Community_Empowerment_Crisis_Response_Evaluation_Tool.docx

Community Empowerment and Crisis Response Services Master Agreement Request for Application DMH Document # DMH-2024-3029-01

EVALUATION TOOL WORKSHEET

APPLICANT:

Date Application filed on COMMBUYS:

Service(s) Being Reviewed:

Capacity Analysis

Other Activities Supporting Mental Wellness, Healing Resilience:

Name of activity: [ ] Name of Activity: [ ] Name of Activity: [ ]

IF THE APPLICATION IS FOR MULTIPLE SERVICES, THEN THE FOLLOWING APPLIES:

1. The Applicant is required to submit a separate PART III of the Application and cost proposal Workbook for each service.

2. If the Application does not meet the Minimum Submission Requirements, the Application should be rejected as to all services.

3. If the Application meets the Minimum Submission Requirements, Part II of the Application should be reviewed first. If the Bidder is rated “Good” on Part II, then the Review Committee needs to review separately Part III of the Application and the corresponding Cost Proposal Workbook for each service to determine if the Applicant is Qualified to provide the service (a rating of “good” on both the Application Part III and Corresponding Cost Proposal Workbook.)

4. If the Application Part II is not rated “Good”, the Applicant should be found as Unqualified as to all the Services. The Applicant should be notified of this decision and the reason why. The Applicant can file a new Application after making the necessary corrections.

IF THE APPLICANT IS CURRENTLY ON THE MA: |_| YES |_| NO. (Reviewer verified status by reviewing MA list on COMMBUYS |_|) THEN THE FOLLOWING APPLIES:

1. If the Application is determined to meet the Minimum Submission Requirements, then the Applicant was not required to complete Part II of the Application and for purposes of this Worksheet.

2. For purposes of completing this evaluation tool, the Application Part II will be deemed to have a rating of “Good”.

A. MINIMUM SUBMISSION REQUIREMENTS CHECKLIST

Minimum Submission Reviewer:

1. RFA Response Submitted on COMMBUYS: |_| YES |_| NO (RFA Subsection 5.1):

· If not, determine if DMH agreed to an accommodation, otherwise reject Application. Applicant can refile the application on COMMBUYS.

2. Required Response Parts (RFA Subsection 5.1):

a. Application Form:

· used |_| YES |_| NO

· completed |_| YES |_| NO (Note: Part II does not need to be completed if Applicant is already on the MA) and

· signed |_| YES |_| NO

b. Cost Proposal Workbook:

· used |_| YES |_| NO

· completed |_| YES |_| NO

· If the Application Form and/or Cost Proposal Workbook were not used, determine if DMH agreed to an accommodation, otherwise reject response.

If the Response is for more than one Service, a separate Application Form Part III and a Cost Proposal Workbooks are for each Service:

Service: Separate Part III |_| YES |_| NO Separate Cost Proposal Workbook |_| YES |_| NO Service: Separate Part III |_| YES |_| NO Separate Cost Proposal Workbook |_| YES |_| NO Service: Separate Part III |_| YES |_| NO Separate Cost Proposal Workbook |_| YES |_| NO

· If a separate Part III of the Application Form or a Cost Proposal Workbook was not submitted for a Service, that Service cannot be evaluated. The response as to that service should be rejected for failing the Minimum Submission Requirements. The Applicant will need to file a new application to pursue that service. The Review Committee may proceed to review those Services that meet this requirement.

c. Attachments included |_| YES |_| NO. List missing attachments .

Attachments limited to those included on the list of Permitted Attachments. |_| YES |_| NO. If “No,” remove unpermitted attachments and ensure that they are not reviewed by the Review Committee.

· If attachments are missing or there are additional attachments included, determined if substantial (e.g., hard to understand; unable to make a complete decision; etc.) If substantial, Application should be rejected.

3. Other Response Requirements

· Determine if substantial.

4. Minimum Applicant Requirements (Subsection 3.1):

· DMH cannot award a Contract to an Applicant that is currently subject to a Massachusetts or Federal debarment order. The Response should be rejected if subject to a Debarment order. Also, the response should be rejected if the other 2 requirements are not met.

MINIMUM REQUIREMENTS DETERMINATION:

|_| Minimum Submission Requirement met.

|_| Application rejected in full. Minimum Submission Requirements not met.

|_| Application rejected in Part as to one or more Service(s) (for failure to file separate Part III and/or Cost Proposal Workbook for the Service(s). Name service(s)

· If it is determined that the Minimum Submission Requirements are met, the Review Committee should proceed with its review. The Application Form Parts II, Part III and the Cost Proposal Workbook are evaluated separately. Determination of eligibility is based on the scores given to Parts II, Parts III, and the Cost Proposal Workbook. The Response shall be reviewed and rated in accordance with the criteria set forth in this Evaluation Tool.

APPLICATION FORM REVIEW

Note: Cover Page and Part I are not subject to review.

PART II

1. If Applicant is already on the Master Agreement, Part II did not need to be completed, or if completed, does not need to be evaluated. Part II will be deemed as being rated as “Good’ for the purposes of this evaluation tool. Check if relevant. |_| YES |_| Clarification sought. NO |_|

2. For Part II to be rated “Good” it must meet the following requirements.

|_| General Experience and Business History. Based on the Applicant’s experience and history it is reasonable to believe that the Applicant can manage, provide, and deliver community programing that promotes resilience and recovery and it has the necessary business infrastructure to meet the fiscal, legal, and reporting contract requirements.

|_| Culturally and Linguistically Responsive Services. It is reasonable to believe that the Applicant understands and has the experience and expertise to provide Culturally and Linguistically Responsive Services.

|_| Staff. The Applicant submitted a completed Agency Staff Demographics Table. (Note to reviewer, this is used not to determine qualification but is used in the selection of Contractors for SOWs.)

Indicate any strengths or weakness:

PART III

State Applicable Service and Service Category:

For Part III to be rated “Good” it must meet the following requirements.

|_| Service Abstract. The Applicant (a) provided the following information (1) key service elements and service objectives; (2) the intended recipients of the service (3) other key stakeholders, if any; (4) how services will be provided; (5) where services will be delivered; (6) the intended duration and frequency of the services; and (7) the DMH Areas/sites or communities to which you are able and willing to provide services; (b) the information provided is complete; and (c) the service model is reasonable and reflects the goals of the RFA.

|_| CIR/CORE. If the proposed Service is a Clinical Incident Response Service (CIR), the Applicant’s response (a) demonstrates a knowledge of FEMA’s Community Counseling Assistance and Training Program (CCP) standards and (b) the Applicant has reasonable plans for implementing the standards and for ensuring SOWs are implemented rapidly.

If the proposed service is a Community Outreach, Resilience, and Empowerment (CORE) service component, the Applicant response is clear on how its proposed service will empower communities, neighborhoods, and groups so they are better equipped to heal and thrive.

|_| Experience and Expertise. Based on the Applicant’s experience and/or staff expertise it is reasonable to believe that the Applicant can manage, provide, and deliver the proposed Service to the applicable service populations and stakeholders.

|_|References. The references are timely (services delivered within the past five years), relevant to the service, and are supportive of the Applicant.

Applicants must use the Business Reference Form included in this Bid’s COMMBUYS file for this purpose. Note to Reviewers: References may be contacted for additional information prior to addition to the MSA.

|_| Subcontractors. If the Applicant intends to use subcontractors in providing the proposed service component, the Applicant has completed and included the Subcontractor Identification List. The proposed role of the subcontractor is consistent with the proposed service.

|_| Not Applicable

|_| Start Up. Any actions and the estimated timeline for such to enter into a SOW with DMH for services is reasonable, including the need to do CORIs as indicated in Subsection 2.3.3, and to ensure that subcontractors, as applicable, are available.

|_| Environmental Preferable Products. At least one item was checked.

COST PROPOSAL WORKBOOK

For the Cost Proposal Workbook to be rated “Good” it must meet the following requirements.

|_| Reasonable: The Cost Reimbursement Response is comprehensive as it reflects the Applicant’s staffing model for the proposed service and other resources that may be needed to ensure the delivery of services (e.g., program supports and indirect/direct costs).

|_| Cost Effective. The stated costs appear to be reasonable and cost effective.

|_| Potential Cost Factors: The Applicant’s list of factors that could impact the cost of services is comprehensive and reasonable and is supported by the assumptions that were made in developing in the response as reflected in the Attachment to the Workbook. Also, It is reasonable to believe that the Applicant should be able to quickly identify these costs in responding to a SOW inquiry.

|_| It is indicated that there are no factors that could impact the cost of the service.

SUMMARY RESPONSE RATINGS

Service:

Qualified |_| YES |_| NO

Application Part II

Application Part III

Cost Proposal Workbook

Key Information for Master Agreement/Master Agreement List and SOW Selection Criteria:

|_| Already on MA |_| Already has Vendor Customer Code (VCC) |_| Needs VCC |_| Certified by the Massachusetts Supplier Diversity Office – certified as |_| Participant of the Massachusetts Small Business Program |_| Indicated Intent to Subcontract |_| Indicated able to provide services statewide |_| Indicated a preference to limit services to Following DMH Areas or communities:

|_| Strengths that were identified in the Response:

|_| Weaknesses that were identified in Response and recommended points of negotation: