HomeMy WebLinkAbout20162041.tiffCONTRACT AGREEMENT AMENDMENT BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND GREELEY COUNSELING CENTER (Core)
This Agreement Amendment, made and entered into /Lo"day of May. 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 Greeley Counseling Center, hereinafter
referred to as the "Contractor".
WHEREAS the parties entered into an Agreement for Mental Health Services, (the "Original
Agreement") identified by the Weld County Clerk to the Board of County Commissioners as
document No. 2014-3338. approved on October 27, 2014.
WHEREAS the parties hereby agree to amend the term of the Original Agreement in
accordance with the terms of the Original Agreement, which is incorporated by reference herein, as
well as the terms provided herein.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as
follows:
• The Original Agreement ended on May 31, 2015.
• The Original Agreement was renewed for the term of June 1, 2015 -May 31. 2016. The
Agreement Amendment is identified by the Weld County Clerk to the Board of County
Commissioners as document No. 2015-1613, approved on June 1, 2015.
▪ The Amendment, together with the Original Agreement, constitutes the entire
understanding between the parties. The following change is hereby made to the Contract
Documents:
1. Term
This agreement became effective on June 1 2O1. upon proper execution of this Agreement
and shall expire May 31, 2017, unless sooner terminated as provided herein.
2. Exhibit D, Paragraph 2 — Fees for Services
$295.00/Hour (Psychological Evaluation — Adult or Adolescent)
$225.00/Hour (Interactional Evaluation)
2016-2041
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$146.00/Hour (Case Consultation)
$126.00/Hour (Individual Therapy)
$126.00/Hour (Family Therapy)
$126.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision
Making Meeting)
$62.00/Episode (Travel Surcharge)
All other terms and conditions of the Original Agreement remain unchanged.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
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f/�•J_ COUNTY:
ATTEST: �/•+�';� BOARD OF COUNTY COMMISSIONERS
Weld Co. ty Clerk to the Board WELD COUNTY, COLORADO rBy: Deputy CI
Mike Freeman, Chair JUN 2 7 2016
CONTRACTOR:
Greeley Counseling Center
1228 8`h Street
Greeley, Colorado 80631
By: `rs`r L,,`��\-�1 V
ck J. ardner, Psy.D.
Date: // ' /,6
020/6 a° ��
Account Number: CO GREE 6310 Date: 6/09/16 Initials: LL
CERTIFICATE OF INSURANCE
ALLIED WORLD INSURANCE COMPANY
C/O: American Professional Agency, Inc.
95 Broadway, Amityville, NY 11701
800-421-6694
This is to certify that the insurance policies specified below have been issued by the company indicated
above to the insured named herein and that, subject to their provisions and conditions, such policies afford
the coverages indicated insofar as such coverages apply to the occupation or business of the Named insured(s)
as stated
THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR
ALTERS THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE.
Name and Address of Insured: Additional Named Insureds:
GREELEY COUNSELING CENTER, PC JACK J. GARDNER, PSY.D.
1228 8TH ST
GREELEY CO 80631
Type of Work Covered: PROFESSIONAL PSYCHOLOGIST
Location of Operations:
(If different than address listed above)
Claim History:
Retroactive date is 04/01
Coverages
Policy
Number
Effective
Date
Expiration
Date
Limits of
Liability
PROFESSIONAL/
LIABILITY
5011-2674
4/01/16
4/01/17
1,000,000
3,000,000
NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED, WHO SHALL
ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF
CANCELLATION.
Comments: THE FOLLOWING IS AN ADDITIONAL INSURED ON THIS POLICY:
WELD COUNTY DEPT OF
HUMAN SERVICES
This Certificate Issued to:
Name: GREEI4Y COUNSELING CENTER, PC
1228 8TH ST
Address:
GREELEY CO 80631
AutXiorized Representative
APA 00138 00 (06/2014)
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