REQUEST FOR PROPOSALS (RFP)

Transcription

1 REQUEST FOR PROPOSALS (RFP) FOR YOUTH TUTORING AND LEADERSHIP SERVICES DATE: April 16, 2012 TO: FROM: All Interested Parties Robert L. Bloom, Executive Director/President SUBJECT: Request for Proposals for Youth Tutoring and Leadership Services Provider The Workforce Investment Board (WIB) of Solano County, Inc. is seeking proposals from Youth Tutoring and Leadership Services Providers that can deliver a county-wide, quality, year-round program to youth in Solano County, ages The ultimate goal of the Youth Program is to provide a comprehensive array of services that give the youth the tools necessary to make sound decisions about their futures and career choices and expose the youth to opportunities that will prepare them for the future. The successful vendor must be experienced in providing both Youth Tutoring and Leadership Development. This Request for Proposals (RFP) will produce an initial nine (9) month contract from OCTOBER 1, 2012 through JUNE 30, However, based upon satisfactory performance the contract can be renewed for up to two additional 12- month contract terms (July-June), or through JUNE 30, Available Funding The current budget allocates an amount not to exceed $56,250 for 9 months for the contracted service elements of the WIB Youth Programs. The service provider recommended and selected for funding in response to this request will enter into a cost-reimbursement contract for the negotiated amount for the scope of services to be provided. The final negotiated budget amount set for deliverables are subject to final availability of funding. Any delays in grant processing by the State could result in delay of contract negotiations with the organization selected for funding. Options to extend contracts will be contingent upon the availability of funds and successful contractor performance, at the WIB s sole discretion. A Service Provider that provides satisfactory service will be eligible for amendment to the original contract for up to 2 ¾ years of total service. The following specifications must be addressed in your written response. Based on your qualifications, your proposal will be analyzed for price reasonableness. Please be as specific as possible in your description of services, experience, cost, etc. In order to be considered for the project your original response and five (5) copies must be received in the WIB Administrative Offices by 5:00 p.m. on Friday, May 18, Late submittals or proposals postmarked 05/18/12 will not be accepted.

2 Request for Proposals Youth Tutoring and Leadership Services April 16, 2012 DESIRED Youth Tutoring and Leadership Training Services: The WIB is seeking the following characteristics in a Youth Tutoring and Leadership Training Services Provider: A. General Expectations 1. Ability to provide an engaging, valuable service to Solano County youth. 2. Utilize creative methods in developing Youth in our community into strong leaders. 3. Ability to leverage resources and collaborative partnerships and provide crossservices that will result in a decrease in the cost of services. 4. Ability to document and communicate youth progress in a reliable, professional and responsible manner. 5. Ability to provide countywide services for both youth programs. Their presence must be in each of the three specified geographic areas. The Solano County geographic areas are defined as follows: North County: Central County: South County: B. Performance Standards Dixon and Vacaville Fairfield, Suisun and Rio Vista Benicia and Vallejo In order to demonstrate an effective use of federal dollars in workforce development efforts, the Workforce Investment Act establishes performance standards as an accountability system for each state. Each state in turn sets standards for each of its local WIB areas. These standards represent a commitment to continuous improvement so performance expectations rise for the local areas, states and overall federal program each year. As a result, contractors are required to deliver high quality, responsible services to Youth and equal care and attention when reporting the results of these services to the WIB. Youth Performance Standards /Common Measures Youth are identified as those who are determined eligible to enter the local WIA program between years of age. This group is subject to the single set of the following performance measures: o Placement in Employment or Education: Percentage of youth who enter employment or enroll in post-secondary education and/or advanced training/occupational skills training or the military in the first quarter after exit. o Diploma or Credential Rate: Percentage of students who attain a GED, high school diploma, or certificate by the end of the third quarter after exit. 2

3 Request for Proposals Youth Tutoring and Leadership Services April 16, 2012 o Literacy and Numeracy Gains: Percentage of basic-skills-deficient students who achieve literacy or numeracy gains of one or more Adult Basic Education level within one year of enrollment. C. Activities and Desired Outcomes This RFP is for services from October 1, 2012 through June 30, Activity: 9 months Estimated Service levels Estimated Budget for Services WIA Elements Tutoring Leadership Development 75 Youth* Participants given tutoring assistance 75 Youth* Participants taking part in Leadership and Adult Mentoring Activities TBD by applying agency TBD by applying agency * Many youth may participate in and be reported in both activities. Total Available: $56,250. D. Tutoring and Leadership Tutoring Study skills training, general educational tutoring and specific instructions are identified as activities leading to completion of secondary school. Tutoring includes dropout prevention strategies for the purpose of attainment of High School Diploma and/or GED and the promotion of post secondary education. The tutoring will focus on improving basic educational skills in the following areas for the WIA youth performance standards: Reading Math Writing The intent of this service is to assist the youth with completing educational goals that will make them more competitive in future employment. The service provider is to assist youth in the attainment of a high school diploma or GED certificate and/or the pursuit of post secondary education as appropriate for an individual youth. Leadership Development Activities and opportunities are to include the following: Exposure to post-secondary educational opportunities; Curriculum for Leadership activities; Community, service learning & peer centered projects. The intent is to develop a positive peer group with a set of positive values and outlook for their future; Organizational and team work training (including team leadership training i.e. parenting, work behavior training and budgeting resources); 3

4 Request for Proposals Youth Tutoring and Leadership Services April 16, 2012 Positive social activities and skill building during non-school hours (often referred to as soft skills that will be incorporated by many local programs as part of their menu or services which may include but are not limited to, positive attitudinal development, self-esteem building, cultural diversity training and work simulation activities). The intent of the Leadership Development activities is to create positive social attitudes and opportunities that WIA youth may not have general exposure to and develop the potential of the youth as citizens and leaders. E. Roles and Responsibilities Frequent, regular and open communication between the contractors and the WIB is paramount to the success of the Youth Program. Therefore, provider s staff must meet bi-weekly with the WIB staff to update/coordinate program activities. Agencies must provide availability and commitment to interact with the WIB s Youth Coordinator and Youth Employability Specialist. Shared Responsibilities: The WIB Operation Unit and the Youth Provider will coordinate services in a manner that allows Youth participants to receive the maximum benefit of WIA services. Contracted Service Provider Responsibilities The Youth Service Providers will be responsible for the following tasks. 1. Provide and train qualified staff to plan and administer the contracted services; 2. Provide program sustainability for duration of contract; 3. Provide services during scheduled business days and hours and/or appropriate to program participant s needs; 4. Provide a regular location where services can reliably be provided for program participants in given locales in north, central and south Solano County; 5. Provide flexible program design to meet the varied needs of program participants; 6. Provide tutoring for youth participants; and 7. Provide leadership activities for youth participants. Documentation of Services Rendered 1. Log WIB referral forms as received; 2. Provide the WIB copies of the following documents regarding youth Participants: a. Report cards and progress reports; b. Copies of weekly case notes; c. Assessment test results, before and after tutoring; d. Classroom-based tests, before and after tutoring; e. Diploma or other certification of academic progress or success; f. Alternative secondary school diplomas and/or certificates; 4

5 Request for Proposals Youth Tutoring and Leadership Services April 16, Maintain an organized, confidential file for each referred client and document participants attendance and progress through the program including: a. Copies of weekly case notes; b. Emergency contact information, in case of an emergency; c. Client documentation of WIA goals; and 4. Invoice services on a monthly basis through the WIB fiscal department Teamwork and Communication 1. Maintain routine contact with referred clients, notifying Youth Employability Specialist of significant changes in attendance or participation; 2. Deliver monthly written report to the WIB, stating participants names, attendance, services received, services planned and case notes, if any; 3. Attend all in-service training sessions and monthly provider meetings at the WIB; 4. Meet with WIB staff at least bi-weekly to coordinate case management ; 5. Maintain an objective assessment of the academic levels, skill levels and service needs of the participant. (Current assessment results from WIB or other providers may be used); and 6. Conform with additional directives/requirements as the State and/or WIB deemed necessary. MODE OF DELIVERY MISCELLANEOUS ELIGIBLE APPLICANTS /CONTRACT REQUIREMENTS Please complete the attached specification forms for all areas described in this RFP. Please summarize any additional services you provide that you feel may be related or of interest to the WIB, in the identified areas. In order to contract for WIA funds, an agency/firm must: 1. Be legally capable of entering into a contract, and be able to provide proof of the ability to manage Youth Tutoring and Leadership Services demands (i.e., previous experience managing and providing similar services). 2. Be able to provide documentation of current fiscal and compliance audits, as required by law. 3. Have an adequate financial management system that controls, records and reports cost receipts and disbursements according to all federal grant accounting policies and procedures. 4. Be able to provide Articles of Incorporation and evidence of current corporate status, as filed with the Secretary of State. 5. Be an Affirmative Action/Equal Opportunity Employer. If selected for funding, agencies will be required to meet AA/EEO requirements. 5

6 Request for Proposals Youth Tutoring and Leadership Services April 16, 2012 General Conditions: 6. Comply with all applicable provisions of the Americans with Disabilities Act of 1990 (ADA) & AB Ensure that reports and/or documents contain correct information. 8. File required insurance documentation with the WIB. The WIB must review all documentation before the initial invoice will be processed. The following are insurance requirements that contractors will be required to carry: a) Comprehensive General Liability in the amount no less than $1,000,000. Combined Single Limit for each occurrence or $2,000,000 General Aggregate for bodily injury, personal injury and property damage. b) Workers' Compensation as required by State law. c) Blanket Honesty Bond for at least 50% of the amount of the grant or $50,000, whichever is less. d) Automobile Liability in an amount not less than $500,000 combined Single Limit per accident for bodily injury and property damage covering owned, non-owned, and hired vehicles. e) Workforce Investment Board of Solano County, and its Officers, Employees, and Agents are to be covered as additional insured. f) Notice of Cancellation must ensure that each insurance policy shall be endorsed to state that the coverage shall not be suspended, voided, or canceled except after 30 days prior written notice has been given to the WIB. Proposals submitted in response to this solicitation are not legally binding documents. However, the contracts, which are based on the proposals and resulting contract negotiations, become legally binding after being signed by both parties. The WIB has the right to reject proposals that do not conform to agency goals and objectives, and may request redesign after submission. Incomplete proposals will be disqualified from the review process. All costs associated with the development of a proposal must be borne by the applicant. Final Contract Award Determination Notwithstanding a recommendation of the WIB Director, and approval of the Board, the Solano County Board of Supervisors, acting as the fiscal agent, retains the right to exercise its judgment concerning the selection of any proposal or agency and the terms of any resultant contract. The Board of Supervisors is the ultimate decision making body and makes the final determinations necessary to arrive at a decision to award, or not award, a contract. Lobbyist Ordinance Compliance Certification Each person, firm or proposer submitting a response to this RFP certifies that no lobbying activities will be carried out using funds provided by this grant. 6

7 Request for Proposals Youth Tutoring and Leadership Services April 16, 2012 EEO Certification Selected service provider will be required to certify and agree that all persons employed by them, their affiliates, subsidiaries, or holding companies are and will be treated equally by the firm without regard to or because of race, religion, ancestry, national origin, or sex and in compliance with all federal, State and local anti-discrimination laws. Compliance with RFP The response to this RFP shall be made according to the specifications contained herein. Failure to adhere to RFP instructions may be cause for rejection of the proposal. A proposal containing conditions or limitations set up by the proposer may be deemed irregular and rejected by the WIB. Acceptance of Terms and Conditions Any proposer submitting a proposal understands and agrees that its proposal shall constitute acknowledgment and acceptance of, and an intent to comply with, all the terms and conditions contained in this RFP. The determination of the compliance with the terms and conditions of this RFP shall be in the WIB's sole judgment and its judgment shall be final and conclusive. Any proposal not meeting the terms and conditions may be rejected. Truth and Accuracy of Representation False, incomplete, or unresponsive statements in connection with a proposal may be cause for its rejection. The evaluation and determination of the fulfillment of this requirement shall be in the WIB s sole judgment, and its judgment shall be final and conclusive. Changes to RFP A proposer submitting a proposal shall not change the wording of the RFP and no words or comments shall be added to the general conditions and detailed specifications. Proposals submitted with unauthorized changes to the RFP may be deemed irregular and rejected. Compliance with All Past, Present, and Future WIB Requirements All firms and individuals awarded contracts will be subject to all actions (past, present, and future) by the U.S. Department of Labor (DOL), State of California Employment Development Department (EDD), the WIB and the County of Solano Board of Supervisors regarding matters affecting the contract. This includes periodically issued State WIA bulletins and directives. Financial Solvency A contracting vendor must be economically viable and have other funding sources so that it will survive with or without a contract resulting from this solicitation. Funding Restrictions 1. Budget must reflect 100% of funds toward actual planned activities; 2. Funds may not be used to support activities that would be provided in the absence of these funds; 3. Costs may not cover activities not appropriate and reasonable for the operation of the contract; 4. Costs may not cover acquisition of equipment not necessary for the operation of the 7

8 Request for Proposals Youth Tutoring and Leadership Services April 16, 2012 contract; and 5. Reimbursement for activities and expenses incurred prior to the effective date of the contract award is prohibited. Past Performance A respondent may not be recommended for funding, regardless of the merits of the proposal submitted, if respondent has a history of contract non-compliance with the WIB or other funding source and/or poor past or current contract performance with the WIB or other funding source. The respondent may be given a provisional award with the stipulation that special terms and conditions regarding the areas of concern will be a part of the contract. Public Records Act All proposals in response to this RFP become the exclusive property of the Workforce Investment Board of Solano County. At such time as the WIB recommends a proposal or contract to the Solano County Board of Supervisors and that recommendation and contract, appears on the Board of Supervisors' agenda, all proposals and related documents become a matter of public record and shall be regarded as public records, with the exception of those parts of each proposal which are clearly defined by the proposer as business or trade secrets, and so marked as confidential or proprietary. Neither the WIB nor the County shall be in any way liable or responsible for the disclosure of any such records or any part thereof if disclosure is required under the Public Records or other applicable law. Cost of Proposals Neither the WIB nor the County shall be in any way liable or responsible for any costs incurred in connection with the preparation of any proposal submitted in response to this RFP. Gratuities It is improper for any WIB or County officer, employee or agent to solicit consideration, in any form, from a proposer with the implication, suggestion or statement that the proposer s provision of the consideration may secure more favorable treatment for the proposer in the award of the contract or that the proposer s failure to provide such consideration may negatively affect the County's consideration of the proposer s submission. A proposer shall not offer or give, either directly or through an intermediary, consideration, in any form, to a WIB or County officer, employee or agent for the purpose of securing favorable treatment with respect to the award of the contract. Among other items, such improper consideration may take the form of cash, discounts, and service, the provision of travel or entertainment, or tangible gifts. Drug-Free Workplace If awarded the contract, the successful proposer shall warrant and certify that it will comply with the California Drug-Free Workplace Act of 1990 (Cal. Gov. Code 8350 et seq.) as amended, including provision of the requisite certification as set forth therein. Copyrights / Rights in Data Code of Federal Regulations 29 CFR (a) states that the recipient may copyright any work that is subject to copyright and was developed, or for which ownership was purchased under an award. DOL reserves a royalty-free, nonexclusive and irrevocable right to reproduce, publish, or otherwise use the work for Federal purposes, and to authorize others to do so. 8

9 Request for Proposals Youth Tutoring and Leadership Services April 16, 2012 Processing Information The Workforce Investment Board of Solano County maintains the right to refuse any proposal that does not fully respond to the specifications. This Request for Proposal in no way obligates the Board to award a contract or service agreement to any qualified vendor. Acceptance of Terms and Conditions Please note, any applicant submitting a proposal understands and agrees that its proposal shall constitute acknowledgment and acceptance of, and intent to comply with, all the terms and conditions contained in this RFP. The determination of compliance with the terms and conditions of this RFP shall be in the WIB s sole judgment and its judgment shall be final and conclusive. Any proposal not meeting the terms and conditions may be rejected. Proposal Review Process A panel of reviewers will independently score eligible proposals received, using proposal review guides. The proposal rating criteria, and weighting, are as follows. Proposal Rating Criteria Points Experience/Expertise 25 Availability/Resources to Perform 15 Approaches to Service Delivery 50 Competitiveness of Financial Rate 5 Competitiveness of Project Hours 5 Total Points 100 Final Contract Award Determination Results from the rating process will be forwarded to the Executive Director for consideration, identifying the recommended proposal. After the results have been validated by the Executive Director, the best-rated proposal will be recommended to the WIB Board of Directors for approval. The successful vendor will be notified of this recommendation, and invited to attend the Board meeting where action is to be taken. The recommended vendor shall be prepared to enter into a contract with the WIB that shall incorporate substantially the same deliverables as the original proposal. The WIB reserves the right to add stipulations, and terms and conditions, deemed to be in the best interest of the WIB, during final contract negotiations. If a responding firm fails to sign and return the contract drawn pursuant to this RFP process and final contract negotiations within 14 days of its delivery to the respondent, the WIB may determine, at its sole discretion that the respondent is non-responsive to the terms of this RFP and reject the proposal. If the WIB determines that the recommended vendor is nonresponsive and rejects the proposal, the WIB reserves the right to negotiate with the next highest rated vendor. 9

10 Request for Proposals Youth Tutoring and Leadership Services April 16, 2012 The final contract award shall be subject to the contract approval of all appropriate WIB officials in accordance with applicable WIB laws and regulations. Staff will recommend a candidate to The Board of Supervisors, ultimate decision making body, and make the final determinations necessary to arrive at a decision to award, or not to award a contract. The RFP files shall be made available for public inspection immediately following contract approval. Failure to provide all requested documentation within a 30-day time frame will be grounds for cancellation of an agency s contract award. Rejection of Applications An application shall be rejected prior to scoring if it: Is received at any time after the exact time and date set for receipt of proposals; Is incomplete or fails to meet the RFP specifications: i.e. does not clearly document ability to meet specifications on the attached forms; Does not include a Proposal Cover Sheet signed by the authorized representative; Is not prepared in the format described; or Contains misrepresentation or lack of accurate and specific information by a respondent. Should a proposal be disqualified for not meeting the minimum criteria, the proposal will not be reviewed or rated and an appeal may not be filed. Final funding decisions cannot be appealed. Appeals Process Proposers may appeal the preliminary funding recommendations by submitting a letter in writing within three working days of the recommendations to: WIB Executive Committee 320 Campus Lane Fairfield CA Attn: Appeals Youth Tutoring and Leadership Services RFP Appeals may also be faxed to the above address at Appeals will be limited to two (2) issues: 1. The requirements, policies and procedures were not followed, or; 2. The rating criteria were incorrectly applied to an applicant s proposal. Appeals will be heard only if the written request is received by Noon on July 11, The WIB will make all funding decisions based on recommendations forwarded to the Board, with staff input and on any appeals, if applicable. If necessary, an appeal hearing is tentatively set for July 20,

11 Request for Proposals Youth Tutoring and Leadership Services April 16, 2012 CALENDAR Issue Solicitation for Proposal/ April 16, 2012 Bidders Conference April 27, 2012, 10:00 a.m. Proposals Due May 18, 2012, 5:00 p.m. Appeals Due July 11, 2012, 12:00 p.m. Appeals Hearing July 20, 2012 Workforce Investment Board of Solano County Funding Recommendation and Approval July 20, 2012 Contract Finalization August 2012 Contract Approved by County Board of Supervisors Mid September Contract Initiation October 1 st, 2012 PREPARATION GUIDELINES: INSTRUCTIONS FOR COMPLETION Agencies/Firms seeking funding must submit a complete proposal package. All headings I. VIII. must be addressed, all areas proposed must be specified and all forms must be completed to be considered for funding. The proposal shall be submitted in the format described below. The narrative shall not exceed 8 pages. General letters of support should not be submitted at this time. Review all RFP specifications before you begin. Identify each of your answers using the numbering system in the Specifications. If the question/specification is not applicable, identify as not applicable and do not respond further. Format Requirements All proposals must be submitted as follows: In 12 point font size or larger, typed/word-processed; 1 margins on all sides Single-spaced; Single-sided; Pages numbered sequentially, bottom center; Use the forms provided where applicable; Single staple or clipped (no binding). 11

12 Request for Proposals Youth Tutoring and Leadership Services April 16, 2012 Bidder s Conference The bidder s conference will be held on Friday, April 27, 2012 at 10:00 a.m. in Training Room 6 at the: Workforce Investment Board Administration Office 320 Campus Lane Fairfield, CA Changes to RFP Proposal Submission The wording of the RFP cannot be changed, and no words or comments shall be added to the general conditions and detailed specifications. Proposals submitted with unauthorized changes to the RFP may be deemed irregular and rejected. Proposals are due May 18, 2012, by the close of business, 5:00 p.m. If you have any RFP questions, you may contact Everlee Mory Antolin at or to eantolin@solanowib.org. Send your response to: WORKFORCE INVESTMENT BOARD OF SOLANO COUNTY Attention: Planning Unit Youth Tutoring and Leadership Services RFP 320 Campus Lane Fairfield CA Telephone: (707) Attachments: Cover Sheet/Signature Page Required Response Sections I-VIII Program Budget Summary Program Line Item Budget Debarment Certificate Drug Free Workplace Certificate Disallowed Cost Certificate Reference Form Proposal Checklist 12

13 YOUTH TUTORING AND LEADERSHIP SERVICES PROPOSAL APPLICATION COVER/SIGNATURE PAGE LEGAL NAME OF AGENCY/FIRM: AGENCY DBA (IF APPLICABLE): PROGRAM NAME: ADDRESS: CONTACT PERSON: TITLE: TELEPHONE: FAX: ADDRESS: FEDERAL ID #: AGENCY STATUS: Public Govt. Private Non-Profit Private for Profit Faith-Based Other Years in Operation: years. TOTAL FUNDS REQUESTED: $ Contribution: Cash $ In-Kind $ Primary Funding Sources Funding Source Annual Amount In compliance with the RFP noted above, and subject to the conditions thereof, the undersigned verifies the information provided in this proposal complete and accurate; offers to furnish the services stipulated; certifies s/he has read, understands and agrees to all terms, conditions and requirements of this RFP; and is authorized to contract on behalf of the firm. Signature of Authorized Representative Title Date

14 REQUIRED RESPONSE INFORMATION FOR YOUTH TUTORING and LEADERSHIP TRAINING SERVICES PROVIDER I. II. III. IV. V. VI. BUSINESS PROFILE LOCATION TELEPHONE EXPERIENCE DESCRIPTION OF PROPOSED TUTORING SERVICES DESCRIPTION OF PROPOSED LEADERSHIP SERVICES Name you do business under, authorized representatives, length of time doing business and a list of references as noted in Section IV. Please also see Eligible Applicants/Contract Requirements Section. Business location(s) Business telephone, fax phone and pager or cellular phone(s), address(es). Description of your organization s experience demonstrated competency in the administration and operation of youth specific programs. In addition all providers must certify that they meet the contractor qualifications listed and supply required documentation as part of their application. The Program Description and Design is your opportunity to describe the program design, the collaboration and planned project outcomes to the extent that they meet or exceed the required outcomes. At a minimum the description shall include the following: 1. A participant flow description (for two contracted services); 2. Hours of service (for the agency); 3. Method of providing services; 4. Group size (if applicable); 5. Program materials; 6. Staffing plan; 7. Instructor client ratio; and 8. A description of partnerships including operational linkages. Also, provide three local references supporting your experience. Description of your organization s ability to assist Youth participants in completing their educational goals with the attainment of a high school diploma or GED certificate fostering the pursuit of post secondary of post secondary education. Description of your organization s ability to develop and create activities and skill building simulations (self-esteem building, cultural diversity and work behavior) that will enhance positive social attitude and develop the potential of the youth as citizens and leaders.

15 VII. AVAILABILITY Describe your availability and schedule, as described in Section VII, Desired Youth Tutoring and Leadership Services Provider. Days/Hours of Proposed Operating hours for Services Locale Mon Tues Wed Thurs Fri Sat Sun North County to to to to to to to Central County to to to to to to to South County to to to to to to to VIII. COST Describe your project rates on the specification forms. Describe any discounted rates. Describe any package-price for administration and operation of youth services. Complete Program Budget Summary/Line Item Summary.

16 YOUTH TUTORING AND LEADERSHIP SERVICES PROGRAM BUDGET SUMMARY Agency/Firm Name: Total Cost: $ CATEGORY WIB PROGRAM MATCH* TOTAL COSTS Personnel Non-Personnel (building, overhead) Participant Costs (Books, tutorial software) TOTALS A. Cumulative Expenditures Program Expenditures QUARTER ENDING 12/31/12 QUARTER ENDING 3/31/13 QUARTER ENDING 6/30/13 * Match is defined as any non-wia funds that will be used in support of the project.

17 YOUTH TUTORING AND LEADERSHIP SERVICES PROGRAM LINE ITEM BUDGET Agency/Firm Name: LINE ITEM PROGRAM COSTS MATCH COSTS TOTAL COSTS TOTALS Copy this page as needed

18 Page 1 of 2 DEBARMENT CERTIFICATION INSTRUCTIONS 1. By signing and submitting this proposal, the Prospective recipient of Federal assistance funds is providing the certification as set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined the prospective recipient of Federal assistance funds knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the Department of Labor (DOL) may pursue available remedies, including suspension and/or debarment. 3. The prospective recipient of Federal assistance funds shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective recipient of Federal assistance funds learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage section of rules implementing Executive Order You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. 5. The prospective recipient of Federal assistance funds agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the DOL. 6. The prospective recipient of Federal assistance funds further agrees by submitting this proposal that it will include the clause titled Certification Regarding Debarment, Suspension, Voluntary Exclusion Lower Tier Covered Transactions, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transactions that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may but is not required to check the List of Parties Excluded from Procurement or Non-procurement Programs.

19 Page 2 of 2 WORKFORCE INVESTMENT BOARD OF SOLANO COUNTY Debarment, Suspension, Ineligibility, and Voluntary Exclusion Lower Tier Covered Transactions Certification DEBARMENT CERTIFICATION This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 34 CFR Part 85, Section , Participant s responsibilities. (1) The prospective recipient of Federal assistance funds certifies, by submission of proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. (2) Where the prospective recipient of Federal assistance funds in unable to certify to any of the statement in this certification, such prospective participant shall attach an explanation to this proposal. Name of Authorized Representative Title of Authorized Representative Agency / Firm Signature Date

20 WORKFORCE INVESTMENT BOARD OF SOLANO COUNTY DRUG-FREE WORKPLACE CERTIFICATION Agency/Firm Name: The agency named above hereby certifies compliance with the Drug Free Workplace Act of The above named agency will: A. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations. B. Establish a Drug-Free Awareness Program to inform employees about all of the following: 1) The dangers of drug abuse in the workplace, 2) The agency s policy of maintaining a drug-free workplace, 3) Any available counseling, rehabilitation, and employee assistance programs, and 4) Penalties that may be imposed upon employees for drug abuse violators. C. Ensure that every employee who works the proposed contract or grant: 1) Will receive a copy of the agency s drug-free policy statement, and 2) Will agree to abide by the terms of the company s statement as a condition of employment on the grant contract. CERTIFICATION I, the official named below, hereby swear that I am duly authorized to legally bind the agency to the above described certification. I am fully aware that this certification, executed on the date and in the county below, is made under penalty of perjury under the laws of the State of California. Agency Official s Name: Title: Signature: Date Executed: Federal I.D. Number: County of:

21 WORKFORCE INVESTMENT BOARD OF SOLANO COUNTY DISALLOWED ACTIVITIES CERTIFICATION The undersigned certifies that he/she will ensure, to the best of her/his ability, that: A. No Federal appropriated funds have been or shall be paid, by or on behalf of any person in this agency/organization, to any persons for influencing or attempting to influence an officer or employee of an agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. B. No Federal appropriated funds have been or shall be paid, by or on behalf of any person in this agency/organization to promote any religious, lobbying or political activities. Additionally, this agency/organization ensures that its program activities are available to all eligible individuals regardless of religious or political affiliation or non-affiliation, and said individuals shall in no way perform or assist in the performance of activities that are sectarian or political in nature. C. No funds under this Contract shall be used in any way to either promote or oppose union activities. No individual shall be required to join a union as a condition for enrollment in a program in which only institutional training is provided unless such training involves individuals employed under a collective bargaining agreement. No trainee may be placed into, or remain working in, any position which is affected by labor disputes involving a work stoppage. CERTIFICATION I, the official named below, hereby swear that I am duly authorized to legally bind the agency to the above described certification. I am fully aware that this certification, executed on the date and in the county below, is made under penalty of perjury under the laws of the State of California. Agency Official s Name: Title: Signature: Date Executed:

22 REFERENCE FORM Please list three (3) local references that can attest to your ability to provide Youth Tutoring and Leadership Services to the Workforce Investment Board of Solano County. 1) Name of Business: Contact: Address: Phone Number: Address: 2) Name of Business: Contact: Address: Phone Number: Address: 3) Name of Business: Contact: Address: Phone Number: Address:

23 YOUTH TUTORING AND LEADERSHIP SERVICES PROPOSAL CHECKLIST Please use this list to verify that all necessary information is included in your RFP. You do not need to submit this form with your proposal. Proposal Application Cover/Signature Page Program Description and Design Organization and Management Program Assessment and Measurement Program Budget Summary/Line Item Budget Program Sustainability Contractor Qualifications Attachments Debarment Certification Drug-Free Workplace Certification Disallowed Activities Certification Reference Form