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Home My WebLink About20143847.tiff RESOLUTION RE: APPROVE CHILD PROTECTION AGREEMENT FOR SERVICES AND AUTHORIZE CHAIR TO SIGN - PAID IN FULL, INC. WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with Child Protection Agreement for Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Paid in Full, Inc., commencing November 1, 2014, and ending May 31, 2015, with further terms and conditions being as stated in said agreement, and WHEREAS, after review,the Board deems it advisable to approve said agreement,a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Child Protection Agreement for Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County,on behalf of the Department of Human Services, and Paid in Full, Inc., be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreement. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 15th day of December, A.D., 2014, nunc pro tunc November 1, 2014. BOARD OF COUNTY COMMISSIONERS ELD COUNTY, COLORADO ATTEST: ,. �44A%��' c � �- -yA, Gr) 'U-rTh �� ou•la Rademacher, Chair Weld County Clerk to the Board L,® I1861 R � � ra Kirkmeyer, ro-Tem ' ►y Dep ty C erk to the Bo.rd r. P . ' n P. Conway APPROVED AS TO FORM: ,R.t ,f1�... - Mike Freeman County A� EXCUSED William F. Garcia galDate of signature: C. 1sb I p� 2014-3847 C HR0085 1861 MEMORANDUM - - j ,I I DATE: December 4, 2014 000NTY TO: Douglas Rademacher, Chair, Board of County C m sioners FROM: Judy A. Griego, Director, Human RE: Child Protection Agreement for Sery s bet een the Weld County Department of Human Services and Paid In Full, Inc. Enclosed for Board approval is a Child Protection Agreements for Services between the Department and Paid in Full, Inc. This Agreement was reviewed under the Board's Pass-Around Memorandum dated October 30, 2014, and approved for placement on the Board's Agenda. The major provisions of this agreement are as follows: No. Provider/Term Service/Funding Rates 1 Paid in Full, Inc. Role Model Mentoring $50.00/Person or Family(One- time (RMM) fee. Design Collage-Level 1) November 1, 2014- $50.00/Person or Family(One-time May 31, 2015 Core fee. Fan Club-Level 1) $50.00/Person or Family(One-time fee. Character Development Challenges-Level 1) $25.00/Person or Family(One-time fee. Life Coach Q&A-Level 1) $500.00/Person or Family(One-time fee. Case Management-Level 1) $300.00/Person or Family (One-time fee. Family Club 12 Pack-Level 2) $175.00/Person or Family(One-time fee. Family Club 2"d 12 Pack-Level 2) $500.00/Person or Family(One-time fee. Mini Camps-Level 2) $1,000.00/Person or Family(One-time fee. Case Management-Level 2) $40.00/Person or Family(Can occur multiple times with Department approval. Core Values Challenge- Level 3) $150.00/Person or Family(One-time fee. Best Day Event-Level 3) $10.00/Person or Family(One-time fee. Case Management-Level 3) $30.00/Person/Session (Additional Fee for Individual R.M.M.) No additional charge for siblings. If you have any questions, give me a call at extension 6510. 2014-3847 PY-14-15-CORE-0234 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND PAID IN FULL, INC. 1� Vat 1191),(2014 Agreement, made and entered into they day of Vat" , 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 «Contractor», 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, Contractor's Proposal, Exhibit B, Scope of Services, and Exhibit C, 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 Child Welfare Administration funding to the Department for Role Model Mentoring(R.M.M.). NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on November 1, 2014 upon proper execution of this Agreement and shall expire May 31, 2015 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, Contractor's Proposal and Exhibit C,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-14-15-CORE-0234 c. Contractor agrees to submit an itemized complete billing statement by the 7`h 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 7th 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, Contractor's Proposal, Exhibit B, Scope of Services,and Exhibit C, 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 PY-14-15-CORE-0234 6. Payment Method Unless otherwise provided in Exhibit A, Contractor's Proposal, Exhibit B,Scope of Services,and Exhibit C, 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. sett. and its implementing regulation,45 C.F.R. Part 80 et.set.; 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.sett 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 3 PY-14-15-CORE-0234 - the Education Amendments of 1972; and - 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. 4 PY-14-15-CORE-0234 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 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 Requirements Contractor and Department agree that 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. 5 PY-14-15-CORE-0234 Contractor shall provide the liability insurances (including professional liability insurances where necessary)and 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,and required by the Colorado Worker's Compensation Act. 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. a. General Requirements: Contractors/Contract Professionals must secure,at or before the time of execution of any agreement or commencement of any work,the following insurance covering all operations,goods or services provided pursuant to this request. Contractors/Contract Professionals shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, during any warranty period,and for three(3)years after termination of the Agreement.The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as"A"VIII or better. Each policy shall contain a valid provision or endorsement stating"Should any of the above-described policies by canceled or should any coverage be reduced before the expiration date thereof,the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty(30)days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10)days prior. If any policy is in excess of a deductible or self-insured retention,County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self-insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond,at no cost to County, in the amount of the deductible or self-insured retention to guarantee payment of claims.The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor/Contract Professional. Contractor/Contract Professional shall maintain, at its own expense,any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor/Contract Professional shall obtain,and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i. Workers'Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act,this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. H. Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations,fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury,and advertising liability with minimum limits as follows: - $1,000,000 each occurrence; - $2,000,000 general aggregate; - $50,000 any one fire; and - $500,000 errors and omissions. iii. Automobile Liability: Contractor/Contract Professional shall maintain limits of 6 PY-14-15-CORE-0234 $1,000,000 for bodily injury per person,$1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv. Additional Provisions: Policies for all general liability,excess/umbrella liability,liquor liability and pollution liability must provide the following: - If any aggregate limit is reduce by twenty-five percent(25%)or more by paid or reserved claims,Contractor shall notify County within ten (10)days and reinstate the aggregates required; - Unlimited defense costs in excess of policy limits; - Contractual liability covering the indemnification provisions of this Agreement; - A severability of interests provision; - Waiver of exclusion for lawsuits by one insured against another; - A provision that coverage is primary; and - A provision that coverage is non-contributory with other coverage or self- insurance provided by County. v. For all general liability,excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims-made policy,the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County,whichever is earlier. c. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator")at or before the time of execution of this Agreement,and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy,including public liability and property damage,in form and company acceptable to and approved by said Administrator,covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker,and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance.County reserves the right to require Contractor/Contract Professional to provide a certificate of insurance,a policy,or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability,excess/umbrella liability, pollution legal liability, liquor liability,and inland marine,Contractor/Contract Professional's insurer shall name County as an additional insured as follows f. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors,subcontractors, independent contractors,sub-vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor/Contract Professional, Contractor/Contract Professional shall include all such subcontractors,independent contractors, sub-vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors,sub-vendors suppliers or other entities upon request by the County. A provider of Professional Services(as defined in the Bid or RFP)shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of$1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 7 PY-14-15-CORE-0234 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. Trainin 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. 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 8 PY-14-15-CORE-0234 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. - 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 Jack McDonald, Executive Director 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.Grieeo, Director Jack McDonald, Executive Director P.O. Box A 7691 Hygiene Road,#3 Greeley.CO 80632 Longmont, CO 80503 (970)352-1551 (720)226-3558 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 9 PY-14-15-CORE-0234 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. 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 relationships 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 1O PY-14-15-CORE-0234 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. 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. 11 PY-14-15-CORE-0234 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 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, B, and C. 12 PY-14-15-CORE-0234 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 covenant or 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 waiver of any other breach.Acceptance by the Department of,or payment for,any services performed 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. 32. Employee Financial Interest/Conflict of Interest.C.R.S.§§24-18-201 et seq.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. 13 PY-14-15-CORE-0234 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. 14 PY-14-15-CORE-0234 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: dedetf G. BOARD OF COUNTY COMMISSIONERS y � Weld C t rk to the Board `` kt.• _ �\::\ WELD COUNTY,C ADO BY: ktrt...Ck— t861 r 1C. . Dougl6s Rademacher,Chair 5 2014 DEC�EC APPROVED AS TO FUNDING: ~' APPRO ED AS TO SUBSTAN : • 11.1 Controller Elec d Official r Departm t Head APPROVE AS TO FO /: N 1A Director of General Services Coun y Attorney PAID IN FULL, INC. eta, if Y ,C. JaclyfvlcDonald, Executive Director 15 dON-3,g417 CONTRACTOR'S PROPOSAL MP r i { i . _ _ . i,,. RMM (Prevention & Foster/Kinship) Proposal October 2014 j n'^ y f. eablh�V11 rn0 t ��aa y'.,P s t qe 4d �ry�thrp,�l,`$� "'..._. ��' 1 y wY4r �� ( �"y1 .. a . b 13B ►t � ry�i+' i ,� t - :11 �.,'rZ� D 'I.A A Level 1—Intro to RMM & Traditions (4-6 sessions) Goal in Level 1: • For the client&family to begin the alliance building process and understand what we do and why we do it Responsibilities at RMM Activities • RMM Staff creates and facilities the program • Case Manager participates and provides intervention when needed • Parent/Guardian participates and encourages client • Client follows directions, shows respect to people in charge,and participates enthusiastically Level 1 Activities: • Intro to RMM "Design collage" • Intro to RMM "FanClub" • Intro to RMM "Character Development Challenges" • Intro to RMM "Life Coach Q&A" Level 1 Totals Design Collage $50.00 FanClub $50.00 Character Development Challenges $50.00 Life Coach Q&A $25.00 Administrative/Service Charge $500.00 (one time fee for Level 1) Grand Total $675.00 Extra fee of$30 per session of individual RMM. All prices are per client or family(no extra charge for siblings). email us: mail us: .. RoleModelMentorind4'gmail.com 2101 Gay St Longmont,CO 80501 f w el s)2012-Role Model/Menton-1g Program'`Au Rights Reserved`I Pad Pi Full(a Colorado 501(c)(3)non-profit,Inc. Webroaster login • •- palate-spun Inc ,� 4 Mk,. /'�3 a'ya,�-" 1 .6PV g ... / 1, ., Level 2—RMM Family Club Membership (Annual activities) Goal in Level 2: • For the family to build camaraderie and sharpen leadership skills Responsibilities at RMM Activities • RMM Staff creates and facilities the program • Case Manager participates and provides intervention when needed • Parent/Guardian participates and encourages client • Client follows directions, shows respect to people in charge, and participates enthusiastically Level 2 Activities: • RMM Family Clubs • RMM Mini Camps • Become a part of the"FanClub" • Participation with activity challenges through our Facebook page • Invites to Calvary Longmont RMM Family events Level 2 Totals RMM Family Club(12 Pack) $300.00 (includes 12 Family Clubs) RMM Mini Camps $500.00 (includes invites to all mini camps) Administrative/Service Charge $1000.00 (one time fee for Level 2) Grand Total $1800.00 Extra fee of$30 per session of individual RMM. 2nd 12 Pack of Family Clubs can be purchased at a discounted rate of$175.All prices are per client or family(no extra charge for siblings). email us: mail us: y .eV RoleModelMentorlm'(sgmail.cum 2101 Gay St Longmont,CO 80501 1 1 r© -Role MudrlrMrntary Pray am"'All Right.Reserved'I Pad In full(a Colorado 501(d(3)non-O ofit,Di. Ylrbma,tei Login .. .� d.. .'A F +46.,E lt' a t �3 ) it ,. ,, F+alO1rPu11 Ina-44,7 icLevel 3—"Core Values" Challenge (4-6 sessions) Goal in Level 3: • For the client to demonstrate RMM "Core Values"through a RMM "Core Values"Challenge and discuss life application of challenge • For the client&family to deepen alliances with the RMM Community Responsibilities at RMM Activities • RMM Staff creates and facilities the program • Case Manager participates and provides intervention when needed • Parent/Guardian participates and encourages client • Client follows directions,shows respect to people in charge,and participates enthusiastically Level 3 Activities: • Complete RMM "Core Value" Challenge • RMM Best Day Events(number of events based on approval and availability of RMM Staff) Level 3 Totals RMM "Core Values" Challenge $40.00 Best Day Event $150.00 (number of events based on RMM Staff availability) Administrative/Service Charge $10.00 (one time fee for Level 3) Grand Total $200.00 Extra fee of$30 per session of individual RMM. The fee for Best Day Events may vary based on the selection chosen with prior approval. Multiple "Core Values"Challenges may be completed($40 per)based on prior approval. email us: mail us: S RoleMudelMentorinc@gmad.com 2101 Gay St Longmont, 'F CO 80501 1 ©2012-Role ModrUtdentoe,g Program'`M Frights Reserved`1 Paid In Full(a Colorado 501(c)(3)non-profit,Inc. vlebmaster L0911 L =.'.wltlrear.n ino .,I� •s� ipy � k1.._ 1-, ,p77--0,,,1�- 9Sf J^iY ?. ' k TMTMbb Cr. 1 alpRPM ("VC. 3 ICCOLITT MITY SSW Dear (superris�r of student) (studentsnarre) is working on his/her role model/mentor"level 3" requirements.As we stated in our meeting he/she must complete the following tasks to your satisfaction. Please fill out the form and date each time student completes a core value. On a scale of 15 (1 being low &5 being high) rate the candidates performance Give Best Effort Rate Date&Comments Performance Try: Did the candidate face their fear of failure? 1 2 3 4 5 Practice:Did the candidate perform(an activity)or exercise(a skill)repeatedly in 1 2 3 4 5 order to improve their proficiency? Reffuse to fail:Did the candidate ever quit a 1 2 3 4 5 challenge? No self-limitation:Did the candidate ever put himself in 1 2 3 4 5 a"dare to be great" situation? Build Camaraderie Rate Date& comments Performance Respect;Did the candidate show honor to the people in 1 2 3 8 5 charge? Participate em husta stfca Ily: Did the candidate "set the 1 2 3 4 5 tone"in front of peers? Show integrity:Did the candidate show qualities of 1 2 3 4 5 being honest and fair under pressure? Encourage others;Did the candidate look for opportunities to bring hope, 1 2 3 4 5 wisdom,and inspiration to friends andfamily? lib) • ��dN1 fMl k l �afi`. 'SY y #► .. A Fftp. pmIdfnFY11 Ino•'e( t i ` � •� -ILL i( � t :tTr�' tU ��L '"1 LEVEL 3 &tern NTILSIL 17 stier Demonstrate Rata Date& Comments P-rrforman:e Team Work Follow directions:Did the candidate listen and proceed 1 2 3 4 5 with the task? Take responsibility for mistakes:Did the candidate make excuses or blame other 1 2 3 4 5 people when things went wrong? Finish strong:Did the candidate bring tasks to 1 2 3 4 5 completion? Lead by example: Did the candidate lead by actions or 1 2 3 4 5 by words alone? Comments: Supervisor's signature: _ Date: (19) RName: Date:mlit�aidiniruii Inca "Fan Club" Survey Would you rather... Ungame question: "Dare to be great" accomplishment: RmM Name: Date: FasidinFul, Ilona Challenge Card 1/2 Minute to Win it Challenges of the week: Challenge 1: Result 1: Challenge 2: Result 2: Challenge 3: Result 3: Home Challenge: Result 4: PY-14-15-CORE-0234 EXHIBIT B SCOPE OF SERVICES 1. Contractor will provide Role Model Mentoring(R.M.M.)services to children and youth,between the ages of six(6)and fourteen{14),who have a)either lost or been abandoned by a parent,and;2)are currently clients of Compass,Youth Services,Child Welfare or Adoption. 2. Contractor and the Department will collaboratively deliver and refine Role Model Mentor services and evidence-informed practices and outcomes in the areas of: • A community-wide system to meet the needs of youth who have lost or been abandoned by a parent and are in need of positive relationships. • Specific mentoring plans will incorporate the Role Model Mentor steps to include individualized parenting support sessions,family alliance building,and"Best Day Ever!"events. • Contractor is responsible for all organization, implementation and staffing for Best Day Ever events as outlined in the approved performance plan. • Case management services include interviewing, assessing, making appropriate side-by-side home visits with existing case managers/workers,accepting the assignment of specific cases for the purposes of delivering the Role Model Mentor program, documenting progress of goals listed in individual family support plans and follow-up contact as indicated in Item 4b, iv. Case management also encompasses IT support,training of Life Coaches, planning/scheduling and travel time. 3. Each referred youth will begin services at Level 1 and progress to a higher level at the discretion of the Contractor and the Department. Services are individual to the referred youth but will include the activities and/or supplies identified below. a. Level 1—Intro to RMM&Traditions(4-6 sessions) • Intro to RMM "Design Collage"(Intro to RMM,collage,Welcome card from"FanClub") • Intro to RMM "FanClub"(Writing e-cards,RMM "FanClub"survey&responses) • Intro to RMM "Character Development Challenges" (Give Your Best Effort, Building Camaraderie,Working as a team challenges) • Intro to RMM"Life Coach Q&A"(Three questions with Life Coach) • Administration(scheduling,communication,web support,travel) b. Level 2—RMM Family Club(12 sessions) • RMM Family Club 1-4 sessions(RMM 12 Core values review,Give Your Best Effort Challenges,Mentors Challenge of the week) • RMM Family Club 5-8 sessions(RMM 12 Core values review,Character Development, Build Camaraderie Challenges, Family Challenge of the week) • RMM Family Club 9-12 sessions(RMM 12 Core values review,Team Challenges, Mentors Challenge of the week) • RMM Mini Camp(Food and activity supplies) • Administration(scheduling,communication,web support,travel) c. Level 3—"Core Values"Challenge(4-6 sessions) • RMM "Core Value"Challenge (Leadership Challenge, Mentor Accountability Team, Facing Battle discussion) • RMM Best Day Event(Activity supplies and costs) • Administration(scheduling,communication,web support,travel) 4. At a minimum,the Role Model Mentor program, through its collaboration between Contractor and the Department,will document if: a. The project successfully focused resources within Human Services and CONTRACTOR to continue the Role Model Mentor program. 1 PY-14-15-CORE-0234 b. The project successfully developed a better system design to meet the needs of youth and families in regards and,at a minimum,to: • Better utilize strengths within the family to promote protective factors. • Increase attendance rates of youth in school. • 85%of youth who successfully discharge from the program will continue to reside at home and have not entered the juvenile justice system at the time of discharge. • For parents and youth who are unresponsive to follow-up contacts,CONTRACTOR will request from Human Services a request for tracking through the TRAILS system;as well as school district attendance liaisons,and the Colorado Courts. 5. Referral Process: a. Contractor will contact Department of Human Services(DHS)Case Managers/Workers within 72 hours of receiving a referral for services. Contractor will meet with Case Manager/Case Worker in order to develop a brief history of the case and clarify who the participants are in the case. Contractor will describe to the Case Manager/Case Worker what services Contractor believes would be the best fit for the client and what family members should be included in the programming. b. Contractor will access all referrals through an intake interview with the family and the Case Manager/Case Worker in order to ensure that the case manager and family will commit to the necessary time resources in order to support a successful intervention. c. Contractor will meet with Prevention Program Supervisor to review cases prior to final acceptance into the program. 6. Role of Human Services: a. Human Services will assign its Supervisor(s)to assist in the development and implementation of program and assignment of clients for Contractor. This will include screening referrals, client staffing and supervision,family support plan and performance plan approvals. b. Human services will be responsible for the identification and referral of youth and families to the Role Model Mentor program. c. Human services will manage bimonthly meetings to be held between the Contractor and Human Services. d. Human services case managers/workers will participate in Best Day Ever development plans and events with their client. 7. Role of Contractor: a. Contractor agrees to participate in the functions of the project as follows: • As a policy and program developer and planning partner for the project by attending meetings and utilizing other forms of communication at least bimonthly with the assigned Human Services Manager(s). • As the case manager to provide intervention,connection skills for program services and post-participation services, as appropriate and recommended by Human Services. Contractor assigned employees will assist clients through individualized parenting workshops,family alliance building and"Best Day"Events. b. Contractor agrees to commit a full-time employee who is familiar with the Prevention Services Unit goals and the overall operational procedures of Weld County Department of Human Services policies and procedures. c. Contractor agrees not to transport any of the youth or their families. d. Contractor agrees to screen,train and complete criminal background checks on all of their volunteer mentors who associate with youth in the Role Model Mentor program who meet with youth outside the presence of the family, case worker or Role Model Mentor program employee. 2 PY-14-15-CORE-0234 e. Contractor agrees to serve up to 75 youth under this agreement. The number of eligible youth and families will be prorated based on the time period that Contractor provided the Role Model Mentor(R.M.M.) programming. 8, 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 Prevention Services Unit Supervisor. 9. Contractor will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 10. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited to, any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately. 11. Contractor agrees any change to an existing referral must be pre-approved through the Child Welfare Contract and Services Coordinator,a Department-facilitated Team Decision Making(TDM) or Family Team Meeting(FTM),or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form.This may include an increase or decrease in services hours, change in frequency,change in location of services,transportation needs,or any change to the initial referral or subsequent authorizations. 12. 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. 13. 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. 3 PV-14-15-CORE-0234 EXHIBIT C 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, 2015. 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 $50.00/Person or Family(One-time fee. Level 1-Design Collage.) $50.00/Person or Family(One-time fee. Level 1 - Fan Club.) $50.00/Person or Family(One-time fee. Level 1-Character Development Challenges.) $25.00/Person or Family(One-time fee. Level 1-Life Coach Q&A.) $500.00/Person or Family(One-time fee. Level 1 Case Management.) $300.00/Person or Family(One-time fee. Level 2-R.M.M. Family Club 12-Pack.) $175.00/Person or Family(One-time fee. Level 2-Second R.M.M. Family Club 12-Pack.) $500.00/Person or Family(One-time fee. Level 2-R.M.M. Mini Camps.) $1,000.00/Person or Family(One-time fee. Level 2 Case Management.) $40.00/Person or Family(Level 3 -R.M.M. "Core Values" Challenge. May complete multiple times with Department approval.) $150.00/Person or Family (One-time fee. Level 3- Best Day Event.) $10.00/Person or Family (One-time fee. Level 3-Case Management.) $30.00/Session (Additional fee. Individual R.M.M. sessions.) No Charge(Siblings) 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 1 PY-14-15-CORE-0234 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 7`h 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. 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. 2 ---., PAIDI-1 OP ID: CSS AiCOR0 CERTIFICATE OF LIABILITY INSURANCE DA 11/03/2014 ) 1 1/0 312 01 4 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). PRODUCER Phone: 303-799-0110 NAME r Casey Sanders Cherry Creek Ins.Agency,Inc. Fax: 303-799-0156 PHONE 720-212-2041 I_FAX No): 303.799-0156 Suite 500 1aC,No,Ertl: I ' 5660 Greenwood Plaza Blvd. E-MAIL .Case•-,aseyS@thinkccig.com Greenwood Village,CO 80111 ADDRESS. y V 4 __- -- Casey Sanders,ClC _ INSURER(S)AFFORDING COVERAGE NAICIt INSURER A:The Hartford I nsu r a n c e Group 22357 • INSURED Paid in Full Inc INSURER e:Landmark American Ins Co Jack McDonald INSURER O: 7691 Hygiene Rd#3 Longmont, CO 80503 INSURER D: INSURER E: INSURER F: I 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 (ADM UBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR MD POLICY NUMBER IMMIDD/YWYI (MMIDD/YWY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A X,' COMMERCIAL GENERAL LIABILITY X 34SBMIW8315 06/17/2014 06/17/2015 ' PREMISES(Ea occurrence/ $ 300,000 7 . I CLAIMS-MADE I_I OCCUR MED EXP(Any one person) $ 10,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X 1 POLICY 7 .78± LOC $ COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea acutlent) $_ A L_ ANY AUTO 345BMIW8315 06/17/2014 06/17/2015 BODILY INJURY(Per person) $ ALL OWNED I SCHEDULED BODILY INJURY(Per accident) $ AUTOS I AUTOS PROPERTY DAMAGE X HIRED AUTOS X NON-OWNED ( li $ AUTOS PROPERTY _ $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ W C STATU- 0TH- ND WORKERS COMPENSATION TORY LIMIT$ ER ANO EMPLOYERS'LIABILITY YIN If— ANY PROPRIETOR/PARTNER/EXECUTiVE N I A E.L.EACH ACCIDENT $ OMEMBER EXCLUDED? (Mandataandalory in NH) I E.L.DISEASE-EA EMPLOVEEI $ II yes.descdhe under I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below B Professional LHM825164 11/01/2014 11/01/2015 II Occurence 1,000,000 Liability RETENTION 510,000 (Aggregate 3,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,II more space is required) As required by written contract or written agreement, the Certificate Holder is included as Additional Insured for ongoing operations under General Liability as their interests may appear. CERTIFICATE HOLDER CANCELLATION WELDC-3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Weld County Department Of ACCORDANCE WITH THE POLICY PROVISIONS. Public Health &Environment 1555 North 17Th Avenue AUTHORIZED REPRESENTATIVE Greeley, CO 80631 ✓2 — 0 2 J ©1988-2010 ACORD CORPORATION. All rights reserved. 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