2 CAMPS RFA Cover Sheet and Application - October2025.docx

The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Mental Health 25 Staniford Street, Boston, MA 02114 Rev 8

APPLICATION RESPONSE FORM, INSTRUCTIONS, AND CHECKLIST

For use with the M03/MM3 RFR

General Instructions:

1. See the RFR and COMMBUYS posting for complete procurement specifications.

2. All responses are to be submitted using the online submission tools available to Vendors registered in COMMBUYS. There is no charge to register in COMMBUYS. To Register go to www.COMMBUYS.com and click on the “Register” link on the front page.

Bidders are solely responsible to monitor COMMBUYS for Bid amendments, if any. Bidders may monitor the record by frequently checking the Amendment Section on the Summary screen for the BID in COMMBUYS.

3. All Bidders are advised to allow adequate time for submission by considering potential online submission impediments like Internet traffic, Internet connection speed, file size, and file volume. DMH is not responsible for delays encountered by Bidders or their agents, or for a Bidder’s local hardware failures, such as computers or related networks, associated with bid compilation or submission. Bids submitted via COMMBUYS are time stamped by the COMMBUYS system clock which is considered the official time of record.

Formatting Instructions:

This document was prepared using Microsoft Word’s forms feature. Complete the form on your computer using Microsoft Word.

1. Save this document file to your computer.

2. Enter your responses in the text box, moving between the text boxes using the tab key on your keyboard.

3. Responses to check boxes are made by clicking once on the check box. To remove the X from a check box, click on the check box again.

4. Text responses are limited to a maximum number of characters and the limits are noted in each question. Once the maximum character limit is reached, MS Word will not allow more than this limit. Please note that a space is counted as a character, and using the enter key to begin a new line in a response is also counted as a character. It is not recommended that applicants insert graphics into the responses. Spell-check does not work in text boxes.

5. Those with visual impairments may use an electronic text reader by unlocking the Application Response Form.

RFR #______

APPLICATION RESPONSE COVER PAGE

Make this the first page of your proposal.

Request for Application TITLE:

Camps for Department of Mental Health Referred Children Master Agreement

RFA # 2026-DMH-3033-01

Organization

Organization Name: [ ]

Address: [ ]

City: [ ] State: [ ] Zip: [ ]

CEO (Chief Executive Officer) First Name: [ ] Last Name: [ ]

Vendor Code: [ ]

FEIN: [ ]

Contact Person

First Name: [ ] Last Name: [ ]

Title: [ ]

Telephone: [ ] FAX: [ ]

E-Mail: [ ]

Contact Person Address (if different):

City: [ ] State: [ ] Zip: [ ]

RFA # 2026-DMH-3033-01

A note about the text boxes: Text input is limited to a maximum number of characters. MS Word will not allow more than this limit. Spaces, commas, line breaks, etc. are counted as characters. The spell-check feature does not work in a text box.

QUESTIONS FOR RESPONSE

Enter your response in the text boxes using Microsoft Word.

A note about the text boxes: Type or paste text into the gray areas. Text input is limited to a maximum number of characters. MS Word will not allow more than this limit. Spaces, commas, line breaks, etc. are counted as characters. The spell-check feature does not work in a text box.

PART 1: APPLICANT OVERVIEW

1. Type of organization (complete all that apply):

|_| Sole Proprietorship. Indicate name of individual, and Doing Business As name (DBA), if different than individual’s name: [ ]

|_| Partnership. Indicate name(s) of Partners: [ ]

|_| Corporation/Company. Indicate type (e.g., |_|For Profit, |_|Non-Profit, |_|Limited Liability) [ ]

|_| Certified by the Massachusetts Supplier Diversity Office. If so, Indicate applicable certification(s): |_| Minority Business Enterprise (MBE), |_| Minority Non-Profit Organization (MNPO), |_| Women Business Enterprises (WBE), |_| Women Non-Profit Organization (WNPO), |_| Portuguese Business Enterprise (PBE), |_| Service-Disabled Veteran-Owned Business Enterprise (SDVOBE), |_| Veteran Business Enterprise (VBE), |_| Veteran Non-Profit Organization (VNPO), |_| Disability-Owned Business Enterprise (DOBE), |_| Lesbian, Gay, Bisexual, and Transgender Business Enterprise (LGBTBE)

|_| Municipality [ ]

|_| Registered Participant of the Massachusetts Small Business Program. [ ]

2. Fiscal Solvency. Affirm the following:

If one or more of the above boxes are not checked, please explain. Text input limit 1,250 characters, approximately 200 words).

Enter text here; text limit 1,250 characters

3. Environmental Preferable Products Checklist: Complete and attach a DMH Environmental Preferable Products Checklist with at least one box checked.

|_| DMH Environmental Preferable Products Checklist uploaded to COMMBUYS.

4. Supplier Diversity Plan: Please complete and upload Supplier Diversity Plan Form with this Application.

|_| Supplier Diversity Plan uploaded to COMMBUYS.

5. Liability Insurance: Please submit proof of liability insurance for the camp the Applicant is seeking approval.

6. Statement of Compliance. For each camp the Bidder is seeking approval, it must include a Statement of Compliance with Department of Public Health (or other applicable licensing authority for out-of-state camps) requirements.

The Bidder does certify that:

a. |_| the camps referenced in this application comply with the Department of Public Health (or other applicable licensing authority for out-of-state camps) requirements

b. |_| the camp is free of DPH Order to Correct Violations;

c. |_| certify that neither the camp or the Bidder is the subject of a DCF Supported Investigation of Child Abuse and/or Neglect If applicable:

d. |_| List any child abuse and neglect investigations within the past two years that were supported on any staff member or volunteer at the camp; and

e. |_| Attach a copy of any Orders to Correct Violations that were issued to the camp within the prior 2 years of service, along with the corrective action plan.

7. Licensure: A copy of the camp’s current Department of Public Health campership license, or if an out-of-state camp a comparable state license.

|X| License uploaded to COMMBUYS.

8. Camp Brochure: If available, must submit a copy of the Camp brochure along with this Application.

|X| Camp brochure uploaded to COMMBUYS.

PART 1: APPLICANT QUALIFICATIONS AND SERVICE DESCRIPTION

9. Experience: Please affirm that the Camp has been in business for the past 3 consecutive years:

|X| Yes

10. Camp Operation: |X| Day Only |X| Overnight

11. Staff to Camper Ratio:

12. Camp Description: Please describe the theme and focus of the camp. (text input limit 2,500 characters, approximately 400 words):

Enter text here; text limit 2,500 characters

13. Pricing Statement: DMH is recommending that Bidders propose an all-inclusive weekly rate. However, DMH will consider alternative rate options, for example a day rate, with sufficient documentation and reasoning for considering the option. (text input limit 3,750 characters, approximately 600 words):

Enter text here; text limit 3,750 characters

APPLICATION RESPONSE SUBMISSION PAGE

CERTIFICATION OF ASSURANCE OF COMPLIANCE:

ADA/ 504 and NON-DISCRIMINATION BASED ON DISABILITY

All DMH-funded projects must certify that the Applicant Organization will comply with all state and federal requirements regarding equal employment opportunity, nondiscrimination and civil rights for persons with disabilities. The Applicant must complete a Certification of Assurance of Compliance-ADA/504/Non-Discrimination based on Disability. By signing, the Applicant formally notifies DMH that the Applicant is in compliance and shall maintain compliance with all applicable requirements.

· I, certify, that the Applicant is in compliance and shall maintain compliance with all applicable federal and state laws protecting the rights of persons with disabilities, including but not limited to the Americans with Disabilities Act (“ADA”), 42 12131-12134; Section 504 (“504”) of the Rehabilitation Act of 1973, 29U.S.C. §§ U.S.C. § 794; Article CXIV of the Massachusetts Constitution; and Chapter 6, §§ 185-87; Chapter 93, § 103; Chapter 151B; and Chapter 272, §§ 92, 98, and 98A of the Massachusetts General Laws.

· I understand that federal and state laws prohibit discrimination in public accommodations and employment based solely on disability. I recognize that to make goods, services, facilities, privileges, advantages, or accommodations readily accessible to and usable by persons with disabilities, the Applicant, under the ADA, must:

· remove architectural and communication barriers in existing facilities, when readily achievable and, if not readily achievable, must use alternative methods;

· purchase accessible equipment or modify equipment;

· modify polices and practices; and

· furnish appropriate auxiliary aids and services where necessary to ensure effective communication.

I recognize that Section 504 of the Rehabilitation Act requires recipients of federal funds (either directly or through contracting with a governmental entity receiving federal funds) to make their programs, services, and activities, when viewed in their entirety, accessible to qualified and/or eligible people with disabilities. I understand that reasonable accommodation is required in both program services and employment, except where to do so would cause an undue hardship or burden. I also understand that the Massachusetts Constitution Article CXIV provides that no otherwise qualified individual shall, solely by reason of disability, be excluded from the participation in, denied the benefits of, or be subject to discrimination under any program or activity within the Commonwealth.

· I agree the Applicant shall cooperate in any compliance review and to provide reasonable access to the premises of all places of business and employment and to records, files, information, and employees therein for reviewing compliance with Section 504, the ADA, the Massachusetts Constitution, other applicable state and federal laws, and this Contractual Agreement.

· I agree that any violation of the specific provisions and terms of this Assurance and/or Corrective Action Plan and/or Special Contract Conditions required herein or Section 504 or the ADA, shall be deemed a breach of a material provision of the Contract between the Department and the Contractor. Such a breach shall be grounds for cancellation, termination, or suspension, in whole or in part, of this Contract by the Department.

I affirm that I will comply with the requirements of this Request for Applications and with the terms of this proposal.

Authorized Signatory:

First Name: [ ] Last Name: [ ] Title: [ ]

|_| By clicking the check box, the submitter attests that s/he is an agent of the Bidder with authority to sign on the Bidder’s behalf and is agreeing all affirmations listed above.

APPLICATION INSTRUCTIONS

1. Save, read and review the completed Application Response Form. Check entries in the text boxes to assure that the input limits did not shorten your response. Proof read text; spell-check does not work in the text boxes.

2. Submit the application and all required attachments in COMMBUYs in accordance with Section 6 in the RFA.

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