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Home My WebLink About20180191.tiffRESOLUTION RE: APPROVE AGREEMENT FOR PROFESSIONAL SERVICES AND AUTHORIZE CHAIR TO SIGN - THIRD WAY CENTER, INC. WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with an Agreement for Professional Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Third Way Center, Inc., commencing August 1, 2017, and ending May 31, 2018, with further terms and conditions being as stated in said agreement, and WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Agreement for Professional Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Third Way Center, Inc., be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair Pro-Tem be, and hereby is, authorized to sign said agreement. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 15th day of January, A.D., 2018, nunc pro tunc August 1, 2017. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: d.,,O44) jC • EXCUSED Steve Moreno, Chair Weld County Clerk to the Board ounty • ttorney Date of signature: 0l-.2'/-/4 CC: 145 0I-24-19 2018-0191 HR0089 C5M-Puk PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: January 5, 2018 TO: Board of County Commissioners — Pass -Around FR: Judy A. Griego, Director, Human Services RE: Weld County Department of Human Services' Child Protection Agreement for Services with Third Way Center Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Departments' Child Protection Agreement for Services with Third Way Center. The Department is seeking therapeutic services with Third Way Center for a specific youth. The major provisions of the Agreement are as follows: No. Term Service/Funding Rate 1 August 1, 2017- May 31, 2018 Therapeutic Services Core $13.61/Episode (AlcoScreen) $15.40/Episode (CLIA UA) $59.99/Episode (Family Therapy with Client) $57.19/Episode (Family Therapy Without Client) $4.24/Episode (Group Therapy) $100.80/Episode (Individual) $92.95/Episode (Individual by MD) $35.43/Episode (Individual by MD 30 Mins.) $92.49/Episode (Individual by MD 60 Mins.) $4.02/Day (Incentive) $32.25/Episode (Medication Management) $29.41/Episode (Psych Testing MMPI) $105.52/Episode (Psychiatric Diagnostic Evaluation) $128.27/Episode (Psychiatric Diagnostic Evaluation with Med Services) $72.00/Day (Low, Home -based - Next Steps Program) $52.00/Day (High, Community -based — Next - Stens Program) nn.i o n. n1 I do not recommend a Work Session. I recommend approval of this Agreement. Page 1 Pass -Around Memorandum; January 5, 2018 - ID 1575 cc. HS 0 O n PJo• Fre of t(S/IS' PRIVILEGED AND CONFIDENTIAL Sean P. Conway Julie A. Cozad Mike Freeman Barbara Kirkmeyer, Pro-Tem Steve Moreno, Chair Approve Schedule Recommendation Work Session rA(-- Other/Comments: Pass -Around Memorandum; January 5, 2018 - ID 1575 Page 2 WELD COUNTY AGREEMENT FOR PROFESSIONAL SERVICES BETWEEN WELD COUNTY & THIRD WAY CENTER. INC. THIS AGREEMENT is made and entered into this Li day of ,40/g. by and between the County of Weld, a body corporate and politic of the State of Colorado, by and throw its Board of County Commissioners; whose address is 1150 "O" Street, Greeley, Colorado 80631 hereinafter referred to as "County," and Third Way Center. Inc., a corporation. whose address is 455 Acoma Street, Denver. Colorado 80204. hereinafter referred to as "Contractor". WHEREAS, County desires to retain Contract Professional as an independent Contract Professional to perform services as more particularly set forth below; and WHEREAS, Contract Professional has the ability, qualifications, and time available to timely perform the services, and is willing to perform the services according to the terms of this Agreement. WHEREAS, Contract Professional is authorized to do business in the State of Colorado and has the time, skill, expertise, and experience necessary to provide the services as set forth below; NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties hereto agree as follows: 1. Introduction. The terms of this Agreement are contained in the terms recited in this document, and in Exhibits A and B, which forms an integral part of this Agreement. Exhibits A and B are specifically incorporated herein by this reference. 2. Service or Work. Contractor agrees to procure the materials, equipment and/or products necessary for the Project and agrees to diligently provide all services, labor, personnel and materials necessary to perform and complete the Project described in Exhibit A. 3. Term. The term of this Agreement begins upon August 1, 2017, and shall continue through and until May 31, 2018. This contract may be extended annually upon written agreement of both parties. 4. Termination. County has the right to terminate this Agreement, with or without cause on thirty (30) days written notice. Furthermore, this Agreement may be terminated at any time without notice upon a material breach of the terms of this Agreement. 5. Extension or Modification. Any amendments or modifications to this agreement shall be in writing signed by both parties. No additional services or work performed by Contractor shall be the basis for additional compensation unless and until Contractor has obtained written authorization and acknowledgement by County for such additional services. 6. Compensation/Contract Amount. Upon Contractor's successful completion of the Project, and County's acceptance of the same, County agrees to pay an amount no greater than the amounts set forth in Exhibit B. County will not withhold any taxes from monies paid to the Contractor hereunder and Contractor agrees to be solely responsible for the accurate reporting and payment of any taxes related to payments made pursuant to the terms of this Agreement. 7. Independent Contractor. Contractor agrees that it is an independent Contractor and that Contractor's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall perform its duties hereunder as an independent Contractor. Contractor shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contractor, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contractor or any of its agents or employees. 8. Subcontractors. Contractor acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor 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. 9. Ownership. All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of County. ,,20/17- 0/9/ 10. Confidentiality. Contractor agrees to keep confidential all of County's confidential information. Contractor agrees not to sell, assign, distribute, or disclose any such confidential information to any other person or entity without seeking written permission from the County. Contractor agrees to advise its employees, agents, and consultants, of the confidential and proprietary nature of this confidential information and of the restrictions imposed by this agreement. 11. Warranty, Contractor warrants that the services performed under this Agreement will be performed in a manner consistent with the standards governing such services and the provisions of this Agreement. Contractor further represents and warrants that all services shall be performed by qualified personnel in a professional and workmanlike manner, consistent with industry standards, and that all services will conform to applicable specifications. 12. Acceptance of Services Not a Waiver. In no event shall any action by County hereunder constitute or be construed to be a waiver by County of any breach of this Agreement or default which may then exist on the part of Contractor. Acceptance by the County of, or payment for, the services completed under this Agreement shall not be construed as a waiver of any of the County's rights under this Agreement or under the law generally. 13. Insurance and Indemnification. Contractor shall procure at least the minimum amount of automobile liability insurance required by the State of Colorado for the use of any personal vehicle. Proof of said automobile liability insurance shall be provided to County prior to the performance of any services under this Agreement. Professional Liability (Errors and Omissions Liability) The policy shall cover professional misconduct or lack of ordinary skill for those positions defined in the Scope of Services of this contract. Contract Professional shall maintain limits for all claims covering wrongful acts, errors and/or omissions, including design errors, if applicable, for damage sustained by reason of or in the course of operations under this Contract resulting from professional services. In the event that the professional liability insurance required by this Contract is written on a claims -made basis, Contract Professional warrants that any retroactive date under the policy shall precede the effective date of this Contract; and that either continuous coverage will be maintained or an extended discovery period will be exercised for a period of two (2) years beginning at the time work under this Contract is completed. Minimum Limits: Per Loss Aggregate $ 1,000,000 $ 2,000,000 14. Indemnity. The Contractor shall defend, indemnify and hold harmless County, its officers, agents, and employees, from and against injury, loss damage, liability, suits, actions, or claims of any type or character arising out of the work done in fulfillment of the terms of this Contract or on account of any act, claim or amount arising or recovered under workers' compensation law or arising out of the failure of the Contractor to conform to any statutes, ordinances, regulation, law or court decree. 15. Non -Assignment. Contractor may not assign or transfer this Agreement or any interest therein or claim thereunder, without the prior written approval of County. 16. 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. 17. Compliance with Law. Contractor 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. 18. Non -Exclusive Agreement. This Agreement is nonexclusive and County may engage or use other Contractors or persons to perform services of the same or similar nature. 19. Entire Agreement/Modifications. This Agreement including the Exhibits attached hereto and incorporated herein, contains the entire agreement between the parties with respect to the subject matter contained in this Agreement. This instrument supersedes all prior negotiations, representations, and understandings or agreements with respect to the subject matter contained in this Agreement. This Agreement may be changed or supplemented only by a written instrument signed by both parties. 20. Fund Availability. Financial obligations of the County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. Execution of this Agreement by County does not create an obligation on the part of County to expend funds not otherwise appropriated in each succeeding year. 21. Employee Financial Interest/Conflict of Interest — C.R.S. §§24-18-201 et seq. and §24-50-507. The signatories to this Agreement state 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. 22. 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. 23. 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 §§24-I0-101 et seq., as applicable now or hereafter amended. 24. No Third Party Beneficiary. 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. 25. 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 or its designee. 26. 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, Contractor agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 27. Public Employment Retirement Program. Contractor is responsible for notifying Weld County of any previous participation in the Colorado Public Employee Retirement Program. Contractor must notify Weld county of the most recent employment for a PERA contributing employer. 28. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contractor will confine 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). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor 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 Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and County within three (3) days that Contractor 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. Contractor 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. Contractor 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 Contractor participates in the State of Colorado program, Contractor shall, within twenty days after hiring an new employee to perform work under the contract, affirm that Contractor 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. Contractor shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, and shall comply with all of the other requirements of the State of Colorado program. If Contractor 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; Contractor shall be liable for actual and consequential damages. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contractor receives federal or state funds under the contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the 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 the contract. 29. Acknowledgment. County and Contractor acknowledge that each has read this Agreement, understands it and agrees to be bound by its terms. Both parties further agree that this Agreement, with the attached Exhibits A and B, is the complete and exclusive statement of agreement between the parties and supersedes all proposals or prior agreements, oral or written, and any other communications between the parties relating to the subject matter of this Agreement. IN WITNESS WHEREOF, the parties hereto have duly executed this Agreement as of the day, month, and year first above written. COI INTY: Al ZEST: j. ,.J O; 4 BOARD OF COUNTY COMMISSIONERS Weld County Clerk to the Board WELD COUNTY, CO • • DO By: Mailing Address: P.O. Box 61385 Denver, Colorado 8020 Barbara Kirkmey•r, Pro -T JAN 15 2018 CONTRACTOR: hird Way Center, Inc. 455 Acoma Street Denver, Colorado 80204 (303) 780-9191, x460 Bv: David'Eisner, Chief Executive Officer Date: 12-15 111- 2O/f- O/9/ EXHIBIT A SCOPE OF SERVICES 1. Contractor will provide therapeutic services to identified client G.B. (Client ID ) under TRAILS Case ID 1582417, as referred and authorized by the Department. No other clients are authorized under this Agreement. 2. The services allowable under this agreement include: • Psychiatric Diagnostic Interview Examination • Family Therapy 1-2 hours per week by a Master's Level Therapist, whenever possible • Medication Management • Individual Therapy 2-4 hours per week by a Master's Level Therapist, or Psychiatrist • Group Therapy 4-10 hours per week by a Master's Level Therapist • Between 8 and 16 hours of direct clinical service per week. All therapy is either conducted or supervised by a licensed therapist. • Individual Therapy: Contractor will customize the approach based on the client's illness, capacity to use the services offered, character structure, interests and responses. Contractor utilizes play therapy, writing, Six Boxes Technique, illustrations, music, reality therapy, traditional psychotherapeutic approaches, cognitive behavior therapy, dialectical behavior therapy. Therapy is offered as part of daily living in a non -threatening and approachable manner. Milieu therapy is offered on a daily basis to support the individual treatment plan. • Group Therapy: Contractor offers several groups at every facility. Several of the groups are on -going as the residents move through the different programs; some have a duration defined by the curriculum utilized. The groups are established to help the residents receive justice for their past trauma which has caused some of their feelings leading to their behaviors which ultimately caused their negative behaviors. Other groups, allow the residents to become more comfortable in the milieu, becoming closer as a community. Some groups allow the residents to just become familiar with themselves and their creativity. Groups continued to be developed if there is a specific need for a group. The referred client will join a group program as determined by the therapeutic goals outlined in the treatment plan. The groups currently offered are as follows: Special Issues Group Females and Males Group Substance Abuse Group Substance Abuse Support Group House Groups DYC Group Creative Expressions Group Offensive Specific Group Grief Group Independent Living Group New Resident's Group Dialectical Behavior Therapy Group Social Skills Group All of the above services are determined based on the treatment plan which is based on the Department of Youth Services and Contractor's assessments, and the DCP through the MDT process. • Trauma Based Therapy: Contractor has developed a trauma based model. This model has been codified in the manual Getting Even, has been recognized during the previous two Council on Accreditation reviews, and has been presented at national conferences. For this population Contractor has experienced success using the Six Boxes Technique. The Six Boxes Technique is a simple approach with tremendous results. It is a way for the youth to organize their treatment process. This technique is about doing, rather than just talking about the trauma. We recognize that bad behaviors (box I) are generally a symptom of something gone wrong. These behaviors are fueled by feelings (box 2) that are the direct result of trauma (box 3). Justice (box 4) is a very individualized process which requires `doing' something about the trauma, which has a direct effect on how someone feels (box 5) with some resolution, which then relieves the behavioral symptoms. Box 6 focuses on the changed behaviors that result from working through the boxes. Children who resolve their issues and develop empathy for themselves are more likely to live productive lives. • Family Services: Contractor uses an eclectic, psycho -dynamic, systemic approach to family therapy. Families are included in the treatment process from intake until discharge. Contractor will attempt to meet with family prior to admission and try to develop a therapeutic relationship at that point. Otherwise, Contractor's goal is to initiate contact within 24 hours of admission with the referred client's family. Contractor's staff has also sought out "lost" family members and our staff has traveled with clients to allow them to reconnect with distant family members. The importance of family involvement in the ultimate success of our clients is recognized and our staff goes to great lengths to maximize this resource. Family sessions are conducted and supervised by Contractor's clinical staff. Contractor's standard practice is to conduct family meetings weekly. We use a systems approach to family therapy. Most families attend weekly meetings and some families require additional individual counseling. We have an all-inclusive approach with the ultimate goal of family reconciliation, whether that means the child can return home or the family will be a strong support system when the child emancipates. Families are also integrally involved in all transitional planning, whether that is to return home or to emancipate. We strongly believe that clients who emancipate have a much greater chance of success when they have family support. Families are included in all aspects of the transition process from the initial contact. It is essential to assess and continue to assess the family's ability to support in whatever capacity the continued progress of the client. This includes the youth's ability to accept the reality of the family relationship. Open and honest communication between the professionals, the client, and the family greatly improve the transition process. • Career and Employability Services: Upon entry, Contractor has the client complete a Career and Academic Assessment. Staff assists residents in understanding these results to further explore career options. Vocational/ Educational staff helps the client take into consideration appropriateness, education and training, job availability, and compensation when looking at career options. Clients may attend job skill preparation groups or receive individual assistance, pertaining to career exploration and job search. Clients may also attend workshops which cover: interviewing skills, practice interviews; resume writing, job hunting strategies; filling out job applications; career exploration, job retention, and how to access community resources available to them. Individual job coaching is provided during each stage of the job search, including - picking up applications, researching the company, completing and submitting applications. Some residents gain work experience by volunteering at local businesses. The staff has developed an aggressive Corporate Develop program where various companies in the community cooperate with Contractor to provide paid and volunteer opportunities for our youth. • Life Skills Training: Preparation for life on their own is of paramount importance throughout the Contractor's program continuum. There is a structure to allow youth to live in a setting appropriate for their individualized emancipation goals from the familial home type structure with community responsibility for household and personal responsibilities, to the apartment program where there is more focus on individual self-sufficiency. In the home structures of Bannock, York and Pontiac the youth learn to care for their own hygiene, laundry, bedroom, and batlu-oom cleanliness. In addition, youth learn how to be a contributing part of the community through shared responsibilities and rotating chores which include household cleaning, yard and garden care, healthy meal planning, cooking, putting away groceries, managing leftovers and food safety. The Contractor aims to model a healthy family dynamic where chores are conducted by the youth. • Next Steps Program: Step-down, supportive, community based program designed to assist the client with the transition from other programs provided by the Contractor to the community. The program is comprising of two sub -programs; the "apartment program" in which staff assist the client in funding and securing an apartment within the community, and the "home based program" in which the staff assist the client and family with the reunification program. The Contractor will assist clients in the "apartment program" with furnishings and will teach the client how to maintain the apartment. 3. 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. 6. Contractor will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 7. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 8. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department (FIDOS), unless otherwise directed by the Department. The Department shall provide access to, and training on, the online format (FIDOS). 9. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 10. Contractor understands that the Department will not reimburse Contractor for "no shows" after two (2) consecutive "no shows". It is the responsibility of the Contractor to communicate "no shows" to the Department in a timely manner to determine continuation of services. 11. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Court Staffings, Family Team Meetings and/or Team Decision Making meetings. EXHIBIT B 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 3I, 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. 2. 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 this Agreement or amend it accordingly. Fees for Services $13,61/Episode (AlcoScreen) $15.40/Episode (CLIA UA) $59.99/Episode (Family Therapy with Client) $57.19/Episode (Family Therapy Without Client) $4.24/Episode (Group Therapy) $100.80/Episode (Individual) $92.95/Episode (Individual by MD) $35.43/Episode (Individual by MD 30 Mins.) $92.49/Episode (Individual by MD 60 Mins.) $4.02/Day (Incentive) $32.25/Episode (Medication Management) $29.41/Episode (Psych Testing MMPI) $105.52/Episode (Psychiatric Diagnostic Evaluation) $128.27/Episode (Psychiatric Diagnostic Evaluation with Med Services) $72.00/Day (Low, Home -based - Next Steps Program) $52.00/Day (High, Community -based — Next Steps Program) Contractor does not charge additional for participation in staffings and/or meetings requested by the Department. Contractor may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. Contractor will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher, utilizing the forms required by the Department, and 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 this Agreement. 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 per Exhibit A. 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. Ac©RE) CERTIFICATE OF LIABILITY INSURANCE ATE D12/05 2017 Y) 12/05/2017 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 IMA, Inc. - Colorado Division 1705 17th Street Suite 100 Denver, CO 80202 CONTACT NAME: {W� No, EM): I FAX C, No): E-MAIL denaccounttechaeimacor com ADDRESS: P- INSURER(S) AFFORDING COVERAGE I NAIC # INSURER A: PHILADELPHIA IND INS CO '18058 INSURED Third Way Center, Inc. 455 Acme, Street Denver, CO 80204 INSURER 6: PINNACOL ASSUR 41190 INSURER C : INSURERD: INSURER E : IN5URERF: I COVERAGES CERTIFICATE NUMBER: 51466645 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L 7 TYPE OF INSURANCE ADDL INSO SUER MD POLICY NUMBER POLICY EFF (MMIDDIYYYYI POLICY EXP IMMID0IYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY PHPIC1653469 05/17/17 05/17/18 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) S 100,000 MED EXP (Anyone person) $ 5,000 PERSONAL&ADVINJURY I$ 1,000,000 GEM. AGGREGATE LIMIT APPLIES POLICY ECT OTHER: PER: LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG I $ 3,000,000 S A AUTOMOBILE X x LIABILITY ANY AUTO AOWNED AUTO HIRED AUTOS x SCHEDULED PHPK1653469 05/17/17 05/17/19 COMBINEDSINGLELIMIT (Ea accident) I IS 1,000,000 BODILY INJURY (Per person) I S BODILY INJURY (Per accident) I $ PROPERTY DAMAGE I 'Per accident) I $ I$ A X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE PHUB583824 05/17/17 05/17/18 EACH OCCURRENCE I$ 2,000,000 AGGREGATE I $ 2,000,000 DED I X I RETENTIONS 10,000 I $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below N 1 J 4033729 N/A 01/01/17 01/01/18 XIS7ATUTE I ISTH I E.L. EACH ACCIDENT I$ 500,000 E.L. DISEASE - EA EMPLOYEE' $ 500, 000 E.L. DISEASE - POLICY LIMIT I $ 50 0, 000 A Professional Liability PHPK1653469 05/17/17 05/17/18 Aggregate $3,000,000 Limit $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Weld County is included as Additional Insured on the General Liability Policy 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 //w ACORD 25 (2014101) SDZM 51466645 © 1988-2014 ACORD CORPORATION. All rights reserved. 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