HomeMy WebLinkAboutbocc.con.081.2014 Rev. 08-30-1ljls
Ise COUNTY CLERK'S
CONTRACT COVERSHEET
CONTRACT #: 81-2014
ORIGINATING DEPARTMENT: Health and Human Services
PROCUREMENT OFFICER: Nan Sundeen PHONE #: 5209
PROJECT NAME: CCCAP HB 1291 Slots CONTRACTOR: Early Learning Center
DOLLAR AMOUNT: $13,068.00 LINE ITEM# 112429462382000
CONTRACT EXECUTION DATE: 1/27/2014 CONTRACT END DATE: 6/30/2014
AUTOMATIC RENEWAL: ❑ YES ® NO TERM: 5 months
Z BOCC AGENDA ITEM (Grants, IGA) ® STAFF AUTHORIZED SIGNATURE
(Requires BOCC Signature) (Per Revised Procurement Code 7/2005)
❑ OVER $50,000 (Requires Section Leader&County Manager's Signature)
✓ CHECK PROCUREMENT TYPE:
❑ None ® Informal ❑ Formal ❑ Sole Source ❑ Emergency ❑ Outside Agency/State Bid
❑ Compliance with C.R.S. 8-17-5-101, 102 as amended (Immigration Form) ❑ Exempt
❑ Contract Renewal
✓ CHECK CONTRACT TYPE:
Z Services/Maintenance ❑ Employment
❑ License/Use ❑ Intergovernmental Agreement(Resolution Required)
❑ Lease ❑ Non-Profit
❑ Construction ❑ Quasi-Public (e.g.-AVH)
❑ Goods, Equipment, Supplies ❑ Grant Agreements(Notify Finance& Resolution Required)
❑ Other(e.g. revenue) ❑ Change Order/Contract Amendment
(C/O: 10%or$25K whichever is the lesser must have County Manager signature)
All Contracts should be proofed and all exhibits and notices must be attached for the following:
✓ ® No Pages Missing ✓❑ All Other Blanks Filled In
✓ ❑ If Page Left Intentionally Blank—Note on Page ✓❑ All Exhibits Attached
✓ [' Page numbered consecutively ✓❑ All Legal Descriptions attached (f applicable)
✓ ® All Original Signatures Affixed ✓❑ Notice of Award/Notice to Proceed Attached (if applicable)
✓ ® All Dates Filled In ✓❑ Warranty(if applicable)
✓ ❑ Special Instructions for Finance Department:
✓ ❑ Authorized Procurement Officer's Name: Nan Sundeen
BY CHECKING ABOVE AND ENTERING NAME, THE AUTHORIZED STAFF PERSON INDICATES THAT
THE ATTACHED DOCUMENT HAS BEEN PROOFED AND READY FOR SCANNING.
NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE
ARCHIVES RETAINAGE SCHEDULE. ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST!
Contract# Rev. 8.29.11 jaafjs
Budget Line Item#
OUTSIDE AGENCY BID MEMORANDUM
TO: File
FROM: Nan Sundeen
RE: Early Learning Center—HB 1291
DATE: 2.14.14
STATE BID
At the procurement officer's discretion, a contract may be awarded for a property, service,
or construction item on the terms and to the contractor that has been selected under the State
of Colorado's or other governmental jurisdiction's competitive procurement process. The
other jurisdiction's process must maintain the spirit of the County's procurement standards
in order for the proposal to be accepted by the County (Pitkin County Procurement Code
section 3-106.)
Contract#81-2014
Description of Project: CCCAP HB 1291 Slots
Budget: $ 13068 Budget Line Item #112.42.94623.82000
Outside Agency Procurement process used (Describe briefly the governmental agency
whose bid you are using and the terms and conditions of the resulting contract. Include a
copy of the outside agency bid in your file.):
Contractor Contacted (who and how):
J am /� fic-(1t,q'
Procurement Officer Date County Manager Date
(Place in procurement file)
Note: Every effort should be made to obtain a written contract when otherwise required
under County procedures. When a contract is obtained, complete the Clerk's check list
and send the original signed contract with coversheet to clerk's office for archiving.
•
•
Licensed Provider Fiscal Agreement
tti d i
tge i Jnty Department of Social Services • PROVIDER u:78935 .
PO Box 660 - Date of Action:5/7/2012 • • • .
Eagle,C0 81631-0000 - - -• • •
EARLY LEARNING CENTER - .. .
215 N Garmisch •• .
• Aspen CO 81611-0000 . .
. IL.L,,,IhII II,,,Illiv II,,,Ilu ll ILI • • � •
•, 816110000-
. LiCense/Certthcate •No:78935 . Tax ID No: . . . .
. This Agreement is entered into and between PitkinCounty Department of Social Services,herein referred to as • ' - .
Department and EARLY LEARNING CENTER,herein referred to as provider who will provide child care at the - .
•
. • following address:215 N Garmisch,Aspen,CO,816110000. This agreement shall be in effect from 07/01/2012 . '
to 06/30/2015.
Provider Agrees to: ' . .
. 1. Provide child care at the facility address listed above and ensure that care is provided only by the .
person or business listed above..' - .
. 2. Conform to all applicable State and Federal Regulations and local law. • . •
. 3. Maintain a valid child care license as required by Colorado Statute. . .
• . 4. Report to the county.if their license has been revoked,suspended,or denied within three calendar •
•• days;of receiving notificalon,a recovery will be established of all payments made as of the effective .
date of closure.
5. Sign the child Care fiscal agreement and all other county or state required forms:. .
8. Develop an Individualized care plan for children with additional child care needs. •
7. Maintain proof of age appropriate immunizations for the children in their care,if required by county
. policy.Immunization records shall be obtained from parents either at the time of admission or within • -
' thirty(30)calendar days of the date of admission and shall be updated annually.For children •� .
• . whose parents object to immunizations on religious grounds or for children whose medical condition .
' contraindicates immunization, shall maintain a statement in the child's file signed by the •
parent stating the reason for not immunizing.
8.- For payment parents shall swipe their children into the child care providers and out at the end of
• each day.Missed swipes may be updated within ten days of the date of service. . .
-. 9. Never keep in their possession(whether at the facility or in any other place)a client's Child Care' .
Benefits Card used to swipe for attendance.Possession of any swipe card(s)will terminate this . ' ..
fiscal agreemenfand preclude that the provider may provide child care assistance services in the
• future with any county. .
10.It is the provider's responsibility to report if the Point of Service(POS)terminal stops working for • • • •-
any reason so that it can be repaired. . .
•
•
Correspondence ID:4410875-1 • Page 1 of 3
(...
11.If the provider stops caring for children under the Colorado Child Care Assistance Program a
recovery will be established for the cost Of replacement for the POS device which is$365.Once the .
• . POS is returned in good shape,barring normal wear and tear,to the county this recovery will be .
deleted.
. 12:Parent fees are due to the provider from the parent at the beginning of the month.Report non-
payment of parent fees no later than the last day of the month for which they have not been '
• received. - '
13.Notify the county of unexplained;frequent and/or consistent absences within ten(10)calendar days
of establishing a pattern. -
14.Shall not charge the counties-more than my established private pay rates and I will keep the county - - .
. informed of changes in my private pay rates within ten(10)days of the change. •
15.Attach a copy of your current charge policies on rates,transportation,activity,registration fees and.• payment policies if you are a licensed provider.Allowable rates and other associated charges shall •- .
be in accordance with State Rules for Colorado Child Care Assistance Program.I am subject • - .
to recovery limy reported private pay rates are lower than the agreed upon county reimbursement •
rates established in my fiscal agreement.16.Shall not charge parents rates in excess of those agreed upon In the fiscal agreement(this includes
. the agreed upon registration,activity and transportation fees if the county pays these fees).The • .
rate in the fiscal agreement is the maximum allowable rate of reimbursement for the care provided •- - .
• and includes any portion for which the parent is responsible. • .
17.I shall offer free,age-appropriate alternatives to voluntary activities. - • . - • - •
• 18.twig maintain a phone line to ensure that the POS terminal can submit attendance information to ; .
• the county for payment on a weekly basis.I may manually bill the county for services authorized,
based on county payroll policies,that are not reimbursable automatically based on the POS '
transactions.I forfeit payment for services if the original manual billing form is submitted more than • ,
. sixty(60)calendar days following the weekly service period.
. • 19.When the parent swipes their child Into the POS if the terminal indicates the status of pending or not .
authorized there is no guarantee of payment to the provider from the county.If the child care case
• is denied then responsibility for payment ties with the parent and the county shall not be held liable. •
. 20.Allow parents immediate access to the child in care.
. • 21.Accept referrals for child care without discrimination in regard to race,color,national origin,age, • '
sex,religion,or physical or mental handicap. • - .
• 22.Provide children with adequate food,shelter and rest.
23:Maintain as strictly confidential all information concerning children and their families..
. 24.Protect children from abuse/neglect and report any suspected child abuse and neglect to the .
Department. .
. 25.Hold the Colorado Department of.Human Services,the State of Colorado and the County - • . •Department of Social Services harmless for any loss or actions caused by the . ` -
.performance of this Agreement. . . . • •
• . 26.I understand that if I commit fraud or intentional program violations I will be subject •
• to disqualification from the Colorado Child Care Assistance Program(CCCAP)as a • .
provider for 12 months for the first offense;24 months for the second offense and
permanently for the third offense.. . .
•27;Charge the Department the agreed upon rates of reimbursement as set forth below.
28.If the county establishes a slot agreement with me I understand that any additional children will be
paid under the regular rates of this Fiscal Agreement.
Full Time Rates -
Rate Type. OM-6M• 6M-12M 12M-18M 18M-24M 24M-30M 30M-36M 3603-SAM SA
•
Regular 64,4 64.4 64.4 59.4 59.4 574 55.4 . 0.00
.Part Time Rates
•
. • - •. Rate Type OM6M 6M-12M 12M-1SM 18M-24M 24M-30M 30M-36M 36M-SAM SA '
Regular " 0.00 0.00 0.00 0.00 - 0.00 0.00 0.00 000
. Full Time Part Time Rates • •Rate Type OM-6M 6M-12M I12M-18M 18M-24M . 24M-30M 30M-36M 36M-SAM' SA • .
' • • Regular • 0.00 0.00 10.00 0.00 0.00- 0.00 0.00 0.00
Full Time Full Time Rates
. Rate Type 0M-6M 6M-12M. 12M-18M 18M-24M 24M-30M 30M-36M 36M-SAM SA
Regular 0.00 0.00 0.00 • 0.00 0.00 . 0.00 0.00 0.00- •
• Correspondence ID:4410875-1 • Page 2 of 3
•
' Provider Rights: -
. 1. When a provider contends that the county has not made adequate payment based on program rules for -
care provided,the provider has the right to an informal conference with county staff pursuant to 9 CCR
. • 2503-1 at Section 3.910,(D).: . - •
. • Providers may request a conference in writing within 15 days of the date of the action. • . • •
• . • • Provider request should be addressed to the county director of the county Department of .
SociavHuman Services responsible for the action.
• Provider may request that state program staff participate In the conference.That participation .
' may be by telephone conference. .
. • The purpose of the conference will be limited to discussion of the payments in dispute and the .
. relevant rules regarding payment. • . . •
_ 2. A provider may request an informal conference if s/he disputes the termination of a fiscal agreement. --
• Providers may request a conference in writing within 15 days of the dates of the date of the
action. - . .
• Provider request should be addressed to the county director of the county Department of - ' 'Social/Human Services responsible for the action. . .
• . •-The purpose of the conference will belimited.to discussion of termination of agreement pursuant . _
to 9 CCR 2503-1 at Section 3.905,(D).. _
Department Agrees to: • • - •
••
1. Reimburse the provider for authorized child care in accordance with Colorado Child Care Assistance •
Program rules.Payment to the licensed provider is the total cost of authorized care based on rates set
by this Agreement minus the parental fee. •
• . 2. Determine client's eligibility for child care services within 30 days of the application date. .-
3.. Send notices to the provider of changes In parental fees,authorized amount of care,added or deleted . . •
• children,and other changes to child care arrangements: • •- .
4. Send Child Care Certificates to the provider within 7 working days of county's initial approval or prior to .
making any changes in eligibility of each child. . -
. 5. Provide an informal conference within 2 weeks of the providers written request to discuss the basis for
any denial or termination of this agreement or to discuss any payment dispute.
• 6. Wll provide a written notice of the results of the informal conference within 15 days of the conference .
. date. .
• Either party may terminate this Agreement by giving the other party 30 days notice by registered mail.This .
Agreement may be terminated without advance notice if a child's health or safety Is endangered or if the
•
provider is under a negative licensing action.The provider may request an informal conference to discuss the ,
. basis of any termination or denial of this agreement by submitting that request in writing within 15 days of the •
- action. . . . .
• By signing this agreement,the provider acknowledges receipt of information regarding the rules and policies of
-the Colorado Child Dare Assistance Program.The effective date of this contract is the date that the county
. receives and signs the fiscal agreement.The provider shall receive a copy of the signed fiscal agreement.
.Violation of the terms of this agreement may be determined a violation of the Colorado Child Care Assitance •
Program -
. CHLDCAREPROVIDERi wa.%ana.414 "DEPARTMETDPSCIAL SERV(CESm:rr1g�r
ii1M.. = L1 £ ox n/vy (9-1 t- -
Authorized Representative a Date Authorized Representative - Ddte - '
Mailing Address • Address
a/5 /0 C ritsci .
City.State Zip - Phone Number Ci State Zip Phone N/umber .
Zl s�'j.',,r1 ��5'/!v// 97o Ado - �f (.!'� �j l(p(I .
9aor
a �� °czo s? /
•
Correspondence ID:4410875.1' • Page 3 of 3
• •
•
Provider#:
Child Care Assistance Program
Fiscal Agreement Slot Contract Addendum
This Agreement is entered into and between Pitkin County nHea�lth&Human Services herein referred to as"Department"and
Tlne- \ Leg rill .1 v-E'n'-e r ,herein referred to as"Provide?'who will provide
child care at the following address: a 1'i t&, m.1 Sc An 'S . ) �s$9,n , CO i6, trhis
agreement shall be in effect on Fetontary ,201'} and shall be terminated on June 30,2014.
Calculation of slots and rate:
Total number of slots approved for infant care?(age 0 to 12 mos)
Daily Rate(taken from Licensed Provider Fiscal Agreement)
Total number of slots approved for toddler care?(age 1 to 3 2
Daily Rate(taken from Licensed Provider Fiscal Agreement) 59_No
Payment Terms:
1. Payment to the provider will be made according to the following payment schedule:
Number of Guaranteed Monthly Payment for Total Monthly
Child Care slots Each Child Care slot Guaranteed Payment
(Average daily rate x 22 days) (Monthly rate x number of slots)
Z 3040$0 aC9IS
2. Total Monthly Guaranteed Payment identified in#1 above is the amount paid if there are no parent fees assessed. If parent
fees are assessed they will be subtracted from this amount resulting in a lower payment to the provider from the county.
3. Registration fees are included in calculation of the daily rate.
4. Slot must be available to eligible CCAP child immediately. If the slot is found to be unavailable for an eligible CCAP child,
then all payments for slots issued under this fiscal addendum must be repaid to the Department.
5. Provider must use the approved slot addendum manual billing form to receive payment.
Either party may terminate this Agreement by giving the other party 15 days notice by registered mail. This Agreement may be
terminated without advance notice if a child's health or safety is endangered or if the provider is under a negative licensing action.The
• provider may request an informal conference to discuss the basis of any termination or denial of this agreement by submitting that
request in writing with 15 days of the action.
C F I D CARE PROVIDER Pitkin County Dept.of Health&Human Services
.h4Aerc9 la-71 '7 Y2-1
Authorized Re esentative Date Authorized Represen tive Date
' i c 01 60/IN1( t S &Los ct •A ,L , • -47
Mailing Address 7QQ ailing Address
Cogkel I cool Ci , State Zi) Phone Number City, State Zip Phone Number �w
gip 920
Jan 2014 1 of 1
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• •
®gyp
Form �I�®9- .Request.for Taxpayer • • • Give form to the
(Rev.October 2007) "identification Nuumher.and Certification • requester. Do not
Department of the Treasury '' . send to the IRS. •
Internal Revenue Service .
•
Name(as shown on your income tax return) . • '
• N 'Ear- (4 .Le_o_niinc,. Cen-I-a-- . . .
•
. d Business name,if different from above
C .
a c0 - S. ..
Check appropriate box: D. Individual/Sole proprietor la Corporation ❑ Partnership
p Exempt
0."�p ❑a Limited liability company.Enter the tax classification(D=disregarded entity.Di-corporation,P=partnership)R ❑ .payee '
O G ❑ Other(see instructions) D . . ..
c 5 Address(number.street,and apt.or suite no.) . Requester's name and address(optional)
°' u P 15 0: C�,rmt sc.1� • . •
. w
.g CI state,and ZIP code • • - .
a Spen CCU 8t I1 •
•
y List account number(s)here(optional) - - ' - - • '
v
Taxpayer Identification Number (TIN) . .
• •
Enter your TIN in the appropriate box.The TIN provided must match the name given on Line 1 to avoid Social security number
backup withholding. For individuals,•this is your social security number(SSN). However,for a resident
alien,sole proprietor,or disregarded entity, see the Part I instructions on page 3.For other entities, it is
.your employer identification number(EIN). If you do riot have'a.number,see How to get a TIN on page 3. . •or
Note.If the account is in more than one name, see the chart on page 4 for guidelines'on whose Employer.identification number•number to enter. .. 69 i 11620185 •
M_ Certification . .
Under penalties of perjury, I certify that: . .
1 The number shown on this form is my correct taxpayer identification number(or I am waiting fora number.to be Issued to me), and
2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal
Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to,report all Interest or dividends,or(c)the IRS has .
notified me that I am no longer subject to backup withholding,and . _ .
.. 3.• I am a U.S.citizen or other U.S. person(defined below): - - . •
Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup •
withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.
For mortgage interest paid,acquisition or abandonment of secured property, cancellation of debt,contributions to an individual retirement
. arrangement(IRA),and generally,'payments other than interest and dividends,you are not required to sign the Certification,but you must • •
provide your correct TIN. See the nstructlons on page 4,
•
Sign Signature of . ' Io•Here • U.S.person V � • :a.-� Date I> 5/ 1�'a __ •
• e,Tenerai.instrI.ECflof6S Definition of a U.S. person. For ederal lax purposes, you are •
Section references are to the Internal Revenue Code unless considered a:U.S.person if you are:
• otherwise noted. _ •. ' o An individual who is a U.S.citizen or U.S. resident alien,
o A partnership,corporation, company,or'association created Or•
. Purpose of Form - . organized in the United States or under the laws of the United
A person who is.required to-file an information return with the States, .. - -
IRS must obtain your correct taxpayer identification number(TIN) -0 An estate(other than a foreign estate),or
• to report,for example, income paid to you, real estate • A domestic trust (as defined in Regulations section •
transactions, mortgage interest you paid, acquisition or • 301.7701-7). . •-
abandonment.of secured property, cancellation of debt, or Special rules for partnerships.Partnerships that conduct a
contributions you made to an IRA. -trade or business in the United States are generally required to •
•
Use Form W-9 only if you are a U.S. person(including a pay a withholding tax on any foreign partners' share of income
. resident alien),to provide your correct TIN to the person . from such business. Further, incertain cases where a Form W-9
' requesting it(the requester)and, when applicable,to: has not been received, a partnership is required to presume that
1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person,and pay the withholding tax.
.waiting fora number to be issued), . Therefore, if you are a U.S. person,that is a-partner in a .
2. Certify that you are not subject to backup withholding, or partnership conducting a trade or business in the United States,
provide Form-W-9 to the partnership to establish your U.S. •
3. Claim exemption from backup withholding if you are a U.S. • status and avoid withholding on your share of partnership .
exempt payee. If applicable,you are also-certifying that as a•
.. income.
U.S. person, your allocable share of any partnership income.from The person who gives Form W-9 to the partnership for
•
a U.S.trade or business is not subject to the-withholding tax on purposes of establishing its U.S. status and avoiding withholding •
. foreign partners'share of effectively connected income. on its allocable share of net income from the partnership
Note. If a requester gives you a form other than Form W-9 to . conducting a.trade or business in the United States is in the
request your TIN, you must use the requester's form if.it is following cases: . - .
• substantially similar to this Form W-9. - • The U.S. owner of a disregarded entity and not the entity,
Cat.No. 10231X Form W-9 (Rev. 10-2007) •
•
. •