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RFB # CJO-6268 BIDDER CHECKLIST Attachment B Substance Abuse Counselors and Clinical Supervision at Robert E Ellsworth Correctional Center (REECC) and Taycheedah Correctional Institution (TCI)
Instructions: The following specifications are the mandatory requirements needed to perform the services requested at REECC and/or TCI. This form must be completed by marking the check boxes for each listed bid specification. By marking these boxes for the location(s) you are bidding, you are acknowledging your ability to meet each requirement.
| BIDDER EXPERIENCE AND QUALIFICATIONS |
| Yes |
| No |
| Yes |
| No |
| 4.1.1 |
| Bidder shall have 12 months or more of experience providing certified substance abuse counseling services to correctional clients and/or human services clients. |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 4.1.2 |
| Bidder shall have 12 months or more of experience providing clinical supervision services for substance abuse counselor(s) providing services to correctional clients and/or human services clients. |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| STAFF QUALIFICATIONS AND EXPERIENCE |
| Yes |
| No |
| Yes |
| No |
| 4.2.1 |
| Substance Abuse Counselor Services |
Bidder agrees to comply with all Substance Abuse Counselor requirements as specified in this RFB Section.
| 4.2.2 |
| Clinical Supervision Services |
Bidder agrees to comply with all Clinical Supervision requirements as specified in this RFB Section.
| PROGRAM REQUIREMENTS |
| Yes |
| No |
| Yes |
| No |
| 4.3.1 |
| Residential Substance Abuse Program |
Bidder agrees to comply with all Residential Substance Abuse Program requirements as specified in this RFB Section.
| 4.3.2 |
| Relapse Intervention Program (TCI only) |
Bidder agrees to comply with all Relapse Intervention Program requirements as specified in this RFB Section.
| 4.3.3 |
| Treatment Program Delivery Requirements |
Bidder agrees to comply with all Treatment Program Delivery requirements as specified in this RFB Section.
| 4.3.4 |
| Participant Expectations |
Bidder agrees to comply with all Participant Expectation requirements as specified in this RFB Section.
| 4.3.5 |
| Program Completion Requirements |
Bidder agrees to comply with all Program Completion Requirements as specified in this RFB Section.
| TREATMENT PROGRAM DOCUMENTION REQUIREMENTS |
| Yes |
| No |
| Yes |
| No |
| 4.4.1 |
| Assessments (REECC only) |
Bidder agrees to comply with all Assessment requirements as specified in this RFB Section.
Bidder agrees to comply with all Treatment Plan requirements as specified in this RFB Section.
Bidder agrees to comply with all Progress Report requirements as specified in this RFB Section.
| 4.4.4 |
| Program Discharge Summary Report |
Bidder agrees to comply with all Program Discharge Summary Report requirements as specified in this RFB Section.
| MONTHLY SERVICE REPORT |
| Yes |
| No |
| Yes |
| No |
| 4.5 |
| Bidder agrees to comply with all Monthly Service Report requirements as specified in this RFB Section. |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| REPORTING REQUIREMENTS |
| Yes |
| No |
| Yes |
| No |
| 4.6 |
| Bidder agrees to comply with all Reporting Requirements as specified in this RFB Section. |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| PERFORMANCE REQUIREMENTS |
| Yes |
| No |
| Yes |
| No |
Bidder agrees to comply with all Staff Vacancy requirements as specified in this RFB Section.
| SUPPORT REQUIREMENTS |
| Yes |
| No |
| Yes |
| No |
| 7.1 |
| INVOICING/PAYMENT REQUIREMENTS |
Bidder understands and will comply with Invoicing requirements as specified in this RFB Section.
| Required Forms |
| Attached ( √ ) |
| DOA-3070, Request for Bid, must be signed by authorized person |
| ☐ |
| Cost Sheet – Attachment A |
| ☐ |
| DOA-3477, Vendor Information |
| ☐ |
| DOA-3027, Designation of Confidential And Proprietary Information |
| ☐ |
| DOA-3333, Wisconsin’s Cooperative Purchasing Service |
| ☐ |
| DOA-3478, Vendor Reference |
| ☐ |
Bidder Name (print or type)
Name and Title of Authorized Company Representative (print or type)
Signature of Authorized Company Representative Date