HomeMy WebLinkAbout20161885.tiffCONTRACT AGREEMENT AMENDMENT BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND CROSSROADS COUNSELING, LLC (CORE)
�1-
This Agreement Amendment, made and entered into0 O day o 016, by and between
the Board of Weld County Commissioners, on behalf of the Weld Cou y Department of Human
Services, hereinafter referred to as the "Department", and Crossroads Counseling, LLC, hereinafter
referred to as the "Contractor".
WHEREAS the parties entered into an Agreement for Home Based Services and Sexual Abuse
Treatment (Offense Specific Treatment), (the "Original Agreement") identified by the Weld County
Clerk to the Board of County Commissioners as document No. 2014-2476, approved on August 11,
2014.
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 ended on May 31, 2015.
• The Original Agreement was renewed for the term of June 1, 2015 -May 31, 2016. The
Agreement Amendment is identified by the Weld County Clerk to the Board of County
Commissioners as document No. 2014-2476, approved on May 20, 2015.
• The Amendment, together with the Original Agreement, constitutes the entire
understanding between the parties. The following change is hereby made to the Contract
Documents:
1. Term
This agreement shall become effective on June 1, 2014, upon proper execution of this
Agreement and shall expire May 31, 2017, unless sooner terminated as provided herein.
2. None
• All other terms and conditions of the Original Agreement remain unchanged.
2016-1885
0,6,,,Q,6
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month,
and year first above written.
ATTEST:
Weld C
By:
COUNTY:
tO; BOARD OF COUNTY COMMISSIONERS
my Clerk to the Board WELD COUNTY, COLORADO
Deputy ClertL to the Boa
Mike Freeman, Chair JUN 2 0 Z016
CONTRACTOR:
rossroads Counseling, LLC
.O. Box 6311
Longmont, Colorado 80501-2078
(970) 685-7469
By: r ` 'x//
pbb Dix, LPC - Owr(er
Date:
02-o/6- /04"
DARWIN NATIONAL ASSURANCE COMPANY
11/07/15 - A Mental Health Counselors' Professional Liability Policy
THIS IS A CLAIMS MADE POLICY - PLEASE READ CAREFULLY
*** RENEWAL ***
NOTICE: A LOWER LIMIT OF LIABILITY APPLIES TO JUDGMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS
OF SEXUAL MISCONDUCT (SEE THE SPECIAL PROVISION "SEXUAL MISCONDUCT" IN THE POLICY).
DECLARATIONS
POLICY NO: 5002-5659 ACCOUNT NO: CO-CROS121-0 0514164R
ITEM I. (a) NAME AND ADDRESS OF INSURED: ITEM 1. (b) ADDITIONAL NAMED INSUREDS:
ROBERT A. DIX
CROSSROADSX COUNSELING
PROFESSIONAL, LLC
PO BOX 6311
LONGMONT, CO 80501
ITEM 2. ADDITIONAL INSUREDS:
DEPARTMENT OF YOUTH
CORRECTIONS
4255 S KNOX CT
DENVER, CO 80236
ITEM 3. POLICY PERIOD:
ITEM 4. LIMITS OF LIABILITY: (a) $
ITEM 5.
ITEM 6.
ITEM 7.
(b) $
TYPE OF ORG: LLC/LLP
SAVIO HOUSE
25 KING ST
DENVER, CO 80219
JEFFERSON COUNTY DEPT
OF HUMAN SERVICES
900 JEFFERSON COUNTY PKW
GOLDEN, CO 80401
Continued...
FROM: 01/13/16 TO: 01/1307
12:01 A.M. STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN:
2,000,000 EACH WRONGFUL ACT OR SERIES OF CONTINUOUS, REPEATED
OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE
5 , 0 0 0 COSTS RELATED TO ANY SINGLE PROCEEDING
2 , 0 0 0 , 0 0 0 AGGREGATE, FOR ALL CLAIMS AND ALL PROCEEDINGS
PREMIUM SCHEDULE:
CLASSIFICATION
NUMBER
RATE
ANNUAL PREMIUM
SELF-EMPLOYED COUNSELOR
PROFESSIONAL
ADDITIONAL INSUREDS
ADDITIONAL INSUREDS AFTER FIRST
DEFENSE LIMIT
1
1
6
424.00
30.00
15.00
424.00
30.00
90.00
.00
RETROACTIVE DATE: 01 / 13 / 10
EXTENDED REPORTING PERIOD
ADDITIONAL PREMIUM (if exercised):$
952.00
ITEM 8. POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY
PRGE3000 (3/2006) PRGe1070 (1/2006) PRGE1138
THIS IS NOT A BILL. PREMIUM HAS BEEN PAID.
PRGE2005 (3/2006)
TOTAL PREMIUM:
544.00
AUT RIZED COMPANY REPRESENTATIVE
Americ Professional Agency * 95 Broadway. Amityville, NY 11701
PAGE 1
POLICY NO.: 5002-5659 ISSUED TO: CROSSROADSX COUNSELING
BY: DARWIN NATIONAL ASSURANCE COMPANY
ITEM 2: ADDITIONAL INSUREDS
001. *** See Policy ***
002. *** See Policy ***
003. *** See Policy ***
004. DOUGLAS COUNTY HUMAN
SERVICES
4400 CASTLETON COURT
CASTLE ROCK, CO 80109
005. WELD COUNTY DEPT OF
HUMAN SERVICES
PO BOX A
GREELEY, CO 80632
006. LARIMER COUNTY DEPT OF
HUMAN SERVICES
2601 MIDPOINT DRIVE #112
FT. COLLINS, CO 80525
007. ARAPAHOE COUNTY
14980 E ALAMEDA DR
AURORA, CO 80012
AUTH(IZED COMPANY REPRESENTATIVE
Hello