Attach C1 Admin Response 12-30 rd.docx

ATTACHMENT C1 - BIDDER RESPONSE TEMPLATE

ADMINISTRATIVE REQUIREMENTS RESPONSE (Pass/Fail) RFQQ 26-DCYF-CW-097 Stakeholder Engagement

Instructions: Bidders must complete this template and attach the PDF to their emailed RFQQ Response. Please thoroughly read all instructions in the RFQQ before completing. All mandatory information must be provided for the Bidder to be responsive. Bidder may provide additional documentation as an additional Attachment; the documentation should be specified in this form.

ADMINISTRATIVE REQUIREMENTS (Mandatory Pass/Fail)

Bidder Information:

Business Name:

Address:

Telephone:

Email of Legal Entity or Individual:

|_|No

Federal Tax Identifier Number:

WA State Uniform Business Identifier (UBI) Number:

|_|No

a. Be an individual sole proprietor or nonprofit with the following characteristics:

a. Demonstrated expertise with youth in foster care within the past 5 years.

b. Expertise in the improvement of foster care systems

c. Access to a research and development hub capable of capturing data, input, and experiences from youth who have had experiences in foster care and other stakeholders;

d. Professional experience in using trauma-informed, culturally responsive, and youth-friendly methods for gathering input and feedback from youth and stakeholders;

e. Capacity to offer reasonable accommodations and modifications as well as language access to ensure participation of individuals with limited English proficiency and physical, intellectual, developmental, and psychiatric disabilities

f. Ability to synthesize and communicate information through multiple formats that are accessible to youth and families from diverse backgrounds

|_|Yes

|_|No

|_|No

Key Personnel

Identify the key personnel you will utilize in performing this Contract, and their experience and qualifications.

Contract History:

Has the Bidder’s performance on any contract unsatisfactory and resulted in a contract termination in the past five (5) years?

|_|Yes |_|No

If yes, provide a list of those contracts terminated, and include the following:

· Other party’s Name

· Address

· Telephone Number

· Description of the Incident

· Bidder’s Position on the matter

State of Washington Employee(s):

|_|No

If yes, provide the following information for each individual:

· Name

· Employing Agency

· Job Title while with the Agency

· Separation Date

Insurance Requirements:

|_|No

Proprietary or Confidential Information:

If applicable, identify the Sections of the Response which the Bidder considers “Proprietary” or “Confidential” information:

(Optional) OMWBE Certification:

Is Bidder or Bidder’s subcontractor OMWBE Certified?

|_|Yes

If yes, Bidder’s OMWBE Certification #:

If Subcontractor(s) is OMWBE Certified, Subcontractor(s) names:

If yes, subcontractor(s) OMWBE Certification #:

(Optional) Veteran Owned Business:

Is Bidder or Bidder’s subcontractor certified Veteran Owned Business?

|_|Yes

If yes, Bidder’s DVA Certification #:

If Subcontractor(s) is Certified Veteran Owned Business, Subcontractor(s) names:

If yes, subcontractor(s) DVA Certification #:

(Optional) Small Business:

|_|No If yes, please be sure to sign and return Attachment B.1 Small Business Self-Certifications as part of your proposal.

If Subcontractor(s) is a self-certified Washington Small Business, Subcontractor(s) names:

If yes, please be sure return a sign Attachment B.1 Small Business Self-Certifications for each subcontractor as part of your proposal.

Checklist of Mandatory Response Attachments:

|_|Completed and signed Bidders Certification and Assurances Form (Attachment B)

|_|Complete and Signed Small Business Self-Certification Form (Attachment B.1) if Bidder is a Self-Certified Small Business

|_|Completed and Signed Administrative Requirements (Attachment C1; this document)

|_|Completed Technical and Management Response (Attachment C2)

|_|Completed Cost Proposal (Attachment C3)

|_|Complete Diverse Business Inclusion Plan – Subcontractor Goals (Attachment D) if Bidder’s proposal includes any Subcontractors.

|_| Three (3) Letters of Reference as described in Section D. Proposal Content, Format and Submission of the Solicitation Document.

|_| 501c for Non Profit/WA State Business License

Page 3 of 3 RFQQ 26-DCYF-CW-097 Stakeholder Engagement Administrative Requirements