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Home My WebLink About20181591.tiffRESOLUTION RE: APPROVE AGREEMENT FOR RESPITE CARE SERVICES AND AUTHORIZE CHAIR TO SIGN - TANNIS AND DERICK JENNINGS WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with an Agreement for Respite Care Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Tannis and Derick Jennings, commencing March 16, 2018, and ending June 30, 2018, with further terms and conditions being as stated in said agreement, and WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Agreement for Respite Care Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Tannis and Derick Jennings be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreement. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 16th day of May, A.D., 2018, nunc pro tunc March 16, 2018. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: dirdiev �•,ok, Weld County Clerk to the Board Deputy Jerk to the APDAS ounty Attorney Date of signature: 46-a7 /S Steve Moreno, Chair Mike Freeman ac HS I) ©7-05is 2018-1591 HR0089 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: April 3, 2018 TO: Board of County Commissioners — Pass -Around FR: Judy A. Griego, Director, Human Services RE: Respite Care Provider Agreements (Various) Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Respite Care Provider Agreements (Various). The Department's Division of Child Welfare contracts throughout the year with individuals and couples, primarily Weld County Certified foster parents, for respite care services. Respite care is limited to four (4) hours per week per child. The hours of care may be provided in any combination throughout a month, but may not exceed 16 hours per month. Payment is $16.75 per each four (4) hour period, but may not exceed $67.00 per month for 16 hours. CMS ID Last Name First Name City Term .IR3S / ? Jennings Tannis and Derick Frederick 03/16/18-06/30/18 1736 Dunn James and Gari Kersey 03/19/18-06/30/18 1737 Haines Ryan and Kara Greeley 0 03/26/18-06/30/18 I do not recommend a Work Session. I recommend approval of these Agreements. Approve Recommendation Sean P. Conway Julie A. Cozad, Chair Mike Freeman Barbara Kirkmeyer, Pro-Tem Steve Moreno, Chair Schedule Work Session Other/Comments: Pass -Around Memorandum; April 3, 2018 — CMS 1,,7'3S 1736, 1737 110 Page 1 oZ0! 4/O 9/ AGREEMENT FOR RESPITE SERVICES BETWEEN WELD COUNTY, ON BEHALF OF WELD COUNTY DEPARTMENT OF HUMAN SERVICES, AND RESPITE CARE PROVIDER, TANNIS JENNINGS AND DERICK JENNINGS THIS AGREEMENT is made and entered into this/b day of / 2018by and between the Board of County Commissioners of the County of Weld, State of Col ado, on behalf of the Weld County Department of Human Services, whose address is 1150 "O" Street, Greeley, Colorado 80631, hereinafter referred to as "County", and Tannis Jennings and Derick Jennings, whose address is 5433 Wolf Street, Frederick, CQ 80504 hereinafter referred to as "Care Provider." 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 County for respite care for Weld County certified foster care homes; and WHEREAS, County has determined that due to the significant challenges often experienced by certified foster care providers, it is necessary to offer them respite services, as described in Exhibit A, "Scope of Services", a copy of which is attached hereto and made a part hereof by this reference), to allow them to continue to provide high quality care for the children in their charge, and WHEREAS, Care Provider is willing and able to abide by the terms and conditions required by County, as more fully set forth in this Agreement, WHEREAS, Care Provider is able and available to provide respite services as defined in this Agreement at the rates set forth in Exhibit B, "Rate of Reimbursement" a copy of which is attached hereto and made a part hereof by this reference), NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties hereto agree as follows: RESPITE CARE PROVIDER'S RIGHTS AND RESPONSIBILITIES: 1. As used in this Agreement "Respite Care" is defined as those child care services required by one or more children who are in the care of a certified foster home, which services are provided by Care Provider in order to give foster parents an opportunity to address matters which cannot be addressed while caring for the child(ren) in their care. These services are described in Exhibit A. These services may also include transporting the child to school and other appointments previously arranged by the foster parent. Transportation services are provided at the sole risk, responsibility and liability of Care Provider. 2018-1591 1 ?. Care Provider may provide up to sixteen (16) hours of Respite Care per child per month for certified Weld County foster homes seeking respite care, as approved by the Department. The hours of respite care may be provided in any combination (schedule) throughout the month so long as the total hours provided does not exceed sixteen (16) hours per month. 3. At all times from the effective date of the Agreement until completion of the Agreement, Care Provider 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. 4. Care Provider agrees to accept payment by either County warrant or ACH direct deposit. 5. Care Provider agrees to obtain a criminal background check, and warrants that if any previous criminal charge filed against Care Provider does not appear in the background check, he/she shall disclose such charges. 6. Care Provider assures that it will fully comply with all applicable Federal and State laws which govern the ability of the County to comply with the relevant funding requirements. 7 Care Provider assures and certifies as follows: a. He/She is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation with any program with a Federal or State department or agency; and b. l-le/She has not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against him/her 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; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and c. He/She is 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 d. He/She has not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. 8. 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 an new employee to perform work under the contract, affirm that Contract Professional has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, and shall comply with all of the other requirements of the State of Colorado program. If Contract Professional fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable for actual and consequential damages. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5- 3 103(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. 10. Care Provider certifies that, at the time of entering into this Agreement, hefshe has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services covered by this Agreement. These requirements include the following: a. Current Colorado driver's license indicating Care Provider is at least eighteen (18) years of age; and b. Completed fingerprint card for a background check through the Colorado Bureau of Investigation (CBI) and the Federal Bureau of Investigation (FBI). The fingerprinting expense must be paid by the Care Provider. Background checks will be paid by the County. c. Current CPR and First Aid certifications. If either certification expires during the term of this Agreement, Care Provider shall renew the certification ensuring that there is no lapse in certification. County will pay for certification through select CPR and First Aid trainers identified by the County. d. Care Provider shall procure at least the minimum amount of automobile liability insurance required by the State of Colorado. County provides no automobile liability coverage for Care Provider. Proof of said automobile liability insurance shall be provided to County prior to the performance of any services under this Agreement. e. Copies of all documentation relating to the foregoing requirements shall be provided to the County by Care Provider prior to the performance of any services covered under this Agreement. County shall determine eligibility for certification based upon the successful completion of all required training and receipt of current documentation. 11. Care Provider shall attend fifteen (15) hours PRIDE training through the Weld County Department of Human Services prior to the performance of services under this Agreement. County shall not compensate Care Provider for said training; including time spent traveling to and from training, time spent in attendance of the 4 training, or any associated costs paid by Care Provider for such training, unless specifically agreed to in writing in advance by County. 12. Care Provider shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents for any damages caused by his/her actions while performing services pursuant to this Agreement, and shall hold County harmless from any loss occasioned as a result of the performance of this Agreement. 13. Care Provider shall be totally responsible to provide whatever personal liability and./or other insurances, he/she deems necessary to cover his/her personal liability for any injuries caused by Care Provider in the course of providing services under this Agreement. 14. Care Provider shall perform his/her duties hereunder as an independent contractor and not as an employee of County. Care Provider shall be solely responsible for his/her acts performed pursuant to this Agreement. Under no circumstances shall Care Provider be deemed to be an agent or employee of Weld County. Care Provider is 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 Care Provider. Unemployment insurance benefits will not be available to Care Provider for services provided under this Agreement. Care Provider shall pay when due any/all applicable employment taxes and income taxes and local head taxes (if applicable) incurred as a result of the services provided under this Agreement. 15. Care Provider shall not have authorization, express or implied, to bind County to any agreement, liability or understanding. 16. Care Provider agrees that he/she shall not use alcohol, illegal drugs, marijuana, whether for recreational or medical purposes, or any other drugs which have the potential of impacting Care Provider's ability to supervise the children in his/her care while providing services under this Agreement or within five (5) hours prior to the provision of said services. Care Provider shall protect the confidentiality of all records and other materials to which he/she has access relating to the foster family and child(ren) to whom the services are provided, which are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. COUNTY'S RIGHTS AND RESPONSIBILITIES: 5 1 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 Care Provider while performing duties described in this Agreement. County shall not indemnify Care Provider for any loss incurred by Care Provider as a result of services performed under this Agreement. 3. County shall pay Care Provider in accordance with the terms set forth in Exhibit B, reference), as long as services are rendered satisfactorily and in accordance with the Agreement. 4. Payment pursuant to this Agreement is subject to, and contingent upon, the continuing availability of funds made available for the purposes hereof. No portion of this Agreement shall be deemed to create an obligation on the part of County to expend funds not otherwise appropriated. The County may terminate this Agreement at any time if said source of funding is no longer available to County 5. County may withhold payment under this Agreement if Care Provider fails to comply with any part of the Agreement. In the event County withholds payment, Care Provider may appeal such circumstance in writing to the Weld County Director of Human Services. The decision of the Weld County Director of Human Services shall be final. .GENERAL PROVISIONS: 1. This Agreement shall become effective on March 16, 2018, upon proper execution of this Agreement, and shall expire on June 30, 2018 unless sooner terminated as provided herein. This Agreement may be renewed by the mutual agreement of the parties for up to two (2) additional one (1) year periods. Renewal of the Agreement shall be documented by the execution of the "Renewal of Agreement" form, a copy of which is attached hereto as "Exhibit C" and made a part hereof by this reference. 2. Either party may terminate this Agreement at any time for any reason by providing the other party with a 30 -day written notice thereof. Furthermore, this Agreement may be terminated by County at any time without notice upon a material breach by Care Provider of the terms of the Agreement. 3. Care Provider may not assign or transfer this Agreement, any interest therein or claim hereunder, without the prior written approval of County. 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 6 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. 4. 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. 5. 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. 6. No officer, member or employee of 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 Care Provider with County when the Care Provider 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 that the Care Provider gain from knowledge of these opposing interests. It is only necessary that the Care Provider knows that the two relationships are in opposition. During the term of the Agreement, Care Provider 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, Care Provider 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 Care Provider. Care Provider certifies that no Federally appropriated funds have been paid or will be paid, by or on behalf of Care Provider, 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. 7. This Agreement, together with Exhibits A, B, and C, constitutes the entire 7 understanding between the parties with respect to the subject matter hereof, and may not be changed or modified, unless by a written amendment executed by both parties. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. Neither County nor Care Provider may assign any of its rights or obligations hereunder without the prior consent of the other party. 9. This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 10. 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, Care Provider agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 11. In the event of a dispute between County and Care Provider, 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. 12. 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. 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. 14. 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. 15. 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 8 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. 16. 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. 17. This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 18. 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. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: , ritG: 'e1 BOARD OF COUNTY COMMISSIONERS Weld . , my Clerk to � p�� WELD COUNTY, COLORADO By: Deputy Cl 10 teve Moreno, Chair CONTRACTOR: Tannis Jennings Derick Jennings 5431 Wolf Street Frederick, CO 80504 (720)-364-1639 By: Date: By: Date: MAY 1 i 2018 (:)r)) Tann' Jen ings eck Jennings c/ '/6 / EXHIBIT A SCOPE OF SERVICES 1. Care Provider will provide up to sixteen (16) hours of Respite care services per month per child for foster children residing in Weld County certified foster homes. Care Provider will, at the time of entering into this Agreement, ensure he/she has completed all the necessary paperwork and has in effect all necessary licenses, approvals, insurance, etc., required to provide the Respite services covered by this Agreement. Care Provider will have: a. Completed and submitted the Colorado Department of Human Services Application and signed as "Foster Parent/Home" PRIOR to completing the PRIDE classes. b. Successfully completed fifteen (15) hours PRIDE training through the County prior to the performance of services under this Agreement. c. Provided a copy of their current Colorado driver's license indicating Care Provider is at least eighteen (18) years of age; and d. Completed and submitted a fingerprint card for a background check through the Colorado Bureau of Investigation (CBI) and the Federal Bureau of Investigation (FBI). The fingerprinting expense must be paid by the Care Provider. , Background checks will be paid by the County. e. Provided three (3) reference forms completed by non -relatives. f. Provided proof of current CPR and First Aid certifications. g. Completed and signed Confidentiality, Discipline and Mandated Reporter Policies. h. Provided proof that Care Provider has procured at least the minimum amount of automobile liability insurance required by the State of Colorado. County provides no automobile liability coverage for Care Provider. Copies of all documentation relating to the foregoing requirements shall be provided to the County by Care Provider prior to the performance of any services covered under this Agreement. County shall determine eligibility for certification based upon the successful completion of all required training and receipt of current documentation. Care Provider further acknowledges that he/she will remain current with all documentation or certifications for the term of this Agreement. Should an item expire or otherwise become invalid, Care Provider will submit current documentation to the County to avoid a lapse in documentation and/or certification. 11 3. Care Provider acknowledges that the County shall not compensate Care Provider for said training; including time spent traveling to and from training, time spent in attendance at the training, or any associated costs paid by Care Provider for such training, unless specifically agreed to in writing in advance by County. 4. Care Provider acknowledges that arrangements to provide Respite services must be communicated to the child's Caseworker and the Foster Care Coordinator prior to Respite taking place in order to discuss arrangements and ensure all the child's needs are met. 5. Care Provider will become familiar with and follow all the State and Federal rules and regulations as applicable to the services provided under this Agreement. 6. Care Provider will complete and submit the Respite Care Payment Form each month by the 10th of the month following the month of service. The Respite Care Payment Form is available on the Foster Parents Internet Database and On-line System (FIDOS). 12 EXHIBIT B PAYMENT SCHEDULE I. Funding and Method of Payment The County agrees to reimburse the Care Provider 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 Care Provider during the term of this Agreement shall be reported by the County after June 30, 2018. Expenses incurred by the Care Provider prior to the term of this agreement are not eligible County expenditures and shall not be reimbursed by the County. 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 County, the County may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Respite care is limited to four (4) hours per week per child. The hours of care may be provided in any combination throughout a month, but may not exceed 16 hours per month. Payment will be $16.75 per each four-hour period, but may not exceed $67.00 per month for 16 hours. Human Services referrals will not be sent to collections by Care Provider for default of co- pay/fees. Services will be performed regardless of client's refusal or inability to pay co - pay. Care Provider will collect any applicable sliding scale co -pays and credit Human Services for any payments received on the monthly billing statements. 3. Submittal of Vouchers Care Provider shall prepare and submit a Respite Care Payment Form each month to certify that the services authorized were provided on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A. The Respite Care Payment Form is available online through the Foster Parent Internet Database and On-line System (FIDOS). w O Q 2 V O O O < Safeco Insurance COLORADO INSURANCE IDENTIFICATION CARD COMPANY SAFECO INSURANCE COMPANY QF AMERICA POLICY NUMBER Y8079659 YEAR 2017 AGENCY/COMPANY ISSUING CARD LAWSON INSURANCE AGENCY I (303) 238-4381 7675 W 14TH AVE STE 201 LAKEWOOD CO 802 EFFECTIVE DATE MAR. 1 2018 MAKE/MODEL KIA EXPIRATION DATE MAR. 1 2019 VEHICLE IDENTIFICATION NUMBER 5XYPGDA51HG216585 NC 14-4153 INSURED TANNIS JENNINGS JOSEPH DERICK JENNINGS 5431 WOLF ST FREDERICK CO 80504-3434 CN-7042/EP 12/08 VEHICLE REGISTRATION COPY Safeco Insurance COLORADO INSURANCE IDENTIFICATION CARD COMPANY SAFECO INSURANCE COMPANY OF AMERICA POLICY NUMBER Y8079659 YEAR 2009 AGENCY/COMPANY ISSUING CARD LAWSON INSURANCE AGENCY T (303) 238-4381 7675 W 14TH AVE STE 201 LAKEWOOD CO 802 EFFECTIVE DATE MAR. 1 2018 MAKE/MODEL CHEVROLET EXPIRATION DATE MAR. 1 2019 VEHICLE IDENTIFICATION NUMBER 3GNCA53V89S630537 NC 14-4153 INSURED TANNIS JENNINGS JOSEPH DERICK JENNINGS 5431 WOLF ST FREDERICK CO 80504-3434 CH-7042/EP 12/08 Safeco Insurance VEHICLE REGISTRATION COPY COLORADO INSURANCE IDENTIFICATION CARD COMPANY SAFECO INSURANCE COMPANY OF AMERICA POLICY NUMBER Y8079659 YEAR 2003 CHEVROLET AGENCY/COMPANY ISSUING CARD LAWSON INSURANCE AGENCY (303) 238-4381 7675 W 14TH AVE STE 201 LAKEWOOD CO 802 EFFECTIVE DATE MAR. 1 2018 MAKE/MODEL EXPIRATION DATE MAR. 1 2019 VEHICLE IDENTIFICATION NUMBER 1GCHK29113E1332.64 INC 14-4153 INSURED TANNIS JENNINGS JOSEPH DERICK JENNINGS 5431 WOLF ST FREDERICK CO 80504-3434 VEHICLE REGISTRATION COPY CM-7042/EP 12/08 N THE PERFORATIONS. IN THE INSURED VEHICLE b84t 808L999 89ZLOOL00000Z000L0000000 GISTRATICM f'ARf 'U C)RADC) RF VIN EXPIRE FUEL TYPE PLATE TAB PAS-REG NOF411 C290399 5XXPGDA51HG216585 01/2019 G _ DUAL REG DUAL NO DUAL TAB DUAL EXPIRE OWNER NAME/MAILING ADDRESS JENNINGS JOSEPH DERICK JENNINGS TANNIS E/11162017/ /012024 THIEVES HAVE BEEN KNOWN TO USE THE ADDRESS FROM A REGISTRATION CARD TO STEAL FROM THE VEHICLE'S OWNER. FOR ADDED SECURITY, YOU ARE ENCOURAGED TO KEEP ONLY THIS REGISTRATION CARD IN YOUR VEHICLE. IT DOES NOT CONTAIN YOUR ADDRESS. TOTAL VALIDATION WELD 01/11/2018 122811 B03 ADM 1036.07 MOTOR VEHICLE INSURANCE IS COMPULSORY IN COLORADO. NON-COMPLIANCE IS A MISDEMEANOR TRAFFIC OFFENSE Hello