TABLE OF CONTENTS - Baltimore City Health Department



TABLE OF CONTENTS

Page

I. BACKGROUND

A. Program Authority …………………………………………………………. 2

B. Purpose and Use of Funds ……………………………………………….. 2

C. Target Populations …………………………………………………………. 3

D. Funds Available for Bid …………………………………………………….. 3

E. Applicant Eligibility ………………………………………………………….. 4

F. Period of Grant Award ……………………………………………………… 4

II. PROCESS

G. Bidders Conference ………………………………………………………… 4

H. Letter of Intent ………………………………………………………………. 4

I. Review Process ……………………………………………………………. 5

J. Evaluation Criteria and Points …………………………………………….. 6

III. CONDITIONS

K. Restrictions and Requirements ……………………………………………. 7

L. Contracts ……………………………………………………………………… 8

M. General Terms and Conditions of City of Baltimore ……………………… 9 N. Tobacco Program Agreements …………………………………………….. 11

O. Grievance …………………………………………………………………….. 12

P. Standards …………………………………………………………………….. 12

IV. APPLICATION

Q. Preparing the Grant Application ……………………………………………. 13

R. Components of the Grant Application ……………………………………… 14

S. Budget and Budget Narrative ………………………………………………. 15

T. Application Check List ………………………………………………………. 15

U. Submitting the Application …………………………………………………… 15

V. Due Date and Delivery ………………………………………………………. 16

ATTACHMENTS:

1. Application Cover Page*

2. Abstract Format*

3. Signatory Letter*

4. Vendor Assurances*

5. Application Check List*

6. Assurance - Reviewer Conflict-of-Interest

7. Budget Forms: DHMH 432A-I

8. Activities Available for Bid

* Return Attachments 1-5 with the grant application.

I. BACKGROUND

A. Program Authority

This document is provided to assist eligible agencies to prepare their FY15 application. Under program components, services are defined to meet the short-term (FY15 objectives and the state’s longer term goals (Section B). The programs are: community, schools, enforcement, and cessation. Funding for the Tobacco Use Prevention and Cessation Program was passed into law in 2000 under Maryland Senate Bill 896.

Tobacco restitution funds are managed by the Maryland Department of Health and Mental Hygiene (DHMH), and then granted to 24 local jurisdictions according to population and prevalence of tobacco-related illness. The grant award to Baltimore City is administered by the Baltimore City Health Department (BCHD).

B. Purpose And Use Of Funds

The intent of the Cigarette Restitution Fund Program (CRFP) is to assist local jurisdictions "to reduce tobacco use among women, minority individuals, and individuals under the age of 18 years" [1] and "to increase availability of and access to cessation programs for uninsured individuals and medically underserved populations" [2]. The long-term goal is to reduce morbidity and mortality caused by the use of tobacco products: cigarettes, chewing tobacco, pipes, cigars, and bidis.

Tobacco use prevention and cessation services, under this Request for Proposals (RFP), must be offered without regard for the individual’s ability to pay, the individual’s past or present health condition, and in a setting that is accessible to low-income residents of Baltimore City. Services must be provided entirely within the jurisdiction boundaries of Baltimore City.

Funds must be used to deliver or to enhance existing tobacco use prevention and cessation services. These services include a range of interventions that will assist users of tobacco products to reduce or eliminate their use of these products. Services may be provided in public and private settings, outpatient and inpatient medical facilities, community health centers, schools and colleges, nonprofit agencies, senior citizen centers, churches and faith-based organizations, and work places. Cessation services may include individual and group counseling, group cessation programs, prescriptions for pharmacotherapies (nicotine gum, patch, nasal spray or lozenges), enforcement of point-of-purchase laws, purchase or translation or development of print materials for specific ethnic or minority groups, hypnotism, and other support services. Imaginative incentives, with tobacco use prevention and cessation messages, are encouraged to reinforce positive behaviors.

Partnerships are a mandatory requirement in all grant applications. The designation of at least one partner is worth 10 evaluation points (Section J). The lead applicant is responsible for completion of all performance measures by its partners, and only the lead applicant enters into contract with the City of Baltimore. DHMH defines a partner as an entity that receives tobacco funds.

►All providers must give a 10% share of their award to their partner organizations.

C. Target Populations

Specific groups of residents in Baltimore City are to receive priority in the provision of services under this offer. Racial and ethnic minorities have the highest rates of tobacco-related chronic illness and are to be specifically identified in the grant applications. These groups are: African, Asian, Hispanic, and Native Americans. Other special populations at risk for harm from tobacco use, or identified as priority groups in Baltimore City, are: adolescents, women, pregnant women, senior citizens, and gay adults.[3] Applications for funds under this offer must identify the target minorities or groups that are the focus of the application. This may be in terms of geography or in terms of a social, racial or ethnic community of people. Applications must provide sufficient health, risk factor, and socio-economic data to describe the population’s need for the services.

D. Funds Available By Component

Grant funds are available only for the activities and performance measures in the application submitted to DHMH by the Baltimore City Health Department, and approved by DHMH. Refer to Part D for the activities that are available for bid in FY15.

Continuation awards are not made. The award of funds is based on a competitive annual bid each year. BCHD reserves the right to increase or decrease any award as a result of any changes in the DHMH grant award to Baltimore City. Future awards will depend upon a vendor's completion of the previous year’s performance measures.

FUNDS AVAILABLE FOR BID IN FY15: $107,067.

|Community |Enforcement |Cessation |Schools |

|$23,567 |$21,000 |$42,500 |$20,000 |

(See Part D for award amounts and performance measures.)

E. Applicant Eligibility

Eligible applicants include entities such as: government agencies, nonprofit health education organizations, community-based organizations, churches and faith-based organizations, out-inpatient hospital services, community health centers, substance abuse and mental health agencies, family planning and prenatal care clinics, colleges and universities, senior citizen centers, and ethnic organizations. The following are not eligible.

• Individuals

• National organizations*

• Private for-profit entities

• FY14 vendors that did not complete their performance measures.

*Local chapters may apply if they meet the definition of a community-based organization, provide the grant-funded activity entirely within the jurisdiction boundaries of Baltimore City, and serve only Baltimore City residents.

F. Period Of Grant Award

Successful grantees will be awarded funds for Fiscal Year 2015. Funds not disbursed during FY15 must be returned to DHMH.

II. PROCESS

G. Bidders Conference

Interested parties are encouraged to attend a Bidders Conference at which the RFP will be discussed and questions will be answered. (SEE COVER PAGE FOR DATE.) Before the Bidders Conference, you may email questions to Emilie Gilde at emilie.gilde@ and your questions will be answered at the Bidders Conference.

H. Letter Of Intent

A Letter of Intent is requested on the Monday following the Bidders Conference. An applicant should state the intent of its organization to submit an application, the program component being addressed and its partner organization(s). This letter is not binding but is requested. (SEE COVER PAGE FOR DATE.)

Address the Letter of Intent to: Emilie Gilde, MPP, Director

Tobacco and Cardiovascular Disease Prevention Initiatives

Baltimore City Health Department

7 E Redwood Street, Room 309

Baltimore, Maryland 21201-1115

The Letter of Intent should be sent by email to: emilie.gilde@.

I. Review Process

The Executive Committee of the Baltimore City Tobacco Community Health Coalition will review all grant applications. Executive Committee reviewers were selected based on their knowledge of community needs, expertise and diversity, and their organization’s intent not to apply for funds under this offer.

Applications will not be accepted from organizations that are represented on the Executive Committee because of the obvious conflict-of-interest. Each reviewer on the Executive Committee must sign a Conflict of Interest Assurance for each application reviewed (Attachment 6). The Assurance attests that the reviewer is not on the board of the organization [application] reviewed nor does the reviewer, or a family member or partner, have a financial or political relationship with the organization [application] reviewed.

Each application must meet all the requirements outlined in this document. Numeric values are assigned to each section and added to achieve a score (Section J). Three reviewers score each application and their scores are summed and averaged to achieve a final score. The reviewers recommend the highest-scoring applications to the Commissioner of Health. The award letters are provided by the Commissioner of Health.

The Award Letter reiterates the requirement for documents to be submitted prior to initiating a contract (Section L). The vendor receives instructions from the Office of Fiscal and Grants Management concerning a final budget and disbursement of checks. BCHD program staff initiate all contracts and monitor them as they move through the City’s approval process. In the City’s contract process, all awards and vendors must be approved by the Board of Estimates, consisting of the Mayor; the City Council President; the Director of Public Works; the City Comptroller; and the City Solicitor.

J. Evaluation Criteria And Points

• Partner Organizations (Cover Page) plus their budgets -- 5 points.

• Capability of the Organization – 20 points

Define the organization structure, constituencies, and current and previous experience with persons who use tobacco. Include mission statement, brief history, legal structure, staff expertise, services delivered, access to the target populations, and funding sources. Include the same information for partner organizations.

• Description of the Target Population(s) – 10 points

Provide sufficient demographic and socioeconomic indicators to describe the geographic or social community to be served. Describe source for reaching clients. Describe services provided to uninsured and medically-underserved residents.

• Fiscal and Accounting Procedures – 5 points

Describe fiscal positions, audit requirements and accounting system (one ¶).

• Work Plan, Time Table, Methods, Activities, Performance Measures – 30 points

Describe the organization’s ability to complete the proposed activities by June 30, 2015. Describe how the project will reach uninsured residents, and how client advocacy will be done. Include the same information for partner organizations.

Describe all positions required for services to be provided, including existing and new positions and volunteers (inc. resumes/job specs [2-page limit], % time on project), and a planned schedule for hiring or training.

• Evaluation – 10 points

How will performance be measured? Who is accountable? Describe the process of quality assurance in place at the organization.

• Budget Forms and Budget Narrative – 20 points

Complete the DHMH Form Set 432A-I (Attachment 7).

Include a detailed and descriptive Budget Narrative.

►Budget must include 10% of award to the partner organization(s).

Write the Budget Narrative as a separate page(s), and insert after budget page I.

For purchases, or purchase of services, calculate costs based on the unit price of an item or the hourly rate for a consultant or service. Multiply the unit price or the hourly rate by the number of units or the number of hours to be purchased.

The partner organization(s) budget amount should be listed on page G "purchase of service" and on the 432B line item. Each partner organization should complete a signed page (432A), line item budget (432B), salaries (432D), fringe costs (432DD), consultants (432E), and purchase of services (432G), as appropriate.

III. CONDITIONS

K. Restrictions & Requirements

1. Grant funds may not be used to supplant or replace currently funded activities. This requirement is subject to audit. (Attachment 4: Assurances)

2. Funds may not be used to purchase or improve land, or to purchase, construct or make permanent improvements to any building.

3. An organization that receives tobacco settlement funds may not charge the client-patient for services provided with these funds. Funds may not be used to make payments to the client-patient.

4. Providers must participate in a referral network that guarantees that the patient-client receives the most-appropriate service to meet his/her needs, and that continuity of care is assured.

5. Funds may not be used for indirect or administrative costs.

6. Program Costs: Include direct costs as program line items when these items directly support program efforts and reflect the percentage of effort provided to the tobacco program. (Example: a nurse is full-time staff in an organization. She will spend 25% of her time on the tobacco project. So, the grant budget may carry 25% of her salary. If supplies will support tobacco program staff or incentives are for the client-patients in the tobacco program, then these items are program costs and should be included in the budget.)

7. Funds may not be used to provide services for which payment has been made or reasonably can be expected by third party payers, including HealthChoice, Medicaid, Medicare and/or other state or local entitlement programs, prepaid health plans or private health insurance. Therefore, it is incumbent upon Providers to assure that eligible individuals are expeditiously enrolled in entitlement programs and that tobacco settlement funds are not used to pay for any services covered by such entitlement programs for their enrollees. BCHD is subject to audit on this requirement and, likewise, so will Providers be subject to audit on the same practice.

8. Providers are required to submit programmatic and fiscal reports to BCHD. Noncompliance with this reporting requirement can lead to reduction or termination of an awarded contract. Providers are required to submit a brief quarterly Program Report and a quarterly Fiscal Report to document services provided, including demographics on clients receiving services and descriptive information on services delivered. These reports are the basis for the City’s reports to DHMH. Payment to Providers will be delayed if required programmatic and fiscal reports are not received. This is a contractual requirement.

10. The intent of the tobacco settlement fund is to provide services to those who need education, prevention, and cessation services. Organizations receiving funds are expected to establish and monitor procedures to verify and document clients in need of these services. Providers should demonstrate these procedures at site visits.

11. Providers that failed to meet the performance measures in their FY14 awards are not eligible to apply for a grant in FY15.

12. Use of funds for print or electronic materials must acknowledge BCHD and DHMH, as follows: “Funded by the Baltimore City Health Department through a grant from the Maryland Department of Health and Mental Hygiene, Cigarette Restitution Fund Program.”

13. Any publication in a professional journal must acknowledge the Baltimore City Health Department by name. Any such publication must be submitted, while still in draft form, to BCHD for review prior to publication.

14. By signing the grant application, the applicant organization assures that it understands these funding requirements and that misuse of funds can result in loss of the current grant and/or removal from future funding cycles. These fiscal and reporting requirements are part of a contract with the City of Baltimore.

15. By signing the grant application, the applicant organization assures that it understands these requirements of a grant award under this offer.

16. By signing the grant application, the applicant organization assures that it has not been debarred from doing business with the City of Baltimore.

L. Contracts

Every Provider that receives an award is required to enter into contract with the City of Baltimore. A contract that results from the FY15 awards must be completed, approved and signed by all parties within BCHD and other City agencies (Law Department, Finance, Audits, Board of Estimates, Bureau of Disbursements), and the Provider, before payment can be disbursed. Payment is a reimbursement for services provided. Payment on an approved contract is processed in response to an invoice from the Provider. These are standard City of Baltimore fiscal and contract procedures.

The following items must be provided in order to initiate a contract:

▪ Signatory Letter (Attachment 3); print on your agency letterhead.

▪ Minority Report (Assurance, Attachment 4)

▪ Nonprofit and/or IRS letter; for example: 501(c)(3) or other status.

▪ Certificate of current liability insurance

▪ Certificate of good standing: MD Department of Assessments and Taxation

▪ Budget Forms -- DHMH Forms 432A-I

Include these contract documents in the Appendix of the application (see Section R).

M. General Terms And Conditions Of The City Of Baltimore

1. BCHD is responsible for reimbursement of services performed under this program. Payment is based on invoices with supporting source documentation. Every effort will be made to make payment under the contract agreement within 45 days of receipt of an invoice.

2. As the tobacco settlement grantee, the BCHD is responsible for the proper stewardship of all grant funds and activities. Providers are expected to establish sound and effective business management systems to assure the proper stewardship of funds and activities. These systems must meet the requirements outlined by the Office of Management and Budget (OMB) since these standards are followed by the City. The OMB Circulars are available online, as follows:

• OMB Circular A-110 - Uniform Administrative Requirement for Grants and Agreements with Institutions of Higher Education, Hospitals, and Other Non-Profit Organizations. Circular provides vendors with the minimum requirements or explanations for standards for financial management systems, purpose of: property standards, procurement standards, reports and records, termination and enforcement, and closeout procedures.

The following three resources establish principles and standards for determining costs applicable to grants, contracts and other agreements:

• OMB Circular A-122 - Cost Principles for Non-Profit Organizations

• OMB Circular A-87 - Cost Principles for State and Local Governments

• OMB Circular A-21 - Cost Principles for Educational Institutions

3. The Provider must obtain an audit in accordance with the revised OMB Circular A-133 - Audits of Institutions of Higher Education and Other Non-Profit Institutions. A copy of this Circular is available online.

4. Compliance with Tax Obligations - Prior to the execution of a contractual agreement, the Provider must be in compliance with federal, state and local tax requirements.

5. Confidentiality - all records and other identifying information should be maintained in a secure place, preferably in locked files.

6. BCHD reserves the right to charge the vendor up to 5% of the award for noncompliance with program and fiscal report submission deadlines.

7. BCHD reserves the right to increase or decrease awards within the funding period due to failure to achieve contracted goals and objectives by June 30, 2015.

8. Baltimore City Insurance requirements: the following sections are excerpts of a standard City contract. Prospective Providers must comply with these insurance requirements in order to enter into contract with the City of Baltimore.

• (Section 4) The PROVIDER shall not commence work under this Agreement until it has obtained all the insurance required under this section. Further, such insurance shall remain in force during the life of this Agreement. The PROVIDER shall name the Mayor and City Council of Baltimore City as additional insured on all policies. The PROVIDER, at its sole expense, shall procure and maintain during the life of this Agreement the following required insurance coverage:

• (Section 4A) Professional Liability, Errors and Omissions Insurance, with annual, aggregate limits of no less than Three Million Dollars ($3,000,000), pertaining to services rendered by professionals on behalf of the PROVIDER. If coverage is purchased on a "claims made" basis, the PROVIDER warrants continuation of coverage, either through policy renewals or the purchase of an extended discovery period from the date of contract termination, and/or conversion from a "claims made" form to an "occurrence" coverage form. Said policy shall be for services performed, pursuant to this Agreement, either directly or indirectly, which involve or require professional services. "Professional Services" for purposes of this Agreement shall mean any services provided by a licensed professional.

• (Section 4B) Commercial General Liability Insurance at limits of not less than One Million Dollars ($1,000,000) per occurrence for claims arising out of bodily injuries or death, and property damages. With those policies with aggregate limits, a minimum limit of Three Million Dollars ($3,000,000) is required. This policy shall include broad form property damage if the PROVIDER uses any City of Baltimore owned facility (or facilities). Such insurance shall include (a) contractual liability insurance and (b) sexual and/or physical abuse liability coverages.

• (Section 4C) Business Automobile Liability Insurance at limits of not less than One Million Dollars ($1,000,000) per occurrence for all claims arising out of bodily injuries or death and property damages. The insurance shall apply to any owned, non-owned, leased, or hired automobiles used in the performance of this Agreement.

• (Section 4D) Workers' Compensation coverage as required by the State of Maryland, as well as any similar coverage required for this work by applicable federal or "other state's" state law.

• (Section 4E) The Mayor and City Council of Baltimore, its elected/appointed officials, employees, and agents shall be covered, by endorsement, as an additional insureds as respects to: liability arising out of any activities performed by or on behalf of the PROVIDER in connection with this Agreement.

• (Section 4F) The PROVIDER's insurance shall apply separately to each insured against whom claim is made and/or lawsuit is brought, except with respect to the limits of the insurer's liability.

• (Section 4G) To the extent of the PROVIDER's negligence, the PROVIDER's insurance coverage shall be primary insurance as respects the CITY, its elected/appointed officials, employees, and agents from any liability arising out of the PROVIDER's performance of the services hereunder. Any insurance and/or self-insurance maintained by the CITY, its elected/appointed officials, employees, or agents shall not contribute with the PROVIDER's insurance or benefit the PROVIDER in any way.

• (Section 4H) Coverage shall not be suspended, voided, canceled, or reduced in coverage or in limits, except by the reduction of the applicable aggregate limit by claims paid, until after forty-five (45) days prior written notice has been given to the CITY. There will be an exception for non-payment of premium, which is ten (10) days notice of cancellation.

• (Section 4I) Insurance is to be placed with insurers with a Best's rating of no less than A: VII, or, if not rated with Best's, with minimum surpluses the equivalent of Best's surplus size VII and said insurers must be licensed/approved to do business in the state of Maryland.

 

• (Section 4J) The PROVIDER shall furnish to the CITY a "Certificate of Insurance", with a copy of the additional insured endorsement as verification that coverage is in force. The CITY reserves the right to require complete copies of insurance policies at any time.

• (Section 4K) Failure to obtain insurance coverage as required or failure to furnish Certificate(s) of Insurance as required may render this Agreement null and void; provided however, that no act or omission of the CITY shall in any way limit, modify or affect the obligations of the PROVIDER under any provision of this Agreement.

• (Section 4L) The PROVIDER shall include all subcontractors as insureds under its policies or shall furnish separate certificates of insurance and policy endorsements for each subcontractor. Insurance coverages provided by subcontractors as evidence of compliance with the insurance requirements of this contract shall be subject to all of the requirements stated herein.

• (Section 4M) If the PROVIDER is self-insured for any of the above requirements, a certification of self-insurance shall be attached hereto and be incorporated by reference herein, and shall constitute compliance with this section. Any deductibles or self-insured retentions must be declared to and approved by the CITY, and shall be the sole responsibility of the PROVIDER. 

END OF INSURANCE REQUIREMENTS

N. Tobacco Program Agreements

The funded Provider agrees to:

1. Participate in the Baltimore City Tobacco Community Health Coalition and to be aware of, and support, all citywide activities funded under the tobacco settlement.

2. Participate in periodic Provider meetings convened for the purpose of increasing, enhancing or maintaining services in Baltimore City.

3. Inform uninsured and medically-underserved residents of the availability of services and ensure access to these services.

4. Participate in periodic site visits made by BCHD and other unannounced visits.

O. Grievance

A grievance may be submitted in writing to the Commissioner of Health. Procedures governing the City of Baltimore bid and contract process will be followed.

P. Standards For FY15 Awards

Costs: Consultants – the hourly rate for consultants may not exceed $50/hour.

Refreshments – the cost per participant in attendance at a meeting or cessation group session may not exceed $3/participant. No “meal” costs will be approved or reimbursed.

Vendors may not exceed these costs. Costs in a budget in excess of these standards will not be approved.

Documentation: In order to receive reimbursement for services provided or goods purchased, all vendors must provide a xerographic copy of the following items as they become available, and no later than the end of the contract period. (The vendor should keep original copies for future state audits.)

Attendance: For activities and events, provide dated sign-in sheets, with participants’ names, addresses, and phone numbers. Required to document performance measures.

Receipts: For all purchases for which reimbursement is sought: a receipt may be a cash receipt, a bill of lading, or an invoice for services or goods purchased, or something similar that documents a date of purchase, the vendor name, address and phone number, cost of commodity or services, and a narrative description of the purchase.

Standardization: In order to appropriately evaluate cessation services and programs, there must be a comparable number of client visits. For example, the ALA cessation program meets seven times. All seven of these visits equal one program. BCHD expects its vendors to meet with a client at least four times to constitute an effective cessation “program.” BCHD recommends that its vendors use program materials from recognized nonprofit or government organizations (American Lung Association; American Cancer Society; Centers for Disease Control "Pathways to Freedom"; National Cancer Institute) that are tested and proven effective in helping people to stop smoking. Providers may create new names for their own cessation programs; but they must use tested programs and cite the source materials.

Follow-Up: The reporting of participant smoking cessation rates within the term of a program is required. In addition, periodic follow-up on clients’ continued or failed cessation efforts over time is expected at least quarterly (or more frequently) within the contract period.

Compliance Visits: Notify the Program Director in writing, in advance, regarding your services schedule. The Director may make unannounced visits to advertised sites.

Payment: In order to receive payment for services, the performance measures must be completed. Reimbursement (payment) for services is based solely on these measures.

IV. APPLICATION

Q. Preparing The Grant Application

It is important that applicants provide complete and clear information so that the reviewers can make recommendations based on factual data. To assist the reviewers:

• Follow the instructions in the RFP. Do not confuse reviewers by putting required information in a different section from the one specified in the RFP.

• Provide accurate and honest information. Reviewers tend to respond more favorably to a candid account of problems and proposed creative plans to address them.

• If any required information or data is omitted, explain why. If the omission is legitimate, the application may not be penalized.

• Do not assume that reviewers know the program or geographic area. The application should be self-explanatory.

• Do not use appendices for information that is required in the body of the application. Use appendices for the Attachments specified in the RFP, resumes, or to document materials mentioned in the application.

• The number of pages of narrative text does not include the abstract, the budget, and the appendix. The Appendix does not have a page limit.

• Prepare the application with the reviewer in mind. Reviewer-friendly tips:

o Include a Table of Contents

o Cross-reference appendices in the text

o Carefully proofread the entire application

o Number all pages consecutively, including appendices

o Use a 12 point font

o Set the margins at one inch

o Text spacing may be either 1.5 or 2.0; do not submit single-spaced copy.

• Organizations are encouraged to adopt a fiscal methodology that is consistent from year to year and includes the same program accounts or budget line items each year.

• The reviewers may consider only the information submitted in the application and may not draw upon personal knowledge about the applicant.

R. Components Of The Grant Application (in this order)

• Cover Page - page 1

Complete the Cover Page. Include the Partner Organization name(s) and budget(s). This is the first page of the grant application. The CEO of the lead applicant must sign this page. (Attachment 1)

• Table of Contents - page 2

List each major section of the application with the page number that starts that section. Consecutively number all pages of the application, including the appendix.

• Abstract - page 3

Use only one single-spaced sheet to write a short summary (Attachment 2)

• Narrative – 12-15 pages

Capability of the Organization and Access to Target Population(s)

Description of the Target Population(s)

Fiscal and Accounting Procedures

Work Plan/Time Table

Evaluation

• Budget Forms and Narrative Justification (DHMH 432A-I) (Attachment 7)*

Complete one set for the Lead Applicant.

Complete appropriate budget pages for each Partner Organization.

• APPENDIX: (no page limit)

Include resumes for key staff in applicant and partner organizations.

Include tobacco cessation credentials for staff or partners.

Include the five completed Attachments (1-5) (signed).

Do not provide letters of support.

Contract Documents

Nonprofit and/or IRS letter: for example: 501(c)(3) or other status.

Certificate of current liability insurance

Certificate of good standing: MD Dept Assessment and Taxation**

Signatory Letter (Attachment 3)

Vendor Assurances (Attachment 4)

Application Check List (Attachment 5)

BCHD will email an electronic copy of the budget forms in response to an email request to: emilie.gilde@

** Go to: . Select department: Assessments and Taxation.

(click) Search DAT. (click) Business Data Search. (click) Business Entity Information.

(enter) business name [search]. Business name and status appears as one line.

(click) on "general information" for an expanded description. There is a fee for each certificate.

S. Budget And Budget Narrative

A complete budget must be submitted on the DHMH Forms (Attachment 7).

432A - Vendor Signature and Information

432B - Line Item Budget

432C - Performance Measures

432D - Salary Costs

432DD - Other Personnel Costs (Fringe Benefits)

432E - Consultant Costs

432F - Equipment Costs

432G - Purchase of Service

432H - Anticipated Sources of Funding

432I - Check List

( Base salaries and percent of time (calculate and show in budget narrative).

( Unit price times the number of items to be purchased or printed (calculate and show).

( Include only the direct program costs in the budget.

Budget Narrative: Use the completed Form 432D as an outline for salaries in the Budget Narrative. The completed Form 432E serves as an outline for the Consultant Costs. Describe what the person or position will do, relationship to other staff, and role in the project. Briefly state why the position or purchase is necessary to support the project.

Partners: Each partner must complete a set of budget forms and a budget narrative. Incomplete or inaccurate information from the applicant’s partner is an impediment to finalizing the budget and contract – a requirement before any payments will be made by the City of Baltimore. DHMH defines a partner as an entity that receives funds.

(The lead applicant should provide a complete copy of this RFP and the budget forms to each partner organization that will be paid from the lead applicant’s grant award.)

T. Application Check List

Attached to this Guidance is a Check List. Return one copy in the envelope marked ORIGINAL. It is recommended that applicants use the Check List to organize the application, and as a final check when assembling the document for submission. (Attachment 5)

U. Submitting The Application

EMAIL: Applicants may submit the ‘entire’ application as a scanned .pdf document. If the applicant uses electronic submission, please mail one complete paper copy to the office, postmarked on the due date.

(OR)

MAIL or DELIVERY: Submit an unbound original application and four copies, each in a separate sealed envelope. Mark each envelope with the organization name and put a label on the original copy with the word: ORIGINAL.

( Do not submit an application by fax machine.

( Do not bring an original to BCHD with the intent of making copies.

V. Due Date And Delivery

►The final and complete application is due by 3:00 pm on the due date.

Send the application to:

Emilie Gilde, Director

Tobacco and Cardiovascular Prevention Initiatives

Ofc Chronic Disease Prevention

Baltimore City Health Department

7 E Redwood Street, Rm 309

Baltimore, Maryland 21202-1115

emilie.gilde@

Delivery or Mail: A receipt will be provided.

►Applications delivered after 3:00 pm on the due date are late and will not be reviewed.

►Applications received in the mail after the 3:00 pm deadline are late and will not be reviewed.

Please do not request an exception to these guidelines.

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[1] Maryland Code, Article - Health - General, Subtitle 10, Section 13-1008(C)(8)

[2] Maryland Code, Article - Health - General, Subtitle 10, Section 13-1008(C)(9)

[3] Maryland Code, Article - Health - General, Subtitle 10, Section 13-1010(B)(1)(III) and (B)(2).

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