HomeMy WebLinkAbout20162716.tiffCorrh'mc.) (b loG5
MEMORANDUM
D \ FE: July 26, 2016
TO: Board of County Commissioners — Pass -Around
FR: Judy A. Griego, Director, Human Services
RE: Weld County Department of Human Services' Child Welfare
2016-2017 Respite Care Provider Renewals
Please review and indicate if you would like a work session prior to placing these items on the
Board's agenda.
Request Board -approval of the Renewal for Respite Services between the Department and
Various Providers. The Department's Division of Child Welfare contracts annually with
individuals and couples. primarily Weld County certi tied foster parents. for respite care services.
Respite care is limited to tour (4) hours per week per child. The hours of care may he provided in
any combination throughout a month, but may not exceed 16 hours per month. Payment is $16.75
per each four hour period. hut may not exceed $67.00 per month for 16 hours. Fhe list of providers
that would like to renew for the term of July I. 2016 through .June 30. 2017, are as follows:
t 144‘11
Brown
Rachel
Greeley��
Irwin
Kasi (Jeremiah)
Severance
Koepp
Jenna (Kristopher)
Evans
1 Alaronek
Patricia (Dennis)
Greeley
Miller
Pamela
Greeley
Ripka
Gary Steven
It. Collins
i Stone Mary Kay (Jamie David)
Greeley
-Fauber Nicole (Jon Wright)
Greeley
L._Tavita ;
Jacquelyn (Bruce)
Greeley
Van Den Elzen
Dawn
Greeley
Walker
Jennifer Lynne
Ft. Collins
CWalker
Renac
W indsor
Workman -W urtr
Kathryn
Greeley
I do not recommend a Work Session. f
Sean Conway
Steve Moreno
Barbara Kirkmeyer
Mike Freeman
Julie Coad
recommend approval of these Renewals.
Approve Request
BOCC t.genda Work Session
I 1
2016-2716
Piss-Arr and ti1e rorandam, July 26, 2016 (T DD, ) / p Page 1
CONTRACT AGREEMENT AMENDMENT BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND DAWN VAN DEN ELZEN (NON -CORE)
This Agreement Amendment, made and entered into a day of June 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 Dawn Van Den Elzen, hereinafter referred
to as the "Contractor".
WHEREAS the parties entered into an Agreement for Respite Care Provider Services (the
"Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as
document No. 2014-2913, approved on September 22, 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 June 30, 2015.
• The Original Agreement was renewed for the term of July 1, 2015 -June 30, 2016. The
Agreement Amendment is identified by the Weld County Clerk to the Board of County
Commissioners as document No. 2015-2196(3), approved on July 20, 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 shall become effective on July 1, 2016, upon proper execution of this
Agreement and shall expire June 30, 2017 unless sooner terminated as provided herein.
2. None
• 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.
�,�,// COUNTY.
ATTEST: S,42:44) �C ld0 BOARD OF COUNTY COMMISSIONERS
Weld County Clerk to the Board WELD COUNTY, COLORADO
eputy Clerk to the Board
Mike Freeman, Chair
CONTRACTOR:
awn Van Den Elzen
819 West 16th Street Lane
Greeley, CO 80634
(970) 371-7876
By:
AUG 2 2 2016
taLte,t,r � o,�� fri
Dawn Van Den Elzen
Date: („ -G 0702,6
5TH ST LN
Co 80634
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NSURANCEIS COMPULSORY IN COLORADO, NON-COMPLIANC
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COLORADO
INSURANCE CARD
INSURED VAN DEN ELZEN, DAWN M
POLICY NUMBER 352 2124•BO$-O$ EF"rE 714E
YR 2013 MAKE FORD FEB 03 2.11 AUG OS 2t15
MODEL ECONOLINE b'IN 1FBSSSBL&DDA4S175
AGENT LARSON INS AGENCY INC
PHONE (!70)3544700 25170
THE MINIMUM LIABILITY LIMITS RAGE PRESCRIY THEBED BY LAW. MEETS THE
A BODILY INJURY/PROPERTY DAMAGE LIABILITY
C MEDICAL PAYMENTS
D COMPREI1ENSWE
0 100 DEDUCT COLLISION
SEE REVERSE SIDE FOR ADOiTIOKAL COVERAGE IPFO AT -31i
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