HomeMy WebLinkAbout20142912.tiff MEMORANDUM
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DATE: September 18, 2014
41 r1 J
a -O ON T Y -� TO: Douglas Rademacher, Chair, Board of County Commis Toners
FROM: Judy A. Griego, Director, Human Serv. es e?
RE: Agreements for Professional Services etween the Weld
County Department of Human Services and Various
Providers for Placement on the Consent Agenda
Enclosed for Board approval are Agreements for Professional Services between the
Department and Various Providers. These Agreements were reviewed under the Board's
Pass-Around Memorandum dated July 15, 2014, and August 21, 2014, respectively, for
placement on the Board's Consent Agenda.
The major provisions for these Agreements are as follows:
No. Provider/Term Program Area Rate
1 Berry Lindstrom, Ph.D., LLC Training Max. $3,500.00
August 18, 2014 —August 17, 2015
2 Aurora Mental Health Center Mental Health $180.00 per Unit
August 18, 2014—October 18, 2014 Evaluation Max. $180.00
If you have any questions, give me a call at extension 6510.
2014-2912
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AGREEMENT FOR PROFESSIONAL SERVICES
THIS AGREEMENT is made by and between the County of Weld, State of Colorado,
whose address is 1 150 O Street, Greeley, Colorado, 80631 ("County"), by and through the
Board of County Commissioners of the County of Weld, on behalf of the Weld County
Department of Human Services, and Barry R. Lindstrom, Ph.D., LLC whose address is 3211 20`h
Street, Suite D, Greeley, Colorado 80634, ("Contractor").
WHEREAS, County desires to retain Contractor as an independent contractor to perform
services as more particularly set forth below; and
WHEREAS, Contractor has the time available to timely perform the services, and is
willing to perform the services according to the terms of this Agreement.
NOW THEREFORE, in consideration of the mutual promises and covenants contained
herein, the parties hereto agree as follows:
1. Enuaaement of Contractor. County hereby retains Contractor, and Contractor
hereby accepts engagement by County upon the terms and conditions set forth in this Agreement.
2. Term. The term of this Agreement shall be from 08/18/2014, through and until
08/17/2015.
3. Services to be Performed. Contractor agrees to perform the Services listed or
referred to in Exhibit A, attached hereto and incorporated herein.
4. Compensation.
a. County agrees to pay Contractor for services performed as set forth on
Exhibit A at the rate of$500.00/Episode (Phase I: Initial lnservice, 3 Hours),
$300.00/Group (Phase II: Supervisor/Manager Groups, 5 - 90 Minute Sessions)
$300.00/Group of Eight (8) Caseworkers (Phase III: Caseworker Groups, Up to 5 - 90
Minute Sessions). Charges shall be based on the time actually spent performing the
services, but shall exclude travel time.
b. Mileage may/may not (circle one) be charged to and from any required job
site at a rate of 0.00 cents per mile. Contractor shall not be paid any other expenses
unless set forth in this Agreement.
c. Payment to Contractor will be made only upon presentation of a proper
claim by Contractor, itemizing services performed and mileage expense incurred.
d. Payment for services and all related expenses under this Agreement shall
not exceed $3,500.00.
1
5. Additional Work. In the event the County shall require changes in the scope,
character, or complexity of the work to be performed, and said changes cause an increase or
decrease in the time required or the costs to the Contractor for performance, an equitable
adjustment in fees and completion time shall be negotiated between the parties and this
Agreement shall be modified accordingly by a supplemental Agreement. Any claims by the
Contractor for adjustment hereunder must be made in writing prior to performance of any work
covered in the anticipated supplemental Agreement. Any change in work made without such
prior supplemental Agreement shall be deemed covered in the compensation and time provisions
of this Agreement.
6. Independent Contractor. Contractor agrees that Contractor is an independent
contractor and that neither Contractor nor Contractor's agents or employees are, or shall be
deemed to be, agents or employees of the County for any purpose. Contractor shall have no
authorization, express or implied, to bind the County to any agreement, liability, or
understanding. The parties agree that Contractor will not become an employee of County, nor is
Contractor entitled to any employee benefits from County as a result of the execution of this
Agreement.
7. Warranty. Contractor warrants that services performed under this Agreement will
be performed in a manner consistent with the professional standards governing such services and
the provisions of this Agreement.
8. Reports County Property. All reports, test results and all other tangible materials
produced in connection with the performance of this Agreement, whether or not such materials
are in completed form, shall at all times be considered the property of the County. Contractor
shall not make use of such material for purposes other than in connection with this Agreement
without prior written approval of County.
9. Acceptance of Product not a Waiver. Upon completion of the work, Contractor
shall submit to County originals of all test results, reports, etc., generated during completion of
this work. Acceptance by County of reports and incidental material furnished under this
Agreement shall not in any way relieve Contractor of responsibility for the quality and accuracy
of the work. Acceptance by the County of, or payment for, any services performed under this
Agreement shall not be construed as a waiver of any of the County's rights under this Agreement
or under the law generally.
10. Insurance and Indemnification. Contractor shall defend and indemnify County, its
officers and agents, from and against loss or liability arising from Contractor's acts, errors or
omissions in seeking to perform its obligations under this Agreement. Contractor shall provide
necessary workers' compensation insurance at Contractor's own cost and expense.
2
I I. Termination. Either party may terminate this Agreement at any time by providing
the other party with a 10 day written notice thereof. Furthermore, this Agreement may be
terminated at any time without notice upon a material breach of the terms of the Agreement. In
the event of an early termination, Contractor shall be paid for work performed up to the time of
notice and County shall be entitled the use of all material generated pursuant to this Agreement.
12. Non-Assignment. Contractor may not assign or transfer this Agreement, any
interest therein or claim thereunder, without the prior written approval of County.
13. Access to Records. County shall have access to Contractor's financial records as
they relate to this Agreement for purposes of audit. Such records shall be complete and available
for audit 90 days after final payment hereunder and shall be retained and available for audit
purposes for at least five years after final payment hereunder.
14. Time of Essence. Time is of the essence in each and all of the provisions of this
Agreement.
15. Interruptions. Neither party to this Agreement shall be liable to the other for delays
in delivery or failure to deliver or otherwise to perform any obligation under this Agreement,
where such failure is due to any cause beyond its reasonable control, including but not limited to
Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions.
16. Notices. Any notice required to be given under this Agreement shall be in writing
and shall be mailed or delivered to the other party at that party's address as stated above.
17. Compliance. This Agreement and the provision of services hereunder shall be
subject to the laws of Colorado and be in accordance with the policies, procedures, and practices
of County.
18. Non-Exclusive Agreement. This Agreement is nonexclusive and County may
engage or use other contractors or persons to perform services of the same or similar nature.
19. Certification. Contractor certifies that Contractor is not an illegal immigrant, and
further, Contractor represents, warrants, and agrees that it has verified that Contractor does not
employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs
illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and
Contractor may be held liable for damages.
20. Entire Agreement/Modifications. This Agreement contains the entire agreement
between the parties with respect to the subject matter contained in this Agreement. This
instrument supersedes all prior negotiation, representation, and understanding or agreements with
respect to the subject matter contained in this Agreement. This Agreement may be changed or
supplemented only by a written instrument signed by both parties.
3
21. Funding Contingency. No portion of this Agreement shall be deemed to create an
obligation on the part of County to expend funds not otherwise appropriated or budgeted for.
22. No Conflict. No employee of Contractor nor any member of Contractor's family
shall serve on a County Board, committee or hold any such position which either by rule,
practice or action nominates, recommends, supervises Contractor's operations, or authorizes
funding to Contractor.
23. Severability. If any term or condition of this Agreement shall be held to be invalid,
illegal, or unenforceable, this Agreement shall be construed and enforced without such provision,
to the extent that this Agreement is then capable of execution within the original intent of the
parties.
24. Governmental Immunity. No portion of this Agreement shall be deemed to
constitute a waiver of any immunities the parties or their officers or employees may possess.
25. No Third Party Beneficiary. It is expressly understood and agreed that the
enforcement of the terms and conditions of this Agreement, and all rights of action relating to
such enforcement, shall be strictly reserved to the undersigned parties and nothing in this
Agreement shall give or allow any claim or right of action whatsoever by any other person not
included in this Agreement. It is the express intention of the undersigned parties that any entity
other than the undersigned parties receiving services or benefits under this Agreement shall be an
incidental beneficiary only.
4
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST: BOARD OF COUNTY COMMISSIONERS
datittad Sc X140;t4 ELD COUNT , ORADO
Weld County Clerk to the Board ie�� �L�suglas demacher, hair SEP 2 2 2014
Ito
B / � � � 1�i tss =,�ice:
D puty Clerk to the Board =®priy A4
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AP D AS ORM:
C ty Attorney
WELD COUNTY DEPARTMENT BARRY R. LINDSTROM, PH.D., LLC
OF HUMAN SERVICES
rityl 7744 [1')
By: By:
J A. Gr. go, Dire r Barry R. Lindstrom, Ph.D.
5
EXHIBIT "A"
CONTRACTOR:
Name: Barry R. Lindstrom, Ph.D., LLC
Address: 3211 201 Street, Suite D, Greeley, Colorado 80634
Tax I.D. or Social Security Number: 84-1328998
1. Services to be Provided by Contractor: Compassion Fatigue or Compassion Satisfaction: Coping with
the Traumatic Effects of Working with Traumatized Clients (Training).
To Name of Client: Weld County Department of Human Services Staff.
Location of Services to be provided to the Client: Weld County Training Center or other facility as
agreed upon.
2. County agrees to purchase and Contractor agrees to furnish 1 units of Initial Inservice at the cost of
$500.00 per unit of service for a maximum amount of$500.00.
County agrees to purchase and Contractor agrees to furnish 5 units of Supervisor/Manager Groups at the
cost of$300.00 per unit of service for a maximum amount of$1,500.00.
County agrees to purchase and Contractor agrees to furnish 5 units of Caseworker Groups at the cost of
$300.00 per unit of service for a maximum amount of$1,500.00.
3. The parties agree that payment pursuant to this Contract is subject to and contingent upon the continuing
availability of funds for the purpose thereof. The payment of such services shall be from:
Core Services as defined in Rule Manual Volume 7 Section 7.303.1 and, if
appropriate, the Colorado Department of Human Services approved County Core Services Plan.
X Child Welfare Administration
Other as defined as
4. County agrees:
a) To determine child eligibility and as appropriate, to provide information regarding rights to fair
hearings.
b) To provide Contractor with written prior authorization on a child or family basis for services to be
purchased.
c) To provide Contract with referral information including name and address of family, social, medical,
and educational information as appropriate to the referral.
d) To monitor the provision of contracted service.
e) To pay Contractor after receipt of billing statements for services rendered satisfactorily and in
accordance with this Contract.
5. Contractor agrees:
1
a) Not to assign any provision of this Contract to a subcontractor.
b) Not to charge clients any fees related to services provided under this Contract.
c) To hold the necessary license(s)which permits the performance of the service to be purchased,
and/or to meet applicable Colorado Department of Human Services qualification requirements.
d) To comply with the requirements of the Civil Rights Act of 1964 and Section 504, Rehabilitation
Act of 1973 concerning discrimination on the basis of race, color, sex, age, religion, political beliefs,
national origin, or handicap.
e) To provide the service described herein at cost not greater than that charged to other persons in the
same community.
f) To submit a billing statement in a timely manner, no later than forty-five (45) days after services.
Failure to do so may result in nonpayment.
g) To safeguard information and confidentiality of the child and the child's family in accordance with
rules of the Colorado Department of Human Services and the County Department of Human
Services.
h) To provide County with reports on the provision of services as follows:
Not applicable.
i) To provide access for any duly authorized representative of the County or the Colorado Department
of Human Services until the expiration of five (5) years after the final payment under this Contract,
involving transactions related to this Contract.
j) Indemnify the County and the Colorado Department of Human Services from the action based upon
or arising out of damage or injury, including death, to persons or property caused or sustained in
connection with the performance of this Contract or by conditions created thereby, as based upon
any violation of any statute, regulation, and the defense of any such claims or actions.
6. In addition to the foregoing,the County and Contractor also agree:
a) Core Services Program expenditures will not be reimbursed when the expenditures may be
reimbursed by some other source. (As set forth in Rule Volume 7, at 7.414, B (12 CCR 2509-5).
b)
c)
2
ALLIED HEALTHCARE PROFESSIONAL AND SUPPLEMENTAL LIABILITY
INSURANCE POLICY DECLARATIONS
RENEWAL DECLARATIONS
ATTACH THIS RENEWAL DECLARATIONS TO YOUR EXPIRING POLICY
Policy Number: PHCP072277 Philadelphia Indemnity Insurance Company
Administered by: CPH&Associates
711 S.Dearborn St,Ste.205
Chicago,IL 60605
Barry R.Lindstrom PhD,LLC
Barry Lindstrom
3211 20th St. Suite D
Greeley,CO 80634
Affiliation: ACA
Professional Occupation:Licensed Psychologist
Coverage Term From: 10/04/2013 To: 10/04/2014
at 12:01 a.m. Standard Time at the Insured's Mailing Address shown above.
COVERAGE A—PROFESSIONAL LIABILITY LIMITS OF LIABILITY PREMIUM
COVERAGE
Individual-Each Incident: $N/A $1050
Aggregate: $N/A
Association,Partnership or Corporation-Each Incident: $1 million
Aggregate: $3 million
COVERAGE B—SUPPLEMENTAL LIABILITY
COVERAGE
Each Incident: $1 million (Included)
Aggregate: $3 million
COMMERCIAL GENERAL LIABILITY COVERAGE
Each Incident: N/A
Aggregate: N/A
PROPERTY COVERAGE
N/A
Premium(including taxes): $1150.00
Policy Forms&Endorsements: PI-PHCP-02(07/10)
By:
7:11/3'
Jamie Maguire,Authorized Representative
State Endorsement(s)made a part of this policy at the time of issue:refer to www.cphins.com
Call the Administrator to Verify Claims History at 1-800-875-1911
Travelers Service Center
P.O. Box 1515
Spokane WA 99210-1515
THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT
09/07/2013
PATHWAYS MANAGEMENT
3211 20TH STREET SUITE D
GREELEY CO 80634
Thank you for continuing your business with Travelers.
FLOOD & PETERSON INS INC, in conjunction with Travelers, is pleased to forward your renewal coverage
contract for the following policy(ies):
Coveraae Policy Form Policy Number
MASTER PAC 680 390N4113
The Travelers Service Center is positioned to assist you. Please take a few minutes to review the coverages, and
cra
call us with any changes or questions that you may have at the following number:
o=
Phone: (888 ) 661 —3938
Travelers Service Center is open Monday—Friday, 8:00 a.m. -8:00 PM EST
If you experience a loss and/or need to report a claim, please contact the Travelers Claim Line directly at
1-800-238-6225. Claim representatives are available 24 hours a day, 7 days a week.
or—
- Travelers is providing the peace of mind and stability that over half a million American business owners rely on
every day. We are glad to be providing you with the thorough protection and superior service that your business
deserves.
— If you have other policies with Travelers, the policy paper may be mailed to you under separate cover.
Sincerely,
Travelers Service Center
008257
PINN/ACOL 7501 E Lowry Blvd
ASSURANCE Denver, CO 80230-7006
303-361-4000/800-873-7242
www.pinnacol.com
May 2, 2013
Policy#: 3217113
ITEM 1. INSURED •
Pathways Management, LLC
3211 20th St. Ste D
Greeley, CO 80634
PR/.00
ITEM 2. POLICY PERIOD: FROM: 05/01/2013 TO 05/01/2014
12:01 A.M. MOUNTAIN STANDARD TIME
ITEM 3. A. Workers'Compensation Insurance: Part One of the policy applies to the workers'compensation
law of the states listed here:
COLORADO
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item
3 A. The limits of our liability under part two are:
BODILY INJURY BY ACCIDENT $100,000 EACH ACCIDENT
BODILY INJURY BY DISEASE $100,000 EACH EMPLOYEE
BODILY INJURY BY DISEASE $500,000 POLICY LIMIT
C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here:
NONE
(Please contact Pinnacol Assurance for information on coverage outside the state of Colorado)
D. This policy includes the attached endorsements and schedules:
511 Other State Endorsement
CAT09 Catastrophe (Other than Certified Acts of Terrorism)
TER09 Terrorism Risk Insurance Program Reauthorization Act
ITEM 4. We will determine the premium for this policy by our manuals of rules, classifications, rates and rating
plans. All information required below is subject to verification and change by audit. The statements of
estimated advanced premium are also a part of this policy.
7501 E Lowry Blvd Denver,CO 80230-7006
Page 2 of 6 P 08408- 05/02/2013 19:05:49 3217113 38657041 P4ALL
Coverage Information for 3217113
Location: Pathways Management, LLC
3211 20th St Ste C&D
Greeley, CO 80631
Period: 05/01/2013-05/01/2014
Class RT Description Emp Payroll Rate Prem Charge
883205 EM PHYSICIANS&CL .00 $167,530 .464000 $777
Total for Pathways Management, LLC $167,530 $777
Description Period Adjustment Amount
Ratable Manual Premium 05/01/2013-05/01/2014 $777
Designated Provider Discount 05/01/2013-05/01/2014 .975 $19-
Retention Discount 05/01/2013-05/01/2014 .930 $53-
Annual Policy Fee 05/01/2013-05/01/2014 $195
Terrorism Insurance Coverage 05/01/2013-05/01/2014 $17
Catastrophe Insurance Coverage 05/01/2013-05/01/2014 $17
Net Estimated Annual Premium 05/01/2013 -05/01/2014 $934
Policyholder Disclosure Notice of Terrorism and Catastrophe Insurance Coverage
Coverage for acts of terrorism is included in your policy Under your existing coverage, any losses resulting from certified acts of
terrorism would be partially reimbursed by the United States government. The United States government would pay 85%of our
insured losses that exceed our insurer deductible.
Premium for terrorism is calculated on the basis of total payroll. The total Colorado payroll is divided by$100 and multiplied by the
approved terrorism rate,$0.01 per$100 of payroll. The calculation is expressed as(Colorado payroll/$100 X Approved Terrorism
Rate=Premium). This premium is not subject to any other modification including, but not limited to, premium discount, experience
rating, schedule rating, or retrospective rating.
Additionally, all workers'compensation carriers are required to charge premium to cover large losses. Premium for Catastrophe
(other than Certified Acts of Terrorism)is calculated on the basis of total payroll. The total Colorado payroll is divided by$100 and
multiplied by the approved Catastrophe(other than Certified Acts of Terrorism)rate, $0.01 per$100 of payroll.The calculation is
expressed as(Colorado payroll/$100 X Catastrophe(other than Certified Acts of Terrorism)Value=Premium). This premium is
not subject to any other modifications including, but not limited to, premium discount, experience rating,schedule rating,or
retrospective rating.
This Policy information Page reflects coverage,premium and payroll Information as of the date of issuance.
7501 E Lowry Blvd Denver,CO 80230-7006
Page 3 of 6 P U 8408- 05/02/201319:05:49 3217113 38657041 P4ALL
AGREEMENT FOR PROFESSIONAL SERVICES
THIS AGREEMENT is made by and between the County of Weld, State of Colorado,
whose address is 1 150 O Street, Greeley, Colorado, 80631 ("County"), by and through the
Board of County Commissioners of the County of Weld, on behalf of the Weld County
Department of Human Services, and Aurora Mental Health Center whose address is 11059 East
Bethany Drive,#200, Aurora, Colorado 80014, ("Contractor").
WHEREAS, County desires to retain Contractor as an independent contractor to perform
services as more particularly set forth below; and
WHEREAS, Contractor has the time available to timely perform the services, and is
willing to perform the services according to the terms of this Agreement.
NOW THEREFORE, in consideration of the mutual promises and covenants contained
herein, the parties hereto agree as follows:
1. Enaagement of Contractor. County hereby retains Contractor, and Contractor
hereby accepts engagement by County upon the terms and conditions set forth in this Agreement.
2. Term. The term of this Agreement shall be from 08/18/2014, through and until
10/18/2014.
3. Services to be Performed. Contractor agrees to perform the Services listed or
referred to in Exhibit A, attached hereto and incorporated herein.
4. Compensation.
a. County agrees to pay Contractor for services performed as set forth on
Exhibit A at the rate of$180.00/Episode (Mental Health Evaluation). Charges shall be
based on the time actually spent performing the services, but shall exclude travel time.
b. Mileage may/may not (circle one) be charged to and from any required job
site at a rate of 0.00 cents per mile. Contractor shall not be paid any other expenses
unless set forth in this Agreement.
c. Payment to Contractor will be made only upon presentation of a proper
claim by Contractor, itemizing services performed and mileage expense incurred.
d. Payment for services and all related expenses under this Agreement shall
not exceed $180.00.
1
5. Additional Work. In the event the County shall require changes in the scope,
character, or complexity of the work to be performed, and said changes cause an increase or
decrease in the time required or the costs to the Contractor for performance, an equitable
adjustment in fees and completion time shall be negotiated between the parties and this
Agreement shall be modified accordingly by a supplemental Agreement. Any claims by the
Contractor for adjustment hereunder must be made in writing prior to performance of any work
covered in the anticipated supplemental Agreement. Any change in work made without such
prior supplemental Agreement shall be deemed covered in the compensation and time provisions
of this Agreement.
6. Independent Contractor. Contractor agrees that Contractor is an independent
contractor and that neither Contractor nor Contractor's agents or employees are, or shall be
deemed to be, agents or employees of the County for any purpose. Contractor shall have no
authorization, express or implied, to bind the County to any agreement, liability, or
understanding. The parties agree that Contractor will not become an employee of County, nor is
Contractor entitled to any employee benefits from County as a result of the execution of this
Agreement.
7. Warranty. Contractor warrants that services performed under this Agreement will
be performed in a manner consistent with the professional standards governing such services and
the provisions of this Agreement.
8. Reports County Property. All reports,test results and all other tangible materials
produced in connection with the performance of this Agreement, whether or not such materials
are in completed form, shall at all times be considered the property of the County. Contractor
shall not make use of such material for purposes other than in connection with this Agreement
without prior written approval of County.
9. Acceptance of Product not a Waiver. Upon completion of the work, Contractor
shall submit to County originals of all test results, reports, etc., generated during completion of
this work. Acceptance by County of reports and incidental material furnished under this
Agreement shall not in any way relieve Contractor of responsibility for the quality and accuracy
of the work. Acceptance by the County of, or payment for, any services performed under this
Agreement shall not be construed as a waiver of any of the County's rights under this Agreement
or under the law generally.
10. Insurance and Indemnification. Contractor shall defend and indemnify County, its
officers and agents, from and against loss or liability arising from Contractor's acts, errors or
omissions in seeking to perform its obligations under this Agreement. Contractor shall provide
necessary workers' compensation insurance at Contractor's own cost and expense.
11. Termination. Either party may terminate this Agreement at any time by providing
the other party with a 10 day written notice thereof. Furthermore, this Agreement may be
2
terminated at any time without notice upon a material breach of the terms of the Agreement. In
the event of an early termination, Contractor shall be paid for work performed up to the time of
notice and County shall be entitled the use of all material generated pursuant to this Agreement.
12. Non-Assignment. Contractor may not assign or transfer this Agreement, any
interest therein or claim thereunder, without the prior written approval of County.
13. Access to Records. County shall have access to Contractor's financial records as
they relate to this Agreement for purposes of audit. Such records shall be complete and available
for audit 90 days after final payment hereunder and shall be retained and available for audit
purposes for at least five years after final payment hereunder.
14. Time of Essence. Time is of the essence in each and all of the provisions of this
Agreement.
15. Interruptions.Neither party to this Agreement shall be liable to the other for delays
in delivery or failure to deliver or otherwise to perform any obligation under this Agreement,
where such failure is due to any cause beyond its reasonable control, including but not limited to
Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions.
16. Notices. Any notice required to be given under this Agreement shall be in writing
and shall be mailed or delivered to the other party at that party's address as stated above.
17. Compliance. This Agreement and the provision of services hereunder shall be
subject to the laws of Colorado and be in accordance with the policies, procedures, and practices
of County.
18. Non-Exclusive Agreement. This Agreement is nonexclusive and County may
engage or use other contractors or persons to perform services of the same or similar nature.
19. Certification. Contractor certifies that Contractor is not an illegal immigrant, and
further, Contractor represents, warrants, and agrees that it has verified that Contractor does not
employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs
illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and
Contractor may da
mages.
held liable for dama es.
20. Entire Agreement/Modifications. This Agreement contains the entire agreement
between the parties with respect to the subject matter contained in this Agreement. This
instrument supersedes all prior negotiation, representation, and understanding or agreements with
respect to the subject matter contained in this Agreement. This Agreement may be changed or
supplemented only by a written instrument signed by both parties.
21. Funding Contingency. No portion of this Agreement shall be deemed to create an
obligation on the part of County to expend funds not otherwise appropriated or budgeted for.
3
22. No Conflict. No employee of Contractor nor any member of Contractor's family
shall serve on a County Board, committee or hold any such position which either by rule,
practice or action nominates, recommends, supervises Contractor's operations, or authorizes
funding to Contractor.
23. Severability. If any term or condition of this Agreement shall be held to be invalid,
illegal, or unenforceable, this Agreement shall be construed and enforced without such provision,
to the extent that this Agreement is then capable of execution within the original intent of the
parties.
No portion Agreement shall be deemed to
of this
24. Governmental Immunity.
constitute a waiver of any immunities the parties or their officers or employees may possess.
25. No Third Party Beneficiary. It is expressly understood and agreed that the
enforcement of the terms and conditions of this Agreement, and all rights of action relating to
such enforcement, shall be strictly reserved to the undersigned parties and nothing in this
Agreement shall give or allow any claim or right of action whatsoever by any other person not
included in this Agreement. It is the express intention of the undersigned parties that any entity
other than the undersigned parties receiving services or benefits under this Agreement shall be an
incidental beneficiary only.
4
08-05-2014 08:41Aµ FROM-AURORA MENTAL HEALTH CENTER T-551 P-002/003 F-523
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as o£the
day, month, and year first above written.
ATTEST BOARD OF COUNTY COMMISSIONERS
� jp;r� WELD COUNT LORADO
Weld County Clerk to the Board
las ' .demache , Chair- SEP 2 2 2014
By:
D puty Clerk to the Board tyt t c It
�����11111 'nit
Co y omey WELD COUNTY DEPARTMENT AUROR
A III CE T
OF HUMAN SERV]C •
By: /1i .�. .r 4 By:
J d A, Gri+go,Dire or
5
A0/14-aq/A
EXHIBIT "A"
CONTRACTOR:
Name: Aurora Mental Health Center
Address: 11059 East Bethany Drive, Suite 200, Aurora, Colorado 80014
Tax I.D. or Social Security Number: 84-0683346
1. Services to be Provided by Contractor: Mental Health Evaluation.
To Name of Client: M.G.S., Trails Client ID 381549, DOB: 11/06/1979.
Location of Services to be provided to the Client: 11059 East Bethany Drive, Suite 200, Aurora,
Colorado 80014.
2. County agrees to purchase and Contractor agrees to furnish 1 units of Mental Health Evaluation service
at the cost of$180.00 per unit of service for a maximum amount of$180.00.
3. The parties agree that payment pursuant to this Contract is subject to and contingent upon the continuing
availability of funds for the purpose thereof. The payment of such services shall be from:
X Core Services as defined in Rule Manual Volume 7 Section 7.303.1 and, if
appropriate, the Colorado Department of Human Services approved County Core Services Plan.
Child Welfare Administration
Other as defined as
4. County agrees:
a) To determine child eligibility and as appropriate, to provide information regarding rights to fair
hearings.
b) To provide Contractor with written prior authorization on a child or family basis for services to be
purchased.
c) To provide Contract with referral information including name and address of family, social, medical,
and educational information as appropriate to the referral.
d) To monitor the provision of contracted service.
e) To pay Contractor after receipt of billing statements for services rendered satisfactorily and in
accordance with this Contract.
5. Contractor agrees:
a) Not to assign any provision of this Contract to a subcontractor.
b) Not to charge clients any fees related to services provided under this Contract.
c) To hold the necessary license(s) which permits the performance of the service to be purchased,
and/or to meet applicable Colorado Department of Human Services qualification requirements.
d) To comply with the requirements of the Civil Rights Act of 1964 and Section 504, Rehabilitation
Act of 1973 concerning discrimination on the basis of race, color, sex, age, religion, political beliefs,
national origin, or handicap.
e) To provide the service described herein at cost not greater than that charged to other persons in the
same community.
1
f) To submit a billing statement in a timely manner, no later than forty-five (45) days after services.
Failure to do so may result in nonpayment.
g) To safeguard information and confidentiality of the child and the child's family in accordance with
rules of the Colorado Department of Human Services and the County Department of Human
Services.
h) To provide County with reports on the provision of services as follows:
Mental Health Evaluation report that details the client's current functioning, identified issues and
treatment history, as well as recommendations.
i) To provide access for any duly authorized representative of the County or the Colorado Department
of Human Services until the expiration of five (5) years after the final payment under this Contract,
involving transactions related to this Contract.
j) Indemnify the County and the Colorado Department of Human Services from the action based upon
or arising out of damage or injury, including death, to persons or property caused or sustained in
connection with the performance of this Contract or by conditions created thereby, as based upon
any violation of any statute, regulation, and the defense of any such claims or actions.
6. In addition to the foregoing, the County and Contractor also agree:
a) Core Services Program expenditures will not be reimbursed when the expenditures may be
reimbursed by some other source. (As set forth in Rule Volume 7, at 7.414, B (12 CCR 2509-5).
b)
c)
2
D9-D5-2014 08:41A41 FROM-AURORA MENTAL HEALTH CENTER T-561 P 003/003 F-513
ATE(MAW DIWYT I
�'��® CERTIFICATE OF LIABILITY INSURANCE D 09/04/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and condltions of the policy,certain policlos may require an endorsement. A statement on this certificate dons not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 1-303-534-4567 CONTACY
IMA, Inc, - Colorado DivIoion PRONE FAX
No.�)111� �iING,Not:
1705 17th street AD0REgy; denpamethaeory.coci
Suite 100
Denver, CO 80202 INSURER(S)AFFORDINO COVERAGE NAIL a
INeuRsR A, 1 NTAL ITLTN >dRd(Nagley Aseocietee, rnc.I44237
INSURED INSURER El: PHILADELPHIA DU CO _ 123eS0
Aurora mental Reelt_h Center PZNNACOL A5577R 41190
I NSURERC-
11059 E Berbany Dr, Ste 200 INSURER n. _
INSURER E:
Aurora, Co 80014
INSURER F-
COVERAGES CERTIFICATE NUMBER: 41349999 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
;NDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERT.FICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SL 3JECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INHR [ADOOtrianalr— POLICY EI:F Douai F.r
LTA i TYPE OF INSURANCE 1NER,I WW2 POLICY NUMBER ,JUM(DDNYW) NNM1c QIvy_ LIIQTS
A GENERAL LIABILITY I OCL0005188 11/01/13 11/01/14 EACHOCCURRENCE 11.000,000
X DAMAGfTO-RtMTt0 300.000
COMMERCIAL GENERAL LIABILITY PREMISES(Ea 0coinp1nre) , f
CLAIMS-MADE X OCCUR MEDEXP(Any any poreon) S 5.000
PERSONAL 4ADVINUURY $1,000,00°
t 3.000.000
GE mERAL AGGREGATE
I OWL. GGR AE` IQ'A'T� LIMIT LIM APPLIES PtR:
PRODUCTS•GOMPIOPAGG 1 3,000,000
MICY TI I IETT I LOC I _
B AUTOMOBILE LIABILITY PHPK1087891 11/OZ/1 11/01/14 I� BI MciDT SINGLE UkIT I1 2,000,000
an
X ANY AUTO 0000.4 INJURY(Per 0erean) I S —,
ALL OWNED SCH O EDULED BODILY INJURY(Per ec0onO i S
AUTOSAUTOS
X HIRED AUTOS X NON oIN ED PROPERTY'µ1AMAGE _t 1
AUTOS -�O `
I1
UMBRELLA LIAe I I OCCUR EACH OCCURRENCE 1
!EXCESS LIA9 r CLAIMS-MADE AGGREGATE S
•
1 up I RETENTION 1 ! S -
WORJcfrR6 COMPENSATION 4044459 10/O1/1' 10/01/14 X I WC STATrI• CTH-
C AND EMPLOYERS UABIJTY TOAY tIMRS FR
YJN
ANY pROFR1ETOrLPAR1NER1EkEClrrn/E L NIA EL.EACH ACCIDENT S 100,000
OFFICER.4MEMEER EXC.UDE07 N ,
SMondatory in NH) E.L.OIEEASE-EA EMPLOYEE 1 100,000
Y yes,Oscati0a under DESCRIPTION OF OPERATIONS oe IOW E.L.DISPOSE•POLICY LIMIT S 500,000
r I
DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (At1uh ADORD 101,Addidorut Ranurl.a SI-hodula,II moo epaoo to ra Ouhod)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
County of Weld THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROV)SION6.
1150 O Street AUYNOrIZEDREPRESENTATIVE /4i
aroaloy, CO 90534 (i
USA
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo aro registered marks of ACORD
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