Attachment 1

Denver Department of Human Services

Denver Collaborative Partnership Program

“Proposer Certification Form”

(Please Print or Type)

Agency/Name: ______

Type (LLC/Sole Prop/etc.): ______

Address: ______

City: ______State: ______Zip: ______

Telephone Number: ______Fax Number: ______

Website: ______Email Address: ______

Contact Person for this Application: ______

Title: ______Phone: ______

Email Address: ______

Executive Director, CEO, or Owner: ______

Title: ______Phone: ______

Email Address: ______

Federal Identification Number or Social Security Number: ______

Total Proposal Request $______

Attachment 2

Denver Department of Human Services

Denver Collaborative Partnership Services Program

“Proposal Checklist”

Your Proposal will not be considered complete unless all of the attachments/documents below are included. Please make certain that you include all of the following:

____Completed “Proposer Certification Form” (Attachment 1)

____Completed “Proposal Checklist Form” (Attachment 2)

____“Proposal Narrative” (proposed Scope of Work) not to exceed ten (10) pages (Attachment 3)

____Proposal Budget and Narrative (Attachment 4)

____IRS 501(c) (3), Certification of Good Standing with Colorado Secretary of State, or State Corporation Papers

____Current Agency Annual Budget

____Most recent Independent Audit, Financial Review or IRS Tax Forms

____List of Board of Directors with occupations and affiliations

____Organizational chart with staff names

____Key staff resumes

____Key staff job descriptions

____Non-discrimination Statement and Policy

____Client Grievance Policy and Procedures

____Completed “Certification Regarding Debarment, Suspension and Other Responsibility Matters” (Attachment 5)

____Completed “Diversity and Inclusiveness in City Solicitations Information Request Form” (Attachment 6)

____Certificate of Insurance completed as in sample (Attachment 7)

____Compliance with Contract and Insurance Certification Form (Attachment 9)

____One original and SIX (6) copies of the proposal as well as an electronic copy on a flash drive or CD.

Please place an X next to the items above to indicate that it is included in your submission. This sheet must accompany your proposal. It is recommended that review your materials to ensure it is responsive and complete before you submit it.

I have reviewed this proposal and have included all the required information:

______

Print Name of Person Completing Proposal

______

Signature of Person Completing ProposalTitleDate

______

Print Name of Agency or Corporation Executive

______

Signature of Executive TitleDate

Attachment 3

“PROPOSAL NARRATIVE”

This RFP is designed to provide sufficient information for providers to prepare and submit a Request for Proposal. All responses should provide a straightforward, concise description of qualifications, and include any details of interest in the specifics you will be providing services for. The following information should be fully explained in your proposal and be presented as follows:

  1. Agency Information
  1. Provide a brief overview ofyour agency including mission,

history, years in operation, total staff size, and staffing related to this

program.

  1. Briefly describe your agency’s experience and services provided as they relate to the requirements and the specifications as stated in the RFP.
  1. List any professional, state, or required licenses, accreditation, and certification levels of your agency’s staff, if any.
  1. Please describe previous contracts with the City and County of Denver and/or other government agencies in the last five years and describe your organizations ability to effectively manage these contracts.
  1. Describe any active partnerships or collaborations in which you are involved and how they would be enhanced by or supported by this program.
  1. Programs/Services to be provided in the context of this RFP

The response should detail the methods and practices that will be employed incorporating the following:

  1. Provide a detailed description of the services you propose to provide and include narrative that explains the proposed activities that methods and practices as described above in thisRFP.
  1. Describe what outcomes will be achieved through the provision of proposed services.
  1. Explain how you will evaluate the outcomes of your proposed services and how results will be measured.
  1. Organizational Experience and Capabilities

Please answer the following questions in relation to your agencies experiences and effectiveness unless requested otherwise.

  1. Please describe the curriculum used by your organization and training received by staff who implementsit.
  1. Describe similar or related services and activities relevant to this procurement request and your capability to operate proposed services.
  1. Describe your organizations rules, guidelines, and expectations as they relate to this RFP.
  1. How frequently are clients informed of these rules?
  1. Does your agency have a client grievance process? If yes, please describe, if no, please explain why not. (DDHS requests a copy of your client grievance policy and procedures to be submitted with this RFP).
  1. Accounting and record Keeping
  1. Please describe your accounting systems.
  1. Describe your process for record keeping. Please explain these procedures, including how your agency ensures the confidentiality of client files.
  1. Describe your agency’s technical and administrative capacity to track program participants.
  1. Reporting Requirements
  1. Describe your methodology and ability to track data and provide periodic reports on program progress.
  1. Describe the methodology you will use to track each outcome.
  1. Program Evaluation
  1. Describe how your agency will monitor and evaluate the quality of the services provided.
  1. Please specify the methods and assessment tools used to measure your program effectiveness.
  1. Budget

Complete a proposal budget, using the budget spreadsheet template form(Attachment #4) attached to this RFP. The line item narrative should be complete. The rationale and methodology used to establish the budget must be clearly explained, showing any calculations in the budget.

Attachment 4


BUDGET (Cost Reimbursement)


Contractor Name:
Contract Term:
Program Name: Denver Collaborative Partnership Services Program
ITEM / BUDGET / BUDGET NARRATIVE JUSTIFICATION
INDIRECT COSTS
Staffing/Administration
Sub-Total (Staffing)
Other Administrative Costs
Sub-Total (Other Admin Costs)
FACILITIES
Operating and Overhead Costs
Sub-Total (Facilities)
SUM OF INDIRECT COSTS:
DIRECT COSTS
Staffing
Sub-Total (Staffing)
Client Services
00
Sub-Total (Client Services)
SUM OF DIRECT COSTS:
TOTAL COSTS):
The Narrative must outline and clearly describe all items associated with each line item, the rationale and methodology used to establish the fees, cost allocations, and calculations associated with the funded program. The Budget Narrative should be outlined to the line items and is to be attached to the Budget Form page.

Attachment 5

Certification Regarding Debarment, Suspension, and Other Responsibility Matters

Primary Covered Transactions

Instructions for Certification

1.By signing and submitting this proposal, the prospective primary participant is providing the certification set out below.

2.The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency’s determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction.

3.The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminated this transaction for cause or default.

4.The prospective primary participant shall provide immediate written notice to the department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

5.The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations.

certification

(1) The prospective primary participant certifies to the best of knowledge and belief, that it and its principals:

(a)Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department;

(b)Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

(c)Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federally, State or local) with a commission of any of the offenses enumerated in paragraph (1) (b) or this certification; and

(d)Have not within a three-year period preceding this application proposal had one or more public transactions (Federal, State or local) terminated for cause or default.

(2) Where the Prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.

______

Signature Principal OfficerTitle

______

Name of AgencyDate

______

AddressCity, State, Zip Code

Attachment 6

DIVERSITY AND INCLUSIVENESS FORM

The following is the required Diversity and Inclusiveness Provision website for all City solicitations of proposals through our Executive Order 101 which sets out this requirement.Executive Order 101 establishes strategies for the City and County of Denver to use diversity and inclusiveness to promote economic development in the City and to encourage more businesses to compete for contracts and procurements awarded by the City.

Please use the following link to complete the diversity and inclusiveness requirements for this solicitation:

ALL PROPOSALS THAT DO NOT COMPLETE EXECUTIVE ORDER 101 DIVERSITY AND INCLUSIVENESS IN CITY SOLICITATIONS INFORMATION REQUEST FORM PRIOR TO THIS RFP SUBMISSION WILL BE REJECTED.

Diversity and Inclusiveness information provided by City contractors/consultants in response to City solicitations for services or goods will be collated, analyzed, and made available in reports consistent with City Executive Order No. 101. However, no personally identifiable information provided by or obtained from contractors/consultants will be in such reports

Attachment 9

Denver Department of Human Services

COMPLIANCE WITH CONTRACT AND

INSURANCE CERTIFICATION FORM

2017 Denver Collaborative Partnership Services Program

I, on behalf of the proposer identified below, hereby certifies thatI have read a copy of thesample contract attached to the RFP and understand the terms and provisions contained in that contract. I further hereby certify that it is the proposer’s intent to comply with each and every term and provision contained in the sample contract and propose no modifications to the sample contract except as follows:

1)

2)

3)

I understand that the modification stated above, if any, are offered for discussion purposes only and that the City and County of Denver reserves the right to accept, reject or further negotiate any and all proposed modification to the sample contract.

Check and Initial Here______

I, on behalf of the applicant identified below, hereby certify that I have submitted and provided a Certificate of Insurance with this proposal that

____ Shows evidence of the insurance required as described in the Description of Required Insurance within this RFP and as stated in the Sample Certificate of Insurance (Attachment 7).

____ Provide current Certificate of Insurance and if selected to contract with the City and County of Denver will purchase and carry the insurance required within ten days of notification of funding.

There will be NO modifications to insurance provisions except in regards to the waiver of Workers’ Compensation for sole proprietors and personal auto in place of business auto for those who use personal autos for business use):

Applicant Name:

Program Name (if applicable):

Authorized Signature: ______

SignatureDate

Name (please print): Title:______