ITN_10848_Attachment R.docx
DOCX document 39 KB Posted
- Attached to
- CINS/FINS & Statewide Respite Care Services
- Solicitation number
- ITN-09961
- Issued by
- Leon County, Florida
About this file
This document is an Invitation to Negotiate (ITN) issued by the Florida Department of Juvenile Justice (DJJ) to select a Respondent to provide Children In Need of Services/Families In Need of Services (CINS/FINS), Statewide Respite Care Services, and evidence-based or promising practices delinquency programming within Florida's 20 judicial circuits. The Department seeks proposals from community, faith-based, not-for-profit organizations, LLCs, and/or divisions of local government to design, create, develop, implement, manage, and ensure coordination of local delivery of residential and non-residential statewide services for CINS/FINS youth and families, as well as provide statewide support services, data collection and reporting, management, and enforcement of the specified services.
The Department is seeking a lead agency that will subcontract for and provide management and administrative oversight of a statewide network of community-based respite care service providers to ensure access to respite care and related services for youth between the ages of ten up to 18 years of age, who have been charged with an offense of domestic violence, are on probation and referred by the Department, or are in need of respite services and have been issued a pre-delinquency citation.
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Text version
ITN #10848
ATTACHMENT R
CERTIFICATION OF EXPERIENCE
THIS FORM SHALL BE COMPLETED BY THE RESPONDENT AND SIGNED BY A PERSON AUTHORIZED TO MAKE STATEMENTS ON BEHALF OF THE RESPONDENT. RETURN OF THE COMPLETED AND SIGNED FORM IS A MANDATORY REQUIREMENT.
COMPANY NAME:
DATE ESTBLISHED:
PRIMARY BUSINESS:
TOTAL NUMBER OF EMPLOYEES:
NUMBER OF EMPLOYEES ENGAGED IN ACTIVITIES RELEVANT TO THIS ITN: (NOT INCLUDING LOCAL SERVICE PROVIDERS)
NUMBER OF YEARS OF PROVIDER EXPERIENCE IN SERVICES RELEVANT TO THE PROVISION OF MANAGEMENT AND OVERSIGHT OF PROGRAMS SERVING VULNERABLE YOUTH POPULATIONS:
LIST ENTITIES FOR WHOM THE COMPANY HAS PROVIDED SERVICES WITHIN THE LAST FIVE YEARS, THE DATES OF THE PERFORMANCE (RESPONDENT MUST DEMONSTRATE THREE YEARS EXPERIENCE WITHIN THE LAST FIVE YEARS), THE BUSINESS NAME AND CONTRACT MANAGER’S NAME, PHONE NUMBER AND EMAIL ADDRESS:
I, , CERTIFY THAT THE RESPONDENT KNOWN AS HAS AT LEAST YEARS EXPERIENCE WITHIN THE LAST FIVE YEARS RELEVANT TO THE PROVISION OF SERVICES SPECIFIED IN THE ATTACHMENT A (SERVICES SOUGHT) AND ATTACHMENT A-1 (STATEWIDE RESPITE CARE SERVICES).
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Title
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