Attachment E.pdf

ATTACHMENT E

RFSQ-BHS-FY25-0176: Behavioral Health Training Services

SAMPLE WORK ORDER PROPOSAL REQUEST FORM

WORK ORDER PROPOSAL REQUEST (WOPR)

Emotional Well-Being: Health Coaching and Education

TO BE COMPLETED BY VENDOR

NOTES: The County will not pay for any travel or travel-related or out-of-pocket expenses. Providers may respond to a WOPR with pricing less than what is stated in the Fee Structure. Please reference Exhibit C of the Agreement for Services and Deliverables requirements. Nothing in this WOPR modifies the Agreement terms and conditions. In the event of a conflict between the Agreement and this WOPR, the Agreement shall control. No provisions of any response or document sent by a provider shall apply in place of, or serve to modify any provision of, the Agreement of Services. Any modifications to the Agreement terms and conditions in this WOPR are void at the County’s sole discretion.

CALIFORNIA PUBLIC RECORDS ACT: The County is a public agency subject to the disclosure requirements of the California Public Records Act (“CPRA”). If Contractor’s proprietary information is contained in documents or information submitted to County, and Contractor claims that such information falls within one or more CPRA exemptions, Contractor must clearly mark such information “CONFIDENTIAL AND PROPRIETARY,” and identify the specific lines containing the information. In the event of a request for such information, the County will make best efforts to provide notice to Contractor prior to such disclosure. If Contractor contends that any documents are exempt from the CPRA and wishes to prevent disclosure, it is required to obtain a protective order, injunctive relief or other appropriate remedy from a court of law in Santa Clara County before the County is required to respond to the CPRA request. If Contractor fails to obtain such remedy within the time the County is required to respond to the CPRA request, County may disclose the requested information. Contractor further agrees that it shall defend, indemnify and hold County harmless against any claim, action or litigation (including but not limited to all judgments, costs, fees, and attorney’s fees) that may result from denial by County of a CPRA request for information arising from any representation, or any action (or inaction), by the Contractor.

GENERAL INFORMATION

Organization Name:

Primary Contact Full Name:

Primary Contact Email:

Primary Contact Phone:

VENDOR WOPR RESPONSE

Description of Services (Provide relevant details such as the names of your offerings, your proposed timeline, training objectives, outlines, presentations, materials, handouts, pre- and post-surveys, library catalogs, etc.):

Demonstrated Work Experience (Provide 2 examples within the past 3 years that demonstrate experience with the type of requested services indicated in the Project Scope.):

PRACTITIONER/COACH/INSTRUCTOR QUALIFICATIONS

(Please include additional practitioners if needed.)

Practitioner/Coach/Instructor #1 Full Name:

Practitioner/Coach/Instructor #1 Experience, Education, and Skills (Provide years of experience; education including credentials, certifications, and degrees;

and skills in providing the requested services.):

Practitioner/Coach/Instructor #2 Full Name:

Practitioner/Coach/Instructor #2 Experience, Education, and Skills (Provide years of experience; education including credentials, certifications, and degrees;

and skills in providing the requested services.):

PRICING

The County will not pay for any travel or travel-related or out-of-pocket expenses. Providers may respond to a WOPR with pricing less than what is stated in the Fee Structure. Please reference Exhibit C of the Agreement for Services and Deliverables requirements.

KEY OFFERINGS/DELIVERABLES

(as proposed in the Description of Services section)

DETAILS

Service Category Cost Unit Onsite or Virtual

Rate (contracted rate or less)

Ex: Nutrition Coaching Wellness Coaching 60-Minute Individual Session Virtual $XX

Ex: “Wellness 101” Workshop Health Education & Promotion Seminars < 4-Hour Session Virtual $XX

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(Add more lines if needed.)

REFERENCE TABLE: PRICING SERVICE CATEGORIES & COST UNITS

Wellness Coaching Health Education & Promotion Seminars 30-Minute Individual Session < 2-Hour Session (< 30 participants) 60-Minute Individual Session < 4-Hour Session (< 30 participants) 30-Minute Group Session (< 30 participants) < 8-Hour Session (< 30 participants) 60-Minute Group Session (< 30 participants)

Well-Being Training or Certifications Manager & Supervisor Support ≤2-Hour Training of Trainers Session (< 30 participants) 1-Hour Individual Session Certification for Individual 1-Hour Group Session (< 30 participants) Certification for Group (< 30 participants) Half-Day Group Session (< 4 hours, < 30 participants) Full-Day Group Session (< 8 hours, < 30 participants)

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