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Home My WebLink About20150196.tiff 186, MEMORANDUM rDATE: January 8, 2015 G O — T Y TO: Barbara Kirkmeyer, Chair, Board of Co my Co is 'oners FROM: Judy A. Griego, Director, Human Se es Departm RE: Agreements for Professional Service etweer the Weld County Department of Human Services and Providers for Consent Agenda Enclosed for Board approval are agreements for professional services between the Department and various providers. The Sills agreement was reviewed under the Board's Pass-Around Memorandum dated December 12, 2015, and the Hearts and Horses, Inc., agreement was reviewed under the Board's Pass-Around Memorandum dated December 29, 2014. Both were approved for placement on the Board's Agenda. Below are the major provisions of the attached agreements: No. Provider/Term Service/Funding Source Rate 1 Theron Sills, MD Psychiatric Consultation $75.00/hour (maximum 01/01/2015-12/31/2015 $3,600.00 and no mileage) 2 Hearts and Horses, Inc. Behavioral Health Services $120.00 (Balance (Changing Leads Program) due after partial 8/23/2014-10/20/2014 scholarship from Core RFCC) If you have questions, please give me a call at extension 6510. 2015-0196 Auldlent Qy �� ; tic litµ 1 - 14-15- /- cc : lie 04(a _..�,ti .. .,a.« AGREEMENT FOR PROFESSIONAL SERVICES THIS AGREEMENT is made by and between the Board of Weld County Commissioners,on behalf of the Weld County Department of Human Services,whose address is 315N. 11'"Avenue,Greeley,Colorado,80631 ("Human Services"),and Theron Sills,M.D.whose address is 3737 West 20th Street,Greeley,CO 80634 ("Contractor or Contract Professional). WHEREAS,Human Services desires to retain Contractor as an independent contract professional 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. WHEREAS,Contract Professional is authorized to do business in the State of Colorado and has the time, skill,expertise,and experience necessary to provide the services as set forth below; NOW THEREFORE,in consideration of the mutual promises and covenants contained herein,the parties hereto agree as follows: 1. Eneseement of Contractor. Human Services hereby retains Contractor,and Contractor hereby accepts engagement by Human Services upon the terms and conditions set forth in this Agreement. 2. Term. The term of this Agreement shall be from January 1,2O15,through and until December 31.2015. 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. Human Services agrees to pay Contractor for services performed as set forth on Exhibit B a maximum rate of$3,600.00 per year,which includes an hourly rate of$75.00 per hour. Charges shall be based on the time actually spent performing the services,but shall exclude travel time. Contractor shall not be paid any other expenses unless set forth in this Agreement. Payment to Contractor will be made only upon presentation of a proper claim by Contractor,itemizing services performed and mileage expense incurred. Payment for services and all related expenses under this Agreement shall not exceed$3.600.00. 5. Additional Work. In the event Human Services 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 Human Services for any purpose. Contractor shall have no authorization,express or implied,to bind Human Services to any agreement,liability,or understanding. The parties agree that Contractor will not become an employee of Human Services,nor is Contractor entitled to any employee benefits from Human Services as a result of the execution of this Agreement. 7. Warranty. Contractor warrants that services performed under this Agreement will he performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. 1 7?O/ 019E (I) 8. Reports Human Services 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 Human Services. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of Human Services. 9. Acceptance of Product not Waiver. Upon completion of the work,Contractor shall submit to Human Services originals of all test results,reports,etc.,generated during completion of this work. Acceptance by Human Services 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 Human Services of;or payment for,any services performed under this Agreement shall not be construed as a waiver of any of Human Services'rights under this Agreement or under the law generally. 10. Insurance and Indemnification. Contractor shall defend and indemnify Human Services,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. Contract Professionals must secure,at or before the time of execution of any agreement or commencement of any work,the following insurance covering all goods or services provided pursuant to this request.Contract Professionals shall keep the required insurance coverage in force at all times during the term of the Agreement,or any extension thereof,and during any warranty period. Professional Liability(Errors and Omissions Liability) The policy shall cover professional misconduct or lack of ordinary skill for those positions defined in the Scope of Services of this contract. a. Minimum Limits: Per Loss $ 1,000,000 Aggregate $ 2,000,000 Commercial General Liability Insurance shall include bodily injury,property damage,and liability assumed under the contract. $1,000,000 each occurrence; $1,000,000 general aggregate. 11. Termination. Either party may terminate this Agreement at any time by providing the other party with a I0 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 Human Services shall be entitled the use of all material generated pursuant to this Agreement. 12. Non-Assienment. Contractor may not assign or transfer this Agreement,any interest therein or claim thereunder,without the prior written approval of Human Services. 13. Access to Records. Human Services 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. 2 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 Human Services. Contract Professional shall strictly comply with all applicable federal and State laws,rules and regulations in effect or hereafter established,including without limitation,laws applicable to discrimination and unfair employment practices. 18. Non-Exclusive Agreement; This Agreement is nonexclusive and Human Services may engage or use other contractors or persons to perform services of the same or similar nature. 19. Public Contracts for Services C.R.S. &8-17.5-101. Contract Professional certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contract Professional will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement,through participation in the E-Verify program of the State of Colorado program established pursuant to C.R.S. §8-17.5-102(5)(c). Contract Professional shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contract Professional that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contract Professional shall not use F.-Verify Program or State of Colorado program procedures to undertake pre- employment screening or job applicants while this Agreement is being performed. If Contract Professional obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contract Professional shall notify the subcontractor and County within three (3) days that Contract Professional has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contract Professional shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. Contract Professional shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8- 17.5-102(5),by the Colorado Department of Labor and Employment.if Contract Professional participates in the State of Colorado program, Contract Professional shall, within twenty days after hiring an new employee to perform work under the contract,affirm that Contract Professional has examined the legal work status of such • employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, and shall comply with all of the other requirements of the State of Colorado program.If Contract Professional fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable for actual and consequential damages. Except where exempted by federal law and except as provided in C.R.S.§24-76.5-103(3),if Contract Professional receives federal or state funds under the contract,Contract Professional must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S.§24-76.5-103(4),if such individual applies for public benefits provided under the contract. If Contract Professional operates as a sole proprietor,it hereby swears or affirms under penalty of perjury that it:(a)is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law,(h) 3 shall produce one of the forms of identification required by C.R.S.§24-76.5-101,et seq.,and(c)shall produce one of the forms of identification required by C.R.S.§24-76.5-103 prior to the effective date of the contract. 20. Entire A$reement/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. FundintContin!enev. No portion of this Agreement shall be deemed to create an obligation on the part of Human Services to expend funds not otherwise appropriated or budgeted for. 22. Confidentiality. The Contractor agrees to comply with 19-1-120 C.R.S., which requires that reports of child abuse and any identifying information in those reports are strictly confidential. 23. No Conflict. No employee of Contractor nor any member of Contractor's family shall serve on a Human Services 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. 24. 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. 25. 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. 26. 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. 27. Fund Availabilitvi Financial obligations of the County payable after the current fiscal year are contingent upon funds for that purpose being appropriated,budgeted and otherwise made available. Execution of this Agreement by County does not create an obligation on the part of County to expend funds not otherwise appropriated in each succeeding year. 4 IN WITNESS WHEREOF�yIYtr,y-r�ereto have duly executed the Agreement as of the day,month,and year first above wrin ATTEST: � / �, BOARD OF COUNTY COMMISSIONERS Weld C' ru erk to B r % H' D COUNTY,COLO •DO BY //�i�iLy'�1� -��• _ A ��.��.� 'bara Kirkmey•r, Chair :JAN 1 4 2015 • "ROVED AS TO F t. ,:�``�lr/,y I APPROVED AS 0 S STANCE: Controller - E ed Off fic. I or Dep ment H d APPROVED AS TO FORM: Director of General Services County Att CONTRACTOR �. j2d Theron Sills,M.D. • • • 020/S- 0/96 (I) • EXHIBIT A SCOPE OF SERVICES Human Services administers a Child Protection Team(CPT)which is an advisory multi-disciplinary team which was formed to advise Human Services on specific child protection casts. The Contractor's participation on the CPT partially fulfills Human Services'statutory responsibility of providing a multi- disciplinary CPT. The Contractor agrees to provide medical consultation and interpretation related to the cases staffed in the CPT in accordance to the policies and procedures provided by Human Services. Contractor shall: I. Attend a maximum of two(2)CPT meetings per month,providing medical consultation on three (3)to four(4)cases per meeting. Each meeting shall be up to(2)hours in duration. 2. Provide consultation on crisis situations where a session is needed to meet the special needs of an abused or neglected child. • Human Services shall: 1. Determine the meeting time,location,and dates of CPT meetings;assess monthly the number of meetings to be attended by the Contractor;and shall notify the Contractor of such schedule. 2. Select cases to be reviewed and staffed by the Contractor. 6 EXHIBIT B PAYMENT SCHEDULE Funding and Method of Payment Human Services agrees to reimburse to the Contractor, in consideration for the work and services performed,a total amount not to exceed Three Thousand Six Hundred Dollars($3,600.00) for the term of this agreement. Expenses incurred by the Contractor, in association with said project prior to the term of this Agreement, are not eligible Human Services expenditures and shall not be reimbursed by Human Services. Payment pursuant to this Contract, if Weld County funds, whether in whole or in part, is subject to and contingent upon the continuing availability of Weld County funds for the purposed hereof. In the event that said funds, or any part thereof, become unavailable as determined by Human Services, Human Services may immediately terminate this Contract or amend it accordingly. 2. Fees for Services • Human Services agrees to pay the Contractor at the rate of$75.00 per hour. 3. Submittal of Voucher Human Services agrees to: a. Itemize monthly, all case record information regarding services authorized and received for service recipients according to its prescribed voucher form. b. Provide a completed voucher to the Contractor each month for review and certification(signature). The Contractor shall: a. Review monthly the Itemized voucher and certify that the services authorized were provided on the date indicated and the charges made were pursuant to the terms and conditions of Exhibit A. b. Return the signed prescribed voucher form to Human Services for payment. 7 ICS COPIC Better Medicine• Better Lives DECLARATION PAGES Policy Number: PCC0002935 Named Insured: Theron G.Sills,M.D. Named Insured/Mailing Address: Theron G.Sills,M.D. 3737 W 20th St Greeley, CO 80634-3419 Policy Term: From:07/17/2014 to 07/17/2015 12:01 A.M.standard time at the address of the named insured stated herein. Policy Number: PCC0002935 Coverage Territory: Colorado COVERAGES LIMITS OF LIABILITY A. Professional Liability As Scheduled Below B. Covered Proceedings $50,000 annual aggregate per individual named insured $50,000 annual aggregate per individual allied health professional $50,000 combined annual aggregate for all insured professional corporations listed on the Declaration Pages or endorsement $150,000 Policy aggregate; Aggregate Policy limit subject to all other terms and conditions C. Peer Review Incident $unlimited per individual named insured D. Cyber Liability $100,000 per individual named insured Aggregate limit subject to physician count(see supplementary coverage booklet) Named Insured:Theron G. Sills, M.D. Retroactive Date: 07/17/1986 Specialty/Classification: Psychiatry Part Time 21-25 hrs Discount 25.00%, Society Discount 10.00%, Solo Discount 15.00%,COPIC Points-Preferred Class 10.00% Coverage(s) Limits of Liability A. Professional Liability: $1,000,000 each medical incident $3,000,000 annual aggregate Deductible(coverage A only): SN/A B.Covered Proceedings As above Included C.Peer Review Incident As above Included D.Cyber Liability As above Included Premium $2,487 CIC-DEC Rev 1/14 Post Office Box 17540 Denver,Colorado 80217-0540 (720)858-6000 1-800-421-1834 FAX(720)858-60D4 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 Hearts& Horses, Inc. whose address is 163 North CR 29, Loveland, Colorado 80537, ("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 August 23,2014,through and until October 20, 2014. 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$120.00(One-time Flat Rate1. 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 $120.00(One-time Flat Rate). 5. Additional Work. In the event the County shall require changes in the scope, character, or complexity of the work to he performed,and said changes cause an increase or c72 o/e5'- Di f •-• ( z� 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. 11pon 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. I 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 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. 2 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 tbr 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 Agrcement. 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 he 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 he changed or supplemented only by a written instrument signed by both parties. • 21. Funding Contingenev. 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 ol'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 • • ATTEST: digrhAl � �1 BOARD OF COUNTY COMMISSIONERS Weld County Clerk to the ar ' , WELD COUNTY, CO ORADO BY: .�, arbara Kirlme er, Chair `JAN 1 4 201 APPROVED AS TO U1D1\ �•r ; 'ti;,�I APPROVED TO 'BSTANCE: Controller e ed on- vial or • ttfarirneni7lead APPROV - AS TO FORM: ARM Director of General Services County Attorney CO RA CTOR t /9.Ltd h.. /- ,Ian .oll a,Executive Director • d C/5 / 96 ()) EXHIBIT "A" CONTRACTOR: Name: Hearts & I lorses. Inc. ('Trails Provider II.): 1649066) Address: 163 North CR 29. Loveland. Colorado 80537 Tax L.D.or Social Security Number: 84-1387873 I. Services to he Provided by Contractor: Behavioral Health Services (Changing Leads Group Lessons) To Name of Client: M.E. (Trails Client ID 1677844) Location of Services to be provided to the Client: 163 North CR 29. Loveland,Colorado.80537 2. County agrees to purchase.and Contractor agrees to furnish up to 1 units of Behavioral Health Services (Changing Leads Group Lessons)at the cost.of$120.00 per unit of service for a maximum amount of 55120.00. 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 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. • h) 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. e) To provide the service described herein at cost not greater than that charged to other persons in the same community. 1 f) To submit a killing statement in a timely manner, no later than forty-five(45)days after services. Failure to do so may result in nonpayment. fit) 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 he 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) • • • ------....1 HEAR-HO OP ID:ICP DATE(MMIDDIYYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE I 02113/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS BELOW. A THIS DOES NOT INSULY RANCE ER DOES NOTLY CONSTTUTE A CONTRACTEND, EXTEND OR TER THE BETWEENOTHE COVERAGE AFFORDED INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Rob Carruth PRODUCER NAME: FAX Goetz Insurors,Inc. PHONE 970-867-8246 I V.Na):970-867.4408 227 Main St lac Na Fan: E-MAIL Fort Morgan,CO 80701 ADDRESS: Rob Carruth INSURER(S)AFFORDING COVERAGE NAIC0 INSURER A:American Bankers Insurance Co 10111 INSURED Hearts&Horses,Inc. INSURER B: 163 N County Rd 29 INSURER C: Loveland,CO 80537 INSURER D: • INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.AWL SUM POLICY EFF POLICY EXP ILTLIMITS R TYPE OF INSURANCE !NCR wvn POLICY NUMBER IMMIDDIYYYYI (MMIDD/YYYYI 1,000,000 R EACH OCCURRENCE $ GENERAL LIABILITY DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY FSL4162281 10/31/2013 10/3112014 PREMISEG(ERa unencel s MED EXP(Any one person) $ 5,000 CLAIMS-MADE X OCCUR PERSONAL B pDV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 • PRODUCTS-COMPIOP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: g POLICY PR LOC COMDINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ BODILY INJURY(Per person) $AUTOANY BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED (PER ACCIDENT) HIRED AUTOS AUTOS $ EACH OCCURRENCE $ _ UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS-MADE AGGREGATE S $ DED I I RETENTIONS WC STAN- I IOTH- WORKERS COMPENSATION WCY LIMITS TH AND EMPLOYERS'LIABILITY ER Y/N EL EACH ACCIDENT $ ANY OFFICER/MEMBER EXCLUDED]ECUTVE I I NIA EL.DIBEASE-EA EMPLOYEE $ (Mandatory NH) E.L.DISEASE-POLICY LIMIT $ If yes,RIPTION VDtlel DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,II more space is required) general proof of insurance CERTIFICATE HOLDER CANCELLATION HEAR-HO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE .---14-- c.. J I ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD HEAR-HO OP ID: KP A1/4,. --- , DATE(MMIDDIYYYY) `..--- CERTIFICATE OF LIABILITY INSURANCE 12/03/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT NAME: Rob Carruth PRODUCER Goetz Insurors,Inc. PHONE 070-867.8246 FAL,No).970-867-4408 227 Main St•PO Box 190 (ac.NO FxW Fort Morgan,CO 80701 ADDRESS: Rob Carruth INSURER(S)AFFORDING COVERAGE NAIL 0 INSURER A:American Bankers Insurance Co 10111 • INSURED Hearts&Horses, Inc. INSURER B: 163 N County Rd 29 INSURER C: Loveland,CO 80537 INSURER O: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUUL S POLICY EFF POLICY EXP ILIMITS TYPE OF INSURANCE INSR Wvn POLICY NUMBER IMM/DDIYYYY) (MM/DEVYYYYI GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 FSL4162281 10/31/2014 10/31/2015 DAMMGETORENIED A X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occunence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL XADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PFO CT LOC $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ , BODILY INJURY(Per person) $ ANY AUTO ALL O SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ NAUTOS ON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (PER ACCIDENT) $ $ UMBRELLA LWB OCCUR EACH OCCURRENCE $ . EXCESS LIAR CLAIMS-MADE AGGREGATE ''$ DED [ I RETENTIONS _ $ WORKERS COMPENSATION WCCY LIMITSTATU-S OER T AND EMPLOYERS'LIABILITY Y/N . ANY PROPRIETORIPARTNEWEXECUTIVE ' E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N IA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GENERAL PROOF ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE --7- s c'1.--r•-•J I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Hello