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CONTRACT AGREEMENT AMENDMENT BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND GARCIA FAMILY GUIDANCE, INC. (Core)
This Agreement Amendment, made and entered into eday of 2016, by and
between the Board of Weld County Commissioners, on behalf of the Weld C my Department of
Human Services, hereinafter referred to as the "Department", and Garcia Family Guidance, Inc.,
hereinafter referred to as the "Contractor".
WHEREAS the parties entered into an Agreement for Mentoring (the "Original Agreement")
identified by the Weld County Clerk to the Board of County Commissioners as document No. 2015-
0594, approved on March 2, 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, 2015.
• The Original Agreement was amended for an additional term of June 1, 2015 -May 31, 2016. This
Agreement Amendment is identified by the Weld County Clerk to the Board of County
Commissioners as document No. 2015-1933(1), approved on July 1, 2015.
• 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 January 19, 2015, upon proper execution of this
Agreement and shall expire May 31, 2017, unless sooner terminated as provided herein.
2. Exhibit B, Scope of Services, is hereby amended as attached.
3. Exhibit C, Payment Schedule, is hereby amended as attached.
• All other terms and conditions of the Original Agreement remain unchanged.
2016-2074
ConswJ AvuX0--
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month,
and year first above written.
COUNTY:
ATTEST: dax,„ BOARD OF COUNTY COMMISSIONERS
Weld . n y Clerk to the Board WELD COUNTY, COLORADO
By:
Ta41.1,
Mike Freeman, Chair
CONTRACTOR:
"JUN 2 9 2816
Garcia Family Guidance, Inc.
2932 Ptarmigan Drive
Evans, Colorado 80620
(970) 405-4898
By:
NW
France/5 Grcia, President
Date: (o/aI1 j.
PY-14-15-CORE-0236
EXHIBIT B
SCOPE OF SERVICES
1. Contractor will provide mentoring services to youth, between the ages of five (5) and eighteen (18), which
are at risk of out -of -home placement, and have been referred by the Department.
2. Services are based on community need to deter juvenile out -of -home placement.
3. Services may include any of the following, as appropriate for the referred youth:
• Connect youth and their families to community resources, in the areas of parenting and
pregnancy, mental health concerns, drug and alcohol treatment, and alternative educational
plans.
• Advocate for youth rights within the systems, while teaching accountability and responsibility for
behaviors.
• Teach skills which foster independence such as job skills, independent living, goal setting and
development.
• Mediate during conflicts, to assist in strengthening conflict resolution, identifying alternative
outlets for self-destructive behavior, as well as assessing risks and developing plans to make
positive choices in difficult situations.
• Engage youth in activities, interests, and plans to promote positive self-image, participation in
pro -social activities, and expansion of positive experiences as well as increase positive peer
associations.
• Assist with compliance of system expectations including probation, community service,
electronic home monitor, court appearances, school attendance, and other professional
meetings.
• Educate and encourage recommended programs, such as therapy, as well as processing barriers
to overcome and meet goals.
• Provide opportunities and discussion to strengthen self-esteem, communication skills, and
coping strategies while building hope and intermediary steps towards long-term goals.
• Guide youth to increase communication with parents and adult supports, utilizing positive
resources.
4. Goals of service:
• Support referral goals and collaborate for linkage to resources, initially identified by the
caseworker, to maximize desired outcomes.
• Promote independence and empowerment for both youth and family, so they may successfully
function within the home, school, and community.
• Provide an environment conducive to healthy role -modeling, by showing mutual respect, open
communication, and a positive attitude.
5. Contractor will meet with the referred youth on a weekly basis, in which transportation and pick up from
youth's home will be provided. Meetings will be held in the community or home of youth.
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.
PY-14-15-CORE-0236
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.
11. Contractor understands that the Department will not reimburse Contractor for "no shows" or cancelled
appointments, either on the part of the client or the Contractor.
12. 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. Contractor is responsible for obtaining the meeting Facilitator's signature on the Client
Verification Form at the time of the staffing/meeting in order to be reimbursed. The Department will
reimburse for actual participation in the meeting only so long as the meeting is at least one hour in length,
the Contractor obtains the Facilitator's signature, and participation in the meeting is deemed appropriate
and necessary by the Department. Staffings and/or meetings other than those listed above are not
considered reimbursable unless otherwise approved by the Child Welfare Contract and Services
Coordinator.
PY-14-15-CORE-0236
EXHIBIT C
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,
2015.
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
$40.00/Hour (Mentoring Services. Court Facilitation/Court Staffing/Family Team Meeting/Team Decision
Making Meeting.)
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
PY-14-15-CORE-0236
c. For Monitored Sobriety services, proof of services rendered shall be the test result.
2
Account Number: CO GARC 2930 Date: 4/25/16 Initials: ANTONIA
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:
GARCIA FAMILY GUIDANCE INC
2932 PTARMIGAN DR
EVANS CO 80620
Additional Named Insureds:
FRANCES J GARCIA
Type of Work Covered: MENTAL HEALTH COUNSELING CORPORATION
Location of Operations:
(If different than address listed above)
Claim History:
N/A
Retroactive date is 06/01/2016
Coverages
Policy
Number
Effective
Date
Expiration
Date
Limits of
Liability
PROFESSIONAL/
PREMISES LIABILITY
5004-3201
6/01/16
6/01/17
1,000,000
1,000,000
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 ARE AN ADDITIONAL INSURED ON THIS POLICY:
1 COUNTY OF WELD
2 STATE OF COLORADO DIVISION OF YOUTH SERVICES
3 WELD ADOLESCENT RESOURCES INC
This Certificate Issued to:
Name: GARCIA FAMILY GUIDANCE INC
2932 PTARMIGAN DR
Address:
EVANS CO 80620 Aut orized Representative
APA 00138 00 (06/2014)
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