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Home My WebLink About20173418.tiffninny s 1 1)44 127a. AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEHAVIORAL HEALTH This Agreement Amendment, made and entered into �v day of 2018 by and between the Board of Weld County Commissioners, on behalf of the Weld Coty D artment of Human Services, hereinafter referred to as the "Department", and North Range Behavioral Health, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Anger Management/Domestic Violence Services, Functional Family Therapy, Mental Health Services, Monitored Sobriety Services, and Multisystemic Therapy (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2017-3418 approved on October 4, 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 Anger Management/Domestic Violence Services, Functional Family Therapy, Mental Health Services, Monitored Sobriety Services, and Multisystemic Therapy. 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; 7../fit at./6& /45D 40/7_,os ifizcoF7 iv. A Medicaid provider is not available to provide the needed service; v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. • 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: �deCilitA) "6'4;1A BOARD OF COUNTY COMMISSIONERS Weld 'o nt Clerk to the B. . rd WELD COUNTY, COLORADO By: Deputy Clerk the Board JUL 18 2018 North Range Behavioral Health 1300 North 17th Avenue Greeley, Colorado 80631 (970) 347-2120 By: Date: irector 02o/7-.3Li? EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Anger Management/Domestic Violence Services, Functional Family Therapy (FFT), Mental Health Services, Monitored Sobriety Services, and Multisystemic Therapy (MST) to individuals and families, as referred by the Department. 1. Anger Management/Domestic Violence: Contractor will provide Anger Management and Domestic Violence services to males and females, 18 years and older, at 1260 H Street, in Greeley. a. Services will be provided at the North Range Behavioral Health Adult Outpatient facility, located at 1260 H Street, in Greeley, CO. b. All services will be provided by academically qualified and/or licensed Domestic Violence Offender Management Board (DVOMB) approved staff. c. Contractor will provide the following services under this contract: Anger Management (Minimum 20 Weeks of Treatment) Domestic Violence (Length of treatment will comply with Domestic Violence Offender management Board (DVOMB) regulations based on placement criteria for treatment levels A, B or C.) Track (level) is determined by assessment DVOMB approved screening tools. Tracks are as follows: Track A: One (1) group session per week. Minimum of two (2) treatment plan reviews taking place every 2-3 months, depending on progress on the required Core Competencies (see below). Track B: One (1) group session per week and one (1) additional contact per month. Minimum of three (3) treatment plan reviews taking place every 2-3 months, depending upon progress on the required Core Competencies (see below). Track C: One (1) group session per week and one (1) additional contact per week. Minimum of three (3) treatment plan reviews • Group Process and Skills • Cognitive -Behavioral Skills • Passive, Aggressive and Assertive Behaviors • Victim Empathy • Treatment Goals • Substance Abuse • Stages of Change • Parenting • Men's Issues/Women's Issues (as applicable) • Effects on Children (DV only) • Steps to Problem Solving • Steps to Conflict Resolution • Characteristics of Assaultive Adults • Attitudes Toward the Opposite Sex • Sex Role Training • Socio-cultural Basis for Violence • Provocation • Appropriate Containment and Expressions of Anger • Experiencing Emotions and Feelings Beyond Anger • Grief and Loss • Depression and Anxiety • Stress Management • Relapse/Recidivism Prevention • Healthy Relationships • Sexuality • Spirituality • Resources 1 taking place every 2-3 months, depending upon progress on the required Core Competencies (see below). Additional contacts will be in a group or individual setting depending on the clinical need. Core Competencies (per DVOMB regulations): A. Commitment to eliminate abusive behavior. B. Personal Change Plan work. Demonstrate change. C. Complete the Personal Change Plan Worksheet. D. Recognize and demonstrate empathy. E. Accept full responsibility for the offense and abusive history. F. Identify and reduce pattern of power and control behaviors, beliefs and attitudes of entitlement. G. Accountable for abusive behaviors, accept consequences, take steps to reconciliation to prevent future abusive behaviors. H. Accept that abusive behavior should have and has consequences. I. Participate and cooperate in treatment. J. Ability to define types of DV. K. Understand, identify and manage own pattern of violence. L. Understand intergenerational effects of violence. M. Understand and use healthy communication skills. N. Understand and use time outs. O. Recognize financial responsibilities as required. 2 P. No new violence or abusive offences. Q. Prohibited from purchasing, possessing, or using firearms and ammunition. d. Anger Management and Domestic Violence Intakes will be completed with recommendations before the client is placed into treatment. The intake will determine the best placement for the client in regards to treatment, which may include group session and/or individual sessions. CONTRACTOR will provide a copy of the intake to the caseworker. e. Individual sessions may be determined necessary at intake but will only be utilized under one or more of the following circumstances: • The referred client's individual treatment needs cannot be adequately addressed in a group setting. • The client is not currently appropriate for a group setting and requires a limited number of individual sessions to prepare for a group setting. • The client's job requirements make it impossible to attend regularly scheduled group sessions and individual sessions are the only option for the client to comply with their treatment plan. • When assessed for a DV track in which an additional contact is required. f. If the client is assessed at a higher level of care than what is offered by CONTRACTOR, a recommendation to an agency that offers that level will be made. g. Contractor will comply with the Colorado Domestic Violence Offender Management Board's Standards and Guidelines. 2. Functional Family Therapy (FFT): Contractor will provide Functional Family Therapy (FFT) services to male and female youth within the approximate age range of 10-17 years of age, and their families, residing in Weld County, as referred by the Department. a. Contractor has offices in both Greeley and Fort Lupton, CO. b. Services are provided in -home in accordance with the National Functional Family Therapy (FFT) model, and its standards and guidelines. All services are overseen/supervised by a FFT National Consultant. c. Youth and family are deemed eligible for services based on one or more of the following inclusionary criteria: • Child must be at risk of out -of -home placement or transitioning back from placement within 30 days. • Child is displaying moderate to severe behavioral problems in the home/school/community. • Child is involved in criminal behaviors to include substance abuse. • Child demonstrates verbal and/or physical aggressions at home/school/community. • Child is engaged with deviant peer group. • Child is struggling with school behaviors to include failing grades, truancy and anti -social behaviors. • Family has persistent conflict and negative child -parent relationship. 3 • Caregiver is abusing substances. • Family has limited resources and would benefit from psycho -education and parenting skill development. d. FFT utilizes Family Interventions, Cognitive Behavioral Therapy, Family Therapy, school and community interventions, and substance abuse intervention, as clinically appropriate. e. The goal of services is to: • Empower families with the skills and resources need to independently address the difficulties they are having raising their children. • Empower youth to cope with family, peer, school and neighborhood problems. • Build community and natural support systems. • Decrease negativity and blame among family members. • Decrease anti -social behavior to include legal contacts, truancy and substance abuse issues f. Service duration is two (2) to six (6) months for one (1) to two (2) hours per week. g. Services include: • Case Management • School Interventions • Advocacy • Court/Staffing Participation • Sustainability Planning • Booster Services After Discharge h. CONTRACTOR has the ability to provide bilingual services (Spanish). 3. Mental Health Services: Contractor is the community mental health center serving Weld County. a. Contractor will provide the following services under this contract: Level 1— Behavioral Health Evaluation: Useful for ruling in/out basic mental health and substance abuse issues, advising on provisional diagnoses, and making recommendations for treatment when appropriate. Approximate completion time is three (3) to six (6) hours. • Review of Department records, and if applicable, NRBH records. • Clinical interview and integrated diagnostic evaluation (assessment of mental health and substance abuse issues). • Possible administration of brief screening inventories (e.g., Beck Inventories, State - Trait Inventories, Personality Assessment Screener). • Feedback to client. • Written report addressing relevant psychosocial history, diagnostic formulation, and treatment recommendations. ii. Level 2 - Partial Psychological Evaluation: Useful for ruling in/out mental health, substance abuse, cognitive, and/or personality issues, advising on diagnoses, and making treatment recommendations. Approximate complete time is eight (8) to 14 hours. • Review of Department records, and if applicable, NRBH records. • Clinical interview and integrated diagnostic evaluation (assessment of mental 4 health and substance abuse issues). • Administration of a partial test battery, such as administration of just cognitive or just personality testing (e.g., Wechsler IQ tests, MMPI, MCMI, PAI, etc.). • Consultation with collateral sources. • Feedback to client. • Written report addressing relevant psychosocial history, diagnostic formulation, and treatment recommendations. iii. Level 3 — Full Psychological Evaluation: Useful in identifying more significant behavioral health issues and diagnoses, as well as addressing personality issues, intellectual functioning, the ability to manage emotions, parenting issues and potential safety of the children in the home, placement issues, and treatment recommendations. Approximate completion time is 16 to 20 hours. • Review of all available records including Department records, prior evaluation and behavioral health treatment records, police records, medical records, records from other agencies involved in the case, and if applicable, NRBH records. • Extensive integrated clinical evaluation (multiple sessions). • Administration of a formal battery of tests (multiple tests) to assess personality, emotional and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQ tests, MMPI, MCMI, PAI, STAXI, STAI, Beck screens, TSI, PSI, etc.). • Consultation with collateral sources. • Feedback to client. • Written report addressing psychosocial history, personality issues, emotional functioning and regulation abilities, and/or intellectual functioning and/or parenting/family issues, substance abuse, and diagnostic formulation, as well as treatment recommendations and prognosis. iv. Level 4 — Extended Psychological Evaluation: Useful in identifying more significant mental health and substance abuse issues and diagnoses, as well as addressing personality issues, intellectual functioning, the ability to manage emotions, parenting issues and potential safety of the child(ren) in the home, placement issues, and treatment recommendations. To be utilized when impairment in cognitive functioning is suspected/known, when the client is unable to read or write, when there are major memory deficits, when resistance leads to invalid measures and instruments need to be re -administered, and/or when other significant barriers to testing are present. • Review of all available records including Department records, prior evaluation and behavioral health treatment records, police records, medical records, records from other agencies involved in the case, and if applicable, NRBH records. • Extensive integrated clinical evaluation (multiple sessions). • Administration of a formal battery of tests (multiple tests) to assess personality, emotional and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQ tests, MMPI, MCMI, PAI, STAXI, STAI, Beck screens, TSI, PSI, etc.). • Consultation with collateral sources. • Feedback to client. • Written report addressing psychosocial history, personality issues, emotional functioning and regulation abilities, and/or intellectual functioning and/or parenting/family issues, substance abuse, and diagnostic formulation, as well as treatment recommendations and prognosis. For partially completed evaluations, Contractor will submit a written report of any finding that can be appropriately offered based upon the information gathered. Evaluations will be conducted at an NRBH location or another suitable location (e.g., client's home, school, detention center, etc.), depending upon the circumstances. Evaluations will be conducted by a qualified NRBH provider. CONTRACTOR will submit the written report, following completion of the evaluation, within forty-five (45) days from the point of initial contact with the client, provided the client can be reached for appointments and the client attends appointments as scheduled. The Department may choose to extend the referral as deemed appropriate or the referral may be closed if the client fails to follow through. CONTRACTOR will communicate with the referring caseworker and the Child Welfare Contract and Services Coordinator regarding any issues contacting the client, missed appointments, or other issues that arise that prevent the completion of the referred evaluation. 4. Monitored Sobriety Services: Contractor will provide timely and quality monitored sobriety services to male and female clients referred by the Department as follows: a. Contractor will provide timely and quality monitored sobriety services to male and female clients referred by the Department as follows: b. Services will be provided at the North Range Behavioral Health Crisis Stabilization Services facility in Greeley, CO, at 1140 M Street. c. Contractor will provide a qualified monitored sobriety collector 24 hours a day/seven (7) days a week at 1140 M Street, in Greeley, CO. d. Contractor will confirm all positive and negative Breathalyzer monitored sobriety results within 24 hours through a phone call, test result, e-mail and/or fax to the referring caseworker. e. Contractor will confirm all positive and negative laboratory Urinalysis results will be confirmed once processing has occurred through Redwood Toxicology (usually within three days). Confirmation will occur through a phone call, test result, e-mail and/or fax to the referring caseworker. f. Contractor will report all positive and negative Instant Urinalysis results within 24 hours. If the result is positive, it will be sent to Redwood for final confirmation. Confirmation will occur through a phone call, test result, e-mail and/or fax to the referring caseworker. g. Contractor will submit a copy of the valid Authorization for Services form, result and client sign -in sheet (if applicable) with each monthly billing. h. All processed (laboratory) test results will be available online 24 hours per day, seven (7) days per week online at Redwood Toxicology (www.webtoxicologv.com). 6 5. Multisystemic Therapy (MST): Contractor will provide Multisystemic Therapy services to male and female youth within the approximate age range of 12-17 years of age, and their families, residing in Weld County, as referred by the Department. a. CONTRACTOR has offices in both Greeley and Fort Lupton, CO. b. Services are provided in -home in accordance with the National Multisystemic Therapy (MST) model, and its standards and guidelines. All services are overseen/supervised by a MST National Consultant. c. Youth and family are deemed eligible for services based on one or more of the following inclusionary criteria: • Child must be at risk of out -of -home placement or transitioning back from placement within 30 days. • Child is involved in criminal behaviors. • Persistent family conflict. • Child and/or caregiver is abusing substances. • Behavior is chronic. • Child is engaged with deviant peers. • Child is struggling at school. • Family has few resources. • Parents would benefit from psycho -education and skill development. • Child is displaying moderate to severe behavior problems. d. MST utilizes In -home Caregiver Interventions, Cognitive Behavioral Therapy, Family Therapy, Individual Therapy, as well as school and community interventions. e. The goal of services is to: • Empower caregivers with the skills and resources needed to independently address the difficulties related to managing their children. • Empower youth to cope with family, peer, school and neighborhood problems. • Build community and natural support systems. • Decrease anti -social behavior. f. Service duration is two (2) to five (5) months for three (3) to five (5) hours per week. g. Services include: • 24/7 On -call Services • Case Management • School Interventions • Advocacy • Court/Staffing Participation • Sustainability Planning h. Contractor has the ability to provide bilingual services (Spanish). 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. 7 7. 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. 8. 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. 9. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 10. 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. 11. Contractor understands that the Department will not reimburse Contractor for "no shows" or cancelled appointments, either on the part of the client or the Contractor. 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. FFT and MST services are inclusive of attendance at staffings. For Mental Health Services only, upon receipt of an invitation from the Department, Contractor must contact the Child Welfare Contract and Services Coordinator to request approval to bill for participation if Contractor wishes to be reimbursed. The Department will reimburse for actual participation in the meeting only so long as the meeting is at least one hour in length, the Contractor requests approval to bill in advance of the meeting and participation in the meeting is deemed appropriate and necessary by the Department. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator. 8 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 in Trails after May 31, 2019, for Core funded services, and June 30, 2018, for other funding sources. Expenses incurred by the Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Anger Management/Domestic Violence Evaluation and Treatment: $200.00/Episode (Anger Management or Domestic Violence Evaluation) $25.00/Hour (Group Session) $17.50/15 Minutes (Individual Session) Functional Family Therapy (FFT): $700.00/Month (Pro -rated for partial month of service) Mental Health Services: $250.00/Episode (Level 1— Behavioral Health Evaluation) $800.00/Episode (Level 2 — Partial Psychological Evaluation) $1,200.00/Episode (Level 3 — Full Psychological Evaluation) $1,800.00/Episode (Level 4 — Extended Psychological Evaluation) $120.00/Hour (Hourly rate for partial evaluation, not to exceed cost of full evaluation) Monitored Sobriety: $20.00/Episode (Urinalysis S Panel: THC, Coacaine, Amphetamines, Benzodiazepines, Opiates) $20.00/Episode (Urinalysis 7 Panel: THC, Coacaine, Amphetamines, Benzodiazepines, Opiates, Barbiturates, Alcohol) $20.00/Episode (Urinalysis — Multi -Panel Instant) $20.00/Episode (Instant Swab) $35.00/Episode (GCMS — Confirmation of Positive Result) $100.00/Episode (Hair Testing) $50.00/Episode (Patch Monitoring) $50.00/Episode (Urinalysis — Expanded Designer Stimulants 14 -Panel) 1 $35.00/Episode (Ethyl Glucuronide/EtG Test Only) $35.00/Episode (Urinalysis — 3 Panel: MDPV, Mephedrone, Methylone) $35.00/Episode (Urinalysis — Synthetic Cannabinoids "Spice") $35.00/Episode (Oral Swab — Synthetic Cannabinoids "Spice") $5.00/Episode (Breathalyzer) $2.00/Episode (Urinalysis — Single Panel EtG Add-on Test with Urinalysis 5 -Panel or 7 -Panel) $2.00/Episode (Urinalysis — Add-on Panel for Oxycodone or Buprenorphrine, with a Urinalysis S -Panel or 7 -Panel) Multisystemic Therapy (MST): $1,800.00/Month (Pro -rated for partial month of service) Contractor may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. Contractor will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher, and signed monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. b. For one-time services, proof of services rendered shall be receipt of the completed product. C. For Monitored Sobriety services, proof of services rendered shall be the test result. 2 PRODUCER Rich & Cartmill Ins of CO of Colorado LLC 8213 W. 20th Street Greeley, CO 80634 Michael J Schmitt CIC INSURED '""''�`I NORTH12 -.. QPID P i% « DATE (MM/DD/YYYY) �_- CERTIFICATE OF LIABILITY INSURANCE 06/29/2017 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). 970-356-8030 CONTACT Michael J Schmitt CIC NAME; North Range Behavioral Health 1300 N 17th Avenue Greeley, CO 80631 PHONE 970-356-8030 (A/C, No, Ext): AD S'AASS FAX (A/C, No)970-356-8032 : INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Philadelphia Insurance Co '.. INSURER B : Pinnacol Assurance INSURER C : Lloyds of London INSURER D : INSURER E : INSURER F : 23850 COVERAGES CERTIFICATE NUMBER: REVISION 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 ADOL SUBR! POLICY NUMBER POLICY EFF POLICY EXP LTR INSD WVD ( lMM/DO(YYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY A A B CLAMSMADEX I OCCUR X Professional Liab X ' HIPAA Cil-.N'I. Ac;GRI-UA I L LIMI F API i It S w`'.Y PCL CY I F:(�f I X OTHER AUTOMOBILE LIABILITY X ANY AUTO OWNED AUTOS ONLY AUTEOS ONLY X UMBRELLA LIAB SCNEDULED AUTOS 1 PJED AUTO NI 1 X OCCUR EXCESS LIAB DEO . X :•i RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS boIow C Privacy CLAIMS -MADE 10,0001 Y/N I X ' X N/A PHPK1676246 IPHSD1258227 07/01/2017 07/01/2018 07/01/2017 07/01/2018 PHPK1676246 07/01/2017 PHUB590527 LIMITS EACH OCCURRANCE DAMAGE 10 12i• N I LI) PREMISES tEa accurroncel MED EXP LAny one persons PERSONA. & ADV INJURY 5 GENERAL AGGREGATE 5 PRODUCTS - COMP/OP AGO $ HIPAA $ COMBINED SINGLE LIMIT (La ncC:dent) 07/01/2018 BODILY INJURY (Per person) DOD/Y NJURY (Per accident( I PROPER I V DAMAGE (PeroccidonI) EACHOCEURRENCE 07/01/2017 07/01/2018 ncGRI Gn?r X PE? STATUTE X 4044331 07/01/2017',. 07/01/2018 I CA(ll ACCIDENT ESG01269611 07/01/20171 07/01/2018 q rl l ER S $ L L DISEASE EA EMPL DYES $ E L DISEASE POLICY L.MIT $ Privacy eVritilcate tiolcienI% °61Ountyr UopartrTt nt ofoHuman ervlces etlre V1lelrZh ed If more space Is required) Division, Attn: Tobi Vegter, Resource Unit ***See Notes*** CERTIFICATE HOLDER WEL-HUM Weld County Department of Human Services (see above) Attn: Tobi Vegter PO Box A Greeley, CO 80632 ACORD 25 (2016/03) CANCELLATION 1,000,000 1,000,000 20,000 1,000,000 3,000,000 3,000,000 50,000 1,000,000 2,000,000 2,000,000 100,000 100,000 500,000 3,000,000 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 Michael J Schmitt CIC © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Coniya\o" 138g CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEJiAVI AL HEALTH /14 This Agreement, made and entered into th day o . 2017by 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 North Range Behavioral Health, hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and incorporated herein by this reference. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided Core Services and Child Welfare Administration funding to the Department for Anger Management/Domestic Violence Services, Functional Family Therapy, Mental Health Services, Monitored Sobriety Services, and Multisystemic Therapy. 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. ce2D7t,64,d/45-0 AterkkL. 0171--/7 2017-3418 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. a. General Requirements: Contractors/Contract Professionals must secure, at or before the 5 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 and reinstate the aggregates required; 6 Unlimited defense costs in excess of policy limits; Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by County. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. c. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance. County reserves the right to require Contractor/Contract Professional to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured as follows: County of Weld 1150'O' Street Greeley, Colorado 80631 f. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors, subcontractors, independent contractors, sub - vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor/Contract Professional. Contractor/Contract Professional shall include all such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 7 10. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training Contractor may be required to attend training that the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-352-1551, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: 8 - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Administrator Larry Pottorff, Executive 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: Larry Pottorff. Executive Director 1300 North 17th Avenue Greeley, CO 80631 (970) 347-2120 Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other 9 reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third -Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall not enter into any third -party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in 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 10 Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 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 11 insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contract Professional or any of its agents or employees. Unemployment insurance benefits will be available to Contract Professional and its employees and agents only if such coverage is made available by Contract Professional or a third party. Contract Professional shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contract Professional shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contract Professional shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and as set forth in Exhibit A, and provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed 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, 12 shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflict with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contract Professional's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contract Professional acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contract Professional. Contract Professional shall not enter into any subcontractor agreements for the completion of this project without County's prior written consent, which may be withheld in County's sole discretion. 36. Attorneys Fees/Legal Costs In the event of a dispute between County and Contract Professional, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contract Professional under this Agreement or individual work order shall become or remain (as applicable), the property of County. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contract Professional in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the County. Contract Professional shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of County. 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 13 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. 14 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: Weld Cou By: Deputy erk to the hoar detrifwv lerk to the Board 15 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Julie Cozad, Chair OCT 4 2017 CONTRACTOR; North Range Behavioral Health 1300 North 17th Avenue Greeley, Colorado 80631 (970) 347-2120 By: Date: ecutive Dire oZ /7- 34!7 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 AU. OF THE INFORMATION CONTAINED IN PAGES 1-9 MAY BE APPLICABLE. THE SCOPE OF WORK AND SPECIFICATIONS UNIQUE TO THIS REQUEST FOR BID FOLLOW PAGES. 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.) AftercareServices Services provided to prepare a child for reunification with his/her family or other permanent placement and to prevent future out- of -home placement of the child. Anger Management/Domestic Violence Diagnostic and/or therapeutic services to assist in the development of the family services plan, to assess and/or improve familycommunication, functioning and relationships, and to prevent further domesticviolence. 1 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 years old. Home -Based Intervention Services provided primarily in the home of the client that include a variety of services which can include therapeutic services, concrete services, collateral services and *crisis intervention directed to meet the needs of the child and family. *Crisis Intervention is defined as 24/7 phone access and in -home counseling. 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 familycommunication, 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 icTherapy Intensive family- and community -based treatment program designed to make positive changes in the various social systems (home, school, community, peer relations) that contribute to the serious antisocial behaviors of children and adolescents who are at risk for out -of -home placement. Relinquishment Counseling Relinquishment counseling for parents considering relinquishment of their children. Substance Abuse Treatment Services Diagnostic and/or therapeutic services to assist in the development of the Family Service Plan (FSP), to assess and/or improve family communication, functioning and relationships, and to prevent further abuse of drugs or alcohol. Other Creative and unique services designed to meet the needs of children, youth and families interacting with the Child Welfare system through a prevention or traditional case. B. Bids for the stated services will be received by the Weld County Department of Human Services, Resource Unit, Attn: Tobi Vegter, through: MONDAY, APRIL 24, 2017, AT 5:00 P.M. (WELD COUNTY DEPARTMENT OF HUMAN SERVICES, RESOURCE UNIT TIME CLOCK). Acceptable bid delivery methods are as follows: Email. Emailed bids are preferred. Bids should be emailed to: vegterta@weldgov.com. Emailed bids must include the following statement on the email: "I hereby waive my right to a sealed bid". An email confirmation will be sent when we receive your bid/proposal. Mail. Mailed bids should be sent in a sealed envelope with the bid title and bid number on it. Bids must include the following statement on the email: "Ihereby waive my right to a sealed bid". Mailed bids should be addressed to: Weld County Department of Human Services, Attn: Tobi Vegter, Division of Child Welfare, Financial Unit, P.O. Box A, Greeley, CO 80632. Please call or email Tobi Vegter at 970-400-6392 or vegterta@weldgov.com if you have any questions. Hand Delivery. Hand -delivered bids should be submitted in a sealed envelopewith the bid title and bid number on it. Bids must include the following statement on the email: "I hereby waive my right to a sealed bid". Hand - delivered bids can be dropped off at: Weld County Department of Human Services, Attn: Tobi Vegter, Financial Unit, 822 7th Street, Suite 150, Greeley, CO 80631. Please call or email Tobi Vegter at 970-400-6392 or vegterta@weldgov.com if you have any questions. 3 II. INVITATION TO BID A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the board of Weld County Commissioners requests bids for the purchase of Various Services (as described above). B. Bids shall include any and all charges for service(s) applied for by the bidder, and shall, in every way, be the total net price which the bidder will expect the Board of County Commissioners of Weld County to pay if awarded the bid. C. Emailed Bids Are Preferred. Emailed (fully typed) bids are preferred. However, if the bidder is unable to submit an emailed bid, the bidder must comply with the requirements set forth in Paragraph I, B. An emailed bid must contain the following statement: "I hereby waive my right to a sealed bid." D. Unless the Bid is emailed, one original and one copy of the Bid must be submitted. One complete bid document, which will be the only official copy of the bid, shall be filed at the Weld County Department of Human Services, Resource Unit. After certification of the bid, the other copy will be routed for applicable review. An e-mail confirmation will be sent when we receive your bid/proposal. III.INSTRUCTIONS TO BIDDERS A. Bids shall be typewritten. Each bid must give the full business address of the bidder and be signed by him with his usual signature. Bids by partnerships must furnish the full names of all partners and must be signed with the partnership name by one of the partners of the partnership or by an authorized representative, followed by the signature and title of the person signing. Bids by corporations must be signed with the legal name of the corporation, followed by the name of the state of the incorporation and by the signature and title of the president, secretary, or other person authorized to bind it in this matter. Bids submitted by limited liability companies must furnish the full names of all members and managers and must be signed by a manager or by an authorized representative, followed by the signature and title of the person signing. The name of each person signing shall also be typed or printed below the signature. A bid by a person who affixes to his signature the word "president," "secretary," "agent," or other title without disclosing his principal, may be held to be the bid of the individual signing. When requested, satisfactory evidence of the authority of the officer signing in behalf of a corporation shall be furnished. All corrections or erasures shall be initialed by the person signing the bid. All bidders shall agree to comply with all of the conditions, requirements, specifications, and/or instructions of this bid as stated or implied herein. All designations and prices shall be fully and clearly set forth. B. Bids may be withdrawn upon written request to the Weld County Department of Human Services received from bidders prior to the submission deadline. Negligence on the part of bidder in preparing the bid confers no right for the withdrawal of the bid after it has been opened. C. Bidders are expected to examine the conditions, specifications, and all instructions contained herein. Failure to do so will be at the bidder's risk. D. Bidders shall not stipulate in their proposals any conditions not contained in the instructions and specifications herein unless specifically requested by the special instructions attached hereto. Any proposal which fails to comply with the letter of the instructions and specifications herein may be rejected. E. Late or unsigned bids shall not be accepted or considered. It is the responsibility of the bidder to ensure that the bid arrives in the Weld County Department of Human Services, Service Utilization Unit, on or prior to the time indicated in Section I., entitled "Notice to Bidders." F. When approximate quantities are stated, Weld County reserves the right to increase or decrease quantity as best fits its needs. 4 G. Whenever requested, samples or descriptive matter shall be filed prior to the opening of bids. H. In accordance with Section 14-9(3) of the Weld County Home Rule Charter, the Board of County Commissioners of Weld County will give preference to resident Weld County bidders in all cases where said bids are competitive in price and quality. It is also understood that the Board of County Commissioners of Weld County will give preference to suppliers from the State of Colorado, in accordance with Section 30-11-110, CRS, when it is accepting bids for the purchase of any books, stationery, records, printing, lithographing or other supplies for any officer of Weld County. I. All discounts shall be figured from the date of delivery and acceptance of the articles, or in the case of an incorrect invoice, from the date of receipt of corrected invoice, if this be subsequent to delivery and acceptance. J. Substitutions or modifications to any of the terms, conditions, or specifications of this bid package which are made by Weld County, Colorado, after the bids have been distributed to prospective bidders, and prior to the date and time of bid opening, will be made in writing and signed by the Families, Youth and Children's Commission. No employee of Weld County, Colorado, is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of Families, Youth and Children's Commission. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. K. The successful bidder shall indemnify and hold harmless Weld County, Colorado, against all claims for royalties, for patents or suit for infringement thereon, which may be involved in the manufacture or use of the material to be furnished. L. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5- 101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et seq., Weld County may terminate this Contract for breach and Contractor shall be liable for actual and consequential damages to Contractor. Except where exempted by federal law and except as provided in C.R.S. 24-76.5- 103(3), if Contractor receives federal or state funds under this Contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of a Contract. M.All goods shall remain the property of the seller until delivered to and accepted by Weld County, Colorado. N. Bids received prior to the time of opening will be kept unopened in a secure place. No responsibility will attach to the Families, Youth and Children Commission, the Weld County Department of Human Services, or the Board of Weld County Commissioners, for the premature opening of a bid not properly addressed and identified. 5 O. In submitting the bid, the bidder agrees that the acceptance of any and all bids by the Board of County Commissioners of Weld County within a reasonable time or period does not constitute a contract. The Board of County Commissioners of Weld County, Colorado, reserves the right to reject any and all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. P. These instructions, the proposal forms, and specifications have been developed with the hope of raising the standard of purchasing negotiations to a level wherein all transactions will be mutually satisfactory. Your cooperation is invited. Q. Substitutions or modifications to any of the terms, conditions, or specifications of this which are made by Weld County after the bids have been distributed to prospective bidders and prior to the date and time of bid opening, will be made in writing. No employee of Weld County is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of said Director of the Weld County Department of Human Services. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. IV.GENERAL SPECIFICATIONS A. Fund Availability: Financial obligations of the Weld County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. By acceptance of the bid, Weld County does not warrant that funds will be available to fund the contract beyond the current fiscal year. B. Governmental Immunity: No term or condition of the contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. C. Independent Contractor: The successful bidder shall perform its duties hereunder as an independent contractor and not as an employee. He or she shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to the contract. Neither the successful bidder nor any agent or employee thereof shall be deemed to be an agent or employee of Weld County. The successful bidder and its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through Weld County and Weld County shall not pay for or otherwise provide such coverage for the successful bidder or any of its agents or employees. Unemployment insurance benefits will be available to the successful bidder and its employees and agents only if such coverage is made available by the successful bidder or a third party. The successful bidder shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to the contract. The successful bidder shall not have authorization, express or implied, to bind Weld County to any agreement, liability or understanding, except as expressly set forth in the contract. The successful bidder shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and (b) provide proof thereof when requested to do so by Weld County. D. Compliance with Law: The successful bidder shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established, including without limitation, laws applicable to discrimination and unfair employment practices. E. Choice of Law: Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of the contract. Any provision included or incorporated herein by 6 reference which conflicts with said laws, rules and/or regulations shall be null and void. F. Binding Arbitration Prohibited: Weld County does not agree to binding arbitration by any extra -judicial body or person. Any provision to the contrary in the contract or incorporated herein by reference shall be null and void. G. No Third Party Beneficiary Enforcement: It is expressly understood and agreed that the enforcement of the terms and conditions of the contract, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in the contract shall give or allow any claim or right of action whatsoever by any other person not included in the contract. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under the contract shall be an incidental beneficiary only. H. Attorney Fees/Legal Costs: In the event of a dispute between Weld County and the successful bidder, concerning the contract, the parties agree that Weld County shall not be liable to or responsible for the payment of attorney fees and/or legal costs incurred by or on behalf of the successful bidder. V. Insurance Requirements i. General Requirements: Contractors/Contract Professionals must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant tothis request. Contractors/Contract Professionals shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, during any warranty period, and for three (3) years after termination of the Agreement. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor/Contract Professional. Contractor/Contract Professional shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. ii. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: (a). Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. (b). Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: 7 • $1,000,000 each occurrence; • $2,000,000 general aggregate; • $50,000 any one fire; and • $500,000 errors and omissions. (c). Automobile Liability: Contractor/Contract Professional shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. (d). Additional Provisions: • Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: • If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County within ten (10) days and reinstate the aggregates required; • Unlimited defense costs in excess of policy limits; • Contractual liability covering the indemnification provisions of this Agreement; • A severability of interests provision; • Waiver of exclusion for lawsuits by one insured against another; • A provision that coverage is primary; and • A provision that coverage is non-contributory with other coverage or self- insurance provided by County. (e). For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. iii. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Bid. iv. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance to the County. County reserves the right to require Contractor/Contract Professional to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. v. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured. vi. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. vii. Subcontractors: All subcontractors, subcontractors, independent contractors, sub- vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor/Contract Professional. Contractor/Contract Professional shall include all such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. 8 Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. VI.Warranty. The successful bidder shall warrant that: A. The services to be supplied pursuant to this bid are fit and sufficient for the purpose intended; B. The services sold to Weld County, Colorado pursuant to this bid conform to the minimum Weld County specifications as established herein. VI. CONFIDENTIAL INFORMATION Confidential financial information of the bidder should be transmitted separately from the main bid submittal, clearly denoting in red on the financial information at the top the word, "CONFIDENTIAL." However, the successful bidder is advised that as a public entity, Weld County must comply with the provisions of C.R.S. 24-72-201, et seq., the Colorado Open Records Act (CORA), with regard to public records, and cannot guarantee the confidentiality of all documents. If Weld County receives a CORA request for bid information marked "CONFIDENTIAL", staff will attempt to contact the bidder in order to allow the bidder to seek an appropriate court order preventing disclosure. Without such an order, Weld County will release the requested information in accordance with CORA. 9 SCOPE OF SERVICES PURPOSE: The Weld County Department of Human Services (WCDHS) is seeking qualified English- speaking and bilingual (English/Spanish) providers in various service areas under various funding sources. Service areas include, but are not limited to, Anger Management/Domestic Violence, Day Treatment, Foster Parent Consultation, Foster Parent Training, Functional Family Therapy, Kinship Services (Therapeutic), Home Studies/Relinquishment Counseling, Life Skills, Mediation, Mental Health, Monitored Sobriety, Multi -Systemic Therapy, Home Based Intervention including 24/7 Crisis Intervention, Sexual Abuse Treatment, and Substance Abuse Treatment Services and Aftercare Services. SERVICE AREAS ARE NOTED BEGINNING ON PAGE 1 OFTHIS REQUEST FOR BID, BUT ARE NOT LIMITED TO THOSE LISTED. OTHER SERVICES WILL BE CONSIDERED AND BIDDERS ARE ENCOURAGED TO SUBMIT FOR UNIQUE AND CREATIVESERVICES. Qualifications: To be considered, a bidder must meet the following minimum qualifications: 1) Complete a Provider Information Form (PIF). 2) If submitting to provide bilingual services, a bidder must demonstrate language proficiency at Full Professional Proficiency or higher, as defined by the U.S. Department of State, and as noted below. • Full Professional Proficiency: Able to use and read the language fluently and accurately on all levels pertinent to professional needs • Native or Bilingual Proficiency: Equivalent to that of an educated native speaker (both speaking and reading). 3) A bidder must agree to language proficiency testing that may include assessment of reading, writing and comprehension of Spanish, as well as a face-to-face conversation with a known native or proficient Spanish speaker selected by Weld County. 4) A bidder must submit a one page or less cover letter that introduces the bidder, the bidder's location(s) of practice and target area, his or her experience and qualifications, and staff, if applicable. A bidder must include current contact information including physical address, mailing address, phone number, email address and website, if applicable. 5) A bidder must submit sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets "minimum qualifications" for all bidders. Each service must be submitted as its own proposal, inclusive of scope of services and rate information. The scope of service should include at a minimum the following information for each service proposed: • Detailed description of service components, modalities used, appropriate use of service, etc. • Target population including age range, specific population characteristics, area of service, etc. • Whether or not the service is billable to Medicaid and if bidder is currently able to bill Medicaid. Bidders are strongly encouraged to become Medicaid certified. Medicaid -billable services are preferred. • Clear rate schedule inclusive of all costs bidder wishes to charge for the provision of the service. 6) A bidder should avoid elaborate artwork, graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Bid. 7) A bidder must demonstrate the knowledge, training and expertise to conduct the proposed service(s). 8) A bidder must provide a current resume, as well as proof of licensure, for self, staff members and contractors of the bidder. Additionally, a bidder must include proof of inclusion on State vendor lists if applicable to the proposed service (ex. Home Study Providers, Sex Offender Management Board Providers). 9) A bidder should clearly outline the supervisory structure of staff members and/or contractors of the bidder. This should include the ratio of supervisor to staffand/or contractors, frequency and duration of supervision, credentials of supervisor and length of time as a supervisor. 10) A bidder should clearly outline the bidder's internal referral acceptance and assignment protocol, including communication to the referring agency. 11) A bidder must demonstrate familiarity with Trauma Informed Care. Bidder must provide copies of applicable training certificates, or proof of registration for training, for all staff members who manage and/or administer services under this proposal. 12) A bidder must demonstrate prior and current capacity to be organized, responsive and to quickly and successfully schedule services 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 ESSETH 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. sec ., 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. g. Subcontractors: All subcontractors, subcontractors, independent contractors, sub - vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor/Contract Professional. Contractor/Contract Professional shall include all such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 10. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training 7 Contractor may be required to attend training that the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-352-1551, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 8 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Administrator CONTRACTOR, TITLE 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of 9 any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall not enter into any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 10 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contract Professional agrees that it is an independent Contract Professional and that Contract Professional's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contract Professional shall perform its duties hereunder as an independent Contract Professional. Contract Professional shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contract Professional, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through county and county shall not pay for or otherwise provide such coverage for Contract Professional or any of its agents or employees. Unemployment insurance benefits will be available to Contract Professional and its employees and agents only if such coverage is made available by Contract Professional or a third party. Contract Professional shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contract Professional shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contract Professional shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law (and as set forth in Exhibit provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in 11 Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflict with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contract Professional's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 12 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contract Professional acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contract Professional. Contract Professional shall not enter into any subcontractor agreements for the completion of this project without County's prior written consent, which may be withheld in County's sole discretion. 36. Attorneys Fees/Legal Costs In the event of a dispute between County and Contract Professional, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contract Professional under this Agreement or individual work order shall become or remain (as applicable), the property of County. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contract Professional in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the County. Contract Professional shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of County. 38. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. 13 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS Weld County Clerk to the Board WELD COUNTY, COLORADO BY: Deputy Clerk to the Board , Chair APPROVED AS TO FUNDING: APPROVED AS TO SUBSTANCE: Controller Elected Official or Department Head APPROVED AS TO FORM: Director of General Services County Attorney CONTRACTOR Contractor, Title 14 EXHIBIT B CONTRACTOR'S PROPOSAL PROVIDER INFORMATION FORM (Bid Cover Sheet) Weld County Department of Human Services NORTH RANGE BEHAVIORAL HEALTH AGENCY OR PRIVATE PRACTICE TRAILS PROVIDER ID (If Known) LARRY POTTORFF EXECUTIVE DIRECTOR PRIMARY CONTACT — FULL NAME PRIMARY CONTACT - TITLE 970 ) 347.2120 (970 ) 300.3127 PHONE NUMBER EXT. FAX NUMBER Iarry.pottorff@northrange.org www.northrange.org PRIMARY CONTACT - E-MAIL ADDRESS AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) 1300 NORTH 17TH AVENUE AGENCY MAILING ADDRESS GREELEY 80631 CITY ZIP REFFERAL CONTACT - FULL NAME (IF DIFFERENT THAN PRIMARY CONTACT) REFERRAL CONTACT - TITLE 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 here the bids are competitive in price and quality. Signature of Authorized Rearesentative: Date of Signature: 4k ---/(r -17 NORTH12 OP ID: DP .A�CO�RL CERTIFICATE OF LIABILITY INSURANCE DATE 04/18/2017Y) 04/18/2017 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 POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Rich & Cartmill Ins of CO of Colorado LLC 8213 W. 20th Street Greeley, CO 80634 Michael J Schmitt CIC CONTACT NAME: Michael J Schmitt CIC PHINNo. N . Ext):NE 970356-8030 I FAXX, No): 970-356-8032 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC N INSURER A : Philadelphia Insurance Co 23850 INSURED North Range Behavioral Health 1300 N 17th Avenue Greeley, CO 80631 INSURER a : Pinnacol Assurance INSURER C : Lloyds of London INSURER D : INSURER E : INSURER F : 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 LTR TYPE OF INSURANCE ADDL INSD SUER' WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DD/YYYY) WARS A X COMMERCIAL GENERAL LIABILITY X X PHPK1514222 07/01/2016 07/01/2017 EACH OCCURRENCE $ 1,000,000 1 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 X Professional Liab MED EXP (Any one person) $ 20,000 X HIPAA Incl PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES JETCTT X PER: LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG 5 3,000,000 Emp Ben. $ 1,000,000 A AUTOMOBILE X - LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS - - SCHEDULED AUTOS AUTOS NON -OWNED AUTOS PHPK1514222 07/01/2016 07/01/2017 SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) S BODILY INJURY(Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PHUB545949 07/01/2016 07/01/2017 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED I X I RETENTION S 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X 4044331 07/01/2016 07/01/2017 X I STATUTE I I ERA E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 C Privacy ESF00193585 07/01/2016 07/01/2017 Each 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder: Weld County Department of Human Services Child Welfare Division, Attn: Tobi Vegter, Resource Unit ***See Notes*** CERTIFICATE HOLDER CANCELLATION WEL-HUM Weld County Department of Human Services (see above) Attn: Tobi Vegter PO Box A Greeley, CO 80632 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 Michael J Schmitt CIC ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD qNORTHORANGE BEHA April 17, 2017 Tobi Vegter Child Welfare Contract and Services Coordinator Weld County Department of Human Services Division of Child Welfare Resource Unit 822 7th Street, Suite 150 Greeley, CO 80631 Dear Tobi: Attached is North Range Behavioral Health's Core and Contracted Services Bid proposal for the Multi -Systemic Therapy services program area. We propose to provide these services to male and female youth ages 12-17 at North Range's youth and family site, 1300 N. 17th Avenue, Greeley. All services will be provided by academically qualified and/or licensed staff as evidenced by the attached resumes and certification / licensure information. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and projected outcomes. If you have any questions, please do not hesitate to contact me. Sincerely, Rebecca Wyperd, LPC Program Director — Outpatient Youth and Family Services 1300 North 17th Avenue Greeley, CO. 80631 970-381-3578 rebecca.wyperd@northrange.org Enclosures Where hope begins, 1300 North 17th Avenue • Greeley, CO 80631 • 970-347-2120 • NRBH - CORE SERVICES CONTRACT 2017-2018 North Range Behavioral Health Scope of Service — Multisystemic Therapy (MST) 1. General Description of Contractor, including target population, area served, and program being proposed. Contractor has offices in Greeley, CO, Frederick, CO, and in Fort Lupton, CO, and provides in -home, evidence -based, therapeutic services in accordance with National Multisystemic Therapy (MST) standards to male and female youth approximate ages 12- 17, within Weld County. North Range Behavioral Health is licensed to provide Multisystemic Therapy to fidelity, and has been since 2006. 2. Type of service, brief description and rate for each proposed service. Description of service should include any assessment tools or specific practices used in the provision of that service. All services are overseen/supervised by a licensed professional and MST National Consultant. Multisystemic Therapy: Age Range: Gender Criteria: Goals: Length of Treatment: Primary Intervention Type: Special Services: Monthly Cost: Inclusionary Criteria: —12 — 17 years Both Male and Female clients served Empower caregivers with the skills and resources needed to independently address the difficulties they are having managing their children; Empower youth to cope with family, peer, school, and neighborhood problems; Build community and natural support systems; Decrease anti -social behavior. 2 — 5 months, 3 — 5 hours per week As clinically appropriate: In -home Caregiver Interventions, Cognitive/Behavioral, Family Therapy, Individual therapy, School and Community based interventions. 24/7 on -call services, Case Management, School Interventions, Advocacy, Court/Staffing Participation, Sustainability Planning. $1800.00 per month/per family, pro -rated for partial month Child must be at risk of out of home placement; Child returning from placement; Child involved in criminal behavior; Persistent family conflict; Child and or Caregiver is abusing substances; Behavior is chronic; Child is engaged with deviant peers; Child is struggling NRBH - CORE SERVICES CONTRACT 2017-2018 at school; Family has few resources; Parents would benefit from psycho -education and skill development; Child is displaying moderate — severe behavior problems. Maximum Program Capacity: Medicaid Eligibility Referral Process/Timelines: Supervisory Structure: Special Assessments/Practices: Trauma Focused Training: 20 - 30 youth MST is a Medicaid covered service at North Range Behavioral Health Referrals must be made to program supervisor for review. Each referral is considered within one week and clients are accepted based on problem severity and therapist availability. Administrative Director: Kimberly Collins, LPC: 10 years exp Program Director: Becky Wyperd, LPC: 10 years exp MST Model Supervisor: Rachel Perez, MSW: 8 years exp MST Clinicians: 4 MST trained clinicians Supervision: three hours weekly, and as needed Supervisor to Staff Ratio: 1:4 Use of MST approved assessments as indicated by licensing agreements and MST consultant directives (provided upon request). Integrative Treatment of Complex Trauma for Adolescents (ITCT-A)-February 2014 Trauma -Focused Cognitive Behavioral Therapy (TF-CBT)-July 2014 Dialectical Behavioral Training for Adolescents (DBT)-March 2014 Multisystemic Therapy Contingency Management (MST -CM) -August 2016 Neurosequential Model of Therapeutics (NMT)-September 2016 -February 2017 The Impact of Trauma on the Developing Child; Dr. Perry -April 2017 3. Fees for Services $1800 per month/per client/family, pro -rated for partial month services. 4. MST Outcomes in Weld County (2005-2017) Impact to the County Prior to Treatment (N=231) • 60% with out of home experience before admission • 34% with juvenile detention before admission • 80% with multiple/chronic disciplinary problems in school; 12% passed most classes • 69% with legal involvement; 56% with more than one type • 31% arrested for crimes against a person • 100% with mental health problems; 87% with more than one • 47% with problems resulting from drug use; 37% with problems related to alcohol use NRBH - CORE SERVICES CONTRACT 2017-2018 Outcomes after receiving MST Treatment (N=495) • 95% decrease in the most common out of home situations, including residential treatment, inpatient psychiatric care, and detention • 93% of youth in school or working • 89% living at home • 91% with no new arrest • Significant reductions in legal issues • Significant reductions in mental health and substance abuse symptoms and problems • Significantly improved ratings of youth and family functioning NRBH MST Program Implementation Data Report (Report Period: 1/1/2016 - 4/14/2017) Ultimate Outcomes after receiving MST Treatment (N=80) • 91% of youth living at home • 91% of youth in school/working • 92% of youth with no new arrests Instrumental Outcomes after receiving MST Treatment (N=80) • 95% of caregivers with parenting skills necessary to handle future problems • 93% of families with improved family relations • 90% of families with improved network of supports • 82% of youth with success in educational/vocational setting • 81% of youth involved with prosocial peers/activities • 82% of cases where changes have been sustained The North Range Behavioral Health MST Team was a finalist for the MST International Team of the Year in 2015, and received the designation of The Green Team in March of 2017 for exceeding all fidelity outcome measures. Print Lookup Details Page 1 of 1 Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C.R.S. - Name Public Address Jillian Marie Burkley Fort Collins, CO 80525 Credential Information License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date CSW.09924535 Examination Licensed Clinical Social Worker Active 10/17/2016 10/17/2016 08/31/2017 Board/Program Actions Discipline There is no Discipline or Board Actions on file forthis credential. Generated on: 4/19/2017 11:21:23 AM https://apps.colorado.gov/dora/licensing/Lookup/PrintLicenseDetails.aspx?cred=1003031... 4/19/2017 Print Lookup Details Page 1 of 1 Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification:: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C.R.S. Name Public Address Lauren Elizabeth Furtney Denver, CO 80246 Credential Information License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date LSW.0009921210 Examination Licensed Social Worker Active 08/23/2016 08/23/2016 08/31/2017 Board/Program Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 4/19/2017 11:24:42 AM https://apps.colorado.gov/dora/licensing/Lookup/PrintLicenseDetails. aspx?cred=1052595... 4/19/2017 Print Lookup Details Page 1 of 1 Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C.R.S. Name Public Address Tonya Lynn Kron Fort Collins, CO 80526-6345 Credential Information License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date LPCC.0014749 Temporary Permit Licensed Professional Counselor Candidate Active 06/01/2016 06/01/2016 06/01/2020 Board/Program Actions >pI Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 4/19/2017 11:25:19 AM https://apps.colorado.gov/dora/licensing/Lookup/PrintLicenseDetails.aspx?cred=1094223... 4/19/2017 CARRIE IRICK 2002 Battlecreek Dr Apt 6304 Fort Collins, Colorado, 80528 970-294-9625 carrielirick@gmail.com WORK EXPERIENCE NORTH RANGE BEHAVIORAL HEALTH, GREELEY, CO Multisystemic Therapist, Aug 2015 — Present • Provide in -home family therapy to 12-17 year old adolescents and their families. • Advocate for adolescents and their families in the legal setting through attendance of court hearings, probation meetings and family team meetings. • Provide individual skill -building and parenting skills through the refined selection of intervention tools aligned with the MST framework. • Attend school meetings and act as advocate for student and families within the school setting. • Keep detailed record of all sessions with families through detailed weekly reports, stakeholder reports and notes in Avatar electronic monitoring system. • Provide diagnoses of adolescent clients at risk for out -of -home placement. • Complete CCAR and DACOD assessments. • Provide 24 -hour on -call crisis support to families, including weekends and holidays. REINS & RAINBOWS, WABASH, IN EAP Counseling Intern, May 2014 - Aug 2015 • Served as clinician for patients with bipolar, depression, anxiety and personality disorders. • Referenced and used various therapy techniques, including psychodynamic, family systems,cognitive behavioral and lifespan integration psychotherapy. • Consulted with and developed appropriate treatment and rehabilitation plans for duallydiagnosed patients. • Led patients in individual, family, group and marital therapy sessions. • Selected and compiled relevant information and resources for clients to support them inovercoming mental and emotional problems.. • Worked with clinical psychiatrist to draft treatment plans for a caseload of 15 patients. • Completed documentation for all clients attending group sessions. • Cultivated positive relationships with other mental health professionals, programs andassociations. • Administered discipline appropriately and set limits for behavior. • Led group therapy sessions consisting of 5 to 15 youth focusing on impulse control, grounding,boundary development and anger management. • Acted as a role model for clients by exhibiting positive behaviors OTIS R. BOWEN CENTER, HUNTINGTON, IN Rehabiliative Services Provider, Sep 2013 - Aug 2015 • Charted and recorded information in client files. • Effectively managed time and caseloads based on 15-35 sessions per week. • Quickly responded to crisis situations when severe mental health and behavioral issues arose. • Efficiently gathered information from families and social services agencies to informdevelopment of treatment plans. • Documented all patient information including service plans, treatment reports and progress notes. • Conducted outreach, advocacy and rehabilitative services for regular cases and crisis intervention. • Collaborated closely with treatment team to appropriately coordinate client care services. • Interacted with clinical staff and external resources such as school or community personnel. • Developed comprehensive treatment plans that focused on accurate diagnosis and 2002 Battlecreek Dr Apt 6304 Fort Collins, Colorado, 80528 970-294-9625 carrielirick@gmail.com behavioral treatment of problems. • Taught clients anger management techniques, relaxation skills, impulse control, social skills, emotional coping skills and functional living skills. • Worked with parents and teachers to implement consistent behavior therapy techniques at home and school. • Consulted with psychiatrists about client medication changes, issues with medicine compliance and efficacy of medications. • Organized treatment projects that focused on problem solving skills and creative thinking. • Referred clients to other programs and community agencies to enhance treatment processes. • Guided clients in understanding illnesses and treatment plans. • Assisted clients in scheduling home visits and phone calls and monitored effectiveness of theseactivities. • Selected and compiled relevant information and resources for clients to support them in overcoming mental and emotional problems. • Conferred with parents and guardians, teachers and administrators to resolve clients' behavioral and academic problems. • Communicated with local agencies, schools, churches, courts and employers regarding client involvement and attendance in programs. • Referred family members to outside support options to help them cope during times of increased stress. • Built positive rapport with law enforcement officers, court officials and community service agencies. LIFESPRING COUNSELING CENTER, HUNTINGTON, IN Counseling Intern, Jan 2013 - Aug 2015 • Interviewed and assessed new clients, providing initial intakes. • Worked with clients with co-occurring disorders. • Assessed and wrote treatment plans and weekly progress notes for each client assigned to caseload. • Completed documentation for all clients attending group sessions. • Pursued ongoing education and training opportunities to further develop professional skills. • Implemented therapeutic plans for each child and recorded child's progress in case file. • Diagnosed clients using DSM-IV criteria. • Led group therapy sessions consisting of 12 to social work undergraduates focusing on group rapport and developing vulnerability in the group setting. • Conducted individual counseling sessions to address physical, mental, social and emotional problems caused by substance abuse. EDUCATION ADDITIONAL SKILLS HUNTINGTON UNIVERSITY, HUNTINGTON, IN Master's in Mental Health Counseling, May 2015 • Coursework in Psychology, Social Work and Counseling • Coursework in Social Work, Marriage and Family Therapy and Child Development TAYLOR UNIVERSITY, UPLAND, IN Bachelor's in Communications, May 2010 • Communications, English and Journalism coursework • Coursework in Public Relations • Marketing and Advertising coursework • Knowledge of the ins and outs of ChildProtective Services (CPS) • Suicide risk assessments • Superior communication skills • Therapeutic expertise • Medicaid familiarity • Psychiatric population familiarity • Family therapy aptitude • Solution -focused counseling 2002 Battlecreek Dr Apt 6304 Fort Collins, Colorado, 80528 970-294-9625 carrielirick@gmail.com • Extensive DSM-IV knowledge • Exceptional problem solver • Clinical documentation mastery • Parenting skills educator • Suicide precautions expertise • Dissociative disorders competency • Accomplished in psychopharmacology • Dual diagnosis expertise • Mood disorders specialist • Certified by the National Board for Certified Counselors (NBCC) 2002 Battlecreek Dr Apt 6304 Fort Collins, Colorado, 80528 970-294-9625 carrielirick@gmail.com JILLIAN Burkley Phone • 970-556-9435 E-mail. jillianburkley@gmail.com Education University of Denver, Denver, CO Master of Social Work, June, 2014 Certificate: Trauma Focused Westminster College, Salt Lake City, UT Bachelor of Science in Psychology, 2012 Minor: Sociology Social Work Experience North Range Behavioral Therapist, Greeley, CO Multisystemic Therapist July 2014- Present • Intensive family -and community based treatment that focuses on addressing all environmental systems that impact chronic and violent juvenile offenders. Catholic Charities Home -Based, Denver, CO August 2013 — May2014 Social Work Intern • Provide treatment to clients dealing with Axis I and comorbid diagnostic issues; as well as to individuals, families, children and adolescents managing server psychosocial environmental stressors in school and home -based. • Prepared referrals, mandated reports, mental status examinations, and facilitated third party billing. • Worked in conjunction with health care providers, school department personnel, Colorado Department of Social Services, criminal justice system, and local support agencies. • Conducted diagnostic assessments, intake evaluations, treatment plans, monthly reports, quarterly client improvement reviews, termination summaries, and all state and facility required paperwork. • Advocated and researched available community resources and coached clients on contacting and utilizing resources. • Empowered clients to pursue a path that is positive and motivated by self-determination. • Prepared creative individual and family therapeutic intervention activities fbr each session, which utilized play and art -based techniques to develop authentic sessions. Denver Public Schools, Denver, CO August2012- May2013 Denver School of the Arts Social Work Intern • Designed and co -lead a 15 week drop -in 8th grade girls group to address issues of girls empowerment, anxiety, social exclusion, depression and relationships. • Participated in student support teams and special education team meetings. • Co -developed Individualized Education Plan (IEP) goals, treatment plans, and psychosocial assessments. • Counseled ten individual clients ranging from 7' grade to 11`x' grade to address issues of anxiety, behavioral concerns, substance abuse, depression, suicidal ideations, grief and trauma, eating disorders, family system dysfunction and middle and high school conflict. • Co -lead a 6th grade and 9'e grade course on "Signs of Suicide", effectively facilitating educational activities that resulted in student having awareness of this issue. • Attended monthly staff enhancements workshops for all Denver public Schools mental health staff. Additional Experience 24 -Hour Fitness, Denver, CO Summer 2012 -Present Kids Club and Frost Desk Representative • Provided a safe, fun and interactive environment to children 6 months — 12 years od • Participated and entertained children with games or other approved activities • Administer first aid to children and adults in accordance with company policy • Supervised activities of all assigned children in the Kid s Club area and ensures child remains in designated area • Ensured all parents received a copy of Kids Club agreement and answered any questions around procedures • Reported any incidents to Kid s Club Supervisor or Service Manager • Acknowledged each member and guest entering or leaving our facility • Enrolled perceptive members and clarified the membership polices and amenities. Continued University of Denver, Denver, CO Program Coordinator Student Assistant Fall 2012- Present • Created enhanced digital copies of articles for Faculty and Adjuncts for their current courses. • Assisted the Assistant Dean with research pertaining to the School of social work curriculum. • Approved the University of Denver Adjunct and course curriculum website. • Analyzed 2012 and 2013 student evaluation reports. • Validated the 2013-2014 and 2014-2015 course curriculum, before submission to faculty and adjuncts. Westminster College, Salt Lake City, UT 2008-2012 Concierge Concierge Coordinator • Maintained present knowledge of college and local events, ranging from musical, sporting, plays, concerts, exhibits and much more • Provided enthusiastic customer service in regards to selling event tickets, equipment rentals, community connections, information and college tours. • Informed Faculty, Adjuncts, Undergraduates and Graduate students of upcoming events and current sales by campus wide e-mail. • Designed and updated the campus Dear John Newsletter which informed of current occasions on campus or community, community jobs and additional resources. • Enhanced leadership, teamwork skills while hiring, training and advising five student employees • Managed work schedule for Concierge Desk employees Westminster College, Salt Lake City, UT 2010- 2012 Resident Advisor • Oversaw traditional and nontraditional students living in the halls. • Created and implemented at least 10 to 15 programs a year centered on personal development, diversity, academic successes, social and community building. • Performed on -call duties in coordination with Campus Patrol and the on -call Resident Director • Mediated roommate conflicts and held hall meetings each semester and when concerns arise. • Enforced Westminster College policies by providing a safe, secure, and academic environment within the residence hall. Westminster College, Salt Lake City, UT 2010-2012 Conference and Events Services Conference Coordinator • Assisting conference guests with housing and community event information • Handled inventory for the camps and conferences and informed supervisor of potential orders or maintained request. • Helped guests with any needs during their stay, including events and local restaurants and stores. • Performed on -call duties over night for conference guest Volunteer Experience The Blue Bench, Denver, CO Feb 2014- Present Denver Metropolitan Sexual Assault Prevention and Support Center Hotline Advocate • Completed 40 hours of a comprehensive training of understanding sexual assault, hotline procedures, clinical experience crisis intervention, legal issues pertinent to sexual assault, vicarious trauma and Self -Care. • Advocate for survivors and secondary survivors. • Informed resources and policies with survivors and secondary survivors medical professionals, mental health providers and educators. • Committed to four 6 -hour shifts each month. Utah Division of Correction, Salt Lake City, UT Fall 2011 Juvenile Justice Services Volunteer • Co -lead an 8 -week curriculum with 10-18 year old females housed in the Utah detention center. • Designed and created lesson plans with the curriculum of empowering women, body image, eating disorders, self care, depression, sexuality, healthy relationships, communication, personal safety, assertiveness skills, diversity and sensitivity and bullying. Continued Utah AIDS Foundation, Salt Lake City, UT 2009-2012 Volunteer • General volunteer for AIDS Foundation • Answered phones, advised service provided from agency • Greeted visitors and answered questions and schedule appointments • Organized and facilitated group mailings • Coordinated special community events Youth City, Salt Lake City, UT After School Program Volunteer • Fostered positive mentoring for youth aged 9-14 who are enrolled in the program. • Facilitated group activities with youth, ranging from technology psychology and recreational activities. • Created a safe, fun, secure and educational environment for youth. • Tutored and monitored youth with their homework and project assignments, • Engaged youth to be active participants in their social surrounding. 2010-2011 Cheyenne, WY 82001 EDUCATION Lauren Furtney (307) 631-1481 lefurtneyCWgmail.com University of Denver, Denver, CO GRADUATED: JUNE 2015 • Masters of Social Work with a concentration in Family Systems Practice 0 Relevant Coursework: Strategies and Techniques in Family Therapy, Trauma Response and Recovery in Social Work Practice, School Social Work Interventions, Cognitive Approaches in Social Work, Assessment of Mental Health in Adults, Relationship Therapy, Health and Wellness Trends and Perspectives, Global Relations and Poverty in Mexico. University of Wyoming, Laramie, WY GRADUATED: MAY 2009 • Bachelor of Arts in English Certifications • Passed Clinical Licensure Exam (LSW) • Working on Certified Addictions Counselor Certification KEY SKILLS JULY 2016 Present FAMILY SPECIFIC EXPERIENCE • Experience working with diverse family systems in a variety of contexts including mandated in -home therapy for high risk behaviors, transitions, times of crisis, and in working towards self-sufficiency. THERAPY • Experience in providing therapeutic interventions to culturally diverse children, adolescents, adults, couples and families with a focus on Cognitive Behavioral Therapy and Structural Therapy. GROUP WORK • Experience in facilitating and co -facilitating support groups for adults and adolescents. WORK WITH CHILDREN • Experience in working with high risk youth to change delinquent behaviors, teaching culturally diverse youth in a cross-cultural context overseas, as well as utilizing play therapy for young children whose parents are divorcing. PARENT SKILL BUILDING • Experience in teaching parents skills to increase structure in the home, collaborate with various systems and improve family relations; coaching divorced parents about conflict management, parenting skills, providing education about child development, and communication skills in the best interest of their children. SOCIAL WORK EXPERIENCE NORTH RANGE BEHAVIORAL HEALTH August 2015 -Present Multisystemic Therapist (MST) • Work with youth and their families to change high risk and delinquent behaviors. • Teach parents skills to support their at -risk youth to keep them in the home and improve behaviors. • Collaborate with stakeholders in the community to support the youth's behavior changes. • Empower parents to work with stakeholders for on -going collaboration after MST is out of the home. • Link families with community resources to provide continued support and maintain behavior changes. • Coordinate with school staff and environment to increase school attendance and improve grades. • Network with peer circles to reduce delinquent behaviors and participate in prosocial activities. • Provide psycho -education to caregivers to increase their understanding of the impacts of mental health on their youth's behaviors. • Develop creative and individualized interventions to support family in positive changes. RESOURCE CENTER FOR SEPARATING & DIVORCING FAMILIES August 2014 -May 2015 Social Work Intern • Build strong relationships with culturally diverse families who are transitioning through divorce to provide the best services in a client -centered model. • Conduct therapy with children and adolescents whose parents are divorcing while building relationships with parents to reinforce family involvement. • Co -facilitate a women's support group, providing client -centered strengths -based interventions and psycho -education about divorce as a grief process. • Utilize cognitive -behavioral interventions to address anxiety and depression with adolescent client. • Enthusiastically embrace working on an interdisciplinary team to provide holistic family services. • Conduct community outreach to build partnerships with other organizations. • Conduct intake assessments to determine families' needs and strengths and provide case management. WARREN VILLAGE FAMILY SERVICES, Denver, CO August 2013 — May 2014 Family Advocate Intern • Supported and advocated for culturally diverse single -parent families with low -incomes. • Communicated regularly with families and used a strengths -based perspective to address individual concerns and challenges regarding education, employment, parenting, and relationships. • Collaborated with other advocates to help residents get the resources they needed. • Conducted intake assessments and presented cases in weekly team meetings. • Facilitated a women's leadership group, providing support and community to single -parent women. UNITED STATES PEACE CORPS, Mayenzere Village, Namibia, Africa August 2010 -October 2012 English as a Second Language Teacher • Taught English and Science to early adolescent students in rural village with limited resources. • Built strong interpersonal relationships while working with diverse range of children, adolescents and adults in school and community settings and interacted consistently with more than 270 individuals over the course of 26 months. • Established girls' support group to reach more than 50 teenage girls from rural villages to address issues of teenage pregnancy, high HIV/AIDS rates, gender inequalities and healthy relationships while developing their leadership skills and self-esteem. • Organized and operated school library, giving more than 150 students access to stories, vocabulary and pictures, as well as teaching responsibility. • Trained a staff of 9 Namibian teachers on basic computer and printer/copier use and demonstrated how to utilize specific programs to aid with electronic documents for teachers. • Received extensive training for Peace Corps assignment in Namibia including Technical Training, Cross - Cultural Training, Health and Medical Training, and Language Training. VOLUNTEER EXPERIENCE DAVIS HOSPICE CENTER, Cheyenne, WY January 2010 -August 2010 Hospice Volunteer • Respected the dignity of all clients and their right to autonomy in decision -making. • Provided quality care to patients and their families with a focus on comfort and caring. • Assisted with patient care, sat with patients to relieve family members, interacted with patients and their families and helped nursing staff to create caring and comfortable environment for patients and their families. • Attended 8 weeks of training on how to assist patients with terminal illnesses and their families. ROSSMAN ELEMENTARY'S ESL PROGRAM, Cheyenne, WY March 2010 -June 2010 ESL Volunteer • Assisted with student learning in an ESL classroom daily, with students from Spanish-speaking and German-speaking homes. • Worked with diverse students in grades 1-6, ages 5-10. • Learned ideas for incorporating fun activities into learning a language. • Saw how teacher worked. • Worked with students to sound out words and learn vocabulary. • Read with students and used context dues to understand meaning. Rachel G. Perez 2830 Crescent Cove Dr. #101 (970) 580-2990 Evans, CO 80620 r_grace_p@hotmail.com EDUCATION Masters of Social Work University of Denver, Denver, CO Bachelor of Arts Colorado State University, Fort Collins, CO Major: Sociology, Concentration: Criminal Justice, Second Major: Psychology June 2008 May 2005 EXPERIENCE IN HUMAN SERVICES FIELD Multi -systemic Supervisor August 2011- Present North Range Behavioral Health, Greeley, CO Provide clinical supervision to MST therapists related to their caseloads and the MST model. Coordinate with internal and external supportive services to assist families in obtaining services. Multi -systemic Therapist August 2008 — August 2011 North Range Behavioral Health, Greeley, CO Provided in home family therapy and case management for families who have youth that are at risk of being removed from their homes related to delinquent behaviors. Clinical Care Coordinator Intern September 2007- May 2008 Mountain Crest Behavioral Healthcare Center, Fort Collins, CO Provided brief supportive therapy and case management, as part of an interdisciplinary team, for adolescents and adults hospitalized on inpatient units. Counselor I, Step Wise May 2007- November 2007 Arapahoe House, Inc., Thornton, CO Provided milieu management, group facilitation, and crisis intervention for co-ed adolescents in a residential substance abuse treatment program. Residential Counselor December 2006- March 2007 Namaqua Center, Loveland, CO Provided milieu management and crisis intervention in a residential program for children 3-12 dealing with abuse, trauma, and severe emotional disturbances. Intern, Step Wise September 2006- May 2007 Arapahoe House, Inc., Thornton, CO Provided individual counseling, group facilitation, and crisis intervention for co-ed adolescents in a residential substance abuse treatment program. Correctional Service Worker March 2005- August 2006 Larimer County Community Corrections, Fort Coffins, CO Supervised and monitored clients placed under a court ordered custody in a residential halfway house and the community. CERTIFICATIONS Currently obtaining hours for Licensed Clinical Social Worker credentials la MC afee • • (501) 590-1841 cell • (970) 818-2604 voicemail ■ • tlkron@gmail.com • 333 Plowman Court • Fort Collins, CO 80526 ■ Education Master of Arts in Counseling, May 2016, GPA 3.825 Colorado Christian University, Loveland, Colorado Masters of Arts coursework (32 hours) completed in Communication Studies Colorado State University, Fort Collins, Colorado Bachelor of Arts in Speech Communication, Cum Laude Bachelor of Arts in Journalism, Cum Laude University of Arkansas at Little Rock, Little Rock, Arkansas Experience Multisystemic (MST) Therapist December 2016 -Present North Range Behavioral Health, Greeley, CO • Conduct in -home therapy for at -risk adolescents and their family, focused on behavioral interventions in the home and in outside systems, such as community and school. • Collaborate with outside parties, such as probation and schools, to provide support for both the client and the family. • Provide on -call support to clients and family members. ■ Complete weekly reports for supervision and stakeholders. • Maintain accurate and complete reports in Avatar, electronic medical records. • Collaborate with other MST team members and supervisor on open caseloads. Assistant Manager February 2014 -Present Dressbarn, Fort Collins, CO • Ensured a great customer experience and relationship building to encourage repeat visits. • Supervised associates during shifts including expectations, duties, and customer experience. • Conducted interviews with potential hires and promotions. • Completed quarterly employee evaluations. Behavioral Health Intern August 2014 -March 2016 North Colorado Family Medicine, Banner Health, Greeley, CO • Conducted Pain Management group once weekly. • Conducted individual psychotherapy sessions with clients presenting with various mental health concerns, as well as treatment planning and case notes. ■ Consulted with medical residents and faculty on patient mental health care. • Created and conducted workshops and presentations for medical residents. Restaurant Server, Manager February 2011 -July 2014 Taps Sports Bar and Grill, Fort Collins, CO • Ensured great customer service for both bar and dining room. ■ Supervised and trained restaurant employees. ■ Created a project to improve quality of service by all front of the house staff. Education Consultant, Home -school Tutor February 2011 -June 2011 Private Home, Fort Collins, CO • Set goals with the two students (5th and 11`'' grade) to complete required online coursework. • Worked with the parent to assist students succeed and adapt with home -school program and the adjustment of recently diagnosed learning disability and behavior concerns. Graduate Teaching Assistant August 2008 -May 2010 Department of Communication Studies, Colorado State University, Fort Collins, CO • Instructed the introduction to public speaking course and assisted professors with other courses. • Created lesson plans and other instructional materials for classroom preparation and lectures. • Evaluated student performances in written assignments as well as speaking presentations. • Utilized interpersonal/conflict management skills in interactions with students. Service Learning Initiative Coordinator January 2009 -May 2009 Department of Communication Studies, Colorado State University, Fort Collins, CO • Coordinated with multiple service organizations and students enrolled in the Service Learning Initiative for the SP 200 Public Speaking course for volunteer opportunities. • Used problem -solving techniques with students and organizations with varying concerns. Opinion Editor, Page Layout Manager, Columnist, Writer August 2005 — December 2007 The Forum, University of Arkansas at Little Rock, Little Rock, AR • Wrote weekly opinion columns relating to the focus of the newspaper issue's theme. • Coordinated columnists' contributions and copy-editing of the Opinion section. • Created captivating headlines and page layouts. • Worked with other editors on the overall appearance and content of the weekly issue. • Conducted weekly staff meetings with the executive editor. Communication Skill Center Intern January 2007 — December 2007 Department of Speech Communication, University of Arkansas at Little Rock, Little Rock, AR • Assisted Speech Communication students with the speech making process and other assignments. • Developed and facilitated workshops for students and faculty. Achievements/Coursework/Continuing Education • Licensed Professional Counselor Candidate (#0014749, exp. 6/1/2020) National Certified Counselor (#684926, exp. 8/31/2021) Achievements and Awards: Member of Chi Sigma Iota, Counseling Academic and Professional Honor Society Scholar -in -Residence finalist, American Counseling Association, 2015 Presenter: Rocky Mountain Communication Association Conference, April 2010 Presenter: Southwest/Texas Pop Culture Association/American Culture Association Conference, March 2009 Participant in the Institute of Political Journalism, Washington, D.C., Summer 2007 Georgetown University, 3.23/4.0 GPA Coursework: Colorado Christian University Masters of Arts in Counseling is CA(: REP accredited. Addictive Behaviors, Eating Disorders, Anxiety & Mood Disorders, Empathy Training, Group Therapy, Crisis & Trauma, Lifestyle and Career, Psychopathology, Professional Orientation, Counseling Skills, Counseling Services & Methods, Human Growth & Development, Social & Cultural Foundations, Lifestyle & Career, Appraisal, Research & Evaluation, Psychopharmacology, Marriage & Family Therapy. CAC classes: Psychopharmacology I. Tonya Kron tlkron@gmail.com 501-590-1841 Workshops/Conferences: The Impact of Trauma and Neglect on the Developing Child training with Dr. Bruce Perry; Motivational Interviewing; Motivational Interviewing for Groups; Advanced Motivational Interviewing; ICD 10/DSM 5 Workshop; Faber Post Trauma Model Workshop; Colorado Counselors Association 2014, 2015, and 2016 Conferences; Gestalt Equine Therapy Workshop; Colorado Association of Addiction Professionals 2014 and 2015 Conferences; The Co -Morbidity of Eating Disorders and Substance Use Disorders Workshop; Trauma, Attachment, and Neuroscience with Dr. Van der Kolk workshop. Memberships: Colorado Counseling Association, American Counseling Association, Colorado Association for Addiction Professionals, NAADAC The Association for Addiction Professionals, Chi Sigma Iota. Volunteer Activities: Poudre School District classroom assistant, Relay for Life activities, Colorado Counseling Association 2015 and 2016 Conference volunteer. Tonya Kron tlkron@gmail.com 501-590-1841 iliNORTHORANGE BEHA April 17, 2017 Tobi Vegter Child Welfare Contract and Services Coordinator Weld County Department of Human Services Division of Child Welfare Financial Unit 822 7th Street, Suite 150 Greeley, CO 80631 Dear Tobi: Attached is North Range's Core and Contracted Services Bid proposal for the Functional Family Therapy services program area. We propose to provide these services to male and female youth ages 11-17 at North Range's youth and family site, 928 12th Street, Greeley. All services will be provided by academically qualified and/or licensed staff as evidenced by the attached resumes and certification / licensure information. In addition, three FFT staff are bilingual with professional proficiency, and agree to proficiency testing. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and projected outcomes. If you have any questions, please do not hesitate to contact me. Sincerely, Jennifer Wallace Program Director — Intensive Youth and Family Services 928 12th Street Greeley, CO 80631 970-397-5331 Jennifer.wallacec northrange.org Enclosures Where hope begins. 1300 North 17th Avenue • Greeley, CO 80631 • 970-347-2120 • NRBH - CORE SERVICES CONTRACT 2017-2018 North Range Behavioral Health Scope of Service — Functional Family Therapy (FFT) 1. General Description of Contractor, including target population, area served, and program being proposed. Contractor has offices in Greeley, CO, Frederick, CO, and in Fort Lupton, CO, and provides in -home, evidence -based, therapeutic services in accordance with National Functional Family Therapy (FFT) standards to male and female youth approximate ages 10-17, within Weld County. North Range Behavioral Health is licensed to provide Functional Family Therapy to fidelity, and has been since 2006. 2. Type of service, brief description and rate for each proposed service. Description of service should include any assessment tools or specific practices used in the provision of that service. All services are overseen/supervised by a licensed professional and FFT National Consultant Functional Family Therapy Age Range: —10 — 17 years Gender Criteria: Both Male and Female clients served Goals: Empower families with the skills and resources needed to independently address the difficulties they have raising their children; Empower youth to cope with family, peer, school, and neighborhood problems; Build community and natural support systems; Decrease negativity and blame among family members; Decrease anti -social behavior to include legal contacts, truancy and substance abuse issues. Length of Treatment: 2 — 6 months, 1 - 2 hours per week Primary Intervention Type: As clinically appropriate: Family Interventions, Cognitive/Behavioral, Family Therapy, School and Community based interventions, and substance abuse intervention. Special Services: Bi-lingual therapist; Case Management, School Interventions, Advocacy, Court/Staffing Participation; Sustainability Planning; Booster services after discharge. Monthly Cost: $700.00 per month/per family, pro -rated for partial month Inclusionary Criteria: Child must be at risk of out of home placement or transitioning back from placement within 30 days; Child is displaying moderate to severe behavioral problems in the home/school/community; Child is involved in criminal behaviors NRBH - CORE SERVICES CONTRACT 2017-2018 to include substance abuse; Child demonstrates verbal and/or physical aggression at home/schooUcommunity; Child is engaged with deviant peer group; Child is struggling with school behaviors to include failing grades, truancy and anti -social behaviors; Family has persist conflict and negative child -parent relationship; Caregiver is abusing substances; Family has limited resources and would benefit from psychoeducation and parenting skill development. Maximum Program Capacity: Medicaid Eligibility Referral Process/Timelines: Supervisory Structure: Special Assessments/Practices: Trauma Focused Training: 40 - 45 youth FFT is a Medicaid covered service at North Range Behavioral Health Referrals must be made to program supervisor for review on approved FFT referral form. Each referral is considered within one week and clients are accepted based on problem severity/risk and therapist availability. Administrative Director: Kimberly Collins, LPC: 10 years exp Program Director: Jennifer Wallace, LCSW: 2 years exp FFT Model Supervisor: Jennifer Wallace, LCSW: 5 years exp FFT Clinicians: 4 FFT trained clinicians Supervision: two hours weekly, and as needed Supervisor to Staff Ratio: 1:4 Use of FFT approved assessments as indicated by licensing agreements and FFT consultant directives including pre, post, and intermittent assessments (provided upon request). Integrative Treatment of Complex Trauma for Adolescents (ITCT-A)-February 2014 Trauma -Focused Cognitive Behavioral Therapy (TF-CBT)-July 2014 Dialectical Behavioral Training for Adolescents (DBT)-March 2014 The Impact of Trauma on the Developing Child; Dr. Perry -April 2017 3. Fees for Services Monthly cost is $700.00 per client/family, pro -rated for partial month services. 4. FFT Outcomes in Weld County Impact to the County Prior to Treatment • All youth receiving FFT services had at least one risk factor of: At risk of out of home placement, returning from out of home placement, legal involvement, and/or school problems prior to admission Current Year of FFT in Weld County (4/14/2016 - 4/14/2017) Outcomes after completing FFT Treatment (N=72 cases completed) NRBH - CORE SERVICES CONTRACT 2017-2018 • 95% of youth living in the home • 99% in school or working • 86% with no new arrest or legal involvement Past years of FFT in Weld County (1/1/2009 — 4/14/2017) Outcomes after completing FFT Treatment (N=490) • 92% of youth living in the home • 92% in school or working • 83% with no new arrest or legal involvement Print Lookup Details Page 1 of 1 Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C. Name Public Address Jennifer Kehl Wallace Windsor, CO 80550-5463 Credential Information License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date CSW.00001141 Examination Licensed Clinical Social Worker Active 08/28/2008 09/01/2015 08/31/2017 Board/Program Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 4/19/2017 11:22:15 AM https://apps.colorado.gov/dora/licensing/Lookup/PrintLicenseDetails.aspx?cred=8 86111 &... 4/19/2017 Print Lookup Details Page 1 of 1 Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C. Name Public Address Bradley James Crookston Evans, CO 80620-9168 Credential Information License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date LPCC.0014658 Temporary Permit Licensed Professional Counselor Candidate Active 03/02/2016 03/02/2016 03/02/2020 Board/Program Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 4/19/2017 11:23:06 AM http s://apps. colorado. gov/dora/licensing/Lo okup/PrintL icenseDetails. aspx?cred=1078 812... 4/19/2017 Print Lookup Details Page 1 of 1 Lookup Detail View Licensee Information This serves as primary source verification * of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C.R.S. Name Public Address La Tisha Marie Cook Brighton, CO 80601 Credential Information License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date LPCC.0015057 Temporary Permit Licensed Professional Counselor Candidate Active 11/29/2016 11/29/2016 11/29/2020 Board/Program Actions Discipline There is no Discipline or Board Actions on file for`this credential. Generated on: 4/19/2017 11:28:12 AM https://apps.colorado.gov/dora/licensing/Lookup/PrintLicenseDetails.aspx?cred=1118883... 4/19/2017 Bradley J. Crookston 3300 Rio Grande Avenue Evans, CO 80620 (970) 673-5640 "To Exceed Expectations" Education (past to present): ➢ University of Northern Colorado Greeley, CO 80631 • August 2015 — December 2018 (anticipated) • Doctoral Degree (PhD) of Counselor Education and Supervision ➢ University of Northern Colorado Greeley, CO 80631 • May 2013 — October 2015 • Master's Degree (MA) of Clinical Counseling: Couples and Family Therapy ➢ University of Northern Colorado Greeley, CO 80631 • August 2005 — May 2006 & August 2009 — December 2012 • Bachelor's Degree (BA) of Psychology Professional Memberships: ➢ American Counseling Association (ACA) Student Member ➢ Association for Counselor Education and Supervision (ACES) Student Member ➢ International Association for Marriage and Family Counselors (IAMFC) Student Member ➢ Colorado Counseling Association (CCA) Student Member Academic Areas of Interest: ➢ Diversity and Multiculturalism in Counseling ➢ Professional Identity Development of Professional Counselors ➢ Couples and Family Counseling ➢ Spirituality & Religion in Counseling ➢ The Therapeutic Relationship Honors and Awards: ➢ International Counseling Honors Society Chi Sigma Iota Rho Epsilon Chapter Student Member Certifications and Abilities: ➢ Fluent in the Spanish Language (read, write, and speak) ➢ National Certified Counselor (NCC) ID# 627433 ➢ Licensed Professional Counselor Candidate (LPCC) in State of Colorado #0014658 ➢ Functional Family Therapy (FFT) Certified ➢ UNC Lesbian, Gay, Bisexual, & Transgender Safe Zone Certified ➢ Crisis Prevention & Intervention (CPI) Certified 1 Teaching Experience: ➢ University of Northern Colorado Greeley, CO 80639 (970) 351-1890 • January 2017 — May 2017 • Co -teaching Experience — Course: Understanding Children, Adolescents, and their Systems • Engage in course planning and design/update of course syllabus. ■ Provide class instruction as agreed upon with faculty, under direct supervision. • Be exposed to evaluation purpose, process, and procedures. • Teach topics salient to the Child & Adolescent course, under faculty supervision. • Adhere to semester format of course and attend all class sessions. ➢ University of Northern Colorado Greeley, CO 80639 (970) 351-1890 • August 2016 — January 2016 • Co -teaching Experience — Course: Family Systems • Engage in course planning and design/update of course syllabus. ■ Provide class instruction as agreed upon with faculty, under direct supervision. • Be exposed to evaluation purpose, process, and procedures. ■ Teach topics salient to the Family Systems course, under faculty supervision. • Adhere to weekend format of course and attend all class sessions. ➢ University of Northern Colorado Greeley, CO 80639 (970) 351-1890 • August 2015 — January 2016 • Graduate Assistant — UNIV 101 Instructor of Record • Teach and instruct first -semester freshman students according to the UNIV 101 curriculum. • Design weekly lesson plans, in accordance to unit objectives. • Encourage, motivate, and provide timely feedback to students. • Grade student assignments. • Attend weekly staff meetings. Supervisory Experience: ➢ University of Northern Colorado Greeley, CO 80639 (970) 351-1890 • January 2017 — March 2017 • Co -supervision (doctoral supervisor) — Practicum II in Individual Counseling • Supervise master's degree seeking students as assigned by faculty. • Provide weekly individual supervision sessions to assigned students. • Provide formative feedback to students. • Consult with supervising faculty and make summative feedback recommendations. • Collaborate with supervising faculty as instructed. ➢ University of Northern Colorado Greeley, CO 80639 (970) 351-1890 • August 2016 — December 2016 • Co -supervision (doctoral supervisor) — Practicum in Counseling Children/Adolescents • Supervise master's degree seeking students as assigned by faculty. 2 • Provide weekly individual supervision sessions to assigned students. • Provide formative feedback to students. • Consult with supervising faculty and make summative feedback recommendations. • Collaborate with supervising faculty and co -lead weekly group supervision as instructed. Professional Conference Presentations: Crookston, B.J. & Ireland, L.E. (2017). Integrating couple and family religious and spiritual practices into counseling. Presented at the American Counseling Association, San Francisco, CA. Ireland, L.E. & Crookston, B.J. (2017). Transforming missteps into steady steps: Addressing counselor -in - training microaggressions. Presented at the Association of Counselor Education & Supervision, Chicago, Ii. Professional and Volunteer Experience: ➢ North Range Behavioral Health Youth and Family Intensive Greeley, CO 80631 (970) 347-2487 • November 2015 — Present • Functional Family Therapist • Screen families referred for FFT services and determine appropriateness of FFT for each family. • Provide family counseling and case management services to families, in accordance with the FFT model and each of the five FFT phases — Engagement, Motivation, Relational Assessment, Behavior Change, and Generalization. • Document family progress within the FFT format. • Attend and engage in weekly group supervision and staff meetings. • Attend individual supervision with FFT supervisor weekly. • Connect families with community resources as needed. ➢ University of Northern Colorado Greeley, CO 80639 (970) 351-1890 • January 2016 — May 2016 & August 2016 — May 2017 • Graduate Research Assistant • Assist assigned faculty with current research projects as directed by the faculty. • Meet with faculty regularly to discuss and update progress on current research projects. ➢ North Range Behavioral Health Youth and Family Intensive Greeley, CO 80631 (970) 347-2487 • May 2015 — October 2015 • Master's Counseling Intern Volunteer • Facilitate group counseling services for adolescent clients. • Complete Level II Clinical Assessments (intakes), formulate initial diagnoses and treatment plans from a collaborative strength -based perspective, and make initial treatment recommendations with clients. • Provide individual and family counseling services. • Assist in Day Reporting Center (DRC) programming and DRC mental health group counseling facilitation. • Complete safety plans and risk assessments with clients. • Attend individual and group supervision sessions. 3 • Consult with client stake holders and collaterals, in regards to client progress. • Assist the Youth and Family Intensive Treatment Team as directed and as needed. ➢ North Range Behavioral Health CSS Greeley, CO 80631 (970) 313-1173 • September 2012 — May 2015 • Behavioral Health Worker II & Fill-in Supervisor • Facilitate client participation in respective individual treatment plan, by providing emotional support, advocating for the client, and assisting the client in problem solving. • Perform on -on -one interviews with clients, intake/discharge of clients from detox facility, and facilitate group counseling sessions. • Fill-in as second shift supervisor as necessary; including, coordinate detox admissions and discharges, field crisis -line emergency calls, coordinate client follow-up care, authorize emergency commitments for drug/alcohol, and assist program coordinators and program director as needed. • Perform monitoring duties, including BA's, UA's, hair follicle samples, sweat patch samples, and corresponding documentation. • Transport clients to and from hospitals and other medical or mental health facilities, measure client vitals, assess client withdrawal symptoms, ensure client safety, and document client progress during client stay at facility. ➢ North Range Behavioral Health CSS Greeley, CO 80631 (970) 313-1173 • May 2012 - July 2012 • Student Intern Volunteer • Client Supervision, Group Counseling assistance and observation, one-on-one interviews with clients, intake/discharge observation, accompany staff on client transports, supervise clients for urine analysis, measuring client's vitals and assist staff as directed. ➢ Whelan Security Denver, CO 80111 (303) 221-4518 • June 2008 — September 2012 • Security Officer Hybrid • Resigned due to accepting a position with North Range Behavioral Health. • Perform building patrols, report suspicious activity, emergency response, escort janitorial staff, & perform lobby post duties. • Perform Security Command Center Operator duties when required, including monitoring of cameras, notification of proper personnel regarding abnormal and emergency situations, coordination of security officers to perform duties, writing and submission of incident reports, and coordination of security emergency response. • In December of 2008 I was promoted to the station of Security Supervisor which I held until December of 2010. I willfully resigned from the position in order to focus on my education at the University of Northern Colorado. During this time I performed the following additional duties: • Assist the Site Account Manager in the scheduling of the SRO (flex) officer as well as the scheduling of time off requests and the arranging of appropriate coverage. • Supervise second shift staff. 4 ■ Lead two separate Task Teams of three to four individuals each. Evaluate and streamline forms and documents utilized by the department as well as evaluate the effectiveness of the technology deployed by the department. • Collaborate in the development of policies and procedures. ➢ The Church of Jesus Christ of Latter -Day Saints Veracruz, Veracruz Mexico • August 2006 — June 2007 • Missionary Volunteer • Learn the Spanish language, proselyte door to door, develop friendships, engage in community service opportunities, baptize and confirm new members. ➢ Universal Mechanical Inc. Fort Collins, CO 80524 • May 2006 — August 2006 • Crew • Resigned due to traveling to Mexico to serve a mission for The Church of Jesus Christ of Latter -Day Saints • Assist in the installation of new HVAC units as well as the removal of old HVAC units. This included, but was not limited to: electrical wiring, making of ventilation duct, & installation of new ventilation duct. ➢ Coldstone Creamery Loveland, CO • June 2003 — May 2006 • Supervisor • Resigned due to accepting a job offer at Universal Mechanical Inc. • Supervision of up to five crew members, service customers, opening the store, closing the store, balancing cash register at open and closing times, general cleaning duties, as well as the making of ice cream. Personal & Professional References: Michael Peirce Crisis Response Professional Counselor (970) 313-2304 Jennifer Wallace NRBH Y&F Intensive Director (970) 347-2487 Braden Price Medical Resident Student (970) 581-8693 Stephen Schoon Police Officer (970) 310-7283 *Letters of Recommendation can be provided upon request* 5 FRANCESCA BIELBY BugejaFrancesca@gmail.cotn 970.443.0773 1861 Indian Hills Circle • Fort Collins, CO 80525 PROFESSIONAL PROFILE An extremely motivated, hardworking, and empathetic professional interested providing therapeutic services to marginalized people groups EDUCATION Masters in Social Work May 2015 Colorado State University, Fort Collins, CO Bachelors in Social Work Colorado State University, Fort Collins, CO May 2012 PROFESSIONAL EXPERIENCE Functional Family Therapist, Greely, CO March 2017 -Current Social Worker & Special Care Unit Coordinator, Fort Collins, CO April 2015- January 2017 • Actively participated in behavior management meetings and provided documentation regarding behavior patterns and psychotropic medication use • Provided individualized support for residents and their family members regarding long-term care placement, dementia education, and care concerns • Managed caseload of 30-34 residents • Mediated conflicts between family and facility • Communicated with interdisciplinary team on daily basis to advocate for resident/family needs • Empathically conducted mood assessments and responded to mood concerns through probing, resourcing, and advocating • Assisted with discharge planning and appropriation of services such as home health, oxygen, outpatient therapies, and assistive devices • Lead interdisciplinary care conferences on a weekly basis with residents and family members • Provided facility wide and special care unit specific training on person -centered dementia care Bereavement Counseling Intern, Pathways Hospice, Fort Collins, CO August 2014 -May 2015 • Accurately provided documentation for all interactions with clients • Provided follow-up contact for primary caregivers of hospice patients • Empathically provided grief counseling to older adults, adults, and children • Represented bereavement department weekly at interdisciplinary meetings • Co -facilitated monthly support group for widows and widowers • Conducted research and program evaluation for Pathways Hospice • Participated in weekly supervision from Janet Severance, LCSW Adult Advocate, Crossroads Safehouse, Fort Collins CO January 2013- January 2015 • Regularly met with clients providing emotional support and domestic violence education • Calmly dealt with clients in crisis through excellent use of empathy and de-escalating • Provided resources and referrals to clients and sought to regularly learn of new or underutilized resources • Efficiently completed shelter tasks including: completing client intakes, answering crisis calls, communicating policies to clients, and daily task completion • Effectively managed a caseload of three to four clients while assisting in day-to-day shelter activities • Communicated with varying disciplines to collectively work toward assisting clients in achieving personal goals • Developed and led a financial empowerment group weekly • Weekly meet with Shelter Manger Susie Martinez: with over 10 years of experience in non- profit organizations and five years of experience as a sexual assault/domestic violence advocate Direct Support Associate, Mosaic, Fort Collins, CO January 2011 -Jan 2013 Served as direct care provider for persons having developmental and intellectual disabilities • Able to connect with individuals and honor differences thus better engaging them in daily activities • Helped clients safely participate in community involvement activities • Assisted in meeting clients direct needs: medication administration and other activities of daily living Care Provider, Buckley AFB Child Development Center, Aurora, CO May 2010- August 2010 • Mediated conflicts and promoted self-discipline while utilizing good listening and empathy skills • Encouraged youth to express themselves and ideas in age appropriate manner • Planned and created opportunities for children (ages 6-8) to participate and engage in • Employed various methods to ensure successful supervision during activities such as field trips, cooking, play time, and creative writing FOREIGN LANGUAGE, SPANISH • Fluent in Spanish PROFESSIONAL REFERENCES Emily Marquess Social Service Representative Emily.Marquess(a7columbinehealth.com 719.238.8553 Janet Severance Grief Counselor, LCSW Janet.severance@pathways-care.org 970.663.3500 Missy Vansickle Transitional Housing Manager and Advocate 970.818.6348 Lourdes Janet Camacho MA, NCC 1921 E 83`d P1 Denver, CO 80229 (303) 847-1653 EDUCATION Master of Arts: Couples, Marriage and Family Counseling/Therapy University of Northern Colorado (UNC) Greeley, CO Bachelor of Arts: Psychology University of Northern Colorado Greeley, CO RELEVANT FIELD EXPERIENCE Ijanet.camacho@gmail.com May 2015 May 2012 North Range Behavioral Health May 2015- Present Functional Family Therapist • Provide intensive in -home family therapy to adolescents ages 10-17and their families in English and Spanish • Provide ongoing progress with referral agents and other community partners through weekly and monthly updates or as needed by email or phone • Provide level I assessments (screens) and level II assessments (intakes) • Participate weekly in individual supervision and FFT group supervision • Collaborative approach with clients in developing a strength based treatment plan • Case management including attendance at school meetings, court hearings, probation, and consultation with other professionals • Follow the Functional Family Therapy evidence -based model for treatment • Maintain client confidentiality per HIPPA • Follow mandated reporting guidelines • Utilize the DSM diagnostic criteria to make diagnosis • Documentation of direct/indirect billable/nonbillable hours • Share client progress/barriers to treatment with collaterals • Link clients to other services as needed and make recommendations for treatment • Establish safety plans when needed • Management of own schedule and follow-up reminder calls to for appointments North Range Behavioral Health August 2014- May 2015 Outpatient Youth and Family Master's Level Clinical Therapist • Provide 300 direct hours individual/family therapy for youth and their families • Provide intake sessions with families • Provide crisis intervention • Conduct therapy outpatient face-to-face therapy sessions • Assess risk of harm to self or others and arrange needed resources and provide ongoing assessment • Assist clients in formulating treatment plan and goals • Attend team meetings and individual clinical supervision • Conduct crisis intervention via telephone • Co -create a strength's based service plan for each client and update as needed • Provide resources in client's community when appropriate • Apply and adhere to ethical and legal standards in marriage, couple, and family counseling • Modify counseling systems, theories, techniques, and interventions to make them culturally appropriate for diverse couples and families • Apply effective evidence based interventions in therapy sessions • Assess the mental status of clients and use current diagnostic criteria • Document sessions electronically UNC Psychological Services Clinic Individual/Family Practicum August 2013 -December 2013 • Provided counseling to individuals and families • Developed fundamental counseling skills • Developed intake skills, including data collection and initial diagnostic assessment • Received supervision on issues related to client, interpersonal, and intrapersonal issues • Formulated treatment and evaluation plans • Begin implementing personal approach to self -care and wellness • Followed the American Association (ACA) ethical guidelines and he UNC Psychological Services Clinic Manual • Create a full case conceptualization for clients A Kid's Place Family Support Advocate December 2013 -April 2015 • Provided support to non -offending parent/caretaker/family of a child victim, during a forensic interview • Supported child victims and other accompanying family members when the parent/guardian is in a pre -interview meeting with law enforcement, caseworkers, and the forensic interviewer • Informed the family about the Victim's Right Act • Collected case information from the non -offending caregiver • Discussed with the caregiver how to keep child safe and behavioral changes in children that experience trauma • Provided emotional support to the child's accompanying family members • Provided mental health counseling resources, assess families for needs and make referrals for families to appropriate human service organizations located in the family's communities. • Collected data and recorded statistics in database Reflections for Youth Advocate December 2012 -March 2014 • Worked with high -risk youth and their families through in -home behavioral support services • Helped keep children in the home and out of residential placements and jail • Utilized community resources to engage clients to be active in their community • Supported the client and family in time of crisis • Used Nurtured Heart Approach while working with clients and their family • Created objectives to achieve goals • Provided crisis intervention • Made reports to child protection services when needed • Provided confidentiality services • Created and implemented a parenting plan • Created and implemented use of safety plan • Helped youth achieve work and academic goals • Informed supervisor trained Assault Survivor Advocacy Program (ASAP) INTERNSHIP August 2011 -August 2012 • Provided confidential services to University of Northern Colorado survivors of sexual assault, domestic violence and stalking as well as their friends, family, and concerned others • Provided immediate and follow-up advocacy, support, and crisis intervention • Presented educational programs for residence halls, academic courses, Greek organizations, athletic teams, and student organizations • Completed 35 hours of training on the effects of sexual assault, crisis intervention, medical and legal processes relating to sexual assault, and services available to support survivors Skills and Past Involvements • Fluency in Spanish and English and passed a Language Proficiency Assessment through Multilingual Services in February 2017 • Under Review for a Publication of undergraduate research as co-author to the Psychology, Crime and Law Editorial Office • QPR Suicide Prevention Gatekeeper • Chi Sigma Iota Counseling Professional Honor's Program • McNair Scholar — Undergraduate research • Presentation of research at a National research symposium • Member of the American Counselor Association • 3rd place winner in the McNair Scholars Research Competition • UNC Best Buddies Program References Jennifer Wallace LCSW Program Director/Coordinator North Range Behavioral Health 928 12th St Greeley, CO 970-397-5331 Jennifer.wallace@northrange.org Jessica Lieby MA, LPC Functional Family Therapist North Range Behavioral Health 928 12th St Greeley, CO 9703421364 Jessica.liebv@northrange.org Chris Sarlo-Bergmann Forensic Interviewer/Program Coordinator A Kid's Place 1610 29th Ave P1 #201 Greeley, CO (970) 353-5970 Chris@AKidsPlace.org Address: 928 12th Street Greeley, CO 80631 Jennifer K. Wallace, LCSW Contact Information: (970) 397-5331 Jennifer.wallace@northrange.org EDUCATION/LICENSURE August 2008 Licensed Clinical Social Worker • Supervise clinicians working towards LCSW • Supervise Interns working towards their master's degree • Supervise both LSCW candidates and LPC candidates Department of Regulatory Agencies 2003-2006 Illinois State University Masters of Social Work with Emphasis on Child and Family Practice • GPA: 3.93/4.0 1999-2003 Saint Louis University Bachelor of Arts with majors in Spanish and Communication • Graduated Magna Cum Laude • Varsity Soccer Player/Division I-NCAA Academic All-American 2002 Colorado Normal, IL St. Louis, MO PROFESSIONAL EXPERIENCE October 2014 -Present North Range Behavioral Health Weld County, CO Director of Youth and Family Intensive Services • Directly supervise Intensive In -home and Functional Family Therapy. Oversee Intensive Outpatient (180 program), Intensive Substance abuse services and Day reporting center. • Provide Clinical and Administrative supervision to coordinator, therapists and interns • Collaborate with community partners regarding clients, services and policies • Participate in the development of new programming. December 2011 -October 2014 North Range Behavioral Health Weld County, CO Functional Family Therapy Coordinator • Provided clinical and administrative supervision for therapists using FE 1 Model • Maintained referrals, performed screens with families, and completed monthly billing. • Maintained medium size caseload of Spanish speaking and insurance families (8-10) September 2008 -October 2014 North Range Behavioral Health Weld County, CO Functional Family Therapist • Practiced therapy in a three phase, evidenced based model for families with an at -risk adolescent • Maintained contact with numerous stakeholders including Department of Social Services, Probation, the court, District Attorneys, Youth and Family Connections, and the schools. January 2010-2012 North Range Behavioral Health Weld County, CO Intern Supervisor • Interviewed, hired and provided administrative and clinical supervision for Masters level interns • Coordinated services with University of Northern Colorado, Colorado State University • Created and implemented an intern training binder which included sections on: Intake, treatment planning, crisis management and supervision April 2006 -September 2008 North Range Behavioral Health Weld County, CO Multisystemic Therapist • Assisted in implementation of first MST team at NRBH • Provided 3-5 hours a week of intensive in -home therapy for families with an at -risk adolescent • Was on call and got lots of experience managing crisis with families. Page 1 of 2 Address: 928 12th Street Greeley, CO 80631 Jennifer K. Wallace, LCSW Contact Information: (970) 397-5331 Jennifer.wallace@northrange.org POST DEGREE TRAININGS April 2017 On -Track First Episode Psychosis training Greeley, CO June 2014 Core Concepts of Child and Adolescent Trauma Fort Collins, CO February 2014 Integrative Treatment of Complex Trauma for Adolescents Denver CO March 2013 February 2012 August 2010-2012 September 2008 March 2008 April 2006 LANGUAGES FFT Supervisor training FFT Externship Have completed all courses for CACII Functional Family therapist Replacement Training ASIST: Applied Suicide Intervention Skills Training Multisystemic Therapy Five Day Training Lima OH and Green Acres FL Florida Greeley, CO Lima, OH Greeley, CO Denver, CO • Provide services for Spanish speaking families at NRBH from January 2006 -Present • Studied the Spanish language and Spanish speaking cultures through college and High school. • Studied abroad in Madrid, Spain during Spring of 2001 • Participated in a 3 week Spanish emersion program in Costa Rica in April of 2008 REFERENCES Personal/professional references and/or academic credentials will be submitted upon request Page 2 of 2 LATISHA COOK LPCC, MA SKILLS Conflict management, Motivation, DBT, Victim Impact, Drug & Alcohol, Animal Assisted therapy, Play therapy, Group therapy, and Individual therapy. EXPERIENCE Behavioral Health Specialist Intern { Lookout Mountain Youth Services Center August 2015 -August 2016 Case management, provided individual, group, & family therapy, treatment planning, collaborated on a multi -disciplinary team, attending clinical meetings, consultations/referrals and advocated for youth needs. Assistant Store Manager I Sprint I June 2004 - Present Co -Lead a team of 20 people to top in the district, achieved A100 status top 27 in nation, motivated and drove sales, helped implement ongoing training and development. Teacher Assistant I Life Skills of Denver August 2003 - June 2004 Aided in opening school and running classroom, facilitated meetings with parole officers, youth, and families, provided referrals. EDUCATION Master's in Counseling 1 August 20161 Regis University Finished with Honors, CSI, GPA 3.875 Bachelor's in Psychology, Minor in Sociology December 2005 I University of Colorado at Denver OBJECTIVE Grow and procure a career in the mental health field by acquiring a therapist position and achieve licensure. I would like to continue to utilize my professional skills in technical, management, and interpersonal arenas, as well as apply the knowledge I have gained from Regis University and Lookout Mountain Youth Services Center. TishCookl @gmail 720-839-3191 .com PROFESSIONAL & TECHNICAL EXPERIENCE CJRA, Trails, MDT, Staffings, UCLA, Outlook, Functional Behavioral Assessment, Evade & Escape, Violent offenders` department. 600NORTHORANGE BEHA April 18, 2017 Tobi Vegter Child Welfare Contract and Services Coordinator Division of Child Welfare Resource unit 822 7th Street, Suite 150 Greeley, CO 80631 Dear Tobi, Attached is North Range's Core Contracted Services Bid Proposal for the Anger Management/ Domestic Violence services program area. We propose these services to male and female adults age 18 and over at North Range's adult outpatient site, 1260 H. Street, Greeley. All services will be provided by academically qualified and/or licensed Domestic Violence approved staff as evidenced by the attached resumes and certification/licensure information. Included in the attached proposal are details on the types of service descriptions, and rates for the services provided, as well as details about the target populations and projected outcomes. If you have any questions, please let me know. Sincerely, Laura Hays, LPC, NCC, CAC III Program Director of Adult Outpatient Program 970-347-2357 laura.hays@northrange.org Where hope begins. 1300 North 17th Avenue • Greeley, CO 80631 • 970-347-2120 • I. J. DOMESTIC VIOLENCE/ANGER MANAGEMENT SERVICES SCOPE OF SERVICES 1. CONTRACTOR will provide Anger Management and Domestic Violence services to males and females, 18 years and older, in Greeley. 2. CONTRACTOR will provide the following services under this contract: Anger Management (Minimum 20 Weeks of Treatment) Domestic Violence (Length of treatment will comply with Domestic Violence Offender Management Board [DVOMB] regulations based on placement criteria for treatment levels A, B or C.) Track (level) is determined by assessment with DV approved screening tools: • Track A — one group session a week: duration — minimum of 2 treatment plan reviews taking place every 2-3 months - depending on progress on the required *Core Competencies • Track B — one group session a week/one additional contact a month: duration — minimum of 3 treatment plan reviews taking place every 2-3 months - depending on progress on the *Core Competencies • Track C — one group session a week/one additional contact per week: duration — minimum of 3 treatment plan reviews taking place every 2-3 months - depending on progress on the *Core Competencies Additional contacts will be in a group or individual setting depending on the clinical need. Monitoring UAs/BAs: When assessed to be appropriate *CORE COMPETENCIES — per DVOMB Regulations A. Commitment to eliminate abusive Behavior B. Personal Change Plan work — Demonstrate change C. Complete the Personal Change Plan Worksheet D. Recognize and demonstrate Empathy E. Accept full responsibility for the offense and abusive history F. Identify and reduce pattern of power & control behaviors, beliefs and attitudes of entitlement G. Accountable for abusive behaviors, accept consequence, take steps to reconciliation to prevent future abusive behaviors H. Accept that abusive behavior should have and has consequences Participate and cooperate in treatment Ability to define types of DV • Group Process and Skills • Cognitive -Behavioral Skills • Passive, Aggressive and Assertive Behaviors • Victim Empathy • Treatment Goals • Substance Abuse • Stages of Change • Parenting • Men's Issues / Women's Issues (as applicable) • Effects on Children (DV only) • Steps to Problem Solving • Steps to Conflict Resolution • Characteristics of Assaultive Adults • Attitudes Toward the Opposite Sex • Sex Role Training • Socio-cultural Basis for Violence • Provocation • Appropriate Containment and Expressions of Anger • Experiencing Emotions and Feelings Beyond Anger • Grief and loss • Depression and Anxiety • Stress Management • Relapse / Recidivism Prevention • Healthy Relationships • Sexuality • Spirituality • Resources K. Understand, identify, & manage own pattern of violence L. Understand intergenerational effects of violence M. Understand & use of healthy communication skills N. Understand & use time outs O. Recognizes financial responsibilities as required P. No new violence or abusive offenses Q. Prohibited from purchasing, possessing, or using firearms & ammunition 3. Anger Management and Domestic Violence intakes will be completed with recommendations before the client is placed into treatment The intake will determine the best placement for the client in regards to treatment, which may include group sessions and/or individual sessions. Individual sessions will only be utilized under one or more of the following circumstances: a. The referred client's individual treatment needs cannot be adequately addressed in a group setting. b. The client is not currently appropriate for a group setting and requires a limited number of individual sessions to prepare for a group setting. c. The client's job requirements make it impossible to attend regularly scheduled group sessions and individual sessions are the only option for the client to comply with their treatment plan. d. When assessed for a DV track in which an additional contact is required. If the client is assessed at a higher level of care than this agency offers, the client will be recommended to enroll into Domestic Violence treatment at an agency in the community that provides that level of care, i.e. Perklin. 4. CONTRACTOR will comply with the Colorado Domestic Violence Offender Management Board's Standards and Guidelines. 5. All therapists providing services will receive Trauma Informed Care training as required. 6. NRBH can provide the services listed above with a bilingual treatment provider. Thus, NRBH agrees to demonstrate language proficiency via a Spanish language proficiency test if required to do so. Fees for Services $200.00/Episode (Anger Management or Domestic Violence Evaluation) $25.00/hour (Group Session) $17.50/15 Minutes (Individual Session) $17.50/15 minutes (Court Testimony including travel, wait, & prep time) Vicki Ruscitti 5604 West 16th Street Lane, Greeley CO 80634 1(970) (970) 347-06301 vickiruscitti4@gmail.com EDUCATION Master of Arts, Clinical Mental Health Counseling University of Northern Colorado, Greeley, CO *Multicultural Professional Development Program Recipient Bachelor of Arts, Psychology Minor, Art & Design University of Northern Colorado Greeley, CO *Daniel's Fund Scholarship Recipient Summer 2015 GPA: 3.89 May 2011 GPA: 3.10 PROFESSIONAL EXPERIENCE Adult Outpatient, Outpatient Therapist August 2015 - Present North Range Behavioral Health, Greeley, CO • Complete mental health intakes which includes assessment, diagnosis, documentation, and service planning • Maintain regularly scheduled groups and clients in order to meet productivity standards • Provide individual and group mental health services to young adults, adults, and older adults • Facilitate Relapse Prevention in Spanish for men and Domestic Violence groups for abusive women • Document all notes and treatment plans daily and on time • Coordinate client care with staff and third parties with appropriate release of information • Collaborate with community members, such as probation, to staff client progress, concerns, and pertinent information as necessary and appropriate • Work with a team of therapists, support staff, psychiatrists, and case managers by communicating daily to coordinate client care, assess client cases, and create plans of action • Attend and participate in required trainings as necessary • Develop professional growth in the field through voluntary trainings, webinars, and continuing education as available Youth and Family, Clinical Intern January 2015 - August 2015 North Range Behavioral Health, Greeley, CO • Completed mental health intakes which includes assessment, diagnosis, documentation, and service planning • Provided mental health services for children, adolescents, and their families individually and groups • Documented every contact with clients regularly and on time • Coordinated client care with staff and third parties with appropriate releases of information Adult Recovery Program, Case Manager Specialist September 2011 - August 2015 North Range Behavioral Health, Greeley, CO • Provided support to individuals with a serious and persistent mental illness through one-on-one appointments fitted for clients' individual needs; this included updating client treatment plans, meeting with clients to monitor their progress, and linking clients with providers in the community • Referred clients to other agencies and assist with benefit acquisition through the Department of Human Services and the Social Security Administration • Worked with a team of therapists, support staff, case managers, payee, and psychiatrists where we communicated daily to coordinate client care, assess client cases, and create plans of action Page 1 of 2 • Supervised the PRN (as needed) Services available to clients at the Adult Recovery Program; responsibilities included managing a caseload of over 300 clients, maintaining client paperwork up to date, and coordinating care for walk-in clients • Facilitated psycho -educational groups for clients residing in the agency's residential facilities Adult Outpatient, Practicum II Intern August 2014 — December 2014 North Range Behavioral Health, Greeley, CO • Completed mental health intakes for new clients; this included an assessment, diagnosis, documentation, and service planning • Provided mental health and substance abuse individual therapy for adults • Documented contact with clients regularly and on time • Coordinated client care with staff and probation officers when appropriate • Co -facilitated a Men's Relapse Prevention Group weekly Center for Human Enrichment, Peer Mentor August 2010 — May 2011 University of Northern Colorado, Greeley, CO • Supported students in their transition from high school to college through one-on-one meetings tailored to meet students' individual needs • Assisted students academically and personally throughout the year by helping them with building schedules, creating four -year -plans, guiding them through major/career exploration, providing academic intervention, teaching study skills and time management, and providing appropriate referrals to campus resources • Served as a student advocate and significant contact person contributing to a caring and supportive campus climate • Managed a caseload of 28 freshmen and sophomore students • Participated in the organization of events to enhance learning for students Assault Survivors Advocacy Program, Advocate and Intern January 2011- May 2011 University of Northern Colorado, Greeley, CO • Served as a Peer Educator, educating students on issues related to violence against women and men (Intern responsibility) • Offered crisis intervention to victim/survivors and concerned persons • Responded to pages promptly when on -call • Arranged appropriate referrals • Provided adequate follow-up to victim/survivors and concerned persons • Designed flyers using Microsoft Publisher for particular dates/events related to sexual assault • Participated and supported events throughout the semester COMMUNITY Volunteer April 2013 - December 2014 Hospice of Northern Colorado, Greeley, CO • Meet with Hospice patients as needed to provide companionship and support • Contact bereaved person's by phone to briefly check -in, offer support, and provide resources when appropriate • Participate in trainings that enhance grief and bereavement skills in order to better serve patients and their families Page 2 of 2 TIMOTHY BURKE tim.burke.co@gmail.com 3230 Grovewood Dr. Fort Collins, CO 80525. (970) 948-6185 OBJECTIVE To obtain an full time position in a helping profession EDUCATION Bachelor of Science in Psychology, May 2014 Colorado State University, Fort Collins Master of Social Work, May 2015 Colorado State University, Fort Collins Related Course Work: Basic Counseling Skills Basic Counseling Skills Lab Seminar-Counseling/Clinical Psychology Special Project Team member of Consensual Qualitative Research project where we investigated how infantrymen found meaning in their lives in the military and after separation from the military. 5/13 -present Experience • Transfer Student Mentor for adult learners and veterans 1/13-5/13 • Aircraft Rescue Firefighter 12/08-9/11 • Graduate Intern Veterans Success Coach 02/15 -present Skills • Exceptional communicator both verbal and written • Experience with Microsoft Word, PowerPoint and Excel • Outstanding time management and organizational skills Sydney Koenig 7411 East Jamison Circle Centennial Co. 80112 303.917.6261 sydney.koenig@yahoo.com Objective: Education: 2010- 2013 2005-2009 2001-2005 To provide every client with empathic counseling services and advocate on their behalf. This will be accomplished by considering each client's unique circumstances and goals, and working with other professionals for the benefit of the client. University of Northern Colorado (Greeley, CO) Master of Arts program for Clinical Counseling Master of Arts program for School Counseling University of Northern Colorado (Greeley, CO) Bachelor of Arts Degree with a GPA 3.97 Graduated Suma Cum Laude. Majored in Psychology, Minored in Sociology Grandview High School (Aurora, CO) Graduated with honors Master's Level Practicum and Internship Experience: January 2013 -May 2013 Internship Student at Mead Elementary School • Help individual students by meeting on a weekly basis • Lead weekly groups on issues such as divorce and social skills • Responsive services August 2012 -December 2012 Internship Student at John Evans Middle School (Greeley, CO) • Help individual students by meeting on a weekly basis • Lead weekly grief and loss group • General school support and responsive services May 2012 —December 2012 Internship Student at Alternatives To Violence (Loveland, CO) • Work with clients through conducting intake appointments and individual therapy • Lead weekly DV 101 group • Help clients by consulting with other personnel about resources in the community • continued to volunteer by running group and conducting individual counseling sessions through May 2013 (Mead, CO) Sydney Koenig 7411 East Jamison Circle Centennial Co. 80112 303.917.6261 sydney.koenig@yahoo.com November 2011 -May 2012 Practicum II Student at Action Counseling (Denver, CO) • Work with court mandated clients in individual and group contexts • Conduct intake appointments for DUI and domestic violence clients • General office work • Helped with intake and release of patients Bachelor's Level Field Experience: Jan 2009 -May 2009 (Greeley, CO) Intern at Children's Advocacy. Resource, and Education Center • Monitored children for signs of physical and mental abuse • Maintained facilities to insure the safety of the children • Lead parents and children in bonding activities May 2008 -August 2008 (Greeley, CO) Intern at North Range Behavioral Health: Acute Treatment Unit • Helped direct patient's activities in groups • Monitored the status of patient's mental health • Conducted one -on -ones with individual patients Work Experience: Dec 2013- Present Mental Health Therapist at North Range Behavioral Health (Greeley. • Conduct Intake appointments for substance abuse and mental health clients • Conduct substance abuse and mental health group counseling • Conduct individual counseling appointments May 2009 -May 2010 Assistant to Robin Garvisch. Apartment Blue Book (Denver, CO) • Data entry • Brochure packaging • Developing brief descriptions of apartment communities for use online and in print Sydney Koenig 7411 East Jamison Circle Centennial Co. 80112 303.917.6261 sydney.koenig@yahoo.com Sept 2009 -Oct 2010 Sales Associate at Walureens (Denver, CO) • Assuring customers have the experience they expect • Aided in re -stocking and inventory management • Constructed new displays and kept the department organized • Daily money and cash register reconciling Licenses and Credentials: Licensed Professional Counselor # 0012823 in the state of Colorado Certified Addiction Counselor II #00080004 in the state of Colorado Registered Psychotherapist in the state of Colorado Substitute authorization #69804 from Colorado Department of Education Special services provider license #82434, to serve as a school Counselor, from Colorado Department of Education Nationally Certified Counselor References: Available Upon Request Nathan Kyle Swisher NORTH RANGE BEHAVIORAL HEALTH RESUME North Range Behavioral Health I Adult Outpatient Program 1260 H Street I Greeley, CO 80631 Ph: 970347.2397 I Fx: 970.964.3169 LICENSURE Licensed Psychologist, Colorado - PSY.OOO384O Issue Date: 01/02/2013 Expire Date: 08/31/2017 Certified Addiction Counselor II, Colorado — ACB.0007799 Issue Date: 05/15/2014 Expire Date: 08/31/2017 EDUCATION 05/2008-08/2011 Doctorate of Psychology in Clinical Psychology Rosemead School of Psychology, Biola University, La Mirada, CA Psy.D. conferred August 31, 2011 08/2006- 05/2008 Master's of Arts in Clinical Psychology Rosemead School of Psychology, Biola University 08/2002- 05/2006 Bachelor of Arts in Biblical Studies, Concentration in Psychology Trinity Western University, Langley, British Columbia, CAN CLINICAL EXPERIENCE North Ranee Behavioral Health Sept 2011 -Present Adult Outpatient Therapist (Full Time Employment) Setting: Community mental health network, Greeley, CO - adult outpatient program. Duties: • Implement clinical assessment, psychological testing (cognitive, personality), and culturally -sensitive individual/group/family/couples psychotherapy for an ongoing caseload of 45-55 individuals (in addition to therapy groups). Caseload consists of both mental health and substance abuse referrals, voluntary and court -mandated. • Engage in regular faculty meetings and trainings, case consultation, individual and group supervision [qualifying for psychologist licensure and CAC (Certified Addiction Counselor) requirements], and external clinical seminars (including training for CAC II, Gottman Couples Therapy, and others). AspenPointe Health Services Sept 2010 -Sept 2011 2,000 -hour APPIC Pre -Doctoral Internship Setting: Community mental health network, Colorado Springs, CO. Major internship rotation located at Adult and Rural Services (adult outpatient); minor internship rotations included: Lighthouse (adult acute inpatient), Peak Vista Community Health Center (primary care), AspenPointe — Fountain, CO (rural outpatient). Duties: • Implemented clinical assessment, psychological testing (cognitive, personality), and culturally -sensitive individual/group/family/couples psychotherapy (EBP) for an ongoing caseload of 25-35 severely and persistently mentally ill adult consumers. • Provided crisis assessment, individual/group/family/couples psychotherapy for an adult population in an acute crisis setting (inpatient). • Coordinated clinical assessment and brief individual psychotherapy in a primary care setting, participating in brief behavioral health consultations for patients. • Implemented supervision with master's level psychology intern, including weekly clinical observation. • Engaged in regular faculty meetings, case consultation, internship training seminars (including presentation of doctoral paper), individual supervision, and external clinical seminars. Harbor UCLA Medical Center — South Bay TIES for Families Sept 2009 -Aug 2010 830 -hour Advanced Practicum Setting: Los Angeles County Department of Mental Health outpatient clinic; a multidisciplinary treatment approach promoting the successful adoption of foster children and adolescents. Duties: • Provided direct clinical assessment, psychological testing (cognitive, academic achievement, personality, socioemotional, neuropsychological), consultation, and individual/family/group psychotherapy for children, adolescents, and families. • Coordinated care with the court system and Department of Child and Family Services as needed. • Engaged in internal and external training for infant mental health (e.g., the Bayley Scales of Infant Development), Narrative Therapy, Reflective Parenting, Mindful Parenting, Incredible Years, and other clinically -relevant seminars and didactic training made available at the Harbor -UCLA Medical Center. Rosemead School of Psvcholo2v, Biola University Fall 2009 — Spring 2010 Setting: Biola University campus, La Mirada, CA. Duties: • 32 -hour Clinical Supervision Practicum (provided weekly, individual supervision for graduate student providing services to adults in an outpatient setting; engaged in weekly supervision and tape review of supervisory sessions; presented audio tapes and progress notes for peer consultation and critique) • 32 -hour Child and Adolescent Practicum (engaged in live peer supervision with teaching assistant using bug -in -the -ear technology; provided individual psychotherapy and parental feedback/consultation to an adolescent client recruited from the community). • 32 -hour Group Therapy Practicum (provided process -oriented group therapy for a group of 10 college students for 10 weeks; consulted and worked successfully with co -therapist; maintained individual client files consistent with group conceptualization; engaged in weekly supervision). Biola Counseling Center August 2007 — June 2009 1,090 -hour University Counseling Center Practicum Setting: Outpatient university and community counseling center, La Mirada, CA. Clientele worked with consisted of an age range of 18-55, from various ethnic backgrounds, and presenting with various forms of mood-, anxiety-, relational-, adjustment/phase of life-, and disorder of thought -related problems. Duties: • Provided short- and long-term psychotherapy for adult individuals and couples, using Cognitive -Behavioral Therapy, Rogerian techniques, Emotion -Focused Therapy for Couples and Individuals, and Psychodynamic Psychotherapy. • Completed biweekly floor duty and structured intake interviews including MMPI-2 interpretation (written reports); provided MMPI-2 feedback sessions to graduate students. • Participated in weekly child therapy seminar/training (spring, 2009), weekly clinic in-service meetings (including case conceptualization and presentation), HIPAA training, and other clinically -related training; • Participated in two Gestalt Therapy seminars (as presented by David Gorton, Ph.D., Director of the Gestalt Therapy and Training Center, Woodland Hills, CA), and participated in Sand Tray and Psychotherapy workshop (as presented by Meredith Phanco, Ph.D., Biola Counseling Center, La Mirada, CA). Measurement and Assessment Practica: Various Settings Fall 2007 — Spring 2008 Setting: La Habra City School District; Arbolita Elementary School (grades K-2), El Cerrito Elementary School (grades K-2) and Walnut Elementary School (grades 3-5), La Habra, CA. Population represented age range from 5-10 years -old, various ethnic backgrounds (predominantly Latino) and levels of socio-economic status. Duties: • 300 -hour school assessment practicum: assessed special education and general education students for learning and behavioral problems, consisting of neuropsychological and psycho -diagnostic tests, student interviews, in -class observation, case conceptualization, report writing, and Individualized Education Programs (IEP); participated in weekly individual supervision and presented in weekly consultation group with practicum supervisor and other practicum students. Setting: Rosemead School of Psychology, La Mirada, CA; comprehensive testing batteries administered to recruited child clients from the community and Biola University undergraduate students. Duties: • Completion of 3 -semester sequence of measurement and assessment courses involving the administration and report writing of 6 comprehensive testing batteries; courses consisted of Measurement and Assessment I (trained to administer, score, and interpret the WAIS-III, WISC-IV, Woodcock -Johnson III, ADSA, Conner's (CPRS-R:L), and PPVT-III), Measurement and Assessment II (trained to administer and score the MMPI-II, MCMI-III, Folstein Mini Mental Status Exam, Thematic Apperception Test, House Tree Person Projective Drawings, Kinetic Family Drawing, and the Forer Structured Sentence Completion Test), and Measurement and Assessment III (trained to administer, score, and interpret the Rorschach). OTHER WORK EXPERIENCE CLINICALLY -RELEVANT EMPLOYMENT : • Intensive Support Services (ISS) Setting: Institute for Applied Behavior Analysis, Santa Ana, CA Hours: 30 per week Duties: Received training in Competency Based Training and provided support to children and adolescents with developmental disabilities. Jun 2007 -Sep 2007 • Homecare Provider Jul 2005 -Jul 2006 Setting: Visiting Angels Living Assistance Services, Bellingham, WA Hours: 20 per week Duties: Provided living assistance services, including various behavioral interventions, for adolescents with autism in home and community settings. TEACHING ASSISTANT EXPERIENCE : • Teacher Assistant: Psychology of Marriage Fall 2009 Keith Edwards, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 3 per week Duties: Facilitate the discussion in and processing of areas such as family of origin issues, and lead skill building exercises in areas such as conflict resolution and empathic listening with undergraduate students. • Teacher Assistant: variety of courses covering the Fall 2007 -Spring 2008 integration of theological topics and psychological theory Steve Porter, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 7 per week Duties: Provided assistance to Dr. Porter for grading of graduate -level coursework. • Teacher Assistant: Psychology of Christian Thought Elizabeth Hall, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 14 per week Duties: Provided assistance to Dr. Hill for grading of undergraduate -level psychology coursework. Spring 2008 • Teacher Assistant: Psychology of Christian Thought Pete Hill, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 14 per week Duties: Provided assistance to Dr. Hall for grading of undergraduate -level psychology coursework. PROFESSIONAL MEMBERSHIPS Fall 2007 • American Psychological Association Current Membership # 95673434 Nataeah Barron-Krier Address: 5718 Foxfire Street Timnath, CO 80547 Telephone: (951) 532-9578 E-mail: nataeahbarron(a,vahoo.com Colorado Candidate Identifier Number - 354000362 Career Objectives To continue gaining experience as a therapist in the mental health field and corrections field. Education Certified Addictions Counselor II (August 10, 2016): North Range Behavioral Health,CO Masters in Marriage Family Therapy (Dec. 2013): Alliant International University, CA BA in Psychology (Dec. 2010): San Diego State University, CA Associates Degree (May, 2004): Mount San Jacinto College, CA Trainings Cognitive Behavioral Therapy — Alliant International University 2012 Solution Focused — Alliant International University 2012 Trauma Informed Care — Alliant International University 2012 Dialectical Behavioral Therapy — San Diego, California 2013 Motivational Interviewing — Mental Health Systems 2014 Work Experience Marriage Family Therapist Candidate, JBBS/ North Range Behavioral Health Adult Outpatient Program 2110 O St Greely CO, 80631 November 2016 to current day. Responsibilities: Provide group therapy, individual therapy, crisis intervention, assessments, client plans, case management, triage, substance abuse counseling, Relapse Prevention, and work with and care for the severely mentally ill, substance abuse, and legally mandated populations Marriage Family Therapist Candidate, North Range Behavioral Health Adult Outpatient Program 1260 H St Greeley CO, 80631 January 5, 2015 to current day. Responsibilities: Provide group therapy, individual therapy, couples therapy, family therapy, crisis intervention, assessments, client plans, case management, triage, substance abuse counseling, Relapse Prevention, and work with and care for the severely mentally ill, substance abuse, and legally mandated populations. Counselor, North Inland Mental Health Center, Escondido, CA May 2012 -June 2014. Responsibilities: Provided group therapy, individual therapy, couple therapy, family therapy, crisis intervention, assessments, client plans, case management, triage, and worked with and cared for the severely mentally ill population. Intern Counselor, North County Serenity House, Escondido, CA, June 2010 -August 2010. Responsibilities: Was trained in assisting in group therapy, observed distribution of medication, writing progress notes, answering phones, and learned to work in a women's rehabilitation facility. Fire Fighter/EMT: California Dept. of Forestry, Temecula, CA, Jan. 2004- April 2008. Responsibilities: Was trained in fire prevention, public protection, lifting of heavy equipment, fire chemistry, and emergency medical technician. Modeled proper fire extinguishing skills, covered public events, and performed medical procedures. References Marci Eisenberg, LCSW Clinical Supervisor at North Inland Mental Health Center 760-747-3424 Laura Hays, LPC, NPC, CAC III Program Director of Adult Outpatient/ BASIC at North Range Behavioral Health 970-347-2357 Maribel Favela, LCSW, CAC III 1260 H Street, Greeley, Colorado 80631 970-347-2393 Ma ri b el. Fa vel a @ n o rth ra ng e. o rq CURRENT EMPLOYMENT STATUS North Range Behavioral Health at Greeley (11/98 -present) 1260 H Street Greeley, Colorado 80631 970-347-2393 EDUCATION North Range Behavioral Health at Ft. Lupton (11/98-5/09) 145 First Street Ft. Lupton, Colorado 80621 303-857-6365 Masters of Social Work Colorado State University, Fort Collins, Colorado Graduated: May 2012 Bachelor of Arts: Spanish & Emphasis: Liberal Arts University of Northern Colorado, Greeley, Colorado Graduated: December 1997 CERTIFICATION Bachelor of Arts: Hispanic Studies Emphasis: Mexican -American Studies Licensed Clinical Social Worker -received 11-21-2016 Approved Domestic Violence Treatment Provider -received 5-4-2004 Approved Spanish Speaking Domestic Violence Treatment Provider -received 5-4-2004 Approved Female Domestic Violence Treatment Provider -received 3-18-2008 Colorado Alcohol and Drug Counselor III -received 2-12-02 Colorado Alcohol and Drug Counselor II -received -11-30-00 PROFESSIONAL EXPERIENCE Bilingual Outpatient Therapist (7/09 -present) North Range Behavioral Health (11/98 -present) .• Therapist for the Adult Outpatient Program servicing the Social Services, Domestic Violence, Mental Health and Substance Abuse populations in English and Spanish. • Provide direct services for clientele with substance abuse, anger management, mental health and domestic violence issues via assessments, intakes, treatment planning, psycho -educational sessions, group and individual therapy utilizing conceptual understanding of group dynamics, clinical supervision, activities, psycho -education, using various therapeutic models and factors, and process therapy to facilitate clients' therapeutic progress in a group and individual setting. • Traditional therapeutic models include Motivational Interviewing, Cognitive Behavioral Therapy, Client -Centered Therapy, Dialectical Behavioral Therapy, Psychoanalytical and Psychodynamic Therapies. Assist clients with specialized case management in engaging with external services, such as medical screens, case management services, family services, Medicaid services, food stamps and other pertinent services. • Advocate for clients at state and local level. • Collaborate with Probation, Intervention, Rocky Mountain Offender Management Systems, Social Services and other community agencies to provide clientele with external services. • Community Collaboration to provide quality, culturally competent therapeutic services to clients in routine and crisis situations in order to ensure clients successful outcomes. • Supervision, translation, and upgrading of Spanish Adult Outpatient Program curriculum and forms. • Intern Supervision Lead Bilingual Outpatient Counselor II (8/02-7/09) Island Grove at North Range Behavioral Health • Lead counselor for the Adult Outpatient Program servicing the Social Services, Domestic violence and Substance Abuse populations with emphasis on the Spanish -Speaking and Social Services population. • Lead counselor for services provided at Ft. Lupton branch, which includes clinical supervision of other counselors. • Primary auditor of counselor work via chart audits. + Assist Adult Outpatient Program Manager with counselor supervision, and the development and implementation of new programming. + Assist Adult Outpatient Program Manager with screening, interviewing, and recruitment of staff. • Supervision, translation, and upgrading of Spanish Adult Outpatient Program curriculum and forms. • Responsible for organization and upkeep of the Counselor Training Manual. • Provide direct services for clientele with substance abuse, anger management, and domestic violence issues via assessments, intakes, treatment planning, educational sessions, group and individual therapy, as well as specialized case management. .• Assist clients in engaging with external services, such as medical screens, mental health services, family services, Medicaid services, food stamps and other pertinent services. •• Advocate for clients at state and local level. • Community Collaboration to provide quality, culturally competent therapeutic services to clients in routine and crisis situations in order to ensure clients successful outcomes. • Participated in Clinical Trials Network — Motivational Enhancement Treatment to Improve Treatment Engagement and Outcome for Spanish -Speaking Individuals Seeking Treatment for Substance Abuse (METS) protocol at Island Grove from 2004 to 2005. Lead Bilingual Outpatient Counselor I (12/01-8/02) • All regular counselor duties listed above, including some administrative tasks, but excluding staff supervision. Bilingual Outpatient Counselor II (11/98-12/01) • All counselor duties listed above excluding administrative tasks. REFERENCES Work and character references available upon request. Laura L. Hays, M.A., CAC HI, LPC ************************************************* Current Clinical Position: North Range Behavioral Health — Adult Outpatient/BASIC Program Director — Greeley, Colorado July, 2008 - Present Island Grove Treatment Center — Outpatient Program Manager - Greeley, Colorado November, 2005 - July, 2008 ************* Island Grove Treatment Center — Clinical Coordinator - Greeley, Colorado May, 2003 — November, 2005 Island Grove Treatment Center — Outpatient Bilingual Counselor - Greeley, Colorado May, 2000 — May, 2003 Professional Certifications: Colorado State: *Chemical Addiction Counselor, Level I - January, 2001 *Chemical Addiction Counselor, Level II - December, 2001 *Chemical Addiction Counselor, Level III - May, 2003 *Approved Domestic Violence Provider - April, 2004 *Licensed Professional Counselor - June, 2007 *EMDR Trained Counselor - September, 2007 The Wellness Institute, Washington (1995-98) *Certified Clinical Hypnotherapist *Certified Advanced Clinical Hypnotherapist *Certified Release Therapist Education: Master in Community Counseling/Maffiage & Family - University of Northern Colorado, Greeley, Colorado - 2003 Bachelor in Human Services/Counseling - Western Washington University; Bellingham, Washington - 1994 Associate in Arts & Science Degree - Bellevue Community College; Bellevue, Washington - 1992 Associate/Legal Secretary Degree - Lewis -Clark State College; Lewiston, Idaho — 1977 Experiencellnternships: Youth & Family Services Counselor - Island Grove Community Counseling Center, Colorado (May, 2002 - May, 2003) Duties: Facilitate counseling sessions with families and individual adolescents. Crisis intervention, charting, case management, treatment plans Private Counseling Practice -offices in Lewiston, Grangeville, & Kooskia, Idaho (1998 99) Duties: Crisis intervention, charting, case management, treatment plans, correspondence, discharge summaries, & day-to-day operations of practice Clinical Counselor Assistant - Jodi Cook's Counseling, Washington (1993-94) Duties: Case management, charting, & assisting in day-to-day operations of practice Educational/Counselor Assistant - Maple Hills Elementary, Washington (1992-93) Duties: Attended staff meetings, crisis intervention, & individual counseling as needed BoliviaSantaCruz Mission(Span2°slang)—ChurchofJesusChristofLatter-DaySaints (1978-79)Duties:Taught day-to-day skills to improve the native people's lives Jessica L. Varner, LPC 201 N. BEULAH AVE, MILLIKEN, CO 80543 • CELL PHONE 814-977-6656 •E-MAIL JLV0271@HOTMAIL.COM GENERAL EDUCATION Undergraduate: • May 2008: Slippery Rock University of Pennsylvania Bachelor of Science in Psychology: GPA- 3.5 Graduate • May 2012: University of Northern Colorado Masters in Clinical Counseling. Emphasis in Couples and Family Therapy (CACREP Accredited): Current GPA- 3.89 Graduate • April 2010: National Board of Certified Counselors and Affiliates, Inc. Nationally Certified Counselor Certificate Graduate • December 2014: Licensed Professional Counselor Graduate • November 2016: Certified Addictions Counselor H PROFESSIONAL EXPERIENCE June 2014 - Present October 2012 - June 2014 January 2012 - August 2012 May 2011 - June 2011 May 2008 - August 2008 August 2007 - May 2008 September 2004 - December 2005 North Range Behavioral Health Center. Adult Outpatient Team Location: Greeley, CO Worked with adults with mental health, substance abuse, and co-occurring disorders in individual and group therapy settings. • Centennial Mental Health Center Location: Sterling, CO Worked with diverse populations, children, adolescents, and adults in individual, family, and group therapy settings. Conducted intakes; wrote treatment plans and reports, crisis management, and collaborated with other professionals such as psychologists, psychiatrists, caseworkers, probation officers, educators and physicians. Centennial Mental Health Center (Internship) Location: Fort Morgan, CO Worked with diverse populations, children, adolescents, and adults in individual, family, and group therapy settings. Conducted intakes; wrote treatment plans, reports, and collaborated with other professionals such as psychologists, psychiatrists, caseworkers, probation officers, educators, and physicians. Assistant/Supervisor Location: Greeley, CO (University of Northern Colorado) Assisted Dr. Betty Cardona (professor) in observing the students' sessions with clients and providing feedback to students in the family practicum course. Your Safe Haven Inc. (Internship) Location: Bedford, PA Provided support for crime victims in Bedford County, filed PFA's (protection from abuse), attended court hearings, and did secretarial work at the office. Research Assistant Location: Slippery Rock, PA Assisted professors in organizing and entering data for research on mutuality in relationships and eating disorders and for research on the LGBT population and smoking. Music Therapy Clinical Work Location: Counties in Western Pa region Provided music therapy services to a wide range of clientele from little children to older adults with issues such as learning disabilities, Alzheimer, and cerebral palsy. TRAININGS • Attended trainings in solution focused brief therapy, dialectical behavior therapy, music therapy, and webinars for trauma -focused CBT and cognitive processing therapy, CAC II classes and strategies for self-improvement and change PROFESSIONAL AFFILIATIONS/MEMBERSHIPS 2009 - Present REFERENCES Chi Sigma Iota (National Counseling Honorary) References available upon request Ortega 1 ISABEL ORTEGA 2002 Buckeye Ave, Greeley CO 80631 (970) 590-6789 EDUCATION Associates of liberal Arts May -2016 Currently attending at University of Northern Colorado August of 2016 -present Colorado Addictions Colorado Alcohol and Drug Counselor III 2011 Colorado Alcohol and Drug Counselor II 2008 Eaton High School, Eaton, Colorado May 2000 SKILLS AND ABILITIES PROFESSIONAL EXPERIENCE Bilingual Outpatient Counselor (1/08 -present) North Range Behavioral Health (1/08 -present) + Substance Abuse Counselor for the Adult Outpatient Program servicing both the English and Spanish populations. :• Provide direct services for clientele with substance abuse, issues via assessments, intakes, treatment planning, psycho -educational sessions, group and individual therapy utilizing conceptual understanding of group dynamics, clinical supervision, activities, psycho - education, using various therapeutic models and factors, and process therapy to facilitate clients' therapeutic progress in a group setting. + Traditional therapeutic models include Motivational Interviewing, Cognitive Behavioral Therapy. s Collaborate with Probation, Intervention, and other community agencies to provide clientele with external services. + Community Collaboration to provide quality, culturally competent therapeutic services to clients in routine in order to ensure clients successful outcomes. e• Complete victim contacts to include contact via mail, phone and in person for victims of domestic violence partners. :• Translation, and upgrading of Spanish Adult Outpatient Program curriculum and forms. Communication -Fluent in Spanish and English, oral and written. - In- house interpreter and translation of forms. Trainings/Certifications -Certified Addiction Counselor III Ortega 2 -Currently facilitating addiction counseling monolingual groups in an outpatient setting. -Customer Service, client crisis, and office trainings: 2012,2007,2006,2005 WORK HISTORY Substance Abuse Counselor North Range Behavioral Health, Greeley, Colorado Consumer Advocate North Range Behavioral Health, Greeley, Colorado Support Staff II North Range Behavioral Health, Greeley, Colorado Secretary Island Grove Regional Treatment Center, Greeley, Colorado Office Technician Island Grove Regional Treatment Center, Greeley, Colorado January 2008 —present January 2013 to March 2014 February 2008 -March 2015 October 2005 -February 2008 August 1999 -October 2005 Grazia Liv Diane DiMauro 4745 Hahns Peak Dr. #204 Loveland, CO 811538 Phone: 303-834-0521 grazialivdimauro(a gmail.com Education • Master of Arts in Counseling, Regis University o Graduation December 10th 2016 o GPA: 3.97 • Bachelor of Science in Psychology, Colorado State University o Completion May 2013 o Overall GPA: 3.94, Major GPA: 4.0 o Dean's List: Fall 2010, Spring 2011, Fall 2011, Spring 2012, Fall 2012, Spring 2013 o Member of the National Society of Collegiate Scholars o Magna Cum Laude N1 'ork Experience • North Range Behavioral Health, Adult Outpatient therapist (Greeley, CO, December 2017 — present) o Offer both substance and mental health therapy. o Run both individual and group sessions. o Work with probation, and DHS when applicable • North Range Behavioral Health, Graduate Intern (Greeley, CO, January 2016 — December 2016) o Intensive Youth and Family, 180 and DRC programs o Conducted intakes, co -facilitated groups, and offered individual therapy o Some issues I worked with include: suicide ideation, self -harm, illegal behaviors, gang -related behaviors, substance abuse, trauma • Aspen House, Care Partner (QMAP) (Loveland, CO, December 2013 — August 2014) o Worked with individuals diagnosed with dementia o Administered medication o Helped residents with daily tasks, and encouraged to engage in activities o Calmed residents when they were unsettled • Research Assistant (Colorado State University, August 2012- December 2012) o Worked on the development of experimental research questions o Researched and summarized academic journals and showed how they supported the need for research in the field olunteer work • Volunteer at Casa de la Esparanza helping second -generation agricultural immigrant children with homework (September 2014 — April 2015) • Helped children who struggled with handwriting to develop their fine motor skills (Namaqua Elementary School, January 2012 — June 2012) • Supported schools and other institutions that suffered from the tsunami (Chennai, India, 2005) DANIELLE SOLANO Longmont, CO 80503 720-301-9449 Dsolano901 @aol.com Education Walden University Masters in Mental Health Counseling, Emphasis in Crisis and Trauma 2015 Westwood College 2009 Bachelor of Science, Criminal Justice, Emphasis on Victim Advocacy Skills -Case Management Specialist -Crisis Intervention Specialist -Victim Advocacy Specialist (Domestic Violence) -Substance Abuse and Mental Health Therapist (group and individual) (On track for CAC II) -Intake Specialist (Assessment, diagnosis, level of care and care coordination) -Theoretical Orientation; A Culturally competent, eclectic client centered approach supported by CBT, DBT, Existentialism, Reality Therapy, and Enhanced Motivational Interviewing. Experience Adult Out Patient Therapist: Mental Health Partners, Adult Services Responsibilities include on -call group facilitation for mandated and voluntary clients seeking mental health or substance treatment. 1/2017 - Present Adult Out Patient Therapist: North Range Behavioral Health, Adult Services 3/2015- Present Responsibilities include Level II Differential Assessments to determine the appropriate level of care and client specific interventions for mental health and substance use. This includes, collaboration with internal and external supportive services, clinical supervisor and psychiatrist. Clients are provided with on -going assessment throughout treatment, immediate crisis intervention, ongoing individual therapy, family support, group therapy, and case management as needed. Additional responsibilities include service plan development, monitoring and measurable goals, and maintaining clinical records and other reporting data for clients. Case Manager: North Range Behavioral Health, Adult Outpatient 3/2012-3/2015 Responsibilities include level II differential intakes and on -going assessment of an individual's therapeutic needs. Secures resources and services for individuals with mild to severe mental illness and/or substance abuse issues. Coordinates with internal as well as external supportive resources to deliver needed services to program participants. Case Manager: Youth and Family Connections/Weld County JAC, Greeley, CO Case management for at -risk youth and their families. Responsibilities included; resources, referrals and assessments with youth and parents to identify and address factors that influence family functioning and academic progression. 2011-2012 1 DANIELLE SOLANO Longmont, CO 80503 720-301-9449 Dsolano901 ®aol.com Related Experience Shelter Staff: Catholic Charities, Guadalupe Center, Greeley, CO 2011-2012 Responsibilities; monitoring a 24 hour facility, resident check in's and shift reports as needed. Victim Advocate: Gateway Battered Women's Shelter, Aurora, CO Victim advocacy for victims of domestic violence in a court setting. Responsibilities included; community resources, preparation for court subpoena, victim interviews, documentation of physical injuries, and educating the victims on the court process and their rights. Colorado Organization for Victims Assistance Internship with the Denver City Attorney's Office Denver City Attorney's Office Contract Juvenile Victim Advocate North Range Behavioral Health MH/SA Counseling Practicum (100 hours) and Internship (600 hours) References Nicena Fontaine 970-405-6085 Bill Dickson 303-875-3270 Laura Hays, AOP Program Director 970-347-2357 Abbey Keeney, AOP Program Coordinator/Internship Supervisor 303-579-1372 2009-2010 2007-2008 2007-2008 2014-2015 Personal Reference Personal Reference Professional Reference Professional Reference 2 Alisha C. Buesing, LPC, CAC II 3713 Riverside Parkway, Evans, CO 80620 abuesing@outlook.com 970-590-4362 Licensing and Credentials: Licensed Professional Counselor — LPC.0013106 State of Colorado Certified Addiction Counselor II — ACB.0008035 State of Colorado Academic Preparation: M. A., Clinical Counseling University of Northern Colorado Greeley, CO B. A., Psychology University of Colorado at Colorado Springs Colorado Springs, CO Counseling Related Experience: Active: 6/21/2016 Expires: 8/31/2017 Active: 4/12/2016 Expires: 8/31/2017 Graduated: May 9, 2014 Graduated: May 20, 2011 Therapist May 2014 — Present North Range Behavioral Health — Adult Outpatient Program • Adhere to utilization, quality improvement and corporate compliance policy and standards. • Conduct Intake Interview Assessments and refer individuals to appropriate services • Facilitate counseling groups and provide individual counseling as assigned to achieve goals of treatment plan. • Working with multiple agencies and conducting case management as needed to provide the client and their families with appropriate resources and needs • Conduct crisis intervention via telephone, and face-to-face treatment; intervene and de-escalate crisis situations with customers; assess risk of harm to self or others and arrange needed resources. • Advocate for participants in many different forums including at the federal, state and local court systems, with family, school system, etc. • Develop written treatment plans/updates and continuing care plans and makes appropriate referrals; maintain electronic health records in accordance with agency standards • Attend staff meetings/clinical supervision and other required meetings as assigned. • Complete written discharge summaries and correspondence within established time lines. Clinical Intern Touchstone Health Partners — Child and Family Services Practicum II/Internship Counseling Experience • Conducted individual talk and play therapies for youth 7-17 and their families • Maintained a caseload of 15 — 18 weekly clients • Conducted Intake Interview Assessments August 2013 — May 2014 • Co -facilitated therapy groups including an adolescent female empowerment group and children's social skills group • Co -created and co -facilitated LGTBQ adolescent counseling group • Working with multiple agencies and conducting case management in providing youth and families with appropriate resources and needs • Established appropriate counseling goals, designed intervention strategies, evaluated client outcome, and successfully terminated the counselor -client relationship • Ability to appropriately prepare and manage clinical documentation Counselor -in -Training Jan. 2013 — May 2013 University of Northern Colorado - Psychological Services Clinic Practicum I: Individual Counseling Experience • Accepted and used supervisory feedback to improve counseling effectiveness • Developed an understanding of essential interviewing and counseling skills to be able to develop a therapeutic relationship • Established appropriate counseling goals, designed intervention strategies, evaluated client outcome, and successfully terminated the counselor -client relationship • Ability to appropriately prepare clinical documentation • Reflected on and critically evaluated in -session counseling behaviors and maintained professional boundaries • Accurately assessed counseling strengths and weaknesses Youth Advisor April 2012 — May 2014 Alternative Homes for Youth, Greeley, CO • Ensure compliance with federal, state and local laws including licensing rules and regulations regarding child welfare, mental health services, alcohol and drug abuse, etc • Responsible for making sure there is proper supervision of the youth residents • Enforce program rules and consequences based on program procedures, individual treatment plan and individual education program • Execute appropriate procedures regarding medication administration and Therapeutic Crisis Intervention • Responsible for providing a therapeutic milieu that promotes growth, empowerment and healing • Attend weekly staff meeting and communicate pertinent information to Program Manager • Carry out additional responsibilities as assigned Hospice Volunteer: In -Patient Unit Jan. 2011 — May 2011 Pikes Peak Hospice and Palliative Care, Colorado Springs, CO • Check on patients on a regular basis (hour, half hour, or fifteen minute intervals) • Respond to patient call lights and fulfill patient requests (make patient more comfortable, take food orders, visit with patient, foot massage, etc.) • Assist CNAs and nurses with patient care • Provide emotional support for both patients and their families • Fulfill tasks assigned by nursing and other hospice staff, and chart patient care. Additional Experience: Wal-Mart Customer Service Manager Customer Service Representative Cashier • Assisted and managed cashiers, service and transactions Feb. 2011 — Apr. 2012 July 2010 — Feb. 2011 July 2009 — July 2010 desk associates, and customers in the completion of tasks • Helped write associate evaluations, problem -solve, and stick to a timely schedule • Completed merchandise returns, processed transactions, trained and disciplined cashiers and service desk associates • Opened and closed the store front end and customer service desk • Helped answer customer questions, cash payroll and government checks, completed Money Gram send and receive transactions • Completed tasks assigned by other management Related Coursework: • Diagnosis and Treatment Planning • Lifespan Developmental Psychology • Children, Adolescents, and Their Systems • Treatment and Assessment of Substance Abuse • Foundations in Play Therapy • Practicum in Play Therapy • Career Theory and Assessment Professional Memberships: American Counseling Association Member September 2011 - 2014 • Gerontology • Group Methods in Counseling • Legal and Ethical Aspects of Counseling • Trauma and Crisis Intervention • Assessment and Appraisal in Counseling • Family Systems • Counseling Diverse Populations Chi Sigma Iota: Rho Epsilon — Professional Counseling Honors Society Member Since May 2014 Recognitions and Trainings: 2012 Broken Hearts, Healthy Hearts Grief Counseling Workshop, Colorado Counseling Association 2012 Trauma Competency Conference, Colorado Counseling Association 2012 Therapeutic Crisis Intervention Certification, Alternative Homes for Youth 2013 Applied Suicide Intervention Skills Training, Living Works Education 2016 ADARA Breakout Conference Cynthia K. Gibbens 505 33rd Street Evans, Colorado 80620 EDUCATION: Paris Junior College, Paris, Texas Aims Community College, Greeley, Colorado University of Northern Colorado, Greeley, Colorado (BA in Psychology) University of Phoenix, Westminster, Colorado (Master of Community Counseling) CERTIFICATION: Licensed Addictions Counselor Colorado Certified Addictions Counselor III National Certified Addictions Counselor II Master Addictions Counselor (NAADAC) LICENSURE: Licensed Professional Counselor (Wyoming) Licensed Professional Counselor (Colorado) 1991 — 1993 1994 — 1995 1993 — 1998 2004 - 2006 2007 2000 2002- 2006 2007 2010 - 2012 10/2012 Cynthia K. Gibbens 505 33rd Street Evans, CO 80620 WORK EXPERIENCE: North Range Behavioral Health, Greeley, CO (970)347-2120 November 4, 2013 Supervisor: Laura Hays I provide assessment, treatment planning, education, individual/group therapy, case management with family members, employers, and community agencies, and discharge planning. I served clientele with mental health and substance abuse and clients with co- occurring disorders. Michaels Arts and Craft Stores, Greeley, CO (970) 353-9780 April 22, 2013 Supervisor: Pearl Smith, Cuprea Lange; Store Manager: Dino Rivera I work as a picture framer in the store frame shop and assist with customer service throughout the store. Advantage Sales and Marketing/In Marketing April 15, 2013 — October 20, 2013 Supervisor: Laci Cummings (970)212-6685 I prepared, presented, and distributed a variety of food products to store shoppers. Bass Pro Shops, Denver, CO (720) 385-3600 October, 17. 2012 — Christmas 2012 Supervisor: Nicole I was working in the Santa's Wonderland at Bass Pro Shops as a seasonal employee. Peak Wellness Center, Cheyenne, Wyoming (307) 632-9362 February 2007 - April 2012 Supervisors: Natalie Milligan, Elaine Renfro, Linda Goodman I began working at PWC after taking time off following completion of my master's degree. I provide assessment with the ASI, treatment planning, education, individual/group therapy with the Matrix System, case management with family members, employers, and community agencies, and discharge planning. I served clientele with substance abuse and clients with co occurring disorders. I completed course training in Seeking Safety by Lisa Najavits and have developed a group therapy for treatment for PTSD and substance abuse following the plan described in this manual. I have also completed trainings including Traumatic/Acquired Brain Injury, Wounded Warrior, Prolonged Exposure Therapy, and EMDR basic training. Turning Point, Ft. Collins, Colorado (970) 232-3660 November 2005 — February 2007 Supervisors: Colleen Timpe, Eddie Russell I completed a master's internship at Turning Point — Birch. I provided individual/group/family therapy, case management with referring agencies and family members, treatment planning, education, and discharge planning. The clientele served was adolescents with substance abuse and co occurring disorders. I also provided clinical supervision for counselors accumulating credits and hours for Certified Addiction Counselor (CAC). Harmony Foundation, Inc., Estes Park, Colorado (970) 586-4491 June 2000 — July 2006 Supervisors: Roger Kirby, Debra Foster, Gary Wise, Sandi Kohtz I was a primary counselor at the Harmony Foundation, residential treatment. I managed a case load and provided assessments with the Addiction Severity Instrument (ASI), treatment planning, case management with family members, referring agencies and continuing care facilities, education lectures, individual therapy, group therapy, and discharge planning. Island Grove Regional Treatment Center, Greeley, Colorado (970) 356-6664 March 1995 — May 2000 Supervisors: BJ Dean, Bill Wendt, Frank Cohoon, Rhonda Fraser I began IGRTC as a Detox Aide and my duties were to admit, monitor withdrawal symptoms and discharge clients with appropriate referrals for treatment and recovery. I also facilitated individual and group therapy/education as well as family groups. I obtained CAC in June 1996. I began co facilitating the Intensive Outpatient Program in 1997 and administering Addiction Severity Index (ASI) to make appropriate treatment referrals for IGTC, Dept. of Social Services, and Probation Dept. I provided individual/group/family therapy and for a time was the solo IOP counselor. My duties also included treatment planning, discharge planning, and case management with referral sources, and other community agencies. Beginning in 1998 I received CAC II and had a small caseload of clients in the Transitional Residential Treatment program. I completed assessments, treatment planning, case management, education, discharge planning, and individual/group/family therapy Cynthia K. Gibbens 505 33rd Street Evans, CO 80620 REFERENCES: Valerie Lemon Ft. Collins, CO 80526 (970) 231-9853 Valerie.lemon@mac.com Ms Kathleen Christopher 970 Sutton Lane Estes Park, Colorado 80517 (970) 586-8478 Gary Denman 25847 WCR 43 Greeley, CO 80631 (970) 412-8237 f7dNORTHORANGE BEHA April 17th, 2014 Tobi Vegter Child Welfare Contract and Services Coordinator Weld County Department of Human Services Division of Child Welfare Resource Unit 822 7th Street, Suite 150 Greeley, CO 80631 Dear Tobi: Attached is North Range's Core and Contracted Services Bid proposal for the Substance Use Disorder Monitoring service program area. We propose to provide these services to male and females at North Range's Crisis Stabilization site, 1140 M St., Greeley. All services will be provided by academically qualified and thoroughly trained staff as evidenced by the attached resumes and certification information. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and projected outcomes. If you have any questions, please do not hesitate to contact me. Sincerely, Ahmad Sedaghat MA, LPC Program Director — Crisis Stabilization Services 970-313-1173 Ahmad.sedaghat@northrange.org Enclosures Where hope begins. 1300 North 17th Avenue • Greeley, CO 80631 • 970-347-2120 • North Range Behavioral Health 2017-18 Monitored Sobriety Services Attachment to Provider Information Form (Proposal Cover Sheet) Weld County Department of Human Services Contracted Services — Program Year 2017-18 PROPOSED SCOPE OF SERVICES and FEES SCOPE OF SERVICES Contractor (North Range Behavioral Health) will provide timely and quality monitored sobriety services to male and female clients referred by the Department as follows: a. Services will be provided at the North Range Behavioral Health - Crisis Stabilization Services facility at 1140 M Street in Greeley, Colorado. b. Contractor will provide a qualified monitored sobriety collector 24 hours a day/seven days a week. c. Contractor will confirm all positive and negative monitored sobriety results for a BA within 24 hours through a phone call, test result, e-mail, and/or fax to the referring caseworker. Contractor will confirm all positive and negative monitored sobriety results for lab UA's once processing has been completed through Redwood, typically within 3 days. Instant UA results will be reported within 24 hours. If the result is positive, the result will be sent to Redwood for final confirmation. d. Contractor will submit a copy of the valid Authorization for Services form, result, and client sign in sheet (if applicable) with each monthly billing. e. All processed test results, will be available online 24 hours a day, seven (7) days per week at Redwood Toxicology (www.webtoxicologv.com). f. Bilingual services are available via contracted translation supports. g. Contractor will accept referrals via email, phone, fax, or by verbal report from client. Upon arrival, contractor will contact DHS staff to confirm the referral of the client for monitoring services. h. Monitoring services are supervised daily by Program Director, Ahmad Sedaghat (1.5 years of supervisory experience). Ahmad receives supervision by Administrative Director, Kim Collins MSEd, LPN, NCC (10 years of supervisory experience). i. Monitoring services are at times eligible for Medicaid funding. Contractor is a Medicaid approved provider. Upon referral, contractor will contact the identified case worker to determine funding. When eligible, contractor will utilize Medicaid resources. FEES $20.00/Episode (Urinalysis Test — 5 Panel: THC, Cocaine, Amphetamines, Benzodiazepines, Opiates) $20.00/Episode (Urinalysis Test — 7 Panel: THC, Cocaine, Amphetamines, Benzodiazepines, Opiates, Barbiturates, Alcohol) $20.00/Episode (Multi -panel Instant UA) $20.00/Episode (Instant Swab) $35.00/Episode (GCMS — Confirmation of Positive Result) $5.00/Episode (Breathalyzer) $100.00/Episode (Hair Testing) $50.00/Episode (Patch Monitoring) $35.00/Episode (Ethyl Glucuronide/EtG Test) $50.00/Episode (UA — Expanded Designer Stimulants — 14 Panel) $35.00/Episode (UA — MDPV, Mephedrone, Methylone — 3 Panel) $35.00/Episode (UA — Synthetic Cannabinoids — "Spice") $35.00/Episode (Oral Swab — Synthetic Cannabinoids — "Spice") $2.00/Episode (UA - Single Panel EtG Add-on Test — Only When Added to a 5 or 7 Panel UA) $2.00/Episode (UA - Optional Add-on Panel (Oxycodone or Buprenorphine) — Only When Added to a 5 or 7 Panel UA) Amber Frazier 3775 W 25th St Apt G306 (970) 218-0945 Greeley, CO 80634 amber.frazier@northrange.org Education Bachelor of Science, Psychology University of Northern Colorado, Greeley, CO May 2010 GPA: 3.2/4.0 Certifications Certified Nurse Assistant, Expiration: January 2012 CPR, Expiration: November 2012 Experience Certified Nurse Assistant, Prospect Park Living Center, EPMC, Estes Park, CO 4/2006-11/2009 • Assisted residence in activities of daily living; patient ratio average of 1:12 • Provided residence with stimulating activities • Documented relevant physical, cognitive and social changes in residence Internship, Crisis Stabilization Services, NRBH, Greeley, CO 1/2010-4/2010 • Performed fifteen minute checks on the Detox and ATU floors • Checked vital signs on Detox clients • Assisted with group and one-on-one therapy sessions for Detox and ATU clients • Aided in Detox admissions and discharges Behavioral Health Worker 2, Crisis Stabilization Services, NRBH, Greeley, CO 8/2010 -Present • Perform sample collections for drug and alcohol testing; urinalysis, oral swabs, patches, hair follicle, and breathalyzers • Maintain client records related to drug and alcohol testing • Monitor clients taking Antabuse • Collect payments for detox and monitoring services • Reporting monitoring results to requesting agencies Trainings QMAP-Qualified Medication Administration Person, Expiration: 9/2015 CAC 1; working towards certification starting 10/2010, expected completion 10/2011 CAC 2; working towards certification starting 10/2010, expected completion 12/2011 Detox Program Training 4/7-8/2011 Activities Alpha Kappa Psi- international, professional business fraternity Psi Chi- international honor society in psychology • Professional development • community service Maeve Widmann maevewidmann@gmail.com • 720-935-5735 widm3875@bears.unco.edu 2602 W. 12th Street Rd. • Greeley, CO 80634 Objective: To expand my education and experience in the field of psychology, mental health and substance abuse. Skills and Qualifications: • 270 hours of internship experience at North Range Crisis Stabilization Services • Working with those going through a mental health crisis and detox • Experience inputting client information in secure servers, including shift notes and progress notes • Conducting therapeutic and motivational one on ones with clients • Conducting group sessions with clients • Exposure to both client intakes and discharges • Following HIPPA guidelines and the client's requests • Performing 15 minute safety checks and taking client's vitals • Show compassion and empathy towards clients and their unique situations • Clinical writing experience • Three years Supervisory experience • High Academic Achievements (3.75 GPA) • Customer service experience • Written and Verbal Communications skills • Computer skills • Punctual • Ongoing education in the mental and behavioral health field • Research experience Employment History: May 2016- Current North Range Crisis Stabilization Services Intern - Greeley, CO Supervisor: Rachel Watson, Katherine Gillette • Observe, learn, and assist in client intakes and discharges on both the Acute Treatment Unit and Detox units • Participate in group sessions and one on ones on the ATU • Conduct one on ones with clients on the Detox unit • Preform 15 minutes checks on both units • Inventory client's personal belongings on both units • Take, record, and enter vitals into Avatar • Enter shift notes into Avatar • Supervise clients during cigarette breaks and meal times • Fill out and enter paperwork for UAs and assist potential clients and visitors in the monitoring room • Set up services for clients after leaving Crisis Stabilization Services • Assist clients in plans for after discharging • Assist therapists and Behavioral Health Workers in daily activities July 2013 — Present Papa Murphy's Pizza Assistant Manager - Greeley, CO Supervisor: Taylor Gies • Supervise Crew members and shift supervisors • Train new crew members • Handle positive and negative feedback paid to the crew or store • Ensure excellent customer service • Assist and support the General Manager • Provide and implement solutions for customer complaints • Maintain clean and sanitary working space • Comply with all food service regulations • Make exceptional pizzas • Clean and close up shop at night • Open shop and prepare store for business • Complete paperwork and inventory for store • Place produce orders Education and Training: July 2013 - present University of Northern Colorado Undergraduate: Major: Psychology Minor: Criminal Justice & Sociology Certificate: Criminal Investigation Greeley, CO Graduating with Latin honors in December 2016 Lakewood High School High School Diploma: General Graduated: May 2013 Lakewood, CO Accomplishments and Activities: • Honors List for Academic Achievement • 3.75 accumulative GPA • Secretary and Treasurer of UNC Club Softball, 2016 • 18 Credit hours per semester while working 35+ hours a week • Criminal Investigation Certificate (current) • Research Assistant with Dr. Doug Woody (University of Northern Colorado) 2015 -Current • Disability Support Services Volunteer References: Taylor Gies, Manager, Current Employer 970-616-2767 Doug Woody, Research Supervisor/Instructor 970-351-2528 Shawna Hollingsworth, Manager, Former Employer 970-980-4994 Austin Perotin, Manager, Former Employer 720-939-6229 Bill Powers, Current Employer 303-995-6480 NORTHORANGE BEHA April 18, 2017 Tobi Vegter Child Welfare Contract and Services Coordinator Division of Child Welfare Resource Unit 822 7th Street, Suite 150 Greeley, CO 80631 North Range Behavioral Health (NRBH) is the community behavioral health center serving Weld County, Colorado. We are a private, non-profit corporation dedicated to providing professional, culturally competent behavioral health services to the residents of our area. NRBH is submitting this contract proposal for the mental health services option, specifically for psychological evaluations, to provide diagnostic/therapeutic services to assist the Department of Human Services, Child Welfare, in developing the family services plan, and to assist the families that are serviced to improve family communication, functioning, and relationships. NRBH is proposing to provide psychological/behavioral health evaluations that involve an integrated assessment of mental health and substance abuse issues. Services to be provided under the terms of this contract will be provided, at a minimum, by an academically qualified, doctorate candidate under the direct supervision of a licensed clinical psychologist. Evaluators will also be competent in the evaluation of substance abuse issues and supervised by a CAC III or LAC supervisor, and trained in Trauma Informed Care. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and service time frames. If desired, NRBH is also available to meet with the Department of Human Services staff to explain the program, time lines of response to referrals, and answer questions to enhance the program. NRBH contact information is as follows: North Range Behavioral Health 1300 North 17th Avenue Greeley, CO 80631 970-347-2120 Website: www.northrange.org If you have any questions, please do not hesitate to contact us. We look forward to hearing from you regarding the status of this proposal. Sincerely, Maureen Huff, Ph.D., Licensed Psychologist, CAC III Primary Contact: 970-313-1186/maureen.huff@northrange.org Where hope begins. 1300 North 17th Avenue • Greeley. CO 80631 • 970-347-2120 • NRBH CONTRACT PROPOSAL NORTH RANGE BEHAVIORAL HEALTH MENTAL HEALTH SERVICES: PSYCHOLOGICAL/BEHAVIORAL HEALTH EVALUATIONS SCOPE OF SERVICES Contractor Description: North Range Behavioral Health (NRBH) is the community behavioral health center serving Weld County, Colorado. We are a private, non-profit corporation dedicated to providing professional, culturally competent behavioral health services to the residents of our area. Target/Elieible Population The target/eligible population includes child welfare family members (children, adolescents, and/or adults) referred by the Department of Human Services due to risks of out -of -home placement and who are in need of possible behavioral health services. Mental Health/Psychological Evaluation Services to be provided under the terms of this contract will be provided, at a minimum, by an academically qualified doctorate candidate under the direct supervision of a licensed clinical psychologist. Evaluators will also be competent in the evaluation of substance abuse issues and will be supervised by a CAC III or LAC supervisor; thereby providing integrated behavioral health evaluations. All providers have been, or will be, trained in Trauma Informed Care. Providers receive one hour of individual clinical supervision each per week, and they attend group supervision to staff cases for one hour each week. The ratio of licensed providers to unlicensed providers in group supervision is approximately 1:1. Supervision of psychological evaluations is provided by a Licensed Clinical Psychologist with CAC III/LAC certification, who has 20 years of experience supervising others. Evaluations will be provided in English. Spanish speaking evaluations will only be provided if/when there is a qualified Spanish speaking evaluator available. NRBH is a Medicaid provider and NRBH is able to provide evaluation services under Medicaid when it is determined that the evaluation request meets criteria for medically necessary services. NRBH can assist the Weld County Department of Human Services by delivering psychological/behavioral health evaluation services for children, adolescents, adults, and families involved with the Child Welfare system. Evaluation results can be useful in the development of treatment plans, placement options, and decisions regarding reunification of families through quality and cost effective behavioral health evaluations. DHS Contract - psych evals 2017-2018 Page 1 of 5 NRBH Rate Schedule: Type of Services, Description of Services, & Rates FOUR -TIER FLAT RATE PSYCHOLOGICAL EVALUATION OPTIONS Level I: Behavioral Health Evaluation Cost: $250.00 Est. Time: 3-6 hours Example: 1. Review of DSS case records, and if applicable NRBH records. 2. Clinical interview and integrated diagnostic evaluation (assessment of mental health and substance abuse issues). 3. Possible administration of brief screening inventories (e.g., Beck Inventories, State -Trait Inventories, Personality Assessment Screener). 4. Feedback given to the client. 5. Written report addressing relevant psychosocial history, diagnostic formulation, and treatment recommendations. The Behavioral Health Evaluation can be useful for ruling in/out basic mental health and substance abuse issues, advising on provisional diagnoses, and making recommendations for treatment when appropriate. Level 2: Partial Psychological Evaluation Cost: $800.00 Est. Time: 8-14 hours Example: 1. Review of DSS case records, and if applicable NRBH records. 2. Clinical interview and integrated diagnostic evaluation (assessment of mental health and substance abuse issues). 3. Administration of a partial test battery, such as administration of just cognitive or just personality testing (e.g., Wechsler IQ tests, MMPI, MCMI, PAI, etc). 4. Consultation with collateral sources. 5. Feedback given to the client. 6. Write-up addressing psychosocial history, test results, diagnostic formulation, and treatment recommendations. This evaluation can be useful for ruling in/out mental health, substance abuse, cognitive, and/or personality issues, advising on diagnoses, and making treatment recommendations. Level 3: Full Psychological Evaluation Cost: $1200.00 Est. Time: 16-20 hours Example: 1. Review of all available records, including DSS records, prior evaluation and behavioral health treatment records, NRBH records if applicable, police reports, medical records, and records from other agencies involved in the case. DHS Contract - psych evals 2017-2018 Page 2 of 5 NRBH 2. Extensive integrated clinical evaluation (multiple sessions). 3. Administration of a formal battery of tests (multiple tests) to assess personality, emotional, and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQ, MMPI, MCMI, PAI, STAXI, STAI, Beck screens, TSI, PSI, etc). 4. Consultation with collateral sources. 5. Feedback given to the client. 6. Write-up addressing psychosocial history, personality issues, emotional functioning and regulation abilities, and/or intellectual functioning and/or parenting/family issues, substance abuse, and diagnostic formulation, as well as treatment recommendations and prognosis. This evaluation can be useful in identifying more significant behavioral health issues and diagnoses, as well as addressing personality issues, intellectual functioning, the ability to manage emotions, parenting issues and potential safety of the children in the home, placement issues, and treatment recommendations. Level 4: Extended Psvchological Evaluation Cost: $1800.00 Est. Time: 20- hours Example: • This level is intended to be utilized when impairment in cognitive functioning is suspected/known, when the client is unable to read or write, when there are major memory deficits, when resistance leads to invalid measures and instruments need to be re -administered, and/or when other significant barriers to testing are present. • Preauthorization is required by WC DSS Administrative Directors prior to requesting or proceeding with this level of evaluation 1 Review of all available records, including DSS records, prior evaluation and behavioral health treatment records, NRBH records if applicable, police reports, medical records, and records from other agencies involved in the case. 2. Extensive integrated clinical evaluation (multiple sessions). 3. Administration of a formal battery of tests (multiple tests) to assess personality, emotional, and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQ, MMPI, MCMI, PAI, STAXI, STAI, Beck screens, TSI, PSI, etc). 4. Consultation with collateral sources. 5. Feedback given to the client. 6. Write-up addressing psychosocial history, personality issues, emotional functioning and regulation abilities, and/or intellectual functioning and/or parenting/family issues, and diagnostic formulation, as well as treatment recommendations and prognosis. This evaluation can be useful in identifying more significant mental health and substance abuse issues and diagnoses, as well as addressing personality issues, intellectual functioning, the ability to manage emotions, parenting issues and DHS Contract - psych evals 2017-2018 Page 3 of 5 NRBH potential safety of the children in the home, placement issues, and treatment recommendations. Changes to Evaluation Requests (requests for higher levels of evaluation) If an evaluation results in recommendations for more extensive testing (e.g., Level II eval moved to a Level III eval), NRBH will only bill for the single rate of the higher level of evaluation. Partially Completed Evaluations When an evaluation is only partially completed, the charge will be the lower of the following: • $120.00 per hour • The cost of the next lower level of evaluation Partially completed evaluations will come with a written report of any finding that can be appropriately offered based upon the information that was gathered. Other Services: $120.00 per hour • Court Facilitation Meetings • Court Testimony • Case Conferences All services will be provided by an NRBH provider at an NRBH location or another suitable location (e.g., client's home, school, detention center), depending on circumstances. All services will be referred via email by the Core Services Specialist. The referral authorization level will be clearly stated on the referral. Any supporting documentation available via email will be sent with the referral. The initial referral will be for either: a Behavioral Health Evaluation; a Partial Psychological Evaluation; or a Full Psychological Evaluation. If, after meeting with the client, the evaluator recommends a higher level of evaluation, the evaluator will submit to the caseworker and the Core Service Specialist a one -page summary of the reasons why such recommendation are being made. An authorization to proceed with higher level testing is needed from the Core Services Specialist before further testing is done. The Core Services Specialist will consult with the Child Protection caseworker and/or their supervisor regarding authorization. Referrals will contain start and end dates for payment authorization. Only services provided within those authorization dates will be paid by the Department. Any services provided outside those dates will be denied for payment. Service Time Frames 1. Evaluations, through a written report, will be completed within forty-five (45) days from the point of first contact with the client, provided that the client can be reached for appointments and the client attends appointments as scheduled. 2. Deadlines may be extended by the Department of Human Services on behalf of North Range when clients cannot be found or reached. DHS Contract - psych evals 2017-2018 Page 4 of 5 NRBH 3. If a client partially complies with appointments, North Range will write the evaluation based on information obtained up to that date and prorated based on hours performed by North Range. If no appointments have been made, the evaluation referral may be dropped by North Range due to the client's failure to follow through and North Range will not bill the Department of Human Services. North Range agrees to: I . Be available to meet with the Department of Human Services staff to explain the program, time lines of response to referrals, and answer questions to enhance the program. 2. Be available for the Families, Youth and Children Commission review and attendance at the FYC meeting, if requested. Termination This Agreement may be terminated at any time by either party given sixty (60) days written notice. DHS Contract - psych evals 2017-2018 Page 5 of 5 MAUREEN E. HUFF, Ph.D., Licensed Psychologist, CAC III Program Director, North Range Behavioral Health Licensed Psychologist, State of Colorado maureen.huff@northrange.org Office: (970) 313-1186 Cell Phone: (970) 219-5031 LICENSURE AND EDUCATION CAC III 2010 Certified Addictions Counselor III, State of Colorado License 2000 Licensed Psychologist, State of Colorado Ph.D. 1998 Counseling Psychology, Colorado State University (4.0 GPA) APA Accredited Internship: Denver VA Medical Center, Colorado. M.S. 1995 Counseling Psychology, Colorado State University (4.0 GPA) B.A. 1992 Psychology Major & Sociology Minor, St. Cloud State University, MN. (4.0 GPA) PROFESSIONAL HONORS AND AWARDS • CSU Alumni Association "Best Teacher Award of the Year" nomination. • CSU Undergraduate "Favorite Faculty of the Year Award." • PHI KAPPA PHI Outstanding Graduate Award for Highest GPA in Social Sciences. • PHI KAPPA PHI National Fellowship Outstanding Applicant Award. • Sociology Department Research Paper Competition, First Place. • PSI CHI Certificate of Recognition for Excellence in Research. • All Colleges and Universities Award, and Letter of Commendation from SCSU's President. • Outstanding College Students of America Recognition. • PHI KAPPA PHI Recognition of High Scholastic Achievement. • SCSU Certificate of Scholastic Achievement and Dean's List (1987-1992). EDUCATIONAL FELLOWSHIPS AND SCHOLARSHIPS: 1995-1997 Teaching Fellowship, Department of Psychology, CSU, Colorado 1995-1996 Women's Forum of Colorado, Graduate Scholarship Grant, Colorado 1994-1995 Working Woman's Scholarship, Working Women's Fair, Inc., Colorado 1992-1993 Graduate Fellowship, Colorado State University, Colorado 1990-1992 PSI CHI Scholarship Award, SCSU Chapter, Minnesota 1990-1991 Ward's SCSU Bookstore Scholarship Award, Minnesota 1989-1992 Nontraditional Student Scholarship Award, SCSU, Minnesota 1989-1992 Allis SCSU Scholarship Award, Minnesota 1988-1992 Phillip Halenbeck Scholarship Award, SCSU, Minnesota PROFESSIONAL INVOLVEMENT, ACTIVITIES, AND COMMITTEES 2004 — pres. Management Team, North Range Behavioral Health, Colorado 2004 - 2008 Mental Health Disaster Response Coordinator, North Range Behavioral Health, Colorado. 2004 - 2008 Emergency Services Committee, Weld County Community Collaborative Efforts 2004 - 2006 Thriving Organizational Practices (TOP) Committee, North Range Behavioral Health 2003 - 2004 Barriers to Productivity Committee, North Range Behavioral Health, Colorado. 2002 - 2004 Training Committee, North Range Behavioral Health, Colorado. 2001 - 2003 Alternatives In Management Committee, North Range Behavioral Health, CO. 2000 - 2012 Quality Assurance Committee, North Range Behavioral Health, Colorado 2000 - 2012 Credentialing Committee, External Provider Network, Northeast Behavioral Heath 1998-2000 Curriculum Committee, Counseling Psychology Program, University of Oregon 1998-2000 Doctoral Competency Examination Committee, University of Oregon 1998-2000 Dissertation Committee Chair, Doctoral Projects, University of Oregon 1998-2000 Program Selection Committee, Doctoral Applicants, University of Oregon 1995-1996 Curriculum Committee - Counseling Psychology Program, CSU, CO. 1993-1996 Graduate Student Representative, Counseling Psychology Program, CSU, CO. 1993-1994 Admissions Committee - Counseling Psychology Program, CSU, CO. 1990-1991 Council of Organizations Representative, St. Cloud State University, MN. 1989-1992 President, PSI CHI, National Honor Society in Psychology, St. Cloud State University Chapter, MN. M. E. Huff, p. 2 of 11 CLINICAL AND SUPERVISORY EXPERIENCE 2000-pres. North Range Behavioral Health, Greeley, Colorado Program Director, Adult Recovery Program, 10/2012 — present Interim Director, Integrated Health Care, 4/2012-10/2012 Director of Training and Utilization Management, 2008-10/2012 Program Director, Assessment and Brief Therapy Program. 2004-2008 Professional Person, Inpatient On -Call Doctor, 2003 — present Clinical Director, Intensive Child, Youth, and Family Services Team. 2000-2004 Licensed Psychologist, North Range Behavioral Health, 2000 -present Responsibilities: Provide administrative and clinical oversight of clinical programs, utilization management, and training programs. Involved in clinical services provided to children, adolescents, adults, couples, and families through the years. Conduct full and abbreviated psychological evaluations with high -risk populations referred through human services agencies, County Courts, and/or the Department of Corrections. Provide "profession person" coverage for inpatient acute treatment facility as per state 27-65 regulations. 2000 Contracted Psychologist: Larimer Center for Mental Health, Fort Collins, Colorado. Responsibilities: Conducted psychological evaluations in a community mental health setting with high -risk populations referred through the Department of Human Services, County Courts, and/or the Department of Corrections. Administration of full and abbreviated assessments, including cognitive, intellectual, personality, emotional, psychosocial, and family functioning. 1998-2000 Clinical Supervisor: DeBusk Memorial Clinic, University of Oregon. Responsibilities: Oversight of clinical services in a community mental health setting. Individual and group supervision of therapists, as well as supervision of clinical supervisors. Clinic provides intake, crisis intervention, therapy, and psychological assessment services to the local community. 1997-1998 Psychology Resident: Denver Veterans Administration Medical Center, CO. Clinical Rotations: Psychological Consultation & Assessment, Inpatient Psychiatric Units (locked & unlocked), Inpatient PTSD Unit, Alcohol & Domestic Violence Unit, & Outpatient Clinic. Responsibilities: Consultation services provided to medical and psychiatric units, psychiatric admissions, and inpatient and outpatient services. Psychological assessments and individual, group, and family therapy, as well as psychoeducational groups, case management, treatment planning, and crisis intervention. 1994-1997 Clinical Supervisor/Staff Therapist: Psychological Services Center, Colorado State University. Responsibilities: Adult, adolescent, child, couples, and family services provided to the Fort Collins community. Intakes, individual and group therapy, psychological evaluations, crisis intervention and mediation, and consultation with human service professionals, school personnel, and medical and legal professionals. Supervision of doctoral students: Monitored client progress, assisted in the development of case conceptualization and treatment planning, advised on assessment matters, processed professional and developmental issues, and encouraged skill building. 1995-1996 Emergency Services Provider: Larimer County Mental Health, Ft. Collins, CO. Responsibilities: Emergency services provider serving the Larimer County community. Case management, crisis intervention, mental status exams, consultation with medical staff, and voluntary/involuntary hospitalizations. 1994-1995 Emergency Services Provider: University Counseling Center & Psychological Services Center Responsibilities: Part-time (72 hours per month). Emergency services provider serving the CSU campus and Fort Collins community. Case management, crisis intervention, mental status exams, consultation with medical staff, and voluntary/involuntary hospitalizations. M. E. Huff, p. 3 of 11 1994-1995 Group Therapist, Anger Management and Anxiety Reduction: Tri-Ethnic Center for Prevention Research, Colorado State University. Responsibilities: Part-time (8 hours per week). Application of cognitive -behavioral interventions, social skills and mediation training, and relaxation techniques for anger management and anxiety reduction. 1993-1998 Training Team Member: Victims Assistance Team, Colorado State University. Responsibilities: Response and prevention training to victim advocates, campus administration, residence hall directors, student assistants, campus organizations, and community organizations. Focus on recognition of trauma symptoms, response to trauma, support & advocacy, and prevention. 1993-1994 Staff Therapist: University Counseling Center, Colorado State University. Responsibilities: Part-time (10 hours per week). Intakes, evaluations, crisis intervention, & individual, couples, & group therapy. 1992-1998 Group Therapist, Sexual Assault Survivors: Victims Assistance Team, CSU. Responsibilities: Part-time (10 hours per week). Group facilitator serving campus and community population. Intake assessments, consultation and referrals, group and individual services, and crisis management. 1992-1997 Emergency Services Provider: Victim Assistance Team, CSU. Responsibilities: Emergency services provider to primary and secondary victims of sexual assault, serving the campus population and Fort Collins community. Crisis intervention, support, advocacy (medical, legal, and academic), and referral. 1989-1991 Advocate/Support Person (volunteer): Women's Center, SCSU, Minnesota. Responsibilities: Serving the campus and St. Cloud community. Intake assessment, support, advocacy, and referral. TRAININGS, PRESENTATIONS, AND COMMUNITY OUTREACH PROVIDED 2011-2013 Group Treatment Interventions. 16 hour training sessions provided to NRBH clinical staff. 2010-2013 Fraud and Abuse: Importance of Accurate Clinical Documentation. 8 hour training sessions provided to NRBH clinical staff. 2009-pres. Mental Health First Aid. Twelve -eight hour certificate training presentations for members of the community addressing mental health first aid crises, how to respond and give assistance, and how/when to get appropriate professional help. Certified to provide training focused on adults and youth. 2009-2012 Lunch & Learn Series. Series of one hour presentations for clinical staff addressing clinical issues, such as mood disorders, anxiety disorders, psychotic disorders, disruptive behavior disorders, pervasive developmental disorders, etc. 2009-2012 Colorado Clinical Assessment Record (CCAR) Training. 4 hour training sessions provided to NRBH clinical staff. 2008-2012 Service Planning and the Golden Thread. 6 hour training sessions provided to NRBH clinical staff. 2008-2012 Diagnoses & GAF. 4 hour training sessions for clinical staff at three different community mental health agencies addressing issues associated with diagnoses and determination of global assessment of functioning (GAF). 2008-2012 Integrated Services: Assessing and Documenting Integrated Mental Health and Substance Abuse Services. 4 hour training sessions for clinical staff at NRBH. M. E. Huff, p. 4 of 11 2008-2012 Clinical Orientation Training. 16 hour training series provided to all new clinical staff at NRBH addressing clinical issues, such as ethical issues, confidentiality, dual roles, professional boundaries, mandatory reporting, mental health holds and substance abuse commitments, diagnoses, service coding, intake assessments, service planning, progress notes, quality of care concerns, and critical incidents and incident reporting. Feb. 2005 Utilization of Beck Inventories to Screen for Mental Health Issues. Two-hour training presentation for community mental health center clinical staff on the administration and utility of Beck's Depression, Anxiety, Hopelessness, and Suicidal Ideation scales for adolescent and adult populations. Jan. 2005 Organizational/Team Communication Based on MBTI Personality Types. Two-hour interactive workshop for Children's Residential Facility staff focused on understanding and enhancing communication among staff. Jan. 2005 Utilization of Beck's Youth Inventories to Screen for Mental Health Issues. Two-hour training presentation for community mental health center children's residential staff on the administration and utility of Beck's Depression, Anxiety, Anger, Obsessive, and Disruptive Behavior scales for children and young adolescents. June 2004 Clinical Documentation, Assessment, and Diagnosis. Seven -hour training presentation for community mental health center staff on state and agency standards for clinical documentation of services, methods of clinical assessment, and differential diagnoses. May 2004 Brief Screening Instruments for the Assessment of Mental Health Issues. Two-hour training presentation for community mental health center clinical staff on numerous brief and rapid screening instruments to be used in assessing mental health issues (e.g., suicide, cognitive confusion, depression, anxiety, anger). April 2004 Legal Workshop: Responding to Subpoenas. Four-hour presentation for community mental health center staff on responding to subpoenas, confidentiality and protecting privileged communication, negotiating releases, and testifying as an expert witness. Feb. 2000 Assessment of Posttraumatic Stress Disorder in Combat Veterans. Eight -hour training workshop for Veterans Administration clinical station the formal assessment of PTSD in combat Veterans. Oct. 1999 Intelligence Testing with the WAIS-III and WISC-IIL Eight -hour training workshop presented to University of Oregon Clinical and Counseling Psychology Doctorate Students. 1994-1996 PTSD and Rape Trauma Syndrome. Educational presentations (3 per semester) given to students enrolled in Abnormal Psychology and Human Sexuality courses at Colorado State University. Aug. 1995 Rough Rapids: Sexual Assault in Residence Halls. Three-day workshop presented to CSU residence hall administrators, directors, student assistants, and support staff. Included large group education presentations and 11/2 -hour small -group interactive presentations focused on prevention, recognition, support, response procedures, state laws, and university regulations. 1994-1997 Rape Trauma Syndrome: Support and Advocacy. Training workshops for new Victim Assistance Team members. Presentation on the aftermath of sexual assault, recognizing symptoms, identifying concerns, crisis intervention, and provision of support services. Nov. 1994 Sexual Assault: Victims and Perpetrators. Educational presentations given to students enrolled in Human Sexuality courses at CSU. Sept. 1994 Sexual Assault: Prevalence, Prevention, Recognition, and Support. Two-week training workshop presented to CSU residence hall administrators, directors, student assistants, and support staff Offered through the Victims Assistance Team. 4 M. E. Huff, p. 5 of 11 ACADEMIC/TEACHING EXPERIENCE 1998-2000 Assistant Professor, Counseling Psychology Doctorate Program; Department of Counseling, Family, and Human Services; University of Oregon. Responsibilities: Teaching, supervision of fellowships, clinical practicums, and psychological assessments, and dissertation and competency exam committee chair/member, and student advising. Teaching Responsibilities: Graduate Courses (counseling, clinical, & school psychology doctorate students) • CPSY644: Group Counseling and Psychotherapy • CPSY622: Advanced Psychological Assessment II — Personality & Emotional • CPSY621: Advanced Psychological Assessment I — Cognitive & Intellectual • CPSY612: Professional Ethics • CPSY607: Doctoral Seminar — Assessment Undergraduate Courses (Family & Human Services Program) • EDST430: Advanced Individual and Group Interventions • EDST330: Individual and Group Interventions 1996-1997 Teaching Fellow, Department of Psychology, Colorado State University. Responsibilities: PY320: Abnormal Psychology (2 sections, 180 students per section) and PY100: General Psychology (2 sections, 215 students per section). Supervision of teaching assistants. 1996-1997 Instructor, Department of Continuing Education, Colorado State University. Responsibilities: PY 100: General Psychology (2 sections, 25 students per section). 1995-1996 Teaching Fellow, Department of Psychology, Colorado State University. Responsibilities: PY 100: General Psychology (4 sections, 215 students per section). Supervision of graduate and undergraduate teaching assistants. 1995 Instructor, Department of Psychology, Colorado State University. Responsibilities: PY496: Professions In Psychology (adv-seminar, 60 students). 1993 Instructor, Department of Psychology, Colorado State University. Responsibilities: PY325: Personality Psychology (35 students). 1993 Teaching Assistant/Mentor, CSU Teaching Assistant Workshop. University -wide training workshop for new graduate teaching assistants from across disciplines. 1990-1992 Lab Instructor: Department of Psychology, St. Cloud State University, MN. Responsibilities: PY260: Descriptive and Inferential Statistics Lab (2 sections per quarter, 40 students per section). Provided supplementary lectures/labs three times a week, graded and recorded daily assignments and exams. 1989-1990 Teaching Assistant: Department of Psychology, St. Cloud State University, MN. Responsibilities: PY 100: Introductory Psychology. Graded and recorded lab reports, essays, and exams. Led weekly groups supplementing course material. RESEARCH PUBLICATIONS AND PRESENTATIONS Martin, V. A. & Huff, M. E. (2005). Relationships Between Attributional Bias, Child Abuse History, and PTSD Symptom Severity in Adult Populations. Cognitive Therapy and Research. Martin, V. A. & Huff, M. E. (2003). A Diathesis -Stress Model of Posttraumatic Stress Disorder: Ecological, biological, and residual -stress pathways. Review of General Psychology, 7(3), 237-250. Martin, V. A., McWhirter, B. & Huff, M. E. (2001, August). Relationships Between Learned Helplessness Factors, Child Abuse, and Combat -Related PTSD. Paper presented at the American Psychological Association Convention, San Francisco, CA. M. E. Huff, p. 6 of 11 Deffenbacher, J. L., Huff, M. E., Lynch, R. S., Oetting, E. R., & Salvatore, N. F. (2000). Characteristics and treatment of high anger drivers. Journal of Counseling Psychology, 47, 5 - 17. Huff M. E. (1998). Attributions and locus of control as related to anger and anger expression styles. Doctoral dissertation, Colorado State University, Fort Collins, Colorado. Deffenbacher, J. L., Huff, M. E., Salvatore, N. F., & Lynch, R. S. (1998). Stress inoculation and applied relaxation in the reduction of driving anger. Paper presented at the Rocky Mountain Psychological and Western Psychological Associations' Convention, Albuquerque, NM. Lynch, R. S., Deffenbacher, J. L., & Huff, M. E. (1998). Reactions of high and low driving anger individuals. Paper presented at the Rocky Mountain Psychological and Western Psychological Associations' Convention, Albuquerque, NM. Powell, K. M., Rosen, L. A., & Huff, M. E. (1997). Disruptive behavior disorders and the avoidance of responsibility. Personality and Individual Differences, 23, 549 - 557. Deffenbacher, J. L., Oetting, E. R., Huff, M. E., Cornell, G. R., & Dallager, C. J. (1996). Evaluation of two cognitive -behavioral approaches to general anger reduction. Cognitive Therapy and Research, 20, 551-573. Huff, M. E. (1995). Therapists' perceptions, preferences, comfort, and confidence with different client types. Unpublished master's thesis, Colorado State University, Fort Collins, Colorado. Deffenbacher, J. L., Oetting, E. R., Huff, M. E., & Thwaites, G. A. (1995). A fifteen -month follow-up of social skills and cognitive -relaxation approaches to general anger reduction. Journal of Counseling Psychology, 42, 400-405. Deffenbacher, J. L., Huff M. E., Cornell, G. & Dallager, C. (1995). A social skills approach to the reduction of anger. Paper presented at Rocky Mountain Psychological Association, Boulder, CO. Huff, M. E. (1991). The effects of motivation and failure on problem solving performance: Reactance vs. helplessness. Paper presented at the Red River Psychology Conference, APA Midwestern Region, Moorhead, MN. OTHER RESEARCH EXPERIENCE 1995-1998 1995-1996 Collaborative Research: Tri-Ethnic Center for Prevention Research, CSU. Description: Work on various NIMH grant funded research projects. Development of Anger - expression scales, including measurement of cognitive factors and associated personal and social consequences. Treatment outcome studies involving group therapy for individuals with anger problems. Collaborative Research, Department of Psychology, CSU. Description: Scale development and statistical analyses of avoidance of responsibility symptoms in disruptive behavior disorder subtypes. 1994 Research Assistant: Department of Human Development and Family Studies, CSU. Responsibilities: Content analysis and data coding to determine the prevalence of aging issues and later family life concerns in marriage and family therapy literature. 1993-1995 Graduate Research Assistant: Tri-Ethnic Center for Prevention Research, CSU. Responsibilities: Work on various NIMH grant funded research projects. Organization and implementation of data collection procedures (pre, post, and follow-up surveys). Data input, statistical programming, and data analyses. Group therapist for treatment groups using cognitive behavioral, social skills training, and/or relaxation techniques to reduce anger and anxiety. M. E. Huff, p. 7 of 11 1992-1993 Graduate Research Assistant: Women's Programs and Studies, CSU. Responsibilities: Academic programming, research, publication of program newsletter, and facilitation of Sexual Assault Support Group. 1990-1992 Member of the Experimental Psychology Research Group (EPRG), SCSU, MN. Responsibilities: Collaboration, design, and implementation of research projects for presentation at professional conferences. Critical analyses of existing research and the feasibility of future projects. 1990 Non -Response Enumerator, US Dept. of Commerce Bureau of the Census. Responsibilities: Interviews with "refusal to respond" and difficult cases for the 1990 United States Census. Aided individuals in filling out census forms, due to inability to read or understand questionnaires. Mapped and routed areas in which inaccurate or incomplete records existed. 1989-1991 Research Assistant: Women's Center, SCSU, MN. Responsibilities: Initiated development of the Women's Center resource/referral manual. Surveyed state, community, and campus resources. SPECIALIZED TRAINING, CONTINUING ED, & PROFESSIONAL DEVELOPMENT 6/2015 Conversion to DSM-5 and ICD-10: 8 hour workshop provided by North Range Behavioral Health. 4/2015 Eating Disorders and Addictions Treatment: 3 hour training provided by Kaizen Holistic Counseling. 4/2013 Social Skills Groups Leadership Training and Pervasive Developmental Disorders: Provided by Lee Rosen, Ph.D., Colorado State University, and sponsored by Autism Speaks. 10/2012 Group Treatment — Train the Trainer: 16 hour training sponsored by the Colorado Division of Behavioral Health. 5/2012 Brain Injury Diagnosis and Treatment Issues: Provided by the Brain Injury Recovery Program. 11/2011 Transformational Supervision: Supporting the Supervisor: 7 hour workshop sponsored by the Colorado Division of Behavioral Health. 10/2011 Strategies for Self -Improvement and Change (SSIC): 21 hours workshop sponsored by the Colorado Division of Behavioral Health. 10/2011 Employment Law: 5 hour training provided by the Mountain States Employment Council. 7/2011 DBT Skills Training: 16 hour training workshop focused on DBT skills with adults and adolescents, provided by Behavioral Tech, LLC. 3/2011 Verbal Judo: Interventions for Patients with Challenging Behaviors — Instructors Course: Train the trainer workshop sponsored by the Colorado Division of Behavioral Health. 2010-2011 Co -Occurring Training Series: (1) Co -Occurring Disorders, (2) PTSD and Co -Occurring Addiction, (3) Seeking Safety, and (4) Contingency Management: Four 8 hour workshops sponsored by the Community Mental Health and Substance Abuse Partnership, The Colorado Trust, and The Colorado Health Foundation. 11/2010 Tri-Occurring Disorder: 8 hour training sponsored by the Colorado Division of Behavioral Health. 8/2010 Building Community Awareness: Responding to the Torture Survivor Experience: 6 hour workshop sponsored by the National Partnership for Community Training and Gulf Coast Jewish Family Services. M. E. Huff, p. 8 of 11 6/2010 Crisis Prevention Intervention (CPI): 8 hour training focused on verbal and non-verbal de-escalation interventions. 5/2010 Regional Offender Treatment Training: 8 hour training workshop sponsored by the Colorado Division of Behavioral Health and the Division of Probation Services. 4/2010 Applied Suicide Intervention Skills Training (ASIST): 15 hour workshop sponsored by the Colorado Office of Suicide Prevention. 12/2009 Treating Traumatized Immigrant and Refugee Youth: 8 hour training provided by the North Colorado Health Alliance. 7/2009 Screening, Brief Intervention, and Referral to Treatment (SBIRT): 14 hour training sponsored by the Colorado Division of Behavioral Health. 4/2009 Mental Health First Aid — Train the Trainer: 40 hour train -the -trainer workshop sponsored by the National Council for Behavioral Health. 2008-2009 Certificate Program in Primary Care Behavioral Health: 36 credit hours, offered by the Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester. Facilitated by Dr. Alexander Blount and Dr. Daniel Lasser. 2008-2009 Certified Addictions Counselor II and III Training: 266 credit hours of training and 3000 supervised hours, certified through the Colorado Department of Regulatory Agencies. • 21 hrs, Principles of Addiction • 14 hrs, Infectious Diseases in • 21 hrs, Addiction Counseling Skills Addiction Treatment • 21 hrs, Advanced Counseling Skills • 14 hrs, Diversity Issues • 14 hrs, Client Records Management • 14 hrs, Ethical Issues • 14 hrs, Cognitive Behavioral • 21 hrs, Motivational Interviewing Therapy • 14 hrs, Advanced Motivational • 14 his, Pharmacology I Interviewing • 14 hrs, Pharmacology II • 14 hrs, Therapeutic Resistance • 14 hrs, Differential Assessment • 21 hrs, Clinical Supervision • 14 hrs, Differential Assessment and • 7 hrs, Tobacco Cessation Personality Disorders 10/2007 Understanding the Needs of Persons with Co -Occurring Disorders: 3 hour workshop offered through Mental Health Law and Policy and the University of South Florida. 2007 EMDR, Part I and Part II: Part I (January of 2007) and Part H (May of 2007). Training approved through EMDRIA and provided by the Rocky Mountain EMDR Training Institute. 6/2006 Family Therapy Interventions: 16 hour training workshop provided by the Family Therapy Institute, Colorado. 5/2006 DBT Skills Training: 16 hour training workshop focused on DBT skills with adults, provided by Behavioral Tech, LLC. 5/2006 Leadership and Supervision Training: 8 hour workshop provided by Mountain States Employment Council. 12/2005 Motivational Interviewing: 21 hours skills training workshop provided by the Sage Institute. 9/2005 Working with Co-occurring Disorders: 8 hour workshop sponsored by Colorado Health People and The Colorado Trust. M. E. Huff, p. 9 of 11 1/2005 Invisible Child Conference: Conference focused on children with "invisible" challenges stemming from brain differences, such as Bipolar Disorder, ADHD, OCD, Anxiety Disorders, and Pervasive Developmental Disorders. 12/2004 Changes in CRS 27-10 Regulations in the State of Colorado, provided by the Division of Mental health. Focus on changes in "involuntary hold and treat" regulations. 10/2004 The Biosocial Effects of Methamphetamine Abuse. Workshop presented by Nicolas Taylor, Ph.D., CAC III. Sponsored by the Colorado Trust/Rural Solutions in partnership with Island Grove Treatment Center. 10/2004 CMHDRS Disaster Response Training — Level II Certification. Training workshop sponsored by the Colorado Mental Health Disaster Response System. 8/2004 CMHDRS Disaster Response Training — Level I Certification. Training workshop sponsored by the Colorado Mental Health Disaster Response System. 8/2004 Developing the Most Effective Systems of Care for People with Co -Occurring Mental Health and Substance Use Disorders: Working Together for Change. Workshop presented by Kenneth Minkoff, MD 7/2004 Summer Leadership Institute for Nonprofit Executives. Two day workshop sponsored by the Kenneth W. Monfort College of Business at the University of Northern Colorado. 4/2004 The 4th Annual Mental Health Performance Indicator and Outcomes (PIO) Conference: The President's New Freedom Commission on Mental Health, Evidence -Based Practices & Recovery. Sponsored by SAMHSA's Center for Mental Health Services Data Infrastructure Grant. 4/2003 Wolves at the Door: Responding to the Demands for Evidence by the Legal System. Workshop presented by Stromberg, Cleveland, Crawford, & Schmidt. 3/2003 Brief and Solution Focused Treatment Approaches. Workshop presented by Michael Kucera, Ph.D. 11/2002 Collaborate: A Call to Action. Weld County Juvenile Collaborative Conference. 11/2001 Disaster Psychology and Mental Health Response. Eight -hour training resulting in certification as a Type H Mental Health Disaster Responder. 9/1999 Multicultural Counseling: Working with differences in Race, Ethnicity, and Sexual Orientation. 32 hour advanced training workshop presented by Derald Wing Sue, Ph.D. 3/1998 Personality Assessment Inventory (PM) Training Workshop. Presentation by Leslie Morey, Ph.D. (creator of the PAI), Vanderbilt University. 10/1997 Wechsler Adult Intelligence Scale - III (WAIS-IH) and Wechsler Memory Scale - III (WMS-III) Training Seminar. Telecommunications seminar presented by the Psychological Corporation (Psych -Corp) Harcort Brace & Company. 9/97-8/98 Psychological Assessment and Evaluation. 100 hours of advanced training in the use of Wechsler Intelligence Scales, MMPI-2, PAI, MCMI-II, Rorschach, TAT, Incomplete Sentences Blank, Hand Test, Object Sorting Test, Behavioral Dyscontrol Scale, and the Self -Administered Interview. Coordinated by the Denver VA Medical Center, Psychology Services. 9/97-8/98 Neuropsychological Assessment. 100 hours of advanced training in symptom recognition, assessment of, and diagnosis of neurological disorders (e.g., dementia, Alzheimer's Disease, Parkinson's Disease, Huntington's Chorea, Korsakoft s, and Traumatic -Brain Injuries and Syndromes). Coordinated by the Denver VA Medical Center, Psychology Services. M. E. Huff, p. 10 of 11 9/97-8/97 Treatment of Culturally Diverse Populations. 100 hours of advanced training involving clinical case presentations using various theoretical perspectives, treatment models, and approaches. Presentations by a variety of expert clinicians with emphasis on different cultural groups. Coordinated by the Colorado Health Sciences Center, Psychology Services. 9/1997 PTSD in Vietnam Veterans of Native American and Asian Descent. Presentation provided through the collaborated research efforts of the Department of Veteran Affairs Medical Centers and the University of Colorado Health Sciences Center. 4/1996 Supervision Issues Workshop. Presentation by John Morse, M.S., LMFT, Rocky Mountain Marriage and Family Center. Sponsored by the Colorado Association for Marriage and Family Therapy. 4/1996 Advancing Brief Therapy: Attitudes and Techniques. Presentation by Tracy Todd, Ph.D., Brief Therapy Institute of Denver, Incorporated. 4/1996 Private Practice Sanity. Presentation by Janet Pipal, Ph.D. Workshop sponsored by the Department of Psychology and the Psychological Services Center at CSU. 3/1996 Dealing with Under -Motivated Adolescents. Presentation by Bill Parks, LMFT, Jim Campion, L.S.C.W., and Lisa Barnes, L.C.S.W. Seminar for professionals offered by Mountain Crest Behavioral Healthcare System. 3/1996 Depression in Childhood and Adolescence. Presentation by Mark Fallon -Cyr, M.D. Mountain Crest Behavioral Healthcare System's Grand Rounds Lecture Series. Sum 1995 Child and Adolescent Assessment and Treatment Five-day training workshop on the assessment and treatment of disruptive behavior disorders and ADHD. Offered by the Department of Psychology, Colorado State University. Sum 1995 Neuropsychological Assessment. Semester of specialized training in administration of neurological test batteries, including the Halstead-Reitan battery. Offered by the Department of Psychology, CSU, and Thomas Bennett, Ph.D., Director of the Brain Injury Recovery Program. Spring 1995 Group Counseling and Psychotherapy. Semester of specialized training in theories and techniques of group therapy. Offered by the Department of Psychology, CSU. 3/1995 Foundations of Multicultural Communication Training. Presentation by Alma Vigo Morales, Director of Fort Collins Human Rights Office, and Barb Kissler, Director of Activities, CSU. Fall 1994 Marriage and Family Therapy. Semester of specialized training in dominant marriage and family therapy theories and techniques. Offered by the Department of Human Development and Family Studies, Colorado State University. Fall 1994 Emergency Services Training, Larimer County Mental Health Center, Fort Collins, CO. 4 hours initial training and 14 hours of in-service training. Fall 1994 Group Treatment and Implementation of Cognitive -Behavioral, Social Skills, and Relaxation Techniques for Anger and Anxiety Management. 24 hours of training and supervision with experiential components involving the group treatment of individuals with high levels of trait anger. 4/1994 Attention Deficit Hyperactivity Disorders. Presentation by Dr. Sam Goldstein. Seminar offered by the McKee Conference and Wellness Center, CO. 4/1994 Marriages From Hell: Trouble in Marriages, Turning Points in Marriages, Sick Marriages, and Treating Marriages. Presentation by Frank S. Pittman, III, MD. Mountain Crest Hospital, Master's Lecture Series, Fort Collins, CO. M. E. Huff, p. 11 of 11 11/1993 Male Survivors of Sexual Abuse. Presented by Mark Brosal, Ph.D. Sponsored by the Women at Noon Forum and the Dept. of Women's Programs and Studies at CSU. 8/1993 Multicultural Training Workshop. Presentations by the McKinley Group, Inc., Washington D. C.; Pima Prevention Partnership; and Team Fort Collins, Colorado. Three-day therapist training. 4/1993 Treating Adult Survivors of Incest. Case presentation and discussion by Dr. Henry Coppolillo. Mountain Crest Hospital Grand Rounds Lecture Series. 3/1993 Multicultural Communication. Presentation by Lillian Robal-Rose. Full day seminar offered through Colorado State University Programs Office. Spring 1993 Emergency Services and Crisis Intervention Training, Victim Assistance Team, Colorado State University, CO. 16 hours initial training and 16 hours of in-service. Spring 1993 Advanced Seminar on College Teaching. Training in various presentation styles, learning styles, and effective teaching techniques. Offered by the Department of Graduate Studies, CSU. 11/1992 Treating Childhood Trauma and PTSD. Case presentation and discussion by Dr. Henry Coppolillo. Mountain Crest Hospital Grand Rounds Lecture Series. 10/1992 The Famine Within. Training on eating disorders presented by Dr. Susan MacQuiddy. Sponsored by the Women at Noon Forum and the Department of Women's Programs and Studies, CSU. 9/1992 Psychic Trauma. Presentation and discussion by Dr. Henry Coppolillo. Mountain Crest Hospital Grand Rounds Lecture Series. Spring 1991 SPSS-X in the Social Sciences. Training in computer analysis using the SPSS and SPSS-X data analysis systems. Offered by the Department of Social Sciences, SCSU. Winter 1991 Research Topics in Psychology. Seminar involving critical analysis and implementation of research designs, Department of Psychology, SCSU. Winter 1991 Psychology of Teaching Practicum. Seminar involving supervised training and practical experience, Department of Psychology, SCSU. References Available Upon Request. 'COLORADO Department of Regulatory Agencies Professions Division of and Occupations Congratulations! Below are your electronic wallet cards to use as proof of your license. You can also print your license at any time through your Online Services account by visiting our homepage at www.dora.colorado.gov/professions and clicking on the "Print your License" link under the label "Quick Links". If you would like a more durable wallet card option, you can order one for a fee by visiting www.nasbastore.org and selecting the "Colorado License Cards" link on the left hand side of the page. If you prefer, you can also contact NASBA by phone at 1-888-925-5237 or by email at nasbastore@nasba.org. Should you have questions about your credential, or need other information, please contact our Customer Service Team at 303-894-7800 or dora_registrations@state.co.us. Cut along the line Colorado Department of Regulatory Agencies Division of Professions and Occupations ACC.0006975 Number Active Credential Status Addiction Counselor Program Maureen Edith Huff Certified Addiction Counselor Ill 09/01/2015 Issue Date 08/31/2017 Expire Date Verify this credential at: www.dora.colorado.gov/professions Di4ision Director: Lauren Larson Credential Holder Signature Colorado Department of Regulatory Agencies Division of Professions and Occupations ACC.0006975 Number Active Credential Status Addiction Counselor Program Maureen Edith Huff Certified Addiction Counselor Ill 09/01/2015 Issue Date 08/31/2017 Expire Date /llVerify this credential at: www.dora.colorado.g ov/profession s sion Director: Lauren Larson Credential Holder Signature 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 303.894.7693 www.dora.colorado.gov/professions COLORADO Department of Regulatory Agencies Division of Professions and Occupations Congratulations! Below are your electronic wallet cards to use as proof of your license. You can also print your license at any time through your Online Services account by visiting our homepage at www.dora.colorado.gov/professions and clicking on the "Print your License" link under the label "Quick Links". If you would like a more durable wallet card option, you can order one for a fee by visiting www.nasbastore.org and selecting the "Colorado License Cards" link on the left hand side of the page. If you prefer, you can also contact NASBA by phone at 1-888-925-5237 or by email at nasbastore@nasba.org. Should you have questions about your credential, or need other information, please contact our Customer Service Team at 303-894-7800 or dora_registrations@state.co.us. Cut along the line Colorado Department of Regulatory Agencies Division of Professions and Occupations Psychologist Examiners Board Maureen Edith Huff Licensed Psychologist PSY.0002498 Number Active Credential Status 09/01/2015 Issue Date 08/31/2017 Expire Date Verify this credential at: www.dora.colorado.Rov/profession s Di4isioonn Director: Lauren Credential Holder Signature Colorado Department of Regulatory Agencies Division of Professions and Occupations Psychologist Examiners Board Maureen Edith Huff Licensed Psychologist PSY.0002498 Number Active Credential Status 09/01/2015 Issue Date 08/31/2017 Expire Date Verify this credential at: www.dora.colorado.gov/profession s fsion Director: Lauren Larson Credential Holder Signature 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 303.894.7693 www.dora.colorado.gov/professions I '* oi CAF- (Si() *, 1876 ; Nathan Kyle Swisher CURRICULUM VITAE 218 47th Avenue Court Phone: (970) 381-6093 Greeley, CO 80634 E-mail: nkswisher@yahoo.com LICENSURE Licensed Psychologist, Colorado - PSY.OOO384O Issue Date: 01/02/2013 Expire Date: 08/31/2015 EDUCATION 05/2008-08/2011 Doctorate of Psychology in Clinical Psychology Rosemead School of Psychology, Biola University, La Mirada, CA Psy.D. conferred August 31, 2011 08/2006- 05/2008 Master's of Arts in Clinical Psychology Rosemead School of Psychology, Biola University 08/2002- 05/2006 Bachelor of Arts in Biblical Studies, Concentration in Psychology Trinity Western University, Langley, British Columbia, CAN CLINICAL EXPERIENCE North Range Behavioral Health Sept 2011 -Present Adult Outpatient Therapist (Full Time Employment) Setting: Community mental health network, Greeley, CO - adult outpatient program. Duties: • Implement clinical assessment, psychological testing (cognitive, personality), and culturally -sensitive individual/group/family/couples psychotherapy for an ongoing caseload of 45-55 individuals (in addition to therapy groups). Caseload consists of both mental health and substance abuse referrals, voluntary and court -mandated. • Engage in regular faculty meetings and trainings, case consultation, individual and group supervision [qualifying for psychologist licensure and CAC (Certified Addiction Counselor) requirements], and external clinical seminars (including training for CAC II, Gottman Couples Therapy, and others). AspenPointe Health Services Sept 2010 -Sept 2011 2,000 -hour APPIC Pre -Doctoral Internship Setting: Community mental health network, Colorado Springs, CO. Major internship rotation located at Adult and Rural Services (adult outpatient); minor internship rotations included: Lighthouse (adult acute inpatient), Peak Vista Community Health Center (primary care), AspenPointe — Fountain, CO (rural outpatient). Duties: • Implemented clinical assessment, psychological testing (cognitive, personality), and culturally -sensitive individual/group/family/couples psychotherapy (EBP) for an ongoing caseload of 25-35 severely and persistently mentally ill adult consumers. • Provided crisis assessment, individual/group/family/couples psychotherapy for an adult population in an acute crisis setting (inpatient). • Coordinated clinical assessment and brief individual psychotherapy in a primary care setting, participating in brief behavioral health consultations for patients. • Implemented supervision with master's level psychology intern, including weekly clinical observation. • Engaged in regular faculty meetings, case consultation, internship training seminars (including presentation of doctoral paper), individual supervision, and external clinical seminars. Harbor UCLA Medical Center — South Bay TIES for Families Sept 2009 -Aug 2010 830 -hour Advanced Practicum Setting: Los Angeles County Department of Mental Health outpatient clinic; a multidisciplinary treatment approach promoting the successful adoption of foster children and adolescents. Duties: • Provided direct clinical assessment, psychological testing (cognitive, academic achievement, personality, socioemotional, neuropsychological), consultation, and individual/family/group psychotherapy for children, adolescents, and families. • Coordinated care with the court system and Department of Child and Family Services as needed. • Engaged in internal and external training for infant mental health (e.g., the Bayley Scales of Infant Development), Narrative Therapy, Reflective Parenting, Mindful Parenting, Incredible Years, and other clinically -relevant seminars and didactic training made available at the Harbor -UCLA Medical Center. Rosemead School of Psychology, Biola University Fall 2009 — Spring 2010 Setting: Biola University campus, La Mirada, CA. Duties: • 32 -hour Clinical Supervision Practicum (provided weekly, individual supervision for graduate student providing services to adults in an outpatient setting; engaged in weekly supervision and tape review of supervisory sessions; presented audio tapes and progress notes for peer consultation and critique) • 32 -hour Child and Adolescent Practicum (engaged in live peer supervision with teaching assistant using bug -in -the -ear technology; provided individual psychotherapy and parental feedback/consultation to an adolescent client recruited from the community). • 32 -hour Group Therapy Practicum (provided process -oriented group therapy for a group of 10 college students for 10 weeks; consulted and worked successfully with co -therapist; maintained individual client files consistent with group conceptualization; engaged in weekly supervision). Biola Counseling Center August 2007 — June 2009 1,090 -hour University Counseling Center Practicum Setting: Outpatient university and community counseling center, La Mirada, CA. Clientele worked with consisted of an age range of 18-55, from various ethnic backgrounds, and presenting with various forms of mood-, anxiety-, relational-, adjustment/phase of life-, and disorder of thought -related problems. Duties: • Provided short- and long-term psychotherapy for adult individuals and couples, using Cognitive -Behavioral Therapy, Rogerian techniques, Emotion -Focused Therapy for Couples and Individuals, and Psychodynamic Psychotherapy. • Completed biweekly floor duty and structured intake interviews including MMPI-2 interpretation (written reports); provided MMPI-2 feedback sessions to graduate students. • Participated in weekly child therapy seminar/training (spring, 2009), weekly clinic in-service meetings (including case conceptualization and presentation), HIPAA training, and other clinically -related training; • Participated in two Gestalt Therapy seminars (as presented by David Gorton, Ph.D., Director of the Gestalt Therapy and Training Center, Woodland Hills, CA), and participated in Sand Tray and Psychotherapy workshop (as presented by Meredith Phanco, Ph.D., Biola Counseling Center, La Mirada, CA). Measurement and Assessment Practica: Various Settings Fall 2007 — Spring 2008 Setting: La Habra City School District; Arbolita Elementary School (grades K-2), El Cerrito Elementary School (grades K-2) and Walnut Elementary School (grades 3-5), La Habra, CA. Population represented age range from 5-10 years -old, various ethnic backgrounds (predominantly Latino) and levels of socio-economic status. Duties: • 300 -hour school assessment practicum: assessed special education and general education students for learning and behavioral problems, consisting of neuropsychological and psycho -diagnostic tests, student interviews, in -class observation, case conceptualization, report writing, and Individualized Education Programs (IEP); participated in weekly individual supervision and presented in weekly consultation group with practicum supervisor and other practicum students. Setting: Rosemead School of Psychology, La Mirada, CA; comprehensive testing batteries administered to recruited child clients from the community and Biola University undergraduate students. Duties: • Completion of 3 -semester sequence of measurement and assessment courses involving the administration and report writing of 6 comprehensive testing batteries; courses consisted of Measurement and Assessment I (trained to administer, score, and interpret the WAIS-III, WISC-IV, Woodcock -Johnson III, ADSA, Conner's (CPRS-R:L), and PPVT-III), Measurement and Assessment II (trained to administer and score the MMPI-II, MCMI-III, Folstein Mini Mental Status Exam, Thematic Apperception Test, House Tree Person Projective Drawings, Kinetic Family Drawing, and the Forer Structured Sentence Completion Test), and Measurement and Assessment III (trained to administer, score, and interpret the Rorschach). OTHER WORK EXPERIENCE CLINICALLY -RELEVANT EMPLOYMENT : • Intensive Support Services (ISS) Setting: Institute for Applied Behavior Analysis, Santa Ana, CA Hours: 30 per week Duties: Received training in Competency Based Training and provided support to children and adolescents with developmental disabilities. Jun 2007 -Sep 2007 • Homecare Provider Jul 2005 -Jul 2006 Setting: Visiting Angels Living Assistance Services, Bellingham, WA Hours: 20 per week Duties: Provided living assistance services, including various behavioral interventions, for adolescents with autism in home and community settings. TEACHING ASSISTANT EXPERIENCE : • Teacher Assistant: Psychology of Marriage Fall 2009 Keith Edwards, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 3 per week Duties: Facilitate the discussion in and processing of areas such as family of origin issues, and lead skill building exercises in areas such as conflict resolution and empathic listening with undergraduate students. • Teacher Assistant: variety of courses covering the Fall 2007 -Spring 2008 integration of theological topics and psychological theory Steve Porter, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 7 per week Duties: Provided assistance to Dr. Porter for grading of graduate -level coursework. • Teacher Assistant: Psvchologv of Christian Thought Elizabeth Hall, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 14 per week Duties: Provided assistance to Dr. Hill for grading of undergraduate -level psychology coursework. • Teacher Assistant: Psychology of Christian Thought Pete Hill, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 14 per week Duties: Provided assistance to Dr. Hall for grading of undergraduate -level psychology coursework. Spring 2008 Fall 2007 PRESENTATIONS • Presentation of Gottman Couples Therapy In -clinic presentation to adult outpatient staff, North Range Behavioral Health, Greeley, CO April 24, 2013 • Presentation of Bipolar Disorder: Diagnosis and Treatment In -clinic presentation to adult outpatient staff, North Range Behavioral Health, Greeley, CO June 6, 27, 2012 • Presentation of Schema Therapy In -clinic presentation to adult outpatient staff, North Range Behavioral Health, Greeley, CO January 18, 2012 • "Reflective Functioning in Couples Therapy" 1 -Hour In -clinic presentation to all clinical staff, AspenPointe Health Services, Colorado Springs, CO August 18, 2011 • Presentation of Doctoral Paper: "The Enhancement of Reflective Functioning in Couples Therapy: Integrative Literature Review and Theoretical Development" 2 -Hour Intern Seminar, AspenPointe Health Services, Colorado Springs, CO June 23, 2011 • "Forming Attachment Bonds in Marriage: Can You Hear Me Now?" "The Risks and Treasures of Love" relationship conference; hosted by Living Hope Church, Colorado Springs, CO April 2, 2011 PROFESSIONAL MEMBERSHIPS • American Psychological Association Current Membership # 95673434 Blair Nyline 6455 Chardonnay St. Unit 2 Evans, CO 80634 blair.nyline@gmail.com 763-227-0458 EDUCATION University of Northern Colorado, Greeley, CO • Ph.D. Counseling Psychology, APA Accredited • Minor in Applied Statistics and Research Methods • Graduation August 2016 • GPA 3.94 University of Northern Colorado, Greeley, CO • M.A. Clinical Counseling, CACREP Accredited • Graduated December 2011 • GPA 3.96 Carleton College, Northfield, MN • B.A. Psychology • Graduated June 2009 PROFESSIONAL CREDENTIALS • Licensed Professional Counselor, Colorado, Lic. # LPC.12174 o Obtained 10/2014 • Sex Offender Management Board (SOMB) Associate Level Treatment Provider o Obtained 6/2013 • Approved Treatment Provider (ATP), Department of Corrections, Colorado o Obtained 1/2012 CLINICAL EXPERIENCE Licensed Therapist Clear View Behavioral Health Johnstown, CO 8/2016 -present • Developed intensive outpatient and partial hospitalization program for new program. • Provide daily intensive group therapy service for patients recently discharged from a psychiatric hospital as well as individuals from the community. • Adapt groups as needed based on group members' psychological presentation. • Communicate effectively with family members and community treatment providers of patients to aid in discharge planning. • Interim clinical director when current clinical director is out of the office. APA Accredited Pre -Doctoral Internship Minnesota Security Hospital Saint Peter Regional Treatment Center, St. Peter, MN 8/2015-8/2016 • Provided individual and group therapy for men and women committed as Mentally Ill and Dangerous (MI&D). • Facilitated groups including Dialectical Behavior Therapy (DBT), Good Lives Group for individuals who have sexually offended, Cognitive Behavioral Therapy (CBT) for Psychosis, and Competency Restoration Group. Supervisors: Dr. Angela Dugan, licensed psychologist; Dr. Melissa Coble, licensed psychologist; Dr. Christopher Bollig, licensed psychologist Group Facilitation Practicum Psychological Services Clinic, Greeley, CO 1/2015-5/2015 • Provided co -therapy process group services to high risk/high needs incarcerated men. • Wrote clinical case notes for each group member and consulted with that group member's primary therapist. Supervisor: Dr. Heather Bean, licensed psychologist External Practicum Sterling Correctional Facility, Sterling, CO 8/2014-5/2015 • Administered, scored, and wrote formal reports for a variety of cognitive and personality assessments for diagnostic clarification and treatment recommendations. • Provided report feedback to clients. • Provided brief individual therapy as needed to high needs clients in the facility Supervisor: Dr. Bryce Willson, licensed psychologist, LPC, CAC -III Clinical Therapist Perklen Center for Psychotherapy, Greeley, CO 5/2011- 8/2014 • Facilitated and co -facilitated group therapy with court mandated domestic violence offenders and sex offenders; including adult males and females, juveniles, and developmentally delayed individuals • SOMB Associate Level Approved Provider and completed many requirements for DVOMB approved provider status • Worked closely with the community supervision team and multidisciplinary team • Facilitated a pro-bono survivors of domestic violence group • Provided counseling to individual clients as needed, both in the forensic and in the general population Supervisor: Kim Ruybal, MA, LPC, NCACII, DVOMB approved supervisor, SOMB approved supervisor External Practicum North Range Behavioral Health, Greeley, CO 8/2013-7/2014 • As part of the BASIC (Behavior Alternative Systems in the Community) team, provided therapy to adults who are on probation, parole, or other form of community supervision and were at risk for recidivism. • Saw clients individually for a variety of concerns including substance abuse, depression, anxiety, PTSD, and vocational concerns within empirically supported models • Began seeing clients in the county jail setting and continued to provide psychological services as they transition back into the community to provide continuity of care with the hopes of reducing recidivism rates. Supervisors: Dr. Nathan Swisher, licensed psychologist; Lori Burdick, LPC, CAC -III; Dr. Mary Sean O'Halloran, licensed psychologist Couples and Family Therapy Practicum Psychological Services Clinic, Greeley, CO 8/2013-12/2013 • Provided co -therapy services to couples and families while working within the Human Validation or Structural models • Provided live consultation for other co -therapy teams working within other models. Supervisors: Dr. Jeffrey Rings, Ph.D.; Dr. Mary Sean O'Halloran, licensed psychologist Psychological Services Clinic Practicum Psychological Services Clinic, Greeley, CO 5/2013-12/2013 • Provided services for long-term clients including adults with interpersonal struggles, juveniles with developmental and cognitive delays, and juveniles with extensive trauma histories. • Worked within a treatment team and regularly consulted with case manager via phone to ensure the best possible care for clients. Supervisor: Dr. Mary Sean O'Halloran, licensed psychologist Advanced Practicum in Individual Counseling UNC Psychological Services Clinic, Greeley, CO 1/2013- 5/2013 • Conducted intakes and provided services for clients of all ages with a variety of presenting problems including trauma, school difficulties, autism, interpersonal difficulties, and developmental delays. • Administered and score the ORS, SRS, and OQ with every adult client at regular intervals to monitor client growth. • Received live group and individual supervision. Supervisor: Dr. Brian Johnson, licensed psychologist Clinical Therapist Alternative Homes for Youth, Greeley, CO 4/2012 - 2/2013 • Provided individual and group therapy services for residential and non-residential male youth in an in -patient setting presenting with a variety of difficulties including offense -specific, drug and alcohol addiction, and violence. • Offered parenting sessions for parents and guardians of troubled youth as well as youth and their partners. • Facilitated family therapy sessions. • Maintained a close working relationship with supervising agencies. Supervisors: Kim Ruybal, MA, LPC, NCACII; Erica Roush, MA, LPC Practicum in Counseling UNC Psychological Services Clinic, Greeley, CO 8/2012-12/2012 • Conducted intakes and provide services for clients of all ages with a variety of presenting problems including trauma, school difficulties, depression, stress, and anxiety utilizing emotion focused therapy. • Administered the ORS, SRS, and OQ with each adult client at regular intervals to monitor client growth. Supervisor: Dr. Mary Sean O'Halloran, licensed psychologist Practicum in Individual Counseling 1/2011 - 5/2011 UNC Psychological Services Clinic, Greeley, CO • Provided therapeutic support for clients with issues related to presenting problems and concerns including anxiety, vocational issues, interpersonal conflicts, and trauma work • Performed general clinic duties: staffing, scheduling, client intakes, record maintenance, peer feedback, and group and individual supervision Supervisor: Dr. Jennifer Murdock, Ph.D., LPC ASSESSMENT EXPERIENCE Pre -Doctoral Internship Minnesota Security Hospital Saint Peter Regional Treatment Center, St. Peter, MN 8/2015 -present • Wrote psychological assessments for severe and persistent mentally ill individuals, many of whom are committed as Mentally Ill and Dangerous (MI&D) or under an initial commitment. • Wrote Good Lives Risk Assessment reports using sexual offending risk assessments STATIC -99 and STABLE -2007 • Utilized several assessments of intelligence (WASI-II), neurocognitive ability (R - BANS), executive functioning (D-KEFS), and personality (MMPI-2-RF), among others • Wrote formal psychological treatment reports to the court to assist with restriction and placement recommendations. Supervisors: Dr. Angela Dugan, licensed psychologist; Dr. Melissa Coble, licensed psychologist; Dr. Christopher Bollig, licensed psychologist External Practicum 8/2014-5/2015 Sterling Correctional Facility, Sterling, CO • Cognitive assessments administered include the General Ability Measure for Adults (GAMA), the Cognistat, and the Wechsler Memory Scale- 4th Edition (WMS-IV). • Personality assessments administered include the Minnesota Multiphasic Personality Inventory (MMPI-2) and the Personality Inventory Assessment (PAI). • Malingering assessments administered include the Structured Inventory of Malingered Symptomology (SIMS) and the SIRS -2. • Other assessments administered and scored include the Mental Status Exam and the Clock Drawing Test. Supervisor: Dr. Bryce Willson, licensed psychologist, LPC, CAC -III Practicum in Rorschach 1/2014-5/2014 UNC Psychological Services Clinic, Greeley, CO • Administered and scored Rorschach projective assessment using the Exner scoring method • Analyzed results and wrote comprehensive reports with assistance from the Exner scoring software Supervisor: Dr. David Gonzalez, licensed psychologist Practicum in Personality Assessment 8/2013-12/2013 UNC Psychological Services Clinic, Greeley, CO • Wrote interpretive reports for the Minnesota Multiphasic Personality Inventory - 2 (MMPI-2), Minnesota Multiphasic Personality Inventory — 2 Restructured Format (MMPI-2-RF), the Personality Assessment Inventory (PAI), Millon Clinical Multiaxial Inventory (MCMI-III) based on the computer program data. • Administered, scored, and wrote interpretive report for the Vineland -II Supervisor: Dr. Stephen Wright, licensed psychologist Practicum in Cognitive Assessments 5/2013-8/2013 UNC Psychological Services Clinic, Greeley, CO • Administered, scored, and wrote interpretive reports for Wechsler Intelligence assessments including Wechsler Adult Intelligence Scale -4h Edition (WAIS-IV), Wechsler Intelligence Scale for Children -4h Edition (WISC-IV), Wechsler Memory Scale -4t Edition (WMS-IV), and the Wechsler Individual Achievement Test -3`d Edition (WIAT-III). • Administered, scored, and wrote interpretive reports for additional intelligence and achievement tests including the Stanford-Binet V, Nelson -Denny Reading Test, and Wide -Range Achievement Test -Fourth Edition (WRAT-4). • Administered, scored, and wrote interpretive reports for language, visual -spatial, and visual -motor tests including the Peabody Picture Vocabulary Test -4t Edition (PPVT-4), Bender Visual -Motor Gestalt Test, and the Beery Developmental Test of Visual -Motor Integration (VMI). • Administered, scored, interpreted the Test of Memory and Malingering (TOMM). Supervisor: Dr. Brian Johnson, licensed psychologist Perklen Center for Psychotherapy, Greeley, CO 5/2011 -present • Administered and scored a battery of assessments in an adult and juvenile jail and mental health agency settings. • Assessments include: Shipley Institute of Living Scale; The Millon Clinical Multiaxial Inventory -III (MCMI-III); The Substance Abuse Subtle Screening Inventory -3 (SASSI-3); Jesness Inventory; The Multiphasic Sex Inventory -I (MSI-I); The State -Trait Anger Expression Inventory -2 (STAXI-2). Supervisor: Kim Ruybal, MA, LPC, NCACII PRESENTATIONS Friedman TeBockhorst, S., O'Halloran, M. S., Nyline, B. (2013, July). Tonic Immobility as Seen in Survivors of Sexual Assault. Poster session presented at the 121St Annual Convention of the American Psychological Association, Honolulu, HI. LeBlond, M., Johnson, B., Firsick, D., Pote, S., Sones, J., Nyline, B., Roche, J. (2013, July). Relationships among aging and resilience among diverse adults aged 45 and older. Poster session presented at the 121St Annual Convention of the American Psychological Association, Honolulu, HI. Pote, S., Northart, D., Wright, S., Nyline, B., Roche, J. (2013, July). The relationship between romantic attachment and attachment to the supervisor in the counseling self= efficacy of graduate trainees. Poster session presented at the 121St Annual Convention of the American Psychological Association, Honolulu, HI. • Poster won the division 17 student research award Bunce, R., Johnson, B., Roche, J, Sones, J., Firsick, D., Hinton, C., Nyline, B. (2013, July). Distinguishing between malingering, fatigue, and distraction on the validity indicator profile. Poster session presented at the 121" Annual Convention of the American Psychological Association, Honolulu, HI. Friedman TeBockhorst, S., O'Halloran, M. S., Nyline, B. (2013, April). The impact of peritraumatic tonic immobility on survivors of sexual violence. Poster session presented at the 83' Annual Rocky Mountain Psychological Association, Denver, CO. PUBLICATIONS Friedman TeBockhorst, S., O'Halloran, M. S., Nyline, B. (2014). Tonic immobility among survivors of sexual violence. Psychology of Trauma: Theory, Research, Practice, and Policy. doi: http://dx.doi.org/10.1037/a0037953 SUPERVISION EXPERIENCE Doctoral Supervisor 6/2014-9/2014 UNC Extended Studies, Denver, CO • Assisted faculty supervisor in providing live supervision and individual supervision to counselors -in -training during their first practicum experience • Reviewed case notes and case conceptualizations and provided feedback Supervisor: Dr. Jennifer Murdock, Ph.D., LPC Practicum in Supervision 1/2014-5/2014 UNC Psychological Services Clinic, Greeley, CO • Assisted faculty supervisor in providing live supervision, individual supervision, and group supervision to counselors -in -training in their first practicum experience • Reviewed case notes and case conceptualizations and provided feedback • Received live supervision of supervision Supervisors: Dr. David Gonzalez, licensed psychologist and Dr. Laura Jones, LPC TEACHING EXPERIENCE TA for Advanced Methods in Couples and Family Therapy 1/2015-5/2015 Counseling Psychology Department, University of Northern Colorado, Greeley, CO • Assisted with preparing students for family role plays using several therapeutic models. • Gave students feedback during live supervision, following sessions, and on clinical case notes and treatment plans. TA for Personality Assessment 8/2014-12/2014 Counseling Psychology Department, University of Northern Colorado, Greeley, CO • Reviewed formal reports and interpretation materials and offered feedback. • Presented on several assessments including the Substance Abuse Subtle Screening Inventory (SASSI-3), State -Trait Anxiety Inventory, State -Trait Anger Inventory, and the Hare Psychopathy Checklist Revised (PCL-R). Adult Learning Instructor 6/2010-7/2012 Community Educational Outreach, Greeley, CO • Assisted students with GED preparation, job search skills, and basic reading, writing, and math skills in a community corrections setting. • Worked closely with fellow instructors to formulate the best possible learning plan for students. WORKSHOPS AND LECTURES Didactic Presentation, Clinical Presentation Differences in Black and Caucasian Individuals, Diversity Didactic, Saint Peter Regional Treatment Center, June 2015 Didactic Presentation, Differentiation Between Alzheimer's Traits and Dementia in Aging Adults, Treatment Didactic, Saint Peter Regional Treatment Center, December 2015 Guest Lecture, Ethical Considerations in Forensic Work, Legal and Ethical Aspects of Counseling and Psychology, Department of Applied Professional Counselor Education, University of Northern Colorado, Spring 2015 Guest Lectures, How to Administer, Score, and Interpret the SASSI-3, STAI, STAXI, and PCL-R, Personality Assessment course, Department of Applied Professional Counselor Education, University of Northern Colorado, Fall 2014 Mental Health Presentation, The Manifestation and Treatment of Domestic Violence and Sex Offenders, North Range Behavioral Health, Fort Lupton, CO, August, 2014 Guest Lectures, Case Notes Using the SOAP Method, The Importance of Immediacy in the Therapy Room, and Case Conceptualization and Treatment Planning, Practicum I Course, Department of Applied Professional Counselor Education, University of Northern Colorado, Summer 2014 Guest Lectures, Diagnosis Using the DSM-5 and Cognitive Behavior Therapy Conceptualization and Application, Practicum I course, Department of Applied Professional Counselor Education, University of Northern Colorado, Spring 2014 Guest Lecture, The Manifestation and Treatment of Domestic Violence and Sex Offenders, Psychological Trauma and Intervention course, Department of Applied Professional Counselor Education, University of Northern Colorado, Spring 2013, Summer 2013, Fall 2013, Spring 2014, Summer 2014 Guest Lecture, The Application of Sex Offense -Specific Treatment with Offenders, Forensic Psychology course, Department of Psychology, Western State Colorado University, April, 2013 Guest Lecture, PTSD and Associated Diagnoses, Psychological Trauma and Intervention course, Department of Applied Professional Counselor Education, University of Northern Colorado, Spring 2013 Guest Lecture, Trauma Assessment, Psychological Trauma and Intervention course, Department of Applied Professional Counselor Education, University of Northern Colorado, Spring 2013 Guest Presentation, Stress Management, Housing and Residential Education Staff, University of Northern Colorado, Spring 2013 Guest Lecture, School Consultation, Psychological Consultation Theory and Practice course, Department of Applied Professional Counselor Education, University of Northern Colorado, Fall 2012, Spring 2013 Mental Health Presentation, Stress Management and Compassion Fatigue, A Woman's Place, Greeley, CO, Fall 2012 Mental Health Presentation, The Impact of Compassion Fatigue, Weld County Domestic Violence Coalition, Greeley, CO, July 2011 PROFESSIONAL ASSOCIATIONS: LEADERSHIP AND MEMBERSHIP American Psychological Association (APA) Division 17: Counseling Psychology Weld County Domestic Violence Coalition 2012 Committee Chair American Counseling Association (ACA) August 2012 -Present January 2012-2013 January 2010-2013 EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Anger Management/Domestic Violence Services, Functional Family Therapy (FFT), Mental Health Services, Monitored Sobriety Services, and Multisystemic Therapy (MST) to individuals and families, as referred by the Department. 1. Anger Management/Domestic Violence: Contractor will provide Anger Management and Domestic Violence services to males and females, 18 years and older, at 1260 H Street, in Greeley. a. Services will be provided at the North Range Behavioral Health Adult Outpatient facility, located at 1260 H Street, in Greeley, CO. b. All services will be provided by academically qualified and/or licensed Domestic Violence Offender Management Board (DVOMB) approved staff. c. Contractor will provide the following services under this contract: Anger Management (Minimum 20 Weeks of Treatment) Domestic Violence (Length of treatment will comply with Domestic Violence Offender management Board (DVOMB) regulations based on placement criteria for treatment levels A, B or C.) Track (level) is determined by assessment DVOMB approved screening tools. Tracks are as follows: Track A: One (1) group session per week. Minimum of two (2) treatment plan reviews taking place every 2-3 months, depending on progress on the required Core Competencies (see below). Track B: One (1) group session per week and one (1) additional contact per month. Minimum of three (3) treatment plan reviews taking place every 2-3 months, depending upon progress on the required Core Competencies (see below). Track C: One (1) group session per week and one (1) additional contact per week. Minimum of three (3) treatment plan reviews • Group Process and Skills • Cognitive -Behavioral Skills • Passive, Aggressive and Assertive Behaviors • Victim Empathy • Treatment Goals • Substance Abuse • Stages of Change • Parenting • Men's Issues/Women's Issues (as applicable) • Effects on Children (DV only) • Steps to Problem Solving • Steps to Conflict Resolution • Characteristics of Assaultive Adults • Attitudes Toward the Opposite Sex • Sex Role Training • Socio-cultural Basis for Violence • Provocation • Appropriate Containment and Expressions of Anger • Experiencing Emotions and Feelings Beyond Anger • Grief and Loss • Depression and Anxiety • Stress Management • Relapse/Recidivism Prevention • Healthy Relationships • Sexuality • Spirituality • Resources 1 taking place every 2-3 months, depending upon progress on the required Core Competencies (see below). Additional contacts will be in a group or individual setting depending on the clinical need. Core Competencies (per DVOMB regulations): A. Commitment to eliminate abusive behavior. B. Personal Change Plan work. Demonstrate change. C. Complete the Personal Change Plan Worksheet. D. Recognize and demonstrate empathy. E. Accept full responsibility for the offense and abusive history. F. Identify and reduce pattern of power and control behaviors, beliefs and attitudes of entitlement. G. Accountable for abusive behaviors, accept consequences, take steps to reconciliation to prevent future abusive behaviors. H. Accept that abusive behavior should have and has consequences. I. Participate and cooperate in treatment. J. Ability to define types of DV. K. Understand, identify and manage own pattern of violence. L. Understand intergenerational effects of violence. M. Understand and use healthy communication skills. N. Understand and use time outs. O. Recognize financial responsibilities as required. 2 P. No new violence or abusive offences. Q. Prohibited from purchasing, possessing, or using firearms and ammunition. d. Anger Management and Domestic Violence Intakes will be completed with recommendations before the client is placed into treatment. The intake will determine the best placement for the client in regards to treatment, which may include group session and/or individual sessions. CONTRACTOR will provide a copy of the intake to the caseworker. e. Individual sessions may be determined necessary at intake but will only be utilized under one or more of the following circumstances: • The referred client's individual treatment needs cannot be adequately addressed in a group setting. • The client is not currently appropriate for a group setting and requires a limited number of individual sessions to prepare for a group setting. • The client's job requirements make it impossible to attend regularly scheduled group sessions and individual sessions are the only option for the client to comply with their treatment plan. • When assessed for a DV track in which an additional contact is required. f. If the client is assessed at a higher level of care than what is offered by CONTRACTOR, a recommendation to an agency that offers that level will be made. g. Contractor will comply with the Colorado Domestic Violence Offender Management Board's Standards and Guidelines. 2. Functional Family Therapy (FFT): Contractor will provide Functional Family Therapy (FFT) services to male and female youth within the approximate age range of 10-17 years of age, and their families, residing in Weld County, as referred by the Department. a. Contractor has offices in both Greeley and Fort Lupton, CO. b. Services are provided in -home in accordance with the National Functional Family Therapy (FFT) model, and its standards and guidelines. All services are overseen/supervised by a FFT National Consultant. c. Youth and family are deemed eligible for services based on one or more of the following inclusionary criteria: • Child must be at risk of out -of -home placement or transitioning back from placement within 30 days. • Child is displaying moderate to severe behavioral problems in the home/school/community. • Child is involved in criminal behaviors to include substance abuse. • Child demonstrates verbal and/or physical aggressions at home/school/community. • Child is engaged with deviant peer group. • Child is struggling with school behaviors to include failing grades, truancy and anti -social behaviors. • Family has persistent conflict and negative child -parent relationship. 3 • Caregiver is abusing substances. • Family has limited resources and would benefit from psycho -education and parenting skill development. d. FFT utilizes Family Interventions, Cognitive Behavioral Therapy, Family Therapy, school and community interventions, and substance abuse intervention, as clinically appropriate. e. The goal of services is to: • Empower families with the skills and resources need to independently address the difficulties they are having raising their children. • Empower youth to cope with family, peer, school and neighborhood problems. • Build community and natural support systems. • Decrease negativity and blame among family members. • Decrease anti -social behavior to include legal contacts, truancy and substance abuse issues f. Service duration is two (2) to six (6) months for one (1) to two (2) hours per week. g. Services include: • Case Management • School Interventions • Advocacy • Court/Staffing Participation • Sustainability Planning • Booster Services After Discharge h. CONTRACTOR has the ability to provide bilingual services (Spanish). 3. Mental Health Services: Contractor is the community mental health center serving Weld County. a. Contractor will provide the following services under this contract: i. Level 1— Behavioral Health Evaluation: Useful for ruling in/out basic mental health and substance abuse issues, advising on provisional diagnoses, and making recommendations for treatment when appropriate. Approximate completion time is three (3) to six (6) hours. • Review of Department records, and if applicable, NRBH records. • Clinical interview and integrated diagnostic evaluation (assessment of mental health and substance abuse issues). • Possible administration of brief screening inventories (e.g., Beck Inventories, State - Trait Inventories, Personality Assessment Screener). • Feedback to client. • Written report addressing relevant psychosocial history, diagnostic formulation, and treatment recommendations. ii. Level 2 - Partial Psychological Evaluation: Useful for ruling in/out mental health, substance abuse, cognitive, and/or personality issues, advising on diagnoses, and making treatment recommendations. Approximate complete time is eight (8) to 14 hours. • Review of Department records, and if applicable, NRBH records. • Clinical interview and integrated diagnostic evaluation (assessment of mental 4 health and substance abuse issues). • Administration of a partial test battery, such as administration of just cognitive or just personality testing (e.g., Wechsler IQ tests, MMPI, MCMI, PAI, etc.). • Consultation with collateral sources. • Feedback to client. • Written report addressing relevant psychosocial history, diagnostic formulation, and treatment recommendations. iii. Level 3 — Full Psychological Evaluation: Useful in identifying more significant behavioral health issues and diagnoses, as well as addressing personality issues, intellectual functioning, the ability to manage emotions, parenting issues and potential safety of the children in the home, placement issues, and treatment recommendations. Approximate completion time is 16 to 20 hours. • Review of all available records including Department records, prior evaluation and behavioral health treatment records, police records, medical records, records from other agencies involved in the case, and if applicable, NRBH records. • Extensive integrated clinical evaluation (multiple sessions). • Administration of a formal battery of tests (multiple tests) to assess personality, emotional and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQ tests, MMPI, MCMI, PAI, STAXI, STAI, Beck screens, TSI, PSI, etc.). • Consultation with collateral sources. • Feedback to client. • Written report addressing psychosocial history, personality issues, emotional functioning and regulation abilities, and/or intellectual functioning and/or parenting/family issues, substance abuse, and diagnostic formulation, as well as treatment recommendations and prognosis. iv. Level 4 —Extended Psychological Evaluation: Useful in identifying more significant mental health and substance abuse issues and diagnoses, as well as addressing personality issues, intellectual functioning, the ability to manage emotions, parenting issues and potential safety of the child(ren) in the home, placement issues, and treatment recommendations. To be utilized when impairment in cognitive functioning is suspected/known, when the client is unable to read or write, when there are major memory deficits, when resistance leads to invalid measures and instruments need to be re -administered, and/or when other significant barriers to testing are present. • Review of all available records including Department records, prior evaluation and behavioral health treatment records, police records, medical records, records from other agencies involved in the case, and if applicable, NRBH records. • Extensive integrated clinical evaluation (multiple sessions). • Administration of a formal battery of tests (multiple tests) to assess personality, emotional and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQ tests, MMPI, MCMI, PAI, STAXI, STAI, Beck screens, TSI, PSI, etc.). • Consultation with collateral sources. • Feedback to client. • Written report addressing psychosocial history, personality issues, emotional functioning and regulation abilities, and/or intellectual functioning and/or parenting/family issues, substance abuse, and diagnostic formulation, as well as treatment recommendations and prognosis. For partially completed evaluations, Contractor will submit a written report of any finding that can be appropriately offered based upon the information gathered. Evaluations will be conducted at an NRBH location or another suitable location (e.g., client's home, school, detention center, etc.), depending upon the circumstances. Evaluations will be conducted by a qualified NRBH provider. CONTRACTOR will submit the written report, following completion of the evaluation, within forty-five (45) days from the point of initial contact with the client, provided the client can be reached for appointments and the client attends appointments as scheduled. The Department may choose to extend the referral as deemed appropriate or the referral may be closed if the client fails to follow through. CONTRACTOR will communicate with the referring caseworker and the Child Welfare Contract and Services Coordinator regarding any issues contacting the client, missed appointments, or other issues that arise that prevent the completion of the referred evaluation. 4. Monitored Sobriety Services: Contractor will provide timely and quality monitored sobriety services to male and female clients referred by the Department as follows: a. Contractor will provide timely and quality monitored sobriety services to male and female clients referred by the Department as follows: b. Services will be provided at the North Range Behavioral Health Crisis Stabilization Services facility in Greeley, CO, at 1140 M Street. c. Contractor will provide a qualified monitored sobriety collector 24 hours a day/seven (7) days a week at 1140 M Street, in Greeley, CO. d. Contractor will confirm all positive and negative Breathalyzer monitored sobriety results within 24 hours through a phone call, test result, e-mail and/or fax to the referring caseworker. e. Contractor will confirm all positive and negative laboratory Urinalysis results will be confirmed once processing has occurred through Redwood Toxicology (usually within three days). Confirmation will occur through a phone call, test result, e-mail and/or fax to the referring caseworker. f. Contractor will report all positive and negative Instant Urinalysis results within 24 hours. If the result is positive, it will be sent to Redwood for final confirmation. Confirmation will occur through a phone call, test result, e-mail and/or fax to the referring caseworker. g. Contractor will submit a copy of the valid Authorization for Services form, result and client sign -in sheet (if applicable) with each monthly billing. h. All processed (laboratory) test results will be available online 24 hours per day, seven (7) days per week online at Redwood Toxicology (www.webtoxicology.com). 6 5. Multisystemic Therapy (MST): Contractor will provide Multisystemic Therapy services to male and female youth within the approximate age range of 12-17 years of age, and their families, residing in Weld County, as referred by the Department. a. CONTRACTOR has offices in both Greeley and Fort Lupton, CO. b. Services are provided in -home in accordance with the National Multisystemic Therapy (MST) model, and its standards and guidelines. All services are overseen/supervised by a MST National Consultant. c. Youth and family are deemed eligible for services based on one or more of the following inclusionary criteria: • Child must be at risk of out -of -home placement or transitioning back from placement within 30 days. • Child is involved in criminal behaviors. • Persistent family conflict. • Child and/or caregiver is abusing substances. • Behavior is chronic. • Child is engaged with deviant peers. • Child is struggling at school. • Family has few resources. • Parents would benefit from psycho -education and skill development. • Child is displaying moderate to severe behavior problems. d. MST utilizes In -home Caregiver Interventions, Cognitive Behavioral Therapy, Family Therapy, Individual Therapy, as well as school and community interventions. e. The goal of services is to: • Empower caregivers with the skills and resources needed to independently address the difficulties related to managing their children. • Empower youth to cope with family, peer, school and neighborhood problems. • Build community and natural support systems. • Decrease anti -social behavior. f. Service duration is two (2) to five (5) months for three (3) to five (5) hours per week. g. Services include: • 24/7 On -call Services • Case Management • School Interventions • Advocacy • Court/Staffing Participation • Sustainability Planning h. Contractor has the ability to provide bilingual services (Spanish). 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. 7 7. 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. 8. 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. 9. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 10. 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. 11. Contractor understands that the Department will not reimburse Contractor for "no shows" or cancelled appointments, either on the part of the client or the Contractor. 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. FFT and MST services are inclusive of attendance at staffings. For Mental Health Services only, upon receipt of an invitation from the Department, Contractor must contact the Child Welfare Contract and Services Coordinator to request approval to bill for participation if Contractor wishes to be reimbursed. The Department will reimburse for actual participation in the meeting only so long as the meeting is at least one hour in length, the Contractor requests approval to bill in advance of the meeting and participation in the meeting is deemed appropriate and necessary by the Department. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator. 8 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 in Trails after May 31, 2018, for Core funded services, and June 30, 2018, for other funding sources. Expenses incurred by the Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Anger Management/Domestic Violence Evaluation and Treatment: $200.00/Episode (Anger Management or Domestic Violence Evaluation) $25.00/Hour (Group Session) $17.50/15 Minutes (Individual Session) Functional Family Therapy (FFT): $700.00/Month (Pro -rated for partial month of service) Mental Health Services: $250.00/Episode (Level 1— Behavioral Health Evaluation) $800.00/Episode (Level 2 — Partial Psychological Evaluation) $1,200.00/Episode (Level 3 — Full Psychological Evaluation) $1,800.00/Episode (Level 4— Extended Psychological Evaluation) $120.00/Hour (Hourly rate for partial evaluation, not to exceed cost of full evaluation) Monitored Sobriety: $20.00/Episode (Urinalysis 5 Panel: THC, Coacaine, Amphetamines, Benzodiazepines, Opiates) $20.00/Episode (Urinalysis 7 Panel: THC, Coacaine, Amphetamines, Benzodiazepines, Opiates, Barbiturates, Alcohol) $20.00/Episode (Urinalysis — Multi -Panel Instant) $20.00/Episode (Instant Swab) $35.00/Episode (GCMS — Confirmation of Positive Result) $100.00/Episode (Hair Testing) $50.00/Episode (Patch Monitoring) $50.00/Episode (Urinalysis — Expanded Designer Stimulants 14 -Panel) 1 $35.00/Episode (Ethyl Glucuronide/EtG Test Only) $35.00/Episode (Urinalysis -3 Panel: MDPV, Mephedrone, Methylone) $35.00/Episode (Urinalysis — Synthetic Cannabinoids "Spice") $35.00/Episode (Oral Swab — Synthetic Cannabinoids "Spice") $5.00/Episode (Breathalyzer) $2.00/Episode (Urinalysis —Single Panel EtG Add-on Test with Urinalysis 5 -Panel or 7 -Panel) $2.00/Episode (Urinalysis — Add-on Panel for Oxycodone or Buprenorphrine, with a Urinalysis 5 -Panel or 7 -Panel) Multisystemic Therapy (MST): $1,800.00/Month (Pro -rated for partial month of service) Contractor may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. Contractor will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher, and signed monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7"' day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. b. For one-time services, proof of services rendered shall be receipt of the completed product. c. For Monitored Sobriety services, proof of services rendered shall be the test result. 2 INSR LTR TYPE OF INSURANCE A X COMMERCIAL GENERAL LIABILITY CLAIMS -.MADE I X I OCCUR X I Professional Liab X HIPAA GFNA AGGREGATE LIMIT APPLIES PER IlEcT POL v X I LOC O'rt/ER A AUTOMOBILE LIABILITY X ANY .AUTO OWNED AUTOS ONLY A��TOS ONLY A X B UMBRELLA LIAB EXCESS LIAB I DED I X RETENTION SCHEDULED AUTOS NONAUTOS ONLY Y X I OCCUR CLAIMS -MADE 10,000; WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) it yes, desarbe under DESCRIPTION OF OPERATIONS below C Privacy NORTH12 OP ID_' A ��R<.7t CERTIFICATE OF LIABILITY INSURANCE DATE 06(29//29/22017017 Y) 06 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 Rich & Cartmill Ins of CO of Colorado LLC 8213 W. 20th Street Greeley, CO 80634 Michael J Schmitt CIC INSURED 970-356-8030 North Range Behavioral Health 1300 N 17th Avenue Greeley, CO 80631 co TACT Michael J Schmitt CIC PHONE 970-356-8030 IDDRESs:_ INSURERIS) AFFORDING COVERAGE INSURER A: Philadelphia Insurance Co INSURER B : Pinnacol Assurance INSURER c : Lloyds of London INSURER D INSURER E : INSURER F: FAX Ne).970-356-8032 CQVERAt3ES _ CERTIFICATE NUM --I ER;_._...__ _ . _.._. --- -----. --- --__ _REVISION NUMBER: NAIL S 23850 (HIS 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. ADDL SUB POLICY EFF POLICY EXP INSD 4WD POLICY NUMBER (MM/DDLYYYY) (MM/DP/YYYY). I X I X IPHPK1676246 07/01/2017 07/01/2018 Y'N IIN/A PHSD1258227 107/01/2017 PHPK1676246 07/01/2017 PHUB590527 07/01/2018 07/01/2017 107/01 /2018 2,000,000 LIMITS _ACI I OCCURRENCE 1,000,000 DAMAGE TO RENTED 1,000,000 PREMISES lEa-occlsrencel 3 MEDEXP (Any ens person) t c 20,000 PERSONAL 8 ADV INJURY ($ 1,000,000 SENERA_ AGGREGATE x 3'000'000 PRODUCTS - COMP/OP AGO t 3,000,000 HIPAA I $ 50,000 COMBINED SINGLE LIMIT I 1,000,000 (Ea. accident) BODILY INJURY (Per person) BODILY INJURY (Per accident), PROPERTYY DAMAGE ( or eca Il EACH OUCURRENCE AGGREGATE X 1 STATUTE I ER X 4044331 07/01/2017 I 07/01/2018 r L EACH ACCIDENT E L DISEASE - EA EMI'I OYEE E L.. DISEASE - POLICY LIMIT_, IESG01269611 07/01/2017 07/01/2018 Privacy der CateTar g SIA°6ounNtyr Lepar irecr ofeHuman Services C:IIIrd Tf S ed If more space Is required) Division, Attn: Tobi Vegter, Resource Unit ***See Notes*** CERTIFJCATEH-IQI—PER WEL-HUM Weld County Department of Human Services (see above) Attn: Tobi Vegter PO Box A Greeley, CO 80632 ACORD 25 (2016/03) ANCELLATION 2,000,000 100,000 100,000 500,000 3,000,000 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 Michael J Schmitt CIC C 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Hello