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 the Certification of Experience form for Florida Department of Juvenile Justice Solicitation #10848 for Children In Need of Services/Families In Need of Services (CINS/FINS), Statewide Respite Care Services, and evidence-based or promising practices delinquency programming. The Department seeks proposals from community, faith-based, not-for-profit organizations, LLCs, and/or divisions of local government to provide residential and non-residential statewide services for CINS/FINS youth and families, as well as manage a statewide network of respite care service providers. The CINS/FINS services are for youth between 10-18 years of age, while the Statewide Respite Care Services are for youth between 10-18 years of age who have been charged with domestic violence, on probation, or in need of respite services.
The Certification of Experience form requires the respondent to provide information about their company, including the date established, primary business, total number of employees, number of employees engaged in relevant activities, and years of provider experience in services for vulnerable youth populations. The respondent must demonstrate at least 3 years of relevant experience within the last 5 years and provide a list of entities for whom they have provided services.
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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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