5-RFP 02 Proposer Questionnaire Fillable.pdf

Proposer Questionnaire 1 Does your agency have non-profit status as a 501(c) (3) organization? YES □ NO □ 2 If not, is your agency in the process of applying for such status? YES □ NO □ 3 Does your agency have a board of directors? YES □ NO □ 4 Does your agency have approved bylaws? YES □ NO □

BOARD

5 Do the bylaws contain a formal process for recruiting and selecting board members? YES □ NO □

6 Do the bylaws contain provisions for conflicts of interest? YES □ NO □ 7 Do your board members sign a code of conduct? YES □ NO □ 8 Do you have available for public review copies of board agendas and meeting minutes? YES □ NO □ 9 Date of your last Board meeting

10 Is your Board representative of the Los Alamos community or your service area? YES □ NO □

EXECUTIVE

11 Does your agency have an Executive Director or equivalent position? YES □ NO □

12 If so, is this position paid?

13 Is this position full-time□ half-time □ other:_______________

14 Do you have a current written and approved job description for the Executive Director? (If so, please upload to the County’s Procurement Portal where indicated)

YES □ NO □

□ Included

15 How many employees and/or volunteers does your executive director directly supervise?

_______Full-time employees

_______Part-time employees

_______Volunteers

OTHER

YES □ NO □

16 Does your board of directors provide an annual performance evaluation of the Executive Director or equivalent position? YES □ NO □

17 Are annual performance evaluations provided on other paid positions? YES □ NO □

18 Does your agency operate under an umbrella agency? YES □ NO □

Local □

State □

National □

19 Are required staff credentials up to date? YES □ NO □ 20 Is there any state or federal regulatory agency with oversight responsibility for your organization or business?

21 Has your agency/business successfully competed for contracts similar to this one? YES □ NO □

FINANCIAL INFORMATION

21 Does your agency have a written policy describing your budget process? YES □ NO □

22 Does your agency have a written policy describing your procurement process? YES □ NO □

23 Does your agency have a Treasurer? YES □ NO □

If so, who?

24 Does your agency have a regular (annual) audit or financial review? YES □ NO □

If so, what kind?

□Financial Review

□Audit

□ Other: ________________

If so, when was the last audit completed and what time period did it cover?

25 Does your agency have a Los Alamos business license? YES □ NO □

Are there other licenses, credential, etc., required of your agency? YES □ NO □

If so, are they current?

26 Annual Report – Where requested on the County’s Procurement Portal, please upload a copy of most recent annual financial statement (audited, if available).

□ Included

Date this form was completed:

Signature of person completing the form:

Name of person completing the form:

Title: