As an authorized representative of the respondent, having carefully examined the Request for Qualifications, propose to furnish services in accordance therewith as set forth in the attached response.I further agree that this response will remain in effect for not less than sixty (60) calendar days from the date that responses are due, and that this response may not be withdrawn or modified during that time.I hereby certify that this response is genuine and not a false or collusive response, or made in the interests or on behalf of any person not therein named; and I have not directly or indirectly induced or solicited any Contractor or supplier on the above work to put in a false response or any person or corporation to refrain from submitting a response; and that I have not in any manner sought by collusion to secure to myself an advantage over any other contractor(s) or person(s).In order to induce the County to consider this response, the respondent irrevocably waives any existing rights which it may have, by contract or otherwise, to require another person or corporation to refrain from submitting a response to or performing work or providing supplies to Pierce County, and respondent further promises that it will not in the future directly or indirectly induce or solicit any person or corporation to refrain from submitting a response to or from performing work or providing supplies to Pierce County.

By submitting a response, I agree that all documents, reports, proposals, submittals, working papers, or other materials prepared by the respondent pursuant to this submission shall become the sole and exclusive property of the County, and the public domain, and not property of the respondent. The respondent shall not copyright, or cause to be copyrighted, any portion of said items submitted to the County because of this solicitation.

I confirm I have reviewed the content of the following attachments included under this RFQ: Sample Agreement and any other documents as identified as "sample" in the Attachments section and acknowledge I understand and agree to these requirements should my organization receive a contract as a result of this response.

By submitting a proposal, I understand and agree that if awarded funding from this RFP, the organization must be able to meet all insurance requirements based on services being purchased, prior to contract execution, and types of insurances may include, but are not limited to:Commercial General Liability Insurance: Required on all contracts. Standard levels are $1M occurrence/$2M aggregate (may be higher/lower, depending on value of contract and type of service).Commercial Automobile Liability Insurance: Required when the Contractor uses owned, rented, or leased automobiles to complete the services as required per the contract. Higher coverages may be required for fleet/large passenger vehicles. Workers Compensation Insurance: As required by Washington State. Professional Liability or Errors and Omissions Insurance: If the Contractor provides services such as analysis, consulting, counseling, daycare, legal, medical, nursing, pastoral, medical, or other services that require professional licensing.Abuse and Molestation: If the Contractor will be working directly with youth under the age of 18, elderly, disabled or other vulnerable populations.Cyber/Privacy and Security Insurance: If the Contractor is doing work that could give the Contractor access to personal or sensitive information from within the County's network or on the Contractor's personal computer, or lead to breaches of security, leading to a loss of privacy or identity theft. Crime/Employee Dishonesty Insurance: If the Contractor is in the custody or control of Pierce County funds such as cash, credit cards, checks or physical property.Other insurance(s) applicable to services being purchased: Such as Excess or Umbrella Liability Insurance if the contract is in excess of $500,000.In addition, Pierce County shall be named as an "Additional Insured,” which must be provided in the insurance endorsement. Insurance requirements also apply to any subcontractors hired by the main Contractor to deliver services, where applicable.Please see "Exhibit D" in the SAMPLE AGREEMENT under attachments to see full insurance requirements. If you have questions regarding insurance requirements, please submit them through the “Question & Answer” section of the RFQ.

As an authorized representative of the respondent, I certify to the best of my knowledge and belief that the organization and its principals:Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;Have not within a three-year period preceding this response been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; andHave not within a three-year period preceding this application/response had one or more public transactions (Federal, State, or local) terminated for cause or default.Does not employ any person nor contracts with any person or agency excluded from participation in federal health care programs under either 42 U.S.C. 1320a-7 (§§1128 or 1128A Social Security Act) or debarred or suspended.By checking the confirmation, I understand that a false statement on this certification may be grounds for rejection of this response or termination of any award. In addition, under 18 USC Sec. 1001, a false statement may result in a fine of up to $10,000 or imprisonment for up to 5 years, or both.

Upload evidence that shows your agency has a credit line or cash reserves to provide services for at least two months for the anticipated services in this RFQ.

I understand that all potentially successful respondents will be required to complete a financial risk assessment prior to a formal contract offer. This assessment requires the organization to submit detailed financial information about the organization’s financial history, current status, and details regarding boards, internal processes, and controls. The results of the risk assessment shall be utilized to determine the potential financial risk and stability of the organization – the outcome of the assessment shall be scored low, medium, high. The County reserves the right not to contract with an organization considered financially “high risk.” If you have questions regarding risk assessments, please submit a question through the "Question & Answer" section of this RFQ.

Upload a projected budget for one year of costs anticipated for the services identified in this RFQ.

Please provide the name and title of the individual authorized to execute a contract on behalf of the organization.

Please provide the legal name, any d/b/a names, years in business, local address, billing address if different, email address, and phone number of the organization making the proposal.

Please provide the Federal Tax Number (EIN), Washington State Unified Business Identification (UBI), and the System of Award Management *Unique Entity Identifier (UEI) issued by SAM.gov.*An organization must have, at the time of submission, a registered or active UEI number when the funding is identified as federal. Funding may or may not create a subrecipient relationship between the organization and the County.

Must choose at least two (2) answers: Profit status (1 or 2) and organizational structure (3, 4, or 5).

Please provide the name, phone, and email for:Executive Director/CEO/PresidentFinancial Manager/CFOContract Manager

Please list all services offered by your agency.

Where/in what counties does the agency currently provide services?

Organizations must provide services in accordance with the County Guide to Achieve DDA Guiding Values. Describe how your organization’s services will align with DDA’s Guiding Values to support clients.

Describe your agency’s system for ensuring the timely filing and retention of records and reports related to client services, staff, finances, and other organizational records.

Describe your plan to address potential conflicts of interest, including but not limited to, if the agency or an agency employee is also the client’s: a) guardian or legal representative; b) family member or decision maker; c) residential provider; or d) provider for another service.

Providing specific examples, describe how your agency delivers high-quality services to clients and families that are responsive and tailored to their different needs, backgrounds, and perspectives.

Describe how staff are supported to learn about, effectively support, and respectfully engage with clients and families from communities across Pierce County, including those with differing perspectives and experiences relating to the roles of people with intellectual disabilities working or participating in community activities.

Explain how your agency is prepared to provide equal access to services for clients who do not speak or have a limited ability to speak, read, or write English.

Please upload a current Organizational Chart.

Please upload job descriptions for each position that will work on this program.

Upload all recent (within the last 24 months) program monitoring or review reports received from ALL funders (i.e., local or state government) for all county-contracted services delivered in Washington State. Please include corrective actions and responses. Please note: Pierce County monitoring reports will also be shared with the Evaluation Committee.

If a monitoring report has not yet been provided to your organization, indicate the date of the site visit or program review, and the name of the monitoring agency which completed the review. If no monitoring occurred, include a narrative explanation.

Are you seeking to become a qualified provider of either Individual or Group Supported Employment Services?

Describe why your agency would like to offer employment services.

Indicate your agency’s current service capacity and the plan to increase capacity for employment services. Please include the number of referrals you plan to accept in the first year of services.

Describe your agency’s relevant experience in providing individualized or group supported employment services, including dates for relevant experiences.

Share your agency’s goals that include: A description of what outcomes you hope to accomplish in the first year of service; How successful employment outcomes will be defined; How progress will be tracked over time; How data will be used to determine next steps; and Goals addressing diversity, equity, and inclusion efforts

Please detail how your employee training plan will meet the staff training requirements under DDA Policy 6.13 and support staff to develop the competencies required to deliver employment services, engage in ongoing training opportunities, and stay abreast of best practices.

Demonstrate how your agency meets the minimum staff experience requirements to be a qualified employment provider under DDA Policy 6.13 - including required skill competencies, years of experience, and assigned roles of staff who meet the requirements.

Describe how Employment Services will be delivered in compliance with the DDA-DVR Memorandum of Understanding.

Describe your plan to complete the accreditation process for Rehabilitation Services Accreditation System (RSAS) or Commission on Accreditation Rehabilitation Facilities (CARF) accreditation; or Association of Community Rehabilitation Educators (ACRE) accreditation (for single-employee agencies only). If accreditation is already obtained, please indicate "Not Applicable" and upload documentation in Question 11.1.9.

If applicable, upload accreditation documentation here.

Upload a sample or redacted Employment Service Plan that identifies client goals and contains all required elements in DDA’s Criteria for Evaluation.

Are you seeking to become a qualified provider of Community Inclusion services?

Describe why your agency would like to offer Community Inclusion services.

Indicate your agency’s current service capacity and the plan to increase capacity for Community Inclusion services. Please include the number of referrals you plan to accept in the first year of services.

Describe your agency’s relevant experience in providing Community Inclusion services.

Share your agency’s goals that include:A description of what outcomes you hope to accomplish in the first year of serviceHow successful Community Inclusion outcomes will be definedHow progress will be tracked over timeHow data will be used to determine next steps; andGoals addressing diversity, equity, and inclusion efforts

Please detail how your employee training plan will meet the staff training requirements under DDA Policy 6.13 and support staff to develop the competencies required to deliver Community Inclusion services, engage in ongoing training opportunities, and stay abreast of best practices.

Demonstrate how your agency meets the minimum staff experience requirements to be a qualified Community Inclusion provider under DDA Policy 6.13 - including required skill competencies, years of experience, and assigned roles of staff who meet the requirements.

Upload a sample or redacted community inclusion service plan that identifies client goals and contains all required elements in DDA’s Criteria for Evaluation.

Please upload all attachments here, including:Copy of current Business License

Please download the below documents, complete, and upload the Pre-Award Risk Assessment and all required supplemental materials, including:2 most recent audited financial statements, including federal single audit, management letters and findings/corrective responses.Prior year Balance Sheet, Profit and Loss and Cash Flow Statements for entire year period.Current YTD Balance sheet, Profit and Loss and Cash Flow Statements.Most recent IRS annual submission, if this has not been sent, please detail why it not been filed yet.Agency’s policies and procedures for fiscal/grant accounting, including cost allocation and record retention policies.Third Party monitoring reports you may have received in last two years.1 example of a management timesheet and 1 example of an employee (non-management) timesheet.