RFPAttC & C-1- PROPOSER INFORMATION AND CERTIFICATION SHEET & TECHNICAL PROPOSAL FORM~2.doc

RFP 5969:

Alcohol / Overdose Strategic Prevention Framework – Partnerships for Success (OregonBuys # S-44300-00010622)

ATTACHMENT C — PROPOSER INFORMATION AND CERTIFICATION SHEET

Legal Name of Proposer:

Address:

City, State, Zip:

Entity Type:

State of Incorporation:

Contact Name:

Telephone:

Email:

Oregon Business Registry Number (if required):

Any individual signing below hereby certifies they are an authorized representative of Proposer and that:

1. Proposer understands and accepts the requirements of this RFP. By submitting a Proposal, Proposer agrees to be bound by the Contract terms and conditions in Attachment A and as modified by any Addenda, except for those terms and conditions that Agency has reserved for negotiation, as identified in the RFP.

2. Proposer acknowledges receipt of any and all Addenda to this RFP.

3. Proposal is a Firm Offer for 180 days following the Closing.

4. If awarded a Contract, Proposer agrees to perform the scope of work and meet the performance standards set forth in the final negotiated scope of work of the Contract.

5. I have knowledge regarding Proposer’s payment of taxes and by signing below I hereby certify that, to the best of my knowledge, Proposer is not in violation of any tax laws of the state or a political subdivision of the state, including, without limitation, ORS 305.620 and ORS chapters 316, 317 and 318.

6. Proposer does not discriminate in its employment practices with regard to race, creed, age, religious affiliation, gender, disability, sexual orientation, national origin. When awarding subcontracts, Proposer does not discriminate against any business certified under ORS 200.055 as a disadvantaged business enterprise, a minority-owned business, a woman-owned business, a business that a service-disabled veteran owns or an emerging small business. If applicable, Proposer has, or will have prior to contract execution, a written policy and practice, that meets the requirements described in ORS 279A.112 (formerly HB 3060), of preventing sexual harassment, sexual assault and discrimination against employees who are members of a protected class. Agency may not enter into a contract with an anticipated contract price of $150,000 or more with a Proposer that does not certify it has such a policy and practice. See https://www.oregon.gov/DAS/Procurement/Pages/hb3060.aspx for additional information and sample policy template.

7. Proposer complies with ORS 652.220 and does not unlawfully discriminate against any of Proposer’s employees in the payment of wages or other compensation for work of comparable character on the basis of an employee’s membership in a protected class. “Protected class” means a group of persons distinguished by race, color, religion, sex, sexual orientation, national origin, marital status, veteran status, disability or age.

Contractor’s continuing compliance constitutes a material element of this Contract and a failure to comply constitutes a breach that entitles Agency to terminate this Contract for cause.

Contractor may not prohibit any of Contractor’s employees from discussing the employee’s rate of wage, salary, benefits, or other compensation with another employee or another person. Contractor may not retaliate against an employee who discusses the employee’s rate of wage, salary, benefits, or other compensation with another employee or another person.

8. Proposer is not engaged in the provision of broadband Internet access service, or if at any time Proposer is engaged in or may engage in the provision of broadband Internet access service Proposer is in compliance with Oregon Laws 2018, Chapter 88 (HB 4155) and applicable Public Utility Commission rules, and will remain in compliance throughout the term of the Contract.

9. Proposer and Proposer’s employees, agents, and subcontractors are not included on:

A. the “Specially Designated Nationals and Blocked Persons” list maintained by the Office of Foreign Assets Control of the United States Department of the Treasury found at: https://www.treasury.gov/ofac/downloads/sdnlist.pdf., or B. the government wide exclusions lists in the System for Award Management found at: https://www.sam.gov/portal/

10. Proposer certifies that, to the best of its knowledge, there exists no actual or potential conflict between the business or economic interests of Proposer, its employees, or its agents, on the one hand, and the business or economic interests of the State, on the other hand, arising out of, or relating in any way to, the subject matter of the RFP. If any changes occur with respect to Proposer’s status regarding conflict of interest, Proposer shall promptly notify the State in writing.

11. Proposer certifies that all contents of the Proposal (including any other forms or documentation, if required under this RFP) and this Proposal Certification Sheet, including the Attachment C-1 Technical Proposal Form attached hereto* are truthful and accurate and have been prepared independently from all other Proposers, and without collusion, fraud, or other dishonesty.

12. Proposer understands that any statement or representation it makes, in response to this RFP, if determined to be false or fraudulent, a misrepresentation, or inaccurate because of the omission of material information could result in a "claim" {as defined by the Oregon False Claims Act, ORS 180.750(1)}, made under Contract being a "false claim" {ORS 180.750(2)} subject to the Oregon False Claims Act, ORS 180.750 to 180.785, and to any liabilities or penalties associated with the making of a false claim under that Act.

13. Proposer acknowledges these certifications are in addition to any certifications required in the Contract and Statement of Work in Attachment A at the time of Contract execution.

Authorized Signature

Date

*Note: Proposer’s Attachment C-1 Technical Proposal Form appears on the following pages.

Attachment C-1 Technical Proposal Form

Instructions to Proposers: Each Proposer shall complete and submit Attachment C-1 Technical Proposal Form to provide responses to Sections 3.2.4.1 through 3.2.4.5 below.

3.2.4.1 Technical Proposal re: Task #1 – Complete SPF-PFS Local Community Health Needs Assessment (CHNA)

Proposer shall:

· Describe the Designated service area for which Proposer proposes to perform the Work (Tasks #1-4).

· Describe Proposer’s understanding of local, state, and national data to identify Priority populations and substance use related trends, or intent to learn about these data sources.

· Describe Proposer’s experience working with Priority populations.

· Describe the types of assessment and readiness activities Proposer will conduct to determine community health needs, gaps, assets, readiness, and opportunities for engagement with Priority populations.

· Explain the steps Proposer will follow to summarize and report findings from the Community Health Needs Assessment and the process for sharing with community members and community partners.

Optional information to provide:

· Identify other currently available Community Health Needs Assessments (CHNAs) in the Designated service area that can inform SPF-PFS Community Health Needs Assessment.

Proposer response:

3.2.4.2 Technical Proposal re: Task #2 Develop a SPF-PFS Community Health Improvement Plan (CHIP) Proposer shall:

· Describe Proposer’s process for using the SPF-PFS Local Community Health Needs Assessment (Task #1) to inform the development of the SPF-PFS Community Health Improvement Plan (CHIP)(Task #2).

· Discuss how the Proposer will determine priority goals, strategies, and interventions to be included in the CHIP.

· Demonstrate Proposer’s familiarity with the six U.S. Substance Use Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Prevention (CSAP) categories of information dissemination, education, problem identification and referral, alternative social settings, environmental and policy strategies, or community-based processes.

Proposer response:

3.2.4.4 Technical Proposal re: Task #3: Implement the Contractor’s alcohol, opioid overdose, and polysubstance use prevention interventions identified in the OHA-approved CHIP.

Proposer shall:

· Describe Proposer’s overall approach to implementing priority goals, strategies, and interventions in the OHA-approved CHIP.

· Describe Proposer’s plan to effectively implement the OHA-approved CHIP, including engaging Priority populations and collaborating with key partners and organizations.

· Describe potential implementation barriers or challenges and anticipated needs for training, technical assistance, and capacity building supports in order to implement the OHA-approved CHIP.

· Note any local, state, or national policies that may impact the project or conversely that the project has potential to impact over the four-year grant period.

Proposer response:

3.2.4.4 Technical Proposal re: Task #4: Evaluate selected alcohol, opioid overdose, and polysubstance use prevention interventions.

· Describe Proposer’s prior experience completing data collection, monitoring, and reporting activities for similar projects.

· Describe potential barriers or challenges in completing reporting and evaluation activities.

· Describe anticipated needs for training and technical assistance (TTA) to successfully meet reporting and evaluation requirements.

· Describe Proposer’s capacity to participate in in culturally and linguistically specific TTA and capacity building services hosted by OHA, SAMHSA, or other local, state, or federal agencies.

Proposer response:

Technical Proposal re: Experience and Qualifications

· Describe Proposer’s mission, background, and prior experience that positions Proposer to successfully perform the Work in Tasks #1-4 of Section 2.4 Scope of Work.

· Specify Key Persons to be assigned to the project and include a current resume (not to exceed two pages each) for each Key Person that demonstrates the person’s qualifications and experience for the Work described in this RFP. If Key Positions are not currently filled, include a position description.

· Describe Proposer’s experience convening and facilitating coalitions or diverse groups working together towards common goals or describe relationships with partners with this expertise, and include any notable successes, if any, achieved through that experience.

Proposer response:

COMMENTS \* FirstCap \* MERGEFORMAT DAS Procurement Services, Version 4.0 – December 21, 2018