720-5122 RFP ATTACHMENTS.docx
DOCX document 106 KB Posted
- Solicitation number
- 86994
- Issued by
- Prince William County, Virginia
About this file
This document contains required attachments for a Request for Proposal (RFP) from the Virginia Department of Behavioral Health and Developmental Services (DBHDS) in Richmond, VA. The attachments include forms for offeror data profiles, pricing schedules, small business subcontracting plans, State Corporation Commission registration, proprietary information identification, proposed contract changes, and certification of compliance. The scope appears to be for a Public Assistance Cost Allocation Plan (PACAP) consultant, with deliverables including an initial audit report, improvement report, procedure format outline, quarterly narrative claiming templates updates, and cost allocation plan consulting services.
The pricing structure requires offerors to provide not-to-exceed costs for each deliverable component. The RFP includes strong emphasis on small business participation, with a stated Commonwealth goal of 42% of purchases from small businesses. Certified small businesses, including women-owned, minority-owned, and service-disabled veteran-owned businesses that hold Virginia Department of Small Business and Supplier Diversity (DSBSD) certification, receive maximum points for the small business participation evaluation criteria. Non-certified businesses must detail their planned subcontracting with DSBSD-certified small businesses.
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THE DEPARTMENT OF BEHAVIORAL HEALTH AND
DEVELOPMENTAL SERVICES (DBHDS)
1220 BANK STREET
RICHMOND, VA 23219
NOTE TO OFFEROR:
The following attachments must be completed, signed (when applicable) and submitted with your proposal; failure to submit a complete proposal may result in you receiving lower evaluation scores.
| ATTACHMENT A | Offeror Data Profile |
| ATTACHMENT B | Pricing/Fee Schedule |
| ATTACHMENT C | Small Business Subcontracting Plan |
| ATTACHMENT D | State Corporation Commission Form |
| ATTACHMENT E | Proprietary/Confidential Information Identification |
| ATTACHMENT F | Proposed Changes |
| ATTACHMENT G | Certification of Compliance |
ATTACHMENT A: OFFEROR DATA PROFILE
The offeror must have the capability and capacity in all respects in order to fully satisfy all of the contractual requirements.
| Company Name(s) |
| Company FEIN or Tax ID Number |
| Provide the formal legal name and the name by which the company is known in the market |
| Provide the official FEIN or Tax ID number of the company |
Legal Name:
DBA:
| eVA Vendor ID Number |
| DSBSD Certification Number |
If applicable, provide company’s certification number from the Virginia Department of Small Business and Supplier Diversity
DSBSD Certification Type & Expiration
Provide the DSBSD Certification Type (i.e. Small, Women, and Minority-owned business, Service-disabled Veteran-owned business, etc) and the expiration of the certification
| Jurisdiction(s) of Formation & Incorporation |
| Corporate Structure |
| Provide justifications and associated dates |
| Indicate sole proprietor, partnership, corporation, limited liability company, etc |
| Company Ownership |
| Contact Information |
| Indicate if the company is privately owned, publicly traded, etc. |
| Provide addresses, phone numbers, company website, and contact email |
Company Officers
Provide names, roles, and tenure with the company
Partner Company Information
Provide the identity of any parent business entity, the parent company’s FEIN or Tax ID number, address, phone number, company website, and contact email
Subsidiary Companies
Indicate the identity of any subsidiary companies, particularly those that may engage in this project, as applicable
CONTRACTOR’S REPRESENTATIVE:
The Contractor shall assign one (1) representative to be in contact with DBHDS for any questions regarding your proposal; as well as any contract that may result from this solicitation. The Contractor’s representative shall handle and resolve all issues including, but not limited to billing and reporting.
Representative’s Name:
Representative’s Telephone:
Representative’s Email:
Past Contracts: Describe all contracts, accounts, projects, and/or engagements that were lost or canceled in the past five (5) years and the reason for the loss.
Litigation: Disclose any past, ongoing, pending, or expected litigation to which the Offeror has been a party in the last ten (10) years that may impact Offeror’s ability to deliver the required solution if a contract is awarded as a result of this RFP. Also indicate if any past, ongoing, pending, or expected litigation is related to Offeror’s services and solutions that are similar in scope to the proposed solution.
Offeror Capacity: In considering the DBHDS;s requirements and timeline, Offeror’s existing or planned projects for other clients that may coincide with a contract with the DBHDS, and Offeror’s experience, resources, and capabilities:
a. Describe Offeror’s capacity to successfully plan, manage, and complete the full scope of work
b. Describe Offeror’s capacity to meet the needs of multiple clients concurrently, if applicable.
Bankruptcy Filing Status: State whether Offeror has filed for bankruptcy protection in the past (5) five years or is currently in the process of filing or planning to file for bankruptcy protection or financial restructuring or refinancing. If so, provide Court and case numbers.
ATTACHMENT B: PRICING/FEE SCHEDULE
PRICING/FEE SCHEDULE
Schedule A-1: Estimated Total Not-To-Exceed Price and Hours
Instructions:
a. Offerors may add or delete rows as needed to the pricing/fee schedule.
NUMBER
BUDGET DESCRIPTION
HOURS
COST
| 1 |
| Offerors Cost for Initial Audit Report |
| 2 |
| Offerors Cost for Improvement Report |
| 3 |
| Offerors Cost for Procedure Format Outline |
| 4 |
| Offerors Cost for Quarterly Narrative Claiming Templates Updates |
| 5 |
| Cost Allocation Plan Consultants (for the Period of Contract) |
TOTAL ESTIMATED COSTS:
ATTACHMENT C: SMALL BUSINESS SUBCONTRACTING PLAN
It is the goal of the Commonwealth that over 42% of its purchases be made from small businesses. All potential offerors are required to return this document with their response.
Small Business: "Small business (including micro)” means a business which holds a certification as such by the Virginia Department of Small Business and Supplier Diversity (DSBSD) on the due date for proposals. This shall also include DSBSD-certified women- owned and minority-owned businesses and businesses with DSBSD service disabled veteran owned status when they also hold a DSBSD certification as a small business on the proposal due date. Currently, DSBSD offers small business certification and micro business designation to firms that qualify.
Certification applications are available through DSBSD online at www.SBSD.virginia.gov (Customer Service).
Offeror Name:
| Preparer Name: | Date: | |
| Who will be doing the work: ☐ I plan to use subcontractors | ☐ I plan to complete all work |
Instructions A. If you are certified by the DSBSD as a micro/small business, complete only Section A of this form.
B. If you are not a DSBSD-certified small business, complete Section B of this form. For the offeror to receive credit for the small business subcontracting plan evaluation criteria, the offeror shall identify the portions of the contract that will be subcontracted to DSBSD-certified small business for the initial contract period the initial contract period in Section B.
Offerors which are small businesses themselves will receive the maximum available points for the small business participation plan evaluation criterion, and do not have any further subcontracting requirements.
Offerors which are not certified small businesses will be assigned points based on proposed expenditures with DSBSD certified small businesses for the initial contract period in relation to the offeror’s total price for the initial contract period.
Points will be assigned based on each offeror’s proposed subcontracting expenditures with DSBSD-certified small businesses for the initial contract period as indicated in Section B in relation to the offeror’s total price.
Section A If your firm is certified by the DSBSD provide your certification number and the date of certification.
Certification number: Certification Date:
Section B If the “I plan to use subcontractors box is checked,” populate the requested information below, per subcontractor to show your firm's plans for utilization of DSBSD-certified small businesses in the performance of this contract for the initial contract period in relation to the offeror’s total price for the initial contract period. Certified small businesses include but are not limited to DSBSD-certified women-owned and minority-owned businesses and businesses with DSBSD service disabled veteran-owned status that have also received the DSBSD small business certification. Include plans to utilize small businesses as part of joint ventures, partnerships, subcontractors, suppliers, etc. It is important to note that these proposed participation will be incorporated into the subsequent contract and will be a requirement of the contract. Failure to obtain the proposed participation dollar value or percentages may result in breach of the contract.
C. Plans for Utilization of DSBSD-Certified Small Businesses for this Procurement
SUBCONTRACTOR #1:
| Company Name: |
| SBSD Cert #: |
| Contact Name: |
| SBSD Certification: |
| Contact Phone: |
| Contact Email: |
| Value % or $ (Initial Term): |
| Contact Address: |
Description of Work:
SUBCONTRACTOR #2:
| Company Name: |
| SBSD Cert #: |
| Contact Name: |
| SBSD Certification: |
| Contact Phone: |
| Contact Email: |
| Value % or $ (Initial Term): |
| Contact Address: |
Description of Work:
SUBCONTRACTOR #3:
| Company Name: |
| SBSD Cert #: |
| Contact Name: |
| SBSD Certification: |
| Contact Phone: |
| Contact Email: |
| Value % or $ (Initial Term): |
| Contact Address: |
Description of Work:
SUBCONTRACTOR #4:
| Company Name: |
| SBSD Cert #: |
| Contact Name: |
| SBSD Certification: |
| Contact Phone: |
| Contact Email: |
| Value % or $ (Initial Term): |
| Contact Address: |
Description of Work:
ATTACHMENT D: STATE CORPORATION COMMISION FORM
Virginia State Corporation Commission (SCC) registration information.
is a corporation or other business entity with the following SCC identification number: ____________ is not a corporation, limited liability company, limited partnership, registered limited liability partnership, or business trust is an out-of-state business entity that does not regularly and continuously maintain as part of its ordinary and customary business any employees, agents, offices, facilities, or inventories in Virginia (not counting any employees or agents in Virginia who merely solicit orders that require acceptance outside Virginia before they become contracts, and not counting any incidental presence of the offeror in Virginia that is needed in order to assemble, maintain, and repair goods in accordance with the contracts by which such goods were sold and shipped into Virginia from offeror’s out-of-state location) is an out-of-state business entity that is including with this proposal an opinion of legal counsel which accurately and completely discloses the undersigned offeror’s current contacts with Virginia and describes why those contacts do not constitute the transaction of business in Virginia within the meaning of § 13.1-757 or other similar provisions in Titles 13.1 or 50 of the Code of Virginia.
**NOTE** >> Check the following box if you have not completed any of the foregoing options but currently have pending before the SCC an application for authority to transact business in the Commonwealth of Virginia and wish to be considered for a waiver to allow you to submit the SCC identification number after the due date for proposals (the Commonwealth reserves the right to determine in its sole discretion whether to allow such waiver):
The Offeror:
ATTACHMENT E: PROPRIETARY/CONFIDENTIAL INFORMATION IDENTIFICATION
Trade secrets or proprietary information submitted by an Offeror shall not be subject to public disclosure under the Virginia Freedom of Information Act; however, the Offeror must invoke the protections of § 2.2-4342F of the Code of Virginia, in writing, either before or at the time the data or other material is submitted. The written notice must specifically identify the data or materials to be protected including the section of the proposal in which it is contained, as well as the page numbers, and must state the reasons why protection is necessary. The proprietary or trade secret material submitted must be identified by some distinct method such as highlighting or underlining and must indicate only the specific words, figures, or paragraphs that constitute trade secret or proprietary information. In addition, a summary of proprietary information submitted shall be submitted on this form. The classification of an entire proposal document, line item prices, and/or total proposal prices as proprietary or trade secrets is not acceptable. If, after being given reasonable time, the Offeror refuses to withdraw such a classification designation, the proposal will be rejected.
Name of Firm/Offeror: ______________________________, invokes the protections of § 2.2-4342F of the Code of Virginia for the following portions of my proposal submitted on __________ (Date).
Signature:
Title:
| DATA/MATERIAL TO BE PROTECTED |
| SECTION # & PAGE # |
| REASON WHY PROTECTION IS NECESSARY |
ATTACHMENT F: PROPOSED CHANGES
Attachment F: Proposed Changes includes instructions and a template that must be used by the Offeror to propose any changes to the Terms and Conditions and RFP Solicitation. Proposed changes and redline edits provided by Offeror directly in the RFP Solicitation, General Terms & Conditions, and Special Terms & Conditions will not be considered.
Offeror Requirements for Proposing Changes Offeror must adhere to the following requirements and instructions when proposing changes to RFP Solicitation and Terms & Conditions:
b. Offeror must use the form to submit all proposed changes. Changes made by Offeor directly in the solicitation document and Terms & Conditions (e.g., redline edits) will not be considered.
c. If there are no proposed changes to the RFP Solicitation and Terms & Conditions, please complete one row with “Not Applicable” or “N/A.”
d. If a Proposed Changes Form is not submitted with the Offeror’s proposal, that will indicate the Offeror’s acceptance of language as provided by the DBHDS.
e. DBHDS expects the Offeror to accept language and content substantially as provided. As such, Offeror is strongly encouraged to minimize the number of proposed changes.
f. Proposed changes must reflect contract-ready language that the Offeror proposes to be incorporated as written, if accepted by the DBHDS, into a definite agreement.
g. Proposed changes, must not include any conditions, such as the need for further authorization, confirmation, input, or reviews required by Offeor, its partners, or other parties external to the DBHDS. Proposed changes submitted with such conditions will be rejected by the DBHDS.
h. Proposed changes must be articulated clearly and fully. Concepts are not acceptable. The submission of statements such as “disagree,” “requires further discussion,” or “to be determined,” will be rejected by the DBHDS.
i. The Offeror must provide a clear, brief rationale for proposed changes in the space provided in the form. Offeror should not assume that the rationale for a proposed change is self-evident and does not require supporting information.
j. Proposed changes that are not captured in the forms provided and submitted with the Offeror’s proposal will not be considered.
k. Offerors may add or delete rows as needed to the proposed changes form.
ATTACHMENT F: PROPOSED CHANGES
Offeor Name:
| # |
| Section Title |
| Sub-Section Title |
| Page Number(s) |
| Originial Language |
| Proposed Language |
| Reason for Change |
ATTACHMENT G: CERTIFICATION OF COMPLIANCE
In compliance with this Request For Proposal (RFP) and all conditions imposed in this RFP, the undersigned firm hereby offers and agrees to furnish all goods and services in accordance with the attached signed proposal or as mutually agreed upon by subsequent negotiation, and the undersigned firm hereby certifies that all information provided below and in any schedule attached hereto is true, correct, and complete.
Name of Firm:
Address of Firm:
Printed Name:
Signature:
Email Address:
Date:
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