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CONTRACT AGREEMENT AMENDMENT
BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PERKLEN CENTER FOR PSYCHOTHERAPY (CORE)
IIP
This Agreement Amendment, made and entered into day of 016, by and between
the Board of Weld County Commissioners, on behalf of the Weld Co ty Department of Human
Services, hereinafter referred to as the "Department", and Perklen Center for Psychotherapy,
hereinafter referred to as the "Contractor".
WHEREAS the parties entered into an Agreement for Mental Health Services and Sexual Abuse
Treatment (Offense Specific Treatment) (the "Original Agreement") identified by the Weld County
Clerk to the Board of County Commissioners as document No. 2014-3046, approved on October 6,
2014.
WHEREAS the parties hereby agree to amend the term of the Original Agreement in
accordance with the terms of the Original Agreement, which is incorporated by reference herein, as
well as the terms provided herein.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as
follows:
• The Original Agreement ended on May 31, 2015.
• The Original Agreement was renewed for the term of June 1, 2015 -May 31, 2016. The
Agreement Amendment is identified by the Weld County Clerk to the Board of County
Commissioners as document No. 2015-1849, approved on June 24, 2015.
• The Amendment, together with the Original Agreement, constitutes the entire
understanding between the parties. The following change is hereby made to the Contract
Documents:
1. Term
This agreement shall become effective on June 1, 2014, upon proper execution of this
Agreement and shall expire May 31, 2017, unless sooner terminated as provided herein.
2. None
• All other terms and conditions of the Original Agreement remain unchanged.
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2016-1939
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month,
and year first above written.
CO NTY:
ATTEST:
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BOARD OF COUNTY COMMISSIONERS
Weld C.. my Clerk to the B • and WELD COUNTY, COLORADO
By:
Deputy Cle
T1ta..3ta.
Mike Freeman, Chair JUN 2 2 2016
CONTRACTOR:
Perklen Center for Psychotherapy
1020 8th Street
Greeley, Colorado 80631
(970) 353-8171
By:
Date:
Kim R. Ruybal, MA, C - President
07o/6—/909
06/06/2016 16:25 FAX
Z002
Client # 9105743
MEMORANDUM OF INSURANCE
rate Issued 03/24/2016
Producer
This memorandum is issued as a matter of informatio
only and confers no rights upon the holder. Thi
Mercer Consumer, a service of
memorandum does not amend, extend or alter th
Mercer Health & Benefits Administration LLC
P.O. Box 14576
coverages afforded by the Certificate listed below.
Des Moines, IA 50306-3576
1-800-503-9230
Company Affording
Coverage
Insured
'Liberty Insurance Underwriters
Inc
Perklen Inc.
1020 8th Street
Greeley CO 80631
This is to certify that the Certificate listed below has been issued to the insured named above for the policy period indicate
not withstanding any requirement, term or condition of any contract or other document with respect to which thi
memorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all th
terms, exclusions and conditions of such Certificate. The limits shown may have been reduced by paid claims.
Type of Insurance
Certificate Number
Effective Date
Expiration Date
Limits
Professional Liability
MentalHS Fm
AHZ-103018005
04/01/2016
04/01/2011
Per Incident/
Occurrence
$1,000,000
Counselor
Annual Aggregate
$3,000,000
Memorandum Holder Is added as an Additional Insured but only as respects to claims arising out of the sole
negligence of the named insured subject to the terms and provisions of the policy.
Memorandum Holder:
Should the above describe Certificate be cancelle
Weld County
before the expiration date thereof, the issuing compan
Dept of Human Services
will endeavor to mail 30 days written notice to
915 10th Street
Memorandum Holder named to the left, but failure
PO Box 758
mail such notice shall impose no obligation or liabili
Greeley CO 80632
of any kind upon the company, its agents o
representatives.
Authorized Representative
Mark llrostowitz
Mercer Conswaer, a service of Mercer Health & Benefits Administration LLC. In CA d/b/a Mercer Health & Benefits Insurance Services LLC. CA Ins Lic. #0G39709
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