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for not less than sixty (60) calendar days from the date that proposals are due, and that this proposal may not be withdrawn or modified during that time.I hereby certify that this proposal is genuine and not a false or collusive proposal, or made in the interests or on behalf of any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.

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

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

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.

Must choose at least two (2) answers: Profit status (1 or 2) and organizational structure (3, 4, 5, or 6).

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

Please provide the Employee Identification Number (EIN).

Does your organization currently operate a domestic violence shelter with supportive service programs that services survivors of domestic violence and their children in Pierce County?

An organization must have, at the time of submission, an active UEI number when the funding is identified as federal. Please list your UEI as issued by Sam.gov. Funding may or may not create a subrecipient relationship between the organization and the County. WARNING: Failure to provide a number OR if the UEI number is NOT ACTIVE may be cause for the application to be disqualified from competition.

Provide an overview of your agency’s program services as it relates to providing domestic violence services for survivors of domestic violence and their children, including how you provide case management and meet basic needs of families.

What is your agency's policy or requirements regarding survivors' pets staying at your shelter?

How do clients access your services and who is eligible to receive the services offered by your agency?

Please indicate the anticipated number of clients the program will serve on an annual basis.

Please indicate the number of bed nights clients are eligible to stay in the domestic violence shelter and receive case management services.

Please describe your agency’s experience providing domestic violence services in Pierce County. Include the number of years providing the services.

Please upload the completed Attachment A: Budget Worksheet here.

Please describe which staff position and/or services would be supported by these funds.

Do you have additional applications to submit under this RFP?

Please download the documents below, complete, and upload for EACH additional application:Application Questions (Word)Attachment A: Budget Workbook (Excel)