HomeMy WebLinkAboutbocc.con.082.2014 Rev. 08-30-1/fls
11011( COUNTY CLERK'S
CONTRACT COVERSHEET
CONTRACT #: 82-2014
ORIGINATING DEPARTMENT: Health and Human Services
PROCUREMENT OFFICER: Nan Sundeen PHONE #: 5209
PROJECT NAME: CCCAP HB 1291 Slots CONTRACTOR: Aspen Tots
DOLLAR AMOUNT: $14,168.00 LINE ITEM# 112429462382000
CONTRACT EXECUTION DATE: 1/27/2014 CONTRACT END DATE: 6/30/2014
AUTOMATIC RENEWAL: ❑ YES ® NO TERM: 5 months
® 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:
❑ 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)
✓ Z 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. 8.29.1 I jaa/js
Budget Line Item #
OUTSIDE AGENCY BID MEMORANDUM
TO: File
FROM: Nan Sundeen
RE: Aspen Tots— FIB 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 I-lB 1291 Slots
Budget: $ 14,168 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):
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N( C-D • ._
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.
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Licensed Provider Fiscal Agreement
Pitkin County Department of Social Services PROVIDER#: 1532165
PO Box 660 Date of Acton: 10/28/2013
Eagle, CO 81631
ASPEN MOUNTAIN TOTS
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215 N. Garmisch•Street, Room #1 •
Aspen, CO 81611
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License/Certificate No: 1532165 •. •
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. . This Agreement is entered into and between Pitkin County, herein referred to as "Department"and Aspen
Mountain Tots, herein referred to as"provider"who will provide child care at the following address: 215
North•Garmisch Street, Room #1, Aspen, CO 81611. This Agreement shall be in effect from 11/1/2013
to-6/30/2015.
Provider Agrees to:
1. Maintain a valid child care license as required by Colorado Statute and conform to all applicable
State,Federal Regulations and local law.
. •2. . Report to the county if the provider's license has been revoked, suspended, or denied within
three(3)calendar days of receiving notification, a recovery will be established of all payments •
• made as of the effective date of closure.
3. Allow parents immediate access to the child(reh) in care. •
• 4. Accept referrals for child care without discrimination with regard to race, color, national origin, •
• age, sex, religion, or physical or mental handicap.
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5. Provide children with adequate food, shelter and rest.
6. Maintain as strictly confidential all information concerning children and their families. •
. •7.• Protect children from abuse/neglect and report any suspected child abuse and neglect to the
Department. .
8. Hold the Colorado Department of Human Services and the State of Colorado harmless for any
loss or actions caused by the performance of this Agreement.
• 9. . Provider shall offer free, age-appropriate alternatives to voluntary activities.
'10. Provide child care at the facility address listed above and ensure that care is provided only by the •
'person or business listed above. Provide care for children under this agreement only if authorized
by the Department in advance.
11. Sign the child care Fiscal Agreement and all other county or state required forms. Develop an
individualized care plan for children with additional child care'needs.
• 12. Notify the Department of unexplained,frequent and/or consistent absences within ten (10)
calendar days of an established pattern.
• 13. Providers are required to collect the full parental fee each month. Parental fees are due to the
provider from the parent or adult caretaker at the beginning of the month. Report non-payment of
. parental fees no later than the last day of the month for which they have not been received. .
14. Maintain proof of age-appropriate immunizations for the children in the provider's care, if required
• by county policy. Immunization records shall be obtained from parents or adult caretakers either
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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 or adult caretakers object to immunizations on
• religious grounds or for children whose medical condition contraindicates immunization, providers
• shall maintain a statement in the child's file signed by the parent or adult caretaker stating the
reason for not immunizing. .
15. Shall not charge the counties more than the established private pay rates and keep the
Department informed of changes in the private pay rates.within ten (10)days of the change.
Attach a copy of the current charge policies on rates, transportation, activity, registration fees and
payment policies. Allowable rates and other associated charges shall be in accordance with State
Rules for Colorado Child Care Assistance Program. The provider is subject to recovery if the
reported private pay rates are lower than the agreed upon county reimbursement rates
established in this Fiscal Agreement.
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16. Shall not charge parents or adult caretakers 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 or adult
caretaker is responsible.
17. The provider understands that they must attend a county face-to-face training before the provider
will receive a Point-Of-Service (POS) device. The provider is required to use the POS device to
record attendance and bill for care provided..
18. Maintain a land-based phone service to ensure that the POS terminal is able to submit
attendance information to the Department for payment on a weekly basis.
• 19. Provider is responsible to ensure the parent or adult caretaker swipes his/her card to check the
child(ren)into and out of care daily for attendance tracking and payment;Missed check-in and
check-out swipes maybe updated within nine(9)days of the date of service.The Department
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does not guarantee payment to the.Provider if the authorization status on the POS device is
"pending,""denied," or"not authorized." If the child care is not authorized, the parent or adult
caretaker shall be responsible for paymentand the Department shall not be held liable.
20. Provider is responsible to contact Affiliated Computer Service, Inc (ACS)at 1-877-779-1932 if the
• Point of Service(POS)terminal stops working for any reason for troubleshooting or repair.
21. If the provider stops caring for children under the Colorado Child Care Assistance Program they
shall contact ACS to request a self-address postage paid return label to assist in returning the
POS device. If the POS device is not returned within thirty(30)days and in good shape (allowing .
for normal wear and tear)to ACS a recovery will be established for the cost of replacement for
the POS device which is $365.
22. The provider is required to maintain sign in/out sheets for children in their care. These records
shall be maintained for three years plus the current year and are to be made available to the
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Department upon request. .
23. The provider may manually bill the Department for services authorized, based on county payroll
policies, that were not reimbursed automatically based on the POS transactions. The provider
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• shall provide sign in/out sheets to support requests for manual payment. The provider forfeits
payment for services if the original manual billing form is submitted more than•sixty(60) calendar
days following the end of the month the service'period ended.
.24:Never keep in their possession(whether at the facility or in any other place)a client's CCAP
Card. Possession of any CCAP Card(s)will terminate this Fiscal Agreement and prevent the
• provider from providing child care assistance'services in the future with any county in Colorado.
25. The provider understands that if the provider commits fraud or an intentional program violation
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the provider 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. .
26. The.Department and/or child care licensing shall have the authority to inspect the provider's
facility for the presence of CCAP Cards or any other suspicious billing information. Upon
discovery of these materials the provider understands either of these entities have the right to
seize these materials including the CCAP Cards and/or POS Device.
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27. I understand that any overpayment will be recovered including, but not limited to, inaccurate or •
fraudulent billing. If at the time any overpayment is established while your fiscal agreement is
active, the amount of the overpayment will be deducted beginning with the next child care
payment and every payment thereafter until the overpayment is paid in full. If your fiscal
agreement is inactive, the county shall collect the overpayment in accordance with standard
collection'procedures which may include State Income Tax intercept. Fraudulent billing will be
. prosecuted. •
28. The provider will be paid the rates agreed upon in the attached Fiscal Agreement Rate
Information Form unless there is a slot agreement with the provider. There will be a separate
fiscal agreement for the slot agreements'and any children above the agreed upon slot amount will
be paid at the same rate listed below.
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Full Time Rates
Rate Type OM-6M 6M-12M 12M-18M 18M-24M 24M-30M 30M-36M 36M-SA SA
Regular $64.40 $64.40. $64.40 $59.40 $59.40 $57.40 $0 $0
Part Time Rates
Rate Type OM-6M 6M-12M 12M-18M. 18M-24M 24M-30M 30M-36M 36M-SA SA
Regular $35.42 $35.42 $35.42 $32.67 $32.67 $31.57 $0 $0
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.
• This request should be addressed to the county director of the county Department of
Social/Human services responsible for the action.
• Provider may request that State CCCAP staff participate in the,conference. That participation
may be by telephone conference.
• The conference shall be held within two weeks of the date the request for a conference is
received by the county. .
• The purpose of the conference is limited to discussion about the payments in dispute and the
relevant rules regarding payment.
• The final decision of the county shall be mailed to the provider within 15 days of the
conference date..
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 date of the action.
• This request should be addressed to the county director of the county Department of
Social/Human services responsible for the action: .
• The conference shall be held within two weeks of the date the request for a conference is
received by the county. .
• The purpose of the conference is limited to discussion about the termination of the fiscal
agreement pursuant to 9 CCR 2503-1 at Section 3.906, (D).
• The final decision of the county shall be mailed to the provider within 15 days of the
conference date. .
Department Agrees to:
1. Provide face-to-face training to the provider on how to use the Point of Service(POS)device prior to
entering into a Fiscal Agreement with the provider.
2. Enter the Fiscal Agreement into the Childcare Automated Tracking System (CHATS)within five (5)
business days of receipt of the completed Fiscal Agreement and all supporting documentation.
3. Determine client's eligibility for child care services within fifteen (15)days of receiving the complete
application packet including verification.
4. Send Child Care Authorization Notices to the provider within seven (7)working days of the
Department's initial approval or prior to making any changes in eligibility for each child such as
parental fees, authorized amount of care, added or deleted children, and/or any other changes to
child care arrangements.
5. 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.
This Agreement may be terminated by either party by giving the other party fifteen (15)days notice.This
Agreement may be terminated without advance notice if a child's health or safety is endangered, if the
provider is under a negative licensing action, or if the Department verified the provider possesses any
CCAP card(s).
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By signing this Agreement,the provider acknowledges receipt of information regarding the rul pd- 23
policies of the Colorado Child Care 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 ocelot-Ma signed
Fiscal Agreement. .
CHILD CARE DIRECTOR S CHILD CARE OWNER
Oo.t...w. O � to:viers .. U &r. 10•79A3
Authorized Represe• a Date Authorized Represe1 tallve" Data
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MaOing Address Mailing Address
Fjcpan t o 3%tois 3o9•61-ztt PRspe" co g%' isit11
City,State, Zip - Phone Number City,State, Zp Phone Number
(� DEPARTMENT OF SOCIAUHUMAN SERVICES
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prized RoprmtiJ� Date
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CLAP Licensed Provider Fiscal Agreement(Rev.09/2071) 4 of 4
• Provider#:
Child Care Assistance Program
Fiscal Agreement Slot Contract Addendum .
This Agreement is entered into and between Pitkin County Health&Human Services herein referred to as"Department"and
Acien 1s u h n ,herein referred to as"Provider"who will provide
child care at the following address: Q N C-so. -tnI5C� t •> Ps,5ev r� •Co $Ibll .This
agreement shall be in effect on FAO, 1 ,20 I 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) 2
Daily Rate(taken from Licensed Provider Fiscal Agreement) (di, 40
Total number of slots approved for toddler care?(age I to 3 yrs)
Daily Rate(taken from Licensed Provider Fiscal Agreement) !�
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)_
2 I,J-14(2•SO Th3, D
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.
CHILD CARE PROVIDER Pitkin County Dept. i ealth& Human Services
Authorized Represen+ a Date Authorized Repr- entative (Date
x-15 N C1arm,scl� St ate S . f c ( sM ( &COL f
Mailing Address Mailing Address
c o 8'1 Le '1 309-1211 C.0 to (
City, State Zip Phone Number Ci S e Zip cPhone Number
ty, P tY, P co 0 C( LoS zocl
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Jan 2014 1 of 1
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, Form.W-9 Request for Taxpayer Give form to the•
(Rev.October 2007) Identification Number and Certification requester. Do not
Department of th07reaa„D, send to the IRS.
Internal Revenue Service
Name(as shown your Income tax return) ` �� -
0
�Q r \ .Nke urT0.t
nBusiness name,If different from above •-
c
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• c Check appropriate box: ❑ IndividuaVSole proprietor igt Corporation ❑ Partnership Exempt
. . o ❑ Limited liability company.Enter the tax classification(D=daregarded entity,C=corporation,P=pannershp)• - 111 Exempt
o p ❑ Other(see Instructions) • .
c= Address(number,street,and apt.or suit .) Requester's name and address(optional)
i u !� (s N � r�ls�
w CT I
N. City,state.an IP code W D 4 Lo l l •List account number(s)here(optional)
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Part I 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 not 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. 1 ; 701 I 0y7
Part II 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 for a 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 instructions on page 4.
Sign Signature of �/ .
Here us /�\.person • � /� ClAj t/l/� Date • —LO •
General Instructions U Definition of a U.S. person. For federal tax pu poses, you are
considered a U.S.person if you are:
Section references are to the Internal Revenue Code unless • An individual who is a U.S. citizen or U.S. resident alien,
otherwise noted.
•• 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) • 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, in certain 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 for a 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)