FAM-25-039 Attachment H Offeror Program Contact Information Sheet.doc
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- Solicitation number
- RFP-118530
- Issued by
- Virginia
About this file
This is an Offeror Program Contact Information Sheet attachment for Request for Proposals FAM-25-039, issued by the Virginia Department of Social Services (VDSS) to procure Regional Post Permanency Consortia Services. VDSS intends to award up to five separate contracts through competitive negotiation, with one contract designated for each of the five VDSS regions: Central, Eastern, Piedmont, Northern, and Western. The RFP was posted on April 20, 2026, with a proposal submission deadline of July 17, 2026, providing potential bidders a three-month window to prepare and submit sealed proposals. Offerors must include program contact information as specified in this attachment, with the form serving as a required submission document for the competitive process.
Specific pricing terms, contract values, and budget ranges for the individual regional contracts are not detailed in this attachment and should be obtained from the complete RFP documentation. Additional information regarding set-aside designations, eligible organization types, disadvantaged business enterprise considerations, incumbent contractor status, specialized qualifications, technology integration requirements, and performance metrics are contained in the referenced RFP document and Attachments A-Q. Prospective offerors are advised to consult all supporting materials, including the VDSS Regional Map (Attachment K), to ensure comprehensive understanding of requirements and eligibility criteria prior to submission.
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Text version
OFFEROR PROGRAM INFORMATION SHEET Attachment H
Contract Agency
Program Name
| RFP # |
| FAM-25-039 |
Contract Amount Match Amount Contract Amount
Match Amount if applicable
Federal ID # (FIN #)
DUNS #
State Corporate Commission # (SCC#)
Address
Region(s) Served if applicable
LDSS Partners with Collaborative Agreements (if applicable)
Target Population
Brief Summary of Services Provided Under this Contract
STAFF
| *Title* |
| Executive Director |
| Finance Officer |
| Program Coordinator |
Name
Address
(if different from above)
Office Phone
Cell Phone
Fax
*Identify all other primary contact people and/or those who need to receive and/or complete invoices, program reports, and fiscal reports. Add another sheet if you need to.
*Title*
Name
Key Responsibility
Reports completed
(e.g. program, fiscal, invoice)
Address
(if different from above)
Office Phone
Cell Phone
Fax
Pre-Award Questionnaire
1. Please indicate the number of years/months your agency/organization has been in operation.
2. Please indicate the number of years/months the project/program for which you are requesting grant funding has been in existence.
3. What is the percentage of this grant in relation to the total agency/organization’s budget?
4. Please indicate the number of years/months the agency/organization director has been in position.
5. Within the last 12 months, has there been turnover of key staff in your agency/organization (e.g. Executive Director, Director, Program Manager, Fiscal Agent)? If yes, what position(s)?
6. Please indicate the number of years/months the Fiscal Agent has been with the agency/organization.
7. Please list two or three individuals (including titles) that have signing authority for your agency/organization.
8. Does your agency or organization receive more than $750,000.00 in federal funding? If so, please state the amount and the federal source of funds.
9. What was the date of your agency/organization’s last internal or external audit?
a.) By whom was it conducted?
b.) Where there any significant findings?
10. Has your agency/organization experienced (currently or in the past) any fraud or wrongdoing? If so, please give a brief, detailed explanation.
11. Credentialing Status: Is the agency/organization fully credentialed by industry standards including 501 (c)(3) status and/or licensing? If so, please list.
PAGE
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