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Home My WebLink About20172861.tiffedvittad- 46a6 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND ARIEL CLINICAL SERVICES This Agreement Amendment, made and entered into OMd day of Uv (c� , 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 Ariel Clinical Services, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Home -Based Intensive Services, Home Studies, Life Skills, and Mentoring (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2017-2861 approved on August 21, 2017. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on May 31, 2018. • The Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following change is hereby made to the Agreement: 1. WHEREAS, the Colorado Department of Human Services has provided Core Services or other funds to the Department for Home -Based Intensive Services, Home Studies, Life Skills, and Mentoring. 2. Paragraph 1, Term This agreement shall become effective on June 1, 2017, upon proper execution of this Agreement and shall expire May 31, 2019, unless sooner terminated as provided herein. 3. Payment The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. Exceptions to this Paragraph may include, if approved by the Department, the following: i. The service being provided by the contractor is not a Medicaid eligible service; ii. The service is not deemed medically necessary; iii. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; iv. A Medicaid provider is not available o provide th needed service; 7-.2- .2o/g- -Don 1-tR00g'g v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. 4. Exhibit C, Scope of Services, amended as attached. 5. Exhibit D, Payment Schedule, amended as attached. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: ,driLtAiv•'4. Wel un Clerk to the Board e / / to t, B Deputy Clerk BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Steve Moreno, Chair 0221PI8 CONTRACTOR: Ariel Clinical Services 4660 Wadsworth Boulevard Wheat Ridge, Colorado 80033 (303) 703-9351 By: Date: ional Director 'DO17 - e Co EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Behavior Coaching, Supervised Visitation and Structured Parenting Time, Mentoring, and Home Study services for individuals and families referred by the Department. 2. Behavior Coaching: a. Purpose/Goal: To provide therapeutic support to behaviorally or emotionally impaired children in the community and/or foster homes. b. Staff: Contractor will provide professionals experienced in working with children in a variety of settings. Contractor employs strength -based; solutions focused, and trauma informed practices. Contractor will engage the child and their family in order to maximize the success of services. c. Services: Services include behavioral support, mentoring, independent living coaching, and respite in the community. Contractor will also be offering DBT groups in the community. d. Target Population: Contractor will provide services to children and youth, male and female, 0-18 years of age, including those with developmental disabilities. e. Location of Services: Weld County, Denver Metro and El Paso County f. Availability of Services: Contractor will provide services Monday through Sunday. Hours will vary based on the needs of the client and/or family. Scheduling is available during normal business hours as well as in the evenings. g. Contractor does not bill Medicaid for this service. 3. Supervised Visitation and Structured Parenting Time: a. Purpose/Goal: To provide a neutral party that can observe contact between biological family members and their children. The goal of Supervised Visitation and Structured Parenting Time is to support the reunification of the children with their parents. Contractor will structure Parenting Time in a way that limits the child's exposure to parental conflict while allowing time for appropriate interactions. Contractor's primary goal is to protect the children from further emotional, physical or sexual abuse. Contractor will strive to maintain and improve the relationship between parents and children, help the parents understand and respond appropriately to their children's cues, and assist parents in improving trust, communication, and stability. Contractor will emphasize the importance of the parent(s) to commit and maintain consistency throughout the Structured Parenting Time. b. Staff: c. Services: Contractor will provide three (3) levels of Supervised Visitation/Structured Parenting Time: i. Structured Parenting Time: Is intended to provide monitoring of both verbal and non- verbal communication. The visit supervisor will intervene in order to help a parent connect with their child, improve interactions and supervision, and give suggestions for improving their relationship with their child and better meeting their needs. ii. Supervised Visitation: Is intended to provide documentation and observation as well as limited instruction. The visit supervisor may redirect the parent to engage with their children or keep conversations appropriate. 1 iii. Supervised Exchanges: Contractor will have staff present at pick up and drop off of the child from one parent to another. Staff remains for 15 minutes to ensure safety. This service also includes a written report of the demeanor of the child at the time of pick up and drop off and during the 15 minute exchange. a. Target Population: Contractor will provide services to any biological family members needing supervised visits. d. Location of Service: Location of Services: Weld County, Denver Metro and El Paso County b. Availability of Services: Contractor will provide services Monday through Sunday. Hours will vary based on the needs of the client and/or family. Scheduling is available during normal business hours as well as in the evenings. 4. SAFE Home Studies: a. Contractor will conduct home studies for foster certification and adoption as referred by the Department. b. Contractor utilizes the Structured Analysis Family Evaluation (SAFE) tool developed by the Consortium of Children. c. Contractor will ensure that all staff completing studies under this contract are SAFE certified and appear on the State's approved home study vendor list. d. Contractor will ensure that all staff conducting studies under this contract attend SAFE Refresher training during the term of the contract. e. Contractor will ensure that all studies are completed utilizing the most up-to-date forms and templates as found on www.consortforkids.org or www.SAFEhomestudy.org. f. Contractor will complete a Department of Motor Vehicle background check at no additional charge. All CBI, FBI and LexisNexis background check information will be completed by the Department, unless otherwise directed by the Department. g. Contractor will submit a completed home study to the Department with their billing within 60 days of receipt of the home study referral. A complete home study will include the study in SAFE format, background check information, SAFE questionnaires completed by the applicants, references and all other original documents submitted by the home study applicant. 5. Mentoring: a. Purpose/Goal: To help individuals build their independent living skills, provide positive role modeling, and assist individuals to reach their full potential. b. Staff: Bachelor level to Master's level. c. Services: Mentoring/Independent Living Skill Building d. Target Population: Contractor will provide services to children and youth, male and female, 0-18 years of age, including those with developmental disabilities. e. Location of Service: Weld County, Denver Metro and El Paso County. f. Availability of Services: Contractor will provide services Monday through Sunday. Hours will vary based on the needs of the client and/or family. Scheduling is available during normal business hours as well as in the evenings. g. Contractor does not bill Medicaid for this service. 6. 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. 2 7. Contractor understands that the Department will not reimburse Contractor for "no shows" after two (2) consecutive "no shows". It is the responsibility of the Contractor to communicate "no shows" to the Department in a timely manner to determine continuation of services. 8. Contractor 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. 9. 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. 10. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department (FIDOS), unless otherwise directed by the Department. 11. 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. 12. 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. Services are inclusive of attendance. Contractor may appear by phone. 3 EXHIBIT D PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2018. Expenses incurred by the Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Life Skills (Core Services): $65.00/Hour (Structured Parenting Time.) $45.00/Hour (Supervised Visitation) $25.00/Hour (Safe Exchange) Home -Based Services (Core Services): $65.00/Hour (Behavior Coaching) $90.00/Hour (Behavior Coaching — Over 50 miles from the closest Ariel office.) Mentoring (Core Services): $50.00/Hour (Mentoring) $75.00/Hour (Mentoring - Over 50 miles from the closest Ariel office.) Home Studies (Child Welfare Administration or Case Services): $1,500.00/Episode (Full Home Study — Foster Certification or Adoption) Mileage shall be reimbursed at two cents below the most current IRS mileage rate/per mile after the first 30 miles. 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. 4 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher, and signed monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. b. For one-time services, proof of services rendered shall be receipt of the completed product. c. For Monitored Sobriety services, proof of services rendered shall be the test result. 5 AWRl7 ARIECLI-01 CERTIFICATE OF LIABILITY INSURANCE AWILLIAMSONI DATE (MM/DD/YYYY) 10/18/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 License # 0757778 CONTACT Julie Cooper NAME; HUB international Insurance Services (COL) NE 1125 17th Street, Suite 900 A/C, No, Est). (303) 893-0300 jai, No): (866) 243-0727 Denver, CO 80202 Miss, INSURED Ariel Clinical Services 2938 N Ave Ste G Grand Junction 81504 INSURERS) AFFORDING COVERAGE Y NAIL N INSURER A: Great American Insurance Company - '.16691_ INSURER e : Princeton Insurance Company 42226 INSURER C : INSURER D INSURER E ; INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS INDICATED CERTIFICATE EXCLUSIONS INSR LTR IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY PERIOD TO WHICH THIS ALL THE TERMS, TYPE OF INSURANCE 'ADDLSUBR' POUCY NUMBER POUCY EFF POUCY EXP INSD : WVDIMM/DD/YYYY1 (IMMIDD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY _ CLAIMS -MADE X OCCUR2211772 10/01/2017 10/01/2018 X x EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED PREMI$ES iEa 9cculrence: $ 1,000,000 X Misconduct/Abuse MED EXP Any one persona $ 20,000 X Limit: 5500,000 GENII_ AGGREGATE LIMIT APPLIES PER POLICY _.; JEC7 i_OC OTHER PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 3,000,000 PRODUCTS i COMPIOP AGG LIQUOR LIAB. 3,000,000 $ ._. $ 1,000,000 A AUTOMOBILE UABILITY X_i ANY AUTO X x 2211773 10/01/2017 10/01/2018 i OWNED SCHEDULED AUTOS ONLY AUTOS X HIRREES� X NON OWNED ,�._ AUTOS ONLY _ AUTOS ONLY Ea COMBINED SINGLE LIMIT a acodenti $ 1,000,000 BOOILY INJURY_Ter person, BODILY INJURY (Per acadeat, $ $ PROPERTY DAMAGE ;Per accident] _... __., S S A X UMBRELLA UAe X OCCUR ! EXCESS UAB CLAIMS -MADE 2211774 10/01/2017 10/01/2018 EACH OCCURRENCE 5 2,000,000 AGGREGATE 5 2,000,000 DED X RETENTIONS 10,00O $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY Y / N pAANY �YIC£WMEMQO��XC NERJE ECUTIVE `-� NIA /Mandatory in NH) I yesdescribe ender DESCRIPTION OF OPERATIONS below PER STATUTE H ER E.L. EACH ACCIDENT S ___.. E . DISEASE - EA EMPLOYEE E . DISEASE - POLICY LIMIT $ $ B Professional Liab 99A3GL1000326-01 10/01/2017 10/01/2018 Professionial Liab 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Weld County Human Services is an additional insured for General Liability on a primary and non-contributory basis and Automobile Liability. Waiver of subrogation in favor of the addition insured Is applicable to General Liability and Automobile Liability. CERTIFICATE HOLDER Weld County Human Services 315 N. 11th Avenue Greeley, CO 80631 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN I ACCORDANCE WITH THE POLICY PROVISIONS 'ESE RD 25 (2014;i0-3., 1988-2015 ACORD CORPORATION All rights reserved. A „r)Rf) fl.sr;a S^ ;t s<+ / A rY::;ist r 1 ira.'k , 71i 4O;.')i-t CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND ARIEL CLINICAL SERVICES This Agreement, made and entered into the/day ofF r, 2017, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department o r H man Services, hereinafter referred to as the "Department' and Ariel Clinical Services, hereinafter referred to as t - Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Weld County's Reuquest for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and incorporated herein by this reference. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided Core Services and Child Welfare Administration funding to the Department for Home -Based Intensive Services, Home Studies, Life Skills, and Mentoring. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1, 2017, upon proper execution of this Agreement and shall expire May 31, 2018, unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Proposal and Exhibit C, Scope of Services. 3. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Department's Resource Manager, Child Welfare Contract and Services Coordinator, or through a Team Decision Making (TDM) meeting or Family Team Meeting (FTM). No other Department staff or other party to the case may authorize services or modifications to services. 81.2-/ /I 7 2017-2861 14/&b88' 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. b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule, attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon, the continuing availability of said funds for the purposes hereof. d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 5. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services , and Exhibit D, Payment Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. 2 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 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. 3 - 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 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 4 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 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. 5 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. 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 6 and reinstate the aggregates required; Unlimited defense costs in excess of policy limits; Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by County. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. c. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance. County reserves the right to require Contractor/Contract Professional to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured as follows f. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors, subcontractors, independent contractors, sub - vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor/Contract Professional. Contractor/Contract Professional shall include all such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 7 10. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training Contractor may be required to attend training that the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-352-1551, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - 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 8 performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Administrator Shirley Lee, Regional Director 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: Shirley Lee, Regional Director 4660 Wadsworth Boulevard Wheat Ridge, Colorado 80033 (303) 703-9351 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 9 It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall not enter into any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, 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 10 parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contract Professional agrees that it is an independent Contract Professional and that Contract Professional's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contract Professional shall perform its duties hereunder as an independent Contract Professional. Contract Professional shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contract Professional, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contract Professional or any of its agents or employees. Unemployment insurance benefits will be available to Contract Professional and its employees and agents only if such 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 11 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 Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflict with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or 12 hold any such position which either by rule, practice or action nominates, recommends, supervises Contract Professional's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contract Professional acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contract Professional. Contract Professional shall not enter into any subcontractor agreements for the completion of this project without County's prior written consent, which may be withheld in County's sole discretion. 36. Attorneys Fees/Legal Costs In the event of a dispute between County and Contract Professional, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contract Professional under this Agreement or individual work order shall become or remain (as applicable), the property of County. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contract Professional in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the County. Contract Professional shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of County. 38. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 13 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. 14 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: diriftiv .d..40;„k BOARD OF COUNTY COMMISSIONERS Weld Co y Clerk to the Board WELD COUNTY, COLORADO By: Deputy Cler o the Boar 1561 4s AS 2 15 u ie Cozad, Chair CONTRACTOR: Ariel Clinical Services 4660 Wadsworth Blvd. Wheat Ridge, CO 80033 (303) 703-9351 By: Date: AUG 2 1 2017 An,/ EXHIBIT A WELD COUNTY'S REQUEST FOR PROPOSAL REQUEST FOR BIDS AND PROPOSALS WELD COUNTY, COLORADO 1150 O STREET GREELEY, CO 80634 DATE: April 3, 2017 BID NUMBER: B1700080 DESCRIPTION: Annual Request for Various Services DEPARTMENT: Human Services MANDATORY PRE -BID CONFERENCE DATE: N/A BID OPENING DATE: APRIL 24, 2017 PAGES 1-9 OF THIS DOCUMENT CONTAINS GENERAL INFORMATION. NOT ALL OF THE INFORMATION CONTAINED IN PAGES 1-9 MAY BE APPLICABLE. THE SCOPE OF WORK AND SPECIFICATIONS UNIQUE TO THIS REQUEST FOR BID FOLLOW PAGE 9. I. NOTICE TO BIDDERS A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the Board of Weld County Commissioners, wishes to purchase the following: VARIOUS ENGLISH AND BILINGUAL (ENGLISH/SPANISH) SERVICES (SERVICE AREAS INCLUDED IN THIS PROPOSAL INCLUDE, BUT ARE NOT LIMITED TO THE BELOW LIST. OTHER SERVICES WILL BE CONSIDERED AND BIDDERS ARE ENCOURAGED TO SUBMIT FOR UNIQUE AND CREATIVE SERVICES.) Aftercare Services Services provided to prepare a childfor reunification with his/her family or other permanent placement and to prevent future out- of -home placement of the child. Anger Management/Domestic Violence Diagnostic and/or therapeutic services to assist in the development of the family services plan, to assess and/or improve familycommunication, functioning and relationships, and toprevent further domesticviolence. 1 Crisis Intervention and Stabilization Services Services that provide an immediate, in- person/in- home response to families, youth and children, in *crisis, 24 hours a day, seven (7) days a week. *A "crisis" is further defined as a situation or circumstance, usually acute (recent) in nature, which breaks down the normal functioning of an individual and/or family, and results in the inability of the individual and/or family to resolve the crisis through normal coping behaviors, orwithout Day Treatment Comprehensive, highly structured services that provide education to children and therapy to children and theirfamilies. Foster ParentConsultation Services provided to foster and group home families caring for Weld County children and youth in their homes to enhance and improve the quality of care being provided. Foster ParentTraining Core training for new Weld County foster parents. Functional Family Therapy Intensive family -based treatment that addresses the pervasive patterns of relational dysfunction known to be determinants of conduct disorder, violent acting out, and substance abuse among youth 10.18 yearsold. Home -Based Intervention Services provided primarily in the home of the client that include a variety of services which can include therapeutic services, concrete services, collateral services and *crisis intervention directed to meet the needs of the child and family. *Crisis Intervention is defined as 24/7 phone access and in -home counseling. Kinship Services (Therapeutic) Kinship services in the areas of (1) consultation and kinship parent support specific to a child placed in a kinship home, (2) corrective consultation specific to a child placed in a kinship home, and (3) critical care consultation specific to a child placed in a kinship home. Children placed in kinship care are maintained in the lowest level of care and least restrictive setting when out - of -home placement is necessary. Life Skills Visitation (both in -home and in -office) and services provided primarily in the home that teach household management, effective accessto community resources, parenting techniques and family conflict management. Mediation/Intensive Family Therapy Therapeutic intervention typically with all family members to improve family communication, functioning and relationships. 2 Mental Health Services Diagnostic and/or therapeutic services to assist in the development of family services plan, to assess and/or improve family communication, functioning and relationships. Multi-systemicTherapy Intensive family- and community -based treatment program designed to make positive changes in the various social systems (home, school, community, peer relations) that contribute to the serious antisocial behaviors of children and adolescents who are at risk for out -of -home placement. RelinquishmentCounseling Relinquishment counseling for parents considering relinquishment of their children. Substance Abuse Treatment Services Diagnostic and/or therapeutic services to assist in the development of the Family Service Plan (FSP), to assess and/or improve family communication, functioning and relationships, and toprevent further abuse of drugs or alcohol. Other Creative and unique services designed to meet the needs of children, youth and families interacting with the Child Welfare system through a prevention or traditional case. B. Bids for the stated services will be received by the Weld County Department of Human Services, Resource Unit, Attn: Tobi Vegter, through: MONDAY, APRIL 24, 2017, AT 5:00 P.M. (WELD COUNTY DEPARTMENT OF HUMAN SERVICES, RESOURCE UNIT TIME CLOCK). Acceptable bid delivery methods are as follows: Email. Emailed bids are preferred. Bids should be emailed to: vegterta@weldgov.com. Emailed bids must include the following statement on the email: "I hereby waive my right to a sealed bid". An email confirmation will be sent when we receive your bid/proposal. Mail. Mailed bids should be sent in a sealed envelope with the bid title and bid number on it. Bids must include the following statement on the email: "Iherebywaive my right to a sealed bid". Mailed bids should be addressed to: Weld County Department of Human Services, Attn: Tobi Vegter, Division of Child Welfare, Financial Unit, P.O. Box A, Greeley, CO 80632. Please call or email Tobi Vegter at 970-400-6392 or vegterta@weldgov.com if you have any questions. Hand Delivery. Hand -delivered bids should be submitted in a sealed envelopewith the bid title and bid number on it. Bids must include the following statement on the email: "I hereby waive my right to a sealed bid". Hand - delivered bids can be dropped off at: Weld County Department of Human Services, Attn: Tobi Vegter, Financial Unit, 822 7th Street, Suite 150, Greeley, CO 80631. Please call or email Tobi Vegter at 970-400-6392 or vegterta@weldgov.com if you have any questions. 3 II. INVITATION TO BID A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the board of Weld County Commissioners requests bids for the purchase of Various Services (as described above). B. Bids shall include any and all charges for service(s) applied for by the bidder, and shall, in every way, be the total net price which the bidder will expect the Board of County Commissioners of Weld County to pay if awarded the bid. C. Emailed Bids Are Preferred. Emailed (fully typed) bids are preferred. However, if the bidder is unable to submit an emailed bid, the bidder must comply with the requirements set forth in Paragraph I, B. An emailed bid must contain the following statement: "I hereby waive my right to a sealed bid." D. Unless the Bid is emailed, one original and one copy of the Bid must be submitted. One complete bid document, which will be the only official copy of the bid, shall be filed at the Weld County Department of Human Services, Resource Unit. After certification of the bid, the other copy will be routed for applicable review. An e-mail confirmation will be sent when we receive your bid/proposal. III.INSTRUCTIONS TO BIDDERS A. Bids shall be typewritten. Each bid must give the full business address of the bidder and be signed by him with his usual signature. Bids by partnerships must furnish the full names of all partners and must be signed with the partnership name by one of the partners of the partnership or by an authorized representative, followed by the signature and title of the person signing. Bids by corporations must be signed with the legal name of the corporation, followed by the name of the state of the incorporation and by the signature and title of the president, secretary, or other person authorized to bind it in this matter. Bids submitted by limited liability companies must furnish the full names of all members and managers and must be signed by a manager or by an authorized representative, followed by the signature and title of the person signing. The name of each person signing shall also be typed or printed below the signature. A bid by a person who affixes to his signature the word "president," "secretary," "agent," or other title without disclosing his principal, may be held to be the bid of the individual signing. When requested, satisfactory evidence of the authority of the officer signing in behalf of a corporation shall be furnished. All corrections or erasures shall be initialed by the person signing the bid. All bidders shall agree to comply with all of the conditions, requirements, specifications, and/or instructions of this bid as stated or implied herein. All designations and prices shall be fully and clearly set forth. B. Bids may be withdrawn upon written request to the Weld County Department of Human Services received from bidders prior to the submission deadline. Negligence on the part of bidder in preparing the bid confers no right for the withdrawal of the bid after it has been opened. C. Bidders are expected to examine the conditions, specifications, and all instructions contained herein. Failure to do so will be at the bidder's risk. D. Bidders shall not stipulate in their proposals any conditions not contained in the instructions and specifications herein unless specifically requested by the special instructions attached hereto. Any proposal which fails to comply with the letter of the instructions and specifications herein may be rejected. E. Late or unsigned bids shall not be accepted or considered. It is the responsibility of the bidder to ensure that the bid arrives in the Weld County Department of Human Services, Service Utilization Unit, on or prior to the time indicated in Section I., entitled "Notice to Bidders." F. When approximate quantities are stated, Weld County reserves the right to increase or decrease quantity as best fits its needs. 4 G. Whenever requested, samples or descriptive matter shall be filed prior to the opening of bids. H. In accordance with Section 14-9(3) of the Weld County Home Rule Charter, the Board of County Commissioners of Weld County will give preference to resident Weld County bidders in all cases where said bids are competitive in price and quality. It is also understood that the Board of County Commissioners of Weld County will give preference to suppliers from the State of Colorado, in accordance with Section 30-11-110, CRS, when it is accepting bids for the purchase of any books, stationery, records, printing, lithographing or other supplies for any officer of Weld County. I. All discounts shall be figured from the date of delivery and acceptance of the articles, or in the case of an incorrect invoice, from the date of receipt of corrected invoice, if this be subsequent to delivery and acceptance. J. Substitutions or modifications to any of the terms, conditions, or specifications of this bid package which are made by Weld County, Colorado, after the bids have been distributed to prospective bidders, and prior to the date and time of bid opening, will be made in writing and signed by the Families, Youth and Children's Commission. No employee of Weld County, Colorado, is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of Families, Youth and Children's Commission. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. K. The successful bidder shall indemnify and hold harmless Weld County, Colorado, against all claims for royalties, for patents or suit for infringement thereon, which may be involved in the manufacture or use of the material to be furnished. L. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5- 101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et seq., Weld County may terminate this Contract for breach and Contractor shall be liable for actual and consequential damages to Contractor. Except where exempted by federal law and except as provided in C.R.S. 24-76.5- 103(3), if Contractor receives federal or state funds under this Contract, Contractor must confirm that any individual natural person eighteen (18) years of age orolder is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of a Contract. M.All goods shall remain the property of the seller until delivered to and accepted by Weld County, Colorado. N. Bids received prior to the time of opening will be kept unopened in a secure place. No responsibility will attach to the Families, Youth and Children Commission, the Weld County Department of Human Services, or the Board of Weld County Commissioners, for the premature opening of a bid not properly addressed and identified. 5 O. In submitting the bid, the bidder agrees that the acceptance of any and all bids by the Board of County Commissioners of Weld County within a reasonable time or period does not constitute a contract. The Board of County Commissioners of Weld County, Colorado, reserves the right to reject any and all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. P. These instructions, the proposal forms, and specifications have been developed with the hope of raising the standard of purchasing negotiations to a level wherein all transactions will be mutually satisfactory. Your cooperation is invited. Q. Substitutions or modifications to any of the terms, conditions, or specifications of this which are made by Weld County after the bids have been distributed to prospective bidders and prior to the date and time of bid opening, will be made in writing. No employee of Weld County is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of said Director of the Weld County Department of Human Services. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. IV.GENERAL SPECIFICATIONS A. Fund Availability: Financial obligations of the Weld County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. By acceptance of the bid, Weld County does not warrant that funds will be available to fund the contract beyond the current fiscal year. B. Governmental Immunity: No term or condition of the contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act §§24- 10-101 et seq., as applicable now or hereafter amended. C. Independent Contractor: The successful bidder shall perform its duties hereunder as an independent contractor and not as an employee. He or she shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to the contract. Neither the successful bidder nor any agent or employee thereof shall be deemed to be an agent or employee of Weld County. The successful bidder and its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through Weld County and Weld County shall not pay for or otherwise provide such coverage for the successful bidder or any of its agents or employees. Unemployment insurance benefits will be available to the successful bidder and its employees and agents only if such coverage is made available by the successful bidder or a third party. The successful bidder shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to the contract. The successful bidder shall not have authorization, express or implied, to bind Weld County to any agreement, liability or understanding, except as expressly set forth in the contract. The successful bidder shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and (b) provide proof thereof when requested to do so by Weld County. D. Compliance with Law: The successful bidder shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established, including without limitation, laws applicable to discrimination and unfair employment practices. E. Choice of Law: Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of the contract. Any provision included or incorporated herein by 6 reference which conflicts with said laws, rules and/or regulations shall be null and void. F. Binding Arbitration Prohibited: Weld County does not agree to binding arbitration by any extra -judicial body or person. Any provision to the contrary in the contract or incorporated herein by reference shall be null and void. G. No Third Party Beneficiary Enforcement: It is expressly understood and agreed that the enforcement of the terms and conditions of the contract, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in the contract shall give or allow any claim or right of action whatsoever by any other person not included in the contract. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under the contract shall be an incidental beneficiary only. H. Attorney Fees/Legal Costs: In the event of a dispute between Weld County and the successful bidder, concerning the contract, the parties agree that Weld County shall not be liable to or responsible for the payment of attorney fees and/or legal costs incurred by or on behalf of the successful bidder. V. Insurance Requirements i. General Requirements: Contractors/Contract Professionals must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant tothis request. Contractors/Contract Professionals shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, during any warranty period, and for three (3) years after termination of the Agreement. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor/Contract Professional. Contractor/Contract Professional shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. ii. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: (a). Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. (b). Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with rhinimum limits as follows: 7 • $1,000,000 each occurrence; • $2,000,000 general aggregate; • $50,000 any one fire; and • $500,000 errors and omissions. (c). Automobile Liability: Contractor/Contract Professional shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. (d). Additional Provisions: • Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: • If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County within ten (10) days and reinstate the aggregates required; • Unlimited defense costs in excess of policy limits; • Contractual liability covering the indemnification provisions of this Agreement; • A severability of interests provision; • Waiver of exclusion for lawsuits by one insured against another; • A provision that coverage is primary; and • A provision that coverage is non-contributory with other coverage or self- insurance provided by County. (e). For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. iii. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Bid. iv. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance to the County. County reserves the right to require Contractor/Contract Professional to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. v. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured. vi. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. vii. Subcontractors: All subcontractors, subcontractors, independent contractors, sub- vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor/Contract Professional. Contractor/Contract Professional shall include all such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. 8 Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. VI.Warranty. The successful bidder shall warrant that: A. The services to be supplied pursuant to this bid are fit and sufficient for the purpose intended; B. The services sold to Weld County, Colorado pursuant to this bid conform to the minimum Weld County specifications as established herein. VI. CONFIDENTIAL INFORMATION Confidential financial information of the bidder should be transmitted separately from the main bid submittal, clearly denoting in red on the financial information at the top the word, "CONFIDENTIAL." However, the successful bidder is advised that as a public entity, Weld County must comply with the provisions of C.R.S. 24-72-201, et seq., the Colorado Open Records Act (CORA), with regard to public records, and cannot guarantee the confidentiality of all documents. If Weld County receives a CORA request for bid information marked "CONFIDENTIAL", staff will attempt to contact the bidder in order to allow the bidder to seek an appropriate court order preventing disclosure. Without such an order, Weld County will release the requested information in accordance with CORA. 9 SCOPE OF SERVICES PURPOSE: The Weld County Department of Human Services (WCDHS) is seeking qualified English- speaking and bilingual (English/Spanish) providers in various service areas under various funding sources. Service areas include, but are not limited to, Anger Management/Domestic Violence, Day Treatment, Foster Parent Consultation, Foster Parent Training, Functional Family Therapy, Kinship Services (Therapeutic), Home Studies/Relinquishment Counseling, Life Skills, Mediation, Mental Health, Monitored Sobriety, Multi -Systemic Therapy, Home Based Intervention including 24/7 Crisis Intervention, Sexual Abuse Treatment, and Substance Abuse Treatment Services and Aftercare Services. SERVICE AREAS ARE NOTED BEGINNING ON PAGE 1 OFTHIS REQUEST FOR BID, BUT ARE NOT LIMITED TO THOSE LISTED. OTHER SERVICES WILL BE CONSIDERED AND BIDDERS ARE ENCOURAGED TO SUBMIT FOR UNIQUE AND CREATIVESERVICES. Qualifications: To be considered, a bidder must meet the following minimum qualifications: 1) Complete a Provider Information Form (PIF). 2) If submitting to provide bilingual services, a bidder must demonstrate language proficiency at Full Professional Proficiency or higher, as defined by the U.S. Department of State, and as noted below. • Full Professional Proficiency: Able to use and read the language fluently and accurately on all levels pertinent to professional needs Native or Bilingual Proficiency: Equivalent to that of an educated native speaker (both speaking and reading). 3) A bidder must agree to language proficiency testing that may include assessment of reading, writing and comprehension of Spanish, as well as a face-to-face conversation with a known native or proficient Spanish speaker selected by Weld County. 4) A bidder must submit a one page or less cover letter that introduces the bidder, the bidder's location(s) of practice and target area, his or her experience and qualifications, and staff, if applicable. A bidder must include current contact information including physical address, mailing address, phone number, email address and website, if applicable. 5) A bidder must submit sufficient information concerning each proposed service for Weld County to 1 evaluate whether or not the bidder meets "minimum qualifications" for all bidders. Each service must be submitted as its own proposal, inclusive of scope of services and rate information. The scope of service should include at a minimum the following information for each service proposed: • Detailed description of service components, modalities used, appropriate use of service, etc. • Target population including age range, specific population characteristics, area of service, etc. • Whether or not the service is billable to Medicaid and if bidder is currently able to bill Medicaid. Bidders are strongly encouraged to become Medicaid certified. Medicaid -billable services are preferred. • Clear rate schedule inclusive of all costs bidder wishes to charge for the provision of the service. 6) A bidder should avoid elaborate artwork, graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Bid. 7) A bidder must demonstrate the knowledge, training and expertise to conduct the proposed service(s). 8) A bidder must provide a current resume, as well as proof of licensure, for self, staff members and contractors of the bidder. Additionally, a bidder must include proof of inclusion on State vendor lists if applicable to the proposed service (ex. Home Study Providers, Sex Offender Management Board Providers). 9) A bidder should clearly outline the supervisory structure of staff members and/or contractors of the bidder. This should include the ratio of supervisor to staff and/or contractors, frequency and duration of supervision, credentials of supervisor and length of time as a supervisor. 10) A bidder should clearly outline the bidder's internal referral acceptance and assignment protocol, including communication to the referring agency. 11) A bidder must demonstrate familiarity with Trauma Informed Care. Bidder must provide copies of applicable training certificates, or proof of registration for training, for all staff members who manage and/or administer services under this proposal. 12) A bidder must demonstrate prior and current capacity to be organized, responsive and to quickly and successfully schedule services as requested. 13) A bidder must agree to track outcome data related to services proposed if awarded a contract and report outcomes upon request. 14) A bidder must agree to enter into an agreement, attached as Exhibit A, with the Weld County Department of Human Services and comply with all requirements of the agreement. Contract Period and Pricing: 1) The initial contract period is to be determined and shall continue as allowable by the funding source, so long as both parties are satisfied. The selected vendor(s) will have the opportunity to resubmit annually. 2) The initial contract will be funded through Core Services Program or other funding, so long as funding is made available. 3) The selected vendor will bill the Weld County Department of Human Services monthly according to billing requirements set forth by the Weld County Department of Human Services. Submittal Requirements for All Proposals: A bidder must submit according to requirements set forth in this Request for Bid - Qualifications. All proposals must contain the following specific information: 1) Provider Information Form (PIF). 2) Identification of language(s) and proficiency level, if applying to provide bilingual (English/Spanish) services. 3) One page or less cover letter that introduces the bidder, the bidder's location(s) of practice, his or her experience and qualifications, and staff, if applicable. 4) A bidder must submit sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets"minimum qualifications" for all bidders. Each service must be submitted as its own proposal, inclusive of scope of services and rate information. The scope of service should include at a minimum the following information for each service proposed: • Detailed description of service components, modalities used, appropriate use of service, etc. • Target population including age range, specific population characteristics, area of service, etc. • Whether or not the service is billable to Medicaid and if bidder is currently able to bill Medicaid. Bidders are strongly encouraged to become Medicaid certified. Medicaid -billable services are preferred. • Clear rate schedule inclusive of all costs bidder wishes to charge for the provision of the service. 5) Bidders should avoid elaborate artwork, graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Bid. 6) Current resume, proof of licensure and copies of applicable training certificates for all staff members who will manage and/or administer services under this proposal. 7) Supervisory structure of staff members and/or contractors of the bidder. This should include the ratio of supervisor to staff and/or contractors, frequency and duration of supervision, credentials of supervisor and length of time as a supervisor. 8) Internal referral acceptance and assignment protocol, including communication to the referring agency. 9) All proposals must demonstrate the bidder has the ability to deliver the services as proposed, and comply with the specific requirements set forth by the Weld County Department of Human Services. 10) All proposals must include a clear and concise rate schedule that accurately correlates to the proposed services and is inclusive of all possible charges related to the proposed service(s). The rate schedule must demonstrate an exact fee for the described service (s). Approximate rates or a range of rates for a service will not be accepted. 11) Each bidder must submit a Standard Certificate of Insurance, or letter of intent from an insurance company authorized to do business in the State of Colorado stating its willingness to insure the bidder pursuant to the terms of this Request for Bid. Evaluation of Proposals: All proposals that meet the basic proposal, service and qualification requirements will be reviewed by the Families, Youth and Children (FYC) Commission. Criteria for review, include but are not limited to the following: • Qualifications, appropriate licensure, and experience. • Cost structure. • Relationships and collaboration. • Organizational experience and past performance. The FYC Commission will make recommendations to the Board of Weld County Commissioners by and through the Weld County Department of Human Services. The Weld County Department of Human Services will make its award of contract to the successful bidders upon final approval of the Board of Weld County Commissioners. EXHIBIT A SAMPLE AGREEMENT CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND This Agreement, made and entered into the _ day of , 2015, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department' and «Contractor», hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Weld County's Reuquest for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and incorporated herein by this reference. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided funding to the Department for NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on , upon proper execution of this Agreement and shall expire , unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Proposal and Exhibit C, Scope of Services. 3. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Department's Resource Manager, Child Welfare Contract and Services Coordinator, or through a Team Decision Making (TDM) meeting or Family Team Meeting (FTM). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit an itemized complete billing statement by the 7th of the month, following the month of service, utilizing billing forms required by the Department. 1 d. Contractor agrees to submit a monthly report with the billing statement by the 7th of the month following the month of service for each client receiving ongoing services. One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation). Verification of Monitored Sobriety Services will be the test result. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. 4. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule, attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon, the continuing availability of said funds for the purposes hereof. d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 5. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services , and Exhibit D, Payment Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit an ACH Form for Colorado Providers, which will be provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of 2 Colorado per the directions on the form. Failure to complete and submit this form in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and Title VII of the Civil Rights Act of 1964; and - the Age Discrimination in Employment Act of 1967; and - the Equal Pay Act of 1963; and - the Education Amendments of 1972; and Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. 3 b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is Core Services. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contract Professional certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contract Professional will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5-102(5)(c). Contract Professional shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contract Professional that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contract Professional shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contract Professional obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contract Professional shall notify the subcontractor and County within three (3) days that Contract Professional has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contract Professional shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. Contract Professional shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contract Professional participates in the State of Colorado program, Contract Professional shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contract Professional has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, 4 and shall comply with all of the other requirements of the State of Colorado program. If Contract Professional fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contract Professional receives federal or state funds under the contract, Contract Professional must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contract Professional operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5-103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR), and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 9. Insurance Requirements Contractor and Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible the insurance provider. a. General Requirements: Contractors/Contract Professionals must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors/Contract Professionals shall keep the required insurance coverage in force at all times during the term of 5 the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non- payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, in the amount of the deductible or self - insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor/Contract Professional. Contractor/Contract Professional shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i. Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii. Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: - $1,000,000 each occurrence; - $2,000,000 general aggregate; - $50,000 any one fire; and - $500,000 errors and omissions. iii. Automobile Liability: Contractor/Contract Professional shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv. Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County within ten (10) days and reinstate the aggregates required; - Unlimited defense costs in excess of policy limits; - Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; A provision that coverage is primary; and - A provision that coverage is non-contributory with other coverage or self-insurance provided by County. v. For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. c. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance. County reserves the right to require Contractor/Contract Professional to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured as follows f. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. B. Subcontractors: All subcontractors, subcontractors, independent contractors, sub - vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor/Contract Professional. Contractor/Contract Professional shall include all such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 10. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training 7 Contractor may be required to attend training that the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-352-1551, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 8 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Administrator CONTRACTOR, TITLE 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of 9 any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall not enter into any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 10 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contract Professional agrees that it is an independent Contract Professional and that Contract Professional's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contract Professional shall perform its duties hereunder as an independent Contract Professional. Contract Professional shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contract Professional, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contract Professional or any of its agents or employees. Unemployment insurance benefits will be available to Contract Professional and its employees and agents only if such coverage is made available by Contract Professional or a third party. Contract Professional shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contract Professional shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contract Professional shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law (and as set forth in Exhibit provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in 11 Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflict with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contract Professional's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 12 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contract Professional acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contract Professional. Contract Professional shall not enter into any subcontractor agreements for the completion of this project without County's prior written consent, which may be withheld in County's sole discretion. 36. Attorneys Fees/Legal Costs In the event of a dispute between County and Contract Professional, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contract Professional under this Agreement or individual work order shall become or remain (as applicable), the property of County. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contract Professional in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the County. Contract Professional shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of County. 38. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. 13 EXHIBIT B CONTRACTOR'S PROPOSAL PROVIDER INFORMATION FORM (Bid Cover Sheet) Weld County Department of Human Services Mel Clinical Services 90205 AGENCY OR PRIVATE PRACTICE Tim Russell TRAILS PROVIDER ID (If Known) Front Range Foster Care and Adoption Program Manager PRIMARY CONTACT — FULL NAME PRIMARY CONTACT - TITLE 303 ) 703-9351 l 303 ) 703-4500 PHONE NUMBER trussell©arielcpa.org EXT. FAX NUMBER www.arielcpa.org PRIMARY CONTACT - E-MAIL ADDRESS AGENCY/PRACTICE WEB ADDRESS (IF APPUCABLE) 4660 Wadsworth Blvd AGENCY MAILING ADDRESS Wheat Ridge 80033 CITY ZIP REFFERAL CONTACT- FULL NAME (IF DIFFERENT THAN PRIMARY CONTACT) REFERRAL CONTACT - TITLE J I REFERRAL CONTACT - PHONE NUMBER EXT. REFERRAL CONTACT - E-MAIL ADDRESS I certify that the services offered for intended use by Weld County will meet all the specifications it has so indicated in this bid form. The Board of Weld County Commissioners reserves the right to reject any or all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are competitive in price and quality. Signature of Authorized pre entative: Date of Signature: _4' RIEL Clinical Services Children a Families a Adults Letter of Introduction 4/24/17 Weld County Dept. of Human Services 1150 O. Street Greeley, CO 80634 Re: BID #B 1700080 To Whom It May Concern, Enclosed is Ariel Clinical Services proposal regarding contracts for parenting time, supervised visits, behavior coaching, and home studies. Ariel has been operating in Colorado since 1994 providing foster care, adult residential services, behavior coaching, therapeutic services, supervised visitation, and adult day program services. Ariel employs a variety of qualified individuals. This includes Bachelor and Master level employees, LCSWs, and employees with many years of experience. Ariel's Front Range contact is: Ariel Clinical Services 4660 Wadsworth Blvd. Wheat Ridge, CO 80033 www.arielcpa.org Ariel has an office on the Western Slope and the Front Range services reach from Pueblo all the way to the Northern border of Colorado. In terms of this RFP, Ariel is hoping to continue to provide coaching, visitation services, and home studies in both Weld county and along the Front Range as needed by Weld. Ariel does have more capacity at the moment to take cases in Northern Colorado and the Metro area. 2938 North Avenue Suite G Grand Junction CO 81504 Phone: 970.245.1616 Fax: 970.241.8722 4660 Wadsworth Blvd Wheatridge CO 80033 Phone: 303.703.9351 Fax: 303.703.4500 2145 Academy Circle Colorado Springs CO 80909 Phone: 719.260.6110 Fax: 719.260.6170 ARIEL Clinical Services Children c Families a Adults Scope of Services Behavior Coaching Purpose: To provide therapeutic support to behaviorally or emotionally impaired children in the community and/or foster homes. Ariel coaches are professionals experienced in working with children in a variety of settings. Coaches employ strength -based; solution focused, and trauma informed practices. Coaches engage the child and their family in order to maximize the success of services. Ariel coaches are able to provide services to children of any gender and age range as well as those with developmental disabilities. Location of Service: Weld County, Denver Metro, El Paso County. Billing information: Ariel is not a Medicaid provider at this time and is unable to bill Medicaid. Ariel provides on -going training and supervision for their coaching staff. Staff ranges from Bachelor level to Master level individuals. Ariel has provided this service to Weld County in the last year and has demonstrated successful outcomes. Schedule: Monday -Sunday. Hours are variable based on the need of the client and family. Scheduling is available during normal business hours as well as in the evenings. Rate for coaching: $65/hour. This rate pays the salary of quality staff, supervision of that staff, mileage(see additional information below), and administrative costs. Additional fees: Any travel over 50 miles an additional $25/hour is applied. 2938 North Avenue Suite G Grand Junction CO 81504 Phone: 970.245.1616 Fax: 970.241.8722 4660 Wadsworth Blvd Wheatridge CO 80033 Phone: 303.703.9351 Fax: 303.703.4500 2145 Academy Circle Colorado Springs CO 80909 Phone: 719.260.6110 Fax: 719.260.6170 14, ARIEL Clinical Services Children a Families Adults Mentoring/Independent Living Skill Building Purpose: To help individuals build their independent living skills, provide positive role modeling, and assist individuals to reach their full potential. Ariel coaches are able to work with individuals on a variety of skills including but not limited to: Job applications, resume building, college applications, budgeting, obtaining housing or transportation. Ariel coaches are able to provide services to children of any gender and age range as well as those with developmental disabilities. Location of Service: Weld County, Denver Metro, El Paso County. Billing information: Ariel is not a Medicaid provider at this time and is unable to bill Medicaid for this service. Ariel provides on -going training and supervision for their coaching staff. Staff ranges from Bachelor level to Master level individuals. Ariel has provided this service to Weld County in the last year and has demonstrated successful outcomes. Schedule: Monday -Sunday. Hours are variable based on the need of the client and family. Scheduling is available during normal business hours as well as in the evenings. Rate for coaching: $50/hour. This rate pays the salary of quality staff, supervision of that staff, mileage (see additional information below), and administrative costs. Additional fees: Any travel over 50 miles an additional $25/hour is applied. 2938 North Avenue Suite G Grand Junction CO 81504 Phone: 970.245.1616 Fax: 970.241.8722 4660 Wadsworth Blvd Wheatridge CO 80033 Phone: 303.703.9351 Fax: 303.703.4500 2145 Academy Circle Colorado Springs CO 80909 Phone: 719.260.6110 Fax: 719.260.6170 ARIEL Clinical Services Children ® Families fl Adults Supervised Visitation and Structured Parenting Time Purpose: To provide a neutral party that can observe contact between biological family member and their children, monitor for safety, or provide hand over hand coaching and intervention if needed. The goal of Supervised Visitation and Structured Parenting Time is to support the reunification of the children with their parents. Parenting Time is structured in a way that limits the child's exposure to parental conflict while allowing time for appropriate interactions. Our main goal is to protect the children from further emotional, physical or sexual abuse. Ariel strives to maintain and improve the relationship between parents and children, help the parents understand and respond appropriately to their children's cues, and assist parents in improving trust, communication, and stability. In addition, it is important for the parent to commit and maintain consistency throughout the Structured Parenting Time Process. Ariel is able to offer three levels of supervision: Structured Parenting Time: is intended to provide monitoring of both verbal and non- verbal communication. The visit supervisor may need to intervene in order to help a parent connect with their child, improve interactions and supervision, and give suggestions for improving their relationship with their child and better meeting their needs. Supervised Visitation: is intended to provide documentation and observation as well as limited instruction. Parents may need redirection to engage with their children or keep conversations appropriate. Supervised Exchanges: Staff is present at pick up and drop off of the child from one parent to another. Staff remains for 15 minutes to ensure safety. This service also includes a written report of the demeanor of the child at the pick up/drop off and the 15 minute interchange. Target Population: Any biological family members needing supervised visits. Ariel provides on -going training and supervision for their Visitation staff. Staff range from Bachelor level to Master level individuals. Ariel has provided this service to Weld county in the last year and has demonstrated successful outcomes. Medicaid: Ariel is unable to bill Medicaid for this service. 2938 North Avenue Suite G Grand Junction CO 81504 Phone: 970.245.1616 Fax: 970.241.8722 4660 Wadsworth Blvd Wheatridge CO 80033 Phone: 303.703.9351 Fax: 303.703.4500 2145 Academy Circle Colorado Springs CO 80909 Phone: 719.260.6110 Fax: 719.260.6170 RIEL Clinical Services Children o Families Q Adults Location of Service: In the community. This includes but is not limited to parks, libraries, restaurants, and any family enrichment centers Ariel might have access to. Service Area: Weld County, Metro Area, El Paso County. Days/Hours: Monday -Sunday during business hours and evenings when needed. Rate of service: $65/hour for Parenting Time, $45/hour for supervised visitation. If transportation for children is requested drive time is added to the hourly bill. This rate pays the salary of quality staff, supervision of that staff, and administrative costs. Supervised exchanges: $25 per exchange supervised. 2938 North Avenue Suite G Grand Junction CO 81504 Phone: 970.245.1616 Fax: 970.241.8722 4660 Wadsworth Blvd Wheatridge CO 80033 Phone: 303.703.9351 Fax: 303.703.4500 2145 Academy Circle Colorado Springs CO 80909 Phone: 719.260.6110 Fax: 719.260.6170 ARIEL Clinical Services Children ® Families ® Adults Home Studies Ariel is able to provide home study assessments to Weld County. Ariel is not able to bill Medicaid for this service. Ariel is able to conduct the assessments in the Weld, Metro, and El Paso areas. In addition to the assessment, Ariel is able to run backgrounds, collect references, collect heath evaluations, and collect a foster care application if requested by the county. All Home Study Evaluators are SAFE certified and included on the State Vendor List. Supervision of the evaluators is provided by a SAFE Placement Supervisor. Cost: $1500/study. This rate pays the salary of quality staff, supervision of that staff, mileage(see additional information below), and administrative costs. If travel is required more than 50 miles then an additional charge of $25/hour will be applied. Medicaid: Ariel is unable to bill Medicaid for this service. 2938 North Avenue Suite G Grand Junction CO 81504 Phone: 970.245.1616 Fax: 970.241.8722 4660 Wadsworth Blvd Wheatridge CO 80033 Phone: 303.703.9351 Fax: 303.703.4500 2145 Academy Circle Colorado Springs CO 80909 Phone: 719.260.6110 Fax: 719.260.6170 RIEL Clinical Services Children Families g Adults Supervisory Structure All staff are supervised by the Foster Care and Adoption Program Manager who holds and LCSW. The ratio at times varies but the Program Manager is in charge of up to two home study evaluators and two coaches/visitation supervisors. The Program Manager has been a supervisor with Ariel for three years and has previous supervising experience in past positions. Supervision occurs every two weeks, an hour at a time, for home study evaluators and coaches/visitation supervisors. The Program Manager is available for informal supervision or guidance as needed. The Program Manager (Timothy Russell) is registered with DORA and current in licensing. Referral Process Referrals will come to the Foster Care and Adoption Program Manager. Ariel will accept the referral within 24-48business hours. The referral is then sent to a staff member for review. There will be an opportunity to discuss before starting the service. Once the Program Manager and staff discuss the case the Ariel staff reaches out to the County Case Worker before introducing themselves to the identified clients. Especially in cases of behavior coaching, it is preferable that an introduction happen with the Case Worker introducing the Ariel worker; however, it is not required. If Ariel is unable to accept a referral the Program Manager will notify the referral source within 24-48 business hours. Trauma Informed Care and Training Ariel's staff members are trained in a variety of disciplines and interventions. This includes but is not limited to Trauma Informed Care, Trust Based Relational Interventions, CPI or Safety Care, Mental Health First Aid, and Mandated Reporting. See attached training list for more information. Certificates available upon request. Last resumes for staff have been included with this packet. Organization In the past year Ariel has contracting with Weld County for the above services. Ariel has been prompt with referrals, reports, billing, and communication with the County. When a services has been discontinued or delayed it has been due to barriers from the client such as lack of communication, no voicemail, and wrong phone numbers: Outcomes Ariel will be tracking outcomes related to services as successful or unsuccessful. Ariel is happy to add additional tracking information that the County may find helpful. As stated, Ariel has been contracting with Weld County over the past year on the services above, has had positive outcomes, and has completed home studies in a satisfactory manner. 2938 North Avenue Suite G Grand Junction CO 81504 Phone: 970.245.1616 Fax: 970.241.8722 4660 Wadsworth Blvd Wheatridge CO 80033 Phone: 303.703.9351 Fax: 303.703.4500 2145 Academy Circle Colorado Springs CO 80909 Phone: 719.260.6110 Fax: 719.260.6170 Insurance Requirements Ariel has reviewed the insurance requirements for the contract and would be willing to an able to comply with the conditions listed. 2938 North Avenue Suite G Grand Junction CO 81504 Phone: 970.245.1616 Fax: 970.241.8722 4660 Wadsworth Blvd Wheatridge CO 80033 Phone: 303.703.9351 Fax: 303.703.4500 2145 Academy Circle Colorado Springs CO 80909 Phone: 719.260.6110 Fax: 719.260.6170 ARIEL Clinical Services Children • Families • Adults SUPERVISED VISIT EXPECTATIONS It is important to be consistent and prompt. If you are more than 15 minutes late to a visit, it will be cancelled and not rescheduled and will be considered a no show. If you are less than 15 minutes late the visit will be that many minutes shorter in duration. If you need to cancel a visit, it may not be made up. The reason a visit may be made up is if you had a medical emergency or were attending a court hearing for yourself. Documentation must be provided to the visit supervisor before the visit will be made up. You are expected to call before 5:00 p.m. the day before your visit to allow the visit supervisor to know you are coming. If you do not call, your visit will be cancelled and not rescheduled. There may be redirection of interactions with the child if the conversation or activity is inappropriate. No physical discipline is allowed during visits. You are expected to bring required supplies, which include items such as food, drinks, sunscreen, diapers, wipes, etc. All letters, cards, pictures, and correspondence must be reviewed by the caseworker before the child sees them. All gifts/presents must be preapproved. You may not use electronic devices during your visit. This includes cell phones, tablets, cameras, Ipads. Only approved individuals by the caseworker will be allowed at the visit with you. The visit supervisor must hear from the caseworker approving any additional individuals at least two hours prior to the start of the visit. If the visit supervisor has not heard from the caseworker, then the individuals will not be allowed to attend the visit. If you miss three visits in a row, your visits will be suspended. In order to resume visitation, you must contact your caseworker to inform them of your intent to visit your children again. Once the caseworker contacts Ariel approving visitation, an Ariel staff member will contact you to fill out the intake paperwork to resume your visits. Signature Date Staff Date 2938 North Avenue Suite G Grand Junction CO 81504 Phone: 970.245.1616 Fax: 970.241.8722 4660 Wadsworth Blvd. Wheatridge CO 80033 Phone: 303.703.9351 Fax: 303.703.4500 1520 North Union Blvd., Suite 100 Colorado Springs CO 80909 Phone: 719.260.6110 Fax: 719.260.6170 ARIEL Clinical Services Children • Families • Adults SUPERVISED VISIT AGREEMENT I agree to the following expectations concerning the visits with my child: • To attend, on time, all of the visits which we plan and schedule. • To focus on my child and meet their emotional and physical needs. • I understand if I am more than 15 minutes late, my visit will not occur. • To confirm the date and time of the visit by 5:00 pm the day before my visit is scheduled. Call or text at . • I understand that my visit supervisor can be reached between the hours of 8:00 a.m. and 5:00 p.m. No threats of any form towards visit supervisors will be tolerated. No weapons of any form are allowed. Signature Date Staff Date 2938 North Avenue Suite G Grand Junction CO 81504 Phone: 970.245.1616 Fax: 970.241.8722 4660 Wadsworth Blvd. Wheatridge CO 80033 Phone: 303.703.9351 Fax: 303.703.4500 1520 North Union Blvd., Suite 100 Colorado Springs CO 80909 Phone: 719.260.6110 Fax: 719.260.6170 Ariel Clinical Services Visitation Record of Parent/Child Interactions Case Name: • Caseworker: Date: Visitation Supervisor: Location: Level: Scheduled Time: Goal to be worked this visit: Persons in Attendance Relationship Age Arrived on Time Describing the greeting— (who initiates, type of greeting, physical contact, who enters room lst)- Verbal and nonverbal interaction— (eye contact, voice tone, physical contact, approaches & retreats) Describe activities during visit-- Ariel Clinical Services Visitation Record of Parent/Child Interactions Ariel Clinical Services Visitation Record of Parent/Child Interactions Parental strengths observed (brought supplies, set limits, divides attention, etc.)- Feedback/Coaching- Areas of Improvement -- Describe end of visit/goodbye-- (who leaves first, who initiates, ending physical contact) Additional comments — Signatures: Visitation Supervisor SPT Coordinator initials: 2938 North Avenue, Suite G Grand Junction, CO 81504 PHONE 970-245-1616 FAX 970-241-8722 CLIENT'S NAME: AGENCY: O PSS Case Manager ARIEL Clinical Services Children . Families ' Adults COACH NARRATIVE PROGRAM 2145 Academy Circle Colorado Springs, CO 80909 PHONE 719-260-6110 FAX 719-260-6107 HOME: O FSS O Ariel O ASA Date of Contact: County: 4660 Wadsworth Blvd Wheat Ridge, CO 80033 PHONE 303-703-9351 FAX 303-303-4500 O MDS O DYC Worker: Explain client's behavior during session: Describe client's emotions: What goals/interventions were successful or unsuccessful, and describe any problem areas/progress areas: Activities this session, explain: Coach comments, concerns: Date: Time Spent by Coach: Coach Signature Date Supervisor Signature Date V1 o re c 6,4 re -. - c O., cd .c , Pig, `J JM Ls...4 S L S. , c e /%41,1 Timothy Russell J 86 Grant St. Apt. 38 Denver, CO 80203 617-549-8034 trussell3@gmail.com Education Masters of Social Work The University of Denver Bachelors of Psychology Worcester State College June 2011 May 2005 Relevant Courses Disrupting Privilege Multicultural Social Work Program Administration and Development Community Social Work Practice Empirically Supported Interventions with Adolescents Couples Therapy Strategies and Techniques for Family Therapy Theories & Practice with Family Systems Clinical Skills 1 & 2 Trauma and Recovery & Intervention for Responses to Trauma Experience Ariel Clinical Services Clinical Social Work Intern, September 2010 June 2011 -Monitor foster child progress and functioning in foster homes and author progress reports -Participate in service meetings with County representatives, GAL's, and treatment providers -Maintain and monitor foster parent and client files to ensure compliance with state regulations -One on One clinical behavior coaching with clients to support functioning in foster homes -Author home visit narratives, coaching narratives, and functional behavior assessments -Conduct Structured Analysis Family Evaluation (SAFE) Updates and author SAFE reports -Co-facilitated Dialectical Behavior Treatment group Denver Public Schools Social Work Intern, September 2009 -May 2010 -Organized foster care support/information sessions for target students -Co-facilitated GLBT student organization and coordinated a grief and loss group for students -Provided emotional support to students on a walk in basis -Facilitated Behavioral System for Children II (BASC 2) and Adaptive Behavior Assessment System (ABAS) in order to determine Individualized Education Plan (IEP) services -Assisted with home visits regarding poor school attendance and created attendance/behavior contracts -Assisted with legal filings regarding truancy Communities For People; Chelsea, MA Senior Service Coordinator/CANS Specialist, October 2006 -August 2009 -Partnered with the Massachusetts Dept. of Children and Families (DCF) to asses, coordinate, and manage services for 300 clients over a two and a half year period, including Intensive Foster Care, Residential and Group Home Services, and Home Based Therapeutic Services -Facilitated service meetings between providers, DCF, and families around permanency goals -Administered the Childhood and Adolescent Needs and Strengths (CANS) assessment tool to help determine level of care and service planning -Trained employees and mental health providers in the use of the CANS assessment tool -Maintained paperwork to ensure proper payment, service start dates, and service end dates -Assisted 120 families over two and a half years in developing goals for home based services -Authored service plans and meeting notes to track and monitor treatment progress Key Program; Worcester, MA Shill Supervisor, April 2006 - June 2006 Residential Caseworker, October 2005 - April 2006 - Responsible for the supervision of between eight and ten adolescent clients -Coordinated and executed client treatment plans -Authored progress reports, and conducted life skill, substance abuse, and sexual education groups -Supervised Caseworkers and assisted in employee evaluations -Administered client medication -Developed level system used in behavior management and daily program routine - Worked in the milieu with youth detained by the Department of Youth Services in a lock -up facility YOU Inc; Worcester, MA Relief Clinical Counselor, February 2005 -October 2005 -Maintained milieu structure by setting limits and using behavior management techniques with male and female adolescent clients. -Employed crisis prevention interventions to maintain safe environment -Managed clients in times of emergency or crisis -Documented client progress in daily notes Additional Experience Mount Saint Vincent; Denver, CO On -Call Staff, October 2010 -May 2011 -Maintained milieu structure by setting limits and using behavior management techniques with child clients -Engaged clients in recreational activities -Assisted in maintaining a neat and orderly unit -Facilitated morning routine with clients South Shore YMCA; Quincy, MA Counselor, Archery Director and Unit Leader, June 2002 -October 2006 (summer position) -Supervised approximately 20 children between the ages 5-13 -Supervised and evaluated approximately seven counselor's work performance -Planned and executed recreational and social skill building activities -Liaison to parents regarding behavioral problems, incidents, and functioning of children Center for Community Independence; Revere, MA Overnight Worker January 2009 -August 2010 -Helped facilitate both morning and evening routine of Traumatic Brain Injury Patients -Supervised client's medication routine -Provided recreational and social support -Supported client develop of life -skills Special Skills -Experience working with diverse populations including: African Americans, Latinos, GLBTQ Youth, Asian Americans, immigrant families, individuals who are undocumented, youth at risk for sexual exploitation, children and families experiencing homelessness, and individuals with disabilities -Assessment Competencies: Childhood and Adolescent Needs and Strengths (CANS), Behavioral System for Children II (BASC 2) and Adaptive Behavior Assessment System (ABAS) -Ability to train others in the use of the CANS -Leadership: Vice President of the Graduate Student Association at the School of Social Work -First Place in the University of Denver Daniel's School of Business Diversity and Inclusive Excellence Case Competition -Trained in Therapeutic Crisis Intervention including physical management and lower level techniques Page 4 of 4 Ariel Clinical Services 03/23/2018 03/23/2017 03/16/2017 09/19/2022 01/08/2017 14 0 I O a o, a m C \ C 0 4 U ..i -44 ro at a M C 0) F 01 0 4 0/ C `1 > .+ gw m a" U 0 W H0 03/16/2017 07/19/2017 01/19/2017 Annual Annual -T Null, Troy CellPhones CI 0 q H O O o a m W W H a .0 14 H 0 0 v a O. so 0 V 0 W H T. T. 0 0 14 14 14 14 k .--I .-1 .i pQ ZZ z z z o 41) m L 0 03/16/2017 Orientation - Orient Orient u 00 c CO b b c 03 CO 03 n 0 01 C4 kcalhoun[315] Paylocity Corporation Kelsey kc) �ze� t.„v/ r,'te,/ce Fe.‘ )v(4 Kelsey Granzen 11262 Clermont Way — (720) 224-1556 — kelseyagranzen@gmail.com Profile • Demonstrate excellent written documentation for comprehensive case notes • Adaptable to difficult situations; ability to prioritize tasks and use good judgment in high -paced, stressful environments • Solid time -management skills developed by the ability to balance multiple projects, jobs and academics while maintaining a high academic GPA • Confident in taking initiative; self -driven team contributor, passion for advocating Education Bachelor of Social Work (BSW) Colorado State University (CSU), Fort Collins, CO Related Experience Trauma Care Intern for Lorimer County Department of Human Services, Fort Collins, CO May 2015 Jan — May 2015 • Worked under Trauma Care Coordinator Andrea Fotsch to implement the Trauma Project; recognized for taking initiative, completing projects on deadline and willingness to take on additional responsibilities • Coordinate, and organize trainings for over 100 people such as Trauma Focused- Cognitive Behavioral Therapy, and multiple different Dr. Jim Henry trainings • Track trauma assessments through accessing reports and documentation from Trails and Wellness Check, to aid case workers with answering questions Companion (practicum) Mosaic, Fort Collins, CO Aug/13 — May/14 • Modeled and fostered an environment for developing clients interpersonal and social skills Relevant Professional Development / Trainings • Observations of Dr. Henry Trauma Assessments Jan —May 2015 • Immigration Issues, Provided by LCDHS Feb 2015 • Collaboration of LCDHS and Crossroads Safe House Feb 2015 Other Experience Cracker Barrel Old Country Store Aug 2011 — Oct 2015 Server • Train new employees • Give support to management and coworkers when needed Target Team Member • Give support for management throughout the store • Train new employees • Volunteer at multiple events April 2014- July2015 Tics bee,. �/ i4r,re/ RENE LUDEMAN COLORAOO:,•PRINCGS. CO 715)•650•!988. MIDHIOHT.Hour 'tAH00.CaM To work in a challenging environment where the highest priority is to serve the needs of children and families, 1/i/2012 TO 8/1i2.013 Springs Rescue Mrsion Colorado Springs, CO. PROGRAM DIRECTOR - THE FAMILY CRISIS CENTER INKA THE FAMILY HOPE CENTER) • Create a Trauma Informed Supportive Housing program for homeless women with children as part of a ministry team. General oversight of facility completion, participate with a development process with regards to funding, growth, development, program promotion, and Implementation of all created policies. • Write a program document, research and develop progtarnming, create intake and assessment process. • Create job descriptions, hire and train all case management and residential staff. • Collaborate with others in the homeless services community, attend meetings, Irainings and luncheons to network and promote the program, as well as other programs at the Springs Rescue Mission. • Teaching and co -writing of human development curriculum to residents. staff, and volunteers. 11/142009 r0 1/1/2012 Er Paso County Department al Human �, Services. Colorado Springs, CO. SOCIAL CASEWORKER - CHILD PROTECTIVE SERVICES. • Interview clients and develops appropriate treatment plans; initiates studies and provides intensive casework services to families and children; investigates allegations of child abuse or neglect and assesses imminent danger for children; makes referrals to community resources coketeral contacts. Supports families in budding and utifizing skills to independently develop their own plans and access their oval resources. Attends and testifies in court hearings and mediations; completes appropriate paperwork, documentation. petitions, reports, reviews, etc. for court hearings; monitors clients' compliance with court orders; serves temporary custody notices and petitions the court (or verbal orders. • Documents all contacts and ensures that all paperwork and documentation are accurately completed and filed; completes necessary case information reports and inputs updates into department database. e/1i 2008 TO 1 t./1/20u9 El Paso County Leparunrgnt of Human Colorado Springs, CO. Servings. SOCIAL CASEWORK - CASE SERVICES AIDE • Serve in an administrative capacity to a team of social caseworkers, in the areas of filing, typing, preparing reports, returning phone calls, scheduling appointments, and any other adlnklistrative tasks as needed. • Provide supervised visitation to parents whose children are in out of home care, visits in community, in family homes and al agency facilities. • Testified in court as a subject matter expert on the issue of child safety in visitation and parenting time. • Worked with Caseworkers and other professionals to ensure successful treatment planning and compliance, participating in stalfings, Team Decision Making, and attend court on behalf of the department. • Worked one-on-one with parents to improve parenting techniques and nurturing/bonding skills. l:,•'1/?007 TO 5/112005 ADMINISTRATIVE SUPPORT, El Paso County Health Department Cols, ado Springs. CO • Served as temporary Administrative support staff to therapists in the McMasters Drug and Alcohol Tieatnrenl Program. Performed alt adminislralivu tasks related to department closure, including file management, closing expired files, processing dosing documents and archiving. • Telephone coverage, track compliance fur UA, management, and secretarial duties as needed. Previous to above: Licensed Foster adoptive home 2002.2004 Bethany Christian Services Colorado Springs. Completed over 1500 hours of foster parent training; to include First Ald and CPR. Receive and provide care for children in crisis, to include therapeutic services. Attended court hearings and staffings as needed for foster children In my care. Work directly with parents of the children in my care to improve their parenfing skills and to :mprove nurturing with their children. Renewal by Andersen — install Department Production Coordinator (Supervisor) • Oversee production process from order to install and warranty. • Coordinate window and door installation crews. • Hiring, firing, and training of production staff • Trouble shoot customer complaints, and resolve repair Issues. Cronkhite Wealth Strategies — Operations Administrative Assistant • Coordinate and perform all operations related functions of the oifico. to include both administrative, customer contact, appointment selling, ordination of fundraising events, and extensive client financial data management. • Bookkeeping using Ouickbooks for business and employer's personal accounts, financial (racking of client investment funds. • Customer support and troubleshooting of customer issues. • Senior level administrative tasks: purchasing, ordering, fax, file, scan, calendars, appointment setting, telephones, and as needed by Ms. Cronkhite. 2001-2010 Liberty University Lynchburg, VA • Bachelor of Science in Multidisciplinary Studies with cognates in Religion and Psychology 2009 • MA Human Services — Marriage and Family Roterenrart; :IVHitotls, On rcgl:esi. VI/V.., LV. I .1 ...Ill Inn VUJI V..1•• - nf.1Cl 0,:(04 yvc//vvvGS 14-/l�l e/ Shiloh Jones 5425 S. Delaware St. Littleton CO 80120 303.470.0796 720.2343613 shilohiones aehocg,aii.com Education: Abilene Christian University: Bachelor of Science in Social Work— Class of 2004 • Member ofliadman Action Council • Member of Women's Social Club — Sigma Theta Chi • Spring Break Campaign Leader 2001, 2002, 2003 • Various extra -curricular activities and committee Social Work Experience: Hope Haven - Abilene, 7X —Internship - 2003 • Interviewed prospective clients, helped them fill out applications to receive - llama ii tt-m the lgetuy ti`s well its outside g vice • Formed relationships with clients and their children who lived at the agency • Worked closely with other agencies that assist the homeless population in Abilene • Taught clients social skills, job skills and relational skills in individual and group settings Central Dallas Ministries -- Dallas, TX- Case Manager Internship- 2004 • Interviewed prospective clients • Met mouthy with clients, helped provide them with utility, medical, dental, housing, childcare, and job placement assistance • Worked with supervisor to design and implement new case management services in the agency Tennyson Center for Children— Youth Treatment Specialist SubAcute Unit - Dec.04- Sept_ 06 • Provide a therapeutic balance of structure and affiliation while demonstrating an understanding of the emotional needs of the children at all times. • Implement agency procedures for behavior management, balancing client's needs for structure, nurturing, learning and recreation • Collaborate within the framework of the special services team: attend and actively participate in weekly team meetings as well as treatment plan reviews, in -services and psychiatric consultations as needed. • Provide knowledgeable clinical input into the treatment plan and treatment needs of clients and them implement those plans in the milieu; Plan, implement and participate in therapeutic groups, educational activities and recreational activities with the children. VI/uY/GVII la .;.I0 1'/IA JVJIV.M flA1LL 1(g uVJ/ vv4 • Collaborate and communicate actively and constantly with Huston team, psychiatrist, therapists, case managers, teachers, the admissions department and other members of the treatment team. Collaborate and communicate also with outside agencies, therapists, case workers, and families. • Complete all appropriate reports and records in a timely manner, including all necessary incident notifications, attendance information. intervention reports and assessment tools. Tennyson Center for Children —Lead Youth Treatment Specialist — Oct 2006 -Nov 2006 • Same Duties as Youth Treatment Specialist • Sign off on Team timesheets and order supplies for the cottage within budget limitations • Organized the therapeutic groups that happen in the milieu. I created a schedule for the weekly topics as well as guidelines to help the groups be as beneficial to the clients as possible. • I was also responsible for the keeping up with the clinical meetings regarding the clients such as medication reviews, monthly, quarterly, annual reviews and others. I brought information to the meetings to help give the other participants a clearer picture of how the client is doing in the cottage setting Bs welhasaayrecommendations we had: I then relayed the iaformettonfrom— the meeting to my team and supervisor. Tennyson Center for Children — Offsite Youth Treatment Specialist — Nov 2006 -OO.2007 • Working in a self contained classroom in a public elementary school. • Build relationships with the families of the students to help them overcome obstacles in the family life and academically so they can transition to a public school • Work to provide a balance of educational training and emotional training in a structured classroom setting Adoption Alliance Case Manager • Work with families to help provide a stable, safe, therapeutic environment for foster children in their care • Provide crisis management as needed • Maintain positive, productive working relationships with counties and various private agencies. • Complete necessary paper work and reports in a timely manner. Current Status: Presently I am working with Adoption Alliance as a Foster Care Case Manager. I routinely visit client's homes, assist with placement of children hi foster homes, provide crisis management as needed and serve as an advocate for my families I work with. Credentials: • Trained in TCI (Therapeutic Crisis Intervention) • First Mde and CPR Certified l o t&f.4- vvi II < re. 66.44-t, Lv/ S iii% i.‘. '1 c y ROBERT COPE 1225 26th Ave. Apt 303 Greeley, CO 80634 (720) 220-3318(cell) RobertCope3@gmail.com QUALIFICATIONS A decade of experience in street outreach with homeless and at -risk youth in Denver and Boulder, Colorado ■ Excellent listener and meeting people at their level ■ Meets uprising issues with patience and grounded view ▪ Organized to meet multiple goals and needs concurrently Career goal of becoming a Child Therapist specializing in Trauma with adolescent and young children EDUCATION Metropolitan State University of Denver, Denver, CO July 2011; graduated May 2015 B.A. in Psychology, Management minor > Relevant Courses: Introduction to Psychology, Psychology of Prejudice and Discrimination, Sociology, Ethics, Legalities of Business, Introduction to Business ➢ Completed research papers on Influence of Parents on Child prejudice and presentation on PTSD in Children ➢ Internship at Metro Manor during the summer of 2013 working with senior citizens. o I provided computer classes, two art therapy groups, an exercise program and "therapy in the hall", I also helped to support with Medicaid enrollment, and RTD bus pass paperwork. > Victim Assistance Certificate program completion October 2014 Student Activities and Organizations: ➢ Delta Alpha Pi Honor Society , 2012 to 2013 o Vice President: working directly with the president to organize events for members, create a constitution, and work to organize and grow the Honor Society through a strategic growth plan. o President: increased membership through two organized induction ceremonies, created and passed a yearly member fee, Facebook page was created boasting 30+ members, proceeded to get the organization recognized as an official honor society by the university. VOLUNTEER Standup for Kids, Denver, CO October 1997 to June 2007 Executive Director Responsibilities ■ Coordinated nightly street outreach to homeless and at -risk youth as the first line of contact in Denver, provided meals, community referrals and organized distribution of donated resources • Recruited, trained and managed more than 100 volunteers in Denver and assisted the Boulder branch with training and volunteer management ■ Solicited and processed in -kind donations from local and national businesses, organized fundraisers such as Skives For Kids in 2005, grant writing and marketed the organization through national events like 48 Hours on the Street • Recruited a local Board of Directors to network in the community and grow the organization ■ Maintained a balanced budget and reported financial statements and activities to the national organization Accomplishments • Worked with Board of Directors and volunteers to redevelop and reinvigorate the organization • Redesigned training for volunteers to improve understanding and retention » Instituted comprehensive financial standards and awarded two national grants • Awarded national Volunteer of the Year in 2005 by Stand Up for Kids WORK EXPERIENCE Community Reach Center, Thornton, CO August 2012 to Current Front Office Coordinator I, working with clients to get them scheduled for appointments. Working in conjunction with on -call crisis to get clients to needed services at hospitals and into scheduled appointments with staff Therapists. Pearl Auto Body, Lakewood, CO September 2010 to August 2012 Autobody technician, providing high -quality collision, specializing in Japanese and European vehicles. Achievements: Promoted to Senior Technician, responsible for quality assurance, leadership among technicians and liaison with management. Page 3 of 4 ci ci O I ri ; 0740 0 - a ri •rl r♦ 0 ry7 O r♦ 8 Ariel Clinical Services 12/30/2015 03/01/2018 03/01/2017 0 H v Id C.1 04 H 01 V a0 (H0 U 0 v> 34 0 L4 0 w 0.0 N H •.a m 2 •.4 1:71v.l 40 .C > 01/11/2016 Mistx, Abuse, 01/11/2016 Orientation - 01/11/2016 02/12/2017 1O H 0 N N ri O Safety Care Metropolitan State Educational rot 0 p U v tv ea > 0 Co 01 .4 01 0 M a HIs a H > 0 Co W Co W W W W W Cope, Robert Cope, Robert Cope, Robert Cope, Robert Cope, Robert Cope, Robert Cope, Robert Cope, Robert NNNNNNNN r4 ri .y ri ri - H ri U) N rn U) U1 U) 11) UI Last, First MI: °ranzen, Kelsey U N ri N N N 0 03/22/2016 V O U r0 X MI Skille 03/22/2017 03/22/2016 Annual Training - 03/01/2018 03/22/2017 03/22/2016 C ro H ro 03/22/2017 03/22/2016 Annual Training - a >a> E 3 F HI r -I r4 0 0 0 40 0 r4 ro C el .1 40 4 ro 40 03/03/2016 ASA- Agency ASA-Train 09/09/2016 03/28/2018 03/28/2016 3 01 4 H )4 0) N 04 0 0 H w V 4 hr class, 03/04/2020 Driver's License or 10/21/2015 Employee Boundaries H 4 0 4 a fs. ro U a a o Co m Co .1 o) w 0 A. w w H H Co o a -4 vat H Q U ro a v a a- 0. m w Co a a.) Co 0 u 0 Id H H Z o g a VI 06/13/2017 03/03/2017 0 U b 14 C 4 N 03/15/2017 Prevention, IS & 03/22/2016 Mistx, Abuse, 10 O N N N O Orientation - 03/10/2021 03/10/2016 03/22/2016 Client Rights 11/08/2016 SAFE- Initial s 01 N @ 01 N 01 d 0/ 0/ 01 01 01 01 O) a U1 a a a 00 a a CO a a a a a ri 40 0 0 r0 rr40 r -1i a r 40 0 rl 0 0 v 0 v v v v U v v v v v v v Co x x x x x x x x x x x x x 4 4 C C 4 4 4 C 4 4 4 4 4 4 v v v v v v v v v 0 0 0 0 0 N N N N N N N N N N N N N N ro 40 ro 40 40 40 ro 40 40 40 40 d H H H H H H 14 H H H 31 H H H M a C7 Co C9 O c7 C7 C7 O CJ Co 0 O Co Co O Granzen, Kelsey 03/30/2017 03/30/2016 Safety Care Safety SafeCare 0v a 0 0 Co Co 0 d 34 k U 06/08/2015 Educational Cognitive Disabilities Various/Miscelaneou 05/20/2016 7 O a r♦ To 01 H 41 Z r-1 X 0 m H LiBu md a H S u m N W H N N N N N N N N N N N N NNNNNNNNN 40 40 40 40 40 40 40 40 4') 40 40 40 (', 40 40 40 40 40 40 40 40 1) in U) U) U) U) U) N U) U) U) U) U) Co U) Co U) U) U) U) Co in a d a Employee ID 03/16/2017 Null, Troy 03/16/2018 03/16/2017 Null, Troy 03/16/2018 03/16/2017 Null, Troy ri r•1 ri m m CO 10 10 10 Date: 4/19/2017 Run Time: 9:04 AM kcalhoun[315] H 0) a Paylocity Corporation Page 2 of 4 8 Employee Skill Renewal by 0 O n n Ariel Clinical Services 03/25/2016 Informed Med Admin & Mars Training 06/22/2011 Medical- Various CA HCO al U ro H Z 36 H HCO 0 .� •0 H $ Jones, Shiloh D Jones, Shiloh D 11/19/2014 0 0 .) 0 .11 u 0 Jones, Shiloh D 11/04/2016 11/04/2011 IDD- Med Abilene Christian University n N 0 0 0 N N \ \ CO 0 o 0 0 \ \ N u) N O N •.i u 0 H h. CO r♦ 04 0 03 0 0) A A A O O O H N N A 0 0 0c;:. I"3 h h Educational Colorful Communication & Various/Miscelaneou Tranec Transcript Var/Mi Var/Misc First MI: Ludeman, Gertrude R 1!1 In U1 U1 N h U7 11 N N N N N N N 41 a 0 u N M a a 0 U a Skill Descri 11/10/2015 11/10/2014 x 44 N N N a 0 0 Last. First MI a H 0 o> 0 01/25/2017 01/25/2016 Annual Training - 03/01/2018 Annual- BP 01/25/2017 01/25/2016 01/25/2017 01/25/2016 12 hours 03/14/2015 to 0 14 0 0 14 w .I ••1 U 0 a a 01 0 N E 0 N N E H al al00 g m v °v 08/07/2015 a N 03 ro r 0 O Full Certification ET' q 0 N a H0 14 W H X 0 u O 0 al 0 6 DI I tK H u U 0 N CO 0 O 06/01/2016 4) H 4 hr class, CPR/FA CPR/FA 02/16/2022 Driver's License or 02/15/2017 DL/Pho Photo ID 04/26/2017 ..4 N 0 0 N N Insurance 11/10/2014 Orientation - 07/07/2019 07/07/2014 IDD- Med 06/05/2014 Liberty University 09/21/2010 Educational Colorful Communication Various/Miscelaneou 0 u N i 0 14. 01/11/2017 01/11/2016 N N N O 01/22/2016 01/22/2017 01/22/2016 .1 a Pi pa 0 4O U 14 co3 E 16 0 0 .4 N r1 .-1 N H H W Iy Ha 0 04 41au la Z H c�0c� r0 00 0 H w H off CP E y m a a" w �a °u U U 0 q 1 0 z a b 0 HI 0 H a co 0 0 a r. \ o 0 a pp0 Gq0 [1� 1 \ H44 O E > d �C 4Ct UU U V 01/22/2017 01/22/2016 Annual Training - 12/30/2015 0 U d Cn 02/04/2016 CORE I- Foster 10/07/2017 01/30/2018 01/30/2016 v H 4 hr class, Qr 44 14 H 1) qqq A E E 0 0 0 E pl 0 E 000000 ICJ o 0 0 Z 0 0 ali 0 1:1 0 0 0 0 '3:1 Z o a a a a a a a a a a a a a a a a U H z .330 11 Co In In In in n n n In n in In in In n In n r r r N N N r r r r r r r r r N 17 N N N N N NN N N N NN N N N NO H H ml !a ►7 a H 0 N Cope, Robert Cope, Robert Cope, Robert Cope, Robert Cope, Robert Cope, Robert Cope, Robert Cope, Robert 04/10/2018 n N 0 N N N O Driver's License or Photo ID NNNNNNNNN N N rl N N 4-1 N N N U1 U) N U) In U) Ill U1 U) User: kcalhoun[315J Paylocity Corporation Page 1 of 4 0 Ariel Clinical Services Last, First MI: Dingwall, ri • • 'i U H First MI Dingwall, Deanna Harassment- 11/11/15 to 12/16/2016 12/16/2015 H, H, COC 01/22/2017 01/22/2016 Annual Training - a OD 0 0 N 0 0 01/22/2017 01/22/2016 01/22/2017 01/22/2016 al a O 0 04/21/2010 Brief Suicide Western State College of CO E 0 ri r1 r1 H r4 H H H H a u 09/01/2007 I- Foster a U CORE Previous Certifications: 06/24/2018 06/03/2020 License or 06/04/2015 08/24/2017 02/24/2017 @ 14 1. a O H q H 09/09/2009 Prevention, IS & 03/25/2016 Informed Medical Administration & Medical- Various 05/07/2018 Health First 05/07/2015 m a Orientation - Consistency 0 )i 0 0 to '-1 ro JJ a H w U) Western- State of CO 05/05/2001 Educational .40 H N rl Trauma Training - Trauma Training In Depth Correcting Various/Miscelaneou 4-' ar HI a ,.:4ri M �0Ey 0 0 14 HHI W @ M @�. y 14 a H H „6.,,,..6, in F F 0. 'i rl r/ ri ri H R' 0 ro a al 0 IQ•.i a00000 algpro 46 ro 14 a w xa 0a u 4 a @ E 16 14 H H H E O U) F F m 0� 0) 0) 01 @ 01 0) • 0) @ d @ N @ 0 @ @ G) d g q q q q q q q o q q O q q ata q q q ri ri rt 'a ri ri i ri ri ri ri ri ri ri ri ri ri ri ri y rl ri rt 'i r♦ 'i 'i r, rf '4 'i '4 'i el r/ 'i 'i 'i r1 ro ro ro ro earo m ro ro alro n)ro 0 0 ro ro alro 3 ) a 171 ) 3 3 3 3 ) ) ) ) 111 ) ) 3 m a a a a a a a a a a a a a a a a a a a M H N •'I M •rl .i M •'1 M +I 4 r♦ •'1 •./ •'I •'/ •'1 '/ q Ca Ca q q q A q g q q A A q q g q q A b to to N N H 'i 40 40 40 40 4.0 b 41 t0 NNNNNNNN ri H rl rl rl H rl rl t0 rl 0 t0 N N 'i H 0 to N N rl ri t0 4.0 N N t-4 H € H 6). 4.0 l0 4.0 • N N N I, H H H @ m ri VI 11/25/2016 11/25/2015 02/12/2017 02/12/2016 Annual Training - 03/01/2018 0 0 N 0 O N H, COC, Safety, 03/11/2017 03/11/2016 03/11/2017 03/11/2016 CORE I & II 10/01/2007 I 0 u •.ai •'.4 m V H F ppa at, H .•i E H al m x aa' u ro 06/03/2018 r0i 0 N 0 O class, renew u al Z i F a H V4)44,5)44414 w Ii Ili i IiU o a 11/23/2019 License or 12/08/2014 @ 0 M ro O 3) O H 04/22/2017 10/22/2016 Photo ID 0l a H a H H ri '4 'i ri H 4 0 ro 0 pI01 ggro qq0 m • w .a u IZ r� K 4 iS U tJ V A H Last, First a H • ri Shiloh D Shiloh D Shiloh D q 0 r+ Shiloh D Shiloh D 0o m m m 0 CO' 0 0 0 0 03 0 0 7 h h h h ' Jones, Shiloh D Jones, Shiloh D Jones, Shiloh D Jones, Shiloh D tD 4.0 t0 t0 t0 t0 t0 t0 t0 t0 N In to N to U) U) N I 01 .-4 H 'i e•1 rl .4 rl H rl H Date: 4/19/2017 Run Time: 9:04 AM User: kcalhoun[315] Paylocity Corporation Page 1 of 1 Ariel Clinical Services 0 0 a a 0 u K 0 a Harassment Only- 11/11/15 to 12/16/2016 12/16/2015 H, H, COC 01/22/2017 01/22/2016 Annual Training - a Z F R O qU CL .-1 .-1 . .4114. v! 4-) 14 U E40 qq 7 77 y�a ? F m H 3 ,0i �0) p, m ro Op RC RG R U U U Pi H M .�7 O .1J U) E F 03/01/2018 12/07/2016 H, COC, Safety, 01/22/2017 01/22/2016 01/22/2017 01/22/2016 m 0 0 N O 05/12/2018 05/12/2016 3 i 0 0 N 0 Ma 14 0 H 0 -.4 HI -4 0 W . ..VI 0 0.1 -_I -. of N ro W m a 0 -.4 -'4i F F C co 4 O H Cro q' 0 E H u 0 w I C g i 7C fC m a x -.>i 0 w0 OO 4 PO U V w 0 H li .7 0 CO 03/31/2020 03/19/2015 06/10/2017 12/10/2016 (0 O N N N 0 08/31/2017 06/14/2016 11/19/2014 06/20/2012 Curriculum Supervisor ' s a 06/02/2011 Educational Informed Trauma Training Trauma Training .i HI. .I .. H a o 0 u O o y a of CO a "a CO 0 0, 01 t, d v u H H a o m ai F .0 .a .0 x x .0 x x .4 x x .0 x .c .0 x p H L Y /J L) L I) L L L L 4) L L 41 J.1 1! F. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 E E E 40000 0 Y A ./ N M .1 .i .I .1 .I .i M .i -.1 .1 -'4 04 co N F F H F F H H F F H F H H H H F -.4 .i fa Hi .-I .a rt el el .1 .1 .y .i H 4 rl 0 0 0 0 0 0 0 0 0 0 0 0 N CO 01 0 10 CO CO VICO 0 0000 a a a a a a a a S R 1 1 11, cognitive Disabilities Various/Miscelaneou Var/Mi Var/Misc CO ri ri H r, ri r4 rr N 0 0 �0 0 H0 H0 0 0 CO 0 0 CO CO CO CI CO 10 CO 01 01 a a a a a a a m m m m m m m m m m m m m m m m m 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 N N N N N N N N N N N N N N N N N N Report Total Records: User: kcalhoun[315] O 0 F Run Date: 4/19/2017 Run Paylocity Corporation RIEL Clinical Services Children a Families a Adults Tim Russell Cognitive Disabilities 4/17/17- 6hours Working with LGBTQ Youth- 1/24/17- 3 hours Legal Issues & Best Practice concerning Parenting Time/SPT- 1/19/17- 3 hours Deanna Dingwall In Depth Correcting Principles 3/9/16- 5.5 hrs In depth Empowering Principles 3/2/16- 5.5 hrs In Depth Connecting Principles 2/24/16- 5.5 hrs Parenting Kids from Hard Places 2/17/16- 5.5 hrs Working with LGBTQ Youth 1/24/17- 3 hours Ariel CM Placement Checklist Mandatory Reporting 12/14/15 Intro to Reasonable & Prudent Parent Standards 1.5 hr. 10/23/15 CDHS- 9/24/14- 3 hrs Investigation Training 2 hrs. 7/18/12 File Org & File Doc. 2 hrs. 7/11/12 Foster Youth Transitioning FC to Adult 2 hrs. 6/29/11 Communication & De-escalation Techniques 2 hrs. 5/18/11 Animal Assisted tx techniques- 4/20/112 hrs Toolkit for Positive Parenting Children 2/15/11-10 hours CO Conference on Girls- 11/5/09- 5 hrs ER Pager Hosp M-1 Criteria- 12/16/09- 1 hr SpeakStrong- 3/18/10- 3 hrs Biological Parent Visitation Boundaries Placement Dynamics/Protocol- 7/14/10-1 hr Group Facilitation Dynamics & Skills- 7/21/10-1 hr Conflict Style Identification, Conflict Resolution & Leadership Skills- 7/22/10- 6 hrs Shiloh Jones In Depth Correcting Principles 3/9/16- 5.5 hrs In depth Empowering Principles 3/2/16- 5.5 hrs In Depth Connecting Principles 2/24/16- 5.5 hrs Parenting Kids from Hard Places 2/17/16- 5.5 hrs Working with LGBTQ Youth 1/24/17- 3 hours Ariel CM Placement Checklist Mandatory Reporting 12/14/15 Intro to Reasonable & Prudent Parent Standards 1.5 hr. 10/23/15 CDHS- 9/24/14- 3 hrs Investigation Training 2 hrs. 7/18/12 File Org & File Doc. 2 hrs. 7/11/12 Foster Youth Transitioning FC to Adult 2 hrs. 6/29/11 Communication & De-escalation Techniques 2 hrs. 5/18/11 Animal Assisted tx techniques- 4/20/112 hrs Toolkit for Positive Parenting Children 2/15/11-10 hours CO Conference on Girls- 11/5/09- 5 hrs ER Pager Hosp M-1 Criteria- 12/16/09- 1 hr SpeakStrong- 3/18/10- 3 hrs Biological Parent Visitation Boundaries Placement Dynamics/Protocol- 7/14/10- 1 hr Group Facilitation Dynamics & Skills- 7/21/10-1 hr Conflict Style Identification, Conflict Resolution & Leadership Skills- 7/22/10- 6 hrs Rene Ludeman Colorful Communication 5/25/16 5.5 hours Severe Bx Problems in Adoption 5/5/16 3 hrs Nuts & Bolts: Family Foster Care Home Certification, Re certification, Recruitment and Retention -13 hrs 1/29/16 Working w/ Trauma 4/24/15 Trauma in Trafficking 10/23/14 Attachment Implications for Caregivers 8/26/14 FP Educational Classes 7/25/14 Kelsey Granzen Cognitive Disabilities 4/17/17 6 hrs EMDR & Trauma Healing for Foster Children- 11/12/16- 2 hr Foster Care On Call Procedures 10/28/16-1 hr Mandatory Reporting Training 1/23/17 Matching, Preparing for Placement, & the 1st 48 hours- 3 hours 1/12/17 EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Behavior Coaching, Supervised Visitation and Structured Parenting Time, Mentoring, and Home Study services for individuals and families referred by the Department. 2. Behavior Coaching: a. Purpose/Goal: To provide therapeutic support to behaviorally or emotionally impaired children in the community and/or foster homes. b. Staff: Contractor will provide professionals experienced in working with children in a variety of settings. Contractor employs strength -based; solutions focused, and trauma informed practices. Contractor will engage the child and their family in order to maximize the success of services. c. Services: Services include behavioral support, mentoring, independent living coaching, and respite in the community. Contractor will also be offering DBT groups in the community. d. Target Population: Contractor will provide services to children and youth, male and female, 0-18 years of age, including those with developmental disabilities. e. Location of Services: Weld County, Denver Metro and El Paso County f. Availability of Services: Contractor will provide services Monday through Sunday. Hours will vary based on the needs of the client and/or family. Scheduling is available during normal business hours as well as in the evenings. g. Contractor does not bill Medicaid for this service. 3. Supervised Visitation and Structured Parenting Time: a. Purpose/Goal: To provide a neutral party that can observe contact between biological family members and their children. The goal of Supervised Visitation and Structured Parenting Time is to support the reunification of the children with their parents. Contractor will structure Parenting Time in a way that limits the child's exposure to parental conflict while allowing time for appropriate interactions. Contractor's primary goal is to protect the children from further emotional, physical or sexual abuse. Contractor will strive to maintain and improve the relationship between parents and children, help the parents understand and respond appropriately to their children's cues, and assist parents in improving trust, communication, and stability. Contractor will emphasize the importance of the parent(s) to commit and maintain consistency throughout the Structured Parenting Time. b. Staff: c. Services: Contractor will provide three (3) levels of Supervised Visitation/Structured Parenting Time: i. Structured Parenting Time: Is intended to provide monitoring of both verbal and non- verbal communication. The visit supervisor will intervene in order to help a parent connect with their child, improve interactions and supervision, and give suggestions for improving their relationship with their child and better meeting their needs. ii. Supervised Visitation: Is intended to provide documentation and observation as well as limited instruction. The visit supervisor may redirect the parent to engage with their children or keep conversations appropriate. 1 iii. Supervised Exchanges: Contractor will have staff present at pick up and drop off of the child from one parent to another. Staff remains for 15 minutes to ensure safety. This service also includes a written report of the demeanor of the child at the time of pick up and drop off and during the 15 minute exchange. a. Target Population: Contractor will provide services to any biological family members needing supervised visits. d. Location of Service: Location of Services: Weld County, Denver Metro and El Paso County b. Availability of Services: Contractor will provide services Monday through Sunday. Hours will vary based on the needs of the client and/or family. Scheduling is available during normal business hours as well as in the evenings. 4. SAFE Home Studies: a. Contractor will conduct home studies for foster certification and adoption as referred by the Department. b. Contractor utilizes the Structured Analysis Family Evaluation (SAFE) tool developed by the Consortium of Children. c. Contractor will ensure that all staff completing studies under this contract are SAFE certified and appear on the State's approved home study vendor list. d. Contractor will ensure that all staff conducting studies under this contract attend SAFE Refresher training during the term of the contract. e. Contractor will ensure that all studies are completed utilizing the most up-to-date forms and templates as found on www.consortforkids.org or www.SAFEhomestudv.org. f. Contractor will complete a Department of Motor Vehicle background check at no additional charge. All CBI, FBI and LexisNexis background check information will be completed by the Department, unless otherwise directed by the Department. g. Contractor will submit a completed home study to the Department with their billing within 60 days of receipt of the home study referral. A complete home study will include the study in SAFE format, background check information, SAFE questionnaires completed by the applicants, references and all other original documents submitted by the home study applicant. 5. Mentoring: a. Purpose/Goal: To help individuals build their independent living skills, provide positive role modeling, and assist individuals to reach their full potential. b. Staff: Bachelor level to Master's level. c. Services: Mentoring/Independent Living Skill Building d. Target Population: Contractor will provide services to children and youth, male and female, 0-18 years of age, including those with developmental disabilities. e. Location of Service: Weld County, Denver Metro and El Paso County. f. Availability of Services: Contractor will provide services Monday through Sunday. Hours will vary based on the needs of the client and/or family. Scheduling is available during normal business hours as well as in the evenings. g. Contractor does not bill Medicaid for this service. 6. Contractor will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the Contractor will notify the caseworker and the Child Welfare Contract and Services Coordinator immediately. 2 7. Contractor understands that the Department will not reimburse Contractor for "no shows" after two (2) consecutive "no shows". It is the responsibility of the Contractor to communicate "no shows" to the Department in a timely manner to determine continuation of services. 8. Contractor 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. 9. 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. 10. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department (FIDOS), unless otherwise directed by the Department. 11. 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. 12. 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. Services are inclusive of attendance. Contractor may appear by phone. 3 EXHIBIT D PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2018. Expenses incurred by the Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Life Skills (Core Services): $65.00/Hour (Structured Parenting Time.) $45.00/Hour (Supervised Visitation) $25.00/Hour (Safe Exchange) Home -Based Services (Core Services): $65.00/Hour (Behavior Coaching) $90.00/Hour (Behavior Coaching — Over 50 miles from the closest Ariel office.) Mentoring (Core Services): $50.00/Hour (Mentoring) $75.00/Hour (Mentoring - Over 50 miles from the closest Ariel office.) Home Studies (Child Welfare Administration or Case Services): $1,500.00/Episode (Full Home Study — Foster Certification or Adoption) Mileage shall be reimbursed at two cents below the most current IRS mileage rate/per mile after the first 30 miles. 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. 4 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"' 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. 5 A` OR0' ARIECLI-01 JBENSON CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 4/27/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 License # 0757776 HUB International Insurance Services (COL) INSURED Ariel Clinical Services 2938 N Ave Ste G Grand Junction 81504 CONTACT Shauna Carruthers NAME: PHONE FAX (A/C, No, Ext): (303) 226-7123 (A/C, No): ADDRESS: shauna.carruthers@hubinternational.com INSURER(S) AFFORDING COVERAGE INSURER A : Alliance of Nonprofits for Insurance, Risk Retention Group (ANI) INSURER B : Pinnacol Assurance Company INSURER C : INSURER D : INSURER E : INSURER F : NAIC # 10023 41190 COVERAGES CERTIFICATE NUMBER: • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DDIYYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X 2016-10702 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FJEF LOC OTHER: EACH OCCURRENCE 10/01/2016 10/01/2017 DPREM SESO(Ea occu ante) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG LIQUOR LIAB $ $ $ $ $ $ $ 1,000,000 500,000 20,000 1,000,000 3,000,000 3,000,000 1,000,000 A AUTOMOBILE LIABILITY X ANY AUTO 2016-10702 OWNED SCHEDULED AUTOS E�ONLY WN AUTOS ONLY AUpTNOpAUTOS S ONL9 COMBINED SINGLE LIMIT (Ea accident) 10/01/2016 10/01/2017 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY acEcidentDAMAGE $ $ $ $ $ 1,000,000 A X UMBRELLA LIAB X OCCUR EXCESS LIAB CLAIMS -MADE 2016-10702A-UMB DED X RETENTION $ 10,000 EACH OCCURRENCE 10/01/2016 10/01/2017 AGGREGATE $ $ $ 2,000,000 2,000,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N 3246850 OFFICER/MEMBER EXCLUDED? N /A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below PER OTH- STATUTE ER 10/01/2016 10/01/2017 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ 1,000,000 1,000,000 1,000,000 A Misconduct / Abuse 2016-10702 A Professional Liab 2016-10702 10/01/2016 10/01/2017 Limit: 10/01/2016 10/01/2017 Limit: 500,000 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) County of Weld is included as additional insured for General Liability on a primary and non-contributory basis. Umbrella Liaibility follows form. CERTIFICATE HOLDER CANCELLATION County of Weld 1150 'O' Street Greeley, CO 80631 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. 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