AttachC1-Admin Response 11-18.docx

ATTACHMENT C-1

ADMINISTRATIVE RESPONSE (Pass/Fail) RFQ 24-DCYF-CW-080 Caregiver Supports Area 9-14

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

ADMINISTRATIVE REQUIREMENTS

Bidder Information:

Business Name:

Place of Business:

Telephone:

Email of Legal Entity or Individual:

|_|No

Authorized Signatory (Name and Title)

Federal Tax Identifier Number:

WA State Uniform Business Identifier (UBI) Number:

Unique Entity Identifier (UEI) Number:

|_|No

|_|No

|_|No

Bidder has the minimum requirements as listed in the RFQ Solicitation Document:

Must be licensed to do business in the state of Washington or provide a commitment that it will become licensed in Washington within thirty (30) days of being selected as the Apparent Successful Bidder (ASB).

Must have three (3) years’ experience providing support services to caregivers and children.

Must have an Executive Director on staff with a physical office located within the catchment area being served.

|_|Yes |_|No

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:

OMWBE Certification:

Is Bidder or Bidder’s subcontractor OMWBE Certified?

|_|Yes

If yes, OMWBE Certification # ______________;

If Subcontractor is OMWBE Certified, Subcontractor’s Name ____________________

Veteran Owned Business:

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

|_|Yes

If yes, DVA Certification # ______________;

If Subcontractor is DVA Certified, Subcontractor’s Name ____________________

Small Business:

Checklist of Mandatory Response Attachments:

· Completed and signed Bidders Certification and Assurances Form (Attachment B) Pass/Fail

· Completed and Signed Administrative Requirements (Attachment C-1; this document) Pass/Fail

· Completed Technical and Management Response (Attachment C-2) Scored

· Three (3) Letters of Reference Pass/Fail

· Organization Chart and Resumes of Key Personnel Pass/Fail

· Proof of physical location (i.e. lease) in the catchment area you wish to serve Pass/Fail