SACRAMENTO COUNTY CHILDREN S TRUST FUND

Transcription

1 SACRAMENTO COUNTY CHILDREN S TRUST FUND administered by the REQUEST FOR PROPOSAL (RFP) Services for Transition Age Youth (TAY) RFP #ADMIN/001 PROPOSALS MUST BE RECEIVED BY, OR PRIOR TO, 5:00 P.M. PST ON OR BEFORE MONDAY, APRIL 16, 2018 Proposal Template Please refer to RFP Proposal Instructions for guidance in completing this proposal. To request this document in Microsoft Word format, Abigail Nosce at noscea@saccounty.net

2 CHILDREN S TRUST FUND RFP# ADMIN/001 The following checklist must be completed and submitted with your proposal. All items must be submitted in the order listed. Please refer to this checklist to ensure that your proposal package is complete. This checklist must accompany the original proposal and your nine (9) copies, as the first page of each. Applicant Organization: EXHIBIT A: PROPOSAL PACKAGE CHECKLIST Administrative Requirements Yes No Applicant Organization was represented at Mandatory Proposer s Conference Proposal submitted using RFP# ADMIN/001 Proposal Template One original full proposal (Proposal Content Requirements 1 15); plus ten (10) copies (Proposal Content Requirements 1 8 only) included in proposal package, in the order specified All original signatures in BLUE ink (***below indicates original signature required) Printed on standard white paper, size 8.5 x11 ; single spaced, single sided pages; one inch page margins; 11 point Arial or Times New Roman font; binder clipped Pages numbered as instructed Section VII of the RFP Proposal Instructions Proposal submitted in the legal entity name of the proposer or an authorized agent Proposal package enclosed in sealed envelope or box and plainly marked Date: MM/DD/YYYY Proposal Content Requirements Yes No 1. Exhibit A: Proposal Package Checklist (pg. A1) 2. Exhibit B: RFP Cover Letter, Proposer s Statements, and Certification of Intent to Meet RFP Requirements*** (pgs. B1, B2, B3 ) 3. Table of Contents (pg. 1) 4. Exhibit C: Work Plan (pgs. C1, C2, C3 ) Program Description, Goals, Objectives, Activities, Target Groups, Evaluation (Outputs & Outcomes) 5. Exhibit D: Budget (pgs. D1, D2, D3 ) Program Budget Form, Budget Narrative, Sustainability Plan 6. Exhibit E: MOU(s), if applicable*** (pgs. E1, E2, E3 ) 7. Exhibit F: Two (2) letters of support (pgs. F1, F2, F3 ) 8. Exhibits G & H: Good Neighbor Policy*** Exhibit G: Narrative (pgs. G1, G2, G3 ) Exhibit H: Signed Statement of Compliance (pg. H1) 9. Exhibit I: Certification of Insurance (pgs. I1, I2, I3 ) 10. Exhibit J: Nonprofit Status (pgs. J1, J2, J3 ) 11. Exhibit K: Articles of Incorporation, if applicable (pgs. K1, K2, K3 ) 12. Exhibit L: List of Board of Directors/Trustees (pg. L1) 13. Exhibit M: Board of Directors Resolution*** (pgs. M1, M2, M3 ) 14. Exhibit N: Financial Statement and Accounting System (pgs. N1, N2, N3 ) Latest audited financial report, not more than 24 months old Description of accounting and record keeping systems 15. Exhibit O: Certification of Compliance with Child, Family and Spousal Support *** (Pg O1) A1

3 CHILDREN S TRUST FUND RFP# ADMIN/001 To: Sacramento County Children s Coalition c/o Abigail Nosce, Coalition Coordinator Department of Health Services 7001 A East Parkway, Sacramento CA SUBJECT: Child Abuse and Neglect Prevention and Intervention Services - Transition Age Youth Target Population Addressed in Proposal: Youth age 16 through 21 Name of proposer: [Legal entity name] Name, Parent Corporation (if applicable): Address of proposer: [Street Address, City, and Zip Code] Proposer s federal tax identification number: EXHIBIT B: RFP COVER LETTER, PROPOSERS STATEMENTS, AND CERTIFICATION OF INTENT TO MEET RFP REQUIREMENTS Contact Person: [Name, title, phone number, address] Name and title(s) of person(s) authorized to sign for agency: PROPOSER S STATEMENTS 1. Number of years proposer has been in business under present business name, as well as prior or related business names: 2. Number of years proposer has been licensed: 3. Provide a brief description and number of years of experience proposer has had in providing equivalent or related services: B1

4 CHILDREN S TRUST FUND RFP# ADMIN/ List grants and contracts completed in the last five years, below: Grant or Granting / Year Type of Service Location Amount Contract? Contracting Agency 5. List grants, contracts or other commitments (i.e.: consulting arrangements), currently in force: Grant or Granting / Year Type of Service Location Amount Contract? Contracting Agency 6. Provide details of any failure or refusal to complete a grant/contract: $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 7. If not a governmental agency, complete the following: a. Does the agency hold a controlling interest in any other organization(s)? Yes No If yes, list organization(s): b. Is the agency owned or controlled by any other person or organization? Yes No If yes, list person(s) or organization(s): c. Financial interest in any other business: d. Name of persons with whom the prospective contractor has been associated in business as partners or business associates in the last five years: Name of Business Associate Name of Business B2

5 CHILDREN S TRUST FUND RFP# ADMIN/ Briefly describe any litigation involving the agency, or principal officers thereof, in connection with any contract: 9. Is all major equipment necessary to complete this project currently on hand? Yes No If no, list all major equipment that needs to be purchased: 10. List any commitments or potential commitments which may impact assets, lines of credit, or guarantor letters, or otherwise affect the bidder s ability to perform the contract services: 11. Attach copies of all professional licenses or certificates required by the nature of the contract work to be performed. Certification I certify that all statements in my proposal are true. This certification constitutes a warranty, the falsity of which shall entitle the Children s Coalition and Sacramento County to pursue any remedy authorized by law which shall include the right, at the option of the Coalition and/or County, of declaring any contract made as a result hereof void. I agree to provide the Coalition and County with any other information the Coalition and County determine is necessary for the accurate determination of the agency s qualification to provide services. I certify that [agency s name] will comply with all requirements specified in the RFP which are applicable to the services which we wish to provide. I agree to the right of the county, state, and federal government to audit [agency s name] financial and other records. Signature of Authorized Agent of Proposer Date B3

6 CHILDREN S TRUST FUND RFP# ADMIN/001 TABLE OF CONTENTS 1

7 CHILDREN S TRUST FUNDRFP# ADMIN/001 The work plan provides the evaluation panel a description of the proposed program, along with its goals, strategies, activities, outcomes and how it will be evaluated. The work plan will serve as the basis for contract language and reporting for funded programs. Work Plan Instructions Complete the work plan on the form provided Refer to the sample work plan on the following pages Submit three work plans, one for each year of funding Limit to 6 pages total Work Plan Components The work plan should include the following components: EXHIBIT C: WORK PLAN Program Description and Goal(s) Provide a clear and concise description of the proposed program and who the program would serve. Include a description of the gaps in existing services the program would help resolve, and how the program would help close the gaps. Objectives Objectives are specific and measurable milestones that must be achieved in order to reach a goal. Specify the measurable objective(s) for the program s goal(s). Objectives should be specific and concise, identifying the target group, stating the result (change), specifying the degree of change in measureable terms, and identifying when the change would happen. If a goal has multiple objectives, number each objective consecutively. Strategies A strategy is a plan of action designed to achieve an objective. Specify the measurable strategy(s) describing how the objective(s) would be accomplished. Activities An activity is a specific action step required to deliver on a strategy. List the specific activities to be implemented and specify a timeframe for start and completion of the activity. Include activities such as hiring staff, conducting outreach or training, implementing activities, etc. If subcontractors or consultants are used, include the services they will provide. Target Groups(s) Identify the population(s) that will participate in the identified activities, and include how the service recipients will be selected, and how many will participate in each activity. Evaluation The program should include an evaluation plan based on its measurable objectives, broken out by anticipated outputs and shortterm outcomes. Outputs describe the result of the activity, help measure whether or not something occurred, and describes how much participation was included. For each activity, list the outputs, describing how you will document program activities and track progress towards completing the objective. (e.g. outreach logs, sign in sheets, lists of referrals made, materials developed, etc.) Outcomes describe the overall effectiveness in producing favorable behavioral effects in the target group. Its principal purpose is to determine whether changes have occurred over time and if the changes can be attributed to the program. For each activity, list the outcome, describing the expected result and the amount of change expected as a result of the program activity. Include how change will be measured. (e.g. pretest/posttest scores, competency/skills testing, interviews, self assessment/reports, questionnaires, etc.) C1

8 CHILDREN S TRUST FUNDRFP# ADMIN/001 AGENCY XYZ Work Plan SAMPLE July 1, 2018 June 30, 2019 Program Description and Goal(s): A Workplace Wellness Program that addresses major health risks, offers choices, targets both the employees and the worksite environment, and provides periodic evaluation of its results. The program emphasizes prevention and follow-up and offers support for the employee as long as he/she is employed. The overarching goals of the program are to lower health care costs, reduce absenteeism, achieve higher employee productivity, reduce injury, and improve employee morale and loyalty. Objective 1: By the end of the year, increase employee participation in the Workplace Wellness Program by at least 25% Strategy A: By the end of the year, increase employee registration in the weight loss challenge program by at least 15% Activity Target Group Timeframe Output Outcome 1. Wellness Program Coordinator recruits employees to meet regularly and serve as leaders for the weight loss challenge program All employees 7/1/18 9/30/ member Weight Loss Leadership Team to implement weight loss challenge program, established by 9/30/18; reported by Wellness Program 4-6% of employees engaged in leading weight loss challenge program; measured by Wellness Program Satisfaction Surveys 2. Provide managers with a fact sheet about the weight loss challenge program to distribute at weekly staff meetings 3. Wellness Program Coordinator conducts initial assessments All employees 7/1/18 9/30/18 Program participants 9/30/18 ongoing Coordinator Weight loss program educational materials distributed to 75 employees by 9/30/18; reported by managers 11 employees will have completed an initial assessment by 12/31/19; kept on file C2 100% of employees receive information about program; measured by manager reports 15% of employees establish a baseline to measure progress; measured by Wellness Program Satisfaction Surveys Strategy B: By end of year, engage 20% of employees in weekly physical activity Activity Target Group Timeframe Output Outcome 1. Wellness Program Coordinator recruits employees to start a walking club All employees 7/1/18 8/31/ employee charter members to promote walking for fitness, established by 8/31/18; reported by Wellness 4-6% of employees engaged in leading fitness walks; measured by Wellness Program Satisfaction Surveys 2. Introduce and promote employee walking club through company newsletters 3. Walking club charter members recruit other members to join All employees 7/1/18 9/30/18 All employees 8/31/18 ongoing Program Coordinator Walking club promotional material distributed to 75 employees by 9/30/18; reported by Wellness Program Coordinator 15 employees (including supervisors and managers) will engage in weekly walks; self-reported 100% of employees receive information about program; measured by Wellness Program Coordinator reports 20% of employees engage in weekly walks; measured by Wellness Program Satisfaction Surveys

9 CHILDREN S TRUST FUNDRFP# ADMIN/001 (Agency Name) Year One Work Plan July 1, 2018 June 30, 2019 Program Description and Goal(s): Objective 1: Strategy A: Activity Target Group Timeframe Output Outcome Strategy B: Activity Target Group Timeframe Output Outcome Objective 2: Strategy A: Activity Target Group Timeframe Output Outcome Strategy B: Activity Target Group Timeframe Output Outcome C3

10 CHILDREN S TRUST FUNDRFP# ADMIN/001 Program Description and Goal(s): (Agency Name) Year Two Work Plan July 1, 2019 June 30, 2020 Objective 1: Strategy A: Activity Target Group Timeframe Output Outcome Strategy B: Activity Target Group Timeframe Output Outcome Objective 2: Strategy A: Activity Target Group Timeframe Output Outcome Strategy B: Activity Target Group Timeframe Output Outcome C4

11 CHILDREN S TRUST FUNDRFP# ADMIN/001 Program Description and Goal(s): (Agency Name) Year Three Work Plan July 1, 2020 June 30, 2021 Objective 1: Strategy A: Activity Target Group Timeframe Output Outcome Strategy B: Activity Target Group Timeframe Output Outcome Objective 2: Strategy A: Activity Target Group Timeframe Output Outcome Strategy B: Activity Target Group Timeframe Output Outcome C5

12 CHILDREN S TRUST FUND RFP# ADMIN/001 EXHIBIT D: BUDGET Instructions Please fill out each budget section accurately and completely, using the forms included in this exhibit (however, if a bidder has supplemental information to be considered, it may be added in support of the completed forms). Budget sections must demonstrate fiscal responsibility and reasonableness as well as sufficient resources to perform tasks, maintain and sustain the proposed program. Narrative should be limited to three pages. Supplemental information should be limited to two pages. Program Budget Form Prepare line item budget for the proposed contract, using the Program Budget forms provided (one annual budget for each year of the program, up to three years). The budget must be prepared on a cash accounting basis. Indirect costs funded by Children s Trust Fund should not exceed 5% of total CTF funded budget. All other indirect expenses must be itemized under operating expenses. Budget Narrative A narrative must be provided to describe: Project funded staff Their specific roles in the project Their knowledge, training, experience, and ability Skill level and education requirements of staff and volunteers Operating Expenses Project funded expenses In kind services/goods directly benefitting the project Sustainability Plan Planned resources used to sustain program beyond funding term Collaborative activities that will contribute to sustainability D1

13 (Agency Name) Year One Program Budget July 1, 2018 June 30, 2019 CHILDREN S TRUST FUND RFP# ADMIN/001 Position Title Salary and Benefits Expenses % Time on (1) Children s Project Trust Fund (2) Contractor Match (3) Total (A) Total Salary and Benefits List Subcontracts Subcontract Expenses (1) Children s Trust Fund (2) Contractor Match (3) Total (B) Total Subcontract Expenses Expense Description Operating Expenses (1) Children s Trust Fund (2) Contractor Match (3) Total (C) Total Operating Expenses (D) Audit Expenses (E) Total CTF Funds (Column 1, A+B+C+D) (F) Total Contractor Match (Column 2, A+B+C+D) (G) Percentage of Contractor Match (F/E) Total Program Budget (E+F) D2

14 CHILDREN S TRUST FUND RFP# ADMIN/001 (Agency Name) Year Two Program Budget July 1, 2019 June 30, 2020 Position Title Salary and Benefits Expenses % Time on (1) Children s Project Trust Fund (2) Contractor Match (3) Total (A) Total Salary and Benefits List Subcontracts Subcontract Expenses (1) Children s Trust Fund (2) Contractor Match (3) Total (B) Total Subcontract Expenses Expense Description Operating Expenses (1) Children s Trust Fund (2) Contractor Match (3) Total (C) Total Operating Expenses (D) Audit Expenses (E) Total CTF Funds (Column 1, A+B+C+D) (F) Total Contractor Match (Column 2, A+B+C+D) (G) Percentage of Contractor Match (F/E) Total Program Budget (E+F) D3

15 CHILDREN S TRUST FUND RFP# ADMIN/001 (Agency Name) Year Three Program Budget July 1, 2020 June 30, 2021 Position Title Salary and Benefits Expenses % Time on (1) Children s Project Trust Fund (2) Contractor Match (3) Total (A) Total Salary and Benefits List Subcontracts Subcontract Expenses (1) Children s Trust Fund (2) Contractor Match (3) Total (B) Total Subcontract Expenses Expense Description Operating Expenses (1) Children s Trust Fund (2) Contractor Match (3) Total (C) Total Operating Expenses (D) Audit Expenses (E) Total CTF Funds (Column 1, A+B+C+D) (F) Total Contractor Match (Column 2, A+B+C+D) (G) Percentage of Contractor Match (F/E) Total Program Budget (E+F) D4

16 CHILDREN S TRUST FUND RFP# ADMIN/001 BUDGET NARRATIVE Provide detailed information that clearly explains the line items included in your budget. Refer to Budget Instructions for specifics on what to include. Limit narrative to three pages. For example, for a line item consultants you might include professional fees paid to health professionals, accountants and program or management consultants. For this expense, you would identify the individuals or agencies to which the fees are paid, their names and titles, and would describe the services provided by each, specifying the total costs and the terms of your agreement(s). D5

17 EXHIBIT E: MEMORANDUM OF UNDERSTANDING BETWEEN [PROPOSING AGENCY] AND [COLLABORATING AGENCY] CHILDREN S TRUST FUND RFP# ADMIN/001 This Memorandum of Understanding, hereinafter referred to as MOU, stands as evidence that the [Proposing Agency] and [Collaborating Agency] will collaborate efforts in order to provide to the target area/population. The paragraph below describes the program and the collaboration of all parties: List of Responsibilities of [Proposing Agency]: List of Responsibilities of [Collaborating Agency]:,, [Proposing Agency] Name, Title, Agency Signature MM/DD/YYYY Date,, [Collaborating Agency] Name, Title, Agency Signature MM/DD/YYYY Date E1

18 EXHIBIT F: LETTERS OF SUPPORT CHILDREN S TRUST FUND RFP# ADMIN/001 Please place two letters of support behind this cover sheet in your proposal package, and be sure to number pages consecutively, starting with letter F. F1

19 CHILDREN S TRUST FUND RFP# ADMIN/001 Review the next three pages outlining Sacramento County s Good Neighbor Policy. Then provide a narrative identifying applicability of the Good Neighbor Policy related to the facilities and services of the proposed project. Plan should include posting of required signage, periodic evaluation, selfdirected corrective action plan, establishment and/or maintenance of ongoing relationships with surrounding businesses, law enforcement, and neighborhood groups, as well as a plan to be an active member of the neighborhood in which the proposer s site is located. County of Sacramento Good Neighbor Policy Preamble EXHIBIT G: GOOD NEIGHBOR POLICY NARRATIVE The County is a political subdivision of the State of California, that is mandated by state and federal law to provide certain services to all residents of the County, and that also provides non mandated, desired or necessary services to enhance the well being and quality of life for its residents. Such services are provided within the territorial boundaries of all cities within Sacramento County and in the unincorporated areas of the County. County facilities are generally located in close proximity to the constituent population served, and in areas that are easily accessible to public transportation. The siting of facilities is ultimately a County responsibility. The County requires its departments to have conducted reasonable outreach to affected neighborhoods in siting County facilities. The County takes into consideration a whole range of factors, including location of clients served, proximity of other related services needed by clientele, and any neighborhood revitalization plans and adoption siting policies of cities. The County will solicit the affected city s input and recommendation as to location, but retains the ultimate decision as to the parameters of the search area and determination of the most appropriate sites. As a general rule, the County does not do site searches for programs, services or facilities operated by non county entities that may receive County funding, but requires contractors to have conducted reasonable outreach to affected neighborhoods. The County contracts for services, but does not dictate the location of the facility. All businesses within the incorporated and unincorporated areas of the county must be in good standing with whatever city or County zoning laws apply in order to receive funding. The County of Sacramento is committed to being an integral part of the neighborhoods and communities in which it is located and will implement measures in order to minimize the impact of such facilities on those neighborhoods and communities. Through its placement and management of facilities and its provision of appropriate services, the County endeavors to enhance revitalizing and strengthening of neighborhoods and communities. This policy is focused on those County owned and County leased facilities and those service providers under contract with the County where programs provide direct service to County constituents that have a potential impact on neighborhoods through increased traffic, noise, trash, parking, people congregating, and security risks to neighborhoods and program participants. Generalized good neighbor policies that prohibit loitering, require litter control services, mandate removal of graffiti, provide for adequate parking and restroom amenities, require landscape and facility maintenance consistent with the neighborhood and require identification of a contact person for complaint resolution have general application to all county facilities and programs. Good neighbor policies will also address specific and individualized impacts of proposed facilities and services based on actual circumstances which must be determined through a case by case analysis. G1

20 Good Neighbor Policies CHILDREN S TRUST FUND RFP# ADMIN/001 This policy applies only to County owned and leased facilities and those service providers under contract with the County if the facility programs and projects provide direct services to County constituents. In addition these service facilities must have a potential impact on neighborhoods and communities through increased traffic, noise, trash, parking, people congregating, and security risks to both neighborhoods and program participants. The County requires, with regard to the actual location of a particular facility or service, that all applicable zoning laws have been complied with. The focus of this good neighbor policy does not include the propriety of the location of a facility or program in a properly zoned neighborhood or community. While location is a consideration and input from cities, neighborhoods and communities will be sought, the ultimate decision as to location rests with the County. Once a facility is sited and in compliance with zoning laws, the intent of this policy is to identify physical impacts and measures to mitigate those impacts so as to be an integral part of the neighborhood and community the County serves. Provision A: Provision B: Provision C: Provision D: Provision E: Provision F: Provision G: Establish a cooperative relationship with all cities, neighborhoods and communities for planning and siting facilities and contracting for services where the service or project has a high impact on the neighborhood and mitigation of those physical impacts is necessary. Promote decentralization of County services where feasible as a means to improve accessibility and service delivery and reduce physical impact on the environment, neighborhoods and communities. Promote collocation of services, where feasible, as a way to enhance efficiency and reduce costs in the delivery of services. Promote exploration of innovative ways to increase accessibility to services that could also reduce physical impacts on the environment, neighborhoods and communities. Establish early communication with affected cities, neighborhoods and communities as a way to identify potential physical impacts on neighborhoods and to establish mitigation as necessary as well as appropriate property management practices so as not to be a nuisance. Maintain ongoing communication with cities, neighborhoods and communities as a way to promote integration of facilities into the community, to determine the effectiveness of established good neighbor practices, and to identify and resolve issues and problems expediently. Establish generalized good neighbor practices for high impact facilities, services and projects that include: Provision of adequate parking Provision of adequate waiting and visiting areas Provision of adequate restroom facilities Provision for litter control services Provision for removal of graffiti Provision for control of loitering and management of crowds G2

21 CHILDREN S TRUST FUND RFP# ADMIN/001 Provision H: Provision I: Provision J: Provision K: Provision L: Provision for appropriate landscape and facility maintenance in keeping with neighborhood standards Provision for identification of a contact person for complaint resolution Provision in contracts for the County to fix a deficiency and deduct it from the money owed to the program if the program fails to fix them. Provision to participate in area crime prevention and nuisance abatement efforts. Establish specific good neighbor practices for high impact facilities, services and projects based on a factual analysis of circumstances that would require more oversight and extraordinary measures to ensure the resolution of problems as they occur. Establish requirements that all facilities, services and projects be in compliance with various nuisance abatement ordinances and any other provision of law that applies. Establish a central point of contact, within the County, for resolving non compliance with this Good Neighbor Policy when all other administrative remedies have been exhausted. This requires contact with funding agencies, site contacts, call report logs, database maintenance, and trends analysis. Conduct a periodic review of all sites and projects included in this policy to determine the effectiveness of the application of the Good Neighbor Policy. Continued non compliance by contractor to this policy and its provisions may result in contract termination and ineligibility for additional or future contracts. Please address how your agency will comply with the requirements of the Sacramento County Good Neighbor Policy as it relates to the facilities and services named in the RFP. If you believe the Good Neighbor Policy does not apply to your proposed service(s), please provide an explanation about this. Limit explanation to two pages. Good Neighbor Policy for [Proposer Organization] (Type Narrative Here) G3

22 EXHIBIT H: STATEMENT OF COMPLIANCE WITH SACRAMENTO COUNTY GOOD NEIGHBOR POLICY CHILDREN S TRUST FUND RFP# ADMIN/001 Contractors submitting proposals shall certify that: 1. Contractor shall comply with COUNTY s Good Neighbor Policy. Contractor shall establish good neighbor practices for its facilities that include, but are not limited to, the following: a) Provision of parking adequate for the needs of its employees and service population; b) Provision of adequate waiting and visiting areas; c) Provision of adequate restroom facilities located inside the facility; d) Implementation of litter control services; e) Removal of graffiti within seventy two hours; f) Provision for control of loitering and management of crowds; g) Maintenance of facility grounds, including landscaping, in a manner that is consistent with the neighborhood in which the facility is located; h) Participation in area crime prevention and nuisance abatement efforts; and i) Undertake such other good neighbor practices as determined appropriate by COUNTY, based on COUNTY s individualized assessment of the contractor s facility, services and actual impacts on the neighborhood in which the facility is located. 2. Contractor shall identify, either by sign or other method as approved by the DIRECTOR, a named representative who shall be responsible for responding to any complaints relating to contractor s compliance with the required good neighbor practices specified in this section. Contractor shall post the name and telephone number of such contact person on the outside of the facility, unless otherwise advised by DIRECTOR. 3. Contractor shall comply with all applicable nuisance ordinances. 4. Contractor shall establish an ongoing relationship with the surrounding businesses, law enforcement and neighborhood groups and shall be an active member of the neighborhood in which Contractor s site is located. 5. If COUNTY finds that contractor has failed to comply with the Good Neighbor Policy, COUNTY shall notify contractor in writing that corrective action must be taken by contractor within a specified timeframe. CONTRACTOR s continued non compliance with the Good Neighbor Policy shall be grounds for termination of this Agreement and may also result in ineligibility for additional or future contracts with the COUNTY. Agency s Name Printed Name Signature MM/DD/YYYY Date H1

23 EXHIBIT I: CERTIFICATION OF INSURANCE CHILDREN S TRUST FUND RFP# ADMIN/001 Attach a standard Certificate of Insurance directly following this cover sheet, and be sure to number pages consecutively starting with letter I. The certificate should describe your current insurance coverage, issued by an insurance broker or agent. If Proposer currently does not have insurance in the amounts specified here, do not obtain additional insurance until a contract is offered. Proposer must, however, provide written evidence of their ability to obtain coverage in the required amounts. A letter from an insurance company or broker confirming coverage can begin on the projected start date of the program is adequate for the purpose of submitting this proposal. Minimum Scope of Insurance Coverage shall be at least as broad as: 1. General Liability: Insurance Services Office s Commercial General Liability occurrence coverage form CG Including, but not limited to Premises/Operations, Products/Completed Operations, Contractual, Sexual Molestation and Abuse, and Personal & Advertising Injury, without additional exclusions or limitations, unless approved by the County Risk Manager. 2. Automobile Liability: Insurance Services Office s Commercial Automobile Liability coverage form CA Commercial Automobile Liability: Auto coverage symbol 1 (any auto) for corporate/businessowned vehicles. If there are no owned or leased vehicles, symbols 8 and 9 for non owned and hired autos shall apply. Personal Automobile Liability: Personal Lines automobile insurance shall apply if vehicles are individually owned. 3. Worker s Compensation: Statutory requirements of the State of California and Employer s Liability Insurance. (If organization employs paid or volunteer employees) 4. Professional Liability or Errors and Omissions Liability insurance including Sexual Molestation and Abuse coverage (unless included under the Contractor s General Liability), appropriate to the Contractor s profession. 5. (Optional) Umbrella or Excess Liability policies are acceptable where the need for higher liability limits is noted in the Minimum Limits of Insurance and shall provide liability coverages that at least follow form over the underlying insurance requirements where necessary for Commercial General Liability, Commercial Automobile Liability, Employer s Liability and any other liability coverage (other than Professional Liability) designated under the Minimum Scope of Insurance. 6. Cyber Liability Including Identity Theft, Information Security and Privacy Injury: Coverage shall include, but is not limited to: 1) Third party injury or damage (including loss or corruption of data) arising from a negligent act, error or omission or a data breach; 2) Defense, indemnity and legal costs associated with regulatory breach (including HIPAA), negligence or breach of contract; 3) Administrative expenses for forensic expenses and legal services; 4) Crisis Management expenses for printing, advertising, mailing of materials and travel costs of crisis management firm, including notification expenses; 5) Identity event service expenses for identity theft education, assistance, credit file monitoring, to mitigate effects of personal identity event, post event services. I1

24 CHILDREN S TRUST FUND RFP# ADMIN/001 Minimum Limits of Insurance Contractor shall maintain limits of no less than: 1. General Liability shall be on an Occurrence basis (as opposed to Claims Made basis). Minimum limits and structure shall be: General Aggregate: $2,000,000 Products Comp/Op Aggregate: $2,000,000 Personal & Adv. Injury: $1,000,000 Each Occurrence: $1,000,000 Fire Damage: $100,000 Sexual Molestation and Abuse $250,000/$1,000,000 (Per person or occurrence/annual aggregate) 2. Automobile Liability: Commercial Automobile Liability for Corporate/business owned vehicles including nonowned and hired, $1,000,000 Combined Single Limit. Personal Lines Automobile Liability for Individually owned vehicles, $250,000 per person, $500,000 each accident, $100,000 property damage. 3. Worker s Compensation: Statutory. 4. Employer s Liability: $1,000,000 per accident for bodily injury or disease. 5. Professional Liability or Errors and Omissions Liability: $1,000,000 per claim and aggregate, including Sexual Molestation or Abuse (unless coverage provided by Commercial General Liability Policy.) Sexual Molestation or Abuse may be included under Professional Liability with a sublimit not less than $250,000 per person or occurrence and $1,000,000 annual aggregate. 6. Cyber Liability including Identity Theft, Information Security and Privacy Injury: $1,000,000 per claim or incident and $1,000,000 aggregate. Deductibles and Self insured Retention Any deductibles or self insured retention that apply to any insurance required must declared and approved by the County. Claims Made Professional Liability Insurance If professional liability coverage is written on a Claims Made form: 1. The Retro Date must be show, and must be on or before the date of Agreement or the beginning Agreement performance by Contractor. 2. Insurance must be maintained and evidence of insurance must be provided for at least one (1) year after completion of Agreement. 3. If coverage is cancelled or non renewed, and not replaced with another claims made policy form with a Retro Date prior to the contract effective date, the Contractor must purchase extended reporting coverage for a minimum of one (1) year after the completion of Agreement. Other Insurance Provisions If a contract is awarded, the insurance policies required in the agreement are to contain, or be endorsed to contain, as applicable, the following provisions: All Policies 1. Acceptability of Insurers: Insurance is to be placed with insurers with a current A.M. Best s rating of no less than A VII. The County Risk Manager may waive or alter this requirement, or accept I2

25 CHILDREN S TRUST FUND RFP# ADMIN/001 self insurance in lieu of any required policy of insurance if, in the opinion of the Risk Manager, the interests of COUNTY and the general public are adequately protected. 2. MAINTENANCE OF INSURANCE COVERAGE: The Contractor shall maintain all insurance coverages and limits in place at all times and provide the County with evidence of each policy's renewal ten (10) days in advance of its anniversary date. 3. Contractor is required by the agreement to immediately notify the County if they receive a communication from their insurance carrier or agent that any required insurance is to be canceled, non renewed, reduced in scope or limits or otherwise materially changed. The Contractor shall provide evidence that such cancelled or non renewed or otherwise materially changed insurance has been replaced or its cancellation notice withdrawn without any interruption in coverage, scope or limits. Failure to maintain required insurance in force shall be considered a material breach of the agreement. Commercial General Liability and/or Commercial Automobile Liability 1. Additional Insured Status: the County, its officers, directors, officials, employees, and volunteers are to be endorsed as additional insureds as respects: liability arising out of activities performed by or on behalf of the Contractor; products and completed operations of the Contractor; premises owned, occupied or used by the Contractor; or automobiles owned, leased, hired, or borrowed by the Contractor. The coverage shall contain no endorsed limitations on the scope of protection afforded to the County, its officers, directors, officials, employees, or volunteers. 2. Primary Insurance: For any claims related to the agreement, the Contractor s insurance coverage shall be endorsed to be primary insurance as respects: the County, its officers, officials, employees, and volunteers. Any insurance or self insurance maintained by the County, its officers, directors, officials, employees, or volunteers shall be excess of the Contractor s insurance and shall not contribute with it. 3. Severability of Interest: The Contractor's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer s liability. 4. Subcontractors: The Contractor shall be responsible for the acts and omissions of all its subcontractors and additional insured endorsements as provided by the Contractor s subcontractor. Professional Liability Professional Liability Provision: Any professional liability or errors and omissions policy required hereunder shall apply to any claims, losses, liabilities, or damages, demands and actions arising out of or resulting from professional services provided under the agreement. Workers Compensation Workers Compensation Waiver of Subrogation: The workers compensation policy required hereunder shall be endorsed to state that the workers compensation carrier waives its right of subrogation against the County, its officers, directors, officials, employees, agents, or volunteers, which might arise by reason of payment under such policy in connection with performance under the agreement by the Contractor. Should the Contractor be self insured for workers compensation, the Contractor agrees to waive its right of subrogation against the County, its officers, directors, officials, employees, agents, or volunteers. Notification of Claim If any claim for damages is filed with the Contractor or if any lawsuit is instituted against the Contractor, that arise out of or are in any way connected with the Contractor s performance under the agreement and that in any way, directly or indirectly, contingently or otherwise, affect or might reasonably affect the County, the Contractor shall give prompt and timely notice thereof to the County. Notice shall be prompt and timely if given within thirty (30) days following the date of receipt of a claim or ten (10) days following the date of service of process of a lawsuit. I3

26 CHILDREN S TRUST FUND RFP# ADMIN/001 ***Important note about Subcontractors: The Contractor shall require all subcontractors to maintain adequate insurance. Subcontractors shall name the Contractor as additional insured on their General Liability policies. The Contractor shall maintain copies of certificates of insurance and additional insured endorsements as provided by the Contractor s subcontractor. All coverages for subcontractors shall be subject to all of the requirements stated herein. I4

27 EXHIBIT J: Nonprofit Status CHILDREN S TRUST FUND RFP# ADMIN/001 Submit evidence of tax exempt status as defined by the Internal Revenue Service or Franchise Tax Board. Use this coversheet and be sure to number pages consecutively starting with letter J. J1

28 EXHIBIT K: Articles of Incorporation CHILDREN S TRUST FUND RFP# ADMIN/001 If applicable, place a copy of organization s Articles of Incorporation behind this sheet, and be sure to number pages consecutively starting with letter K. If not applicable, state reason why. K1

29 EXHIBIT L: List of Board of Directors/Trustees CHILDREN S TRUST FUND RFP# ADMIN/001 Provide a complete list of organization s Board of Directors/Trustees, below. Be sure to include their name and any positions held on the Board (ie: President, Vice President, Secretary, etc). Name Title Organization Board Position (if applicable) L1

30 EXHIBIT M: Board of Directors Resolution CHILDREN S TRUST FUND RFP# ADMIN/001 Place a copy of organization s Board Resolution allowing for pursuit of these funds behind this sheet, and be sure to number pages consecutively starting with letter M. If your agency does not require a Board Resolution to pursue grants or contracts, please include a signed letter from your Board president indicating such, and include individuals authorized to execute a contract and submit claims. **SAMPLE** RESOLUTION NO. BY THE BOARD OF DIRECTORS WHEREAS, a proposal to request funding for a program of services to be submitted to Sacramento County has been determined to be in the best interest of [NAME OF AGENCY] by its duly constituted Board of Directors. NOW, THEREFORE, BE IT RESOLVED that the persons named below are authorized to submit such a proposal and to negotiate and execute, on behalf of this corporation, any resulting Agreement and any and all documents pertaining to such Agreement, and to submit claims for reimbursement of other financial reports required by said Agreement. AND FURTHERMORE, that the signatures recorded below are the true and correct signatures of the designated individuals. AUTHORIZED TO EXECUTE AGREEMENT TITLE PRINT NAME SIGNATURE AUTHORIZED TO SUBMIT CLAIMS TITLE PRINT NAME SIGNATURE CERTIFICATION I certify that I am the duly qualified and acting Secretary of [NAME OF AGENCY], a duly organized and existing [NATURE OF BUSINESS]. The foregoing is a true copy of a resolution adopted by the Board of Directors of said corporation, at a meeting legally held on [DATE] and entered into the minutes of such meeting, and is now in full force and effect. DATE PRINT NAME SIGNATURE M1

31 EXHIBIT N: Financial Statement and Accounting System CHILDREN S TRUST FUND RFP# ADMIN/001 Place a copy of organization s latest audited financial report, not more than 24 months old, behind this sheet, and be sure to number pages consecutively starting with letter N. See Proposal Instructions for the type of financial statement required. In addition, use the space below to provide a description of organization s accounting and record keeping systems. Please limit this description to no more than two (2) pages. N1

32 CHILDREN S TRUST FUND RFP# ADMIN/001 EXHIBIT O: Certification of Compliance with Child, Family and Spousal Support Review and sign the following to indicate organization s compliance with court ordered child, family and spousal support. COUNTY OF SACRAMENTO CONTRACTOR CERTIFICATION OF COMPLIANCE FORM WHEREAS it is in the best interest of Sacramento County that those entities with whom the County does business demonstrate financial responsibility, integrity and lawfulness, it is inequitable for those entities with whom the County does business to receive County funds while failing to pay court ordered child, family and spousal support which shifts the support of their dependents onto the public treasury. Therefore, in order to assist the Sacramento County Department of Child Support Services in its efforts to collect unpaid court ordered child, family and spousal support orders, the following certification must be provided by all entities with which the County does business: CONTRACTOR hereby certifies that either: (a) the CONTRACTOR is a government or non profit entity (exempt), or (b) the CONTRACTOR has no Principal Owners (25% or more) (exempt), or (c) each Principal Owner (25% or more), does not have any existing child support orders, or (d) CONTRACTOR S Principal Owners are currently in substantial compliance with any court ordered child, family and spousal support order, including orders to provide current residence address, employment information, and whether dependent health insurance coverage is available. If not in compliance, Principal Owner has become current or has arranged a payment schedule with the Department of Child Support Services or the court. New CONTRACTOR shall certify that each of the following statements is true: a. CONTRACTOR has fully complied with all applicable state and federal reporting requirements relating to employment reporting for its employees; and b. CONTRACTOR has fully complied with all lawfully served wage and earnings assignment orders and notices of assignment and will continue to maintain compliance. Note: Failure to comply with state and federal reporting requirements regarding a contractor s employees or failure to implement lawfully served wage and earnings assignment orders or notices of assignment constitutes a default under the contract; and failures to cure the default within 90 days of notice by the County shall be grounds for termination of the contract. Principal Owners can contact the Sacramento Department of Child Support Services at (916) or (866) , by writing to P.O. Box , Sacramento, , or by E mailing DCSS BidderCompliance@SacCounty.net. CONTRACTOR NAME Printed Name of person authorized to sign Signature Date O10