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Home My WebLink About20183920.tiffRESOLUTION RE: APPROVE AGREEMENT FOR CHILD PROTECTION SERVICES AND AUTHORIZE CHAIR TO SIGN - NOCO BEHAVIORAL HEALTH, LLC 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 NOCO Behavioral Health, LLC, commencing September 1, 2018, and ending May 31, 2019, 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 NOCO Behavioral Health, LLC, be and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair 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 5th day of December, A.D., 2018, nunc pro tunc September 1, 2018. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: datiftio `ld;ti Weld County Clerk to the Board BY: vl,, AP Deputy Cle County A :rney Date of signature: (161/ lq cc t-tsO ►13%19 Steve Moreno, Chair • can P. Conway _kit; eraad ie A. Cozad 2018-3920 HR0089 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: September 28, 2018 TO: Board of County Commissioners — Pass -Around FR: Judy A. Griego, Director, Human Services RE: Child Protection Agreement for Services with Noco Behavioral Health 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 Noco Behavioral Health. This agreement is for Therapeutic Services and Supervised Visitation; both home based and community based. The major provisions of the Agreement are as follows: Term Service/Fundin Rate September 1, Therapeutic $110.00/Hour (Couples Therapy. First session is an intake at 1.5 hours 2018 -May 31, 2019 Services Supervised and is not charged for new clients.) Visitation $120.00/Hour (Family Therapy. First session is an intake at 1.5 hours and is not charged for new clients.) Core/Other $90,00/Hour/Individual (Group Therapy — Individual. Groups are weekly for two (2) hours, for six weeks.) $95.00/Hour/Family (Group Therapy — More than two from one family. Individual. Groups are weekly for two (2) hours, for six weeks.) $95.00/Hour (At -Risk Youth Population Therapeutic Support. No charge for "no shows".) $95.00/Hour (Adolescent Therapy Services. First session is an intake at 1.5 hours and is not charged for new clients.) $95.00/Hour (Individual Therapy. First session is an intake at 1.5 hours and is not charged for new clients.) $110.00/Hour (Supervised Visitation, 1-2 hours.) $150.00/Episode (Supervised Visitation, 3 hours) $65.00/Hour (Court Facilitations/Court Staffings/Family Team Meetings/Team Decision Making Meetings. Mileage will not be charged.) $0.20/Mile (Mileage. ReQuires pre -approval of the Department.) Pass -Around Memorandum; September 28, 2018 — CMS 2113 12/5 2018-3920 tac o PRIVILEGED AND CONFIDENTIAL I do not recommend a Work Session. I recommend approval of this Agreement. Sean P. Conway Julie A. Cozad Mike Freeman Barbara Kirkmeyer, Pro-Tem Steve Moreno, Chair Approve Schedule Recommendation Work Session Other/Comments: Pass -Around Memorandum; September 28, 2018 — CMS 2113 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NOCO BEHAVIORAL HEALTH, LLC This Agreement, made and entered into thej day of ,t{,t�, 2018, 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 NOCO Behavioral Health, LLC., hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Contractor's Information; Exhibit B, Scope of Services, and Exhibit C, Payment Schedule. Each of these documents is attached hereto and incorporated herein by this reference. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided Core Services or other funding to the Department for Therapeutic and Life Skills (Supervised Visitation) Services. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on September 1, 2018, upon proper execution of this Agreement and shall expire May 31, 2019, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit A, Contractor's Proposal and Exhibit B, 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 1 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. 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. 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; v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. 2 b. Payment shall be made in accordance with Exhibit A, Contractor's Proposal, Exhibit B, Scope of Services, and Exhibit C, 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 A, Contractor's Proposal, Exhibit B, Scope of Services , and Exhibit C, Payment Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit an ACH Form for Colorado Providers, which will be provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of Colorado per the directions on the form. Failure to complete and submit this form in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, 3 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. 4 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 5 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, 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 6 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 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 7 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 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 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. 10 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. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: Heather Walker, Administrator 17. Notice For Contractor: Robert Cope, Chief Executive Officer 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: For Contractor: Judy A. Griego, Director Robert Cope, Chief Executive 11 P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation Officer 710 11`h Avenue, Suite 304 Greeley, CO 80631 (720) 220-3318 Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 12 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 13 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. 14 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 (b) 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. 15 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and &24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflict with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contract Professional's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contract 16 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. 17 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ddrittAi COUNTY: ATTEST: v•sidiOsIA BOARD OF COUNTY COMMISSIONERS Weld C t lerk to the : oard WELD COUNTY, COLORADO By: Deputy Cle 18 Steve Moreno, Chair DEC 0 5 2018 CONTRACTOR: NOCO Behavioral Health, LLC 710 11th Avenue, Suite 304 Greeley, CO 80631 (720) 220-3316 By: Date: Robert Cope, Chief Executive Officer o?o/Y 3g02,O EXHIBIT A CONTRACTOR'S INFORMATION May 19, 2018 Noco Behavioral Health LLC Introduction for RFP with Weld County Good afternoon, My organization, Noco behavioral Health LLC was formed in June 2016 with the aim of providing mental health services to the Northern, Colorado area. I have worked for Ariel clinical services for the last 2 and half years and enjoyed my time working in conjunction with Weld county. I am building my private practice to build on this relationship and provide mental health services to the weld county community. I have a Master's degree in Social work from Colorado State University and a Bachelor's degree in Psychology from Metropolitan State University. I focused my studies in child and adolescent psychological functioning and health. I also have my LSW (Licensed Social Worker license) and will be serviced by a former professor and close friend, Shari Simmons whom is an LCSW; my greatest teacher and mentor. I started in the social work field in 1998, working with at -risk youth on the streets of Denver Colorado. Whereby, I ran a non-profit for 10 years, and served the homeless youth population, 21 years of age and under. After this experience I made the decision to focus on building an organization that will provide mental health support to populations that are hidden and need a helping hand. When I took over as Executive Director, we went from 10 volunteers to over 100, where I redesigned the training program and built a strong relationship with the city and police institutions within Denver. In my time with Ariel, I have been able to build on skills such as relationship building, attachment to primary care providers and communication in the family unit. I will continue to provide services with Ariel in a different format, by only providing home studies for Ariel, while Noco Behavioral Health will be where I focus on providing mental health support to youth, couples and families and at -risk populations. I have experience working with at -risk populations, suicidal ideation, depression, trauma, couples, families and senior populations. As well as adoptive families. The aim of Noco Behavioral Health is to provide an alternative to the structure of community mental health; where I will provide support in my office, and in the community. My office is less than two blocks from Weld county human services which allow me to work closer with caseworkers and be more available on a daily basis to the county's needs. Through Ariel Clinical services, I have built a relationship with Weld county, and would be privileged to continue this relationship through my organization Noco Behavioral Health LLC. Thank you for your time and consideration, Sincerely, Robert Cope, HSP, MSW, LSW EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services Noco Behavioral Health LLC AGENCY OR PRIVATE PRACTICE TRAILS PROVIDER ID (If Known) Robert Cope CEO/Therapist PRIMARY CONTACT— FULL NAME PRIMARY CONTACT -TITLE ( 720 )220-3318 PHONE NUMBER EXT. Nocobehavioralhealth@gmail.com PRIMARY CONTACT- E-MAIL ADDRESS 710 11th Avenue STE 304 AGENCY MAILING ADDRESS Greeley ( ) FAX NUMBER https://nocebehavioralhealth.wordpress.com/ AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) CITY 80631 ZIP REFERRAL CONTACT Robert Cope REFFERAL CONTACT- FULL NAME (720 )220-3318 REFERRAL CONTACT - PHONE NUMBER EXT. Owner/operator _ REFERRAL CONTACT - TITLE nocobehavioralhealth@gmail.com REFERRAL CONTACT- E-MAIL ADDRESS BILLING CONTACT Robert Cope BILLING CONTACT- FULL NAME (720 )220-3318 BILLING CONTACT- PHONE NUMBER Owner/operator _ BILLING CONTACT - TITLE nocobehavioralhealth@gmail.com EXT. BILLING CONTACT- E-MAIL ADDRESS I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it has so indicated in this bid form. I further affirm intention to enter into an agreement with Weld County, on behalf of the Weld County Department of Human Services, and comply with all requirements of the contract, if awarded. The Board of Weld County Commissioners reserve 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 BI800058 EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services resident Weld County bidders in all cases where the bids are competitive in price and quality. Signature of Authorized Representative: Date of Signature: _5/20/2018 B1800058 EXHIBIT B PROVIDER INFORMATION FORM County Department of Human Services resident Weld County bidders in all cases where the bids - cam , `five in price and quality. Signature of Authorized Representative: Date of S re: _5/20/2018 131800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 1. Bidder's legal entity name: 2. Program name or service type being proposed: Noco Behavioral Health LLC Adolescent therapy services 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. 4. Cognitive behavioral therapy, Gestalt, motivational interviewing, solution focused interventions, 5. Psychotherapy 6. Anticipated frequency of the service (ex. 4 hours/week). 4 hours per week 7. Anticipated duration of the service (ex. 3-4 months). 12 months 8. Goals of the service. Provide a safe environment for adolescent specific therapy is to help them identify triggers and learn skills to work through trauma and learn to have better daily functioning with mental health disorders. As well as work through perceptions of others, and learn to prepare for adulthood, and move past risky behaviors. 9. Outcomes of service. 10. For client to demonstrate the ability to identify triggers and manage mental health disorders in a better way that promotes positive community integration. While also learning to identify and correct negative choice, look through a new conceptual lens and at how actions in the present affect long term goals. 11. Target population for service. Adolescent therapy services are aimed toward Male, Female and LGBTQ populations between the ages of 12 to 19 years of age. 12. Service access. Adolescent therapy services will take place in both the community and at the office location at 710 11th Avenue Suite 304, Greeley, CO 80631. The geographic region is Greeley, Evans, Longmont, and Johnstown and within the weld county borders. 13. Languages service is available in. Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) Expert proficiency in English Language. 14. Medicaid eligibility of service. No Medicaid ability at the current time, bidder will be applying to Medicaid by August 1St,2018. 15. Transportation of clients. This bidder can provide transportation to individual whom are not of driving age or are under restricted driving provisions. The bidder will provide transportation to the office within a twenty mile radius. Starting point will be from the clinical office of practice to the clients home to locations as needed by therapy goals to build appropriate coping and social skills, as well as at the office. The clinical will transport clients within a 50 mile radius of the clinical office. 16. Rates of service. Adolescent therapy services is billed at $95 an hour. The first session is considered the intake and is 1.5 hours and not charged for new clients. A minimum of 6 months is required for services. Client will be required to see therapist once, every two weeks at minimum. Cancellations within 24 hours are not charged, over 24 hours cancellations will be at charged a rate of $15. Mileage will be billed at 20 cents per mile, starting from the clients home to the clinical office and resuming at the clients home. Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 1. Bidder's legal entity name: 2. Program name or service type being proposed: 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Cognitive behavioral therapy, Gestalt, motivational interviewing, solution focused interventions, Psychotherapy 4. Anticipated frequency of the service (ex. 4 hours/week). 6hours/week 5. Anticipated duration of the service (ex. 3-4 months). 12 months Noco Behavioral Health LLC Individual therapy 6. Goals of the service. Provide a safe environment for individuals to identify triggers and learn skills to work through trauma and learn to have better daily functioning with mental health disorders 7. Outcomes of service. For client to demonstrate the ability to identify triggers and manage mental health disorders in a better way that promotes positive community integration. 8. Target population for service. Age range is 18 to 60 years of age, Genders: Male, Female, LGBTQ and disabled individuals. 9. Service access. N Individual therapy is to take place at 71011th Avenue Suite 304, Greeley, CO 80631, the individual sessions can take place in the clients home, the geographic region is Greeley, Evans, Longmont, and Johnstown and within the weld county borders. 10. Languages service is available in. English, expert proficiency 11. Medicaid eligibility of service. No Medicaid ability at the current time, bidder will be applying to Medicaid by August 1st,2018. 12. Transportation of clients. This bidder can provide transportation to individual whom are not of driving age or are under Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) restricted driving provisions. 13. Rates of service. The cost for individual therapy is $95 an hour. The first session is considered the intake and is 1.5 hours and not charged for new clients. A minimum of 6 months is required for services. Client will be required to see therapist once, every two weeks at minimum. Cancellations within 24 hours are not charged, over 24 hours cancellations will be at charged a rate of $15. Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 1. Bidder's legal entity name: 2. Program name or service type being proposed: 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Short term and crisis interventions using Cognitive behavioral therapy, Gestalt, motivational interviewing 4. Anticipated frequency of the service (ex. 4 hours/week). 1 to 2 hours per week 5. Anticipated duration of the service (ex. 3-4 months). 12 months Noco Behavioral Health LLC At- risk youth populations therapeutic support 6. Goals of the service. To provide short term therapeutic support on a crisis basis for at -risk youth who have suicidal or depressive tendencies, individuals who have been hospitalized or incarcerated and in need of therapeutic to aid the individual in preparing for transition to the home or residential program. This is not a crisis service, but stabilization over the time of hospitalization or incarceration 7. Outcomes of service. To provide adolescent with coping skills to stabilize, discuss and help them prepare for transition to back to the home or to a lower level of care. 8. Target population for service. Any individual who has been hospitalized, after the initial day of entry on the 72 hour hold, or first 24 hours incarcerated. The ideal age range is 14 to 19 years of age. All genders are applicable, especially those whom are LGBTQ, transgender, or suicidal youth whom are identified at potential risk of suicide or in need of therapeutic support to prepare for transition to a lower level of care. 9. Service access. This is a community based service and extend to the first 1 to 2 days of returning home or placed in the lower level care as appropriate. The geographical region is Greeley, Evans, Longmont, and Johnstown and within the weld county borders. This region may be extended to Denver and Westminster if appropriate placement is needed to ensure a smooth transition of service providers. 10. Languages service is available in. Expert proficiency in English Language. Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 11. Medicaid eligibility of service. No Medicaid ability at the current time, bidder will be applying to Medicaid by August 1st,2018 12. Transportation of clients. Transportation will not be provided to clients for this service. 13. Rates of service. The at -risk population therapeutic support is billed at a rate of $95 per hour. Mileage will be billed at a rate of 20 cents a mile to the location of service only. There is not charge for cancellations or no shows due to the potential that the adolescent will be on hospital hold or incarcerated and supervised by medical or juvenile detention staff. Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 1. Bidder's legal entity name: 2. Program name or service type being proposed: 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Using the Yalow model of group services plus Cognitive behavioral therapy, Gestalt, motivational interviewing, in an organic format. 4. Anticipated frequency of the service (ex. 4 hours/week). 3 hours per week Noco Behavioral Health LLC Group therapy services 5. Anticipated duration of the service (ex. 3-4 months). 12 months 6. Goals of the service. The goal of the groups would be to allow individuals and families who have lost a child(through death or removal from the home), adopted a difficult child that they are struggling to build bonds with or navigating the adoption world to come together, learn to communicate their feelings, discuss the issues at hand and learn skills of acceptance and moving forward. 7. Outcomes of service. To help families or individual to gain coping skills to help them have better functioning while working with a difficult and traumatized child or learning to accept the loss and honor the memory of the child. 8. Target population for service. The target population is any individual, parent or family that has experience a loss of a child, struggled with adoption/conceiving or struggled with a traumatized child and need a community of families outside of other services to gain support and learn coping skills. All ages and genders are welcome. 9. Service access. The groups will be held in the office located at 710 11th Avenue Suite 304, Greeley, CO 80631. Groups will only take place in the office and not be available for travel or community based needs. 10. Languages service is available in. Expert proficiency in English Language. Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 11. Medicaid eligibility of service. No Medicaid ability at the current time, bidder will be applying to Medicaid by August 1st,2018. 12. Transportation of clients. Transportation will not be provided for groups. 13. Rates of service. Group therapy is billed at a rate of $90 and hour per single member; families of more than two are billed at a single rate of $95 an hour. The groups will be 2 hours in length and take place once per week, on Tuesday evenings between 4pm and 7 pm. The groups will run for 6 weeks, with two weeks off between the start of the next group. Each group will be provided with journals at a rate of $2 per member and billed directly to the group member; each group member will have access to one free therapy session during the 6 week group timeline. Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 1. Bidder's legal entity name: 2. Program name or service type being proposed: Noco Behavioral Health LLC Family service care taker meetings 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Communicate the successes or struggles of the client through therapeutic lenses 4. Anticipated frequency of the service (ex. 4 hours/week). 4 hours per week 5. Anticipated duration of the service (ex. 3-4 months). 12 months 6. Goals of the service. The goal of this service is to provide information on how well the client is meeting goals of service with the provider and whether they are able to apply skills. 7. Outcomes of service. To assist client in identifying how they have learned skills and communicate the clients ability to follow treatment protocols, and their success or failures in service. 8. Target population for service. All populations are appropriate, ages 0 to 60 years of age that this clinical is working with at the time of the service provider meetings. 9. Service access. This provider will travel to the meetings in a community based service or host the meetings as needed in the building located at 710 11th Avenue Suite 304, Greeley CO 80631 as needed. The geographical region is Greeley, Longmont, Evans, and those within the Weld county borders. 10. Languages service is available in. Expert English level proficiency 11. Medicaid eligibility of service. No, this provider is not a Medicaid provider, but will be applying to be a Medicaid provider as of August 1st 2018. Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 12. Transportation of clients. No transportation will be provided to clients to or from the service provider meetings. 13. Rates of service. Family team care taker meetings at billed at a rate of $65. No mileage will be charged. Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 1. Bidder's legal entity name: 2. Program name or service type being proposed: Noco Behavioral Health LLC Family therapy services 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Cognitive behavioral therapy, Gestalt, motivational interviewing, solution focused interventions, Psychotherapy. I also use a Minuchin family systems and attachment theory to help build bonds, attachment and structure while also building boundaries. 4. Anticipated frequency of the service (ex. 4 hours/week). 2 hours per week 5. Anticipated duration of the service (ex. 3-4 months). 12 months 6. Goals of the service. 7. Provide a safe environment for individuals and families to learn communication skills and work through the relationship disruption that has caused a rift in the overall family structure, identify triggers and learn skills to work through trauma and learn to have better daily functioning 8. Outcomes of service. For family members to be able to learn positive communication skills and overcome or learn ways to move past the issue that brought them into service. 9. Target population for service. The families targeted are 16 years of age to 60 years of age, either with child, expecting child or grieving the loss of a family member as well as struggling with family member attachment to the family unit.. All genders (Male,Female and LGBTQ), as well as disabled veterans. 10. Service access. Family therapy will be office based at 71011th Avenue Suite 304, Greeley, CO 80631, community based and home based services are available to individuals who are indigent or unable to access public transportation. The geographic region is Greeley, Evans, Longmont, and Johnstown and within the weld county borders. 11. Languages service is available in. Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) Expert proficiency in English Language. 12. Medicaid eligibility of service. No Medicaid ability at the current time, bidder will be applying to Medicaid by August 15%2018. 13. Transportation of clients. This bidder can provide transportation to individual whom are not of driving age or are under restricted driving provisions. The bidder will provide transportation to the office within a twenty mile radius. Starting point will be from the clinical office of practice to the clients home and returning to the clinical office. 14. Rates of service. The cost for Family therapy is $120 an hour. The first session is considered the intake and is 1.5 hours and not charged for new clients. A minimum of 6 months is required for services. Families will be required to see therapist once, every two weeks at minimum. Cancellations within 24 hours are not charged, over 24 hours, cancellations will be charged at a rate of $15. Mileage will be billed at a rate of 20 cents per mile, starting at the clients home and ending at the clients home. Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 1. Bidder's legal entity name: 2. Program name or service type being proposed: Noco Behavioral Health LLC Couples therapy services 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Cognitive behavioral therapy, Gestalt, motivational interviewing, solution focused interventions, Psychotherapy as well as a Minuchin inspired format of family systems theory. Couples will be required to purchase the book "all about us" at their expense, to use as a format for rebuilding the foundations of the relationship. 4. Anticipated frequency of the service (ex. 4 hours/week). 4 hours per week 5. Anticipated duration of the service (ex. 3-4 months). 12 months 6. Goals of the service. Provide a safe environment for couples to learn communication skills and work through the relationship disruption that has caused a rift in the overall family structure, identify triggers and learn skills to work through trauma and learn to have better daily functioning, as well as learn what has brought them into services and how to overcome immediate challenges. 7. Outcomes of service. 8. For couples to be able to learn positive communication skills and overcome or learn ways to move past the issue that brought them into service. 9. Target population for service. The target population is Heterosexual, Same sex and transgender couples. The couples can be both voluntary and court ordered to attend services. The couple does not need to have any specific traits, but must have a relationship need that they wish to address and work on with the therapist. 10. Service access. Couples therapy services will be office based at 71011th Avenue Suite 304, Greeley, CO 80631, community based and home based services are available to individuals who are indigent or unable to access public transportation. The geographic region is Greeley, Evans, Longmont, and Johnstown and within the weld county borders. Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 11. Languages service is available in. Expert proficiency in English Language. 12. Medicaid eligibility of service. No Medicaid ability at the current time, bidder will be applying to Medicaid by August 1st,2018. . 13. Transportation of clients. No transportation will be provided to individuals who are engaged in couples therapy. 14. Rates of service. Couples therapy is billed at a rate of $110 dollars an hour.. The first session is considered the intake and is 1.5 hours and not charged for new clients. A minimum of 6 months is required for services. Couples will be required to see therapist once, every two weeks at minimum. Cancellations within 24 hours are not charged, over 24 hours, cancellations will be charged at a rate of $15. Bid No.: B1800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 1. Bidder's legal entity name: 2. Program name or service type being proposed: Noco Behavioral Health Supervised visitation of individuals or families 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Prompts and teaching of appropriate boundaries, rules and communication styles, utilizing Cognitive behavioral therapy, Gestalt, motivational interviewing, in an organic format. 4. Anticipated frequency of the service (ex. 4 hours/week). 6 hrs a week 5. Anticipated duration of the service (ex. 3-4 months). 12 months 6. Goals of the service. To help client and family learn to build appropriate relationships, boundaries and rule setting. As well as assisting parents or caretakers to learn appropriate parenting and communication that is age appropriate and cognitively applicable to the child or children. 7. Outcomes of service. For parent or care provider to learn how to set limits, rules and boundaries that builds attachment, repair relationships and strengthens the bonds of family for a long term strong family structure. 8. Target population for service. Families or individual caretakers who are trying to regain custody or visitation with their children. The children most appropriate are between the ages of 0 to 18 and parents/care takers between the ages of 16 to 60 years of age. 9. Service access. The supervised visits are available in both the office located at 71011th Avenue Suite 304, Greeley, CO 80631 or community based as appropriate and defined by the GAL or caseworker. The geographical region served is Greeley, Evans, Longmont, and Johnstown and within the weld county borders. 10. Languages service is available in. Expert proficiency in English Language. Bid No.: 61800058 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 11. Medicaid eligibility of service. No Medicaid ability at the current time, bidder will be applying to Medicaid by August 15t,2018. 12. Transportation of clients. The bidder will provide transportation to children, from their foster or biological home to the home or site of the visit and return them home after the visit to the foster or biological home. 13. Rates of service. The supervised visits are billed at a rate of $110 for 1 and 2 hour visits per each session. Visits that are 3 hours are billed at a rate of $150 per each visit. Mileage for transporting clients to and from visits will be charged at a rate of 20 cents per mile, to and from the location of the child at the beginning of the visit. Visits will be arranged in accordance with the agreed upon schedule that accommodates both the caregiver or biological parents and the individual or family whom is court ordered to participate in the visit. No shows to visits will be charged at a rate of $15 per session, cancellations within 24 hours are not charged, over 24 hours, cancellations after this 24 hour window will be charged at a rate of $15. Bid No.: B1800058 PROPOSED SERVICE OR SERVICE TYPE: Family team meetings BIDDER LEGAL ENTITY NAME: Noco Behavioral Health LLC OR CONTRACTOR INFORMATION _ -� - - - SUPERVISOR INFORMATION, No.. Last Name - ., - First Name _ Work# -, - - Work Email Education Level . - Degree Focus Ucensure/ Credentials DORA 8 (If applicable) Last Name First Name 1 Cope Robert 720-220-3318 nocobehavloralhealth@gmail.com MSW Masters of Social wor LSW LSW.0009922012 Cope Robert 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Worts ,. Work Email 720-220-3318 nocobehavioralhealth@8mail.com EXHIBIT B SCOPE OF SERVICES 1. Contractor will provide Therapeutic and Life Skills (visitation) services to individuals and families, as referred by the Department. 2. Therapeutic Services available under this Agreement include: a. Couples Therapy i. Anticipated Frequency of Service: Four (4) hours week. ii. Anticipated Duration of Service: Twelve (12) months. iii. Goal of Services: To provide a safe environment for couples to learn communication skills and work through the issues that have disrupted the relationship and the overall family structure. Contract will help couple identify triggers and learn skills to work through trauma and Team to have better daily functioning, as well as learn what has brought them into services and how to overcome immediate challenges. iv. Outcomes of Service: To help couples learn positive communication skills and overcome or learn ways to move past the issues. v. Target Population: Heterosexual, same sex or transgender couples in a relationship they wish to address and work on. vi. Location of Services: 710 11th Avenue, Suite 304, Greeley, Colorado 80631. Community -based or home -based services are available to individuals who are indigent or unable to access public transportation in the Greeley, Evans, Longmont, Johnstown communities, and within the borders of Weld County. vii. Languages: English only. viii. Medicaid Eligibility: Service is Medicaid -eligible. Contractor is applying to become a Medicaid provider. ix. Transportation: Transportation is not available. b. Family Therapy i. Anticipated Frequency of Service: Two (2) hours week. 19 ii. Anticipated Duration of Service: Twelve (12) months. iii. Goal of Services: To provide a safe environment for family members to learn communication skills and work through the issues that have disrupted the relationships and the overall family structure. Contractor will help families identify triggers and learn skills to work through trauma and learn to have better daily functioning. iv. Outcomes of Service: To help family members learn positive communication skills and overcome or learn ways to move past the issues. v. Target Population: Family members 16-60 years of age, either with child, expecting a child or grieving the loss of a family members as well as struggling with family member attachment to the family unit. Family members of all genders, sexual orientation and veterans. vi. Location of Services: 710 11th Avenue, Suite 304, Greeley, Colorado 80631. Community -based or home -based services are available to individuals who are indigent or unable to access public transportation in the Greeley, Evans, Longmont, Johnstown communities, and within the borders of Weld County. vii. Languages: English only. viii. Medicaid Eligibility: Service is Medicaid -eligible. Contractor is applying to become a Medicaid provider. ix. Transportation: Contractor will transport individuals to the office who are within a 20 -mile radius of 710 11th Avenue, Greeley, CO, 80631, and are not of driving age or are under restricted driving provisions. c. Group Therapy i. Anticipated Frequency of Service: Three (3) hours week. ii. Anticipated Duration of Service: Twelve (12) months. iii. Goal of Services: To allow individuals and families who have lost a child, through death or removal from home, adopted a difficult child that they 20 are struggling to bond with, or learning to navigate the adoption process, to come together, learn to communicate their feelings, discuss the issues and learn skills of acceptance and moving forward. iv. Outcomes of Service: To help families or individuals to gain coping skills to help them have better functioning while working with a difficult and traumatized child or learning to accept the loss and honor the memory of the lost child. v. Target Population: Any individual, parent or family that has experienced a loss of a child, struggled with adoption/conceiving or struggled with a traumatized child, and needs a community of families outside of other services to gain support and learn coping skills. All ages, genders and orientations. vi. Location of Services: Office -based only at 710 11th Avenue, Suite 304, Greeley, Colorado 80631. vii. Languages: English only. viii. Medicaid Eligibility: Service may be Medicaid -eligible. Contractor is applying to become a Medicaid provider. ix. Transportation: Transportation is not available. d. At -Risk Youth Populations Therapeutic Support i. Anticipated Frequency of Service: One (1) to two (2) hours per week. ii. Anticipated Duration of Service: Twelve (12) months. iii. Goal of Services: To provide short-term therapeutic support for at -risk youth who have suicidal or depressive tendencies, individuals who have been hospitalized or incarcerated and in need of therapeutic services to aid the individual in preparing for transition to the home or residential program. Service is not intended as a crisis intervention; only stabilization over the time of the hospitalization or incarceration. iv. Outcomes of Service: To provide at -risk youth with coping skills to stabilize, discuss and help them prepare to return home or to a lower level of care. 21 v. Target Population: Any at -risk youth, ages 14-19, who has been hospitalized, after the initial day of entry on a 72 -hour hold, or the first 24 hours incarcerated. All genders and orientations, especially those who are lesbian, gay, bisexual, transgender or queer (LGBTQ) or suicidal youth who are identified at potential risk of suicide or in need of therapeutic support to prepare to transition home to a lower level of care. vi. Location of Services: Community -based in Greeley, Evans, Longmont, and Johnstown communities, and within the borders of Weld County. Contractor will consider providing services in the Denver and Westminster communities on a case -by -case basis. vii. Languages: English only. viii. Medicaid Eligibility: Service may be Medicaid -eligible. Contractor is applying to become a Medicaid provider. ix. Transportation: Transportation is not available. e. Individual Therapy i. Anticipated Frequency of Service: Six (6) hours per week. ii. Anticipated Duration of Service: Twelve (12) months. iii. Goal of Services: To provide a safe environment for individuals to identify triggers and learn skills to work through trauma and learn to have better daily functioning with mental health disorders. iv. Outcomes of Service: Individual will demonstrate he ability to identify triggers and manage mental health disorders in a better way that promotes positive community integration. v. Target Population: Individuals 18 to 60 years of age. All genders and orientations. vi. Location of Services: Office -based at 710 11t" Avenue, Suite 304, Greeley, Colorado 80631, or in the referred individual's home within the Greeley, Evans, Longmont, and Johnstown communities, and within the borders of Weld County. 22 vii. Languages: English only. viii. Medicaid Eligibility: Service is Medicaid -eligible. Contractor is applying to become a Medicaid provider. ix. Transportation: Contractor will transport individuals who are not of driving age or are under restricted driving provisions. f. Adolescent Therapy i. Anticipated Frequency of Service: Four (4) hours per week. ii. Anticipated Duration of Service: Twelve (12) months. iii. Goal of Services: To provide a safe environment for adolescent specific therapy to identify triggers and learn skills to work through trauma and learn to have better daily functioning with mental health disorder, work through perceptions of others, and learn to prepare for adulthood, and move past risky behaviors. iv. Outcomes of Service: Adolescent will demonstrate he ability to identify triggers and manage mental health disorders in a better way that promotes positive community integration, while also learning to identify and correct negative choices, look through a new conceptual lens at how actions in the present affect long term goals. v. Target Population: Individuals 12-19 years of age. All genders and orientations. vi. Location of Services: Office -based at 710 1 1 th Avenue, Suite 304, Greeley, Colorado 80631, or in the Greeley, Evans, Longmont, and Johnstown communities, and within the borders of Weld County. vii. Languages: English only. viii. Medicaid Eligibility: Service is Medicaid -eligible. Contractor is applying to become a Medicaid provider. ix. Transportation: Contractor will transport individuals to the office who are within a 50 -mile radius of 710 11th Avenue, Greeley, CO, 23 80631, and are not of driving age or are under restricted driving provisions. 3. Life Skills services available under this Agreement include: a. Supervised Visitation i. Anticipated Frequency of Service: Six (6) hours per week. ii. Anticipated Duration of Service: Twelve (12) months. iii. Goal of Services: To assist families to learn to build appropriate relationships, boundaries and rule setting, as well as assisting parents or caregivers to learn appropriate parenting and communication that is age appropriate and cognitively applicable to the child(ren). iv. Outcomes of Service: Parent or caregiver will demonstrate ability to set limits, rules and boundaries that build attachment, repair relationships and strengthen the bonds of the family long term. v. Target Population: Parents or caregivers with who are working towards reunification or needing visitation with their children. Children ages 0-18, and parents ages 16-60, are most appropriate for this service. vi. Location of Services: Office -based at 710 1 1 th Avenue, Suite 304, Greeley, Colorado 80631, or in the Greeley, Evans, Longmont, and Johnstown communities, and within the borders of Weld County. vii. Languages: English only. viii. Medicaid Eligibility: Service is not Medicaid -eligible. ix. Transportation: Contractor can transport children from their foster or biological home to visit location and back. 4. Contractor will offer an initial appointment within seven (7) days of receiving the referral and will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the Contractor will notify the caseworker and the Child Welfare Contract and Services Coordinator immediately. 24 5. Contractor will document in detail 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. 6. 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 onthe 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. 7. Contractor understands that the Department will not reimburse Contractor for "no shows" after two (2) consecutive "no shows". It is the responsibility of the Contractor to communicate "no shows" to the Department in a timely manner to determine continuation of services. 8. Contractor understands that the Department does not reimburse for 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. The Department will reimburse for actual participation in the meeting only so long as the meeting is at least one hour in length, the Contractor obtains the Facilitator's signature on the Client Verification Form at the time of the meeting and participation in the meeting is deemed appropriate and necessary by the Department. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator. 25 EXHIBIT C 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 $1 10.00/Hour (Couples Therapy. First session is an intake at 1.5 hours and is not charged for new clients.) $120.00/Hour (Family Therapy. First session is an intake at 1.5 hours and is not charged for new clients.) $90.00/Hour/Individual (Group Therapy — Individual. Groups are weekly for two (2) hours, for six weeks.) $95.00/Hour/Family (Group Therapy — More than two from one family. Individual. Groups are weekly for two (2) hours, for six weeks.) $95.00/Hour (At -Risk Youth Population Therapeutic Support. No charge for "no shows".) $95.00/Hour (Adolescent Therapy Services. First session is an intake at 1.5 hours and is not charged for new clients.) $95.00/Hour (Individual Therapy. First session is an intake at 1.5 hours and is not charged for new clients.) $1 10.00/Hour (Supervised Visitation, 1-2 hours.) 26 $150.00/Episode (Supervised Visitation, 3 hours) $65.00/Hour (Court Facilitations/Court Staffings/Family Team Meetings/Team Decision Making Meetings. Mileage will not be charged.) $0.20/Mile (Mileage. Requires pre -approval of the Department.) Contractor may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. Contractor will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher, 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. 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. 27 NASW Insurance Company, RRG Customer ID: 3Z3XPKTBDT Named Insured: Noco Behavioral Health LLC Policy Number: P-GRO3Z455VYQHB-00 Effective Date: 06/01/2018 Expiration Date: 06/01/2019 Retroactive Date: 06/01/2018 Address: 710 11th Avenue Ste 304 Greeley, CO 80631 NOTICE: A LOWER LIMIT OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT. (SEE POLICY FOR DETAILS) THE POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED, THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. Liability Per Claim Limit $1,000,000.00 $64.00 Liability Aggregate Limit $3,000,000.00 Liability Per Claim Limit Liability Aggregate Limit Deposition Expense $5,000 per deposition/$35,000 per policy period $1,000,000.00 $3,000,000.00 Subpoena Expense $400.00 per policy period State License Board Investigation Defense $35,000.00 per policy period Emergency First Aid $15,000.00 per policy period Health Information - HIPAA $25,000.00 per policy period First Party Assault $15,000.00 per policy period Medical Payments $5,000 per incident/$50,000 per policy period Wage Loss and Expense $1,000 per day/$35,000 per policy period TOTAL PREMIUM FOR THIS COVERAGE PART: $64.00 NOTICE: THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK RETENTION GROUP. ATTENTION: THE POLICY OF INSURANCE IDENTIFIED ABOVE HAS BEEN ISSUED TO THE NAMED INSURED FOR THE POLICY PERIOD INDICATED. ALL INSUREDS ARE SUBJECT TO THE LIMITS OF LIABILITY THAT ARE APPLICABLE TO THE POLICY. THE LIMITS OF LIABILITY MAY NOT BE STACKED TO INCREASE THE AMOUNT WE WILL PAY FOR ANY CLAIM. THE AGGREGATE LIMIT MAY HAVE BEEN REDUCED BY PAID CLAIMS. Regarding Cancellation: Should the policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions to the Named Insured. Authorized Representative: Tony Benedetto Brokered and Administered by: NASW Insurance Company, RRG NASW RRG Plan Administrator 1200 E. Glen Avenue Peoria Heights, 1161616-5348 License: CAC 0F76076, ARC 1322 The NASW RRG Inc. supports this policy with its full faith, credit and assets. This policy is reinsured by Swiss Re America. OSwiss Re Policy Form: RRG PLI-1131 (January 9, 20171; ACORD 4..------- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/29/2018 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, 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 endorsements. PRODUCER NASW RRG Plan Administrator 1200 East Glen Avenue Peoria Heights, IL 61616-5348 CONTACT NAME: PHONE FM WC, No, Ext.): WC, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Noco Behavioral Health LLC 710 11th Avenue Ste 304 Greeley, CO 80631 INSURER A: NASW Risk Retention Group 14366 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: CUSTOMER ID: 3Z3XPKTBDT 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICYEFF (MMIDD/YYYY) POLICYEXP (MMIDDm'Y'F LIM)TS COMMERCIAL SEML GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea Occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INIURY $ GENERAL AGGREGATE $ EPLI - OCCUR PRODUCTS - COMP/OP AGO $ AGGREGATE LIMIT APPLIES PER: POLICY ❑ PROJECT ❑ LOC OTHER $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA I LLAB EXCESS LVIB DED n RETENTION OCCUR CLAIMS -MADE $ EACH OCCURRENCE AGGREGATE % 7DTHER WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/ PARTNER/ ❑ EXECUTIVE OFFICER/ MEMBER EXCLUDED? If yes, describe under (Mandatory in NHjDescription of Operations below N/A .1 PER STATUTE E.L. EACH ACCIDENT $ E.L. DISEASE - EACH EMPLOYEE E.L. DISEASE - POLICY LIMIT $ A Professional Liability Insurance Retroactive Date: 06-01-2018 Y N P-GRO3Z455VYQHB-0o 06/01/2018 06/01/2019 Per Claim Limit $1,000,000.00 Aggregate Limit $3,000,000.00 State Licensing Board Limits $35,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE NUMBER: P-GRO3Z455VYQHB-00 REVISION NUMBER: 001 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED ON ACCORDANCE WITH POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE five ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO® 44.------ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/29/2018 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: tithe certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or 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 endorsements. PRODUCER NASW RRG Plan Administrator 1200 East Glen Avenue Peoria Heights, IL 61616-5348 CONTACT NAME: PHONE FAX WC, No, EM): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Noco Behavioral Health LLC 710 11th Avenue Ste 304 Greeley, CO 80631 INSURER A: NASW Risk Retention Group 14366 INSURER B: INSURER C: INSURER D: INSURER E: INSURER R CUSTOMER ID: 3Z3XPKTBDT 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 DESCR BED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENT ]POLICY GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea Occurrence) $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ EPLI - OCCUR PRODUCTS - COMP/OP AGG $ AGGREGATE LIMIT APPLIES PER: ❑ PROIECT ❑ OC OTHER L $ AUTOMOBILE LIABILITY ANY AUTO SCHEDULED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA I LIAB EXCESS LABCLAIMS-MADE DED n RETENTION OCCUR $ EACH OCCURRENCE $ AGGREGATE $ $ 7OTHER WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/ PARTNER/ ❑ EXECUTIVE OFFICER/ MEMBER EXCLUDED? If yes, describe under (Mandatory in NH)Description of Operations below N/A I PER STATUTE E.L EACH ACCIDENT $ EL. DISEASE - EACH EMPLOYEE 5 E.L. DISEASE - POLICY LIMIT $ A Professional Liability Insurance Retroactive Date: 06-01-2018 Y N P-GRO3Z455VYQHB-0o 06/01/2018 06/01/2019 Per Claim Limit $1,000,000,00 Aggregate Limit $3,000,000.00 State Licensing Board Limits $35,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) CERTIFICATE NUMBER: P-GRO3Z45SVYQHB-00 REVISION NUMBER: 001 CERTIFICATE HOLDER CANCELLATION Tyler And Thomas LLC 710 11th Avenue Ste 304 Greeley CO 80631 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED ON ACCORDANCE WITH POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE h„OPC--e ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Hello