RFP D27 007 Appendix A through C.docx

Appendix A

OFFEROR IDENTIFICATION AND INFORMATION FORM

Exact Legal Name of Offeror, including “dba” or “division” of a corporation (furnish the exact legal name of the entity under which an awarded contract, if any, will be executed):

Address:

Principal Place of Business (may not be a P.O. Box):

Mailing Address (only if different):

Payment Address (only if different)

Offeror’s Primary Contact Person:

Name

Title

Telephone Number

Fax Number

Email Address

Federal Tax Identification Number:

State of Hawaii General Excise Tax License Number:

Limited Liability Company Other

Names of all Offeror’s parent, affiliate and subsidiary organizations:

A Compliant Non-Hawaii business incorporated or organized under the laws of the State of on (date) _____________, and, if applicable, registered with the State of Hawaii Department of Commerce and Consumer Affairs Business Registration Division to do business in the State of Hawaii.

The undersigned has carefully read and understands the terms and conditions specified herein and hereby submits the following offer to provide the goods and/or perform the work specified herein, all in accordance with the true intent and meaning thereof, and further that the Offeror shall comply with all terms, conditions and requirements of the solicitation. The undersigned further understands and agrees that by submitting this offer, 1) the undersigned is declaring the undersigned’s offer is not in violation of Chapter 84, Hawaii Revised Statutes, concerning prohibited State contracts, and 2) the undersigned is certifying that the price(s) submitted was (were) independently arrived at without collusion.

Authorized (Original in ink) Signature Name (printed)

Title Date

SUPPORT ESTABLISHING AND IMPLEMENTING THE COMMUNITY SCHOOL MODEL STRATEGY IN HAWAII STATE DEPARTMENT OF EDUCATION SCHOOLS

RFP D27-007

RFP D27-007 Appendix A Appendix B

OFFEROR PROJECT EXAMPLE FORM

Directions:

1. Provide information regarding up to three (3) recent project examples that demonstrate the Offeror’s experience, qualifications, and ability to successfully deliver services similar in scope and complexity to those proposed under this RFP.

1. Project examples should be relevant to one or more of the proposed Service Areas and demonstrate the Offeror’s experience supporting the establishment, implementation, continuous improvement, or sustainability of the community school model or comparable initiatives.

Offerors are encouraged to include project examples that reflect different types of clients, service areas, or implementation contexts, where applicable.

1. Any supplemental information related to this project although not required, should be attached to the respective Appendix B, Offeror Project Example Form.

Name of Your Company:

Name of Client:

Name of Client Contact Person:

Client’s Phone Number:

Service Area(s) Provided:

Date or period of project/service:

Description of the services provided and the Offeror’s role; outcomes or results achieved, including implementation or organizational outcomes, where applicable.

Other Information or comments:

|_|check here if supplemental information related to this project is attached.

RFP D27-007 Appendix B-21 Appendix C

SUMMARY OFFER OF SERVICES AND PRICING

Instructions:

· This form may not be modified and/or reformatted.

1. Contact Information Company / Organization Name:

Mailing Address:

Geographic Areas Served (check all that apply):

|_|Oahu |_|Hawaii Island |_|Maui |_|Kauai |_|Molokai |_|Lanai |_|All Islands |_|Other (specify):___________________

Name of Primary Representative:

Representative Title:

Representative Phone Number:

Representative Email Address:

2. Service Area(s) |_| Professional Learning

|_| Technical Assistance

|_| Specialized Community School Support

3. Summary of Services Instructions:

· Complete Section 3, Summary of Services and Section 4, Pricing Structure for each Service Area identified in Section 2 above.

· Be concise and succinct in each narrative.

Service Area (Select the Service Area that this Summary of Services applies to)

|_| Professional Learning |_| Technical Assistance |_| Specialized Community School Support

Service Focus Identify which programmatic feature(s) the service primarily supports:

|_| Integrated Student Supports |_| Family and Community Engagement |_| Collaborative Leadership and Shared Decision-Making |_| Expanded and Enriched Learning Time and Opportunities

Specific Service Focus Within the Service Area selected above, identify the specific focus of the proposed service. Select all that apply.

Specialized Community School Supports:

Service Focus Description Summarize the specific expertise, supports, or programming and describe the specific service focus.

Service Description and Implementation Approach Describe the proposed services and implementation approach for this Service Area. Explain how the proposed services support the establishment, implementation, continuous improvement, and/or sustainability of the community school model while strengthening the organization of in-school and community resources, supports, partnerships, and opportunities that contribute to positive outcomes for students, families, and the broader school community. As applicable, include:

· the key features and intended purpose of the services;

· how services will be planned, delivered, and adapted to meet the unique needs and context of the requesting School, Complex Area, or State Office;

· how needs, assets, and priorities will be identified and used to inform service design, recommendations, and implementation;

· the delivery methodology (e.g., facilitation, coaching, consultation, direct services, partnership development, or other implementation strategies.);

· expected implementation timeline and major phases of service delivery;

· expected implementation and learning outcomes; and

· any additional information that will assist in understanding the proposed services. This may include, but is not limited to, how services align with one or more community school programmatic features and how services will coordinate with school leadership and, where applicable, the Community School Coordinator.

Participants Describe all role groups, participants, or the audience that the service is designed for or will benefit from the service. Describe the resources, time, and commitment, which the participants should expect to invest if engaging the service to fully realize its benefits.

Capacity Building Describe how the services will strengthen the long-term capacity to establish, implement, continuously improve, and sustain the community school model beyond the duration of the contracted services. Describe how the services build local knowledge, skills, leadership, systems, partnerships, and organizational capacity that support sustainable implementation over time. As applicable, include:

· the knowledge, skills, and competencies that will be developed;

· how leadership and stakeholders will assume increasing ownership of implementation;

· strategies for building sustainable systems, structures, processes, or resources;

· coaching, mentoring, technical assistance, or communities of practice that reinforce implementation;

· approaches for transferring knowledge, tools, resources, or practices; and

· how the proposed services will build local capacity rather than create dependency on external support.

Evidence of Success Describe the anticipated benefits, value, and expected outcomes of the services. Explain how success will be monitored, measured, and evaluated. As applicable, include:

· the intended goals and expected outcomes;

· implementation outcomes (e.g., strengthened partnerships, improved implementation, increased organizational capacity);

· anticipated student, family, school, or community outcomes;

· the measures, data sources, or evidence that will be used to monitor progress and evaluate success; and

· how data will be used to inform continuous improvement.

RFP D27-007 Appendix C-2

4. Pricing Structure Instructions:

· Complete Section 3, Summary of Services and Section 4, Pricing Structure for each Service Area identified in Section 2 above.

· Provide breakdown of costs as follows:

· Professional Learning services and Technical Assistance services – present pricing in terms of the cost per day, which should be inclusive of consultant fee, air and ground travel and per diem, if applicable, all costs (direct or indirect), and all applicable taxes. If there are additional costs for materials, that should be stated separately and explained. Include options to customize services where a School/Complex Area/Office can either request for fewer days or add additional days, and state the cost of each additional day of service.

· Specialized Community School Support services – provide a detailed pricing structure for the services. Pricing shall clearly identify the major cost components associated with service delivery.

· Community School Coordinator services - pricing should clearly identify the costs associates with employing, supervising, supporting, and providing professional learning for the Community School Coordinators. This may be broken down in buckets which includes, but is not limited to, personnel, services, and materials and supplies.

· Examples of common service packages or engagement options are encouraged.

Service Area Select the Service Area that the below Pricing applies to

|_| Professional Learning |_| Technical Assistance |_| Specialized Community School Support

Pricing