Job and Family Services Respect Care Protect

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1 REQUEST FOR PROPOSALS Date Issued: March 7, 2016 Proposals Due: 11:15 A.M. March 31, 2016 Bidders must submit three (3) hard copies in a sealed envelope entitled: 2016 TANF Summer Youth Employment c/o Mercer County Commissioners Office 220 W. Livingston St. Suite 201 Celina, Ohio NOTE: Three (3) hard copies must be received by the submission date at the address listed above in order to be considered. Faxed or ed proposals will not be accepted. Bidders Conference 2:00 P.M. March 17, 2016 Central Services Building 1 ST Floor Conference 220 W. Livingston St. Celina, Ohio Purpose Mercer County Job and Family Services Respect Care Protect Mercer County Job and Family Services is currently soliciting proposals for providers of paid summer employment programs for lowincome Mercer County youth ages and Foster Children ages Subsidized employment provides valuable skills and work experience for young people and serves as a stepping stone to unsubsidized employment. Programs can provide summer employment opportunities as work crew(s) or customized individual placements. Providers can place youth at government, non-profit, or private sector worksites. Summer youth program participants cannot displace or jeopardize the status of current employees. In addition, youth work experience participants should not replace the work of employees who have experienced layoffs (see 20 CFR for non-displacement requirements). TANF Summer Youth Employment Programs will allow eligible low income youth the opportunity to gain valuable work experience while earning a paycheck to help meet basic needs. Programs to provide additional summer employment opportunities are estimated to start May 1, 2016 and end on or before August 31, 2016 with an opportunity to transition into Comprehensive Case Management and Employment Program with Mercer County Job & Family Services. Funding is contingent upon the Ohio Department of Job and Family Services allocating TANF/PRC funds for summer youth programs. Information provided in this RFP is based upon preliminary information provided by the Ohio Department of Job and Family Services and is subject to change. Details regarding the funding are forthcoming and will be communicated as it becomes available. The 2015 TANF Summer Youth allocation was $94, Page of 72

2 TABLE OF CONTENTS Background... 3 Eligible Population... 4 Program Requirements... 5 Other Program Considerations... 6 RFP Limitations... 7 Contact Information... 8 Exhibit 1 - Proposal Contents... 9 Exhibit 2 - Budget Template Attachment A Attachment B Attachment C Attachment D Attachment E Attachment F Attachment G Proposal Scoring Exhibit 3 Family Assistance Letter # Exhibit 4 Sample Sub Grant Agreement Page of 72

3 Background Mercer County Job and Family Services administers several programs focusing on the work first philosophy and strives to provide quality employment, training and supportive services to assist individuals with obtaining and maintaining self-sufficiency. These programs incorporate a combination of supportive services, education, training, and soft skills development in order to help families transition off of public assistance and/or prevent the cycle of dependency on public assistance. Programs/funding sources include:. Ohio Works First (OWF)/Temporary Assistance for Needy Families (TANF) In October 1997, Mercer County began full implementation of the Ohio Works First (OWF) program. As the name implies, this program emphasizes employment for families receiving public assistance. The basic philosophy encourages employment of cash recipients so families are able to transition to self-sufficiency. Prevention, Retention, and Contingency Program (PRC) This program is designed to provide benefits and services to income eligible families who are in need of help to obtain and/or maintain self-sufficiency. The PRC Program is funded by the Federal Temporary Assistance for Needy Families (TANF) Program through the Ohio Works First Program (OWF). The PRC Program provides counties with the opportunity to develop locally driven, flexible, responsive, and innovative services designed to meet the needs of eligible families. Mercer County s PRC Plan incorporates categories which allow PRC eligible individuals the opportunity to obtain assistance in order to meet TANF priorities defined by the State of Ohio, and based on Federal guidelines. The TANF Summer Youth Employment Program meets the first two purposes of TANF: 1. To provide assistance to needy families so that children may be cared for in their own home or the home of relatives; 2. End the dependence of needy parents on government benefits by promoting job preparation, work and marriage Payment for services will be based on a reimbursement process. Start up or advanced funds are not available. Page of 72

4 Eligible Population The Summer Youth Employment Program shall only serve persons ages 14 to 24 from a PRCeligible family and/or Foster Children ages 14 through 18 years of age. Foster children who are 18 years old must also be enrolled full time in secondary school. All summer youth participants must be a United States citizen or qualified alien, and resident of Mercer County. Foster Children must be in temporary or permanent custody of MCJFS or other County Department of Job & Family Services/Children Services Boards. Final eligibility is determined by Mercer County Job and Family Services. TANF/PRC Family Composition guidelines** In order for youth to meet family composition guidelines they must meet any one of the following guidelines: a. Youth ages 14-17, as long as the youth is a minor child* in a needy family and is in school (youth may be 18 if they are a full time student in a secondary school); b. Youth ages as long as they are in a needy family that also has a minor child; or c. Youth ages that have a minor child and are considered needy. * For TANF/PRC eligibility, the definition of minor child is as follows: An individual has not attained age eighteen(18); or An individual who is eighteen and is a full-time student in a secondary school (high school) or enrolled in a high school level of vocational or technical training. Foster youth in the temporary or permanent custody of a County Department Job and Family Services who are placed in a licensed foster care or kinship setting between the ages of 14 and 17 or 18 years of age and are enrolled full time in secondary school. Page of 72

5 Program Requirements TANF Summer Youth Employment programs can provide project based group employment (work crew) or develop individualized work sites that meet the skills and interests of the youth participants. Work site locations may include private or public non-profits, government entities, or private sector worksites. Worksites/job placements at private residences are discouraged unless work is being provided as a mobile work crew project with appropriate supervision and in collaboration with a non-profit community organization. An approved agreement with each worksite is required prior to performing work. The worksite agreement must outline job duties, responsibilities of the Program Provider (employer), worksite, and youth participant. The worksite agreement shall identify who is responsible for daily supervision of youth while at the worksite, ensure all applicable employment and wage regulations are followed and that the summer youth participant will not displace a regularly paid employee or replace employees who have been laid off. Important: The program provider will serve as the actual employer (i.e., employer of record) of the youth participants. While a third party payroll agent, such as a temporary employment agency, may be used for payroll services, the program provider must remain the employer of record. Other program requirements include but are not limited to: Identifying and establishing projects and/or worksites for all eligible youth Developing, providing, and reviewing job descriptions of duties to be performed with each youth participant Identifying and recruiting youth participants to be served by the proposed program Hiring and employing eligible youth Providing occupational skills and employability skills training Providing rainy day or alternate work when planned activities are not possible Ensuring youth participants have transportation to and from work daily or as needed. (Transportation costs are allowable and should be included when developing a program budget.) Pay the youth up to $10.00 per hour Providing employer functions as the employer of record including paying all payroll expenses including Workers Compensation (worker compensation premiums and claims paid) Responsible for youth activity coordination, direct supervision and training Ensuring that all applicable employment rules and regulations and minor wage and safety laws are being followed ( Providing case management and supportive services as needed Communicating with job site supervisor regarding youth needs and job related issues Completing necessary state reports and maintain fiscal records Ensuring that costs are allowable according to state and federal regulations Hiring qualified program staff and supervisors and provide appropriate background checks for individuals working with the youth program. Youth program volunteers are expected to meet the same background standards as paid employees. Page of 72

6 Other Program Considerations The following components should be considered in developing Summer Employment Activities: Summer employment may last through August 31, 2016, with youth working up to 40 hours per week or as allowed defined by safety and child labor laws ( Provider must follow the Family Assistance Letter #152 which is included as Exhibit 3. Youth still enrolled in school may need accommodations to their schedule after returning to school, working after school hours or on weekends as allowed by applicable labor laws. Mercer County JFS reserves the right to negotiate the number of paid work hours based upon the availability of funds. All programs will be required to follow all applicable Minor Labor Laws as issued by the Ohio Department of Commerce, Division of Labor and Worker Safety and the Federal Department of Labor. Training While the TANF Summer Youth Program is mainly intended to be a work experience program designed to provide youth with an opportunity to earn a wage, gain work experience, and develop employment related skills however, ten Percent (10%) of the county s allocation may be used for paying for soft skills training. Soft Skills training includes, but is not limited to, how to write a resume and cover letter, tips for interviewing and job etiquette. Worksites Work site development should take in consideration the age appropriateness of the activities, and should also encourage youth to help develop social skills needed to become successful employees. Employment opportunities should be meaningful and provide opportunities for youth to explore career options. Worksites should be established with employers who are committed to provide youth with the skills and supervision necessary to enhance youth job readiness. In addition, work sites should be flexible and properly informed regarding the youth s needs and barriers, and prepared to provide supervision and guidance. The program provider/employer will be responsible to ensure youth are safe and supervised at all times. Regardless of the type of employment activity, the Provider is responsible to ensure the ratio of supervision of youth to supervisors is adequate. Providers are encouraged to establish partnerships with local businesses. Work site agreements are required to be in place prior to youth starting employment. Summer youth program participants can not displace or jeopardize the status of current employees. In addition, youth work experience participants should not replace the work of employees who have experienced layoffs (see 20 CFR for non-displacement requirements). Youth Payroll Youth must be paid at least minimum wage, but reimbursement for participant wages will not exceed $10.00 per hour. The provider will be responsible to follow minor wage agreements and posting requirements, obtaining I-9 forms, parent consent forms and work permits for minors when applicable. Payroll, associated costs*, and employer functions** are the Provider s responsibility. The program provider will be required to administer all payroll functions and associated costs and will be reimbursed by Mercer County Job and Family Services. The vendor may use a payroll service to provide payroll functions however the program provider must retain responsibility as the employer of record. The vendor must have adequate cash flow to cover payroll/program costs for up to 30 days. The provider must be the actual employer of the youth participants. *Associated costs for payroll administration includes but is not limited to: Medicare, Social Security (or other retirement), Federal/State/Local/School income taxes, etc. **Employer functions include but are not limited to: minor wage agreements, obtaining I-9 forms, parental consent forms, and work permits, etc. for minors as applicable. Page of 72

7 RFP LIMITATIONS The provider/employer is required to maintain independent books, records, payroll, documents accounting procedures and practices which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of this Agreement. Such records shall be subject at all reasonable times for inspection. Reimbursement is based upon actual expenditures for the program. Provider will be expected to have cash flow resources to sustain youth payroll and project operations for at least 30 days. Start up or advanced funds are not available. Providers/Employers will be required to submit monthly reports of actual expenses and youth time sheets to verify hours worked. Workers Compensation paid to a participant after the program end date is not reimbursable. Provider will be required to carry liability insurance, and to also secure the persons and estates of eligible individuals against reasonable foreseeable torts which would cause injury or death. Provider will be required to conduct appropriate background checks for individuals/staff working or volunteering with the youth program. This Request for Proposals does not commit Mercer County or the Mercer County Job and Family Services to award a contract or to pay any cost incurred in the preparation of a proposal. Mercer County/Mercer County Job and Family Services reserves the right to accept or reject any or all proposals received, to negotiate services and costs with proposers/employers, and to cancel in part or in entirety this RFP. All Proposals submitted will remain the property of Mercer County. Funding for programs is anticipated to be available on or after May 1, Contracts will be awarded for the provision of 2016 TANF Summer Youth Employment Programs. This RFP may be cancelled or modified at any time due to a reduction of Federal, State, or Local funds or a change in regulations. Allowable and disallowable costs for this program can be found in Exhibit 3 in this proposal. Contracts may be amended or terminated during this period if there is a change in Federal, State or Agency regulations that apply to the contract; a reduction of Federal, State or Local funds; unsatisfactory performance by the Provider as determined by Mercer County Job and Family Services; or upon thirty (30) days written notice by either party. If a contract is awarded, this RFP guideline shall become a part of the contractual agreement. Page of 72

8 CONTACT INFORMATION Program questions concerning this RFP may be directed to: Elizabeth Rinderle, ERS Administrator Mercer County Job and Family Services (419) ext. 524 Fiscal questions concerning this RFP may be directed to: Anita Kremer, Fiscal Administrator Mercer County Job and Family Services (419) ext. 528 OR Cindy Bittinger, Fiscal Specialist Mercer County Job and Family Services (419) ext. 540 Page 8 of 72

9 Exhibit 1 Proposal Contents TANF Summer Youth Employment Program Page 9 of 72

10 PROPOSAL GUIDELINES Providers interested in being considered for TANF Summer Youth Employment Program funding for Summer 2016 must include the following information: Please number your responses accordingly 1. Cover Letter: Provider name, program name, contact person, mailing address, phone number, fax number, address, Federal ID# and DUNS #. Also include name, title and original signature of person submitting RFP. 2. Briefly describe your organization. Include if you are private for profit, non-profit (private or public) or government/school entity. Describe the nature of your business, the number of years you have been providing services, and any previous experience working with youth. Describe previous summer youth programming provided in the past. 3. Identify partnerships with other entities for the provision of summer work including sub-contractors (e.g. payroll processing), or any other partnerships involved with the provision of the program. Include letters of support that identify established partnerships and define partnership roles and responsibilities with the summer youth program. 4. Describe the program being proposed. Include if the program will involve mobile work crew(s)/group activities or customized worksite placement. Describe training and activities provided to develop occupational skills and work readiness. Describe how training activities will be provided, frequency, and how success will be measured. 5. Describe the specific employment activities the youth will perform, include identified work sites or proposed worksites, job descriptions, work schedules including the number of hours worked per day, days per week, and hourly rate of pay. Describe who will be responsible to supervise the youth at each work site. Include copies of your worksite agreements if already obtained. If not, include a blank worksite agreement. 6. Describe how participants will be recruited, screened for eligibility, and referred to MCJFS for the application process. Identify the number of youth you intend to recruit and the number of youth you intend to employ in your program. 7. Describe timeline of recruitment, orientation and prospective start and end date. List pre-employment screenings you will require such as physicals, drug tests and background checks. Page 10 of 72

11 8. Describe how youth will be matched with employment activities. What assessments will be conducted (if applicable) to help with job placement? 9. Describe your payroll process. Will payroll be handled by your organization or contracted to a third party such as a temporary agency or a payroll service? Include how frequent the youth will be paid, how hours will be tracked and how the youth be paid (direct deposit or check)? 10. Describe what other supportive services will be offered to your youth participants-(e.g. transportation, training/certifications, safety equipment and supplies). How will the supportive services be communicated and utilized by the youth? 11. Describe your communication process with the site supervisors including frequency of site visits, expectations of the job sites to report issues and intervention process. 12. Explain how your work and break schedule will coincide with appropriate labor regulations. Identify potential hazardous work activities/work sites and how your program will ensure appropriate safety measures are in place. Identify worksite safety protocols for injuries & accidents. 13. Identify staff positions and include job descriptions. List pre-employment screenings you will require of staff including drug screens, criminal background checks, etc. These documents may be monitored if a contract is awarded. Describe staff roles and responsibilities. 14. Include proof of general and professional liability coverage. 15. Provider is required to issue a certificate of completion to the participating youth who participate in the Summer Youth Program. Please provide a sample of your certificate showing the name of the program, name of the youth, the date of participation, name of the employer and include the following statement: Funding for this program was provided by The Ohio Department of Job and Family Services. 16. The following attachments and Exhibits must be completed and returned as part of this packet: Attachment A: Assurance Form Attachment B: Americans with Disabilities Act and Compliance Statement Attachment C: Certification regarding debarment and suspension Attachment D: Affidavit in Compliance with Section of the ORC Attachment E: Equal Opportunity Certification Attachment F: W-9 Attachment G: Proposal Checklist Form Attachment H: Sample Sub-recipient agreement Exhibit 2: Detailed Budget Page 11 of 72

12 Exhibit 2 EXAMPLE Budget Template Page 12 of 72

13 Exhibit 2: BUDGET INSTRUCTIONS AND EXAMPLE Note: Subcontractors of the service provider must complete a separate budget to be submitted along with the service provider s budget. BUDGET FACE SHEET Provider Enter the legal name of the provider who is providing the services. Address Enter the location where the services are provided, street number, city and zip code. Telephone & Fax Number Enter for the location where the services are provided. Contract Period This will be completed by MCJFS s upon approval of contract. Budget Period Enter the period of time upon which the budget expenditures are based. In most cases, this should be for one year. Programs List program title for each service being proposed. Total Cost for Program Enter the total program budget cost from the Recap of Budget Items for each program. Total Program Units Once the budget figures are known, the agency/organization has documented numbers to reflect what it will cost to provide the program(s) service for both eligible and ineligible clients. MCJFS s will only reimburse for eligible clients. For each service, list the total number of direct units (eligible and ineligible) of service to be provided within the proposed budget period. A unit can be per hour, per class, per participant, etc. The agency/organization must give a clear definition of a unit as described later. It is very important to be reasonable about the number of units anticipated to be served. The higher the number of units projected, the lower the unit rate will be. MCJFS s will only reimburse actual cost for a direct billable unit not to exceed the negotiated unit rate. If the actual cost continues to exceed the negotiated unit rate on a cumulative basis, then the contract will need to be amended so that the unit rate is at a level to cover all actual cost incurred. A per hour unit would be based on one hour of billable time/action directly providing a program service to an eligible client. This shall be documented and billed in quarter hour increments. Page 13 of 72

14 A per class unit would be based on one or more eligible clients being in attendance for a specific period of time when a program service is directly being provided. This time period shall be documented and billed by a number of negotiated hours, days, or weeks. A per client or participant unit would be based on one unit for an eligible client for a specific negotiated time period or as a one time only unit when a program service is directly being provided. Direct service unit and/or direct billable unit is defined as time actually spent providing the contracted service in the following manners: either in direct or telephone contact with the eligible client(s); direct, telephone, or written contact with agencies, friends, relatives, and others directly related to assisting the eligible client in receiving the contracted service or in reaching the established goals; obtaining pertinent information, making arrangements for travel, and appointments; time spent actually transporting an eligible client to and from an agency, employer, or place directly related to assisting the eligible client in reaching the established goals. Direct service unit and/or direct billable unit must represent an action taken by the provider resulting in the eligible client(s) responding such as leaving a message requesting the eligible client return a call or make contact. A direct service unit and/or direct billable unit shall not include time spent in agency meetings, conferences, completing paperwork, dictation, reports, traveling, review of a case, or making calls and getting a busy signal. This cost is included in the budget and is covered but should not be considered when determining the number of units to be provided and/or billed for. Time spent providing a direct unit must be documented. MCJFS s suggests that daily logs that track by quarter hour increments, with a space noting which client is being served, be used to track time and actual direct units. Please be aware that when a monitoring is done, all costs and units must be documented and available to support actual/reimbursed costs in order to prevent a finding of disallowed and non-reimbursable costs resulting in cost recovery. Unit Costs List the cost for each unit of service being provided (total costs for service divided by total program units). Federal regulations state that providers shall relate financial data to performance data and develop unit cost information whenever practical. Units under Contract List total units to be purchased under this contract. This will be completed by the MCJFS s. Amount under Contract Compute the dollar amount of contracted units by service title (Unit cost times Units under Contract). This will be completed by the MCJFS s. Unit Definition Give a clear definition of each unit for each program being proposed. Describe the specific activities that will be provided to comprise each unit. Page 14 of 72

15 SALARY PAGE Position Title List all staff positions subject to reimbursement. Filled or Vacant - Indicate if filled (F) or Vacant (v). If vacant, the salary must be prorated to reflect the date position will be filled. Salary Enter the salary per hour. Hours per Week The number of hours per week the individual works to earn the listed salary. Length of Budget Enter the length of the Program(s) budget (days, weeks, months, and year). Allow the required amount of time to review, negotiate, and approve the contract. This information was previously discussed on Page 1. Percent of Time to Program(s) Place the percentage of total salary relevant to the program(s) under contract. Time shown for contract services require a time study summary documentation of six to eight weeks for employees performing multiple services, unless this is for an agency/organization that has not previously contracted with MCJFS s. Salary Charged to the Program Indicate the amount of salary applicable to the program(s) under contract (Salary Cost multiplied by Percent of Time to program(s). PAYROLL RELATED EXPENSES Attach a worksheet if related expenses are not uniformly, or across the board, for all staff. Insert in each program heading the amount from salary page totals. Indicate the employer share of taxes and fringe benefits relevant to the salary of listed staff. These costs are to reflect actual established rates. CONSULTATION FEES Attach a service agreement or fee schedule for the consultation service. Type Indicate the type of consulting fee (e.g. attorney, accountant, program consultant). Rate Enter the normal rate charged by consultant per hour or day. Hours/Days Enter number of hours or days purchasing. Programs Enter in the program the amount benefiting each program. Page 15 of 72

16 TRAVEL Agency/Employee Vehicle Expense - Enter on the appropriate line the agency/employee vehicle expenses incidental to the delivery of contract programs, including the costs of transporting clients to and from their residences and provider program locations. Vehicle depreciation or lease expenses will be entered on the appropriate equipment schedule. Mileage Reimbursement Indicate the per mile reimbursement paid to staff, not to exceed the counties guidelines ($.45 per mile), the total amount of miles, and the total amount of the anticipated expenditure in the appropriate program, including client transportation. Conferences, Meetings, etc. Indicate the agency s anticipated expense for this purpose. The travel shall be for official business directly related to a program(s) under contract and considered reasonable and allowable only to the extent such costs do not exceed charges normally allowed by the County s and/or the MCJFS s policies. Client Purchased Transportation Enter in the appropriate program column anticipated purchased transportation expenditures for client transportation. If the transportation is being provided by a vendor, other than the vendor this contract is with, that MCJFS s already contracts with, the transportation rates cannot exceed the MCJFS s current contracted rate with that provider. CONSUMABLE SUPPLIES Enter in the appropriate program column the costs of consumable supplies directly related to the program. Do not enter consumable supplies that are more of a general supply used within the agency/organization that will be budgeted for as an indirect cost. OCCUPANCY COSTS Rental - Enter the total square feet, monthly square foot cost, and the total square footage cost per month. Utilities - Enter the relevant utility costs per month on the appropriate line, if not included in rental charge. Depreciation or Usage Allowance If the agency/organization owns the building, a charge for depreciation or usage allowance is an allowable cost. Both are applied to the original acquisition cost. Enter in the acquisition cost, acquisition date and useful life. Depreciation shall be by straight-line method. If the building has already been fully Page 16 of 72

17 depreciated, the usage allowance method shall be applied (limited to 2% per year). Enter the depreciation or usage allowance amount and divide by twelve to calculate a monthly cost. Miscellaneous Building Expenses - Enter the anticipated miscellaneous item and costs per month. Total Monthly Occupancy Costs Add the totals for above costs and multiply by the budget period to calculate the total occupancy costs. Apply this amount to the program(s) being provided. Use the Full Time Equivalency Rate, square footage rate, or other means of allocating to determine the allowable amount to charge and the amount to spread to each program. Records substantiating development of the means of allocating must be provided and also maintained in the agency/organization. INSURANCE COSTS - Calculate the relevant insurance cost for the program(s) budget period on the appropriate line and enter in the appropriate program column. Use the Full Time Equivalency Rate or other means of allocating to determine the allowable amount to charge and the amount to spread to each program. Records substantiating development of the means of allocating must be provided and also maintained in the agency/organization. INDIRECT COSTS - Item - Enter the indirect costs, as defined in the Allowable Operation Costs, excluding any direct costs. Calculate the relevant indirect costs for the program budget period on the appropriate line and enter in the appropriate program column. Use the Full Time Equivalency Rate or other means of allocating to determine the allowable amount to charge and the amount to spread to each program. Records substantiating development of the means of allocating indirect costs must be provided and also maintained in the agency/organization. NOTE: Indirect cost rates may be developed in any method that produces an equitable distribution. The Full Time Equivalency Rate is a suggested method of arriving at an indirect cost rate for the contract. If another method is used, describe the computation for arriving at the indicated indirect cost rate in a separate attachment. EQUIPMENT SUBJECT TO DEPRECIATION OR USAGE ALLOWANCE Depreciation or Usage Allowance - If the agency/organization has, or acquires for this program(s), equipment costing $5, or more with an anticipated useful life in excess of one year, a charge for depreciation or usage allowance for the equipment is an allowable cost. Both are applied to the original acquisition cost. Enter in the acquisition cost less any trade-ins, discounts, etc., acquisition date, and useful life. Page 17 of 72

18 Depreciation shall be by straight-line method. If the equipment has already been fully depreciated, the usage allowance method shall be applied (limited to 6 2/3% per year). Calculate the relevant depreciation and/or usage allowance costs for the length of the program(s) on the appropriate line. Use the Full Time Equivalency Rate or other means of allocating to determine the allowable amount to charge and the amount to spread to each program. Records substantiating development of the means of allocating costs must be provided and also maintained in the agency/organization. SMALL EQUIPMENT - Item - List or categorized anticipated small equipment purchases of under $5, during the budget period. Quantity - Indicated the quantity of items to be purchased. Item Cost - Cost of listed items. Programs Enter in the program the amount benefiting each program. LEASED AND RENTED EQUIPMENT Equipment should only be leased and/or rented when it is feasible and the lease or rent amount does not exceed the cost to purchase the item(s). Item - List or categorized anticipated leased and/or rented equipment of under $5, during the budget period. Equipment costing over $5, and obtained by lease/purchase agreement must be depreciated. Quantity - Indicated the quantity of items to be leased and/or rented. Rental Cost - Cost to lease and/or rent listed items. Programs Enter in the program the amount benefiting each program. MISCELLANEOUS COSTS Item - List or categorized anticipated miscellaneous items. Quantity - Indicate the quantity of items to be purchased. Item Cost - Cost of listed items. Programs Enter in the program the amount benefiting each program. RECAP OF BUDGET ITEMS This page is a summary of the costs of providing agency programs. Enter the totals for the various categories that are detailed on the attached sheets of this EXHIBIT. Page 18 of 72

19 TOTAL INCOME FOR BUDGET PERIOD - Income For Program(s) Under This Contract determines if it is necessary for MCJFS to enter into a contract to provide additional income for the program(s) being provided and if there is revenue available to support the programs and/or to support services provided to ineligible clients. Fees from Private Consumers - Indicate the anticipated income for the budget period to supplement this program(s). Fees Generated by Contract for Recipients - Indicate the dollar value of the contract pro- rated to the contract period if different from the budget period. Other Federal Support of Contract Services - Indicate any other Federal support such as contracts, grants or awards for contract programs. State, County or Municipal Allocations - Indicate any state, county or municipal support of program services (i.e., levies, county general fund allocations). Contributions - Indicate private contributions in support of program services. Other Contracts Indicate the amount of any other contracts for the programs being provided. Miscellaneous - List sources of income for contract programs not previously itemized. Total Income for Program(s) Under This Contract Indicate total from total amounts 1 through 7. Income for Other Program(s) Services Provided by Agency Not Under This Contract determines if the agency/organization is financially sound to operate without MCJFS s funds. From Private Consumers - Indicate other anticipated income for the budget period that does not supplement this program(s). Federal Monies (Grants or Contracts) - Indicate any other Federal support such as contracts, grants or awards for other programs. State, County or Municipal Allocations - Indicate any state, county or municipal support for other program(s) services (i.e., levies, county general fund allocations). Contributions - Indicate private contributions in support of other program(s) services. Miscellaneous - List sources of income for other programs not previously itemized. Total Other Program(s) Services Indicate total from total amounts 1 through 5. Page 19 of 72

20 Total Agency Income (Section A + B) Indicate total from total amounts to sections A. and B. The following example and instructions are to assist you in submitting your proposal if your agency/organization doesn t already have an approved cost allocation plan. In order to capture all related costs and establish an equitable unit rate for the services for which you wish to contract, an allocation of costs to the program/programs must be completed and a budget established. Example: an agency/organization may have different programs it wants to provide. It has separate direct costs for each program and other costs not directly associated with any specific program. In order to find out what it costs to provide each program and spread general and administrative expenses, a cost allocation is required. Complete the following to prepare for cost allocating. 1. Program employees who are involved in more than one activity, and who will be performing activities for the program(s) under this contract, should participate in a minimum six to eight week time study. This would not include indirect staff such as directors, fiscal, receptionist, janitorial, etc. unless they provide direct program activities to the clients. 2. Break timings down to fifteen-minute increments with a column for each program and one for unidentifiable time. 3. At the end of each day, add total hours timed and add totals for each column. 4. At the end of the time study period, add the totals from each time study form for each week and transpose the numbers for each week to the TIME SUMMARY FORM. Add all totals for each column. A TIME SUMMARY FORM must be done for each employee who participated in the time study. 5. Calculate percentage of the time spent in each program from Total Hours Tracked (THT) to determine how much of the program employee s time benefits each program. 6. Add all TIME SUMMARY FORM S columns individually and all those employees who are involved in only one activity (100% of their time), if any, for each program. Must also add, in the Other Identified Programs column, all organization/agency program staff members who provide program services not included in this contract. The total of all these will give a grand total of program staff under this contract and not included in this contract. Report these totals on the FULL TIME EQUIVALENCY FORM. 7. Divide number of program employees for each program included in this contract by the total number of program employees in the organization/agency. Page 20 of 72

21 This cost allocation only benefits agencies that are currently providing services under contract with MCJFS s. A new contractor to MCJFS s can use this cost allocation with projected numbers based on planned or historical activity devoted to each program. These calculations will enable the organization/agency to determine how much of a specific program employee s time benefits each program; furthermore, and just as important, it will enable the organization/agency to allocate program costs and indirect costs to each program under contract. This calculation of time is known as the Full Time Equivalency (FTE). Page 21 of 72

22 TIME STUDY Name Position Time Frame Time Study Program A Program B Program C Program D Other Identified Programs Unidentified Total Hours Tracked 8:00 AM 8:15 AM 8:30 AM 8:45 AM 9:00 AM 9:15 AM 9:30 AM 9:45 AM 10:00 AM 10:15 AM 10:30 AM 10:45 AM 11:00 AM 11:15 AM 11:30 AM 11:45 AM 12:00 PM 12:15 PM 12:30 PM 12:45 PM 1:00 PM 1:15 PM 1:30 PM 1:45 PM 2:00 PM 2:15 PM 2:30 PM 2:45 PM 3:00 PM 3:15 PM 3:30 PM 3:45 PM 4:00 PM 4:15 PM 4:30 PM 4:45 PM Total Page 22 of 72

23 TIME SUMMARY FORM Organization s Name Time Frame Time Study Program A Program B Program C Program D Other Identified Programs Unidentified Total Hours Tracked (THT) WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5 WEEK 6 WEEK 7 WEEK 8 TOTALS Percentage of time spent for each program (A D, Other, and Unidentified) calculated by dividing the program total by the Total Hours Tracked (THT). Program A Program B Program C Program D Other Identified Programs Unidentified THT (100% Or 1 Employee) % Page 23 of 72

24 FULLTIME EQUIVALENCY FORM Employees from all Time Summary Forms Program A Program B Program C Program D Other Identified Programs Unidentified Total # of Program Employees Divide number of program employees for each program column by the total number of program employees in the agency/organization and enter below. Program A Program B Program C Program D Other Identified Programs Unidentified Total # of Program Employees (100%) % These percentage rates will enable the agency/organization to allocate program costs and indirect costs to each program under contract. Page 24 of 72

25 ALLOWABLE STAFF COSTS: Salaries - Includes all remuneration, paid currently or accrued, for services rendered during the period of the contract. Salaries are allowable to the extent that the costs are reasonable for the services rendered, and are supported by documented payroll vouchers or a generally accepted method of documentation. Payroll must be supported by payroll logs, time and attendance logs, or equivalent records for individual employees. The method used should produce an equitable distribution of time and effort. Compensation for owners is allowable provided the service performed is a necessary function. Payroll Related Expenses - Employee benefits in the form of employer contributions to social security, state and municipal retirement systems, life and health insurance plans, Unemployment Insurance coverage, Worker's Compensation Insurance and pension plans are allowable if equitably distributed. Severance pay is allowable when payment is consistent with standard or approved policy. Incentive Compensation - payments to employees based on cost reduction, efficient performance, suggestions awards, etc. are allowable to the extent that overall compensation is determined to be reasonable and such costs are paid or accrued pursuant to an established plan followed by the employer so consistently as to imply, in effect, an agreement to make such payment. Deferred Compensation - Such cost is allowable to the extent that except for past service pension and retirement costs: (1) it is for services rendered during the period of the projected budget; (2) it is, together with all other compensation paid to the employee, reasonable in amount; 3) it is paid pursuant to an agreement entered into in good faith between the agency/organization and its employees before the services are rendered, or pursuant to an established plan followed by the agency/organization so consistently as to imply, in effect, an agreement to make such payments; (4) the benefits of the plan are vested in the employees or their designated beneficiaries and no part of the deferred compensation reverts by the Internal Revenue Service, and falls within the criteria and standards of the Internal Revenue Code and the regulations of the Internal Revenue Service. Severance Pay - Commonly referred to as dismissal wages, is payment in addition to regular salaries and wages by employers to workers whose employment is being terminated. Costs of severance pay are allowable only to the extent that, in each case: it is required by law; employer/employee agreement; or established policy that constitutes, in effect, an implied agreement on the employer s part. Only severance benefits that accrue during the period of the contract are allowable. ALLOWABLE OPERATION COSTS Consultation Fees - The reasonable cost of consultation fees, charges for the use of personal services of outside agencies or persons not on the payroll; or functions related to contract services, i.e. audit service, legal service, and specialized consultation are allowable if equitably distributed among programs and cost centers. Travel - the costs of operation, maintenance, and repairs of agency vehicles when relevant to the delivery of contract services; reasonable expenses for transportation, lodging subsistence, and related items incurred by employees who are on a travel status while on official business related to delivery of contract services, either an actual basis, or a per diem and mileage basis; expenses for meetings and conferences, if the primary purpose is the dissemination of technical information Page 25 of 72

26 relating to contract services. Purchased transportation is allowable if required for the delivery of contract services. Consumable Supplies - The reasonable costs of materials and supplies are allowable. Direct charges to services should be based upon the actual price less cash discounts, trade discounts, rebates, and allowances. Consumable supplies are those items, which will be used up within one year. Occupancy Costs - Rental of Privately Owned Building - Rental cost for space is an allowable charge and should not exceed the cost of comparable space and facilities in the same locality. The lease agreement must stipulate the extent of the lessor's responsibility for renovations. Major renovations, which add to the permanent value of the property or appreciably prolong its useful life, the cost of which is borne by the provider, must be depreciated. Rental of Publicly Owned Building - The rental cost of a publicly owned building is allowable if the charge does not exceed the cost of comparable space and facilities in the same locality. The rental charge should include the costs of service, maintenance, depreciation on the building, and depreciation of major renovations. Use Allowance or Depreciation of Provider Owned Building - The computation of use allowances or depreciation will be based upon acquisition cost. The computation will exclude any cost borne by the federal government through other federal grant programs, the cost of land, and idle or excess buildings and capital improvement. Depreciation must be computed on the Straight Line Depreciation Method. If the building is fully depreciated, a use allowance for buildings and improvements may be computed at an annual rate not exceeding two percent of acquisition cost. Repair and Maintenance - Costs incurred for necessary maintenance, repair, and upkeep of property which neither add to the permanent value of the property nor appreciably prolong its useful life, but keep it in efficient operating condition, are allowable. If these expenditures add to the value or prolong the life of the property they must be depreciated as capital improvements. Utilities - Utility costs for agency facilities are allowable if equitably distributed among programs and cost centers. Insurance Costs - Cost of insurance in connection with the general conduct of activities is allowable to the extent that the cost will be in accordance with sound business practice. Employee liability insurance is allowable. Protection against liabilities for loss of assets related to the provision of contract services is allowable and should be provided, because losses incurred through the lack of available insurance coverage would not be considered an allowable cost; however, the deductible portion of insurance coverage or minor uninsurable losses is allowable. Indirect Costs - Indirect costs are those costs incurred for common or joint purpose benefiting more than one service area or cost objective. Indirect cost pools should be distributed to benefited cost objectives on bases that will produce an equitable result in consideration of relative benefits derived. The allocation distribution must be equitable. Allowable indirect costs for the indirect cost pool include, but are not limited to, the accounting and budgeting functions, disbursing services, personnel administration and payroll preparation, procurement services and general administrator's office. Page 26 of 72

27 ALLOWABLE EQUIPMENT COSTS: Depreciable Equipment - Includes depreciation charges for capital equipment (any item or group of like items costing $5, or more). Computation of depreciation is based upon the acquisition cost of the item excluding; (1) any cost borne by the Federal Government through other Federal Grant Programs, and (2) any idle or excess equipment. Adequate property records must be maintained and the straight-line method of computing depreciation must be used. When equipment is replaced, the value received for the old equipment less the salvage value and any unrealized depreciation charges are deducted from the acquisition cost of the new equipment. If the equipment is fully depreciated, a use allowance for equipment may be computed at an annual rate not exceeding six and two-thirds percent of acquisition cost. Non-depreciable Equipment - Small equipment items costing less than $5, may be expensed (purchased outright during the period of the contract.) Leased Equipment - The cost of leased equipment is allowable, to the extent of its reasonableness as sound business policy. Equipment in excess of $5,000.00, obtained by lease to purchase agreement must be depreciated. MISCELLANEOUS COST: Miscellaneous - Allowable miscellaneous costs include memberships and subscriptions, reference material, printing and reproduction, mailing and postage, and any other costs incidental to the delivery of service. UNALLOWABLE COSTS: Bad Debt - Losses arising from uncollectible accounts, and other claims and related costs are unallowable. Contingencies - Contributions to a contingency reserve or any similar provision for unforeseen events are unallowable. Contributions and Donations - Outlays of cash with no prospective benefit to the contracting agency or program are unallowable. Entertainment - Costs of amusements, social activities, and related cost are unallowable. Advertising - Costs of advertising, with the exception of contract related recruitment needs, procurement of scarce items, disposal of scrap and surplus, is unallowable. All contract-related advertising must clearly disclose that the program(s) and/or service(s) are in whole or in part funded by the MCJFS s. Advertising must only be as a direct cost and can not be designed solely to promote the MCJFS s. Fines and Penalties - Costs resulting from violations of or failure to comply with laws and regulations are unallowable. Page 27 of 72

28 Interest and Other Financial Costs - Interest on borrowings, bond discounts, or any cost of financing or refinancing operations are unallowable. Costs Borne By Other Federal or State Programs - Any costs specifically subsidized by other State or Federal dollars are unallowable and must be deducted from the applicable line items prior to unit rate computation. Cash Payments - Cash payments to eligible individuals such as a cash allowance to children in residential treatment are unallowable. Sabbatical Leave - Payment of any sabbatical leave is unallowable. Fundraising - Cost of activities to raise monies to support the provider program is unallowable. Education - Cost activities provided by the public schools that are free of charge of the general public is unallowable. The MCJFS S receives allocations for many different programs and services. Based on regulations, policies, and plans of the funding source, costs may be allowable under one program but not under another. Page 28 of 72

29 BUDGET FACE SHEET Enter below the total cost for each program from the Budget Recap Sheet, units to be served, and unit cost. Note: Subcontractors of the service provider must complete a separate budget to be submitted along with the service provider s budget. PROVIDER: CONTACT PERSON: ADDRESS: TELEPHONE: FAX: BUDGET PERIOD: CONTRACT PERIOD: PROGRAMS TOTAL COST TOTAL UNITS UNIT COST PROGRAM A Name PROGRAM B Name PROGRAM C Name PROGRAM D Name CONTRACT UNITS COMPLETED BY ACDJFS CONTRACT AMOUNT COMPLETED BY ACDJFS UNIT DEFINITION - Please give clear definition of each unit of service for each program being proposed. A unit can be per hour, per class, per participant, etc. Describe the specific activities that will be provided to comprise each unit. PROGRAM A - PROGRAM B - PROGRAM C - PROGRAM D - Page 29 of 72

30 SALARY PAGE Budget Item Number I A. PROGRAM A PROGRAM B PROGRAM C PROGRAM D Name Name Name Name POSITION F SALARY HRS LENGT % SALARY % SALARY % SALARY % SALARY H OR or PER PER OF TO THE CHGD TO THE TO THE CHGD TO THE TO THE CHGD TO THE TO THE CHGD TO THE TITLE V HOUR WEEK BUDGET PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM TOTALS Page 30 of 72

31 PAYROLL RELATED EXPENSES Budget Item Number I B. ATTACH WORK SHEET IF RELATED EXPENSES ARE NOT UNIFORM, OR ACROSS THE BOARD, FOR ALL STAFF PROGRAM A PROGRAM B PROGRAM C PROGRAM D Name Name Name Name INSERT IN EACH PROGRAM THE AMOUNT FROM SALARY PAGE Amt. Amt. Amt. Amt. TOTAL SOCIAL SECURITY 6.2%,PERS 14%,SERS % MEDICARE 1.45% WORKERS COMP % RETIREMENT % HOSPITALIZATION % UNEMPLOYMENT % OTHER (IDENTIFY TOTAL PAYROLL RELATED EXPENSES ATTACH SERVICE AGREEMENT OR FEE SCHEDULE CONSULTATION FEES Budget Item Number I C. PROGRAM A PROGRAM B PROGRAM C PROGRAM D TYPE: e.g. accountant, etc. RATE HOURS/DAYS Name Name Name Name TOTAL TOTAL CONSULTATION FEES Page 31 of 72

32 TRAVEL Budget Item Number II A. AGENCY/EMPLOYEES ACTUAL VEHICLE EXPENSE GAS & OIL REPAIRS AND OTHER MAINTENANCE LICENSE INSURANCE OTHER MILEAGE 50 CENTS/MILE FOR MILES CONFERENCE, MEETINGS, ETC. CLIENTS PURCHASED TRANSPORTATION Please see note below. PROGRAM A PROGRAM B PROGRAM C PROGRAM D Name Name Name Name TOTAL TOTAL TRAVEL NOTE: If the service being provided requires transportation for clients and if the transportation is being provided by a vendor, other than the vendor this contract is with, that MCDJFS already contracts with, the transportation rates can not exceed MCDJFS PROGRAM A PROGRAM B PROGRAM C PROGRAM D Consumable Supplies related directly to the program(s). Name Name Name Name TOTAL OFFICE TRAINING PROGRAM OTHER (SPECIFY) TOTAL CONSUMABLE SUPPLIES CONSUMABLE SUPPLIES Budget Item Number II B. NOTE: Attach an itemized list so that MCDJFS is aware of the consumable supplies being budgeted for. Page 32 of 72

33 OCCUPANCY COSTS Budget Item Number II C. A. RENT (Office Space) 1. Total # of 2. Cost per Sq. Square Feet Ft. per Month 3. Total Cost per Month B. UTILITIES (If Not Included In Rent) 1. HEAT 2. ELECTRICITY 3. TELEPHONE 4. WATER 5. JANITORIAL & MAINTENANCE 6. INTERNET SERVICE 7. TOTAL PER MONTH C. DEPRECIATION OR USAGE ALLOWANCE 1. DEPRECIATION a. Item b. Acquisition Cost c. Acquisition Date e. Useful Life Years f. Straight-line Annual Dep. 2. USAGE ALLOWANCE (Limited to 2% for buildings per year) a. Item b. Acquisition Cost c. Acquisition Date e. Useful Life Years f. Usage Allowance Amt 3. DEPRECIATION (C.1.f.) OR USAGE ALLOWANCE ( C.2.f.) DIVIDED BY 12 EQUALS D. MISCELLANEOUS BUILDING EXPENSES 1. Item 2. Cost 3. TOTAL COST PER MONTH E. TOTAL MONTHLY OCCUPANCY COSTS (A.3.+B.7.+C.3.+D.3.) X LENGTH OF THE BUDGET EQUALS TOTAL OCCUPANCY COSTS FOR BUDGET PERIOD. Please see note below. NOTE: USE THE FULL-TIME EQUIVELANCY RATE, SQUARE FOOTAGE RATE, OR OTHER MEANS OF ALLOCATING TO DETERMINE THE ALLOWABLE AMOUNT TO CHARGE AND THE AMOUNT TO SPREAD TO EACH PROGRAM. PROGRAM A PROGRAM B PROGRAM C PROGRAM D Name Name Name Name % AMT CHGD % AMT CHGD % AMT CHGD % AMT CHGD UNRELATED TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAMS Page 33 of 72

34 INSURANCE COSTS Budget Item Number II D. NOTE: USE THE FULL-TIME EQUIVELANCY RATE OR OTHER MEANS OF ALLOCATING TO DETERMINE THE ALLOWABLE AMOUNT TO CHARGE AND THE AMOUNT TO SPREAD TO EACH PROGRAM. PROGRAM A PROGRAM B PROGRAM C PROGRAM D Name Name Name Name % AMT CHGD % AMT CHGD % AMT CHGD % AMT CHGD UNRELATED LENGTH OF TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE INSURANCE BUDGET PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAMS LIABILITY See note below. AGENCY EMPLOYEE BONDING # OF EMPLOYEES COVERED OTHER TOTAL INSURANCE NOTE: Liability Insurance covers damage done to other persons or to property other than that of contractor. INDIRECT COSTS Budget Item Number II E. ENTER BELOW OTHER INDIRECT COSTS NOT ALREADY CAPTURED (e.g. GENERAL OFFICE SUPPLIES, ETC.) PROGRAM A PROGRAM B PROGRAM C PROGRAM D Name Name Name Name % AMT CHGD % AMT CHGD % AMT CHGD % AMT CHGD UNRELATED LENGTH OF TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE ITEM BUDGET PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAMS TOTAL INDIRECT NOTE: Attach an itemized list so that MCDJFS is aware of the indirect costs being budgeted for. Page 34 of 72

35 EQUIPMENT SUBJECT TO DEPRECIATION OR USAGE ALLOWANCE Budget Item Number III A. A. DEPRECIATION OR USAGE ALLOWANCE 1. DEPRECIATION List below the items costing $5, or more. a. Item b. Acquisition Cost c. Acquisition Date e. Useful Life Years f. Straight-line Annual Dep. TOTAL PER YEAR 2. USAGE ALLOWANCE (Limited to 6 2/3% for equipment per year) List below items already owned and depreciation by contractor. a. Item b. Acquisition Cost c. Acquisition Date e. Useful Life Years f. Usage Allowance Amt (b. X.0667) TOTAL PER YEAR 3. DEPRECIATION (A.1.f.) + USAGE ALLOWANCE ( A.2.f.) EQUALS ANNUAL DEPRECIATION AND USAGE ALLOWANCE, DIVIDED BY 12 EQUALS PER MONTH, X LENGTH OF PROGRAM EQUALS TOTAL EQUIPMENT DEPRECIATION AND USAGE ALLOWANC NOTE: USE THE FULL-TIME EQUIVELANCY RATE OR OTHER MEANS OF ALLOCATING TO DETERMINE THE ALLOWABLE AMOUNT TO CHARGE AND THE AMOUNT TO SPREAD TO EACH PROGRAM. PROGRAM A PROGRAM B PROGRAM C PROGRAM D Name Name Name Name % AMT CHGD % AMT CHGD % AMT CHGD % AMT CHGD UNRELATED TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAMS Page 35 of 72

36 SMALL EQUIPMENT ( Equipment Costing Under $5,000.00) Budget Item Number III B. ITEM PROGRAM A PROGRAM B PROGRAM C PROGRAM D ITEM QUANTITY COST Name Name Name Name TOTAL COST TOTAL SMALL EQUIPMENT PURCHASES LEASED AND RENTED EQUIPMENT Budget Item Number III C. NOTE: ONLY WHEN FEASIBLE AND WHEN THE LEASE OR RENT AMOUNT DOES NOT EXCEED THE COST TO PURCHASE THE ITEM(S). RENTAL PROGRAM A PROGRAM B PROGRAM C PROGRAM D ITEM QUANTITY COST Name Name Name Name TOTAL COST TOTAL LEASED AND RENTED EQUIPMENT MISCELLANEOUS COSTS Budget Item Number IV ITEM PROGRAM A PROGRAM B PROGRAM C PROGRAM D ITEM QUANTITY COST Name Name Name Name TOTAL COST TOTAL MISCELLANEOUS COSTS Page 36 of 72

37 I STAFF COSTS A. SALARIES RECAP OF BUDGET ITEMS Enter below the totals for the various categories which are detailed on the attached sheets of this EXHIBIT. TOTAL PROGRAM A PROGRAM B PROGRAM C PROGRAM D BUDGET Name Name Name Name AMOUNT B. PAYROLL RELATED EXPENSES C. CONSULTATION FEES TOTAL STAFF COSTS II OPERATIONAL COSTS A. TRAVEL B. CONSUMABLE SUPPLIES C. OCCUPANCY D. INSURANCE E. INDIRECT COSTS TOTAL OPERATIONAL COSTS III EQUIPMENT COSTS A. DEPRECIATION AND USAGE ALLOWANCE B. SMALL EQUIPMENT PURCHASES C. LEASED AND RENTED EQUIPMENT TOTAL EQUIPMENT COSTS IV MISCELLANEOUS TOTAL PROGRAM BUDGET FOR PROGRAM(S) UNDER CONTRACT Page 37 of 72

38 TOTAL INCOME FOR BUDGET PERIOD A. INCOME FOR PROGRAM(S) UNDER THIS CONTRACT: 1. FEES FROM PRIVATE CONSUMERS 2. FEES GENERATED BY CONTRACT FOR RECIPIENTS 3. OTHER FEDERAL SUPPORT OF CONTRACTED PROGRAM(S) PROGRAM A PROGRAM B PROGRAM C PROGRAM D Name Name Name Name TOTAL 4. STATE, COUNTY OR MUNICIPAL ALLOCATIONS 5. CONTRIBUTIONS 6. OTHER CONTRACTS 7. MISCELLANEOUS TOTAL INCOME FOR PROGRAM(S) UNDER CONTRACT B. INCOME FOR OTHER SERVICES PROVIDED BY AGENCY NOT UNDER THIS CONTRACT TOTAL 1. FROM PRIVATE CONSUMERS 2. FEDERAL MONIES (GRANTS OR CONTRACTS) 3. STATE, COUNTY OR MUNICIPAL ALLOCATIONS 4. CONTRIBUTIONS 5. MISCELLANEOUS TOTAL OTHER PROGRAM SERVICE(S) INCOME TOTAL AGENCY INCOME (SECTION A TOTAL + SECTION B TOTAL) Page 38 of 72

39 ATTACHMENT A. ASSURANCES FORM I recognize that I must give assurances for each item below. If I cannot, this proposal will be automatically rejected. The assurances are: 1. I am authorized by my Board of Directors, Trustees, other legally qualified officer, or as the owner of this agency or business to submit this proposal. 2. We are not currently on any Federal, State of Ohio, or local Debarment List. 3. We will provide records to show that we are fiscally solvent. 4. We have, or will have; all of the fiscal control and accounting procedures needed to ensure that TANF funds will be used as required by law and contract. 6. We will meet all applicable Federal, State and Local compliance requirements. These include, but are not limited to: * Records accurately reflect actual performance. * Maintaining record confidentiality, as required. * Reporting financial, participant, and performance data, as required. * Complying with Federal and State non-discrimination provisions. * Meeting all applicable labor laws, including Child Labor Law standards. * Drug Free Workplace We will not: * Place a youth in a position that will displace a current employee. * Use TANF money to assist, promote or deter union organizing. * Use funds for youth in the construction, operation or maintenance of any part of a facility to be used for sectarian instruction or religious worship. I hereby assure that all of the above are true. Signature Name (printed) Date Title Page 39 of 72

40 ATTACHMENT B Americans with Disabilities Act and Compliance Statement The Americans with Disabilities Act (ADA), Public Law , was signed into law on July 26, 1990 to provide a national mandate for the elimination of discrimination against individuals with disabilities. If selected to be a contractor through Mercer County Job & Family Services, I hereby will abide by all mandates of the ADA, Public Law as it applies to the activities provided by the contract. Name of Organization Signature of agency s responsible representative: Date: Page 40 of 72

41 Attachment C Certification Regarding debarment, suspension, ineligibility, And voluntary exclusion lower tier covered transactions This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 20 CFR Part 98, Section , participants Responsibilities. The regulations were published as Part VII of the May 26, 1988 Federal Register (pages ). The prospective lower tier participant certifies, by submission of the proposal, that neither it nor its principals is Debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from participation in this transaction by any Federal department or agency. 1. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Name of Organization Signature of agency s responsible representative Date Page 41 of 72

42 Attachment D AFFIDAVIT IN COMPLIANCE WITH SECTION OF THE OHIO REVISED CODE STATE OF OHIO COUNTY OF MERCER SS: Personally appeared before me the undersigned, as an individual or as a representative of for a contract for (Name of Entity) (Type of Product or Service) to be let by the County of Mercer, who, being duly cautioned and sworn, makes the following statement with respect to prohibited activities constituting a conflict of interest or other violations under Ohio Revised Code Section , and further states that the undersigned has the authority to make the following representation on behalf of himself or herself or of the business entity: 1. That none of the following has individually made within the two previous calendar years and that, if awarded a contract for the purchase of goods or services in excess of $500, none of the following individually will make, beginning on the date the contract is awarded and extending until one year following the conclusion of the contract, as an individual, one or more campaign contributions totaling in excess of $1,000, to any member of the Mercer County Board of Commissioners or their individual campaign committees: a. myself; b. any partner or owner or shareholder of the partnership (if applicable); c. any owner of more than 20% of the corporation or business trust (if applicable); d. each spouse of any person identified in (a) through (c) of this section; e. each child seven years of age to seventeen years of age of any person identified in divisions (a) through (c) of this section (only applicable to contributions made on or after January 1, 2007). 2. That none of the following have collectively made since January 1, 2007, and that, if awarded a contract for the purchase of goods or services in excess of $500, none of the following collectively will make, beginning on the date the contract is awarded and extending until one year following the conclusion of the contract, one or more campaign contributions totaling in excess of $1,000, to any member of the Mercer County Board of Commissioners or their individual campaign committees: a. myself; b. any partner or owner or shareholder of the partnership (if applicable); c. any owner of more than 20% of the corporation or business trust (if applicable); d. each spouse of any person identified in (a) through (c) of this section; e. each child seven years of age to seventeen years of age of any person identified in divisions (a) through (c) of this section. Signature Title: Sworn to before me and subscribed in my presence this day of,, 20. Notary Public My Commission Expires: Page 42 of 72

43 ATTACHMENT E EQUAL OPPORTUNITY CERTIFICATION Prior to contract award, potential contractors must assure that they are in compliance with nondiscrimination and equal opportunity requirements. The following statements must be in all proposals submitted and will be included in any contract with Mercer County Job & Family Services (MCJFS). As a condition to the award of a contract the contractor assures, with respect to the operation of MCJFS activities, that it will fully comply with the nondiscrimination and equal opportunity provisions. These will include: Title IV of the Civil Rights Act of 1964, as amended Section 504 of the Rehabilitation Act of 1975, as amended Age Discrimination Act of 1975, as amended Nontraditional employment for Women Act of 1991 Title IX of Education Amendments of 1972, as amended Name of organization: Signature of Agency s responsible representative Page 43 of 72

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45 ATTACHMENT G PROPOSAL CHECKLIST FORM Format Narrative Three originals of proposal included Completed Cover Letter serving as the first page of proposal Project Narrative Budget Narrative Evaluation Criteria Understand and Agree to All Evaluation Criteria (pages 30-32) Contract Award Understand and Agree to Contract Award Information Forms Attachments A-F completed and signed Detailed Budget (may use your own format) Proposal Checklist Form completed & attached (Attachment G) Proposer s Signature Date Page 45 of 72

46 Proposal Scoring Prospective Providers are advised that an offer for a contract may be initiated after a review of the proposals. Proposals will be reviewed for acceptability with emphasis on various factors and according to the type of service to be provided. Proposals will be evaluated on the following criteria: Provider/Employer Name TANF Summer Youth Employment Program RFP Y/N Criteria COMMENTS 1. COVER LETTER Provider contact information and signatures have been provided along If no RFP is found to be incomplete and will not be considered for selection. SCORING CONFLICT OF INTEREST STATEMENT I state that I do not have a conflict of interest in scoring the attached proposal for the Mentoring Program. A conflict of interest is generally understood to exist where a person has a direct personal, organizational, or financial tie to an organization, and where that person is in a position to influence, or appears to influence, the actions of another organization for the benefit of themselves or an organization with which they have such ties. I have read the scoring conflict of Interest statement and understand that I am responsible for the information contained in it. I have had all questions answered about this statement. I understand I can refer future questions to the agency Director, to the Mercer County Prosecutor s office or to the Ohio Ethics Commission. My signature below and my signature on the scoring sheet indicates my agreement to comply with this statement. Signature Date Signature Date Signature Date Page 46 of 72

47 2. ORGANIZATION DESCRIPTION Information on organization and experience running a youth employment program 0 = Not Addressed 1 = 1-2 Years Experience 2 = 3-4 Years Experience 3 = 5 or More Years Experience 3. PARTNERSHIP Partnership identification and letters of support explaining the roles and responsibilities between partners 0 = Not Addressed 1 = Addressed 4. PROGRAM PROPOSAL Program description and how training and activities will be provided, frequency, and how success will be measured 0 = Not Addressed 1 = Minimally Addressed 2 = Adequately Addressed 3 = Well Planned and Thought Out 5. EMPLOYMENT ACTIVITIES Identified proposed work sites, role of supervisor and copy of example of worksite agreement 0 = Not Addressed 1 = Minimally Addressed 2 = Adequately Addressed 3 = Well Planned and Thought Out 6. PARTICIPANT RECRUITMENT Participant recruitment, screening, and indication of number of youth they intend to recruit/employ 0 = Not Addressed 1 = Minimally Addressed 2 = Adequately Addressed 3 = Well Planned and Thought Out 7. INTAKE AND APPLICATION Intake and application process and pre-employment screening requirements 8. YOUTH MATCHING Description on how youth will be matched and placed with employers 0 = Not Addressed 1 = Minimally Addressed 2 = Adequately Addressed 3 = Well Planned and Thought Out 0 = Not Addressed 1 = Minimally Addressed 2 = Adequately Addressed 3 = Well Planned and Thought Out 9. PAYROLL PROCESS Description of payroll process and if third party will be used, tracking of hours and payment frequency 0 = Not Addressed 1 = Minimally Addressed 2 = Adequately Addressed 3 = Well Planned and Thought Out Page 47 of 72

48 10. SUPPORTIVE SERVICES Description of supportive services that will be used and how services will be communicated and utilized. 11. COMMUNICATION PROCESS Description of communication process with site supervisors, expectations of the job sites and intervention process when issues arise. 12. WORKPLACE SAFETY Description of worksite safety protocols 13. STAFF RESPONSIBILITIES Description of staff roles and responsibilities involved in the youth program including background checks and screenings 14. LIABILITY INSURANCE Proof of liability insurance provided 15. CERTIFICATE OF COMPLETION Sample provided has all required components 1 = Limited Services Available 2 = Moderate Services Available 3 = Provider Will Ensure Supportive Services are Provided As Needed 0 = Not Addressed 1 = Minimally Addressed 2 = Adequately Addressed 3 = Well Planned and Thought Out 0 = Not Addressed 1 = Minimally Addressed 2 = Adequately Addressed 3 = Well Planned and Thought Out 0 = Not Addressed 1 = Minimally Addressed 2 = Adequately Addressed 3 = Well Planned and Thought Out 0 = Not Provided 1 = Requirement Met 0 = Not Addressed 1 = Sample Provided without all Required Components 2 = Sample Provided Meets All Required Components 16. ATTACHMENTS All required attachments (A,B,C,D,E,F,G) are returned and completed 0 = Incomplete 1 = Completed 16. BUDGET Detailed costs complete and accurate. 0 = Incomplete 1 = Completed 17. BUDGET/PROGRAM COST Costs are deemed as appropriate and reasonable Maximum total score = 42 0 = Contains Unallowable Charges 1 = All Charges Allowable But Some Charges Deemed Excessive 2 = All Charges Allowable and Reasonable 3 = All Charges Allowable, Reasonable and Exceeds Expectations TOTAL SCORE Page 48 of 72

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