3-RFP Past Present FILLABLE.pdf

136 KB Posted

Attached to
Re-Entry Transitional Management
Solicitation number
RFP-RC-2026-010
Issued by
Rockland County, New York

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This is a Past & Present Performance Information Form related to a Re-Entry Transitional Management RFP (RFP-RC-2026-010) issued by the Rockland County Department of Mental Health in New York. The form is designed to be completed by offerors and included in their technical proposals to document relevant past contract experience. Offerors must provide detailed information for each reference contract, including the contracting entity, contract name, contract term, original and current/final contract values, and a brief description of the effort indicating whether the offeror served as prime or subcontractor. The form requests original and current/final dates, the number of change orders with primary causes, and the names and contact information for both a reference program/project manager and a reference contracting officer.

The form also requires offerors to identify any subcontractors used and their respective percentages of contract responsibility, as well as specify key individuals who participated in the reference contract and who are proposed to support the current RFP acquisition. Offerors are instructed to provide frank, concise comments regarding their performance on identified contracts and to limit the number of past efforts submitted and the length of each submission according to specifications. The underlying contract opportunity involves providing Transition Management and Re-entry services for individuals with serious mental illness and/or substance use disorders being released from Rockland County Jail, with an initial contract period expected from commencement through December 31, 2028, followed by two optional 1-year renewal periods. The contract will be awarded to a single qualified non-profit agency pending funding from the Office of Addiction Services and Supports (OASAS) and the Office of Mental Health (OMH).

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1-Appendix B Standard Terms Conditions for Service Contracts.pdf PDF

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Edwin J. Day, County Executive

PAST & PRESENT PERFORMANCE INFORMATION FORM

COMPLETE AND INCLUDE THIS FORM IN YOUR TECHNICAL PROPOSAL

NAME OF OFFEROR: __________________________________

Provide the information requested on this form for each contract/program being described as a reference. Provide frank, concise comments regarding your performance on the contracts you identify. Provide a separate completed form for each contract/program submitted. Limit the number of past efforts submitted and the length of each submission to the limitations, if any, set forth in specifications.

Name of Contracting Entity: ___________________________________ Contract Name/Title: __________________________________

Term of Contract: ____________________________

Original Contract Value: ________________________________ Current or Final Contract Value: _______________________________________

A. Brief Description of your effort. Identify whether you were a Prime or Subcontractor.

1. Original Date: ______________________________ 2. Current or Final Date: __________________________

3. Number of Change Orders (if any): ________________

Primary Causes or Reasons of Change: ________________________________________________________________________

B. Primary Customer Points of Contact:

NOTE: CONFIRM CONTACT INFORMATION PROVIDED IS CURRENT PRIOR TO SUBMISSION.

Reference Program/Project Manager:

Name:______________________________________________________

Address:____________________________________________________

Telephone: ______________________ Fax: _______________________

E-mail: _____________________________________________________

Reference Contracting Officer

Name:__________________________________________________

Address: _______________________________________________

Telephone: ___________________ Fax: ___________________

E-mail: _________________________________________________

C. If subcontractors were used, identify the names of the subcontractors and the percentage of the contract the subcontractor was responsible for. ____________________________________________________________________________________________

D. Specify, by name, any key individual(s) who participated in this contract and are proposed to support acquisition detailed in the RFP.

Title: Re-Entry Transitional Management RFP Number: RFP-RC-2026-010

NAME OF OFFEROR:
Name of Contracting Entity:
Contract Name/Title:
Term of Contract:
Original Contract Value:
Current or Final Contract Value:
A:
1 Original Date:
3 Number of Change Orders (if any):
Primary Causes or Reasons of Change:
Primary Causes or Reasons of Change_1:
2 Current or Final Date:
2 Current or Final Date_1:
responsible for:
D:
D_1:
Name:
Address:
Telephone:
Fax:
E-mail:
Name_1:
Address_1:
Telephone_1:
Fax_1:
E-mail_1:

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