history about Mexico Current/Previous Employers Wing Shack Crew Member, April 2015 -On Going • Proper cleaning/sanitation in kitchen, proper food handling, counting money, greeting guests, customer service, fast pace Taste of Philly Front Girl, March 2015 -July 2015 • Clean front counter, clean booths and soda machine, greet guests, take care of all customer needs, count money, and organizing under the front counter. University of Northern Colorado's Science Education Department Undergraduate Assistant, November 2013 -May 2014 • Worked under Professor Emmett Evanoff curating and documenting fossils for the Earth Science Department • Used Excel Spreadsheet to organize type of Fossil, age, location, and more University of Northern Colorado's Alumni Association Student Fund Raiser, January 2013 -September 2013 • Called past graduates to conduct report with them • Updated information • Explain how scholarship support worked • Collected funds for the school Education and Certifications Graduated May 2012 Cheyenne Mountain High School Colorado Springs, Co High School Diploma Completed and Maintained TIPS Certification Graduated May 2017 University of Northern Colorado Greeley, CO Bachelor Degree - Psychology 74 Myrna W. Reese -Stevens 4313 Wapiti Way Evans, Colorado 80620 Weld 970-356-5771 970-213-3234 Summary Skilled trainer, communicator, problem solver - Team oriented, goal directed leader - Experienced in management skills and public relations - Dedicated, organized, motivated Highlights of Qualifications • Assessed and identified the needs and rights of individuals • Located available resources/services for individuals, families and communities • Advocated and developed crisis support safety plans • Fourteen years professional experience in Law Enforcement Victim Advocacy • Fourteen years in Child -Family Advocacy • Home visitor • Supervise family visits • Drug and alcohol counseling • Monitor and supporter of 65 plus clients in treatment placement • Orientation of new clients • Fourteen years Colorado Organization for Victim Assistance member and eleven year participant at the national conference • Customer service, trained new employees, scheduled work and assigned duties, in charge of tools, documentation, and quality control Professional Experience January 2012 — Present 1999- December 2011 April 2003- December 2011 1999 — Present 2000 - Present July 2006 — October 2009 1999 - 2003 1994 - 1998 1988 - 1997 1984 - 1988 Lutheran Family Services Rocky Mountain Child Advocacy Resource and Education, Inc. Supervised Visitation Center, c.a.r.e. House Greeley Police Department Victim Assistance Critical Incident Responder, Greeley Police Department Weld County Legal Services Inc. Administrator Residential Treatment Center, Greeley CO EFTC, Greeley, CO Western Sizzlin Steakhouse, Greeley, CO James Flowers 75 Education • 2010 Completed Colorado Organization for Victim Assistance Academy • 2010 Trained class leader for Powerful Tools for Caregivers • Aims Community College: Completed Colorado Addiction (CAC I) Courses On -going courses in related fields (CAC II) Awards 2004 2003 2002 2001 - 2008 Presidential Service Award Colorado Governor's Commitment to Caring Award Weld County Stars of Excellence Award through United Way of Weld County in partnership with North Colorado Medical Center, Inc. Greeley Police Citizens Certificate of Merit References Available upon request 76 VICTORIA ANISSA MENDOZA 3501 Dahlia Street Evans, Co'orado 80620 Mend2 78`. w' eors.Unco.edu 970-576-9710 Skills Summary Treatment plans Relationship building Objective documentation Team participation Crisis response strategies Community agency communication Person centered approach Education Bachelors degree in Psychology and a minor in Criminal Justice from the University of Northern Colorado, Greeley, Colorado/Graduated May 2016 Experience Lutheran Family Service December 2015 -Current Visitation Supervisor I supervise parent -child visitations for families that require supervised visits ordered by the courts or the Department of Human Services, and objectively document all interactions Supervised visits include those held at the facility and in public settings. Ross Dress for Less June 2013 -June 2014 Sates Associate I provided customer service, as well as handling cash as a cashier. 77 North Range Behavioral Health Crisis Stabilization Services November 2012 - November 2013 Behavior Health Worker Implement individual care plans for clients in accordance for applicable policies, rules, regulations and directives of the organization, Facilitate client participation in their care plan through interaction as a source of emotional support, resource problem solving, and advocating for their needs. Assured security for clients by monitoring and supervising the facility and the services delivered. Life Care Center of Greeley August 2012 -November 2013 Certified Nursing Assistant My main role was to provide basic care to patients, as well as assist them in daily activities they might have trouble with on their own, such as bathing. Awards and Achievements • As a senior in High school, I had completed all course required for graduation. As a result, the school district afforded me the opportunity Certified Nurses Aid course through AIMS Community College, Upon completion of the program, I obtained state certification. • Due to my academic accomplishment in high school, I competed a course called Teacher Cadet. In Teacher Cadet, I was allowed to observe a Second grade class. I was able to teach the children many different courses. • As a senior in college I was asked to participate in a program called Campus Connections, Campus Connections engages youths ages 11-18 who are referred by our community partners within the juvenile justice system of Weld County, local schools, community agencies and directly from families, With my mentee, I provided academic support and career planning, encouraged and demonstrated positive social skills development, assisted with goal setting, and implemented wellness programing. Reference: Christina Thomas, PhD Candidate (720) 277-7746 Sondra Rainer, LCSW, LAC, Behavioral Health Therapist (970) 545-9133 cell ivonne Varela, Co-worker 970-371-7406 2 78 EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Monitored Visitation, Supervised Visitation and Safe Exchange under Life Skills to individuals and families, as referred by the Department. 2. Target Population: Families who have had their children removed, or are at risk of having their children removed due to imminent safety concerns, are appropriate for this service. 3. Supervised Visitation: Contractor's visitation supervisor will be physically present with the family at all times, allowing for immediate intervention, coaching and role modeling. The parents are then given the opportunity to practice new skills during the visits with a goal of improving positive family relationships. In order to accomplish parenting instruction without undermining the parental authority in front of the children, some of the education sometimes occurs at a time outside of the scheduled visitation, usually just prior to, or immediately following a visit. 4. Monitored Visitation: Contractor's visitation supervisor will be present at the visit location, within earshot of the visit but not physically supervising the family at all times. Contractor will intervene as necessary. 5. Safe Exchanges: Contractor's visitation supervisor is present during the exchange of children for the purpose of parenting time in situations that do not allow for face-to-face contact by the parents. 6. Services will occur at the Contractor's Supervised Visitation and Therapy Program in Greeley, CO, or at the Contractor's Fort Collins office. Services may also occur in appropriate community settings or in the family home if deemed appropriate, and approved by the Department. Contractor will provide day, evening and weekend appointments. 7. Contractor will complete the Weld County Visitation Assessment upon request. 8. Contractor will maintain the technology to record visits upon request. 9. Contractor will ensure visitation supervisors have a minimum of an associate's degree. 10. 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. 11. 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. 12. 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. 13. 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. 1 14. 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. 15. 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. 16. 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. Contractor may participate by phone 2 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 $85.00/Hour (Supervised Visitation) $50.00/Hour (Monitored Visitation and Safe Exchanges) All hourly rates include preparation time, mileage to and from visitation appointments, coordination with parents to schedule appointments, communication with the Department regarding services and staff participation in team meetings, and report writing. 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. 1. 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. 1 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. ACG # CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDOIYYYY) 08/24/2017 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. H 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 1-303-534-4567 ZMA, Inc. - Colorado Division 1705 17th Street Suite 100 Denver, CO 80202 CONTACT NAME PHONE FA No 4AIG_NR-EMO EMAIL denaccounttechs0imacorp.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC I INSURERA PHILADELPHIA INS CO 23850 INSURERS PINNACOL ASSUR 41190 INSURED Lutheran Social Services of CO Lutheran Family Services Rocky Mountain 363 South Harlan, Ste 200 Denver, CO 80226 INSURERC ZURICH AMER INS COIPinnacol Assurance) 16535 INSURERO. INSURER E INSURERF. • COVERAGt5 a.Cra 'VI —Mori. G Inu,.,u...-s. —•. ........ -- - -- - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADDL L SiJ8R1 VD 1 POLICY NUMBER POLICY EFF IMMIDDIYYYYI POLICY EXP IMMIDDTYYYY1 LIMITS LTR A X COMMERCIAL GENERAL LIABILITY -- - ,SD PHPX1669517 07/01/17 07/01/18 EACHOCCURRENCE f 1,000,000 $ 1,000,000 DAMAGE -10 -RENTED PREMISES] a ocwrrence) CLAIMS -MADE 1 X OCCUR . MED EXP (Any one person) $ 20,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE f 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO- X LOC ACT OTHER: PRODUCTS • COMP1OP AGO 5 3,000,000 A AUTOMOBILE X - X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS - S !, SCHEDULED AUTOS NON -OWNED AUTOS PHPR1669529 07/01/17 07/01/18 LEe occulBIN D11INGLELIMIT $ 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per ecadent) S PROPERTY DAMAGE (Per ecddenll S $ UMBRELLA UAB EXCESSLIAR OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S S ( DED I I RETENTIONS , B C WORKERS COMPENSATION AND EMPLOYERS' ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below YIN N NfA 4040538 - CO ONLY WC969160406 - NM ONLY 03/01/17 03/01/17 03/01/18 �STA�IE PER ERH- 03/01/18 EL EACH ACCIDENT s 500,D0D EL DISEASE • EA EMPLOYEE $ 500,000 EL. DISEASE - POLICY LIMIT $ S00,000 A Professional Liability PHP&1669517 07/01/17 07/01/18 Each Occurrence S 1,000,000 Aggregate $3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Scheduta, may be attached II mom space Is required) County of Weld is included as Additional Insured on the General Liability Policy if required by written contract or agreement subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of Additional Insure on the General Liability and Workers Compensation Policies if required by written contract or agreement subject to the policy terms and conditions. CERT'FICA I t I1VLutrt County of Weld 1150 '0' Street Greeley, CO 80631 USA 1 "^'----- -'—•- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE t • /./# ....0,.,. A nnnnA rlA\1 All .I,.INe rncnnred ACORD 25 (2014/01) sadie55 50648339 The ACORD name and logo are registered marks of ACORD Hello