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MEMORANDUM
DATE: June 30, 2016
TO: Board of County Commissioners — Pass -Around
FR: Judy A. Griego, Director, Human Services
RE:
Weld County Department of Human Services' Child
Protection Agreement Extension/Renewal with Art & Soul
Care, LLC (Core)
Please review and indicate if you would like a work session prior to placing this item on the
Board's agenda.
Request Board Approval for the Departments' Child Protection Agreement
Extension/Renewal with Art & Soul Care, LLC (Core). The parties agree to extend the term
and rate structure of their original agreement (2015-2473) for Life Skills and Therapeutic
Kinship Services, under the standard form for renewals. The standard form was approved as
new business on March 9, 2015. The renewal term is for June 1, 2016 to May 31, 2017.
I do not recommend a Work Session. I recommend approval of this Renewal.
Sean Conway
Steve Moreno
Barbara Kirkmeyer
Mike Freeman
Julie Cozad
Approve Request
BOCC Agenda Work Session
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2016-2351
Pass -Around Memorandum; June 30, 2016 - Contract ID 525 Page 1
CONTRACT AGREEMENT AMENDMENT BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND ART & SOUL CARE, LLC (Core)
This Agreement Amendment, made and entered into o day o s 2016, by and
between the Board of Weld County Commissioners, on behalf of the Weld /u t Department of
Human Services, hereinafter referred to as the "Department", and Art & Soul Care, LLC, hereinafter
referred to as the "Contractor".
WHEREAS the parties entered into an Agreement for Life Skills and Therapeutic Kinship Services
(the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners
as document No. 2015-2473, approved on July 29, 2015.
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, 2016.
• The Amendment(s), together with the Original Agreement, constitutes the entire
understanding between the parties. The following change is hereby made to the Contract
Documents:
1. Term
This agreement shall become effective on June 1, 2015, upon proper execution of this
Agreement and shall expire May 31, 2017, unless sooner terminated as provided herein.
2. None
• All other terms and conditions of the Original Agreement remain unchanged.
020/& - ��1
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month,
and year first above written.
COUNTY:
ATTEST: did et) G
BOARD OF COUNTY COMMISSIONERS
Weld C. ty Clerk to the Board WELD COUNTY, COLORADO
By:
Deputy Cler! to y�Y ? ;"r � 1. �j % Mike Freeman, Chair
CONTRACTOR:
JUL 2 5 2016
Art & Soul Care, LLC
4625 W. 20th St., Suite. 110
Greeley, CO 80634
(720) 936-9300
By:
Date:
Nic ole T. Miller, M.fA., LPC
ao/ '- 23�/
CERTIFICATE OF INSURANCE
Master Policy Named insured
National Professional Purchasing Group Association, Inc.
THIS CERTIFICATE IS ISSUED AS A MATTER OF
Go Lockton Affinity, LLC
INFORMATION ONLY AND CONFERS NO RIGHTS UPON
P. O. Box 410679
THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
Kansas City, Missouri 64141-0679
NOT AMEND, EXTEND, OR ALTER THE COVERAGE
AFFORDED BY THE CERTIFICATE DESCRIBED BELOW.
Named Insured Member:
Nichole Miller DBA Art & Soul Care, LLC
INSURERS AFFORDING COVERAGE:
4265 W. 20th St. #110
Greeley, CO 80634
Certain Underwriters at Lloyd's, London
Member Certificate Number: 120-1005563-03
Primary Occupation: National Certified Counselor
THE CERTIFICATE OF INSURANCE LISTED BELOW HAS BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE
POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR
OTHER DOCUMENT WITH RESPECT TO WHICH THIS DOCUMENT MAY PERTAIN, THE INSURANCE AFFORDED BY THE
CERTIFICATE ISSUED TO THE MEMBER NAMED ABOVE IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND
CONDITIONS OF THE MASTER POLICY TO WHICH IT REFERS TO. AGGREGATE LIMITS MAY HAVE BEEN REDUCED BY
PAID CLAIMS.
1. Unique Market Reference Number: B0713GLOPR1500702
2. Policy Period: The Policy Period shall commence during the Policy Period set forth below. Coverage shall
commence from the date upon which the Named Insured holds a valid RPG membership during the Policy
Period and shall continue up to but not exceeding 365 days in all.
From: 06/28/2016
To: 06/28/2017
Both dates at 12:01 a.m Local Time at the address stated in Item 1 above.
3. Policy Administrator: Lockton Affinity, LLC P.O. Box 410679 Kansas City, MO 64141-0679
4. Insuring Agreements and Limits of Liability
A. Professional Liability:
i. Each Claim includes Claims Expenses
$1,000,000
ii. Aggregate Limit of Liability includes Claims Expenses
$3,000,000
B. General Liability (includes Host Liquor Liability)
i. Each Claim includes Claims Expenses
$1,000,000
ii. Aggregate Limit of Liability includes Claims Expenses
$3,000,000
C. Fire/Water Damage Legal Liability from any one fire or Water Damage
includes Claims Expenses
$100,000
D. Medical Expense Payments
i. Each Person
$2,000
ii. Aggregate Limit of Liability
$50,000
E. Policy Aggregate Limit of Liability includes Claims Expenses
$3,000,000
Supplementary payments are in addition to these limits.
CERTIFICATE HOLDER
CANCELLATION
Weld County Department of Human Services
315 N. 11th Avenue
Greeley, CO 80631
SHOULD THE ABOVE DESCRIBED POLICY BE
CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS
AUTHORIZED REPRESENTATIVE
II 482 Certificate of Insurance (I0-13)
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