HomeMy WebLinkAbout20141307.tiffCm.Iro.d c5cret
MEMORANDUM
111E: July 26, 2016
Tt?' Board of County Commissioners — Pass -Around
FR: Judy \. Griego. Director, I luman Sery ices
RE: Weld County Department of Human Services' Child Welfare
2016-2017 Respite Care Proy ider Renewals
Please review and indicate if you would like a work session prior to placing these items on the
Board's agenda.
Request Board Approval of the Renewal for Respite Services between the Department and
Various Providers. The Department's Division of Child Welfare contracts annually with
individuals and couples, primarily Weld County certified fester parents, for respite care services.
Respite care is limited to four ( 1) hours per week per child. The hours of care may he provided in
any combination throughout a month, but may not eticeed 16 hours per month. Payment is S16.75
per each four hour period. hut may not e\ceed $67.00 per month for 16 hours. [he list of providers
that would like to renew for the term of July I, 2016 through June 31), 201 7, are as follows:
IBrown
Rachel
Greeley
•I Irwin
Kasi (Jeremiah)
Severance
Koepp .
Jenna (Kristopher)
Evans
Maronek Patricia (Dennis)
Greeley
tiTiller Pamela
Greeley
Ripka t Gary Steven
F t. Collins
Stone !Mary Kay (Jamie David)
Greeley
Fauber
Nicole (Jon Wright)
Greeley
f Tavita
Jacquelyn (Bruce)
Greeley
Van Den Ellen
Dawn
Greeley
Walker
Jennifer Lynne
Ft. Collins
Walker
Renac
W"indsor
I Workman-Wurti
Kathryn
Greeley
I do not recommend a Work Session. I recommend approval of these Renewals.
Sean Conway
Steve yforeno
Barbara Kirkmever
\E ke F rceman
fulie Co/ad
1
))1k.sfoid
Approve Request
BOCC t Benda Work Session
Pass -Around Memorandarn, July 26. 2016 (TBF))
- ��- - Ili ce2
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AFSD
85
CONTRACT AGREEMENT AMENDMENT BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND KASI AND JEREMIAH IRWIN (NON -CORE)
na
This Agreement Amendment, made and entered into 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 Jeremiah and Kasi Irwin, hereinafter
referred to as the "Contractor".
WHEREAS the parties entered into an Agreement for Respite Care Provider Services, (the
"Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as
document No. 2014-1307, approved on April 28, 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 June 30, 2015.
• The Original Agreement was renewed for the term of July 1, 2015 -June 30, 2016. The
Agreement Amendment is identified by the Weld County Clerk to the Board of County
Commissioners as document No. 2015-2200, approved on July 20, 2015.
• The Amendment, together with the Original Agreement, constitutes the entire
understanding between the parties. The following change is hereby made to the Contract
Documents:
1. Term
This agreement shall become effective on July 1, 2016, upon proper execution of this
Agreement and shall expire June 30, 2017, unless sooner terminated as provided herein.
2. None
• All other terms and conditions of the Original Agreement remain unchanged.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST:
Weld County Clerk to the Board
Warefeti
!K,
puty Clerk to the Board
RemitcZ
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
Mike Freeman, Chair AUG 2 2 2016
si and Jeremiah Irwin
760 Avery Plaza St.
Severance, CO 80550
(970)690-0382-9
By:
U..;
Kasi Irwin
Date: be I (o,
By:
Jeremiah Irwin
Date: , 6, 20/(a
6O1L-1301
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MEMORANDUM
DATE: April 24, 2014
TO: Douglas Rademacher, Chair, Board pf Countyssioners
FROM: Judy A. Griego, Director, Hum
RE: Respite Agreement between the{d County Department
of Human Services and Shane and Kasi Irwin for Placement
on the Consent Agenda
Enclosed for Board approval is a Respite Agreement between the Department and Shane and
Kasi Irwin. The template for this agreement was approved by the Board June 24, 2013, for
placement on the Consent Agenda.
The major provisions for these Agreements are as follows:
No.
Provider
Term
Rate
1
Irwin, Shane & Kasi
March 14, 2014 — June 30,
2014
$16.75 per each four hour
Period. Max. $67.00 per
month for 16 hours
If you have any questions, give me a call at extension 6510.
Ccv,a_s_A-----* A1_
M-2$
2014-1307
cc" ,also (s>0 Hg 00S'5
1 -so -/f
a3-.91-1042410 '
RECEIVED
13-14 RESPITE CARE
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND SHANE AND KASI IRWIN
This Agreement, made and entered into thep(p day of "'!""' 2014. by and between the Board of
Weld County Commissioners on behalf of the Weld County Department of Human Services, hereinafter referred to
as "I Inman Services." and Shane and Kasi Irwin referred to as "Contractor".
WITNESSli fll
WHEREAS. required approval. clearance. and coordination hase been accomplished from and with
appropriate agencies; and
WHEREAS. the Colorado Department of I Iuman Services has provided Child Welfare Regular
Administration funding for respite care for county foster care Contractors and
WI IEREAS, Contractor is a for-profit Sole -Proprietor.
NOW THERF:IORE. in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on March 14, 2014, upon proper execution of this Agreement and shall
expire June 30. 2014. unless sooner terminated as provided herein.
2. Scope ofServices
Services shall be provided by Contractor to any persons) eligible for child protection services in compliance
with Exhibit A "Scope of Services," a copy of which is attached by reference.
Pas ment
a. Payment shall be made on the basis of Exhibit B. --Payment Schedule," copies of which are attached hereto
and incorporated herein by reference.
b. "Payment Schedule" shall establish the maximum reimbursement, which will he paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c. Contractor shall submit an itemized monthly bill to Iluman Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by I Iuman
Sere ices. Contractor shall submit all itemized monthly billings to Human Services no later than the twenty -
filth (25) day of the month following the month the cost was incurred.
d. Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability- of
Child Welfare Regular Administration funds to Human Services.
e. Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not he
reimbursed or considered part of this Agreement.
13-14 RESPITE CARE
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, Contractor shall comply
with the administrative requirements. cost principles and other requirements set lirrth in the Financial
Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under
Child Welfare Regular Administration funding must conform to the Single Audit Act of 1984 and OMB
Circular A -I3 3.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. Contractor shall provide proper monthly ins oices and itemization of sen ices performed for costs incurred in
the performance of the agreement.
h. Human Services may withhold any payment if Contractor has failed to comply with the Financial
Management Requirements. program objectives_ contractual terms, or reporting requirements. In the event
of a forfeiture of reimbursements. Contractor may appeal such circumstance to the Director of Human
Sen ices. The decision of the Director of I luman Sers ices shall be final.
6. Assurances
Contractor shall abide by all assurances as set forth in the attached Exhibit C. which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable laws
At all times during the performance of this contract. Contractor shall strictly adhere to all applicable federal and
state laws. orders, and all applicable standards, regulations. interpretations or guidelines issued pursuant thereto.
This includes the protection of the confidentiality of all applicant/recipient records. papers. documents. tapes
and any other materials that hase been or may hereafter he established which relate to the Contract. Contractor
acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964.42 U.S.C. Sections 2000d —I et. seq. and its implementing regulation.
45 C.F.R. Part 80 et. seq.: and
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. Sections 6101 et. seq. and its implementation regulations, 45
C.F.R. Pan 91: and
- Title VII of the Cis il Rights Act of 1964: and
- the Age Discrimination in Employ ment 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.I.. 99-603:
42 C.F.R. Part 2 and all regulations applicable to these laws prohibiting discrimination because of race.
color. National origin. and 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 Human Services will resist in judicial proceedings any
efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 45 C.F.R. Part 74 Appendix G 9. which requires that aftirmatiyc steps he taken to assure that small
and minority businesses arc utilized. when possible. as sources of supplies. equipment. construction and
sonices. This assurance is given in consideration of and for the purpose of obtaining any and all federal and/or
state financial assistance.
13-14 RESPITE CARE
Any person who feels that s/he has been discriminated against has the right to file a complaint either with the
Colorado Department ()Hinman Iuman Services or with the U.S. Department of I lealth and Human Services. Office
for Cis it Rights.
8. Certifications
Contractor certifies that. at the time of entering into this Contract. it has currently in effect all necessary
licenses. appros als. insurance. etc.. required to properly provide the services and/or supplies covered by this
contract. A copy of certificate will he provided to I Inman Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and l:valuation
Contractor and I Iuman Services agree that monitoring and evaluation of the perlormance of this Agreement
shall he conducted bs Contractor and Human Services. The results of the monitoring and evaluation shall be
pros ided to the Hoard of Weld County Commissioners and Contractor.
Contractor shall permit I Iuman Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by 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
perlo med in a manner that will not unduly interfere with agreement work.
0. Modification of Agreement
All modifications to this agreement shall he in writing and signed by both parties.
I. Remedies
The Director of I Iuman Services or designee may exercise the following remedial actions should s/he find
Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to
satisfy the scope ofwork shall be defined to mean incorrect or improper actin ities or inaction by Contractor.
These remedial actions are as Iollows:
a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily
completed:
b. Deny payment or recom er reimbursement for those sers ices or deliverables. which has not been performed
and which due to circumstances caused by Contractor cannot he performed or if performed would he of no
value to Human Services. Denial of the amount of payment shall be reasonably related to the amount of
work or deliverables lost to Human Services;
c. Incorrect pay ment to Contractor due to omission. error. fraud. and/or defalcation shall he recovered from
Contractor by deduction from subsequent payments under this Agreement or other agreements between I luman
Services and Contractor. or by Human Services as a debt due to I Iuman Services or otherwise as provided by
law.
3
13-14 RESPITE CARD:
12. 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 I luman Services:
!leather Walker
Name
for Contractor:
Administrator
Title
Shane and Kasi Irwin Respite Care Contractor
Name 'Rifle
13. Notice
All notices required to he given by the parties hereunder shall he 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:
To: I luman Sen ices
Judy A. Griego, Director
P.O. Box A
Greeley. CO 80632
(970)352-1551
lb: Contractor
Shane and Kasi Incin
4544 Sunshine Circle
Loveland. CO 80538
(970) 690-0382
14. Litigation
Contractor shall promptly. notify Human Services 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 fled in
any federal or state court or administrative agency. shall deliver copies of such document(s) to the Human
Sen ices Director. The term "litigation" includes an assignment 1br the benefit of creditors. and filings in
bankruptcy. reorganization and/or foreclosure.
15. Termination
This Agreement may be terminated at any time by either party given thirty (30) days written notice and is subject
to the availability of funding. Contractor reserves the right to suspend services to clients if funding is no longer
a' ailable.
16. I 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 stated in Paragraph 10
herein.
17. No Third Party Beneficiary. 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 he strictly reserved to
the undersigned parties and nothing in this Agreement shall gite 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.
4
13-14 RESPITE CARE
IS. No portion of this Agreement shall he deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to hate created a duty of
care which did not previously exist with respect to any person not a party to this Agreement.
IN W II NIiSS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first
above written.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
.4l"f EST:WaithAi 1-242
Weld County Clerk to the Board �� #���.uel' Rademacher. Chair APR 2 � 11-14
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
CONTRACTOR
Sne Irwin
i/
)
Kasi Irwin
5
X0/11 -130q
13-14 RESPITE C'ARIf
EXHIBIT A
SCOPE OF SERVICES
Each Contractor will:
I. Complete a fingerprint card fix a background check at the Contractor's expense with the Colorado Bureau of
Investigation. A Federal I3ureau of Investigation background check will be done if the Contractor has been a
resident of the State of Colorado for less than two ' cars. Human Sen ices will clear the Contractor through
CBI and FBI;
Complete a course in CPR and first aid. in which a current cope of the certifications must he provided to
human Sen ices with this agreement. I f either certification should expire during the contracted period. the
Contractor will send a new current certification cop) to Human Services;
3. Provide transportation for the child to appointments during the hours of secs ice as agreed upon with the 'Oster
parent:
4. Become familiar with State rules and regulations governing certified foster homes:
Must be eighteen ) ears of age or older.
6
13-14 RESPITE CARE.
EXHIBIT B
PAYMENT SCHEDULE
I. Funding and Method of Payment
I luman Services agrees to reimburse Contractor in consideration for the work and sexy ices performed under
Child Welfare Regular Administration funding.
Expenses incurred by Contractor, in association with said project prior to the term of this agreement. are not
eligible I luman Services expenditures and shall not be reimbursed by I luman Services.
Pay ment pursuant to this Contract. if Child Welfare Regular Administration funds. whether in whole or in part.
is subject to and contingent upon the continuing availability olChild Welfare Regular Administration funds
for the purposes hercrof. In the event that said funds, or any part thereof. become unavailable as determined by
I luman Services. I luman Sun ices may immediately terminate this Contract or amend it accordingly.
2. Fees for Scn ices
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each four
hour period. but not to exceed $67.00 per month Mr 16 hours.
I luman Services referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
he performed regardless of client's refusal or inability to pay co -pay.
Contractor will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
Submittal of Vouchers
Contractor shall prepare and submit monthly, the itemized voucher and certify that the services authorized were
provided on the date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
7
13-14 RESt ITI! CARE
EXHIBIT C
ASSURANCES
Contractor agrees it is an independent contractor and that its officers and employees do not become employees
of Weld Counts, nor are they entitled to any employee benefits as Weld County employees. as the result of the
execution of this Agreement.
2. Weld County. the Board of County Commissioners of Weld County. its officers and employers. shall not be
held liable Ibr injuries or damages caused by any negligent acts or omissions of Contractor -contracted
Contractors or its employees. volunteers. or agents while perlbrming duties as described in this Agreement.
Contractor shall indemnify. defend, and hold harmless Weld County. the Board of County Commissioners of
Weld County. its employees. y olunteers. and agents. Contractor shall provide adequate liability and worker's
compensation insurance or all its employees, volunteers. and agents engaged in the performance of the
Agreement upon request. Contractor shall provide Human Services with the acceptable evidence that such
coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a v aiv er of any immunities the parties or their
officers or employees may possess. not shall any portion of this Agreement he deemed to have treated a duty
of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld. State or
Colorado. to expend funds not otherwise appropriated in each succeeding year.
I f any section. subsection. paragraph. sentence. clause. or phrase of this Contract 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 Contract 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 he declared to he unconstitutional or ins alid.
6. No officer. member or employ ec 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.
7. Contractor assures that they will comply with the Title VI of the Civil Rights Act of 1986 and 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 this approved Contract.
8. Contractor assures that sufficient. auditable. and otherwise adequate records that will provide accurate, current,
separate. and complete disclosure of the status of the funds received under the Contract are maintained for
three (3) years or the completion and resolution of an audit. Such records shall be sufficient to allow
authorized local. Federal. and State auditors, and representatives to audit and monitor Contractor.
9. All such records, documents, communications, and other materials shall be the property of I luman Services
and shall he maintained by Contractor, in a central location and custodian. in behalf of Human Services, for a
period of four (4) y ears from the date of final payment under this Contract. or Ibr such further period as may he
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 behalfof the federal and/or state government has begun but is not
completed at the end of the four (4) year period. or if audit findings have not been resolved after a four (4) year
period. the materials shall he retained until the resolution of the audit finding.
III. Contractor assures that authorized local. federal. and state auditors and representatives shall. during business
hours. have access to inspect any copy records, and shall be allowed to monitor and review through on -site
y isits. all contract activities. supported with funds under this Contract 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 he prov ided to the appropriate and interested parties.
8
13-14 RESPITE CARE
I I. This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives. and
assigns. Contractor or Human Services may not assign any of its rights or obligations hereunder without the
prior Witten consent of both panics.
12. Contractor certifies that federal appropriated funds have not been paid or will he 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 ofa 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 any Federal contract. loan. grant. or cooperative agreement.
13. Contractor assures that it will fully comply with all other applicable federal and state laws. Contractor
understands that the source of funds to he used under this Contract is Child Welfare Regular Administration
funds.
14. Contractor assures and certifies that it and its principals:
a. Arc not presently debarred, suspended, proposed for debarment. declared ineligible or voluntarily
excluded from covered transaction by a federal department or agency.
h. Have not. within a three-) ear period of preceding this Agreement. been cony icted of or had a civil
judgment rendered against them for commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a public (federal. state. or local) transaction or contract
under a 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
c. 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 paragraph 14(b) of this
certification: ication: and
d. Hay e not within a three -y ear period preceding this Contract. had one or more public transactions
(federal. state. and local) terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship ofa contractor with Human Services 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
knots ledge of these opposing interests. It is only necessary that the contractor knots that the two relationships
are in opposition. During the term of the Contract. Contractor shall not enter any third party relationship that
gives the appearance of creating a conflict of interest. Upon learning of an existing appearance ofa conflict of
interest situation, Contractor shall submit to I luman Services. a full disclosure statement setting lhrth the
details that create the appearance ofa conflict of interest. Failure to promptly submit a disclosure statement
required by this paragraph shall constitute grounds for Human Services' termination. fix cause of its contract
with Contractor.
I6. Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in
accordance with this Contract. 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 firm identifiable with the applicant/recipient or a minor's parent or guardian unless in
accordance with Contractor written policies governing access to. duplication and dissemination of. all such
information. Contractor shall advise its employees, agents. and subcontractors. i f any, that they arc 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
9
13-14 RESPITE CARE
permitted.
I 7. Proprietary in formation for the purposes of this contract is inlbrmation 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 ( I ) 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 Contract. Any proprietary information removed from the State's site by
Contractor in the course of providing services under this Contract will be accorded at least the same
precautions as are employed by Contractor I'or similar information in the course of its own business.
18. Contractor certifies that s/he will abide by Colorado Revised Statute (C.R.S.):6-6-104. requiring criminal
background checks for all employ ees. contractors. and sub -contractors.
10
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POLICY NUMBER
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EFFECTIVE DATE
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EXPIRATION DATE
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YEAR / MAKE / MODEL
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Colorado - Proof of Auto
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Allstate Fire and Casualty Insurance Company
Jeremiah & Kasi hwin
4544 Sunshine Cr
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EFFECTIVE DATE
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EXPIRATION DATE
05/03/14
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Colorado - Proof of Auto
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Allstate Fire and Casualty Insurance Company
Jeremiah & Kasi Irwin
4544 Stshine Or
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POLICY NUMBER
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EFFECTIVE DATE
11/03/13
EXPIRATION DATE
05/03/14
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2007 Chevy Tat Siiv1500 4wd
VEHICLE ID NUMBER
2GCFK19Y771610107
Colorado - Proof of Auto
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Allstate Fire and Casualty Insurance Company
Jeremiah & Kasi Irvin
4544 Sunshine Cr
Loveland CO 80538-1955
POLICY NUMBER
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EFFECTIVE DATE
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05/03/14
Allstate.
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YEAR / MAKE / MODEL
2007 Chevy Trh 5110500 4wd
VEHICLE ID NUMBER
2GcfK19Y771610107
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