Request for Qualifications Specification No. RFQ For. CEDA LIHEAP & WEATHERIZATION INTAKE SITES for COOK COUNTY

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THE COMMUNITY AND ECONOMIC DEVELOPMENT ASSOCIATION OF COOK COUNTY, INC Request for Qualifications Specification No. For LIHEAP & WEATHERIZATION INTAKE SITES for COOK COUNTY Submittals from minority, women and disadvantaged business enterprises are encouraged. Faxed, e-mailed or late bids will not be accepted. SUBMITTAL DEADLINE Monday, April 28, 2014 by 3:00pm DELIVERY BY HAND or MAIL Receptionist 208 S. LaSalle Street, Suite 1900 Chicago, IL 60604 Attn: Procurement Specification No. SUBMIT In a sealed envelope one (1) unbound original plus one (1) electronic copy (cd or jump drive) PRE-PROPOSAL CONFERENCE Thursday, April 10, 2014 at 10:00AM at New Zion M.B. Church Banquet Hall 1950 W. 13 th Street Chicago, IL 60608

DEPARTMENT OF PROCUREMENT SECTION 1 INTRODUCTION The Community and Economic Development Association of Cook County Inc. () is a community action agency for Cook County. It provides economic development and human service programs to address the needs of low-income Chicago and suburban Cook County residents and the underlying conditions that cause those needs. provides a variety of energy services in Cook County including but not limited to the Low Income Home Energy Assistance Program LIHEAP/PIPP/STARS and the Illinois Home Weatherization Assistance Program. LIHEAP and Weatherization assist low-income households by making energy more affordable and their homes more energy efficient. Not-for-profit agencies and faith-based organizations in the community are utilized to inform community members of these programs, act as the first step in the application process for eligible community residents and inform community residents of other programs for which they may be eligible. Although we currently have contracts with organizations that provide sufficient coverage throughout the City of Chicago, in addition to city locations is seeking to increase coverage in suburban areas of Cook County. Organizations with the ability to provide that coverage for intake services are encouraged to respond to this procurement. Proposers may apply with more than one location in mind to this procurement; sites can be in the City of Chicago and Suburban Cook County. SECTION 2 SCOPE OF SERVICE s Low Income Home Assistance Energy Program (LIHEAP) and Weatherization (WX) Program is seeking proposals from community/faith based organizations to act as LIHEAP and Weatherization Intake Sites. 2.1 Responsibilities LIHEAP & WEATHERIZATION (WX) INTAKE SITES must provide the following services at a primary, physical approved location: o Processing of WX, LIHEAP, Percentage of Income Payment Plan (PIPP) and ES (Emergency Service) Furnace applications Review LIHEAP and PIPP program options with applicants; provide applicants information regarding benefit levels and client payment requirements for both programs. Collect all necessary documentation required by LIHEAP, PIPP & WX regulations Perform direct entry into the Standard Tracking And Reporting System (STARS), LIHEAP.net and completely fill out all forms required for processing LIHEAP, PIPP, ES Furnace & WX applications o Perform Referrals for clients Assess interested parties to determine if they are eligible for LIHEAP/WX services and other programs Refer LIHEAP/WX applicants to other assistance services or programs for which they may be eligible Complete other program applications with clients as necessary o Perform Program Outreach Inform community members of the availability and requirements of the LIHEAP, PIPP and WX programs All outreach plans must be approved by 2.2 Location and Time Frame 2

DEPARTMENT OF PROCUREMENT Selected proposer will be required to: o Conduct business a minimum of 20, preferably 40 hours per week, as well as offer hours on weekends and evenings. o Once a contract is awarded sites cannot move or open another site location without prior written approval. It is also highly desirable to have a location in close proximity (within ½ mile) of public transportation (CTA, Metra or Pace). 2.3 Expected Goals and Outcomes Selected proposer shall be able to have capabilities, including, but not limited to the following: An application denial rate below 5% No compliance issues Excellent customer service and ability to provide accurate and appropriate program information Knowledgeable in all energy service and related programs offered, and will be required to demonstrate that ability Cooperative with on training, site visits and audits Strong communication with such as timely reading and adherence to all site emails Satisfactory or better rating reviews, which are completed twice a program year, mid-year and end of year which measures program outcomes 2.4 Proposer Qualifications The selected proposer must meet the following requirements: Must be a 501(C) 3 corporation or township with a minimum of five (5) years experience providing utility or general assistance funds to residents. Must provide organization By-laws, Board of Directors list and Board of Director Meeting minutes for the past 12 months (minimum of 2 reports). Maintenance of minimum insurance requirements, as shown in Exhibit A Proposed location(s) must be free of code violations that impact health and safety For applicants with multiple sites, if the sites are at a different organization, there must be a written and notarized agreement with the authorized organization of the host site. The host site will have to adhere to the same physical requirements, as the applicant site. They must maintain good standing with the State of Illinois throughout the term of the contact. In addition, the following qualifications will be critical for intake sites to be considered: Must maintain at least twenty (20) regular business hours during the period of Monday through Friday 9:00AM to 5:00PM, 40 hours is preferable, as well as evening and weekend hours. Must have the ability to service a commensurate number of approved applications per year, with a minimum of 1,000 LIHEAP, Weatherization and Fuel Funds applications annually. This ability will be described in an outreach statement. Must provide three business references relevant to energy or related assistance programs Must provide staffs that are experienced in interviewing and in the provision of energy related counseling and referral services. o Staff must have basic computer & Internet literacy. o Staff must participate in sponsored LIHEAP, PIPP and WX staff training and at the completion of training be able to pass certification test showing they can enter application information into the STARS/LIHEAP software and search designated LIHEAP database as required. A physical, non-residential location where interviews can be taken that is smoke-free and clean o The location must provide for client privacy. Need to specify or define client privacy ie: private office space, cubicles, etc.. o Must have at least 2 lockable 4 drawer file cabinets or a designated lockable room with a minimum 4 drawer file cabinet to maintain confidentiality of client documents. 3

DEPARTMENT OF PROCUREMENT Location must be Americans With Disabilities Act (ADA) compliant or must be physically accessible to persons with disabilities Must have the following equipment and technology: o Hardwired, active broadband Internet access (DSL, T1, or Cable) with Internet Explorer 7 or above and an active email account o Must have at least two (2) operating computers with Windows XP or above operating system o Active anti-virus program o Adobe Reader 8.0 or better o Working telephone, printer, copier and fax machine o Active voice mail service o Microsoft Excel 2003 or above Must have an operating year-round HVAC system No City of Chicago building code violations 2.5 Pre-Proposal Meeting A pre-proposal meeting will be held on Thursday, April 10, 2014, at New Zion M.B. Church Banquet Hall, 1950 W. 13 th Street, Chicago, IL 60608 at 10:00AM. SECTION 3 EVALUATION PROCESS Proposers must adhere to the following instructions. 3.1 Proposals Evaluation and Award Proposals will be evaluated based on the quality of the Proposers experience and/or demonstrated competency, proven through successful training classes. Evaluation of proposals is the sole responsibility of staff and based totally on s assessment of competitive responses. The Procurement Director reserves the right to award a contract or reject any or all proposals when, in her opinion, the best interest of will be served 3.2 Investigations Prior to Proposal Award may make such investigations as are deemed necessary to determine the ability of the vendor to perform the work, and the vendor shall furnish all such information and data for this purpose as may request. reserves the right to reject any proposal if the evidence submitted by, or investigation of such vendor, fails to satisfy it that such vendor is properly qualified to carry out the obligations of the contract. 3.3 Contract Award The contract period for LIHEAP and Weatherization Intake Sites extends from July 1, 2014 to June 30, 2015 with two (2) optional one (1) year extensions. Extensions will be exercised at the mutual agreement of and the contractor. All awards are contingent on the availability of program funds. A contract will be awarded to the proposer whose proposal, in the sole judgment of ; most thoroughly meets the specifications outlined in this document while providing the most beneficial pricing to the agency. 3.4 Evaluation Criteria 3.4.1 Responsiveness of Proposal: Proposal has met all of the material submission requirements. 3.4.2 Technical Proposal: 1. Qualifications and experience of the organization as evidenced by relevant experience in projects of similar in scope to. 4

DEPARTMENT OF PROCUREMENT 2. Proposed plan of action for outreach to accomplish all the services requested in this RFQ. 3. Qualifications of personnel assigned to the project as evidenced by their credentials and relevant experience. 4. Quality of references included such as community leaders and clients. SECTION 4 SUBMISSION INSTRUCTIONS AND REQUIREMENTS 4.1 Proposal Documents All terms, conditions, specifications and provisions included, are included as a part of the requirements set forth in this document. Submissions submitted with incomplete or missing information will be deemed non-responsive and ineligible for consideration. reserves the right to reject any and all proposals, to accept proposals in whole or in part, and to waive any irregularities or defects in any proposal, should it deem such action to be in the best interests of. 4.2 Document Submittal and Questions Proposers must submit one (1) original and one (1) electronic copy (cd or jump drive) of their proposal. Proposals must be returned on the date specified on the cover page. Proposals must be submitted to:, 208 South LaSalle, 19 th Floor, Chicago, IL. Receptionist Desk, Attn: Procurement. Documents will be date and time stamped; late proposals will not be accepted. Proposers should submit questions to Shawnee Little via email at slittle@cedaorg.net. Questions will be accepted until April 16, 2014 by 3:00pm. Oral interpretations of this RFQ are not binding. 4.3 Ambiguity, Conflict or Other Errors in the RFQ If a Proposer discovers any ambiguity, conflict, discrepancy, omission, or other error in the Request for Proposals, it shall immediately notify the Department of Procurement of such errors in writing and request modification or clarification of the document. Procurement will make modifications by issuing a written revision and will give written notice to all parties who have received this RFQ from the Department of Procurement. The Proposer is responsible for clarifying any ambiguity, conflict, discrepancy, omission, or other error in the Request for Proposals prior to submitting the proposal or it shall be waived. 4.4 Submittal Requirements for LIHEAP and Weatherization Intake Sites Proposer s proposal must contain the following: A. Federal 501(c)(3) Letter (Unless government entity) B. State of Illinois Certificate of Good Standing from the Illinois Secretary of State C. Must provide organization By-laws, Board of Directors list and Board of Director Meeting minutes for the past 12 months (minimum of 2 reports). D. A brief statement describing the agency s mission and role in the community E. Staff resumes F. One letter of support from a client, community agency with whom the agency has a linkage agreement, or other community partner o List references in Exhibit D G. Proposed plan of action for outreach H. Answers to questions & submittals in Exhibit D which include: 1. Listing of business equipment available in your agency, specifically number of computers, copiers, fax machines, etc. (include make and model) 2. Certificate of Insurance listing insurance currently maintained by the agency I. Fully executed Exhibits to this RFQ J. Signed agreement to accept stated compensation 5

DEPARTMENT OF PROCUREMENT K. For applicants with multiple sites, if the sites are at a different organization, there must be a written and notarized agreement with the authorized organization of the host site. The agreement must be included. These sites are required to maintain the same level of insurance (with listed as and additional insured)as well as meet the same requirements as the host site. 4.5 Verification & Interviews reserves the right to interview and inspect the proposed sites of any and all agencies. Agencies agree to participate in any subsequent meetings or presentations requested by in the evaluation of this proposal. staff prior to contract award will verify information provided by agencies regarding its facility, technology, equipment and staffing. Verification will take place in the following manner: Once the submittal documents are reviewed, will contact all organizations via email informing them of their selection for consideration. Organizations have forty-eight (48) hours to respond to the email and schedule a date and time when staff can inspect their site and verify technology & equipment capacity. Upon completion of the equipment/technology verifications and evaluation process selected organizations will be contacted via an award letter and email regarding a contract review meeting. Organizations must respond to the email to confirm attendance at the contract review meeting within forty-eight (48) hours of email notification. Sundays and federal holidays will not count under the forty-eight (48) hour limit. SECTION 5 PAYMENT TERMS 5.1 LIHEAP Intake Sites Agency agrees to accept the following rate plan: $15.00 per approved LIHEAP/PIPP application if approval rate is above 95% $13.00 per approved LIHEAP/PIPP application if approval rate is 95% or below Fuel Fund Applications $5 per fuel fund applications as available These rates are for the provision of the following services: Intake of energy services applications and necessary follow-up Outreach to assist in advertising availability of program services Counseling program applicants by providing information relevant to the energy assistance program as well as providing referral to other programs and services that could assist them 5.2 Weatherization Intake Sites Agency agrees to accept the following rate plan: $15.00 per approved WX application if approval rate is above 95% $13.00 per approved WX application if approval rate is 95% or below These rates are for provision of the following services: Intake of Weatherization applications and necessary follow-up Outreach to assist in advertising availability of program services Counseling program applicants by providing information relevant to the Weatherization assistance program as well as providing referral to other programs and services that could assist them NOTE: Application rates include all expenses and there will be no additional expenses paid. will not pay LIHEAP or Weatherization Intake Site for an incomplete application or an application that requires intervention by the Central Office to provide additional intake. Reimbursement for LIHEAP/PIPP and Weatherization applications will be paid the 20 th of each month for approved applications taken in the previous month. SECTION 6 6

DEPARTMENT OF PROCUREMENT ACCEPTANCE OF RATE LIHEAP & WEATHERIZATION INTAKE SITE On behalf of I submit this qualifications document to (Organization Name) the Community and Economic Development Association of Cook County to provide the LIHEAP & WX Intake Site services described in this document and exhibits for reimbursement at: $15.00 per approved LIHEAP/PIPP application if approval rate is above 95% $13.00 per approved LIHEAP/PIPP application if approval rate is 95% or below $15.00 per approved WX application if approval rate is above 95% $13.00 per approved WX application if approval rate is 95% or below For questions regarding this response please contact: Name _ Title Telephone Number Fax Number Email Address Mailing Address, City, State Zip NOTARY PUBLIC On this day, personally appeared before me to me known to be the person(s) described in and who executed the within and foregoing instrument, and acknowledged that he/she signed the same as his/her voluntary act and deed, for the uses and purposes therein mentioned. Witness my hand and official seal hereto affixed This day of,. Notary Public in and for the State of, County of. My commission expires. Notary Signature AFFIX NOTARY SEAL: 7

DEPARTMENT OF PROCUREMENT EXHIBIT A INSURANCE REQUIREMENTS Vendors must advise of the limits it currently maintains of the types of insurance coverage set forth below, and must provide the with certificates evidencing such coverage. reserves the right to ask for higher levels of coverage. TYPE Worker s Compensation Employers a. Each Accident b. Each Employee Disease c. Policy Aggregate Disease Commercial General Liability a. Per occurrence b. General Aggregate 1. General Aggregate-Per Project 2. General Aggregate Products Completed Operations Personal and Advertising Injury Fire Legal Liability (any one fire) Medical Expense (any one person) Umbrella Excess Liability (Coverage must be in excess of Commercial General Liability, Automobile Liability, and Employer's Liability. It shall be no more restrictive than the primary coverage listed.) Business Auto Liability (This Policy must provide coverage for all owned, non-owned, and hired autos.) MINIMUM ACCEPTABLE LIMITS OF LIABILITY Statutory-State of Illinois $500,000.00 $500,000.00 $500,000.00 $1,000,000.00 $1,000,000.00 $1,000,000.00 $1,000,000.00 $50,000.00 $5,000.00 $1,000,000.00 over Primary Insurance $1,000.00 retention for Self-Insured Hazards Each Occurrence $1,000,000.00 must be named as additional insured on this coverage as well as on Umbrella Liability (4). Vendor must name the following as additional insured on all certificates of insurance:, its board members, officers, employees, agents and consultants. All insurance companies must be rated A-VIII or better by the A. M. Best Company. Vendor's assumption of liability is independent from, and not limited in any manner by, the Vendor's insurance coverage obtained pursuant to this Proposal, or otherwise. All amounts owed by Vendor to the as a result of the liability provisions of the Contract shall be paid on demand. 8

DEPARTMENT OF PROCUREMENT EXHIBIT B CONTRACTOR S AFFIDAVIT Contractor Name Contractor Address Contractor Telephone Number Instructions: FOR USE WITH ALL CONTRACTS. Every Contractor submitting a bid/proposal to must complete this Affidavit. Please note that in the event the Contractor is a joint venture, the joint venture and each of the joint venture partners must submit a separate and completed Contractor's Affidavit. In the event the Contractor is unable to certify any of the statements contained herein, the Contractor must contact and provide a detailed factual explanation of the circumstances leading to the Contractor's inability to so certify. I certify that I am authorized to execute this Contractor s Affidavit on behalf of the Proposer set forth above, that I have personal knowledge of all the information set forth herein and that all statements, representations, information and documents provided in or with this Affidavit and attachments hereto are true and accurate. The Contractor may report any change in any of the facts stated in this Affidavit within fourteen (14) days of the effective date of such change by completing and submitting a new Affidavit. Company Name Signature of Authorized Officer Name of Authorized Officer (Print or Type) Title 9

DEPARTMENT OF PROCUREMENT All bidders/proposers/contractors shall provide the following information with their bid/ proposal/ contract. Complete all blanks by entering the requested information, or, if the question is not applicable, answer with "N/A". If the answer is other, please identify. 1. Date of application: 2. Company: 3. Parent Company: 4. Contact Name: 5. Street Address: 6. Mailing Address [if different]: 7. Telephone (1): 8. Telephone (2): 9. Fax Number: 10. Website Address: 11. E-mail Address (include name): 12. Employer s Federal ID# / Social Security #: 13. DUNS #: Contractor is a [ ] Corporation [ ] Sole Proprietor [ ] Partnership [ ] Not-For-Profit [ ] Joint Venture [ ] LLC Date Business Started: _ SECTION 1. For Profit Corporations, Limited Liability Corporations, or Not-For-Profit Corporations a. Incorporated in b. Authorized to do business in the State of Illinois [ ] Yes [ ] No c. Names of all officers and directors of corporation (or attach a list) Name & Title SECTION 2. Partnership 10

DEPARTMENT OF PROCUREMENT If the bidder/proposer is a partnership, indicate the name of each partner or attach a list and the percentage of interest of each therein. Name of Partners Percentage of Interest % % % % % SECTION 3. Sole Proprietorships a. The bidder/proposer is a sole proprietor and is not acting in any representative capacity on behalf of any beneficiary: [ ] Yes [ ] No If No, complete items b and c. b. If the sole proprietorship is held by an agent(s) or a nominee, indicate the principle(s) for which the agent or nominee holds such interest. Name(s) c. If the interest of a spouse or any other party is constructively controlled by another person or legal entity, state the name and address of such person or entity possessing such control and the relationship under which such control is being or may be exercised: SECTION 4. Certification Regarding Suspension and Disbarment The contractor certifies to the best of its knowledge and belief, that it and its principles are not presently debarred, suspended, proposed for debarment, ineligible or voluntarily excluded from transactions by any Federal, State or local government agency and have not within a (3) year period preceding this proposal been convicted of or had a civil judgment rendered against them for the 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, a violation of Federal or State antitrust statues, or the commission of embezzlement, theft forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property. Further, contractor certifies it is not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State or Local) with commission of any of the offenses enumerated in Section 2(a) above, and have not within a (3) year period preceding this agreement had one or more public transactions (Federal, State or Local) terminated for cause or default. SECTION 5. Verification 11

DEPARTMENT OF PROCUREMENT Under penalty of perjury, I certify that I am authorized to execute this Contractor s Affidavit on behalf of the Contractor set forth on this page, that I have personal knowledge of all the certifications made herein and that the same are true. Signature of President or Authorized Officer Title Date NOTARY PUBLIC On this day, personally appeared before me to me known to be the person(s) described in and who executed the within and foregoing instrument, and acknowledged that he/she signed the same as his/her voluntary act and deed, for the uses and purposes therein mentioned. Witness my hand and official seal hereto affixed This day of,. Notary Public in and for the State of, County of. My commission expires. Notary Signature AFFIX NOTARY SEAL: 12

DEPARTMENT OF PROCUREMENT EXHIBIT C CERTIFICATION REGARDING LOBBYING Certification for Contracts, Grants, Loans, and Cooperative Agreements The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person 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. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, ``Disclosure Form to Report Lobbying,'' in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Statement for Loan Guarantees and Loan Insurance The undersigned states, to the best of his or her knowledge and belief, that: If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, ``Disclosure Form to Report Lobbying,'' in accordance with its instructions. Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Authorized Officer Signature Title Organization 13

DEPARTMENT OF PROCUREMENT EXHIBIT D QUALIFICATIONS AND REFERENCES Service Area 1. What is the geographical area(s) that you serve? North South East West Suburban 2. How many years has this agency served this community(ies)? Year(s) 3. Who is your target population(s)? 4. What is the primary language spoken at the organization? _ Secondary Language Tertiary Language Services 5. What services are provided by this agency other than LIHEAP or WX (include proof)? References 6. Please list three references including contact person, email and telephone numbers. One of the three references may be the letter of support. 7. Please attach resumes (or a brief summary) for all your professional staff. 8. Who is the contact person for this project? Please provide telephone number and an active email address. 14

DEPARTMENT OF PROCUREMENT Equipment 9. List the number and make and model of functioning business equipment that you have. (Please indicate which, if any, computers are State LIHEAP computers.) a) Computers b) Laptops c) Fax Machines d) Printers e) Copiers f) Scanners g) Tablets 10. How many lockable file cabinets or lockable rooms does the organization have? No. of File Cabinets No. of Rooms Location 11. Does the organization have any Building or Health Code violations? Yes or No If yes, what are they (submit supporting documentation). Outreach 12. Please list all sites and locations at which your agency intends to offer LIHEAP and Weatherization Intake Site services. Please indicate which of these sites are a part of your agency and which sites you intend to sub-contract with. Each of these sites must have the Technology and Equipment requirements described in Section 2.4 of this RFQ. (Use additional sheets if needed) 13. Please list all senior citizen buildings or other outreach locations your agency intends to service. (All outreach locations will need to be approved by prior to outreach being done.) (Use additional sheets if needed) ADA Compliant 14. Is your location Americans With Disabilities Act (ADA) Compliant? Yes or No 15

DEPARTMENT OF PROCUREMENT If No, please explain how you would accommodate the disabled. If No, is your location accessible to all persons with disabilities? Yes No Existing LIHEAP/WX Intake Sites 15. Past experience (>1 year) How many applications did your organization process during the past year? 16. Has your organization had any suspensions in past three years? Yes No 17. If an existing Intake Site, has your organization had any compliance issues reported for previous and current year? Yes No Not an existing Intake Site 18. If a new applicant, what federal, state or other programs have you had compliance issues within the past five (5) years? Have not been involved in federal, state or other programs No compliance issues Compliance Issues 16

DEPARTMENT OF PROCUREMENT EXHIBIT D.1 CERTIFICATION REGARDING FACILITY, TECHNOLOGY & EQUIPMENT I,, certify that (Print Name) at (Name of Organization) (Location Address) has the following facility, technology and equipment outlined in Section 2.4 of this RFQ in working condition and available for use. Agency has the minimum LIHEAP & WX Site facility, technology and equipment requirements. (At least one physical location) Agency has the minimum LIHEAP & WX Site facility, technology and equipment requirements plus the required technology and equipment to provide outreach at remote locations. o o Organization must have at least one physical location LIHEAP applications taken at outreach locations requires and organization have at least one laptop with wireless internet connection, portable scanner and printer Certified by: Verified During Site Visit by: Authorized Officer Signature Title Date Signature Title Date 17

DEPARTMENT OF PROCUREMENT EXHIBIT D.2 CERTIFICATION REGARDING NO DIRECT OR INDIRECT CHARGING APPLICANTS OR CLIENTS FOR LIHEAP, FUEL FUNDS OR WEATHERIZATION SERVICE I,, certify that (Print Name) at (Name of Organization) (Location Address) will not permit or authorize the charging of any monetary or non-monetary fee by the Board, staff, employees, volunteers or any persons affiliated with the above named organization on the premises or grounds of any of its facilities to any applicants or clients of LIHEAP, Fuel Funds or Weatherization Services. Such action(s) subjects the applicant to suspension and or removal from the program, and may result in investigation by and local, state or federal regulatory agency(ies). Certified by: Authorized Officer Signature Title Date 18

DEPARTMENT OF PROCUREMENT EXHIBIT D.3 CERTIFICATION REGARDING CONFLICT-OF-INTEREST and NON-DISCLOSURE OF CLIENT INFORMATION I,, certify that (Print Name) at (Name of Organization) (Location Address) will not permit or authorize the employment of any individual who has an economic interest in the contracting of the Low Income Home Energy Assistance and/or Weatherization Assistance Programs, and will certify that applicant and client information is confidential and will be obtained only for use by these programs. Certified by: Authorized Officer Signature Title Date 19