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AGREEMENT FOR PROFESSIONAL SERVICES
THIS AGREEMENT is made by and between the County of Weld, State of Colorado,
whose address is 1150 'O' Street, Greeley, Colorado, 80631 ("County"), by and through the
Board of County Commissioners of the County of Weld, on behalf of the Weld County
Department of Human Services, and Deep Rivers Family Counseling, Inc. whose address is 518
28 Road, #A207, Grand Junction, Coloraod 81501, ("Contractor").
WHEREAS, County desires to retain Contractor as an independent contractor to perform
services as more particularly set forth below; and
WHEREAS, Contractor has the time available to timely perform the services, and is
willing to perform the services according to the terms of this Agreement.
NOW THEREFORE, in consideration of the mutual promises and covenants contained
herein, the parties hereto agree as follows:
1. Eneaeement of Contractor. County hereby retains Contractor, and Contractor
hereby accepts engagement by County upon the terms and conditions set forth in this Agreement.
2. Term. The term of this Agreement shall be from July 1. 2016, through and until May
31 2017.
3. Services to be Performed. Contractor agrees to perform the Services listed or
referred to in Exhibit A, attached hereto and incorporated herein.
4. Compensation.
a. County agrees to pay Contractor for services performed as set forth on
Exhibit A at the rate of $125.00/Episode (Intake). $90.00/Hour (Individual Therapy or
Family Therapy). . Charges shall be based on the time actually spent performing the
services, but shall exclude travel time.
b. Mileage may/may not (circle one) be charged to and from any required job
site at a rate of 0.00 cents per mile. Contractor shall not be paid any other expenses
unless set forth in this Agreement.
c. Payment to Contractor will be made only upon presentation of a proper
claim by Contractor, itemizing services performed and mileage expense incurred.
d. Payment for services and all related expenses under this Agreement shall
not exceed $5 000.00.
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5. Additional Work. In the event the County shall require changes in the scope,
character, or complexity of the work to be performed, and said changes cause an increase or
decrease in the time required or the costs to the Contractor for performance, an equitable
adjustment in fees and completion time shall be negotiated between the parties and this
Agreement shall be modified accordingly by a supplemental Agreement. Any claims by the
Contractor for adjustment hereunder must be made in writing prior to performance of any work
covered in the anticipated supplemental Agreement. Any change in work made without such
prior supplemental Agreement shall be deemed covered in the compensation and time provisions
of this Agreement.
6. Independent Contractor. Contractor agrees that Contractor is an independent
contractor and that neither Contractor nor Contractor's agents or employees are, or shall be
deemed to be, agents or employees of the County for any purpose. Contractor shall have no
authorization, express or implied, to bind the County to any agreement, liability, or
understanding. The parties agree that Contractor will not become an employee of County, nor is
Contractor entitled to any employee benefits from County as a result of the execution of this
Agreement.
7. Warranty. 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.
8. Reports County Property. All reports, test results and all other tangible materials
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. Contractor
shall not make use of such material for purposes other than in connection with this Agreement
without prior written approval of County.
9. Acceptance of Product not a Waiver. Upon completion of the work, Contractor
shall submit to County originals of all test results, reports, etc., generated during completion of
this work. Acceptance by County of reports and incidental material furnished under this
Agreement shall not in any way relieve Contractor of responsibility for the quality and accuracy
of the work. Acceptance by the County of, or payment for, any services performed under this
Agreement shall not be construed as a waiver of any of the County's rights under this Agreement
or under the law generally.
10. Insurance and Indemnification. Contractor shall defend and indemnify County, its
officers and agents, from and against loss or liability arising from Contractor's acts, errors or
omissions in seeking to perform its obligations under this Agreement. Contractor shall provide
necessary workers' compensation insurance at Contractor's own cost and expense.
1 I. Termination. Either party may terminate this Agreement at any time by providing
the other party with a 10 day written notice thereof. Furthermore, this Agreement may be
terminated at any time without notice upon a material breach of the terms of the Agreement. In
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the event of an early termination, Contractor shall be paid for work performed up to the time of
notice and County shall be entitled the use of all material generated pursuant to this Agreement.
12. Non -Assignment. Contractor may not assign or transfer this Agreement, any
interest therein or claim thereunder, without the prior written approval of County.
13. Access to Records. County shall have access to Contractor's financial records as
they relate to this Agreement for purposes of audit. Such records shall be complete and available
for audit 90 days after final payment hereunder and shall be retained and available for audit
purposes for at least five years after final payment hereunder.
14. Time of Essence. Time is of the essence in each and all of the provisions of this
Agreement.
15. 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.
16. Notices. Any notice required to be given under this Agreement shall be in writing
and shall be mailed or delivered to the other party at that party's address as stated above.
17. Compliance. This Agreement and the provision of services hereunder shall be
subject to the laws of Colorado and be in accordance with the policies, procedures, and practices
of County.
18. Non -Exclusive Agreement. This Agreement is nonexclusive and County may
engage or use other contractors or persons to perform services of the same or similar nature.
19. Certification. Contractor certifies that Contractor is not an illegal immigrant, and
further, Contractor represents, warrants, and agrees that it has verified that Contractor does not
employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs
illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and
Contractor may be held liable for damages.
20. Entire Agreement/Modifications. This Agreement contains the entire agreement
between the parties with respect to the subject matter contained in this Agreement. This
instrument supersedes all prior negotiation, representation, and understanding or agreements with
respect to the subject matter contained in this Agreement. This Agreement may be changed or
supplemented only by a written instrument signed by both parties.
21. Funding Contingency. No portion of this Agreement shall be deemed to create an
obligation on the part of County to expend funds not otherwise appropriated or budgeted for.
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22. No Conflict. No employee of Contractor nor any member of 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 Contractor's operations, or authorizes
funding to Contractor.
23. Severability. If any term or condition of this Agreement shall be held to be invalid,
illegal, or unenforceable, 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.
24. Governmental Immunity. No portion of this Agreement shall be deemed to
constitute a waiver of any immunities the parties or their officers or employees may possess.
25. No Third Party Beneficiary. It is expressly understood and agreed that the
enforcement of the terms and conditions of this Agreement, and all rights of action relating to
such enforcement, shall be strictly reserved to the undersigned parties and nothing in this
Agreement shall give or allow any claim or right of action whatsoever by any other person not
included in this Agreement. It is the express intention of the undersigned parties that any entity
other than the undersigned parties receiving services or benefits under this Agreement shall be an
incidental beneficiary only.
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IN WITNESS WHEREOF, the parties have executed this Agreement as of the date and
year written below.
,,,,// COUNTY;,
ATTEST: „�� ) Je.Lloiii BOARD OF COUNTY COMMISSIONERS
Weld .0 tAClerk to the Bo rd WELD COUNTY, COLORADO
By:
puty Cle �y to the `CtT!!!�, Mike Freeman, Chair
SEP 21 2016
Deep Rivers Family Counseling, Inc.
518 28 Road, #A207
Grand Junction, Colorado 81501
(970) 245-3212
By:
Date:
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Matthew Pettit, LMFT
0.2o/_a9.. /
EXHIBIT "A"
CONTRACTOR:
Name: Deep Rivers Family Counseling, Inc.
Address: 518 28 Road, #A207, Grand Junction, Colorado 81501
Tax I.D. or Social Security Number: 47-4025184
1. Services to be Provided by Contractor: Mental Health Services
To Name of Client: A.L.
Location of Services to be provided to the Client: 518 28 Road, #A207. Grand Junction, Colorado
81501
2. County agrees to purchase and Contractor agrees to furnish TBD units of Mental Health Services service
at the cost of $125.00/Episode (Intake). $90.00/Hour (Individual or Family Therapy) per unit of service
for a maximum amount of $5,000.00.
3. The parties agree that payment pursuant to this Contract is subject to and contingent upon the continuing
availability of funds for the purpose thereof. The payment of such services shall be from:
X Core Services as defined in Rule Manual Volume 7 Section 7.303.1 and, if appropriate, the
Colorado Department of Human Services approved County Core Services Plan.
Child Welfare Administration
Other as defined as
4. County agrees:
a) To determine child eligibility and as appropriate, to provide information regarding rights to fair
hearings.
b) To provide Contractor with written prior authorization on a child or family basis for services to be
purchased.
c) To provide Contract with referral information including name and address of family, social, medical,
and educational information as appropriate to the referral.
d) To monitor the provision of contracted service.
e) To pay Contractor after receipt of billing statements for services rendered satisfactorily and in
accordance with this Contract.
5. Contractor agrees:
a) Not to assign any provision of this Contract to a subcontractor.
b) Not to charge clients any fees related to services provided under this Contract.
c) To hold the necessary license(s) which permits the performance of the service to be purchased,
and/or to meet applicable Colorado Department of Human Services qualification requirements.
d) To comply with the requirements of the Civil Rights Act of 1964 and Section 504, Rehabilitation
Act of 1973 concerning discrimination on the basis of race, color, sex, age, religion, political beliefs,
national origin, or handicap.
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e) To provide the service described herein at cost not greater than that charged to other persons in the
same community.
f) To submit a billing statement in a timely manner, no later than forty-five (45) days after services.
Failure to do so may result in nonpayment.
g) To safeguard information and confidentiality of the child and the child's family in accordance with
rules of the Colorado Department of Human Services and the County Department of Human
Services.
h) To provide County with reports on the provision of services as follows:
Monthly reports will be submitted through the County's online reporting system, FIDOS, by the 7th
of the month following the month of service unless otherwise directed or agreed to by the County.
Contractor is responsible to set up FIDOS training with the County's Contract and Service
Coordinator prior to the due date of the first report.
i) To provide access for any duly authorized representative of the County or the Colorado Department
of Human Services until the expiration of five (5) years after the final payment under this Contract,
involving transactions related to this Contract.
j) Indemnify the County and the Colorado Department of Human Services from the action based upon
or arising out of damage or injury, including death, to persons or property caused or sustained in
connection with the performance of this Contract or by conditions created thereby, as based upon
any violation of any statute, regulation, and the defense of any such claims or actions.
6. In addition to the foregoing, the County and Contractor also agree:
a) Core Services Program expenditures will not be reimbursed when the expenditures may be
reimbursed by some other source. (As set forth in Rule Volume 7, at 7.414, B (12 CCR 2509-5).
b)
c)
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Certificate of Insurance (Proof of Coverage) Date Issued: 07/28/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Insured Name and Mailing Address*
Program Administrator
Matthew Pettit
PO Box 23360
Glade Park, CO 81523
Administered By:
CPH and Associates
711 S. Dearborn, Suite 205
Chicago, IL 60605
P. 312-987-9823 F. 312-987-0902
info{a cphins.com
*Additional insured locations are often requested by individual business owners who have more than
one office. Your coverage is portable, meaning that you are covered at any location for practice under
the occupation(s) listed on your policy.
Underwritten By:
Philadelphia Indemnity Insurance
Company
Coverage
Policy #: E 100961 'Effective Date: 10/14/2015 'Expiration Date: 10/14/2016
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH
RESPECT BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Limits of Liability
Coverage Part
EACH OCCURRENCE
(Per individual claim)
AGGREGATE
(Total amount per policy year)
$1,000,000
$3,000,000
Professional Liability
N/A
N/A
Commercial General Liability
Includes: General Liability, Fire & Water Legal Liability
and Personal Liability
N/A
N/A
Property Coverage
$1,000,000
$3,000,000
Supplemental Liability
Unlimited
Unlimited
Defense Expense Coverage
$35,000
$35,000
State Licensing Board Investigation Defense Coverage
$15,000
$15,000
Assault Coverage
$10,000
$35,000
Deposition Expense Benefit
$5,000/person
$50,000
Medical Expense Coverage
$15,000
$15,000
First Aid Coverage
escrlptlon/ Special Provisions:
Certificate Holder
Cancellation
County of Weld
1150 O St
Greeley, CO 80631
Should any of the above described policies be cancelled before the expiration date thereof,
notice will be delivered in accordance with the policy provisions.
Holder has also been added to the policy as an additional insured:**
[.. .Yes/No ] •Ifthe certificate holder is an ADDITIONAL INSURED, the policy(ies) must be
endorsed. A statement on this certificate does not confer rights to the certificate holder
in lieu of such endorsement(s).
' /211LJ40
I
Authorized Representative
C. Philip Hodson
DISCLAIMER:The Certificate of Insurance does not constitute a contract between the Issuing insurer(s), authorized representative or producer, and
the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon.
THIS ENDORSEMENT CHANGED THE POLICY. PLEASE READ IT CAREFULLY
Additional Insured Endorsement
This endorsement modifies insurance provided under the following:
ALLIED HEALTHCARE PROVIDERS PROFESSIONAL
AND SUPPLEMENTAL LIABILITY POLICY
In consideration of the premium paid, this policy is amended as follows:
County of Weld is hereby added as an Additional Insured, solely for Damages arising out of a Professional Incident
covered under this policy. The Professional Incident must arise out of services provided by the Insured, under contract
with County of Weld.
Additional Insured Name and Mailing Address:
County of Weld
1150 O St
Greeley, CO , 80631
**Added to the policy effective 07/28/2016, at the additional premium of $0.00.
All other terms and conditions of this policy remain unchanged. This endorsement is part of your policy and takes effect on
the effective date of your Policy, unless another effective date is shown below.
Policy: E100961
Effective on and after: 07/28/2016
Issued to: Matthew Pettit
Expiration date: 10/14/2016
PI-PHCP-3(03/01)
Rb 42-c9V
By: Robert O'Leary, Authorized Representative
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