Attachment H.pdf
PDF 264 KB Posted
- Attached to
- Program Evaluator Services
- Solicitation number
- RFSQ-BHS-FY24-0084
- Issued by
- California
About this file
Summary of Attachment H: Sample Work Order Proposal Request
This document is a sample work order proposal request (WOPR) form for program evaluator services issued by the County of Santa Clara Health System Behavioral Health Services Department (BHSD) in California under solicitation RFSQ-BHS-FY24-0084. The form is designed for mental health services evaluations under the Mental Health Services Act (MHSA) Prevention and Early Intervention initiatives. The WOPR template allows the County to request proposals from qualified providers across five primary service categories: Cross Systems Services, Mental Health Services, Substance Use Treatment Services, Quality Assurance and Data Analytics, and Property Management Services. Each request includes fields for project overview, desired outcomes, response deadlines (with responses due by 3:00 P.M. on specified dates), and requestor contact information. The form requires responding offerors to provide relevant educational experience, years of professional experience, and specific skills related to the requested service category.
Responding providers must address the County's desired outcomes and include details regarding target population experience, timeline, milestones, deliverables, and pricing. The County will not reimburse travel expenses or out-of-pocket costs. Providers may propose pricing rates less than those stated in Appendix I, Service Rates, with examples provided for services such as annual reports and evaluator consultation ranging from $2,000 to $10,000 per deliverable. All responses are subject to the terms and conditions of the master agreement for services and deliverables, with any conflicting provisions in the WOPR form rendered void at the County's sole discretion. The form emphasizes that modifications to the agreement terms through the WOPR are prohibited.
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Other files
| File | Type | Posted |
|---|---|---|
| Appendix B rev 07142025.docx | DOCX document | |
| Attachment B.pdf | ||
| Appendix A.docx | DOCX document | |
| Appendix D.docx | DOCX document | |
| Attachment A rev 07142025.pdf | ||
| Solicitation_Document.pdf | ||
| Attachment F.pdf | ||
| Addendum 3.pdf | ||
| Addendum 5.pdf | ||
| Appendix H.docx | DOCX document | |
| Appendix G.docx | DOCX document | |
| Attachment G.pdf | ||
| RFSQ-BHS-FY24-0084 rev 07142025.pdf | ||
| Appendix E rev 07142025.docx | DOCX document | |
| Addendum 2.pdf | ||
| Appendix F.docx | DOCX document | |
| Attachment D.pdf | ||
| Appendix I.docx | DOCX document | |
| Solicitation_Document_1.pdf | ||
| Attachment C.pdf | ||
| Addendum 4.pdf | ||
| Appendix C.docx | DOCX document | |
| Attachment E.pdf | ||
| Addendum 6.pdf | ||
| Addendum 1.pdf |
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Text version
ATTACHMENT H
RFSQ-BHS-FY24-0084: Program Evaluator Services Page 1 of 4 ATTACHMENT H: Sample Work Order Proposal Request
WORK ORDER PROPOSAL REQUEST (SAMPLE FORM)
WORK ORDER PROPOSAL REQUEST FOR
MENTAL HEALTH SERVICES ACT (MHSA):
PREVENTION AND EARLY INTERVENTION
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 Appendix I, Service Rates. Please reference Exhibit C of the Agreement for Services and Deliverables requirements. Nothing in this WOPR form modifies the Agreement terms and conditions. In the event of a conflict between the Agreement and this WOPR form, 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 form are void at the County’s sole discretion.
Sec�on I: County to Complete
Date of Request: Click or tap to enter a date.
Requestor: Ex: First Last Contact Informa�on: Ex: First.Last@hhs.sccgov.org Department/Division/Program:
Ex: MHSA Division
BHSD
Project Overview: Ex: Evaluator Services for INN-## Project, [Project Name] Desired Outcomes from Request:
Deadline for Qualified Pool (QP) Response:
Click or tap to enter a date. by 3:00 P.M.
Iden�fy Desired Service Category
☐ Category 1: Cross Systems Services
☐ Access and Unplanned Services ☐ Cross Systems Ini�a�ves ☐ Forensic, Diversion and Reintegra�on (FDR) ☐ Mental Health Services Act (MHSA)-funded programs (e.g., preven�on and early interven�on; innova�on projects) ☐ Other:
☐ Category 2: Mental Health (MH) Services ☐ Adult and Older Adult System of Care (e.g., outreach services to culturally diverse and treatment resistant popula�ons) ☐ Children, Youth, and Family System of Care (e.g., clinical treatment plans)
RFSQ-BHS-FY24-0084: Program Evaluator Services Page 2 of 4 ATTACHMENT H: Sample Work Order Proposal Request
☐ Category 3: Substance Use Treatment Services (SUTS) ☐ Preven�on Services ☐ Detoxifica�on and Recovery Services ☐ Interven�on Services and Treatment Services (e.g., medica�on assistance) ☐ Other:
☐ Category 4: Quality Assurance and Data Analy�cs ☐ Data coordina�on and analy�cs projects (e.g., sta�s�cal methodology) ☐ Quality Assurance and Improvement Prac�ces (e.g., County compliance and targets with accredi�ng agencies) ☐ Other:
☐ Category 5: Property Management Services ☐ Master Leasing Models ☐ Suppor�ve Housing Services ☐ Other:
Sec�on II: QP Response
Date of Response: Click or tap to enter a date.
Responding Offeror/Organiza�on Name:
Contact Informa�on: Ex: First Last, [Title] Name@email.com
Educa�onal Experience, Years of Experience, and Skills
(related to requested category)
Educa�onal Experience (Select Highest Degree) ☐ Bachelor’s Degree ☐ Master’s Degree ☐ Doctoral Degree Years of Experience ☐ Less than 5 years ☐ 5-8 years ☐ 8-10 years ☐ More than 10 years Skills:
RFSQ-BHS-FY24-0084: Program Evaluator Services Page 3 of 4 ATTACHMENT H: Sample Work Order Proposal Request
Provide response to address the reques�ng County’s desired outcomes including but not limited to experience with specific target popula�on, �meline, milestones, deliverables, and pricing. Include recommended topics, as relevant.
Service Rates
Key Offerings/Deliverables Details Service
Category Cost Unit Onsite or
Virtual Rate (contracted rate or less)
Ex: Annual Report XXXX Per Report N/A $2,000-$10,000 Ex: Evaluator Consultation XXXX <2-Hour
Session Virtual $250-$400
1.
2.
3.
Reference Table: Service Rates
CATEGORY RATES
1. Complete Reports
a. Annual $4,000-$10,000
b. Quarterly $2,000-$6,000
2. Supplemental Reports
a. Dashboard
i. Full Build
ii. Support
$5,000-$10,000 $500- $2,000
b. Data Visualization (e.g., infographic information using Excel, Tableau, etc.)
$150-$200/request
c. Data Model (e.g., scalable data; unaggregated dataset) $3,000
3. Ad Hoc Repor�ng or Requests
a. Evaluator Consultation $250-$400/call
b. Executive Summary $4,000
c. Board of Supervisors or Board Committee Report $200/hour
d. Results Presentation $150-$200/hour
RFSQ-BHS-FY24-0084: Program Evaluator Services Page 4 of 4 ATTACHMENT H: Sample Work Order Proposal Request
An�cipated Timeline of Comple�on (By Month)
Descrip�on of Project Services 1 2 3 4 5 6 7 8 9 10 11 12
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