SECTION I: - Chicago



youth workforce experience programming 2013

common Application and instructions

1. Proposal Deadline and Pre-Submittal Conference

A. Submission Information

The due date for submission of proposals is March 11, 2013 by 4:00pm.

Proposals will be accepted prior to the due date, from 9:00 a.m. to 4:00 p.m. Monday – Friday at the same location. All proposals must be complete. Incomplete proposals may not be reviewed. In-person or bonded messenger delivery of proposals is encouraged. Time stamped receipts will be issued as proof of timely submittal.

One (1) original and two (2) copies must be delivered in a sealed envelope or box to:

Jennifer Axelrod

Deputy Commissioner of Youth Services

Department of Family and Support Services

1615 West Chicago Avenue, 3rd Floor

Chicago, IL 60622

Additionally, please e-mail an exact and complete scanned copy of your proposal, budget and ALL attachments to: andrew.fernandez@ by March 11, 2013, 4:30 p.m. Both the paper original and e-mailed copies are required for the submission to be considered complete.

No proposal will be considered complete and therefore reviewed unless the original copy is delivered and received at DFSS offices.

Proposals received after the due date and time may be deemed NON-RESPONSIVE and, therefore, subject to rejection.

B. Questions

Respondents are strongly encouraged to submit all questions and comments related to the RFP via e-mail. For answers to program-related questions please contact:

Andrew Fernandez: 312-743-0938, Andrew.fernandez@

All other questions regarding the administrative aspects of this RFP may be directed to: Julia Talbot: jtalbot@

C. Pre-Submittal Conference

A Pre-Proposal conference will be held on February 25, 2013, 10:00 a.m. – 3:00 p.m. at the Department of Family and Support Services, 1615 W. Chicago Ave., 1st Fl. Conference Room.

Summer Employment Pre-Proposal Conference: 10:00am to 12:00pm

Juvenile Justice Pre-Proposal Conference: 1:00pm to 3:000pm

If you are submitting a proposal for both areas, please plan to attend the entire conference time. Attendance at this conference is not mandatory but is highly advised.

D. Timeline

This is the anticipated timeline for the funded programming:

|Proposal Release Date: |February 14, 2013 |

|Bidders Conferences: |February 25, 2013 10:00 & 1:00 |

|Proposal Due: |March 11, 2013 |

|Award Notification Date: |April 12, 2013 |

|Anticipated Contract Start Date: |April 19, 2013 |

2. Application Requirements

A. Format of the Proposal

In addition to the requested information stated in accompanying application and budget files (constituting the narrative and budget portions of the proposal), Respondents must supply the following additional information in their response to this RFP identified in the list below in items 4-10). The proposal should consist of the following items, in this order:

1. A proposal cover sheet signed by an authorized representative of the Respondent’s organization (found in the accompanying application packet).

2. Written responses and supporting documentation to questions (found in the accompanying application packet).

3. An itemized budget request developed using the guidelines and budget forms (found in the accompanying application packet/files).

4. A System for Award Management (SAM) number. For information on how to obtain a SAM number for your organization, please refer to the following website:

5. For non-profit applicants only: proof of 501(c)3 Good Standing from the IRS. This can be accomplished by filling out the following form and printing the result for inclusion in your application packet.

6. Copy of Official Articles of Incorporation

7. A copy of the applicant’s most recent fiscal audit report

8. Certificate of Insurance

9. A Certificate of Good Standing from the Illinois Secretary of State’s Office

10. A Certificate of Economic Disclosure will be required for all awarded contracts but is not required at the time of submission.

B. E-Mail Submissions

Often large files cannot be quickly or successfully electronically submitted to us. If your application packet consists of these files, we highly recommend the use of a file compression software such as Win Zip (which can be downloaded for a free trial period at ) or any other similar software in order to keep your e-mail submissions to a single e-mail.

If you find yourself working with files that are not easily compressed or are compressed but still very large, we suggest considering a file location service such as Drop Box or Google Drive (which provide free storage for a limited number of GB) or any similar service which will allow you to upload the necessary file to a virtual location and send us a link allowing access to your submission folder. The City of Chicago does not in any way endorse or require the use of any

C. Formatting

Please submit ONE complete proposal for each program you intend to apply for. Submitted proposals must adhere to all of the following requirements:

• One complete set of the proposal containing original signatures signed by an authorized representative of the organization will be marked “Original” plus two complete copies

• One complete scanned copy of the proposal will be emailed to the following address Andrew.fernandez@ by March 11, 2013 at 4:30.

• Recycled paper appreciated but not mandatory

• 8 1/2 x 11 letter size

• Double-sided printing

• One inch margins

• At least 1.5 -spaced

• At least 11-point font

The complete application packet should consist of the following items, in this order:

1. Agency Application Information Form (page 7)

2. Executive Summary (2 page limit, page 8)

3. Program Narrative (20 page limit, page 8)

4. Budget Instructions (page 12)

5. Attachments

The Narrative portion of the proposals should be no longer than 20 pages in length.

Failure to submit a complete proposal and/or to respond fully to all requirements may cause the proposal to be deemed unresponsive and, therefore, subject to rejection.

Receipt of a final proposal does not commit the department to award a grant to pay any costs incurred in the preparation of an application.

1. Evaluation and Selection Procedures

A. Evaluation Process

An evaluation committee selected by DFSS will evaluate and rate all proposals based on the evaluation criteria outlined below. Each proposal will be evaluated on the strengths of the proposal and the responsiveness to the selection criteria outlined below. DFSS reserves the right to consult with other city departments or public or private funders during the evaluation process. Selected Respondent must be ready to proceed with proposed program at the time of contracting.

Failure to submit a complete proposal and/or to respond fully to all requirements may cause the proposal to be deemed unresponsive and, therefore, subject to rejection. The Commissioner upon review of recommended agencies may reject, deny or recommend agencies that have applied for grants based on previous performance and/or area need.

Selections will not be final until the City and the Respondent have fully negotiated and executed a contract. The City assumes no liability for costs incurred in responding to this RFP or for costs incurred by the Respondent in anticipation of a fully executed contract.

B. General Selection Criteria

1. Proposal Evaluation Process

An evaluation committee selected by DFSS will evaluate and rate all proposals based on the evaluation criteria outlined below. Each proposal will be evaluated on the strengths of the proposal and the responsiveness to the selection criteria outlined below. DFSS reserves the right to consult with other city departments or public or private funders during the evaluation process. Selected Respondent must be ready to proceed with proposed program at the time of contracting.

The Commissioner, upon review of recommended agencies, may reject, deny or recommend agencies that have applied for grants based on previous performance and/or area need. Selections will not be final until the City and the Respondent have fully negotiated and executed a contract. The City assumes no liability for costs incurred in responding to this RFP or for costs incurred by the Respondent in anticipation of a fully executed contract.

2. General Selection Criteria

The Proposals will be evaluated on the Respondent’s ability as defined in this RFP. The following criteria will be used in evaluating all proposals:

a. Previous Programmatic Experience

Respondent will demonstrate knowledge of the populations to be served or similar populations and the way in which these populations should be served as evidenced by previous or current operation of a successful program of a similar nature.

b. Administrative/Fiscal Capacity and Experience

Respondent will demonstrate the resources and expertise to assume and meet all administrative and fiscal requirements. This includes the Respondent’s fiscal (including financial management systems), technological, management, administrative and staff capabilities

c. Program Design and Administration

Respondent will show program and administrative design relevant to the goals of the program.

3. Additional Evaluation Criteria

• Agency’s mission, programs and services, and resources specifically targeting youth.

• Evidence of experience working with at-risk youth and/or youth involved in the juvenile justice system.

• Quality and variety of Respondent’s references concerning past performance.

• Quality and variety of Respondent’s current and planned service linkages and resources.

• Evidence of appropriate linkage agreements with potential employers and service providers.

• Evidence of an operating budget of greater than $500,000.

• Prior experience managing programs of similar size and scope.

• Proof and amount of match funding if required.

• Evidence of effectiveness of current programming.

• Quality of youth engagement strategies to recruit and retain youth.

• Quality of training provided to staff.

• Quality of proposed plan for supervision.

• Quality of proposed plan for staffing.

• Willingness and capacity to participate in the evaluation component/data collection.

• Geographic region, linguistic or cultural specificity.

The Proposals will be evaluated on the Respondent’s ability to provide programming as defined in this RFP. An agency will qualify based on the extent to which the respondent demonstrates capacity, competency and a successful history of meeting the requirements outlined in this RFP. Past performance on similar services will be considered as part of the evaluation process. Eligible proposals will be evaluated on the basis of completeness of application:

DFSS reserves the right to seek clarification of information submitted in response to this Application and/or to request additional information during the evaluation process and make site visits and/or require Respondents to make an oral presentation or be interviewed by the review subcommittee, if necessary.

The Commissioner, upon review of recommended agencies, may reject, deny or recommend agencies that have applied for grants based on previous performance and/or area need.

Selections will not be final until the City and the Respondent have fully negotiated and executed a contract. The City assumes no liability for costs incurred in responding to this RFP or for costs incurred by the Respondent in anticipation of a fully executed contract.

DEPARTMENT OF FAMILY AND SUPPORT SERVICES

Youth Workforce Experience Programming 2013

Common Agency Application Information Form

|Legal Name of Applicant Agency | FEIN Number |

| | |

|Administrative/Mailing Address |DUNS Number |

|Executive Director |Executive Director’s Phone Number |

| | |

|Executive Director’s Fax Number |Executive Director’s Email Address |

| | |

|Contact Person for Proposal |Contact Person’s Phone Number |

|Contact Person’s Fax Number |Contact Person’s Email Address |

Type of Organization (check one)

| |Not-for-Profit Agency | | For-Profit Agency | |Faith-Based Agency |

| |Other, if yes Description: | |

Amount Requested: $______________________

Program applying to in this application (please check ONE):

___Summer Youth Employment Program ____ Youth Working for Success

___ One Summer Chicago PLUS ____ Bridges to Pathways Initiative

___ Greencorps Youth Program

Agency Statement of Certification

This proposal has been duly authorized by the governing body of the proposed. The proposed activities, dates, availability of resources, staff, cost, and all statements made are true and correct. The applicant will comply with all rules and regulations of the funding agency and will revise this proposal if necessary.

| | |

|Authorized Signer’s Name |Authorized Signature |

| | |

|Authorized Signer’s Title |Date Signed |

Application

Executive Summary – Required for all program applications

Please attach an Executive Summary, which briefly describes your organization’s qualifications, and relevant experience to participate in the proposed programs. The Executive Summary may be no more than two pages.

Program Narrative - Required for all program applications

Write a narrative that provides information and description about your organization’s capacity, vision and plans on the following areas in reference with respect to operating a Youth Workforce Experience program in 20 pages or less. The 20 page narrative should include the overall program narrative questions as well as the program specific questions.

General Administrative Capacity

1. Provide a narrative overview of your agency. The narrative should minimally address the following items: brief history of your agency; agency’s philosophy and mission; and your organization’s specific experience serving at-risk and/or providing work experiences for young people ages 16-24 and a brief overview of the services you provide.

2. Describe what supportive services your agency is capable of providing or coordinating for youth (for example childcare, transportation, clothing or uniform needs) and how these services have been or will be funded. Feel free to attach partnership letters with other organizations who provide support services to you.

3. Describe your organization’s programmatic, fiscal and administrative capacity for operating and managing the proposed program, if funded. This should include a detailed explanation of how you will successfully execute a timely and accurate payroll for the youth participants.

4. Does your agency currently or intend to sub-contract the payroll portion of this program to a third party? If yes, to whom and what qualifications will you use to determine their ability to meet payroll.

5. Please include your agency’s most recent annual audited budget and financial statements.

6. Has the organization ever been declared seriously deficient in the operation of a grant? If so, explain.

7. Please include as an attachment job descriptions and resumes for the program manager and all other key staff. Please identify the person who will act as the project leader for this program.

8. What type of professional development do you provide for your staff working with youth?

9. Please attach an organizational chart for your organization.

10. Please submit your proposed staffing plan for the program.

11. Please attach a minimum of three (3) to five (5) verifiable references regarding your agency’s performance (references can be from a variety of sources, i.e., funding sources, social service agencies or other professional agencies or community groups) on that agencies’ letterhead.

12. Please attach a table outlining all of your current grants

|Name of program |Source of funding (please be as |Grant Amount |Grant start/end |Data tracking software |

| |specific as possible) | |dates |used |

| | | | | |

| | | | | |

| | | | | |

Please expand as needed.

Geographic Location

1. Do you serve a specific population or geographical area? If yes, which ones?

2. Describe the physical location of the service site(s) and how they can be accessed by public transportation.

3. Describe the accessibility of the project site(s) and compliance with American with Disabilities Act (ADA) requirements. Identify any accommodations that the proposed site may require to become compliant with ADA. Explain the organization’s plans to continually assess and comply with ADA requirements.

Program Questions

Participant Recruitment and Retention

1. How do you recruit high-risk youth?

2. How do you retain youth who may have multiple barriers to employment in your programs?

3. How do you resolve disputes, address complaints, and provide overall program support to ensure youth and employers satisfaction and gains?

Program Activities

1. Describe your experience in managing youth

2. Provide a detailed implementation plan identifying the key activities and corresponding timeframes for the project.

3. Please describe your youth orientation.

4. What kinds of on-going youth workforce development training will your organization provide in the one day soft skills and job expectations training? Please list the type of training, duration and instructor qualifications.

5. Please describe your proposed plan for providing the youth time for non-work activities including training, professional development and/or enrichment.

6. Please describe your plan for identifying worksites related to the program type that are safe, have appropriate jobs for the targeted population and have the amount of necessary youth positions to place participants. Additionally, how will you identify jobs that positively coincide with an individual youth’s interests?

Financial Literacy

1. Do you have a computer room or access to computers for youth to complete a financial literacy curriculum?

2. How would you engage youth in the completion of an on-line financial literacy curriculum?

Mentoring

1. Describe how you will recruit, screen and hire coaches, mentors and/or instructors (if not already on-staff)? Please attach your relevant job description(s).

2. How will the proposed program ensure quality supervision for coaches?

3. Have you utilized or implemented a mentoring component for current or past employment programs? If so, which one?

Program Monitoring, Data Collection, Reporting and Recordkeeping

1. How do you measure success and by those measurements how successful have your youth programs been? Why or why not?

2. What internal processes do you have to ensure proper and timely reporting?

3. What are your internal practices to ensure quality assurance for record keeping?

4. Please describe your experience with performance measures and reports based on those measures. Please attach a sample outcomes report.

Program Specific Questions

Please answer the following program specific questions regarding the specific program application you are completing.

Summer Youth Employment Program

Please fill this out if you are applying for a Summer Youth Employment Program

1. Describe your experience with workforce development programs or contracts of comparable size and scope, identifying the number of years providing workforce development or similar services

2. Please describe your organization’s current experience in delivering services to youth enrolled in Chicago Public High Schools, specifically, within the CPS high school networks. Additionally, please identify up to three networks you would like to work with.

3. How will you recruit youth mentors, 21 to 24 years old for the program?

4. How will you supervise the youth mentors?

5. Please complete this table if your agency anticipates operating its own worksites. For example: you are a local community based organization with ten program sites, please list the sites where you anticipate placing youth in employment. If this information is not known at the time of application, please indicate the anticipated number of sites and youth to be engaged and write pending.

|Worksite Name |Address |Zip |Number of |

| | | |Youth at site |

| | | | |

| | | | |

Expand as needed

Total youth to be employed (anticipated): ________

One Summer Chicago PLUS Program

Please fill this out if you are applying for a One Summer Chicago PLUS Program

1. Please describe your organization’s experience in identifying employment opportunities for hi-risk youth involved in the justice system.

2. Please describe your organization’s history and specific experience working with or in high school(s), surrounding neighborhood(s), detention centers, probation departments, and/or the Juvenile Intervention Support Center you have proposed serving and/or any similar programs or services you have provided or are currently providing in those environments.

3. What is your agency’s history of in providing intensive mentoring services to the population targeted for this program?

4. What is your organization’s history of collaborative with justice-related organizations such as (but not limited to) Chicago Police Department, Juvenile Intervention Support Center, detention centers, probation departments and diversion programs?

Greencorps Program

Please fill this out if you are applying for a Greencorps Program

1. Please describe your organization’s current experience in delivering services to youth enrolled in Chicago Public High Schools, specifically, within the CPS high school networks. Additionally, please identify up to three networks you would like to work with.

2. Please describe your organization’s prior experience in working with youth involved in the juvenile justice system, those youth exposed to violence and specifically, adjudicated delinquent or dependent youth.

3. Please describe your recruitment plan of youth in high schools/networks you identified?

4. What is your strategy to recruit and retain mentors that fit the Greencorps program requirements as outlined in the RFP?

5. Please describe your past and current experience with programs or projects focused on “green” initiatives.

6. Specifically, what is your organization’s experience in providing project-based learning to youth?

7. What types of job will you be able to identify and place youth into after the completion of the summer component of the Greencorps program?

Youth Working for Success Program

Please fill this out if you are applying for a Youth Working for Success Program

1. Please describe your ability to recruit and work with youth with a history of two or more arrests or who have been adjudicated as a delinquent.

2. Please describe your organization’s history and specific experience working with or in detention centers, probation departments, diversion programs and/or the Juvenile Intervention Support Center.

3. Please describe how your organization will provide youth with an authentic opportunity to make meaningful contributions to their communities, specifically focused on the civic leadership skill building, social entrepreneurship, and job placement in the social services sector.

4. Please describe current examples of civic leadership projects that your organization has developed and completed.

5. Specifically, what is your agency’s history of effectiveness in providing youth leadership training that are project-based to the target population served in this RFP?

6. Please describe your organization’s implementation plan for each of the three phases of the program as described in the RFP.

Bridges to Pathways Initiative Program

Please fill this out if you are applying for a Bridges to Pathways Initiative Program

1. Please describe your organization’s history and specific experience working with or in detention centers, probation departments, diversion programs and/or the Juvenile Intervention Support Center.

2. What is your experience working with alternative schools/non-traditional educational pathways?

3. What is your experience with career exploration, workforce skills development, and post-secondary placement? Is it curriculum based? If yes please provide examples.

4. How will you recruit, train and support mentors to this program?

5. Please outline your specific experience in providing job placement, re-placement and retention services to high-risk youth with criminal records.

Budget Instructions

Budget Forms - Instructions

Please attach a budget for each proposed program you are applying for, remembering that there is a 10 percent cap on administrative functions and a minimum of a 15 percent in-kind match requirement.

BUDGET SUMMARY- Form 1

The purpose of this form is: 1) to summarize, by item of expenditure, the total budget of a program or project to be funded in whole or in part by the City of Chicago, Department of Family and Support Services and identify any additional funds that will be leveraged for this program either cash or in-kind; and 2) to specify the share of total cost charged to the awarded grant program and the share of total cost charged to other matching or supplemental funding sources.

Please show both the expenses that will be paid for with awarded funds and those that will be paid for with other share. Numbers should be rounded to the nearest dollar.

A. Respondent- Name of Applicant Agency.

B. Department Program - Filled out by City Department.

C. Project Name - Name of project.

D. Department - Filled out by City Department.

E. Contract Term - Indicate beginning (month/day/year) and ending (month/day/year) of contract period.

F. Allocation – Indicate the amount of awarded funds allocated for this project.

G. Vendor Code Number - Filled out by City Department.

H. Service Contract Number - Filled out by City Department.

I. Fund/Dept./Organization #: Filled out by City Department.

J. Project Budget - Columns (1) and (2): Item of expenditure and account number - The required information has already been provided in these two columns. Respondent budgets are limited to the accounts listed on the Budget Summary. In exceptional cases, City Departments may obtain approval to use "other" accounts by contacting their budget analyst at the Office of Budget and Management.

Personnel Costs (Account 0005) - salaries, stipends, overtime, salary adjustments.

Fringe Benefits (Account 0044) - term life insurance, worker’s compensation, health insurance, unemployment insurance, dental plan, Medicare.

Operating/Technical Costs (Account 100) - accounting, auditing (if anticipating expending $500,000 or more in federal funds), legal, publications, rental of property, rental of equipment/services, repair/maintenance of property, repair/maintenance of equipment, utilities, telephone, local transportation, postage, advertising, technical meeting costs, general liability insurance, reproduction, dues, promotions, memberships, messenger service.

Professional and Technical Services (Account 0140) - consultants/subcontractors.

Materials and Supplies (Account 0300) - stationery and office supplies, tools, materials and supplies, books and related material.

Equipment Costs (Account 0400) - office machinery, furniture and furnishings, equipment, and communication devices. If purchases are $5,000 or greater a property inventory must be maintained.

Other Program Costs (Account 0900) - All other expenses that do not fit in the other account categories.

Insurance - The City Comptroller’s Office has established minimum insurance requirements for applicants awarded City of Chicago, state and federal funds. If all insurance requirements have not been met, the City Comptroller will withhold reimbursement from an applicant until such requirements are met. The types of insurance required include worker’s compensation; general liability; a fidelity bond (if applicable); automobile liability; and professional liability. The City Comptroller reserves the right to require additional types of insurance, if deemed necessary. City Departments should contact the City Comptroller’s Insurance Division, Maria Santiago at (312) 744-7923 with questions regarding your agencies’ insurance requirements.

Local Transportation - The automobile allowance for applicant staff is the same as the allowance for City employees - .505 cents per mile. The per-person reimbursement cannot exceed $250 per month.

Column (3): Provider Share of Cost - Summarize by budget line item the of the awarded budget allocation for this program or project.

Column (4): Other Share - Summarize by budget line item the share of the project’s cost which will be funded with matching or supplemental public or private funds. If funding is supporting the agency's general operations then "Other Share" should represent all non-funded awarded operating support.

Column (5): Total Cost - Add columns (3) and (4) to derive the amount of the total budget for the program or project.

K. Percentage of Total Project Costs Paid by Other Share - Column 4 divided (÷) by Column 5. Please indicate any leveraged or matching funds allocated to this program.

Personnel Budget - Form 2

The purpose of this form is to estimate the total personnel costs the sub-recipient expects to incur in operating its funded project, and to provide a brief summary of job responsibilities for each budgeted position.

A. Name of Respondent: Self-explanatory.

B. Department: Filled out by Department.

C. Project Name: Self-explanatory.

D. Federal Employer Identification Number - The Internal Revenue Service (IRS) assigns a 9-digit Federal identification number to every organization employing one or more individuals. Indicate the sub-recipient's number in the space provided. Should an agency have questions concerning its identification number, call the IRS at (800) 829-1040.

E. Personnel Budget Allocation

Column (1): Position Title - List all positions (even those for which the salary will be paid exclusively with an "other share" funding source) that will be funded under this project.

Columns (2) and (3): Number and Rate - For each position listed in Column (1) indicate the number of employees to be funded and the corresponding salary rates (either annually or hourly). If there are different rates for the same position, list the rates one under another.

Column (4): % of Time Spent on Project - Often an employee spends only a fraction of his or her time on the funded project because they are engaged in other sub-recipient projects. Please indicate for each employee to be funded, percentage (%) of time that will be spent on this project. If the employee is part time, please show the percentage (%) of the hours they work on this project out of the total hours they work.

Column (5): Grant Award Share of Total Cost - For each position listed, please indicate the amount of total salary cost to be paid with grant funds.

Column (6): Total Cost - To determine the total salary cost for each position; multiply Column (3) by Column (2) for each position/rate. Then multiply this amount by the percentage of time to be spent on the project Column (4) and put the final amount in Column (6).

Column (7): Brief Summary of Job Responsibilities - Describe briefly the duties and responsibilities associated with each position listed in Column (1).

Line (8): Positions/Salaries Subtotals - Add the number of positions to be funded for this project and indicate the number at the bottom of Column (2). Also, subtotal Columns (5) and (6) to derive respectively the funded share of total cost and the total salary cost.

F. Fringe Benefits and Total Personnel Costs: Both the federal and state governments require employers to pay various employee taxes and contributions. These taxes and contributions, along with certain fringe benefits that a sub-recipient may wish to offer its employees, are funded eligible expenses. The share of fringe costs to be borne by funded amount must be reasonably proportional to the share of the salary costs borne by funded amount. Please estimate these various costs on the form where indicated. You must have written organizational policies to support those costs.

Line (9): F.I.C.A. and Medicare - Federal Insurance Contribution Act tax otherwise known as the Social Security Tax and Medicare.

Line (9a): The Social Security Tax is computed every payroll period 6.2% of total payroll, up to $ 106,800 per employee year.

Line (9b): The Medicare Tax is computed every payroll period as 2.9% of total payroll per employee year.

For further information regarding the F.I.C.A., contact the Internal Revenue Service at 800-829-1040 or refer to Publication 15 - Circular E. Calculate the funded share of the total F.I.C.A. cost for the annual value of the contract in columns (5) and (6) respectively.

Line (10): State Unemployment Insurance - It is likely that your organization is liable for Unemployment Insurance. For further information contact the Illinois Department of Employment Security hotline at (312) 793-1905. In Columns (5) and (6) show respectively the share of this total to be borne by funded share and the total State Unemployment Insurance Cost.

Line (11): State Worker's Compensation Insurance - This insurance is computed at a rate determined by the employee's type of business or organization. How often an employer must pay worker's compensation is based on the size of its insurance premium. All applicants are encouraged to call the National Council of Compensation Insurance (NCCI) at 800-622-4123 for technical assistance in this matter. In Columns (5) and (6) show respectively the share of this total to be borne by funded share and the total State Worker's Compensation Insurance cost.

Lines (12-13): Other - Please list any other employer expenses or benefits the agency will offer its employees. Most non-profit agencies do not have to pay the Federal Unemployment Tax, which is computed every payroll period as .008 of total payroll up to $7,000 per employee per year. This rate is subject to change and will be determined by the Internal Revenue Service. Check with the IRS at (800) 829-1040 to determine if your agency is exempt. An agency should also check with the lead City department to determine whether additional benefit(s) it wishes to offer are grant awarded eligible expenses. In Columns (5) and (6) show the GRANT AWARD share and the total cost for each benefit listed.

Line (14): Subtotal Fringe Benefits - Add lines (9) through (13) to obtain the total fringe benefits (account number 0044).

Line (15): Total Personnel Costs - Add lines (8) and (14) in both Column (5) and (6), to obtain both the Grant award Share of the total costs and the Total Personnel Costs for the project.

Non-Personnel Budget - Form 3

The purpose of this form is to estimate and justify the non-personnel line item amounts shown on the Budget Summary (Form 1).

A. Name of Respondent.

B. Self-explanatory.

C. Self-explanatory.

D. Federal Employer Identification Number - The Internal Revenue Service (IRS) assigns a 9-digit Federal identification number to every organization employing one or more individuals. Indicate the sub-recipient's number in the space provided. Should an agency have questions concerning its identification number, call the IRS at (800) 829-1040.

E. Detailed Schedule of Non-Personnel Allocations

Columns (1) and (2): Item of Expenditure and Account Number - List the account descriptions and the corresponding account numbers specified on the Budget Summary (Form 1) which are applicable to this project. Do not include the personnel account.

Column (3): Grant Award Share of Cost - Indicate the share of the total cost listed in Column (3) that will be paid from awarded Grant.

Column (4): Total Cost - Indicate the total amount of funds budgeted for each item of expenditure specified in Column (1).

Column (5): Line Item Description and Justification - Each amount of budgeted funds listed in Column (4) must be justified. Please show all calculations. Include quantities and unit costs wherever possible (add additional sheets if necessary).

Column (6): Total - Indicate the totals for Columns (3) and (4).

Each Respondent must submit a complete line-item budget and budget narrative.

Additional Required Attachments

Please include/submit the following documents as part of your application packet.

1. IRS statement of tax exempt status

2. Federal Employer Identification Number (FEIN)

3. Copy of Official Articles of Incorporation

4. Applicant’s most recent fiscal audit report or pre-approved equivalent.

5. Certificate of Insurance (Attachment A).

6. Linkage Agreements with Other Community-based Organizations to leverage additional resources and supports.

7. Curriculum for mentoring component.

Checklist for Submission of the Proposal

Use the following list as a guide before submitting your application.

|YES |N/A |ATTACHMENTS |

| | |Original application plus two (2) copies |

| | |IRS statement of tax exempt status |

| | |Federal Employer Identification Number (FEIN) |

| | |Copy of Official Articles of Incorporation |

| | |List of Board of Directors |

| | |Audit |

| | |Executive Summary |

| | |Application Narrative |

| | |Complete Budget Packet |

| | |ATTACHMENTS – not counted as part of the 20 pg. narrative limit. |

| | |Staff resumes and job descriptions |

| | |Organizational Chart |

| | |Staffing Chart |

| | |Grant Table |

| | |Three - five (3-5) references regarding your agency’s performance. |

| | |Worksite and/supportive service linkage agreements |

| | | Sample evaluation report |

| | | Mentor and/or workforce skills curricula (as per program) |

| | | Work site address list (if known) |

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