The URL can be used to link to this page

Browse Search

Home My WebLink About20140934.tiff �861 MEMORANDUM xvirEDATE: March 20, 2014 G O LiN T TO: Douglas Rademacher, Chair, Board of County Gp issioners FROM: Judy A. Griego, Director, Human S�}'c 1 ep arttU RE: Child Protection Agreement for Services between the Weld County Department of Human Services and Carla Kruse Enclosed for Board approval is a Child Protection Agreement for Services between the Weld County Department of Human Services and Carla Kruse. This Agreement was reviewed under the Board's Pass-Around Memorandum dated March 14, 2014, and approved for placement on the Board's Agenda. This Agreement is for a specific client. As part of his aftercare, the Department feels it is in the best interest of this youth and is recommending that he continue therapy with Ms. Kruse. Ms. Kruse was one of his inpatient counselors but has since gone into private practice. This service is expected to be short term. The major terms of this agreement are as follows: Program Area (Service)/ No. Contractor/Term Funding Source Rates 1 Carla Kruse, LMFT, CACII Mental Health Services $75.00/Hour (Individual and Family Therapy) Individual and Family March 1, 2014—May 31, 2014 Counseling- Therapeutic Core Services Hour. Court Facilitation or Staffing. Family Team Meeting. Team Decision Making Meeting If you have questions, give me a call at extension 6510. ` C�✓�o T �� 2014-0934 a`, /1/2OD(f,s • PY-13-14-CORE-0136 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND CARLA M.KRUSE This Agreement,made and entered into the_day of 2014,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 Carla M.Kruse,hereinafter referred to as the"Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Scope of Services, and Exhibit B, Payment Schedule. Each of these documents is attached hereto and incorporated herein by this reference. WITNESSETH WHEREAS,required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the Department for Mental Health Services(Individual and Family Therapy);and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on March 1,2014,upon proper execution of this Agreement and shall expire May 31,2014,unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the Contractor to any person(s)eligible for services in compliance with Exhibit A,Scope of Services. 3. Referrals,Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e-mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Department's Resource Manager,Child Welfare Contract and Services Coordinator,or through a Team Decision Making(TDM)meeting or Family Team Meeting(FTM). No other Department staff or other party to the case may authorize services or modifications to services. 1 PY-13-14-CORE-0136 c. Contractor agrees to submit an itemized complete billing statement by the 7th of the month, following the month of service,utilizing billing forms required by the Department. d. Contractor agrees to submit a monthly report with the billing statement by the 7`h of the month following the month of service for each client receiving ongoing services. One-time services will be verified through receipt of the completed product(ex. psychological evaluation,substance abuse evaluation). Verification of Monitored Sobriety Services will be the test result. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. Monthly reports will be submitted through the Department's online reporting system,unless otherwise directed or agreed to by the Department. 4. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid(if Contractor is a Medicaid eligible provider)or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. b. Payment shall be made in accordance with Exhibit A,Scope of Services and Exhibit B,Payment Schedule,attached hereto and incorporated herein by reference,so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement,whether in whole or in part,is subject to,and contingent upon, the continuing availability of said funds for the purposes hereof. d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement,including the Financial Management requirements,program objectives,contractual terms,or reporting requirements. In the event of forfeiture of reimbursement,Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. • 5. Financial Management At all times from the effective date of the Agreement until completion of the Agreement,Contractor shall comply with the administrative requirements,cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMG Circular A-133. 2 PV-13-14-CORE-0136 6. Payment Method Unless otherwise provided in Exhibit A,Scope of Services and Exhibit B, Payment Schedule: a. If services are funded through Core Services,Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit,Contractor agrees to complete and submit an ACH Form for Colorado Providers,which will be provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of Colorado per the directions on the form. Failure to complete and submit this form in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement,Contractor will strictly adhere to all applicable Federal and State laws,order,and applicable standards,regulations,interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records,papers,documents,tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations,including,but not limited to the following: - Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et.seq.and its implementing regulation,45 C.F.R. Part 80 et.seq.;and - all provisions of the Civil Rights Act of 1986 so that no person shall,on the grounds of race, creed,color,sex,or national origin,be excluded from participation in,be denied the benefits of,or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and its implementing regulations,45 C.F.R.Part 84;and - the Age Discrimination Act of 1975,42 U.S.C.Section 6101 et.seq.and its implementation regulations,45 C.F.R.Part 91;and - Title VII of the Civil Rights Act of 1964;and - the Age Discrimination in Employment Act of 1967;and - the Equal Pay Act of 1963;and - the Education Amendments of 1972;and 3 PY-13-14-CORE-0136 - Immigration Reform and Control Act of 1986,P.L.99-603,42 C.F.R.Part 2;and - all regulations applicable to these laws prohibiting discrimination because of race,color, national origin,sex,religion,and handicap,including Acquired Immune Deficiency Syndrome (AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R.Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute(C.R.S.)26-6-104,requiring criminal background record checks for all employees,contractors and sub-contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services,Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is Core Services. d. Contractor assures and certifies that it and its principals: - Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not,within a three-year period preceding this Agreement,been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining,attempting to obtain,or performing a public(Federal,State or Local)transaction or contract under public transaction;violation of federal or state antitrust statutes or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property;and - are not presently indicted for or otherwise criminally or civilly charged by a government entity(federal,state or local)with commission of any of the offenses enumerated in this certification;and - have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,or local)terminated for cause or default. e. Contractor certifies that it shall comply with the provision of the Colorado Revised Statutes(C.R.S.)8- 17.5-101,et.seq. Contractor shall not knowingly employ or contract with an illegal alien to perform 4 PY-13-14-CORE-0136 work under this Agreement or enter into a contract with a subcontractor that fails to certify to the Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor represents,warrants,and agrees that it(a) has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). Contractor shall comply with all reasonable requires made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If Contractors fails to comply with any requirement of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and Contractor shall be liable for actual and consequential damages to the Department. Except where exempted by Federal law and except as provided in C.R.S.24-76.5-103(3),if Contractor receives federal or state funds under this Agreement,Contractor 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 this Agreement. If Contractor operates as a sole proprietor,it hereby affirms under penalty of perjury that s/he(a)is a citizen of the United States or is otherwise lawfully present in the United State Pursuant to federal law,(b)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 this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety,Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review(CFSR),and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d)of this Agreement. 9. Insurance Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor,it subcontractor,or their employees,volunteers,or agents while performing duties described in this Agreement. Contractor shall indemnify,defend and hold harmless Weld County,the Board of County Commissioners of Weld County,its employees,volunteers and agents. Contractor shall provided the liability(including professional liability insurances where necessary)and 5 PY-13-14-CORE-0136 worker's compensation insurances for all its employees,volunteers,and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect within seven (7)days of the date of this Agreement. At a minimum,Contractor shall procure,either personally or through its employer as applicable to the Contractor's business,at its own expense,and maintain for the duration of the work,the following insurance coverage. Weld County,State of Colorado, by and through the Board of County Commissioners of Weld County,its employees and agents,shall be named as additional named insured on the insurance, where permissible the insurance provider. - Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at the work site. - General Liability(PL and PD)(Minimum) o Combined single limit-$500,000.00 written on an occurrence basis. o Additional insurance required if claims reduce the annual aggregate below$500,000.00. o Weld County,State of Colorado,to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. - Automobile Liability(Minimum)for any Contractor transporting children or any party to whom Department services are being provided. - Additional coverage may be required in specific program areas. For any insurance that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification Contractor certifies that,at the time of entering into this Agreement,it has currently in effect all necessary licenses,approvals,insurance,etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training Contractor may be required to attend training that the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees,time spent traveling to and from training,attending the training or any other associated costs unless otherwise agreed to by the Department. 6 PY-13-14-CORE-0136 12. Subpoenas Contractor will,on behalf of its employees and/or officers,accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose,Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service,the Contractor will contact the Weld County Attorney's Office immediately at 970-352-1551,x6503,and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners,the Department and the Contractor. Contractor shall permit the Department,and any other duly authorized agent or governmental agency,to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. 7 • PY-13-14-CORE-0136 - Incorrect payment to the Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker,Administrator Carla M. Kruse,LMFT,CACII 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s)or address to whom such notices shall be sent. For Department: For Contractor: Judy A.Griego, Director Carla M.Kruse,LMFT,CACII P.O.BoxA 8182 Acoma Way Greeley,CO 80632 Denver,CO 80221 (970)352-1551 (720)318-6079 18. Litigation Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department,or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 8 PY-13-14-CORE-0136 20. No Third Party Beneficiary Enforcement 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. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver,express or implied,of any of the immunities,rights, benefits,protections or other provisions,of the Colorado Governmental Immunity Act of§§24-10-101 et.seq. as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection,paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer,member or employee of weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationship are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement,Contractor shall not enter into any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation,Contractor shall submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with the Contractor. 9 PY-13-14-CORE-0136 Contractor certifies that Federal appropriated funds have not been paid or will be paid,by or on behalf of Contractor,to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan,the entering into of any cooperative agreement,and the extension,continuation,renewal, amendment,or modification of an Federal contract, loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records Contractor agrees that authorized local,Federal,and State auditors and representatives shall,during business hours,have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents,communications,and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request,for a period of seven(7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven(7)year period, or if audit findings have not been resolved after a seven(7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of,all such information,in any form,including social networks. Contractor shall advise its employees,agents,and subcontractor,if any,that they are subject to these confidentiality requirements. Contractor shall provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs,internal operations and management procedures and those 10 • PY-13-14-CORE-0136 of its customers,clients or affiliates,but does not include information (1) lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contractor agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors,heirs, legal representatives,and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The 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. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A and B. 31. Acceptance of Services Not a Waiver Upon completion of the work,the Contractor shall submit to Department originals of all tests and results, reports,etc.,generated during completion of this work.Acceptance by Department of reports and incidental material(s)furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services.In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenantor default which may then exist on the part of the Contractor,and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default;and no assent,expressed or implied,to any breach of any one or more covenants,provisions or conditions of the Agreement shall be deemed or taken to be a g waiver of any other breach.Acceptance by the Department of,or payment for,any services performed 11 • PV-13-14-CORE-0136 under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. g 32. Employee Financial Interest/Conflict of Interest.C.R.S.§§24-18-201 et see.and§24-50-507 The signatories to this Agreement aver that to their knowledge,no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement.The Contractor has no interest and shall not acquire any interest direct or indirect,which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests.During the term of this Agreement,the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflict with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result,in the Department's sole discretion,in immediate termination of this Agreement. No employee of the Contractor nor any member of the 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 Contract Professional's operations,or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County,Colorado. 34. Choice of Law/Jurisdiction Colorado law,and rules and regulations established pursuant thereto,shall be applied in the interpretation,execution,and enforcement of this Agreement.Any provision included or incorporated herein by reference which conflicts with said laws,rules and/or regulations shall be null and void.In the event of a legal dispute between the parties,Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Attorneys Fees/Legal Costs In the event of a dispute between County and Contract Professional,concerning this Agreement,the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 12 PY-13-14-CORE-0136 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. AT TESST: BOARD OF COUNTY COMMISSIONERS ld W """ ��, ; L WELD CO TY,CO RADO Weld County Clerk to the Board ___'' William P . trcia; Acting Chair Pro-Tern By: 4 La MAR 2 4 2014 Deputy Cler o the Board p 1861 ` (-} 4O a 6th APP oV AS T,9 `'^� � ounty Attorney WELD COUNTY DEPARTMENT CARLA M.KRUSE OF HUMAN SERVICES /� � �/� /r� �� /�,Q� QQ /��N//q By: By: (Ida}ll./ W'�' - '(AF TON( I Ju A.Grieg Director Carla M.Kruse,LMFT,CACII 13 o?D/S/- ©9,5i1 PY-13-14-CORE-0136 EXHIBIT A SCOPE OF SERVICES 1. Contractor will provide Mental Health Services in the form of individual and family therapy as referred by the Department. 2. All services will be provided at the Contractor's office located at 10001 West 32nd Avenue,in Wheat Ridge,Colorado,80033. 3. Contractor can serve adolescents,ages 12-17,and adults,with depression,anxiety,relational problems,addiction,eating disorders,and personality disorders. 4. Contractor is not bilingual. 5. Contractor understands that the Department will not reimburse Contractor for"no shows"or cancelled appointments,either on the part of the client or the Contractor. 6. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations,Court Staffings,Family Team Meetings and/or Team Decision Making meetings. Upon receipt of an invitation from the Department,Contractor must contact the Child Welfare Contract and Services Coordinator to request approval to bill for participation if Contractor wishes to be reimbursed. The Department will reimburse for actual participation in the meeting only so long as the meeting is at least one(1) hour in length,the Contractor requests approval to bill in advance of the meeting and participation in the meeting is deemed appropriate and necessary by the Department. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator. 7. Contractor will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the Contractor will notify the caseworker and the Child Welfare Contract and Services Coordinator immediately. 14 • PY-13-14-CORE-0136 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specified in Paragraph 2,below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by the Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof,become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $75.00/Hour(Individual and Family Therapy-50 Minute Session. Court Staffing,Court Facilitation,Family Team Meeting,and Team Decision Making Meeting.) Contractor may not attempt to collect co-pays and/or fees for services for which a Department client is responsible,but which a particular client refuses or fails to pay. Contractor will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher,and signed monthly report if applicable,certifying that services authorized were provided on the date(s)indicated and the charges made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. For ongoing services,proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d)of this Agreement. 15 PY-13-14-CORE-0136 b. For one-time services,proof of services rendered shall be receipt of the completed product. c. For Monitored Sobriety services, proof of services rendered shall be the test result. 16 AL ® DATE(MMIDDIYYYY) �rr� CERTIFICATE OF LIABILITY INSURANCE 5/01/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS BELOW CERTIFICATE THIS CERTIFICATEF OF M INSURANCE DOES ATIVELY OR ANOTLCONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),Y AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 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 PRODUCE RNAME PHONE AXNO): The Van Wagner Group INC.NO.Exit I INC.I E4ulii A Division of SterlingRisk AODREss: PRODUCER P.O.Box 9017 CUSTOMER ID N: Woodbury,New York 11797 iNSURER(S)AFFORDING COVERAGE HAIG# INSURED INSURER A: ACE American Insurance Company Carla M.Kruse INSURER B: 8182 Acoma Way INSURER C: Denver,CO 80221 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. ALIDLSVER- POLICYEFF POLICYEXP LIMITS ILTRR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYYI IlMWDD1YYYYI GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) S 100*000 i CLAIMS•MADE {X OCCUR AHM7 19745 4/24/2013 4/24/2014 MEDEXP(Any one person) $ 2,000 PERSONALS ADV INJURY S 1,000,000 _ GENERAL AGGREGATE 5 3,000,000 PRODUCTS-COMP1OP AGO 5 1,000,000 GEN'L AGGREGATE LIMIT APPLIES�`�( PER: 5 7 POLICY PRO- IT JECT I 1 L� COMBINEOSINGLELII.UT 5 - AUTOMOBILE LIABILITY (Ea accldenq ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED AUTOS BODILY INJURY(Pet accident) S SCHEDULED AUTOS PROPERTY DAMAGE 5 (Per accident) HIRED AUTOS S NON•OWNED AUTOS 5 • UMBRELLAUAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE 5 , 5 DEDUCTIBLE 5 RETENTION S YJC SiATU I OT H- WORKERSCOMPENSATiON I TORY LIMfTS I FR AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT 5 ANY PROPRIETOR+PARTNERIEXECUTIVEE 1N NfA OFRCERr1.MEMBER EXCLUDED ' E.L.DISEASE•EAEAIPLOYEE S (Mandatory In NH) It yes.desafae under EL.DISEASE-POLICY OMIT S DESCRIPTION OF OPERATIONS beiaw A Professional Liab. AHM719745 4/24/2013 4/24/2014 Each Incident $ 1,000,000 Aggregate $ 3,000,000 _i DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Outpatient Therapist CERTIFICATE HOLDER CANCELLATION FOR RECORD PURPOSES ONLY 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 i ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Hello