HomeMy WebLinkAbout20152733.tiffAGREEMENT FOR PROFESSIONAL SERVICES (CORE)
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 Carmina Hadley, Psy.D. whose address is 9679
Kilninver Court, Colorado Springs, Colorado 80908, ("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. Engagement 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 June 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 $85.00/Initial Neurofeedback Consultation (90 -minute Clinical
Interview). $85.00/Neurofeedback Session (Applies to 90 -minute Session).
$65.00/Neurofeedback Session (60 -minute session. Rate applies to first 20 sessions).
$45.00/Neurofeedback Session (60 -minute session. Rate applies to sessions 21+).
$42.50/Initial Neurofeedback Consultation (No Show/No Call up to Two Sessions).
$32.50/Neurofeedback Session, Session 2-20 (No Show/No Call up to Two Sessions).
$22.50/Neurofeedback Session, Sessions 21+ (No Show/No Call up to Two Sessions).
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
Ib-«-Ili io - /a- ico,
02_016
eeof
claim by Contractor, itemizing services performed and mileage expense incurred.
d. Payment for services and all related expenses under this Agreement shall
not exceed $10,000.00.
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
2
necessary workers' compensation insurance at Contractor's own cost and expense.
11. 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
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.
3
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.
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.
4
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the
day, month, and year first above written.
Cam( COUNTY:
ATTEST: 4N v• •t1 BOARD OF COUNTY COMMISSIONERS
Weld •o i ty Clerk to the Board WELD COUNTY, COLORADO
By: _��S!.i!.►i
Deputy erk o _�:�'' �� Mike Freeman, Chair
5
OCT 12 2016
Carmina Hadley, Psy.D.
9679 Kilninver Court
Colorado Springs, Co do 80908
By:
Carmina Hadley, Psy.D.
Date: ci 1(2- I
orb/o-02 7L3
EXHIBIT "A"
CONTRACTOR:
Name: Carmina Hadley, Psy.D. (Trails Provider ID: PENDING)
Address: 9679 Kilninver Court, Colorado Springs, Colorado 80908
Tax I.D. or Social Security Number:
1. Services to be Provided by Contractor: Neurofeedback
To Name of Client: Various - Clients in the Colorado Springs Area
Location of Services to be provided to the Client: 1414 North Nevada Avenue, Colorado Springs
2. County agrees to purchase and Contractor agrees to furnish up to TBD units of Mental Health Services
(Neurofeedback) at the cost of $85.00/Initial Neurofeedback Consultation (90 -minute Clinical
Interview). $85.00/Neurofeedback Session (Applies to 90 -minute Session). $65.00/Neurofeedback
Session (60 -minute session. Rate applies to first 20 sessions). $45.00/Neurofeedback Session (60 -
minute session. Rate applies to sessions 21+). $42.50/Initial Neurofeedback Consultation (No
Show/No Call up to Two Sessions). $32.50/Neurofeedback Session, Session 2-20 (No Show/No Call up
to Two Sessions). $22.50/Neurofeedback Session, Sessions 21+ (No Show/No Call up to Two Sessions)
per unit of service for a maximum amount of $10,000.00 (Maximum reimbursement of all services
authorized and provided).
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 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.
1
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.
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:
Not applicable.
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)
2
EVIDENCE OF INSURANCE
Master Policy Named insured
National Professional Purchasing Group Association, Inc.
THIS EVIDENCE IS ISSUED AS A MATTER OF
do Lockton Affinity, LLC
INFORMATION ONLY AND CONFERS NO RIGHTS UPON
P. O. Box 410679
THE EVIDENCE HOLDER. THIS EVIDENCE DOES NPT
Kansas City, Missouri 64141-0679
AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED
BY THE CERTIFICATE DESCRIBED BELOW.
Named Insured Member:
Carmina Hadley
INSURERS AFFORDING COVERAGE:
9679 Kilninver Court
Colorado Springs, CO 80908
Certain Underwriters at Lloyd's, London
Member Certificate Number: 105-1020081-03
Primary Occupation: Mental Health Counselor
Secondary Occupation:
THE EVIDENCE 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: 08/12/2016
To: 08/12/2017
Both dates at 12:01 a.m Local Time at the address listed in Named Insured stated 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
$3,000,000
ii. Aggregate Limit of Liability includes Claims Expenses
B. General Liability (includes Host Liquor Liability)
i. Each Claim includes Claims Expenses
$1,000,000
$3,000,000
ii. Aggregate Limit of Liability includes Claims Expenses
C. Fire/Water Damage Legal Liability from any one fire or Water Damage
includes Claims Expenses
$100,000
D. Medical Expense Payments
i. •€ach 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.
EVIDENCE HOLDER
CANCELLATION
County of Weld
1150 "O" Street
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
Customer #: 1369808
LII 482 Evidence of Insurance (10-13)
RESOLUTION
RE: APPROVE PROFESSIONAL SERVICES AGREEMENT AND AUTHORIZE CHAIR TO
SIGN - CARMINA HADLEY, PSY.D.
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an agreement between the County of
Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on
behalf of the Department of Human Services, and Carmina Hadley, Psy.D., commencing July 20,
2015, and ending May 31, 2016, with further terms and conditions being as stated in said
agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Professional Services Agreement between the County of Weld, State
of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Human Services, and Carmina Hadley, Psy.D., be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 17th day of August, A.D., 2015, nunc pro tunc July 20, 2015.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: dititet) jeliz;ek
Weld County Clerk to the Board
BY: 71 lX ) rJ�J
y Clerk to the B
APPROVED AS TO FORM:
County Attorney
Date of signature:
EXCUSED
Barbara Kirkmeyer, Chair
Mike Freeman, Pro-Tem
can P. Conway
c c . ttsftem. q1I t
2015-2733
HR0086
26Yc.aCJ- lb 158
MEMORANDUM
DATE: July 31, 2015
TO: Board of County Commissioners — Pass -Around
FR: Judy A. Griego, Director, Human Services
RE: Weld County Department of Human Services' Agreement for
Professional Services with Carmina Hadley, Psy.D.
Please review and indicate if you would like a work session prior to placing this item on the
Board's agenda.
Request Board Approval of an Agreement for Professional Services with Carmina Hadley,
Psy.D. (Core). The County agrees to pay for Neurofeedback services at the rate of:
• $85.00/Initial Neurofeedback Consultation (90 -minute Clinical Interview)
• $65.00/Neurofeedback Session (60 -minute session. Rate applies to first 20 sessions)
• $45.00/Neurofeedback Session (60 -minute session. Rate applies to sessions 21+)
Charges shall be based on the time actually spent performing the services, but shall exclude
travel time. The term of this Agreement shall be from July 20, 2015, through and until May 31,
2016.
I do not recommend a Work Session. I recommend approval of this Agreement.
Approve Request
BOCC Agenda Work _Session
Sean Conway
Steve Moreno
Barbara Kirkmeyer
Mike Freeman
Julie Cozad
Pass -Around Memorandum; July 31, 2015 Page 1
2015-2733
44 R dbgl�
AGREEMENT FOR PROFESSIONAL SERVICES (CORE)
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 Carmina Hadley, Psy.D. whose address is 1414 North
Nevada Avenue, Colorado Springs, Colorado 80907, ("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. En2aaement 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 20, 2015, through and until
May 31, 2016.
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 $85.00/Initial Neurofeedback Consultation (90 -minute Clinical
Interview). $65.00/Neurofeedback Session (60 -minute session. Rate applies to first 20
sessions). $45.00/Neurofeedback Session (60 -minute session. Rate applies to sessions
21+). Charges shall be based on the time actually spent performing the services, but shall
exclude travel time.
b. Mileage may a nog (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 $2,000.00.
1
020/5 2 735
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.
11. 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
2
terminated at any time without notice upon a material breach of the terms of the Agreement. In
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.
3
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.
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.
4
� ��
, - '
=-�,-
IN WITNESS WHEREOF, the parties hereto have duly executed tl�e Agreement as of the
day, month, and year first above wntten.
A"ITEST: ��sN v• ��� BOAItD OF COLTNTY COMMISSIONERS
Wcld Co Clerk to the Board WEI.D COUNTY, COLORADO
BY: � � rl��./1p� —
Mike Freeman, Pro-Tem A(J� 1 � �E�
VED S T � � � PPROVED AS TO S�UBSTANCE:
�����a/��.�C,��� + _.
� �.(� ._J
Controller �le t�d Offi 'a or lle artme Head
+ i
I i
APPROVE AS TO FORIvt: r �I�(�}
�� Director of General Services
��
County Attomey
CARMINA I Y, PSY.D.
Cannina Hadley, sy. . `
I
5
02 D/a� 02,7� �.-,
EXHIBIT "A"
CONTRACTOR:
Name: Carmina Hadley. Psy.D. (Trails Provider ID: PENDING)
Address: 1414 North Nevada Avenue Colorado S rin . Colorado 80907
Tax I.D. or Social Security Number:
1. Services to be Provided by Contractor: Neurofeedback
To Name of Client: J.R. - DOB 06/09/1998jTrails Case ID 1520427)
Location of Services to be provided to the Client: 1414 North Nevada Avenue. Colorado Springs
2. County agrees to purchase and Contractor agrees to furnish up to TBD units of Life Skills or Mental
Health Services at the cost of $85.00/Initial Neurofeedback Consultation (90 -minute Clinical Interview).
$65.00/Neurofeedback Session (60 -minute session. Rate applies to first 20 sessions).
$45.00/Neurofeedback Session (60 -minute session. Rate applies to sessions 21+) per unit of service for
a maximum amount of $2.000.00 (Maximum reimbursement of all services authorized and provided).
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 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.
1
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:
Not applicable.
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)
2
EVIDENCE OF INSURANCE
•
Master Policy Named insured
National Professional Purchasing Group Association, Inc.
Go Lockton Affinity, LLC
P. 0. Box 410679
Kansas City, Missouri 64141-0679
THIS EVIDENCE IS ISSUED AS A MATTER OF
INFORMATION ONLY AND CONFERS NO RIGHTS UPON
THE EVIDENCE HOLDER. THIS EVIDENCE DOES NOT
AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED
BY THE CERTIFICATE DESCRIBED BELOW.
Named Insured Member:
Canning Hadley
9679 Kilninver Court
Colorado Springs, CO 80908
Member Certificate Number: 105-1020081-01
Primary Occupation: Psychological Assistant or Associate
Secondary Occupation:
INSURERS AFFORDING COVERAGE:
Certain Underwriters at Lloyd's, London
THE EVIDENCE 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: B0713GLOPR1300702
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: 08/12/2014
To: 08/12/2015
Both dates at 12:01 a.m Local Time at the address listed in Named Insured stated 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.
EVIDENCE HOLDER
CANCELLATION
County of Weld
1150 "0" Street
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
Customer #: 1369808
LII 482 Evidence of Insurance (10-13)
ahcerthldr
EVIDENCE OF INSURANCE
ISSUE DATE:
Master Policy Named insured
National Professional Purchasing Group Association, Inc.
THIS EVIDENCE IS ISSUED AS A MATTER OF
do Lockton Affinity, LLC
INFORMATION ONLY AND CONFERS NO RIGHTS UPON
P. O. Box 410679
THE EVIDENCE HOLDER. THIS EVIDENCE DOES NOT
Kansas City, Missouri 64141-0679
AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED
BY THE CERTIFICATE DESCRIBED BELOW.
Named Insured Member:
Carmine Hadley
INSURERS AFFORDING COVERAGE:
9679 Kilninver Court
Colorado Springs, CO 80908
Certain Underwriters at Lloyd's, London
Member Certificate Number: 105-1020081-02
Primary Occupation: Psychological Assistant or Associate
Secondary Occupation:
THE EVIDENCE 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: B0713GLOPR1400702
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: 08/12/2015
To: 08/12/2016
Both dates at 12:01 a.m Local Time at the address listed in Named Insured stated 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
$50,000
ii. Aggregate Limit of Liability
E. Policy Aggregate Limit of Liability includes Claims Expenses
$3,000,000
Supplementary payments are in addition to these limits.
EVIDENCE HOLDER
CANCELLATION
County of Weld
1150 "0" Street
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
Customer #: 1369808
LII 482 Evidence of Insurance (10-13)
ahcerthldr
Hello