AttachC1-AdminResponse.docx

ATTACHMENT C-1

ADMINISTRATIVE RESPONSE

RFQ NO. 26-DCYF-CW-104

Adolescent Transitional Living Program (ATLP)

Instructions: Bidders must complete this template and attach the Word or PDF document to their 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 (PASS/FAIL)

1. Bidder Information:

Business Name:

Address:

Telephone:

Email of Legal Entity or Individual:

|_|No

Federal Tax Identifier Number:

|_|No

Bidder certifies they meet the minimum qualifications detailed in Section A.4 of the Solicitation Document:

a. Must be licensed to do business in the state of Washington and have a licensed facility that meets the ATLP contract requirements or provide a commitment that it will submit a licensing application for facility-based care to Washington State’s DCYF’s Licensing Division sixty (60) days of being selected as the Apparent Successful Bidder (ASB).

b. Must propose to operate the ATLP in DCYF Regions 6

c. Bidder attests they will have a residential home owned or leased by the bidder’s organization which meets local zoning requirements at the time of contract execution for ATLP services. If leased, the lease must be legally binding throughout the contract’s duration. Copy of the lease/documentation showing ownership will be required.

|_| Yes |_| No

2. Contract History:

|_| No

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

· Other Party’s Name

· Address

· Telephone Number

· Description of the Incident

· Bidder’s Position on the Matter

3. 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

4. Insurance Requirements:

|_|No

5. Proprietary or Confidential Information: Information

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

6. OMWBE Certification:

Is Bidder or Bidder’s subcontractor OMWBE Certified?

|_| Yes |_| No

If yes, OMWBE Certification # ______________;

If Subcontractor is OMWBE Certified, Subcontractor’s Name ____________________

7. Veteran Owned Business:

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

|_| Yes |_| No

If yes, DVA Certification # ______________;

If Subcontractor is DVA Certified, Subcontractor’s Name ____________________

8. Small Business:

|_| No

9. Checklist of Mandatory Response Submittals:

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

|_| Small Business Self Certification Form (Attachment B1) Complete only if a Small Business as defined in RFQ

|_| Completed and signed Administrative Requirements Document (Attachment C-1; this document)

|_| Completed Technical and Management Response Form (Attachment C-2)

|_| Project Schedule (see RFQ Section D.5)

|_| Letters of Reference (see RFQ Section D.6)

|_| Key Personnel Descriptions, Resumes and Organizational Chart (see RFQ Section D.7)

|_| Diverse Business Inclusion Plan-Subcontractors (Attachment D)