RFA# 202603032 - FY 2026 Substance Use Disorder Assistance Program_Final.docx

STATE OF MAINE

Department of Public Safety Commissioner’s Office

RFA# 202603032

FY 2026 Substance Use Disorder Assistance Program

RFA Coordinator

Submitted Questions Due Date

March 26, 2026, no later than 4:00 p.m., local time

TABLE OF CONTENTS

Page

A. PURPOSE AND BACKGROUND

B. GENERAL PROVISIONS

C. ELIGIBILITY TO SUBMIT APPLICATIONS

D. CONTRACT TERM

E. AWARDS

F. APPLICABLE LEGISLATION

A. VENDOR SELF SERVICE SYSTEM (VSS)

B. INFORMATIONAL SESSION

C. QUESTIONS

D. AMENDMENTS

E. APPLICATION SUBMISSION

A. EVALUATION PROCESS – GENERAL INFORMATION

B. SCORING WEIGHTS & PROCESS

C. NEGOTIATIONS

D. SELECTION AND AWARD

E. APPEAL OF CONTRACT AWARDS

A. CONTRACT DOCUMENT

B. STANDARD STATE CONTRACT PROVISIONS

PUBLIC NOTICE

State of Maine Department of Public Safety

The State of Maine is seeking applications for the FY 2026 Substance Use Disorder Assistance Program.

A copy of the RFA and all related documents can be obtained through the Vendor Self Service System (VSS): https://mevss.hostams.com/PRDVSS1X1/AltSelfService

Applications must be submitted to the Office of State Procurement Services, via the Vendor Self Service System (VSS). Application submissions must be received no later than 4:00 p.m., local time, on April 2, 2026. Applications will be opened the following business day.

RFA TERMS/ACRONYMS with DEFINITIONS

The following terms and acronyms, as referenced in the RFA, have the meanings indicated below:

State of Maine Department of Public Safety Commissioner’s Office

PART I INTRODUCTION

A. Purpose and Background

The Department of Public Safety (DPS) is seeking applications from eligible applicants to provide programs designed to assist persons with presumed substance use disorder using liaison strategies both before and after arrest to refer alleged low-level (non-felony) offenders into community-based treatment and support services as defined in this Request for Applications (RFA) document. This document provides instructions for submitting applications, the procedure, and criteria by which the Applicant(s) will be selected and the contractual terms which will govern the relationship between the State of Maine (State) and the awarded applicant(s).

B. General Provisions

1. From the time this RFA is issued until award notification is made, all contact with the State regarding this RFA must be made through the RFA Coordinator identified on the cover page of this RFA. No other person/State employee is empowered to make binding statements regarding this RFA. Violation of this provision may lead to disqualification from the application process, at the State’s discretion.

2. Issuance of the RFA does not commit the Department to issue an award or to pay expenses incurred by an Applicant in the preparation of a response to the RFA. This includes attendance at personal interviews or other meetings, where applicable.

3. All applications must adhere to the instructions and format requirements outlined in the RFA and all written supplements and amendments (such as the Summary of Questions and Answers), issued by the Department. Applications must follow the format and respond to all questions and instructions specified in Part III of the RFA.

4. Applicants will take careful note that in evaluating an application submitted in response to this RFA, the Department will consider materials provided in the application, information obtained through interviews/presentations (if any), and internal Departmental information of previous contract history with the Applicant (if any). The Department also reserves the right to consider other reliable references and publicly available information in evaluating the Applicant’s experience and capabilities.

5. The application must be signed by a person authorized to legally bind the Applicant and must contain a statement that the application and the pricing contained therein will remain valid and binding for a period of 180 days from the date and time of the bid opening.

6. The RFA and the awarded Applicant’s application, including all appendices or attachments, will be the basis for the final contract, as determined by the Department.

7. Following announcement of an award decision, all submissions in response to this RFA will be public records, available for public inspection pursuant to the State of Maine Freedom of Access Act (FOAA) (1 M.R.S. § 401 et seq.). State contracts and information related to contracts, including application submissions, are generally public records per FOAA.

8. In the event that an Applicant believes any information that it submits in response to this RFA is confidential, it must mark that information accordingly, and include citation to legal authority in support of the Applicant’s claim of confidentiality. In the event that the Department receives a FOAA request that includes submissions marked as confidential, the Department shall evaluate the information and any legal authority from the Applicant to determine whether the information is an exception to FOAA’s definition of public record. If the Department determines to release information that an Applicant has marked confidential, it shall provide advance notice to the Applicant to allow for them to seek legal relief.

9. The Department, at its sole discretion, reserves the right to recognize and waive minor informalities and irregularities found in applications received in response to the RFA.

10. If awarded a contract resulting from this RFA, vendors shall be required to disclose, in writing and in accordance with applicable Maine law, any actual or potential conflicts of interest. Such disclosure must include any financial, professional, or personal relationships that could give rise to a conflict of interest or the appearance of a conflict of interest. Failure to disclose a known conflict or appearance of conflict may result in disqualification, contract termination, or other remedies as provided by law.

11. All applicable laws, whether or not herein contained, shall be included by this reference. It shall be the Applicant’s responsibility to determine the applicability and requirements of any such laws and to abide by them.

C. Eligibility to Submit Applications

Applicants must not have outstanding debt or delinquent reports due to DPS for SUD to be eligible for award under this RFA.

All municipal governments, county governments, federally recognized Indian tribal governments or regional jails are invited to submit bids in response to this RFA. Private and non-profit agencies are not eligible to apply for Substance Use Disorder Assistance Program funds.

These projects must be designed to facilitate pathways to evidence-based, community-based treatment, medically assisted treatment, and/or recovery and support services.

D. Contract Term

The term of anticipated contract period resulting from this RFA is defined in the table below. The dates below are estimated and may be adjusted, as necessary, in order to comply with all procedural requirements associated with the RFA, the specific project awarded, and the contracting process. The actual contract start date will be established by a completed and approved contract.

E. Awards

DPS anticipates making multiple awards as a result of this RFA process. There is $500,000.00 available in funding.

The Department may award all, part, none, or modify this allocation at its discretion.

The Department reserves the right to make partial awards, eliminate the lowest scoring application(s) and/or make awards for amounts less than requested, whichever is in the best interest of the State.

F. Applicable Legislation

These projects are funded under Title 25, Part 13, Chapter 601, §5101 Substance Use Disorder Assistance Program

PART II ACTIVITIES AND REQUIREMENTS

A. Required Activities

1) Municipal or county governments or regional jails for programs designed to assist persons with presumed substance use disorder by using liaison strategies both before and after arrest to refer alleged low-level offenders into community-based treatment and support services. Programs may include, but are not limited to:

a) Referral of participants in the Substance Use Disorder Assistance Program to evidence-based treatment programs, including medically assisted treatment; and

b) Provision of case management services to participants in order to secure appropriate treatment and support services such as housing, health care, job training, and mental health services.

2) County governments for programs in the county jails designed to facilitate the accessing of persons with presumed substance use disorder of post-adjudication diversion and reentry programs. Programs may include, but are not limited to:

a) Provision of evidence-based treatment programs, including medically assisted treatment, to jail inmates; and

b) Provision of case management or other support services to participants to assist in the transition from jail upon release.

3) Municipal governments for programs designed to facilitate pathways to community-based treatment, recovery, and support services for persons with substance use disorder who present themselves to municipal law enforcement agencies and request assistance and referral to evidence-based treatment programs, including medically assisted treatment.

B. Allowable Use of Funds Allowable uses of funds can include, but are not limited to, the following:

1. Licensed Addiction Counselor

2. Treatment therapist, family therapy

3. Case management services

4. Medically assisted treatment

5. Health care

6. Job training Allowable costs are those cost principles identified in the State Administrative and Accounting Manual, authorizing legislation, and the Substance Use Disorder Assistance Program grant requirements and solicitation. In addition, costs must be reasonable, allocable, necessary to the project, and comply with the funding statute requirements. Any questions about allowable use of funds should be directed to DPS prior to application submission using the process described in Part III, Sections A and B.

Contracts & Consultants

When a funded applicant engages in contracts for work or services, the following is required:

• All consultant and contractual services shall include written contracts stating the services to be performed, rate of compensation, and length of time over which the services will be provided. This shall not exceed the length of the grant contract period.

• A copy of all written contracts shall be provided to DPS upon their ratification.

• Payments shall be supported by invoices outlining the services rendered and supporting the period covered.

• Any consultant costs shall be fair and reasonable.

C. Non-Allowable Use of Funds

1. Funds shall not be used for land acquisition or construction projects.

2. No arrangement shall be made by the funded applicant with any other party for furnishing any services herein contracted for without prior review and approval of the contracting agreement by the Grant Administrator.

3. No grant funds may be spent for office furniture or other like purchases, e.g., copiers, air conditioners, heat lamps, fans, file cabinets, desks, chairs, and rugs.

4. Substance Use Disorder Assistance Program funds shall not be used for lobbying purposes such as but not limited to:

a. Attempting to influence the outcome of any Federal, State, or local election, referendum, initiative, or similar procedure, through in -kind or cash contributions, endorsements, publicity, or similar activity;

b. Establishing, administering, contributing to, or paying for the expenses of a political party, campaign, political action committee, or other organization established for the purpose of influencing the outcome of elections;

c. All funded applicants must understand that no appropriated funding made available under the grant program may be used, either directly or indirectly, to support the enactment, repeal, modification, or adoption of any law, regulation, or policy, at any level of government, without the express approval of DPS.

D. Reporting Requirements Performance Measures

DPS is required to collect and submit data documenting the outcome or impact of the grant-funded activities for all funded applicants. To aid DPS in meeting this requirement all applicants who receive funding under this solicitation must provide data that measures the effectiveness and results of their work. Progress reporting will take place no later than 15 days after the end of each quarter using the form to be provided at contract award.

Progress Reports serve as the basis for the annual reporting performance to the Maine Legislature and must include performance information on implementation, activity, goals/objectives, and data metrics specific to your program. The Annual Report must be provided on the anniversary date of the grant award regarding the status of the program for which the grant was awarded. The report must include a description of how the grant funds were spent, the results of the program, and any recommendations for modification of the program, including any available information concerning the program’s effectiveness in reducing substance use disorder and recidivism. It is imperative that applicants review the data required prior to submitting their application.

The scope of your project will determine which performance measures will be required – an example is provided below.

Number Data Grantees Provide

A. Total number of participants currently enrolled in the program B. Number of new participants admitted to the program

Percentage of participants successfully completing the program.

A. Total number of participants successfully completing the program B. The total number of participants who do not complete the program.

Percentage of aftercare participants charged with drug or non-drug offenses(s)

A. Number of aftercare participants B. Number of aftercare participants charged with drug offenses(s) C. Number of aftercare participants charged with non-drug offense(s)

Average treatment cost per participant

A. Total grant-funded expenditures this reporting period B. Total number of participants currently enrolled

PART III KEY PROCESS EVENTS

A. Vendor Self Service System (VSS)

1. The Office of State Procurement Services Vendor Self Service System website is found at the link below: https://www.maine.gov/dafs/bbm/procurementservices/vendors/vendor-self-service-system

2. A copy of the RFA and all associated documents will be published in VSS.

3. Only documents published in VSS will be considered binding.

4. Any interested party may view open solicitations in VSS using the Public Access feature.

5. Vendors must have an active User ID and password in VSS to submit questions and respond to solicitations, including this RFA.

a. Vendor registration instructions and User Guide may be found at the link above, which include steps for searching for an existing account/User ID, or registering for a new account/User ID.

b. Vendors interested in responding to a solicitation are encouraged to obtain a User ID and password for VSS as soon as possible.

6. Vendors must have an active Vendor Code (VC or VS) to contract with the department.

B. Questions

1. General Instructions: It is the responsibility of all Applicants and other interested parties to examine the entire RFA and to seek clarification, in writing, if they do not understand any information or instructions.

a. Questions must be submitted in VSS as soon as possible but no later than the date and time published in VSS.

b. Questions should be clearly stated and reference the applicable section and/or page number of the RFA.

c. The Department assumes no liability for assuring accurate/complete/on time transmission and receipt.

2. Question & Answer Summary: Responses to all questions will be compiled in writing and published in VSS no later than seven (7) calendar days prior to the Application Submission Deadline. It is the responsibility of all interested parties to go to VSS to obtain a copy of the Question & Answer Summary. Only those answers issued in writing in VSS will be considered binding.

C. Amendments

All amendments released in regard to the RFA will be published in VSS. It is the responsibility of all interested parties to go to VSS to obtain amendments. Only those amendments published in VSS are considered binding.

D. Application Submission

1. Applications Due

a. Application submissions must be received no later than the Application Submission Deadline (closing date) published in VSS.

b. Any application submissions or any additional or revised application files received after the Application Submission Deadline will be rejected without exception.

2. Delivery Instructions

a. Application submissions must be submitted to the Office of State Procurement Services via VSS.

b. Only application submissions received via VSS will be considered. The Department assumes no liability for assuring accurate/complete receipt.

c. Submissions containing links to file sharing sites or online file repositories will not be accepted as submissions. Only application submissions that have the actual requested files attached will be accepted.

d. Encrypted submissions received which require opening attachments and logging into a proprietary system will not be accepted. Applicants should work with their Information Technology team to ensure that the application submission will not be encrypted due to any security settings.

e. File size limits are 15MB per file. Applicants may separate their submissions into multiple files, as necessary, due to file size concerns.

3. Submission Format

a. Applicants must submit at least one (1) file, labeled and including the required information as defined below:

File Name: RFA# 202603032 Application Submission – [Applicant’s Name]

· Must contain: Applicant’s completed Application Form and all required information and attachments as stated in the form.

b. The Application Form must be submitted as a single, typed file. If including attachments in the same file presents a file size issue, Applicants may submit those attachments as a separate, clearly labeled file.

c. Applicants must include any forms provided in the RFA (such as the Application Form) or reproduce those forms as closely as possible.

d. Applicants are not to provide additional attachments beyond those specified in the RFA or Application Form for the purpose of extending their response. Materials not requested will not be considered part of the application and will not be evaluated.

PART IV APPLICATION EVALUATION AND SELECTION

A. Evaluation Process – General Information

1. An evaluation team, composed of qualified reviewers, will judge the merits of the applications received in accordance with the criteria defined in the RFA.

2. Officials responsible for making decisions on the award selection will ensure that the selection process accords equal opportunity and appropriate consideration to all who are capable of meeting the specifications. The goals of the evaluation process are to ensure fairness and objectivity in review of the applications and to ensure that all contracts are awarded to the Applicants that provide the best value to the State of Maine.

3. The Department reserves the right to communicate and/or schedule interviews/presentations with Applicants, if needed, to obtain clarification of information contained in the applications received. The Department may revise the scores assigned in the initial evaluation to reflect those communications and/or interviews/presentations.

4. Changes to applications, including updating or adding information, will not be permitted during any interview/presentation process and, therefore, Applicants must submit applications that present their rates and other requested information as clearly and completely as possible.

5. Failure to respond to all questions and instructions throughout the RFA may result in the application being disqualified as non-responsive or receiving a reduced score. The Department, and its evaluation team, has sole discretion to determine whether a variance from the RFA specifications will result either in disqualification or reduction in scoring of an application.

B. Scoring Weights & Process

1. Scoring Weights: The score will be based on a 100-point scale and will measure the degree to which each application meets the following criteria. The information required in each section of the Application Form aligns with the Scoring Criteria defined below.

Past project performance may affect the rating and ranking of an application. Factors that may be included in the past performance review may include the following:

· Applicant compliance with programmatic and financial reporting requirements

· Applicant adherence to special conditions in prior awards

2. Scoring Process: For applications that demonstrate meeting the eligibility requirements defined in Part I, if applicable, the evaluation team will use a consensus approach to evaluate and score all sections listed above. Members of the evaluation team will not score those sections individually but, instead, will arrive at a consensus as to assignment of points for each of those sections.

C. Negotiations

1. The Department reserves the right to negotiate with the awarded Applicant(s) to finalize a contract.

2. The Department reserves the right to terminate contract negotiations with an awarded Applicant who submits a proposed contract significantly different from the application they submitted in response to the advertised RFA.

3. In the event that an acceptable contract cannot be negotiated with an Applicant, the Department may withdraw its award and negotiate with the next-highest ranked Applicant, and so on, until an acceptable contract has been finalized. Alternatively, the Department may cancel the RFA, at its sole discretion.

D. Selection and Award

1. The final decision regarding the award of the contract will be made by representatives of the Department subject to approval by the State Procurement Review Committee.

2. Notification of conditional award selection or non-selection will be made in writing by the Department.

3. Issuance of the RFA in no way constitutes a commitment by the State of Maine to award a contract, to pay costs incurred in the preparation of a response to the RFA, or to pay costs incurred in procuring or contracting for services, supplies, physical space, personnel or any other costs incurred by an Applicant.

4. The Department reserves the right to reject any and all applications or to make multiple awards.

E. Appeal of Contract Awards

Any person aggrieved by the award decision that results from the RFA may appeal the decision to the Director of the Bureau of General Services in the manner prescribed in 5 M.R.S.A. § 1825-E and 18-554 Code of Maine Rules Chapter 120. The appeal must be in writing and filed with the Director of the Bureau of General Services, 9 State House Station, Augusta, Maine, 04333-0009 within fifteen (15) calendar days of receipt of notification of conditional contract award.

PART V CONTRACT ADMINISTRATION AND CONDITIONS

A. Contract Document

1. The awarded Applicant will be required to execute a State of Maine Service Contract with appropriate riders as determined by the issuing department.

All exceptions will be negotiated between the awarded Applicant(s) and the State. The State will not accept any proposed exceptions as part of this RFA process. The State is not obligated to accept, negotiate, or compromise of any proposed exceptions.

The complete set of standard State of Maine Service Contract documents, along with other forms and contract documents commonly used by the State, may be found on the Office of State Procurement Services’ website at the following link: Office of State Procurement Services Forms Page

2. Allocation of funds is final upon successful negotiation and execution of the contract, subject to the review and approval of the State Procurement Review Committee. Contracts are not considered fully executed and valid until approved by the State Procurement Review Committee and funds are encumbered. No contract will be approved based on an RFA which has an effective date less than fourteen (14) calendar days after award notification to Applicants. (Referenced in the regulations of the Department of Administrative and Financial Services, Chapter 110, § 3(B)(i).)

This provision means that a contract cannot be effective until at least fourteen (14) calendar days after award notification.

3. The State recognizes that the actual contract effective date depends upon completion of the RFA process, date of formal award notification, length of contract negotiation, and preparation and approval by the State Procurement Review Committee. Any appeals to the Department’s award decision(s) may further postpone the actual contract effective date, depending upon the outcome. The contract effective date listed in the RFA may need to be adjusted, if necessary, to comply with mandated requirements.

4. In providing services and performing under the contract, the awarded Applicant must act as an independent contractor and not as an agent of the State of Maine.

B. Standard State Contract Provisions

1. Contract Administration Following the award, a Contract Administrator from the Department will be appointed to assist with the development and administration of the contract and to act as administrator during the entire contract period. Department staff will be available after the award to consult with the awarded Applicant in the finalization of the contract.

State of Maine RFA# 202603032 1 Rev. 11/10/2025 – DAFS/Office of State Procurement Services

PART VI APPLICATION FORM

As defined in Part III, D, 3 of the RFA, Applicants must complete the Application Form embedded below and produce all required attachments.

The Application Form may be obtained in a Word (.docx) format by double clicking on the document icon below.

Viewing this RFA in a web browser will likely not allow for opening of the embedded document. Download the RFA and view it in the desktop application to access the embedded Application Form below.

image1.jpeg image2.emf

RFA APPLICATION FORM.docx State of Maine - Department of Public Safety

Substance Use Disorder Assistance Program

APPLICATION COVER PAGE

Applicant’s Organization Name:

Chief Executive - Name/Title:

Project Director’s Name/Title:

Tel:

E-mail:

Headquarters Street Address:

Headquarters City/State/Zip:

(Provide information requested below if different from above)

Lead Point of Contact for Application - Name/Title:

Tel:

E-mail:

Street Address:

City/State/Zip:

Federal Tax ID#:

State of Maine Vendor#:

UEI # / Expiration Date:

Project Title:

Project Allocation Category:

Project Period – From:

To:

Congressional District Served:

Population of Project Area:

Federal Proposed Cost:

Proposed Match:

Required by Federal Funding Accountability and Transparency Act (FFATA or Transparency Act P.L. 109-282:

Does the Applicant meet all three criteria below?

1.

Received 80% or more of the Subgrant Recipient’s annual gross revenues in Federal awards in the preceding fiscal year.

YES ☐ NO ☐

2.

Received $25 million or more in annual gross revenues from Federal awards in the preceding fiscal year.

YES ☐ NO ☐

3.

The public does not have access to the information about the compensation of the senior executives of the Subgrant Recipient.

(PLEASE NOTE: The public has access to State and local government agency records (e.g. salary information), as well as information about State and local law enforcement agencies. Therefore, these entities don’t meet Requirement #3 and do not have to report requested information)

YES ☐ NO ☐

If the Subgrant Recipient (Applicant) answers YES to all three criteria above, fill in the following information for the five most highly compensated officers of the Applicant’s organization:

Name

Total Compensation

Officer 1

Officer 2

Officer 3

Officer 4

Officer 5

· This Application and the pricing structure contained herein will remain firm for a period of 180 days from the date and time of the bid opening.

· No personnel currently employed by the Department or any other State agency participated, either directly or indirectly, in any activities relating to the preparation of the Applicant’s Application.

· No attempt has been made, or will be made, by the Applicant to induce any other person or firm to submit or not to submit an Application.

· The above-named organization is the legal entity entering into the resulting contract with the Department should they be awarded the contract.

· The undersigned is authorized to enter contractual obligations on behalf of the above-named organization.

To the best of my knowledge, all information provided in the enclosed application, both programmatic and financial, is complete and accurate at the time of submission.

Name (Print):

Title:

Authorized Signature:

Date:

RESPONSBILE APPLICANT CERTIFICATION

Applicant’s Organization Name:

By signing this document, I certify to the best of my knowledge and belief that the aforementioned organization, its principals and any subcontractors named in this proposal:

a. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from bidding or working on contracts issued by any governmental agency.

b. Have not within three years of submitting the proposal for this contract been convicted of or had a civil judgment rendered against them for:

i. Fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state, or local government transaction or contract.

ii. Violating Federal or State antitrust statutes or committing embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property.

c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or Local) with commission of any of the offenses enumerated in paragraph (b) of this certification.

d. Have not within a three (3) year period preceding this proposal had one or more federal, state, or local government transactions terminated for cause or default.

e. Have not entered into a prior understanding, agreement, or connection with any corporation, firm, or person submitting a response for the same materials, supplies, equipment, or services and this proposal is in all respects fair and without collusion or fraud. The above-mentioned entities understand and agree that collusive bidding is a violation of state and federal law and can result in fines, prison sentences, and civil damage awards.

f. Is not a foreign adversary business entity (https://www.maine.gov/oit/prohibited-technologies).

g. Is not on the list of prohibited companies (https://www.maine.gov/oit/prohibited-technologies) or does not obtain or purchase any information or communications technology or services included on the list of prohibited information and communications technology and services https://www.maine.gov/oit/prohibited-technologies (Title 5 §2030-B).

Name (Print):

Title:

Authorized Signature:

Date:

Eligibility

Applicants must provide documentation to demonstrate meeting the eligibility requirements stated in Part I of the RFA.

Does the Applicant have any outstanding debt or delinquent reports due to DPS for SUD Grant?

☐ YES ☐ NO

If yes, please explain: _________________________

Does Applicant’s Organization fall within guidelines outlined in Part I of the RFA.

☐ YES ☐ NO

Organization Qualifications and Experience

Applicants must describe their qualifications and skills to provide the requested services in the RFA. Applicants must include three (3) examples of projects which demonstrate their experience and expertise in performing these services as well as highlighting the Applicant’s stated qualifications and skills.

Project 1

Client Name:

Client Contact Person:

Telephone:

E-Mail:

Brief Description of Project

Project 2

Client Name:

Client Contact Person:

Telephone:

E-Mail:

Brief Description of Project

Project 3

Client Name:

Client Contact Person:

Telephone:

E-Mail:

Brief Description of Project

Subcontractors

If subcontractors are to be engaged, Applicants must describe the application and review process the Applicant will use to evaluate the qualifications and experience of potential subcontractors, and how the Applicant will ensure that debarred, suspended, or otherwise ineligible parties are excluded from all subcontract relationships.

Subcontractor 1

Subcontractor Name:

Contact Person:

Telephone:

E-Mail:

Brief Description of Anticipated Role and Qualifications

Subcontractor 2

Subcontractor Name:

Contact Person:

Telephone:

E-Mail:

Brief Description of Anticipated Role and Qualifications

Subcontractor 3

Subcontractor Name:

Contact Person:

Telephone:

E-Mail:

Brief Description of Anticipated Role and Qualifications

Organizational Chart

Applicants must provide an organizational chart. The organizational chart must include the project being proposed. Each position must be identified by position title and corresponding to the personnel job descriptions.

The organizational chart may be included below or may be attached to the application separately and appropriately labeled.

Litigation

Applicants must include a list of all current litigation in which the Applicant is named and a list of all closed cases that have closed within the past five (5) years in which the Applicant paid the claimant either as part of a settlement or by decree. For each, list the entity bringing suit, the complaint, the accusation, amount, and outcome.

Certificate of Insurance

Bidders must provide a certificate of insurance on a standard ACORD form (or the equivalent) evidencing the bidder’s general liability, professional liability and any other relevant liability insurance policies that might be associated with the proposed services.

The Certificate of Insurance may be included below or may be attached to the application separately and appropriately labeled.

Proposed Project

Funds received through this grant will be used to supplement, not supplant, funds allocated for the program.

YES ☐ NO ☐

Is this proposal a continuation of a previously funded grant program?

YES ☐ NO ☐

If “yes”, please provide a summary of how the prior grant funding was used and incorporate program information outlining the population served, successes of the project work, and the project’s effectiveness at meeting the stated goals or if applicable, any barriers the project may have encountered.

Describe the need that will be addressed by the proposed project.

Provide evidence of the problem to be addressed through qualitative or quantitative data, or anecdotal evidence.

Describe the project objectives that are designed to help the Applicant meet the project’s stated goals.

Describe the project activities that are designed to meet the project’s stated objectives.

Provide a detailed project timeline.

Discuss the Applicant’s plan for evaluating the success of the project and performance measurement reporting to DPS.

Describe the overall capacity of the Applicant’s organization to carry out the proposed activities.

Describe the Applicant’s consultation efforts and resulting partnerships with local agencies.

Budget

Budget Category

Amount Requested From State

Explanation of expense

Personnel (salary and benefits)

Travel

Equipment (Items over $5,000/each)

Contracted services

Other (specify)

Other (specify)

TOTAL REQUEST

Budget Narrative

In the space below, provide a detailed explanation of your anticipated grant-supported expenses in each of the above budget categories.

Cost Proposal Form Continued

Budget Worksheet #1

Personnel Services

List each position by title and name of the employee, if available. Show the annual salary rate and the percentage of time to be devoted to the project. Compensation paid for employees engaged in grant activities must be consistent with that paid for similar work within the applicant organization. In the budget narrative, including a description of the responsibilities and duties of each position with the fulfillment of the project goals and objectives. All requested information must be included in the budget detail worksheet and budget narrative.

Position Title

Annual Salary

Fringe Benefits

(list)

% of Time on Project

State Funds

Match

TOTAL

TOTALS

Column 2: Record the total annual salary for the position named in column 1.

Column 3: If fringe benefits are expressed as a percentage of salary, list elements to allow evaluation

Column 4: The percentage of time expected to be spent on the project and paid for from grant and/or matching funds

Column 7: Column 2 + Column 3, multiplied by Column 4

Cost Proposal Form Continued

Budget Worksheet #2

Travel Expenses

Itemize travel expenses of staff personnel (e.g. staff to training, field interviews, advisory group meeting, etc.). Describe the purpose of each travel expenditure with the project objectives. Show the basis of computation (e.g., six people to 3‐day training at $X airfare, $X lodging, $X subsistence). In training projects, travel and meals for trainees should be listed separately. Show the number of trainees and the unit costs involved. Identify the location of travel, if known; or if unknown, indicate "location to be determined."

Item

State Funds

Match

TOTAL

TOTALS

Travel reimbursement must be consistent with the state travel policy and state rates are to be used for calculating mileage (.50 per mile), per diem, and lodging. List each item separately and BE SPECIFIC (for example, mileage and meals should be listed separately). For rate information see Section B7.

Cost Proposal Form Continued

Budget Worksheet #3

Equipment

List non‐expendable items that are to be purchased that exceed $5000.00 per item. In the budget narrative, explain how the equipment is necessary for the success of the project, and describe the procurement method to be used.

Item

Quantity

Unit Cost

State Funds

Match

TOTAL

TOTALS

Any item with a unit cost of less than $5000 must be listed with Other (supplies and operating expenses). To be considered for funding, equipment must be necessary for a project. Sole source procurement must be justified and will require prior approval.

Cost Proposal Form Continued

Budget Worksheet #4

Consultant and Contractual Expenses

Item or Service

State Funds

Match

Total

TOTALS

ALL CONTRACTS MUST BE COMPETITIVELY BID. Sole source procurements will be approved only when very specific circumstances exist. Contracts and/or consultant costs must be identified separately and detailed in the narrative. The consultant costs more than $650 per day will require justification and prior approval. Travel costs for the consultant(s) would be included in travel Budget Worksheet #2.

Cost Proposal Form Continued

Budget Worksheet # 5

Other (Supplies and Operating Expenses)

List items (e.g., rent, reproduction, telephone, janitorial or security services, and investigative or confidential funds) by type and the basis of the computation. For example, provide the square footage and the cost per square foot for rent, or provide a monthly rental cost and how many months to rent. This category includes miscellaneous accessories and material where the single cost of an item is $5000.00 or less. All requested information must be included in the budget detail worksheet and budget narrative

Item

State Funds

Match

TOTAL

TOTALS

List each item separately and BE SPECIFIC.

Justification for expenditures and further explanation should be provided in the budget narrative. For example, if the amount listed for postage or printing includes a large project, those amounts should be listed separately in the narrative.