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Home My WebLink About20173212.tiffAGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND IDEA FORUM, INC. ll This Agreement Amendment, made and entered into �' day of 2018 by and between the Board of Weld County Commissioners, on behalf of the Wel • Cou y Department of Human Services, hereinafter referred to as the "Department", and IDEA Forum, Inc., hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Monitored Sobriety Services (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2017-3212 approved on September 18, 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 Monitored Sobriety Services. 2. Paragraph 1, Term This agreement shall become effective on June 1, 2017, upon proper execution of this Agreement and shall expire May 31, 2019, unless sooner terminated as provided herein. 3. Payment The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. Exceptions to this Paragraph may include, if approved by the Department, the following: i. The service being provided by the contractor is not a Medicaid eligible service; ii. The service is not deemed medically necessary; iii. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; iv. A Medicaid provider is not available to provide the needed service; 0 -04.60 -d -e> ki<D /beObJB EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Anger Management Evaluation and Treatment, Domestic Violence Evaluation and Treatment, and Monitored Sobriety Services. 2. Anger Management Evaluation and Treatment, and Domestic Violence Evaluation and Treatment: a. Contractor will provide treatment as mandated by the current Colorado Domestic Violence Offender Management (DVOMB) Standards. b. Completion of Domestic Violence treatment is solely determined by gaining and demonstrating competencies established by the DVOMB to reduce level of risk and need. c. Contractor has approved Domestic Violence Treatment providers on staff including staff approved to work with female offenders. d. Contractor is a licensed provider sensitive to multicultural issues and can provide all services in both English and Spanish. 3. Monitored Sobriety Services: a. Contractor will provide timely and quality monitored sobriety services to adult and adolescent clients, both male and female, referred by the Department, as follows: b. Services are available in Denver, Aurora, Brighton and Thornton, CO. Hours of service for all sites are Monday through Thursday, 9 a.m.-9 p.m.; Friday, 9 a.m.-7 p.m.; Saturday, 9 a.m.-1 p.m. c. Contractor will provide qualified monitored sobriety collectors. d. Contractor is a licensed provider sensitive to multicultural issues and can provide all services in both English and Spanish. e. Contractor will confirm all positive and negative Breathalyzer monitored sobriety results within 24 hours through a phone call, test result, e-mail and/or fax to the referring caseworker. f. Contractor will confirm all positive and negative laboratory Urinalysis results will be confirmed once processing has occurred through Redwood Toxicology (usually within three days). Confirmation will occur through a phone call, test result, e-mail and/or fax to the referring caseworker. g. Contractor will report all positive and negative Instant Urinalysis results within 24 hours. If the result is positive, it will be sent to Redwood for final confirmation. Confirmation will occur through a phone call, test result, e-mail and/or fax to the referring caseworker. h. Contractor will submit a copy of the valid Authorization for Services form, result and client sign -in sheet (if applicable) with each monthly billing. i. All processed (laboratory) test results will be available online 24 hours per day, seven (7) days per week online at Sentry Norchem (https://sentrv.norchemlab.com). 1 4. 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. 5. 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. 6. 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. 7. 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. 8. 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. 9. 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 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 Anger Management/Domestic Violence: $67.00/Episode (Domestic Violence Intake, Evaluation and First Session) $35.00/Episode (Domestic Violence Group) $35.00/Episode (Standard Group Therapy) $65.00/Episode (Individual Therapy) $30.00/Episode (Youth Group Therapy) $45.00/Episode (Youth Individual Therapy) $65.00/Episode (Family Therapy) $80.00/Episode (Eye Movement Desensitization and Reprocessing-EMDR) $125.00/Episode (Anger Management Evaluation) Monitored Sobriety Services: $17.00/Episode (Urinalysis — 7 Panel with EtG) $165.00/Episode (Urinalysis — Steroids) $10.00/Episode (Breathalyzer) $15.00/Episode (Swab Test) $50.00/Episode (Hair Test) 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 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher, and signed monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. b. For one-time services, proof of services rendered shall be receipt of the completed product. c. For Monitored Sobriety services, proof of services rendered shall be the test result. 2 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: d....ah,t) v• '� Weld 'o ty Clerk to the Boa d By: Deputy Clerk to BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Beard teve Moreno, Chair CONTRACTOR: SEP 0 5 2018 IDEA Forum, Inc. 2560 West 29th Avenue Denver, Colorado 80211 (303) 477-8280 By: Paiz, CEO/Owner 4-4.16-- irnr RESOLUTION RE: APPROVE AGREEMENT FOR CHILD PROTECTION SERVICES AND AUTHORIZE CHAIR TO SIGN - IDEA FORUM, 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 Child Protection 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 IDEA Forum, Inc., commencing June 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 Child Protection 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 IDEA Forum, 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 18th day of September, A.D., 2017, nunc pro tunc June 1, 2017. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: ..,;i0k. EXCUSED Julie A. ozad, Chair Weld County Clerk to the Board BY: . Rs e puty Clerk to the Board APP' • AS ou " y Attorney Date of signature: q / ag Steve Moreno, Pro -Tern cc HSO,Pc) 10/q/17 Sean P. Conway rbara Kirkmeyer C/GL-6 2017-3212 HR0088 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: August 22, 2017 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 IDEA Forum, Inc. 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 IDEA Forum, Inc. The final draft of this agreement was delayed due to negotiations between the County and the Contractor. The major provisions of the Agreement are as follows: No. Term Service/Funding Rate I June 1, 2017 -May 31, 2018 Anger Management/Domestic Anger Management/Domestic Violence Violence: Monitored Sobriety $67.00/Episode (Domestic Non -Core Violence Intake, Evaluation and First Session) $35.00/Episode (Domestic Violence Group) $35.00/Episode (Standard Group Therapy) $65.00/Episode (Individual Therapy) $30.00/Episode (Youth Group Therapy) $45.00/Episode (Youth Individual Therapy) $65.00/Episode (Family Therapy) $80.00/Episode (Eye Movement Desensitization and Reprocessing-EMDR) $125.00/Episode (Anger Management Evaluation) 2017-3212 Pass -Around Memorandum; August 22, 2017 — ID 1380 Page I PRIVILEGED AND CONFIDENTIAL Monitored Sobriety Services: $17.00/Episode (Urinalysis — 7 Panel with EtG) $165.00/Episode (Urinalysis — Steroids) $10.00/Episode (Breathalyzer) $15.00/Episode (Swab Test) $50.00/Episode (Hair Test) I do not recommend a Work Session. I recommend approval of the Agreement. Sean P. Conway Julie A. Cozad, Chair Mike Freeman Barbara Kirkmeyer Steve Moreno, Pro -Tern m Approve Recommendation Work Session Schedule Other/Comments: Pass -Around Memorandum; August 22, 2017 - ID 1380 Page 2 Lo- r.a4i3D CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND IDEA F(ZRUM, I C. This Agreement, made and entered into theOddf any of , 2017, by and between the Board of Weld County Commissioners, on behalf of the Weld County Depar ent f Human Services, hereinafter referred to as the "Department' and IDEA Forum, Inc., 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 Child Welfare Administration funding to the Department for Monitored Sobriety Services. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1, 2017, upon proper execution of this Agreement and shall expire May 31, 2018, unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Proposal and Exhibit C, Scope of Services. 3. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Department's Resource Manager, Child Welfare Contract and Services Coordinator, or through a Team Decision Making (TDM) meeting or Family Team Meeting (FTM). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit an itemized complete billing statement by the 7th of the month, following the month of service, utilizing billing forms required by the Department. 1 020/7- % /0L 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 Marcela Paiz, CEO/Owner 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: Marcela Paiz, CEO/Owner 2560 West 29th Avenue Denver, CO 80211 (303) 477-8280 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. 13 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. 14 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: Weld Cou y Clerk to the Board 15 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Steve Moreno, Chair Pro-Tem SEP 18 2017 CONTRACTOR: IDEA Forum, Inc. 2560 West 29th Avenue Denver, CO 80211 (303) 477-8280 By: Date: Marcela Paiz, CEO/Owner AO/7-Oa-/.Z-, EXHIBIT A WELD COUNTY'S REQUEST FOR PROPOSAL REQUEST FOR BIDS AND PROPOSALS WELD COUNTY, COLORADO 1150 O STREET GREELEY, CO 80634 DATE: April 3, 2017 BID NUMBER: B1700080 DESCRIPTION: Annual Request for Various Services DEPARTMENT: Human Services MANDATORY PRE -BID CONFERENCE DATE: N/A BID OPENING DATE: APRIL 24, 2017 PAGES 1-9 OF THIS DOCUMENT CONTAINS GENERAL INFORMATION. NOT ALL OF THE INFORMATION CONTAINED IN PAGES 1-9 MAY BE APPLICABLE. THE SCOPE OF WORK AND SPECIFICATIONS UNIQUE TO THIS REQUEST FOR BID FOLLOW PAGE 9. I. NOTICE TO BIDDERS A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the Board of Weld County Commissioners, wishes to purchase the following: VARIOUS ENGLISH AND BILINGUAL(ENGLISH/SPANISH) SERVICES (SERVICE AREAS INCLUDED IN THIS PROPOSAL INCLUDE, BUT ARE NOT LIMITED TO THE BELOW LIST. OTHER SERVICES WILL BE CONSIDERED AND BIDDERS ARE ENCOURAGED TO SUBMIT FOR UNIQUE AND CREATIVE SERVICES.) Program Area Definition Afterca re Services Services provided to prepare a child for reunification with his/her family or other permanent placement and to prevent future out- of -home placement of the child. Anger Management/Domestic Violence Diagnostic and/or therapeutic services to assist in the development of the family services plan, to assess and/or improve familycommunication, functioning and relationships, and to prevent further domesticviolence. 1 Program Area Crisis Intervention and Stabilization Services Day Treatment Foster ParentConsultation Foster ParentTraining Functional Family Therapy Home -Based Intervention Definition 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 Comprehensive, highly structured services that provide education to children and therapy to children and theirfamilies. 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. Core training for new Weld County foster parents. 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. 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 Program Area Definition 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. Relinquishment Counseling Relinquishment counseling for parents considering relinquishment of their children. Substance Abuse Treatment Services Diagnostic and/or therapeutic services to assist in the development of the Family Service Plan (FSP), to assess and/or improve family communication, functioning and relationships, and to prevent further abuse of drugs or alcohol. Other Creative and unique services designed to meet the needs of children, youth and families interacting with the Child Welfare system through a prevention or traditional case. B. Bids for the stated services will be received by the Weld County Department of Human Services, Resource Unit, Attn: Tobi Vegter, through: MONDAY, APRIL 24, 2017, AT 5:00 P.M. (WELD COUNTY DEPARTMENT OF HUMAN SERVICES, RESOURCE UNIT TIME CLOCK). Acceptable bid delivery methods are as follows: Email. Emailed bids are preferred. Bids should be emailed to: vegterta@weldgov.com. Emailed bids must include the following statement on the email: "I hereby waive my right to a sealed bid". An email confirmation will be sent when we receive your bid/proposal. Mail. Mailed bids should be sent in a sealed envelope with the bid title and bid number on it. Bids must include the following statement on the email: "Ihereby waive my right to a sealed bid". Mailed bids should be addressed to: Weld County Department of Human Services, Attn: Tobi Vegter, Division of Child Welfare, Financial Unit, P.O. Box A, Greeley, CO 80632. Please call or email Tobi Vegter at 970-400-6392 or vegterta@weldgov.com if you have any questions. Hand Delivery. Hand -delivered bids should be submitted in a sealed envelopewith the bid title and bid number on it. Bids must include the following statement on the email: "I hereby waive my right to a sealed bid". Hand - delivered bids can be dropped off at: Weld County Department of Human Services, Attn: Tobi Vegter, Financial Unit, 822 7th Street, Suite 150, Greeley, CO 80631. Please call or email Tobi Vegter at 970-400-6392 or vegterta@weldgov.com if you have any questions. 3 II. INVITATION TO BID A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the board of Weld County Commissioners requests bids for the purchase of Various Services (as described above). B. Bids shall include any and all charges for service(s) applied for by the bidder, and shall, in every way, be the total net price which the bidder will expect the Board of County Commissioners of Weld County to pay if awarded the bid. C. Emailed Bids Are Preferred. Emailed (fully typed) bids are preferred. However, if the bidder is unable to submit an emailed bid, the bidder must comply with the requirements set forth in Paragraph I, B. An emailed bid must contain the following statement: "I hereby waive my right to a sealed bid." D. Unless the Bid is emailed, one original and one copy of the Bid must be submitted. One complete bid document, which will be the only official copy of the bid, shall be filed at the Weld County Department of Human Services, Resource Unit. After certification of the bid, the other copy will be routed for applicable review. An e-mail confirmation will be sent when we receive your bid/proposal. III.INSTRUCTIONS TO BIDDERS A. Bids shall be typewritten. Each bid must give the full business address of the bidder and be signed by him with his usual signature. Bids by partnerships must furnish the full names of all partners and must be signed with the partnership name by one of the partners of the partnership or by an authorized representative, followed by the signature and title of the person signing. Bids by corporations must be signed with the legal name of the corporation, followed by the name of the state of the incorporation and by the signature and title of the president, secretary, or other person authorized to bind it in this matter. Bids submitted by limited liability companies must furnish the full names of all members and managers and must be signed by a manager or by an authorized representative, followed by the signature and title of the person signing. The name of each person signing shall also be typed or printed below the signature. A bid by a person who affixes to his signature the word "president," "secretary," "agent," or other title without disclosing his principal, may be held to be the bid of the individual signing. When requested, satisfactory evidence of the authority of the officer signing in behalf of a corporation shall be furnished. All corrections or erasures shall be initialed by the person signing the bid. All bidders shall agree to comply with all of the conditions, requirements, specifications, and/or instructions of this bid as stated or implied herein. All designations and prices shall be fully and clearly set forth. B. Bids may be withdrawn upon written request to the Weld County Department of Human Services received from bidders prior to the submission deadline. Negligence on the part of bidder in preparing the bid confers no right for the withdrawal of the bid after it has been opened. C. Bidders are expected to examine the conditions, specifications, and all instructions contained herein. Failure to do so will be at the bidder's risk. D. Bidders shall not stipulate in their proposals any conditions not contained in the instructions and specifications herein unless specifically requested by the special instructions attached hereto. Any proposal which fails to comply with the letter of the instructions and specifications herein may be rejected. E. Late or unsigned bids shall not be accepted or considered. It is the responsibility of the bidder to ensure that the bid arrives in the Weld County Department of Human Services, Service Utilization Unit, on or prior to the time indicated in Section I., entitled "Notice to Bidders." F. When approximate quantities are stated, Weld County reserves the right to increase or decrease quantity as best fits its needs. 4 G. Whenever requested, samples or descriptive matter shall be filed prior to the opening of bids. H. In accordance with Section 14-9(3) of the Weld County Home Rule Charter, the Board of County Commissioners of Weld County will give preference to resident Weld County bidders in all cases where said bids are competitive in price and quality. It is also understood that the Board of County Commissioners of Weld County will give preference to suppliers from the State of Colorado, in accordance with Section 30-11-110, CRS, when it is accepting bids for the purchase of any books, stationery, records, printing, lithographing or other supplies for any officer of Weld County. I. All discounts shall be figured from the date of delivery and acceptance of the articles, or in the case of an incorrect invoice, from the date of receipt of corrected invoice, if this be subsequent to delivery and acceptance. J. Substitutions or modifications to any of the terms, conditions, or specifications of this bid package which are made by Weld County, Colorado, after the bids have been distributed to prospective bidders, and prior to the date and time of bid opening, will be made in writing and signed by the Families, Youth and Children's Commission. No employee of Weld County, Colorado, is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of Families, Youth and Children's Commission. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. K. The successful bidder shall indemnify and hold harmless Weld County, Colorado, against all claims for royalties, for patents or suit for infringement thereon, which may be involved in the manufacture or use of the material to be furnished. L. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5- 101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et seq., Weld County may terminate this Contract for breach and Contractor shall be liable for actual and consequential damages to Contractor. Except where exempted by federal law and except as provided in C.R.S. 24-76.5- 103(3), if Contractor receives federal or state funds under this Contract, Contractor must confirm that any individual natural person eighteen (18) years of age orolder is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of a Contract. M.All goods shall remain the property of the seller until delivered to and accepted by Weld County, Colorado. N. Bids received prior to the time of opening will be kept unopened in a secure place. No responsibility will attach to the Families, Youth and Children Commission, the Weld County Department of Human Services, or the Board of Weld County Commissioners, for the premature opening of a bid not properly addressed and identified. 5 O. In submitting the bid, the bidder agrees that the acceptance of any and all bids by the Board of County Commissioners of Weld County within a reasonable time or period does not constitute a contract. The Board of County Commissioners of Weld County, Colorado, reserves the right to reject any and all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. P. These instructions, the proposal forms, and specifications have been developed with the hope of raising the standard of purchasing negotiations to a level wherein all transactions will be mutually satisfactory. Your cooperation is invited. Q. Substitutions or modifications to any of the terms, conditions, or specifications of this which are made by Weld County after the bids have been distributed to prospective bidders and prior to the date and time of bid opening, will be made in writing. No employee of Weld County is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of said Director of the Weld County Department of Human Services. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. IV.GENERAL SPECIFICATIONS A. Fund Availability: Financial obligations of the Weld County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. By acceptance of the bid, Weld County does not warrant that funds will be available to fund the contract beyond the current fiscal year. B. Governmental Immunity: No term or condition of the contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act §§24- 10-101 et seq., as applicable now or hereafter amended. C. Independent Contractor: The successful bidder shall perform its duties hereunder as an independent contractor and not as an employee. He or she shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to the contract. Neither the successful bidder nor any agent or employee thereof shall be deemed to be an agent or employee of Weld County. The successful bidder and its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through Weld County and Weld County shall not pay for or otherwise provide such coverage for the successful bidder or any of its agents or employees. Unemployment insurance benefits will be available to the successful bidder and its employees and agents only if such coverage is made available by the successful bidder or a third party. The successful bidder shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to the contract. The successful bidder shall not have authorization, express or implied, to bind Weld County to any agreement, liability or understanding, except as expressly set forth in the contract. The successful bidder shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and (b) provide proof thereof when requested to do so by Weld County. D. Compliance with Law: The successful bidder shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established, including without limitation, laws applicable to discrimination and unfair employment practices. E. Choice of Law: Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of the contract. Any provision included or incorporated herein by 6 reference which conflicts with said laws, rules and/or regulations shall be null and void. F. Binding Arbitration Prohibited: Weld County does not agree to binding arbitration by any extra -judicial body or person. Any provision to the contrary in the contract or incorporated herein by reference shall be null and void. G. No Third Party Beneficiary Enforcement: It is expressly understood and agreed that the enforcement of the terms and conditions of the contract, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in the contract shall give or allow any claim or right of action whatsoever by any other person not included in the contract. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under the contract shall be an incidental beneficiary only. H. Attorney Fees/Legal Costs: In the event of a dispute between Weld County and the successful bidder, concerning the contract, the parties agree that Weld County shall not be liable to or responsible for the payment of attorney fees and/or legal costs incurred by or on behalf of the successful bidder. V. Insurance Requirements i. General Requirements: Contractors/Contract Professionals must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant tothis request. Contractors/Contract Professionals shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, during any warranty period, and for three (3) years after termination of the Agreement. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor/Contract Professional. Contractor/Contract Professional shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. ii. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: (a). Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. (b). Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: 7 • $1,000,000 each occurrence; • $2,000,000 general aggregate; • $50,000 any one fire; and • $500,000 errors and omissions. (c). Automobile Liability: Contractor/Contract Professional shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. (d). Additional Provisions: • Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: • If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County within ten (10) days and reinstate the aggregates required; • Unlimited defense costs in excess of policy limits; • Contractual liability covering the indemnification provisions of this Agreement; • A severability of interests provision; • Waiver of exclusion for lawsuits by one insured against another; • A provision that coverage is primary; and • A provision that coverage is non-contributory with other coverage or self- insurance provided by County. (e). For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. iii. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Bid. iv. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance to the County. County reserves the right to require Contractor/Contract Professional to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. v. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured. vi. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. vii. Subcontractors: All subcontractors, subcontractors, independent contractors, sub- vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor/Contract Professional. Contractor/Contract Professional shall include all such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. 8 Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. VI.Warranty. The successful bidder shall warrant that: A. The services to be supplied pursuant to this bid are fit and sufficient for the purpose intended; B. The services sold to Weld County, Colorado pursuant to this bid conform to the minimum Weld County specifications as established herein. VI. CONFIDENTIAL INFORMATION Confidential financial information of the bidder should be transmitted separately from the main bid submittal, clearly denoting in red on the financial information at the top the word, "CONFIDENTIAL." However, the successful bidder is advised that as a public entity, Weld County must comply with the provisions of C.R.S. 24-72-201, et seq., the Colorado Open Records Act (CORA), with regard to public records, and cannot guarantee the confidentiality of all documents. If Weld County receives a CORA request for bid information marked "CONFIDENTIAL", staff will attempt to contact the bidder in order to allow the bidder to seek an appropriate court order preventing disclosure. Without such an order, Weld County will release the requested information in accordance with CORA. 9 SCOPE OF SERVICES PURPOSE: The Weld County Department of Human Services (WCDHS) is seeking qualified English- speaking and bilingual (English/Spanish) providers in various service areas under various funding sources. Service areas include, but are not limited to, Anger Management/Domestic Violence, Day Treatment, Foster Parent Consultation, Foster Parent Training, Functional Family Therapy, Kinship Services (Therapeutic), Home Studies/Relinquishment Counseling, Life Skills, Mediation, Mental Health, Monitored Sobriety, Multi -Systemic Therapy, Home Based Intervention including 24/7 Crisis Intervention, Sexual Abuse Treatment, and Substance Abuse Treatment Services and Aftercare Services. SERVICE AREAS ARE NOTED BEGINNING ON PAGE 1 OFTHIS REQUEST FOR BID, BUT ARE NOT LIMITED TO THOSE LISTED. OTHER SERVICES WILL BE CONSIDERED AND BIDDERS ARE ENCOURAGED TO SUBMIT FOR UNIQUE AND CREATIVESERVICES. Qualifications: To be considered, a bidder must meet the following minimum qualifications: 1) Complete a Provider Information Form (PIF). 2) If submitting to provide bilingual services, a bidder must demonstrate language proficiency at Full Professional Proficiency or higher, as defined by the U.S. Department of State, and as noted below. • Full Professional Proficiency: Able to use and read the language fluently and accurately on all levels pertinent to professional needs • Native or Bilingual Proficiency: Equivalent to that of an educated native speaker (both speaking and reading). 3) A bidder must agree to language proficiency testing that may include assessment of reading, writing and comprehension of Spanish, as well as a face-to-face conversation with a known native or proficient Spanish speaker selected by Weld County. 4) A bidder must submit a one page or less cover letter that introduces the bidder, the bidder's location(s) of practice and target area, his or her experience and qualifications, and staff, if applicable. A bidder must include current contact information including physical address, mailing address, phone number, email address and website, if applicable. 5) A bidder must submit sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets "minimum qualifications" for all bidders. Each service must be submitted as its own proposal, inclusive of scope of services and rate information. The scope of service should include at a minimum the following information for each service proposed: • Detailed description of service components, modalities used, appropriate use of service, etc. • Target population including age range, specific population characteristics, area of service, etc. • Whether or not the service is billable to Medicaid and if bidder is currently able to bill Medicaid. Bidders are strongly encouraged to become Medicaid certified. Medicaid -billable services are preferred. • Clear rate schedule inclusive of all costs bidder wishes to charge for the provision of the service. 6) A bidder should avoid elaborate artwork, graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Bid. 7) A bidder must demonstrate the knowledge, training and expertise to conduct the proposed service(s). 8) A bidder must provide a current resume, as well as proof of licensure, for self, staff members and contractors of the bidder. Additionally, a bidder must include proof of inclusion on State vendor lists if applicable to the proposed service (ex. Home Study Providers, Sex Offender Management Board Providers). 9) A bidder should clearly outline the supervisory structure of staff members and/or contractors of the bidder. This should include the ratio of supervisor to staffand/or contractors, frequency and duration of supervision, credentials of supervisor and length of time as a supervisor. 10) A bidder should clearly outline the bidder's internal referral acceptance and assignment protocol, including communication to the referring agency. 11) A bidder must demonstrate familiarity with Trauma Informed Care. Bidder must provide copies of applicable training certificates, or proof of registration for training, for all staff members who manage and/or administer services under this proposal. 12) A bidder must demonstrate prior and current capacity to be organized, responsive and to quickly and successfully schedule services asrequested. 13) A bidder must agree to track outcome data related to services proposed if awarded a contract and report outcomes upon request. 14) A bidder must agree to enter into an agreement, attached as Exhibit A, with the Weld County Department of Human Services and comply with all requirements of the agreement. Contract Period and Pricing: 1) The initial contract period is to be determined and shall continue as allowable by the funding source, so long as both parties are satisfied. The selected vendor(s) will have the opportunity to resubmit annually. 2) The initial contract will be funded through Core Services Program or other funding, so long as funding is made available. 3) The selected vendor will bill the Weld County Department of Human Services monthly according to billing requirements set forth by the Weld County Department of Human Services. Submittal Requirements for All Proposals: A bidder must submit according to requirements set forth in this Request for Bid - Qualifications. All proposals must contain the following specific information: 1) Provider Information Form (PIF). 2) Identification of language(s) and proficiency level, if applying to provide bilingual (English/Spanish) services. 3) One page or less cover letter that introduces the bidder, the bidder's location(s) of practice, his or her experience and qualifications, and staff, if applicable. 4) A bidder must submit sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets"minimum qualifications" for all bidders. Each service must be submitted as its own proposal, inclusive of scope of services and rate information. The scope of service should include at a minimum the following information for each service proposed: • Detailed description of service components, modalities used, appropriate use of service, etc. • Target population including age range, specific population characteristics, area of service, etc. • Whether or not the service is billable to Medicaid and if bidder is currently able to bill Medicaid. Bidders are strongly encouraged to become Medicaid certified. Medicaid -billable services are preferred. • Clear rate schedule inclusive of all costs bidder wishes to charge for the provision of the service. 5) Bidders should avoid elaborate artwork, graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Bid. 6) Current resume, proof of licensure and copies of applicable training certificates for all staff members who will manage and/or administer services under this proposal. 7) Supervisory structure of staff members and/or contractors of the bidder. This should include the ratio of supervisor to staff and/or contractors, frequency and duration of supervision, credentials of supervisor and length of time as a supervisor. 8) Internal referral acceptance and assignment protocol, including communication to the referring agency. 9) All proposals must demonstrate the bidder has the ability to deliver the services as proposed, and comply with the specific requirements set forth by the Weld County Department of Human Services. 10) All proposals must include a clear and concise rate schedule that accurately correlates to the proposed services and is inclusive of all possible charges related to the proposed service(s). The rate schedule must demonstrate an exact fee for the described service (s). Approximate rates or a range of rates for a service will not be accepted. 11) Each bidder must submit a Standard Certificate of Insurance, or letter of intent from an insurance company authorized to do business in the State of Colorado stating its willingness to insure the bidder pursuant to the terms of this Request for Bid. Evaluation of Proposals: All proposals that meet the basic proposal, service and qualification requirements will be reviewed by the Families, Youth and Children (FYC) Commission. Criteria for review, include but are not limited to the following: • Qualifications, appropriate licensure, and experience. • Cost structure. • Relationships and collaboration. • Organizational experience and past performance. The FYC Commission will make recommendations to the Board of Weld County Commissioners by and through the Weld County Department of Human Services. The Weld County Department of Human Services will make its award of contract to the successful bidders upon final approval of the Board of Weld County Commissioners. EXHIBIT A SAMPLE AGREEMENT CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND This Agreement, made and entered into the _ day of , 2015, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department' and «Contractor», hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Weld County's Reuquest for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and incorporated herein by this reference. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and for WHEREAS, the Colorado Department of Human Services has provided funding to the Department NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on , upon proper execution of this Agreement and shall expire , unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Proposal and Exhibit C, Scope of Services. 3. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Department's Resource Manager, Child Welfare Contract and Services Coordinator, or through a Team Decision Making (TDM) meeting or Family Team Meeting (FTM). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit an itemized complete billing statement by the 7th of the month, following the month of service, utilizing billing forms required by the Department. 1 d. Contractor agrees to submit a monthly report with the billing statement by the 7th of the month following the month of service for each client receiving ongoing services. One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation). Verification of Monitored Sobriety Services will be the test result. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. 4. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule, attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon, the continuing availability of said funds for the purposes hereof. d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 5. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services , and Exhibit D, Payment Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit an ACH Form for Colorado Providers, which will be provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of 2 Colorado per the directions on the form. Failure to complete and submit this form in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and Title VII of the Civil Rights Act of 1964; and the Age Discrimination in Employment Act of 1967; and the Equal Pay Act of 1963; and the Education Amendments of 1972; and Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. 3 b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is Core Services. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contract Professional certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contract Professional will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5-102(5)(c). Contract Professional shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contract Professional that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contract Professional shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contract Professional obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contract Professional shall notify the subcontractor and County within three (3) days that Contract Professional has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contract Professional shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. Contract Professional shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contract Professional participates in the State of Colorado program, Contract Professional shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contract Professional has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, 4 and shall comply with all of the other requirements of the State of Colorado program. If Contract Professional fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contract Professional receives federal or state funds under the contract, Contract Professional must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contract Professional operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5-103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR), and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 9. Insurance Requirements Contractor and Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible the insurance provider. a. General Requirements: Contractors/Contract Professionals must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors/Contract Professionals shall keep the required insurance coverage in force at all times during the term of 5 the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non- payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, in the amount of the deductible or self - insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor/Contract Professional. Contractor/Contract Professional shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii. Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: $1,000,000 each occurrence; $2,000,000 general aggregate; $50,000 any one fire; and $500,000 errors and omissions. iii. Automobile Liability: Contractor/Contract Professional shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv. Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County within ten (10) days and reinstate the aggregates required; Unlimited defense costs in excess of policy limits; Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by County. v. For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. c. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance. County reserves the right to require Contractor/Contract Professional to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured as follows f. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors, subcontractors, independent contractors, sub - vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor/Contract Professional. Contractor/Contract Professional shall include all such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 10. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training 7 Contractor may be required to attend training that the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-352-1551, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 8 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Administrator CONTRACTOR, TITLE 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of 9 any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall not enter into any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records Contractor agrees that authorized local, Federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 10 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contract Professional agrees that it is an independent Contract Professional and that Contract Professional's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contract Professional shall perform its duties hereunder as an independent Contract Professional. Contract Professional shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contract Professional, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contract Professional or any of its agents or employees. Unemployment insurance benefits will be available to Contract Professional and its employees and agents only if such coverage is made available by Contract Professional or a third party. Contract Professional shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contract Professional shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contract Professional shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law (and as set forth in Exhibit provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in 11 Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflict with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contract Professional's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 12 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contract Professional acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contract Professional. Contract Professional shall not enter into any subcontractor agreements for the completion of this project without County's prior written consent, which may be withheld in County's sole discretion. 36. Attorneys Fees/Legal Costs In the event of a dispute between County and Contract Professional, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contract Professional under this Agreement or individual work order shall become or remain (as applicable), the property of County. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contract Professional in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the County. Contract Professional shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of County. 38. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. 13 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS Weld County Clerk to the Board WELD COUNTY, COLORADO BY: Deputy Clerk to the Board , Chair APPROVED AS TO FUNDING: APPROVED AS TO SUBSTANCE: Controller Elected Official or Department Head APPROVED AS TO FORM: Director of General Services County Attorney CONTRACTOR Contractor, Title 14 EXHIBIT B CONTRACTOR'S PROPOSAL PROVIDER INFORMATION FORM (Bid Cover Sheet) Weld County Department of Human Services IDEA Forum, Inc. 1517584 AGENCY OR PRIVATE PRACTICE TRAILS PROVIDER ID (If Known) Marcela Paiz CEO PRIMARY CONTACT — FULL NAME PRIMARY CONTACT - TITLE ) 303 ) 477-8280 1303 1477-1369 PHONE NUMBER EXT. FAX NUMBER mpaiz@ideacares.com www.ideacares.com PRIMARY CONTACT- E-MAIL ADDRESS 2560 W. 29th Avenue AGENCY MAILING ADDRESS Jose Flores AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) Denver 80211 CITY Office Manager ZIP REFFERAL CONTACT - FULL NAME (JF DIFFERENT THAN PRIMARY CONTACT) REFERRAL CONTACT - TITLE ) 303 ) 659-9440 REFERRAL CONTACT- PHONE NUMBER EXT. jflores@ideacares.com 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 where the bids are compe ti - in price and quality. Signature of Authorized Representative: Date of Signature: 0V• 2/ ,O I i FORUM INC Denver 2560 W. 29th Ave. Denver, CO 80211 303.4 7 7.8280 303.4 77.1369 Aurora 14311 E. 4th Ave. Aurora, CO 80011 720.949.0095 720.949.2005 Marcela Paiz BS, CAC III, President CEO Brighton 83 N. 4th Ave. Brighton, CO 80601 303.659.9440 303.659.9430 Rachel Montoya, CFO April 21, 2017 Thornton 9150-8 N. Washington St. Thornton, CO 80229 303.996.9966 303.996.9954 Miguel Avina, COO W W W. I D E A C A R E S C O M Tobi Vegter„ Child Welfare Contract and Services Coordinator Weld County Department of Human Services — Division of Child Welfare Financial Unit P.O. Box A Greeley, CO 80632 Dear Ms. Vegter, Enclosed is the Bid for bid number B1700080; contract year 2017-2018. IDEA bid is to provide services as a contractor with Weld County Department of Human Services: 1) Anger Management / Domestic Violence 2) Substance Abuse Treatment Services — billable to Medicaid — IDEA Medicaid Provider IDEA continues to provide quality evaluations and treatment utilizing Evidence Based Practices (EBP) for which therapists have been trained and certified. IDEA therapists have been trained in providing trauma informed care and are Certified to provide treatment in Helping Men Recover (HMR) and Seeking Safety (SS). Clients are evaluated for trauma histories and for the impact of trauma on their behaviors; HMR and SS address trauma triggered thinking and behaviors. IDEA service providers are culturally sensitive and bilingual, proficient in English, Spanish, and one Vietnamese. We provide gender specific treatment, treatment to adults and adolescents, and LGBT. Counselors are Certified Addiction Counselors (CAC) and eight are DVOMB Approved Domestic Violence Treatment Providers. Evidence Based Practices are listed on IDEA Services Offered. Monitored sobriety services include urinalysis (UA), breathalyzers (BA), hair tests, swabs, and Antabuse. IDEA office hours are sensitive client needs, open 9:00 am to 9:00 pm. IDEA provides services at 4 locations listed above. Referring agents are provided reports on the frequency and formats requested. Enclosed: 1) Provider Information and W-9 2) Resumes and licensure/approvals of IDEA service providers 3) Certificate of Insurance 4) IDEA Services Offered and Fee/Rate Schedule. Please contact a if . d . itii. al information is needed. Since ly, Marcela Paiz, BS, CAC III, CE CHARTING A NEW Evidence Based Practices Clinicians (03/03/2017) BILINGUAL CLINICIANS - ENGLISH AND SPANISH Impaired Driver Education/Therapy Program (IDEP) Interlock Enhancement Counseling (IEC) Moral Reconation Therapy (MRT) Matrix Model Seeking Safety Helping Men Recover Solution Focused Therapy Criminal Conduct & Substance Abuse Therapy Strategies for Self -Improvement and Change (SSIC) Pathways to Self -Discovery & Change: Criminal Conduct &Substance Abuse Therapy for Adolescents Dialectical Behavioral Therapy (DBT) Certified Clinical Trauma Professional Mental Health First Aid Name Abbey Williams, BA, CAC III Charlie Johns, MA, LPC, CAC III Covin Picone, CAC II Crystal McCubbin, BS, CAC II Diana Lozano, BA, CAC I, ADVTP Deidre Tygart, CAC III Ed Tilton, BA, CAC II Elizabet Garcia, CAC I Frank Clavijo, PhD, LPC, CAC III, ADVTP Innael Miranda, BS, CAC III, ATP Ira Slotkin, MSW, CAC II, ADVTP, CCTP, ATP, Jaclyn DeLong, MSW, CAC II Jacob Hernandez, CAC III, PRC, ATP Jason Polk, LCSW, LAC, ATP John Mancha, CAC III Juana Soto Arroyo, CAC I Kathleen Bui, BSN, CAC II, ADVTP Laura Rivera, MA, CAC I, ATP Marcela Paiz, BS, CAC III, CCTP, CPS Mario Castro, BS, CAC I, ATP Margaret Hernandez, MA, CAC 11, ADVTP, MFTC, CPS, ATP Martin Munoz, Ed.D., LPC, ATP Michelle Wert, BS CAC III Nanci Gonzales, LPC, CAC III, ADVTP Nancy Ortiz Moreno, BA, CAC III, ADVTP, ATP Raul Suarez, BA, CAC III, ATP Sam Hawkins, CAC II Sara Fellers, MA, LAC Sharon Hawkins, CAC III Shelley Paiz, BS, CAC III, ATP Yvonne Saldana, MSW, CAC III, ADVTP, CCTP, ATP, RP: Registered Psychotherapist CIT: Certified Addictions Counselor in Training CAC: Certified Addictions Counselor LPC: Licensed Professional Counselor ATP: Approved Treatment Provider (DOC) CCTP: Certified Clinical Trauma Professional CPS: Certified Prevention Specialist ADVTP: Approved Domestic Violence Treatment Provider (DVOMB) PRC: Peer Recovery Coach E-mail awilliams(cr�ideacares.corn cjohnsideacares.com cpicone(dd,ideacares.com cmccubbinCiidecares.com dlozano(c�idecares.com dtygart(a7ideacares.com etilton at ideacares.com egarcia(cD.ideacares.com fclavijoAideacares.com imirandaaideacares.com islotkinAideacares. com jdelonclaideacares.com jhernandezCa ideacares.com jpolkt ideacares.com jmanchaAideacares,com jsotoCci≥ideacares,com kbui@ideacares.com. Iriverai ideacares.com mpaiz(a%ideacares.com mcastroAideacares. com mhernandezajdeacares.com mmnuozCc�ideacares.com michellewert(a msn.corn ngonzales(a7ideacares.com nortiz@ideacares.com rsuarezi ideacares.com samhawkinsRideacares.com sfellers(a>ideacares.com shawkins(a ideacares.com spaizCa ideacares.cam ysaldana(a7ideacares. com ,, al DOC Approved Treatment Provider List Innael Miranda, BS, CAC Ill, ATP Ira Slotkin, MSW, MA, CAC II, ADVTP, CCTP , ATP, Jacob Hernandez, CAC III, PRC, ATP Jason Polk, LAC, ATP Laura Rivera, MA, CAC I, ATP Mario Castro, BS, CAC I, ATP Margaret Hernandez, MA, CAC I, ADVTP, ATP Martin Munoz, Ed.D., LPC, ATP Nancy Ortiz Moreno, BA, CAC III, ADVTP, ATP Raul Suarez, BA, CAC III, ATP Shelley Paiz, BA, CAC III, ATP Yvonne Saldana, MSW, CAC III, ADVTP, CCTP, ATP, IDEA Staff Ratio imiranda@)ideacares.com islotkin(a>ideacares. corn ihernandez(aideacares.com jpolkca'7ideacares.corn Iriveraadeacares.com mcastro(ideacares.com mhernandezaideacares.com m m u n oza ideacares. co rn nortizaideacares.com rsuarez(ideacares. com spaiz(cbideacares.com ysaldanaajdeacares.com Per OBH requirements IDEA Forum Inc. maintains a treatment team that is comprised of more than fifty percent (50%) CAC II. Counselors in training and CAC I do not compose any more than twenty-five percent (25%) of the total treatment staff. Services Offered In English, Spanish, and Vietnamese NO INTAKE FEE — CREDIT CARDS ACCEPTED I. , Walk-ins welcome DUI Education & Therapy • Level I Education • Level II Education • Level II Therapy (Track A,B,C,D) • Interlock Enhancement Counseling • DUI for Underage Drinkers Substance Use Disorder Treatment • Intensive Outpatient Treatment (IOP) • Relapse Prevention • Recovery Planning • Cognitive Therapy • Smoking Cessation Domestic Violence • Domestic Violence Treatment —. • Dating Violence • Male/Female/LGBT General Treatment • Anger Management • Adult Responsibility • Victim Empathy • Parenting • Life Skills Adolescent Programs • DUI for Underage Drinkers • Adolescent Domestic Violence • Alcohol and Drug Treatment • Minor in Possession (MIP) • Life Skills Monitored Sobriety • Urinalysis • Breathalyzer • Antabuse • Swab • Hair Test Evaluations • Alcohol and Drug • Domestic Violence • Anger Management IDEA Denver 2560 West 29th Avenue Denver, Colorado 80211 Ph: 303.477.8280 Fx: 303.477.1369 denverfd@ideacares.com V-0912012016 IDEA Charting IDEA Aurora 14311 East 4th Avenue Aurora, Colorado 80011 Ph: 720.949.0095 Fx: 720.949.2005 aurorafd@ideacares.com a New Course: For more Office Hours Monday -Thursday 9:00am-9:00pm Friday 9:00am-7:00pm Saturday 9:00am-1:00pm Medicaid Approved (If Medically Necessary) • Evaluations (SUD Only) • SUD/DUI TX Group Counseling • Behavioral Health Counseling and Therapy Evidence Based Practices (Book Purchase Required) • Driving With Care (DWC) • IDEP • Interlock Enhancement Counseling • Matrix Model • Seeking Safety • Helping Men Recover • Solution Focused Tx • Criminal Conduct & Substance Abuse Tx Strategies for Self Improvement and Change • Pathways to Self -Discovery & Change: Criminal Conduct & Substance Abuse Tx for Adolescents • Dialectical Behavioral Therapy (DBT) • Eye Movement Desensitization & Reprocessing (EMDR) • Moral Reconation Therapy (MRT) IDEA/Providers licensed or approved by: Colorado Department of Human Services Office of Behavioral Health (OBH) hIIGr.liwww.cdhs stale.co us/adad/ Department of Corrections (DOC) Approved Treatment Provider (ATP) httti /iwww.doc_state:cu.us Domestic Violence Offender Management Board (DVOMB) co.i.is/odvsorn/domestic violence/index.html OBH Licensed: Outpatient/Enhanced/Intensive Treatment • General Services • Level I DUI Education • Level II DUI Education & Therapy • Offender Education & Treatment (Non -DUI) • Services to Child Welfare Clients • Treatment Program Specific to Minors • Treatment Program Specific to Women • Involuntary Commitment IDEA Brighton 83 North 4th Avenue Brighton, Colorado 80601 Ph: 303.659.9440 Fx: 303.659.9430 brightonfd@ideacares.com information about our services IDEA Thornton 9150B North Washington Street Thornton, Colorado 80229 Ph: 303.996.9966 Fx: 303.996.9954 thorntonfd@ideacares.com visit www.ideacares.com IDEA IDEA Denver 2560 West 29th Avenue Denver, Colorado 80211 Ph: 303.477.8280 Fx: 303.477.1369 denverfd@ideacares.com Fee Schedule Services in English, Spanish, and Vietnamese Department of Corrections Approved Treatment Provider (ATP) Medicaid Approved, Sliding Fee Scale NO INTAKE FEE - CREDIT CARDS ACCEPTED Aurora 14311 East 4th Avenue Aurora, Colorado 80011 Ph: 720.949.0095 Fx: 720.949.2005 aurorafd@ideacares.com DV Intake Evaluation and First Session DUI/ATOD Orientation and Monitored Sobriety Orientation Group Therapy tpy Family Therapy LV 01.40tion Minor in Possession (MIP) Parenting -One Day Intensive Partners in t ng Aa rDivorce Youth Group Therapy UA 7 Panel + EtG Antabuse (Tx Clients) Antal Hair Test $67 $0-$40 $25 $30-$45 $0-$45 $0-$65 $0-$30 $0-$45 $0-$65 $175 $120 $80 $80 $50 $17 $165 $10 $17 No Fee $50/Month $50 IDEA Brighton 83 North 4th Avenue Brighton, Colorado 80601 Ph: 303.659.9440 Fx: 303.659.9430 brightonfd@ideacares.com IDEA Thornton 9150B North Washington Street Thornton, Colorado 80229 Ph: 303.996.9966 Fx: 303.996.9954 thorntonfd@ideacares.com Books/Manuals Evidence Based Practices (Purchase required at the time of first session) DUI • Impaired Driver Education Program • Impaired Driver Therapy Program • Interlock Enhancement Counseling Trauma Informed Care • Matrix • Seeking Safety Manual • Helping Men Recover • Dialectical Behavior Therapy • Strategies for Self -Improvement and Change • Moral Reconation Therapy (MRT) • Anger Management: Substance Abuse and Mental Health • The Parent's Handbook $70 V-09/20/2016 IDEA Charting a New Course: For more information about our services visit www.ideacares.com ACQ 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). CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 8/1612016 PRODUCER SterlingRisk PO Box 9017 Woodbury NY 11797 INSURED Idea Forum, Inc. 2560 W. 29th Avenue Denver CO 80211 IDEAF-1 CONTACT NAME: PHONE 800-735-1588 Imo, Nql; 888-290-0302 (A/C. Nr�Fef�• _.- E-MAIL SelectCertRequests@steriingrisk.com ADDRESS: INSURER(S) AFFORDING COVERAGE INSURER A:Granite State Insurance Company INSURER B:Beazley Insurance Company, Inc. INSURER C : NAIC # 23809 37540 INSURER D : INSURER E : INSURER F : REVISION NUMBER: ..e.tcr rJrnocr•-•- •, COVERAGES L.cicIrrit�. �- 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. HER TYPE OF INSURANCE ADOL INSD SUER WVD I POLICY EFF POLICY NUMBER LIMMIDDIYYYY) POLICY EXP (MM/DD/TYYY) DM(TS LTR A X COMMERCIAL GENERAL LIABILITY Y 02LX00738386811 8/14/2016 8/14/2017 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 I CLAIMS -MADE I X I OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PER PRO- I JECT LOC PRODUCTS - COMP/OP AGO $1,000,000 $ COMBINED SINGLE LIMIT (Ea accident) $ AUTOMOBILE '----4AN --AUl LIABILITY ANY O�AUTO O NFL HIRED AUTOS A AUTOS LED NON -OWNED BODILY INJURY (Per person) S BODILY INJURY (Peracddent) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA UAB EXCESS LIAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ S 1 DED RETENTION $ J WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE (MandatoryIn OFFICER/MEMBER EXCLUDED? (Mandatory In NH) B yes, describe under DESCRIPTION OF OPERATIONS below NIA _ STATUTE i ER E.L. EACH ACCIDENT $ Si. DISEASE - EA EMPLOYEE $ E DISEASE- POLICY LIMIT $ A B Professional Liability 02LX00738388811 8/14/2016 8/14/2017 - Occurence $1,000,000 Aggregate $3,000,000 Aggregate $1,000,000 DESCRIPTION As required volunteers ABUSE Limits Retroactive OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) by written contract, The City and Weld County Department of Human Services, its elected and appointed officials,employees and are included as additional insureds, as respects to Commercial General Liability AND MOLESTATION ENDORSEMENT - CLAIMS MADE of Insurance: $100,000 Each Incident Limit, $100,000 Aggregate Limit Date: 8-14-2004 CERTIFICATE HOLDER Weld County Department of Human Services 315 North 11th Ave Greeley CO 80601 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) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Home DV Home DC) Units Important Links FAQs Contact Us About Us Search this site DVOMB Approved Provider List by Last Name DVOMB Approved Provider List by County q Search again FIRST NAME LAST NAME A, AGENCY NAME ADDRESS CITY NOTES PHONE Maria Arroyo IDEA @ Denver 2560 W. 29th Avenue Denver Speaks Spanish 303-477-8280 �J View Details Merle Arroyo IDEA@ Aurora 14311 East 4th Avenue Aurora Speaks Spanish (720) 949-0095 . View Details Maria Arroyo IDEA @ Brighton 83 North 4th Avenue Brighton Speaks Spanish (303) 659-9440 ?� View Details Marla Arroyo IDEA @ Thornton 9150-8 North Washington Street Thornton Speaks Spanish (303) 996-9966 View Details Kathleen Bui IDEA 2560 W. 29th Ave, Denver (303) 477-8280 J View Details Kathleen Bui IDEA 14311 E. 4th Ave Aurora (720) 949-0095 J View Details Kathleen Bui IDEA 83 North 4th Ave Brighton (303) 659-9440 View Details Kathleen Bui IDEA 9150-B N. Washington St. Thornton (303) 996-9966 r View Details Records 1-8 of 28 Cloud Database by Caspio Page 1 of 4 P. H What the List Means • When a provider is on the List, it means that he/she (1) has met the education and experience qualifications established in the Standards, (2) has provided sufficient information for a determination that services appear to be provided according to the Standards and (3) each provider agrees in writing to provide services in compliance with the standards of practice outlined in the Standards. ■ Only Providers on the List are eligible to provide treatment anywhere in Colorado, unless they are provisionally approved. If a provider is provisionally approved, he/she may only provide treatment in the judicial district(s) listed. • Being on the List is neither licensure nor certification of the provider. It does not imply that all providers offer exactly the same services • The List also does not create an entitlement for referrals from the criminal justice system. Complaints • To make a formal complaint against a treatment provider, you may contact our program administrator at got -24Q -44c6. • You may also submit a formal complaint against a treatment provider by contacting the the Department of Regulatory Agencies (DORA) by clicking HE or calling (10 t) 8Q4-2Qoo. • Anonymous complaints are not accepted by the DVOMB; however, you may submit anonymous complaints through the DORA by clicking HERE or calling l'oa) 894-2900. • Formal complaints must be submitted in writing. It should be noted that DORA is not affiliated in anyway with the DVOMB and is a different governmental entity. Please note that it is helpful for the DVOMB to receive the complaints initially because DORA consults with the DVOMB regarding all complaints against DVOMB Approved Treatment Providers as part of their deliberation Process. For the status of any provider whose application is still pending or not listed, please call 303-239-4528. 700 Kipling Street, Suite 1000 Lakewood, CO 80215 1.800-201-1325 303-233-4442 g ra n I Recent Site Activity I Report Abuse i Print Page I "nwe,eu BY 600nle Sites Home DV Home DC) Units Important Links FAQs Contact Us About Us Lce Search this site DVOMB Approved Provider List by Last Name DVOMB Approved Provider List by County 0. Search again FIRST NAME LAST NAME AGENCY NAME ADDRESS CITY NOTES PHONE Frank Clavijo IDEA 2560 W. 29th Ave. Denver Speaks Spanish (303) 477.8280 . View Details Frank Clavijo IDEA 14311 E. 4th Ave. Aurora Speaks Spanish (303) 671-0010 J View Details Frank Clavijo IDEA 9150-B N. Washington St. Thornton Speaks Spanish (303) 996-9966 View Details Margaret Hemandez IDEA 2560 W. 29th Avenue Denver (303)477-8280 J View Details Margaret Hernandez IDEA 9150-8 North Washington Street Thornton (303) 996.9966 J View Details Margaret Hernandez IDEA 83 North 4th Avenue Brighton (303) 659-9440 j View Details Margaret Hernandez IDEA 14311 East 4th Avenue Aurora (720) 949-0095 '-raj° yew Details Diana Lozano IDEA Forum, Inc. 14311 East 4th Avenue Aurora Speaks Spanish (720) 949-0095 .- View Details Records 9-16 of 28 Cloud Database by Caspio N 4 Page 2 of4 I H What the List Means • When a provider is on the List, it means that he/she (1) has met the education and experience qualifications established in the Standards, (2) has provided sufficient information for a determination that services appear to be provided according to the Standards and (3) each provider agrees in writing to provide services in compliance with the standards of practice outlined in the Standards. • Only Providers on the List are eligible to provide treatment anywhere in Colorado, unless they are provisionally approved. If a provider is provisionally approved, he/she may only provide treatment in the judicial district(s) listed. • Being on the List is neither licensure nor certification of the provider. It does not imply that all providers offer exactly the same services • The List also does not create an entitlement for referrals from the criminal justice system. Complaints • To make a formal complaint against a treatment provider, you may contact our program administrator at not -2a9-4456. • You may also submit a formal complaint against a treatment provider by contacting the the Department of Regulatory Agencies (DORA) by clicking HERE or calling (tot) 8q4-zgo0. • Anonymous complaints are not accepted by the DVOMB; however, you may submit anonymous complaints through the DORA by clicking HERE or calling { oak 894-29OO. • Formal complaints must be submitted in writing. It should be noted that DORA is not affiliated in anyway with the DVOMB and is a different governmental entity. Please note that it is helpful for the DVOMB to receive the complaints initially because DORA consults with the DVOMB regarding all complaints against DVOMB Approved Treatment Providers as part of their deliberation Process. For the status of any provider whose application is still pending or not listed, please call 303-239-4528. 700 Kipling Street, Suite 1000 Lakewood, CO 80215 1-800-201-13251303.239-4442 S' n in 1 Recent Site Activity I Report Abusq I Print Page I Powered By Gooale Sites COL Division o: Department of Search this site Home DV Home DO Units Important Links FAQs Contact Us About Us DVOMB Approved Provider List by Last Name DVOMB Approved Provider List by County Q Search again FIRST NAME LAST NAME AGENCY NAME ADDRESS CITY NOTES PHONE Diana Lozano IDEA Forum, Inc. 83 North 4th Avenue Brighton Speaks Spanish (303) 659-9440 @ View Details Nancy Ortiz -Moreno IDEA 2560 W. 29th Avenue Denver Speaks Spanish (303) 477-8280 R View Details Nancy Ortiz -Moreno IDEA 1090 S. Sable Blvd. Aurora Speaks Spanish (303) 671-0010 -i View Details Nancy Ortiz -Moreno IDEA 83 N. 4th Ave. Brighton Speaks Spanish (303) 659-9440 `I View Details Nancy Ortiz -Moreno IDEA 9150-B North Washington Street Thornton Speaks Spanish (303) 996-9966 @ View Details Yvonne Saldana IDEA @ Aurora 14311 East 4th Avenue Aurora (720) 949-0095 .J View Details Yvonne Saldana IDEA @ Thornton 9150 Washington Street Thornton (303) 996-9966 • View Details Yvonne Saldana IDEA @ Brighton 83 North 4th Avenue Brighton (303) 659-9440 View Details Claud Database by Casplo Records 17-24 of 28 What the List Means 14 4 Page 3 of4 )' N . When a provider is on the List, it means that he/she (i) has met the education and experience qualifications established in the Standards, (2) has provided sufficient information for a determination that services appear to be provided according to the Standards and (3) each provider agrees in writing to provide services in compliance with the standards of practice outlined in the Standards. • Only Providers on the List are eligible to provide treatment anywhere in Colorado, unless they are provisionally approved. If a provider is provisionally approved, he/she may only provide treatment in the judicial district(s) listed. • Being on the List is neither licensure nor certification of the provider. It does not imply that all providers offer exactly the same services • The List also does not create an entitlement for referrals from the criminal justice system. Complaints • To make a formal complaint against a treatment provider, you may contact our program administrator at 'tot -249-4456. • You may also submit a formal complaint against a treatment provider by contacting the the Department of Regulatory Agencies (DORA) by clicking HERE or calling (Ion) 894-29OO. • Anonymous complaints are not accepted by the DVOMB; however, you may submit anonymous complaints through the DORA by clicking MBE or calling f tort) 8ea-2000. • Formal complaints must be submitted in writing. It should be noted that DORA is not affiliated in anyway with the DVOMB and is a different governmental entity. Please note that it is helpful for the DVOMB to receive the complaints initially because DORA consults with the DVOMB regarding all complaints against DVOMB Approved Treatment Providers as part of their deliberation Process. For the status of any provider whose application is still pending or not listed, please call 303-239-4528. 700 Kipling Street, Suite 1000 Lakewood, CO 8021S L800-201-1325 1303-239-4442 Sion in Recent Ste Activity Resort Abuse I Print Parse I Powered By Goopre sites COL Division af, Search this slte Home DV Home DCJ Units Important Links FAQs Contact Us About Us DVOMB Approved Provider List by Last Name DVOMB Approved Provider List by County Search again FIRST NAME LAST NAME AL AGENCY NAME ADDRESS CITY NOTES PHONE Ira Slotkin IDEA @ Denver 2560 West 29th Avenue Denver (303) 477-8280 view Details Ira Slotkin IDEA@Thornton (303)996-9966 .. View Details Ira Slotkin IDEA @ Brighton 83 North 4th Street Brighton (303) 659.9440 .'J View Details Ira Slotkin IDEA Aurora Aurora w) View Details Cloud Database by Caspio Records 25-28 of 28 What the List Means N 4 Page 4 of4 • When a provider is on the List, it means that he/she (1) has met the education and experience qualifications established in the Standards, (2) has provided sufficient information for a determination that services appear to be provided according to the Standards and (3) each provider agrees in writing to provide services in compliance with the standards of practice outlined in the Standards. • Only Providers on the List are eligible to provide treatment anywhere in Colorado, unless they are provisionally approved. If a provider is provisionally approved, he/she may only provide treatment in the judicial district(s) listed. • Being on the List is neither licensure nor certification of the provider. It does not imply that all providers offer exactly the same services • The List also does not create an entitlement for referrals from the criminal justice system. Complaints • To make a formal complaint against a treatment provider, you may contact our program administrator at 3o3-2 t4 -44c6. • You may also submit a formal complaint against a treatment provider by contacting the the Department of Regulator/ Agencies (DORA) by clicking HERE or calling jtto't) 894-2400. ■ Anonymous complaints are not accepted by the DVOMB; however, you may submit anonymous complaints through the DORA by clicking HERE or calling iIca) 894-2900. • Formal complaints must be submitted in writing. It should be noted that DORA is not affiliated in anyway with the DVOMB and is a different governmental entity. Please note that it is helpful for the DVOMB to receive the complaints initially because DORA consults with the DVOMB regarding all complaints against DVOMB Approved Treatment Providers as part of their deliberation Process. For the status of any provider whose application is still pending or not listed, please call 3O3-239-4528. 700 Kipling Street, Suite 1000 Lakewood, CO 80215 1.800 201 1325 1303- 235-4442 Sian in ( .Recent Stte Activity I Report Abuse I Pr st Pane I Powered By Goo/le Sites Kathleen Bui 9360 North Quay Street, Broomfield, CO 80021 kathibui@yahoo.it (720)-557-3448 Language Skills Strengths Education (1995) Bachelor of Science/Nursing (1993) Associate of Science Training Certifications (2002) CAC II #5962 CAC III (Pending) Domestic Violence (Pending) English, Spanish, Vietnamese Culturally/Linguistically competent, Documentation University of Colorado Health Sciences Center Front Range Community College Behavioral Health Services Training Center, Denver Behavioral Health Services Training Center, Denver Behavioral Health Services Training Center, Denver Work Experience 2002 Present: Behavioral Alternative Center Associates/ (Pathways Counseling) Providing (Substance Abuse) DUI Level II Education and Therapy. Conducting Drug/Alcohol, Relapse Prevention, Cognitive, Anger Management, Parenting Skills, and Life Skills groups in English, Spanish and Vietnamese. Coordinating care with Probation, Social Services, and/or other third party funders. Co -facilitating Domestic Violence groups with DVOMB approved providers and participated in DV staffing. 2009-2015: Addiction Research Treatment Services (ARTS), CU Medical School Providing trilingual outpatient substance abuse treatment for populations infected with HIV. Promoting and delivering services related to methadone and opiate replacement therapy while utilizing concepts of Harm Risk Reduction. Providing substance abuse evaluations for Social Service clients and third party funders. Conducting Relapse Prevention, Cognitive, and DUI level II groups. 2011: Empowerment Counseling Services Co -facilitated Domestic Violence groups (separately) with male and female offenders. 2002-2006: Denver Area Youth Services (DAYS) Providing outpatient trilingual drug/alcohol treatment services to high risk youth and adults. Working with clients infected with HIV/AIDS to promote health/wellness using the Harm Risk Reduction concepts. Coordinating a Diabetes grant working with clients/families in home to promote health/wellness. CPR certified instructor through Red Cross. Responsible for training of staff Coordinate care with Probation, Social Services, and/or other third party funders. 2000-2002: Chestor House Acting as Host Home Provider for a developmentally delayed person (Consumer) in my home. Teaching basic daily living skills and integrating Consumer to family, social, and community events. Working in office full time as Health Coordinator of Host Home providers to ensure adherence to state standards related to consumer health, medications, and housing safety. 1995-2000: Denver Area Youth Services (DAYS) Providing Drug/Alcohol education, prenatal/postnatal nutritional education, and case management to pregnant teens in community based settings. Co -facilitating a Strengthening Families program to increase communication, effective parenting skills and bonding with use of evidenced based material. Co -facilitating a Women's Empowerment group. Referrals /Educational Transcripts furnished upon request. Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C.R.S. redential Information Name Public Address Kathleen Bui Broomfield, CO 80021 License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date ACB.0005962 Original Certified Addiction Counselor II Active 04/28/2003 09/01/2015 08/31/2017 Board/Program Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 4/21/2017 2:20:06 PM Dr. Martin K. Munoz Ed.D., L.P.C. 5244 Sagebrush Brighton, CO. 80601 (720) 223-8144 mmunozAregis.edu EDUCATION 1997 Ed.D., University of Northern Colorado, Greeley, CO. Degree Awarded in Counseling Education 1992 M.A., University of Northern Colorado, Greeley CO. Degree awarded in Agency Counseling. 1983 B.A., Adams State College, Alamosa, CO. Major in Selected Studies Licensure Licensed Professional Counselor Colorado L.P.C. 5173 TEACHING EXPERIENCE Regis University 2007-2011, Associate Professor in the School of Education and Counseling University of Houston -Victoria 1997-2007 Associate Professor in the School of Education. RELATED EXPERIENCE El Centro de Esperanza, Denver Colorado, 2009-2010- Counselor. Conducted pro bono therapy for members of the Hispanic community. Duties included individual and family therapy. Colorado Department of Heath at Fort Logan, Denver Colorado, 2009-2010. Counselor. Worked as an on call milieu therapist for an inpatient psychiatric hospital. Reach Community Center, Commerce City Colorado, 2008-2009. Counselor Practiced as a Bilingual therapist working with the chronic mentally ill. Duties included individual, and family therapy. Midcoast Family Services, Victoria Texas, 2001-2006. I worked in a community counseling center that served a diversity of clientele, including Spanish Speaking substance abuse, domestic violence, and dual diagnosed clients. Island Grove Treatment Center, Greeley Colorado, 1994-1997. Counselor. I was a CAC II counselor working with Spanish speaking clients conducting intake assessments, group counseling, and individual therapy. 17th Judicial District, Greeley Colorado, 1994-1995. Alcohol Evaluator. My duties included drug and alcohol assessment in probation department. The vast majority of clients served were Spanish Speaking. Mental Health Corporation of Denver, 1992-1994. Counselor. I worked as a therapist serving the adult chronic populations that were diagnosed as poly substance abusers, chronic mentally ill, and homeless. I also conducted group and individual counseling as well as emergency triage. Bridge Counseling Services, Denver, Colorado, 1987-1988. Internship at a community mental health clinic that worked with court referred clients. I worked with poly substance abusers, sex offenders, and dual diagnosed clients. Peace Corps Volunteer Marrakech, Morocco1983-1985. Vocational Education Program Instructor for a women's cooperative. Vocational Education/ Art Instructor 1985-1988. Assistant Branch Director, Boys and Girls Club of Metro Denver, Denver, Colorado. Vocational/Rehabilitation Workshop Manager. 1988-1992. Work Performance Center, Denver, Colorado. Developed and fabricated tools as well as teach basic woodworking and welding skills in a rehabilitation setting. Vocational/rehabilitation Workshop Manager 1992-1996. Benchmark Rehabilitation L.L.P. Greeley, Colorado. Developed and fabricated tools as well as teach basic woodworking and welding skills to injured workers. Conducted ergonomic work -site evaluations throughout Northern Colorado. Counselor/Instructor. 1996-1997. Island Grove Treatment Center. Therapist in a community counseling center. Greeley, Colorado. School Counselor. 1996-1997. Boards of Cooperative Educational Services (BOCES). Evans Colorado. SCHOLARLY ACTIVITIES Association of Jesuit Colleges and Universities. May 2011. Xavier University, Cincinnati, Ohio. Submitted ''Utilizing Lonergan's Generalized Empirical Model in Teaching Social Justice and Multicultural Counseling: A Spiritual Journey". The presentation was not accepted. Colorado Counseling Association. October 2010. Submitted "Utilizing Lonergan's Generalized Empirical Model in Teaching Social Justice and Multicultural Counseling: A Spiritual Journey". The presentation was not accepted. 2010 Regis University Diversity Day- Submitted a presentation on the use of Bernard Lonergan's Generalized Empirical Model as a method of teaching cultural awareness. Presentation was accepted American Counseling Association National Conference, Pittsburg PA. 2010. Submitted "Utilizing Lonergan's Generalized Empirical Model in Teaching Social Justice and Multicultural Counseling: A Spiritual Journey". Ignation Scholars Program. Regis University, 2008-2010. Rocky Mountain Association for Counseling Educators and Supervisors. Breckenridge CO. March 2009- Presented with Drs. Sablatura and Bennett on the the Tradition of depth . Bridging the Divide: Suicide Awareness and Prevention Summit. Regis University. May 19 - 22, 2008. "Suicidology: A New Specialty in Graduate Counseling Training". 7th Annual Cross Cultural Issues in Counseling Southeastern Conference. February 8-9, 2008. Savannah Georgia. Presented "Utilizing Multimedia in Teaching Cross Cultural Issues in Counseling". Grant Director/Local evaluator: Safe Schools/Healthy Students Initiative: 2004- 2007. The Students in Need of Assistance (SNAP) Program are funded by a Federal Grant. "Safe Schools/Healthy Students" initiative. The grant targeted at -risk youth in the Victoria Independent School District. The SNAP program helps students that were experiencing problems that interfere with learning, such as emotional distress, family problems. and chemical dependency. My duties included the design, implementation and analysis of a multi -site program. Eisenhower Professional Development Grant Program, 2002-2004. Evaluator of three professional Development grants awarded to the University of Houston -Victoria in the school of Education. Victoria Independent School District, Victoria, TX. February 2002 Presented a one day workshop entitled: "Counseling Hispanic Students". Hispanic Outlook for Hispanics in Higher Education. Article submission (Accepted) with a publication date of July 2002. Article titled: "Hispanics in Higher Education: More Questions than Answers". Texas Homeless Coalition, Annual Conference, September 2001. Presented research data on the Safe Schools/ Healthy Students Initiative. Victoria Independent School District, Victoria TX. August 15, 2001. Conducted an 8 -hour workshop on cultural diversity. Safe and Drug Free Schools and Communities Annual State Conference - Waco TX. February 2001. Participated as a Scholar Committee Member. Safe Schools and Healthy Students Annual Conference. Washington D.C. November 2000. Participated in numerous panel discussions as well and meetings with national site evaluators. Regional Outreach Center, University of Houston -Victoria. August 2000. Survey report submitted to the U.S. Department of Justice Office of Community Oriented Policing Services. Co-authored by Drs. Paul Carlson and Rosemary Stanford. Southwest Psychological Association, Dallas, TX. April 2000. Poster Session Titled: AA Comparative study between Male and Female Perpetrators of Domestic Violence. American Counseling Association, Washington D.C., March 2000. Poster Session titled: Strategies for Living in a Violent World. Safe and Drug Free Schools and Communities Annual State Conference - Waco, TX. February 2000. Participated as a Scholar Committee Member. As a Scholar Committee member my duties will include the presentation of Safe Schools/Healthy Students analysis of the 2000-2001 academic year for Victoria Independent School District. Gulf Bend Mental Health Services, Victoria TX, April 1999. Numerous Workshops on "Managing Trauma". JTPA, Victoria TX, October, 1998. Numerous workshops for individuals which addressed unemployment and underemployment. Society for Prevention Research, Park City Utah. May 1998. Presented "A Comparative Study Between Male and Female Perpetrators of Domestic Pecan Valley AHEC, Victoria TX. January, 1998,. Women's Health Issues Related to Sexual Trauma and Violence. La Bahia Counseling Association, November 1997, Victoria TX. Presented a workshop on Domestic Violence prevention. Formosa Chemical, Port Lavaca, TX. Conducted critical incident training after a major accident at a petrochemical industrial site. British Petroleum Incorporated, Bloomington, TX. Conducted a workshop entitled "Managing shift -work and Stress Management". The Journal of Counseling and Development -December 2001. Submitted a Paper Entitled "Personality Factors of Female Perpetrators of Domestic Violence". Safe and Drug Free Schools and Communities State Conference, Corpus Christi, TX. February 2002. Presentation titled- Student Assistance Program A collaborative model for assuring success with at -Risk Students. The 25th Annual Meeting of the Southwest Educational Research Association, Austin, TX. February 14, 2002. Presentation titled: "Death and Dying: A developmental approach". (Accepted) The 15th Annual Research Conference A System of Care for Children's Mental Health, Tampa, Florida March 3-6, 2002. Presentation titled: Safe Schools and Healthy Students: Expanding the Research Base (Accepted). Texas Association for Counselor Education and Supervision, February 8, 2002. Presentation entitled: The Recruitment of Minorities in Counseling Education: Issues in Ethnicity and Gender. VISD Strategic Planning Committee- Co -Chair- Fall 2001-2002. Co Chairman of the Professional Development Committee. Results presented to the VISD school board on October 26, 2002 Grant evaluator- U.S. Department of Education and SAMSHA- Evaluated grants related to the Safe Schools and Healthy Students Initiative. CONSULTATION El Centro de Esperanza- Denver Colorado -2008-2010. Supervision of graduate students in a clinical setting addressing the mental health needs of the Denver Spanish speaking community. Also acted as clinical director. Pro Bono. William Smith Sr. Tri-County Child Development Council, Inc. Houston TX. 1998- 2005 Development of wellness programs for Early Start and Regular Head Start children. Golden Crescent Workforce Center, Victoria, TX. 1998-2003 Job Search Workshops and Training. Habitat for Humanity, Victoria, TX. 2000-2001. Developing of Conflict Resolution Workshops Critical Incident Task Force Member. 1998-1999. Task Force member that look at issues surrounding community disasters and critical incident response. Mental Health Counselor and Consultant. 1998. Flood Victims Counseling Center, Victoria TX. January, 1998. Training Consultant. 1997-1999. Women's Crisis Center, Victoria, TX. SERVICE TO REGIS UNIVERSITY Mentored 3 affiliate faculty members from 2008-2011. All affiliates are presently employed by the School for Education and Counseling. Ignation Scholar — 2009-2011. Reviewed numerous affiliate faculty essays on Jesuit educational traditions. Academic Council -2011- Assessed the Academic Unit Review for the CPS liberal arts program. Supervisor -Presently supervise 2 recent Regis graduates as the pursue their professional licensure. Pro bono. Program Assessment- 2009-2011. Lead faculty on the assessment of the multicultural counseling and abnormal courses. Developed the Substance abuse course which includes resources for affiliate faculty. Ignation Scholars Program -2011 -Presented to the newest class of Ignation scholars research presented at the American Counseling Association in Pittsburg, PA. Meet and Greet- 2008 -Present- Represented the Counseling Department at approximately 7 Meet and Greet meetings for potential students interested in attending Regis. Student Assessment and Orientation. Participated in numerous assessments of new student applications as well as orientation for those individuals that were accepted into the program. Coyote Hills Elementary. Aurora, Colorado. 2011 -Present. Assistig the school administration in identifying services in the community for at risk youth. Regis University Faculty Advisor. 2010-2011. Chi Sigma Iota. El Centro de Esperanza, Denver Colorado. 2009-2010. Served as a Clinical Director for an agency that works primarily within the Hispanic community. COMMUNITY SERVICE Victoria Independent School District Health Advisory Council. 2001-2004. Member South Texas Hospice, 2001-2004. Victoria TX. Board Member Ronald McDonald House, Victoria TX. 1999-2000. Member of HALER, (Minority Scholarship Program). Ronald McDonald Charities, Victoria, TX Human Subjects Committee. 1998-2000. University of Houston- Victoria, Victoria, TX. DeLeon Symposium Committee Member. 1998- 2000. University of Houston -Victoria Regional Outreach Center. 1998-2000. Assisting in the development of continuing Education and Community research. University of Houston - Victoria TX. Mexican American Student Organization 1998-1999. Faculty Advisor. University of Houston -Victoria, TX. Substance Abuse, Domestic Violence, Licensing review For LCDC certification. 1998-1999. University of Houston -Victoria TX. Health Advisory Board 2001-2004. Victoria Independent School District. Safe Schools/Healthy Students Advisory Board 2001-2004. Victoria Independent School District. Community Concerned Citizens for the Needs of Adolescents 2003-2004. - Victoria, TX. Art Committee 2002-2006- UHV Committee Member. Academic Affairs UHV - Committee Member - Eisenhower Professional Development Grant Evaluator 200-2006 UHV - Local Evaluator for a grant program that provides staff development for in service programs For educators that work with predominantly under -represented populations. PROFESSIONAL ORGANIZATIONS American Counseling Association Association of Counseling Educators and Supervisors Chi Sigma Iota -Pending membership AWARDS and HONORS Excellence in Teaching- 2010 School of Counseling and Education, University of Houston -Victoria. Victoria Hispanic Chamber of Commerce March 2002- Hispanic Educators that Make a Difference. Finalist for Enron's Teacher of the Year. University of Houston -Victoria. 1999, 2002, 2004, 2005, 2006. Cesar Chavez Centers Outstanding Hispanic Graduate Students- University of Northern Colorado. 1995-1996. Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C.R.S. Name Public Address Martin Kirk Munoz Brighton, CO 80601-4645 Credential Information License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date LPC.0005173 Endorsement Licensed Professional Counselor Active 02/05/2009 09/01/2015 08/31/2017 Board/Program Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 4/21/2017 2:21:46 PM SHELLEY -PAIZ 3549 Maple Circle, Brighton, Co. 80601 (720) 979-7444 Summary of Qualifications/Experience Psychotherapist • Certified Addictions Counselor III, State of Colorado, Department of Regulatory Agencies • Intake (DSM-IV-screening-and-orientation), treatment planning, client -education, -case management, computer based documentation • Multi -disciplinary team interaction with Parole and Probation Officers and Social Services Caseworkers • Provide Evidence Based Practices in group -and individual counseling -to -adults and -adolescents • Highly self -motivated, dependable, team player with a passion for being client focused • Accountable for all clinical documentation: group and progress notes, individual counseling, individualized treatment plans and -reviews, assessments, discharge plans and -summaries • Psychotherapist computer skills: DBH/TMS, Signal and CWISE Victim Advocacy • Initial outreach to Victims of Domestic Violence • Provide Services Per State Standards (DVOMB) Business Manager • Personnel management/supervision, leasing, office management, customer service, problem solving skills, competent in public relations, team oriented, ability to work in high-pressure environment, and results driven Recruiting, interviewing, hiring, training, and supervision of office and maintenance staff on property • Resolving tenant conflicts and complaints • Contracting and scheduling of maintenance including painting, carpet cleaning and installation • Worked closely with contractors and maintenance on rehabilitation of property • Coordinating eviction process with attorneys • Collecting rents, posting non-payment notices, and posting insufficient funds • -Coordinating office -operations -including telephones, computer entries, work orders, renewal leases, inquiries, resident file maintenance, and special mail deliveries • A/R, A/P, invoicing, payroll time sheets, monthly audits, and weekly, monthly, and year-end reports + Responsible for -monthly -owner report -and budget • Business Management computer sk₹lls: Microsoft Office (Word, Excel, Power Point), WordPerfect, AIvMSI, Rent Roll, Yardi IDEA Torun Denver, Aurora, Brighton -and Thornton Certified Addiction Counselor Brighton, Colorado 5280 Premier Solutions Owner/Self Employed Brighton, Colorado Remodel/Painting en Cleaning/Temporary Office Staffing Mile Hi Frozen Foods Denver, Colorado 1/2008-7-2008 Fleet Administrative Assistant Administrative assistant to the Accounting Department, responsible for registration of ninety -tractor trailer trucks, .and.ordering permits for -the state lines that the tractors travel -across. Lincoln Property Company Acacia Pointe Business Manager Bala Desertscape Business Manager The Legend at Kierland Business Manager Phoenix, Ariona Mesa, Arizona Scottsdale, Ariiona 8/2008 -Present 9/2008 -Present 10/2003 - 08/2005; 06/2006 - 11/2007 0512007-1112007 09120Z-0412007 0612006-09/2006 Villages at•Curti-Park Denver, -Colorado Business Manager/Tax Credit/Public Housing/Market/Lease Up McCormack Baron & Regan Matthew Henson Phoenix, Ari vna Business Manager/Tax Credit/Public Housing/Market/Lease Omni Property Company Peakview Lafayette, Colorado Business Manager/Tax Credit/Market -Garden -Center Denver, Colorado Business Manager/Tax Credit/Market Dorchester Park Denver, Colorado Assistant Community Manger/Accountant The Peaks of Green Mountain Denver, Colorado Community Manager Highland Village Denver, Colorado Assistant Community Manager Archon Management Services The Parkway Apartments Denver, Colorado Assistant Community Manager/Accountant Education 07/-1995 Up 1-0/2003-08/2005 09/2005 - 06/2006 -03/1998; 01/2000 _ 10/2003 01/2002-10/2003 071200.1- 01 /2002 0112000 - 07/2001 0611996 - 03/1998 07/1%5 - 06/1996 06/1998-01/2000 Odyssey Training Center Certified Addiction Counselorll7 University -Of Phoenix BA - Business Selena Business Management Degree Front Range Community College Other coursework: Real Estate 1993 12/2010 06/2011 0312008-612009 ALISON Page 1 of I Colorado The Official Stale web Portal Division of Registrations Back to your search results New Search Individual Information All Licensing Types Shelley Jean Paiz Address Brighton, CO 80601 License Number License Type License Status License Method License First Issued Last Renewal Date Last Expiration Date ACC -7117 Certified Addiction Counselor III Active Original February 25, 2011 September 01, 2011 August 31, 2013 Board or Program Actions No actions on file (Information about Program or Board Actionsi motek Return to Colorado Division of Registrations - Main Search Page Search for Company - All Licensing Types Search for Individuals - All Licensing Types View Registrations Online Documents Generated : 03119/12 3:28 pm Usage Statistics Privacy Statement I Disclaimer Technical Assistance: L. -Mail Information Technoloat Section Federal Home Page II State Home Page Department Home Page Contact the Division of Registrations 1560 Broadway, Suite 135O Denver, CO 8O2O2 (303) 894-7900 - Phone (303) 894-7693 - Fax Relay Colorado (TTY (English 8, Spanish), Voice, VCO, ASCII, STS Assistance Numbers) https: //www.doradls.state.co. us/alison.php?action=COMPDETA1L&ind=true&soboard=99... 3/19/2012 Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C.R.S. Name Public Address Shelley Jean Paiz Brighton, CO 80601-3431 Credential Information License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date ACC.0007117 Original Certified Addiction Counselor III Active 02/25/2011 09/01/2015 08/31/2017 Board/Program Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 4/21/2017 2:22:36 PM INNAEL T. MIRANDA Innaelni@ gmaiLcom 6891 Warren Dr, Denver, CO 80221 Cell (720) 670-7276 EDUCATION Cornell University, Ithaca, NY Cornell Institute of Public Affairs Masters of Public Administration, degree to be conferred in 2011 Concentration in International Economic Development Cornell (SPA Fellowship Recipient University of Minnesota, Minneapolis, MN College of Agriculture, Food, and Environmental Sciences Bachelor of Science in Food Science, December 2001 CAC III license number 7097 expires 8/31/11 WORK Grants Manager EXPERIENCE Sisten cfrotor Unttedfir ciication Supervisor: Belinda Garcia 303-446-8800 July 2009 — Present Salary: $43,950 Full Time Supervised 15 staff members working in several social service programs that provide a range of services including disease prevention, case management, treatment, and counseling. Analyze community health trends and report about them to the Executive Director and the staff. Write grants to renew or apply for program funding. Conducted presentations on health and nutrition for over 40 community participants, 20 of which were monolingual Spanish speakers. Conducted substance abuse treatment in both individual and group sessions while receiving CAC supervision. Project Manager BoMatdxetns C.erker for'Excp',len Denier, CO May 2008 - July 2009 Supervisor. Les ley Cabotie 720-865-2330 Salary: $45,000 Full Time Supervised a social service program that provides case management to clients of the Community Reentry Project. Services included job placement, emergency housing, and substance abuse counseling for over 100 clients coming out of the Denver County Jail. Conducted program intakes and coordinated treatment plans for substance abuse counseling and probation requirements while receiving CAC Supervision. Project Manager Mana xt Stars intenntional, Washington DC June 2007 -January 2008 Supervisor. Marina Fanning 202-4847170 Salary: $40,000 Full Time Managed contract requirements for three international development projects worth over $26 million in USAID grants. Coordinated with over 30 staff members to achieve the project goals. Projects involved restructuring the legal system in Mexico, providing financial and technical support for shelters that assist victims of trafficking in persons, and providing employment skills for adults. Traveled throughout Mexico to supervise the closeout of a project. Curriculum Specialist Sn' Sthool District 15-3, Wakpala, SD Supervisor. Susan Smit 605-845-3040 November 2002 — June 2003 Salary: $35,000 Full Time Assisted a culture and language expert in developing an interactive language and culture curriculum. Coordinated discussion sessions with language and culture experts to ensure accuracy. Created an interactive language and culture computer program, managed the program budget, and conducted internal program evaluations. The final product was an interactive CD -Rom game that teaches K-8 students Lakota Sioux vocabulary and traditional cultural values. Supervisor Carrunidades L atirras Unidas En Serriacq Mir ctpdis, MN July 2000 — Jime 2002 Supervisor. Jesse Gomez-Bethkey 651-379-4200 Salary $32,000 Full Time Social Program Management Supervised three mental health and case management programs for people with HIV/AIDS, a counseling and case management program for victims of domestic abuse, and • a child protection program. Managed budgets, conducted internal program assessments and evaluations, analyzed program evaluation results to suggest improvements, created reports, and wrote proposals for contract renewals with Hennepin and Cook counties in Minnesota My efforts helped secure over $250,000 in annual funding. Case Manager Provided one to one case management services in which I assisted clients in obtaining health care resources. Emphasi7Pd the role that proper nutrition plays in health and wellness of their families. Community Education Program Identified a need for computer training classes in Spanish for our Hispanic clients and made special arrangements with the (MO to host free computer training classes in Spanish on the weekends. Consequently, I trained 22 Spanish speaking clients on how to operate a computer and how to use Microsoft Word and ExceL LANGUAGES Proficient in speaking reading and writing English and Spanish REFERENCES Belinda Garcia Executive Director SOCUE 303-116-8800 Marina Fanning Vice President MSI 202-484-7170 Jesse Gornez-Bethkey President CLUES 651-379-4200 Maria Marino Former Director for Healthy Kids 218-333-8989 ALISON Page lofI Color ado The Official State Web Portal Division of Registrations Back to your search results New Search Individual Information All Licensing Types Innael Todd Miranda Address Denver, CO 80221 License Number License Type License Status License Method License First Issued Last Renewal Date Last Expiration Date ACC -7097 Certified Addiction Counselor Ill Active Original January 21, 2011 September 01, 2011 August 31, 2013 Board or Program Actions No actions on file (Information about Program or Board Actionsl Return to Colorado Division of Registrations - Main Search Page Search for Company - All Licensing Types Search for Individuals - All Licensing Types View Registrations Online Documents Generated : 03/19/12 324 pm Usage Statistics Privacy Statement I Disclaimer Technical Assistance: E -1 ai1 information Technology Section Federal Home Page II State Home Page It Department Home Page Contact the Division of Registrations 1560 Broadway, Suite 1350 Denver, CO 80202 (303) 894-7800 - Phone (303) 894-7693 - Fax Relay Colorado (TTY (English & Spanish), Voice, VCO, ASCII, STS Assistance Numbers) https://www. doradls.state, co.us/alison.php?action=COMPDETAIL&ind=true&soboard=99... 3/19/2012 Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C.R.S. Name Public Address Innael Todd Miranda Denver, CO 80221-2583 Credential Information License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date ACC.0007097 Original Certified Addiction Counselor III Active 01/21/2011 09/01/2015 08/31/2017 Board/Program Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 4/21/2017 2:24:31 PM 301 E. Malley Drive # 359, Northglenn Colorado 80233°720-885-7497■mhetnandez@1deacares.com Margaret Hernandez Strengths Motivated, personable professional with multiple college degrees. Diplomatic and tactful with professionals and non-professionals at all levels. Accustomed to handling sensitive, confidential records. Poised and competent with demonstrated ability to easily transcend cultural differences. Thrive in deadline -driven environments. Excellent team -building skills. Experience 2006 -Present Counselor • Conduct Domestic Violence treatment sessions for court ordered clients ■ Administer intakes, orientations and evaluations ■ Maintain client records 1993-2001 Special Education Teacher ■ Assessment of students with mild/moderate learning disabilities. ■ Prepare and implement Individualized Educational Plans. ■ Adapt and modify current curriculums to meet the needs of students with educational and emotional needs. IDEA Denver CO 1988-1993 Substitute Teacher • Coverage for contract teachers when unable to attend -varying subject areas. • Long-term substitute coverage when contract teachers were absent for more than two weeks Boulder Valley Schools Boulder, CO Education 1992-1993 1978-1980 Five Star Schools -District 12 Thornton, CO University of Colorado at Denver Denver, CO University of Colorado at Boulder Boulder CO Master of Art- Special Education Bachelor of Science in Education Certificates Certified Addictions Counselor I Approved Domestic Violence Treatment Provider References References are available on request. ALISON Page 1 of I Colorado The Official State Web Peal Division of Registrations Back to your search results New Search Margaret E Hernandez Address License Number License Type License Status License Method License First Issued Last Renewal Date Last Expiration Date Individual Information All Licensing Types Northglenn, CO 80233 ACA -6718 Certified Addiction Counselor I Active Original October 25, 2010 September 01, 2011 August 31, 2013 Board or Program Actions No actions on file (Information about Program or Board Actions) Return to Colorado Division of Registrations - Main Search Page Search for Company - All Licensing Types Search for individuals - All Licensing Types View Registrations Online Documents Generated : 03122/12 1:55 pm Usage Statistics Privacy Statement l Disclaimer Technical Assistance: E -Mail Information Technology Section Federal Home Page it State Home Page Ii Department Home Page Contact the Division of Registrations 1560 Broadway, Suite 1350 Denver, CO 80202 (303) 994-7800- Phone (303) 894-7693 - Fax Relay Colorado (TTY (English & Spanish), Voice, VCO, ASCII, STS Assistance Numbers) ttts.i/www.doradls.state.co.us/alison.php?action=CO1v DETAIL&ind=trtke&soboard=99.., 3/22/2012 COLORADO DOMESTIC VIOLENCE OFFENDER MANAGEMENT BOARD Department of Public Safety Division of Criminal Justice 700 Kipling Street, Suite 1000 Denver, CO 80215 303-239-4442 Fax:303-299-1491 March 15, 2011 Margaret E. Hernandez IDEA 2560 W. 20th Avenue Denver, CO 80211 • Dear Ms. Hernandez: The Application Review Committee (Committee) has completed its review of your Entry Level application for placement on the Approved Provider List. The Committee determined that you have met all the requirements for Approved Providers and as of March 10, 2011, you are an Entry Level Approved Provider for Court Ordered Domestic Violence Offender Treatment with a specialty of working with female offenders in Colorado. Entry Level Approved Providers are eligible to treat domestic violence offenders according to the Standards for Treatment with Court Ordered Domestic Violence Offenders (Standards) anywhere in the state of Colorado. During the review of your application materials, the ARC noted the evaluations did not have the date of when they took place. Please make sure that all future evaluations and/or treatment plan documents must identify the date they took place. Please note if you would like to provide domestic violence treatment for same sex offender populations, please make sure you meet all criteria identified in Standard 10.0, and provide documentation as outlined in Standard 10.02 a & b. All Specific Offender Population Applications can be found on our website: http://dcj.state.co.us/odvsom Click on applications then go to specific offender population where you will find all the required documentation to submit to the Application Review Committee for Approval. This letter will serve as evidence that you are on the Approved Provider List as an Entry Level Provider to work with male court -ordered offenders as well as having a specialty of working with female offenders. Please note all Entry Level Providers, both "licensed and unlicensed Approved Providers are required to have clinical supervision..." Refer to Standard 9.01 V A & B for details. COLORADO DOMESTIC VIOLENCE OFFENDER MANAGEMENT BOARD Department of'Public Safety Division of Criminal Justice 700 Kipling Street, Suite 1000 Denver, CO 80215 503-2'39-4442 Fax 303-239-4491 Please notify our office of your business address, phone, county and judicial district where you will be working. We have enclosed a questionnaire for your convenience. Please let us know if you have not yet received a copy of the current Standards, so that we may mail you a copy. Please feel free to call me with any questions you may have now or in the future. Sincerely, Debbie Stjernholm, LPC, CAC II, EAP Application Review Coordinator, 303-239-4536 or Debbie.stjernholm@cdps.state.co.us Enclosure: Questionnaire Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C. Name Public Address Margaret Elizabeth Hernandez Thornton, CO 80229-5633 ation License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date ACB.0008164 Original Certified Addiction Counselor II Active 03/06/2017 03/06/2017 08/31/2017 Board/Program Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 4/21/2017 2:24:56 PM JUN 30 1999 08:23 FR GUEST 3037079623 TO 93034771369 P.02 YV'ONNE E. SALDANA 5875 Sanchez Drive Colorado Spring, CO 80923 Cell (719) 320-2925 e-mail:ysaldan@qwest.com SUMMARY OF QUALIFICATIONS .Enjoy working with people of all levels and roles .Enthusiastic, creative and willing to assume increased responsibility .Ability to adapt quickly to challenges and changing environments Energetic, positive and self -motivated .Strong customer service and people skills .Personable, articulate and professional EDUCATION Bachelor of Science, Business Administration, Regis University Bachelor of Social Work, Colorado State University EXPERIENCE October 2004 — Present Ideas Directed to Eliminate Abuse (IDEA) Denver CO Co -Facilitate Level II Education and Therapy groups for DUI. Adults Complete necessary documentation for client, contact Probation Officers and complete Client discharges. Co -Facilitate Adult Men, Domestic Violence groups Complete necessary documentation and progress notes May 2004 — October 2004 Counselor, Emily Griffith's Canyon Lodge, Internship Monitored S behaviorally challenged adolescents and completed daily paperwork regarding point levels for behavior. Interacted with youth using behavior modification Strategies to learn other approaches for dealing with anger and solving problems. Counseled individuals regarding fighting, not participating, not following rules, family issues and depressing, March 1995 — September 1999 Counselor, Pueblo Suicide Prevention Line Counsel community callers. Many just needed to be listened to. Refer callers to community agencies and 911 if caller was suicidal. August 1996 — October 1996 Co -facilitate, YWCA Women's Shelter Co -facilitate Women's groups in Domestic Violence ALISON Page 1 of 1 Colorado The Official Stale Web Portal division of Registrations Back to your search results New Search Individual Information All Licensing Types Yvonne Euginia Saldana Address License Number License Type License Status License Method License First Issued Last Renewal Date Last Expiration Date Board or Program Actions Colorado Springs, CO 80923 ACC -6809 Certified Addiction Counselor III Active Original August 20, 2009 September 01, 2011 August 31, 2013 No actions on file (information about Program or Board Actions) Return to Colorado Division of Registrations - Main Search Page Search for Company - All Licensing Types Search for Individuals - All Licensing Types View Registrations Online Documents Generated : 03/19/12 3:43 pm Usage Statistics Privacy Statement l Disclaimer Technical Assistance: E -Mail Information Technology Section Index Search Federal Home Page II State Home Page II Department Home Page Contact the Division of Registrations 156O Broadway, Suite 135O Denver, CO 8O2O2 (303) 894-7800 - Phone {303) 894-7693 - Fax Relay Colorado {TTY (Eng€ish & Spanish), Voice, VCO, ASCII, STS Assistance Numbers) https://vr ,rw.doradls.state.co.usialison.php?action—COMPDETAI ,&ind=true&soboard-99.., 3/19/2012 COLORADO DOMESTIC VIOLENCE OFFENDER MANAGEMENT BOARD Department of Public Safety Division of Criminal Justice 700 Kipling Street, Suite 1000 Denver, CO 809.15 Tel 303-239-444.2 Fax 503-239-44.91 April 5, 2011 Yvonne Saldana, CAC II IDEA @ Denver 2560 W. 29th Avenue Denver, CO 80211 Dear Ms. Saldana: The Application Review Committee (Committee) of the Domestic Violence Offender Management Board has completed its review of your Renewal for Continued Placement on the Approved Provider List. The Committee determined that you have met all the requirements and therefore you will maintain your Listing as an Approved Provider with a specialty of working with female and same -sex domestic violence offenders for Court Ordered Domestic Violence Treatment in Colorado. Because the Renewal process is now every two years, your continuing education requirements will be 28 hours every two years. All providers will renew again in February of 2013. We appreciate your continued dedication to this work. Sincerely, Debbie Stjernholm, LPC, CAC II, BAP Application Review Coordinator 303-239-4536 Debbie.Stjemhohn@cdps.state.co.us JUN 30 1999 08:23 FR QWEST 3037079523 TO 93034771369 P.03 GOALS March 2007 complete all paper work for CAC I June 2007 complete all classes for DV certification September 2007 Inquire and visit Master level schools Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C.R.S. Name Public Address Yvonne Euginia Saldana Colorado Springs, CO 80923-7636 Credential Information License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date ACC.0006809 Original Certified Addiction Counselor III Active 08/20/2009 09/01/2015 08/31/2017 Board/Program Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 4/21/2017 2:25:28 PM Ira Slotkin MSW, MA, CACII 3322 Vallejo Street Denver, CO 80211 (720) 855-9232 email: iraslotkin@hotmail.com Direct Service Expertise Drug and Alcohol Treatment counseling Domestic Violence Treatment counseling Treatment Intakes and Assessments Research Interviewing Grief counseling - pet loss specialist Family assessments Vocational assessment and counseling Management and Communication Skills Contract Compliance monitoring Hiring, training, supervising staff Workshop development and presentation Project monitoring and evaluation Project design and implementation Grant/RFP preparation and evaluation Published essayist, columnist, poet Professional Employment History Drug, Alcohol, Domestic Violence Treatment Counselor IDEA of Denver, Brighton, Aurora, CO Family Assessment Worker/Program Case. Manager II Department of Human Services, City and County of Denver, CO Field Interviewer (Temporary) 1998 Denver Youth Survey, University of Colorado, Boulder, CO 1997 National Longitudinal Survey of Youth (CO), University of Chicago, IL Senior Survey Interviewer Colorado Consumer Outcome Project, University of California- Berkeley, CA Employment Training Representative The Training Advantage, Delta, CO Contract Compliance Specialist Human Services/Conservation Services Departments, City of Austin, TX Program Monitor Texas Commission on Alcohol and Drug Abuse, Austin, TX Director of Development Humane Society of Austin and Travis County, Austin, TX Project Manager MeJames and Company, Austin, TX Employment Program Manager Austin Area Urban League, Austin, TX Employment Program Monitor St. Louis Agency on Training and Employment, St. Louis, MO Education MSW — Washington University 1980 MA Ed — Washington University 1980 BA — Webster College 1977 11/01 — Present 8/98 — 12/99 3/98 — 8/98 1/97 -- 6/97 3/95 -- 3/98 9/93 — 3/95 7/89 — 7/93 8/87 — 5/88 7/85 — 5/87 12/84 — 5/85 4/81 —12/84 5/77 — 5/78 Ira Slotkin MSW, MA, CACTI 3322 Vallejo Street Denver, CO 80211 (720) 855-9232 email: iraslotkin@hotmail.com PROFESSIONAL EXPERIENCE Drug/Alcohol/Domestic Violence Treatment Counselor (Contractor) 11/01 — Present IDEA of Denver, Brighton, Aurora, CO Facilitate treatment groups as well as conduct intakes, assessments, evaluations, treatment planning, and case management for clients referred by the criminal justice system for alcohol, drug, and domestic violence offenses. Maintain case records in accordance with legal, licensure and professional standards; represent agency at task force and coalition meetings; develop and revise agency policies and procedures; train new staff as needed. Case Manager II (Contractor) 8/98 —12/99 Department of Human Services, City and County of Denver, CO Vocational, educational, psycho -social assessment for teen-age and two -parent families applying for cash assistance. Presented orientations; determined eligibility, family circumstances, and barriers to self sufficiency; negotiated individualized service plans; made referrals to internal and external supportive services and training; monitored progress; maintained case files. Field Interviewer (Temporary) 3/98 — 8/98 Denver Youth Survey, University of Colorado, Boulder, CO Conducted computerized, in -home interviews with 150 participants in longitudinal survey of at - risk youth. Located participants; obtained consent/converted refusals; conducted interviews within confidentiality/reliability parameters; maintained search, contact and payment records. Senior Survey Interviewer 3/95 — 3/98 Colorado Consumer Outcome Project - University of California, Berkeley, CA Research interviewer for 3 -year study of indigent, severely mentally ill in Colorado. Completed 600+ comprehensive, standardized psychological evaluations with caseload of 160 participants. Located and tracked clients, maintained contact and rapport over several years, maintained inter - rater reliability, edited project surveys for consistency and completeness, traveled statewide. Employment Training Representative 9/93 -- 3/95 The Training Advantage, Delta CO Provided vocational, educational and personal assessment and counseling for adults and youth participating in federally funded employment and training program ()TPA). Conducted assessment interviews; administered and interpreted interest, aptitude and basic skills tests; developed individualized employment plans; prepared and presented job readiness and job search classes; identified and addressed supportive service needs. Contract Compliance Specialist 7/89 — 7/93 Health and Human Services Department, City of Austin, 1X Environmental and Conservation Services Department, City of Austin, TX Researched, wrote, issued, and evaluated proposals, solicitations, grants and contracts. Assisted multiple divisions in developing and implementing contracts for services and commodities; coordinated evaluation teams; monitored expenditures; cited deficiencies and recommended corrective actions; ensured minority business participation; developed ADA compliance plans. Program Monitor 8/87 — 5/88 Texas Commission on Alcohol and Drug Abuse, Austin, TX Monitored contractors' program and administrative compliance with contracts for treatment, prevention, and early intervention. Traveled statewide, reviewed case files and program records; prepared monitoring reports; cited deficiencies and recommended corrective actions; developed evaluation instruments. Director of Development 7/85 — 5/87 Humane Society of Austin and Travis County Directed grant writing, membership development, public speaking and capital campaign. Designed, implemented and supervised computerization of contributor database and solicitation records; authored numerous funded grants; increased individual and business membership. Assisted in the development of volunteer training program. Project Manager 12/84 — 6/85 McJames and Company, Austin, TX Managed federally funded employment program targeting chronically unemployed disabled adults, and single mothers. Supervised staff (4); monitored progress toward contractual goals; prepared and presented reports to board and funding sources; authorized expenditures. Employment Program Specialist 4/81-12/84 Austin Area Urban League, Austin, TX Directed operations of federally funded employment and training services. Developed program designs; authored local and federally funded grant applications; hired, trained and supervised staff (8 — 15); ensured compliance with contractual requirements; reported to funding sources. Program Monitor 5/77 — 5/78 St. Louis Agency on Training and Employment Reviewed and evaluated programmatic and administrative performance of contractors offering employment, training, and supportive services to participants in job training programs targeting economically disadvantaged and minority populations. Work Training Specialist 8/74 — 5/75 Human Development Corporation, St. Louis MO Case worker for employment program offering education and work experience to poorly educated and chronically unemployed participants. Conducted assessment; developed service plans; monitored performance; conducted interviews and site visits; maintained case records. Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C.R.S. Name Public Address Ira Charles Slotkin 2560 W 29th Ave Idea Denver, CO 80211-3712 Credential Information License Number License MethodStatus License Type License Original Issue Date Effective Date Expiration Date ACB.0006109 Original Certified Addiction Counselor II Active 01/29/2004 09/01/2015 08/31/2017 Board/Program Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 4/21/2017 2:25:50 PM Frank Clavijo, Ph. D. Certified Addiction Counselor, G.A.C. III 1420 W. 71St Place, 106, CO 80221 720-839-7196 / 303-428-2479 fclavi icu aol.corri Summary of Qualifications Provide quality case management and psychotherapeutic services to adults, adolescents, and children. r Conduct psychosocial assessment to document history, identify primary issues for treatment focus group and family process - treatment focus, and provide group and family process -oriented therapies using various professional treatment modalities. r Assess family and community resources to meet client's after -care needs. • Develop and coordinate individualized plans. ✓ Dedicated to understand of "how the system works" and to effectively work within that system. ➢ Coordinate meetings and present program and daily outpatient service information to hospital staff, physicians and treatment centers throughout the state for referrals. r Conduct support group for sexual assault survivors and domestic and sexual violence. Conduct groups for information and training in alcohol/drugs and HIV/AIDS. Areas of Expertise ✓ Patient Care ✓ Patient Relations ✓ Polices and Procedures ✓ Medical Documentation ✓ Counseling ✓ Case Management V Psychosocial Assessment ✓ Problem Solving Education Bachelor degree in Psychology and Licensing of Psychology ✓ "San Martin de Porres University", Lima- Peru 1981-1987 r Master of Psychology ✓ "Inca Garcilaso de la Vega University", Lima -Peru 1990-1992 • Doctorate of Psychology ✓ "San Martin de Porres University", Lima- Peru 1995-1997 • The English Language Center ✓ "Brigham Young University", Utah 2002-2003 • Health Services Management ✓- "Broward Community College", Florida 2003-2004 Counselor Training Programs ✓ "Denver Health", Denver, CO 2004-2005 d Driving with Care Alcohol and Drug; Education and Tto. ✓ "Center for Impaired Driving Research", Golden, CO 2005 Professional Experience IDEA, Ideas Directed ® Eliminating Abuse, Denver, Aurora and Brighton, CO ✓ Counselor in alcohol and drugs ✓ Counselor in Domestic Violence ✓ Alcohol and Drug Evaluator ✓ Mental Health Evaluator r Nurse Core, Denver, CO ✓ Home Care Service Provider Crossroads Assisted Living, Northglenn, CO ✓ Qualified Medication Administration Person American Red Cross, Fort Lauderdale, H ✓ Volunteer for HIV/AIDS program 2005 -Present 2005 -Present 2004-2006 2003-2004 Ministry of Women and Human bevelopment, Peru 1997-2002 As Minister Advisor & Psychologist: ✓ Assessed and referred children, adolescents, and adults for heath services. ✓ Conducted psychosocial assessments, document history, current symptoms and acute needs for treatment. ✓ Conducted therapeutic and educational group and individual sessions. ✓ Assessed and referred children and adults for domestic and sexual violence. ✓ Assessed and referred adolescents and adults for drug and alcohol abuse. Peruvian Institute on Parental Responsibilities, 1990-2002 As project coordinator and psychologist: ✓ Work on reproductive health and population. ✓ Coordinator for the Office of Information & Education for the institute. ✓ Conducted individual, group, and family counseling. ✓ Conducted individual home visits as a tool to assess and advocate parental involvement. ✓ Trained staff on the developmental stages of childhood and the impact of sexual abuse on a child's life. > Private Practice 1992 -Present As counselor: ✓ Counselor in couple therapy and sexual counseling. ✓ Counselor in alcohol and drugs. ✓ Counselor in Mental Health. Radio and Newspaper Specialist ✓ Currently write articles for two newspapers: "El Comercio" Colorado and "Mundo Hispano" - Utah. ✓ Currently a weekly guest on radio station 1150 AM "La Buena Onda", Denver, Colorado. Skills ✓ Spanish and English speaker and writer. ✓ Computer programs such as Windows, Office XP Professional, Internet, Photo Suite, Studio Version and others. References ✓ Marcelo Paiz, Director at IDEA3O3-477-828O ✓ Kay Lorenz -Love, Director at Crossroads 303-457-2395 ✓ Jamaica Shackton, RN at Nurse Core 303-691-3500 ✓ Blanca Molina, Radio 1150, La nueva Onda303-293-5695 ✓ Eva Tejeda, El Comercio de Colorado ............ ✓ Patricia Quijano, Mundo Hispano801-569-3338 Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C.R.S. Name Public Address Frank Clavijo Lakewood, CO 80226-8106 License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date ACC.0006304 Original Certified Addiction Counselor III Active 07/21/2005 09/01/2015 08/31/2017 Bo -- ----a- Case Number Public Action Resolution Effective Date Completed Date 2010-4715 CLS Letter of Admonition Letter of Admonition 06/21/2011 Online Documents IMPORTANT NOTICE: All available online documents are accessible through our DPO Public Documents System. To view, click the link(s) below to access the Documents System. Once there you may enter the licensee name or license number to complete the search. All public documents related to the licensee will be visible upon completion of the search. If you have any questions or further issues, please contact us at dora_dpo_onlinelicenses@state.co.us. Link Unique ID Number DocType DocSource DPO Public 202672 HPPP-CO PUBLIC DISCIPLINARY ACTION IMAGE Documents Generated on: 4/21/2017 2:26:18 PM MARCELA MARIA PAIZ Bachelor of Science Human Services — Magna Cum Laude Colorado Certified Addictions Counselor III Certified Trauma Professional — Prevention Specialist 303-257-1450 mpaiz@ideacares.com PROFESSIONAL EXPERIENCE IDEA Forum, Inc (DBA IDEA) IDEAS Directed @ Eliminating Abuse — Denver, CO. 1995- Present Owner/CEO - Psychotherapist ✓ Established an outpatient facility in Denver 1995, expanded to Aurora 2000, Brighton 2003, and Thornton 2007 to provide substance abuse and domestic violence treatment and services directed at eliminating all forms of abuse. ✓ Created with continuous maintenance, a holistic approach to organizational success by creating a positive, supportive, and constructive environment for internal staff and external partners. ✓ Facilitate and oversee formulation and administration of policies and procedures, ensuring organizational compliance with government and licensing regulations. ✓ Manage and direct resource expansion, program development and implementation, project and fiscal management and overall operations. ✓ Develop contracts for treatment referrals with federal, state and county agencies. ✓ Created and implemented client records management and reporting systems. ✓ Recruit, interview, hire, train, and supervise counseling and administrative staff. ✓ Deliver services linguistically and culturally appropriate for underserved populations and communities. ✓ Plan, schedule, and direct Clinical Supervision. ✓ Administer and complete clinical evaluations. V Provide evidence based, trauma informed care and psychotherapy to individuals and families. ✓ Implement and evaluate services and tools for monitored sobriety. ✓ Establish and maintain relationships with community based organizations for collaboration in providing resources, wrap around services. Coors Brewing Company — Golden. CO 1984 - 1995 ✓ Manager, Guest Relations — Marketing Division 1993 - 1995 ✓ Senior Employment Representative, Human Resources Division 1986 - 1993 ✓ Inventory Analyst/Critical Materials — Purchasing Division 1984 - 1986 Valleylab, Inc, - Boulder, CO 1981-1982 V. Senior Recruiter / Employee Relations Representative Community Involvement 1973- Present: Co-founder and member of several organizations committed to eliminate racism and discrimination, specific focus on minority populations, women, and LGBTQ. Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C.R.S. Credential Information License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date ACC.0004855 Original Certified Addiction Counselor III Active 04/10/1999 09/01/2015 08/31/2017 Name Public Address Marcela M Paiz Thornton, CO 80229 Board/Prot ram Actions Case Number Public Action Resolution Effective Date Completed Date 2008-2346 CLS Letter of Admonition Letter of Admonition 06/03/2008 2011-3 CLS Letter of Admonition Letter of Admonition 06/21/2011 M2007-2615 Letter of Admonition Letter of Admonition 10/31/2007 Online Documents IMPORTANT NOTICE: All available online documents are accessible through our DPO Public Documents System. To view, click the link(s) below to access the Documents System. Once there you may enter the licensee name or license number to complete the search. All public documents related to the licensee will be visible upon completion of the search. If you have any questions or further issues, please contact us at dora_dpo_onlinelicenses@state.co.us. Link Unique ID Number DocType DocSource DPO Public 32298 HPPP-CO PUBLIC DISCIPLINARY ACTION IMAGE Documents DPO Public 35946 I PPP -CO PUBLIC DISCIPLINARY ACTION IMAGE Documents Link Unique ID Number DocType DocSource DP0 Public 202651 HIPPP-CO PUBLIC DISCIPLINARY ACTION IMAGE Documents Generated on: 4/21/2017 3:09:49 PM Weld County Fee Schedule IDEA Denver 2560 West 29th Avenue Denver, Colorado 80211 Ph: 303.477.8280 Fx: 303.477.1369 denverfd@ideacares.com Services in English, Spanish, and Vietnamese Department of Corrections Approved Treatment Provider (ATP) Medicaid Approved, Sliding Fee Scale NO INTAKE FEE - CREDIT CARDS ACCEPTED IDEA Aurora 14311 East 4th Avenue Aurora, Colorado 80011 Ph: 720.949.0095 Fx: 720.949.2005 aurorafd@ideacares.com Counseling Services DV Intake Evaluation and First Session DUI/ATOD Orientation and First Session Monitored Sobriety Orientation DV Group Group Therapy Individual Therapy Youth Group Therapy Youth Individual Therapy Family Therapy LV I Education Minor in Possession (MIP) EMDR Parenting -One Day Intensive Partners in Parenting After Divorce Monitored Sobriety UA 7 Panel + EtG UA Steroids BA Swab Test Antabuse (Tx Clients) Antabuse Only Hair Test Evaluations Adult/Youth ATOD Evaluation Anger Management Evaluation Fee $67 $40 $25 $35 $35 $65 $30 $45 $65 $175 $120 $80 $80 $50 Fee $17 $165 $10 $17 No Fee $50/Month $50 ree $125 $125 Brighton 83 North 4th Avenue Brighton, Colorado 80601 Ph: 303.659.9440 Fx: 303.659.9430 brightonfd@ideacares.com Thornton 9150B North Washington Street Thornton, Colorado 80229 Ph: 303.996.9966 Fx: 303.996.9954 thorntonfd@ideacares.com Books/Manuals Evidence Based Practices (Purchase required at the time of first session) DUI • Impaired Driver Education Program • Impaired Driver Therapy Program • Interlock Enhancement Counseling Trauma Informed Care • Matrix • Seeking Safety Manual • Helping Men Recover • Dialectical Behavior Therapy • Strategies for Self -Improvement and Change • Moral Reconation Therapy (MRT) • Anger Management: Substance Abuse and Mental Health • The Parent's Handbook Walk In/One Time $17 $200 $10 $17 $ 70 Employer Referral / Out Of State Client $300 $200 V-09/20/2016 IDEA Charting a New Course: For more information about our services visit www.ideacares.com Services Offered In English, Spanish, and Vietnamese IDEAA NO INTAKE FEE - CREDIT CARDS ACCEPTED -,.,.,,...GC I Walk-ins welcome DUI Education & Therapy • Level I Education • Level II Education • Level II Therapy (Track A,B,C,D) • Interlock Enhancement Counseling • DUI for Underage Drinkers Substance Use Disorder Treatment • Intensive Outpatient Treatment (IOP) • Relapse Prevention • Recovery Planning • Cognitive Therapy • Smoking Cessation Domestic Violence • Domestic Violence Treatment • Dating Violence • Male/Female/LGBT General Treatment • Anger Management • Adult Responsibility • Victim Empathy • Parenting • Life Skills Adolescent Programs • DUI for Underage Drinkers • Adolescent Domestic Violence • Alcohol and Drug Treatment • Minor in Possession (MIP) • Life Skills Monitored Sobriety • Urinalysis • Breathalyzer • Antabuse • Swab • Hair Test Evaluations • Alcohol and Drug • Domestic Violence • Anger Management Denver 2560 West 29th Avenue Denver, Colorado 80211 Ph: 303.477.8280 Fx: 303.477.1369 denverfd@ideacares.com V-09/2012016 IDEA Charting Aurora 14311 East 4th Avenue Aurora, Colorado 80011 Ph: 720.949.0095 Fx: 720.949.2005 aurorafd@ideacares.com a New Course: For more Office Hours Monday -Thursday 9:00am-9:00pm Friday 9:00am-7:00pm Saturday 9:00am-1:00pm Medicaid Approved (If Medically Necessary) • Evaluations (SUD Only) • SUD/DUI TX Group Counseling • Behavioral Health Counseling and Therapy Evidence Based Practices (Book Purchase Required) • Driving With Care (DWC) • IDEP • Interlock Enhancement Counseling • Matrix Model • Seeking Safety • Helping Men Recover • Solution Focused Tx • Criminal Conduct & Substance Abuse Tx Strategies for Self Improvement and Change • Pathways to Self -Discovery & Change: Criminal Conduct & Substance Abuse Tx for Adolescents • Dialectical Behavioral Therapy (DBT) • Eye Movement Desensitization & Reprocessing (EMDR) • Moral Reconation Therapy (MRT) IDEA/Providers licensed or approved by: Colorado Department of Human Services Office of Behavioral Health (OBH) http.//www.cdhs.state.co.us/adaa, Department of Corrections (DOC) Approved Treatment Provider (ATP) nttp.//www.doc.state.co.us Domestic Violence Offender Management Board (DVOMB) http.i/dcl.state.co.us/odvsomidomestic violence/index.html OBH Licensed: Outpatient/Enhanced/Intensive Treatment • General Services • Level I DUI Education • Level II DUI Education & Therapy • Offender Education & Treatment (Non -DUI) • Services to Child Welfare Clients • Treatment Program Specific to Minors • Treatment Program Specific to Women • Involuntary Commitment IDEA- Brighton 83 North 4th Avenue Brighton, Colorado 80601 Ph: 303.659.9440 Fx: 303.659.9430 brightonfd@ideacares.com information about our services IDEA Thornton 9150B North Washington Street Thornton, Colorado 80229 Ph: 303.996.9966 Fx: 303.996.9954 thorntonfd@ideacares.com visit www.ideacares.com EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Anger Management Evaluation and Treatment, Domestic Violence Evaluation and Treatment, and Monitored Sobriety Services. 2. Anger Management Evaluation and Treatment, and Domestic Violence Evaluation and Treatment: a. Contractor will provide treatment as mandated by the current Colorado Domestic Violence Offender Management (DVOMB) Standards. b. Completion of Domestic Violence treatment is solely determined by gaining and demonstrating competencies established by the DVOMB to reduce level of risk and need. c. Contractor has approved Domestic Violence Treatment providers on staff including staff approved to work with female offenders. d. Contractor is a licensed provider sensitive to multicultural issues and can provide all services in both English and Spanish. 3. Monitored Sobriety Services: a. Contractor will provide timely and quality monitored sobriety services to adult and adolescent clients, both male and female, referred by the Department, as follows: b. Services are available in Denver, Aurora, Brighton and Thornton, CO. Hours of service for all sites are Monday through Thursday, 9 a.m.-9 p.m.; Friday, 9 a.m.-7 p.m.; Saturday, 9 a.m.-1 p.m. c. Contractor will provide qualified monitored sobriety collectors. d. Contractor is a licensed provider sensitive to multicultural issues and can provide all services in both English and Spanish. e. Contractor will confirm all positive and negative Breathalyzer monitored sobriety results within 24 hours through a phone call, test result, e-mail and/or fax to the referring caseworker. f. Contractor will confirm all positive and negative laboratory Urinalysis results will be confirmed once processing has occurred through Redwood Toxicology (usually within three days). Confirmation will occur through a phone call, test result, e-mail and/or fax to the referring caseworker. g. Contractor will report all positive and negative Instant Urinalysis results within 24 hours. If the result is positive, it will be sent to Redwood for final confirmation. Confirmation will occur through a phone call, test result, e-mail and/or fax to the referring caseworker. h. Contractor will submit a copy of the valid Authorization for Services form, result and client sign -in sheet (if applicable) with each monthly billing. i. All processed (laboratory) test results will be available online 24 hours per day, seven (7) days per week online at Sentry Norchem (https://sentrv.norchemlab.com). 1 4. 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. 5. 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. 6. 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. 7. 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. 8. 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. 9. 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 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 Anger Management/Domestic Violence: $67.00/Episode (Domestic Violence Intake, Evaluation and First Session) $35.00/Episode (Domestic Violence Group) $35.00/Episode (Standard Group Therapy) $65.00/Episode (Individual Therapy) $30.00/Episode (Youth Group Therapy) $45.00/Episode (Youth Individual Therapy) $65.00/Episode (Family Therapy) $80.00/Episode (Eye Movement Desensitization and Reprocessing-EMDR) $125.00/Episode (Anger Management Evaluation) Monitored Sobriety Services: $17.00/Episode (Urinalysis— 7 Panel with EtG) $165.00/Episode (Urinalysis — Steroids) $10.00/Episode (Breathalyzer) $15.00/Episode (Swab Test) $50.00/Episode (Hair Test) 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 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher, and signed monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. b. For one-time services, proof of services rendered shall be receipt of the completed product. c. For Monitored Sobriety services, proof of services rendered shall be the test result. 2 ACOR�� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 8/10/2017 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 SterlingRisk 135 Crossways Park Drive P.O. Box 9017 Woodbury NY 11797 CONTACT NAME: PHONE 800-735-1588 FAX 888-290-0302 (A/C Nn FYI)' IA/C. Nol: -MAg- SelectCertRequests@sterlingrisk.com AnnRFq @ 9SelectCertRe risk.com INSURER(S) AFFORDING COVERAGE NAIC S INSURERA:Granite State Insurance Company 23809 INSURED IDEAF-1 Idea Forum, Inc. 2560 W. 29th Avenue Denver CO 80211 INSURER B :Beazley Insurance Company, Inc. 37540 INSURER C: INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1109329151 IS THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT'MTHSTANDING 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 LIR TYPE OF INSURANCE ADOL INSO SUBR WVO POLICY NUMBER POLICY EFF IMMIDD!YYYY) POLICY EXP IMM/ODIYYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY Y 02LX00738386811 8/14/2017 8/14/2018 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $5,000 MED EXP (Any one person) 5100,000 PERSONAL & ADV INJURY $1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO - JECT EC PER: LOC GENERAL AGGREGATE $3,000,000 PRODUCTS - COMP/OP AGG $1,000,000 S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED - SCHEDULED AUTOS NON -OWNED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE (Per accident) $ S UMBRELLA LIAB EXCESS LIAB O OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S DED I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y I N' N / A I PER4 + I 1 ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMU S A Professional Liability 02LX00738386811 8/14/2017 8/14/2018 Occurence $1,000,000 Aggregate $3,000,000 Cyber-Aggregate $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As required by written contract, The C.ty and Weld County Department of Human Services, its elected and appointed off)cials,empioyees and volunteers are included as additional insureds, as respects to Commercial General Liability ABUSE AND MOLESTATION ENDORSEMENT - CLAIMS MADE Limits of Insurance: $100,000 Each Incident Limit, $100,000 Aggregate Limit Retroactive Date: 8-14-2004 CERTIFICATE HOLDER CANCELLATION Weld County Department of Human Services 315 North 11th Ave Greeley CO 80601 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) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Hello