Denver Human Services

Attachment 1

Denver Human Services

2017Homeless Street Outreach Services

Proposal 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 $______

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Attachment 2

Denver Human Services

2017Homeless Street Outreach Services

Proposal Checklist

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

____Completed Proposer Certification Form (Attachment 1)

____Completed Proposal Checklist (Attachment 2)

____Proposal Narrative (Scope of Work) not to exceed Ten (10) pages (Attachment 3)

____Proposal Budget with narrative (Attachment 4) –Cost

Reimbursement or Fee for Service

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

____Current Agency Annual Budget

____Current Independent Audit, Financial Review or IRS Tax Form

____List of Board of Directors with occupations and affiliations

____Organizational chart with staff names for Primary Agency

____Key Staff Resumes for Primary Agency

____Key Staff Job Descriptions for Primary Agency

____Non-discrimination Statement and Policy for Primary Agency

____Client Grievance Policy and Procedures for Primary Agency

____Certification Regarding Debarment, Suspension (Attachment 8)

____Diversity And Inclusiveness in City Solicitations Information Request Executive Order 101 Diversity and Inclusiveness in City Solicitations Information Request has been completed per Part I, #15 on page six (6) of this RFP

____Certificate of InsuranceperAttachment 6

____Compliance with Insurance Statement and Contract Certification Form (Attachment 10)

____One (1) original, and six (6) copies (total seven) of the full proposal and attachments, plus one full electronic copy.

Please place an X next to the items above to indicate that it is included in your submission. This sheet must accompany your proposal. You are advised to review your materials to ensure it is comprehensive 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

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Attachment 3

2017Homeless Street Outreach ServicesNarrative

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 Capacity and Experience

1. Provide an overview of your agency or organization including mission, history, years in operation, total staff size, and program staff including number of staff, role in program, education or licensure requirements, and training provided.
2. Describe your agency’s experience providing emergency services and basic needs programs and capacity to successfully manage the scope of work and other requirements described in the RFP.
3. Briefly describe your agency’s participation, active partnerships, experience managing emergency services or collaborations in local homeless initiatives and planning efforts. Describe how they are enhanced by or will be supported by the program you are proposing for funding.
4. Detail previous contracts with the City and County of Denver and/or other government agencies in the last five years and describe your agency’s experience managing/capacity and accounting for public funding.

1. Programs/Services to be provided in the context of this RFP

1. Provide a detailed description of the services you propose to provide and include narrative that explains the proposed activities that meet the goals, objectives and scope of this RFP.
2. Provide detailed information about goals, objectives, activities, timeline and staffing for proposed services.
3. Describe what outcomes will be achieved through the provision of proposed services.
4. Explain how you will evaluate the outcomes of your proposed services and how results will be measured.

1. Experience and Qualifications

1. What experience does your organization have in using HMIS?

1. Responses should include the number of employees trained in HMIS use and your agencies Data Quality results for each HMIS program.
2. The source of the Data Quality results should be based on the latest report issued by the Colorado Coalition for the Homeless.

1. Describe your agency’s experience with the following:
2. Providing sheltering and or emergency services for specific populations.
3. Providing case management and supportive services towards housing retention, attainment, income attainment, benefits applications, and medical benefits attainment.
4. Describe your agency’s technical and administrative capacity to track program participants.
5. Describe program/agency rules, guidelines and expectations.
6. How frequently are clients informed of these rules?
7. Explain your communication process.

1. Emergency Situations

What is your ability to scale staff and capital resources in an emergency situation?

1. Cultural Competencyand Diversity

1. Describe the process your agency uses to identify specific culturally based needs of populations other than the majority population, and how it uses that information to modify engagement, access and service delivery in order to meet unique needs. Give examples, if possible, from prior agency projects.
2. Explain your agency’s philosophy of cultural competency and specific efforts to ensure equity and social justice.
3. Specifically describe your agency’s client grievance process especially as it pertains to the proposed project. Include information about how and when clients are informed about it, the time frame in which a client’s grievance is heard and how decisions are rendered.
4. Does your grievance process require clients to be dismissed from your facility/program before the grievance procedure is completed?
5. Please explain how your organization ensures that clients filing a grievance are provided with due process? (DDHS requests a copy of your client grievance policy and procedures to be submitted with this RFP).
6. If your agency or the proposed project is associated with or supported by the faith community or religious organization(s), are clients required to participate in religious programming?

1. Budget and Narrative

1. Provide a summary of your budget request, including personnel, facility/operating, the basis for administrative costs, and any other information that helps clarify project costs.
2. Please find and complete Attachment 4 Budget Form and follow the instructions included. Provide any and all needed narrative related to the budget and be as detailed as possible.
3. Describe whether your organization has the administrative capacity to manage the fiscal controls and reporting requirements of multi-million dollar federal programs.
4. Please describe any additional resources that will be leveraged in support of the proposed service/program.

1. Program Evaluation

1. Describe how your organization will monitor and evaluate the quality of the services provided.
2. Describe the methodology you will use to track each outcome.
3. Please specify the methods and assessment tools used to measure your program effectiveness.
4. Describe how your organization will monitor and evaluate the quality of the services. Specify methods/assessment tools used to measure program effectiveness.

1. Reporting and Accounting Requirements

1. Describe your methodology and ability to track data and provide periodic reports on program progress.
2. Please describe your accounting systems.

1. Sustainability

1. Describe how you would continue to support this program or services to serve clients in the community if there was a reduction in funding in the future?
2. Please explain how this programming could be planned for and sustained in your organization in the future?
3. Is the program in alignment with your organizational vision and goals?

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Attachment 4 Cost Reimbursement

BUDGET (Cost Reimbursement )
Contractor Name:
Contract Term:
Program Name: 2017 Homeless Street OutreachServices
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
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 4 Fee for Service

BUDGET (Fee for Service )

Contractor Name:
Contract Term:
Program Name: 2017 Homeless Street Outreach Services
Unit of Service / Unit Price / Number of Units / Total
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-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
TOTAL BUDGET / $0.00 / $0.00
A Budget Narrative must accompany this Budget Form. The Budget Narrative must outline and clearly describe all items associated with each item listed in the Budget with the rationale and methodology used to establish the fees, cost allocations, and calculations associated with the program. The Budget and Budget Narrative should be outlined identically on a line-by-line basis.

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Attachment 5

DHS Financial Services Required Documentation

Billings submitted for reimbursement must be accompanied by adequate documentation as described below.

1. Salaries & fringe

Complete Expense Breakdown for Salary and Fringe form

Payroll Register (employee information)

Activity report (if applicable)

Time Sheets signed by employee

100% time certification

Supervisory approval

1. Supplies, capital Equipment (<$5,000), Facility expense

Invoice

Proof of payment ( receipts) Sales Tax NOT reimbursed

1. Gift Card, Bus Passes, and client foods and Incentives

Complete Items Provided To Clients form

Client signature or confirmation of client receipt for anything given to clients

Receipts Sales Tax NOT reimbursed

Copy of gift card back, proof of payment

Serial numbers for bus passes and tickets, proof of payment

1. Administrative / Indirect Costs

Administrative 10 percent or lower

• Documentation to substantiate submitted charges

Administrative over 10 percent

• Documentation to substantiate submitted charges

Indirect 10 percent or lower

• No documentation required

Indirect over 10 percent

• Federally Approved Indirect Cost letter

*Indirect Cost Rate depends on contract funding source. Non-federal funding sources will be negotiated during contract creation

1. Rental Assistance

Lease or Rental Agreement

• First page showing all rental and deposit amounts
• Last Page showing signatures of all parties
• Must show the size of the unit (1 bedroom, 2 bedroom etc.)
• A Rent Reasonableness Test should be submitted with any new lease locations
• Rent Reasonableness Test required if rental amount increases (even if there is no new lease agreement and rent is within FMR)
• If receiving eviction services, please send lease

TPP Calculation Sheet (Tenant Payment Portion)

• Required with every new rental
• Required with all changes to rental amount or tenant portion

Proof of Payments

• Proof of Tenant Payment
• Proof of payment to rental unit

Utilities

• If this is being reimburse an invoice and proof of payment should be submitted with the invoice

Other Charges

• If the contractor is invoicing for any other expenses, the invoice must be accompanied with a bill for these charges and proof of payment

1. Professional Services/Fee For service

Detailed invoice from Service provider

• This must include the service provided
• Client identifier if services were provided for a client

Proof of Payment or Attendance

• Canceled check or bank statement to prove payment
• Sign in sheet, certificate of attendance, registration for proof of attendance if needed

1. Mileage/Travel Expense

Mileage

• Must have mileage spreadsheet showing starting and ending physical address for every trip
• Purpose of trip

Non-Mileage Travel to include Parking

• Supporting documentation or proof of payment for all charges. This could be an invoice, receipts, ACH forms, bank statements or credit card bill
• All documentation must be clear and identifiable amounts must match the requested reimbursement

1. Conference/Training (employee)

Employee name and purpose

Proof of Attendance (Certificate of Attendance, Agenda, Travel documents)

Itemized Receipts for Expenses

1. Training/Certification (client)

Client name and purpose

Proof of Attendance (Client registration, Certificate of Completion, List of Attendees)

Proof of Payment

** NOTE: All backup documentation must be legible. If multiple items have been purchased but a select few are reimbursable, please annotate applicable expenses on documentation

ITEMS PROVIDED TO CLIENT(S)
Report of items given to clients allowed by fund / program
Contractor Name*:
Contractor Address*:
Contract Number*
During the dates shown below, the following goods were received by the listed client(s)
Detailed Description of Item and Purpose* / Client Name/ID# (type or print)* / Client Signature* / Date* / Qty* / Total Value*
King Soopers gift card - emergency food for client / John Smith / 5/5/2015 / 1 / $ 25.00
Total Value: / $ 25.00
By signing this report, I certify that I have firsthand knowledge that the client(s) listed above was given the items listed and that the client(s) is/are eligible to receive these items,in accordance with the rules and requirements of the program/fund associated with this expense.
Employee Printed Name* / Employee Signature* / Date
***NOTE: You must attach legible supporting documentation to this sheet (copies of receipt, gift card, bus pass/ticket etc.). If Client ID # is mandatory, printed name/signature not applicable. Gift card and bus expenses will not be reimbursed prior to client issuance. If multiple items have been purchased please annotate which items on the amount being billed.
INSTRUCTIONS
1. All fields with an asterisk (*) must be completed and legible even if the value is zero (0)
2. The Contractor Name is the company name referenced on the contract with Denver
3. The Contractor Address is the company address referenced on the contract with Denver
4. If a client number is used in lieu of a name, the number must be a unique identifier associated to only one client
5. You must select the type of property given to client; "GIFT CARD", "BUS PASS/TICKET", or "OTHER"
6. Client signature required as proof of receipt of expense item(s).
7. Date is the month, day, and year that client physically received the item(s).
8. Qty is the quantity of items received, if more than one. If this field is left blank, Denver will assume that only one (1) item was received by the client.
9. A worker must sign this form certifying distribution of items to client(s)
BACKUP DOCUMENTATION
1. All expenses given to client must be supported with legible proof of payment.
1a. This would be a copy of the receipt for items purchased
1b. All gift cards given out must include a legible copy of the gift card number

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Attachment 8

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