SV Application Response Form.docx

State of Maine - Department of Health and Human Services

RFA# 202608134

Supervised Visitation Services

APPLICATION RESPONSE FORM

PRELIMINARY INFORMATION

APPLICATION COVER PAGE

Proposed District(s) Select each District the Applicant intends to provide Supervised Visitation Services

Applicant Name:

Chief Executive - Name/Title:

Tel:

E-mail:

Headquarters Street Address:

Headquarters City/State/Zip:

(Provide information requested below if different from above)

Lead Point of Contact for Application - Name/Title:

Tel:

E-mail:

Street Address:

City/State/Zip:

· This Application and the pricing structure contained herein will remain firm for a period of 180 days from the date and time of the bid opening.

· No personnel currently employed by the Department participated, either directly or indirectly, in any activities relating to the preparation of the Applicant’s Application.

· No attempt has been made, or will be made, by the Applicant to induce any other person or firm to submit or not to submit an Application.

· The above-named organization is the legal entity entering into the resulting contract with the Department should they be awarded the contract.

· The undersigned is authorized to enter contractual obligations on behalf of the above-named organization.

To the best of my knowledge, all information provided in the enclosed application, both programmatic and financial, is complete and accurate at the time of submission.

RESPONSIBLE APPLICANT CERTIFICATION

Applicant Name:

By signing this document, I certify to the best of my knowledge and belief that the aforementioned organization, its principals and any subcontractors named in this application:

a. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from bidding or working on contracts issued by any governmental agency.

b. Have not within three years of submitting the application for this contract been convicted of or had a civil judgment rendered against them for:

i. Fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state, or local government transaction or contract.

ii. Violating Federal or State antitrust statutes or committing embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property.

c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or Local) with commission of any of the offenses enumerated in paragraph (b) of this certification.

d. Have not within a three (3) year period preceding this application had one or more federal, state, or local government transactions terminated for cause or default.

e. Have not entered into a prior understanding, agreement, or connection with any corporation, firm, or person submitting a response for the same materials, supplies, equipment, or services and this application is in all respects fair and without collusion or fraud. The above-mentioned entities understand and agree that collusive bidding is a violation of state and federal law and can result in fines, prison sentences, and civil damage awards.

f. Is not a foreign adversary business entity (https://www.maine.gov/oit/prohibited-technologies).

g. Is not on the list of prohibited companies (https://www.maine.gov/oit/prohibited-technologies) or does not obtain or purchase any information or communications technology or services included on the list of prohibited information and communications technology and services https://www.maine.gov/oit/prohibited-technologies (Title 5 §2030-B).

ORGANIZATION QUALIFICATIONS AND EXPERIENCE

Applicants must describe their qualifications and skills to provide the requested services outlined in the RFA.

1. Describe the Applicant’s experience, including number of years, providing Supervised Visitation Services for Children in foster care or involved in child protection, include the approach to:

a. Ensuring child safety;

b. Supporting healthy parent-child interactions;

c. Managing challenging situations;

d. Documenting observations;

e. Collaborating with child welfare professionals; and

f. Delivering trauma-informed, culturally responsive services.

2. Description the Applicant’s experience working with Children and/or families involved in the child welfare system.

3. Provide a description of similar programs currently or previously operated, outcomes achieved, and how the Applicant will meet the requirements of the contract resulting from this RFA.

4. Describe the Applicant’s experience providing transportation to Children and Parents.

5. Describe any specialized experience the Applicant has with infants, Children and adults with disabilities, families affected by domestic violence, and/or Parents with mental health or substance use concerns.

Applicants must include three (3) examples of projects which demonstrate their experience and expertise in performing these services as well as highlighting the Applicant’s stated qualifications and skills.

Project One

Business Reference Name:

Reference Contact Person:

Telephone:

E-Mail:

Project Start Date

Project End Date

Include a detailed description of the project below:

Project Two

Business Reference Name:

Reference Contact Person:

Telephone:

E-Mail:

Project Start Date

Project End Date

Include a detailed description of the project below:

Project Three

Business Reference Name:

Reference Contact Person:

Telephone:

E-Mail:

Project Start Date

Project End Date

Include a detailed description of the project below:

Subcontractors

If subcontractors are to be engaged, Applicants must describe the application and review process the Applicant will use to evaluate the qualifications and experience of potential subcontractors, and how the Applicant will ensure that debarred, suspended, or otherwise ineligible parties are excluded from all subcontract relationships.

Subcontractor 1

Subcontractor Name:

Contact Person:

Telephone:

E-Mail:

Brief Description of Anticipated Role and Qualifications

Subcontractor 2

Subcontractor Name:

Contact Person:

Telephone:

E-Mail:

Brief Description of Anticipated Role and Qualifications

Subcontractor 3

Subcontractor Name:

Contact Person:

Telephone:

E-Mail:

Brief Description of Anticipated Role and Qualifications

Provide a description of how subcontractors/consultants, if any, will interact with the Applicant’s organization, (i.e., oversight and management of subcontractors.)

Organizational Chart

Applicants must provide an organizational chart. The organizational chart must include the project being proposed. Each position must be identified by position title and corresponding to the personnel job descriptions.

The organizational chart may be included below or may be attached to the application separately and appropriately labeled.

Litigation

Applicants must include a list of all current litigation in which the Applicant is named and a list of all closed cases that have closed within the past five (5) years in which the Applicant paid the claimant either as part of a settlement or by decree. For each, list the entity bringing suit, the complaint, the accusation, amount, and outcome. If no litigation has occurred, write “none”.

Financial Viability

Select the Applicant’s type of Agency/Organization and include the required financial documentation.

a. Balance Sheets; and

b. Income (Profit/Loss) Statements

Insurance Requirements

The awarded Applicant will be required to provide a certificate of insurance on a standard ACORD form (or the equivalent) evidencing its general liability, professional liability, and any other relevant liability insurance policies that might be associated with the services provided as part of the contract resulting from this RFA.

ACTIVITIES AND REQUIREMENTS

The Department intends to utilize a Standard Service Contract for all Applicants who are conditionally awarded to provide Supervised Visitation Services. As part of Supervised Visitation Services, Providers will be expected to comply with the requirements outlined in Part II of the RFA.

This RFA is intended to ensure sufficient capacity to meet the State’s Child welfare needs, therefore Applicants who are considered to be a Small Agency/Organization are not expected to have a facility or to provide transportation to Children and Parents if not feasible.

Type of Agency/Organization

Select the Applicant’s type of agency/organization:

☐ Small Agency/Organization (Five (5) or less staff who conduct the Supervised Visits) ☐ Large Agency/Organization (more than five (5) staff who conduct Supervised Visits)

1. Describe the Applicant’s Agency/Organization (i.e., number of staff, hours of operation, location(s) where operations occur, etc.)

2. How many Supervised Visitation Units does the Applicant intend to provide (One (1) Hour = One (1) Unit), annually?

Provide a justification for the annual number of Units proposed; if providing Units in multiple Districts include the specific number of Units to be provided within each distinct District.

Annual # of Proposed Units

3.

4. Describe the specific location/geographic area within the proposed District(s) identified on the cover page of this Application form which the Applicant intends to provide Supervised Visitation coverage.

The Department expects Supervised Visitation to occur in a safe, secure, and Least-Restrictive Environment.

5. Describe the location(s) where the Applicant intends to provide Supervised Visitation.

6. Does this Applicant intend to provide transportation to Children and Parents?

If yes, describe in detail the Applicant’s transportation services.

☐ Yes ☐ No

7. Describe the Applicant’s procedures for assessing and managing risk, Safety protocols during Supervised Visits, emergency response procedures, and incident reporting progress.

8. Describe the Applicant’s policies for responding to aggressive or inappropriate behavior.

9. Describe the Applicant’s approach to trauma-informed care and strategies to reduced re-traumatization during visits.

10. Describe the Applicant’s methods for supporting emotional regulation before, during, and after visits.

11. Describe the Applicant’s staffing capacity and plan for service continuity during absences.

12. Describe the Applicant’s proposed service model.

In addition to the responses above, Applicants must provide as a separate attachment:

a. A proposed evidence informed positive parenting model.

b. A training plan or description of a learning management platform evidencing how the Applicant will ensure the required trainings outlined in Part II of the RFA will be provided.

c. Applicable Job Descriptions detailing the primary responsibilities, duties, and required qualifications for specific job positions (do not include individual resumes) for all project staff including the project lead.

d. A staffing plan that describes the minimum staffing (position titles and time allocation) necessary to meet the requirements in Part II of the RFA.

e. A realistic work plan for the implementation of Supervised Visitation Services. The work plan must be displayed in a timeline chart, and concisely describe each program development and implementation task, the month it will be carried out, and the person or position responsible for each task. If applicable, Bidders must identify all tasks to be delegated to subcontractors.

Cost Structure Reimbursement Acknowledgement

Applicants are not required to submit information related to cost. Reimbursement rates are established by the Department’s Office of Child and Family Services at an all-inclusive rate per unit (One (1) Hour = One (1) Unit) and as outlined below. The Department will not reimburse for start-up costs.

By signing and submitting this Cost Structure Reimbursement Acknowledgement Form, if awarded, the Applicant agrees to provide Supervised Visitation Services in accordance with the established all-inclusive rate per unit (One (1) Hour = One (1) Unit) by District.

Name (Print):

Title:

Authorized Signature:

Date:

DHHS RFA Application Response Form (Rev. 10/2025)