In-home RFA_2025-06.pdf

Rogue Valley Council of Governments Senior & Disability Services

Issues the Following

REQUEST FOR APPLICATIONS

For

HOME CARE SERVICES AND PERSONAL CARE (IN-HOME) SERVICES

Date of Issuance: June 9, 2025

Applications Due by: 5:00 pm, June 16, 2025

Via email to: amalfrey@rvcog.org with a cc to mclark@rvcog.org and ksachse@rvcog.org.

Contact:

Ann Marie Alfrey, Interim SDS Program Director, for questions amalfrey@rvcog.org or 541.664.6674 mailto:amalfrey@rvcog.org mailto:mclark@rvcog.org mailto:ksachse@rvcog.org

I. PURPOSE/OVERVIEW

The purpose of this Request for Applications (RFA) is to seek Applicants who wish to establish a contractual relationship with the Rogue Valley Council of Governments (RVCOG) to provide throughout the Jackson and Josephine County area home care and personal care (in-home) services to authorized Oregon Project Independence (OPI) and Family Caregiver (FCG) consumers.

The mission of RVCOG SDS is “Together we promote the dignity, quality of life, and self-determination of seniors and people with disabilities.” Each awarded Contractor shall become an integral part of this mission on a one-to-one basis with our consumers. Each awarded Contractor shall work with RVCOG SDS to create this relationship by providing in-home services as stated in this RFA.

Each awarded Contractor shall be licensed with, and maintain compliance with Oregon Administrative Rules (OAR) 333-536-0000 through 0125, OAR 411-032- 0000 through 411-032-0050 and any other applicable rules.

II. CONTRACT AWARD, CONSIDERATION, AMENDMENTS AND

EXTENSIONS

It is RVCOG’s intent to offer a contract to the most competitive Applicants who meet the Minimum Qualifications and adequately describe their ability to provide the work outlined in the Scope of Work.

The initial term of the Contract shall be July 1, 2025, through June 30, 2026. If RVCOG determines that the work performed has been satisfactory, RVCOG may at its option, amend or extend the Contract for an additional time up to four years (through June 30, 2030) without further solicitation. Any additions or changes shall be by amendment to the original Contract.

RVCOG shall reimburse successful Contractors awarded Contracts for home care and personal care services for the period July 1, 2025, through June 30, 2026, as follows:

Home Care Services $38.08/hour Personal Care Services $38.08/hour

III. MINIMUM QUALIFICATIONS. Applications will be scored based on the thoroughness of responses to the Minimum Qualifications described below.

An application that simply restates the Minimum Qualification and says that they will meet the Minimum Qualification will be rejected.

Describe your ability to meet each of the following Minimum Qualifications.

a. The Applicant shall have been in continuous business providing direct care services of the same kind described in this RFA for a minimum of two consecutive calendar years prior to the date that this application is due.

Application shall provide a history of the company with dates that the company was founded, history of name changes, and changes in ownership, including current ownership. This history shall provide all known business addresses and how long the business has been at each address.

b. Applicant’s employees providing services as a registered nurse (RN), according to the RFA, shall be currently licensed in Oregon as an RN, and be in good standing.

c. Applicant shall be currently licensed for services that will be provided under this RFA, in good standing, by the Oregon Department of Human Services (ODHS) – Public Health. Applicant shall submit a copy of current license with the application.

d. Applicant shall have, at a minimum, one business office either in Jackson or

Josephine County, which operates at least Monday through Friday from 8 am to 5 pm. It is preferred that the Applicant have a satellite office in the other county. Each location shall provide safe, easy access to consumers and be staffed adequately, including adequate clerical staff for each office, to handle expected workload including any anticipated increases in workload or populations served by Applicant. Application submitted shall provide information for each location including address and capacity to deliver services. Applicant shall provide a narrative description of each location and a 5-year plan detailing how Applicant will respond to expected changes to operations including changes to consumer and community populations over the next 5 years. Applicant shall include in its narrative its preparedness and planning to accept consumers upon the effective date of any contract resulting from this RFA.

e. Applicant shall deliver services on short notice, for unusual hours, and for rural areas when needed by the consumer. Applicant shall provide services to all eligible consumers referred by RVCOG.

f. Applicant shall provide with the Application it’s most current Financial

Statement prepared by an independent CPA.

g. Applicant shall provide with its Application a full listing of citations, lawsuits and other legal and court actions that Applicant has been involved in or party to in the two calendar years prior to the Application due date.

h. Applicant shall provide a description of its ability to deliver the following

Scope of Work.

IV. SCOPE OF WORK. The following Scope of Work shall become a part of any Contract that is awarded:

The services (The “Work”), including the delivery schedule for such work, is contained herein. Contractor shall be required to perform the Work in accordance with the terms and conditions in an awarded contract.

a. Services shall include but not be limited to:

(1) Provide in-home care services to RVCOG-authorized OPI and FCG consumers.

(2) Comply with OAR 333-536-0000 through 0125, OAR 411-032-0000 through

411-032-0050 and any other applicable rules. Agencies must be licensed in accordance with these rules.

b. Criminal Records and Abuse Checks. Contractor agrees to meet provider requirements set forth in OAR 407-007-0200 through 407-007-0370. Subject individuals, as defined in OAR 407-007-0210, include employees of the Contractor, volunteers of the Contractor, and employees and volunteers of Contractor’s subcontractors.

c. Agency Personal Care Services

(1) Personal Care Service means in-home services provided to maintain, strengthen, or restore an older adult’s or adult with physical disability’s functioning in their own home when an individual is dependent in one or more Activities of Daily Living (ADLs), or when an individual requires substantial assistance, and one or more of the following conditions exist:

(a) Medical instability;

(b) Potential for skin breakdown or pressure ulcers;

(c) Multiple health problems or frailty with a strong possibility of deterioration; or

(d) Consumer has potential for increased self-care, but requires instruction and support to reach goals.

(2) Personal Care Services shall be performed by qualified and trained providers under the supervision of the Contractor or Contractor’s designee.

(3) Personal Care Services may vary and may include but are not limited to:

(a) Basic personal hygiene, including bathing, grooming, nail care, foot care, dressing, and skin care;

(b) Toileting, bowel and bladder care, including bowel care requiring delegation by an RN;

(c) Mobility and transfers, including assistance with ambulating and positioning;

(d) Nutrition, hydration, feeding;

(e) Maintaining clean oxygen equipment and assuring adequate oxygen supply; and

(f) Assisting with medication set-up as ordered by the physician and refilled as appropriate. May include screening and education by a Registered Nurse to ensure compliance with medication regimens and that medications are used appropriately to avoid adverse drug reactions. This may include individualized reviews and caregiver training and education regarding medication treatment plans.

(g) For consumers whose conditions are stable and predictable, the Contractor shall conduct nursing assessment, monitoring, intermittent nursing care, and delegation of special tasks of nursing care. Nursing services shall be conducted in accordance with the Oregon State Board of Nursing Administrative Rules, OAR Chapter 851, Division 045, 047, and 048, and DHS, Public Health Administrative Rules OAR Chapter 333 Division 536 regarding In-Home Care Agencies.

Contractor shall provide nursing delegation and teaching services as defined in OAR 411-048-0180.

d. Agency Personal Care Aides (APCA)

(1) Contractor shall provide qualified and trained employees sufficient in number to meet the needs of the consumers receiving services.

(2) Contractor shall ensure that all APCA’s employed by the Contractor must be at least 18 years old, be in compliance with DHS’ Criminal History Clearance Administrative Rules and have sufficient communication and language skills to enable them to perform their duties and interact effectively with consumers and other agency staff.

(3) Contractor shall ensure that all APCAs have completed the Contractor-specific orientation, conducted by the Contractor or designee, prior to independently providing services to consumers. The orientation should include: APCA duties and responsibilities, consumer rights, confidentiality, infection control, and any other requirements as specified in OAR 333-536-0070. Contractor shall document and maintain records of APCA attendance at orientations.

(4) Contractor shall supervise APCAs, observe job performance in the home at least quarterly, and document job performance after probationary period and annually thereafter as specified in OAR 333-536-0070.

(5) Contractor shall post a prioritized emergency contact list (e.g., physician, ambulance, fire department, family members/friends, etc.) by the consumer's telephone and give a copy of the list to the APCA.

(6) Contractor shall assure that the APCA receives a copy of the Contractor's emergency procedure, local area disaster plan and understands the importance of following the plan.

(7) Contractor shall reassess the consumer at least quarterly or within one week following emergency treatment and revise the service plan as changes occur.

(8) Contractor shall conduct an initial screening in the prospective consumer's home to evaluate the requested service and needs prior to accepting the prospective consumer and assigning an APCA. The Contractor may bill up to three hours at the Personal Care rate for each initial assessment based on actual time spent on initial assessment.

e. Agency Home Care Services (AHCS)

(1) Home care services means all those Activities of Daily Living (ADL) or

Independent Activities of Daily Living (IADL) in-home services, requiring minimal to substantial assistance necessary to help consumers achieve the greatest degree of independent functioning. The AHCS is supervised by the Contractor who verifies the AHCS's capability and monitors ongoing adequacy in the provision of care services

(2) AHCS Tasks may vary and may include but are not limited to:

(a) Housekeeping tasks necessary to maintain the consumer in a healthy and safe environment, including cleaning, laundry, shopping, and meal preparation.

(b) Observation of consumer’s status and reporting of any significant changes to physician and RVCOG Case Manager.

(c) Handle first aid and other emergencies.

(d) Provide extra support for consumers with confusion, dementia, mental illness or other cognitive deficits.

(e) Arrange or assist in arranging necessary medical appointments and transportation to the appointments; as well as arranging or assisting in arranging transportation to meet other ADL or IADL needs, such as shopping, etc.

(3) AHCS

(a) Contractor shall ensure that the AHCS must have recognized capability to perform the tasks authorized for the consumers they serve. The Contractor must ensure the AHCS is qualified, competent, trained and capable of meeting the consumer's individual care needs as determined by the RVCOG Case Manager.

(b) Contractor shall ensure that all AHCS’s employed by the Contractor must be at least 18 years old, be in compliance with DHS’ Criminal History Clearance Administrative Rules, and have sufficient communication and language skills to enable them to perform their duties and interact effectively with consumers and other agency staff.

(c) Contractor shall ensure that all AHCS’s can provide tasks requiring the skills of an APCA when they have received adequate training and are supervised by the home care supervisor or designee.

(d) Contractor shall provide supervision of AHCS by the home care manager or designee. AHCS supervision may be provided through telephone conferences or face-to-face conferences as needed, and by quarterly on-site monitoring of the services they provide in the home;

(e) Contractor shall provide training to Contractor’s staff which enables the AHCS staff to demonstrate knowledge and skill in performing those tasks described in Contractor’s In-Home Care Services Plan.

(f) Contractor shall provide a AHCS Supervisor with the training and / or experience leading to demonstrated knowledge and skill in performing those tasks described as AHCS. The AHCS Supervisor shall supervise through telephone conferences, face-to-face conferences, as needed, and quarterly on-site monitoring of the services provided in the home.

f. Miscellaneous Contractor Services. The Contractor shall:

(1) Make provision for weekend, evening, holiday and rural service as needed. Services to consumers shall be available, when needed, 24 hours a day, 7 days a week, and 365 days a year including emergency care.

(2) Provide authorized services for all consumers referred by RVCOG.

The Contractor shall make a special effort to meet the needs of consumers with unique and challenging living and personal situations and is expected to initiate and continue services under less than ideal conditions while an acceptable plan is being developed in cooperation with the RVCOG Case Manager.

(3) Recruit, select and maintain adequate numbers of qualified staff to provide services required under the contract.

(4) Train staff with RVCOG SDS and DHS policies, procedures, and in-home service requirements.

(5) Provide authorized service to each eligible person referred to Contractor according to the indicated schedule (such as one hour of housekeeping twice per week) up to the maximum amount authorized.

(6) Promptly assign and begin services as indicated in all cases referred as follows:

(a) within 24 hours from referral on emergency cases (someone who requires immediate assistance and has no supports in the home) as determined by RVCOG;

(b) within three calendar days from referral on urgent cases (someone who currently has support in the home that will be meeting the person’s care needs for the next three days) as determined by RVCOG; and

(c) within five calendar days from referral on all other cases.

(7) Notify the referring RVCOG Case Manager by noon the following day if the consumer refuses to accept services.

(8) Notify the referring RVCOG Case Manager of any problems with the service plan, scheduling, authorized services, significant changes to the consumer’s health status or if specifically requested via the SDS 0546N (Attachment C) due to consumer circumstances as soon as possible.

(9) Notify the Consumer in all cases of either temporary or permanent changes in service (day, time of day, or worker) or the reason for the change in advance of the change.

(10) Submit invoices for RVCOG-referred consumers on the RVCOG

Monthly Oregon Project Expense Report form (Attachment D) to the appropriate RVCOG Office within 15 days after the end of the month in which services were provided. The invoices shall indicate the consumer for whom services were provided, the consumer’s prime number, the type and number of units of service authorized, the type and number of units of service delivered, the month services were provided, and the amount being billed, by service. An explanation of discrepancies between authorized and actual service hours that are 20% or more under the authorized shall be provided on the Monthly Expense Report. RVCOG will make payment to contractor within 30 days after receipt of an accurate and complete invoice.

(11) Electronic visit verification (EVV) will be required for staff clocking in and clocking out. It is the responsibility of the IHCA to provide an approved EVV system.

(12) Maintain in consumer case files, accurate and timely documentation including but not limited to: current care plans and reviews; service authorization form (SDS 0546N – Attachment C) home visit or other consumer contact notes (i.e., telephone conversations, including notations of consumer changes); supervisory conference notes; Case Manager staffing notes; and other consumer-related documents, such as consumer acknowledgment of Contractor’s grievance procedure.

(13) Upon termination of Contractor’s contract, Contractor shall immediately transfer the original copies of all RVCOG consumer case files to RVCOG.

(14) Maintain a disaster plan designed to assist in protecting the life and safety of consumers in the event of a disaster. A disaster is defined as any sudden event, from either natural or human causes, that threatens the lives and / or safety of numbers of people. The disaster plan shall consider the fact that in many emergencies the power may go out, leaving many areas dark, even in the daytime. In addition, phones may be inoperable and roads may be impassable. Also, the disaster plan shall take into account how staffing shall be achieved, given that many in-home workers may not be available due to the disaster, and how the Contractor shall coordinate with disaster relief officials. The Contractor shall encourage home-bound, isolated consumers to get on the RVCOG Disaster Registry.

g. On-Site Monitoring and Assessment. Contractor shall provide information and documents as requested by RVCOG. This requested information may include, but is not limited to:

(1) Consumer records (OAR 333-536-0085);

(2) Consumer nursing services (OAR 333-536-0080);

(3) Quality improvement records (OAR 333-536-0090);

(4) Protective service investigation findings (OAR 333-536-0043);

(5) Organization, administration, and personnel (OAR 333-356-0050);

(6) Other agreements as defined in the DHS Public Health, In-Home Care

Agencies Administrative Rules (OAR 333-536-0000 through 333-536- 0125).

The requested information shall be submitted to RVCOG within 5 working days of the request, unless RVCOG indicates the request involves consumer safety, well-being or a protective service investigation in which case the information must be submitted to RVCOG within 24 hours of the request.

Contractor shall cooperate with any RVCOG quality assurance visits regarding monitoring of any provision of services under the Agreement.

Contractor shall participate in consumer conferences with RVCOG Case Managers, as requested.

V. OTHER INFORMATION

a. RVCOG Consumers. The typical consumer under this RFA may: 1) have limited or no personal / family support system; 2) have worn out their social support system; 3) have involvement with numerous support service agencies; 4) have impaired cognitive abilities; and 5) have severe mental health issues.

b. Service Guidelines. RVCOG Case Managers are responsible for screening and assessing consumers to determine service needs and eligibility. When authorizing in-home services, the RVCOG Case Manager, the Consumer and the Consumer’s family work together to develop a care plan to meet the needs of the Consumer and determine the best option of home care and personal care service provision.

c. Authorization of Services. RVCOG Case Manager shall communicate with the Contractor via fax or email using a SPD 0546N In-Home Service Plan (Attachment C). The form provides the type of services to be provided (home care and / or personal care), the number of hours per month authorized, any schedule preferences, and a general indication of the consumer’s need. The Case Manager may, as needed, also telephone and discuss individual strengths, anticipated problems, difficulties and the expectations of services with the Contractor in order to prepare the Contractor’s worker for the assignment and to establish goals of coordinated services. Contractor will insure that monthly authorized hours are not exceeded.

d. Consistency and Continuity of Care. It is RVCOG’s philosophy that consistency and continuity of consumer care (in terms of both care schedules and care providers) is important to the long-term well-being of the consumer. While we recognize that some changes are unavoidable, and some may occur based on consumer availability and consumer choice, the success of the contract is largely dependent on the Contractor being able to establish a stable work force and maintain continuity of care. Decisions on scheduling services shall be made primarily on the basis of consumer need.

e. Removal of In-home Workers. RVCOG reserves the right to require the

Contractor to reassign or otherwise remove any home care or personal care worker who poses a threat to the health, safety, or welfare of a consumer including suspending anyone who is the subject of a protective service investigation pending the decision. If an employee of the Contractor was involved in a substantiated protective service complaint, Contractor shall terminate the employee.

f. RVCOG/Contractor Dispute Resolution Process. The following process shall be used in resolving differences of opinion between the Contractor and RVCOG. This shall in no way prevent the Contractor from discussing specific consumer issues with RVCOG Case Managers. This process is for issues that are beyond an individual RVCOG Case Manager or issue:

(1) The Contractor shall notify the SDS Program Supervisor within three business days of the situation.

(2) The SDS Program Supervisor shall arrange a meeting with the Contractor and attempt to reach a mutually acceptable agreement within five business days.

(3) If the Contractor and SDS Program Supervisor are unable to reach a mutually acceptable solution, the Supervisor shall immediately notify the SDS Program Director. If the Supervisor does not contact the SDS Program Director, the Contractor may contact the SDS Program Director.

(4) The RVCOG SDS Program Director shall staff the situation with the SDS Program Supervisor and the Contractor and attempt to reach a mutually acceptable agreement within ten business days. The SDS Program Director shall make final decision on resolution of differences of opinion.

g. Payments

(1) RVCOG shall pay for expenses as approved by RVCOG Case

Managers. The RVCOG Finance Department shall process payment by the next regularly scheduled payment date. RVCOG reserves the right to refuse payment for billings received more than 60 days following the close of a service period and more than 30 days following the end of the fiscal year.

(2) RVCOG shall not pay for unauthorized services rendered (except in the case of an emergency which is essential to the well-being of the consumer), for claimed services which have inadequate proof of delivery, or for services which do not meet specifications. If billings result in payments for which the Contractor is not entitled under the terms of the contract, RVCOG may withhold payments due to Contractor from future payments, as are necessary to recover the amount of overpayment.

(3) Service authorization shall be for a minimum of one hour per visit and may be in increments of one quarter hour thereafter. If a combination of home care and personal care is authorized for one consumer, the Contractor may charge the first hour of the visit at the personal care rate. Additional time over the one hour shall be charged at the rate appropriate to the type of care provided, as set forth in the RVCOG authorization.

(4) Only direct care time may be billed. For example, travel time between consumer homes may not be billed, nor may supervisory / care planning time. These costs are included in the unit rate for home care and personal care services.

(5) For released or cancelled time (i.e., when the consumer is not home or refuses services), the Contractor may bill for one unit (one hour) of service, if, and only if, there was not 24 hours’ notice for released time. Such instances must be documented, and the Contractor must notify the RVCOG Case Manager.

VI. APPLICATION REQUIREMENTS

a. Overview. Applications must be submitted in electronic format, preferably a PDF document. Applications should be typed but without expensive artwork, unusual printing or other materials not essential to the utility and clarity of the Applications. Submissions in response to this RFA must be in the form of an Application Package (Attachment A) containing the Application Summary, Statement of Assurances, and the Application and all required supporting information and documents.

b. Application Evaluation. Applications must be complete at the time of submission. RVCOG shall conduct a comprehensive and impartial evaluation of the Applications received. Contractors must successfully meet all requirements of the application packet to contract with RVCOG. It is RVCOG’s intent to offer a contract to each Contractor who meets the minimum qualifications and requirements as stated in this Application.

Applications shall be evaluated on overall quality of content and responsiveness to the Purpose, Minimum Qualifications, and Scope of Work of this RFA. Only those Applications that include complete information as required by this RFA shall be considered for evaluation.

c. Pass / Fail Items. The items listed below shall be scored on a pass/fail basis:

(1) Application Format

(2) Complete Application Summary, Statement of Assurances, and

Application

(3) Organizational Capacity and Fiscal Stability

VII. SOLICITATION SCHEDULE & PROCEDURES

a. Schedule

(1) RFA Period Opens: June 9, 2025

(2) RFA Applications Due: By 5:00 pm, June 16, 2025

(3) Contract(s) Award: June 23, 2025

(4) Work to begin: July 1, 2025

b. Closing Date for Submittal of Applications. RVCOG must receive Applications no later than 5:00 pm local time on June 16, 2025, via email to amalfrey@rvcog.org with a cc to mclark@rvcog.org and ksachse@rvcog.org. Applications received after closing date and time are late and shall not be accepted.

c. Questions Relating to This RFA. Questions about this RFA document or the solicitation process must be submitted in writing to amalfrey@rvcog.org.

Notification of any substantive clarifications provided in response to any question shall be distributed to all by June 13, 2025.

d. Reservation of RVCOG Rights. RVCOG reserves all rights regarding this

RFA, including, without limitation, the right to:

(1) Amend or cancel this RFA without liability if it is in the best interest of the public to do so;

(2) Reject any and all Applications received by reason of this RFA upon finding that it is in the best interest of the public to do so;

(3) Waive any minor informality;

(4) Seek clarification of each Application;

(5) Reject any Application that fails to substantially comply with all prescribed solicitation procedures and requirements;

(6) Negotiate the Work within the Scope of Work described in this RFA;

(7) Amend or extend the term of any Contracts that are a result of this RFA;

(8) Engage Contractors by selection or procurement for different or additional services independent of this RFA process and/or any contracts/agreements entered into pursuant hereto;

(9) Amend or extend the contract for additional time or dollars and to negotiate any future rate increases; and

(10) Amend Scope of Work to delete or add any services stated in this application, or any combination of the foregoing.

e. RFA Amendments. Any interpretation, correction or change to this RFA shall be made by written addendum. Interpretations, corrections or changes to this RFA made in any other manner shall not be binding, and Contractor shall not rely upon such interpretations, corrections or changes.

f. Withdrawal. If a Contractor wishes to withdraw a submitted Application, a request in writing must be signed by the Contractor and submitted to amalfrey@rvcog.org.

g. Release of Information. No information shall be given to any Contractor (or any other individual) relative to their standing with other Contractors during the RFA process.

h. Public Information. All Applications are public information after the

Applications have been opened. However, copies of Applications shall not be provided until the evaluation process has been completely closed. Any person may request copies of public information. Requests for copies of public information must be in writing. A fee of $0.25 per page copied shall mailto:ksachse@rvcog.org be assessed, and RVCOG must receive payment before copies shall be delivered to the requestor. If any part of an Application is considered a trade secret, the Contractor must clearly designate that portion as confidential in order to obtain protection, if any, from disclosure at the time of submission.

See Oregon Revised Statutes 192.501(2) and 646.461 to 646.475.

Application of the Oregon Public Records Law shall determine if the confidential information claimed to be exempt is in fact exempt from disclosure.

i. Cost of Applications. All costs incurred in preparing and submitting an

Application in response to this RFA shall be the responsibility of the Contractor and shall not be reimbursed by RVCOG.

j. Recyclable Materials. Vendors shall use recyclable products to the maximum extent economically feasible in the performance of the contract work set forth in this document.

k. Contractual Obligation. All Contractors who submit an Application in response to this RFA understand and agree that RVCOG is not obligated thereby to enter into a contract with any Contractor and, further, has absolutely no financial obligation to any Contractor.

l. Contract Documents. The final contract shall be based on the draft Contract form, which is attached as Attachment B to this RFA, and shall include all Exhibits and attachments identified in the Contract, including this RFA and the successful Contractor’s Application. The terms and conditions included in Attachment B, other than Exhibit A, Scope of Work, are not subject to negotiation.

ATTACHMENT A - APPLICATION PACKAGE

APPLICATION SUMMARY – Page 1

1. Project Title: In-Home Services

2. Contract Period: July 1, 2025, through June 30, 2026

3. Applicant: [ ] Public [ ] Private/Non-Profit [ ] Private / For Profit [ ] Other (Describe)

Organization Name:

Primary Contact Person/Title:

Address, City, State, Zip:

Phone/Fax/Email:

Date of Incorporation:

Name of Person(s) and Title(s) authorized to represent the Applicant in any negotiations and sign any Personal Services Contract that may result:

4. Provide at least three references that are able to verify the quality of your previous work providing in-home services. For each reference, provide the following information:

Reference No. 1

Contact Person:

Project Title:

Verified Phone/Fax/Email:

Phone/Fax/Email:

Reference No. 2

Contact Person:

Project Title:

Reference No. 3

Contact Person:

Project Title:

APPLICATION SUMMARY – Page 2

5. STATEMENT OF ASSURANCES

The undersigned attests that:

a. Applicant has the authority and/or responsibility to submit an application and to represent applicant’s organization in all phases of the Request for Application (RFA) and contract process;

b. Applicant or the delegated representative, has read the contents of this RFA, understands it fully, and agrees to comply with all provisions stated in the RFA;

c. The information provided is true and accurate to the best of applicant’s knowledge;

d. Applicant understands any false or substantially incorrect statements may disqualify this Application from further consideration or be cause for termination of any future contract;

e. Applicant understands that the Application submitted is firm for the period July 1, 2025, through

June 30, 2026;

f. Applicant accepts as a condition of any contract that may be awarded, the obligation to comply with the applicable state and federal requirements, policies, standards and regulations; and

g. Applicant recognizes that this is a public document and open to public inspection.

6. In addition, to verify the legal authority to contract, the following proofs will be submitted to RVCOG prior to signing any contract resulting from this RFA.

a. Evidence of all required insurance coverage effective July 1, 2025;

b. Copy of license to do business in Oregon;

c. State of Oregon and IRS tax number and status;

d. Certification as an Equal Employment Opportunity Employer;

e. Copy of Agency/Corporate policy for a Drug Free Workplace; and

f. Copy of Corporate Certificate.

Typed Name and Title__________________________________________________

Signature Date

7. APPLICATION

a. Fully describe your ability to meet each of the minimum qualifications outlined in Section III.

Minimum Qualifications, Items a. through g of this RFA. List each Minimum Qualification Item number before your response (i.e., Section III. a.).

b. Fully describe your ability to provide the Work outlined in Section IV. Scope of Work, Items a through h of this RFA. List each Scope of Work Item number before your response (i.e., Section IV. f.

1.).

ATTACHMENT B - SAMPLE CONTRACT FORM

ROGUE VALLEY COUNCIL OF GOVERNMENTS

CONTRACT FOR SERVICES

This contract is between Rogue Valley Council of Governments, hereinafter referred to as “RVCOG” and ______________________, hereinafter referred to as

"CONTRACTOR."

I. EFFECTIVE DATE and DURATION. This contract shall become effective on

July 1, 2025. Unless terminated or extended as otherwise provided herein in Exhibit C, this contract shall expire when RVCOG accepts CONTRACTOR’s completed performance or on June 30, 2026, whichever date occurs first.

Expiration shall not extinguish or prejudice RVCOG’s right to enforce this contract with respect to any breach of a CONTRACTOR warranty or any default or defect in CONTRACTOR performance that has not been cured.

II. PURPOSE. CONTRACTOR agrees to provide, throughout Jackson and

Josephine Counties, home care and personal care (in-home) services for RVCOG as requested.

III. STATEMENT of WORK. The Statement of Work (Work) is contained in: the

Request for Applications released June 19, 2025 and the Application package dated at time of signing. CONTRACTOR agrees to perform the Work in accordance with the terms and conditions of this contract as further defined in Section VI. of this contract.

IV. CONSIDERATION.

RVCOG will reimburse the CONTRACTOR for home care and personal care services for the period July 1, 2025, through June 30, 2026, as follows:

Home Care Services $38.08/hour Personal Care Services $38.08/hour

RVCOG reserves the right to modify rates due to changes in program requirements.

V. ORDER of PRECEDENCE. All rights and obligations of the parties to this contract shall be subject to and governed by the terms and conditions contained in the text of this contract instrument. In the event of an inconsistency in this contract, unless otherwise provided herein, the inconsistency shall be resolved by giving precedence as follows:

1. Federal statutes and regulations;

2. Oregon statues and administrative rules;

3. This contract document;

4. RFA dated June 19, 2025;

5. Application dated at time of signing.

VI. CONTRACT in its ENTIRETY. This contract consists of this document and includes the following listed exhibits which are incorporated into this contract by reference:

Exhibit A Scope of Work Exhibit B Special Provisions Exhibit C Standard Terms and Conditions Exhibit D Insurance Requirements Exhibit E Independent Contractor Certification Statement Exhibit F Required Federal Terms and Conditions

There are no other contract documents unless specifically referenced and incorporated in the contract.

VII. MERGER CLAUSE; WAIVER. This contract and attached exhibits constitute the entire agreement between the parties on the subject matter hereof. There are no understandings, agreements, or representations, oral or written, not specified herein regarding this contract. No waiver, consent, modification or change of terms of this contract shall bind either party unless in writing and signed by both parties. Such waiver, consent, modification or change, if made, shall be effective only in the specific instance and for the specific purpose given. The failure of RVCOG to enforce any provision of this contract shall not constitute a waiver by RVCOG of the right to any subsequent enforcement of that or any other provision.

CONTRACTOR, BY EXECUTION OF THIS CONTRACT, HEREBY

ACKNOWLEDGES THAT CONTRACTOR HAS READ THIS CONTRACT,

UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND

CONDITIONS.

VIII. CONTRACTOR DATA and CERTIFICATION; SIGNATURES

Name (exactly as filed with the IRS):

Address:

Telephone/Fax/Email:

Business Designation (check one):

[ ] Corporation [ ] Nonprofit [ ] Professional Corporation [ ] Partnership [ ] Sole Proprietorship [ ] Limited Liability Company [ ] Limited Partnership [ ] Limited Liability Partnership

Federal Tax ID#:

Above payment information must be provided prior to contract approval. This information will be reported to the Internal Revenue Services (IRS) under the name and taxpayer identification submitted. (See IRS W9 for additional instructions regarding taxpayer I.D. numbers.) Information not matching IRS records could subject CONTRACTOR to 28 percent backup withholding.

Failure to return the W9 will require RVCOG to withhold taxes from the payment amount per IRS requirements.

Certification: The individual signing on behalf of CONTRACTOR hereby certifies and swears under penalty of perjury: (a) the number shown on this form is CONTRACTOR’s correct taxpayer identification; (b) CONTRACTOR is not subject to backup withholding because (i) CONTRACTOR is exempt from backup withholding, (ii) CONTRACTOR has not been notified by the IRS that CONTRACTOR is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified CONTRACTOR that CONTRACTOR is no longer subject to backup withholding; (c) s/he is authorized to act on behalf of CONTRACTOR, s/he has authority and knowledge regarding CONTRACTOR’s payment of taxes, and to the best of her/his knowledge, CONTRACTOR is not in violation of any Oregon tax laws as defined in OAR 150-305.385; (d) CONTRACTOR is an independent CONTRACTOR as defined in ORS 670.600; and (e) the above CONTRACTOR data is true and accurate.

CONTRACTOR: YOU WILL NOT BE PAID FOR SERVICES

RENDERED PRIOR TO NECESSARY RVCOG APPROVALS.

IX. SIGNATURES

CONTRACTOR

Signature: ______________________________ Date: ________________

Printed Name: _______________________ Title: ____________________

ROGUE VALLEY COUNCIL OF GOVERNMENTS

Signature: ______________________________ Date: _________________ Ann Marie Alfrey, Executive Director

EXHIBIT A

SCOPE of WORK

The Statement of Work (Work), including the delivery schedule for such Work, is contained herein. CONTRACTOR agrees to, and shall perform the Work in accordance with the terms and conditions in this contract and the following:

1. RFA dated June 19, 2025

2. Application Package dated at time of signature

EXHIBIT B

SPECIAL PROVISIONS

I. Confidentiality of Consumer Information

A. All information as to personal facts and circumstances obtained by the

Contractor on the consumer shall be treated as privileged communications, shall be held confidential, and shall not be divulged without the written consent of the consumer, his or her attorney, the responsible parent of a minor child, or his or her guardian except as required by other terms of this contract. Nothing prohibits the disclosure of information in summaries, statistical, or other form, which does not identify particular individuals.

B. The use or disclosure of information concerning consumers shall be limited to persons directly connected with the administration of this contract. Confidentiality policies shall be applied to all requests from outside sources.

C. RVCOG, Contractor, and any subcontractor will share information as necessary to effectively serve RVCOG consumers.

II. Identification The Contractor agrees to identify RVCOG as a source of funding for the services rendered under this Contract. A statement substantially similar to the following will may be used for this purpose: “Funds for this service are provided by Rogue Valley Council of Governments under Oregon Project Independence.”

EXHIBIT C

STANDARD TERMS & CONDITIONS

I. Governing Law, Consent to Jurisdiction This Contract shall be governed by and construed in accordance with the laws of the State of Oregon without regard to principles of conflicts of law. Any claim, action, suit or proceeding (collectively, “Claim”) between RVCOG and Contractor that arises from or relates to this Contract shall be brought and conducted solely and exclusively within the appropriate Circuit Court for the State of Oregon; provided, however, if a Claim must be brought in a federal forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the District of Oregon. In no event shall this section be construed as a waiver by RVCOG of the jurisdiction of any court or of any form of defense to or immunity from any Claim, whether sovereign immunity, governmental immunity, immunity based on the eleventh amendment to the Constitution of the United States or otherwise. CONTRACTOR, BY EXECUTION OF THIS

CONTRACT, HEREBY CONSENTS TO THE IN PERSONAM JURISDICTION

OF SAID COURTS.

II. Compliance with Law Contractor shall comply with all state and local laws, regulations, executive orders and ordinances applicable to the Contract or to the performance of Work. Without limiting the generality of the foregoing, Contractor expressly agrees to comply with the following laws, regulations and executive orders to the extent they are applicable to the Agreement: (a) all applicable requirements of state civil rights and rehabilitation statutes, rules and regulations; (b) all state laws governing operation of locally administered public health programs, including without limitation, all administrative rules adopted by DHS related to public health programs; (c) all state laws requiring reporting of Agency Consumer abuse; (d) ORS 659A.400 to 659A.409, ORS 659A.145 and all regulations and administrative rules established pursuant to those laws in the construction, remodeling, maintenance and operation of any structures and facilities, and in the conduct of all programs, services and training associated with the delivery of services. These laws, regulations and executive orders are incorporated by reference herein to the extent that they are applicable to the Contract and required by law to be so incorporated. All employers, including Contractor, that employ subject workers who provide services in the State or Oregon shall comply with ORS 656.017 and provide the required Workers’ Compensation coverage, unless such employers are exempt under ORS 656.126.

III. Independent Contractor The parties agree and acknowledge that their relationship is that of independent contracting parties and that Contractor is not an officer, employee, or agent of RVCOG.

IV. Representations and Warranties Contractor represents and warrants to RVCOG that:

A. Contractor has the power and authority to enter into and perform this

Contract, B. This Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, C. Contractor has the skill and knowledge possessed by well-informed members of its industry, trade or profession and Contractor will apply that skill and knowledge with care and diligence to perform the Work in a professional manner and in accordance with standards prevalent in Contractor’s industry, trade or profession, D. Contractor shall, at all times during the term of this Contract, be qualified, professionally competent, and duly licensed to perform the Work, and

E. Contractor prepared its Application related to this Contract independent from all other Applicants, and without collusion, fraud, or other dishonesty.

Warranties cumulative: The warranties set forth in this section are in addition to, and not in lieu of, any other warranties provided.

V. Time is of the Essence Contractor agrees that time is of the essence under this Contract.

VI. Funds Available and Authorized; Payments Contractor shall not be compensated for Work performed under this Contract by any other agency or department of RVCOG, the State of Oregon, or the federal government.

RVCOG certifies that it has sufficient funds currently authorized for expenditure to finance the costs of this Contract within RVCOG’s current biennial appropriation or limitation. Contractor understands and agrees that RVCOG’s payment for Work performed is contingent on RVCOG receiving appropriations, limitations, allotments or other expenditure authority sufficient to allow RVCOG, in the exercise of its reasonable administrative discretion, to continue to make payments under this Contract.

VII. Recovery of Overpayments If billings under this Contract, or under any other contract between Contractor and RVCOG, result in payments to Contractor to which Contractor is not entitled, RVCOG, after giving written notification to Contractor, may withhold from payments due to Contractor such amounts, over such periods of time, as are necessary to recover the amount of the overpayment.

VIII. Indemnity A. General Indemnity. Contractor shall defend, save, hold harmless, and indemnify RVCOG, the State of Oregon and DHS and their officers, employees and agents from and against all claims, suits, actions, losses, damages, liabilities, costs and expenses of any nature whatsoever, including attorneys fees, resulting from, arising out of, or relating to (1) the activities of contractor or its officers, employees, subcontractors, or agents under this contract and (2) the activities of RVCOG or its officers, employees, subcontractors, or agents under this contract.

B. Indemnity for infringement claims. Without limiting the generality of section IX. A. contractor expressly agrees to defend, indemnify, and hold RVCOG, DHS, the State of Oregon and their agencies, subdivisions, officers, directors, agents, and employees harmless from any and all claims, suits, actions, losses, liabilities, costs, expenses, including attorneys fees, and damages arising out of or related to any claims that the Work, the Work product or any other tangible or intangible items delivered to RVCOG by Contractor that may be the subject of protection under any state or federal intellectual property law or doctrine, or RVCOG’s use thereof, infringes any patent, copyright, trade secret, trademark, trade dress, mask, utility design, or other proprietary right of any third party; provided, that RVCOG shall provide contractor with prompt written notice of any infringement claim.

C. Control of defense and settlement. Contractor shall have control of the defense and settlement of any claim that is subject to this sections IX.A.

or IX.B.; however, neither Contractor nor any attorney engaged by Contractor shall defend the claim in the name of RVCOG, nor purport to act as legal representative of RVCOG, without first receiving from RVCOG’s attorney, in a form and manner determined appropriate by RVCOG’s attorney, authority to act as legal counsel for RVCOG, nor shall Contractor settle any claim on behalf of RVCOG without the approval of RVCOG’s attorney. he RVCOG may, at its election and expense, assume its own defense and settlement in the event that RVCOG determines that Contractor is prohibited from defending RVCOG, or is not adequately defending RVCOG’s interests, or that an important governmental principle is at issue and RVCOG desires to assume its own defense.

IX. Agency Default Contractor shall be in default under this Contract upon the occurrence of any of the following events:

A. Contractor fails to perform, observe or discharge any of its covenants, agreements or obligations set forth herein.

B. Any representation, warranty or statement made by Contractor herein or in any documents or reports relied upon by RVCOG to measure the delivery of services, the expenditure of payments or the performance by Contractor is untrue in any material respect when made;

C. Contractor (1) applies for or consents to the appointment of, or taking of possession by, a receiver, custodian, trustee, or liquidator of itself or all of its property, (2) admits in writing its inability, or is generally unable, to pay its debts as they become due, (3) makes a general assignment for the benefit of its creditors, (4) is adjudicated as bankrupt or insolvent,

(5) commences a voluntary case under the Federal Bankruptcy Code (as now or hereafter in effect), (6) files a petition seeking to take advantage of any other law relating to bankruptcy, insolvency, reorganization, winding-up, composition or adjustment of debts, (7) fails to controvert in a timely and appropriate manner, or acquiesces in writing to, any petition filed against it in an involuntary case under the Bankruptcy Code, or (8) takes any action for the purpose of effecting any of the foregoing; or

D. A proceeding or case is commenced, without the application or consent of Contractor, in any court of competent jurisdiction, seeking (1) the liquidation, dissolution or winding-up, or the composition or readjustment of debts, of Contractor, (2) the appointment of a trustee, receiver, custodian, liquidator, or the like of Contractor of all or any substantial part of its assets, or (3) similar relief in respect to Contractor any law relating to bankruptcy, insolvency, reorganization, winding-up, or composition or adjustment of debts, and such preceding or case continues undismissed, or an order, judgment, or decree approving or ordering any of the foregoing is entered and continues unstayed and in effect for a period of sixty consecutive days, or an order for relief against Contactor is entered in an involuntary case under the Federal Bankruptcy Code (as now or hereafter in effect).

X. RVCOG…