RFP_948-0605-24_Attachment_A_-_Proposal_Form_(Fillable_Form).pdf

RFP NO: 952-0605-24

SUBMISSION DATE: JULY 7, 2023 5:00 PM PDT

ATTACHMENT A

COUNTY OF SOLANO

HEALTH AND SOCIAL SERVICES

PUBLIC HEALTH DIVISION

REQUEST FOR PROPOSALS (RFP) NO. 948-0605-24

SOLANO PUBLIC HEALTH COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP)

IMPLEMENTATION

PROPOSAL FORM

COUNTY OF SOLANO

Health & Social Services Department, Public Health division

ISSUE DATE June 5, 2023

REQUEST FOR

PROPOSALS #948-0605-24

RFP

Coordinator: Nes Despabiladeras Submit your Proposal to:

OpenGov Procurement Platform Solano County Portal website at https://procurement.opengov.com/portal/solanocounty

Proposals must be received no later than

July 7, 2023, 5 PM PST

Late Proposals will not be accepted.

E-mail Address: nadespabiladeras@solanocounty.com

Proposal Instructions: Proposers must fully complete this Proposal form (Attachment A), responding to every question, and attach all necessary requested documents. Proposers must fill in desired check boxes and adhere to page limits where indicated.

https://procurement.opengov.com/portal/solanocounty

Solano Community Health Improvement Plan Request for Proposal

RFP #948-0605-24

Proposer Organization:

Proposer Contact Name & Phone Number:

Proposer Address/City/State/Zip:

Form of Business:

For-profit Non-profit Government Agency Other:

The undersigned acknowledges that the County’s Standard Contract (Attachment C) has been reviewed and that, if awarded, all contract terms and conditions are accepted.

YES NO

If NO, Qualifications to Funding Agreement (add additional pages as needed):

The undersigned certifies and makes assurance of the Proposer’s compliance with:

• All requirements, terms, and conditions of RFP#2024-001;

• The laws of the County of Solano http://www.solanocounty.com/countycode.asp;

• Title VI of the federal Civil Rights Act of 1964 https://www.justice.gov/crt/fcs/TitleVI

• Title IX of the federal Education Amendments Act of 1972 https://www.justice.gov/crt/title-ix-education-amendments-1972

• The Equal Employment Opportunity Act and the regulations issued thereunder by the federal government https://www.eeoc.gov/federal-sector/statutes-and-regulations

• The Americans with Disabilities Act of 1990 and the regulations issued thereunder by the federal government https://www.ada.gov/law-and-regs/ada/

• All contract employees performing services and/or work as a result of this solicitation must have documented legal authority to work in the United States of America;

• The condition that the submitted proposal was independently arrived at, without collusion, under penalty of perjury; and

• The condition that no amount shall be paid directly or indirectly to an employee or official of The

Department of Health and Social Services Public Health Division as wages, compensation, or gifts in exchange for acting as an officer, agent, employee, subcontractor, or consultant to the Proposer in connection with the Procurement under this RFP.

YES NO A NO response shall disqualify this Proposal.

http://www.solanocounty.com/countycode.asp https://www.justice.gov/crt/fcs/TitleVI https://www.justice.gov/crt/title-ix-education-amendments-1972 https://www.justice.gov/crt/title-ix-education-amendments-1972 https://www.eeoc.gov/federal-sector/statutes-and-regulations https://www.ada.gov/law-and-regs/ada/

SECTION 1: PROPOSER INFORMATION

A. PERSON RESPONSIBLE FOR PREPARATION OF PROPOSAL

NAME TITLE

ADDRESS FLOOR SUITE ROOM

CITY STATE ZIP CODE

PHONE NUMBER FACSIMILE NUMBER CELL PHONE NUMBER (OPTIONAL)

E-MAIL ADDRESS

B. SIGNATORY ON PAGE 1 (if different than 1.A. above)

NAME TITLE

ADDRESS FLOOR SUITE ROOM

FAILURE TO SIGN THIS SECTION MAY DISQUALIFY YOUR RESPONSE

ORGANIZATION

SIGNATURE DATED FED EMPLOYER ID NO.

If signature is other than “Executive Director”, evidence showing authority to bind the organization must be attached.

PRINTED NAME

TITLE

CITY STATE ZIP CODE

PHONE NUMBER FACSIMILE NUMBER CELL PHONE NUMBER (OPTIONAL)

E-MAIL ADDRESS

C. PERSON RESPONSIBLE FOR PROGRAM AND CONTRACT MANAGEMENT

Same as Section A above.

Same as Section B above.

NAME TITLE

ADDRESS FLOOR SUITE ROOM

CITY STATE ZIP CODE

PHONE NUMBER FACSIMILE NUMBER CELL PHONE NUMBER (OPTIONAL)

E-MAIL ADDRESS

SECTION 2 PROGRAM DESCRIPTION

A.

Instructions: Please check the priority area(s) you are applying for in this proposal and the related goals and strategies your activities will address.

� Behavioral Health: Ensure all Solano County residents feel safe, supported, and well in their communities � Goal 1: Improve the safety and well-being of youth and young adults:

� Goal 2: Increase access to culturally and linguistically responsive behavioral health care.

� Goal 3: Expand connection to community resources.

� Access to Care: Eliminate inequities in access to preventive services and health care across Solano County � Goal 1: Reduce barriers to care for vulnerable populations � Goal 2: Increase access to culturally and linguistically responsive care

� Maternal and Infant Health: Improve the well-being of Black women, infants, children, and families � Goal 1: Expand reproductive health services for BIPOC teens

� Goal 2: Expand and improve prenatal care options for pregnant Black women

� Goal 3: Improve early outcomes for Black and Latinx infants

� Housing and Stability: Ensure all Solano County Residents have access to safe, stable, and affordable housing � Goal 1: Expand low-income, affordable, and workforce housing stock

� Goal 2: Provide a wide array of support to ensure housing security

� Goal 3: Improve access and connection to supportive services for people experiencing homelessness

B. Geography: Please check the location where activities will be provided/targeted.

� City (Please Specify):

� Regional (Please Specify):

� Countywide

C.

Instructions: Provide a brief logic model for your program, including your activities, short term outcomes, and long term or community outcomes. Please see each column for further instructions. (1 page maximum)

Activities/Outputs: Please list your 1-3 main activities related to the selected priority area(s), goals, and strategies.

Short Term Outcomes:

What outcomes relating to this activity will be achieved by the end of the contract period?

Long Term or Community Outcomes: What longer term outcomes or community impacts will your program contribute to as a result of the activity?

SECTION 4: QUALIFICATIONS AND EXPERIENCE

A.

Describe the capacity of the organization to provide the activities as outlined in this Request for Proposals. (2 pages maximum).

Please include:

• Experience doing work in the selected priority area.

• Why your organization is best suited to implement the project.

• Qualifications and experience of key personnel who will be implementing the project.

SECTION 3 PROGRAM DESCRIPTION NARRATIVE

A.

Provide a description of the systems-building, training or technical assistance, and/or coordination of services activities that you will provide. (2 pages maximum).

Please include:

• Description of how activities will be implemented and evaluated.

• How activities will be integrated within your agency and within other community efforts.

• How you will ensure your activities are equitable and inclusive.

B.

If you are proposing to address more than one priority within this proposal, provide a description of how you will ensure each priority gets addressed separately, but activities will be integrated as one program. (1 page maximum). If you are only addressing one priority with this proposal, skip this question.