Constant Contact
175 WEST JACKSON BLVD. τ CHICAGO, ILLINOIS 60604 τ
Procurement Department
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Request for Proposals
2018-100-025
For
SERVICES FOR SOUTH SUBURBAN YOUTH:
SELECT COMMUNITIES
For
HOUSING AUTHORITY OF COOK COUNTY
Proposals are due no later than 2:00 P.M. Central Standard Time on June 18, 2018.
There will be a Pre-Proposal Conference on June 1, 2018 at 11:00AM located at the Housing Authority of Cook County, 175 West Jackson Blvd. 22nd Floor, Chicago, Illinois 60604.
Questions regarding the RFP should be directed to: Deborah O’Donnell, Procurement Manager at dodonnell@.
Prepared by:
Procurement Department
Housing Authority of Cook County
175 West Jackson Blvd., Suite 350
Chicago, Illinois 60604
Request for Proposals
for
SERVICES FOR SOUTH SUBURBAN YOUTH:
SELECT COMMUNITIES
The Housing Authority of Cook County (“HACC”) hereby invites qualified human services organizations to submit proposals for consideration to provide services for youth residing in three select communities in Cook County’s South Suburbs as specified in this Request for Proposals (RFP).
As a part of our social mission and federal mandate, HACC is committed to providing economic, training and educational opportunities, as well as service linkages to low income individuals in the communities we serve.
The Housing Authority of Cook County will hold a pre-submittal meeting and will receive proposals for Services for South Suburban Youth at the times, dates and locations specified on the “RFP Information At A Glance” page.
The Requests for Proposals can be obtained online at .
Notice: Contact with members of the HACC Board of Commissioners, or HACC officers and employees other than the contact person shown above, by any prospective Respondent, after publication of the RFP and prior to the execution of a contract with the successful Respondent(s) could result in disqualification of your proposal. In fairness to all prospective Respondent(s) during the RFP process, if HACC meets in person with anyone representing a potential provider of these services to discuss this RFP other than at the pre-submittal meeting, an addendum will be issued to address all questions so as to insure no Respondent has a competitive advantage over another. This does not exclude meetings required to conduct business not related to the RFP, or possible personal presentations after written qualifications have been received and evaluated.
TABLE OF CONTENTS
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| Introduction |1 |
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|RFP Information at a Glance |12 |
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|General Information |13 |
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|HACC Reservation of Rights |13 |
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|Scope of Proposal |15 |
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|Conditions to Submittal |21 |
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|Form of Submittal |23 |
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| Proposal Evaluation |28 |
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|Insurance |30 |
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|Right to Protest |30 |
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| Disputes |31 |
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| Additional Considerations |32 |
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| Appendix (Forms) |39 |
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INTRODUCTION
The federal Office of Juvenile Justice and Delinquency Prevention (OJJDP), through a competitive request for proposals process, solicited applications for funding under the OJJDP FY 2016 Safe and Thriving Communities: Uniting and Enhancing Community-Based Violence Prevention, Defending Childhood, and National Forum Approaches grant program. The purpose of the grant is to support and enhance efforts to prevent youth victimization and violence, especially gun and gang violence, through comprehensive and collaborative approaches, and through the promotion of well-being for youth. The Cook County Justice Advisory Council (JAC) partnered with the Housing Authority of Cook County (HACC) and Lurie Children’s Hospital’s Strengthening Chicago’s Youth (SCY) to prepare and submit a proposal in response to OJJDP’s solicitation. Cook County received one of the six grants awarded nationally to develop and implement a project in three South Suburban areas: the Village of Ford Heights, the Village of Robbins, and the City of Harvey. Locally, the initiative is referred to as the Cook County South Suburban Safe and Thriving Communities Project.
OJJDP is awarding the grant in two distinct phases: a planning phase (October 1, 2016 through October 30, 2017) followed by an implementation phase (May 1, 2018 through June 30, 2019). The awarding of implementation funding was contingent upon OJJDP’s approval of a local needs assessment and strategic plan, both of which were developed during the planning phase. During the planning phase, a collaborative group of stakeholders consisting of the project partners, additional government representatives, local faith and community representatives, educational institutions, local youth and families, and others was convened to mobilize participation, assess local needs, and develop the strategic plan to guide the implementation phase. Members of this collaborative were recruited to serve on a Planning Steering Committee and/or to participate in one or more Working Groups. The primary roles of the Planning Steering Committee were to assist in developing the strategic direction for the initiative, to support community engagement in the planning process, and to provide input. Working Groups assisted in gathering the necessary information and provided input for both the needs assessment and strategic plan. Under SCY’s direction, the Cook County South Suburban Safe and Thriving Communities Needs Assessment and Cook County South Suburban Safe and Thriving Communities Strategic Plan were completed and subsequently approved by OJJDP, paving the way to begin the implementation phase. (see Attachment 1 for the Cook County South Suburban Safe and Thriving Communities Strategic Plan and Needs Assessment).
The purpose of this RFP is to support the implementation phase through the solicitation and selection of qualified service providers to deliver services to youth and families residing in the targeted communities and to enact system improvement initiatives. A total of up to $650,000 in grant funding has been allocated for these activities. The initiative seeks to improve outcomes for a minimum of 300 youth ages 10—24 with a focus on gang and gun violence. The planned duration of contracts to be awarded to qualified providers is 12-months, with an anticipated contract period from July 1, 2018 through June 30, 2019. Contract start dates will be contingent upon completion of the selection process and negotiations, as needed, with selected providers.
This RFP seeks providers who can deliver comprehensive services that are responsive to the needs specified herein. The RFP contains scope of service and submission requirements as well as terms, conditions, and other pertinent information. Proposals are invited from organizations with the capacity to provide direct services within the three selected communities that are easily accessible to local residents.
SOLICITATION DOCUMENTS ARE AVAILABLE:
Online for download at:
SOLICITATION DOCUMENTS ARE ALSO AVAILABLE FOR PICK-UP ON May 24, 2018 BETWEEN
8:30 AM AND 4:30 PM AT THE FOLLOWING LOCATION:
HOUSING AUTHORITY OF COOK COUNTY
175 West Jackson Blvd., Suite 350
Chicago, Illinois 60604
Attn: Procurement Department
COMPLETED PROPOSAL PACKAGES MUST BE SUBMITTED AS FOLLOWS:
ONE (1) USB/Flash Drive, FIVE (5) Bound Copies, AND ONE (1) Bound ORIGINAL of the complete proposal package must be submitted to HACC at the address below, and labeled as follows:
RFP for Services for South Suburban Youth: Select Communities
HOUSING AUTHORITY OF COOK COUNTY
175 West Jackson Blvd., Suite 350
Chicago, Illinois 60604
Attn: Procurement Department
A Pre-Proposal Conference will be held at June 1, 2018 at 11:00AM in the conference room located at 175 West Jackson, 22nd Floor, Chicago, Illinois 60604.
Proposals may NOT be withdrawn for a period of ninety (90) days from the submission deadline date.
The following schedule will be applied for this Request for Proposal (RFP):
• Advertisement/ Issue of RFP: May 24, 2018
• Pre-Proposal Conference: June 1, 2018
• Questions Due: June 6, 2018 at 2:00 PM
• Responses to Written Questions: June 11, 2018
• RFP Due Date: June 18, 2018 at 2:00 PM
MISSION AND DESCRIPTION
The Housing Authority of Cook County (HACC) is committed to providing quality affordable housing in a suitable living environment to low and moderate income individuals and families without discrimination; and to creating economic opportunities for our customers to become self-sufficient.
HACC manages: (a) 8 multi-family apartment complexes totaling 446 units; (b) 15 senior complexes, totaling 1,481 units; (c) 4 single-family homes throughout Evanston and Wheeling; and (d) administers a total of 13,800 Section 8 Housing Choice Vouchers. HACC currently has approximately 136 employees.
In partnership with the Cook County Justice Advisory Council, HACC will oversee and will provide Project Management for the Cook County South Suburban Safe and Thriving Communities Project.
SCOPE OF SERVICES
The grantor’s intent for these funds is to increase the number of localities that will initiate or strengthen work to end youth violence, improve well-being, and contribute to public safety. Because no one policy or program can completely or effectively respond to youth violence and victimization, OJJDP encourages communities to use the principles set forth in the Shared Framework for Reducing Youth Violence and Promoting Well Being as a blueprint to stop violence and victimization; address the individual, peer, family, community, and societal level factors; adopt developmentally appropriate, trauma informed, and healing-based approaches; and build the social capital and community efficacy that characterize safe and thriving communities (if you have trouble with the link above, the Shared Framework is accessible here: ).
The targeted communities have limited access to primary and wellness care, with at least one third of the population living below the federal poverty level. Academic achievement and economic status are two key indicators for risk of violence. In the State of Illinois, Partnership for Assessment of Readiness for College and Career (PARCC) tests were designed to measure academic performance against a higher set of standards. The tests go beyond multiple-choice questions and require students to use skills like analyzing, problem solving, and writing effectively. According to the Illinois State Board of Education (2016), 87.1% of elementary and middle school students in these municipalities did not meet or exceed expectations on PARCC tests, and 96.7% of students are eligible for free or reduced-price lunch, live in substitute care, or have families that receive public aid. This trend continues into high school where the percentage of college-ready students (scoring a minimum of 21 on the ACT) is 16.7%, and the graduation rate is 74.2%.[1]
In all three communities, the unemployment rate ranges from 21-39%, significantly higher than the Illinois rate of 6.4% and national rate of 4.7%. In addition, according to a report published by the Great Cities Institute at the University of Illinois Chicago, two of the three target communities - Ford Heights and Harvey - have the highest jobless rate for 20-24 year olds in Cook County at over 60%. In Robbins, the number is over 50%.[2]
Against the backdrop of low academic achievement and limited employment opportunities are the consequences of violence and the trauma resulting from that violence. While violence in Chicago is well-publicized, similar issues in the Southland region do not receive the same media attention. According to the Cook County Medical Examiner’s Office, from January to May 2016, there were 255 gunshot deaths in Cook County; of those 89 (35%) were in suburban Cook County. Additionally, in 2014, based on FBI statistics, the municipality of Harvey had 329 violent crimes.
Key findings of the Cook County Safe and Thriving Communities Needs Assessment include the following:
• Ford Heights, Harvey and Robbins in South Suburban Cook County have populations of 2,780, 25,773 and 5,157 respectively. Despite a proud history and active community organizations, these three communities face many significant challenges today. The three communities are not identical, but have many issues in common.
• These communities are home to minority populations, with nearly all (95%) of the residents of Ford Heights and Robbins identifying as Black, Non-Hispanic. The majority (75%) of Harvey residents also identify as Black Non-Hispanic and a substantial proportion (19%) identify as Hispanic.
• Among middle school students, a majority of students were identified as low income with 98% in Cottage Grove Upper Grade Center in Ford Heights, 97% in Brooks and 96% in Rosa L Parks in Harvey, and 91% in Kellar located in Robbins.
• When looking at the percentage of high school graduates who enrolled into a two- or four- year college within 12 months of graduation, all high schools fell short of the state total (68%) with 56% for Bloom Trail, 56% for Thornton, 54% for Eisenhower, and 62% for A B Shephard High School.
• In Ford Heights, 45% of the population lives in poverty compared to 36% in Harvey and 32% in Robbins.
• For youth ages 20- to 24- years-old, the jobless rate in Ford Heights, Harvey, and Robbins was 72%, 52%, and 58% respectively.
• Among youth ages 10 to 24, of the total percentage of inpatient hospital admissions due to mental illness in the zip code area that includes Ford Heights was 21%, 19% in the zip code area that includes Harvey, and 44% in the zip code area that includes Robbins.
• Across all three communities, of youth active on probation, almost 90% were male and 95% were Black Non-Hispanic.
The needs assessment was used as the basis for development of the strategic plan. The objectives contained in this RFP mirror those indicated in the strategic plan. Respondents will be selected based on the quality and responsiveness of their proposal. Successful Respondents will be those deemed both responsive and qualified to provide immediate and comprehensive youth and family services; including recruitment of local youth, acceptance of referrals, intake, needs assessment, direct service provision, service provision via referral as needed, ongoing monitoring, and reporting on progress to the project partners.
Services must be responsive to both the individual needs of the participating youth (and families) and to the objectives of the Safe and Thriving Communities initiative. This means that services must be designed to:
1) significantly impact youth victimization and violence through assessment of both risk and protective factors,
2) incorporate trauma informed approaches,
3) promote multiple domains of well-being,
4) respond to the community-level and societal-level factors that youth are facing, and
5) illustrate meaningful and quantifiable outcome measures through trackable and demonstrable data.
Before responding to this RFP, prospective organizations should consider some key requirements. First, it is anticipated that many participating clients will present multiple and complex needs. As such, Respondents must demonstrate experience in addressing the needs of high-risk clients and families through a trauma informed lens. Secondly, as transportation is an issue in the targeted communities, Respondents must demonstrate that the services they propose to provide will be accessible to local residents. While Respondents are not required to provide transportation, this issue should be considered and addressed in the submitted proposal. Thirdly, the Safe and Thriving Communities grant was awarded to Cook County in the form of a Cooperative Agreement. As such, the project involves substantial involvement from the federal Office of Juvenile Justice and Delinquency Prevention as grantor. Contracted service providers will need to be prepared to participate in grantor-sponsored training and technical assistance and to be both receptive and responsive to recommendations for programmatic adjustments. For example, it may be necessary to make adjustments as needed over the course of the project to increase the effectiveness of the interventions employed. Contracted agencies will be required to track participant involvement and outcomes and to report on these outcomes in accordance with OJJDP-specified reporting requirements (see Attachment 1 for OJJDP’s Data Collection Measurements). Contracted service providers must also be receptive to the recommendations of the local project partners and must be willing to participate in the initiative collaboratively.
As the agencies contracted under this RFP will be carrying out activities specified in Cook County’s application and subsequently approved by OJJDP through a Federal grant, by definition the contracted agencies will be subrecipients and the contracts will be considered subawards. As a subrecipient of Federal funding, all contracted agencies will be required to comply with all applicable conditions and restrictions included in the grant award, including the following:
General appropriations-law restrictions on use of federal funds. See, e.g., Award Condition: General appropriations-law restrictions on use of federal award funds (FY 2016)
• Requirements (including requirements to report allegations) pertaining to prohibited conduct related to the trafficking of persons. See Award condition: Prohibited conduct by recipients and subrecipients related to trafficking in persons,
• Restrictions on “lobbying,”
• Restrictions on nondisclosure agreements,
• Compliance with 28 C.F.R. Part 38 (pertaining to civil rights and nondiscrimination),
• Compliance with 28 C.F.R. Part 42 (pertaining to civil rights and nondiscrimination),
• Compliance with applicable laws and official Department of Justice guidance governing the use of federal funds for expenses related to conferences (as that term is defined by the DOJ),
• Reporting of potential fraud, waste, and abuse, and similar misconduct to the DOJ Office of the Inspector General, and
• Part 200 Uniform Requirements.
Respondents may submit under multiple categories. However, a separate proposal must be submitted for each category under which the Respondent wishes to apply. Following are descriptions for each category, along with the strategic objectives related to the category. Proposed services must seek to address at least one of the listed strategic objectives. A total of up to $650,000 is available for services under the following categories:
Respondents to this RFP may submit proposals under five different categories:
• Prevention –Primary
• Prevention -Secondary
• Intervention – Level 1 (Violence Interruption)
• Intervention – Level 2 (Out of School Support)
• Intervention – Level 3 (Career or Job Readiness)
Qualifying Applicants will be selected based on documentation of the following criteria:
All prevention and intervention activities should align with the problems identified and should be specific to gang issues.
Ability to track, monitor, and report program related data and willingness to share data findings with collaborative.
Explain in detail the multidisciplinary, collaborative approach that will be implemented.
Explain in detail collaborative strategies with organizations with diverse capacities that are either from Harvey, Robbins, or Ford Heights, or members of the South Suburban Safe and Thriving Communities Collaborative.
Service providers with the intention to work directly with gang involved youth need to demonstrate a track record with examples of working with gangs and their peers, families, law enforcement, and community.
Demonstrate which risk factors are being targeted and how you will respond to them along with knowledge of the cultural, familial, economic, and historical factors affecting targeted communities.
Demonstrate which protective factors will be used to reduce the likelihood of adversity leading to negative child outcomes and behaviors.
Incorporation of social interventions which includes “reaching out” to gang involved youth and their families and linking them with the conventional world and needed services.
Incorporation of opportunities provision which includes a variety of specific education or trainings such as tutoring, remedial education, job training, and job placement.
Risk Factors for Gang Membership
According to the National Gang Center, risk factors for gang membership span all five of the risk factor domains and have a cumulative effect. The greater the number of risk factors experienced by the youth, the greater the likelihood of gang involvement. For example, youth in Seattle possessing seven or more risk factors were 13 times more likely to join a gang than were children with no risk factor indicators or only one risk factor indicator. Third, the presence of risk factors in multiple developmental domains appears to further enhance the likelihood of gang membership. For youth in the Rochester study (Thornberry et al., 2003), a majority (61%) of the boys and 40% of the girls who exhibited elevated risk in all domains self-reported gang membership. In contrast, only one-third of the boys and one-fourth of the girls who experienced risk in a simple majority of the domains joined a gang.
The greater the number of risk factors experienced by the youth, the greater the likelihood of gang involvement. Children who are on a trajectory of worsening antisocial behavior are more likely to join gangs during adolescence, and they tend to have more risk factors than ordinary delinquents (Howell and Egley, 2005). Gang entry might be thought of as the next developmental step in escalating delinquent behavior. Future gang members not only evidence a large number of risk factors, they are likely to show risk factors in multiple developmental domains, including community or neighborhood, family problems, school problems, delinquent peer influence, and individual characteristics. The table below breaks out risk factors by domain: community, family, school, peer group, and individual.
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Protective Factors
Protective factors are those characteristics of the child, family, and wider environment that reduce the likelihood of adversity leading to negative child outcomes and behaviors, such as delinquency and later adult offending (Vanderbilt -Adriance and Shaw 2008; DSG 2013).
Risk factors are indicators of the probability of youths becoming involved in problem behaviors. However, protective factors are conceptually distinct from risk factors, in that they are characteristics or conditions that may reduce the influence of risk factors causing delinquent and violent behavior (Rutter 1987; Garmezy 1991).
Protective factors can also be thought of as “buffers,” where they are seen as characteristics or conditions that reduce the negative effect of adversity on child outcomes (Vanderbilt Adriance and Shaw 2008, 2). Thus, where exposure to risk factors increases the likelihood of adverse outcomes, exposure to protective factors buffers risk and reduces the likelihood of delinquency and other problem behaviors (Jenson and Fraser 2011).
Examples:
• Community, school, and family opportunities for prosocial involvement
• Presence and involvement of caring/supportive adults
• Family opportunities for positive Involvement
• Social Skills
• Strong school motivation/positive attitude toward school and student bonding
Prevention Overview
For the purpose of this RFP, prevention is defined as efforts that support youth prior to gang involvement, as well as those youth who are becoming gang involved through delinquent behavior that could potentially result in entering the juvenile justice system. Strategies should align with problems identified based on assessments and should be specific to gang issues. These prevention efforts include arbitration, mediation programs, and community service work or other treatment. This solicitation will include two prevention categories. Category 1 Primary Prevention will aim to direct focus on the families and communities of gang involved youth. Category 2 Secondary Prevention will target youth that are becoming more gang involved.
Category 1: Primary Prevention
Primary Prevention targets the entire population including at-risk and gang involved youth and families in high crime, high risk communities. Successful programs will aim to prevent violence before it occurs and effectively reduces community risk factors or provide protective factors. Activities might include facilitating workshops and trainings to enhance community awareness about gangs; working to change existing and potential conditions contributing to gang involvement within the targeted communities; creating a one-stop concept that facilitates effective distribution of health and support services; or creating procedures for community members to report crimes.
Category 2: Secondary Prevention
Secondary Prevention efforts support youth who are becoming gang involved and exhibiting delinquent behavior between the ages of 10-14, and are also focused on the families, siblings, or associates of target youth. Activities can include tutoring, mentoring, after-school programming, and recreational activities that incorporate service provision such as tutoring and job readiness programs.
Intervention Overview
For the purposes of this RFP, intervention is defined as programs or services that are intended to disrupt a juvenile's delinquency process, reduce risk factors for delinquency and other negative behaviors, and/or build skills and prevent a youth from penetrating further into the juvenile justice or child welfare systems. Successful intervention strategies will be designed to reduce violence, specifically around gang involvement for youth ages 15-24 years old. Trauma Informed Care must be integrated with the intent to disrupt the delinquency process and reduce risk factors for delinquency and other negative behaviors. Successful applicants may consider school, community or faith-based collaborations, as well as community policing efforts. Applicants should also demonstrate their ability to work with law enforcement to encourage community norms for youth behavior which works in concert with suppression strategies to address less serious antisocial, gang related behavior. There should also be inclusion of out of school suspensions; tracking and reporting of attendance/grades; tracking project participation; setting clear rules regarding proscribed behavior in job training and on the job; setting and implementing clear, fair rules; organizing parent patrols, and being aware of and supporting conditions of probation/parole. In addition, service providers are expected to appropriately collaborate with police, probation, parole and other justice system officers.
Gang members can find themselves temporarily in and out of custody, victims of violence, and vulnerable to retaliatory actions when trying to change the trajectory of their life. Programming should also include mentorship and skill building to prevent youth from penetrating further into the juvenile justice or child welfare systems. It is also strongly encouraged to offer monitoring, well-being checks, social interventions, providing tutelage, motivational activities to engage or reengage youth in academic achievement, and strategies to reduce barriers to employment. All of these interventions can be applied through one of the following three intervention levels, violence interruption, out of school time, and workforce development.
Category 3 Intervention – Level 1 (Violence Interruption)
The goal is to identify and reduce risk factors to disrupt the delinquency process and build skills to prevent gang involved youth from penetrating further into the juvenile justice system. The services provided under this category should include evidence-based violence intervention models in violence interruption and mediation of conflict. Understanding that violence is a health issue, it will be expected that service providers demonstrate experience through a track record or an ability to effectively respond to gang involved youth and their families, while working with community-based organizations, hospitals, faith leaders, local residents, schools, and law enforcement to collaboratively support their work through a multi-disciplinary approach.
Additionally, successful respondents should provide violence interruption and conflict resolution through mediation and mentoring strategies with built-in mechanisms to monitor, track, assess, and report youth and families served. There should be the ability to follow-up with the activities of individuals, family and groups; provide multiple referral services that align with identified needs as appropriate; and help them devise a risk reduction plan that guides them through issues that disrupts their lives in addition to social intervention and relationship building activities.
Trauma Informed Care must be integrated through clinical, restorative, or crisis intervention services and will include such supports as short-term crisis housing or Cognitive Behavioral Therapy and Structured Psychotherapy for Adolescents Responding to Constant Stress (SPARCS). These services will be provided as needed for participants.
Category 4: Intervention – Level 2 (Out of School Support)
The goal is to provide gang involved youth with social emotional learning, conflict resolution, and self-regulation skills. This population includes gang involved youth that are transient or attend school but seek refuge in order to stay out of trouble. The strategy is to expand out of school (OST) programs by enhancing existing and developing new programs that motivate youth by providing them with guidance, positive social interactions, learning opportunities and safe space, as an alternative to loitering in the streets and getting into trouble. Programs should also integrate Trauma Informed Care and other health based support services that provide mindfulness and well-being care. Services and programs must ensure that holistic approaches which factor considerations such as relationships with peers, relationships with family members and other adults will reduce youth trauma symptoms. Other acceptable programming led by service providers can be family programming, mentorship, tutoring, recreation or sports, in addition to arts and cultural activities. Expansion of programs should offer coordinated service linkages to families of the gang involved youth that are served in these programs by contracting service providers with the capacity to monitor, track, assess and address the needs of both youth and their families. Successful collaborations to implement out of school time include law enforcement agencies, schools, faith-based organizations, and community leaders that offer out of school programming.
Category 5: Intervention – Level 3 (Career or Job Readiness)
Intervention Level 3 will focus on youth and young adults that have barriers to employment based on academic challenges, criminal records, or both due to gang involvement. There should be an outreach and recruitment plan to identify and enroll youth in addition to an assessment of the needs of each individual for program placement. Respondents should also explain how they plan to retain participants. Case management records should be maintained to evaluate the effectiveness of the program. Emphasis should be placed on diverse employment preparation and training – soft and hard skills – with culturally responsive supplemental activities that focus on areas such as work ethic and character development, problem solving, conflict resolution, computer skills, financial literacy, joint school-work experiences, internships and paid job opportunities, job or career fairs, life enrichment, and recreational opportunities.
Successful service providers should have a track record in working with gang involved youth and workforce development. Service providers should work with schools, private companies, community-based agencies, not-for-profits, local businesses, faith-based communities, and law enforcement, etc. to create work experiences. There also can be opportunities to support innovative entrepreneurial ideas through the guidance and mentorship of business professionals with this expertise.
Additional details are provided in Section 5: Proposal Requirements.
The overall objective of this funding is to provide direct service opportunities for youth and families throughout the target communities as a means toward preventing or reducing gang and gun violence by addressing the needs and risk factors presented by local youth that may be contributing to involvement in violence as either a victim or perpetrator. However, achieving this objective is contingent upon the receipt of qualified proposals from Respondents that are capable of providing service in each of the three communities. To ensure that the overall objective is met and that services are equitably distributed in accordance with local needs, a degree of flexibility must be available for funding determinations. Therefore, should the situation arise that a given community is deemed to be insufficiently covered upon consideration of all qualified proposals; HACC reserves the right to negotiate proposed service plans among qualified Respondents. This could include inquiries of qualified Respondents as to the possibility of covering a larger area than proposed, scaling a proposed program upward or downward, or withholding a portion of funds to reissue a targeted solicitation for services in a given locality. HACC also reserves the right to reallocate funding across the three application categories to meet the overall objective.
RFP INFORMATION AT A GLANCE
|DATE ISSUED |May 24, 2018 |
|PRE-SUBMITTAL MEETING |June 1, 2018, 2018 at 11:00 A.M. |
| |175 W. Jackson Blvd, 22nd Floor |
| |Chicago, Illinois 60604 |
|LAST DATE FOR QUESTIONS |June 6, 2018 @ 2:00 P.M. |
|PROPOSAL DUE DATE |June 18, 2018 at 2:00 P.M. |
| |HACC Procurement Dept. |
| |175 W. Jackson Blvd, Suite 350 |
| |Chicago, Illinois 60604 |
|ANTICIPATED APPROVAL BY THE BOARD |N/A |
POINT OF CONTACT: Deborah O’Donnell, Procurement Manager
Housing Authority of Cook County
175 West Jackson Blvd, Suite 350
Chicago, Illinois 60604
Phone: (312) 542-4725
E-Mail: dodonnell@
1.0 GENERAL INFORMATION
1.1 Statement of Purpose: HACC is seeking proposals from qualified entities to provide, monitor, and report on services to youth and families. Services must be designed to prevent gang involved violence by changing behaviors, intervening in situations where violence has already occurred, addressing the trauma associated with violence, modifying systems to promote wellness, or addressing needs specific to gaining job skills and retaining employment.
1.2 Prospective respondents acknowledge by downloading and receiving the RFP documents and/or by submitting a response that the submission of a response to HACC is not a right by which to be awarded a contract, but merely is an offer by the prospective respondent to perform the requirements of the RFP documents in the event HACC decides to consider to award a contract to that respondent.
3. Pre-Proposal Conference: The pre-proposal conference will be held at the time, date, and location indicated herein. The purpose of this conference is to assist prospective Respondents in the full understanding of the RFP documents so Respondents are confident in submitting an appropriate proposal. Therefore, at this conference, HACC will conduct an overview of the RFP documents, including attachments. Because the purpose of this conference is to review the RFP documents, attendees should bring a copy of the RFP documents to this conference. HACC will not distribute at this conference any copies of the RFP documents. Questions concerning the contents of the project and procedural aspects of the RFP may be answered at this time; however, technical questions are required to be delivered in writing prior to a response. Any questions not answered during the conference will be responded to in writing via an addendum posted on HACC’s website: . All prospective Respondents are encouraged to attend.
4. Proposal Submission: June 18, 2018 at 2:00 p.m. (Central Time) at 175 West Jackson Blvd. Suite 350, Chicago, Illinois 60604.
5. Respondent’s Responsibilities-Contact with HACC: It is the responsibility of the Respondent to address all communication and correspondences pertaining to this RFP only to the contact person listed on the RFP Information At A Glance page. Respondents must not make inquiry or communicate with any other HACC staff member or official (including members of the Board of Commissioners) pertaining to this RFP. Failure to abide by this requirement may be cause for HACC to forego consideration of a proposal submittal received from any Respondent who has not followed this directive. During the RFP solicitation process, HACC will not conduct any ex parte conversations which may give one prospective Respondent an advantage over other prospective Respondents.
2. HACC’S RESERVATION OF RIGHTS
1. HACC reserves the right to reject any or all proposals, to waive any informality, or to terminate the RFP process at any time, if deemed by HACC to be in its best interests.
2. HACC reserves the right not to award a contract pursuant to this RFP and issue subsequent RFPs if in HACC’s best interest.
3. HACC reserves the right to retain all proposals submitted and not permit withdrawal for a period of 90 days subsequent to the deadline for receiving proposals without the written consent from HACC.
4. HACC reserves the right to negotiate the fees proposed by all Respondents. If such negotiations are not, in the opinion of HACC, successfully concluded within a reasonable timeframe as determined by HACC, HACC shall retain the right to end such negotiations.
5. HACC reserves the right to reject and not consider any proposal that does not meet the requirements of this RFP, including but not necessarily limited to incomplete proposals and/or proposals offering alternate or non-requested services, proposals deemed non-responsive, Respondents deemed not responsible and conditional proposals (ex. “All or None”).
6. HACC shall have no obligation to compensate any Respondent for any costs incurred in responding to this RFP.
7. HACC reserves the right to at any time during the RFP or contract process to prohibit any further participation by a Respondent or reject any proposal submitted that does not conform to any of the requirements detailed herein. Each prospective Respondent further agrees that he/she will inform HACC in writing within five (5) days of the discovery of any item that is issued thereafter by HACC that he/she feels needs to be addressed. Failure to abide by this timeframe shall relieve HACC, but not the prospective Respondent, of any responsibility pertaining to such issue.
8. HACC reserves the right, prior to award, to revise, change, alter or amend any of the instructions, terms, conditions, and/or specifications identified within the RFP documents issued, within any attachment or drawing, or within any addenda issued. All addenda will be posted on HACC’s website . Such changes that are issued before the proposal submission deadline shall be binding upon all prospective Respondents.
9. HACC reserves the right to reduce or increase estimated or actual quantities in whatever amount necessary without prejudice or liability to HACC, if:
1. Funding is not available,
2. Legal restrictions are placed upon the expenditure of monies for this category of service or supplies; or,
3. HACC’s requirements in good faith change after award of the contract.
10. HACC reserves the right to make an award to more than one Respondent.
11. HACC reserves the right to require additional information from any Respondent to assist in its evaluation. The information shall be submitted in the form required by HACC within two (2) days of written request or proposal shall be deemed non-responsive.
12. HACC reserves the right to require the Contractor to keep accurate timesheets for all employees assigned to perform any project, task, or assignment resulting from this RFP and any resulting contract.
13. HACC reserves the right to contact any individuals, entities, or organizations that have had a business relationship with the Respondent regardless of their inclusion in the reference section of the proposal submittal.
14. In the case of rejection of all proposals, HACC reserves the right to advertise for new proposals or to proceed to do the work otherwise, if in the judgment of HACC, the best interest of HACC will be promoted.
15. HACC reserves the right, without any liability, to cancel the award of any proposal(s) at any time before the execution of the contract documents by all parties.
16. HACC reserves the right to add or delete locations and/or properties for services on an as needed basis.
17. In the event any resulting contract is prematurely terminated due to nonperformance and/or withdrawal by the Contractor(s), HACC reserves the right to seek monetary restitution (to include but not limited to withholding of monies owed) from the Contractor(s) to cover costs for interim services and/or the difference of a higher cost (difference between terminated Contractor’s rate and new company’s rate) beginning the date of Contractor’s termination through the contract expiration date.
3. SCOPE OF PROPOSAL:
1. Prevention Support Systems: This solicitation will include two prevention categories. Category 1 Primary Prevention will aim to direct focus on the entire community including gang involved youth and families. Category 2 Secondary Prevention will target youth that are becoming more gang involved.
1. Overview of Prevention Category 1: For the purpose of this RFP, prevention is defined as efforts that support youth prior to gang involvement as well as those youth who are becoming gang involved through delinquent behavior that could potentially result in entering the juvenile justice system. These prevention efforts include arbitration, mediation programs, and community service work or other treatment.
2. Primary Prevention: targets the entire population including at-risk and gang involved youth and families in high crime, high risk communities. Successful programs will aim to prevent violence before it occurs and effectively reduces community risk factors or provide protective factors.
3. Appropriate program strategies may include but not limited to:
1. Mobilizing residents to conduct community watch and incorporate the role of law enforcement in providing resources, support, and trainings.
2. Canvassing hot spots offering violence prevention through public education.
3. Conducting community engagement activities and events that promote violence prevention and relationship building among community residents, law enforcement, stakeholders, and those impacted by gang violence.
4. Facilitating workshops and trainings to enhance community awareness about gangs.
5. Establishing a crime detection reporting system in consultation with local law enforcement.
6. Collaborative activities with law enforcement, community and faith leaders.
7. Creating a one-stop concept that facilitates effective distribution of support services.
8. Funding level: Ten percent (10%) of funded contracts will be under this section.
4. Secondary Prevention: Efforts that support youth who are becoming gang involved and exhibiting delinquent behavior between the ages of 10-14 and also focused on the families, siblings, or associates of target youth. Activities can include tutoring, mentoring, after-school programming, and recreational activities that incorporate service provision like tutoring and job readiness programs.
5. Appropriate program strategies may include but not limited to:
1. Restorative justice peace circles and practices.
2. Multi-tiered school based, trauma informed prevention activities.
3. Family engagement and connecting with parents.
4. Providing well-being checks by community ambassadors.
5. Offering safe passage services by either transporting or monitoring youth from home to school or service site.
6. Conducting preventative outreach activities with sports, arts, technology, and cultural activities.
7. Providing tutoring or mentoring support.
8. Opportunity provision or strategies to provide youth with educational and employment opportunities to reduce gang involvement.
9. Funding level: Ten percent (10%) of funded contracts will be under this section.
6. Other requirements:
1. Trauma Informed Care must be integrated through clinical, restorative, or crisis intervention services and will include such supports as short-term crisis housing or Cognitive Behavioral Therapy and Structured Psychotherapy for Adolescents Responding to Constant Stress (SPARCS). These services will be provided as needed for participants.
2. Service provider must be clear in describing the violence prevention model that will be implemented.
2. Intervention Strategies – Level One (Violence Prevention)
1. Overview: The goal is to identify and reduce risk factors to disrupt the delinquency process, reduce overall violence, and build skills to prevent gang involved youth from penetrating further into the juvenile justice system. The services provided under this category should include evidence-based violence intervention models in violence interruption and mediation of conflict. Understanding that violence is a health issue, it will be expected that service providers demonstrate experience through a track record or an ability to effectively respond to gang involved youth and their families, while working with community-based organizations, hospitals, faith leaders, local residents, schools, and law enforcement to collaboratively support their work through a multi-disciplinary approach.
Additionally, successful respondents should provide violence interruption and conflict resolution through mediation and mentoring strategies with built-in mechanisms to track, monitor, assess, and report youth and families served. There should be the ability to follow-up with the activities of individuals, family and groups; provide and define the multiple referral services that align and will be used with identified needs as appropriate; and help them devise a risk reduction plan that guides them through issues that disrupts their lives in addition to social intervention and relationship building activities.
Trauma Informed Care must be integrated through clinical, restorative, or crisis intervention services and will include such supports as short term crisis housing or Cognitive Behavioral Therapy and Structured Psychotherapy for Adolescents Responding to Constant Stress (SPARCS). These services will be provided as needed for participants.
1. Appropriate program strategies may include but are not limited to:
2. Substance abuse counseling and treatment.
3. Behavioral therapy or other behavioral interventions.
4. Functional family therapy.
5. Restorative justice initiatives that clearly address accountability and victim restitution through peer juries.
6. Community policing.
7. Violence reduction.
8. Violence interruption.
9. Violence detection.
10. Gang summits.
11. Truancy intervention.
12. Mental health and anger management.
13. Tattoo removal.
14. Legal assistance.
15. Connecting with parents and families who are gang impacted.
16. Funding level: Fifty percent (50%) of all funded contracts will be under this section.
2. Other requirements:
1. Trauma Informed Care must be integrated through clinical, restorative, or crisis intervention services and will include such supports as short term crisis housing or Cognitive Behavioral Therapy and Structured Psychotherapy for Adolescents Responding to Constant Stress (SPARCS). These services will be provided as needed for participants.
2. Service provider must be clear in describing the violence prevention model that will be implemented.
3. Intervention Strategies – Level Two (Out of School Support)
1. Overview: The goal is to provide gang involved youth with social emotional learning, conflict resolution, and self-regulation skills. This population includes gang involved youth that are transient or attend school but seek refuge in order to stay out of trouble. The strategy is to expand out of school (OST) programs by enhancing existing and developing new programs that motivate youth by providing them with guidance, positive social interactions, learning opportunities and safe space, as an alternative to loitering in the streets and getting into trouble. Programs should also integrate Trauma Informed Care and other health based support services that provide mindfulness and well-being care. Services and programs must ensure that holistic approaches that factor considerations as relationships with peers, relationships with family members and other adults will reduce youth trauma symptoms. Other acceptable programing led by service providers can be family programing, mentorship, tutoring, recreation or sports, in addition to arts and cultural activities. Expansion of programs should offer coordinated service linkages to families of the gang involved youth that are served in these programs by contracting service providers with the capacity to monitor, track, assess and address the needs of both youth and their families. Successful collaborations to implement out of school time include law enforcement, agencies, schools, faith-based organizations, and community organizations that offer out of school programming.
2. Appropriate program strategies may include but not limited to:
1. Direct outreach models that involve gang members that are transient or in school.
2. Mentoring Programs.
3. Programs that offer arts, culture, technology, and sports/recreation.
4. Social Emotional Learning.
5. Peace hubs.
6. Civic engagement.
7. Collaborative and relationship building with law enforcement.
8. Parent and family engagement.
9. Funding Level: Fifteen percent (15%) of funded contracts will be in this category.
3. Other requirements:
1. Trauma Informed Care must be integrated through clinical, restorative, or crisis intervention services and will include such supports as short-term crisis housing or Cognitive Behavioral Therapy and Structured Psychotherapy for Adolescents Responding to Constant Stress (SPARCS). These services will be provided as needed for participants.
4. Intervention Strategies – Level Three (Career and Job Readiness)
1. Overview: Intervention Level 3 will focus on youth and young adults that have barriers to employment based on academic challenges or criminal records or both due to gang involvement. There should be an outreach and recruitment plan to identify and enroll youth in addition to assessments of the needs of each individual for program placement. Case management records should be maintained to evaluate the effectiveness of the program. Provider should also explain how they plan to recruit participants. Activities may include but are not limited to life enrichment, recreational activities, internships, work ethic and character, problem solving, computer and financial literacy. Successful Service Providers should have a track record in working with gang involved youth and workforce development. Service providers should work with private companies, community-based agencies, not-for-profits, local businesses, faith-based communities, and law enforcement, etc.to create work experiences. There also can be opportunities to support innovative entrepreneurial ideas through the guidance and mentorship of business professionals with this expertise.
2. Appropriate program strategies may include:
1. Life skills and job readiness training.
2. Financial literacy.
3. Job coaching/training.
4. Social Emotional Learning.
5. Entrepreneurial training.
6. Job placement and retention services.
7. Internships.
8. Academic attainment assistance (completing High School/GED).
9. Apprenticeships.
10. Vocational training.
11. Transportation assistance.
12. Job fairs.
13. Counselling for mental health issues.
14. Funding Level: Fifteen percent (15%) of funded contracts will be in this category.
3. Other requirements:
1. Trauma Informed Care must be integrated through clinical, restorative, or crisis intervention services and will include such supports as short term crisis housing or Cognitive Behavioral Therapy and Structured Psychotherapy for Adolescents Responding to Constant Stress (SPARCS). These services will be provided as needed for participants.
4. CONDITIONS TO SUBMITTAL:
1. Pre-Qualification of Respondents: Prospective Respondents will not be required to pre-qualify in order to submit a proposal except as specified below. All Respondents shall submit adequate information showing that the Respondent is qualified to perform the required work. Failure by any prospective Respondent to provide requested information may, at HACC’s discretion, eliminate that Respondent from consideration.
4.2 RFP Forms, Documents, Specifications and Drawings:
1. Prior to submitting a proposal in response to the RFP, it shall be each prospective Respondent’s responsibility to examine carefully and, as may be required, properly complete all documents issued pursuant to this RFP.
4.3 Submissions and Receipt by HACC:
1. Time for Receiving Proposals: Qualification responses received prior to the submittal deadline shall be securely kept, unopened, by HACC. The Purchaser whose duty it is to open such responses will decide when the specified time has arrived. No response received after the designated deadline shall be considered.
1. Respondents are cautioned that any submittal that is time-stamped as being received by HACC after the exact time set as the deadline for the receiving of Qualifications shall not be considered. Any Qualifications not submitted in a timely manner that are inadvertently opened shall be ruled invalid. No responsibility will attach to HACC or any official or employee thereof, for the pre-opening of, or the failure to open a response not properly addressed and/or identified.
2. One (1) USB/Flash Drive, One (1) original signature copy (marked “ORIGINAL”) with a cover and extending tabs, and five (5) exact copies (marked “COPY”) are required. The submittal shall be placed unfolded in a sealed package with the respondent’s name and return address and addressed as follows:
Services for South Suburban Youth: Select Communities
Attn: Deborah Elliott O’Donnell
Housing Authority Cook County
Procurement Department
175 West Jackson Blvd, Suite 350
Chicago, Illinois 60604
3. Withdrawal of Qualifications: Qualification responses may be withdrawn as detailed within Section 6(h) HUD-5369-B (8/93), Late Submissions, Modifications and Withdrawals of Offers. Negligence on the part of the Respondent in preparing his/her response confers no right of withdrawal or modification of his/her response after such proposal has been received and opened.
1. Procedure to withdraw proposal submitted: A request for withdrawal of a response due to a purported error need not be considered by HACC unless filed in writing by the Respondent within 48 hours after the submission deadline. Any such request shall contain a full explanation of any purported error and shall, if requested by HACC, be supported by the original calculations on which the response was computed, together with a certification and notarization thereon that such computation is the original and was prepared by the respondent or his/her agent, who must be identified on the notarized form. The foregoing shall not be construed that such withdrawal will be permitted, as HACC retains the right to accept or reject any proposed withdrawal for a mistake.
4.4 Exceptions to Specifications:
4.4.1 A prospective Respondent may take exception to any of the qualifications documents or any part of the information contained therein, by submitting, in writing to the HACC Contact Person named herein, at least seven (7) days prior to the proposal submission deadline, a complete and specific explanation as to what he/she is taking exception. Proposed alternate documents or information must also be included. HACC reserves the right to agree with the prospective Respondent and issue an addendum to the applicable RFP requirements, or may reject the prospective Respondent’s request.
2. When taking exception, prospective Respondents must propose services that meet the requirements of the RFP documents. Exceptions to the specification and/or approved "equal" requests may be discussed at the pre-submission conference. Any verbal communications or instructions provided by any HACC staff shall only become official and binding when issued as an addendum or as a written answer issued by addendum pursuant to receipt of a written question by the HACC Procurement Department.
3. Interpretations: No official oral interpretation can be made to any Respondent as to the meaning of any instruction, condition, specifications, drawing (if any), or any other document issued pertaining to this RFP.
5. PROPOSAL Requirements: Proposals should be submitted in 12 point font, one side only, and double-spaced. Proposals must include the following information to be deemed responsive:
1. Proposal Requirements Overview:
1. Section A: Cover Letter (1 page maximum)
2. Section B: Executive Summary & Organization Chart (2 pages maximum)
3. Section C: Application Category and Target Population (2 pages maximum)
4. Section D: Proposed Service Plan & Implementation Schedule (4 pages maximum)
5. Section E: Expected Outcomes (2 pages maximum)
6. Section F: Budget and Budget Narrative (use the provided templates)
7. Section G: Qualifications of the Proposer (2 pages maximum)
8. Section H: Key Personnel (as many pages as needed)
2. Section A: Cover Letter (Page limit: 1 page maximum)
1. The cover letter shall be signed by an authorized representative of the Respondent’s organization. The letter shall indicate the Respondent’s selected application category, state a commitment to provide the services proposed at the price and schedule proposed. Also, the cover letter shall identify the members of the team that comprise the Proposer and the organizational relationship of the team members.
3. Section B: Executive Summary & Organization Chart (Page limit: 2 page maximum)
1. The Executive Summary should include an agency description, summary of the proposed project that highlights the key project components, activities, and key personnel who will be responsible for the services to be provided, and an organizational chart specific to the proposed project.
2. The agency description may include a description of your experience with similar programs/projects and provide evidence of a successful track record with the administration/implementation of current and/or previous programs/projects. It should also explain your previous experience dealing with the targeted population with specifics about how your organization helped to meet this population’s needs.
3. The Organizational Chart should be specific to the proposed project and illustrate where the project and any proposed services will be housed within your organizational structure and which organizational units will be responsible for management, implementation, and periodic reporting.
4. Section C: Application Category, Needs Statement, and Target Population (Page limit: 2 page maximum)
1. Provide a detailed description of the specific problem or issue that your proposed project seeks to address and indicate specifically who the targeted populations are that will benefit from your proposed activities. Include a response to each of the following bulleted items.
2. Specifically state the application category for which you are seeking funding.
3. Define the problem to be addressed and the geographic area in which the problem occurs. Describe the specific geographic service area that your proposed project will target.
4. Describe the particular types of gun or gang violence that your program or project will address within the proposed geographic service area.
5. Explain the impact that these types of gun or gang violence have on the proposed service area.
6. Explain any service gaps or barriers to service access that your proposed program will address.
7. Provide a detailed description of the targeted population(s) including location and, to the extent possible, demographic breakouts of your intended participants. Provide reasons why this population is at risk of being involved in gun or gang violence, including listing specific risk factors for violence involvement.
8. Include relevant data and/or informational sources to validate that your intended intervention is either evidence-based, evidence-informed or incorporates promising/emerging practices relative to reducing violence among the targeted population.
9. The systemic partners who will be involved.
10. The potential for sustainability beyond the contract period.
5. Section D: Proposed Service Plan and Implementation Schedule (Page limit: 4 page maximum)
1. Proposers must provide a detailed description of the proposed program/project. Include a response to each of the following items:
1. Describe the activities that will be funded in detail.
2. Describe the logistics regarding how services will be delivered including service locations, projected number to receive services, the components that comprise each proposed service, and whether transportation assistance will be available.
3. Explain how the target population will be engaged including any existing and planned recruitment and referral sources, the agency’s intake process, and strategies for retention.
4. Explain how participants will be assessed and screened, including the screening and assessment tools that will be used.
5. Provide details regarding the interventions participants will receive and the dosage of these interventions (frequency, intensity, duration, etc.).
6. Explain how you will ensure that a trauma informed approach is incorporated into service delivery.
7. Explain how the proposed activities will ultimately result in a reduction of or prevention of incidents of violence, risk factors, or trauma associated with violence.
8. If workforce development services are proposed, explain any existing relationships with employers and the agency’s track record relative to skills development, job placement, and job retention.
9. Describe the agency’s plan for sustaining the proposed services beyond the contract period.
10. Explain the roles of each collaborative partner who will participate in the initiative and also explain how oversight coordination will be assured throughout the duration of the project.
2. Include a detailed Implementation Schedule that plots key activities over the project’s timeline. Include an indication of the staff/agency that will be responsible for each activity and the timeframe by which each activity will be completed.
6. Section E: Expected Outcomes (Page limit: 2 page maximum): Proposers must demonstrate that they have considered, and will be prepared to report on, measures that will demonstrate the degree to which the program has been successful. This should be demonstrated through the presentation of clear goals and objectives for the proposed program/project, as well as defined targeted outcomes. This information should include:
1. Realistic Goals: Goals are broad, general statements of what the program, project, or activity intends to accomplish.
2. Objectives: Objectives are intended results or consequences of a particular program component, service, or intervention. Objectives should be brief, clear statements that describe the intended results; i.e., the specific skills, values, and attitudes participants should exhibit after receiving the intervention.
3. Outcomes: Outcomes are the achieved results that demonstrate the degree to which the objectives have been met. Outcomes must be measurable. A successful proposal has outcome measures that are quantitative. For example, an unacceptable outcome would be “Participants will be better prepared for job placement.” This example would be considered unacceptable because there is no quantifiable measure of success that indicates what “better prepared” means. An example of an acceptable outcome is: “Of those participants placed in employment, 75% will retain employment for six months or longer.” The following are the required core measurements for subgrantees:
Required Performance Measures for Direct Services Intervention
• Number of youth served
• Number of programs using an evidence based program or practice
• Number of youth served with an evidence based program or practice
• Number of youth who offend (short and long term)
• Number of youth who are victimized (short and long term)
• Changes in behavior among youth program participants (e.g., increased school engagement, reduced involvement with justice system/recidivism)
• Changes in trauma symptoms and functional outcomes among youth program participants
• Changes in trauma symptoms and functional outcomes among parents/caregivers
• Participants’ change in knowledge or attitudes, as self-reported via surveys
• Participants’ satisfaction with programs
1. An explanation of the process your organization will follow to measure outcomes, including an explanation of all measurement tools that will be used to collect data, the frequency of data collection, and how data will be used to report outcomes.
2. In addition to measuring agency self-identified outcomes, proposers are apprised that OJJDP requires specific outcome reporting measures and that contracted providers will be required to prepare periodic reports for measures reflected in Attachment 1: DCTAT Report. Proposers must indicate their capacity relative to reporting on the measures in the DCTAT report.
7. Section F: Budget and Budget Narrative (Page limit: Use the provided templates)
1. Proposers must provide a detailed Budget on the attached document (Appendix I) that includes a cost breakout for the aforementioned program plan activities. Instructions are provided on the form.
2. Proposers must also provide a Budget Narrative on the attached document (Appendix II) that includes detailed descriptions of each cost item, explains the need for the item, and how the item’s cost was determined. Instructions are provided on the form.
8. Section G: Qualifications of the Proposer (Page limit: 2 page maximum): Include a brief description of the organization’s track record, including history, number of employees, number of years in business, and a list of projects relevant to this RFP. Provide a list of three (3) references where a program was implemented. Include the name of the contact person, name of the organization, dollar value of the project, address, telephone number and email address. Information shall include but not be limited to:
1. Demonstrated experience with the populations to be served. If historically, your agency has never served the target population please explain how your organization has prepared to begin serving this population.
2. Demonstrated experience serving the proposed community areas. If historically, your agency has never served the target area please explain how your organization has prepared to begin serving this area.
3. Evidence of appropriate agency licenses, as applicable.
4. Evidence of a strong track record of service provision and administration.
5. If the proposed project has partners who will utilize grant funds, include a letter of collaboration from the partnering agency stating the nature of the partnership, that the partner has read the proposal and agrees to their stated role, and that the partner understands and accepts that all grant expenditures must comply with the requirements set forth in this RFP. (NOTE: Any proposed partners who receive grant funds are subject to the same provisions, including Federal provisions, as the contracted agency.
6. A description of the Proposer’s organizational readiness for program implementation and oversight, and capacity for administering the contract.
9. Section H: Key Personnel (Page limit: as many pages as needed): Proposers must identify the key personnel that will be committed to the project including their roles and qualifications. Please include resumes for each key individual.
6.0 PROPOSAL EVALUATION:
1. Submittal Opening Results: It is understood by all Respondents that the Request for Qualifications results will be a matter of public record. When HACC has concluded all evaluations, has chosen a final top-rated Respondent(s), has completed the award and is ready to issue such results, HACC shall notify the successful Respondent(s).
6.1.1 All proposal documents submitted by the Respondents are generally a matter of public record and are subject to disclosure.
6.2 Evaluation: Each proposal submittal will be evaluated based upon the following information and criteria listed previously:
6.2.1 Initial Evaluation-Responsiveness: Each proposal received will first be evaluated for responsiveness (i.e., meeting the minimum requirements as stated in the RFP).
6.2.2 Evaluation-Responsibility: HACC shall, using the criteria established below, evaluate each of the Qualifications submitted in response to this RFP to determine the Respondent’s level of responsibility. HACC will consider capabilities or advantages that are clearly described in the proposal that may be confirmed by oral presentations, site visits, demonstrations, and references contacted by HACC. All Qualifications would be evaluated as to their overall value to HACC.
6.2.3 Evaluation Criteria: The evaluation panel will use the following rating criteria to evaluate each of the required elements specified in the proposal.
|Criteria |Maximum Points |
|Section C: Application Category, Needs Statement, and Target Population |15 Points |
|Section D: Proposed Service Plan and Implementation Schedule |35 Points |
|Section E: Expected Outcomes |15 Points |
|Section F: Budget and Budget Narrative |15 Points |
|Section G: Qualifications of the Proposer |20 Points |
|TOTAL |100 POINTS |
6.2.5 Competitive Range: Presentations for Respondents within the competitive range may be required and shall be a factor in the award if utilized.
6.3 Irregular Proposal Submittal: A proposal shall be considered irregular for any one of the following reasons, any one or more of which may, at HACC's discretion, be reason for rejection:
6.3.1 If the forms furnished by HACC are not used or are altered or if the proposed costs are not submitted as required and where provided.
6.3.2 If all requested completed attachments do not accompany the proposal submittal.
6.3.3 If there are unauthorized additions, conditional or alternate proposals, or irregularities of any kind which may tend to make the proposal incomplete, indefinite or ambiguous as to its meaning or give the Respondent submitting the same a competitive advantage over other Respondents.
4. If the Respondent adds any provisions reserving the right to accept or reject any award or to enter into a contract pursuant to an award.
6.4 Disqualification of Respondents: Any one or more of the following shall be considered as sufficient for the disqualification of a prospective Respondent and the rejection of his/her proposal:
1. Evidence of collusion among prospective Respondents.
2. More than one proposal for the same work from an individual, firm, or corporation under the same or different name(s).
6.5.3 Lack of competency, lack of experience and/or lack of adequate machinery, plant and/or other resources.
6.5.4 Unsatisfactory performance record as shown by past work for HACC or with any other local, state or federal agency, judged from the standpoint of workmanship and progress.
6.5.5 Incomplete work, which in the judgment of HACC, might hinder or prevent prompt completion of additional work, if awarded.
6.5.6 Failure to pay or satisfactorily settle all bills due on former contracts still outstanding at the time of letting.
6.5.7 Failure to comply with any qualification requirements of HACC.
6.5.8 Failure to list, if required, all subcontractors (if subcontractors are allowed by HACC) who will be employed by the successful Respondent(s) to complete the work of the proposed contract.
9. As required by the RFP documents, failure of the successful Respondent to be properly licensed by the City, County and/or the State of Illinois and/or to be insured by a commercial general liability policy and/or worker's compensation policy and/or business automobile liability policy, if applicable.
6.5.10 Any reason to be determined in good faith, to be in the best interests of HACC.
6.6 Award of Proposal(s): The award shall be to the top-rated responsive and responsible Respondent(s) determined by the evaluation process, presentations (if requested), negotiations, Best & Final Offers (BAFO), HACC’s business needs and, Respondent’s ability to deliver within budget the specified items in a timely manner. HACC reserves the right to award in any manner that best serves the business needs of the agency. Respondents shall be recommended for award if in HACC’s opinion, it is in the best interest to accept the proposal after preferences for Section 3 business concerns are considered.
7.0 Insurance: If a Respondent receives an award and unless otherwise waived in the Contract, the Contractor will be required to provide an original Certificate of Insurance confirming the following minimum requirements to HACC within 10 days of contract signature:
|Professional Liability |Required Limits |
|HACC and its affiliates must be named as an Additional Insured and be a Certificate Holder. Must|$1,000,000 plus E & O of |
|include Errors and Omissions coverage. |$1,000,000 per occurrence |
| |$2,000,000 aggregate |
|Business Automobile Liability |Required Limits |
|HACC and its affiliates must be named as an additional insured and as the certificate holder. |$500,000 combined single limit, per occurrence |
|Must include both owned and un-owned vehicles. | |
|Workers Compensation and Employer’s Liability |Required Limits |
|Workers’ Compensation coverage is Statutory and has no pre-set limits. Employer’s Liability | |
|limit is $500,000 A waiver of Subrogation in favor of HACC must be included in the Workers’ |Statutory |
|Compensation policy. |$500,000 |
|HACC and its affiliates must be named as a Certificate Holder. | |
|Commercial General Liability |Required Limits |
|This is required for any vendor who will be doing hands on work at HACC properties. HACC and its|$1,000,000 per accident |
|affiliates must be named as an Additional Insured and as the Certificate Holder. |$2,000,000 aggregate |
8.0 Right to Protest:
1. Rights: Any prospective or actual Respondent, offeror, or contractor who is allegedly aggrieved in connection with the solicitation of a proposal or award of a contract, shall have the right to protest. Such right only applies to deviations from laws, rules, regulations, or procedures. Disagreements with the evaluators’ judgments as to the number of points scored are not reasons for an appeal. An alleged aggrieved protestant claiming this right is hereby informed that these regulations do not provide for administrative appeal as a matter of right for that alleged aggrieved protestant.
1. Definition: An alleged aggrieved “protestant” is a prospective Respondent or Respondent who feels that he/she has been treated inequitably by HACC and wishes HACC to correct the alleged inequitable condition or situation.
2. Eligibility: To be eligible to file a protest with HACC pertaining to an RFP or contract, the alleged aggrieved protestant must have been involved in the RFP process in some manner as a prospective Respondent (i.e. recipient of the RFP documents) when the alleged situation occurred. HACC has no obligation to consider a protest filed by any party that does not meet these criteria.
8.1.3 Procedure: Any actual or prospective contractor may protest the solicitation or award of a contract for material violation of HACC’s procurement policy. Any protest against a HACC solicitation must be received before the due date for receipt of proposals and any protest against the award of a contract must be received within ten calendar days after contract award or the protest will not be considered.
All protests must be in writing and submitted to the Executive Director (ED) for a written decision. The ED shall make a recommendation to the Contracting Officer who shall issue a written decision and findings to the Contractor within 30 days from receipt of the written protest. This decision is then appealable to the Board of Commissioners within 30 days of receipt of the written decision. Appeals which are not timely filed will not be considered and the decision becomes final. All appeals shall be marked and sent to the address as listed in the example below:
APPEAL OF RFP
(SERVICES FOR SOUTH SUBURBAN YOUTH: SELECT COMMUNITIES)
Housing Authority Cook County
Attn: Executive Director
175 West Jackson Blvd., Suite 350
Chicago, Illinois 60604
9.0 Disputes under the contract:
9.1 Procedures: In addition to the procedures in the attached HUD documents, in the event that any matter, claim, or dispute arises between the parties, whether or not related to this RFP or any resulting contract, both parties shall be subject to nonbinding mediation if agreed to by both parties within thirty days of either party making a request in writing. The parties further agree that if the matter, claim or dispute is not settled during mediation, it shall thereafter be submitted to binding arbitration. The parties shall make a good-faith attempt to mutually agree upon an arbitrator. If the parties cannot mutually agree upon an arbitrator after reasonable efforts have been exerted, then the matter, claim or dispute shall be submitted to the American Arbitration Association for final and binding arbitration. Unless extended by the arbitrator for good cause shown, the final arbitration hearing shall begin no later than two months after selection of the arbitrator.
10.0 Additional Considerations:
10.1 Required Permits and Licenses: Unless otherwise stated in the RFP documents, all Federal, State or local permits and licenses which may be required to provide the services ensuing from any award of this RFP, whether or not they are known to either the HACC or the Respondents at the time of the proposal submittal deadline or the award, shall be the sole responsibility of the successful Respondent and all offers submitted by the Respondent shall reflect all costs required by the successful Respondent to procure and provide such necessary permits or licenses.
10.2 Taxes: HACC, as a governmental entity, is exempt from Illinois State Sales and Use Taxes and Federal Excise Taxes. A letter of Tax Exemption will be provided upon request.
10.3 Government Standards: It is the responsibility of the prospective Respondent to ensure that all items and services proposed conform to all local, state and federal law concerning safety (OSHA) and environmental control (EPA and Bexar County Pollution Regulations) and any other enacted ordinance, code, law or regulation. The successful Respondent shall be responsible for all costs incurred for compliance with any such possible ordinance, code, law or regulation. No time extensions shall be granted or financial consideration given to the successful Respondent for time or monies lost due to violations of any such ordinance, code, law or regulations that may occur.
10.4 Delivery: All costs submitted by the successful Respondent shall reflect the cost of delivering the proposed items and/or services to the locations specified within the RFP documents or within the Agreement. All costs in the proposal submittal shall be quoted as FOB Destination, Freight Prepaid and allowed unless otherwise stated in this RFP.
1. The successful Respondent agrees to deliver to the designated location(s) on or before the date as specified in the finalized contract. Failure to deliver on or before the specified date constitutes an event of default by the successful Respondent. Upon default, the successful Respondent agrees that HACC may, at its option, rescind the finalized contract under the termination clause herein and seek compensatory damages as provided by law.
10.5 Work on HACC Property: If the successful Respondent’s work under the contract involves operations on HACC premises, the successful Respondent shall take all necessary precautions to prevent the occurrence of any injury to persons or property during the progress of such work and shall immediately return said property to a condition equal to or better than the existing condition prior to the commencement of work at the site at no cost to HACC.
10.6 Estimated Quantities: Unless otherwise indicated, the quantities shown are estimates only and are used to evaluate the responses and may or may not reflect anticipated purchases. HACC does not guarantee any minimum purchase quantity.
10.7 Warranty: All goods and/or services installed or provided under any contract resulting from this RFP must include a minimum of a two (2) year warranty including labor and installation plus a minimum of a two (2) year Warranty from the Contractor for labor, materials, and installation except as specified otherwise herein. This period will begin on the date of “FINAL” acceptance by HACC.
10.7.1 The services provided under the contract shall conform to all information contained within the RFP documents as well as applicable Industry Published Technical Specifications, and if one of the above mentioned Specifications contains more stringent requirements than the other, the more stringent requirements shall apply.
10.7.2 In addition to all other warranties, the warranty shall include the warranty for merchantability and the warranty of fitness for a particular purpose.
10.7.3 Assignment of Warranty: Contractor shall assign any warranties and guarantees to HACC and provide the Contractor’s Warranty for Labor and Installation to HACC along with all Manufacturers’ Warranty documents.
10.8 Official, Agent and Employees of the HACC Not Personally Liable: It is agreed by and between the parties hereto that in no event shall any official, officer, employee, or agent of the HACC in any way be personally liable or responsible for any covenant or agreement herein contained whether expressed or implied, nor for any statement, representation or warranty made herein or in any connection with this agreement.
10.9 Subcontractors: Unless otherwise stated within the RFP documents, the successful Respondent may not use any subcontractors to accomplish any portion of the services described within the RFP documents or the contract without the prior written permission of HACC. Any substitution of subcontractors must be approved in writing by HACC prior to their engagement.
10.10 Salaries and Expenses Relating to the Successful Respondents Employees: Unless otherwise stated within the RFP documents, the successful Respondent shall pay all salaries and expenses of, and all Federal, Social Security taxes, Federal and State Unemployment taxes, and any similar taxes relating to its employees used in the performance of the contract. The successful Respondent further agrees to comply with all Federal, State and local wage and hour laws and all licensing laws applicable to its employees or other personnel furnished under this agreement.
10.11 Independent Contractor: Unless otherwise stated within the RFP documents or the contract, the successful Respondent is an independent contractor. Nothing herein shall create any association, agency, partnership or joint venture between the parties hereto and neither shall have any authority to bind the other in any way.
10.12 Severability: If any provision of this agreement or any portion or provision hereof applicable to any particular situation or circumstance is held invalid, the remainder of this agreement or the remainder of such provision (as the case may be), and the application thereof to other situations or circumstances shall not be affected thereby.
10.13 Waiver of Breach: A waiver of either party of any terms or conditions of this agreement in any instance shall not be deemed or construed as a waiver of such term or condition for the future, or of any subsequent breach thereof. All remedies, rights, undertakings, obligations, and agreements contained in this agreement shall be cumulative and none of them shall be in limitation of any other remedy, right, obligation or agreement of either party.
10.14 Time of the Essence: Time is of the essence as to each provision in which a timeframe for performance is provided in this RFP. Failure to meet these timeframes may be considered a material breach, and HACC may pursue compensatory and/or liquidated damages under the contract.
15. Limitation of Liability: In no event shall HACC be liable to the successful Respondent for any indirect, incidental, consequential or exemplary damages.
16. Indemnity: The Contractor covenants and agrees to FULLY INDEMNIFY and HOLD, HARMLESS HACC and employees, officers, directors, volunteers and representatives of HACC, individually and collectively, from and against any and all costs, claims, liens, damages, losses, expenses, fees, fines, penalties, proceedings, actions demands, causes of action, liability and suits of any kind and nature, including but not limited to, personal or bodily injury, death and property damage, made upon HACC directly or indirectly arising out of, resulting from or related to Contractor’s activities under this contract, including any acts or omissions of Contractor, any agent, officer, director, representative, employee, consultant or subcontractor of Contractor, and their respective officers, agents employees, directors and representatives while in the exercise of performance of the rights or duties under this Agreement. The indemnity provided for in this paragraph shall not apply to any liability resulting from the negligence of HACC, its officers or employees, in instances where such negligence causes personal injury, death, or property damage. IN THE EVENT Contractor AND HACC ARE FOUND JOINTLY LIABLE BY A COURT OF COMPETENT JURISDICTION, LIABILITY SHALL BE APPORTIONED COMPARATIVELY IN ACCORDANCE WITH THE LAWS FOR THE STATE OF ILLINOIS, WITHOUT, HOWEVER, WAIVING ANY GOVERNMENTAL IMMUNITY AVAILABLE TO HACC UNDER ILLINOIS LAW AND WITHOUT WAIVING ANY DEFENSES OF PARTIES UNDER ILLINOIS LAW. The provisions of this INDEMNIFICATION are solely for the benefit of the parties hereto and not intended to create or grant any rights, contractual or otherwise, to any other person or entity.
10.17 Public/Contracting Statutes. HACC is a governmental entity as that term is defined in the procurement statutes. HACC and this RFP and all resulting contracts are subject to federal, state and local laws, rules, regulations and policies relating to procurement.
10.18 Termination: Any contract resulting from this RFP may be terminated under the following conditions:
10.18.1 Consent: By mutual consent of both parties, and
10.18.2 Termination for Cause: As detailed within the attached HUD Forms.
10.18.2.1 HACC may terminate any and all contracts for default at any time in whole or in part, if the contractor fails to perform any of the provisions of any contract, so fails to pursue the work as to endanger performance in accordance with the terms of the RFP or any resulting contracts, and after receipt of written notice from HACC, fails to correct such failures within seven (7) days or such other period as HACC may authorize or require.
10.18.2.1.1 Upon receipt of a notice of termination issued from HACC, the Contractor shall immediately cease all activities under any contract resulting from this RFP, unless expressly directed otherwise by HACC in the notice of termination.
10.18.2.1.2 HACC may terminate any contract resulting from this RFP in whole or in part, if funding is reduced, or is not obtained and continued at levels sufficient to allow for the expenditure.
10.18.3 Termination for Convenience: In the sole discretion of the Contracting Officer, HACC may terminate any and all contracts resulting from this RFP in whole or part upon fourteen days prior notice to the Contractor when it is determined to be in the best interest of HACC.
10.18.4 The rights and remedies of HACC provided under this section are not exclusive and are in addition to any other rights and remedies provided by law or under any contract.
10.18.5 In the event the resulting contract from this RFP is terminated for any reason, or upon its expiration, HACC shall retain ownership of all work products including deliverables, source and object code, microcode, software licenses, and documentation in whatever form that may exist. In addition to any other provision, the Contractor shall transfer title and deliver to HACC any partially completed work products, deliverables, source and object code, or documentation that the Contractor has produced or acquired in the performance of any resulting contract.
10.19 Examination and Retention of Contractor’s Records: HACC, HUD, or Comptroller General of the United States, or any of their duly authorized representatives shall, until three years after final payment under all contracts executed as a result of this RFP, have access to and the right to examine any of the Contractor’s directly pertinent books, documents, papers, or other records involving transactions related to this contract for the purpose of making audits, examinations, excerpts and transcriptions.
10.20 Inter-local Participation
10.20.1 HACC may from time to time enter into Inter-local Cooperation Purchasing Agreements with other governmental entities or governmental cooperatives (hereafter collectively referred to as “Entity” or “Entities”) to enhance HACC’s purchasing power. At HACC’s sole discretion and option, HACC may inform other Entities that they may acquire items listed in this RFP. Such acquisition(s) shall be at the prices stated herein, and shall be subject to Contractor’s acceptance.
10.20.2 In no event shall HACC be considered a dealer, remarketer, agent or other representative of Contractor or Entity. Further, HACC shall not be considered and is not an agent; partner or representative of the Entity making purchases hereunder, and shall not be obligated or liable for any such order.
10.20.3 Purchase orders shall be submitted to Contractor by the individual Entity.
10.20.4 HACC shall not be liable or responsible for any obligation, including but not limited to, payment and for any item or service ordered by an Entity, other than HACC.
10.21 Right to data and Patent Rights: In addition to other ownership & use rights HACC shall have exclusive ownership of all, proprietary interest in, and the right to full and exclusive possession of all information, materials, documents, software, and all electronic data discovered or produced by Contractor and/or subcontractor(s) pursuant to the terms of any resulting contract, including but not limited to, reports, memoranda or letters concerning the research and reporting tasks of any resulting contract. Both parties agree to comply with HUD Bulletin 909-23, which is the Notice of Assistance Regarding Patent and Copyright Infringement.
10.22 Lobbying Certification: By proposing to do business with HACC or by doing business with HACC, each Respondent certifies the following:
10.22.1 No Federal appropriated funds have been paid or will be paid, by or on behalf of the Respondent, to any person for influencing or attempting to influence an officer or employee of Congress, or an employee of a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan or cooperative agreement.
10.22.2 If any funds other than Federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form “Disclosure Form to Report Lobbying’, in accordance with its instructions.
10.22.3 The successful Respondent shall require that the language of this certification be included in the award documents for all sub-awards at all tiers, (including but not limited to subcontractors, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.
10.22.4 This clause is a material representation of fact upon which reliance will be placed when the award is made or a contract is entered into. The signing of a contract or acceptance of award certifies compliance with this certification, which is a prerequisite for making or entering into a contract, which is imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certifications shall be subject to civil penalty of not less than $10,000.00 and not more than $100,000.00 for each such failure.
10.23 Applicable Statutes, Regulations & Orders: Contractors shall comply with all statutes, rules, regulations, executive orders affecting procurements by Housing Authorities including but not limited to:
10.23.1 Executive Order 11246
10.23.2 Executive Order 11063
10.23.3 Copeland “Anti-Kickback” Act (18 USC 874)
10.23.4 Davis Bacon Act (40 USC 276a-276a-7)
10.23.5 Clean Air & Water Acts (42 USC 1857(h); 33 USC 1368)
10.23.6 Contract Work Hours & Safety Standards Act (40 USC 327-330)
10.23.7 Energy Policy & Conservation Act (PL 94-163, 89 STAT 871)
10.23.8 Civil Rights Act of 1964, Title VI (PL 88-352)
10.23.9 Civil Rights Act of 1968, Title VIII (PL 90-284 Fair Housing Act)
10.23.10 Age Discrimination Act of 1975
10.23.11 Anti-Drug Abuse Act of 1988 (42 USC 11901 et. Seq.)
10.23.12 HUD Information Bulletin 909-23
10.23.13 Immigration Reform & Control Act of 1986
10.23.14 Fair Labor Standards Act (29 USC 201, et. Seq.)
10.24 Additional Information: Each provision of law and each clause, which is required by law to be inserted in this RFP or any contract, shall be deemed to have been inserted herein, and this RFP and any resulting contract shall be read and enforced as though such provision or clause had been physically inserted herein. If, through mistake or otherwise, any such provision is not inserted or is inserted incorrectly, this agreement shall forthwith be physically amended to make such insertion or correction upon the application of either party. The fore-mentioned statutes, regulations and executive orders are not intended as an indication that such statute, regulation or executive order is necessary applicable nor is an omission of such statute, regulation or executive order intended to indicate that it is not applicable.
10.25 Conflicting Conditions: In the even there is a conflict between the documents comprising this RFP and any resulting contracts, the following order of precedence shall govern: (1) the more restrictive terms of either: any and all attached HUD forms and the term/conditions in the body of any resulting contract; (2) the RFP; and (3) Contractor’s Response. In the event that a conflict exists between any state statute or federal law the most restrictive terms shall apply.
10.26 Contract Form: HACC will not execute a contract on the successful Respondent’s form. Contracts will only be executed on HACC’s form. By submitting a proposal, the successful Respondent agrees to this condition. However, HACC will consider any contract clauses that the Respondent wishes to include therein, but the failure of HACC to include such clauses does not give the successful Respondent the right to refuse to execute HACC’s contract form. It is the responsibility of each prospective Respondent to notify HACC, in writing, with the proposal submittal of any contract clauses that he/she is not willing to include in the final executed contract. HACC will consider such clauses and determine whether or not to amend the Contract.
10.27 Force Majeure: Neither HACC nor Contractor shall be held responsible for delays nor default caused by fire, flood, riot, acts of God or war where such cause was beyond, respectively, HACC or Contractor’s reasonable control. Contractor shall make all reasonable efforts to remove or eliminate such a cause of delay or default and shall, upon the cessation of the cause, diligently pursue performance of its obligations under this Agreement.
Appendix I Budget Form
Appendix II Budget Narrative
Appendix III Budget Guidance
Appendix IV Agency Designated Contacts and Proposed Program Service Area(s)
Appendix V Compliance Policy
Appendix VI Checklist
Appendix VII Identification of Subcontractor/Supplier/Subconsultant Form
Appendix VIII Economic Disclosure Statement Forms
Appendix I Budget Form
Proposers are required to submit an itemized project budget using the attached Appendix I: Budget Form. The budget must be submitted in both hard copy and electronic formats. You are advised to consult Appendix III: Budget Guidance as you prepare your Budget.
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|Appendix I: Budget Form |
|Applicants are required to complete and submit this Budget Form. Please refer to Appendix III: Budget Guidance for instructions regarding appropriate expenditures for each budget category. Enter the |
|grant funds you are requesting under "Requested HACC Grant Funds.” The sum of your "Requested HACC Grant Funds" cannot exceed the funding amount specified in this RFP and your proposed budget must cover |
|the full 12-month funding period. Please note that if you are allocating grant funds toward Contractors, Consultants or Partnering Agencies you must also submit the Contractor/Partner Budget Line Item |
|Detail form for each of these entities. Indirect costs may not exceed 10% of the award. The 10% cap includes the collective sum of the Proposer’s indirect costs AND the indirect costs of any contractors |
|or partners. Enter any additional contributions your agency is making to the proposed project (encouraged - but not required) under "Applicant Share." |
|Applicant Organization Name: | |
|Project Name: | |
|Budget Contact Person: | |Phone: | |Email: | |
| |
| |
| | |Annual Rate |% Time | | | |
|Name (Indicate if Salaried or Hourly) |Position Title |(if Salaried) |(if Salaried) |Line Item Cost |Requested HACC Grant|Applicant Share |
| | |Hourly Rate |# Hours | |Funds | |
| | |(if Hourly) |(if Hourly) | | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
|Total Personnel |$0.00 |$0.00 |$0.00 |
|FRINGE BENEFITS |
|Name |Title |Cost Allocated to |Fringe Rate (%) |Line Item Cost |Requested HACC Grant|Applicant Share |
| | |Project | | |Funds | |
|PERSONNEL | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
|Total Fringe Benefits |$0.00 |$0.00 |$0.00 |
|TRAVEL |
|Appendix I: Budget Form |
|Local Travel |
|Purpose |Staff Name |Mileage Rate |No. Miles |Line Item Cost |Requested HACC Grant|Applicant Share |
| | | | | |Funds | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
|Out of Town Travel |
|Purpose and Person(s) Traveling |Airfare |Lodging |Per Diem |Line Item Cost |Requested HACC Grant|Applicant Share |
| | | | | |Funds | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
|Total Travel |$0.00 |$0.00 |$0.00 |
|EQUIPMENT |
|Item |Purpose |Unit Cost |Quantity |Line Item Cost |Requested HACC Grant|Applicant Share |
| | | | | |Funds | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
|Total Equipment |$0.00 |$0.00 |$0.00 |
|MATERIALS & SUPPLIES |
|Item |Purpose |Unit Cost |Quantity |Line Item Cost |Requested HACC Grant|Applicant Share |
| | | | | |Funds | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
| | | | |$0.00 | | |
|Total Materials & Supplies |$0.00 |$0.00 |$0.00 |
|Appendix I: Budget Form |
|CONSULTANTS/CONTRACTS (NOTE: A COMPLETED "CONTRACTOR/PARTNER BUDGET LINE ITEM DETAIL" FORM MUST BE COMPLETED AND INCLUDED FOR EACH CONTRACTOR/PARTNER AGENCY WHO WILL HAVE A SUBSTANTIAL ROLE IN THE |
|PROJECT AND WHO IS ALLOCATED A PORTION OF GRANT FUNDS.) MULTIPLE COPIES OF THE FORM ARE INCLUDED HERE - CLICK THE "CONTRACTOR BUDGET DETAIL" TABS OF THIS WORKBOOK TO ACCESS THE FORM. |
|Description of Services to be Provided |Consultant or Contractor/Partner Agency |Hourly Rate |Budgeted Hours |Line Item Cost |Requested HACC Grant|Applicant Share |
| | | | | |Funds | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
|Total Consultants/Contracts |$0.00 |$0.00 |$0.00 |
|OTHER DIRECT COSTS |
|Item |Purpose |Unit Cost |Quantity |Line Item Cost |Requested HACC Grant|Applicant Share |
| | | | | |Funds | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
|Total Other Direct Costs |$0.00 |$0.00 |$0.00 |
| |
|TOTAL DIRECT COSTS |$0.00 |$0.00 |$0.00 |
| |
|INDIRECT COST (NOTE: Indirect Costs Cannot Exceed 10% of the Grant Award. This 10% limit includes indirect costs budgeted by contractors/consultants.) |
|Indirect Cost Elements |Explanation of How Costs are Calculated |Line Item Cost |Requested HACC Grant|Applicant Share |
| | | |Funds | |
| | | | | |
|TOTAL INDIRECT COSTS |$0.00 |$0.00 |$0.00 |
| |
| |Requested HACC Grant|Applicant Share |
| |Funds | |
|GRAND TOTAL |$0.00 |$0.00 |
THIS FORM MUST BE COMPLETED FOR EACH PARTNER UTILIZED
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$0.00
Appendix II: Budget Narrative Form
(Template Attached as MS Word file)
• Proposers are required to submit a detailed Budget Narrative using the Appendix II: Budget Narrative Form on the following pages.
• Please ensure that you follow the instructions on the form.
• You are also advised to consult Appendix III: Budget Guidance as you prepare your Budget Narrative.
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The Budget Narrative is reviewed in conjunction with your Budget Form. It should serve to; a) justify your proposed expenditures, b) explain how the expenditures are related to your program, and c) explain how you arrived at the cost of each item. Each cost item entered on your Budget Form under the “Requested HACC Grant Funds” column should be thoroughly explained on this Budget Narrative Form. It is recommended that you provide calculations to illustrate how costs were determined.
|Applicant Organization Name: | | | |
|Project Name: | | | |
|Budget Contact Person: | |Phone: | |
|Contact Person’s Email: | | | |
NOTE: Please ensure that you provide sufficient detail to enable reviewers to understand your proposed expenditures. Cells are formatted to expand as you enter information.
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Appendix III: Budget Guidance
Use the Appendix III: Budget Guidance on the following pages to assist you in preparing your budget and budget narrative.
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Budget Guidance
(Revised February, 2018)
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It is critical that all costs charged to a grant are:
• APPLICABLE to the operation of the funded grant program (not to be used for other agency purposes);
• ALLOWABLE by HACC policy (as reflected in this document); and
• REASONABLE and NECESSARY for the implementation of the proposed project.
Any items that are not budgeted and approved are considered ineligible for reimbursement.
NOTE: HACC reserves the right to negotiate changes to the budget post award, to ensure that budgeted costs are aligned with the HACC’s Budget Guidance policy. To the extent possible, all negotiated changes will occur at the start of the contract period.
BUDGET LINE ITEMS: Explanation and Documentation
|Line Item |Explanation |Documentation to Support Expenditures |
| | |(If awarded, supporting documentation must be included with all |
| | |fiscal reports) |
|Personnel |The “Personnel ” category includes the salary and wage costs that will be paid to |Check copies / payroll registers / general ledger |
| |personnel who have an active role in the implementation or administration of your | |
| |program. This line item is applicable only to personnel who are on your agency’s | |
| |payroll. If they are not on your payroll they belong in either “Contract/Consultant” or | |
| |“Other.” Depending on the start-date and duration of budgeted personnel, you may need to| |
| |include pay raise estimates to ensure that your budget will have sufficient funds to | |
| |cover costs. Personnel costs may be budgeted based on a salary or an hourly rate. Use | |
| |of grant funds to pay stipends to personnel on the agency’s payroll is not allowed. Use| |
| |grant funds for staff bonuses is not allowed. | |
|Fringe Benefits |Budgeted costs for fringe benefits should be based on your agency’s standard policy. |Verification of fringe benefit rate (i.e. fringe rate schedule or |
| |Typical fringe costs include such items as social security, unemployment / worker’s |other documentation) or explanation of how fringes are calculated |
| |compensation, retirement, and health insurance and are typically applied as a percentage| |
| |of salary. Fringe benefit costs are not allowed for contractors. | |
|Travel |Travel expenses should be budgeted in accordance with your agency’s standard travel |Receipts |
| |policy. Local travel is allowable provided that it is directly related to the funded |Documentation illustrating that the travel was related to the funded |
| |program. Travel between a regular worksite/office and home is not reimbursable. Parking |project (i.e. project staff travel roster indicating departure and |
| |expenses are allowed but similar exclusions apply. For example, parking expenses |arrival locations and dates that corresponds with submitted receipts)|
| |incurred while traveling between program site locations is permitted, but parking | |
| |expenses associated with travel between home and a regular worksite/office are not | |
| |reimbursable. | |
| | | |
| |Out of town travel expenses related to attendance at conferences or training events are | |
| |allowed provided that the event is included and approved in the budget. In these | |
| |instances, grantees may be reimbursed for airfare, lodging, per diem, ground | |
| |transportation, and attendee fees. All proposed expenses should be itemized with clear | |
| |calculations illustrating how the costs were determined. | |
|Equipment |For the purposes of HACC grants, equipment is defined as any item of nonexpendable, |Purchase receipts, cancelled checks, bank statements |
| |tangible property that has a useful life of more than one year. The HACC does not follow| |
| |the federal definition that an item must have an acquisition cost that is equal to or | |
| |greater than $5,000 to be considered equipment. Examples of items typically budgeted | |
| |under equipment are computers, laptops, printers, peripherals, etc. | |
|Materials and Supplies |Typically, materials and supplies fall under two categories: office materials and |Purchase receipts, cancelled checks, bank statements |
| |supplies (consumable items such as paper, ink, filing supplies, etc. that staff assigned| |
| |to the project will use as part of day to day implementation and administration), and | |
| |program materials and supplies (consumable items that are required to carry out program | |
| |activities such as assessment materials or flip charts used by program staff, or items | |
| |used directly by program participants such as workbooks). Proposers may have additional | |
| |materials and supplies categories. An example would be staff development/training | |
| |materials. All costs should be itemized with calculations illustrating how the costs | |
| |were determined (i.e. unit costs, quantity, etc.) | |
|Consultants / Contracts |Any external individuals or partners that, under a formal agreement, will provide |Contractor itemized invoices with attached receipts |
| |services to your proposed project should be budgeted under the “Contract / Consultant” |Proof of payment to contractor (copy of checks or bank statements |
| |category. A copy of the formal agreement delineating the specific services to be |showing debited expenditure |
| |provided must be shared with HACC upon request. Any fees, travel, or other expenses the | |
| |contracted entity will incur should be itemized and included under this line item as | |
| |well. Fringe benefit costs and equipment costs are not allowed for | |
| |consultants/contractors. | |
|Other Direct Costs |Any items that do not fall within the above budget categories should be included under |Purchase receipts, cancelled checks |
| |“Other Direct Costs.” Following are examples of typical items. Do not budget indirect |For equipment leases: explanation indicating how the agency allocates|
| |costs under this category. Indirect costs must be budgeted under the “Indirect Costs” |lease costs by program |
| |line only. |Gift cards/transit cards require a tracking system that records card |
| |Stipends (i.e. participant stipends or stipends for the purpose of engaging family or |distribution: who issued the card to the participant, date of issue, |
| |community members). Stipends may not be used for agency personnel. |value of card, and signature of participant indicating receipt. HACC |
| |Event/Field Trip costs (i.e. one-time, event-specific costs such as rent and fees |reserves the right to deny reimbursement if agencies fail to keep |
| |associated with securing space, bus rental, admission fees, etc.) |distribution records. |
| |Printing costs include the production of flyers, newsletters, brochures, or any |Communication costs should be prorated if they are not 100% |
| |informational/ promotional materials related to the project. |attributable to the funded program. The allocation to the program |
| |Postage |must be explained. |
| |Equipment leases (i.e. a portion of the monthly lease/ service costs for a photocopier. |In addition to receipts, food costs should be supported with |
| |Costs need to be prorated according to a formula that clearly demonstrates what portion |documentation explaining the event for which the food was purchased, |
| |is attributable to the HACC-funded project. |the number of attendees, the purpose of the event and the audience in|
| |Client assistance (i.e. gift cards for emergency food or clothing, transit cards, etc.) |attendance. |
| |Program participant incentives (i.e. gift cards in small denominations not to exceed | |
| |$50, t-shirts, food, etc.) | |
| |Communications (i.e. phone, Internet, cellular, or WAN that is not encompassed under | |
| |“Indirect Costs”). | |
| |Food expenses are allowable provided they are incurred for an event or scheduled program| |
| |activity at which program participants are in attendance. Food costs in the absence of | |
| |program participants are not allowable. All food costs must be reasonable. If food is | |
| |purchased in conjunction with unrelated items, the items being charged to the grant must| |
| |be marked on the receipt. | |
|Indirect Costs |Indirect costs are considered to be any administrative or overhead expenses that are |Explanation of the agency’s method for prorating the allocation of |
| |attributable to multiple programs or functions across the agency. This means that any |indirect costs to the funded program. This explanation should be |
| |cost that is not exclusive to the funded program is considered an indirect cost and |included in the Budget Narrative. |
| |should be prorated to determine the portion that is allocable to the funded program. | |
| |Proposers must have a means for determining the allocation of indirect costs. For | |
| |example, indirect costs may be prorated based on the number of personnel (i.e. payroll | |
| |costs), square footage (i.e. rent, utilities, maintenance, etc.), or programs (i.e. | |
| |costs that are common to multiple programs may be allocated according to the number of | |
| |programs the agency operates). | |
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|Miscellaneous Unallowable |Expenditures not supported with appropriate documentation when submitted for |Not applicable. |
|Costs |reimbursement. Only properly documented expenditures will be processed for payment. | |
| |Expenditures that are normally allowable but unsupported with backup documentation will | |
| |be held until proper documentation is received. | |
| |Costs incurred before or after the contract period | |
| |Using funds to establish petty cash accounts | |
| |Stipends for staff and staff bonuses | |
| |Finance charges/Late fees associated with credit cards or other accounts | |
| |Bar charges/Alcohol | |
| |Construction/Renovation | |
| |Lobbying, political contributions, legislative liaison activities | |
| |Parking tickets or other fees resulting from any violation | |
| |Organized fundraising, including salaries of persons while engaged in these activities | |
| |Fringe benefits for consultants and others providing services on a contractual basis | |
| |Major equipment purchases and/or equipment purchases by sub-contractors | |
| |Goods or services for personal use by agency staff | |
| |Equipment, peripherals, or cellular phones for personnel who do not have a direct role | |
| |in the HACC-funded program | |
| |All unallowable costs as previously stated in this budget guidance. | |
Appendix IV
Agency Designated Contacts and Proposed Program Service Areas (Template attached as MS Word file)
(THIS FORM MUST BE INCLUDED WITH YOUR PROPOSAL SUBMISSION)
Agency Designated Contacts
Following determination of award and upon the final execution of the contract, the issuing department will contact the agency to schedule an initial orientation meeting. This meeting will cover administrative procedures associated with the programmatic and fiscal management of the funded project. Please complete this form and include it with your submission so that, if awarded, the issuing department knows who the appropriate program and fiscal contacts are for your agency.
Agency Name: [Type text]
Agency Address: [Type text]
Agency Program Contact: [Type text]
Agency Program Contact Title: [Type text] Agency Program Contact Address: [Type text] Contact Phone: [Type text]
Contact Email: [Type text]
Agency Fiscal Contact: [Type text]
Agency Fiscal Contact Title: [Type text] Agency Fiscal Contact Address: [Type text] Contact Phone: [Type text]
Contact Email: [Type text]
Program Service Area(s)
Please indicate the service area(s) the proposed program will serve. Indicate both the neighborhoods that will be served and the corresponding zip codes that will be served.
|PROPOSED PROGRAM SERVICE AREAS BY NEIGHBORHOODS AND ZIP CODE |
|Please indicate the applicable neighborhoods for your proposed program service area(s) in the appropriate cell. Also indicate the corresponding zip |
|codes served by each program service area. |
|Neighborhood(s) to be served by Proposed Program |Corresponding Zip Code(s) to be served by Proposed Program |
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Appendix V:
Compliance Policy for Grant Recipients
Overview
The HACC is charged with ensuring that programs and services supported by grant funds meet minimal quality and ethical standards. This includes monitoring performance relative to the grantee’s adherence to: a) HACC guidelines, b) contractual obligations as specified in the contractual grant award, and c) following the approved program plan and budget. It also includes monitoring to ensure that programs and services are delivered in a manner that ensures the safety, respect, and highest level of success for program participants.
Determination of Non-Compliance
Based on the HACC’s assessment of multiple factors over the course of the contract period, a grantee may be designated “non-compliant” if situations arise where the grantee is determined to be in non-compliance with two or more of these factors and fails to take corrective action after receiving formal notification from the HACC. The following factors are monitored to determine that grantees are meeting minimal standards.
|Factor |Minimal Standard |Determination of Non-Compliance |
|Responsiveness |The grantee is required to respond to the HACC in each|The grantee displays a pattern of unresponsiveness by either |
| |instance where the HACC is requesting information or |failing to communicate or communicating incomplete or |
| |requiring action on the part of the grantee. |inaccurate information. |
| | |The grantee displays a pattern of failure to follow up on |
| | |action items. |
| | |The grantee displays a pattern of failing to meet critical |
| | |deadlines or requires repeated coaxing to respond. |
|Scope of Work |The grantee is required to adhere to the approved |The agency is not following the approved scope of services per|
| |scope of work as reflected in the grantee’s contract |its contract with the HACC. |
| |or in a subsequent approved revision of the agreed |The agency has changed the scope of work without seeking HACC |
| |upon scope. |approval. |
| | |The agency indicates that they are unable to perform the scope|
| | |of work per its contract. |
|Budget and Expenditure of |The grantee is required to adhere to the approved |The agency is spending grant funds on items that are not | |
|Grant Funds |budget as reflected in the grantee’s contract or in a |included in the approved budget. | |
| |subsequent approved budget revision. |The agency has changed the budget without seeking HACC | |
| | |approval. | |
| | |The agency significantly under-spent grant funds (i.e. more | |
| | |than 10% of the grant remains unexpended at the close of the| |
| | |contract period. | |
| | |The agency submits unallowable expenses more than once. | |
| | |The agency fails to return unspent funds. | |
|Reporting |The grantee is required to follow a set reporting | |The agency is delinquent in the submission of programmatic| |
| |schedule which is communicated to the grantee upon | |or fiscal reports without communication with the HACC. | |
| |award. | |Delinquency in reporting is defined as follows: The | |
| | | |grantee has not submitted a report within seven days | |
| |The grantee is also expected to comply with any | |beyond the due date and the grantee has neither offered an| |
| |additional reporting requirements that may arise over | |explanation nor been approved for an extension. | |
| |the course of the contract period. | |The agency’s reports lack sufficient content. | |
| | | |The agency is not reporting on its proposed and approved | |
| | | |outcome measures. | |
Consequences of Non-Compliant Determination
If a grantee’s performance is determined to be below minimal standards, the HACC will inform the grantee and offer assistance toward corrective action. If the grantee fails to make corrective actions the HACC may designate the grantee as “non-compliant.”
In the event that an organization was designated as “non-compliant” and subsequently applies for future funding, the HACC may consider this designation and past performance in determining whether to award the agency a subsequent grant.
Appendix VI: RFP Proposal Requirement Checklist
Per Section 5 (Proposal Requirements) in the RFP, please be sure that your proposal submission addresses response requirements outlined in Section A through M of the aforementioned RFP. Please be sure to adhere to the specific page allotment of each section.
Proposals must be organized, must adhere to maximum page allotment, font, and spacing requirements, and must include the following information:
Section A: Cover Letter (1 page maximum)
• Section B: Executive Summary & Organization Chart (3 pages maximum)
• Section C: Description of Problem and Target Population (3 pages maximum)
• Section D: Proposed Program & Implementation Schedule (4 pages maximum)
• Section E: Expected Outcomes (2 pages maximum)
• Section F: Budget and Budget Narrative (use the provided templates)
• Section G: Qualifications of the Proposer (3 pages maximum)
• Section H: Key Personnel (as many pages as needed)
• Appendix I: Budget Form (attached as Excel File)
• Appendix II: Budget Narrative Form (attached as MS Word file)
• Appendix IV: Agency Designated Contacts and Proposed Program Service Area(s) Form (attached as MS Word file)
• Appendix VII: Identification of Subcontractor/Supplier/Subconsultant
Appendix VII
Identification of Subcontractor, Supplier, Subconsultant Form
Housing Authority of Cook County
Identification of Subcontractor/Supplier/Subconsultant Form
The Bidder/Proposer/Respondent (“the Contractor”) will fully complete and execute and submit an Identification of Subcontractor/Supplier/Subconsultant Form (“ISF”) with each Bid, Request for Proposal, and Request for Qualification. The Contractor must complete the ISF for each Subcontractor, Supplier or Subconsultant which shall be used on the Contract. In the event that there are any changes in the utilization of Subcontractors, Suppliers or Subconsultants, the Contractor must file an updated ISF.
| |Date: |
|Bid/RFP/RFQ No.: | |
| |Contract Title: |
|Total Bid or Proposal Amount: | |
| |Subcontractor/Supplier/ Subconsultant to be added or substitute: |
|Contractor: | |
|Authorized Contact for Contractor: |Authorized Contact for Subcontractor/Supplier/ Subconsultant: |
|Email Address (Contractor): |Email Address (Subcontractor): |
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|Company Address (Contractor): |Company Address (Subcontractor): |
|City, State and Zip (Contractor): |City, State and Zip (Subcontractor): |
|Telephone and Fax (Contractor) |Telephone and Fax (Subcontractor) |
|Estimated Start and Completion Dates (Contractor) |Estimated Start and Completion Dates (Subcontractor) |
Note: Upon request, a copy of all written subcontractor agreements must be provided to the OCPO.
|Description of Services or Supplies |Total Price of Subcontract for Services |
| |or Supplies |
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The subcontract documents will incorporate all requirements of the Contract awarded to the Contractor as applicable. The subcontract will in no way hinder the Subcontractor/Supplier/Subconsultant from maintaining its progress on any other contract on which it is either a Subcontractor/Supplier/Subconsultant or principal contractor. This disclosure is made with the understanding that the Contractor is not under any circumstances relieved of its abilities and obligations, and is responsible for the organization, performance, and quality of work. This form does not approve any proposed changes, revisions or modifications to the contract approved MBE/WBE Utilization Plan. Any changes to the contract’s approved MBE/WBE/Utilization Plan must be submitted to the Office of the Contract Compliance.
Contractor
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Name
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Title
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Prime Contractor Signature Date
Appendix VIII:
Economic Disclosure Statement Forms
HOUSING AUTHORITY OF COOK COUNTY ECONOMIC DISCLOSURE STATEMENT
AND EXECUTION DOCUMENT INDEX
|Section |Description |Pages |
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|1 |Instructions for Completion of EDS |EDS i - ii |
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|2 |Certifications |EDS 1– 2 |
| |Economic and Other Disclosures, Affidavit of Child Support Obligations, | |
|3 |Disclosure of Ownership Interest and Familial Relationship Disclosure Form |EDS 3 – 12 |
| | | |
|4 |Cook County Affidavit for Wage Theft Ordinance |EDS 13-14 |
|5 |Contract and EDS Execution Page |EDS 15-17 |
|6 |Cook County Signature Page |EDS 18 |
SECTION 1 INSTRUCTIONS FOR COMPLETION OF
ECONOMIC DISCLOSURE STATEMENT AND EXECUTION DOCUMENT
This Economic Disclosure Statement and Execution Document (“EDS”) is to be completed and executed by every Bidder on a County contract, every Proposer responding to a Request for Proposals, and every Respondent responding to a Request for Proposal, and others as required by the Chief Procurement Officer. The execution of the EDS shall serve as the execution of a contract awarded by the County. The Chief Procurement Officer reserves the right to request that the Bidder or Proposer, or Respondent provide an updated EDS on an annual basis.
Definitions. Terms used in this EDS and not otherwise defined herein shall have the meanings given to such terms in the Instructions to Bidders, General Conditions, Request for Proposals, Request for Qualifications, as applicable.
Affiliate means a person that directly or indirectly through one or more intermediaries, Controls is Controlled by, or is under common Control with the Person specified.
Applicant means a person who executes this EDS.
Bidder means any person who submits a Bid.
Code means the Code of Ordinances, Cook County, Illinois available on .
Contract shall include any written document to make Procurements by or on behalf of Cook County.
Contractor or Contracting Party means a person that enters into a Contract with the County.
Control means the unfettered authority to directly or indirectly manage governance, administration, work, and all other aspects of a business.
EDS means this complete Economic Disclosure Statement and Execution Document, including all sections listed in the Index and any attachments.
Joint Venture means an association of two or more Persons proposing to perform a for- profit business enterprise. Joint Ventures must have an agreement in writing specifying the terms and conditions of the relationship between the partners and their relationship and respective responsibility for the Contract
Lobby or lobbying means to, for compensation, attempt to influence a County official or County employee with respect to any County matter.
Lobbyist means any person who lobbies.
Person or Persons means any individual, corporation, partnership, Joint Venture, trust, association, Limited Liability Company, sole proprietorship or other legal entity.
Prohibited Acts means any of the actions or occurrences which form the basis for disqualification under the Code, or under the Certifications hereinafter set forth.
Proposal means a response to an RFP. Proposer means a person submitting a Proposal. Response means response to an RFQ.
Respondent means a person responding to an RFQ.
RFP means a Request for Proposals issued pursuant to this Procurement Code.
RFQ means a Request for Qualifications issued to obtain the qualifications of interested parties.
INSTRUCTIONS FOR COMPLETION OF
ECONOMIC DISCLOSURE STATEMENT AND EXECUTION DOCUMENT
Section 1: Instructions. Section 1 sets forth the instructions for completing and executing this EDS.
Section 2: Certifications. Section 2 sets forth certifications that are required for contracting parties under the Code and other applicable laws. Execution of this EDS constitutes a warranty that all the statements and certifications contained, and all the facts stated, in the Certifications are true, correct and complete as of the date of execution.
Section 3: Economic and Other Disclosures Statement. Section 3 is the County’s required Economic and Other Disclosures Statement form. Execution of this EDS constitutes a warranty that all the information provided in the EDS is true, correct and complete as of the date of execution, and binds the Applicant to the warranties, representations, agreements and acknowledgements contained therein.
Required Updates. The Applicant is required to keep all information provided in this EDS current and accurate. In the event of any change in the information provided, including but not limited to any change which would render inaccurate or incomplete any certification or statement made in this EDS, the Applicant shall supplement this EDS up to the time the County takes action, by filing an amended EDS or such other documentation as is required.
Additional Information. The County’s Governmental Ethics and Campaign Financing Ordinances impose certain duties and obligations on persons or entities seeking County contracts, work, business, or transactions, and the Applicant is expected to comply fully with these ordinances. For further information please contact the Director of Ethics at (312) 603-4304 (69 W. Washington St. Suite 3040, Chicago, IL 60602) or visit the web-site at ethics-board-of.
Authorized Signers of Contract and EDS Execution Page. If the Applicant is a corporation, the President and Secretary must execute the EDS. In the event that this EDS is executed by someone other than the President, attach hereto a certified copy of that section of the Corporate By-Laws or other authorization by the Corporation, satisfactory to the County that permits the person to execute EDS for said corporation. If the corporation is not registered in the State of Illinois, a copy of the Certificate of Good Standing from the state of incorporation must be submitted with this Signature Page.
If the Applicant is a partnership or joint venture, all partners or joint venturers must execute the EDS, unless one partner or joint venture has been authorized to sign for the partnership or joint venture, in which case, the partnership agreement, resolution or evidence of such authority satisfactory to the Office of the Procurement must be submitted with this Signature Page.
If the Applicant is a member-managed LLC all members must execute the EDS, unless otherwise provided in the operating agreement, resolution or other corporate documents. If the Applicant is a manager-managed LLC, the manager(s) must execute the EDS. The Applicant must attach either a certified copy of the operating agreement, resolution or other authorization, satisfactory to the County, demonstrating such person has the authority to execute the EDS on behalf of the LLC. If the LLC is not registered in the State of Illinois, a copy of a current Certificate of Good Standing from the state of incorporation must be submitted with this Signature Page.
If the Applicant is a Sole Proprietorship, the sole proprietor must execute the EDS.
A “Partnership” “Joint Venture” or “Sole Proprietorship” operating under an Assumed Name must be registered with the Illinois county in which it is located, as provided in 805 ILCS 405 (2012), and documentation evidencing registration must be submitted with the EDS.
Effective October 1, 2016 all foreign corporations and LLCs must be registered with the Illinois Secretary of State's Office unless a statutory exemption applies to the applicant. Applicants who are exempt from registering must provide a written statement explaining why they are exempt from registering as a foreign entity with the Illinois Secretary of State's Office.
SECTION 2
CERTIFICATIONS
THE FOLLOWING CERTIFICATIONS ARE MADE PURSUANT TO STATE LAW AND THE CODE. THE APPLICANT IS CAUTIONED TO CAREFULLY READ THESE CERTIFICATIONS PRIOR TO SIGNING THE SIGNATURE PAGE. SIGNING THE SIGNATURE PAGE SHALL CONSTITUTE A WARRANTY BY THE APPLICANT THAT ALL THE STATEMENTS, CERTIFICATIONS AND INFORMATION SET FORTH WITHIN THESE CERTIFICATIONS ARE TRUE, COMPLETE AND CORRECT AS OF THE DATE THE SIGNATURE PAGE IS SIGNED. THE APPLICANT IS NOTIFIED THAT IF THE COUNTY LEARNS THAT ANY OF THE FOLLOWING CERTIFICATIONS WERE FALSELY MADE, THAT ANY CONTRACT ENTERED INTO WITH THE APPLICANT SHALL BE SUBJECT TO TERMINATION.
A. PERSONS AND ENTITIES SUBJECT TO DISQUALIFICATION
No person or business entity shall be awarded a contract or sub-contract, for a period of five (5) years from the date of conviction or entry of a plea or admission of guilt, civil or criminal, if that person or business entity:
1) Has been convicted of an act committed, within the State of Illinois, of bribery or attempting to bribe an officer or employee of a unit of state, federal or local government or school district in the State of Illinois in that officer's or employee's official capacity;
2) Has been convicted by federal, state or local government of an act of bid-rigging or attempting to rig bids as defined in the Sherman Anti-Trust Act and Clayton Act. Act. 15 U.S.C. Section 1 et seq.;
3) Has been convicted of bid-rigging or attempting to rig bids under the laws of federal, state or local government;
4) Has been convicted of an act committed, within the State, of price-fixing or attempting to fix prices as defined by the Sherman Anti-Trust Act and the Clayton Act. 15 U.S.C. Section 1, et seq.;
5) Has been convicted of price-fixing or attempting to fix prices under the laws the State;
6) Has been convicted of defrauding or attempting to defraud any unit of state or local government or school district within the State of Illinois;
7) Has made an admission of guilt of such conduct as set forth in subsections (1) through (6) above which admission is a matter of record, whether or not such person or business entity was subject to prosecution for the offense or offenses admitted to; or
8) Has entered a plea of nolo contendere to charge of bribery, price-fixing, bid-rigging, or fraud, as set forth in sub- paragraphs (1) through (6) above.
In the case of bribery or attempting to bribe, a business entity may not be awarded a contract if an official, agent or employee of such business entity committed the Prohibited Act on behalf of the business entity and pursuant to the direction or authorization of an officer, director or other responsible official of the business entity, and such Prohibited Act occurred within three years prior to the award of the contract. In addition, a business entity shall be disqualified if an owner, partner or shareholder controlling, directly or indirectly, 20% or more of the business entity, or an officer of the business entity has performed any Prohibited Act within five years prior to the award of the Contract.
THE APPLICANT HEREBY CERTIFIES THAT: The Applicant has read the provisions of Section A, Persons and Entities Subject to Disqualification, that the Applicant has not committed any Prohibited Act set forth in Section A, and that award of the Contract to the Applicant would not violate the provisions of such Section or of the Code.
B. BID-RIGGING OR BID ROTATING
THE APPLICANT HEREBY CERTIFIES THAT: In accordance with 720 ILCS 5/33 E-11, neither the Applicant nor any Affiliated Entity is barred from award of this Contract as a result of a conviction for the violation of State laws prohibiting bid- rigging or bid rotating.
C. DRUG FREE WORKPLACE ACT
THE APPLICANT HEREBY CERTIFIES THAT: The Applicant will provide a drug free workplace, as required by (30 ILCS 580/3).
D. DELINQUENCY IN PAYMENT OF TAXES
THE APPLICANT HEREBY CERTIFIES THAT: The Applicant is not an owner or a party responsible for the payment of any tax or fee administered by Cook County, such as bar award of a contract or subcontract pursuant to the Code, Chapter 34, Section 34-171.
E. HUMAN RIGHTS ORDINANCE
No person who is a party to a contract with Cook County ("County") shall engage in unlawful discrimination or sexual harassment against any individual in the terms or conditions of employment, credit, public accommodations, housing, or provision of County facilities, services or programs (Code Chapter 42, Section 42-30 et seq.).
F. ILLINOIS HUMAN RIGHTS ACT
THE APPLICANT HEREBY CERTIFIES THAT: It is in compliance with the Illinois Human Rights Act (775 ILCS 5/2-105), and agrees to abide by the requirements of the Act as part of its contractual obligations.
G. INSPECTOR GENERAL (COOK COUNTY CODE, CHAPTER 34, SECTION 34-174 and Section 34-250)
The Applicant has not willfully failed to cooperate in an investigation by the Cook County Independent Inspector General or to report to the Independent Inspector General any and all information concerning conduct which they know to involve corruption, or other criminal activity, by another county employee or official, which concerns his or her office of employment or County related transaction.
The Applicant has reported directly and without any undue delay any suspected or known fraudulent activity in the County’s Procurement process to the Office of the Cook County Inspector General.
H. CAMPAIGN CONTRIBUTIONS (COOK COUNTY CODE, CHAPTER 2, SECTION 2-585)
THE APPLICANT CERTIFIES THAT: It has read and shall comply with the Cook County’s Ordinance concerning campaign contributions, which is codified at Chapter 2, Division 2, Subdivision II, Section 585, and can be read in its entirety at .
I. GIFT BAN, (COOK COUNTY CODE, CHAPTER 2, SECTION 2-574)
THE APPLICANT CERTIFIES THAT: It has read and shall comply with the Cook County’s Ordinance concerning receiving and soliciting gifts and favors, which is codified at Chapter 2, Division 2, Subdivision II, Section 574, and can be read in its entirety at .
J. LIVING WAGE ORDINANCE PREFERENCE (COOK COUNTY CODE, CHAPTER 34, SECTION 34-160;
Unless expressly waived by the Cook County Board of Commissioners, the Code requires that a living wage must be paid to individuals employed by a Contractor which has a County Contract and by all subcontractors of such Contractor under a County Contract, throughout the duration of such County Contract. The amount of such living wage is annually by the Chief Financial Officer of the County, and shall be posted on the Chief Procurement Officer’s website.
The term "Contract" as used in Section 4, I, of this EDS, specifically excludes contracts with the following:
1) Not-For Profit Organizations (defined as a corporation having tax exempt status under Section 501(C)(3) of the United State Internal Revenue Code and recognized under the Illinois State not-for -profit law);
2) Community Development Block Grants;
3) Cook County Works Department;
4) Sheriff's Work Alternative Program; and
5) Department of Correction inmates.
SECTION 3
REQUIRED DISCLOSURES
1. DISCLOSURE OF LOBBYIST CONTACTS
List all persons that have made lobbying contacts on your behalf with respect to this contract: Name Address
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2. LOCAL BUSINESS PREFERENCE STATEMENT (CODE, CHAPTER 34, SECTION 34-230)
Local business means a Person, including a foreign corporation authorized to transact business in Illinois, having a bona fide establishment located within the County at which it is transacting business on the date when a Bid is submitted to the County, and which employs the majority of its regular, full-time work force within the County. A Joint Venture shall constitute a Local Business if one or more Persons that qualify as a "Local Business" hold interests totaling over 50 percent in the Joint Venture, even if the Joint Venture does not, at the time of the Bid submittal, have such a bona fide establishment within the County.
a) Is Applicant a "Local Business" as defined above?
Yes: No:
b) If yes, list business addresses within Cook County:
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c) Does Applicant employ the majority of its regular full-time workforce within Cook County? Yes: No:
3. THE CHILD SUPPORT ENFORCEMENT ORDINANCE (CODE, CHAPTER 34, SECTION 34-172)
Every Applicant for a County Privilege shall be in full compliance with any child support order before such Applicant is entitled to receive or renew a County Privilege. When delinquent child support exists, the County shall not issue or renew any County Privilege, and may revoke any County Privilege.
All Applicants are required to review the Cook County Affidavit of Child Support Obligations attached to this EDS (EDS-5) and complete the Affidavit, based on the instructions in the Affidavit.
4. REAL ESTATE OWNERSHIP DISCLOSURES.
The Applicant must indicate by checking the appropriate provision below and providing all required information that either:
a) The following is a complete list of all real estate owned by the Applicant in Cook County:
PERMANENT INDEX NUMBER(S):
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(ATTACH SHEET IF NECESSARY TO LIST ADDITIONAL INDEX NUMBERS)
OR:
b) The Applicant owns no real estate in Cook County.
5. EXCEPTIONS TO CERTIFICATIONS OR DISCLOSURES.
If the Applicant is unable to certify to any of the Certifications or any other statements contained in this EDS and not explained elsewhere in this EDS, the Applicant must explain below:
If the letters, “NA”, the word “None” or “No Response” appears above, or if the space is left blank, it will be conclusively presumed that the Applicant certified to all Certifications and other statements contained in this EDS.
COOK COUNTY AFFIDAVIT OF CHILD SUPPORT OBLIGATIONS
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Privilege Information:
County Privilege: County Department:
Applicant Information:
|Last name: |First Name: | |MI: SS# (Last Four Digits): |
|Date | |of |Birth: |
Street
Address: City: State: Zip: Home Phone: ( ) - Driver’s License No:
Child Support Obligation Information:
The Applicant, being duly sworn on oath or affirmation hereby states that to the best of my knowledge (place an “X” next to “A”, “B”, “C”, or “D”).
The Applicant understands that failure to disclose any judicially or administratively ordered child support debt owed will be grounds for revoking the privilege.
Name:
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Signature: Date:
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Subscribed and sworn to before me this day of , 20
X
Notary Public Signature Notary Seal
Note: The above information is subject to verification prior to the award of the contract.
HOUSING AUTHORITY OF COOK COUNTY
DISCLOSURE OF OWNERSHIP INTEREST STATEMENT
The Cook County Code of Ordinances (§2-610 et seq.) requires that any Applicant for any County Action must disclose information concerning ownership interests in the Applicant. This Disclosure of Ownership Interest Statement must be completed with all information current as of the date this Statement is signed. Furthermore, this Statement must be kept current, by filing an amended Statement, until such time as the County Board or County Agency shall take action on the application. The information contained in this Statement will be maintained in a database and made available for public viewing.
If you are asked to list names, but there are no applicable names to list, you must state NONE. An incomplete Statement will be returned and any action regarding this contract will be delayed. A failure to fully comply with the ordinance may result in the action taken by the County Board or County Agency being voided.
"Applicant" means any Entity or person making an application to the County for any County Action.
“County Action” means any action by a County Agency, a County Department, or the County Board regarding an ordinance or ordinance amendment, a County Board approval, or other County agency approval, with respect to contracts, leases, or sale or purchase of real estate.
“Person” "Entity” or “Legal Entity" means a sole proprietorship, corporation, partnership, association, business trust, estate, two or more persons having a joint or common interest, trustee of a land trust, other commercial or legal entity or any beneficiary or beneficiaries thereof.
This Disclosure of Ownership Interest Statement must be submitted by :
1. An Applicant for County Action and
2. A Person that holds stock or a beneficial interest in the Applicant and is listed on the Applicant’s Statement (a “Holder”) must file a Statement and complete #1 only under Ownership Interest Declaration.
Please print or type responses clearly and legibly. Add additional pages if needed, being careful to identify each portion of the form to which each additional page refers.
This Statement is being made by the [ ] Applicant or [ ] Stock/Beneficial Interest Holder
This Statement is an: [ ] Original Statement or [ ] Amended Statement
Identifying Information:
Name D/B/A: FEIN NO.:
Street Address:
City:
State: Zip Code: Phone No.: Fax Number: Email:
Cook County Business Registration Number: (Sole Proprietor, Joint Venture Partnership)
Corporate File Number (if applicable):
Form of Legal Entity:
[ ] Sole Proprietor [ ] Partnership [ ] Corporation [ ] Trustee of Land Trust
[ ] Business Trust [ ] Estate [ ] Association [ ] Joint Venture
[ ] Other (describe)
Ownership Interest Declaration:
1. List the name(s), address, and percent ownership of each Person having a legal or beneficial interest (including ownership) of more than five percent (5%) in the Applicant/Holder.
Name Address Percentage Interest in Applicant/Holder
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2. If the interest of any Person listed in (1) above is held as an agent or agents, or a nominee or nominees, list the name and address of the principal on whose behalf the interest is held.
Name of Agent/Nominee Name of Principal Principal’s Address
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3. Is the Applicant constructively controlled by another person or Legal Entity? [ ] Yes [ ] No
If yes, state the name, address and percentage of beneficial interest of such person, and the relationship under which such control is being or may be exercised.
Name Address Percentage of Relationship Beneficial Interest
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Corporate Officers, Members and Partners Information:
For all corporations, list the names, addresses, and terms for all corporate officers. For all limited liability companies, list the names, addresses for all members. For all partnerships and joint ventures, list the names, addresses, for each partner or joint venture.
Name Address Title (specify title of Term of Office Office, or whether manager
or partner/joint venture)
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Declaration (check the applicable box):
[ ] I state under oath that the Applicant has withheld no disclosure as to ownership interest in the Applicant nor reserved
any information, data or plan as to the intended use or purpose for which the Applicant seeks County Board or other County Agency action.
[ ] I state under oath that the Holder has withheld no disclosure as to ownership interest nor reserved any information required to be disclosed.
HOUSING AUTHORITY OF COOK COUNTY
DISCLOSURE OF OWNERSHIP INTEREST STATEMENT SIGNATURE PAGE
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Name of Authorized Applicant/Holder Representative (please print or type) Title Signature Date
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E- mail address Phone Number
Subscribed to and sworn before me My commission expires: this day of , 20 .
X Notary Public Signature Notary Seal
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COOK COUNTY BOARD OF ETHICS
69 W. WASHINGTON STREET, SUITE 3040
CHICAGO, ILLINOIS 60602 312/603-4304 Office 312/603-9988 Fax
FAMILIAL RELATIONSHIP DISCLOSURE PROVISION
Nepotism Disclosure Requirement:
Doing a significant amount of business with the County requires that you disclose to the Board of Ethics the existence of any familial relationships with any County employee or any person holding elective office in the State of Illinois, the County, or in any municipality within the County. The Ethics Ordinance defines a significant amount of business for the purpose of this disclosure requirement as more than $25,000 in aggregate County leases, contracts, purchases or sales in any calendar year.
If you are unsure of whether the business you do with the County or a County agency will cross this threshold, err on the side of caution by completing the attached familial disclosure form because, among other potential penalties, any person found guilty of failing to make a required disclosure or knowingly filing a false, misleading, or incomplete disclosure will be prohibited from doing any business with the County for a period of three years. The required disclosure should be filed with the Board of Ethics by January 1 of each calendar year in which you are doing business with the County and again with each bid/proposal/quotation to do business with Cook County. The Board of Ethics may assess a late filing fee of $100 per day after an initial 30-day grace period.
The person that is doing business with the County must disclose his or her familial relationships. If the person on the County lease or contract or purchasing from or selling to the County is a business entity, then the business entity must disclose the familial relationships of the individuals who are and, during the year prior to doing business with the County, were:
• its board of directors,
• its officers,
• its employees or independent contractors responsible for the general administration of the entity,
• its agents authorized to execute documents on behalf of the entity, and
• its employees who directly engage or engaged in doing work with the County on behalf of the entity.
Do not hesitate to contact the Board of Ethics at (312) 603-4304 for assistance in determining the scope of any required familial relationship disclosure.
Additional Definitions:
“Familial relationship” means a person who is a spouse, domestic partner or civil union partner of a County employee or State, County or municipal official, or any person who is related to such an employee or official, whether by blood, marriage or adoption, as a:
Parent Child Brother Sister Aunt Uncle Niece Nephew
Grandparent Grandchild Father-in-law Mother-in-law Son-in-law Daughter-in-law Brother-in-law
Sister-in-law
Stepfather Stepmother Stepson Stepdaughter Stepbrother Stepsister Half-brother Half-sister
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A. PERSON DOING OR SEEKING TO DO BUSINESS WITH THE COUNTY
Name of Person Doing Business with the County:
Address of Person Doing Business with the County:
Phone number of Person Doing Business with the County:
Email address of Person Doing Business with the County:
If Person Doing Business with the County is a Business Entity, provide the name, title and contact information for the individual completing this disclosure on behalf of the Person Doing Business with the County:
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B. DESCRIPTION OF BUSINESS WITH THE COUNTY
Append additional pages as needed and for each County lease, contract, purchase or sale sought and/or obtained during the calendar year of this disclosure (or the proceeding calendar year if disclosure is made on January 1), identify:
The lease number, contract number, purchase order number, request for proposal number and/or request for qualification number associated with the business you are doing or seeking to do with the County:
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The aggregate dollar value of the business you are doing or seeking to do with the County: $
The name, title and contact information for the County official(s) or employee(s) involved in negotiating the business you are doing or seeking to do with the County:
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The name, title and contact information for the County official(s) or employee(s) involved in managing the business you are doing or seeking to do with the County:
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C. DISCLOSURE OF FAMILIAL RELATIONSHIPS WITH COUNTY EMPLOYEES OR STATE, COUNTY OR MUNICIPAL ELECTED OFFICIALS
Check the box that applies and provide related information where needed
D The Person Doing Business with the County is an individual and there is no familial relationship between this individual and any Cook County employee or any person holding elective office in the State of Illinois, Cook County, or any municipality within Cook County.
D The Person Doing Business with the County is a business entity and there is no familial relationship between any member of this business entity’s board of directors, officers, persons responsible for general administration of the business entity, agents authorized to execute documents on behalf of the business entity or employees directly engaged in contractual work with the County on behalf of the business entity, and any Cook County employee or any person holding elective office in the State of Illinois, Cook County, or any municipality within Cook County.
D The Person Doing Business with the County is an individual and there is a familial relationship between this individual and at least one Cook County employee and/or a person or persons holding elective office in the State of Illinois, Cook County, and/or any municipality within Cook County. The familial relationships are as follows:
Name of Individual Doing Business with the County
Name of Related County Employee or State, County or Municipal Elected Official
Title and Position of Related County Employee or State, County or Municipal Elected Official
Nature of Familial Relationship*
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If more space is needed, attach an additional sheet following the above format.
D The Person Doing Business with the County is a business entity and there is a familial relationship between at least one member of this business entity’s board of directors, officers, persons responsible for general administration of the business entity, agents authorized to execute documents on behalf of the business entity and/or employees directly engaged in contractual work with the County on behalf of the business entity, on the one hand, and at least one Cook County employee and/or a person holding elective office in the State of Illinois, Cook County, and/or any municipality within Cook County, on the other. The familial relationships are as follows:
|Name of Member of Board of | |Name of Related County Employee| |Title and Position of Related County | |Nature of Familial |
|Director for Business Entity | |or State, County or Municipal | |Employee or State, County or | |Relationship* |
|Doing Business with the County | |Elected Official | |Municipal Elected Official | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
|Name of Officer for Business | |Name of Related County Employee| |Title and Position of Related County | |Nature of Familial |
|Entity Doing Business with the | |or State, County or Municipal | |Employee or State, County or | |Relationship* |
|County | |Elected Official | |Municipal Elected Official | | |
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|Name of Person Responsible for| |Name of Related County Employee| |Title and Position of Related County | |Nature of Familial |
|the General Administration of | |or State, County or Municipal | |Employee or State, County or | |Relationship* |
|the Business Entity Doing | |Elected Official | |Municipal Elected Official | | |
|Business with the County | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
|Name of Agent Authorized to | |Name of Related County Employee| |Title and Position of Related County | |Nature of Familial |
|Execute Documents for Business| |or State, County or Municipal | |Employee or State, County or | |Relationship* |
|Entity Doing Business with the| |Elected Official | |Municipal Elected Official | | |
|County | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
|Name of Employee of Business | |Name of Related County Employee| |Title and Position of Related County | |Nature of Familial |
|Entity Directly Engaged in | |or State, County or Municipal | |Employee or State, County or | |Relationship* |
|Doing Business with the County| |Elected Official | |Municipal Elected Official | | |
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If more space is needed, attach an additional sheet following the above format.
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VERIFICATION: To the best of my knowledge, the information I have provided on this disclosure form is accurate and complete. I acknowledge that an inaccurate or incomplete disclosure is punishable by law, including but not limited to fines and debarment.
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Signature of Recipient Date
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SUBMIT COMPLETED FORM TO: Cook County Board of Ethics
69 West Washington Street, Suite 3040, Chicago, Illinois 60602
Office (312) 603-4304 – Fax (312) 603-9988
CookCounty.Ethics@
* Spouse, domestic partner, civil union partner or parent, child, sibling, aunt, uncle, niece, nephew, grandparent or grandchild by blood, marriage (i.e. in laws and step relations) or adoption.
SECTION 4
COOK COUNTY AFFIDAVIT FOR WAGE THEFT ORDINANCE
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I. Contract Information:
Contract Number:
County Using Agency (requesting Procurement):
II. Person/Substantial Owner Information:
Person (Corporate Entity Name):
Substantial Owner Complete Name:
FEIN#
Date of Birth: E-mail address:
Street Address:
City: State: Zip:
Home Phone: ( ) -
III. Compliance with Wage Laws:
Within the past five years has the Person/Substantial Owner, in any judicial or administrative proceeding, been convicted of, entered a plea, made an admission of guilt or liability, or had an administrative finding made for committing a repeated or willful violation of any of the following laws:
Illinois Wage Payment and Collection Act, 820 ILCS 115/1 et seq., Illinois Minimum Wage Act, 820 ILCS 105/1 et seq.,
Illinois Worker Adjustment and Retraining Notification Act, 820 ILCS 65/1 et seq., Employee Classification Act, 820 ILCS 185/1 et seq.,
Fair Labor Standards Act of 1938, 29 U.S.C. 201, et seq.,
Any comparable state statute or regulation of any state, which governs the payment of wages
If the Person/Substantial Owner answered “Yes” to any of the questions above, it is ineligible to enter into a Contract with Cook County, but can request a reduction or waiver under Section IV.
IV. Request for Waiver or Reduction
If Person/Substantial Owner answered “Yes” to any of the questions above, it may request a reduction or waiver in accordance with Section 34-179(d), provided that the request for reduction of waiver is made on the basis of one or more of the following actions that have taken place:
There has been a bona fide change in ownership or Control of the ineligible Person or Substantial Owner Disciplinary action has been taken against the individual(s) responsible for the acts giving rise to the violation Remedial action has been taken to prevent a recurrence of the acts giving rise to the disqualification or default Other factors that the Person or Substantial Owner believe are relevant.
The Person/Substantial Owner must submit documentation to support the basis of its request for a reduction or waiver. The Executive Director reserves the right to make additional inquiries and request additional documentation.
V. Affirmation
The Person/Substantial Owner affirms that all statements contained in the Affidavit are true, accurate and complete. Signature: Date:
Name of Person signing (Print): Title:
Subscribed and sworn to before me this day of , 20
X
Notary Public Signature Notary Seal
Note: The above information is subject to verification prior to the award of the Contract.
Corporation’s Name President’s Printed Name and Signature
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Telephone Email
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Secretary Signature Date
Execution by LLC
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LLC Name *Member/Manager Printed Name and Signature
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Date Telephone and Email
Execution by Partnership/Joint Venture
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Partnership/Joint Venture Name *Partner/Joint Venturer Printed Name and Signature
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Date Telephone and Email
Execution by Sole Proprietorship
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Printed Name Signature Assumed Name (if applicable)
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Date Telephone and Email
Subscribed and sworn to before me this
day of , 20 .
My commission expires:
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Notary Public Signature Notary Seal
*If the operating agreement, partnership agreement or governing documents requiring execution by multiple members, managers, partners, or joint venturers, please complete and execute additional Contract and EDS Execution Pages.
Corporation’s Name President’s Printed Name and Signature
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Telephone Email
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Secretary Signature Date
Execution by LLC
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LLC Name *Member/Manager Printed Name and Signature
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Date Telephone and Email
Execution by Partnership/Joint Venture
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Partnership/Joint Venture Name *Partner/Joint Venturer Printed Name and Signature
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Date Telephone and Email
Execution by Sole Proprietorship
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Printed Name and Signature Date
Corporation’s Name President’s Printed Name and Signature
[pic] [pic]
Telephone Email
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Secretary Signature Date
Execution by LLC
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LLC Name *Member/Manager Printed Name and Signature
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Date Telephone and Email
Execution by Partnership/Joint Venture
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Partnership/Joint Venture Name *Partner/Joint Venturer Printed Name and Signature
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Date Telephone and Email
Execution by Sole Proprietorship
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Printed Name and Signature Date
HOUSING AUTHORITY OF COOK COUNTY SIGNATURE PAGE
ON BEHALF OF THE HOUSING AUTHORITY OF COOK COUNTY, a body corporate and politic created under the provisions of the Housing Authorities LAW; THIS CONTRACT IS HEREBY EXECUTED BY:
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RICHARD J. MONOCCHIO
EXECUTIVE DIRECTOR
DATED AT CHICAGO, ILLINOIS THIS DAY OF ,20 .
IN THE CASE OF A BID/ PROPOSAL/RESPONSE, THE HOUSING AUTHORITY OF COOK COUNTY HEREBY ACCEPTS:
THE FOREGOING BID/PROPOSAL/RESPONSE AS IDENTIFIED IN THE CONTRACT DOCUMENTS FOR CONTRACT NUMBER
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OR
ITEM(S), SECTION(S), PART(S):
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TOTAL AMOUNT OF CONTRACT: $
(DOLLARS AND CENTS)
FUND CHARGEABLE:
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[1] Illinois State Board of Education Illinois Report Card. Retrieved from: (2016)
[2] A lost Generation: The Disappearance of Teens and Youth from the Job Market in Cook County, Cordova & Wilson
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NOTE: Careful consideration must be given to the budget. If awarded, the budget you submit with your proposal will be incorporated into your contract as your approved spending plan. As such, you will be required to adhere to the approved budget over the course of the contract period. HACC will not honor expenditures that are not included in your approved budget. A budget revision will be required if your spending plan changes.
|Contractor/Partner Budget Line Item Detail |
|Applicants are required to complete and submit this Budget Line Item Detail for each contractor/partnering agency who will have a substantial role in|
|the proposed project and who is being allocated a portion of the grant funds under the contractual line in the applicant agency's budget. Please refer |
|to Appendix III: Budget Guidance for instructions regarding appropriate expenditures for each budget line item category. The total budgeted amount must|
|equal the same amount allocated for this agency in the applicant agency's budget. A justification of the proposed contractor/partner costs (by line |
|item) must be provided in the Budget Narrative. |
|Contractor/Partner Organization Name: | | |
|Organization Address: | | |
|Name/Title of Agency Liaison: | | |
| |
|PERSONNEL |
|Name and Title |Calculation Item |Cost |
| | | |
| | | |
| | | |
| | | |
| | | |
| |Total Personnel |$0.00 |
|FRINGE BENEFITS (Not Applicable) |
|(NOTE: Fringe Benefit Costs for Contractor/Partner Agency Personnel are Not Allowable) |
|TRAVEL |
|Purpose |Calculation Item |Cost |
| | | |
| | | |
| | | |
| | | |
| |Total Travel |$0.00 |
|EQUIPMENT (Not Applicable) |
|(NOTE: Equipment Costs for Contractual/Partner Agencies are Not Allowable) |
|MATERIALS & SUPPLIES |
|Item |Calculation Line Item |Cost |
| | | |
| | | |
| | | |
| | | |
| |Total Materials & Supplies |$0.00 |
|OTHER DIRECT COSTS |
|Item |Calculation Line Item |Cost |
| | | |
| | | |
| | | |
| | | |
| |Total Other Direct Costs |$0.00 |
|INDIRECT COST |
|(NOTE: The combined sum of allocated indirect costs for applicant AND partner agencies cannot exceed 10%) |
|Explanation of How Costs are Calculated |Calculation Line Item |Cost |
| | | |
| |Total Indirect Costs |$0.00 |
|TOTAL HACC GRANT FUNDS REQUESTED FOR THIS CONTRACTOR/PARTNER | |
Appendix II: Budget Narrative Form
BUDGET CATEGORY – PERSONNEL
List each position by title and name of employee if available. Explain each position’s role in the proposed program. Also, indicate if the position is existing or new and when the position will be on-boarded.
BUDGET CATEGORY – FRINGE BENEFITS
Fringe benefits should be based on actual known costs or an established formula. Please explain which budgeted positions in the Personnel line will be receive fringe benefits.
BUDGET CATEGORY – TRAVEL
List travel expenses by project personnel and explain the purpose of the travel. Also indicate whether the travel is local or out-of-town and explain how costs were determined.
BUDGET CATEGORY – EQUIPMENT
For each budgeted item, explain the need for the item, how it will be utilized in the proposed program, and how costs were determined. Also indicate where the item will be located, who will use the item, and how inventory will be maintained.
BUDGET CATEGORY – MATERIALS & SUPPLIES
List materials and supplies by category (i.e. office supplies, program supplies, training supplies, etc.) and explain the need for the budgeted items and how costs were determined.
BUDGET CATEGORY – CONSULTANT / CONTRACTS
Explain the need for the consultant / contract as it relates to the proposed program. List all associated costs and provide a narrative explanation that describes the need. Also explain the method for determining the associated costs. A narrative corresponding to each submitted “Contractor/Partner Budget Line Item Detail” form must also be included.
BUDGET CATEGORY – OTHER DIRECT COSTS
List other direct cost by category (i.e. communications, event costs, postage, etc.) and explain why they are needed. Also provide an explanation as to how costs were determined, including the method for prorating costs that will be partially charged to the HACC grant.
BUDGET CATEGORY – INDIRECT COSTS
Explain what comprises indirect costs and the method used to determine the allocation charged to the HACC grant. (NOTE: Indirect costs may not exceed 10% of the grant award. This is inclusive of indirect costs budgeted by contractors and consultants. The combined sum of indirect costs budgeted by the applicant organization and by contractors/consultants or partnering agencies may not exceed the 10% cap.)
Appendix III: Budget Guidance
NOTE: This document provides general guidance on budgeting, allowable costs and supporting documentation required to justify expenditures under awarded grant. It is by no means considered to address every scenario. Proposers are responsible for ensuring that costs budgeted for expenditure under grant awards conform to this guidance document.
NOTE: The HACC does not allow equipment expenditures by third parties, including contractors. Grantees are responsible for ensuring that all HACC-funded equipment is properly inventoried.
NOTE: The purchase of transit cards and gift cards should be proportionate to the number of program participants so that there is not an excess of cards remaining at the close of the contract period. Bulk purchases of these items require HACC pre-approval.
NOTE: Indirect costs cannot exceed 10% of the awarded funds regardless of any indirect cost rates approved by a state or federal agency (the funds supporting these grants do not include any state or federal funding).
Indirect costs budgeted by consultants/contractors are included in the 10% cap. This means that the combined sum of indirect costs budgeted by the Proposer and any consultants/contractors cannot exceed 10%.
All indirect costs must be budgeted solely under the indirect cost line. Costs that are deemed indirect but budgeted under other line items will result in the HACC’s request for a budget revision at the onset of the contract period.
OCPO ONLY:
⃝ Disqualification
⃝ Check Complete
Effective July 1, 1998, every applicant for a County Privilege shall be in full compliance with any Child Support Order before such applicant is entitled to receive a County Privilege. When Delinquent Child Support Exists, the County shall not issue or renew any County Privilege, and may revoke any County Privilege.
"Applicant" means any person or business entity, including all Substantial Owners, seeking issuance of a County Privilege or renewal of an existing County Privilege from the County. This term shall not include any political subdivision of the federal or state government, including units of local government, and not-for-profit organizations.
"County Privilege" means any business license, including but not limited to liquor dealers' licenses, packaged goods licenses, tavern licenses, restaurant licenses, and gun licenses; real property license or lease; permit, including but not limited to building permits, zoning permits or approvals; environmental certificate; County HOME Loan, and contracts exceeding the value of $10,000.00.
"Substantial Owner" means any person or persons who own or hold a twenty-five\ percent (25%) or more percentage of interest in any business entity seeking a County Privilege, including those shareholders, general or limited partners, beneficiaries and principals; except where a business entity is an individual or sole proprietorship, Substantial Owner means that individual or sole proprietor.
All Applicants/Substantial Owners are required to complete this affidavit and comply with the Child Support Enforcement Ordinance before any privilege is granted. Signature of this form constitutes a certification the information provided below is correct and complete, and that the individual(s) signing this form has/have personal knowledge of such information.
|A. |The Applicant has no judicially or administratively ordered child support obligations. |
|B. |The Applicant has an outstanding judicially or administratively ordered obligation, but is paying in accordance with the terms of |
| |the order. |
|C. |The Applicant is delinquent in paying judicially or administratively ordered child support obligations |
|D. |The Applicant is not a substantial owner as defined above. |
Effective May 1, 2015, every Person, including Substantial Owners, seeking a Contract with Cook County must comply with the Cook County Wage Theft Ordinance set forth in Chapter 34, Article IV, Section 179. Any Person/Substantial Owner, who fails to comply with Cook County Wage Theft Ordinance, may request that the Chief Procurement Officer grant a reduction or waiver in accordance with Section 34-179(d).
"Contract" means any written document to make Procurements by or on behalf of Cook County.
"Person" means any individual, corporation, partnership, Joint Venture, trust, association, limited liability company, sole proprietorship or other legal entity. "Procurement" means obtaining supplies, equipment, goods, or services of any kind.
"Substantial Owner" means any person or persons who own or hold a twenty-five percent (25%) or more percentage of interest in any business entity seeking a County Privilege, including those shareholders, general or limited partners, beneficiaries and principals; except where a business entity is an individual or sole proprietorship, Substantial Owner means that individual or sole proprietor.
All Persons/Substantial Owners are required to complete this affidavit and comply with the Cook County Wage Theft Ordinance before any Contract is awarded. Signature of this form constitutes a certification the information provided below is correct and complete, and that the individual(s) signing this form has/have personal knowledge of such information.
-----------------------
EDS-i
EDS-ii
EDS-1
EDS-2
EDS-3
EDS-4
EDS-5
EDS-6
EDS-7
EDS-8
EDS-11
COOK COUNTY BOARD OF ETHICS FAMILIAL RELATIONSHIP DISCLOSURE FORM
EDS-12
EDS-13
EDS-15
SECTION 5
CONTRACT AND EDS EXECUTION PAGE
PLEASE EXECUTE THREE ORIGINAL PAGES OF EDS
The Applicant hereby certifies and warrants that all of the statements, certifications and representations set forth in this EDS are true, complete and correct; that the Applicant is in full compliance and will continue to be in compliance throughout the term of the Contract or County Privilege issued to the Applicant with all the policies and requirements set forth in this EDS; and that all facts and information provided by the Applicant in this EDS are true, complete and correct. The Applicant agrees to inform the Executive Director in writing if any of such statements, certifications, representations, facts or information becomes or is found to be untrue, incomplete or incorrect during the term of the Contract or County Privilege.
Execution by Corporation
SECTION 5
CONTRACT AND EDS EXECUTION PAGE
PLEASE EXECUTE THREE ORIGINAL COPIES
The Applicant hereby certifies and warrants that all of the statements, certifications and representations set forth in this EDS are true, complete and correct; that the Applicant is in full compliance and will continue to be in compliance throughout the term of the Contract or County Privilege issued to the Applicant with all the policies and requirements set forth in this EDS; ,68Bdfpz€Žœ¦¬®Üäæè üøðéâéâéðéâé×̼¯¡—ƒrƒaM'hÉ|Rh>*5?@ˆýÿCJ$OJQJ^JaJ$!h s5?@ˆýÿCJ$OJQJ^JaJ$!h+'=5?@ˆýÿCJ$OJQJ^JaJ$'hÉ|Rh‚)³5?@ˆýÿCJ$OJQJ^JaJ$h sCJOJQJjh>*U[pic]mHnHu[pic]h s>*[pic]CJOJQJaJhÀ
Ðh s5?CJOJQJaJh s>*[pic]CJOJQJhì_Æ>*[pic]CJOJQJand that all facts and information provided by the Applicant in this EDS are true, complete and correct. The Applicant agrees to inform the Executive Director in writing if any of such statements, certifications, representations, facts or information becomes or is found to be untrue, incomplete or incorrect during the term of the Contract or County Privilege.
Execution by Corporation
Telephone
Email
Subscribed and sworn to before me this
day of , 20 .
My commission expires:
Notary Public Signature
Notary Seal
EDS-17
................
................
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