As an authorized representative of the Proposer, having carefully examined the Request for Proposals, propose to furnish services in accordance therewith as set forth in the attached proposal.I further agree that this proposal will remain in effect for not less than sixty (60) calendar days from the date that proposals are due, and that this proposal may not be withdrawn or modified during that time.I hereby certify that this proposal is genuine and not a false or collusive proposal, or made in the interests or on behalf of any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 proposal or any person or corporation to refrain from submitting a proposal; 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 proposal, the Proposer irrevocably waives any existing rights which it may have, by contract or otherwise, to require another person or corporation to refrain from submitting a proposal to or performing work or providing supplies to Pierce County, and Proposer 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 or proposal to or from performing work or providing supplies to Pierce County.

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

I confirm I have reviewed the content of the following attachments included under this RFP: 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 proposal.

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; andInsurance 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 RFP.

As an authorized representative of the Proposer, 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 proposal 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 proposal 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 proposal 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.

Pierce County is now requiring applicants to complete and submit a Financial Risk Assessment and related documentation annually. In addition, applicants must update their submission six months after their most recent annual submission.An updated Financial Risk Assessment must also be submitted at any time within the 12-month period following the most recent assessment if either of the following occurs:A change in leadership has occurredThe agency has experienced a funding loss or reduction of 20% or more of its total budgetPierce County is collecting Financial Risk Assessment documentation through this form. Upon completion and submission of the form, whether for an initial Financial Risk Assessment or any required update, you will receive a confirmation email. The confirmation email is REQUIRED as part of this application, so save the email confirmation as a .PDF and upload it here. WARNING: Failure to provide evidence of an acceptable and up-to-date Financial Risk Assessment may be cause for the application to be disqualified from competition. I understand and agree that my organization has completed the Financial Risk Assessment form within the last six months and/or has updated the Financial Risk Assessment form submission if any of the above conditions apply. Completing the Financial Risk Assessment does not guarantee an award.

Once you have submitted the Pre-Award Financial Risk Assessment Form, you will receive an email confirmation. Save the email confirmation as a .PDF and UPLOAD HERE.WARNING: Failure to provide evidence of an acceptable and up-to-date Risk Assessment may be cause for the application to be disqualified from competition.

I confirm that my organization has reviewed Attachment B: Sample Contract Data Reporting Requirements and understand that the final contract will include mandated data reporting requirements.

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

Which of the following procurements did you previously submit a proposal that was determined responsive and advanced to evaluation? Must choose at least one (1) answer:

Please provide the organization's UBI number. WARNING: Failure to provide a UBI number will be cause for the application to be disqualified from competition.

Please provide the Employee Identification Number (EIN).

By submitting a proposal, I confirm that, if awarded funding, my organization will comply with all applicable federal confidentiality requirements (42 CFR, Part 2 and HIPAA), as applicable to the services proposed, in addition to the data reporting requirements described in Section 1.4.4.

Will any services under this proposal be subcontracted?

Identify the subcontractor(s) and describe the services to be subcontracted.

Confirm that subcontractor(s) meet eligibility requirements described in Section 1.5.1.

Describe the program you are proposing and how services will be delivered to youth. Include:the primary services, activities, and intervention approach;frequency and duration of youth engagement;service delivery setting(s), such as school-based, community-based, or virtual services;hours and availability of services;anticipated number of youth served; andhow the proposed approach will achieve the objectives and outcomes identified in this RFP.

Describe your organization's experience and capacity to successfully implement the proposed program. Include:experience providing comparable behavioral health promotion, prevention, and/or early intervention services that demonstrate your operational and administrative capacity to deliver the proposed services;experience serving youth populations, including relevant age ranges and service settings;ability to meet the reporting, funding management, and performance requirements identified in this RFP.Describe your readiness to begin services upon contract execution, including which staff, facilities, partnerships, and operational systems are currently in place and any significant start-up activities that must occur before services can begin.

Describe the population and geographic area the proposed program will serve and the need the proposed program is intended to address. Include:the population to be served, age range and estimated number of youth to be served;the geographic areas in which services will be provided;the primary behavioral health needs, risks, barriers or service gaps the program will address;relevant data, experience, or other information demonstrating the need for the proposed services how the proposed program will address those needs or gaps.

Describe how your organization will identify, reach , engage, and retain the youth you proposed to serve and make services are accessible and responsive to their needs. Include:the population you propose to serve and any eligibility or prioritization criteria your program will use;how participants will be identified, referred, or connected to services;barriers to accessing and participating in services and how you will address them;how service locations, schedules, communication methods, accommodations, and service approach will respond to participant needs.

What SMART-objective performance metric are you proposing and why is it appropriate for your program model? Include:What specific tool(s) will you use to measure behavioral health functioning pre/post (e.g., named validated instrument), and how often will you administer it?What data system(s) or tools will you use to track youth participation, service encounters, and outcomes (e.g., case management software, HMIS-type system, spreadsheets).

Complete and attach the required Budget Worksheet. See Section 1.5.2 for funding guidance.Describe the proposed program budget and how the requested funding will support the proposed services.