Appendix E Vendor Experience and Administrative Fiscal Capability RFP-SSA-FY26-0522 Community Living Connection_1.docx

Appendix E

Community Living Connection

BID NUMBER: RFP-SSA-FY26-0522

VENDOR EXPERIENCE AND ADMINISTRATIVE & FISCAL CAPABILITY

Agency Name:

Program Name:

1. Agency Status (check one):

|_| Private Nonprofit |_| Educational Institution |_| Public Agency (Non-County)

|_| Other: _____________________

2. Is the entity and/or any person providing the proposed services suspended or debarred from receiving funds as listed in the List of Parties excluded from Federal Procurement or Non-Procurement Programs Issued by the Federal Services Administration – System for Award Management (https://sam.gov/content/exclusions) 3.

|_| Yes |_| No

4. Number of years the Vendor has been providing services:

Under the Present Name: ___ Under Other Name: ___

*Note: Item 4 does not apply to an individual Vendor or newly formed business. However, SSA reserves the right to request additional financial information and the Vendor shall be required to supply any requested information in a timely manner in order to comply with the requirements of the RFP.

5. Have administrative and fiscal capability to administer the proposed program and have internal procedures to:

a. Establish and maintain a system of financial controls and accounting in conformance with generally accepted accounting principles (GAAP).

b. Maintain accurate and complete financial reports for all costs and operating expenses in connection with the proposed program funding, but not limited to subcontracts, invoices, timecards, cash receipts, vouchers, cancelled checks, bank statements and other official documentation indicating in proper detail the nature and propriety of all cost incurred, and reimbursed by County.

c. Maintain financial records that show funds received under the proposed program are used for purposes consistent with the terms of the proposed program.

d. Must attach a current independent audited financial statement and management letter within the past eighteen (18) months. The audited financial statement must be within a fiscal period of not more than eighteen (18) months old at the proposal due date and prepared by an independent, certified public accountant.

e. Must be able to meet current and subsequent amended or added statutes, regulations, policies, procedures, program rules, or other requirements of the Federal Government, State of California, and/or Santa Clara County, including working with mandatory clients.

|_| Yes |_| No

5. Able to meet and comply with the standard contract provisions.

|_| Yes |_| No

6. Has your organization ever received a “Notice of Intent to Consider Corrective Action” or “Notice of Corrective Action” letter due to non-compliance of contract provisions for services provided on behalf of the County?

|_| Yes |_| No

If yes, please describe the type of letter that you receive and reason(s) that led to the issuance of such letter including any resulting corrective action taken.

7. Have any contracts held by you for the services provided on behalf of the County ever been cancelled?

|_| Yes |_| No

8. For any cancelation, failure or refusal to complete a contract, provide an explanation.

9. Provide the name(s) of other organization(s) or business(’) in which Vendor holds a controlling interest, and the name(s) of other person(s) or organization(s) who owns or has a controlling interest in Vendor’s business.

10. Provide any financial interest in other lines of business and type of business.

11. Provide the names of persons with whom the Vendor has been associated in business as partners or business associates in the last five years.

12. Provide an explanation of any litigation involving the Vendor, or any principal officers in connection with any contract.

RFP-SSA-FY12-0104 Page 1 of 2

RFP-SSA-FY26-0522 Page 1 of 3 image1.png