RFP Psychological First Aid Trainings.pdf

The Ohio Department of Mental Health and Addiction Services (OhioMHAS), Office of Treatment Services is requesting proposals for:

Bipartisan Safer Communities Act (BSCA) - Psychological First Aid Trainings

For the Period: State Fiscal Year 2025 and 2026 - February 1, 2025 through September 29, 2025

Submit Proposals through the Ohio|Buys website for this particular RFP.

This RFP consists of 46 pages. Please verify that the complete copy is included.

Please submit all inquiries about this RFP through the Ohio|Buys website for this particular RFP. Please refer to Part Three of this RFP, “General Instructions”, for more information about submitting inquiries. All responses to inquiries submitted by Proposers will be posted on the RFP Inquiry tab for viewing by all prospective

Proposers.

REQUEST FOR PROPOSALS (RFP)

Contents

PART ONE: STRUCTURE OF THIS RFP

PART TWO: SERVICES REQUESTED INFORMATION

I. Mission and Guiding Principles

II. Purpose

III. Background

IV. Scope of Work and Deliverables

V. Minimum Qualifications of Contractor

VI. Ethical and Conflict of Interest Requirements

PART THREE: GENERAL INSTRUCTIONS

I. Calendar of Events & Online Information

II. Proposal Format

III. Proposal Submittal

IV. Inquiries

PART FOUR: EVALUATION OF PROPOSALS

I. Evaluation Process

II. Proposal Evaluation Criteria

III. Scoring

PART FIVE: CONTRACT AWARD

I. Contractual Requirements

II. Contract Award Process

III. Number of Awards

IV. Funding Approval Threshold

Appendix 1:

Appendix 2:

Appendix 3

PART ONE: STRUCTURE OF THIS RFP

PARTS

Part One Structure of this RFP Part Two Information on requested services Part Three General Instructions Part Four Evaluation of Proposals Part Five Contract Award Part Six Template Attachments (Required for a Complete Application Part Seven Reference Materials

APPENDIX

Appendix 1 – Standard Affirmation and Disclosure Form o Standard Affirmation and Disclosure Form must be signed by an authorized official of Proposer’s organization and must be included for any proposal to be scored

Appendix 2 – Contractor Information Form o Contractor Information Form must be completed and submitted with the proposal.

Appendix 3 – Example Personal Service Contract o The Example Personal Service Contract (PSC) does not need to be filled out and returned with a bid response. The Contractor that is selected will be supplied with a completed OhioMHAS PSC to sign, once this has been determined.

Please note: The term “application” and “response” may be used interchangeably to indicate materials applicants must submit to OhioMHAS for consideration for services outlined in this

RFP.

PART TWO: SERVICES REQUESTED INFORMATION

I. Mission and Guiding Principles

The mission of the Ohio Department of Mental Health and Addiction Services (OhioMHAS) is to provide statewide leadership of a high-quality mental health and addiction prevention, treatment and recovery system that is effective and valued by all Ohioans. OhioMHAS strives to be a national leader in implementing a comprehensive, accessible, and quality-focused system of addiction and mental health care and wellness for all Ohio citizens.

II. Purpose

OhioMHAS is seeking proposals from qualified contractors to conduct Psychological First Aid (PFA) trainings within Ohio’s communities and expand knowledge of this evidence-informed approach to behavioral health disaster recovery.

III. Background

The Bipartisan Safer Communities Act (BSCA) (P.L. 117-159) provides supplemental funding for the Community Mental Health Services Block Grant (MHBG) to enable states, the District of Columbia, and territories to expand access to mental health care. Overseen by the Substance Abuse and Mental Health Services Administration (SAMHSA), the BSCA supplemental funding seeks to support state behavioral health systems in examining what is needed to address the mental health needs in the aftermath of traumatic events and natural disasters within our communities. To address the massive disruption and loss of life caused by these crises, SAMHSA is recommending that states utilize this funding to strengthen and enhance behavioral health disaster preparedness and crisis response efforts. This funding provides a unique opportunity to develop improved and sustainable public behavioral health systems that are more adept at meeting the needs of vulnerable people, including those with more complex presentations. This opportunity will provide funding to conduct Psychological First Aid (PFA) trainings within Ohio’s communities and expand knowledge of this evidence-informed approach to behavioral health disaster recovery.

Developed by the National Child Traumatic Stress Network (NCTSN) and the National Center for PTSD, Psychological First Aid (PFA) is an evidence-informed approach to helping children, youth, adults, and families in the immediate aftermath of a disaster, natural and human-made.

Following a disaster or traumatic event, survivors, witnesses, and/or responders may struggle and face new challenges. “PFA is designed to reduce the initial stress caused by traumatic events and to foster short- and long-term adaptive functioning and coping. PFA does not assume that all survivors will develop severe mental health problems or long-term difficulties in recovery. Instead, it is based on an understanding that disaster survivors and others affected by such events will experience a broad range of early reactions (e.g., physical, psychological, behavioral, spiritual). Some of these reactions will cause enough distress to interfere with adaptive coping, and recovery may be helped by support from compassionate and caring disaster responders.” (NCTSN, n.d., para. 2)

PFA’s core objectives are to provide early assistance within the days or weeks following an event. The eight PFA Core Actions include:

Contact and Engagement – Respond to survivors in a non-intrusive and helpful manner

Safety and Comfort – Enhance immediate and ongoing safety needs and provide physical and emotional comfort

Stabilization (if needed) – Calm and orient emotionally overwhelmed and disoriented survivors

Information Gathering on Current Needs and Concerns – Identify immediate needs, concerns, and assist in gathering additional information to tailor interventions

Practical Assistance – Offer practical and reasonable help to survivors in addressing their immediate needs and concerns

Connection with Social Supports – Help survivors establish brief and ongoing contacts with support persons including family members, friends, and community resources

Information on Coping – Provide information on stress reactions, coping to reduce distress, and promote adaptive functioning

Linkage with Collaborative Services – Link survivors with available services needed in the immediate aftermath and/or in the future

PFA can be used by first responders, incident command systems, primary and emergency health care providers, school crisis response teams, faith-based organizations, disaster relief organizations, Community Emergency Response Teams (CERT), Medical Reserve Corps (MRC), and Citizens Corps. PFA is designed to be delivered in diverse settings.

These core objectives can be delivered in the field, shelters, medical triage areas, emergency departments and hospital settings, staging areas, respite centers, emergency operations centers, crisis hotlines, feeding locations, disaster assistance service centers, family reception and assistance centers, homes, businesses, and a variety of other community settings to meet the needs of the populations affected.

This funding opportunity seeks to hire a contractor to provide PFA training opportunities to Ohio’s communities and disaster response teams in an effort to reduce stress symptoms and assist in health recovery following a traumatic event, natural disaster, public health emergency, or even a personal crisis.

IV. Scope of Work and Deliverables

Contractor will provide four (4) in-person Psychological First Aid trainings in four (4) regions of Ohio and four (4) virtual trainings culminating in eight (8) PFA trainings for Ohio. Each in-person training will register up to 60 individuals allowing for concentrated interaction and group work. Each virtual training will register up to 125 individuals. The Contractor must educate participants on all of the eight PFA Core Actions within their trainings. The

Contractor will provide and implement the virtual platform for these trainings. The Contractor must work collaboratively with OhioMHAS staff to determine the logistics of each training including, but not limited to, dates, times, and registration of each training.

The Contractor must be able to provide Psychological First Aid training outlined within the Background section of this RFA. The selected Contractor shall be a certified Psychological First Aid trainer. Additionally the Contractor must have prior experience:

Conducting large group Psychological First Aid trainings both in-person and virtually;

Must have completed Psychological First Aid training and be able to demonstrate their proven ability to conduct trainings on this model;

Apply principles of Psychological First Aid to mediate the traumatic impact of disasters;

Address the Psychological First Aid themes and objectives outlined within the Background section of this RFA.

Contractor must provide previous work and references to demonstrate their experience and ability to provide the Psychological First Aid trainings both in-person and virtually.

Contractor will provide a description of their virtual platform they intend to use for the virtual Psychological First Aid trainings.

The Contractor will engage with training participants, external, and internal stakeholders.

The Contractor will attend meetings with OhioMHAS, as necessary, to successfully complete the scope of work.

Travel to the various regions will be necessary to deliver in-person trainings.

OhioMHAS will be responsible for identifying, selecting, and planning the locations for the in-person trainings. The Contractor will be responsible for set-up and tear-down of the training space at the identified locations.

The Contractor will provide OhioMHAS with copies of all training materials.

The Contractor will provide registration reports to the OhioMHAS lead. The report must include names, licensures, and other identifying information of participants registered for and that have completed the PFA trainings, both in-person and virtual.

V. Minimum Qualifications of Contractor

Contractor shall not be subject to an “unresolved” finding for recovery under Section

9.24 of Ohio Revised Code. To be eligible to participate in this application process, the proposal must describe the contractor’s qualifications to conduct the identified scope of work activities, expertise, knowledge, and experience. Experience must include examples of conducting similar or related work. The contractor will include in their proposal experience with the behavioral health field, in particular county ADAMHS boards, local health departments, emergency management systems, and first responders.

The proposal should include examples of work similar to the scope of work requested within this RFP.

VI. Ethical and Conflict of Interest Requirements

No contractor or individual, company or organization seeking a contract shall promise or give to any OhioMHAS employee any item of value that is of such character as to manifest a substantial and improper influence upon the employee with respect to his or her duties.

No contractor or individual, company or organization seeking a contract shall solicit any OhioMHAS employee to violate any of the conduct requirements for employees.

Any contractor acting on behalf of OhioMHAS shall refrain from activities that could result in violations of ethics and/or conflicts of interest. Any contractor or potential contractor who violates the requirement and prohibitions defined Section 102.03 or Section 102.04 of the Ohio Revised Code is subject to termination of the contract or refusal by OhioMHAS to enter into a contract.

PART THREE: GENERAL INSTRUCTIONS

The following sections provide a calendar of events, details on how to respond to this RFP and how to get more information about this RFP. All responses must be complete and in the prescribed format.

I. Calendar of Events & Online Information

The schedule for this RFP is given with the Ohio|Buys solicitation and is subject to change.

OhioMHAS may change this schedule at any time. If OhioMHAS changes the schedule before the Proposal Due Date, it will do so through an announcement on the Ohio|Buys web site area for this. The web site announcement will be followed by an addendum to this RFP, which also will be made available through the same Ohio|Buys web site, a possible new round or lot may be started.

It is each prospective Proposer’s responsibility to check the Ohio|Buys web site’s solicitation area for this RFP for current information and the calendar of events scheduled through award of any contract.

Other than by adherence to the RFP Inquiry process, set forth within Ohio|Buys, no contact related to this RFP shall be made with OhioMHAS until a contract award is announced. Notwithstanding this prohibition, OhioMHAS, at its sole discretion, may request additional information as part of the review process outlined below.

II. Proposal Format

Proposals must be prepared in accordance with instructions in this section. The proposal must clearly outline how each of the deliverables of Part 2 Section IV will be completed and with the time frames specified in that same section.

To be accepted, a proposal must include a technical proposal and cost proposal as described in this section, contain all the information specified for each of the categories listed in this section, and meeting the requirements of this section. Both technical and cost proposal will be identified within the RFP on the Ohio|Buys web site and must be filled out in its entirety to be accepted.

A. Technical Proposal

a. Transmittal letter includes:

Identifies the bidder The name, title, address, and telephone number of the proposer’s contract person with authority to answer questions concerning the RFP The name, title, address, telephone number, and email address of the proposer’s contact person with authority to execute a contract on behalf of the proposer.

b. Organizational experience including:

Information on the background of the firm or individual, including background information of any subcontractor(s)

Any prior experience relevant to this RFP (includes current contact names and phone numbers for these references), and a list of similar projects currently underway by the proposer or by any subcontractor(s) as well as completed over the past three (3) years unless requested otherwise within the Evaluation Section of this RFP. The Evaluation/Selection Review Committee will consider these additional references and may contact each of these sources.

c. Technical Approach and work plan that indicates how the proposer plans to address the purpose, objectives and deliverables, within the timeframes as stated in this RFP.

A procedure for reporting the status of the project, including work completed.

A proposal for how coordination will occur and how information will be shared with OhioMHAS

A chart indicating the names of staff and staff hours/activities/tasks linked to the responsibility of each of those individuals involved in each deliverable of the project

Samples of previous related projects

d. Personnel Qualifications Must include names, resumes, education, and experience of personnel listed in the table of organization/personnel chart for this project (including any subcontractors), and fully explain how their education and experience is relevant to the sections ____ of this RFP.

OhioMHAS shall require a clause in the resulting contract regarding key personnel that any person identified as critical to the success of the project may not be removed without reasonable notice to OhioMHAS.

One Project Manager shall be named on behalf of the proposer. All correspondence shall be directed through this named individual.

B. Cost Proposal

The cost proposal must indicate the total cost for the entire project and a separate cost breakdown for state fiscal year 2025 for the following elements, each of which will be identified within the Financial Questionnaire in Ohio|Buys for the RFP.

Proposals must include a budget that identifies all costs associated with the tasks described in the RFP. The budget must encompass all aspects of the proposed work, including any travel necessary for completing the work. The total award will not exceed $22,000.00.

Travel cost should be encompassed within the cost of the deliverables. Travel is not to be listed separately. For purposes of this RFP, travel includes all modes of transportation (airfare, tax, car rentals, etc.), lodging expenses, meals, and cost of communications by phone, mail, e-mail, or fax.

III. Proposal Submittal

Proposals must be submitted in the following manner:

Proposals must be submitted via the Ohio|Buys website by no later than 2:00 pm EST on the date indicated on the sourcing project.

The page limit for this application is x pages, single spaced, on-inch margins, 12-point

Times New Roman. The x pages do not include the Budget Expenditure Form and Budget Narrative.

No proposals or corrections/additions to submitted proposals will be accepted after the Proposal Due Date and time. Proposals that are submitted after the Proposal Due Date and time will not be scored.

Proposals that are not submitted in the format requested will not be scored. Proposals that do not contain all of the required information will not be scored.

All costs incurred in the preparation of the Proposal shall be borne by the Proposer alone, and OhioMHAS shall not contribute, in any way, to the cost of the preparation of the Proposal.

Any and all documents developed by the Proposer during the course of this project will be provided to OhioMHAS upon request and will become the property of OhioMHAS, and the Proposer shall not assert any claims arising under copyright or otherwise inconsistent with the transfer of ownership of such documents.

All information submitted by the Proposer will be considered to be public information unless the proposer specifically demonstrates, in writing, which information it considers to be proprietary. “Proprietary information” is information which, if made public, would put the proposer at a disadvantage in the market place and trade in which the proposer is a part.

Consequently, an assertion of “proprietary” information must be clearly identified and the basis of the assertion must be included. It is not adequate for the bidder to simply state that disclosure of the information will put it at a disadvantage in the market place.

OhioMHAS will make the final decision as to whether information is “public” or “proprietary”.

OhioMHAS reserves the right to:

Accept or reject any and all Proposals and/or bids if OhioMHAS determines that it is in the best interests of the State to do so.

Rebid this RFP, requesting new Proposals from qualified firms.

Waive or modify minor irregularities in Proposals received.

Negotiate with Proposer(s), within the requirements of this RFP, to best serve the interests of the State of Ohio.

Require the submission of modifications or additions to Proposals as a condition of further participation in the selection process.

Fund any Proposal in full or in part; any assignments of work by OhioMHAS under the scope of this RFP will be made dependent on need and the availability of adequate, specific funding.

Not make an award at the end of the evaluation process; this RFP is not to be interpreted or construed to guarantee that one or more Proposers submitting responses will be awarded contracts.

Adjust the RFP Calendar of Event dates for whatever reason it deems appropriate.

Contact Proposer to clarify any portion of the Proposer’s submittal.

If, during the review process, OhioMHAS determines that it is necessary to make further distinctions between certain Proposers, OhioMHAS may request certain selected Proposers to interview or make a presentation to staff and reviewers. The Proposer shall bear the cost of travel to any scheduled interview.

In accordance with federal and state statutes and OhioMHAS policy, no person shall be excluded from participation or subject to discrimination in the RFP process on the basis of race, color, age, sex, national origin, military status, religion, or disability.

IV. Inquiries

From the issuance date of this RFP, until a contract is awarded to a proposer, there may not be communications concerning the RFP between any supplier who expects to submit a proposal and any employee of OhioMHAS involved in the issuing of the RFP. The only exception is provided through the submission of written requests for clarification/interpretation via the RFP through the Ohio|Buys website during the specified inquiry period.

Prospective Proposers may make inquiries or seek clarifications regarding this RFP any time during the inquiry period listed in the RFP Calendar of Events. To make an inquiry, prospective Proposers must use the Inquiry tab on the RFP in Ohio|Buys to submit all inquiries or to seek clarification.

Prospective Proposers submitting inquiries will receive an immediate acknowledgement by e-mail that their inquiry has been received. The prospective Proposer who submitted the inquiry will not receive an e-mail response to the question, but will need to view the response on the State Procurement web site where it will be posted for viewing by all prospective Proposers.

Prospective Proposers may all view inquiries through the Inquiry tab located within the

RFP.

OhioMHAS will try to respond to all properly posed inquiries within 48 hours, excluding weekends and state holidays. OhioMHAS will not respond to any inquiries received after the date and time indicated on the RFP. Prospective Proposers who attempt to seek information or clarifications verbally will be directed to reduce their questions to writing in accordance with the terms of this RFP and state purchasing policy. No other form of communication is acceptable and use of any other form of communication or any attempt to communicate with OhioMHAS staff or any other agency of the State to discuss this RFP may result in the Proposer being deemed ineligible.

PART FOUR: EVALUATION OF PROPOSALS

I. Evaluation Process

OhioMHAS’s evaluation process of responses submitted to this request may consist of up to four distinct phases:

A. OhioMHAS’s initial review of all proposals for timely submission;

B. An evaluation committee review of the proposals for defects and scoring;

C. OhioMHAS’s request for more information (clarifications, interviews, presentations, and/or Demonstrations); and, D. Negotiations or best offer requests.

At its sole discretion, OhioMHAS will determine whether phases three and/or four are necessary under this RFP, reserving for itself the ability to eliminate or add phases three or four at any time during the evaluation process. OhioMHAS may add or remove sub-phases to phases 2 through 4 at any time if OhioMHAS believes doing so will improve the evaluation process.

II. Proposal Evaluation Criteria

In the proposal evaluation phase, OhioMHAS staff or reviewers selected by OhioMHAS (the committee) will rate the proposals submitted in response to this RFP based on the following criteria and weight assigned to each criterion.

Evaluation Criteria Weight Rating Extended Score

Proposer meets the minimum qualifications under “Minimum Qualifications” section of the RFP.

Proposer’s references and previous work demonstrate that Proposer has experience and ability to complete the outlined work.

Proposer has submitted a technical proposal that is complete, and the quality of the proposal demonstrates proposer’s ability to successfully complete all deliverables in accordance with timeframes specified.

Proposer has submitted a cost proposal that is complete, and the quality of the proposal demonstrates proposer’s ability to successfully complete all deliverables within a budget considered reasonable.

Total: ____/500

III. Scoring

Each proposal will be scored, and numerical technical point values will be assigned according to the criteria listed below. The scale (0-5) will be used to rate each Proposal response to the RFP on the technical evaluation sections. OhioMHAS will score the Proposal responses by multiplying the score received in each category by its assigned weight and adding all categories together for the Offeror’s total technical score.

RATINGS DEFINED:

Point Value Explanation

0 DOES NOT MEET: Response description does not comply substantially with requirements or is not provided.

1 WEAK: Response description is poor related to meeting the objectives.

2 WEAK TO MEETS: Response description indicates the objectives will not be completely met or at a level that will be below average.

3 MEETS: Response description generally meets the objectives or expectations.

4 MEETS TO STRONG: Response description indicates the objectives will be exceeded.

5 STRONG: Response description significantly exceeds objectives or expectations in ways that provide tangible benefits or meets objectives or expectations and contains at least one enhancing feature that provides significant benefits.

The minimum acceptable score to award a contract will be: 310

PART FIVE: CONTRACT AWARD

I. Contractual Requirements

Any contract(s) resulting from this issuance of this RFP are subject to the terms and conditions as provided in the personal services contract. The information contained in the RFP and in the proposal submitted by the selected contractor shall be considered part of the contract.

Payments for any and all services provided pursuant to the contract are contingent upon the availability of state and federal funds.

All aspects of the contract apply equally to work performed by any and all subcontractors.

The Contractor, and any subcontractor(s), will not use or disclose any information made available to them for any purpose other than to fulfill the contractual duties specified in the RFP. The Contractor, and any subcontractor(s), agrees to be bound by the same standards of confidentiality including federal and state statutory and regulatory requirements that apply to the employees of OhioMHAS and the State of Ohio.

Before a contract can be awarded, an Affirmative Action Program Verification Form must be completed using the Ohio Business Gateway Electronic filing website (https://ohiobusinessgateway.ohio.gov). Contractor must have an approved Affirmative Action plan recorded with the State of Ohio Department of Administrative Services.

II. Contract Award Process

It is OhioMHAS’s intention to under the scope of this RFP and as based on the RFP Calendar of Events schedule, so long as OhioMHAS determines that doing so is in the State’s best interests and OhioMHAS has not otherwise changed the award date.

Any award decision by OhioMHAS under this RFP is final. After OhioMHAS makes its decision under this RFP, all Contractors will be notified (in writing or by phone, at OhioMHAS’s discretion) of the final evaluation and determination as to their Proposals.

OhioMHAS will issue a notice of contract award to the selected Contractor(s) and finalized contract terms and conditions will be forwarded for signature. Contract will include RFP and attachments and the Contractor’s accepted proposal. Once executed copies of the contract are submitted by the Contractor(s) and pending any further approvals that may be required (e.g., State Controlling Board), OhioMHAS will fully execute the contract.

Once the contract is fully executed, OhioMHAS will issue a purchase order (PO). OhioMHAS will issue to the Contractor(s) one (1) copy of the signed instrument and one (1) copy of the PO for its/their files.

Unless otherwise negotiated and included in the executed contract/scope of work, the selected contractor(s) shall be bound by all outlined services, policies and procedures as contained in the contractor’s submitted and evaluated proposal.

Contractor may commence work upon receipt of a state issued purchase order.

The selected contractor(s) shall be compensated based on deliverables listed in the RFP. The personal services contract issued will further specify the timelines for completion of each deliverable and payment structure.

III. Number of Awards It is OhioMHAS’s intention to award one or more contract(s) depending on programs’ needs and the fit of the Contractor(s) to the scope of this RFP.

IV. Funding Approval Threshold

In the event that contractual expenditures with the selected Contractor(s) will exceed $50,000 in spending under any contract that results from this RFP, or that otherwise exceed $50,000 in aggregate spending across all contracts between the contractor and OhioMHAS, the contract will be subject to the approval of the State of Ohio Controlling Board.

Appendix 1:

Executive Order 2019-12D

Governing the Expenditure of Public Funds for Offshore Services

No Contract Funds May be Spent Offshore

Executive Order 2019-12D “Governing the Expenditure of Public Funds for Offshore Services” prohibits the use of any public funds within the control of an executive agency to purchase services which will be performed outside of the United States. The Executive Order can be found at the following website:

https://governor.ohio.gov/wps/portal/gov/governor/media/executive-orders/2019-12d

To be considered by the OhioMHAS, a bid response must be accompanied by an Affirmation and Disclosure in the form attached to this RFP.

STANDARD AFFIRMATION AND DISCLOSURE FORM -EXECUTIVE ORDER 2019-12D

Governing the Expenditure of Public Funds on Offshore Services

By the signature affixed hereto, Contractor affirms, understands and will abide by the requirements of Executive Order 2019-12D. Both Contractor and any of its subcontractors shall perform no services under any contract with the Department of Developmental Disabilities outside of the United States.

The Contractor shall provide all the name(s) and location(s) where services under any contract with the Department of Developmental Disabilities will be performed in the spaces provided below or by attachment. Failure to provide this information may subject the Contractor to sanctions. If the Contractor will not be using subcontractors, indicate “Not Applicable” in the appropriate spaces.

1. Name/Principal location of Contractor:

(Name) (Address, City, State, Zip)

2. Name/Principal location of subcontractor(s):

(Name) (Address, City, State, Zip)

(Name) (Address, City, State, Zip)

3. Location(s) where services will be performed by Contractor or by subcontractors if different from principal location(s):

(Address, City, State, Zip) (Address, City, State, Zip)

4. Location where state data will be stored, accessed, tested, maintained or backed-up, by Contractor or subcontractors if different from principal location(s):

(Address, City, State, Zip) (Address, City, State, Zip)

Contractor affirms that Contractor and all subcontractors shall immediately disclose to the Department of Developmental Disabilities any change or shift in location of services performed by Contractor or subcontractors after execution of any Contract with the Department. On behalf of the Contractor, I am duly authorized to execute this Affirmation and Disclosure form and have read and understand that this form is a part of any Contract that Contractor may enter into with the Department and is incorporated therein.

By: ____________________________________ ____________________________________ Contractor Signature Printed Name and Title

Date: ___________________________________

Appendix 2:

Contractor Information Form

The Contractor Information Form must be filled out and returned with a bid response.

CONTRACTOR INFORMATION FORM

THIS FORM MUST BE SUBMITTED WITH YOUR PROPOSAL

CONTRACTOR NAME:

STREET ADDRESS:

CITY: STATE: ZIP CODE:

AUTHORIZED CONTACT NAME:

PHONE NUMBER: EMAIL:

1. Identify all of contracts currently with the State of Ohio (including OhioMHAS).

Total # of Contracts:

State Agency: Amount:

Contracted Services:

Duration of Contract:

(Attach additional sheets if necessary.)

2. Provide current employee information on both a nationwide basis (including Ohio), and Ohio’s based operations.

NATIONWIDE OHIO

Total # of Employees:

Percent of Women:

Percent of Minorities:

3. Provide OAKS Supplier ID or Tax Identification Number:

4. If your billing address is different than mailing address above, please provide below:

Contractor Name:

Street Address:

City: State: Zip Code:

Authorized Signature Date

Appendix 3 Example of OhioMHAS’ Personal Service Contract

The Example Personal Service Contract (PSC) does not need to be filled out and returned with a bid response. The Contractor that is selected will be supplied with a completed OhioMHAS

PSC to sign, once this has been determined.

AGREEMENT

BETWEEN THE

OHIO DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES

AND

(Insert Name of Contactor)

THIS AGREEMENT is between the Ohio Department of Mental Health and Addiction Services (hereinafter the “OhioMHAS”), 30 E. Broad St. Columbus, Ohio 43215, and [Name of Contractor] (hereinafter “Contractor”), [Insert Address].

The parties agree as follows:

I. NATURE OF AGREEMENT

A. Contractor shall be employed as an independent contractor, to fulfill the terms of this Agreement and to act as a contractor to OhioMHAS. It is specifically understood that the nature of the services to be rendered under this Agreement are of such a personal nature that OhioMHAS is the sole judge of the adequacy of such services.

B. OhioMHAS enters into this Agreement in reliance upon Contractor’s representations that it has the necessary expertise and experience to perform its obligations hereunder, and Contractor warrants that it does possess the necessary expertise and experience.

C. Contractor shall perform the services to be rendered under this Agreement and OhioMHAS shall not hire, supervise, or pay any assistants to Contractor in its performance of services under this Agreement.

II. SCOPE OF WORK

A. Contractor shall perform the services (the “Work”) set forth in Exhibit 1, Scope of Work, attached hereto and made a part hereof.

B. Contractor shall, prior to undertaking any work, complete the following (select all that apply):

☐ Contractor who will be undertaking work at an OhioMHAS facility, or any personnel employed by the contractor who will be undertaking work at an OhioMHAS facility, shall, at the Contractor's expense, undergo a background investigation in the same manner as set forth in Ohio Administrative Code 5122-7-21(E)(1)(e). If the background investigation reveals a conviction or guilty plea that would disqualify an employment candidate according to Ohio Administrative Code 5122-7-21(D), the Contractor must immediately provide new personnel or OhioMHAS may unilaterally terminate this contract.

☐ Contractor who will be undertaking work at an OhioMHAS facility, or any personnel employed by the contractor who will be undertaking work at an OhioMHAS facility, shall provide results of a negative tuberculosis test conducted within six months prior to the contractor or employee beginning work at the OhioMHAS facility.

☐ Contractor who will be undertaking work at an OhioMHAS facility, or any personnel employed by Contractor who will be undertaking work at an OhioMHAS facility to provide care, treatment, or other services for patients, shall provide proof of vaccination for COVID-19 in accordance with the facility policy before entering the OhioMHAS facility, as well as proof of receipt of immunization against any other disease specified in facility policy and in accordance with that policy. (Note: Some services and tasks performed in or for an OhioMHAS facility may be conducted so infrequently that COVID-19 vaccination is not required, such as ad hoc non-healthcare services (annual elevator inspection) or services that are performed exclusively off-site and not at or adjacent to any site of patient care (such as accounting services). However, OhioMHAS may choose to extend COVID-19 source control measures as appropriate. OhioMHAS facilities should consider the frequency of presence, services provided, and proximity to patients and staff.)

III. TIME OF PERFORMANCE

A. The Work shall be commenced on or after the date of an approved purchase order.

The Work shall be concluded on or before Click or tap to enter a date., and this Agreement shall terminate on the earlier to occur of: (i) the date on which the Work is completed to the satisfaction of OhioMHAS or (ii) the date on which this Agreement is terminated as provided in Article VI, Termination of Contractor’s Services.

B. The State Agency may renew this Agreement for an additional term of Click or tap here to enter text. on the same terms and conditions by giving written notice prior to expiration. As the current General Assembly cannot commit a future General Assembly to expenditure, this Agreement and any renewal shall in any event expire no later than June 30, 2023.

C. It is expressly agreed by the parties that none of the rights, duties, and obligations herein shall be binding on either party if award of this Agreement would be contrary to the terms of Ohio Revised Code (“R.C.”) 3517.13, 127.16 or Chapter 102.

IV. COMPENSATION

A. OhioMHAS shall pay Contractor no more than [Dollar amount] for the Work.

B. The total amount due shall be computed according to the following cost schedule (lump sum for work produced, installment payments on a schedule, hourly pay, etc):

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C. Travel – (choose one)

☐ No Travel - Contractor shall not be separately reimbursed for travel, lodging or any other expenses incurred in the performance of the Work.

☐ Travel Reimbursement - Contractor shall be reimbursed for the Contractor’s reasonable, actual and necessary travel, lodging, and other travel-related expenses incurred in the performance of the Work to the extent that such reimbursement is in the best interest of the state.

1. Only travel expenses which are pre-approved by OhioMHAS will be reimbursed.

2. Travel expenses shall be reimbursed under the same rules and conditions that apply to state employees under Ohio Adm.Code 126-1-02, pursuant to the Ohio Office of Budget and Management (“OBM”) Travel Policy, attached as Exhibit 2.

3. If it is not possible to follow the OBM Travel Policy, with prior approval of OhioMHAS, Contractor shall be reimbursed pursuant to the federal rates for reimbursement in the Continental United States.

4. Meals shall not be reimbursed unless overnight travel is both critical and essential.

D. Contractor must receive a purchase order from OhioMHAS prior to filling an order or performing any of the Work.

E. After Contractor receives a purchase order, Contractor shall submit an invoice for the Work performed consistent with this Article IV, Compensation. Each invoice shall contain an itemization of the Work performed, including dates the Work was performed and total hours worked, if required by Paragraph B.1., above, the location or address where the Work was performed, and the sum due at that time pursuant to this Agreement. All invoices shall contain Contractor's name and address and shall reference OhioMHAS and list the billing address as [Billing Address], Attn: [Department, City, State, Zip]. All invoices must be submitted no later than sixty days after the Work performed. After receipt and approval by OhioMHAS of a proper invoice, as defined by Ohio Adm.Code 126-3- 01(A)(5), payment will be made pursuant to Ohio Adm.Code 126-3-01. Unless otherwise directed by OhioMHAS, invoices should be directed via email to: [Invoices Email Address].

F. In the event that any customer of Contractor negotiates a lower fee structure for the Work or comparable services, Contractor shall promptly notify OhioMHAS and shall extend the lower negotiated rate to OhioMHAS retroactively to the first date the lower rate was offered to another customer.

V. CERTIFICATION OF FUNDS

A. It is expressly understood and agreed by the parties that none of the rights, duties, and obligations described in this Agreement shall be binding on either party until all relevant statutory provisions of the Ohio Revised Code, including, but not limited to, R.C. 126.07, have been complied with, and until such time as all necessary funds are available or encumbered and, when required, such expenditure of funds is approved by the Controlling Board of the State of Ohio, or in the event that grant funds are used, until such time that OhioMHAS gives Contractor written notice that such funds have been made available to OhioMHAS by OhioMHAS’s funding source.

VI. TERMINATION OF CONTRACTOR’S SERVICES

A. OhioMHAS may, at any time prior to completion of the Work, suspend or terminate this Agreement with or without cause by giving written notice to Contractor.

B. In the event that the Work includes divisible services, OhioMHAS may, at any time prior to completion of the Work, by giving written notice to Contractor, suspend or terminate any one or more such portions of the Work.

C. Contractor, upon receipt of notice of suspension or termination, shall cease work on the suspended or terminated activities under this Agreement, suspend or terminate all subcontracts relating to the suspended or terminated activities, take all necessary or appropriate steps to limit disbursements and minimize costs, and, if requested by OhioMHAS, furnish a report, as of the date Contractor receives notice of suspension or termination, describing the status of all Work, including, without limitation, results, conclusions resulting there from, and any other matters OhioMHAS requires.

D. Contractor shall be paid for services rendered up to the date Contractor received notice of suspension or termination, less any payments previously made, provided Contractor has supported such payments with detailed factual data containing Work performed and hours worked. In the event of suspension or termination, any payments made by OhioMHAS for which Contractor has not rendered services shall be refunded.

E. In the event this Agreement is terminated prior to completion of the Work, Contractor shall deliver to OhioMHAS all work products and documents which have been prepared by Contractor in the course of performing the Work. All such materials shall become, and remain the property of, OhioMHAS, to be used in such manner and for such purpose as OhioMHAS may choose.

F. Contractor agrees to waive any right to, and shall make no claim for, additional compensation against OhioMHAS by reason of any suspension or termination.

G. Contractor may terminate this Agreement upon sixty (60) days’ prior written notice to OhioMHAS.

H. If the Contractor fails to perform any of the requirements of this contract, or is in violation of a specific provision of this contract, OhioMHAS may provide the Contractor written notice of the failure to perform or the violation and may provide a specified period to cure any and all defaults under this contract. During the cure period, the Contractor shall incur only those obligations or expenditures which are necessary to enable the Contractor to continue its operation and achieve compliance as set forth in the notice. Should the Contractor fail to comply within OhioMHAS's cure period, the Contractor shall be held in default of this contract and the contract shall terminate at the end of the cure period.

VII. RELATIONSHIP OF PARTIES

A. Contractor shall be responsible for all of its own business expenses, including, but not limited to, computers, email and internet access, software, phone service and office space. Contractor will also be responsible for all licenses, permits, employees’ wages and salaries, insurance of every type and description, and all business and personal taxes, including income and Social Security taxes and contributions for Workers’ Compensation and Unemployment Compensation coverage, if any.

B. While Contractor shall be required to render services described hereunder for OhioMHAS during the term of this Agreement, nothing herein shall be construed to imply, by reason of Contractor’s engagement hereunder as an independent contractor, that OhioMHAS shall have or may exercise any right of control over Contractor with regard to the manner or method of Contractor’s performance of services hereunder.

C. Except as expressly provided herein, neither party shall have the right to bind or obligate the other party in any manner without the other party’s prior written consent.

D. It is fully understood and agreed that Contractor is an independent contractor and neither Contractor nor its personnel shall at any time, or for any purpose, be considered agents, servants, or employees of OhioMHAS. Unless Contractor is another State of Ohio entity or a participant in the Ohio Public Employees Retirement System (OPERS), Contractor and its personnel shall not be considered agents, servants, or employees of the State of Ohio, or public employees for the purpose of OPERS benefits.

E. Unless Contractor is a “business entity” as that term is defined in R.C. 145.037 (“an entity with five or more employees that is a corporation, association, firm, limited liability company, partnership, sole proprietorship, or other entity engaged in business”), Contractor shall have any individual performing services under this Agreement complete and submit to OhioMHAS the Independent Contractor/Worker Acknowledgement form found at https://www.opers.org/forms-archive/PEDACKN.pdf. This paragraph is not applicable to OPERS member employers.

F. Contractor’s failure to complete and submit the Independent Contractor/Worker Acknowledgement form linked in Paragraph VII(E) at the time Contractor executes this Agreement shall serve as Contractor’s certification that Contractor is a “business entity” as that term is defined in R.C. 145.037.

G. Contractor declares that it has complied with all applicable federal, state, and local laws regarding business permits and licenses of any kind, including but not limited to any insurance coverage that is required in the normal course of business.

H. Contractor agrees that it does not have any authority to sign agreements, notes, and/or obligations or to make purchases and/or dispose of property for, or on behalf of, the State of Ohio or OhioMHAS.

I. Contractor agrees that while operating in an OhioMHAS facility, the Contractor and/or any employee or subcontractor of the Contractor, shall follow all applicable rules and regulations for that facility.

VIII. RECORD KEEPING

A. The Contractor must keep all financial records in a manner consistent with generally accepted accounting principles. Additionally, the Contractor must keep separate business records for this project, including records of disbursements and obligations incurred that must be supported by contracts, invoices, vouchers and other data as appropriate.

B. During the period covered by this contract and until the expiration of three (3) years after final payment under this contract, the Contractor agrees to provide the State, its duly authorized representatives or any person, agency or instrumentality providing financial support to the work undertaken hereunder, with access to and the right to examine any books, documents, papers and records of the Contractor involving transactions related to this contract.

C. The Contractor shall, for each subcontract in excess of two thousand five hundred dollars ($2,500), require its subcontractors to agree to the same provisions. The Contractor may not artificially divide contracts with its subcontractors to avoid requiring subcontractors to agree to this provision.

D. The Contractor must provide access to the requested records no later than five (5) business days after the request by the State or any party with audit rights. If an audit reveals any material deviation from the contract requirements, and misrepresentations or any overcharge to the State or any other provider of funds for the contract, the State or other party will be entitled to recover damages, as well as the cost of the audit.

E. If this contract or the combination of all other contracts with the Contractor exceeds ten-thousand dollars ($10,000) over a twelve (12) month period, the Contractor agrees to allow federal government access to the contracts and books, documents, and records needed to verify the Contractor's and/or subcontractor's costs.

F. The Contractor must comply with any direction from OhioMHAS to preserve documents and information, in both electronic and paper form, and to suspend any scheduled destruction of such documents and information.

IX. RELATED AGREEMENTS

A. All Work is to be performed by Contractor, who may subcontract without OhioMHAS’s approval for the purchase of articles, supplies, components, or special mechanical services that do not involve the type of work or services described in Exhibit 1, Scope of Work, but which are required for satisfactory completion of the Work.

1. Contractor shall not enter into subcontracts related to the Scope of Work without prior written approval by OhioMHAS. All work subcontracted shall be at Contractor’s expense.

2. Contractor shall furnish to OhioMHAS a list of all subcontractors; their addresses; tax identification numbers; current licensure, certification, or accreditation, including any renewal or re-issuance thereof; and the dollar amount of each subcontract.

B. Contractor shall bind its subcontractors to the terms of this Agreement, so far as applicable to the work of the subcontractor, and shall not agree to any provision which seeks to bind OhioMHAS to terms inconsistent with, or at variance from, this Agreement.

C. Contractor warrants that it has not entered into, nor shall it enter into, other agreements, without prior written approval of OhioMHAS, to perform substantially identical work for the State of Ohio such that the Work duplicates the work called for by the other agreements.

X. RIGHTS IN DATA AND COPYRIGHTS/PUBLIC USE

A. OhioMHAS shall have unrestricted authority to reproduce, distribute and…