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 Attachment R Certification of Experience Form for Invitation to Negotiate (ITN) #10848 issued by the Florida Department of Juvenile Justice (DJJ). The ITN is seeking proposals from respondents 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 respondent must demonstrate at least 3 years of experience within the last 5 years providing services to vulnerable youth populations. The ITN requires respondents to list the entities for whom they have provided relevant services, along with the dates of performance, business names, and contact information for the contract managers.
The ITN is for a lead agency that will subcontract and provide management and 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 10 and 18 years old. The respondent must design, create, develop, implement, manage, and ensure coordination of the local delivery of both residential and non-residential statewide CINS/FINS services, as well as provide innovations in evidence-based or promising practices in delinquency prevention programming.
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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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