HomeMy WebLinkAbout20150304.tiff •
r8..1 MEMORANDUM
thite. •
DATE January 21,2015
\ijn`p pU N TY TO: Barbara Kirkmeyer, Chair, Board of County Commissioners
FROM: Judy A. Griego, Director, Human Services Department
RE: Agreement for Professional Services between the Weld
County Department of Human Services and Sherri Malloy,
Ph.D. for Consent Agenda
Enclosed for Board approval is an agreement for professional services between the Department
and Sherri Malloy, Ph.D. This agreement was reviewed under the Board's Pass-Around
Memorandum dated November 19, 2014 and was approved for placement on the Board's
Consent Agenda.
The major provision for this agreement is as follows:
No. Provider/Term Service/Funding Source Rate
1 Sherri Malloy, Ph.D. Psychological Services (Mental $75.00/Hour(Up to
Health Services) 26 Units for a max
May 30, 2014 — reimbursement of
December 31, 2014 Core/CW Admin(A portion of the $1,950.00)
services we are ordered to pay will be
non-reimbursable under Core)
•
If you have questions, please give me a call at extension 6510.
/ 2015-0304
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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 Sherri Malloy, Ph.D. whose address is 1703 61st Avenue,
Suite 103, Greeley, CO 80634, ("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 May 30, 2014, through and until
December 31, 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$75.00/Session (Hour). 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 $1,950.00.
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
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C/ c3c 61 )
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
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.
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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.
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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.
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05/28/2006 05:18 9703517218 DRSHERRIMALLOY PAGE 02/03
EN WITNESS WHEREOF, the artics hereto have duly executed the Agreement as of the
day,month,and year fii'st above •Vier"""�1
♦,J� ILA
ATTEST:\ didet) �W. Ii�. ,�,•' �� BOARD OF COUNTY COMMISSIONERS
Weld dupty Clerk to the D• 3 % .�T'!`b�'�WELD COUNTY, COLORADO
l ,
r ` L
BY: - ._�+=, her /•r►/ ' �_ � .
Barbara Kirlemeyer,, Chair JAN 2 8 2015
APPROVED AS T FUNDING APPROVED AS TO UBSTANCE: -
Controller E1 Ofize or D me Head
APPROVED AS TO FORM: _ NI/A A
Agez7-- > Director of General Services
County Att rney
CONTRACTOR
oetawf. ., eh 4D-
Sherri Malloy, Ph..D_
5
:.72075--0364 (0)
EXHIBIT "A"
CONTRACTOR:
Name: Sherri Malloy, Ph.D. (Trails Provider ID 1526159)
Address: 1703 61``Avenue, Suite 103, Greeley, Colorado 80634
Tax I.D. or Social Security Number: 38-3862046
1. Services to be Provided by Contractor: Psychological Services (Mental Health Services)
To Name of Client: S.B. (Trails Client ID 2806353)
Location of Services to be provided to the Client: 1703 611 Avenue, Suite 103, Greeley, CO 80634
2. County agrees to purchase and Contractor agrees to furnish up to 26 units of Psychological Services
(Mental Health Services) at the cost of$75.00 per unit of service for a maximum amount of$1,950.00.
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.
X 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.
e) To provide the service described herein at cost not greater than that charged to other persons in the
same community.
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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)
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05/24/2008 02:08 970517218 DRSHERRIMALLOY PAGE 05/09
Sherri Malloy, Ph.D.
Licensed Clinical Psychologist
Education
Ph.D. Double Major: Child Clinical Psychology and Clinical Psychology.
August 1993 University of Colorado, Boulder. Licensed as Psychologist January 1995.
M.A- Department of Psychology,Clinical Program. University of Colorado,
July 1989 Boulder.
B.A. Major: Psychology; Minor:Spanish. Arizona State University.
May 1987 Summa Cum laude.
Teaching Cert. Roston Montessori Teacher Training Institute
August 1977 Orange, California. Montessori Elementary Education Certificate.
Clinical Experience
April 1917 Clinical Psychologist, Private Practice,Greeley,Colorado.
present Provide outpatient psychotherapy to children,adolescents, adults,and
families. Specializing in:trauma,grief, loss, life transitions, adoption,attachment.
August 1991- Child and Family Psychotherapist, Mental Health Center of Boulder County,
March 1997 Boulder, Colorado. Provided outpatient psychotherapy to children and their
families. Parent,teacher,and other agency consultation. Consultation to
foster and adoptive families.
Sept. 1992- Psychology Intern: Denver Health Medical Center, Denver, Colorado.
August 1993 Outpatient assessment,consultation,and treatment for children,adolescents,
and adults. Adolescent inpatient treatment.Consultation to multidisciplinary
hospital staff. Rotation in neuropsychology.
August 199x- Psychotherapist, University of Colorado, Farrand Residence Hall. Provided
May 1992 individual and group psychotherapy to Farrand residents. Consultation to
faculty and staff.Seminars and workshops given to faculty and students.
August 1988- Emergency Psychiatric Services Clinician, Mental Health Center of Boulder
August 1992 County, Boulder, Colorado. Evaluation and disposition planning for clients with
psychiatric emergencies. Composed a training manual for E.P.S. clinicians.
January 198fI- Psychotherapy intern, Raimy Psychology Clinic, Department of Psychology,
May 1992 University of Colorado at Boulder. Provided outpatient psychotherapy to adults,
families, and children. Parent and teacher consultation.
Feb. 1986- Intake Clinician; Group Facilitator,Tri-City Behavioral Health Center, Mesa,
July 1987 Arizona. Conducted intakes for the adult team. Children's psychotherapy group
facilitator.
1703 cl s t ftue, S'u;11- 103
3527 West 12th Street, Suite 108 • Greeley, CO 80634
970.352.3811 • Fax 970.351.7218
05/24/2008 02:08 970351721E DRSHERRIh4ALLOY PAGE 0b/09
2 Malloy
Administrative and Supervisory Experience
April 1998- Private consultation and supervision provided to colleagues and to
present unlicensed practitioners who are working toward Ilcensure.
January 1996-- Team Leader, Mental Health Center of Boulder County, Boulder,
May 1998 Colorado.Clinical and administrative supervision of a team of
psychologists and psychotherapists. Budgeting; supervision of support
staff.Coordinated services provided to joint agency programs including
Head Start;Specialized Foster Care; Permanency Planning team; School
Based Services; People's Clinic.
August 1990- Adult Team Coordinator, Raimy Psychology Clinic, Department of Psychology,
August 1991 University of Colorado at Boulder.Chaired the Adult Team meetings and case
conferences. Administrative tasks.
August 1990- Peer Counselor Supervisor, Farrand Residence Hall, University of Colorado at
May 1991 Boulder. Developed,implemented,and supervised a peer counseling program.
June 1989- Adult Team Intake Coordinator,Raimy Psychology Clinic, Department of Psychology,
August 1990 University of Colorado at Boulder. Intake and disposition of psychotherapy clients.
Sept. 1989- Clinical Supervisor, Emergency Psychiatric Services Team, Mental Health Center
August 1992 of Boulder County, Boulder, Colorado.Trained and supervised masters level interns
in emergency clinical assessment techniques, legal and procedural practices,and
psychological report writing.
Feb. 1988- Volunteer Trainer,Maslin House for Chronically Mentally Ill, Mental Health Center
May 1989 of Boulder County, Boulder, Colorado. Recruited and trained volunteer college
students to work with chronically mentally 111 patients.
Publications
2002 The Little Bunnies Say Good-b_e to Birth Mom. Publisher: Families by Design.
Dec.1994- Columnist:The Boulder County Parent,a monthly publication of the Parenting
April 1998 Place, Boulder, Colorado. Circulation: 8,000.Topics include child development
and parenting concerns.
ob/24/2008 02:08 97e3517219 DRSHERRIMALLOY PAGE 07/09
3 Malloy
Teaching Experience
January 20O1- Instructor, University of Northern Colorado,Greeley,Colorado.
May 2001 Graduate level Play Therapy Practicum,
August 1985)- Psychology Instructor, Front Range Community College, Boulder Campus,
May 1992 Colorado.
Fall 1988 Head Teaching Assistant, Department of Psychology,University of Colorado
at Boulder_Trained and supervised graduate level teaching assistants.
August 1987- Teaching Assistant, Department of Psychology, University of Colorado at
May 1989 Boulder.
August 1975- Montessori Elementary Teacher, Roston Montessori School,Orange, California,
May 1983 and subsequently,Tempe Montessori School,Tempe,Arizona. Preschool
through second grade classes.Academic program planning and implementation,
supervising teacher assistants, conducting parent-teacher conferences,
educational presentations to parent groups.
Presentations and Trainings
Legal and E.mntional Aspects of Adoption
ReaclIve Attachment Disorder
Inclusiveness:The Child with Different Needs
Parents and Teachers Working Together in a Culturally Sensitive Way
Transitions for Children in Foster Care
Corrective Attachment Therapy
Eye Movement Desensitization and Reprocessing(EMDR)
Creation of Life Books for Foster and Adopted Children
Play Therapy
Engaging So-called"Resistant" Clients
Psychotherapy with Adolescents and Their Families
Case Conferences
Parent-Toddler Attachment Patterns
Child Abuse
Child Psychopathology
Stress Management
Depression and Risk in College Students
u / vi wells U2:08 9703517218 DRSHERRIMALLOY
PAGE 0e/F15
4 Malloy
Research Projects
Adult Attachment Style and College Functioning(Doctoral Dissertation), 1992
Parent-Toddler Attachment Relationships(Masters Thesis), 1990
Post-Divorce Visitation Patterns and Parent-Toddler Attachment, 1988
Effects of Divorce on Children, 1987
Mental Health Center Client Satisfaction Study, 1986
Professional Affiliations
1996-1997 Member: Professional Advisory Board, Mental Health Center of Boulder County
1991-1992 Co-chair: Multi-Ethnic Action Committee, Department of Psychology,
University of Colorado at Boulder
1991-1993 Member: American Psychological Association, Division 12,Clinical Child Psychology
1989-1991 Member: Multi-Ethnic Action Committee, Department of Psychology,
University of Colorado at Boulder
19884989 Student Representative: Department of Clinical Psychology, University of
Colorado at Boulder
1987-1985 Member: Developmental Psychology Research Group, Department of Psychology,
University of Colorado at Boulder
1987-present Member:American Psychological Association
Honors and Awards
1988 Department of Clinical Psychology Scholarship, University of Colorado at Boulder
1987 Phi Beta Kappa
1987 Academic Scholarship,Arizona State University,Tempe, Arizona
1986 Phi Kappa Phi Honor Society
1986 Golden Key National Honor Society
1979 West Valley College Track Team, West Valley,California; State Champions
1977 Fellowship Award, Roston Montessori School, Orange, California
•
Licensed Psychologist
Board:PaYchW r Exsrm us%Boerd Type:P;N Number 204
STATE OF COLORADO Mali Correspondence to: Home Business
Department of Regulatory Agencies (Circle one)
Division pi Professlons•and Occupations
Active PRINTED ON SECURE PAPER Home Phone: } Business.P ne:
PSY •. _ 1f
psr.rpp!M2 Oaratcoia O*312O1 Name:
Number issue Date Expire Date
Street Address: —
Sherri R.Malloy
Greeley CO 8034 _ City,State and Zlp Code:
I J £Use the Area above for 2ny ADCI.4E136 Chao eye A 1
Division Director slgnatur•c 4 THIS IC vnr 10 Mn,i c* ^^
._ - - . -__, on-Ira sraaz ib7.150
05/24/2008 02:08 9703517218 DRSHERRIMALLOY PAGE 04/09
Psychologists' Professional Liability
ACE American Insurance Company Claims Made insurance
(�'� Policy Declarations
PRODUCER NUMBE:I1 273865 l DATE OF ISSUE February 10,2014
PSYCHOLOGISTS' PROFESSIONAL LIABILITY
CLAIMS MADE INSURANCE POLICY
THIS POLICY/CERTIFICAIL IS ISSUED IN ASSOCIATION WITH THE PSYCHOLOGISTS PURCHASING
GROUP ASSOCIATION
—
Item POLICY/CERTIFICATE NUMBER: 58G22297843
i Named Insured: Sherri Malloy
1. Address: 237 N 53Rd Avenue Ct
City, State &Zip Code: Greeley, CO 80634 4259
2 Policy Period: From: 04/01/2014 To; O4/01/2015
12:01 A M.local time at the address shown In Item 1.
3 COVERAGE LIMITS OF LIABILITY PREMIUM
Professional Liability $1,000,000 Each incident ( $3,000,000 Aggregate
Wrongful Employment $5,000 Aggregate $1,253,00
Practices i
REIMBURSEMENTS
Licensing Board Defense $5,000 per Proceeding
Other Governmental Regulatory $5,000 per Proceeding
Body Defense
Deposition E;cpense $5,000 per Insured
Premises Medical Payment $2,500 per Person $75,000 Aggregate
Assault andlor Battery $1,000 Aggregate
Loss of Eamlnal, $500 per Day,per Insured E $15,000 Aggregate Per Incident
Surcharge(s)
Total Premium $1,253.00
4. Retroactive Dat4, 04/01/1998
5, This policy is m;iide and accepted subject to the printed conditions in this policy together with the provisions,stipulations end
agreements contained in the following forms)or endorsement(s).
PF15215a,FF33748,PF15217a (05/07),CC-1K11g(01/11), PF15245a,ALL22368 ,PF15742a,PF17914(02/05),
6 Notice of claim should be sent to: All other correspondence should be sent to:
Trust Risk Management Services, Inc. Trust Risk Management Services,Inc.
181 W MadiE on St Ste 2900 1791 Paysphere Circle
Chicago, IL 6061)2 Chicago, IL 60674
7. REPRESENTATIVE=: Agent or broker: Trust Risk Management Services,Inc.
doing business in CO as Potomac Risk Management Services,Inc.
Office address: 1791 Paysphere Circle
City,State,Zip Chicago, IL 60674
Website: i www.apalt.org
Phone: 1.877.637.9700
PF-15215a(04/C7) O 2007 The Trust
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