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HomeMy WebLinkAbout20162820.tiffCmibu►d 1 * 657 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NICHE MARTINEZ, LPC This Agreement, made and entered into theday of 2016, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department f Human Services, hereinafter referred to as the "Department' and Nichole 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 ESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided 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. cc: /-16 2016-2820 d. Contractor agrees to submit a monthly report with the billing statement by the 7th of the month following the month of service for each client receiving ongoing services. One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation). Verification of Monitored Sobriety Services will be the test result. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. 4. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule, attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon, the continuing availability of said funds for the purposes hereof. d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 5. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services , and Exhibit D, Payment Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit an ACH Form for Colorado Providers, which will be provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of 2 Colorado per the directions on the form. Failure to complete and submit this form in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. 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. 3 b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is Core Services. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contract Professional certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contract Professional will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5-102(5)(c). Contract Professional shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contract Professional that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contract Professional shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contract Professional obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contract Professional shall notify the subcontractor and County within three (3) days that Contract Professional has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contract Professional shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. Contract Professional shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contract Professional participates in the State of Colorado program, Contract Professional shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contract Professional has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, 4 and shall comply with all of the other requirements of the State of Colorado program. If Contract Professional fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contract Professional receives federal or state funds under the contract, Contract Professional must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contract Professional operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5-103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR), and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 9. Insurance Requirements Contractor and Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible the insurance provider. a. General Requirements: Contractors/Contract Professionals must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors/Contract Professionals shall keep the required insurance coverage in force at all times during the term of 5 the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non- payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, in the amount of the deductible or self - insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor/Contract Professional. Contractor/Contract Professional shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: 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. 7 11. Training Contractor may be required to attend training that the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-352-1551, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - 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 8 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 Nichole Martinez, LPC 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: Nichole Martinez, LPC 422 East Vermijo Avenue, Suite 2096 Colorado Springs, CO 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. 9 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, 10 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: deritiv ' aos. BOARD OF COUNTY COMMISSIONERS Weld County Clerk to the Board By: Deputy Clerk to 14 WELD COUNTY, COLORADO - Mike Freeman, Chair CONTRACTOR: SEP 0 7 2016 Nichole Martinez, LPC 422 East Vermijo Avenue, Suite 209 Colorado Springs, Colorado 80903 (719) 565-9151 By: /t24 17274/ Z -/CC Nichole Martinez, LPC Date: 7/29/16 0104. - O2,'02l% EXHIBIT A WELD COUNTY'S REQUEST FOR PROPOSAL Bid No.: 81600047 BOARD OF COUNTY COMMISSIONERS OF THE 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. Page 1 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. B. Bids may be withdrawn upon written request to the Weld County Department of Human Services received from bidders prior to the submission deadline. Negligence on the part of bidder in preparing the bid confers no right for the withdrawal of the bid after it has been opened. C. Bidders are expected to examine the conditions, specifications, and all instructions contained herein. Failure to do so will be at the bidder's risk. D. Bidders shall not stipulate in their proposals any conditions not contained in the instructions and specifications herein unless specifically requested by the special instructions attached hereto. Any proposal which fails to comply with the letter of the instructions and specifications herein may be rejected. E. Late or unsigned bids shall not be accepted or considered. It is the responsibility of the bidder to ensure that the bid arrives in the Weld County Department of Human Services, 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. G. Whenever requested, samples or descriptive matter shall be filed prior to the opening of bids. H. In accordance with Section 14-9(3) of the Weld County Home Rule Charter, the Board of County Commissioners of Weld County will give preference to resident Page 2 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.: 81600047 State of Colorado. P. These instructions, the proposal forms, and specifications have been developed with the hope of raising the standard of purchasing negotiations to a level wherein all transactions will be mutually satisfactory. Your cooperation is invited. Q. Substitutions or modifications to any of the terms, conditions, or specifications of this which are made by Weld County after the bids have been distributed to prospective bidders and prior to the date and time of bid opening, will be made in writing. No employee of Weld County is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of said Director of the Weld County Department of Human Services. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. IV. General Specifications. A. Fund Availability: Financial obligations of the Weld County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. By acceptance of the bid, Weld County does not warrant that funds will be available to fund the contract beyond the current fiscal year. B. 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.: 81600047 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. v. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured. vi. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. vii. Subcontractors: All subcontractors, subcontractors, independent contractors, sub - vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor/Contract Professional. Contractor/Contract Professional shall include all such subcontractors, independent contractors, sub -vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. 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; B. 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.: 81600047 SERVICE AREA DEFINITIONS (NOT LIMITED TO THIS LIST - OTHER SERVICES WILL BE CONSIDERED) 1.• f ';+ � .fJG` � ��0 J � '�i ,J' ,g � 411 ! .!f .+fg 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 � s a � , :;r �n.�s���J'`' Jr r ,� �� > +.'f L.=. ...,. n.�.Tr km }x .: ,Lt�,.,.s5.,s`,MJYv,,t%rs<« ,nr r, 1+ F F.r, p.r ,�f:. f Xv�"�''�s, � r: `�x F�skJ�'r�u� ���'•'";:�' �r�„.r,� .. k,F «rus4tt�' x., rlinc fu xl ..Y... ,G .€x lid. r.-✓ d � n4 r 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 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 accom• ished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided fu" 'ng to the Department for NOW THEREFORE, in consideration of the premises, the parts 1. Term This agreement shall become effective on , upon 't . per; ` ecution of this Agreement and shall expire , unless sooner terminated as pro=d hereiri:",,, e agreement is for a period of three years. However, the agreement must be renewed .'uo `.arties, in writing, on an annual basis. venant and agree as follows: 2. Scope of Services Services shall be provided by the tort. any person(s) eligible for services in compliance with Exhibit B, Contractor's Proposa : ; . 'bit C, Scope of Services. 3. Referrals, Billing a a. Contract. r un'''1' :s and will comply with all aspects of the referral authorization, billing and tracking r ire.•e as set forth by the Department. Failure to comply with all aspects may result in a forfei `: '�. r. rent. 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 pri to insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligib der) or Victim's Compensation must be exhausted before Core Services or other Departme funds can be accessed for services. b. Payment shall be made in accordance with Exhibit A, B, Contractor's Proposal, Exhibit C, Scope of Service hereto and incorporated herein by reference, so I accordance with the Agreement. ty's Request for Proposal, Exhibit it D, Payment Schedule, attached ices are rendered satisfactorily and in c. Payment pursuant to this Agreeme w er in whole or in part, is subject to, and contingent upon, the continuing availability of said fu foe purposes hereof. d. The Department may with. ely ment if Contractor has failed to comply with any part of the Agreement, including the ial nagement requirements, program objectives, contractual terms, or reporting requir In the event of forfeiture of reimbursement, Contractor may appeal such circumst. a in ? to the Director of Human Services. The decision of the Director of Human Services sha 5. Financial an At all times fro e e ective date of the Agreement until completion of the Agreement, Contractor shall comply with the . istrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services , and Exhibit D, Payment Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit an ACH Form for Colorado Providers, which will be provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of 2 Colorado per the directions on the form. Failure to complete and submit this form in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 20 id -1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and ementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so th race, creed, color, sex, or national origin, be exc benefits of, or be otherwise subjected to d - Section 504 of the Rehabilitation Act implementing regulations, 45 C.F.' `"`art 84; a - the Age Discrimination Act o implementation regulatio n shall, on the grounds of participation in, be denied the n under the approved Agreement. 9 U.S.C. Section 794, and its U.S.C. Section 6101 et. seq. and its art 91; and Title VII of the is A ` of 1964; and - the Age in Employment Act of 1967; and the ��.. Pa �,� ect of 1963; and ation 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. 3 b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is Core Services. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreem nt, been convicted of or had a civil judgment rendered against them for commission off ud or criminal offense in connection with obtaining, attempting to obtain, or perfor ublic (Federal, State or Local) transaction or contract under public transaction• violation o deral or state antitrust statutes or commission of embezzlement, theft, forr riber falsification or destruction of records, making false statements, or receiving stop y; and - are not presently indicted for or other i ally or civilly charged by a government entity (federal, state or local) with commission o ' y f the offenses enumerated in this certification; and - have not, within a three -ye p -°.d preceding this Agreement, had one or more public transactions (federal, state, or loc. ter-`nated for cause or default. e. Public Contracts for 5eryR. 7.5-101. Contract Professional certifies, warrants, and agrees that it does not know' ploy r contract with an illegal alien who will perform work under this contract. Contract Pr i I will confirm the employment eligibility of all employees who are newly hired for empl e 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 ` ra rofessional shall not knowingly employ or contract with an illegal alien to perform wor un. f greement or enter into a contract with a subcontractor that fails to certify with Cont r t r e' 'onal that the subcontractor shall not knowingly employ or contract with an illegal alien to p r under this Agreement. Contract Professional shall not use E -Verify Program or State of Color rogram procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contract Professional obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contract Professional shall notify the subcontractor and County within three (3) days that Contract Professional has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contract Professional shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. Contract Professional shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contract Professional participates in the State of Colorado program, Contract Professional shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contract Professional has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, 4 and shall comply with all of the other requirements of the State of Colorado program. If Contract Professional fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contract Professional receives federal or state funds under the contract, Contract Professional must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contract Professional operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5-103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service out es in three areas; Safety, Permanency and Well Being of families. For each outcom measure each state's performance according to national standard Following the review, a Program Improvement Plan (PIP) will services to families. and .erformance indicators tor progress over time. nted for the state to enhance Contractor agrees to continually strive for positive outc. . he areas of Safety, Permanency and Well Being. Contractor will ensure that any employ r subcon actor of Contractor providing services under this Agreement will work towards positive o o 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 Paragr 3(d) of this Agreement. 9. Insurance Requirements Contractor and Departme gr td/eld County, the Board of County Commissioners of Weld County, its officers and employees, be held liable for injuries or damages caused by any negligent acts or omissions of the Con i bcontractor, or their employees, volunteers, or agents while performing duties described i. thi ent. Contractor shall indemnify, defend and hold harmless Weld County, the Board of C "+nt . ` issioners of Weld County, its employees, volunteers and agents. Contractor shall . :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 5 the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non- payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self -insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, in the amount of the deductible or self - insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor/Contract Professional. Contractor/Contract Pr fessional shall maintain, at its own expense, any additional kinds or amounts of insurance that i ay deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor/Contract Profe io shall btain, and maintain at all times during the term of any Agreement, insurance in the I inds and amounts: Workers' Compensation Insu Liability Insurance covering all of Con within the course and scope of their e Contractor, as defined by the shall not apply. Contractor Contractor Status Form prior ii. Comme 01 10/93 or e Contractors, injury, a► • adv uired by state statute, and Employer's o tract Professional's employees acting nt. If Contractor is an Independent orado r er's Compensation Act, this requirement bmit to the Department a Declaration of Independent art of this agreement. bility Insurance written on ISO occurrence form CG 00 , covering premises operations, fire damage, independent and completed operations, blanket contractual liability, personal 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, incl ding public liability and property damage, in form and company acceptable to and approve y said Administrator, covering all operations hereunder set forth in the related Bid o st for Proposal. d. Proof of Insurance: Contractor/Contract Profes information to its insurance agent or broker, and shall ha Contractor/Contract Professional's required insuran Contractor/Contract Professional to provide a insurance as required by the County's Risk Ad ; inistra. r o'I shallrovide a copy of this or broker provide proof of eserves the right to require f insurance, a policy, or other proof of his sole discretion. e. Additional Insureds: Forgen- :` liability, `= cess/umbrella liability, pollution legal liability, liquor liability, and inland marine, CE ` tra .r/Contract Professional's insurer shall name County as an additional insured as follows f. Waiver of Subro shall waive subrogation g. vendors, suppliers be subject t requiredQf C such unde Contract overages, Contractor/Contract Professional's insurer ains County. for "r contractors, subcontractors, independent contractors, sub - entities providing goods or services required by this Agreement shall quirements herein and shall procure and maintain the same coverages /Contract Professional. Contractor/Contract Professional shall include all ors, independent contractors, sub -vendors suppliers or other entities as insureds s or shall ensure that all subcontractors maintain the required coverages. ntract 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. Trainin 7 Contractor may be required to attend training that the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-352-1551, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation o '. rformance of this Agreement shall be conducted by the Contractor and the Department. The res of the monitoring and evaluation shall be provided to the Board of Weld County Commi• is rs, th Department and the Contractor. Contractor shall permit the Department, and any other t ' 'zed agent or governmental agency, to monitor all activities conducted by the Contractor purs ant to', e erms of this Agreement. As the monitoring agency may in its sole discretion deem nece , ry . ' . ppropriate, such program data, special analyses, on -site checking, formal audit examin ons, or a`other reasonable procedures. All such monitoring shall be performed in a manner t " t not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreemen All modifications to this Agree 15. Remedies The Director of H the Contractor, failure to satis the Contractor. T be in writing and signed by both parties. or designee may exercise the following remedial actions should s/he find ly failed to satisfy the scope of work found in this Agreement. Substantial pe of work shall be defined to mean incorrect or improper activities or inaction by remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 8 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: Heather Walker, Administrator 17. Notice For Contractor: CONTRACTOR, TITLE 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 Contractor shall promptly notify the Departme litigation in which it is a party defendant in a Contractor, within five (5) calendar days after b which has been filed in any Federal or Si court document(s) to the Director of Hu benefit of creditors, and filings of 19. Termination For Contractor: n the eve that Contractor learns of any actual t involves services provided under this Agreement. ed with a summons, complaint, or other pleading administrative agency, shall deliver copies of such he term "litigation" includes an assignment for the ptcy,'reorganization and/or foreclosure. This Agreement may i ed at any time by either party giving thirty (30) days written notice to the individuals identif d i ph 18. No portion of this Agreement shall be deemed to create an obligation on pa o : he County of Weld, State of Colorado, to expend funds not otherwise appropriated i s ceeding year, as this Agreement is subject to the availability of funding. Therefore, the D 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 go,•rning bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proc •ds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractith the Department when the Contractor also maintains a relationship with a third pay' d the opposition. In order to create the appearance of a conflict of inter Contractor to gain from knowledge of these opposing intere know that the two relationships are in opposition. Duri not enter into any third party relationship that gives th Upon learning of an existing appearance of a conflict o Department, a full disclosure statement settin of interest. Failure to promptly submit a disc grounds for the Department's termination, for rth the wo relationships are in t necessary for the necessary that the Contractor of the Agreement, Contractor shall nc� of creating a conflict of interest. situation, Contractor shall submit to the ails that create the appearance of a conflict tatement required by this paragraph shall constitute its Agreement with the Contractor. Contractor certifies that Federal apA. • • a ds have not been paid or will be paid, by or on behalf of Contractor, to any person for infl i • .. or a empting to influence an officer or employee of an agency, a Member of Congress, an offi ` . • r • .loyee of Congress, or an employee of a Member of Congress in connection with the away. '•: o eeral contract, the making of any Federal grant, the making of any Federal loan, the entering i ..; y cooperative agreement, and the extension, continuation, renewal, amendment, or modi _':. • .:;nFederal contract, loan, grant, or cooperative agreement. 24. Stora 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 . written confidentiality agreement and shall provide a copy of such agreement to the Department, if -quested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is info development, trade secrets, business affairs, internal operat of its customers, clients or affiliates, but does not includ parties, (2) that which is in the public domain, or (3) th party shall use or disclose directly or indirectly without information concerning the other party obtain information removed from the Department' under this Agreement will be accorded at least for similar information in the course of r .wn 27. Independence of Contra s a resu ating to a party's research, nagement procedures and those on (1) lawfully obtained from third veloped independently. Neither ten authorization any proprietary this Agreement. Any proprietary the Contractor in the course of providing services e precautions as are employed by the Contractor ess. mployee of Weld County Contract Professional agr-- tha a` `independent Contract Professional and that Contract Professional's officers, age p oyees will not become employees of County, nor entitled to any employee benefits fr. n `=ry s a result of the execution of this Agreement. Contract Professional shall perform its dutie er ` r* an independent Contract Professional. Contract Professional shall be solely respons e o 'ts cts and those of its agents and employees for all acts performed pursuant to this Agreemen tr t Professional, its employees and agents are not entitled to unemployment insurance or wor ompensation 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,. nd D. 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to Dep rt nt on inals of all tests and results, reports, etc., generated during completion of this work. Acceptanc rtment of reports and incidental material(s) furnished under this Agreement shall n y relieve the Contractor of responsibility for the quality and accuracy of the service nt shall any action by the Department hereunder constitute or be construed to be a waiver b ' he De`, : rt ent of any breach of covenant or default which may then exist on the part of the Contrac an he Department's action or inaction when any such breach or default shall exist shall not i- `:air or pr- ""dice any right or remedy available to the Department with respect to such breach or .'` au nd no assent, expressed or implied, to any breach of any one or more covenants, provisions or con.. • ns, `the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance the De ment of, or payment for, any services performed under this Agreement shall not be Agreement or under the law gen 32. Employee Financ waiver of any of the Department's rights under this nte ` flict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507 The signatories to thi t aver that to their knowledge, no employee of Weld County has any personal or benel ial i - " hatsoever in the service or property which is the subject matter of this Agreement. T o . r has no interest and shall not acquire any interest direct or indirect, which would in any r .egree with the performance of the Contractor's services and the Contractor, shall not employ erson 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 Professionalconcerninis Agreement, the parties agree that each party shall be responsible for the paymen incurred by or on its own behalf. 37. Ownership torney fees and/or legal costs All work and information obtained by Contract Profess' -r this Agreement or individual work order shall become or remain (as applicable), the pr rty of Co"ty. In addition, all reports, documents, data, plans, drawings, records and computer fi rated by Contract Professional in relation to this Agreement and all reports, test results and of tangible materials obtained and/or produced in connection with the performance of thi' reeme , whether or not such materials are in completed form, shall at all times be considered the • t County. Contract Professional shall not make use of such material for purposes other tha nect on with this Agreement without prior written approval of County. 38. Interruptions Neither party to is A " t shall be liable to the other for delays in delivery or failure to deliver or otherwise to p or obligation 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 ac 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. 13 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS Weld County Clerk to the Board WELD COUNTY, COLORADO BY: Deputy Clerk to the Board APPROVED AS TO FUNDING: , Chair APPROVED AS TO SUBSTANCE: Controller Elected Official or Department Head APPROVED AS TO FORM: County Attorney Director of General Ser CONTRACTOR 14 EXHIBIT A WELD COUNTY'S REQUEST FOR PROPOSAL THIS PAGE INTENTIONA ► T BLANK EXHIBIT B CONTRACTOR'S PROPOSAL THIS PAGE INTENTIONA T BLANK EXHIBIT C SCOPE OF SERVICES THIS PAGE INTENTIONA T T BLANK EXHIBIT D PAYMENT SCHEDULE THIS PAGE INTENTIONA PROVIDER INFORMATION FORM (Proposal Cover Sheet) Weld County Department of Human Services tI-v\). firoil -A/rcnc —urn j :)cr'A AGENCY OR PRIVATE PRACTICE TRAILS PROVIDER ID (If Known) ig cc, / L -PL PRIMARY CONTACT - FULL NAME PRIMARY CONTACT - TITLE PHONE NUMBER Cf u i -kt 1 e1 PRIMARY CONTACT- E-MAIL ADDRESS V e AGENCY MAILING ADDRESS ( 719 ZJ q &7J ip EXT. FAX NUMBER AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) ve,,Sv)I-ezbi CdCa lib .Si (1 Eoq>> CITY ZIP REFFERAL CONTACT- FULL NAME (IF DIFFERENT THAN PRIMARY CONTACT) REFERRAL CONTACT - TITLE REFERRAL CONTACT - PHONE NUMBER EXT. REFERRAL CONTACT - E-MAIL ADDRESS I certify that the services offered for intended use by Weld County will meet all the specifications it has so indicated in this bid form. The Board of Weld County Commissioners reserves the right to reject any or all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are competitive in price and quality. n , Signature of Authorizled Representative: Date of Signature: -7 Please indicate the program area(s) you wish to be considered for: ❑ ❑ 0 ❑❑❑❑❑❑❑ 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 Mental Health Services ❑ Monitored Sobriety Only ❑ Multi -Systemic Therapy ❑ Relinquishment Counseling exual Abuse Treatment ❑ Substance Abuse Evaluation and Treatment O Other: ❑ Other: O 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. I 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, 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 719 565 9151 martineztim@hotmail.com 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, LLC 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. Pueblo, Colorado Child Placement Paraprofessional 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 / 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. Cut along the line Colorado Department of Regulatory Agencies Division of Professions and Occupations Licensed Professional Counselor Examiners Board LPC.0011275 Number Timothy Joseph Martinez Licensed Professional Counselor 09/01/2015 Issue Date Active 08/31/2017 Credential Status Expire Date Verify this credential at: ` l@t4isr- > >{z ion Director: Lauren Larson credential 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: 09/01/2015 Issue Date 08/31/2017 Expire Date DiGisionn Director. Lauren den al Holder ignature 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 303.894.7693 www.dora.cotorado.gov/professions COLORADO Sex Offender Management Unit 700 Ki 0:n.o Street. Suite 1500 Lai(evccd . 0 80215 303.2:9.4442 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://dcj.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 700 Kipling Street Suite 1000. Lakewood. CO 80215 John W. Hickeoloocer, Governor Stan Hilkey. Executive Director HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP Certificate of Normce HPSO H cal,ncan I'r,, J,,,n _. ,c, 6r_.nian,m- OCCURRENCE POLICY FORM PRODUCER BRANCH PREFIX POLICY NUMBER 018098 970 Named Insured 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 cO'emnA 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-250-4-CON-H1 20100218-141 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 Nichole Martinez, LPC. All services follow Sex Offender Board Management guidelines, if applicable. Nichole Martinez is an SOMB Clinical Supervisor and Full Operating Level SOMB Provider 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 $75.00/Hour (In -home, within 10 miles of 4625 West 20th Street, Greeley, Colorado 80634) $98.50/Hour (In -home, within 25 miles of 4625 West 20th Street, Greeley, Colorado 80634) $131.40/Hour (In -home, within 60 miles of 4625 West 20th Street, Greeley, Colorado 80634) Contractor may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. Contractor will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher, and signed monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. b. For one-time services, proof of services rendered shall be receipt of the completed product. 1 c. For Monitored Sobriety services, proof of services rendered shall be the test result. 2 HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP CNA Certificate of Amirante ®HPSO PRODUCER I BRANCH 018098 970 Named Insured Hu1,hurc P, J,,. Smwr Onanizmor,- OCCURRENCE POLICY FORM PREFIX POLICY NUMBER HPG 0622357360-8 Nichole Martinez 125 Rio Grande Dr Canon City, CO 81212-3967 Medical Specialty Licensed Professional Counselor Excludes Cosmetic Procedures Professional Liability Your professional liability limits shown above include the following: • Good Samaritan Liability • Malpiacement Liability • Personal Injury Liability • Sexual Misconduct included in the PL Limit shown above subject to $25,000 aggregate sublimit Coverage Extensions Code 80723 Policy Period: From 02/22/16 to 02/22/17 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: 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 Workplace Liability Fire and Water Legal Liability Personal Liability Total: $163.00 American Casualty Company of Reading, Pennsylvania 333 South Wabash Avenue Chicago, Illinois 60604 $1,000,000 each claim $3,000,000 aggregate $ 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 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, part-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 Board204,di Ms(L-N- 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-505-N-CON-H1 20160223-/61 HEALTHCARE PROVIDERS PROFESSIONAL LIABILITY INSURANCE ENDORSEMENT Additional Insured — Healthcare Professional or Entity In consideration of the premium paid, and subject to the Professional Liability limit of liability shown on the certificate of insurance, it is agreed that the PROFESSIONAL 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 for your medical incidents and solely to the extent that: 1. a professional liability claim is made against you and the additional insured; and 2. in any ensuing litigation arising out of such claim, you and the additional insured remain as co-defendants. In no event is there any coverage provided under this policy for a medical incident that is the direct liability of the additional insured. Additional Insured: County of Weld 1150 O St. Greely, CO 80631 Additional Premium: $ 165.00 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. 1 POLICY NO. 622357360 G -141231-A (07/2001) smn 8/11/16 Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy ISSUED TO Nichole Martinez ENDORSEMENT EFFECTIVE DATE Hello