ESBD_360779_1716575700843_Youth Crisis Respite Staffing for Direct Care Services RFP 2024.pdf
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- Youth Crisis Respite Staffing Services
- Solicitation number
- RFP24-0628
- Issued by
- Texas
About this file
This document is a Request for Proposals (RFP) issued by the Pecan Valley Centers for Behavioral and Developmental Healthcare (Pecan Valley Centers) seeking proposals for staffing of direct care services for their Therapeutic Respite Program Oak House in Weatherford, Texas. The program will provide a safe, enriching environment that offers case management, skills training, and innovative therapies for youth between 13-17 years old with behavioral health needs. Proposals are due by June 28, 2024, and Pecan Valley Centers expects to select a vendor by July 1, 2024, with a contract start date of September 1, 2024. The selected vendor will be responsible for providing direct care staff to monitor the program environment, assist with activities, transportation, medication management, meal planning and preparation, and other support services.
The RFP outlines specific requirements for the direct care staffing, including qualifications, training, and certifications. Pricing is to be provided in an itemized format, with additional information requested on the vendor's experience, quality assurance processes, and any additional fees that may be anticipated. Pecan Valley Centers is committed to promoting opportunities for Historically Underutilized Businesses (HUBs) and has included a HUB Questionnaire for respondents to complete as part of the proposal.
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Text version
Request for Proposals
RFP 24-0628
Staffing of Direct Care Services
Release Date: May 24, 2024 Proposal Due Date: June 28, 2024
Table of Contents
1. General Information
a. RFP Notice
b. PVC Background
c. Agency Requirements
d. Process Overview
e. Objectives
f. Functional Priorities
g. Evaluation Criteria
h. General Conditions and Stipulations
i. Instructions
2. Organization Background
a. Overview
b. Consumers’ Needs
c. Current Method of meeting needs
3. Required Vendor Information
4. Service Capabilities
a. General
b. Capacity
c. Existing Route
d. Dispatch procedures
5. Organization Information
6. References
7. Pricing
8. Attachments
Request for Proposal Notice:
Pecan Valley Mental Health and Mental Retardation Region d/b/a Pecan Valley Centers for Behavioral and Developmental HealthCare (Pecan Valley Centers) is requesting proposals for staffing of direct care services for their Therapeutic Respite Program Oak House‐ in Weatherford, Texas.
For Direct care staffing summary, please see Attachment A.
Youth Therapeutic Respite Program – 1410 Wendy Lane, Weatherford, TX. The Pecan Valley Centers Therapeutic Respite Program for Youth Oak House – will provide a safe, enriching environment that provides case management, skills training, and an array of innovative therapies for youth between ages 13‐17 years old with behavioral health needs. It is anticipated that the average length of stay will be from three to 10 days. Evidence‐ based practices will be implemented in trauma‐focused cognitive behavior therapy, family therapy, brief‐solution focused therapy and more. This 24/7 structured and therapeutic program will focus the following objectives:
1. Assist youth in improving social interactions and developing meaningful relationships.
2. Provide a safe, supportive, and accepting environment.
3. Provide services and supports that stabilize, enhance, and develop skills to support effective coping and problem‐solving skills.
4. Collaborate with outpatient Pecan Valley Centers services, community services and partners, and other supports and resources to help the youth and family with successful transition to their home environments.
Direct care management of the environment includes continuous monitoring, observation, intervention, and activity support.
Program is scheduled for opening in October 2024.
Pecan Valley Centers Background Information Pecan Valley Centers for Behavioral and Developmental Healthcare (the “Center”) is a unit of local government with non‐ profit status. The Center is the Health and Human Services Commission (HHSC) designated local mental health authority (LMHA) and local intellectual and developmental disabilities authority (LIDDA) established by the State of Texas to plan, coordinate, develop policy, develop, and allocate resources, supervise, and ensure the provision of community based mental health and/or mental retardation services for the residents of Erath, Hood, Johnson, Palo Pinto, Parker and Somervell Counties.
In August 2023, the Center was recertified as a Texas Certified Community Behavioral Health Clinic.
Agency Requirements These facilities are operated under the rules established by the Health and Human Services Standards and/or Pecan Valley Centers policy and procedures identified in their Crisis Service Standards.
Professional services to serve and support individuals in the facility will be provided by Pecan Valley Centers Clinical Staff. It will be critical that the selected contractor be willing to provide Behavioral Health Technicians to provide services in a cooperative manner in order for optimum treatment progress to be achieved. Pecan Valley Centers Clinical Staff will provide training to Behavioral Health Technicians that will enhance their skills as these needs are identified. Behavioral Health Technicians must be responsive to guidance provided by Pecan Valley Centers Clinical Staff in regard to creating the optimum environment to maintain safety and stabilization, as well as to provide individualized support for guests as these needs are identified.
This facility is unique in its intent to provide services for individuals of “all abilities.” Therefore, any individual demonstrating the need for this level of care will not be denied access simply because of their diagnosis or lack of diagnosis. It is intentional that individuals with developmental disabilities will receive the accommodations needed to benefit from treatment at this facility, along with others who have behavioral health needs.
Direct Care staff would be expected to monitor the milieu at all times to ensure individual safety and to encourage participation in group and/or individual recreational activity and the practice of good positive interactions. Direct Care staff will be expected to inform Pecan Valley Centers Clinical Staff when there is a concern about an individual’s condition that could indicate a need for reassessment (such as deterioration in condition, display of unsafe behavior or outcry for help).
For the protection of all concerned, one female Direct Care staff must always be on duty to provide personal support to females with this need.
Procedures for Submitting Proposals Proposals will be accepted by email to the following address contracts@pecanvalley.org. It is the responsibility of the Vendor for the proposal to be submitted to the Contracts Management office. The proposal is not considered received until it is in the possession of Contracts Management.
Proposals must be submitted to:
contracts@pecanvalley.org
Proposal must be received no later than 3:00pm CT on July 31, 2024
Proposals should be clearly marked as a response to the RFP. The time on the received email will be considered the time submitted. If you have any questions concerning the proposal process please contact: Sunny Armstrong, Contract Manager in writing at sarmstrong@pecanvalley.org. All questions for this proposal must be received no later than 3:00pm CT on June 17, 2024.
ADDITIONAL PROVISIONS:
Historically Underutilized Businesses Pecan Valley Centers is committed to promoting full and equal opportunities for all businesses. In order for Pecan Valley Centers to promote these opportunities and as part of its good faith effort, it is important to identify Historically Underutilized Businesses (HUB). HUBs are defined as for‐profit corporation, sole proprietorship, partnership, or joint venture in which 51% of all classes of the shares of stock or other equitable securities are owned by one or more persons have been historically underutilized (socially disadvantaged) because of their identification as members of the following groups; Black American, Hispanic American, Asian American, Pacific American, Native American, and Women. These persons must have a proportionate interest and demonstrate active participation in the control, operation, and management of the business.
Proposal Respondents must include answers to the HUB questionnaire included in this RFP.
mailto:contracts@pecanvalley.org.
mailto:contracts@pecanvalley.org mailto:contracts@pecanvalley.org.
Assignment No right, interest or obligation in or under this contract shall be assigned or transferred by the Vendor without the express written consent of Pecan Valley Centers. Any attempted assignment or transfer by the Vendor without such consent shall be considered failure of contractual obligations and Pecan Valley Centers will reserve the right for immediate cancellation.
Applicable Law, Venue This contract shall be governed, construed and interpreted under the laws of the State of Texas. Venue for any litigation arising under this contract shall lie in Parker County, Texas.
Advertising Vendor shall not advance or publish without Pecan Valley Centers’ prior written consent the fact that Pecan Valley Centers has entered into a contract, except to the extent necessary to comply with proper requests for information from an authorized representative of the state or Federal government.
Dispute Resolution The Pecan Valley Centers dispute resolution process must be used to attempt to resolve all disputes arising out of this contract.
PROHIBITED CONDITIONS:
Prohibition Against Personal Interest in Contracts Employees and officers of Pecan Valley Centers and its contractors and subcontractors must not participate in the selection, award or administration of a contract paid with funds received from or through Pecan Valley Centers if a conflict of interest, real or apparent, is involved. A conflict of interest arises any time such an employee or officer has a financial interest or other interest, e.g. dual employment, in the entity selected for an award, and the existence of such conflict of interest will result in a voided contract. Pecan Valley Centers’ Code of Conduct will apply to this proposal.
By submitting the proposal, the Vendor certifies that there is no conflict of interest in performing the duties listed in the proposal and:
• is an authorized agent of the Vendor and,
• is not currently employed by Pecan Valley Centers and,
• has not offered or provided any gifts or gratuities to any employees in the decision‐making process of
Pecan Valley Centers or a Board Member of Pecan Valley Centers and,
• is not related within the second degree of consanguinity or affinity to an employee in the decision‐ making process which is currently employed by Pecan Valley Centers or a Board Member of Pecan Valley Centers.
Gratuities Pecan Valley Centers may, by written notice to the Vendor, cancel this contract without liability to the Vendor if it is determined by Pecan Valley Centers that the Vendor or its agent gave, offered to give or intends to give at any time hereafter any economic opportunity, future employment, gift, gratuity, special discount, trip, favor or service to a public servant in connection with the quote, proposal, or offer.
Collusion Vendor warrants that no person or selling agency has been employed or retained to solicit or secure this contract upon an agreement or understanding for commission percentage, brokerage, or contingent fee except bona fide established commercial or selling agencies maintained by the Vendor for the purpose of securing businesses and disclosed to Pecan Valley Centers prior to the date of this contract. For breach of this warranty, Pecan Valley Centers may, in addition to other rights it may have, deduct from the contract price or otherwise recover the full amount of such commission, percentage, brokerage, or contingent fee, or cancel this contract.
Advertisement Vendors are prohibited from using contract award information, sales values/volumes and/or Pecan Valley Centers consumers in sales brochures or other promotions, including press releases, unless prior written approval is obtained from Pecan Valley Centers.
Funding Out If applicable, the Purchase Order or contract is made contingent upon the continuation of federally funded programs, or upon the continued availability of state or local funds to cover the full term and cost of this contract.
This contract is subject to cancellation, without penalty, either in whole or in part, if funds are not appropriated. In this instance, Pecan Valley Centers may cancel this contract, by giving thirty (30) days written notice to the Vendor.
PROCESS OVERVIEW
Pecan Valley Centers reserves the right to accept or reject any or all proposals and to waive formalities and select the service Vendor that best meets the needs of Pecan Valley Centers and its employees. Pecan Valley Centers‘ objective is to select a service Vendor who will provide the best possible service at the best possible cost while meeting Proposal specifications. Pecan Valley Centers is not obligated to award the contract based on cost alone.
During the evaluation process, Pecan Valley Centers reserves the right, where it may serve its best interest, to request additional information or clarifications from Vendors, or to allow corrections of errors or omissions.
Pecan Valley Centers reserves the sole right to evaluate the qualifications submitted, waive any irregularities, reject any respondent’s proposals and select the firm that, in its judgment, will provide the most satisfactory service.
Timeline Responses are due by June 28, 2024. Pecan Valley Centers expects to make a Vendor recommendation for approval to the Pecan Valley Centers Executive Director on July 1, 2024. A mutually agreed upon start date will be selected by the Vendor and Pecan Valley Centers which will allow for a 60‐day transition period post contract approval. The following table outlines Pecan Valley Centers’ anticipated schedule. Dates are subject to change.
RFP ISSUED May 24, 2024 Question(s) Deadline June 17, 2024 RFP Due June 28, 2024 Final Vendor Recommended Selection July 1, 2024 Board Approval July 26, 2024 Vendor Notifications August 1, 2024 Contract Start Date September 1, 2024
Vendor awarded the business shall submit an action plan and timetable for providing services to Pecan Valley Centers within fifteen (15) days of approval of the contract.
Objectives and Services Requested:
Through the procurement of direct care services, Pecan Valley Centers seeks proposals for direct care services for our residential programs.
In addition, we have the following duties to include:
The Vendor will provide the following:
• Orientation of individuals at admission to the facility
• Transportation to local Pecan Valley Centers Clinic for appointments and potentially to local schools, depending on treatment team recommendations.
• Oversight of self‐administration of medications
• Handling of laundry for individuals including the laundering of clothing residents present in
• The purchase and supply of linens that need to be replaced, upon direction of Program
Manager, including pillows, bedding, blankets, towels, blankets and bathmats.
• The purchase and supply of toiletries, including: tissue paper, hand soap, paper towels (and dispensers), toilet paper, face cloths, toothpaste, toothbrushes, soap, feminine hygiene products, hand sanitizer, tissues, razors, shaving cream, deodorant, combs and brushes.
• Daily meals (breakfast, lunch, and dinner). Meal planning will incorporate and accommodate all dietary restrictions including but not limited to vegetarian, vegan, gluten free, and diabetic restrictions. Meal planning will also ensure a variety of foods that are nutritious and well balanced in accordance with the most recent version of the United States Department of Agriculture’s guidelines.
• Two snacks (afternoon and evening) & fresh fruit available
• Provide for the safe management and operations of the milieu including programmatic interventions, following schedule and direct supervision of individuals as direct by the treatment team and program manager.
• Perform locator checks every fifteen (15) minutes, unless directed to perform checks more frequently as part of an individualized safety plan
• Provide daily personal care assistance in hygiene, mobility, communication, and implementation of behavior plans as directed and trained by Pecan Valley Centers professional staff.
• Must have a female staff member on each shift to assist with females in our care.
Functional Priorities The successful vendor will provide a solution for the above stated objectives.
Evaluation Criteria This RFP is not intended to favor any vendor. It is solely designed to provide the best value to Pecan Valley Centers in meeting organization needs. The evaluation team will make a recommendation to the Executive Director for final approval and then notify the vendor according to the schedule included in this proposal. The evaluation team will review each proposal based on the following criteria:
• Vendor Qualifications and Years of Experience
• Quality and reliability of Vendor Services
• Service costs
• Proper completion of proposal requirements
General Conditions and Stipulations
Indemnification and Workers’ Compensation The Proposer agrees that if the contract is awarded to their company, the company shall defend, indemnify and hold harmless Pecan Valley Centers, its officials, agents, and employees from and against all claims, damages, losses, and expenses, including attorney fees, arising out of or resulting from the Proposer’s acts or omission in the performance of the duties required under the contract.
Independent Contractor It is agreed that nothing herein contained is intended or should be construed in any manner as creating or establishing the relationship of co‐partners between the parties hereto or as constituting the Service Vendor as the agent, representative or employee of Pecan Valley Centers for any purpose or in any manner whatsoever. The Vendor is to be and shall remain an independent contractor with respect to all services performed under this contract. The Vendor represents that it has, or will secure at its own expense, all personnel required in performing services under this contract. Any and all personnel of the Vendor or other persons while so engaged, and any and all claims whatsoever on behalf of any such person or personnel arising out of employment or alleged employment including, without limitation, claims of discrimination against the Vendor , its officers, agents, contracts or employees shall in no way be the responsibility of Pecan Valley Centers; and the Vendor shall defend, indemnify and hold Pecan Valley Centers, its officers, agents, and employees harmless from any and all such claims regardless of any determination of any pertinent tribunal, agency, board, commission or court. Such personnel or other persons shall not require nor be entitled to any compensation, rights or benefits of any kind whatsoever from Pecan Valley Centers, including, without limitation, tenure rights, medical and hospital care, sick and vacation leave, Workers’ Compensation, Unemployment Compensation, disability, and severance pay.
Audit The proposers agree to present an independent 3rd party audit of their books, records, documents, and accounting procedures and practices.
Nondiscrimination In the performance of this contract, the Successful Proposer shall not discriminate on the grounds of or because of race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, disability, sexual orientation, or age against any of its employees, subcontractors or applicants for employment. The Successful Proposer shall include a similar provision in all contracts with subcontracts to this contract.
Miscellaneous The proposer agrees to at all times observe and comply with all relevant laws, ordinances, regulations, and codes of the federal, state, and local government which may in any manner affect the preparation of proposals or the performance of the contract.
Instructions Vendor can respond to the Request for Proposal by completing the information requested in Section 3: Required Vendor Information, which includes, service, organization information, references and pricing. Responses may be typed directly on the electronic version of the RFP and returned with attachments but must be sent to the designated agency email address.
Required Vendor Information
Prepared marketing materials may be submitted in addition to answering the questions below, however they will not be accepted in lieu of answering the below questions directly.
Services Descriptions In context of the services being requested described above in item Objectives and Services Requested, provide a brief description of your organization’s scope of work, experience in like direct care services, typical length of time to hire and deploy direct care staff, your staff training programs and background checks, and successes in similar direct care services arrangements.
Vendor Organization Information
1. Where is your company headquartered?
2. What is your primary business focus and how many years of experience do you have providing on site direct care services?
3. Provide an overview of your staff qualifications for workers assigned to the location.
4. Also provide a description to ensure the quality and reliability of your work.
5. Has your company received any awards? How do you distinguish yourself from the competition?
6. What is the average size of your client? What is your client retention rate? On average, how long do your clients remain with you?
7. Proposals for staffing patterns (See attachment A), please provide a diagram that indicates job titles and supervisory roles to match the staffing justification.
8. Please also provide a plan for availability and use of as needed staff (PRN) to fill in for vacancies in the current staffing plan.
9. Job Descriptions for Direct Care staff positions that adhere to the requirements as set forth in Pecan
Valley Centers and HHSC Crisis Service Standards requirements for support identified in Information Item V. of this document must accompany the proposal. Job descriptions will be expected to match all positions on the workflow and in the staffing description. Also include hiring criteria and Administrator.
10. Identification of a method or position to coordinate the staffing pattern and serve as the link between Pecan Valley Centers Clinical Staff and contracted Direct Care Staff to assure there is a solution‐focused process to address needs as they are identified by either party. Please also provide agency organizational chart that clearly identifies supervisory roles of Agency clinicians and/or administrators with local Behavioral Health Technician.
11. A description of the applicants Quality Assurance plan that includes the evaluation of satisfaction with services through guest surveys that are completed independently and submitted directly to Pecan Valley Centers, as well as review of data and addressing needs for improvement as it relates to direct care services at the facility. Please include any current client satisfaction surveys the agency uses for similar facilities.
12. Preparation of a draft budget for proposed services. Please include fixed costs and salary costs by position. See attachment A for each programs Scope of Work. Please include the hourly rate to be paid to the administrator, direct care staff, and shift leaders.
13. Inclusion of a list of training along with a training description that will be provided to Direct Care
Staff positions by the contractor prior to and during the course of the contract.
14. A description of the contractors related experience facilitating delivery of the same or similar services to the identified population. Please provide specifics regarding the names of organizations, populations served, services provided, length of time providing services, size of unit and number of staff providing services for each organization.
15. A detailed action plan and timetable for providing services to Pecan Valley Centers within thirty
(30) days of approval of the contract.
16. Any information the agency wishes to provide that speaks to the overall quality of their performance. This may include “above and beyond” practices, policies and procedures that result in excellent quality of care, high staff retention rates and/or overall agency performance.
17. Please provide details on how vacancies or call in will be handled to ensure full staffing integrity is maintained.
References
1. List any relevant clients within the same industry and client size that you work with. Provide contact information for at least two organizations.
2. List all Texas Community Centers that currently use your services. Provide contact information for these organizations.
Pricing
1. Please provide an itemized list of cost and pricing for providing direct care services at the location and services described above.
2. Describe any additional fees that may be anticipated during this engagement.
Attachments
• A ‐ Youth Therapeutic Respite Program (Oak House) Requirements
• B ‐ HUB Questionnaire (see attached and complete)
Attachment A Youth Therapeutic Respite Program ‐ Requirements
The following are considered components of a Crisis Respite Unit Day:
• Orientation of individuals at admission to Therapeutic Respite Unit (Oak House)
• Handling of laundry for individuals including the laundering of resident clothing
• The purchase and supply of all linens needing replacement, after approval by the Program
Manager, including pillows, bedding, blankets, towels, blankets, and bathmats
• The purchase and supply of toiletries, including tissue paper, hand soap, paper towels (and dispensers), toilet paper, face cloths, toothpaste, toothbrushes, soap, feminine hygiene products, hand sanitizer, tissues, razors, shaving cream, deodorant, combs and brushes.
• Daily meals* (breakfast, lunch, and dinner)
• Two snacks (afternoon and evening) & fresh fruit available
• Facilitation of daily coordinated Activities Groups lasting at least two hours a day. Activity Groups may include any of the following: Arts & Crafts, Walks, Games, Group Exercise, etc.
• Provide for the safe management and operations of the milieu including programmatic interventions, following schedule and direct supervision of individuals as directed by the treatment team and program manager.
• If implemented, manage unit token economy behavioral management system
• Ensure that the use of electronic devices:
• Are age‐appropriate,
• Do not exceed two (2) hours per day; and
Staffing Pattern:
We are willing to negotiate on hours, however:
• Open to 8‐ or 12‐hour shifts.
• A schedule is to be provided in advance.
• 2 techs are required at all times.
Additional Services for which Vendor is responsible:
• Assistance of Pecan Valley Centers Case Managers when requested
• Maintaining all State required inspections and licensing standards
• Maintaining public postings
• Facilitating and coordinating all Fire and Disaster drills
• Reporting all facility maintenance issues including but not limited to HVAC, plumbing, furniture, blinds, windows, flooring, and other structural and non‐structural issues as they arise
• Completion and filing of all admission and discharge paperwork
• Keying of completed satisfaction surveys
• Reporting computer hardware problems
• Train all Vendor employees on applicable Pecan Valley Centers policies and procedures
• Maintain proper documentation for admissions and discharges for all individuals
• Call Pecan Valley Centers MCOT for all psychiatric emergencies
• Call Pecan Valley Centers on‐call nursing for all medical emergencies and PRN medication request/approval
• Assist with providing complete First Aid Kits, spill kits, masks, and CPR masks (Grant provides some funding for these items through FY24 and part of FY25).
• Provide all gardening tools, such as hoses and sprayers.
• Ensure the facility is clean, sanitized and up to code for all announced and unannounced state inspections and/or tours and in compliance with Center for Disease Control Guidelines for infectious disease.
• Provide breakfast, lunch and dinner for all staff and techs.
• Supply coffee and creamer in the staff room.
*Meal planning will incorporate and accommodate all dietary restrictions including but not limited to vegetarian, vegan, gluten free, and diabetic restrictions.
Provider will:
• Ensure that at least two (2) paraprofessionals are on site 24/7 who are trained in CPR, seizure management, choking, first aid, and supervision of self‐administration of medications
• Ensure that employees are at least twenty one (21) years of age and have a high school diploma or GED {
• Collaborate with the Program Manager, or designee, for the interviewing of Behavioral Health Technicians.
• Provide staff schedules in advance and will notify Program Manager of changes (resignations, terminations, sick, vacation, etc.) to schedule prior to change in staffing.
• Ensure staff follow Pecan Valley Centers Infection Control guidelines.
• Ensure that staff are awake and alert at all times.
• Ensure employees have and maintain all necessary current licensure and certifications on file at
Pecan Valley Centers.
• Ensure employees complete all training required by Authority prior to the provision of services including but not limited to: professionalism, an overview of working with integrated populations, infection control, abuse and neglect, HIPAA, record keeping and reporting to include incident reports and non‐aggressive behavior management. As such, employees not having all required training will only be on shift as shadowing staff, and not part of the count unless on weekday morning shift when the untrained staff person is the third person on shift.
• Ensure staff receive all program specific training required by the authority.
• Ensure all staff receive PMAB or SAMA training (all 4 courses)
• Ensure all staff receive Trauma‐Informed Care training.
• Require TB Screening within 2 weeks of employment and annually thereafter.
• Maintain current liability insurance as identified in the Agreement.
• Adhere to the requirements set forth by HHSC under the licensure exemption category. The exception allows for operations of the Crisis Respite Unit by obtaining:
• Current Fire Marshal Inspection for the facility.
• Current Health Department Inspection for the facility as applicable;
• A site assessment Survey, and
• Infection Control Plan for the facility
Criminal History Clearances:
Contractor agrees to provide sufficient information to the Authority to enable Authority to receive criminal history record information on the contractor or its employees, pursuant to Texas Health and Safety Code Chapter 533.007 and Chapter 250, the Texas Government Code Chapter 411.115, and 25 Texas Administrative Code Chapter 414, Subchapter K
Applicable Crisis Standards:
Texas Rules and Statutes: https://hhs.texas.gov/laws‐regulations/policies‐rules/texas‐administrative‐ code
Texas Resilience and Recovery Utilization Management Guidelines: https://hhs.texas.gov/doing‐ business‐hhs/provider‐portals/behavioral‐health‐services‐providers/substance‐use‐disorder‐service‐ providers
Pecan Valley Centers Youth Crisis Respite Procedures: Copies will be provided.
Information Item V, Crisis Service Standards https://www.hhs.texas.gov/sites/default/files/documents/doing‐business‐with‐hhs/ http://www.hhs.texas.gov/sites/default/files/documents/doing
Attachment B HUB or DBE
Questionnaire
Historically Underutilized Businesses are defined as for‐profit corporation, sole proprietorship, partnership, or joint venture in which 51% of all classes of the shares of stock or other equitable securities are owned by one or more persons who have been historically underutilized (socially disadvantaged) because of their identification as members of the following groups: Black American, Hispanic American, Asian American, Pacific American, Native American, and Women. These persons must have a proportionate interest and demonstrate active participation in the control, operation, and management of the business.
1. Appropriate structure of business: sole proprietorship, partnership, corporation, limited liability partnership, joint venture
2. Which group best describes the owner or primary stockholder (51%) of the firm which demonstrates active participation in the control, operation, and management of the firm’s business affair.
Black American: Female/Male
Hispanic American: Female/Male
Asian Pacific American: Female/Male
American Woman:
Other:
3. Contractor is eligible to do business in the State of Texas. YES NO
4. Is this company a Foreign Owned Corp.? YES NO
5. Has your business or any of its owners ever been denied HUB certification by any organization?
6. Are you a certified Historically Underutilized Business/ Disadvantage Business Enterprise (DBE) by any Federal or State Agency, city, county, or government entity? YES NO
END OF RFP –
| References |
| Pricing |
| Attachments |
| Attachment A |
| Attachment B HUB or DBE |
| END OF RFP – |
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