STATE OF DELAWARE DELAWARE HEALTH AND SOCIAL SERVICES DIVISION OF MANAGEMENT SERVICES 1901 N. DuPont Highway New Castle, DE 19720 REQUEST FOR PROPOSAL NO. #PSCO 820 FOR TITLE III-E RESPITE CARE SERVICES FOR THE DIVISION OF SERVICES FOR AGING AND ADULTS WITH PHYSICAL DISABILITIES DELAWARE HEALTH AND SOCIAL SERVICES HERMAN M. HOLLOWAY SR. CAMPUS 1901 N. DUPONT HIGHWAY NEW CASTLE, DE. 19720 Deposit Waived Performance Bond Waived Date Due: June 23rd, 2008 11:00 AM EDT A mandatory pre-bid meeting will be held on May 20th, 2008 11:30 AM EDT at Delaware Health and Social Services, Herman M. Holloway Sr. Campus, South Loop, First Floor Conference Room #198, 1901 N. DuPont Highway, New Castle, DE 19720. All Bidders Who Wish To Bid On This Proposal Must Be Present, On Time, At The Mandatory Pre-Bid Meeting. No Proposals Will Be Accepted From Bidders Who Either Did Not Attend The Mandatory Pre-Bid Meeting Or Who Are More Than Fifteen (15) Minutes Late. REQUEST FOR PROPOSAL # PSCO 820 Sealed proposals for TITLE III-E RESPITE CARE SERVICES will be received by the Delaware Health and Social Services, Herman M. Holloway Sr. Campus, Procurement Branch, Main Administration Building, South Loop, Second Floor, Room #259, 1901 North DuPont Highway, New Castle, Delaware 19720, until 11:00 AM local time June 23rd, 2008 at which time the proposals will be opened and read. A mandatory pre-bid meeting will be held on May 20th, 2008 11:30 AM EDT at Delaware Health and Social Services, Herman M. Holloway Sr. Campus, South Loop, First Floor Conference Room #198, 1901 N. DuPont Highway, New Castle, DE 19702. All RFP-PSCOs can be obtained online at www.dhss.delaware.gov/dhss/rfp/dhssrfp.htm NOTE TO VENDORS: Your proposal must include the forms in Attachment C, signed, where appropriate and all information on the forms complete. All Bidders Who Wish To Bid On This Proposal Must Be Present, On Time, At The Mandatory Pre-Bid Meeting. No Proposals Will Be Accepted From Bidders Who Either Did Not Attend The Mandatory Pre-Bid Meeting Or Who Are More Than Fifteen (15) Minutes Late. NOTIFICATION TO BIDDERS Bidder shall list all contracts awarded to it or its predecessor firm(s) by the State of Delaware; during the last three years, by State Department, Division, Contact Person (with address/phone number), period of performance and amount. The Evaluation /Selection Review Committee will consider these as additional references and may contact each of these sources. Information regarding bidder performance gathered from these sources may be included in the Committee's deliberations and factored in the final scoring of the bid. Failure to list any contract as required by this paragraph may be grounds for immediate rejection of the bid. If you do not intend to submit a bid you are asked to return the face sheet with “NO BID” stated on the front with your company’s name, address and signature. REQUEST FOR PROPOSAL # PSCO 820 IMPORTANT: ALL PROPOSALS MUST HAVE OUR RFP NUMBER (# PSCO 820) ON THE OUTSIDE ENVELOPE. IF THIS NUMBER IS OMITTED YOUR PROPOSAL WILL IMMEDIATELY BE REJECTED. FOR FURTHER BIDDING INFORMATION PLEASE CONTACT: SANDRA SKELLEY DELAWARE HEALTH AND SOCIAL SERVICES PROCUREMENT BRANCH MAIN BLD-2ND FLOOR –ROOM #259 1901 NORTH DUPONT HIGHWAY HERMAN M. HOLLOWAY SR. HEALTH AND SOCIAL SERVICES CAMPUS NEW CASTLE, DELAWARE 19720 PHONE: (302) 255-9290 IMPORTANT: DELIVERY INSTRUCTIONS IT IS THE RESPONSIBILITY OF THE BIDDER TO ENSURE THAT THE PROPOSAL HAS BEEN RECEIVED BY THE DEPARTMENT OF HEALTH AND SOCIAL SERVICES BY THE DEADLINE. There will be a ninety (90) day period during which the agency may extend the contract period for renewal if needed. If a bidder wishes to request a debriefing, they must submit a formal letter to the Procurement Administrator, Delaware Health and Social Services, Main Administration Building, Second Floor, South Loop, 1901 North DuPont Highway, Herman M. Holloway Sr., Health and Social Services Campus, New Castle, Delaware 19720, within ten (10) days after receipt of “Notice of Award”. The letter must specify reasons for request. Table of Contents IMPORTANT: DELIVERY INSTRUCTIONS iii 1 Project Overview 1 1.1 Introduction 1 1.2 Background and Purpose 1 2 Scope of Work 2 3 General Instructions for Submission of Proposal 3 3.1 Contracting Officer 3 3.2 Proposal Submission Requirements 3 3.3 Issuing Officer 4 3.4 Bidder Questions 4 3.5 Procurement Schedule 4 3.6 Directions 5 3.7 Delaware Business License Application 5 3.8 Cost of Proposal 5 3.9 Withdrawal of Proposals 5 3.10 Disposition of Proposals 5 3.11 Debriefing 5 4 Terms and Conditions 6 5 Proposal Format & Bidders Instructions 12 5.1 Application : Required Forms and Transmittal Letter 12 5.1.1 Proposal Response Table of Contents 12 5.1.2 Bidder’s Signature Form 12 5.1.3 Office of Minority and Women Business Enterprise Self-Certification Tracking Form 13 5.1.4 Compliance Form 13 5.1.5 Certification Sheet 13 5.1.6 Notification to Bidders 13 5.1.7 Mandatory Submission Requirements Checklist 13 5.1.8 Transmittal Letter 13 5.2 Technical Proposal 14 5.2.1 Corporate Qualifications (30 Points) 14 5.2.2 Work Plan (35 Points) 14 5.2.3 Project Staffing & Organization (35 Points) 15 5.3 Budget Proposal 15 5.3.1 Budget Worksheet(s) & Supplement 15 5.4 Appendices 16 Appendix A: Resumes of Professional Staff 16 Appendix B: Job Descriptions 16 Appendix C: Program and Agency Organizational Charts 16 Appendix D: Service Specifications 16 Appendix E: Audit 16 Appendix F: Emergency Preparedness Plan 16 Appendix G: Delaware Business License or Form 501 C 16 6 Proposal Evaluation/Contractor Selection 17 6.1 Technical Review 17 6.2 Ranking of Proposal 17 6.3 Evaluation – Mandatory Requirements 17 6.4 Program Cost 18 7 Standard Department Contract 19 DHSS Boilerplate & Divisional Requirements 19 Attachment A: 28 Service Specifications 30 Attachment B: 36 Description of Allowable Cost 36 Budget Worksheets and Instructions 38 Attachment C: 62 Attached Forms to be Completed 62 Mandatory Submission Requirements Checklist 63 Proposal Response Table of Contents 65 Bidder’s Signature Form 67 Office of Minority and Women Business Enterprise Self-Certification Tracking Form 69 Compliance Form 72 Certification Sheet 74 Notification to Bidders 78 1 Project Overview 1.1 Introduction This is a Request for Proposal (RFP) for Title III-E Respite Care Services issued by Delaware Department of Health and Social Services, Division of Services for Aging and Adults with Physical Disabilities’ (DSAAPD) C.A.R.E. Delaware Program (henceforth referred to as “The Division”). The Division’s mission is to improve and maintain the quality of life for Delawareans who are elderly, or who are at least eighteen years of age with physical disabilities. The Division is committed to the development and delivery of consumer driven services, which maximize independence through individual choice in the least restrictive environment possible enabling individuals to continue living active and productive lives, and protecting those who may be vulnerable or at risk. Additional information about the Division and about services for older persons and adults with physical disabilities in Delaware may be found on the Division’s website at www.dhss.delaware.gov/dsaapd. 1.2 Background and Purpose The Division currently contracts for the provision of Title III-E Respite Care Services on a statewide basis. The purpose of this RFP is to procure Title III-E Respite Care Services for eligible Delawareans for the period from October 1, 2008 to September 30, 2009. C.A.R.E. Delaware is a program of the Division of Services for Aging and Adults with Physical Disabilities which administers funding from the National Family Caregiver Support Program under the Older Americans Act Title III-E and also receives minimal funding through the State of Delaware’s General Fund. The goal of Respite Care is to provide the family caregiver with relief from the daily demands of caregiving. The intent is to maintain the health and well-being, reduce stress levels and prevent exhaustion of the caregiver, while assuring continuous care for the care recipient, thereby extending the period of time that the care recipient can remain independent in the home environment. Title III-E respite care services can be rendered to care recipients’ who are age 60 or older, or under age 60 with a diagnoses of early-onset dementia. Respite can be provided in a number of ways: In the home by a licensed professional or trained companion; in a long-term care facility (such as a nursing home or assisted living facility); or in an adult day services program. Respite care may be provided for caregivers that reside outside of Delaware, if they are the principal caregiver of a frail, older Delawarean and provide substantial care (i.e. arrange for the assistance of at least two Activities of Daily Living). 2 Scope of Work The Division engages in many activities to support its mission, including contracting with outside vendors to provide a wide range of home and community-based services. As noted in the previous section, the purpose of this RFP is to procure Title III-E Respite Care Services for eligible Delawareans for the period from October 1st, 2008 to September 30, 2009. The Division has developed "service specifications" for Title III-E Respite Services. These specifications define the scope of work for this service. They include service descriptions, client eligibility, service limits, standards for service, monitoring requirements, and other relevant information. The specifications for Title III-E Respite Care Services are included in Attachment A. These specifications will provide important guidelines for the development of your proposal. Please read them carefully. In developing your proposal, you will be expected to explain the following: * how you will deliver the services (your work plan) * the qualifications of your staff * your budget * your service area * It is expected that the work plan, staff qualifications and budget will be consistent with the scope of services outlined in the service specifications in Attachment A. Instructions for completing these and other components of the proposal are provided in Proposal Format and Bidders Instructions (Section 5) of this RFP. *Service may be provided in one or more counties. 3 General Instructions for Submission of Proposal Delaware Health and Social Services (DHSS) is requesting proposals for Title III-E Respite Care services for care recipients age 60 or older, or under age 60 with a medical diagnosis of early onset dementia. 3.1 Contracting Officer The contracting officer is Sandra Skelley, Procurement Administrator, Delaware Department of Health and Social Services, Division of Management Services. 3.2 Proposal Submission Requirements Two (2) copies with original signatures and four (4) additional signed copies of the proposal must be submitted. A CD or diskette with an electronic version of the budget proposal must also be submitted. These must be received by the Department on June 23rd, 2008 11:00 AM EDT Any proposal received after this time and date will be automatically rejected and returned unopened to the bidder. Important Delivery Instructions Delivery of the proposal is the sole responsibility of the bidder. In order to make sure that your bid is received by the Division of Management Services on the date and time specified above, bidders are encouraged to use one of the following recommended delivery methods: hand delivery, Federal Express or United Parcel Service. It is the applicant’s responsibility to insure that the proposal is received by the Division of Management Services on time. Late proposals will not be accepted. Proposals should be sent to: Ms. Sandra Skelley, Procurement Administrator Delaware Department of Health & Social Services Division of Management Services Procurement Office Herman M. Holloway Campus Administration Building 2nd Floor, Room 259 1901 N. DuPont Highway New Castle, Delaware 19720 Any amendments to the proposal as originally submitted which are not required by the Department, must comply with the requirements of this section, and must be received on or before the due date previously specified. 3.3 Issuing Officer This Request for Proposal (RFP) is issued by the State of Delaware, Delaware Department of Health and Social Services. The issuing officer for the Division is the sole point of contact from the date of release of this RFP, until selection of the successful bidder. All questions and requests for clarification shall be submitted in writing to: Gwen Miller-Reilly, Issuing Officer DHSS / Division of Services for Aging and Adults with Physical Disabilities 1901 N. DuPont Highway, Main Annex, Room 139 New Castle, Delaware 19720 gwen.miller-reilly@state.de.us 3.4 Bidder Questions All questions must be submitted in writing or electronic form (email) and shall reference the pertinent RFP section(s) and page number(s). Written responses will be binding and included in the RFP as an addendum and in the contract. Bidders may not contact State staff with questions. Only those questions received by the above Issuing Officer (Section 3.3) by the Submission of questions deadline, as presented below in the Procurement Schedule (Section 3.5), will be considered. DHSS will not respond to questions received after the Mandatory Pre- Bid meeting. A final list of written questions and responses will be posted as an RFP addendum on the Internet at http://www.dhss.delaware.gov/dhss/rfp/dhssrfp.htm 3.5 Procurement Schedule The following timetable is anticipated for key activities within the procurement process: Activity Schedule Advertise RFP May 5th, 2008 (on DHSS website only) Submission of Questions May 5th, 2008 – May 20th, 2008 Mandatory Pre-Bid Meeting May 20th, 2008 11:30 AM EDT Response to Questions May 26th, 2008 4:30 PM EDT Bid Opening – Applications Due June 23rd, 2008 11:00 AM EDT Evaluation & Selection Process July 8th, 2008 (Tentative) Notification of Award July 22nd, 2008 (Tentative) The Mandatory Pre-Bid Meeting will be held at: Delaware Health and Social Services Herman M. Holloway Sr. Campus, South Loop First Floor Conference Room #198 1901 N. DuPont Highway, New Castle, DE 19702 May 20th, 2008 11:30 AM EDT 3.6 Directions Driving directions can be obtained online at: http://www.dhss.delaware.gov/dhss/main/maps/holloway/hlwydir.htm 3.7 Delaware Business License Application All for-profit agencies are required to have a current Delaware business license. To obtain a license to perform work in the State of Delaware, call (302) 577-8778 and request an application. A business license can also be obtained online at: https://onestop.delaware.gov/osbrlpublic/Home.jsp. Include a copy of your current business license with your proposal. Non-profit agencies must include a copy of Form 501 C. 3.8 Cost of Proposal Costs for developing and submitting the proposals are the sole responsibility of the bidders. The Department will provide no reimbursement for such costs. 3.9 Withdrawal of Proposals Once submitted, a proposal shall remain a valid proposal for at least 150 days after the proposal date. A submitted proposal may be withdrawn by submitting a written request for its withdrawal to the Department, signed by the bidder, within 72 hours after the proposal due date that is indicated in the Procurement Schedule (Section 3.5) of this RFP. 3.10 Disposition of Proposals All proposals become the property of the State of Delaware and will be a matter of record subject to the provisions of Delaware statutes. The State of Delaware shall have the right to use all ideas, or adaptations of those ideas, contained in any proposal received in response to this RFP. Selection or rejection of the proposal will not affect this right. 3.11 Debriefing If a bidder wishes to request a debriefing, a formal request letter must be submitted to: Sandra Skelley, Procurement Administrator Herman M. Holloway Campus Delaware Health and Social Services Main Building – 2nd Floor Room 259 1901 N. DuPont Highway New Castle, De. 19720 This letter of request must be received within 10 days of receipt of “Notice of Award”. The letter must specify reasons for the request. A debriefing is not an appeal process. 4 Terms and Conditions Reserved Rights Notwithstanding anything to the contrary, the Department reserves the right to: * Select proposals other than that with the lowest cost; * Reject any and all proposals received in response to this RFP; * Waive or modify any information, irregularities or inconsistencies in proposals received; * Negotiate as to any aspect of the proposal with any bidder and negotiate with more than one bidder at the same time; and, * Terminate negotiations and select the next responsive bidder, prepare and release a new RFP or take other action as deemed appropriate, if negotiations fail to result in an agreement. Notice of Contract Award Written notice of contract award will be sent to all bidders. Fair Process The procurement process will provide for the submission, evaluation, and selection of the winning proposal in accordance with applicable State and Federal laws and regulations. The procurement process shall be fair, impartial, and honest. All bidders shall be accorded fair and equal treatment prior to the submission date specified in the RFP with respect to any opportunity for written clarification. Contract Composition The terms and conditions contained in this section constitute the basis for any contract resulting from this RFP. The State will be solely responsible for rendering all decisions on matters involving interpretation of terms and conditions. All contracts shall be in conformity with, and shall be governed by, the applicable laws of the federal government and the State of Delaware. Length of Contract The contract will begin on October 1, 2008 after signing of the contract and issuance of the purchase order by the Department of Finance, and shall end on September 30, 2009. Funding Source This project is funded by State general funds and Federal funds received through the National Family Caregiver Support Program under the Older Americans Act Title III-E, through the Delaware Department of Health and Social Services and the Division of Services for Aging and Adults with Physical Disabilities, respectively. Option to Renew The option to renew annually, up to six (6) years, will include review of the following: 1. Current performance 2. Need of service to the State 3. Funding availability to contract for services 4. Approval for any cost increase requested by the vendor Confidentiality The contractor shall safeguard any client information obtained during the course of the project, and will not use this information for purposes other than required by the contract and in accordance with HIPAA (Health Insurance Portability and Accountability Act). Monitoring The contractor will be monitored on-site on a regular basis by the Division of Services for Aging and Adults with Physical Disabilities. This monitoring will be based upon the contract, laws, rules, regulations, and the standards for the program. The contractor must also comply with the appropriate policies of the Department and the Division. Failure of the contractor to resolve problems(s) identified in the monitoring may be cause for termination of the contract. Forms The forms in this packet should not be altered in any way. We recommend that these forms be used as masters from which you make copies for work sheets. For clarity, the final document should be typed onto the original forms from this packet. Reproduced copies must be reasonably centered and legible so that no portion of the data is omitted. Computerized forms generated by applicants are admissible, but must replicate the forms provided in this RFP. Significant differences may result in rejection of the entire application. More specific instructions accompany the section containing the forms. These instructions should be followed explicitly. Failure to do so will cause delay and/or possible rejection of your entire application. Availability of Funds Any contract awarded will be subject to the eventual availability of funds. Audit Requirement One (1) copy of the latest agency audit must be attached. Circular A-133 audits are required for some agencies receiving $500,000 or more in Federal awards during the most recent audit year. Emergency Preparedness Plan Provide a copy of your plan of action describing how you would ensure that clients are cared for during an emergency or catastrophic event. This would include any state of emergency resulting from a natural or man-made disaster. Insurance Documentation If selected, a copy of a current Insurance Certificate, which meets the Standard Department Contract, Administrative Requirements, Item # 6 (Section 7), must be provided. The copy must include agency name, date of coverage, and coverage limits. It must also list the Division Representative as a Certificate Holder. Volunteers / Procedures Each Service Provider utilizing volunteers to work with clients shall have written procedures governing the training and supervision of volunteers. Volunteers shall receive a written job description, orientation to their duties, and training. Annual performance evaluations are recommended but not required. Information regarding volunteers must be made available to the DSAAPD monitor and becomes the property of the Division in case of contract termination. Method of Payment The contractor or vendor must accept full payment by procurement (credit) card and or conventional check and/or other electronic means at the State’s option, without imposing any additional fees, costs or conditions. Code of Conduct No Division employee or agent of the Division shall solicit or accept gratuities, favors or anything of monetary value from a service provider, contractor, or potential contractor. No paid or volunteer staff person of any service provider may solicit or accept gratuities, favors or anything of monetary value from program participants, or offer for sale any type of merchandise or service; nor may they seek to encourage acceptance of any particular belief or philosophy by any program participant. Visibility & Client Recruitment Service Providers must publicize their services to assure that eligible persons throughout the service area know about the availability of services. All written materials used to publicize the program must acknowledge the Division as the funding source. Cost of Proposal Preparation All costs of proposal preparation will be borne by the bidder. Proposal and Final Contract The bidder's proposal will be incorporated into the final contract and will become binding upon the successful bidder. If bidders are unwilling to comply with certain RFP requirements, terms and conditions, objections must be clearly stated in the proposal and will be subject to negotiation at the discretion of the Department. Amendments to Proposals Amendments to proposals will not be accepted after the submission deadline. DHSS reserves the right to request clarification and/or further technical information from any contractor submitting a proposal at any time. Standard for Subcontractors The contractor is fully responsible for all work performed under the contract, and must get prior written approval for all subcontract(s) for carrying out certain functions under the contract. Copies of subcontracts must be sent to the Division. No subcontract, with respect to performance under the contract, shall in any way relieve the contractor of any responsibility for performance of its duties. Notification of Bidders Investigation of Contractor’s Qualifications The State of Delaware may make such investigation as it deems necessary to determine ability of potential contractors to furnish required services, and contractors shall furnish the State with data requested for this purpose. The State reserves the right to reject any offer if evidence submitted or investigation of such contractor fails to satisfy the State that the contractor is properly qualified to deliver services. Bidder shall list all contracts awarded to it or its predecessor firm(s) by the State of Delaware during the last three years, by State Department, Division, Contact Person (with address/phone number), period of performance and amount. The Evaluation/Selection Review Committee will consider these as additional references and may contact these sources. Information regarding bidder performance gathered from these sources may be included in the Committee's deliberations and may be factored into the final scoring of the bid. Failure to list any contract as required by this paragraph may be grounds for immediate rejection of the bid. Project Cost The Department reserves the right to award this project to a bidder other than the one with the lowest cost or to decide not to fund this project at all. Cost will be balanced against the score received by each bidder in the rating process. The State of Delaware reserves the right to reject, as technically unqualified, proposals that are unrealistically low if, in judgment of the Evaluation Committee, a lack of sufficient budgeted resources would jeopardize the successful completion of the project. Reserved Rights of the Department of Health & Social Services The Department reserves the right to: * Reject any and all proposals received in response to this RFP * Select for contract or for negotiations a proposal other than that with the lowest cost * Waive or modify any information, irregularities or inconsistencies in proposals received; * Negotiate as to any aspect of the proposal with any proposer and negotiate with more than one proposer at the same time; * If negotiations fail to result in an agreement within two weeks, terminate negotiations and select the next most responsive proposer, prepare and release a new RFP, or take such other action as the Department may deem appropriate. Right to a Debriefing To request a debriefing on a bidder selection, the bidder must submit a letter requesting a debriefing to the Procurement Administrator, DHSS, within ten days of the announced selection. In the letter, the bidder must specifically state the reason(s) for the debriefing. Debriefing requests must be based on pertinent issues relating to the selection process. Debriefing requests based on specifications in the RFP will not be accepted. All debriefing requests will be evaluated in accordance with these conditions. Debriefing requests that meet these conditions will be reviewed and respectively answered by the Procurement Administrator and/or Debriefing Committee. General Reporting Requirements All programs funded by the Division must submit Program and Financial Reports as required. Delaware Contract Language The Standard Department Contract (Section 7) contains a copy of the standard Departmental contract, which will be used for the agreement between the State and the wining bidder. By submitting a proposal to this RFP, the bidder agrees to be bound by the terms and conditions in that contract document. Proposal Becomes State Property All proposals become the property of the State of Delaware and will not be returned to contractors. Public Record The Department will not divulge specific content of proposals to the extent that the contractor identifies contents as privileged or confidential. Any information not so designated will be considered public information. Minority/Women/Disadvantaged Business Certification If the proposer wishes to have M/W/D business enterprise status taken into consideration, they should summit proof of such certification with their bid response. Further information, guidelines and forms for such certifications can be found at: http://omwbe.delaware.gov or in Attachment C 5 Proposal Format & Bidders Instructions General Instructions All submitted proposals must follow the format presented in this section. Proposals must also be complete and accurate. Failure to follow this instruction may result in automatic rejection and return of your proposal without consideration for the project. Each page of the proposal, narrative, and forms should be numbered and identified with the agency name. The proposal shall be bound and labeled, and must include the items identified and follow the order shown in the Proposal Response Table of Contents (Attachment C). This Table of Contents should accompany the application and reference appropriate page numbers. Each section of the proposal should be clearly marked and tabbed for reference. 5.1 Application : Required Forms and Transmittal Letter The following Items 5.1.1 through 5.1.7 list the forms that must be completed and signed by an individual authorized to legally bind the bidder and must be included in your proposal. Item 5.1.8, a Transmittal Letter, as described below, must also be submitted. 5.1.1 Proposal Response Table of Contents * Each application must contain all items listed in the Proposal Response Table of Contents. This form is included in Attachment C * Each item in the application must be in sequential order of this Proposal Response Table of Contents. * Each page of the application must be numbered, preferably in the lower right hand corner. The number of the first page of any item having more than one page will be the page number to be shown in the Proposal Response Table of Contents. 5.1.2 Bidder’s Signature Form This form is included in Attachment C. This page is the first page of your proposal and shall contain: * Name of Bidding Agency * Signature of Authorized contracting staff member * Printed / typed name of authorized contracting staff member * Mailing address of bidding agency * Name, Telephone, and Fax number(s) of agency contact person for the proposal * Bidding agency’s Federal Employer Identification Number * The final statement on the form must include company/Agency Name. 5.1.3 Office of Minority and Women Business Enterprise Self-Certification Tracking Form Note: MUST BE NOTARIZED One copy only. This form is included in Attachment C and is self-explanatory. The second page of the form contains definitions. 5.1.4 Compliance Form This form is included in Attachment C and must be completed and signed by an individual authorized to legally bind the bidder. 5.1.5 Certification Sheet This form is included in Attachment C and must be completed and signed by an individual authorized to legally bind the bidder. 5.1.6 Notification to Bidders Bidders shall list all contracts awarded to it and its predecessor firm(s) by the State of Delaware during the last three years, by State Department, Division, Contact Person (with address/phone number), period of performance and amount. The Evaluation/Selection Review Committee will consider these as additional references and may contact each of these sources. Information regarding bidder performance gathered from these sources may be included in the Committee’s deliberations and factored into the final scoring of the bid. Failure to list any contract as required by this paragraph may be grounds for immediate rejection of the bid. The Notification to Bidders form is included in Attachment C. It must be completed and signed by an individual authorized to legally bind the bidder. 5.1.7 Mandatory Submission Requirements Checklist This is the mandatory submission requirements checklist. Agreement to or acknowledgement of a requirement is shown by a Y (Yes) or N (No) next to the requirement and a signature at the bottom of the checklist. Failure to adequately meet any one (1) mandatory requirement may cause the entire proposal to be deemed non-responsive and be rejected from further consideration. However, the State reserves the right to waive minor irregularities and minor instances of non-compliance. This form is included in Attachment C. 5.1.8 Transmittal Letter The Transmittal Letter shall be in the form of a standard business letter and shall be marked “Section 1: Transmittal Letter”. An individual authorized to legally bind the bidder shall sign it. It shall include at a minimum: * A statement indicating that the bidder is a corporation or other legal entity and satisfies all licensing requirements of the State or Federal law. * A statement that no attempt has been made or will be made by the bidder to induce any other person or firm to submit a proposal. * A statement that proposed services satisfy the requirements established in the RFP. * A statement of affirmative action that the bidder does not discriminate in its employment practice with regard to race, color, religion, age (except as provided by law), sex, marital status, political affiliation, national origin, or handicap. * A statement that the bidder will comply with all terms and conditions as indicated in the General Instructions for Submission of Proposals (Section 3), Terms and Conditions (Section 4) and in the Standard Department Contract (Section 7), included as part of this RFP, except as to modifications mutually agreed upon by the contractor and Department. * A statement that the bidder has the capability to provide the services requested through this RFP. * A statement that the bidder will comply with the requirements of The Americans with Disabilities Act of 1990 (ADA) and the terms and conditions of the Department Boilerplate including the Divisional Requirements. 5.2 Technical Proposal This section should be labeled “Section 2: Technical Proposal”. 5.2.1 Corporate Qualifications (30 Points) Describe the organization’s expertise in area of the proposed project, and experience in operating any similar projects. A summary of similar current and completed projects should be included. Also supply three (3) references of people who will receive no financial gain or are not members of the board. Give a contact person, name of organization and telephone number. 5.2.2 Work Plan (35 Points) This section must explain your approach for operating a program, which meets the Service Specification requirements. The Work Plan description must provide information, which describes how you will meet the criteria listed in the Service Specifications (Attachment A) for each of the following areas: 1. Service Goal 2. Service Area (geographical) 3. Service Location (address, available space, accessibility and hours/days of operation) 4. Hours of Operation 5. Service Activities 6. Administrative Requirements 7. Time frames to accomplish Work Plan 8. Describe how you plan to meet the service standards of the program 9. Describe agency’s internal program evaluation and monitoring process. Proposals will be evaluated by the soundness of the bidder’s proposed approach to operating the program. Emphasis will be given to the comprehensiveness of the bidder’s understanding of the tasks to be completed and the methodologies to be used. 5.2.3 Project Staffing & Organization (35 Points) The following areas must be addressed: * Identify the number and type of staff involved in the project, including identification of the bidder’s project manager. * Summarize their qualifications related to specific requirements of this project. * Include resumes of professional staff. * Job descriptions for all project staff must be included. Descriptions must include the hours the staff person works each week and the number of hours assigned to this program each week. * A Program Organizational Chart must be included. If you operate more than one program, also include an Agency Organizational Chart showing the line of authority. * The Service Specifications for this program (Attachment A) must be included. 5.3 Budget Proposal This section should be labeled “Section 3: Budget Proposal”. 5.3.1 Budget Worksheet(s) & Supplement Complete the required budget worksheet(s) according to the instruction provided in Budget Worksheets and Instructions (Attachment B). The Budget Worksheet Supplement page is intended to more fully explain items and costs associated with the budget for this project proposal. Every effort should be made to supply a clear, concise, and accurate budget. Some of the general topics that should be addressed include, but are not limited to: * Justification should be given for budgeted items based on projections and/or assumptions. Briefly describe the basis for the cost calculations and any rationale that serves to support the process used. * Explain the method of allocation for specific costs prorated to the program based on the agency’s total budget. It is important that the bidder provide any information that may help reviewers understand items in the budget. The contract shall be awarded to the bidder whose proposal is deemed to be the most advantageous to the State, considering the criteria set forth in the Request for Proposal. 5.4 Appendices Appendix A: Resumes of Professional Staff Provide the resumes of all professional staff that will be working with the project. This should include any staff members identified by name and title on the Salary Worksheet provided in the Budget Worksheets Section (Attachment B) of the RFP Appendix B: Job Descriptions Provide a formal job description for all staff members involved in this program. This should be included for all budgeted positions. Appendix C: Program and Agency Organizational Charts Provide your agency’s organizational chart and a program specific organizational chart. Appendix D: Service Specifications Attach the Service Specifications, found in Attachment A. Appendix E: Audit Provide a copy of your agency’s most recent audit. Appendix F: Emergency Preparedness Plan Provide your plan of action in case of emergency as explained in the Terms and Conditions (Section 4). Appendix G: Delaware Business License or Form 501 C Provide a copy of your Delaware Business license or, if not applicable, a copy of form 501 C. 6 Proposal Evaluation/Contractor Selection Delaware Department of Health and Social Services (DHSS) will conduct a comprehensive, fair and impartial evaluation of all proposals received in response to this RFP that comply with the due dates specified in the Procurement Schedule (Section 3.5) of this RFP. Selection of the successful bidder will be based on the proposal that is determined to be in the best interest of the Department, taking into consideration criteria set forth in this RFP. The Department reserves the right to reject any or all proposals received, or cancel this RFP, regardless of evaluation, if it is determined to be in the best interest of the Department. 6.1 Technical Review A Technical Review Committee will evaluate each proposal that has met the mandatory requirements. Committees may consist of staff from the Division and Department and/or members of the community. An oral presentation by the bidder may be requested. 6.2 Ranking of Proposal The evaluation committee will recommend proposal(s) with the highest total points from this section. The final decision to contract will be made by the Director of the Division of Services for Aging and Adults with Physical Disabilities. The following represents the basis used for determining total points: CORPORATE QUALIFICATIONS (30 POINTS) WORK PLAN (35 POINTS) PROJECT STAFFING AND ORGANIZATION (35 POINTS) 6.3 Evaluation – Mandatory Requirements The Technical Proposal will be evaluated to determine if it meets the Mandatory Submission Requirements described in the Mandatory Submission Requirements Checklist found in Attachment C. Failure to adequately meet any one (1) mandatory requirement may cause the entire proposal to be deemed non-responsive and be rejected from further consideration. However, the State reserves the right to waive minor irregularities and minor instances of non-compliance. Proposals meeting the mandatory submission requirements will be given to the DSAAPD Evaluation Team. Specific requirements are as follows: 1. The bid is submitted no later than the closing date and time. 2. Two (2) original signatures and four (4) additional signed copies of the proposal 3. Transmittal letter signed by an officer of the organization, or authorized designee 4. Acceptance of General Instructions and Terms and Conditions of the RFP and Standard Department Contract by inclusion in the proposal, or specific exception noted 5. Stipulation that the bid terms will remain in effect for at least 150 days 6. Most recent audit report. 7. Copy of current business license or Form 501 C 8. Notification to Bidders 9. Office of Minority and Women Business Enterprise Self-Certification Tracking Form 6.4 Program Cost The Department reserves the right to award this contract to a bidder other than the one with the lowest cost. While an integral part of the bid process, cost will be balanced against the score received by each bidder in the rating process described above. 7 Standard Department Contract DHSS Boilerplate & Divisional Requirements CONTRACT A) Introduction 1. This contract is entered into between the Delaware Department of Health and Social Services (the Department), Division of ______________ (Division) and _______________________(the Contractor). 2. The Contract shall commence on __________________ and terminate on _____________ unless specifically extended by an amendment, signed by all parties to the Contract. Time is of the essence. (Effective contract start date is subject to the provisions of Paragraph C 1 of this Agreement.) B) Administrative Requirements 1. Contractor recognizes that it is operating as an independent Contractor and that it is liable for any and all losses, penalties, damages, expenses, attorney's fees, judgments, and/or settlements incurred by reason of injury to or death of any and all persons, or injury to any and all property, of any nature, arising out of the Contractor's negligent performance under this Contract, and particularly without limiting the foregoing, caused by, resulting from, or arising out of any act of omission on the part of the Contractor in their negligent performance under this Contract. 2. The Contractor shall maintain such insurance as will protect against claims under Worker’s Compensation Act and from any other claims for damages for personal injury, including death, which may arise from operations under this Contract. The Contractor is an independent contractor and is not an employee of the State. 3. During the term of this Contract, the Contractor shall, at its own expense, carry insurance with minimum coverage limits as follows: a) Comprehensive General Liability $1,000,000 and b) Medical/Professional Liability $1,000,000/ $3,000,000 or c) Misc. Errors and Omissions $1,000,000/$3,000,000 or d) Product Liability $1,000,000/$3,000,000 All contractors must carry (a) and at least one of (b), (c), or (d), depending on the type of service or product being delivered. If the contractual service requires the transportation of Departmental clients or staff, the contractor shall, in addition to the above coverage, secure at its own expense the following coverage: e) Automotive Liability (Bodily Injury) $100,000/$300,000 f) Automotive Property Damage (to others) $ 25,000 4. Not withstanding the information contained above, the Contractor shall indemnify and hold harmless the State of Delaware, the Department and the Division from contingent liability to others for damages because of bodily injury, including death, that may result from the Contractor’s negligent performance under this Contract, and any other liability for damages for which the Contractor is required to indemnify the State, the Department and the Division under any provision of this Contract. 5. The policies required under Paragraph B3 must be written to include Comprehensive General Liability coverage, including Bodily Injury and Property damage insurance to protect against claims arising from the performance of the Contractor and the contractor's subcontractors under this Contract and Medical/Professional Liability coverage when applicable. 6. The Contractor shall provide a Certificate of Insurance as proof that the Contractor has the required insurance. The certificate shall identify the Department and the Division as the “Certificate Holder” and shall be valid for the contract’s period of performance as detailed in Paragraph A 2. 7. The Contractor acknowledges and accepts full responsibility for securing and maintaining all licenses and permits, including the Delaware business license, as applicable and required by law, to engage in business and provide the goods and/or services to be acquired under the terms of this Contract. The Contractor acknowledges and is aware that Delaware law provides for significant penalties associated with the conduct of business without the appropriate license. 8. The Contractor agrees to comply with all State and Federal licensing standards and all other applicable standards as required to provide services under this Contract, to assure the quality of services provided under this Contract. The Contractor shall immediately notify the Department in writing of any change in the status of any accreditations, licenses or certifications in any jurisdiction in which they provide services or conduct business. If this change in status regards the fact that its accreditation, licensure, or certification is suspended, revoked, or otherwise impaired in any jurisdiction, the Contractor understands that such action may be grounds for termination of the Contract. a) If a contractor is under the regulation of any Department entity and has been assessed Civil Money Penalties (CMPs), or a court has entered a civil judgment against a Contractor or vendor in a case in which DHSS or its agencies was a party, the Contractor or vendor is excluded from other DHSS contractual opportunities or is at risk of contract termination in whole, or in part, until penalties are paid in full or the entity is participating in a corrective action plan approved by the Department. A corrective action plan must be submitted in writing and must respond to findings of non-compliance with Federal, State, and Department requirements. Corrective action plans must include timeframes for correcting deficiencies and must be approved, in writing, by the Department. The Contractor will be afforded a thirty (30) day period to cure non- compliance with Section 8(a). If, in the sole judgment of the Department, the Contractor has not made satisfactory progress in curing the infraction(s) within the aforementioned thirty (30) days, then the Department may immediately terminate any and/or all active contracts. 9. Contractor agrees to comply with all the terms, requirements and provisions of the Civil Rights Act of 1964, the Rehabilitation Act of 1973 and any other federal, state, local or any other anti discriminatory act, law, statute, regulation or policy along with all amendments and revision of these laws, in the performance of this Contract and will not discriminate against any applicant or employee or service recipient because of race, creed, religion, age, sex, color, national or ethnic origin, disability or any other unlawful discriminatory basis or criteria. 10. The Contractor agrees to provide to the Divisional Contract Manager, on an annual basis, if requested, information regarding its client population served under this Contract by race, color, national origin or disability. 11. This Contract may be terminated in whole or part: a) by the Department upon five (5) calendar days written notice for cause or documented unsatisfactory performance, b) by the Department upon fifteen (15) calendar days written notice of the loss of funding or reduction of funding for the stated Contractor services as described in Appendix B, c) by either party without cause upon thirty (30) calendar days written notice to the other Party, unless a longer period is specified in Appendix A. In the event of termination, all finished or unfinished documents, data, studies, surveys, drawings, models, maps, photographs, and reports or other material prepared by Contractor under this contract shall, at the option of the Department, become the property of the Department. In the event of termination, the Contractor, upon receiving the termination notice, shall immediately cease work and refrain from purchasing contract related items unless otherwise instructed by the Department. The Contractor shall be entitled to receive reasonable compensation as determined by the Department in its sole discretion for any satisfactory work completed on such documents and other materials that are usable to the Department. Whether such work is satisfactory and usable is determined by the Department in its sole discretion. Should the Contractor cease conducting business, become insolvent, make a general assignment for the benefit of creditors, suffer or permit the appointment of a receiver for its business or assets, or shall avail itself of, or become subject to any proceeding under the Federal Bankruptcy Act or any other statute of any state relating to insolvency or protection of the rights of creditors, then at the option of the Department, this Contract shall terminate and be of no further force and effect. Contractor shall notify the Department immediately of such events. 12. Any notice required or permitted under this Contract shall be effective upon receipt and may be hand delivered with receipt requested or by registered or certified mail with return receipt requested to the addresses listed below. Either Party may change its address for notices and official formal correspondence upon five (5) days written notice to the other. To the Division at: _______________________________________ _______________________________________ _______________________________________ To the Contractor at: ________________________________________ ________________________________________ ________________________________________ 13. In the event of amendments to current Federal or State laws which nullify any term(s) or provision(s) of this Contract, the remainder of the Contract will remain unaffected. 14. This Contract shall not be altered, changed, modified or amended except by written consent of all Parties to the Contract. 15. The Contractor shall not enter into any subcontract for any portion of the services covered by this Contract without obtaining prior written approval of the Department. Any such subcontract shall be subject to all the conditions and provisions of this Contract. The approval requirements of this paragraph do not extend to the purchase of articles, supplies, equipment, rentals, leases and other day-to-day operational expenses in support of staff or facilities providing the services covered by this Contract. 16. This entire Contract between the Contractor and the Department is composed of these several pages and the attached: Appendix A - Divisional Requirements Appendix B - Services Description Appendix C - Contract Budget Appendix ……. 17. This Contract shall be interpreted and any disputes resolved according to the Laws of the State of Delaware. Except as may be otherwise provided in this contract, all claims, counterclaims, disputes and other matters in question between the Department and Contractor arising out of or relating to this Contract or the breach thereof will be decided by arbitration if the parties hereto mutually agree, or in a court of competent jurisdiction within the State of Delaware. 18. In the event Contractor is successful in an action under the antitrust laws of the United States and/or the State of Delaware against a vendor, supplier, subcontractor, or other party who provides particular goods or services to the Contractor that impact the budget for this Contract, Contractor agrees to reimburse the State of Delaware, Department of Health and Social Services for the pro-rata portion of the damages awarded that are attributable to the goods or services used by the Contractor to fulfill the requirements of this Contract. In the event Contractor refuses or neglects after reasonable written notice by the Department to bring such antitrust action, Contractor shall be deemed to have assigned such action to the Department. 19. Contractor covenants that it presently has no interest and shall not acquire any interests, direct or indirect, that would conflict in any manner or degree with the performance of this Contract. Contractor further covenants that in the performance of this contract, it shall not employ any person having such interest. 20. Contractor covenants that it has not employed or retained any company or person who is working primarily for the Contractor, to solicit or secure this agreement, by improperly influencing the Department or any of its employees in any professional procurement process; and, the Contractor has not paid or agreed to pay any person, company, corporation, individual or firm, other than a bona fide employee working primarily for the Contractor, any fee, commission, percentage, gift or any other consideration contingent upon or resulting from the award or making of this agreement. For the violation of this provision, the Department shall have the right to terminate the agreement without liability and, at its discretion, to deduct from the contract price, or otherwise recover, the full amount of such fee, commission, percentage, gift or consideration. 21. The Department shall have the unrestricted authority to publish, disclose, distribute and otherwise use, in whole or in part, any reports, data, or other materials prepared under this Contract. Contractor shall have no right to copyright any material produced in whole or in part under this Contract. Upon the request of the Department, the Contractor shall execute additional documents as are required to assure the transfer of such copyrights to the Department. If the use of any services or deliverables is prohibited by court action based on a U.S. patent or copyright infringement claim, Contractor shall, at its own expense, buy for the Department the right to continue using the services or deliverables or modify or replace the product with no material loss in use, at the option of the Department. 22. Contractor agrees that no information obtained pursuant to this Contract may be released in any form except in compliance with applicable laws and policies on the confidentiality of information and except as necessary for the proper discharge of the Contractor’s obligations under this Contract. 23. Waiver of any default shall not be deemed to be a waiver of any subsequent default. Waiver or breach of any provision of this Contract shall not be deemed to be a waiver of any other or subsequent breach and shall not be construed to be a modification of the terms of the Contract unless stated to be such in writing, signed by authorized representatives of all parties and attached to the original Contract. 24. If the amount of this contract listed in Paragraph C2 is over $100,000, the Contractor, by their signature in Section E, is representing that the Firm and/or its Principals, along with its subcontractors and assignees under this agreement, are not currently subject to either suspension or debarment from Procurement and Non-Procurement activities by the Federal Government. C) Financial Requirements 1. The rights and obligations of each Party to this Contract are not effective and no Party is bound by the terms of this contract unless, and until, a validly executed Purchase Order is approved by the Secretary of Finance and received by Contractor, if required by the State of Delaware Budget and Accounting Manual, and all policies and procedures of the Department of Finance have been met. The obligations of the Department under this Contract are expressly limited to the amount of any approved Purchase Order. The State will not be liable for expenditures made or services delivered prior to Contractor's receipt of the Purchase Order. 2. Total payments under this Contract shall not exceed $ ______ in accordance with the budget presented in Appendix C. Payment will be made upon receipt of an itemized invoice from the Contractor in accordance with the payment schedule, if any. The contractor or vendor must accept full payment by procurement (credit) card and or conventional check and/or other electronic means at the State’s option, without imposing any additional fees, costs or conditions. Contractor is responsible for costs incurred in excess of the total cost of this Contract and the Department is not responsible for such costs. 3. The Contractor is solely responsible for the payment of all amounts due to all subcontractors and suppliers of goods, materials or services which may have been acquired by or provided to the Contractor in the performance of this contract. The Department is not responsible for the payment of such subcontractors or suppliers. 4. The Contractor shall not assign the Contract or any portion thereof without prior written approval of the Department and subject to such conditions and revisions as the Department may deem necessary. No such approval by the Department of any assignment shall be deemed to provide for the incurrence of any obligations of the Department in addition to the total agreed upon price of the Contract. 5. Contractor shall maintain books, records, documents and other evidence directly pertinent to performance under this Contract in accordance with generally accepted accounting principles and practices. Contractor shall also maintain the financial information and data used by Contractor in the preparation of support of its bid or proposal. Contractor shall retain this information for a period of five (5) years from the date services were rendered by the Contractor. Records involving matters in litigation shall be retained for one (1) year following the termination of such litigation. The Department shall have access to such books, records, documents, and other evidence for the purpose of inspection, auditing, and copying during normal business hours of the Contractor after giving reasonable notice. Contractor will provide facilities for such access and inspection. 6. The Contractor agrees that any submission by or on behalf of the Contractor of any claim for payment by the Department shall constitute certification by the Contractor that the services or items for which payment is claimed were actually rendered by the Contractor or its agents, and that all information submitted in support of the claims is true, accurate, and complete. 7 The cost of any Contract audit disallowances resulting from the examination of the Contractor's financial records will be borne by the Contractor. Reimbursement to the Department for disallowances shall be drawn from the Contractor's own resources and not charged to Contract costs or cost pools indirectly charging Contract costs. 8. When the Department desires any addition or deletion to the deliverables or a change in the services to be provided under this Contract, it shall so notify the Contractor. The Department will develop a Contract Amendment authorizing said change. The Amendment shall state whether the change shall cause an alteration in the price or time required by the Contractor for any aspect of its performance under the Contract. Pricing of changes shall be consistent with those prices or costs established within this Contract. Such amendment shall not be effective until executed by all Parties pursuant to Paragraph B 14. D) Miscellaneous Requirements 1. If applicable, the Contractor agrees to adhere to the requirements of DHSS Policy Memorandum # 46, (PM # 46, effective 3/11/05), and divisional procedures regarding the reporting and investigation of suspected abuse, neglect, mistreatment, misappropriation of property and significant injury of residents/clients receiving services, including providing testimony at any administrative proceedings arising from such investigations. The policy and procedures are included as Appendix _____ to this Contract. It is understood that adherence to this policy includes the development of appropriate procedures to implement the policy and ensuring staff receive appropriate training on the policy requirements. The Contractor’s procedures must include the position(s) responsible for the PM46 process in the provider agency. Documentation of staff training on PM46 must be maintained by the Contractor. 2. The Contractor, including its parent company and its subsidiaries, and any subcontractor, including its parent company and subsidiaries, agree to comply with the provisions of 29 Del. Code, Chapter 58: “Laws Regulating the Conduct of Officers and Employees of the State,” and in particular with Section 5805 (d): “Post Employment Restrictions.” 3. When required by Law, Contractor shall conduct child abuse and adult abuse registry checks and obtain service letters in accordance with 19 Del. Code Section 708; and 11 Del. Code, Sections 8563 and 8564. Contractor shall not employ individuals with adverse registry findings in the performance of this contract. 4. If applicable, the Contractor agrees to adhere to the requirements of DHSS Policy Memorandum # 40, and divisional procedures regarding conducting criminal background checks and handling adverse findings of the criminal background checks. This policy and procedure are included as Appendix _____ to this Contract. It is understood that adherence to this policy includes the development of appropriate procedures to implement the policy and ensuring staff receive appropriate training on the policy requirements. The Contractor’s procedures must include the title of the position(s) responsible for the PM40 process in the contractor’s agency. 5. All Department campuses are tobacco-free. Contractors, their employees and sub- contractors are prohibited from using any tobacco products while on Department property. This prohibition extends to personal vehicles parked in Department parking lots. E) Authorized Signatures: For the Contractor: For the Department: ________________ __________________ Name Vincent P. Meconi Secretary ________________ _________________ Title Date ________________ For the Division: Date __________________ Guy Perrotti Director __________________ Date DIVISIONAL REQUIREMENTS 1. The contractor agrees to comply with all policies and procedures contained within the DSAAPD Policy Manual for Contracts, which is hereby included by reference. 2. The contractor agrees to meet or exceed all minimum service standards as indicated in the service specifications for the contracted service. 3. This agreement is subject to the availability of State and/or Federal funds. 4. The contractor agrees to submit quarterly (or monthly) financial reports, program performance reports and other reports as required by the Division on the due dates as specified in the DSAAPD Policy Manual for Contracts policies Q and S. Payments for the following months may be withheld if the contractor fails to comply with these requirements. 5. The contractor agrees that the project will be carried out in accordance with the applicable Federal and State statutes, rules, regulations, and the policies and procedures established by the Department and Division, the terms and conditions of this contract and the RFP application as approved by the Department. 6. If, at any given time the Contractor cannot provide the contracted and authorized services, the Division has the authority to remove funds from the contract. 7. The contractor agrees to acknowledge the Division of Services for Aging and Adults with Disabilities as a funding source in all publicity about the project. 8. For Federally funded programs, HHS form 690 (Assurance of Compliance) is incorporated by reference and made part of this agreement. 9. No part of any funds under this contract shall be used to pay the salary or expenses of any contractor or agent acting for the contractor, to engage in lobbying designed to influence legislation or appropriations pending before the legislature and/or Congress. 10. The contractor acknowledges that no state or federal funds may be requested unless the contractor has the local resources to meet the required match, if applicable. These resources may not be used as match for any other program. Failure of any contractor to document and provide the budgeted required match could result in an audit finding and the funds returned to the Division. 11. In cost reimbursement contracts, any funds paid by the Division to the contractor, in excess of actual expenditure, incurred and paid by the contractor, must be returned to the Division. 12. Any changes in the line items of a cost reimbursement budget must be in compliance with the DSAAPD Policy Manual for Contracts Policy F. Non- compliance will result in a disallowed cost and audit finding. 13. The period of notice required for the Contractor to terminate or to not renew this agreement without cause is extended to ninety (90) calendar days with written notice to the Division pursuant to B. Administrative Requirements, Item 11 of the Department boilerplate. 14. The Contractor agrees to list the DSAAPD as a Certificate Holder on their current Insurance Certificate, as required by the Department. 15. The Contractor agrees to provide the Division with a current copy of its Emergency Preparedness Plan. 16. The contractor agrees to cooperate and assist in efforts undertaken by the Division, the U.S. Administration on Aging, or any other agency or organization duly authorized by any of the preceding to evaluate the effectiveness, feasibility and cost of the project. 17. The contractor of an Older Americans Act program acknowledges that the total cost of the contract, excluding program income, must include a 10% match of non-DSAAPD resources (e.g. local cash and/or in-kind that is provided by the contractor). During the year-end closeout, the contractor will refund all unmatched DSAAPD funds as required by Federal regulations. Attachment A: Service Specifications Service Specifications TITLE III-E RESPITE CARE 1.0 SERVICE DEFINITION 1.1 Title III-E Respite Care is a service which provides short-term relief to a principal caregiver providing care to a frail individual 60 years of age or older, or under the age of 60 with a medical diagnosis of early onset dementia (i.e. Alzheimer’s Disease) who cannot care for him or herself. 1.2 This service offers the principal caregiver a break from the demands of ongoing care and can be provided in the absence of the caregiver or while the caregiver remains in the home. 1.3 Respite care service can be provided in a number of ways, and the type and extent of care may vary dependent upon circumstances. 1.4 Respite care can be provided: 1.4.1 in the home by a licensed professional or trained companion; 1.4.2 in a long-term care facility (such as a nursing home or assisted living facility); or 1.4.3 in a facility which houses an adult day services program. 1.5 Regardless of the setting, participant’s right of privacy and confidentiality will be maintained to the fullest extent possible. 1.6 Respite care may be provided for caregivers who reside outside of Delaware, if they are the principal caregiver of a frail, older Delawarean. 1.7 Definitions: 1.7.1 A principal caregiver is an adult who is a family member or other individual providing ongoing care to an older person. This includes providing or arranging for the provision of personal care and other activities and instrumental activities of daily living. The caregiver is not required to live with the frail older person. However, if the caregiver does not live with the care recipient, the care provided by the caregiver must be substantial, hands on care and must be provided on an almost daily basis. If the caregiver lives with the care recipient, the caregiver is not required to be in the home 24-hours a day. 1.7.2 A frail, older person is someone who is determined to be functionally impaired because: 1.7.2.1 the individual is unable to perform at least two activities of daily living without substantial human assistance, including verbal reminding, physical cueing, or supervision; or 1.7.2.2 due to a cognitive or other mental impairment, requires substantial supervision because the individual behaves in a manner that poses a serious health or safety hazard to the individual himself/herself or to another person. 1.7.3 Activities of daily living include basic activities such as eating, bathing, dressing, toileting, walking or moving about the house, or transferring into or out of a chair or bed. 2.0 SERVICE GOAL 2.1 The goal of Respite Care is to provide the caregiver with relief from the demands of caregiving. The intent is to maintain the caregiver’s health and well-being, reduce stress levels and prevent exhaustion of the caregiver, while assuring continuous care for the care recipient. 3.0 SERVICE UNIT 3.1 The unit of service for Respite Care may be either hourly or daily depending on the extent and type of service rendered. The provider shall develop rate schedules, as applicable: 3.1.1 In-Home Respite 3.1.1.1 An hourly rate for in-home respite care. 3.1.1.1.1 In-home respite is defined as respite provided in the home by a licensed professional or trained companion, this service relieves the primary caregiver so that they may rest or leave the home for short periods of time. 3.1.1.1.1.1 Services will not exceed 260 hours per client per contract year for in-home and/or institutional respite. 3.1.2 In-Home Respite, weekend and evening hours 3.1.2.1 An hourly rate for in-home respite care provided on weekdays from 6pm to 6am and weekends from Friday 6pm through 6am Monday. 3.1.3 In-Home Respite Urgent Need 24 hour care 3.1.3.1 A daily rate (24 hours) for one-time emergency or short-term needs. A provider agency would provide around-the-clock care in the home for up to 72 continuous hours if justified and approved by the Division Contract Manager (limited to one occurrence per year per client). 3.1.3.1.1 Each day of in-home urgent need respite care counts as 24 hours of service toward the maximum of 260 hours per client per contract year. 3.1.4 Institutional Respite 3.1.4.1 A daily rate (24 hours) for institutional setting respite services. 3.1.4.1.1 Institutional respite is defined as respite provided in a licensed nursing home facility or a licensed assisted living facility. 3.1.4.1.1.1 Each day of institutional respite counts as 24 hours of service toward the maximum limit of 260 hours per client per contract year. 3.1.5 Adult Day Services 3.1.5.1 A daily rate for Adult Day Services. 3.1.5.1.1 Adult Day Services respite is defined as respite provided in a licensed Adult Day Services facility. This service not only relieves the primary caregiver but also provides a therapeutic environment for the care recipient. 3.1.5.1.1.1 Regular attendance should be scheduled for 2 days per week and may not exceed 2 days per week. 3.1.5.1.1.2 Adult Day Services Respite cannot be used in conjunction with in-home or institutional respite. 3.1.5.1.1.3 A care recipient who is no longer appropriate for Adult Day Services and has only partially used their days, may transfer to another type of respite service with approval of the Division Contract Manager. 3.1.5.1.1.3.1 Services will not exceed 104 days per client per contract year for Adult Day Services Respite. 4.0 SERVICE AREA 4.1 The Respite program is available to all eligible persons within Delaware subject to availability of the service. 4.2 Providers may apply for sub-areas of the State. 5.0 ELIGIBILITY & PRIORITY 5.1 Respite care funded by Title III-E is available only to those clients who would not otherwise qualify for this service under any other program, except Title III-B. Individuals may qualify for Title III-B and/or Title III-E respite; however the individual cannot be served by both programs in a contract year. A request for Title III respite over 260 hours per client per contract year requires written approval from the Division Contract Manager. 5.2 Criteria that providers will use to determine client eligibility for Title III-E respite include, but are not limited to, the following; 5.2.1 Care recipient must be a resident of the State of Delaware 5.2.2 Client is age 60 or older, or under age 60 with a medical diagnosis of early onset dementia (i.e. Alzheimer’s Disease) 5.2.3 Care recipient is unable to perform at least two activities of daily living (ADL’s) (refer to section 1.7.2 & 1.7.3) 5.2.4 Client is currently receiving substantial in-home care from a principal caregiver (refer to section 1.7.1) 5.3 Priorities: 5.3.1 Priority shall be given to the following: 5.3.1.1 Caregivers who are older individuals with greatest social need; and 5.3.1.2 Caregivers with greatest economic need (with particular attention to low-income older individuals); and 5.3.1.3 Older individuals providing care to individuals with severe disabilities and 5.3.1.4 Persons providing care for individuals with Alzheimer’s disease or related disorder; or, neurological or organic brain disorder; and 5.3.1.5 Persons residing in rural areas. 5.3.2 Priority for respite care should go to those individuals meeting the above conditions who are otherwise eligible for admission to a nursing care facility if they do not receive respite care. 5.3.3 Priority for respite care in an Adult Day Care setting will go to caregivers who reside with the care recipient and who provide 24 hour care. 6.0 SERVICE STANDARDS 6.1 Respite services must meet or exceed the following standards: 6.1.1 The agency must meet and comply with all Federal, State and local rules, regulations and standards applying to the service being provided. 6.1.2 The agency must have the capacity to provide, at a minimum, the following service components based on the care recipient’s individualized care plan: 6.1.2.1 Household duties such as light cleaning, laundry and meal preparation 6.1.2.2 Personal care services for the care recipient such as; bathing, shampooing, shaving, dressing and toileting 6.1.2.3 Companionship 6.1.2.4 Training / Instruction / Cueing 6.1.3 The agency must complete a caregiver and care recipient assessment form as provided by the C.A.R.E. Delaware administrator in order to comply with statistical reporting requirements of the Older Americans Act. 6.1.4 Client records must be kept in a secure location to protect confidentiality. 6.1.5 Staff must be fully trained, qualified, and when applicable, licensed to provide service. 6.1.6 Agency must maintain, follow, and continually update a training and supervision program to make sure respite staff are fully trained and familiar with agency procedures. 6.1.7 Agency must assign staff with appropriate qualification levels to meet the needs of clients while providing the service in the most economical manner possible. 6.1.8 All requests for service must be processed within five (5) working days of receipt, including identification of possible eligibility for respite service funded from a source other than the Division of Services for Aging and Adults with Physical Disabilities. 6.1.9 In-home case assessments must be done within five (5) working days of receipt of application, unless there is a prioritized waiting list. 6.1.10 A plan of care must be developed for each new client within five working days after enrollment. 6.1.11 In developing the plan of care, the client must be 1) unable to perform two or more activities of daily living without substantial human assistance, including verbal reminding, physical cueing or supervision; or 2) due to a cognitive or other mental impairment, requires substantial supervision because the individual behaves in a manner that poses a serious health or safety hazard to the individual or others. 6.1.12 The provider agency must prepare an Individualized Care Plan for the client. The plan must identify those services to be provided to the client in relief of the caregiver. The caregiver must play an integral role in the development of the care plan to ensure that the hours and services provided meet their needs and the needs of the client. 6.1.13 Assessments and reassessments must be done by a Registered Nurse (RN); or, by a Licensed Practical Nurse (LPN), with the RN supervisor co-signing the assessments and reassessments. 6.1.14 Service must be provided by a licensed agency or facility when applicable. 6.1.15 Clients must be reassessed every six (6) months, with revisions made in the plan of care as necessary and to determine if services currently provided through the program continue to meet the needs of the client. Any observed changes must be immediately noted in the client plan of care. 6.1.16 A caregiver assessment must be completed at the initial interview, and every six (6) months thereafter. These written assessments of the caregiver’s needs should become part of the client’s permanent case file, and be available for review during monitoring or other auditing sessions. Caregiver’s assessments should be detailed and thorough, with adjustments in service hours where applicable, to ensure the caregiver’s needs remain the primary focus and are being met to the best of the provider’s ability. 6.1.17 Caseload must be reviewed whenever a vacancy arises (or more frequently) to make sure priority clients are being served. 6.2 Prohibited service components: 6.3 For purposes of planning and reimbursement, respite service may not include any of the following: 6.3.1 Persons eligible under some other financing program (i.e. Elderly & Disabled Waiver), unless on a temporary basis until eligibility is confirmed. Exceptions must receive approval from the Division Contract Manager on a case-by-case basis. 6.3.2 Nursing care, unless provided by a Registered Nurse or Licensed Practical Nurse. 6.3.3 Nail or foot care of diabetics. 6.3.4 Lawn care, garden care, raking or snow removal. 6.3.5 Heavy-duty cleaning, furniture moving, or other heavy work. 6.3.6 Financial or legal advice or services (except for referral to qualified agencies or programs). 6.3.7 More than 260 hours of respite care per client per contract year for in-home or institutional respite. 6.3.8 More than 104 days of respite care per client per contract year for Adult Day Services respite. 6.3.9 Using respite hours to extend approved personal care (Exceptions must be approved, in writing, by the Division Contract Manager). 6.3.10 Providing service to persons less than sixty years of age unless they have a medical diagnosis of early onset dementia (Caregiver may be of any age). 7.0 WAITING LISTS 7.1 When the demand for service exceeds the ability to provide the service, a waiting list is required. Applicants will be placed on the waiting list until services can be provided; or, until the applicant no longer desires services. The waiting list must be managed in accordance with DSAAPD Policy Manual for Contracts, Policy Log Number X-K, Client Waiting Lists. In all cases, the reason for the selection of an individual ahead of others on the waiting list must be documented (e.g. in writing and available for review). 8.0 INVOICING REQUIREMENTS 8.1 The provider will invoice DSAAPD pursuant to the DSAAPD Policy Manual for Contracts, Policy Log Number X-Q, Invoicing. 8.2 The following information will also be included on the invoice: 8.2.1 Legal name of care recipient 8.2.2 Hours provided per care recipient 8.2.3 Rate of service provided 9.0 DONATIONS 9.1 Care recipients, family members, and/or caregivers must be informed of the cost of providing respite service and must be offered the opportunity to make voluntary contributions based on a recommended donation scale (provided by DSAAPD) to help defray the cost, thereby making additional service available to others. 9.2 Service cannot be withdrawn or refused, as a result of a client’s refusal to donate. 9.3 With regard to voluntary contributions, providers must: 9.3.1 Protect privacy and confidentiality with respect to client and caregiver declaration of income. 9.3.2 Safeguard and account for all donations. 9.3.3 Use the contributions to expand services. 9.4 Invoices should reflect total amount due, less donations, for example: Total Invoice for October: $1,200.00 Donations Collected in October: $ -200.00 Total Due from DSAAPD for October: $1,000.00 Attachment B: Description of Allowable Cost DESCRIPTION OF ALLOWABLE COSTS DESCRIPTION OF LINE ITEMS Salaries and Wages Project Directors, Supervisors, Site Managers, Healthcare workers, Nutritionists, Clerks, Accountants, Bookkeepers, Janitors, Drivers, Case Managers, Outreach Workers, Secretaries, Training Instructors, Laborers, Executive Directors, Dietitians, Activity Coordinators, etc. Fringe Benefits Proportionate fringe benefits for above labor including Social Security, unemployment compensation, life insurance, worker’s compensation, health insurance, pension, etc. paid by the agency. Travel/Training Include any staff training costs. Mileage reimbursement shall be a maximum of $.40 per mile. Training may include subscriptions and association dues. Contractual Services Rent, utilities, repairs (building, vehicle, equipment, etc.), telephone, advertising, printing, transportation insurance, vehicle, communication, consultants, tax preparation, storage, audit costs, etc. Supplies Vehicle supplies (not repairs), health supplies, program supplies, office supplies, janitorial, building (not sub-contracts), educational, medical, any type of meals purchased, etc. Other/Equipment Any items or lot costing $1000.00 and a useful life of one (1) year or more. Requests for equipment will be considered. A justification must be submitted for any item of equipment requested. Include in the justification: Is equipment requested a replacement for existing equipment or in addition to existing equipment. And, what is the impact on the agency’s capacity to provide services to consumers or improve administrative capacity. Indirect Cost If the provider has a federal or state approved indirect cost rate, it may be used. The use of a federal or state approved rate may be negotiated with DSAAPD. Attachment B Budget Worksheets and Instructions Contract Budget Package Instructions December 2007 Introduction to the DSAAPD Budget Package This budget package is a standardized format for all DSAAPD contracts. It replaces all contract budget formats and forms previously used. The budget package is an Excel workbook. The workbook consists of: 1. Salary Worksheet 2. Budget Worksheet 3. Budget Worksheet Supplement 4. Final Budget 5. Matching Funds Worksheet 6. Comparison Worksheet Portions of the budget workbook and its worksheets are automated. Some items are calculated by the worksheet and some are transferred from other areas of the worksheet and workbook. As a result, the Salary and Budget worksheets require the most entries and time. Questions should be directed to the program manager. Definitions and Other Helpful Information * A complete budget package must be submitted for each service. Save and rename a copy of the budget workbook file for each service. * It is useful to keep a running list of fixed and variable costs. Fixed costs are those that remain the same as units of service increase or decrease. Variable costs change as the units of service increase or decrease. * Develop a methodology for allocation of costs to each funding stream. This will speed the completion of the salary, fringe benefit and budget worksheets. In reviewing the budget proposal, DSAAPD may ask for an explanation of the methodology. * When a worksheet is printed, the validation column will not print. * Funding stream refers to the source of funds for each service/program. o Older Americans Act (OAA): includes federal Older Americans Act funds, such as Title III, federal NSIP and state funds administered in conjunction with the OAA funds. o SSBG: federal Social Services Block Grant funds and state funds administered in conjunction with the SSBG funds.. o State: legislative appropriations to DSAAPD o Tobacco: funds available to DSAAPD from the Tobacco Settlement Agreement. o USDA: commodity foods made available by the US Department of Agriculture. o Local Cash: funds from local sources such as town/city/county government, United Way, and foundations. State Grant-In-Aid is considered local cash. o In-kind: non-cash contributions provided by third parties and the contractor. Third party and contractor in-kind contributions may be in the form of staff time, real property, equipment, supplies and other expendable property, and the value of goods and services directly benefiting and specifically identifiable to the project or program. o Program Income: client contributions, donations and fees; payments from staff and guests for the full cost of meals consumed; income earned from contract supported activities, such as the sale of arts and crafts, bazaars, dinners, dances, and any other fund-raising activity supported by contract funds; interest income earned from program funds. ? Budgeting Program Income: In this budget process, program income is built into the budget. A reasonable estimate of the program’s project income must be made at the beginning of the process. The estimate is based on the agency’s program income history. If the trend over each o the last three years has been an increase of 5% per year, use that percent in your estimations. If total program income has gone up and down over the last 3 -5 years, use the 3-5 year average as the basis for the estimate. * Indirect Costs are those costs that have been incurred for common or joint objectives, and thus are not readily subject to treatment as direct costs of a specific program/service or other ultimate or revenue producing cost centers. * Administrative costs are those costs of doing business which are not direct service costs. For example, the salary of the “project director” is part administrative and part direct service. The time completing forms, updating records, reviewing and approving invoices, compiling reports are classified as administrative cost. Instructions for Completing the DSAAPD Contract Budget Package * Each service must have its own budget package. * The program manager will provide additional instructions as appropriate. * Before beginning – save the budget package file with a new name for each service/program. * OAA programs must complete the “Local Cash/In-kind” and “Program Income” columns. The Local Cash/In-kind column must reflect the required 10% local match or as negotiated for Title V contracts. * OAA programs must complete the “Matching Funds Worksheet.” (Red Tab) * SSBG programs do not complete the “Local Cash/In-kind” and “Program Income” columns and the “Matching Funds Worksheet.” * State funded programs do not complete the “Local Cash/In-kind” and “Program Income” columns and the “Matching Funds Worksheet.” * Tobacco funded programs do not complete the “Local Cash/In-kind” and “Program Income” columns and the “Matching Funds Worksheet.” * No entries are needed or permitted in the areas shaded light blue, pale yellow/beige or orange. * The orange column is the validation column. The value for this column should be either zero or “True”. If it is not, then too much or too little money has been entered. * The three (3) grey columns on the right side of each worksheet are for provider use. This information does not need to be transmitted to DSAAPD. Step 1 Salary Worksheet The first step in the development of the budget is to complete the Salary Worksheet. In the boxes provided, enter the agency name, program/service and contract year for this budget. The contract year should be entered in the month/day/year format (July 1, 20XX to June 30, 20XX; October 1, 20XX to September 30, 20XX, etc.). The words “Agency,” “Program” and “Contract Year” will be replaced by the entries. NOTE: If additional rows are needed to list staff, use the Excel “insert rows” command anywhere between row 10 and row 34. Column A. Name of Staff In this column list the name of each person scheduled to work on the project. If this is a new position or currently a vacant position, put “To Be Hired” in this column. Nonprofessional staff can be combined in a single line (ex., all direct care staff such as aides) indicating all staff in that position. B. Title/Position In this column, enter the title or position of each person or group of persons. Important: For the lines where “Name of Staff” or “Title/Position” are blank, leave the “1” in this column. C. Project Hours Replace the “1” with the number of hours per week each individual will work in this project. If a group of nonprofessional staff has been combined on a single line, leave the “1” in this column for that line. Important: For the lines where “Name of Staff” or “Title/Position” are blank, leave the “1” in this column. D. Total Hours Enter the total number of hours per week each individual is scheduled to work for the agency in all activities. This number may be more than the number of project hours. For example, if the individual is a part time employee in your agency, enter the total number of hours that employee is on the payroll – if a person works 20 hours per week enter 20 hours. If the employee works 20 hours a week on the project and is a full time employee, enter the number of hours per week that is considered full-time by the agency for that employee such as 40 hours. If a group of nonprofessional staff has been combined on a single line, leave the “1” in this column for that line. Important: For the lines where “Name of Staff” or “Title/Position” are blank, leave the “1” in this column. E. Annual Salary Enter the total annual salary for each individual. This may be more than the salary paid from project funds. The annual salary is the payment for the total number of number of hours the employee works for the agency as a whole, not just for this contract. If a group of nonprofessional staff has been combined on a single line, enter the total amount this group will be paid. F. % of Time on Project This is the percent of the individual’s total work time that is spent on this project. The percentage is automatically calculated. G-L. Salary Breakouts In columns G through L, indicate the dollar amount of salary paid from each funding stream used in this contract, as appropriate. The individual’s salary may be paid from just one funding stream or more than one. For example, part of salary is paid with Older Americans Act funds and the balance by local cash. M. Total Contract Salary This column calculates from columns E and F using the formula E*F and must equal the sum of Columns G through L on each line. Line 34 Total The totals are automatically calculated. Line 35 Column F Enter the percentage that fringe benefits are of salaries. The amount each funding stream pays for fringe benefits is calculated automatically. On the Budget Worksheet Supplement, provide detail on the items included in fringe benefits and the percent each item is of total fringe benefits. Line 36 Column F Indirect Costs are those costs that have been incurred for common or joint objectives, and thus are not readily subject to treatment as direct costs of a specific program/service or other ultimate or revenue producing cost centers. If the agency wants to charge an indirect cost, it must have an approved indirect cost rate; enter the lesser of the approved rate or the maximum rate allowed by the Division. A copy of the federal or state agency approval must be submitted with this application. An approved indirect cost rate must be applied to gross salaries and wages only. Public Agencies (city, county, public government body): The indirect cost rate is negotiated with and approved by the U.S. Department of Health and Human Services or other applicable federal agency. Private Agencies (non-governmental organizations): If a private agency is not receiving federal funds directly from a federal agency, an indirect cost rate is negotiated with and approved by DSAAPD. Line 35 Columns G-M These values are calculated using the percentage entered in Column F times the total salaries paid by each funding stream. These values are automatically calculated. Step 2 Budget Worksheet Note: Sections C-1 and C-2 are automatically imported from the Salary Worksheet. For sections C-3 through C-9, no entries are needed or permitted in the light blue, pale yellow/beige and orange shaded areas. Administration Column In this column enter the dollar value of the administrative cost included in the “Total” column for each line item. Administrative costs are those costs of doing business which are not direct service costs. For example, the salary of the “project director” is part administrative and part direct service. The time completing forms, updating records, reviewing and approving invoices, compiling reports are classified as administrative cost. If the agency has an indirect cost rate, no entry should be made in this column for any line item that is included in the indirect cost rate. Validation Column For each line, the value in Column C must be equal to the values in Columns D through J. The validation column subtracts the total of Columns D through J from Column C. The validation column must be equal to zero. If it is not zero, too much or too little money has been allocated. Budget Worksheet Supplement For each section, use the Budget Worksheet Supplement to explain how a particular cost was calculated, explain why a certain cost is necessary or provide more information to clarify items in “Other Specify”. This is the budget justification, budget narrative. Suggestion: Develop your justification in Word. Cut and paste each paragraph in a single cell on the worksheet. The cell will wrap the text and expand the cell to fit the paragraph. Section C-3 Travel and Training Expenses Line 12 Line 12 is the sum of lines 13 through 15. The values for this line are automatically calculated. Mileage Mileage expense is the projected number of miles that will be driven by staff and volunteers in their personal vehicles for agency purposes multiplied by the rate per mile reimbursement. This rate cannot exceed DSAAPD’s maximum allowable of forty-four cents ($0.40) per mile. If an agency chooses to exceed the DSAAPD maximum, it may do so as long as the amount over the maximum is paid by the agency from local or other sources. In Column C, enter the value of the total number of miles multiplied by the reimbursement rate. Allocate the cost in Column C to each funding stream (Columns D through I). Training In Column C, enter the planned total cost for staff training. This may include such things as registration fees, meeting space rental, trainer/consultant, breaks/meals. In columns D through I allocate the cost to the appropriate funding streams. Section C4 Contractual Line 16 Line 16 is the sum of Lines 17 through 28. The values for this line are automatically calculated. Line 17 Rent Enter the cost of space rental. Allocate the cost in Column C to each funding stream. Use the Budget Worksheet Supplement to identify each space rented, the square footage and the cost per square foot. Lines 18-24 Electricity Heat Telephone/Internet Utilities (Other) Printing/Advertising Postage Insurance Enter the total cost for each line item and allocate the cost to the appropriate funding stream(s). Line 25 Repairs Use the Budget Worksheet Supplement to describe the proposed repairs and the need for them. Lines 26-28 Other Specify Use the Budget Worksheet Supplement to identify each cost. Section C5 Supplies Line 29 Line 29 is the sum of the lines 30 through 39. The values for this line are automatically calculated. Lines 30-37 Office Supplies Paper Supplies Medical Supplies Photocopy Raw Food Prepared Meals Vehicle (oil, gas, etc) Enter the total cost for each line item and allocate the cost to the appropriate funding stream(s). Lines 38-39 Other (Specify) Use the Budget Worksheet Supplement to identify each “other specify” item. Section C6 Equipment/Other Direct Costs If existing equipment is being used as match, it should be shown as a cost. Use the Budget Worksheet Supplement to describe the methodology for determining the budgeted amount. If replacement or additional equipment is being requested, use the Budget Worksheet Supplement to provide details on the specific piece of equipment requested and explain why it is needed. Line 40 Line 40 is the sum of lines 41 through 42. The values for this line are automatically calculated. Section C7 Indirect Costs The values for this section are transferred from the Salary Worksheet. Section C8 Total Budget These values are calculated by the worksheet. Section C9 Total Budget Without Local Cash or In-kind This value is calculated by the worksheet. Step 3 Final Budget NOTE: The final budget imports the values from the Budget Worksheet except for units of service. Cost Reimbursement Contracts All needed information has been imported from the Budget Worksheet. Do not enter any additional information. Budget rmation. Unit Cost Contracts For each funding stream, enter the planned number of service units to be provided. The unit reimbursement rate is calculated by the form. Step 4 Matching Funds – Older Americans Act Only (Red Tab) Older Americans Act funds may be used for no more than 90% of the program/service cost. Local resources must be used for 10% (or as negotiated for Title V) of program/service costs. In-Kind Enter the source and value of each in-kind resource used as match. Local Cash Enter the source and the amount of all cash used for match. Validation D23 D24 This cell calculates the required match and then subtracts it from the Grand Total (cell C23). The result must be zero. If the result is negative, additional match is required. This cell compares the Grand Total (C23) with the amount of Local cash and in-kind budgeted on the Budget Worksheet H44. Matching Funds Worksheet C23 must be less than or equal to Budget Worksheet H44. True is the required response. If False is the response, then more local cash and in-kind is shown on the Matching Funds Worksheet than is budgeted on the Budget Worksheet. Step 5 Comparison Worksheet Current Budget In this column enter the budgeted amounts for each item for the current contract year. Note: If budget pages are being completed for a new contract or an RFP, no entries are required. DO NOT enter amounts for current contract year. Proposed Budget No entries are required. The entries are automatically completed. Variance No entries are required. This column automatically calculates the percent change. A B C D E F G H I J K L M 2 SALARY WORKSHEET 3 4 Agency: Program/Service: 5 Contract Year: Name of Staff Title/Position Project Hours Total Hours Annual Salary % of Time on Project Salary Paid with OAA Funds Salary Paid with SSBG Funds Salary paid with State Funds Salary Paid with Tobacco Funds Salary Paid with Local Cash/In-kind Salary Paid with Program Income Total Contract Salary 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 29 28 30 31 32 33 34 35 Totals 36 Fringe Benefits 37 Indirect Cost A B C D E F G H I J K 2 BUDGET WORKSHEET 3 4 5 Agency: Program/Service: 6 Contract Year: Budget Items TOTAL OAA NSIP SSBG State Tobacco Local Cash In-Kind Program Income USDA Administrative 10 C-1 Staff Salaries 11 C-2 Staff Fringe Benefits 12 C-3 Travel/Training (Total) 13 Mileage = Rate $0.00 x 0000 14 Training 15 Other (Specify) 16 C-4 Contractual (Total) 17 Rent (include cost per sq. ft.) 18 Electricity 19 Heat 20 Telephone/Internet 21 Utilities Other 22 Printing/Advertising 23 Postage 24 Insurance 25 Repairs (Specify 26 Other (Specify) 27 Other (Specify) 28 Other (Specify) 29 C-5 Supplies (Total) 30 Office Supplies 31 Paper Supplies 32 Medical Supplies 33 Program Supplies 34 Photocopy 35 Raw Food 36 Prepared Meals 37 Vehicle (oil, gas, etc.) 38 Other (Specify) 39 Other (Specify) 40 C-6 Equipment/Other Direct Cost (Total) 41 Specify 42 Specify 43 C-7 Indirect Cost (Total Salaries w/o Fringe Rate) 44 C-8 Total Budget 45 C-9 Total Budget w/o Local Cash or In-Kind A B C D E F G 2 FINAL BUDGET 3 4 Agency: Program/Service: 5 Contract Year: 6 7 BUDGET ITEMS BUDGET 8 9 10 C-1 Staff Salaries (Attach Salary Back Up Schedule) 11 C-2 Staff Fringe Benefits 12 C-3 Travel / Training (Total) 13 C-4 Contractual (Total) 14 C-5 Supplies (Total) 15 C-6 Equipment / Other Direct Cost (Total) 16 C-7 Indirect Cost (Total Salaries w/o fringe x rate) 17 C-8 Total Budget w/o Local Cash or In-Kind 18 OAA SSBG State Tobacco 19 Planned Units of Service 20 Unit Cost 21 Planned Program Income 22 Program Income per unit of Service 23 Other Resources (USDA Commodities) 24 DSAAPD Resources Needed OAA SSBG State Tobacco 25 Total Resources w/o Local Cash / In-Kind 26 Reimbursement Rate 27 28 29 30 DSAAPD Resources Needed = Total Budget (w/o Local Cash or In-Kind) – Program Income – Other Resources (Commodities) Rate = Unit Cost – Program Income Cost Per Unit – Other Resources Cost Per Unit 31 BUDGET WORKSHEET SUPPLEMENT Agency: Program/Service: Contract Year: C-1 Staff Salaries C-2 Staff Fringe Benefits C-3 Travel / Training BUDGET WORKSHEET SUPPLEMENT Agency: Program/Service: Contract Year: C-4 Contractual C-5 Supplies C-6 Equipment / Other Direct Costs Explain how PROGRAM INCOME was determined Explain how INDIRECT COST was determined A B C 5 MATCHING FUND WORKSHEET (OAA FUNDING ONLY) 6 7 8 9 Agency: 10 Contract Year: 11 Program/Service 12 13 Source of Funds Detailed Description of Revenue Source Amount 14 (A) In- Kind Contribution 15 16 17 18 TOTAL 19 (B) Local Cash 20 21 22 23 TOTAL 24 GRAND TOTAL A B C D E F 1 COMPARISON WORKSHEET 2 3 4 5 Agency: Program / Service: 6 Contract Year: 7 8 A. Projected Contract Expenses Current Proposed 9 % Line Item Change Contract Contract Variance 10 1. Salary 11 2. Fringe Benefits 12 3. Travel / Training 13 4. Contractual 14 5. Supplies 15 6. Equipment / Other (specify) 16 7. Indirect Costs 17 8. Total Projected 18 Contract Expenses 19 20 B. Project Revenue (Funding Sources) 21 1. Total DSAAPD Funds Requested 22 ? Final Budget 23 2. Other Revenue Sources 24 ? USDA 25 ? Project Income 26 3. Total Contract Revenue 27 28 C. Units of Service 29 *Total Contract Revenue must equal Total Contract Expenses *Total DSAAPD Funds is the sum of Title III & NSIP Cash or SSBG 30 Attachment C: Attached Forms to be Completed * Mandatory Submissions Requirements Checklist * Proposal Response Table of Contents * Bidder’s Signature Form * Office of Minority and Women Business Enterprise Self-Certification Tracking Form * Compliance Form * Certification Sheet * Notification to Bidders Attachment C: Mandatory Submission Requirements Checklist Mandatory Submission Requirements Checklist Mandatory Submission Requirement RFP Section Compliance Y or N The bid is submitted no later than the closing date and time 3.2 The correct number of copies of each proposal is submitted 3.2 Transmittal Letter submitted on official business letterhead and signed by an authorized representative 5.1.9 Most recent audit report 4 Copy of current business license or Form 501 C 3.7 Completed Budget Worksheets Attachment B The required forms are submitted: * Mandatory Submission Requirements Checklist * Proposal Response Table of Contents * Bidder’s Signature Form * Office of Minority and Women Business Enterprise Self-Certification Tracking Form * Compliance Form * Certification Sheet * Notification to Bidders Attachment C _________________________________________ Signature of Authorized Representative _________________________________________ Title / Company _______________ Date Attachment C: Proposal Response Table of Contents PROPOSAL RESPONSE TABLE OF CONTENTS AGENCY NAME _________________________________________ _ Section 1: Application Identification and Contents Page # Table of Contents (Insert Proposal Response Table of Contents with corresponding page #s.) Bidder’s Signature Form (Attachment C) Office of Minority and Women Business Enterprise Self-Certification Tracking Form (Attachment C) Compliance Form (Attachment C) Certification Sheet (Attachment C) Notification to Bidders (Attachment C) Mandatory Submission Requirements Checklist (Attachment C) General Instructions for Submission of Proposal (Section 3) Terms and Conditions (Section 4) Transmittal Letter (Section 5.1.8) Section 2: Technical Proposal Corporate Qualifications (Section 5.2.1) Work Plan (Section 5.2.2) Project Staffing and Organization (Section 5.2.3) Section 3: Budget Proposal Budget Worksheets and Supplements (Section 5.3.1) Section 4: Appendices Appendix A: Resumes of Professional Staff Appendix B: Job Descriptions Appendix C: Program and Agency Organizational Charts Appendix D: Service Specifications (Attachment A) Appendix E: Audit (one copy) Appendix F: Emergency Preparedness Plan Appendix G: Delaware Business License or 501 C Form Attachment C: Bidder’s Signature Form DELAWARE HEALTH AND SOCIAL SERVICES REQUEST FOR PROPOSAL BIDDERS SIGNATURE FORM NAME OF BIDDING AGENCY: _____________________________________________ SIGNATURE OF AUTHORIZED PERSON: ____________________________________ TYPE IN NAME OF AUTHORIZED PERSON: TITLE OF AUTHORIZED PERSON: STREET NAME AND NUMBER: CITY, STATE, & ZIP CODE: CONTACT PERSON: TELEPHONE NUMBER: FAX NUMBER: DATE: BIDDER’S FEDERAL EMPLOYERS IDENTIFICATION NUMBER: DELIVERY DAYS/COMPLETION TIME: F.O.B.: TERMS: THE FOLLOWING MUST BE COMPLETED BY THE VENDOR: AS CONSIDERATION FOR THE AWARD AND EXECUTION BY THE DEPARTMENT OF HEALTH AND SOCIAL SERVICES OF THIS CONTRACT, THE (COMPANY NAME) HEREBY GRANTS, CONVEYS, SELLS, ASSIGNS, AND TRANSFERS TO THE STATE OF DELAWARE ALL OF ITS RIGHTS, TITLE AND INTEREST IN AND TO ALL KNOWN OR UNKNOWN CAUSES OF ACTION IT PRESENTLY HAS OR MAY NOW HEREAFTER ACQUIRE UNDER THE ANTITRUST LAWS OF THE UNITED STATES AND THE STATE OF DELAWARE, RELATING THE PARTICULAR GOODS OR SERVICES PURCHASED OR ACQUIRED BY THE DELAWARE HEALTH AND SOCIAL SERVICES DEPARTMENT, PURSUANT TO THIS CONTRACT. Attachment C: Office of Minority and Women Business Enterprise Self-Certification Tracking Form OFFICE OF MINORITY AND WOMEN BUSINESS ENTERPRISE SELF-CERTIFICATION TRACKING FORM IF YOUR FIRM WISHES TO BE CONSIDERED FOR ONE OF THE CLASSIFICATIONS LISTED BELOW, THIS PAGE MUST BE SIGNED, NOTARIZED AND RETURNED WITH YOUR PROPOSAL. COMPANY NAME NAME OF AUTHORIZED REPRESENTATIVE (Please print) SIGNATURE COMPANY ADDRESS TELEPHONE # FAX # EMAIL ADDRESS FEDERAL EI# STATE OF DE BUSINESS LIC# Note: Signature of the authorized representative must be of an individual who legally may enter his/her organization into a formal contract with the State of Delaware, Delaware Health and Social Services. Organization Classifications (Please circle) Women Business Enterprise (WBE) Yes/No Minority Business Enterprise (MBE) Yes/No Please check one--- Corporation Partnership Individual For appropriate certification (WBE), (MBE), (DBE) please apply to Office of Minority and Women Business Enterprise Phone # (302) 739-4206 L. Jay Burks, Executive Director Fax# (302) 677-7086 Certification # Certifying Agency http://www.omwbe.delaware.gov SWORN TO AND SUBSCRIBED BEFORE ME THIS ______________DAY OF ___________20________ NOTARY PUBLIC_________________________MY COMMISION EXPIRES ____________________ CITY OF _________________________COUNTY OF _________________STATE OF________________ DEFINITIONS The following definitions are from the State Office of Minority and Women Business Enterprise. Women Owned Business Enterprise (WBE): At least 51% is owned by women, or in the case of a publicly owned enterprise, a business enterprise in which at least 51% of the voting stock is owned by women; or any business enterprise that is approved or certified as such for purposes of participation in contracts subject to women-owned business enterprise requirements involving federal programs and federal funds. Minority Business Enterprise (MBE): At least 51% is owned by minority group members; or in the case of a publicly owned enterprise, a business enterprise in which at least 51% of the voting stock is owned by minority group members; or any business enterprise that is approved or certified as such for purposes of participation in contracts subjects to minority business enterprises requirements involving federal programs and federal funds. Corporation: An artificial legal entity treated as an individual, having rights and liabilities distinct from those of the persons of its members, and vested with the capacity to transact business, within the limits of the powers granted by law to the entity. Partnership: An agreement under which two or more persons agree to carry on a business, sharing in the profit or losses, but each liable for losses to the extent of his or her personal assets. Individual: Self-explanatory For certification in one of above, the bidder must contract: L. Jay Burks Office of Minority and Women Business Enterprise (302) 739-4206 Fax (302) 739-1965 Attachment C: Compliance Form DELAWARE HEALTH AND SOCIAL SERVICES REQUEST FOR PROPOSAL STATEMENTS OF COMPLIANCE FORM As the official representative for the contractor, I certify on behalf of the agency that (Company Name) will comply with all Federal and Delaware laws and regulations pertaining to equal employment opportunity and affirmative action. In addition, compliance will be assured in regard to Federal and Delaware laws and regulations relating to confidentiality and individual and family privacy in the collection and reporting of data. Authorized Signature: Title: Date: Attachment C: Certification Sheet DELAWARE HEALTH AND SOCIAL SERVICES REQUEST FOR PROPOSAL CERTIFICATION SHEET As the official representative for the proposer, I certify on behalf of the agency that: a. They are a regular dealer in the services being procured. b. They have the ability to fulfill all requirements specified for development within this RFP. c. They have independently determined their prices. d. They are accurately representing their type of business and affiliations. e. They will secure a Delaware Business License. f. They have acknowledged that no contingency fees have been paid to obtain award of this contract. g. The Prices in this offer have been arrived at independently, without consultation, communication, or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other contractor or with any competitor; h. Unless otherwise required by Law, the prices which have been quoted in this offer have not been knowingly disclosed by the contractor and prior to the award in the case of a negotiated procurement, directly or indirectly to any other contractor or to any competitor; and i. No attempt has been made or will be made by the contractor in part to other persons or firm to submit or not to submit an offer for the purpose of restricting competition. j. They have not employed or retained any company or person (other than a full-time bona fide employee working solely for the contractor) to solicit or secure this contract, and they have not paid or agreed to pay any company or person (other than a full-time bona fide employee working solely for the contractor) any fee, commission percentage or brokerage fee contingent upon or resulting from the award of this contract. k. They (check one) operate _____ an individual; _____ a Partnership _____ a non-profit (501 C-3) organization; _____ a not-for-profit organization; or _____ for profit corporation, incorporated under the laws of the State of ________________________. l. The referenced offerer has neither directly or indirectly entered into any agreement, participated in any collusion or otherwise taken any action in restraint of free competitive bidding in connection with this bid submitted this date to Delaware Health and Social Services. m. The referenced bidder agrees that the signed delivery of this bid represents the bidder’s acceptance of the terms and conditions of this invitation to bid including all Specifications and special provisions. n. They (check one): _______ are; ______ are not owned or controlled by a parent company. If owned or controlled by a parent company, enter name and address of parent company: __________________________________________ __________________________________________ __________________________________________ __________________________________________ Violations and Penalties: Each contract entered into by an agency for professional services shall contain a prohibition against contingency fees as follows: 1. The firm offering professional services swears that it has not employed or retained any company or person working primarily for the firm offering professional services, to solicit or secure this agreement by improperly influencing the agency or any of its employees in the professional service procurement process. 2. The firm offering the professional services has not paid or agreed to pay any person, company, corporation, individual or firm other than a bona fide employee working primarily for the firm offering professional services, any fee, commission, percentage, gift, or any other consideration contingent upon or resulting from the award or making of this agreement; and 3. For the violation of this provision, the agency shall have the right to terminate the agreement without liability and at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. The following conditions are understood and agreed to: a. No charges, other than those specified in the cost proposal, are to be levied upon the State as a result of a contract. b. The State will have exclusive ownership of all products of this contract unless mutually agreed to in writing at the time a binding contract is executed. Date Signature & Title of Official Representative Type Name of Official Representative Attachment C: Notification to Bidders Notification to Bidders Vendor/Predecessor Firm Name State Department and Division Contact Name, Address and Phone Number Period of Performance Contract Number Amount Sample Vendor Firm Name DHSS \ DMS Contact Name 1901 N DuPont Highway New Castle, DE 19720 302.999.9999 01/01/2002 – 12/31/2002 PSC-999999 $100,000 Bidder shall list all contracts awarded to it or its predecessor firm(s) by the State of Delaware during the last three (3) years, by State Department, Division, Contact Person (with address/phone number), period of performance, contract number and amount. The Evaluation/Selection Review Committee will consider these additional references and may contact each of these sources. Information regarding bidder performance gathered from these sources may be included in the Committee's deliberations and factored in the final scoring of the bid. Failure to list any contract as required by this paragraph may be grounds for immediate rejection of the bid. List contracts in the format specified. Include those contracts whose period of performance has been within the past three (3) years in addition to those awarded within this timeframe. Contracts with amendments only have to be listed once. If a vendor has had no contracts within this timeframe, enter “No contracts to specify” under Vendor/Predecessor Firm Name in the first row of the table. iii Title III-E Respite Care Services RFP PSCO 820 76 Personal Attendant Services RFP PSCO 811