RFP_1239_Attachment_1_Cover_Page_and_Page_Numbers.docx

ATTACHMENT 1: Cover Page & Page Number Form

RFP COVER PAGE RFP# 1239 – CalWORKs Learning Needs Assessment

NAME OF ORGANIZATION:

ADDRESS, CITY, ZIP:

DIRECTOR:

CELL PHONE:

EMAIL:

Are you a current certified vendor?

If so, list your Supplier ID.

If not, you are required to become a certified vendor with the City and County of San Francisco within ten (10) days of notice of award.

FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN):

I certify to the best of my knowledge and belief that the information provided herein is true, complete, and accurate. I am aware that the provision of false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative consequences including, but not limited to, violations of U.S. Code Title 18, Sections 2, 1001, 1343 and Title 31, Sections 3729–3730 and 3801–3812. Additionally, I understand that the San Francisco Human Services Agency (SFHSA) reserves the right to modify the specifics of this application at the time of funding and/or during the grant negotiation; that a grant may be negotiated for a portion of the amount requested; and that there is no grant until a written grant has been signed by both parties and approved by all applicable City Agencies. Submission of a proposal signifies that the proposed services and prices are valid for 180 calendar days from the proposal due date and that the quoted prices are genuine and not the result of collusion or any other anti-competitive activity. I understand that I will comply with the City contracting requirements set forth in Section VIII of this RFP.

Signature of authorized representative(s):

Name:

Title:

Signature:

Date:

Name:

Title:

Signature:

Date:

PAGE NUMBER FORM

This form is to assist the review panel in finding the information in the Proposal that corresponds to the evaluation criteria. For each item listed below, please list the page number(s) where the reviewer may find the answer(s) to the criteria.

Evaluation and Selection Criteria

Minimum Qualifications

Organizational Capacity (40 points) Page Number(s)

Learning Needs Assessments to the target population? Did proposer describe demonstrated use of recognized and validated learning disabilities tools? Did proposer include name and description of the validated tools that are used? Were recently completed projects listed, detailing quality, requirements, timelines, and/or success?? (15 points)

staffed? Did proposer identify whether services will be performed by existing or proposed staff? Are job descriptions/resumes for all key positions attached and do they clearly identify which staff positions they occupy? Do job descriptions include the appropriate experience/qualifications/skills for the project, a realistic description of tasks to be performed, and a reasonable workload/work schedule? Do the job descriptions include the required acceptable licenses for California – Licensed Education Psychologist (LEP), Licensed Psychologist (Clinical or School), and/or Credentialed School Psychologist? Were relevant staff training plans clearly described to ensure service and outcome objectives are being achieved? Did they provide written assurance that key individuals listed/identified will be performing the work and will not be substituted with other personnel or reassigned to another project without the City’s approval? (10 points)

activities will ensure that it provides equitable access to program participants? Do they address the cultural and linguistic competencies related to working with the identified Target Population and the envisioned program design? Do they describe how the organization intends to meet the cultural needs of the target population? (5 points)

Program Approach (35 points)

Fiscal Capacity (25 points)

Submit an electronic copy to Colleen.Birmingham@sfgov.org and HSARFP@sfgov.org