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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PARKER PERSONAL CARE HOMES DBA DAVID KALIS INC.
This Agreement, made and entered into the
g s2_ day of lj¢CCMbfl , 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 Parker Personal Care Homes dba David Kalis, Inc., hereinafter referred to as
the "Contractor".
The parties to this Agreement understand and agree that the provisions of this Agreement specifically
include the following documents: Exhibit A, Weld County's Request for Bid, Exhibit B, Contractor's Bid, Exhibit C,
Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and incorporated
herein by this reference.
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Services has provided Core Services or other funding to the
Department for Mental Health Services.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This agreement shall become effective on June 1, 2018, upon proper execution of this Agreement and
shall expire May 31, 2019, unless sooner terminated as provided herein. The agreement is for a period of
three years. However, the agreement must be renewed by both parties, in writing, on an annual basis.
2. Scope of Services
Services shall be provided by the Contractor to any person(s) eligible for services in compliance with
Exhibit B, Contractor's Bid and Exhibit C, Scope of Services.
3. Referrals, Billing and Tracking
a. Contractor understands and will comply with all aspects of the referral authorization, billing and
tracking requirements as set forth by the Department. Failure to comply with all aspects may result
in a forfeiture of payment.
b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e-
mail address prior to the start of this Agreement. Contractor acknowledges that services are not
authorized until the Contractor has received an authorized referral form from the Department.
Contractor further acknowledges that services provided prior to the authorized start date or outside
the scope of services on the referral form will not be eligible for reimbursement.
Contractor acknowledges that any and all modifications to an existing referral must be approved
through the Department's Resource Manager, Child Welfare Contract and Services Coordinator, or
through a Team Decision Making (TDM) meeting or Family Team Meeting (FTM). No other
Department staff or other party to the case may authorize services or modifications to services.
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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.
b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Bid, Exhibit B,
Contractor's Bid, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule, attached hereto and
incorporated herein by reference, so long as services are rendered satisfactorily and in accordance
with the Agreement.
c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent
upon, the continuing availability of said funds for the purposes hereof.
d. The Department may withhold reimbursement if Contractor has failed to comply with any part of
the Agreement, including the Financial Management requirements, program objectives, contractual
terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may
appeal such circumstance in writing to the Director of Human Services. The decision of the Director
of Human Services shall be final.
5. Financial Management
At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133.
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6. Payment Method
Unless otherwise provided in Exhibit B, Contractor's Bid, Exhibit C, Scope of Services, and Exhibit D,
Payment Schedule:
a. If services are funded through Core Services, Contractor agrees to accept reimbursement
through ACH direct deposit one time per month.
b. If Contractor is not currently set up with the State of Colorado to accept direct deposit,
Contractor agrees to complete and submit an ACH Form for Colorado Providers, which will be
provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of
Colorado per the directions on the form. Failure to complete and submit this form in a timely and
accurate manner may result in a delay of payment.
c. Contractor agrees to accept payment through county warrant when funding source does not
allow for direct deposit.
7. Compliance with Applicable Laws
a. At all times during the performance of this Agreement, Contractor will strictly adhere to all
applicable Federal and State laws, order, and applicable standards, regulations, interpretations
and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials that have been or may
hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws
and regulations, including, but not limited to the following:
- Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil
Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45
C.F.R. Part 80 et. seq.; and
- all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of
race, creed, color, sex, or national origin, be excluded from participation in, be denied the
benefits of, or be otherwise subjected to discrimination under the approved Agreement.
- Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its
implementing regulations, 45 C.F.R. Part 84; and
- the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et seq. and its
implementation regulations, 45 C.F.R. Part 91; and
Title VII of the Civil Rights Act of 1964; and
the Age Discrimination in Employment Act of 1967; and
the Equal Pay Act of 1963; and
- the Education Amendments of 1972; and
Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and
- all regulations applicable to these laws prohibiting discrimination because of race, color,
national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome
(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of
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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.
b. Contractor is further charged with the knowledge that any person who feels that s/he has been
discriminated against has the right to file a complaint either with the Colorado Department of Human
Services or with the United States Department of Health and Human Services, Office for Civil Rights.
c. Contractor assures that it will fully comply with all other applicable Federal and State laws which
may govern the ability of the Department to comply with the relevant funding requirements.
Contractor understands the source of funds to be accessed under the Agreement is Core Services.
d. Contractor assures and certifies that it and its principals:
- Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transaction by a Federal or State department or agency;
and
- have not, within a three-year period preceding this Agreement, been convicted of or
had a civil judgment rendered against them for commission of fraud or criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State or
Local) transaction or contract under public transaction; violation of federal or state antitrust
statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction
of records, making false statements, or receiving stolen property; and
- are not presently indicted for or otherwise criminally or civilly charged by a government
entity (federal, state or local) with commission of any of the offenses enumerated in this
certification; and
- have not, within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, or local) terminated for cause or default.
e. Public Contracts for Services C.R.S. §8-17.5-101. Contract Professional certifies, warrants, and
agrees that it does not knowingly employ or contract with an illegal alien who will perform work under
this contract. Contract Professional will confirm the employment eligibility of all employees who are
newly hired for employment in the United States to perform work under this Agreement, through
participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S.
§8-17.5-102(5)(c). Contract Professional shall not knowingly employ or contract with an illegal alien to
perform work under this Agreement or enter into a contract with a subcontractor that fails to certify
with Contract Professional that the subcontractor shall not knowingly employ or contract with an illegal
alien to perform work under this Agreement. Contract Professional shall not use E -Verify Program or
State of Colorado program procedures to undertake pre -employment screening or job applicants while
this Agreement is being performed. If Contract Professional obtains actual knowledge that a
subcontractor performing work under the public contract for services knowingly employs or contracts
with an illegal alien Contract Professional shall notify the subcontractor and County within three (3)
days that Contract Professional has actual knowledge that a subcontractor is employing or contracting
with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or
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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 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 Bid, 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.
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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 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.
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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 Bid.
d. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this
information to its insurance agent or broker, and shall have its agent or broker provide proof of
Contractor/Contract Professional's required insurance. County reserves the right to require
Contractor/Contract Professional to provide a certificate of insurance, a policy, or other proof of
insurance as required by the County's Risk Administrator in his sole discretion.
e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability,
liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as
an additional insured as follows:
County of Weld
1150 'O' Street
Greeley, Colorado 80631
f. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer
shall waive subrogation rights against County.
g. Subcontractors: All subcontractors, subcontractors, independent contractors, sub -
vendors, suppliers or other entities providing goods or services required by this Agreement shall
be subject to all of the requirements herein and shall procure and maintain the same coverages
required of Contractor/Contract Professional. Contractor/Contract Professional shall include all
such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds
under its policies or shall ensure that all subcontractors maintain the required coverages.
Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors,
independent contractors, sub -vendors suppliers or other entities upon request by the County.
A provider of Professional Services (as defined in the Bid or RFP) shall provide the following
coverage:
Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and
$2,000,000 aggregate limit for all claims.
10. Certification
Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all
necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies
covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any Agreement.
11. Training
Contractor may be required to attend training that the request of the Department specific to services
provided under this Agreement. The Department will not compensate the Contractor for said training in
the form of registration fees, time spent traveling to and from training, attending the training or any other
associated costs unless otherwise agreed to by the Department.
12. Subpoenas
Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the
Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For
this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the
Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will
contact the Weld County Attorney's Office immediately at 970-352-1551, x6503, and advise that the
subpoena must be personally served.
13. Monitoring and Evaluation
Contractor and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners, the Department and the
Contractor.
Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with the work conducted under
this Agreement.
14. Modification of Agreement
All modifications to this Agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
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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:
David Kalis, Ph.D., Director of Clinical and
Psychological Services
All notices required to be given by the parties hereunder shall be given by certified or registered mail to
the individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent.
For Department:
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
(970) 352-1551
18. Litigation
For Contractor:
David Kalis, Ph.D., Director of Clinical and
Psychological Services
P.O. Box 271168
Louisville, CO 80027
(303) 428-7041
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.
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19. Termination
This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the
individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an
obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise
appropriated in each succeeding year, as this Agreement is subject to the availability of funding.
Therefore, the Department may terminate this Agreement at any time if the source of funding for the
services made available to the Contractor is no longer available to the Department, or for any other
reason. Contractor reserves the right to suspend services to clients if funding is no longer available.
20. No Third -Party Beneficiary Enforcement
It is expressly understood and agreed that the enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned parties and nothing in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties receiving services or benefits
under this Agreement shall be an incidental beneficiary only.
21. Governmental Immunity
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of
any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental
Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended.
22. Partial Invalidity of Agreement
If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held
or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions.
The parties hereto declare that they would have entered into this Agreement and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional
or invalid.
23. Improprieties/Conflict of Interest
No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department
when the Contractor also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the
Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor
know that the two relationships are in opposition. During the term of the Agreement, Contractor shall
not enter into any third -party relationship that gives the appearance of creating a conflict of interest.
Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the
Department, a full disclosure statement setting forth the details that create the appearance of a conflict
of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute
grounds for the Department's termination, for cause, of its Agreement with the Contractor.
Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of
Contractor, to any person for influencing or attempting to influence an officer or employee of an agency,
a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
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connection with the awarding of any Federal contract, the making of any Federal grant, the making of any
Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of an Federal contract, loan, grant, or cooperative agreement.
24. Storage, Availability and Retention of Records
Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during
business hours, have access to inspect and copy records, and shall be allowed to monitor and review
through on -site visits, all activities related to this Agreement, supported with funds under this Agreement,
to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The
results of the monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
All such records, documents, communications, and other materials created pursuant or related to this
Agreement shall be maintained by the Contractor in a central location and shall be made available to the
Department upon its request, for a period of seven (7) years from the date of final payment under this
Agreement, or for such further period as may be necessary to resolve any matters which may be pending,
or until an audit has been completed with the following qualifications: If an audit by or on behalf of the
Federal and/or State government has begun but is not completed at the end of the seven (7) year period,
or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until
the resolution of the audit finding.
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.
11
27. Independence of Contractor: Not an Employee of Weld County
Contract Professional agrees that it is an independent Contract Professional and that Contract
Professional's officers, agents or employees will not become employees of County, nor entitled to any
employee benefits from County as a result of the execution of this Agreement. Contract Professional shall
perform its duties hereunder as an independent Contract Professional. Contract Professional shall be
solely responsible for its acts and those of its agents and employees for all acts performed pursuant to
this Agreement. Contract Professional, its employees and agents are not entitled to unemployment
insurance or workers' compensation benefits through County and County shall not pay for or otherwise
provide such coverage for Contract Professional or any of its agents or employees. Unemployment
insurance benefits will be available to Contract Professional and its employees and agents only if such
coverage is made available by Contract Professional or a third party. Contract Professional shall pay when
due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred
pursuant to this Agreement. Contract Professional shall not have authorization, express or implied, to
bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement.
Contract Professional shall have the following responsibilities with regard to workers' compensation and
unemployment compensation insurance matters: (a) provide and keep in force workers' compensation
and unemployment compensation insurance in the amounts required by law, and as set forth in Exhibit A,
and provide proof thereof when requested to do so by County.
28. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as state in
Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or
obligations hereunder without the prior consent of both parties.
29. Agreement Nonexclusive
This Agreement does not guarantee any work nor does it create an exclusive agreement for services.
30. Warranty
The Contractor warrants that services performed under this Agreement will be performed in a manner
consistent with the professional standards governing such services and the provisions of this Agreement.
The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training,
diligence and judgment provided by highly competent individuals and entities that perform services of a
similar nature to those described in this Agreement including Exhibits A, B, C, and D.
31. Acceptance of Services Not a Waiver
Upon completion of the work, the Contractor shall submit to Department originals of all tests and results,
reports, etc., generated during completion of this work. Acceptance by Department of reports and
incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of
responsibility for the quality and accuracy of the services. In no event shall any action by the Department
hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or
default which may then exist on the part of the Contractor, and the Department's action or inaction when
any such breach or default shall exist shall not impair or prejudice any right or remedy available to the
Department with respect to such breach or default; and no assent, expressed or implied, to any breach of
any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a
waiver of any other breach. Acceptance by the Department of, or payment for, any services performed
12
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 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.
13
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. Severabiiity
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and
year first above written.
COUNTY:
ATTEST:
date/44).(CL;(4.
Weld CyyntyClerk to the Board
By.
Deputy Clerk to
14
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
Steve Moreno, Chair
DEC 032018
CONTRACTOR:
Parker Personal Care Homes dba David Kali c.
P.O. Box 271168
Louisville, CO 8+
(303) 428-7. 1
By:
Date:
Jodi alters, Executive Director
ao/F-3(7b
EXHIBIT A
WELD COUNTY'S REQUEST FOR BID
Weld County Department of Human Services
Bid No. 61800058
REQUEST FOR BID
WELD COUNTY, COLORADO
1150 O STREET
GREELEY, CO 80634
DATE: March 1, 2018
BID NUMBER: B1800058
DESCRIPTION: Child Welfare — Various Services
DEPARTMENT: Human Services
BID OPENING DATE: March 16, 2018
I. NOTICE TO BIDDERS
The Human Services Advisory Commission (HSAC), on behalf of the Weld County Department of
Human Services (WCDHS), by and through the Board of Weld County Commissioners, wishes to
purchase the following:
VARIOUS SERVICES
PAGES 1-9 OF THIS REQUEST CONTAINS GENERAL INFORMATION. NOT ALL OF THE
INFORMATION CONTAINED IN PAGES 1-8 MAY BE APPLICABLE. SPECIFICATIONS UNIQUE TO
THIS REQUEST FOR PROPOSAL FOLLOW PAGE 10.
Bids for the stated services will be received electronically by the Weld County Department of
Human Services, Resource Unit, Attn: Tobi Vegter at HS Contract Management@co.weld.co.us
through: FRIDAY, MARCH 16, 2018 AT 5:00 P.M.
II. INVITATION TO BID
A. The Human Services Advisory Commission, on behalf of the Weld County
Department of Human Services, by and through the board of Weld County
Commissioners requests bids for the purchase of Various Services.
B. Bids shall include any and all charges for service(s) applied for by the bidder, and
shall, in every way, be the total net price which the bidder will expect the Board of
County Commissioners of Weld County to pay if awarded the bid.
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Weld County Department of Human Services
Bid No. B1800058
C. Emailed Bids Are Required. Emailed (fully typed) bids are required. See Bid
Specifications for specific instructions. After certification of the bid, the other copy
will be routed for applicable review. An e-mail confirmation will be sent when we
receive your bid/proposal.
III. INSTRUCTIONS TO BIDDERS
A. Bids shall be typewritten. Each bid must give the full business address of the bidder
and be signed by him/her with his/her usual signature. Bids by partnerships must
furnish the full names of all partners and must be signed with the partnership name
by one of the partners of the partnership or by an authorized representative,
followed by the signature and title of the person signing. Bids by corporations must
be signed with the legal name of the corporation, followed by the name of the state
of the incorporation and by the signature and title of the president, secretary, or
other person authorized to bind it in this matter. Bids submitted by limited liability
companies must furnish the full names of all members and managers and must be
signed by a manager or by an authorized representative, followed by the signature
and title of the person signing. The name of each person signing shall also be typed
or printed below the signature. A bid by a person who affixes to his signature the
word "president," "secretary," "agent," or other title without disclosing his
principal, may be held to be the bid of the individual signing. When requested,
satisfactory evidence of the authority of the officer signing in behalf of a
corporation shall be furnished. All corrections or erasures shall be initialed by the
person signing the bid. All bidders shall agree to comply with all of the conditions,
requirements, specifications, and/or instructions of this bid as stated or implied
herein. All designations and prices shall be fully and clearly set forth.
B. Bids may be withdrawn upon written request to the Weld County Department of
Human Services received from bidders prior to the submission deadline.
Negligence on the part of bidder in preparing the bid confers no right for the
withdrawal of the bid after it has been opened.
C. Bidders are expected to examine the conditions, specifications, and all instructions
contained herein. Failure to do so will be at the bidder's risk.
D. Bidders shall not stipulate in their proposals any conditions not contained in the
instructions and specifications herein unless specifically requested by the special
instructions attached hereto. Any proposal which fails to comply with the letter of
the instructions and specifications herein may be rejected.
E. Late or unsigned bids shall not be accepted or considered. It is the responsibility of
the bidder to ensure that the bid arrives in the Weld County Department of Human
Services, Service Utilization Unit, on or prior to the time indicated in Section I.,
entitled "Notice to Bidders."
F. When approximate quantities are stated, Weld County reserves the right to
increase or decrease quantity as best fits its needs.
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Weld County Department of Human Services
Bid No. B1800058
G. Whenever requested, samples or descriptive matter shall be filed prior to the
opening of bids.
H. In accordance with Section 14-9(3) of the Weld County Home Rule Charter, the
Board of County Commissioners of Weld County will give preference to resident
Weld County bidders in all cases where said bids are competitive in price and
quality. It is also understood that the Board of County Commissioners of Weld
County will give preference to suppliers from the State of Colorado, in accordance
with Section 30-11-110, CRS, when it is accepting bids for the purchase of any
books, stationery, records, printing, lithographing or other supplies for any officer
of Weld County.
I. All discounts shall be figured from the date of delivery and acceptance of the
articles, or in the case of an incorrect invoice, from the date of receipt of corrected
invoice, if this be subsequent to delivery and acceptance.
J. Substitutions or modifications to any of the terms, conditions, or specifications of
this bid package which are made by Weld County, Colorado, after the bids have
been distributed to prospective bidders, and prior to the date and time of bid
opening, will be made in writing and signed by the Human Services Advisory
Commission. No employee of Weld County, Colorado, is authorized in any way to
modify any of the terms, conditions, or specifications of this bid without written
approval of Human Services Advisory Commission. This is not to imply that bids will
not be accepted or considered with specifications which are different from those
herein. Any item which does not meet all the terms, conditions, or specifications
of this bid, must be clearly indicated on a separate sheet of paper, attached to the
bid specification and proposal sheets and returned with the bid.
K. The successful bidder shall indemnify and hold harmless Weld County, Colorado,
against all claims for royalties, for patents or suit for infringement thereon, which
may be involved in the manufacture or use of the material to be furnished.
L. Contractor certifies that it shall comply with the provisions of Colorado Revised
Statutes (C.R.S.) 8-17.5-101, et seq. Contractor shall not knowingly employ or
contract with an illegal alien to perform work under this Contract or enter into a
contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to
perform work under this Contract. Contractor represents, warrants, and agrees
that it (a) has verified that it does not employ any illegal aliens, through
participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b)
otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor
shall comply with all reasonable requests made in the course of an investigation
under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If
Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-
101, et seq., Weld County may terminate this Contract for breach and Contractor
shall be liable for actual and consequential damages to Contractor.
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Weld County Department of Human Services
Bid No. B1800058
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-
103(3), if Contractor receives federal or state funds under this Contract, Contractor
must confirm that any individual natural person eighteen (18) years of age 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 this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury
that it (a) is a citizen of the United States or is otherwise lawfully present in the
United States pursuant to federal law, (b) shall produce one of the forms of
identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of
the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date
of a Contract.
M. All goods shall remain the property of the seller until delivered to and accepted by
Weld County, Colorado.
N. Bids received prior to the time of opening will be kept unopened in a secure place.
No responsibility will attach to the Families, Youth and Children Commission, the
Weld County Department of Human Services, or the Board of Weld County
Commissioners, for the premature opening of a bid not properly addressed and
identified.
O. In submitting the bid, the bidder agrees that the acceptance of any and all bids by
the Board of County Commissioners of Weld County within a reasonable time or
period does not constitute a contract. The Board of County Commissioners of
Weld County, Colorado, reserves the right to reject any and all bids, to waive any
informality in the bids, and to accept the bid, or part of a bid, that, in the opinion
of the Board, is in the best interests of the Board and of the County of Weld, State
of Colorado.
P. These instructions, the proposal forms, and specifications have been developed
with the hope of raising the standard of purchasing negotiations to a level wherein
all transactions will be mutually satisfactory. Your cooperation is invited.
Q. Substitutions or modifications to any of the terms, conditions, or specifications of
this which are made by Weld County after the bids have been distributed to
prospective bidders and prior to the date and time of bid opening, will be made in
writing. No employee of Weld County is authorized in any way to modify any of the
terms, conditions, or specifications of this bid without written approval of said
Director of the Weld County Department of Human Services. This is not to imply
that bids will not be accepted or considered with specifications which are different
from those herein. Any item which does not meet all the terms, conditions, or
specifications of this bid, must be clearly indicated on a separate sheet of paper,
attached to the bid specification and proposal sheets and returned with the bid.
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Weld County Department of Human Services
Bid No. 81800058
IV. General Specifications.
A. Fund Availability: Financial obligations of the Weld County payable after the current
fiscal year are contingent upon funds for that purpose being appropriated, budgeted
and otherwise made available. By acceptance of the bid, Weld County does not
warrant that funds will be available to fund the contract beyond the current fiscal
year.
B. Governmental Immunity: No term or condition of the contract shall be construed or
interpreted as a waiver, express or implied, of any of the immunities, rights,
benefits, protections or other provisions, of the Colorado Governmental Immunity
Act §§24-10-101 et seq., as applicable now or hereafter amended.
C. Independent Contractor: The successful bidder shall perform its duties hereunder
as an independent contractor and not as an employee. He or she shall be solely
responsible for its acts and those of its agents and employees for all acts performed
pursuant to the contract. Neither the successful bidder nor any agent or employee
thereof shall be deemed to be an agent or employee of Weld County. The successful
bidder and its employees and agents are not entitled to unemployment insurance
or workers' compensation benefits through Weld County and Weld County shall not
pay for or otherwise provide such coverage for the successful bidder or any of its
agents or employees. Unemployment insurance benefits will be available to the
successful bidder and its employees and agents only if such coverage is made
available by the successful bidder or a third party. The successful bidder shall pay
when due all applicable employment taxes and income taxes and local head taxes
(if applicable) incurred pursuant to the contract. The successful bidder shall not have
authorization, express or implied, to bind Weld County to any agreement, liability
or understanding, except as expressly set forth in the contract. The successful bidder
shall have the following responsibilities with regard to workers' compensation and
unemployment compensation insurance matters: (a) provide and keep in force
workers' compensation and unemployment compensation insurance in the
amounts required by law, and (b) provide proof thereof when requested to do so by
Weld County.
D. Compliance with Law: The successful bidder shall strictly comply with all applicable
federal and State laws, rules and regulations in effect or hereafter established,
including without limitation, laws applicable to discrimination and unfair
employment practices.
E. Choice of Law: Colorado law, and rules and regulations established pursuant
thereto, shall be applied in the interpretation, execution, and enforcement of the
contract. Any provision included or incorporated herein by reference which conflicts
with said laws, rules and/or regulations shall be null and void.
F. Binding Arbitration Prohibited: Weld County does not agree to binding arbitration
by any extra -judicial body or person. Any provision to the contrary in the contract
5
Weld County Department of Human Services
Bid No. B1800058
or incorporated herein by reference shall be null and void.
G. No Third -Party Beneficiary Enforcement: It is expressly understood and agreed that
the enforcement of the terms and conditions of the contract, and all rights of action
relating to such enforcement, shall be strictly reserved to the undersigned parties
and nothing in the contract shall give or allow any claim or right of action
whatsoever by any other person not included in the contract. It is the express
intention of the undersigned parties that any entity other than the undersigned
parties receiving services or benefits under the contract shall be an incidental
beneficiary only.
H. Attorneys Fees/Legal Costs: In the event of a dispute between Weld County and the
successful bidder, concerning the contract, the parties agree that Weld County shall
not be liable to or responsible for the payment of attorney fees and/or legal costs
incurred by or on behalf of the successful bidder.
I. Insurance Requirements.
i. General Requirements: Contractors/Contract Professionals must secure, at or
before the time of execution of any agreement or commencement of any work, the
following insurance covering all operations, goods or services provided pursuant 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, during
any warranty period, and for three (3) years after termination of the Agreement. The
required insurance shall be underwritten by an insurer licensed to do business in
Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain
a valid provision or endorsement stating "Should any of the above -described policies by
canceled or should any coverage be reduced before the expiration date thereof, the
issuing company shall send written notice to the Weld County Director of General
Services by certified mail, return receipt requested. Such written notice shall be sent
thirty (30) days prior to such cancellation or reduction unless due to non-payment of
premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of
a deductible or self -insured retention, County must be notified by the
Contractor/Contract Professional. Contractor/Contract Professional shall be
responsible for the payment of any deductible or self -insured retention. County
reserves the right to require Contractor/Contract Professional to provide a bond, at no
cost to County, in the amount of the deductible or self -insured retention to guarantee
payment of claims. The insurance coverages specified in this Agreement are the
minimum requirements, and these requirements do not decrease or limit the liability of
Contractor/Contract Professional. Contractor/Contract Professional shall maintain, at
its own expense, any additional kinds or amounts of insurance that it may deem
necessary to cover its obligations and liabilities under this Agreement.
ii. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain
at all times during the term of any Agreement, insurance in the following kinds
and amounts:
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Weld County Department of Human Services
Bid No. B1800058
(a). Workers' Compensation Insurance as required by state statute, and Employer's
Liability Insurance covering all of Contractor's Contract Professional's employees
acting within the course and scope of their employment. If Contractor is an
Independent Contractor, as defined by the Colorado Worker's Compensation Act,
this requirement shall not apply. Contractor must submit to the Department a
Declaration of Independent Contractor Status Form prior to the start of this
agreement.
(b). Commercial General Liability Insurance written on ISO occurrence form CG 00 01
10/93 or equivalent, covering premises operations, fire damage, independent
Contractors, products and completed operations, blanket contractual liability,
personal injury, and advertising liability with minimum limits as follows:
* $1,000,000 each occurrence;
* $2,000,000 general aggregate;
* $50,000 any one fire; and
* $500,000 errors and omissions.
(c). Automobile Liability: Contractor/Contract Professional shall maintain limits of
$1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each
accident, and $1,000,000 for property damage applicable to all vehicles operating
both on County property and elsewhere.
(d). Additional Provisions:
* Policies for all general liability, excess/umbrella liability, liquor liability and
pollution liability must provide the following:
* If any aggregate limit is reduce by twenty-five percent (25%) or more by paid
or reserved claims, Contractor shall notify County within ten (10) days and reinstate
the aggregates required;
* Unlimited defense costs in excess of policy limits;
* Contractual liability covering the indemnification provisions of this
Agreement;
* A severability of interests provision;
* Waiver of exclusion for lawsuits by one insured against another;
* A provision that coverage is primary; and
* A provision that coverage is non-contributory with other coverage or self-
insurance provided by County.
(e). For all general liability, excess/umbrella liability, liquor liability, pollution
liability and professional liability policies, if the policy is a claims -made policy, the
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Weld County Department of Human Services
Bid No. B1800058
retroactive date must be on or before the contract date or the first date when any
goods or services were provided to County, whichever is earlier.
iii. Contractors/Contract Professionals shall secure and deliver to County's Risk
Administrator ("Administrator") at or before the time of execution of this
Agreement, and shall keep in force at all times during the term of the Agreement as
the same may be extended as herein provided, a commercial general liability
insurance policy, including public liability and property damage, in form and
company acceptable to and approved by said Administrator, covering all operations
hereunder set forth in the related Bid or Request for Proposal.
iv. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this
information to its insurance agent or broker, and shall have its agent or broker
provide proof of Contractor/Contract Professional's required insurance to the
County. County reserves the right to require Contractor/Contract Professional to
provide a certificate of insurance, a policy, or other proof of insurance as required
by the County's Risk Administrator in his sole discretion.
v. Additional Insureds: For general liability, excess/umbrella liability, pollution legal
liability, liquor liability, and inland marine, Contractor/Contract Professional's
insurer shall name County as an additional insured.
vi. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's
insurer shall waive subrogation rights against County.
vii. Subcontractors: All subcontractors, subcontractors, independent contractors, sub -
vendors, suppliers or other entities providing goods or services required by this
Agreement shall be subject to all of the requirements herein and shall procure and
maintain the same coverages required of Contractor/Contract Professional.
Contractor/Contract Professional shall include all such subcontractors, independent
contractors, sub -vendors suppliers or other entities as insureds under its policies or
shall ensure that all subcontractors maintain the required coverages.
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.
V. Warranty. The successful bidder shall warrant that:
A. The services to be supplied pursuant to this bid are fit and sufficient for the purpose
intended;
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Weld County Department of Human Services
Bid No. B1800058
B. The services sold to Weld County, Colorado pursuant to this bid conform to the
minimum Weld County specifications as established herein.
VI. Confidential Information: Confidential financial information of the bidder should be
transmitted separately from the main bid submittal, clearly denoting in red on the
financial information at the top the word, "CONFIDENTIAL." However, the successful
bidder is advised that as a public entity, Weld County must comply with the provisions of
C.R.S. 24-72-201, et seq. the Colorado Open Records Act (CORA), with regard to public
records, and cannot guarantee the confidentiality of all documents. If Weld County
receives a CORA request for bid information marked "CONFIDENTIAL", staff will attempt
to contact the bidder in order to allow the bidder to seek an appropriate court order
preventing disclosure. Without such an order, Weld County will release the requested
information in accordance with CORA.
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Weld County Department of Human Services
Bid No. B1800058
BID SPECIFICATIONS
I. PROJECT OVERVIEW
The Weld County Department of Human Services (WCDHS) is seeking qualified providers
in various service areas under various funding sources. Service areas include, but are not
limited to Aftercare, Anger Management/Domestic Violence, Crisis Intervention and
Stabilization Services, Day Treatment, Foster Parent Consultation, Foster Parent Training,
Functional Family Therapy, Home Based Intervention including 24/7 Crisis Intervention,
Kinship Services (Therapeutic), Home Studies, Life Skills, Mediation, Mental Health
Services, Monitored Sobriety, Multisystemic Therapy, Relinquishment Counseling, Sexual
Abuse Treatment, and Substance Abuse Treatment Services. Refer to pages 13-15 for
specific definitions related to the above -mentioned service areas.
II. CONTRACT PERIOD AND PRICING
1) The initial contract period is to be determined and shall continue as allowable
by the funding source, so long as both parties are satisfied. The agreement, if
awarded, shall be for a period of three years, but shall require renewal by both
parties, in writing, on an annual basis.
2) The initial contract will be funded through Core Services Program, Child
Welfare Administration, or other funding, so long as funding is made available.
3) Selected vendors will be required to bill the WCDHS monthly according to
billing requirements set forth in Exhibit A, Sample Agreement, and by the
applicable funding source.
III. DUE DATE
All bids must be submitted electronically to the Weld County
Department of Human Service at HS Contract Management@weldgov.com,
Attn: Tobi Vegter, Contract and Services Coordinator. Proposals will be accepted
through Friday, March 16, 2018, at 5:00 p.m.
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Weld County Department of Human Services
Bid No. B1800058
IV. QUESTIONS
All questions regarding the requirements in this Request for Proposal must be
submitted in writing to HS Contract Management@weldgov.com, Attn: Tobi Vegter,
Contract and Services Coordinator. To guarantee sufficient time to provide bidders
with a response, all questions must be received by Friday, March 9, 2018 at 5:00 p.m.
V. INTRODUCTION LETTER
A bidder must submit a one (1) page or less letter in Microsoft Word that introduces
the bidder and addresses, at a minimum, the following:
1) Ability to deliver the service(s) as proposed and comply with the specific
requirements set forth by the Weld County, as stated in the Request for
Proposal (RFP) and in Exhibit A, Sample Agreement.
2) Capacity to be organized, responsive and to quickly and successfully schedule
services as requested.
VI. PROVIDER INFORMATION FORM
1) Bidder must complete and submit one (1) Provider Information Form, herein
attached as Exhibit B. The form is available at
https://www.weldgov.com/departments/purchasing/bids proposals/.
VII. PROPOSAL CONTENT
1) Proposal content must be submitted in Microsoft Word and may not exceed
three (3) pages per proposed services.
2) A bidder must utilize the Proposal Template, herein attached as Exhibit C, for
each service being proposed. All questions noted on the template must be
addressed for each service proposed by the bidder. The template is available at
https://www.weldgov.com/departments/purchasing/bids proposals/.
3) If submitting to provide services in a language other than English, a bidder must
demonstrate language proficiency at Full Professional Proficiency or higher, as
defined by the U.S. Department of State, and as noted below.
a. Full Professional Proficiency: Able to use and read the language
fluently and accurately on all levels pertinent to professional needs.
b. Native or Bilingual Proficiency: Equivalent to that of an educated
native speaker (both speaking and reading).
11
Weld County Department of Human Services
Bid No. B1800058
VIII. STAFF INFORMATION
1) Bidder must attach a list of applicable staff and/or contractors who will manage
and/or administer the proposed service(s), utilizing the Staff Data Sheet. Bidder
should submit one Staff Data Sheet per proposed service. Bidder should not
combine services. Resumes and/or Curriculum Vitae should not be submitted
with the proposal, but may be requested later if bidder is awarded a contract.
2) The Staff Data Sheet is herein attached as Exhibit D. It is available at
https://www.weldgov.com/departments/purchasing/bids proposals/.
IX. CERTIFICATE OF INSURANCE (COI)
Bidder must attach a standard Certificate of Insurance (COI), or letter of intent from an
insurance company authorized to do business in the State of Colorado stating its
willingness to insure the bidder pursuant to the terms of this Request for Proposal. If
awarded a contract, bidder will be required to provide a Standard COI that meets the
requirements set forth by Weld County in the Sample Agreement, herein attached as
Exhibit A, and list Weld County on the COI as an Additional Insured.
X. EVALUATION OF PROPOSALS
All proposals that meet the requirements will be reviewed by the Division of Child
Welfare and the Human Services Advisory Commission (HSAC), Contracted Services
Workgroup. The HSAC will make recommendations regarding bid awards to the Board of
Weld County Commissioners by and through the Weld County Department of Human
Services. The Weld County Department of Human Services will make its award of
contract to the successful bidders upon final approval of the Board of Weld County
Commissioners.
12
Weld County Department of Human Services
Bid No. B1800058
XI. SERVICE AREA DEFINITIONS (NOT LIMITED TO THIS LIST - OTHER
SERVICES WILL BE CONSIDERED)
Program Area
Definition
Aftercare Services
Services provided to prepare a child for
reunification with his/her family or other
permanent placement and to prevent future out -
of -home placement of the child.
Anger Management/Domestic Violence .
Diagnostic and/or therapeutic services to assist in
the development of the family services plan, to
assess and/or improve family communication,
functioning and relationships, and to prevent
further domestic violence.
Crisis Intervention and Stabilization
Services
Services that provide an immediate, in-person/in-
home response to families, youth and children, in
*crisis, 24 hours a day, seven (7) days a week.
*A "crisis" is further defined as a situation or
circumstance, usually acute (recent) in nature, which
breaks down the normal functioning of an individual
and/or family, and results in the inability of the
individual and/or family to resolve the crisis through
normal coping behaviors, or without immediate
intervention.
Day Treatment
Comprehensive, highly structured services that
provide education to children and therapy to
children and their families.
Foster Parent Consultation
Services provided to foster and group home
families caring for WCDSS children and youth in
their homes to enhance and improve the quality of
care being provided.
Foster Parent Training
Topic specific training for new Weld County foster
parents.
13
Weld County Department of Human Services
Bid No. B1800058
Program Area
Definition
Functional Family Therapy
Intensive family -based treatment that addresses
the pervasive patterns of relational dysfunction
known to be determinants of conduct disorder,
violent acting out, and substance abuse among
youth 10-18 years old.
Home -Based Intervention
Services provided primarily in the home of the
client that include a variety of services which can
include therapeutic services, concrete services,
collateral services and *crisis intervention directed
to meet the needs of the child and family.
*Crisis Intervention is defined as 24/7 phone
access and in -home counseling.
Home Studies
Structured Analysis Family Evaluation (SAFE) for
the purpose of foster home certification, kinship
placement, and/or adoption.
Kinship Services (Therapeutic)
Kinship services in the areas of (1) consultation and
kinship parent support specific to a child placed in
a kinship home, (2) corrective consultation specific
to a child placed in a kinship home, and (3) critical
care consultation specific to a child placed in a •
kinship home. Children placed in kinship care are
maintained in the lowest level of care and least
restrictive setting when out -of -home placement is
necessary.
Life Skills
Visitation (both in -home and in -office) and services
provided primarily in the home that teach
household management, effective access to
community resources, parenting techniques and
family conflict management.
14
Weld County Department of Human Services
Bid No. B1800058
- Program Area ,'' ' °
Definition •
Mediation
Intervention typically with all family members
to improve family communication, functioning
and relationships.
Mental Health Services
Diagnostic and/or therapeutic services to assist in
the development of family services plan, to assess
and/or improve family communication, functioning
and relationships.
Multisystemic Therapy
Intensive family- and community -based treatment
program designed to make positive changes in the
various social systems (home, school, community,
peer relations) that contribute to the serious
antisocial behaviors of children and adolescents
who are at risk for out -of -home placement.
Relinquishment Counseling
Relinquishment counseling for parents considering
relinquishment of their children.
Sexual Abuse Treatment
Therapeutic intervention designed to address
issues and behaviors related to sexual abuse
victimization, sexual dysfunction, sexual abuse
perpetration, and to prevent further sexual abuse
and victimization.
Substance Abuse Treatment Services
Diagnostic and/or therapeutic services to assist in
the development of the Family Service Plan (FSP),
to assess and/or improve family communication,
functioning and relationships, and to prevent
further abuse of drugs or alcohol.
15
EXHIBIT A
SAMPLE AGREEMENT
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND
This Agreement, made and entered into the _ day of 201 by and between the Board of Weld
County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as
the "Department' and «Contractor», hereinafter referred to as the "Contractor".
The parties to this Agreement understand and agree that the provisions of this Agreement specifically
include the following documents: Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal,
Exhibit C, Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and
incorporated herein by this reference.
WITNESSETH
WHEREAS, required approval, clearance, and coordination have beep accomplished from a
appropriate agencies; and
for
WHEREAS, the Colorado Department of Human Services has pr
NOW THEREFORE, in consideration of the premises, t
1. Term
e Department
to covenant and agree as follows:
This agreement shall become effective on , , upon prop execution of this Agreement and shall
expire , unless sooner terminated as provided herein. Theegreement is for a period of three years.
However, the agreement must be renewed by both parties, in writing, on an annual basis.
2. Scope of Services
Services shall be provided
Exhibit B, Contractor
3.
a. Contr
ing requf
in lure of";' yme
ractorto any person(s) eligible for services in compliance with
hibit C, Scope of Services.
s a°t will comply with all aspects of the referral authorization, billing and
t forth by the Department. Failure to comply with all aspects may result
es £o receive referrals for services through e-mail and will provide an identified e-
s prior to the start of this Agreement. Contractor acknowledges that services are not
ntil the Contractor has received an authorized referral form from the Department.
Contra r rther acknowledges that services provided prior to the authorized start date or outside
the sc of services on the referral form will not be eligible for reimbursement.
Contractor acknowledges that any and all modifications to an existing referral must be approved
through the Department's Resource Manager, Child Welfare Contract and Services Coordinator, or
through a Team Decision Making (TDM) meeting or Family Team Meeting (FTM). No other
Department staff or other party to the case may authorize services or modifications to services.
c. Contractor agrees to submit an itemized complete billing statement by the 7th of the month,
following the month of service, utilizing billing forms required by the Department.
1
EXHIBIT A
SAMPLE AGREEMENT
d. Contractor agrees to submit a monthly report with the billing statement by the 7th of the month
following the month of service for each client receiving ongoing services. One-time services will be
verified through receipt of the completed product (ex. psychological evaluation, substance abuse
evaluation). Verification of Monitored Sobriety Services will be the test result.
Contractor will document in detail any and all observed or verbalized concerns regarding any child
whom the Contractor is working with under the Agreement. Areas of concern may include, but are
not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be
reported immediately to the caseworker AND on the required monthly report.
Monthly reports will be submitted through the Department's online reporting system, unless
otherwise directed or agreed to by the Department.
4. Payment
a. The Department and the Contractor agree that all benefits from private insurance and/or other
funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's
Compensation must be exhausted before Core Services or other Department funds can be accessed
for services.
b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit
B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule, attached
hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in
accordance with the Agreement.
c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent
upon, the continuing availability of said funds for the purposes hereof.
d. The Department may withhold reimbursement if Contractor has failed to comply with any part of
the Agreement, including the Financial -Management requirements, program objectives, contractual
terms, or reportingrequiirements. 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 tithes from the effective date of the Agreement until completion of the Agreement, Contractor shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133.
6. Payment Method
Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services , and Exhibit D,
Payment Schedule:
a. If services are funded through Core Services, Contractor agrees to accept reimbursement
through ACH direct deposit one time per month.
b. If Contractor is not currently set up with the State of Colorado to accept direct deposit,
Contractor agrees to complete and submit an ACH Form for Colorado Providers, which will be
provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of
2
EXHIBIT A
SAMPLE AGREEMENT
Colorado per the directions on the form. Failure to complete and submit this form in a timely and
accurate manner may result in a delay of payment.
c. Contractor agrees to accept payment through county warrant when funding source does not
allow for direct deposit.
7. Compliance with Applicable Laws
a. At all times during the performance of this Agreement, Contractor will strictly adhere to all
applicable Federal and State laws, order, and applicable standards, regulations, interpretations
and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials that have been or may
hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws
and regulations, including, but not limited to the following:
- Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil
Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Lt., . 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 1573 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
Education Amendments of 1972; and
Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and
- all regulations applicable to these laws prohibiting discrimination because of race, color,
national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome
(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of
1973, as amended, cited above. If necessary, Contractor and the Department will resist in
judicial proceedings any efforts to obtain access to client records except as permitted by 42
C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken
to assure that small and minority businesses are utilized, when possible, as sources of
supplies, equipment, construction and services. This assurance is given in consideration of
and for the purpose of obtaining any all Federal and/or State financial assistance.
- Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks
for all employees, contractors and sub -contractors.
3
EXHIBIT A
SAMPLE AGREEMENT
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. §8-17.5401. Contract Professional certifies, warrants, and
agrees that it does not knowingly emptoy or contract with an illegal alien who will perform work under
this contract. Contract Professional will confirm the employment eligibility of all employees who are
newly hired for employment in the United States to perform work under this Agreement, through
participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S.
§8-17.5-102(5)(c). Contract Professional shall not knowingly employ or contract with an illegal alien to
perform work under this Agreement or enter into a contract with a subcontractor that fails to certify
with Contract Professional that the subcontractor shall not knowingly employ or contract with an illegal
alien to perform work under this Agreement. Contract Professional shall not use E -Verify Program or
State of Colorado program procedures to undertake pre -employment screening or job applicants while
this Agreement is being performed. If Contract Professional obtains actual knowledge that a
subcontractor performing work under the public contract for services knowingly employs or contracts
with an illegal alien Contract Professional shall notify the subcontractor and County within three (3)
days that Contract Professional has actual knowledge that a subcontractor is employing or contracting
with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or
contracting with the illegal alien within three (3) days of receiving notice. Contract Professional shall
not terminate the contract if within three days the subcontractor provides information to establish that
the subcontractor has not knowingly employed or contracted with an illegal alien. Contract
Professional shall comply with reasonable requests made in the course of an investigation, undertaken
pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contract
Professional participates in the State of Colorado program, Contract Professional shall, within twenty
days after hiring a new employee to perform work under the contract, affirm that Contract Professional
has examined the legal work status of such employee, retained file copies of the documents, and not
altered or falsified the identification documents for such employees. Contract Professional shall deliver
to County, a written notarized affirmation that it has examined the legal work status of such employee,
4
EXHIBIT A
SAMPLE AGREEMENT
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 &n the areas of Safety, Permanency and Well
Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under
this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under
the Child and Family Services Review (CFSR), and will address the aforementioned three areas when
completing monthly reports as required by Paragraph 3(d)of this Agreement.
9. Insurance Reguirenr nts
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 Bard of County Commissioners Hof Weld County, its employees, volunteers and agents.
Contractor shallprovide the liability insurances (including professional liability insurances where
necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged
in the performance of this Agreement which are required under Weld County's Request for Proposal, and
required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the
acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement.
At a minimum, Contractor shall procure, either personally or through its employer as applicable to the
Contractor's business, at its own expense, and maintain for the duration of the work, the following
insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners
of Weld County, its employees and agents, shall be named as additional named insured on the insurance,
where permissible the insurance provider.
a. General Requirements: Contractors/Contract Professionals must secure, at or before the
time of execution of any agreement or commencement of any work, the following insurance
covering all operations, goods or services provided pursuant to this request. Contractors/Contract
Professionals shall keep the required insurance coverage in force at all times during the term of
5
EXHIBIT A
SAMPLE AGREEMENT
the Agreement, or any extension thereof, and during any warranty period. The required insurance
shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best
Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating
"Should any of the above -described policies by canceled or should any coverage be reduced
before the expiration date thereof, the issuing company shall send written notice to the Weld
County Director of General Services by certified mail, return receipt requested. Such written
notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-
payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess
of a deductible or self -insured retention, County must be notified by the Contractor/Contract
Professional. Contractor/Contract Professional shall be responsible for the payment of any
deductible or self -insured retention. County reserves the right to require Contractor/Contract
Professional to provide a bond, at no cost to County, in the amount ofthe 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 shaft 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 rIf 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, coveting prises operations, fire damage, independent Contractors,
products and completed operations, blanket contractual liability, personal injury, and
advertising liability with minimum limits as follows:
$1,Oo0,000 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;
6
EXHIBIT A
SAMPLE 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 approvecf'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 ofinsurance, a policy, or other proof of
insurance as required by the County's Risk Administrator in his sole discretion.
e. Additional Insureds: Forgeneral 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 fellows
f. Waiver ofSubrogation For all coverages, Contractor/Contract Professional's insurer
shall waive subrogation rights against County.
R. Subcontractors: All subcontractors, subcontractors, independent contractors, sub -
vendors, suppliers or other entities providing goods or services required by this Agreement shall
be subject to all of the requirements herein and shall procure and maintain the same coverages
required of Contractor/Contract Professional. Contractor/Contract Professional shall include all
such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds
under its policies or shall ensure that all subcontractors maintain the required coverages.
Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors,
independent contractors, sub -vendors suppliers or other entities upon request by the County.
A provider of Professional Services (as defined in the Bid or RFP) shall provide the following
Coverage:
Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and
$2,000,000 aggregate limit for all claims.
10. Certification
Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all
necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies
covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any Agreement.
11. Training
7
EXHIBIT A
SAMPLE AGREEMENT
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, x6509, 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 CountyCommissioners,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 necessaryorappropriate, such program data, special
analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with the work conducted under
this Agreement.
14. Modification of agreement
All modifications to this Agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human,Services ordesignee may exercise the following remedial actions should s/he find
the Crractor substantially failed to satisfy the scope of work found in this Agreement. Substantial
failureippsatisfy the sope of Work shall be defined to mean incorrect or improper activities or inaction by
the Contractor These remedial actions are as follows:
Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed.
Deny payment or recover reimbursement for those services or deliverables, which have
not been performed and which due to circumstances caused by the Contractor cannot be
performed or if performed would be of no value to the Department. Denial of the amount
of payment shall be reasonably related to the amount of work or deliverables lost to the
Department.
- Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation
shall be recovered from Contractor by deduction from subsequent payments under this
Agreement or other agreements between the Department and Contractor, or by the
Department as a debt due to the Department or otherwise as provided by law.
8
EXHIBIT A
SAMPLE AGREEMENT
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 CONTRACTOR, TITLE
For Contractor:
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to
the individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent.
For Department:
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
(970) 352-1551
18. Litigation
For Contractor:
Contractor shall promptly notify the Department in the event that Contractor learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading
which has been filed in any Federal or State court or administrative agency, shall deliver copies of such
document(s) to the Director of Human Services. The term "litigation" includes an assignment for the
benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the
individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an
obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise
appropriated in each Succeeding year, as this Agreement is subject to the availability of funding.
Therefore, the Department may terminate this Agreement at any time if the source of funding for the
services made available to the Contractor is no longer available to the Department, or for any other
reason. Contractor reserves the right to suspend services to clients if funding is no longer available.
20. No Third Party Beneficiary Enforcement
It is expressly understood and agreed that the enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned parties and nothing in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties receiving services or benefits
under this Agreement shall be an incidental beneficiary only.
21. Governmental Immunity
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of
9
EXHIBIT A
SAMPLE AGREEMENT
any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental
Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended.
22. Partial Invalidity of Agreement
If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held
or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions.
The parties hereto declare that they would have entered into this Agreement and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional
or invalid.
23. Improprieties/Conflict of Interest
No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department
when the Contractor also maintains a relationship with athixd 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 forinfluencing or attempting to influence an officer or employee of an agency,
a Member of Congres pan 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.
torage, AGila
nd 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 ens,i re„compliance with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation othe performance of the Agreement shall be conducted by appropriate funding sources. The
results of the monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
All such records, documents, communications, and other materials created pursuant or related to this
Agreement shall be maintained by the Contractor in a central location and shall be made available to the
Department upon its request, for a period of seven (7) years from the date of final payment under this
Agreement, or for such further period as may be necessary to resolve any matters which may be pending,
or until an audit has been completed with the following qualifications: If an audit by or on behalf of the
Federal and/or State government has begun but is not completed at the end of the seven (7) year period,
or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until
the resolution of the audit finding.
10
EXHIBIT A
SAMPLE AGREEMENT
25. Confidentiality of Records
Contractor shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Agreement except for purposes directly connected with the
administration of Child Protection. No information about or obtained from any applicant/recipient in
possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's
parent or guardian unless in accordance with the Contractor's written policy governing access to,
duplication and dissemination of, all such information, in any form, including social networks. Contractor
shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality
requirements.
Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written
explanation of these confidentiality requirements before access to confidential data is permitted.
Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality
agreement and shall provide a copy of such agreement to the Department, if requested.
26. Proprietary Information
Proprietary information for the purposes of this Agreement is information relating to a party's research,
development, trade secrets, business affairs, internal operations and management procedures and those
of its customers, clients or affiliates, but does not include information. (1) lawfully obtained from third
parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither
party shall use or disclose directly or indirectly without prior written authorization any proprietary
information concerning the other party obtained as a result of this Agreement. Any proprietary
information removed from the Department's site by the Contractor in the course of providing services
under this Agreement will be accorded at least the same precautions as are employed by the Contractor
for similar information in the course of its own business.
27. Independence of Contractor: Not an Employee of Weld County
Contract Professional agrees that it is an independent Contract Professional and that Contract
Professional's,officers, agents or employees will not become employees of County, nor entitled to any
employee benefits from Countyas a result of the execution of this Agreement. Contract Professional shall
perform its duties hereunder as an independent Contract Professional. Contract Professional shall be
solely responsible for its acts and those of its agents and employees for all acts performed pursuant to
this Agreement. Contract Professional, its employees and agents are not entitled to unemployment
insurance or workers' compensation benefits through County and County shall not pay for or otherwise
provide such coverage for Contract Professional or any of its agents or employees. Unemployment
insurance benefits will be available to Contract Professional and its employees and agents only if such
coverage is made available by Contract Professional or a third party. Contract Professional shall pay when
due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred
pursuant to this Agreement. Contract Professional shall not have authorization, express or implied, to
bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement.
Contract Professional shall have the following responsibilities with regard to workers' compensation and
unemployment compensation insurance matters: (a) provide and keep in force workers' compensation
and unemployment compensation insurance in the amounts required by law (and as set forth in Exhibit
provide proof thereof when requested to do so by County.
28. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as state in
11
EXHIBIT A
SAMPLE AGREEMENT
Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or
obligations hereunder without the prior consent of both parties.
29. Agreement Nonexclusive
This Agreement does not guarantee any work nor does it create an exclusive agreement for services.
30. Warranty
The Contractor warrants that services performed under this Agreement will be performed in a manner
consistent with the professional standards governing such services and the provisions of this Agreement.
The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training,
diligence and judgment provided by highly competent individuals and entities that perform services of a
similar nature to those described in this Agreement including Exhibits A, B, C, and D.
31. Acceptance of Services Not a Waiver
Upon completion of the work, the Contractor shall submit to Department originals of all tests and results,
reports, etc., generated during completion of this work. Acceptance by Department of reports and
incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of
responsibility for the quality and accuracy of the services. In no event shall any action by the Department
hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or
default which may then exist on the part of the Contractor, and the Department's action or inaction when
any such breach or default shall exist shallnotimpair 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
Agreernent. The Contractor hos no interest and shall not acquire any interest direct or indirect, which
would In any manner or degree with the performance of the Contractor's services and the Contractor,
shall not employ any person having such known interests. During the term of this Agreement, the
Contractor shall not engage in any in any business or personal activities or practices or maintain any
relationships which actually conflict with or in any way appear to conflict with the full performance of its
obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may
result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of
the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or
hold any such position which either by rule, practice or action nominates, recommends, supervises
Contract Professional's operations, or authorizes funding to the Contractor.
33. Board of County Commissioners of Weld County Approval
This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld
County, Colorado.
12
EXHIBIT A
SAMPLE AGREEMENT
34. Choice of Law/Jurisdiction
Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation,
execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference
which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute
between the parties, Contract Professional agrees that the Weld County District Court shall have exclusive
jurisdiction to resolve said dispute.
35. Subcontractors
Contract Professional acknowledges that County has entered into this Agreement in reliance upon the
particular reputation and expertise of Contract Professional. Contract Professional shall not enter into any
subcontractor agreements for the completion of this project without County's priorwritten 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 tinier 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
othe 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 orcondition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of
competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the
extent that this Agreement is then capable of execution within the original intent of the parties.
13
EXHIBIT A
SAMPLE AGREEMENT
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first
above written.
ATTEST: BOARD OF COUNTY COMMISSIONERS
Weld County Clerk to the Board WELD COUNTY, COLORADO
BY:
Deputy Clerk to the Board , Chair
APPROVED AS TO FUNDING: APPROVED AS TO SUBSTANCE:
Controller Elected Official or Department Head
APPROVED AS TO FORM:
Director of General Services
County Attorney
CONTRACTOR
Contractor, Title
14
EXHIBIT B
CONTRACTOR'S BID
3/15/2018
To whom it may concern:
Dr. David Kalis has 25 years of experience providing services to individuals with mental health
issues, learning disabilities and developmental disabilities including autism. Much of Dr. Kalis' work
has focused on helping individuals and families increase functioning in their daily lives. Dr. Kalis
has a Ph.D. in Clinical Psychology, a master's Degree in social work, and has conducted numerous
seminars and trainings for employers, agencies, federal and state governments, and educators
who work with individuals with disabilities. His professional interests include family dynamics,
developmental and learning disabilities in the therapeutic setting, and diagnostic and evaluative
procedures for individuals with hidden disabilities.
Dr. Kalis and his experience team have been providing services to individuals with developmental
disabilities in multiple capacities. They have worked with children, adolescents, and adults in
multiple settings including in -home, in the community, and our offices. Since approximately 1996,
Dr. Kalis has worked with different human service organizations, including Denver County Human
Services, Jefferson County Human Services, Boulder County Housing and Human Services, and
Arapahoe County Human Services, and currently has a contract with Weld County. The focus of
the practice has been on helping families who experience developmental and/or learning
disabilities reach their maximum potential and providing a safe and healthy environment so that
families and individuals are able to flourish. There are currently five additional experienced
clinicians that support Dr. Kalis.
Dr. Kalis and his team has a unique perspective in dealing with child protective issues as he has
been trained in both social work as well as psychology. This combination gives him both the
experience and training to address family issues from a systems approach while also having
expertise in individual psychopathology. This expertise has been trained into his team and the
expertise allows the team to work efficiently and effectively with caseworkers, GAL's, lawyers, and
the court system to better support families and children.
Parker Personal Care Homes Dba Dr. Kalis Inc has offices in Denver, Lakewood, and Louisville. We
are also able to provide in home or community -based services to meet the needs of the clients. A
full menu of services is included in Exhibit C, attached. As a current Weld County contractor, we
have the staff capacity and expertise to respond to referrals. Our team currently meets the
requirements of attempting contact within 24 hours and notifying the referring individual if efforts
to engage the client are not successful after three attempts. We are willing to travel to Weld
County to provide the service have already have negotiated a travel reimbursement with the
Department. Staff is additionally trained on the reporting criteria and are meeting those guidelines
for billing and reporting. Dr. Kalis and his team are as aware that there is not reimbursement for
no-shows. The new collaboration between Parker Personal Care Homes Dba David Kalis, Inc an
Weld County has been a mutually beneficial partnership, and we look forward to the continuation
of that partnership. I A
Sincere y
Walters
1597 Cole Blvd. Ste. 250 / Lakewood. CO 80401 / p 303 424.6078 / f 303.424.6194 / www.parkerpch.com
EXHIBIT B
PROVIDER INFORMATION FORM
Weld County Department of Human Services
Parker Personal Care Homes Dba David Kalis. Inc
AGENCY OR PRIVATE PRACTICE
TRAILS PROVIDER ID (If Known)
David Kalis
Director of Clinical and Psychological Services
PRIMARY CONTACT —FULL NAME
PRIMARY CONTACT - TITLE
303.428.7041
PHONE NUMBER
EXT.
FAX NUMBER
david(a'kal(sandassociiates net www.kalisaudassociates.net and www.patkcrpch.com
PRIMARY CONTACT -E-MAIL ADDRESS
AGENCY/PRACTICE WEB ADDRESS (IF APPUCABLE)
PO Box 271168
Louisville, CO
80027
AGENCY MAILING ADDRESS
CITY
ZIP
REFERRAL CONTACT
Dr. David Kalis
Director of Clinical and Psychological Services
REFFERAL CONTACT - FULL NAME
REFERRAL CONTACT - TITLE
303.428.7041
davidtrrkalisandassociates.net
REFERRAL CONTACT - PHONE NUMBER
EXT.
REFERRAL CONTACT - E-MAIL ADDRESS
BILLING CONTACT
Amber Allen
Billing Director
BILLING CONTACT - FULL NAME
BILLING CONTACT - TITLE
303.885.2754
ambccrtulkalisandassocia(es nct
BILLING CONTACT - PHONE NUMBER
EXT.
BILLING CONTACT - E-MAILADDRESS
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, f• waive any informality in the
bids, and to accept the bid, or part of a bid, that, in the opinion of the Bard, 's in the b. st interests of the Board and
of the County of Weld, State of Colorado. The Board. ld County om issioners 1 . I1 g e reference to
resident Weld County bidders in all cases where th s `` competit ve in : rice and ; lily
Signature of Authorized Representative:
Date of Signature:
3 Pi
81800058
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:
Parker Personal Care Homes Dba Dr. Kalis, Inc.
Mental Health Services to children, youth and adults
3. Modalities, curriculum or tools that will be utilized in the delivery of the service.
Multiple modalities will be utilized depending on the type of service. All services are offered using research
based modalities that have efficacy. Our clinicians continue to develop their clinical skills through training and
supervision to be on the forefront of the field.
Services available under this agreement include:
• Psychological Evaluation — Includes a thorough evaluation of background, mental health
concerns, cognitive abilities and academic skills.
• Learning Disability/Attention Deficit Disorder Evaluation — Can include a full psychological
(mental health) evaluation including cognitive and academic testing.
• Developmental Disabilities Evaluation — Can include a full psychological (mental health)
evaluation including cognitive and academic testing.
• Behavioral Evaluation — Includes observations, review of records, identification of target
behaviors, and recommendations for behavioral modification.
• Trauma -Informed Assessment/Evaluation —Trauma-informed Assessment/Evaluation — Includes
a psychological evaluation in addition to a full trauma assessment.
• Adaptive Behavior Evaluation — Evaluation of skills/abilities versus current daily performance.
• Parent/Child Interactional Evaluation — Includes observation of parent with child/children as well
as opinions and thorough recommendations.
• Sex Offender Specific Evaluation —Completed by a licensed full operating level Sex Offender
Management Board (SOMB) professional. Can include other assessments as well as cognitive,
mental health, and developmental.
• Counseling/Psychotherapy
• Family Therapy
• Home -Based Therapy/Therapeutic Visits
• Psychotherapy for Individuals with Limited Cognitive Abilities
• Consultation
• Anger Management
• Foster Parent Consultation
• Foster Parent Training
• Relinquishment Counseling
• Sexual Abuse Counseling
• Substance Abuse Treatment
4. Anticipated frequency of the service (ex. 4 hours/week).
Depends on the service based on need. We can provide a high level of intensity.
5. Anticipated duration of the service (ex. 3-4 months).
Depends on the service -based need and the authorization.
6. Goals of the service.
Goals depend on the nature of the service, ie an evaluation vs. ongoing. Goals are determined with client and team
input.
7. Outcomes of service.
Outcomes are based on goals established by clients and teams and monitored on an ongoing basis. Monthly reports
are submitted to track progress towards outcomes.
8. Target population for service.
Clinical specialty: Our clinical specialty is working with individuals with intellectual/developmental disabilities
including genetic disorders, autism, and comorbid mental health and/or substance abuse disorders. We provide
wraparound services that can include in -home, community, and in the office. Our services range from individual
therapy, family therapy, couples therapy, and community type interventions depending on the needs of the
client. We as well provide Parent -child interactional, life skills/parenting coaching, and consultation.
Additionally, we provide a full range of psychological testing and diagnostics. We can provide behavioral
evaluations, developmental and/or cognitive, mental health, and neuropsychological testing when appropriate.
Testing is not limited to but can include; diagnosing developmental disorders including autism, chronic mental
illness such as schizoaffective disorder, bipolar, attachment, posttraumatic stress disorder, and schizophrenia.
Evaluations often include components of developmental, cognitive, adaptive behavior, executive functioning,
and mental health diagnoses.
9. Service access.
Clients can access services through Core contract, Medicaid, private health insurance (some carriers) and private pay.
Our policy is to respond within one business day to schedule. There are currently six clinicians with David Kalis, Inc
and we will coordinate with Weld County staff to access services efficiently and quickly. Office addresses are: 1597
Cole Blvd., Lakewood, CO 80401.; 357 S. McCaslin Ste. 200, Louisville, CO 80027; 2001 York Street, Denver, CO 80205.
10. Languages service is available in.
Service is available in English
11. Medicaid eligibility of service.
Parker Personal Care Homes Dba David Kalis, Inc is a Medicaid provider.
12. Transportation of clients.
Parker Personal Care Homes Dba David Kalis, Inc typically does not provide transportation, but can in individual
situations.
13. Rates of service,
SERVICES AND FEES
Psychological (mental health)* $125/hour up to 12 hours
Learning Disability/Attention Deficit Disorder* $125/hour up to 12 hours
Developmental Disabilities* $125/hour up to 12 hours
Behavioral Evaluation $125/hr up to 12 hr for PHD
$100/hr up to 12 hr for Masters
Trauma Informed Assessments/evaluation $125/hour up to 20 hours
(this includes a psychological evaluation in addition to a trauma assessment)
Adaptive Behavior Evaluation $125/hr up to 3 hrs for PHD
$100/hr up to 3 hrs for Masters
Parent/child interactional evaluation $125/hour up to 12 hours
Counseling/Psychotherapy
Family Therapy
Home Based Therapy/Therapeutic Visits
$100/ hr for Masters
$125/hr for PHD
$100/ hr for Masters
$125/hr for PHD
$100/ hr for Masters
Psychotherapy for individuals
with limited cognitive abilities
Consultation
Anger Management
Foster Parent Consultation
Relinquishment Counseling
Sexual Abuse Counseling
Substance Abuse Counseling
$125/hr for PHD
$100/hr for Masters
$125/hr for PHD
$100/ hr for Masters
$125/hr for PHD
$100/ hr for Masters
$125/hr for PHD
$100/ hr for Masters
$125/hr for PHD
$100/ hr for Masters
$125/hr for PHD
$100/ hr for Masters
$125/hr for PHD
$100/ hr for Masters
$125/hr for PHD
* Can include a thorough evaluation of mental health, cognitive abilities, and academic skills
Parker Personal Care Homes Dba David Kalis, Inc. charges 50 cents/ mile over 25 miles outside of your radius.
Bid No.: B1800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Anger Management
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis, Inc.
-'
` ""
APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION ;..._
'
R IN
NFORMATION
FORMATION
No
Last Name
=
First Name •
Work#i
Work Email ..
Education
Level ,
'
Degree Focus
Licensure/
'Credentials
DORA #
(If applicable)
Last Name
; .
First Name
Work # . ' -.
Work Email
1 Kalis
2
3
4
5
6
7
8
Kalis
Bansch-Wickert
Cunningham
Veeder
Pagnotta
Read
David
David
Julie
Shana
Kate
Jolene
Gretchen
303.428.7041
303.428.7041
303.519.7060
216.905.9595
720.471.9973
720.335.7332
720.936.7645
david@kalisandas PHD
david@kalisandas
jbansch-wckert@
shana@kalisandas
kate@kalisandass
jpagnotta@parker
gretchen@kalisan
PHD
Masters
Masters
Masters
Masters
Masters
Psychology
Psychology
Social Work
Social Administ
Social Work
Marriage and F.
Social Work
Licensed
Psychologist PSY 3755
LCSW
LCSW
LCSW
LSW
SOMB, LAC
LCSW
CSW 077
CSW 2041
CW 1178
9921232
LAC 0000842
CSW 09924196
Walters
Walters
Kalis
Kalis
Kalis
Kalis
Kalis
Jodi
Jodi
David
David
David
David
David
303-424.6078X10 jwalters@parkerp.
303.424.6078X10E
303.428.7041
303.428.7041
303.428.7041
303.428.7041
303.428.7041
jwalters@parkerpi
david@kalisandas:
david@kalisandas:
david@kalisandas:
david@kalisandas:
david@kalisandas:
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
B1800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
281
81800058
T I I I I I I I I I I
STAFF DATA SHEET
EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
ch.com
ch.com
sociates.net
sociates.net
sociates.net
sociates.net
sociates.net
B1800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Consultation
BIDDER LEGAL ENTITY NAME:
.
- APPLICABLE STAFF.MEMBER'OR CONTRACTOR .: . "-
Education `-- : • Licensure/ DORA ft
[ INFORMATION SUPERVISOR INFORMATION
• '
No Last:Narne -: First Name.-- Work# Work Email _` • Level . • Degree Focus Credentials, (Ifapplicable)f Last Name First Name' Work It. • • Work Email
Licensed
1 Kalis David 303.428.7041 david@kalisandas PHD Psychology Psychologist PSY 3755 Walters Jodi 303-424.6078X10 jwalters@parkerpch.com
2 Kalis David 303.428.7041 david • kalisandas PHD Psychology LCSW CSW 077 Walters Jodi 303.424.6078X10: 'waiters • .arker.ch.com
3 Bansch-Wickert Julie 303.519.7060 jbansch-wickert@ Masters SocialWork LCSW CSW2041 Kalis David 303.428.7041 david@kalisandassociates.net
4 Cunningham Shana 216.905.9595 shana@kalisandasMasters SocialAdminist LCSW CW 1178 Kalis David 303.428.7041 david@kalisandassociates.net
5 Veeder Kate 720.471.9973 kate@kalisandass Masters SocialWork LSW 9921232 Kalis David 303.428.7041 david@kalisandassociates.net
6 Pagnotta Jolene 720.335.7332 jpagnotta@parker Masters Marriage and F SOMB, LAC LAC 0000842 Kalis David 303.428.7041 david@kalisandassociates.net
7 Read Gretchen 720.936.7645 gretchen@kalisan Masters SocialWork LCSW CSW09924196 Kalis David 303.428.7041 david@kalisandassociates.net
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Parker Personal Care Homes Dba David Kalis
Inc
B1800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Psychotherapy for individuals with limited cognitive abilities
Parker Personal Care Homes Dba David Kalis, Inc
BIDDER LEGAL ENTITY NAME:
' `` ` 'APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION
RIN SUPERVISO FORMATION
No.
Last Name,' .
First: Names
Work#., •
Work'Email ..
Education
Level ..
Degree Focus c,
Licensure/„
Credentials•
DORA#
(If 'applicable). '`
Last Name •
First Name
Work #
Work. Email
1
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
Licensed
Psychologist
PSY 3755
Walters
Jodi
303-424.6078X10
jwalters@parkerpch.com
2
Kalis
David
303.428.7041
david . kalisandas
PHD
Psychology
LCSW
CSW 077
Walters
Jodi
303.424.6078X10:
'waiters , .arker.ch.com
3
Bansch-Wickert
Julie
jbansch-wickert(e
Masters
Social Work
LCSW
CSW 2041
Kalis
David
303.428.7041
david@kalisandassociates.net
4
Cunningham
Shana
216.905.9595
shana@kalisanda≤Masters
SocialAdminist
LCSW
CW1178
Kalis
David
303.428.7041
david@kalisandassociates.net
5
Veeder
Kate
720.471.9973
kate@kalisandass
Masters
SocialWork
LSW
9921232
Kalis
David
303.428.7041
david@kalisandassociates.net
6
Pagnotta
Jolene
720.335.7332
jpagnotta@parker
Masters
Marriage and F,
SOMB, LAC
LAC 0000842
Kalis
David
303.428.7041
david@kalisandassociates.net
7
Read
Gretchen
720.936.7645
gretchen@kalisan
Masters
SocialWork
LCSW
CSW09924196
Kalis
David
303.428.7041
david@kalisandassociates.net
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
B1800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE: Adaptive Behavior Evaluation
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis, Inc.
. •:• .,APPLICABLE STAFF MEMBER OR CONTRACTORINFORMATION -' t • -
, - ' "°
SUPERVISOR INFORMATION
No: ;
Last Name •Y ,
a ,.�
F.irst.Name,'
Work#
x ::
Work Dual!, ,
Education
Level.', •
Degree Focus'
Licensure/,
Credentials '•
DORA #
(If applicable) ' ,
Last Name '
First Name - ' •
Work #
Work Email
1
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
Licensed
Psychologist
PSY 3755
Walters
Jodi
303-424.6078X10
.
jwalters@parkerpch.com
2
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
LCSW
CSW 077
Walters
Jodi
303-424-6078 X1C
jwalters@parkerpch.com
3
Veeder
Kate
720.471.9973
kate@kalisandass
Masters
SocialWork
LSW
9921232
Kalis
David
303.428.7041
david@kalisandassociates.net
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
81800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Behavioral Evaluation
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis, Inc.
.:APPLICABLE STAFF;MEMBER 0R,C0NTRACT0R INFORMATION ,• •
SUPERVISOR INFORMATION
No .
Last Name .
First;Name
Work#:
_,Work Email
Education
Level— : , ..
Degree Focus.
Licensure/,_ -
Credentials
DORA tl , fl'
(If.applicable),.
,;; Last Name
First Name
# :-Work ,
Work Email
1
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
Licensed
Psychologist
PSY 3755
Walters
Jodi
303-424.6078X101
jwalters@parkerpch.com
2
Kalis
David
303.428.7041
david@kalisandasPHD
Psychology
LCSW
CSW077
Walters
Jodi
303.424.6078X10Ejwalters@oarkeroch.com
303.428.7041
david@kalisandassociates.net
3
Bansch-Wickert
Julie
303.519.7060
jbansch-wckert@
Masters
SocialWork
LCSW
CSW2041
Kalis
David
4
Cunningham
Shana
216.905.9595
shana@kalisandasMasters
SocialAdminist
LCSW
CW 1178
Kalis
David
303.428.7041
david@kalisandassociates.net
5
Veeder
Kate
720.471.9973
kate@kalisandass
Masters
SocialWork
LSW
9921232
Kalis
David
303.428.7041
david@kalisandassociates.net
6
Pagnotta
Jolene
720.335.7332
jpagnotta@parker
Masters
Marriage and F
SOMB, LAC
LAC 0000842
Kalis
David
303.428.7041
david@kalisandassociates.net
7
Read
Gretchen
720.936.7645
gretchen@kalisan
Masters
SocialWork
LCSW
CSW09924196
Kalis
David
303.428.7041
david@kalisandassociates.net
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
81800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Counseling/ Psychotherapy
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis, Inc.
,',
--`APPLICABLE STAFF MEMBER OR' CONTRACTOR' INFORMATION' .'
SUPERVISOR INFORMATION
No.,
Last;Name ;--
First Name
Work# r:
Work Email -
Education
Level
-
Degree Focus -
Licensure/.
Credentials
DORA #
(If applicable) '
Last Name 4-
First Name .-
-
Work'# " ,
Work Email -.
1
Kalis
David
303.428.7041
david@kalisandas
PHD
-
Psychology
Licensed
Psychologist
PSY 3755
Walters
Jodi
-
303-424.6078X10
jwalters@parkerpch.com
2
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
LCSW
CSW 077
Walters
Jodi
303.424.6078X10kjwalters@parkerpch.com
303.428.7041
3
Bansch-Wickert
Julie
303.519.7060
jbansch-wickert@
Masters
SocialWork
LCSW
CSW2041
Kalis
David
david@kalisandassociates.net
4
Cunningham
Shana
216.905.9595
shana@kalisanda!
Masters
Social Administ
LCSW
CW 1178
Kalis
David
303.428.7041
david@kalisandassociates.net
5
Veeder
Kate
720.471.9973
kate@kalisandass
Masters
SocialWork
LSW
9921232
Kalis
David
303.428.7041
david@kalisandassociates.net
6
Pagnotta
Jolene
720.335.7332
jpagnotta@parker
Masters
Marriage and F
SOMB, LAC
LAC 0000842
Kalis
David
303.428.7041
david@kalisandassociates.net
7
Read
Gretchen
720.936.7645
gretchen@kalisan
Masters
SocialWork
LCSW
CSW09924196
Kalis
David
303.428.7041
david@kalisandassociates.net
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
B1800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Developmental Disabilites Evaluation
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis, Inc.
�' ':'APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION .
INFORMATION
No.
Last Name,"
First. Name ,, '
Work#
Work Email
Education .
Level -
_SUPERVISOR
•
Degree Focus
Licensure/ ' "
Credentials,
DORA St
(If applicable)
Last Name
First Name
Work tt
Work Email
1
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
Licensed
Psychologist
PSY 3755
Walters
Jodi
303-424.6078X10
jwalters@parkerpch.com
2
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
LCSW
CSW 077
Walters
Jodi
303-424-6078 X1Cjwalters@parkerpch.com
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
B1800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Family Therapy
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis, Inc.
' . '- .-':APPLICABLESTAFF MEMBER OR CONTRACTOR INFORMATION , .
-
SUPERVISOR INFORMATION ;
No:
Last.Name , -
First' Name;..- ,
Work#
; •.
':
Work Email :' ;
Education
Level ,:
... , "
Degree Focus
Licensure/
Credentials..
DORA R -•
(If -applicable)...
Last Name
_
First Name _
Work # `
Work, Email
1
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
Licensed
Psychologist
PSY 3755
Walters
Jodi
303-424.6078X10
jwalters@parkerpch.com
2
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
LCSW
CSW077
Walters
Jodi
303.424.6078X10£jwalters@parkerpch.com
303.428.7041
3
Bansch-Wickert
Julie
303.519.7060
jbansch-wickert@
Masters
SocialWork
LCSW
CSW2041
Kalis
David
david@kalisandassociates.net
4
Cunningham
Shana
216.905.9595
shana@kalisandalMasters
SocialAdminist
LCSW
CW1178
Kalis
David
303.428.7041
david@kalisandassociates.net
5
Veeder
Kate
720.471.9973
kate@kalisandass
Masters
SocialWork
LSW
9921232
Kalis
David
303.428.7041
david@kalisandassociates.net
6
Pagnotta
Jolene
720.335.7332
jpasnotta@parkei
Masters
Marriage and F
SOMB, LAC
LAC 0000842
Kalis
David
303.428.7041
david@kalisandassociates.net
7
Read
Gretchen
720.936.7645
gretchen@kalisan
Masters
SocialWork
LCSW
CSW09924196
Kalis
David
303.428.7041
david@kalisandassociates.net
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
81800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Home Based Therapy/ Theraputic Visits
Parker Personal Care Homes Dba David Kalis. In
BIDDER LEGAL ENTITY NAME:
■
APPLICABLE STAFF; MEMBER OR CONTRACTOR INFORMATION ' ,_ �•-
SUPERVISOR INFORMATION
No.
Last Name
First Name.:
,.
Work# •
Work Email
Education
Level:. ' ,'
Degree Focus
Licensure/
Credentials,,
DORA #
(If applicable) -
Last Name -,First
Name
Work #
Work Email
1
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
Licensed
Psychologist
PSY 3755
Walters
Jodi
303-424.6078X101
jwalters@parkerpch.com
david@kalisandassociates.net
2
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
LCSW
CSW077
Walters
Jodi
303.424.6078X10Ljwalters@parkerpch.com
303.428.7041
3
Bansch-Wickert
Julie
303.519.7060
jbansch-wickert(D
Masters
Social Work
LCSW
CSW 2041
Kalis
David
4
Cunningham
Shana
216.905.9595
shana@kalisandas
Masters
Social Administ
LCSW
CW 1178
Kalis
David
303.428.7041
david@kalisandassociates.net
5
Veeder
Kate
720.471.9973
kate@kalisandass
Masters
Social Work
LSW
9921232
Kalis
David
303.428.7041
david@kalisandassociates.net
6
Pagnotta
Jolene
720.335.7332
joagnotta@parker
Masters
Marriage and Fi
SOMB, LAC
LAC 0000842
Kalis
David
303.428.7041
david@kalisandassociates.net
7
Read
Gretchen
720.936.7645
gretchen@kalisan
Masters
SocialWork
LCSW
CSW09924196
Kalis
David
303.428.7041
david@kalisandassociates.net
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
B 1800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Learning Disability/ Attention Deficit Disorder Evaluation
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis, Inc.
APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION. _ :; _
• _ SUPERVISOR INFORMATION' •`
No.,
Last:Name
"
First Name:
'- :
Work#
. -
Work Email - :-
Education
Level •::
-
Degree Focus_
Licensure/ •
Credentials ,
DORA St
(If applicable) • :
Last Name
First Name'
Work X :
Work. Email -.
1
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
Licensed
Psychologist
PSY 3755
Walters
Jodi
303-424.6078X10
jwaltersCalparkerpch.com
2
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
LCSW
CSW 077
Walters
Jodi
303-424-6078 X1Cjwalters@parkerpch.com
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
B1800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Parent/ Child Interactional
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis, Inc.
'..-APPLICABLESTAFF:MEMBER.OR CONTRACTOR INFORMATION. ' : ' ',
SUPERVISOR FORMATION
No.:
Last Name
First Name
Worktt
Work Email
Education
Level
Degree Focus
Licensure/..
Credentials
DORA 4 "
(If applicable)
Last Name .
First Name
Work N
Work Email
1
Kalis
David
303.428.7041
daviditkalisandas
PHD
Psychology
Licensed
Psychologist
PSY 3755
Walters
Jodi
303-424.6078X10
jwalters(Bparkerpch.com
2
Kalis
David
303.428.7041
davidPkalisandas
PHD
Psychology
LCSW
CSW 077
Walters
Jodi
303-424-6078 X1Cjwalters(aparkerpch.com
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
B1800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Psychological (Mental Health) Evaluation
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis. Inc.
• ,;APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION - ' `a
_ SUPERVISOR ' INFORMATION: • .-.-.
No.';
Last Name `.
First Name ,
Wo►k*t
Work,Email • ;-
Education,
Level ..
Degree.Focus''
Licensure/.`.
Credentials _
DORAtt
(If applicable). '
Last. Name
First Name
Work it •
Work Email
1
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
Licensed
Psychologist
PSY 3755
Walters
Jodi
303-424.6078X101(walters@parkeroch.com
303-424-6078 X1Cjwalters@oarkeroch.com
2
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
LCSW
CSW 077
Walters
Jodi
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
81800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.
PROPOSED SERVICE OR SERVICE TYPE:
Sexual Abuse Counseling
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis, Inc.
• APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION _
- SUPERVISOR INFORMATION .
.
No
Last Name - _
First Name - '
_
Work# ,
Work Email
Education_-
Level
- °
Degree Focus
Licensure/
Credentials'
DORA # - .
(Ifapplicable) ;
Last Name
First Name
Work #
Work Email
1
Pagnotta
Jolene
720.335.7332
jpasnotta@parkei
Masters
Marriage and
Family Services
SOMB, LAC
LAC 0000842
Kalis
David
303.428.7041
david@kalisandassociates.net
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
81800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
SOMB Evaluation
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis, Inc.
t
"APPLICABLE STAFF' MEMBER: OR CONTRACTOR INFORMATION . = ' `
, - SUPERVISOR INFORMATION'•
No.
. _
Cast Name;
First Name ; ,
:. =._
Work#
Work. Email.
Education
Level" . '
Degree Focus
Licensure/.: _
Credentials'
DORA #,._
(If applicable)
Last Name -
First Name '.'
Work # •
Work Email
1
Pagnotta
Jolene
720.335.7332
jpagnotta@parker
Masters
Marriage and
Family Services
SOMB, LAC
LAC 0000842
Kalis
David
303.428.7041
david@kalisandassociates.net
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
B1800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Substance Abuse Treatment
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis. Inc.
• -APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION ,
INFORM
SUPERVISOR INFORMATION
No,
Last Name, ;;.
'
First;Name
-
Work#
i
Work Email�
Education..
Level • • -
"'
Degree Focus .'-
Licensure/
Credentials
DORA It
(If applicable) '
Last Name
•
first Name
Work St
Work Email � .:
_
1
Pagnotta
Jolene
720.335.7332
jpaenotta(a)parkei
Masters
Marriage and
Family Services
SOMB, LAC
LAC 0000842
Kalis
David
303.428.7041
davidPkalisandassociates.net
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
81800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE: Trauma -Informed Assessment/ Evaluation
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis, Inc.
APPLICABLE. STAFF MEMBER OR CONTRACTOR INFORMATION " • - "
SUPERVISOR INFORMATION
No.:
Last Name' •First
•ail
:.
Name ".
Work# `
Work Em'
Education
Levef •
Degree. Focus t
Licensure/
Credentials
DORA#
(If -applicable), ,
Last Name
First Name
Work #
Work Email
1
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
Licensed
Psychologist
PSY 3755
Walters
Jodi
303-424.6078X10
jwalters@oarkerpch.com
2
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
LCSW
CSW 077
Walters
Jodi
303-424-6078 X1Cjwalters@oarkerpch.com
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
B1800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Foster Parent Consultation
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis. Inc.
'- =APPLICABLE STAFF MEMBER OR CONTRAINFORMATION
a .
-Licensure/
SUPERVISOR INFORMATION
No. "
Last Name,'
First Name,,'• `'
Work#
Work Email -
duOR
Level -
Degree Focus` -
Credentials.
DORA #
(If applicable) `
Last Name •
First Name ,
Work#
Work Email ".
1
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
Licensed
Psychologist
PSY 3755
Walters
Jodi
303-424.6078X10
jwalters@parkerpch.com
2
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
LCSW
CSW077
Walters
Jodi
303.424.6078X10Ejwalters@oarkeroch.com
303.428.7041
david@kalisandassociates.net
3
Bansch-Wickert
Julie
303.519.7060
jbansch-wickert@
Masters
SocialWork
LCSW
CSW2041
Kalis
David
4
Cunningham
Shana
216.905.9595
shana@kalisandasMasters
SocialAdminist
LCSW
CW 1178
Kalis
David
303.428.7041
david@kalisandassociates.net
5
Veeder
Kate
720.471.9973
kate@kalisandass
Masters
SocialWork
LSW
9921232
Kalis
David
303.428.7041
david@kalisandassociates.net
Read
Gretchen
720.936.7645
gretchen@kalisan
Masters
Social Work
LCSW
CSW 09924196
Kalis
David
303.428.7041
david@kalisandassociates.net
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
B1800058
STAFF DATA SHEET EXHIBIT D
(Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.)
PROPOSED SERVICE OR SERVICE TYPE:
Relinquishment Counseling
BIDDER LEGAL ENTITY NAME:
Parker Personal Care Homes Dba David Kalis. Inc
-, APPLICABLE STAFF MEMBER'OR CONTRACTOR INFORMATION_" , :
SUPERVISOR INFORMATION
No.
Last -Name . ' T
First Name , _.
-- - -
Work#
Work Email ,
Education
Level '
Degree Focus,.
Licensure/ ..
Credentials
DORA # -•
(If applicable)
Last Name
First Name
Work #
Work Email
1
Kalis
David
303.428.7041 •
david@kalisandas
PHD
Psychology
Licensed
Psychologist
PSY 3755
Walters
Jodi
303-424.6078X10
jwalters@parkerpch.com
2
Kalis
David
303.428.7041
david@kalisandas
PHD
Psychology
LCSW
CSW077
Walters
Jodi
303.424.6078X10tiwalters@parkeroch.com
303.428.7041
david@kalisandassociates.net
3
Bansch-Wickert
Julie
303.519.7060
jbansch-wckert@
Masters
Social Work
LCSW
CSW 2041
Kalis
David
4
Cunningham
Shana
216.905.9595
shana@kalisanda!
Masters
Social Administ
LCSW
CW 1178
Kalis
David
303.428.7041
david@kalisandassociates.net
5
Veeder
Kate
720.471.9973
kate@kalisandass
Masters
Social Work
LSW
9921232
Kalis
David
303.428.7041
david@kalisandassociates.net
6
Read
Gretchen
720.936.7645
gretchen@kalisan
Masters
Social Work
LCSW
CSW 09924196
Kalis
David
303.428.7041
david@kalisandassociates.net
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
B1800058
EXHIBIT B
SCOPE OF SERVICE
1. Contractor will provide Mental Health Services to children, youth and adults, as referred by the
Department.
2. Services available under this agreement include:
a. Psychological Evaluation — Includes a thorough evaluation of background, mental health
concerns, cognitive abilities and academic skills.
b. Learning Disability/Attention Deficit Disorder Evaluation — Can include a full psychological
(mental health) evaluation including cognitive and academic testing.
c. Developmental Disabilities Evaluation — Can include a full psychological (mental health)
evaluation including cognitive and academic testing.
d. Behavioral Evaluation — Includes observations, review of records, identification of target
behaviors, and recommendations for behavioral modification.
e. Trauma -Informed Assessment/Evaluation —Trauma-informed Assessment/Evaluation — Includes
a psychological evaluation in addition to a full trauma assessment.
f. Adaptive Behavior Evaluation — Evaluation of skills/abilities versus current daily performance.
g. Parent/Child Interactional Evaluation — Includes observation of parent with child/children as well
as opinions and thorough recommendations.
h. Sex Offender Specific Evaluation — Completed by a licensed full operating level Sex Offender
Management Board (SOMB) professional. Can include other assessments as well as cognitive,
mental health, and developmental.
i. Counseling/Psychotherapy
j. Family Therapy
k. Home -Based Therapy/Therapeutic Visits
I. Psychotherapy for Indivduals with Limtied Cognitive Abilities
m. Consultation
n. Anger Management
o. Foster Parent Consultation
p. Foster Parent Training
q. Relinquishment Counseling
r. Sexual Abuse Counseling
s. Substance Abuse Treatment
3. Anticipated Frequency: Determined by the referred service and need.
4. Anticipated Duration of Service: Determined by the referred service and need.
5. Goals of Service:
a. Goals depend on the nature of the service such as ongoing or evaluative.
b. Goals are determined with client and treatment team input.
6. Outcomes of Service:
a. Outcomes are based on goals established through client and team input and monitored on an
ongoing basis. •
7. Target Population:
a. Individuals with intellectual/developmental disabilities including genetic disorders, autism and
comorbid mental health and/or substance abuse disorders.
b. Individuals requiring testing/evaluation for:
i. Developmental disorders
ii. Chronic mental health illness
8. Service Access: Available in -office at three (3) locations.
a. 1597 Cole Boulevard, Lakewood, CO 80401
b. 357 South McCaslin, Suite 200, Louisville, CO 80027
c. 2001 York Street, Denver, CO 80205
9. Language: English only.
10. Medicaid Eligibility: Eligible services will be billed to Medicaid.
11. Transportation: Contractor does not generally transport clients but will consider it on a case -by -
case basis.
12. Contractor will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
13. 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.
14. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom
the Contractor is working with under an active referral. Areas of concern may include, but are not limited
to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported
immediately AND on the required monthly report.
15. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department, unless otherwise directed by the
Department.
16. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare
Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team
Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented
service on the initial authorized referral form. This may include an increase or decrease in services hours,
change in frequency, change in location of services, transportation needs, or any change to the initial
referral or subsequent authorizations.
17. 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 (if in person) 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. Contractor may participate by phone.
EXHIBIT D
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse the Contractor in consideration of the work and services performed
under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to the
Contractor during the term of this Agreement shall be reported by the Department after May 31, 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
$125.00/Episode (Evaluative or Therapeutic Services - Ph.D.)
*Psychological (Up to 12 Hours)
*Learning Disability/Attention Deficit Disorder (Up to 12 Hours)
*Developmental Disabilities (Up to 12 Hours)
Behavioral Evaluation (Up to 12 Hours)
Trauma Informed Assessment/Evaluation (Up to 20 Hours. Includes Psychological.)
Adaptive Behavior Evaluation (Up to 3 Hours)
Parent/Child Interactional Evaluation (Up to 12 Hours)
Counseling/Psychotherapy
Family Therapy
Home -Based Therapy/Therapeutic Visits
Psychotherapy for Individuals with Limited Cognitive Abilities
- Consultation
- Anger Management
- Foster Parent Consultation
Relinquishment Counseling
Sexual Abuse Counseling
Substance Abuse Counseling
*Can include a thorough evaluation of mental health, cognitive abilities and academic skills.
$100.00/Episode (Evaluative or Therapeutic Services — Master's) •
Adaptive Behavior Evaluation
Behavioral Evaluation (Up to 12 Hours)
Counseling/Psychotherapy
Family Therapy
1
Home -Based Therapy/Therapeutic Visits
Psychotherapy for Individuals with Limited
Consultation
- Anger Management
Foster Parent Consultation
- Relinquishment Counseling
Sexual Abuse Counseling
Substance Abuse Counseling
$ .50/Mile over 25 miles from identified office location.
Cognitive Abilities
Contractor may not attempt to collect co -pays and/or fees for services for which a Department client is
responsible, but which a particular client refuses or fails to pay.
Contractor will collect any applicable sliding scale co -pays and credit the Department for any payment
received on the monthly billing.
3. Submittal of Vouchers
Contractor shall prepare and submit monthly an itemized voucher, and signed monthly report if
applicable, certifying that services authorized were provided on the date(s) indicated and the charges
made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A.
Contractor shall submit all monthly billings and applicable reports to the Department by the 7`h day of the
month following the month the cost was incurred. Failure to submit by the aforementioned deadline may
result in forfeiture of payment.
a. For ongoing services, proof of services rendered shall be a Client Verification Form signed by
the client and a monthly report submitted in accordance with Paragraph 3(d) of this
Agreement.
b. For one-time services, proof of services rendered shall be receipt of the completed product.
c. For Monitored Sobriety services, proof of services rendered shall be the test result.
2
AFRO- CERTIFICATE OF LIABILITY INSURANCE
DATE 08/06/2018 Y'
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 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER 1-303-534-4567
IMA, Inc. - Colorado Division
1705 17th StreetMAILADDRESS:
Suite 100
Denver, CO 80202
CONTACT
NAME:
PHONE FAX
lA/C. No. Est): I (A/C. No):
EenAccountTechs@imacor
Dp.com
INSURER(S) AFFORDING COVERAGE
NAICE
INSURER A: BERKSHIRE HATHAWAY HOMESTATE INS CO(Irwir20044
INSURED .
Parker Personal Care Homes
David Kaiie, Inc., dba
357 S MCCaelin Blvd #200
Louieiville, CO 80027
INSURER B: PINNACOL ASSUR
41190
INSURER C:
INSURERD:
INSURER E:
INSURER F:
:53616260
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY. HAVE BEEN REDUCED BY °AID CLAIMS.
IN,T
(R
TYPE OF INSURANCE
ADDL
INSD
SUER
MO
POLICY NUMBER
POLICY EFF
(MM/DO/YYYYI
POLICY EXP
(MM/DWYYYY)
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
478PK25819802
07/31/18
07/31/19
EACH OCCURRENCE
$ 1,000,000
1 CLAIMS -MADE
X
OCCUR
TO RENTE
PREM DAMAGE wr $ Ea occence)
5 1,000,000
MED EXP (Any one person)
S 20,000
I PERSONAL &ADV INJURY
$ 1.000,000
GENt
AGGREGATE
UMIT APPLIES PER:
PRO -
j' LOC
GENERAL AGGREGATE
S 3,000,000
PRODUCTS - COMP/OP AGG
5 3,000,000
S
A
AUTOMOBILE
X
_ X
_.
LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
_
X
—
SCHEDULED
AUTOS
NON -OWNED
AUTOS ONLY
47RWS258199C2
07/31/18
07/31/19
COMBINEDSINGLELIMIT
{Ea BCpdent)
S 1,000,000
BODILY INJURY (Per person)
S
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
(Per accident)
S
I
A
X
,_
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
478UM25820002
07/31/18
07/31/191
EACH OCCURRENCE
000/
$ ,000
AGGREGATE
S 1, 000, 000
DED I X I RETENTON$ 10,000
S
B
WORKERS COMPENSATION Y!N
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUrIVE
OFFICER/MEMBEREXCLUDED? I N
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
4007978
-
12/01/17
12/01/18
XISTATUTE I IERH
E.L. EACH ACCIDENT
S 500,000
E.L. DISEASE- EA EMPLOYEE
S 500,000
E.L. DISEASE - POLICY LIMIT
5 500,000
A
Professional Liability
Coverage
47SPK25819802.
07/31/18
07/31/19
Per Occurrence
Aggregate
;1,000,000
;3,000,000
DESCRIPTION OF OPERATIONS ! LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apace Is required)
Weld County is included as Additional Insured on the General and Umbrella Liability Policies if required by written
contract or agreement subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of
'Additional Insured on the General Liability and Workers Compensation Policies if required by written contract or
agreement subject to the policy terms and conditions.
CANCELLATION
Weld County Department of Human Services
1150 0 STREET
GREELEY, CO 80634
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POUCY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
briannah
53616260
® 1988.2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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