HomeMy WebLinkAbout20162817.tiff�,A�+rcuk [04-i46
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND TIMOTHY J. MARTINEZ, LPC
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This Agreement, made and entered into the Z day of ' 2016, by and between the Board of Weld
County Commissioners, on behalf of the Weld County Depart ent f Human Services, hereinafter referred to as the
"Department' and Timothy J. Martinez, LPC, 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 funding to the
Department for Mental Health Services and Sexual Abuse Treatment (Offense Specific).
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, 2016, upon proper execution of this Agreement and
shall expire May 31, 2017, 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.
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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.
S. 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
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Colorado per the directions on the form. Failure to complete and submit this form in a timely and
accurate manner may result in a delay of payment.
c. Contractor agrees to accept payment through county warrant when funding source does not
allow for direct deposit.
7. Compliance with Applicable Laws
a. At all times during the performance of this Agreement, Contractor will strictly adhere to all
applicable Federal and State laws, order, and applicable standards, regulations, interpretations
and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials that have been or may
hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws
and regulations, including, but not limited to the following:
- Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil
Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45
C.F.R. Part 80 et. seq.; and
- all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of
race, creed, color, sex, or national origin, be excluded from participation in, be denied the
benefits of, or be otherwise subjected to discrimination under the approved Agreement.
- Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its
implementing regulations, 45 C.F.R. Part 84; and
- the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its
implementation regulations, 45 C.F.R. Part 91; and
- Title VII of the Civil Rights Act of 1964; and
- the Age Discrimination in Employment Act of 1967; and
- the Equal Pay Act of 1963; and
the Education Amendments of 1972; and
- Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and
- all regulations applicable to these laws prohibiting discrimination because of race, color,
national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome
(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of
1973, as amended, cited above. If necessary, Contractor and the Department will resist in
judicial proceedings any efforts to obtain access to client records except as permitted by 42
C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken
to assure that small and minority businesses are utilized, when possible, as sources of
supplies, equipment, construction and services. This assurance is given in consideration of
and for the purpose of obtaining any all Federal and/or State financial assistance.
- Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks
for all employees, contractors and sub -contractors.
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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,
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
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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:
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.
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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
Al! 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
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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 Tim J. Martinez, Owner
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:
Tim J. Martinez, Owner
422 East Vermijo Avenue, Suite 209
Colorado Springs, Colorado 80903
(719) 565-9151
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.
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21. Governmental Immunity
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of
any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental
Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended.
22. Partial Invalidity of Agreement
If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held
or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions.
The parties hereto declare that they would have entered into this Agreement and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional
or invalid.
23. Improprieties/Conflict of Interest
No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department
when the Contractor also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the
Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor
know that the two relationships are in opposition. During the term of the Agreement, Contractor shall
not enter into any third party relationship that gives the appearance of creating a conflict of interest.
Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the
Department, a full disclosure statement setting forth the details that create the appearance of a conflict
of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute
grounds for the Department's termination, for cause, of its Agreement with the Contractor.
Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of
Contractor, to any person for influencing or attempting to influence an officer or employee of an agency,
a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contract, the making of any Federal grant, the making of any
Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of an Federal contract, loan, grant, or cooperative agreement.
24. Storage, Availability and Retention of Records
Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during
business hours, have access to inspect and copy records, and shall be allowed to monitor and review
through on -site visits, all activities related to this Agreement, supported with funds under this Agreement,
to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The
results of the monitoring and evaluation activities shall be provided to the appropriate and interested
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,
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or until an audit has been completed with the following qualifications: If an audit by or on behalf of the
Federal and/or State government has begun but is not completed at the end of the seven (7) year period,
or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until
the resolution of the audit finding.
25. Confidentiality of Records
Contractor shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Agreement except for purposes directly connected with the
administration of Child Protection. No information about or obtained from any applicant/recipient in
possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's
parent or guardian unless in accordance with the Contractor's written policy governing access to,
duplication and dissemination of, all such information, in any form, including social networks. Contractor
shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality
requirements.
Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written
explanation of these confidentiality requirements before access to confidential data is permitted.
Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality
agreement and shall provide a copy of such agreement to the Department, if requested.
26. Proprietary Information
Proprietary information for the purposes of this Agreement is information relating to a party's research,
development, trade secrets, business affairs, internal operations and management procedures and those
of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third
parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither
party shall use or disclose directly or indirectly without prior written authorization any proprietary
information concerning the other party obtained as a result of this Agreement. Any proprietary
information removed from the Department's site by the Contractor in the course of providing services
under this Agreement will be accorded at least the same precautions as are employed by the Contractor
for similar information in the course of its own business.
27. Independence of Contractor: Not an Employee of Weld County
Contract Professional agrees that it is an independent Contract Professional and that Contract
Professional's officers, agents or employees will not become employees of County, nor entitled to any
employee benefits from County as a result of the execution of this Agreement. Contract Professional shall
perform its duties hereunder as an independent Contract Professional. Contract Professional shall be
solely responsible for its acts and those of its agents and employees for all acts performed pursuant to
this Agreement. Contract Professional, its employees and agents are not entitled to unemployment
insurance or workers' compensation benefits through County and County shall not pay for or otherwise
provide such coverage for Contract Professional or any of its agents or employees. Unemployment
insurance benefits will be available to Contract Professional and its employees and agents only if such
coverage is made available by Contract Professional or a third party. Contract Professional shall pay when
due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred
pursuant to this Agreement. Contract Professional shall not have authorization, express or implied, to
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
provide proof thereof when requested to do so by County.
11
28. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as state in
Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or
obligations hereunder without the prior consent of both parties.
29. Agreement Nonexclusive
This Agreement does not guarantee any work nor does it create an exclusive agreement for services.
30. Warranty
The Contractor warrants that services performed under this Agreement will be performed in a manner
consistent with the professional standards governing such services and the provisions of this Agreement.
The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training,
diligence and judgment provided by highly competent individuals and entities that perform services of a
similar nature to those described in this Agreement including Exhibits A, B, C, and D.
31. Acceptance of Services Not a Waiver
Upon completion of the work, the Contractor shall submit to Department originals of all tests and results,
reports, etc., generated during completion of this work. Acceptance by Department of reports and
incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of
responsibility for the quality and accuracy of the services. In no event shall any action by the Department
hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or
default which may then exist on the part of the Contractor, and the Department's action or inaction when
any such breach or default shall exist shall not impair or prejudice any right or remedy available to the
Department with respect to such breach or default; and no assent, expressed or implied, to any breach of
any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a
waiver of any other breach. Acceptance by the Department of, or payment for, any services performed
under this Agreement shall not be construed as a waiver of any of the Department's rights under this
Agreement or under the law generally.
32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507
The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any
personal or beneficial interest whatsoever in the service or property which is the subject matter of this
Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which
would in any manner or degree with the performance of the Contractor's services and the Contractor,
shall not employ any person having such known interests. During the term of this Agreement, the
Contractor shall not engage in any in any business or personal activities or practices or maintain any
relationships which actually conflict with or in any way appear to conflict with the full performance of its
obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may
result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of
the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or
hold any such position which either by rule, practice or action nominates, recommends, supervises
Contract Professional's operations, or authorizes funding to the Contractor.
12
33. Board of County Commissioners of Weld County Approval
This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld
County, Colorado.
34. Choice of Law/Jurisdiction
Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation,
execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference
which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute
between the parties, Contract Professional agrees that the Weld County District Court shall have exclusive
jurisdiction to resolve said dispute.
35. Subcontractors
Contract Professional acknowledges that County has entered into this Agreement in reliance upon the
particular reputation and expertise of Contract Professional. Contract Professional shall not enter into any
subcontractor agreements for the completion of this project without County's prior written consent, which
may be withheld in County's sole discretion.
36. Attorneys Fees/Legal Costs
In the event of a dispute between County and Contract Professional, concerning this Agreement, the
parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs
incurred by or on its own behalf.
37. Ownership
All work and information obtained by Contract Professional under this Agreement or individual work order
shall become or remain (as applicable), the property of County. In addition, all reports, documents, data,
plans, drawings, records and computer files generated by Contract Professional in relation to this
Agreement and all reports, test results and all other tangible materials obtained and/or produced in
connection with the performance of this Agreement, whether or not such materials are in completed form,
shall at all times be considered the property of the County. Contract Professional shall not make use of such
material for purposes other than in connection with this Agreement without prior written approval of
County.
38. Interruptions
Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or
otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond
its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or
Governmental actions.
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.
COUNTY:
ATTEST:
Weld Co
didieu
Clerk to the Board WELD COUNTY, COLORADO
By:
Deputy Clerk to th Board Mike Freeman, Chair
SEP 0 7 Z016
BOARD OF COUNTY COMMISSIONERS
14
CONTRACTOR:
Timothy J. Martinez, LPC
422 East Vermijo Avenue, Suite 209
Colorado Springs, Colorado 80903
(7 565- 151
By:
Date:
artinez, LPC - Owner
020/‘-02//7
HEALTHCARE PROVIDERS SERVICE
ORGANIZATION PURCHASING GROUP
Certificate of 3n0iratice HPSO
H ith ar' Pru, tkr> Jcnzc. Omniation-
OCCURRENCE POLICY FORM
PRODUCER
BRANCH
PREFIX
POLICY NUMBER
018098
Named Insured
970
HPG
0590292711-8
Timothy J Martinez
1701 Keeler Ave
Pueblo, CO 81005-2217
Medical Specialty Code
Clinical Counselor/LPCC
Excludes Cosmetic Procedures
Professional Liability
Your professional liability limits shown above include the following:
• Good Samaritan Liability • Malplacement Liability
80723
Policy Period:
From 02/21/16 to 02/21/17 at 12:01 AM Standard Time
Program Administered by:
Healthcare Providers Service Organization
159 E. County Line Road
Hatboro, PA 19040-1218
1-800-982-9491
www.hpso.com
Insurance is provided by:
American Casualty Company of Reading, Pennsylvania
333 South Wabash Avenue Chicago, Illinois 60604
$1,000,000 each claim $3,000,000 aggregate
• Personal Injury Liability
• Sexual Misconduct included in the PL Limit shown above subject to $25,000 aggregate sublimit
Coverage Extensions
License Protection
Defendant Expense Benefit
Deposition Representation
Assault
Includes Workplace Violence Counseling
Medical Payments
First Aid
Damage to Property of Others
Information Privacy (HIPAA) Fines & Penalties
Workplace Liability
25,000 per proceeding
1,000 per day limit
10,000 per deposition
25,000 per incident
25,000 per person
10,000 per incident
10,000 per incident
25,000 per incident
$ 25,000 aggregate
$ 25,000 aggregate
$ 10,000 aggregate
$ 25,000 aggregate
$ 100,000 aggregate
$ 10.000 aggregate
$ 10,000 aggregate
$ 25,000 aggregate
Workplace Liability
Fire and Water Legal Liability
Personal Liability
Total: $326.00
Included in Professional Liability Limit shown above
Included in the PL limit above subject to $150,000 aggregate sublimit
$1,000,000 aggregate
Premium reflects self-employed, full-time rate.
Policy Forms & Endorsements (Please see attached list for a general description of many common policy forms and endorsements.)
G -121500-D G -121501-C G -121503-C CNA82011 G -145184-A G -147292-A CNA81753 CNA81758 GSL13424 GSL15563
GSL15564 GSL15565 GSL17101 CNA80052 CNA80051 G -123846-005 CNA79575
Chairman of the Board
Secretary
Keep this Certificate of Insurance in a safe place. This Certificate of Insurance and proof of payment are your proof of coverage.
There is no coverage in force unless the premium is paid in full. In order to activate your coverage, please remit premium in full by
the effective date of this Certificate of Insurance.
Form #: G -141241-B (3/2010)
Master Policy: 188711433
HPSO-250-H-CON-Ht 20160218-141
HEALTHCARE PROVIDERS
PROFESSIONAL LIABILITY INSURANCE ENDORSEMENT
Additional Insured — General Liability
In consideration of the premium paid, and subject to the General Liability limit of liability
shown on the certificate of insurance, it is agreed that the GENERAL LIABILITY
COVERAGE PART is amended as follows
The person or entity named below (the "Additional Insured") is an insured under this
Coverage Pare but only as respects its liability arising out of named insured's operations,
or premises owned by or rented by the named insured and solely to the extent that:
1. a general liability claim is made against the named insured and the additional
insured; and
2 in any ensuing litigation arising out of such claim, the named insured and the
additional insured remain as co-defendants.
In no event is there any coverage provided under this policy for an occurrence that is the
direct liability of the additional insured.
Additional Insured:
County of Weld
1150 O Street
Greeley, CO 80631
This endorsement is a part of your policy and takes effect on the effective date of your policy, unless
another effective date is shown below. All other provisions of the policy remain unchanged.
Must Be Completed
ENDT. NO.
POLICY NO.
1
590292711
G -123827-B (07/2001)
Complete Only When This Endorsement (s Not Prepared with the Policy
Or rs Not to be Effective with the Policy
ISSUED TO
Timothy J. Martinez
ENDORSEMENT EFFECTIVE DATE
08/11/2016
JB 08/11/2016
WELD COUNTY'S REQUEST FOR PROPOSAL 1 PAGE OF DOCUMENT
INCLUDED IN PAPER FILE.
Bid No.: B1600047
REMAINDER RETAINED
ELECTRONICALLY IN TYLER.
BOARD OF COUNTY COMMISSIONERS OF TI-.
COUNTY OF WELD, STATE OF COLORADO,
BY AND THROUGH THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
DATE: MARCH 9, 2016
PAGES 1-10 OF THIS REQUEST FOR PROPOSAL CONTAIN GENERAL INFORMATION. NOT ALL
OF THE INFORMATION CONTAINED IN PAGES 1-10 MAY BE APPLICABLE. SPECIFICATIONS
UNIQUE TO THIS REQUEST FOR PROPOSAL FOLLOW PAGE 11.
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
(AS DEFINED ON PAGES 15-17)
B. Bids for the stated services will be received by the Weld County Department of
Human Services, Resource Unit, Attn: Tobi Vegter at vegterta@weldgov.com or
P.O. Box A, 315 A North 11th Avenue, Greeley, CO 80631, through: FRIDAY,
MARCH 25, 2016, AT 5:00 P.M. (WELD COUNTY DEPARTMENT OF HUMAN
SERVICES, RESOURCE UNIT TIME CLOCK).
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 on pages 15-17).
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 II D below. 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.
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Bid No.: B1600047
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.
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, Resource 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.
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
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Bid No.: B1600047
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. Successful bidder certifies, warrants, and agrees that it does not knowingly
employ or contract with an illegal alien who will perform work under this
contract. Successful bidder 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). Successful bidder 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 Successful bidder that the subcontractor
shall not knowingly employ or contract with an illegal alien to perform work
under this Agreement. Successful bidder 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 Successful bidder obtains
actual knowledge that a subcontractor performing work under the public
contract for services knowingly employs or contracts with an illegal alien
Successful bidder shall notify the subcontractor and County within three (3) days
that Successful bidder 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. Successful bidder shall not terminate
Page 3
Bid No.: B1600047
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. Successful bidder 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 Successful bidder
participates in the State of Colorado program, Successful bidder shall, within
twenty days after hiring a new employee to perform work under the contract,
affirm that Successful bidder 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. Successful bidder 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 Successful bidder 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, Successful bidder
shall be liable for actual and consequential damages.
Except where exempted by federal law and except as provided in C.R.S. § 24-
76.5-103(3), if Successful bidder receives federal or state funds under the
contract, Successful bidder 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 Successful bidder 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.
M All goods shall remain the property of the seller until delivered to and accepted by
Weld County, Colorado.
N Late or unsigned bids shall not be accepted or considered. Bids received prior to
the time of opening will be kept unopened in a secure place. No responsibility will
attach to the Families, Youth and Children Commission, the Weld County
Department of Human Services, or the Board of Weld County Commissioners, for
the premature opening of a bid not properly addressed and identified.
O. In submitting the bid, the bidder agrees that the acceptance of any and all bids
by the Board of County Commissioners of Weld County within a reasonable time
or period does not constitute a contract. The Board of County Commissioners of
Weld County, Colorado, reserves the right to reject any and all bids, to waive any
informality in the bids, and to accept the bid, or part of a bid, that, in the opinion
of the Board, is in the best interests of the Board and of the County of Weld,
Page 4
Bid No.: B1600047
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.
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. 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, and "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., with regard to public records, and
cannot guarantee the confidentiality of all documents.
C. 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.
D 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
Page 5
Bid No.: B1600047
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.
E. 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.
F Choice of Law: Colorado law, and rules and regulations established pursuant
thereto, shall be applied in the interpretation, execution, and enforcement of the
contract. Any provision included or incorporated herein by reference which
conflicts with said laws, rules and/or regulations shall be null and void.
G 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.
H 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.
I. Attorneys Fees/Legal Costs: In the event of a dispute between Weld County and
the successful bidder, concerning the contract, the parties agree that Weld County
shall not be liable to or responsible for the payment of attorney fees and/or legal
costs incurred by or on behalf of the successful bidder.
J. Procurement and Performance: The successful bidder agrees to procure the
materials, equipment and/or products necessary for the project and agrees to
diligently provide all services, labor, personnel and materials necessary to perform
and complete the project. The successful bidder shall further be responsible for
the timely completion, and acknowledges that a failure to comply with the
standards and requirements outlined in the Bid within the time limits prescribed
by County may result in County's decision to withhold payment or to terminate this
Agreement.
K. Term: The term of this Agreement begins upon the date of the execution of this
Page 6
Bid No.: B1600047
Agreement by County, and shall continue for three years. However, the agreement
must be renewed by both parties, in writing, on an annual basis.
L. Termination: County has the right to terminate this Agreement, with or without
cause on thirty (30) days written notice. Furthermore, this Agreement may be
terminated at any time without notice upon a material breach of the terms of the
Agreement.
M Subcontractors: The successful bidder acknowledges that County has entered into
this Agreement in reliance upon the particular reputation and expertise of the
successful bidder. The successful bidder 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.
N Non -Assignment: The successful bidder may not assign or transfer this Agreement
or any interest therein or claim thereunder, without the prior written approval of
County. Any attempts by the successful bidder to assign or transfer its rights
hereunder without such prior approval by County shall, at the option of County,
automatically terminate this Agreement and all rights of the successful bidder
hereunder. Such consent may be granted or denied at the sole and absolute
discretion of County.
O. Insurance Requirements.
i. General Requirements: Contractors/Contract Professionals must secure, at or
before the time of execution of any agreement or commencement of any work, the
following insurance covering all operations, goods or services provided pursuant to
this request. Contractors/Contract Professionals shall keep the required insurance
coverage in force at all times during the term of the Agreement, or any extension
thereof, 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.
Page 7
Bid No.: B1600047
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:
* $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
Page 8
Bid No.: B1600047
* 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 Proposal.
iv. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this
information to its insurance agent or broker, and shall have its agent or broker
provide proof of Contractor/Contract Professional's required insurance to the
County. County reserves the right to require Contractor/Contract Professional to
provide a certificate of insurance, a policy, or other proof of insurance as required
by the County's Risk Administrator in his sole discretion.
Additional Insureds: For general liability, excess/umbrella liability, pollution legal
liability, liquor liability, and inland marine, Contractor/Contract Professional's
insurer shall name County as an additional insured.
vi. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's
insurer shall waive subrogation rights against County.
vii. Subcontractors: All subcontractors, subcontractors, independent contractors, sub -
vendors, suppliers or other entities providing goods or services required by this
Agreement shall be subject to all of the requirements herein and shall procure and
maintain the same coverages required of Contractor/Contract Professional.
Contractor/Contract Professional shall include all such subcontractors,
independent contractors, sub -vendors suppliers or other entities as insureds under
its policies or shall ensure that all subcontractors maintain the required coverages.
Contractor/Contract Professional agrees to provide proof of insurance for all such
subcontractors, independent contractors, sub -vendors suppliers or other entities
upon request by the County.
Page 9
Bid No.: B1600047
A provider of Professional Services (as defined in the Bid or RFP) shall provide the
following coverage:
Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each
claim, and $2,000,000 aggregate limit for all claims.
V Warranty. The successful bidder shall warrant that:
A. The services to be supplied pursuant to this bid are fit and sufficient for the
purpose intended;
The services sold to Weld County, Colorado pursuant to this bid conform to the
minimum Weld County specifications as established herein.
Page 10
Bid No.: B1600047
Project Overview:
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. Refer to pages 15-17 for specific definitions related to the
above -mentioned service areas.
Qualifications:
To be considered, a bidder must meet the following minimum qualifications:
1) 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).
2) 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.
3) 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.
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.
Page 11
Bid No.: B1600047
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 Proposal.
6) A bidder must demonstrate the knowledge, training and expertise to conduct the
proposed service(s).
7) 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).
8) Bidder should clearly outline the supervisory structure of staff members and/or
contractors of the bidder. This should include the ratio of supervisor to staff and/or
contractors, frequency and duration of supervision, credentials of supervisor and length
of time as a supervisor.
9) 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.
10) A bidder must demonstrate prior and current capacity to be organized, responsive and
to quickly and successfully schedule services as requested.
11) A bidder must agree to enter into a contract, attached as Exhibit A, with the Weld
County Department of Human Services and comply with all requirements of the
contract.
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 Child Welfare
Administration funding, so long as funding is made available.
Page 12
Bid No.: B1600047
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 Proposal. All
proposals must contain the following specific information:
1) Identification of language(s) and proficiency level, if applying to provide bilingual
(English/Spanish) services.
2) 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.
3) 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.
4) Bidders should avoid elaborate artwork, graphics, binding, presentation or other artifice
that does not directly address the requirements set forth in this Request for Proposal.
5) 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.
6) 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.
7) 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.
8) 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.
Page 13
Bid No.: B1600047
9) 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 Proposal.
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. 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.
Page 14
Bid No.: B1600047
SERVICE AREA DEFINITIONS (NOT LIMITED TO THIS LIST - OTHER SERVICES WILL BE
CONSIDERED)
Program Area
Definition
Aftercare Services
Services provided to prepare a child for
reunification with his/her family or other
permanent placement and to prevent future out -
of -home placement of the child.
Anger Management/Domestic Violence
Diagnostic and/or therapeutic services to assist in
the development of the family services plan, to
assess and/or improve family communication,
functioning and relationships, and to prevent
further domestic violence.
Crisis Intervention and Stabilization
Services
Services that provide an immediate, in-person/in-
home response to families, youth and children, in
*crisis, 24 hours a day, seven (7) days a week.
*A "crisis" is further defined as a situation or
circumstance, usually acute (recent) in nature, which
breaks down the normal functioning of an individual
and/or family, and results in the inability of the
individual and/or family to resolve the crisis through
normal coping behaviors, or without immediate
intervention.
Day Treatment
Comprehensive, highly structured services that
provide education to children and therapy to
children and their families.
Foster Parent Consultation
Services provided to foster and group home
families caring for WCDSS children and youth in
their homes to enhance and improve the quality of
care being provided.
Foster Parent Training
Core training for new Weld County foster parents.
Page 15
Bid No.: B1600047
Program Area
Definition
Functional Family Therapy
Intensive family -based treatment that addresses
the pervasive patterns of relational dysfunction
known to be determinants of conduct disorder,
violent acting out, and substance abuse among
youth 10-18 years old.
Home -Based Intervention
Services provided primarily in the home of the
client that include a variety of services which can
include therapeutic services, concrete services,
collateral services and *crisis intervention directed
to meet the needs of the child and family.
*Crisis Intervention is defined as 24/7 phone
access and in -home counseling.
Kinship Services (Therapeutic)
Kinship services in the areas of (1) consultation and
kinship parent support specific to a child placed in
a kinship home, (2) corrective consultation specific
to a child placed in a kinship home, and (3) critical
care consultation specific to a child placed in a
kinship home. Children placed in kinship care are
maintained in the lowest level of care and least
restrictive setting when out -of -home placement is
necessary.
Life Skills
Visitation (both in -home and in -office) and services
provided primarily in the home that teach
household management, effective access to
community resources, parenting techniques and
family conflict management.
Page 16
Bid No.: B1600047
Program Area
Definition
Mediation/Intensive Family Therapy
Therapeutic intervention typically with all family
members to improve family communication,
functioning and relationships.
Mental Health Services
Diagnostic and/or therapeutic services to assist in
the development of family services plan, to assess
and/or improve family communication, functioning
and relationships.
Multisystemic Therapy
Intensive family- and community -based treatment
program designed to make positive changes in the
various social systems (home, school, community,
peer relations) that contribute to the serious
antisocial behaviors of children and adolescents
who are at risk for out -of -home placement.
Relinquishment Counseling
Relinquishment counseling for parents considering
relinquishment of their children.
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.
Page 17
EXHIBIT A
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND
This Agreement, made and entered into the _ day of , 2016, by and between the Board of Weld
County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as
the "Department' and «Contractor», hereinafter referred to as the "Contractor".
The parties to this Agreement understand and agree that the provisions of this Agreement specifically
include the following documents: Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal,
Exhibit C, Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and
incorporated herein by this reference.
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Services has provided funding to the Department
for
Nit1/4 soh, At
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.
misk
2. Scope of Services
Ar
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 requirem. nts as set forth by the Department. Failure to comply with all aspects may result
in a forfeiture of p ment.
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 prid4e insurance and/or other
funding sources such as Medicaid (if Contractor is a Medicaid eligible=nrQ 4er) or Victim's
Compensation must be exhausted before Core Services or other Departmehtfunds can be accessed
for services.
b. Payment shall be made in accordance with Exhibit A,'Id}aAbnty's Request for Proposal, Exhibit
B, Contractor's Proposal, Exhibit C, Scope of Service. d Eu ibit D, Payment Schedule, attached
hereto and incorporated herein by reference, so locg as seices 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 withlidltfreiniburi6ment if Contractor has failed to comply with any part of
the Agreement, including the'iryna zial Management requirements, program objectives, contractual
terms, or reporting requiretepthth.,ln the event of forfeiture of reimbursement, Contractor may
appeal such circumstance in\'' riting'to the Director of Human Services. The decision of the Director
of Human Services shall a _' ,J1.
5. Financial Ma niketherit
At all times frothe 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
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 2009d-1 Title VI of the Civil
Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and=it≤ir$ilementing regulation, 45
C.F.R. Part 80 et. seq.; and
4,7
- all provisions of the Civil Rights Act of 1986 so th trr&*!f n 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 d,striMination under the approved Agreement.
lt' ,i
- Section 504 of the Rehabilitation Act 41973x'29 U.S.C. Section 794, and its
implementing regulations, 45 C.F.RPPart 84; a`r d
- the Age Discrimination Act of 75,42 U.S.C. Section 6101 et. seq. and its
implementation regulation :,45 C.F.It-Part 91; and
,, j
- Title VII of the C`vi,1. Ra
is Aei of 1964; a n d
- the Age iscririaliptitin Employment Act of 1967; and
- the `' "act of 1963; and
-Cossiation Amendments of 1972; and
- gration 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.
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 frud or criminal offense in
connection with obtaining, attempting to obtain, or perforthir a'..public (Federal, State or
Local) transaction or contract under public transaction -violation o federal or state antitrust
statutes or commission of embezzlement, theft, for
of records, making false statements, or receiving stol
- are not presently indicted for or other
entity (federal, state or local) with commi
certification; and
ribery, falsification or destruction
y; and
ally or civilly charged by a government
ny of the offenses enumerated in this
- have not, within a three-yearperidd preceding this Agreement, had one or more public
transactions (federal, state, or locat) ter iinated for cause or default.
e. Public Contracts for Serv' RS`,§8.17.5-101. Contract Professional certifies, warrants, and
agrees that it does not knowi - ``ploybr contract with an illegal alien who will perform work under
this contract. Contract Pro: i ..I will confirm the employment eligibility of all employees who are
newly hired for empl a h= United States to perform work under this Agreement, through
participation in the E- gram or the State of Colorado program established pursuant to C.R.S.
§8-17.5-102 5 c grgra rofessional shall not knowingly employ or contract with an illegal alien to
( �( ) � g Y P Y g
perform work,unc1 r th is -Agreement or enter into a contract with a subcontractor that fails to certify
with Contr.,:!ct Professional that the subcontractor shall not knowingly employ or contract with an illegal
�'gY p Y g
alien torn v' rk under this Agreement. Contract Professional shall not use E -Verify Program or
p ,:. ,.� g g
State of Colora'`dprogram 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,
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 out`emes 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'.nd�;i, or progress over time.
Following the review, a Program Improvement Plan (PIP) will " -nted for the state to enhance
services to families.
Contractor agrees to continually strive for positive outche areas of Safety, Permanency and Well
Being, Contractor will ensure that any employe:or subcon ractor of Contractor providing services under
this Agreement will work towards positive ou orn in the aforementioned three areas as outlined under
the Child and Family Services Review (CFSR), an ill dress the aforementioned three areas when
completing monthly reports as required 'f Paragraph 3(d) of this Agreement,
9. Insurance Requirements
Contractor and Departmen-t agre i l at 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 Cone-- ittubcontractor, or their employees, volunteers, or agents while performing
duties described i i thi ent. Contractor shall indemnify, defend and hold harmless Weld County,
the Board of Cn``' nt issioners of Weld County, its employees, volunteers and agents.
Contractor shall pots ,>; e 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
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 kmay deem necessary to
A.
cover its obligations and liabilities under this Agreement.
b. Types of Insurance: Contractor/Contract Profe io shall obtain, and maintain at all
times during the term of any Agreement, insurance in the I 'kinds and amounts:
Workers' Compensation Insu s uired by state statute, and Employer's
Liability Insurance covering all of Con actor' o -`tract Professional's employees acting
within the course and scope of their a to nt. If Contractor is an Independent
Contractor, as defined by thes+lorado r er's Compensation Act, this requirement
5:s
shall not apply. ContractorMust'ubmit to the Department a Declaration of Independent
Contractor Status Form prior 0445 -start of this agreement.
ii. Commercial°- eritaIhability Insurance written on ISO occurrence form CG 00
01 10/93 or e u'1:" let covatring premises operations, fire damage, independent
Contractors, and completed operations, blanket contractual liability, personal
injury, aad iability 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 approvedkby said Administrator,
covering all operations hereunder set forth in the related Bid or Request for Proposal.
\Jt
d, Proof of Insurance: Contractor/Contract Profess.of(,shall,provide a copy of this
information to its insurance agent or broker, and shall hav ittgt€ 't or broker provide proof of
Contractor/Contract Professional's required insurance Cauntt...Jreserves the right to require
Contractor/Contract Professional to provide a cptiffcatf insurance, a policy, or other proof of
insurance as required by the County's Risk Administra-or i his sole discretion.
e. Additional Insureds: For generl liability-excess/umbrella liability, pollution legal liability,
liquor liability, and inland marine, C ` ;. ra- `' r/Contract Professional's insurer shall name County as
an additional insured as follows
f. Waiver of Subrogaf,r., 1;1overages, Contractor/Contract Professional's insurer
shall waive subrogation ttkts`gainst County.
g. Subcontractorsb,,Al&s Ybcontractors, subcontractors, independent contractors, sub -
vendors, suppliers r?otb r entities providing goods or services required by this Agreement shall
be subject to411of th`Os'requirements herein and shall procure and maintain the same coverages
required „of Cactvf/Contract Professional. Contractor/Contract Professional shall include all
such subcoatra ;ors, independent contractors, sub -vendors suppliers or other entities as insureds
under is polio%es or shall ensure that all subcontractors maintain the required coverages.
Contractor./:contract Professional agrees to provide proof of insurance for all such subcontractors,
independent contractors, sub -vendors suppliers or other entities upon request by the County.
A provider of Professional Services (as defined in the Bid or RFP) shall provide the following
coverage:
Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and
$2,000,000 aggregate limit for all claims.
10. Certification
Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all
necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies
covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any Agreement.
11. Training
Contractor may be required to attend training that the request of the Department specific to services
provided under this Agreement, The Department will not compensate the Contractor for said training in
the form of registration fees, time spent traveling to and from training, attending the training or any other
associated costs unless otherwise agreed to by the Department.
12. Subpoenas
Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the
Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For
this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the
Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will
contact the Weld County Attorney's Office immediately at 970-352-1551, x6503, and advise that the
subpoena must be personally served.
13. Monitoring and Evaluation
Contractor and the Department agree that monitoring and evaluation ofthe_piyformance of this
Agreement shall be conducted by the Contractor and the Departme t. The resuI)s of the monitoring and
evaluation shall be provided to the Board of Weld County Commi&i rs, thi Department and the
Contractor.
Contractor shall permit the Department, and any other tl ized agent or governmental agency, to
monitor all activities conducted by the Contractor purs ant to H e erms of this Agreement, As the
monitoring agency may in its sole discretion deem necessary • :;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 t t vnot unduly interfere with the work conducted under
this Agreement.
14. Modification of Agreemen E
4\ -
All modifications to this Agree, I 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: substant illy failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfyi#he scope of work shall be defined to mean incorrect or improper activities or inaction by
the Contractor. Tlxes 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.
For Department:
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
(970) 352-1551
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 Contractor:
+\/
18. Litigation
Contractor shall promptly notify the Department«n the eve nthat Contractor learns of any actual
litigation in which it is a party defendant in a •aae,that involves services provided under this Agreement.
Contractor, within five (5) calendar days after be ngfretved with a summons, complaint, or other pleading
which has been filed in any Federal or Si* court. ar'administrative agency, shall deliver copies of such
document(s) to the Director of Hu ..``'nrv*> r he term "litigation" includes an assignment for the
benefit of creditors, and filings of ptcy, eorganization and/or foreclosure.
19. Termination
This Agreement may
individuals identif'_-d
obligation on
appropriated i
Therefore, the Dep
ed at any time by either party giving thirty (30) days written notice to the
ph 18. No portion of this Agreement shall be deemed to create an
he County of Weld, State of Colorado, to expend funds not otherwise
ceeding year, as this Agreement is subject to the availability of funding.
ent 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.
I
The Appearance of Conflict of Interest applies to the relationship ofa Contractotwith the Department
a,
when the Contractor also maintains a relationship with a third pajty'and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, itis,fot necessary for the
Contractor to gain from knowledge of these opposing interestsvIt is only necessary that the Contractor
know that the two relationships are in opposition. Duriggithe-term of the Agreement, Contractor shall
s,
not enter into any third party relationship that gives th rappea ance of creating a conflict of interest.
Upon learning of an existing appearance of a conflict of`interesfsituation, Contractor shall submit to the
Department, a full disclosure statement setting.<fbrth 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 Muse, of its Agreement with the Contractor.
Contractor certifies that Federal app ai sated f ids have not been paid or will be paid, by or on behalf of
Contractor, to any person for infldi pci `g'or attempting to influence an officer or employee of an agency,
a Member of Congress, an officer;ar ejn..,ployee of Congress, or an employee of a Member of Congress in
connection with the award any -Federal contract, the making of any Federal grant, the making of any
Federal loan, the entering i tytarycooperative agreement, and the extension, continuation, renewal,
amendment, or modi �: n Federal contract, loan, grant, or cooperative agreement.
24. Stora Av.' a ,ity and Retention of Records
Contractor agree- 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, ifsrequested.
26. Proprietary Information
%
Proprietary information for the purposes of this Agreement is inforrnatrn ,elating to a party's research,
development, trade secrets, business affairs, internal operati&Oarlapnagement procedures and those
of its customers, clients or affiliates, but does not includel`iifcrrnation (1) lawfully obtained from thirdparties, (2) that which is in the public domain, or (3) the which44:s developed independently. Neither
art shall use or disclose directly or indirectly without s,�'rior wri'�tten authorization any proprietary
partyOrr :r Stp p
vt.
information concerning the other party obtainedtas a resul`t�of this Agreement. Any proprietary
information removed from the Department's:Site jethe Contractor in the course of providing services
under this Agreement will be accorded at least `t ie sa' precautions as are employed by the Contractor
for similar information in the course of i'4 ;own business.
27. Independence of Contractor: ,Not an`Employee of Weld County
Contract Professional agree .that ittY` h independent Contract Professional and that Contract
Professional's officers, rrt age;de J pl`oyees will not become employees of County, nor entitled to any
employee benefits fro ounfy' s a result of the execution of this Agreement. Contract Professional shall
perform its duties,berd4Rdert an independent Contract Professional. Contract Professional shall be
solely responsible &rats and those of its agents and employees for all acts performed pursuant to
this Agreements.Contr t'Professional, its employees and agents are not entitled to unemployment
insurance or workersx44ompensation 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.
sl
31. Acceptance of Services Not a Waiver
incidental material(s) furnished under this Agreement shall n
responsibility for the quality and accuracy of the service r.
hereunder constitute or be construed to be a waiver b he De
default which may then exist on the part of the Contrac an 'the Department's action or inaction when
any such breach or default shall exist shall not Difi air or prejudice any right or remedy available to the
Department with respect to such breach or daul_t� and no assent, expressed or implied, to any breach of
any one or more covenants, provisions or conditf arns of4he Agreement shall be deemed or taken to be a
waiver of any other breach. Acceptance' ,%Qhe Department of, or payment for, any services performed
under this Agreement shall not be c ns to east waiver of any of the Department's rights under this
Agreement or under the law gene rJlyn•
32. Employee FinanciaLinte`P QThflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507
Upon completion of the work, the Contractor shall submit to Dep,rtrt":ent originals of all tests and results,
reports, etc., generated during completion of this work. Acceptant }i fepartment of reports and
i
y=>'4i a relieve the Contractor of
Y
nt shall any action by the Department
ent of any breach of covenant or
The signatories to this l rr_ent* t aver that to their knowledge, no employee of Weld County has any
,A1 g
personal or beneficial 'in'kefe&Nwhatsoever in the service or property which is the subject matter of this
Agreement. Tbetontrac r has no interest and shall not acquire any interest direct or indirect, which
would in any Mariner c$ degree with the performance of the Contractor's services and the Contractor,
shall not employ a"rtyverson 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 concerninghis Agreement, the
parties agree that each party shall be responsible for the paymerI o torney fees and/or legal costs
incurred by or on its own behalf.
37. Ownership
All work and information obtained by Contract Profess' r this Agreement or individual work order
shall become or remain (as applicable), the pra rty of County, In addition, all reports, documents, data,
plans, drawings, records and computer file gOerated by Contract Professional in relation to this
Agreement and all reports, test results and a� other' tangible materials obtained and/or produced in
connection with the performance of this°Agreemer ;whether or not such materials are in completed form,
shall at all times be considered the top''. fthe County. Contract Professional shall not make use of such
material for purposes other that% c innect n with this Agreement without prior written approval of
County.
38. Interruptions
Neither party to ,is Pi' &rient shall be liable to the other for delays in delivery or failure to deliver or
otherwise to pobligation under this Agreement, where such failure is due to any cause beyond
its reasonable rol ncluding but not limited to Acts of God, fires, strikes, war, flood, earthquakes or
Governmental act
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.
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 :1\1
Iiiib
Contractor, -Ti
14
EXHIBIT A
WELD COUNTY'S REQUEST FOR PROPOSAL
THIS PAGE INTENTIONAT BLANK
44.
itatiSt"
C;%.
EXHIBIT B
CONTRACTOR'S PROPOSAL
THIS PAGE INTENTIONA`T BLANK
4(</.
4iti%4q\/
COP%.
EXHIBIT C
SCOPE OF SERVICES
THIS PAGE INTENTIONAvet
LLY LEFT BLANK
EXHIBIT D
PAYMENT SCHEDULE
THIS PAGE INTENTIONA
44.
C;%.
T BLANK
EXHIBIT B
CONTRACTOR'S PROPOSAL
PROVIDER INFORMATION FORM (Proposal Cover Sheet)
Weld County Department of Human Services
n ,
rn&n, LPL
AGENCY OR PRIVATE PRACTICE
fld-de ctil�
TRAILS PROVIDER ID (If Known)
LPCJ
PRIMARY CONTACT — FULL NAME PRIMARY CONTACT - TITLE
-41 q )14C40 4-1-00 Les. (Mg )a\Ct-- (Oa I (.0
PHONE NUMBER
EXT. FAX NUMBER
pMekr-brozzt.sda*:
PRIMARY COACT— E-MAIL ADDRESS
r1 jt j'� `� � �^\ AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) (]�;
. �1 C. v \ i-1`I) 0 1 ��.J e • AC)) 1/40 CI O
AGENCY MAILING ADDRESS
GiA0 art✓ S
CITY J ZIP
REF FERAL 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 where the bids are competitive in price and quality.
Signature of Authorized Re resentativ :
Date of Signature: 31 //b-;
LI (Ur
Please indicate the program area(s) you wish to be considered for:
❑o❑o❑oc
Aftercare Services
Anger Management/Domestic Violence
Crisis Intervention and Stabilization
Services
Day Treatment
Foster Parent Consultation
Foster Parent Training
Functional Family Therapy
Home -Based Intensive Services
Home Studies
Kinship Services
❑ Life Skills
❑ Mediation
B. Mental Health Services
❑ Monitored Sobriety Only
❑ Multi -Systemic Therapy
❑ Relinquishment Counseling
isk Sexual Abuse Treatment
❑ Substance Abuse Evaluation and
Treatment
❑ Other:
O
O
Other:
Other:
INTRODUCTION
Nichole Longo -Martinez, LPC
422 E. Vermijo Ava, Suite 209
Colorado Springs, CO 80903
Licensed Professional Counselor
Colorado SOMB Juvenile Treatment Provider
I have recently started providing outpatient private practice to a female youth placed
through Weld County for offense specific therapy who is placed at a group home in El
Paso County. This is current out of home placement contract and I am hoping to
become a CORE service provider for Weld County so I may continue providing
treatment services to this youth and other youth in placement through Weld County.
My focus of treatment will be for females and males, ages 10-21. Although my specialty
area is offense specific treatment, I have worked with a variety of youth with various
mental health needs to include mood dysregulation (depression, anxiety, etc.), conduct
and behavior problems, sexual identity, transgender issues, exploited youth, and youth
with past trauma.
I have attached the additional documentation requested_ Thank you for your
consideration in this matter.
Respectfully,
Nichole Longo -Martinez
Nichole Longo -Martinez, LPC
422 E. Vermijo, jo, Suite 209
Colorado Springs, CO 80903
Assurance Therapeutic Services, LTD.
Services Include (depending on individual's need):
Outpatient Adolescent Therapy:
Healthy Sexuality
Offense Specific Treatment
Trauma Informed Care
Trauma Focused Cognitive Behavior Therapy
Cognitive Behavior Therapy
Family Therapy
Treatment Team Meeting Participation
Treatment Plan Development (No Charge)
Services are $65.00 per hour = $15.25 per 15 minute unit.
125 Rio Grande
Canon City, CO 81212
(719) 406-4000
Nichole Longo Martinez
CAREER OBJECTIVES:
Full time position which will enable me to administer present
skills, as well as gain insight and experience within the counseling field.
EDUCATION:
Adams State University-Alamosa, Colorado
MA Clinical/Mental Health Counseling 2010-2013
Colorado State University-Pueblo/Pueblo, Colorado
BS Sociology and Social Work (BSW) 2001-2005
Pueblo County High School/ Pueblo, Colorado
Graduated May 2001
PROFESSIONAL SKILLS:
Licensed Professional Counselor (State of Colorado) #.0012477
Sex Offender Management Board (BOMB) Full Operating Level
Treatment Provider -Juvenile
Trained in Trauma Focused Cognitive Behavioral Therapy (TF-
CBT); Crisis Debriefing; Suicide Prevention/Intervention;
Dialectical Behavioral Therapy (DBT); Acknowledgment and
handling of Methamphetamine Labs
Exceptional verbal and written communications
Ability to analyze large amounts of written documents and apply
that information to the work situation.
Experience in Microsoft Word, Word Perfect, Windows
HONORS/ACTIVITIES:
Honors
National Certified Counselor (NCC)
Chi Sigma Iota Honor Society, 2012 -Present
Phi Alpha Honor Society, January 2003 -Present
Colorado State University -Pueblo Dean's List, Spring 2004
President's Academic Scholarship, 2001-2002
Sons of Italy Academic Scholarship, 2001-2002
Activities
INN
Student Social Work Association, September 2002 -May 2005,
Senate Pro -Council Advisor, Colorado State University -Pueblo
Associated Student Government, July 2002 -January 2003
Senate Pro -Council Member, Colorado State University -Pueblo
Colorado State University -Pueblo Cheerleading Squad, June 2001 -
May 2002
WORK EXPERIENCE:
Southern Peaks Regional Treatment Center -Canon City, Colorado
May 2009 -Present
Position: SOMB Therapist (2012 -Present)
Duties: Supervise the Male and Female Offense Specific Programs; Provide
Supervision to 2 Therapists; Facilitate weekly training for Offense
Specific population on campus and follow all standards set forth by
the Colorado Sex Offender Management Board (SOMB) in
reference to providing treatment to the juvenile offense specific
population (male/female); Provide individual therapy to a
caseload of approximately 8-10 adolescents with behavioral, mental
health, and offense specific issues, ages 10-21, placed in residential
treatment on a daily basis, assisting them in developing skills
needed to appropriately manage mental health disorders, drug and
alcohol addictions, emotions, and life situations; Provide family
therapy to adolescents both face-to-face and by phone with
parents/guardians to assist families in the reunification process;
Facilitate weekly groups with adolescents in various areas such as
Anger Management, Life Skills, Transition, Offense Specific
Treatment (male and female), and Relapse Prevention; Assist in
crisis intervention across campus; Administer assessments to
adolescents including Mental Health Assessment, Erasor, and J -
Soap II; Attend monthly staffing's for adolescents and
communicate with individual Multi -Disciplinary Teams on a
consistent basis regarding treatment needs, successes, concerns,
etc.; Complete monthly treatment reports for all adolescents on
caseload as well as any other required documentation, including
weekly billing for services of clients and insurance documentation
for clients.
Jewett's-Canon City, Colorado
September 2013 -April 2014
Position: Sales Associate
Duties: Assist customers with their purchases; Stock products on the floor
as needed.
El Pueblo Boys and Girls Ranch -Pueblo, Colorado
December 2006 -May 2009
Position: Direct Care Staff III
Duties: Supervise and monitor adolescents ages 10-20, in crisis in a lock
down unit on a daily basis, assist in meeting their needs, teaching
basic and social skills needed to function in everyday life; Facilitate
group therapy sessions utilizing Dialectical Behavioral Therapy
(DBT), Anger Management, Thinking Errors, Positive Affirmation,
as well as other social skills groups approximately 5-6 times a week
as well as co -facilitate and sit in on various groups with other staff,
provide necessary feedback in regards to group, and mentor other
staff on each of the crisis units; Hold individual therapy sessions
with each adolescent in unit on a daily basis; Assist in crisis
intervention, as well as suicide intervention/prevention across the
facility; Administer resident's medications on a daily basis (QMA);
Attend trainings on a regular basis, work in high stress and
emotion charged situations on a daily basis, document all necessary
paperwork; Review daily group documentation by all staff in my
unit, attend weekly meetings to address various situations across
campus as well as any issues and/ or concerns that need to be
addressed regarding customer service and residential status across
the facility; Attend weekly meetings with the Clinical
Administrator to review my group and individual documentation
as well as discuss individual cases in regards to treatment.
Target
October 2006 -November 2006
Position: Team Member
Duties: Assisted customers on the sales floor, as well as worked on keeping
all displays organized; Worked as cashier at times when additional
assistance was needed.
16th Judicial District Probation Department -La Junta, Colorado
January 2006 -September 2006
Position: Probation Officer I
Duties: Supervised a caseload of minimum, medium, and maximum risk
offenders, which included Adults, Juveniles, Domestic Violence
offenders and minimum risk sex offenders; Conducted initial
intake appointments, reviewed terms and conditions of probation,
performed standardized assessments, performed collaborative
efforts with various agencies; Wrote Pre -sentence Investigation
Reports for the court; Duties included documentation of
interactions with clients, worked with clients to complete their case
plans, coordinated treatment referrals, worked in conjunction with
treatment providers and other outside agencies; Conducted agency
visits to observe domestic violence groups and maintain contact
with outside agencies in regards to client progress; Administered
Urinalysis tests; Attended court proceedings and testified when
called upon; Assessed Domestic Violence Screening Inventories
(DVSI), Spousal Risk Assessment (SARA), Alcohol and Substance
Use Survey (ASUS), Level of Supervision Inventory (LSI), Colorado
Young Offender Level of Service Inventory (CYO-LSI), Simple
Screening Instrument (SSI), and the Substance Use Survey (SUS} -IA
on various offenders.
10th Judicial District Probation Department -Pueblo, Colorado
May 2005 -December 2005
Position: Probation Intern/Volunteer
Duties: Performed Probation Officer duties on a daily basis, including
management and professional documentation; worked extensively
in the Domestic Violence Unit, meeting face-to-face with clients for
scheduled appointments, Documentation of interactions with
clients; worked in conjunction with treatment providers and other
outside agencies; exposure to court proceedings, including Fast
Track; proficient in ECLIPSE programming; assisted with Adult
Orientation and conducted individual intake appointments.
Dillard's-Pueblo, Colorado
September 2005 -January 2006
September 2002 -May 2005
Position: Sales Associate
Duties: Provided customer service with retail selections, maintained
financial responsibility of keeping the register accurate, inventoried
merchandise, created and organized merchandise displays.
4th Judicial District Probation Department -Colorado Springs, Colorado
January 2003 -April 2003
Position: Probation Volunteer
Duties: Administered standardized offender assessments (i.e. Level of
Supervision Inventory and Alcohol and Substance Use Survey)
developed and implemented required treatment plans according to
those results; provided case management services which included
face-to-face meetings and arranging collaborative efforts with
outside agencies; monitored/supervised offenders of all levels in
substance abuse treatment and other court ordered requirements
Colorado State University -Pueblo Admissions/Records Office -Pueblo,
Colorado
May 2002 -May 2003
Position: Clerical Aide
Duties: Provided administrative support to applicants and incoming
students, conducted data entry, answered phones.
Convergy's-Pueblo, Colorado
July 2000 -October 2001
Position: Sales and Service Consultant
Duties: Assisted in inbound Citigroup customers with credit card
applications.
Kentucky Fried Chicken -Pueblo, Colorado
July 1998 -July 2000
Position: Shift Supervisor
Duties: Provided customer service, supervised crew members, completed
daily paperwork, inventoried and ordered all stock on a weekly
basis, attended monthly supervisor and staff meetings, attended
safety trainings.
REFERENCES: References available upon request.
i
.1
9
R
Colorado Department of Regulatory Agencies
Division of, Prof e≤sibns and occupations
Licensed Professional Counselor Examiners Board
Nichole Longo Martinez
Licensed Professional Counselor
06/09/2015
LPC.OQi2477 Issue Qate
Number .08/ 31/2017
Active expire Date
Credential Status
Verify this credential at: www.dora.coiorado. n rofessions
sion Director: Lauren Larson Credential Holder Si: nature
t.
COLORADO
Division of Criminal Justice
Sex Offender Management Unit
700 Kipling Street, Suite 1000
Lakewood, CO 80215
303.239.4442
November 10, 2015
Nichole Longo Martinez, LPC
Southern Peaks Regional Treatment Center
700 Fourmile Parkway
Canon City, CO 81212
Dear Ms. Longo Martinez,
The Colorado Sex Offender Management Board (hereafter Board) is pleased to inform you that you have been identified as meeting the
criteria established for Full Operating Level Treatment Provider under the Standards and Guidelines for the Evaluation, Assessment,
Treatment and Supervision of Juveniles Who Have Committed Sexual Offenses (hereafter Standards), pursuant to Section 16-11.7-106 C.R.S.
Your name will appear in the next published Provider List. Until the next list is published, you may use a copy of this letter to verify for
referral sources that the Board has determined that you meet the criteria under the Standards in Colorado. Please refer to the Provider List,
updated regularly, on the Board's webpage at http://dci.somb.state.co.us.
Your period of inclusion on the list of providers will end on December 31, 2016, at which time you will have an opportunity to renew your
application. In addition, during this period, the Board will periodically conduct additional record checks and may request updated
information as necessary.
The Board would like to remind you that the Standards require that you accumulate at least 40 additional hours of continuing education
every three years in order to maintain proficiency and remain current in the field of the evaluation, assessment, treatment, and supervision
of JWCSO. This additional training requirement is evaluated through the regulation process at the end of your inclusion period.
To be included on the list of providers means that (1) you meet the education and experience qualifications established in the Standards (2)
you have agreed to, and appear to be able to, provide your services according to the standards of practice established in the Standards.
Inclusion on the list places you in the pool of people eligible for referrals for JWCSO. It does not create an entitlement or guarantee that you
will receive referrals. The sentencing judge, probation, parole and community corrections have historically chosen, and will continue to
determine, which provider(s) on the Board's list offer the type of treatment program they are seeking in the best interest of community
safety. As you know, inclusion on the list does not imply either licensure or certification, and should not be represented as such. Any
reference should be stated as, for example, "Full Operating Level Treatment Provider".
Please note that it is your responsibility to provide the Board with any address changes and/or additions, as well as any changes to
program materials. This will ensure accurate information, provided to referral sources, on our website. Pursuant to Section 4.000 of the
Standards, you must remain in compliance with the Standards and maintain the qualifications listed, including listing with the Department
of Regulatory Agencies. In addition, you must also notify the SOMB if you are ever arrested, as failure to do this in a timely fashion has the
potential to jeopardize your status as a provider.
Should you have any questions, please feel free to contact me at (303) 239-4197 or via email at: Raechel.Alderete@state.co.us
Sincerely,
Raechel Alderete
Juvenile Standards Coordinator
Office of Domestic Violence & Sex Offender Management
Division of Criminal Justice, Department of Public Safety
Cotorado Department of Public. Safety I 700 itipting Street Suite 1000, Lakewood, CO 80215
John W. Hickenlooper, Governor I Stan Hilkey. Executive Director
PROVIDER INFORMATION FORM (Proposal Cover Sheet)
AGENCY OR PRIVATE PRACTICE
Weld County Department of Human Services
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PHONE NUMBER
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TRAILS PROVIDER ID (If Known)
PRIMARY CONTACT - TITLE
EXT. FAX NUMBER
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PRIMARY CONTACT — E-MAIL ADDRESS
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AGENCY/PRACTICE WEB ADDRESS (IF APPUCABLE)
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REFFERAL CONTACT- FULL NAME (IF DIFFERENT THAN PRIMARY CONTACT)
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REFERRAL CONTACT - PHONE NUMBER
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REFERRAL CONTACT - TITLE
EXT. REFERRAL CONTACT- E-MAIL ADDRESS
I certify that the services offered for intended use by Weld County will meet all the specifications it has so indicated
in this bid form. The Board of Weld County Commissioners reserves the right to reject any or all bids, to waive any
informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests
of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give
preference to resident Weld County bidders in all cases where the bids are competitive in price and quality.
n
we _
Signature of Authorizied Representative:
Date of Signature:
Please indicate the program area(s) you wish to be considered for:
❑❑❑❑❑❑❑
Aftercare Services
Anger Management/Domestic Violence
Crisis Intervention and Stabilization
Services
Day Treatment
Foster Parent Consultation
Foster Parent Training
Functional Family Therapy
Home -Based Intensive Services
Home Studies
Kinship Services
❑ Life Skills
❑ Mediation
itilAental Health Services
❑ Monitored Sobriety Only
❑ Multi -Systemic Therapy
❑ Relinquishment Counseling
exual Abuse Treatment
❑ Substance Abuse Evaluation and
Treatment
❑ Other:
❑ Other:
❑ Other:
AGENCY INTRODUCTION
Assurance Therapeutic Services, ltd
422 E. Vermijo Ave., Suite 209
Colorado Springs, CO 80903
Tim Martinez, Owner
Licensed Professional Counselor
Colorado SOMB Clinical Supervisor / Treatment Provider
I started my outpatient private practice at the above listed address in March of 2013
after being encouraged by various El Paso County DHS Caseworkers who were in need
of a skilled out -patient offense specific treatment provider. Since starting my practice, I
have established additional contracts with many Colorado County Department of
Human Service Agencies to include; Weld, Adams, Arapahoe, Denver, Baca, Teller,
Pueblo, and Fremont.
I work primarily with male juveniles who have been adjudicated for a sexual offense or
who have a history of sexually abusive behaviors ages 10 — 21. Although I specialize in
offense specific treatment, I have also provided outpatient services to both male and
female children and adolescents (11 — 21) who have experienced trauma, conduct
related issues, mood disorder, sexually exploited youth, family issues, gender identity,
and sexual identity issues. I also have provided treatment to female juveniles who have
been adjudicated for a sexual offense. I have also been successful in reunification with
DHS closing out cases for the successful return home of the child after being in many
out of home placements.
I am currently working through the certification process of Trauma Focused Cognitive
Behavioral Therapy with the University of Colorado Institute of Behavioral Health.
hope to obtain this certification by Summer 2016. I am an approved Colorado SOMB
Full Level Treatment Provider / Clinical Supervisor. I do not have additional employees
working within my agency. I have recently submitted my Letter of Intent to Value
Options in becoming a Colorado Medicaid Mental Health Treatment Provider and I am
awaiting response in the next step of this process.
I have attached the additional documentation requested. Thank you for your
consideration in this matter.
Respectfully,
1/4
Tim Martinez, LPC
Tim J. Martinez, LPC
422 E. Vermijo, Suite 209
Colorado Springs, CO 80903
Assurance Therapeutic Services, LTD.
Services Include (depending on individual's need):
Outpatient Adolescent Therapy:
Healthy Sexuality
Offense Specific Treatment
Trauma Informed Care
Trauma Focused Cognitive Behavior Therapy
Cognitive Behavior Therapy
Family Therapy
Treatment Team Meeting Participation
Treatment Plan Development (No Charge)
Services are $65.00 per hour = $15.25 per 15 minute unit.
Tim J. Martinez
422 E. Vermijo, Suite 209
Colorado Springs, CO 80903
7/95659151
martineztim@hotmailocom
2010 - MA Community Counseling Adams State College
2007 - BA Major Psychology Minor Sociology Colorado State University Pueblo
- Licensed Professional Counselor— State of Colorado 11275
- National Certified Counselor
- Approved Colorado Sex Offender Management Board Treatment Provider and Clinical
Supervisor for Juveniles Who Have Committed Sexual Offenses
- 2012 Recipient of Award from Colorado Association of Family and Children's Agencies
for Outstanding Commitment & Service to Children & Families.
- Trauma Focused Cognitive Behavioral Therapy
2013 — Current
Assurance Therapeutic Services, LILC Colorado Springs, Colorado
Therapist / Owner
Provide outpatient mental health services to adolescents and families in compliance
with Colorado Department of Regulatory Agencies and Colorado Department of Human
Services. Provide mental health services to children and adolescents to address
trauma history, family issues, mental health and behavioral issues which are preventing
family reunification. Work closely with various DHS County Agencies throughout
Colorado in providing mental health services to children and adolescents who are
currently in out of home placement so that they may remain in the least restrictive living
environment in the community.
2014 - Current
Southern Peaks Regional Treatment Center Canon City, Colorado
Clinical Supervisor
Responsible for the oversight and monitoring of the clinical department to ensure
appropriate services are delivered to youth in treatment in compliance with CDHS rules
and regulations. Responsible for staff development and supervision. Provide direction
and support to clinician's in delivering services in order to transition the youth to the
community. Communicate effectively with CDHS placement agencies.
2010 — 2014
Southern Peaks Regional Treatment Center Canon City, Colorado
Therapist
Responsible to provide individual, family, and group counseling services delivered in an
ethical and client centered manner. Responsible to identify therapeutic treatment needs
and develop youth treatment plans to address those needs. Provide crisis intervention to
youth in crisis. Develop after care planning and placement recommendations for the
adolescent transitioning back into the community. Provide therapeutic services in
compliance with the Colorado Department of Regulatory Agencies, Colorado Department
of Human Services Rules and Regulations, and the Colorado Sex Offender Management
Board.
2007 -2010
Southern Peaks Regional Treatment Center Canon City, Colorado
Case Manager
Worked closely with the youth's therapist to coordinate case management services for
the youth in treatment. Acted as liaison between court, probation, case workers, parents,
and other professionals involved in the child's treatment to ensure the treatment needs of
the child in placement were met.
1997 — 2005
Pueblo Community Connections Inc.
Child Placement Paraprofessional
Pueblo, Colorado
Worked with the Colorado Department of Human Services Child Division to procure
licensure as a Child Placement Agency. Developed policies and procedures for agency
and family foster care homes. Responsible for oversight and monitoring of children with
dual diagnosis in foster care. Developed, wrote, and implemented positive behavioral
intervention plans. Conducted monthly Medicaid and State billing.
Host Home I Group Home Supervisor
Responsible for the monitoring and oversight of adults with developmental disabilities
placed in a host home or group home setting. Responsible for staff supervision,
development and training. Communicated with courts, case workers, psychiatrists,
doctors, and other professionals to ensure the client's individual habilitation plan was
implemented. Participated Colorado Department of Human Services compliance surveys
and implemented corrective action for any deficiencies noted to ensure compliance with
State rules and regulations.
LPC.0011275
Number
Active
Credential Status
Cut along the line
Colorado Department of Regulatory Agencies
Division of Professions and Occupations
Licensed Professional Counselor Examiners Board
Timothy Joseph Martinez
Licensed Professional Counselor
09/01/2015
Issue Date
08/31/2017
Expire Date
Verify this credential at: www.do .coiorado.2. ov}'prof`s sion s
bl<ision Director: Lauren Larson
'redential Holder Signature
Colorado Department of Regulatory Agencies
Division of Professions and Occupations
Licensed Professional Counselor Examiners Board
Timothy Joseph Martinez
Licensed Professional Counselor
LPC.0011275
Number
Active
Credential Status
Verify this credential at: www.dora.colorado, o �/ ~rat ession s,
09/01/2015
issue Date
08/31/2017
Expire Date
ision Director. Lauren Larson . '"f den lal Holder ignature
1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 301894.7693 www.dora.cotorado.gov/professions
7 i
COLORADO
i vision. of Criminal Justice
Sex Offender Management Unit
700 Kipling Street, Suite 1000
Lakewood, CO 80215
303.239.4442
February 10, 2016
Tim Martinez, LPC
422 East Vermijo, Suite #209
Colorado Springs, CO 80903
Dear Mr. Martinez,
The Colorado Sex Offender Management Board (hereafter Board) is pleased to inform you that you have been identified as meeting the
criteria established for Full Operating Level Treatment Provider and Clinical Supervisor under the Standards and Guidelines for the
Evaluation, Assessment, Treatment and Supervision of Juveniles Who Have Committed Sexual Offenses (hereafter Standards), pursuant to
Section 16-11.7-106 C.R.S.
Your name will appear in the next published Provider List. Until the next list is published, you may use a copy of this letter to verify for
referral sources that the Board has determined that you meet the criteria under the Standards in Colorado. Please refer to the Provider List,
updated regularly, on the Board's webpage at http://dci.somb.state.co.us.
Your period of inclusion on the list of providers will end on December 31, 2017, at which time you will have an opportunity to renew your
application. In addition, during this period, the Board will periodically conduct additional record checks and may request updated
information as necessary.
The Board would like to remind you that the Standards require that you accumulate at least 40 additional hours of continuing education
every three years in order to maintain proficiency and remain current in the field of the evaluation, assessment, treatment, and supervision
of JWCSO. This additional training requirement is evaluated through the regulation process at the end of your inclusion period.
To be included on the list of providers means that (1) you meet the education and experience qualifications established in the Standards (2)
you have agreed to, and appear to be able to, provide your services according to the standards of practice established in the Standards.
Inclusion on the list places you in the pool of people eligible for referrals for JWCSO. It does not create an entitlement or guarantee that you
will receive referrals. The sentencing judge, probation, parole and community corrections have historically chosen, and will continue to
determine, which provider(s) on the Board's list offer the type of treatment program they are seeking in the best interest of community
safety. As you know, inclusion on the list does not imply either licensure or certification, and should not be represented as such. Any
reference should be stated as, for example, "Full Operating Level Treatment Provider".
Please note that it is your responsibility to provide the Board with any address changes and/or additions, as well as any changes to
program materials. This will ensure accurate information, provided to referral sources, on our website. Pursuant to Section 4.000 of the
Standards, you must remain in compliance with the Standards and maintain the qualifications listed, including listing with the Department
of Regulatory Agencies. In addition, you must also notify the SOMB if you are ever arrested, as failure to do this in a timely fashion has the
potential to jeopardize your status as a provider.
Should you have any questions, please feel free to contact me at (303) 239-4197 or via email at: Raechel.Alderete@state.co,us
Sincerely,
Raechel Alderete on behalf of the SOMB
Juvenile Standards Coordinator
Office of Domestic Violence & Sex Offender Management
Division of Criminal Justice, Department of Public Safety
Colorado Department of Public Safety l 700 Kipling Street Suite 1000, Lakewood, CO 80215
John W. Hicken[ooper, Governor 1 Stan Hi[key, Executive Director
EXHIBIT C
SCOPE OF SERVICES
1. Contractor will provide Mental Health Services and Sexual Abuse Treatment Services (Offense Specific) to
Weld County individuals and families residing in the Colorado Springs area, as referred by the
Department.
2. Services will be provided by Timothy J. Martinez, LPC, and/or Nichole Martinez, LPC. All services follow
Sex Offender Board Management guidelines, if applicable. Both are SOMB Clinical Supervisors and Full
Operating Level SOMB Providers for juveniles.
3. Services are available in -office only at 422 East Vermijo Avenue, Suite 209, Colorado Springs, Colorado
80903.
4. Services available under this agreement include:
• Outpatient Adolescent Therapy
• Healthy Sexuality
• Offense Specific Treatment
• Trauma Informed Care
• Trauma Focused Cognitive Behavioral Therapy
• Family Therapy
5. Contractor is sensitive to family ethnicity, culture, values and beliefs.
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. 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.
1
11. Contractor understands that the Department will not reimburse Contractor for "no shows" after two (2)
consecutive "no shows". It is the responsibility of the Contractor to communicate "no shows" to the
Department in a timely manner to determine continuation of services.
12. Contractor understands that the Department does not reimburse for cancelled appointments, either on
the part of the client or the Contractor.
13. Contractor agrees to attend meetings when available and as requested by the Department. Such
meetings include Court Facilitations, Court Staffings, Family Team Meetings and/or Team Decision Making
meetings. The Department will reimburse for actual participation in the meeting only so long as the
meeting is at least one hour in length, participation in the meeting is deemed appropriate and necessary
by the Department, and the Contractor obtains the Facilitator's signature on the Client Verification Form
at the time of the meeting. Staffings and/or meetings other than those listed above are not considered
reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator,
2
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,
2017.
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
Mental Health Services:
$65.00/Hour or $16.25/15 Minutes (All Services -See Exhibit C, Item 4. Court Facilitation/Court
Staffing/Family Team Meeting/Team Decision Making Meeting.)
Sexual Abuse Treatment (Offense Specific):
$65.00/Hour or $16.25/15 Minutes (All Services -See Exhibit C, Item 4. Court Facilitation/Court
Staffing/Family Team Meeting/Team Decision Making Meeting.)
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.
1
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.
Hello