HARRIS COUNTY by Z5HN4T6E

VIEWS: 4 PAGES: 38

									       HARRIS COUNTY
                                                                                   JOB NO. 990826
    REQUEST FOR PROPOSAL                                                Date Due: December 14, 1999
           Cover Sheet                                                   DUE NO LATER THAN 1:00 P.M.

                                                                        Proposals received later than the date
                                                                        and time above will not be considered.


  PROPOSAL TO: Provide Project Leap Program for Ryan White Title I for HIV Services/ Harris
  County Public Health and Environmental Services (Beginning on or about March 1, 2000 and ending
  February 28, 2001.
                                                 OFFERORS NOTE!!
Carefully read all instructions, requirements and                 Please return proposal in the envelope provided or in a
specifications.  Fill out all forms properly and                  comparable size envelope. Be sure that return envelope
completely. Submit your proposal with all appropriate             shows the Job Number, Description and is marked
supplements and/or samples.                                       "SEALED PROPOSAL."

                                           RETURN PROPOSAL TO:
                                   HARRIS COUNTY PURCHASING AGENT
                                     1001 PRESTON AVENUE, SUITE 670
                                           HOUSTON, TEXAS 77002

   For additional information, contact Mary Lou Sotolongo at (713) 755-6832.
   You must sign below in INK; failure to sign WILL disqualify the offer. All prices must be typewritten or
   written in ink.
                        Total Amount of Proposal $____________________________

   Company Name:            _____________________________________________________________

   Company Address:         _____________________________________________________________

   City, State, Zip Code: ____________________________________________________________

   Taxpayer Identification Number (T.I.N.): _____________________________________________

   Telephone No. _______________________________                       FAX No. ______________________

   Print Name: ____________________________________________________________________

   Signature: ______________________________________________________________________
   [Your signature attests to your offer to provide the goods and/or services in this proposal according to the published
   provisions of this Job. When an award letter is issued, it becomes a part of this contract. Contract is not valid until
   Purchase Order is issued.]

   ACCEPTED BY:_____________________________________________                               Date:______________________
               HARRIS COUNTY JUDGE ROBERT ECKELS
   Revised 10/99




                                                                                                                   Page 1
                                                   TABLE OF CONTENTS

 Items checked below represent components which comprise this bid/proposal package. If the item IS NOT checked, it is NOT
APPLICABLE to this bid/proposal. Offerors are asked to review the package to be sure that all applicable parts are included. If
any portion of the package is missing, notify the Purchasing Department immediately.

It is the Offeror's responsibility to be thoroughly familiar with all Requirements and Specifications. Be sure you understand the
following before you return your bid packet.

__X__ 1.          Cover Sheet
                  Your company name, address, the total amount of the bid/proposal, and your signature (IN INK) should appear
                  on this page.

__X__ 2.          Table of Contents
                  This page is the Table of Contents.

__X___ 3.         General Requirements
                  You should be familiar with all of the General Requirements.

__X__ 4.          Special Requirements/Instructions
                  This section provides information you must know in order to properly make an offer.

__X__ 5.          Specifications
                  This section contains the detailed description of the product/service sought by the County.

__X___ 6.         Pricing/Delivery Information
                  This form is used to solicit exact pricing of goods/services and delivery costs.

______ 7.         Attachments

                  __X___ a.          Residence Certification
                                     Be sure to complete this form and return with packet.

                  _____    b.        Bid Guaranty & Performance Bond Information & Requirements
                                     This form applies only to certain bids/proposals. Please read carefully and fill out
                                     completely.

                  _____    c.        Bid Check Form
                                     This form applies only to certain forms. Please read carefully and fill out completely.

                  _____    d.        Vehicle Delivery Instructions
                                     Included only when purchasing vehicles.

                  _____    e.        Minimum Insurance Requirements
                                     Included when applicable (does not supersede "Hold Harmless" section of General
                                     Requirements).

                  ______ f.          Workers' Compensation Insurance Coverage Rule 110.110
                                     This requirement is applicable for a building or construction contract.

                  ______ g.          Financial Statement
                                     When this information is required, you must use this form.
                  ______ h.          Reference Sheet

                  __X____i.          Other
                                     From time to time other attachments may be included.
Revised 7/97




                                                                                                                               Page 2
                                          GENERAL REQUIREMENTS
                                              FOR PROPOSALS

READ THIS ENTIRE DOCUMENT CAREFULLY. FOLLOW ALL INSTRUCTIONS. YOU ARE RESPONSIBLE
FOR FULFILLING ALL REQUIREMENTS AND SPECIFICATIONS. BE SURE YOU UNDERSTAND THEM.

General Requirements apply to all advertised requests for proposals, however, these may be superseded, whole or in part, by the
SPECIAL REQUIREMENTS/INSTRUCTIONS OTHER DATA CONTAINED HEREIN. Review the Table of Contents. Be
sure your proposal package is complete.
GOVERNING LAW
This request for proposals is governed by the competitive bidding requirements of the County Purchasing Act, Texas Local
Government Code, §262.021 et seq., as amended. Offerors shall comply with all applicable federal, state and local laws and
regulations. Offeror is further advised that these requirements shall be fully governed by the laws of the State of Texas and that
Harris County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County Attorney
concerning any portion of these requirements.

PROPOSAL COMPLETION
Fill out and return to Purchasing, ONE (1) complete proposal form, using the envelope provided. An authorized company
representative should sign the Cover Sheet. Completion of these forms is intended to verify that the offeror has submitted the
proposal, is familiar with its contents and has submitted the material in accordance with all requirements.

PROPOSAL RETURNS
Offerors must return all completed proposals to the office of the Harris County Purchasing Agent reception desk at 1001 Preston
Avenue, Suite 670, Houston, Texas before 1:00 P.M. on the date specified. Late proposals will not be accepted.

GOVERNING FORMS
In the event of any conflict between the terms and provisions of these requirements and the specifications, the specifications shall
govern. In the event of any conflict of interpretation of any part of this overall document, Harris County's interpretation shall
govern.

ADDENDA
When specifications are revised, the Harris County Purchasing Agent will issue an addendum addressing the nature of the change.
Offerors must sign it and include it in the returned proposal package.

HOLD HARMLESS AGREEMENT
Contractor, the successful offeror, shall indemnify and hold Harris County harmless from all claims for personal injury, death
and/or property damage resulting directly or indirectly from contractor's performance. Contractor shall procure and maintain,
with respect to the subject matter of this proposal, appropriate insurance coverage including, as a minimum, public liability and
property damage with adequate limits to cover contractor's liability as may arise directly or indirectly from work performed under
terms of this proposal. Certification of such coverage must be provided to the County upon request.

WAIVER OF SUBROGATION
Offeror and offeror's insurance carrier waive any and all rights whatsoever with regard to subrogation against Harris County as an
indirect party to any suit arising out of personal or property damages resulting from offeror's performance under this agreement.

SEVERABILITY
If any section, subsection, paragraph, sentence, clause, phrase or word of these requirements or the specifications shall be held
invalid, such holding shall not affect the remaining portions of these requirements and the specifications and it is hereby declared
that such remaining portions would have been included in these requirements and the specifications as though the invalid portion
had been omitted.

BONDS
If this proposal requires submission of proposal guarantee and performance bond, there will be a separate page explaining those
requirements. Offers submitted without the required proposal bond or Cashier's Check are not acceptable.




                                                                                                                            Page 3
TAXES
Harris County is exempt from all federal excise, state and local taxes unless otherwise stated in this document. Harris County
claims exemption from all sales and/or use taxes under Texas Tax Code §151.309, as amended. Texas Limited Sales Tax
Exemption Certificates will be furnished upon written request to the Harris County Purchasing Agent.

FISCAL FUNDING
A multi-year lease or lease/purchase arrangement (if requested by the specifications), or any contract continuing as a result of an
extension option, must include fiscal funding out. If, for any reason, funds are not appropriated to continue the lease or contract,
said lease or contract shall become null and void on the last day of the current appropriation of funds. After expiration of the
lease, leased equipment shall be removed by the contractor from the using department without penalty of any kind or form to
Harris County. All charges and physical activity related to delivery, installation, removal and redelivery shall be the
responsibility of the offeror.

PRICING
Prices for all goods and/or services shall be negotiated to a firm amount for the duration of this contract or as agreed to in terms of
time frame. All prices must be written in ink or typewritten. Where unit pricing and extended pricing differ, unit pricing prevails.

SILENCE OF SPECIFICATIONS
The apparent silence of specifications as to any detail, or the apparent omission from it of a detailed description concerning any
point, shall be regarded as meaning that only the best commercial practice is to prevail and that only material and workmanship of
the finest quality are to be used. All interpretations of specifications shall be made on the basis of this statement. The items
furnished under this contract shall be new, unused of the latest product in production to commercial trade and shall be of the
highest quality as to materials used and workmanship. Manufacturer furnishing these items shall be experienced in design and
construction of such items and shall be an established supplier of the item proposed.

SUPPLEMENTAL MATERIALS
Offerors are responsible for including all pertinent product data in the returned proposal package. Literature, brochures, data
sheets, specification information, completed forms requested as part of the proposal package and any other facts which may affect
the evaluation and subsequent contract award should be included. Materials such as legal documents and contractual agreements,
which the offeror wishes to include as a condition of the proposal, must also be in the returned proposal package. Failure to
include all necessary and proper supplemental materials may be cause to reject the entire proposal.

MATERIAL SAFETY DATA SHEETS
Under the "Hazardous Communication Act", commonly known as the "Texas Right To Know Act", a offeror must provide to the
County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of
the offeror to furnish this documentation will be cause to reject any bid applying thereto.

EVALUATION
Evaluation shall be used as a determinant as to which proposed items or services are the most efficient and/or most economical
for the County. It shall be based on all factors which have a bearing on price and performance of the items in the user
environment. All proposals are subject to negotiations by the Purchasing Agent and other appropriate departments, with
recommendation to Commissioners Court. Compliance with all requirements, delivery and needs of the using department are
considerations in evaluating proposals. Pricing is NOT the only criteria for making a recommendation. A preliminary
evaluation by Harris County will be held and appropriate proposals will be subjected to the negotiating process. Upon
completion of the negotiations, Harris County will make an award. All proposals that have been submitted shall be available and
open for public inspection after the contract is awarded except for trade secrets or confidential information contained in the
proposals and identified as such.

INSPECTIONS
Harris County reserves the right to inspect any item(s) or service location for compliance with specifications and requirements
and needs of the using department. If an offeror cannot furnish a sample of a proposed item, where applicable, for review, or fails
to satisfactorily show an ability to perform, the County can reject the offer as inadequate.




                                                                                                                               Page 4
TESTING
Harris County reserves the right to test equipment, supplies, material and goods proposed for quality, compliance with
specifications and ability to meet the needs of the user. Demonstration units must be available for review. Should the goods or
services fail to meet requirements and/or be unavailable for evaluation, the offer is subject to rejection.

DISQUALIFICATION OF OFFEROR
Upon signing this proposal document, an offeror offering to sell supplies, materials, services, or equipment to Harris County
certifies that the offeror has not violated the antitrust laws of this state codified in §15.01, et seq., Business & Commerce Code, or
the federal antitrust laws, and has not communicated directly or indirectly the offer made to any competitor or any other person
engaged in such line of business. Any or all proposals may be rejected if the County believes that collusion exists among the
offerors. Proposals in which the prices are obviously unbalanced may be rejected. If multiple proposals are submitted by an
offeror and after the proposals are opened, one of the proposals is withdrawn, the result will be that all of the proposals submitted
by that offeror will be withdrawn, however, nothing herein prohibits a vendor from submitting multiple offers for different
products or services.

AWARD
Harris County reserves the right to award this contract on the basis of LOWEST AND BEST OFFER in accordance with the laws
of the State of Texas, to waive any formality or irregularity, to make awards to more than one offeror, to reject any or all
proposals. In the event the lowest dollar offeror meeting specifications is not awarded a contract, the offeror may appear before
the Commissioners Court and present evidence concerning his responsibility after officially notifying the Office of the Purchasing
Agent of his intent to appear.

ASSIGNMENT
The successful offeror may not assign, sell or otherwise transfer this contract without written permission of Harris County
Commissioners Court.

TERM CONTRACTS
If the contract is intended to cover a specific time period, the term will be given in the specifications under SCOPE.

MAINTENANCE
Maintenance required for equipment proposed should be available in Harris County by a manufacturer authorized maintenance
facility. Costs for this service shall be shown on the Pricing/Delivery Information. If Harris County opts to include maintenance,
it shall be so stated in the purchase order and said cost will be included. Service will commence only upon expiration of
applicable warranties and should be priced accordingly.

CONTRACT OBLIGATION
Harris County Commissioners Court must award the contract and the County Judge or other person authorized by the Harris
County Commissioners Court must sign the contract before it becomes binding on Harris County or the offeror. Department
heads are NOT authorized to sign agreements for Harris County. Binding agreements shall remain in effect until all products
and/or services covered by this purchase have been satisfactorily delivered and accepted.

TITLE TRANSFER
Title and Risk of Loss of goods shall not pass to Harris County until Harris County actually receives and takes possession of the
goods at the point or points of delivery. Receiving times may vary with the using department. Generally, deliveries may be made
between 8:30 a.m. and 4:00 p.m., Monday through Friday. Offerors are advised to consult the using department for instructions.
The place of delivery shall be shown under the "Special Requirements/Instructions" section of this proposal and/or on the
Purchase Order as a "Deliver To:" address.

WARRANTIES
Offerors shall furnish all data pertinent to warranties or guarantees which may apply to items in the proposal. Offerors may not
limit or exclude any implied warranties. Offeror warrants that product sold to the County shall conform to the standards
established by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970. In the event product does
not conform to OSHA Standards, where applicable, Harris County may return the product for correction or replacement at the
offeror's expense. If offeror fails to make the appropriate correction within a reasonable time, Harris County may correct at the
offeror's expense.




                                                                                                                              Page 5
PURCHASE ORDER AND DELIVERY
The successful offeror shall not deliver products or provide services without a Harris County Purchase Order, signed by an
authorized agent of the Harris County Purchasing Agent. The fastest, most reasonable delivery time shall be indicated by the
offeror in the proper place on the proposal document. Any special information concerning delivery should also be included, on a
separate sheet, if necessary. All items shall be shipped F.O.B. INSIDE DELIVERY unless otherwise stated in the
specifications. This shall be understood to include bringing merchandise to the appropriate room or place designated by the using
department. Every tender or delivery of goods must fully comply with all provisions of these requirements and the specifications
including time, delivery and quality. Nonconformance shall constitute a breach which must be rectified prior to expiration of the
time for performance. Failure to rectify within the performance period will be considered cause to reject future deliveries and
cancellation of the contract by Harris County without prejudice to other remedies provided by law. Where delivery times are
critical, Harris County reserves the right to award accordingly.

CONTRACT RENEWALS
Renewals may be made ONLY by written agreement between Harris County and the offeror. Any price escalations are limited to
those stated by the offeror in the original proposal.

INVOICES AND PAYMENTS
Offerors shall submit invoices in duplicate on each purchase order or purchase release after each delivery, indicating the purchase
order number. Invoices must be itemized. Any invoice which cannot be verified by the contract price and/or is otherwise
incorrect, will be returned to the offeror for correction. Under term contracts, when multiple deliveries and/or services are
required, the offeror may invoice following each delivery and the County will pay on invoice. Contracts providing for a monthly
charge will be billed and paid on a monthly basis only.

TERMINATION
Harris County reserves the right to terminate the contract for default if Seller breaches any of the terms therein, including
warranties of offeror or if the offeror becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to
and not in lieu of any other remedies which Harris County may have in law or equity. Default may be construed as, but not
limited to, failure to deliver the proper goods and/or services within the proper amount of time, and/or to properly perform any
and all services required to Harris County's satisfaction and/or to meet all other obligations and requirements. Contracts may be
terminated without cause upon thirty (30) days written notice to either party unless otherwise specified.

RECYCLED MATERIALS
Harris County encourages the use of products made of recycled materials and shall give preference in purchasing to products
made of recycled materials if the products meet applicable specifications as to quantity and quality. Harris County will be the
sole judge in determining product preference application.

SCANNED OR RE-TYPED RESPONSE
If in its response, offeror either electronically scans, re-types, or in some way reproduces the County's published proposal
package, then in the event of any conflict between the terms and provisions of the County's published proposal package, or any
portion thereof, and the terms and provisions of the response made by offeror, the County's proposal package as published shall
control. Furthermore, if an alteration of any kind to the County's published proposal package is only discovered after the contract
is executed and is or is not being performed, the contract is subject to immediate cancellation.

FLOPPY DISK
If offeror obtained the specifications on a floppy disk in order to prepare a response, the proposal must be submitted in hard
copy according to the instructions contained in this Request-for-Proposals package. If, in its response, offeror makes any changes
whatsoever to the County's published specifications, the County's specifications as published shall control. Furthermore, if an
alteration of any kind to the County's published specifications is only discovered after the contract is executed and is or is not
being performed, the contract is subject to immediate cancellation.

YEAR 2000 COMPLIANCE
All products and/or services furnished as part of this contract must be year 2000 compliant. This applies to all computers
including hardware and software as well as all other commodities with date sensitive embedded chips.



Revised 1/99

                                            ATTENTION VENDORS

                                                                                                                            Page 6
This document is an alternative competitive proposal as specified in LGC
262.030.

All documents will be held by the County and are NOT subject to public
review until an award is made. Harris County will hold a preliminary
evaluation. Appropriate proposals will be subjected to review and may go
through negotiating process.

After award by Commissioners Court, proposals will be made public.




                   SPECIAL REQUIREMENTS/INSTRUCTIONS


                                                                           Page 7
Where these specific requirements differ from the preceding General Requirements, these specific
requirements will control. If you need additional information, contact Mary Lou Sotolongo at (713) 755-
6832. For technical assistance contact Charles Henley at (713) 439-6034.

The following statement is made in accordance with the FY 1995 Appropriations Act (P.L.103-333). All
funds being offered in this Request for Proposal (RFP) are 100% Ryan White C.A.R.E. Act funds with no
contribution of any non-Federal funds required of the vendor, although subsequent to any award made to
the vendor resulting from this RFP the vendor will be required to document, in a manner acceptable to the
County, the total cost of the project, the amount and percentage financed by federal money and the amount
and percentage financed by non governmental sources.

PRE-PROPOSAL CONFERENCE
A Pre-Proposal Conference will be held December 1, 1999 @ 2:30 p.m.in the Harris County Health
Department Building, 4th Floor Conference Room (room 416) located at 2223 W. Loop South,
Houston, TX 77027. This is not a mandatory requirement, however, it is highly recommended that
vendors attend in order to discuss and clarify the requirements of this Request for Proposal. Persons with
disabilities requiring special accommodations please contact Vicki Cerna at (713) 439-6042 for special
arrangements.

Special Requirements

I.      SUBMISSION INSTRUCTIONS
The proposal submitted must include a complete description of all products and services to be supplied
by the vendor and responses to all questions, together with the costs associated with the proposed
services. All other required documentation must also be included. All proposals must be typewritten
(not to exceed 12 characters per inch) on 8 1/2” by 11” paper, doubled spaced (unless otherwise
specified), left and right margins of 1 inch each, with page numbers on all pages, including all
appendices. Forms specified have been included in the Forms Section and must be inserted in the
proposal as noted. All respondents MUST address each of the forms by filling out each one with the
appropriate, detailed information required in the form. Omission of any or all of these forms may be
cause to reject your proposal in its entirety. If, for some reason, the form does not apply to your
response, you must note that decision on your copy of the form. Where applicable, the forms must be dated
and signed by authorized persons, include the persons title. All signatures for all forms throughout this
package must be original on the copy marked, "ORIGINAL". Copies of the original may contain
copies of signatures. Submit signed original and seven (7) copies. Original and copies must be
bound individually with a single binder clip for each.

This document is an alternative competitive proposal as specified under Local Government Code
262.030. See proposal returns and proposal completion in the general requirements for instructions.
The due date is specified on the first page. On that date the proposals will be opened in private and will
remain confidential until after award. Neither information nor copies of proposals will be available to
anyone other than Harris County and the External Review Committee until a formal award is made by
Commissioners Court.




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Evaluation Criteria and Award Process

The following guidelines will be used in the Evaluation/ Award process.
1. Present your best proposal initially. A technical review will be conducted by Harris County to ensure
   all proposals contain the required documentation and are in conformance with the requirements set
   forth herein. The External Review Committee will score acceptable proposals, based on the
   information supplied in the vendor’s proposal, a vendor presentation, if requested, and the evaluation
   criteria stated below. The point system is based on a total of 100 points.

2. Award of the contract shall be made to the responsible vendor, whose proposal is determined to be
   the highest scored proposal best meeting the County’s needs. No award or acquisition can be made
   until Commissioners Court approves such action. Submission of a proposal implies the vendor’s
   acceptance of the evaluation process and vendor recognition that subjective judgments must be made
   by the reviewers and Harris County.


The Evaluation Criteria follows:
All proposals MUST be submitted in the order listed below.

       A.      Request For Proposal Cover Sheet (Enclosed in RFP)

       B.      Residence Certification (Enclosed in RFP)

       C.      Signed Assurances Form I (Enclosed in RFP Forms Section)

       D.      Signed Certification Concerning Lobbying (Enclosed in RFP Forms Section)

       E.      Signed Compliance With Americans With Disabilities Act of 1990
               (Enclosed in RFP Forms Section)

       F.      Assurances for Non Construction Programs (s-424B) (Enclosed in RFP
               Forms Section)

       G.      Respondent Certification (Enclosed in RFP Forms Section)

       H.      Licenses, Permits, & Certifications (Provided by Vendor)

       I.     Cover page (Enclosed in RFP Forms Section)

       J.      Table of Contents for Proposal (Provided by Vendor)
               Evaluation Criteria /Proposals should include responses to the 7 items
               listed.
               The External Review will score proposals based on the responses and the
               points assigned to each.


               1. The vendor must provide documentation of education in human services, social
                  services, education, or a related field for staff responsible for providing training. The
                  names, education and experience of all training staff must be included in the proposal.
                                                                                                     Page 9
               If subcontractors will be utilized, this same information must also be included in the
               proposal. Maximum of 10 points.
          2.   The vendor must demonstrate that personnel involved in providing the training are
               experienced and competent to provide training in HIV/AIDS funding and allocation
               issues.
               Please provide specifics. Maximum of 10 points.
          3.   Describe plan to recruit participants. Maximum of 10 points.
          4.   Design and describe course curriculum for the 96 hours of training sessions including
               the project objectives listed in the Request for Proposal. Maximum of 40 points.
          5.   Describe vendor’s proposed role as it relates to the following:
                   A. The vendor will consult with the Ryan White Planning Council in curriculum
                        development, applicant review/trainee selection and training activities.
                        Please provide the specific plan the vendor will use to accomplish this
                        requirement. How will you consult with the Ryan White Planning Council.
                        Maximum of 5 points.
                   B. The vendor will involve the County and other administrative agents for public
                        HIV services funds in curriculum development. Please provide the specific
                        plan the vendor will use to accomplish this requirement. How will you
                        consult with the County and other Administrative Agents for curriculum
                        development. Maximum of 5 points.
          6.   Describe the evaluation design to summarize activities (describe process, outcomes
               and recommendation for future training efforts) of the project. Maximum of 10
               points.
          7.   Budget Forms #1 & 2 – (Enclosed in RFP Forms Section). Maximum of 10 points.

II. ADDITIONAL INFORMATION

     A.   SUGGESTIONS FOR COMPLETING PROPOSALS
          In addition to the proposal writer, one or more individuals should review your proposal for
          content and form. Have them read through this RFP, and then let them pretend that they are
          on the independent review panel: have them read through your application, paying special
          attention to the information that you have provided, and using the evaluation criteria as a
          basis for their review and comment.

          Also, one or more individuals should review your application for completeness and format
          correctness, that all required information has been assembled; that all pages, including
          attachments, have been numbered sequentially; that binder clips have been used; that odd
          sized pages have been reduced/photocopied to 8 ½ x 11” paper; that the correct number
          (one original and seven copies) of the finished proposal has been prepared for delivery.




                                                                                              Page 10
       B. GRIEVANCES

              Grievance Procedures are as required by the Ryan White CARE Act for contracts funded
              with Ryan White Title I grant money.

              Eligibility: Only individuals within the following groups are authorized to bring
              grievances.
              1. HIV service providers eligible to receive Ryan White Title I funding;
              2. persons with HIV disease;
              3. consumer groups or coalitions or caucuses of persons with HIV disease; or
              4. members of the Houston Area HIV Health Services Planning Council (“Planning
                  Council”).
              Grievable Actions: Only the following actions are the proper subject of a grievance under
              these procedures:
              1. deviations from the procedures established by the Harris County Purchasing Agent in
                  the competitive bid package and
              2. contracts and awards which are inconsistent with the priorities and resource allocations
                  made by the Planning Council.
              3. deviations from any established, written process for any subsequent changes to priorities
                  or allocations.

              *note: only a member of the Planning Council is authorized to bring a grievance under
              grievable actions item 2.

             The procedure with timelines and appropriate forms for grievances defined in Grievable
             Actions above may be obtained from the Harris County Purchasing Department by calling
       713-755-5036.
             Filing of the appropriate forms will initiate the grievance process. Contact Mary Lou
             Sotolongo at (713) 755-6832 in order to seek an informal resolution to your concerns.

              The awarding of contracts is the responsibility of Harris County Commissioners Court and
              their award decision is final. Award will be based on the evaluation criteria and process
              described in the RFP document.

             The priority setting of service categories is the responsibility of the Ryan White Planning
             Council. All grievances pertaining to the priority setting process should be directed in
             writing to the Ryan White Planning Council. For information call the Ryan White
             Planning Council Coordinator at (713) 572-3724.

III. OVERVIEW

A. The Ryan White Comprehensive AIDS resources Emergency (CARE) Act of 1990 provides federal
support for comprehensive health and social services for people living with HIV/AIDS in the Houston
Eligible Metropolitan Area (Houston EMA). Houston EMA includes Chambers, Fort Bend, Harris,
Liberty, Montgomery & Waller counties. Title I provides emergency relief grants to meet needs of
individuals affected. CARE Act funding is intended to supplement, not supplant, existing and planned
funding for HIV/AIDS services at local and state levels.


                                                                                                    Page 11
The Ryan White Planning Council is responsible for establishing priorities, conducting needs
assessments, and long range planning for Title I funds. It’s members are appointed by the Harris County
Judge and are representatives of various segments of the community, including service providers,
caregivers, medical authorities, and persons affected by HIV/AIDS.

The Harris County Commissioners Court has appointed HIV Services, Harris County Public Health &
Environmental Services as the Administrative Agent to the program. In this capacity, HIV Services is
responsible for assisting the Planning Council in its duties by providing grant administration and
monitoring for the Houston EMA. The Harris County Commissioners Court, as the governing body of
the grant recipient, has ultimate authority over awards of Ryan White Title I Grant funds.

B. AVAILABLE MONIES
The term and estimated dollar amount is identified under the Service Category description.

C. COMMENCEMENT OF SERVICES/FORFEITURE OF FUNDS
Each agency must demonstrate its ability to implement proposed services quickly, including
hiring/training appropriate personnel. If an agency fails to begin expending funds within 30 days from
receipt of funds, the agency may have to forfeit said funds.

D. APPLICABLE LAWS
Vendors MUST comply with all applicable federal, state, and local laws and regulations. HIV Services
may conduct site visits to insure compliance of all the above.

E. OTHER CONDITIONS/RESTRAINTS
The following conditions/restraints are imposed on all recipients of Ryan White Title I funds. However
vendors are not required to submit information concerning these issues within your proposal, agency
must comply with them if it receives Ryan White Title I funds.
1.     AUDIT
       Not for profit and governmental agencies receiving Federal funding assistance in the aggregate
       amount of $300,000.00 or more within their fiscal year must have an audit conducted in
       accordance with Office of Management and Budget (OMB) Circular A-133. The audit must be
       submitted to the Harris County Auditor’s Office no later than 13 months of an agency’s fiscal
       year end (within 9 months for fiscal years beginning after June 30, 1998). Proprietary agencies
       receiving awards of $25,000.00 or more must submit an audit of their general financial
       statements within 12 months of their fiscal year end. Not for profit and governmental agencies
       meeting the $300,000.00 aggregate threshold may charge OMB A-133 single audit costs
       proportionally to their Ryan White grants. However, agencies who do not meet the $300,000.00
       aggregate threshold may not use Federal funds to pay for OMB A-133 single audit costs. Those
       agencies not meeting the $300,000.00 aggregate threshold may use Federal funds to pay for
       limited scope audits, site visits, document reviews and other monitoring activities.

2.     BONDING
       All employees of agencies receiving Title I funds must be covered by the terms of a fidelity bond,
       if they handle those funds, providing for indemnification of losses by:

       a. any fraudulent or dishonest act or acts committed by any of the above mentioned employees
       either individually or in concert with others, and/or



                                                                                                  Page 12
b. the failure of the agency or any of its employees to perform faithfully his/her duties or to
account properly for all monies and properties received by virtue of his/her position of
employment.

Fidelity bond will be in an amount not less than ten thousand dollars ($10,000.). Documentation
of bonding must be provided within sixty (60) days of receipt of grant award.




                                                                                        Page 13
                                       SPECIFICATIONS

 Term Contract to Provide Project Leap Program for Ryan White Title I Services for HIV
 Services/Harris County Public Health and Environmental Services


SCOPE
Vendor will provide specified services beginning on or about March 1, 2000, and ending February 28,
2001.




RENEWAL OPTION
                                                                                            Page 14
Harris County wishes to consider two (2) annual renewal options, renewable one year at a time,
based on the same terms, conditions and pricing as the original year. If the vendor does not wish to
renew, mark “N.A.” in the space for the year indicated.

Harris County retains the option to rebid at any time if in its best interest and is not automatically
bound to renewal or rebid.

Vendor agrees to continue this contract for the time frames stated below under the same terms and
conditions and pricing as the original contract. If vendor does not wish to renew, write “N.A.” in the
space provided.

Renewal Year 1 (FY 2001)                ______________ 3-1-01 through 2-28-02

Renewal Year 2 (FY2002):               ______________ 3-1-02 through 2-28-03




                                                                                               Page 15
SERVICE CATEGORY:            Program Support

TITLE OF SERVICE:            Project L.E.A.P. (Learning, Empowerment, Advocacy, Participation)
                             A program to increase the number and effectiveness of Persons Living With
                             HIV (PLWH) who can participate in organizations, councils and committees
                             dealing with the allocation of public funds for HIV-related services.

AMOUNT AVAILABLE:            $73,214.00

TERM:                        Estimated to be 12 months (3/1/2000 - 2/28/2001)

BUDGET:                      Fee for Service Budget. The proposer must provide at least 192 units of
                             service. Fee may not exceed $381.32 per class hour.

UNIT OF SERVICE
DEFINITION:                  One class hour of training provided to project LEAP participants.

DEFINITION OF SERVICE: A training program specifically developed to provide HIV-infected and
                       affected persons with the knowledge and skills necessary to become active,
                       informed, and empowered members of HIV planning councils, consortia,
                       review committees, and other groups responsible for the assessment of HIV-
                       related service needs in the Houston EMA. Training must strictly adhere to
                       the curriculum described below.

SERVICES TO BE PROVIDED:
                      Two classes, each with a minimum of 96 total hours of training sessions,
                      will be provided during the term of the agreement. Training content will
                      include, at a minimum, HIV funding sources, general and specific
                      operational procedures of HIV-related service organizations, information
                      regarding assessment of the needs of HIV-infected persons in the Houston
                      EMA, evaluation skills needed to review proposals submitted by vendors for
                      Request for Proposals (RFPs) issued by local funding sources,
                      organizational case studies and mentoring, presentation skills, knowledge
                      related to accessing services, overview of HIV-related quality assurance
                      (QA) processes and parliamentary procedure/meeting management skills.
                      Vendor will provide reimbursement of eligible expenses to participants
                      during the period of enrollment to reimburse these participants for costs,
                      including but not limited to transportation, child care, meals and other
                      expenses, related to participation. Vendor agrees to provide the Planning
                      Council with written reports and project summaries as requested by the
                      County and in a form acceptable to the County, regarding the progress and
                      outcome of the project. Vendor will provide the County with a written
                      report summarizing the activities accomplished during the term of the
                      contract within thirty calendar days after the completion of the contract.


Project Objectives:   By 02/28/2001, Vendor will identify and provide training to at least 30 HIV-infected
                      individuals and no more than 6 affected significant others for them to receive the
                                                                                                   Page 16
necessary skills and knowledge to participate in the decision-making process to fund
and allocate public money to HIV-related services in the Houston EMA; the
following training curriculum shall be provided:

1.     Information on the sources and purposes of HIV service funds in the
       Houston EMA;
2.     The structure, functions, policies and procedures of the Houston HIV
       Health Services Planning Council (Ryan White Planning
       Council)(RWPC), The Houston Health Services Delivery Area Care
       Consortium (TDHCC) and the Houston HIV Prevention Community
       Planning Group (CPG);
3.     Specific training and skills building in needs assessments,
       parliamentary procedures and meeting management procedures,
       presentation skills, reviewing and evaluating HIV-related bid
       proposals, accessing and utilizing support resources and role models,
       and competence in organizational participation and conduct.
4.     Specific training on HIV-related Standards of Care, Quality
       Assurance methods and HRSA Service Category definitions.

Vendor will enhance the participation of the HIV-infected and affected persons
participating in this project by the following documented activities:

1.     Establishing realistic training schedules which accommodate varying
       health situations of participants;
2.     Conduct a Pre-training evaluation of participants to determine their
       knowledge and beliefs concerning HIV disease and understanding of
       HIV-related funding processes in the Houston area. Proposer must
       incorporate responses from this Pre-training evaluation in the final
       design of the course curriculum to ensure that, to the extent
       reasonably possible, the specific training needs of the selected
       participants are addressed in the curriculum;
3.     Conducting a Post-training evaluation to measure the change in
       participants knowledge and beliefs concerning HIV disease and
       understanding of HIV-related funding processes in the Houston area;
4.     Providing reimbursement of allowable expenses, at a level not
       reducing an individual's eligibility for public assistance, to help
       defray costs of the individual's participation, including but not
       limited to transportation, child care, meals and other expenses related
       to participation.
5.     Providing both lecture and hands-on experiential class activities to
       enable participants to maximize opportunities for learning.

Vendor will encourage cooperation and coordination among entities responsible for
administering public funds for HIV-related services by:

1.     Involving the County and other administrative agents for public HIV
       services funds in curriculum development, applicant review/trainee
       selection, and training activities;


                                                                                 Page 17
               2.   Involving representatives from the County, RWPC, TDHCC and
                    CPG as members of the Project LEAP External Advisory Panel, to
                    review applications from potential participants and recommend
                    specific individuals for enrollment in the program. Vendor shall
                    determine the criteria used to determine applicants through a
                    collaborative effort involving representatives from the County,
                    RWPC, TDHCC and CPG during the initial 60 days of the
                    commencement of services. The criteria developed and utilized will,
                    to the maximum extent possible, ensure participants selected
                    represent the groups most affected by HIV disease, consistent with
                    current epidemiological data on the epidemic in the Houston EMA.
               3.   All information and educational materials developed and provided
                    by Vendor will be accurate, comprehensive, and consistent with the
                    current findings of the United States Public Health Service.


THE VENDOR SHOULD PROVIDE RESPONSES TO THE SEVEN (7) ITEMS LISTED
UNDER ITEM J., PAGES 9 & 10.




                                                                                          Page 18
                                          FORMS SECTION

The forms contained in this section must be filled in and submitted in the appropriate order in your
proposal.




                                                                                                   Page 19
                              RESIDENCE CERTIFICATION

Pursuant to Texas Government Code §2252.001 et seq., as amended, Harris County requests
Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on
the awarding of governmental contracts; pertinent provisions of §2252.001 are stated below:

       (3)    "Nonresident bidder" refers to a person who is not a resident.

       (4)    "Resident bidder" refers to a person whose principal place of business is in
              this state, including a contractor     whose ultimate parent company or
              majority owner has its principal place of business in this state.


 I certify that ______________________________________ is a Resident Bidder of Texas as
                            [Company Name]
      defined in Government Code §2252.001.



      I certify that ______________________________________ is a Nonresident Bidder as
                              [Company Name]

       defined in Government Code §2252.001 and our principal place of business is
       _______________________.
       [City and State]
                                       Assurances Form I



By signing and submitting this proposal, the applicant organization certifies compliance with the
following assurances in the event that Ryan White funds are awarded:

·      Assurance that applicant agency will not discriminate against persons eligible for services
       on the grounds of race, creed, color, handicap, national origin, sex, political affiliation or
       beliefs, or sexual orientation.

·      Assurance that drug-free workplace guidelines are or will be in place in agency at time of
       funding award in accordance with Federal Regulation 45 CFR part 76.


·      Assurance that applicant agency will comply with Federal Regulation 45 CFR part 76
       regarding debarment and suspension.

·      Assurance that agency understands specified restrictions on the use of grant award funds.




       _______________________                                   ____________________________
       Date                                                               Applicant Organization



                           ___________________________________
                            Signature and Title of Authorized Official
                                Certification Concerning Lobbying

                    DEPARTMENT OF HEALTH AND HUMAN SERVICES
                           U.S. PUBLIC HEALTH SERVICE

The Undersigned certifies, to the best of his or her knowledge and belief, that:

       (1)     No Federal appropriated funds have been paid or will be paid, by or on behalf of the
               undersigned, to any person or influencing organization attempting to influence an
               officer or employee of any agency, a member 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 of
               any cooperative agreement,and the extension, continuation, renewal, amendment, or
               modification of any Federal contract, grant, loan, or cooperative agreement.

       (2)     If any funds other than Federal 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, 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-LLL, "Disclosure Form to
               Report Lobbying," in accordance with its instructions.

       (3)     The undersigned shall require that the language of this certification be included in
               the award documents for all subawards at all tiers (including subcontracts,
               subgrants, and contracts under grants, loans, and cooperative agreements) and that
               all subrecipients shall certify and disclose accordingly.

This certification is a material representation of the fact upon which reliance was placed with this
transaction was made or enter into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any persons who fail
to file the required certification shall be subject to a civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.


                                                        ____________________________________
Date                                                                                   Entity


                                                __________________________________________
Address of Organization                         Name and Title of Official Signing for Organization


                                                     ______________________________________
Telephone of Organization                                                  Signature of Official
                   Compliance with American With Disabilities Act of 1990




__________________________________
Name of Applicant Agency


guarantees and assures, with respect to the operation of the program and activities outlined in this
proposal and all agreements or arrangements to carry out such program or activities for which
financial assistance may be awarded in any subsequent subcontract, that will comply fully with the
Americans with Disabilities Act of 1990 (ADA) and any and all Regulations promulgated
thereunder. The applicant agency understands that failure to comply with this requirement shall be
sufficient cause to terminate any contract existing between the applicant agency and the Harris
County HIV Services Division.




_____________________________________________________
Signature of Person Authorized to Represent Applicant Agency




________________________________________
Printed Name and Title




___________________________________
Date Signed
                    ASSURANCE — NON-CONSTRUCTION PROGRAMS


Note:           Certain of these assurance may not be applicable to your project or
                program. If you have questions, please contact the awarding agency.
                Further, certain Federal awarding agencies may require applicants to
                certify to additional assurances. If such is the case, you will be
                notified.


        As the duly authorized representative of the applicant I certify that the applicant:

1.      Has the legal authority to apply for                    1970 (42 U.S.C. 4728-4763) relating
        Federal      assistance,    and     the                 to prescribed standard for merit
        institutional, managerial and financial                 systems for programs funding under
        capability (including funds sufficient                  one of the nineteen statutes of
        to pay the non-Federal share of                         regulations specified in Appendix A
        project costs) to ensure proper                         of OPM's Standards of a Merit
        planning,        management        and                  System of Personnel Administration
        completion of the project described in                  (5 C.F.R. 900, Subpart F).
        this application.
                                                        6       Will comply with all Federal statutes
2.      Will give the awarding agency, the                      relating to nondiscrimination. These
        Comptroller General of the United                       include but are not limited to: (a)
        States, and if appropriate, the State,                  Title VI of the Civil Rights Act of
        through any authorized representative,                  1964 (P.L. 88-352) which prohibits
        access to and the right to examine all                  discrimination on the basis of race,
        records, books, papers, or documents                    color, or national origin; (b) Title IX
        related to the award; and will                          of the Educational Amendments of
        establish a proper accounting system                    1972, as amended (20 U.S.C. 1681-
        in accordance with generally accepted                   1683, and 1685-1686), which
        accounting standards or agency                          prohibits discrimination on the basis
        directives.                                             of sex; (c) Section 504 of the
                                                                Rehabilitation Act of 1973, as
3.      Will establish safeguards to prohibit                   amended (29 U.S.C. 794), which
        employees from using their positions                    prohibits discrimination on the basis
        for a purpose that constitutes or                       of     handicaps;    (d)    the    Age
        presents the appearance of personal or                  Discrimination Act of 1975, as
        organizational conflict of interest, or                 amended (42 U.S.C. 6101-6107),
        personal gain.                                          which prohibits discrimination on the
                                                                basis of age; (e) the Drug Abuse
4.      Will initiate and complete the work                     Office and Treatment Act of 1972
        within the application time frame after                 (P.L. 92-255, as amended, relating to
        receipt of approval of the awarding                     nondiscrimination on the basis of
        agency.                                                 drug abuse; (f) the Comprehensive
                                                                Alcohol Abuse and Alcoholism
5.      Will      comply      with     the                      Prevention,       Treatment         and
        Intergovernmental Personnel Act of                      Rehabilitation Act of 1970 (P.L. 91-
     616, as amended, relating to                      House and Safety Standards Act (40
     nondiscrimination on the basis of                 U.S.C. 327-333), regarding labor
     alcohol abuse or alcoholism; (g) 523              standards for federally assisted
     and 527 of the Public Health Service              construction subagreements.
     Act of 1912 (42 U.S.C. 290 dd-3 and
     290 ee-3), as amended, relating to          10.   Will comply, if applicable, with flood
     confidentiality of alcohol and drug               insurance purchase requirements of
     abuse patient records; (h) Title VII of           Section 102(a) of the Flood Disaster
     the Civil Rights Act of 1968 (42                  Protection Act of 1973 (P.L. 93-2343)
     U.S.C. 3501 et seq.) as amended,                  which requires recipients in a special
     relating to nondiscrimination in the              flood hazard area to participate in the
     sale, rental or financing of housing; (i)         program and to purchase flood
     any       other        nondiscrimination          insurance if the total cost of insurable
     provisions in the specific statute(s)             construction and acquisition is
     under which application for Federal               $10,000 or more.
     assistance is being made; and (j) the
     requirements        of     any     other    11.   Will comply with environmental
     nondiscrimination statute(s) which                standards which may be prescribed
     may apply to the application.                     pursuant to the following (a)
                                                       institution of environmental quality
7.   Will comply, or has already complied,             control measures under the National
     with the requirements of Titles II and            Environmental Policy Act of 1969
     III of the Uniform Relocation                     (P.L. 91-190) and Executive Order
     Assistance and Real Property                      (EO 11514; (b) notification of
     Acquisition Policies Act of 1970 (P.L.            violating facilities pursuant to EO
     91-646) which provide for fair and                11738; (c) protection of wetlands
     equitable treatment of persons                    pursuant to EO 11990; (d) evaluation
     displaced or whose property is                    of flood hazards in flood plains in
     acquired as a result of Federal or                accordance with EO 11988; (e)
     federally assisted programs. These                assurance of project consistency with
     requirements apply to all interests in            the approved State management
     real property acquired for project                program developed under the Coastal
     purposes regardless of Federal                    Zone Management Act of 1972 (16
     participation in purchases.                       U.S.C. 1451 et seq.); (f) conformity of
                                                       Federal actions to State (Clear Air)
8.   Will comply with the provisions of                Implementation Plans under Section
     the Hatch Act (5 U.S.C. 1501-1508                 176(c) of the Clear Air Act of 1955,
     and 7324-7328) which limit the                    as amended (42 U.S.C. 7401 et seq.);
     political activities of employees                 (g) protection of underground sources
     whose        principal   employment               of drinking water under the Safe
     activities are funded in whole or in              Drinking Water Act of 1974, as
     part with Federal funds.

9.   Will comply, as application, with the
     provisions of the Davis-Bacon Act
     (40 U.S.C. 276a to 276a-7), the
     Copeland Act (40 U.S.C. 276c and 18
     U.S.C 874, and the Contract Work
      amended, (P.L. 93-523); and (h)
      protection of endangered species          18.   Will comply with all applicable
      under the Endangered Species Act of             requirements of all other Federal
      1973, as amended, (P.L. 93-205).                laws, executive orders, regulations
                                                      and policies governing this program.
12.   Will comply with the Wild and
      Scenic Rivers Act of 1968 (16 U.S.C.
      1271 et seq.) related to protecting
      components or potential components
      of the national wild and scenic rivers
      system.

13.   Will assist the awarding agency in
      assuring compliance with Section 106
      of the National Historic Preservation
      Act of 1966, as amended (16 U.S.C.
      470), EO 11593 (identification and
      protection of historic properties), and
      the Archaeological and Historical
      Preservation Act of 1974 (16 U.S.C.
      469a-1 et seq.).

14.   Will comply with P.L. 93-348
      regarding the protection of human
      subjects involved in research,
      development, and related activities
      supported by this award assistance.

15.   Will comply with the Laboratory
      Animal Welfare Act of 1966 (P.L. 89-
      544, as amended, 7 U.S.C. 2131 et
      seq.) pertaining to the care, handling,
      and treatment of warm-blooded
      animals held for research, teaching, or
      other activities supported by this
      award of assistance.

16.   Will comply with the Lead-Based
      Paint Poisoning Prevention Act (42
      U.S.C. 4801 et seq.) which prohibits
      the use of lead-based pain in the
      construction or rehabilitation of
      residence structures.

17.   Will cause to be performed the
      required financial and compliance
      audits in accordance with the Single
      Audit Act of 1984.
Signature of Authorized Certifying Official   Title


Applicant Organization                        Date Submitted
                              RESPONDENT CERTIFICATION



________________________________________
Name of Applicant Agency




I,                                       , certify that I am the



______________________________________
Title Printed


of the corporation, committee, commission, association, partnership, or public agency named as the Applicant
Agency herein, that this proposal was duly submitted and signed for on behalf of said corporation, committee,
commission, association, or public agency by authority of its governing body and is within the scope of its legal
powers.



_________________________________________________
Signature of Person Making Certification



_____________________________________
Date Signed
                                       COVER PAGE
                                2000 Ryan White Title I Funds

Applicant organization:   _________________________________________________________



Service category of proposal as designated in RFP:    __________________________________



Code Number:       _______________________________________________________________



Total amount requested:     ________________________________________________________



Contact person for proposal clarifications:   __________________________________________



Contact person telephone number:      ________________________________________________



Fax number:     _________________________________________________________________




Identify your Agency as one of the following: For Profit                _______
                                               Non-Profit               _______
                                               Public (Governmental)    _______



Has your agency complied with all HRSA requirements and regulations for all previously funded programs.
                    Yes ____________ No _____________ If no, explain.
                                                   BUDGET NARRATIVE
                                                     (Budget Form #1)




                    You must complete this form when you are submitting a fee for service budget.



Name of Agency:             _____________________________________


         Name of Sub-Contracting Agency: _________________________________________
         (If applicable)

Service Category: ___________________________________________________________

Title of Service:           ___________________________________________________________

1.       PERSONNEL                                                              $ _____________________

         ____________________________________________            $___________________
         (______________________/mo. x 12 months x __%)
         ____________________________________________
         ____________________________________________
         ____________________________________________


         (______________________/mo. x 12 months x __%) $___________________
         ____________________________________________
         ____________________________________________
         ____________________________________________


         (______________________/mo. x 12 months x __%) $___________________
         ____________________________________________
         ____________________________________________
         ____________________________________________


         (______________________/mo. x 12 months x __%) $___________________
         ____________________________________________
         ____________________________________________
         ____________________________________________




Note: Use additional pages as needed.
2.   FRINGE
     (Total Personnel costs x TOTAL %)                                          $_____________________
              FICA                           __________%
              State Unemployment             __________%
              Workers Comp.           _________%
              Health Insurance        _________%
              Life Insurance          _________%
              ___________________________ __________%
              ___________________________ __________%
              ___________________________ __________%
              TOTAL                   _________%

            Note: All fringe benefits must be included.

3.   TRAVEL                                                                     $_____________________
     Local Travel                                         $__________________
     ________________miles x $/mile

     Out of Town Travel                         $__________________
     (within the Houston EMA only)
     ________________________________________________:
     Transportation $_________________
     Lodging           $_________________
     Per Diem/Meals $_________________
     TOTAL             $_________________

     _______________________________________________:
     Transportation $_________________
     Lodging        $_________________
     Per Diem/Meals $_________________
     TOTAL          $_________________

4.   EQUIPMENT                                                                  $______________________
     Description:   ____________________________ $___________________
                    ____________________________ $___________________
                    ____________________________ $___________________

5.   SUPPLIES                                                         $______________________
     General Consumable Office Supplies          $___________________
     Other:         ____________________________ $___________________
                    ____________________________ $___________________
                    ____________________________ $___________________
                    ____________________________ $___________________


6.   CONTRACTUAL                                                                         $____________________

     _____________________________________________               $____________________
     ($______/hr. x ____________ hours)

     _____________________________________________               $____________________
     ($______/hr. x ____________ hours)
7.    OTHER                                                                  $____________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      _____________________________________________     $___________________
      TOTAL                                      $_________________

      Note: Include all other expenses.

TOTAL DIRECT COSTS                                                           $____________________

TOTAL INDIRECT COSTS (NOT ALLOWED)                                           $____________________

TOTAL COSTS                                                                  $____________________
                                              FEE FOR SERVICES BUDGET FORM
                                                      (Budget Form # 2)


                      You must complete this form when you are submitting a fee for services budget.



Name of Agency: ____________________________________

Service Category: ____________________________________________

Title of Service:          ____________________________________________

1.       Fee Charged per Unit of Service:                                            $_______________

2.       Number of Units of Service to be Provided:                                  $_______________

3.       Total Cost of these Services (#1 x #2):                                     $_______________

4.       Breakdown of Fee per Unit of Service:

         ___________________________________                 $________________
         ___________________________________                 $________________
         ___________________________________                 $________________
         ___________________________________                 $________________
         ___________________________________                 $________________
         ___________________________________                 $________________
         ___________________________________                 $________________
         ___________________________________                 $________________
         ___________________________________                 $________________
         ___________________________________                 $________________

         TOTAL                                               $________________

5.       Definition of Unit of Service:

                    1 unit of service=______________________________________
                                                          EXAMPLE
                                                     BUDGET NARRATIVE
                                                       (Budget Form # 1)



     You must complete this form when you are submitting a fee for service budget.


Name of Agency: My Child Care

         Name of Sub-Contracting Agency: ___________________________
         (If applicable)

Service Category: Day Care

Title of Service:           Child Day Care

1.       PERSONNEL                                                                   $182,660.00

         Day Care Coordinator                                      $27,500.00
         (2,600.00/mo. x 5 months x 50 %)
         (4,000.00/mo. X 7 months x 75%)
         Supervise schedule and coordinate
         Day care activities

         Day Care Worker                                   $16,340.00
         (1,361.67/mo. X 12 months x 100 %)
         Responsible for planning and over-
         Seeing daily activities including but not
         Limited to daily classroom activities

         Day Care Worker                                   $16,340.00
         (1,361.67/mo. X 12 months x 100 %)
         Responsible for planning and over-
         Seeing daily activities including but not
         Limited to daily classroom activities

         Day Care Worker                                   $16,340.00
         (1,361.67/mo. X 12 months x 100 %)
         Responsible for planning and over-
         Seeing daily activities including but not
         Limited to daily classroom activities
1.      PERSONNEL (continued)
        Day Care Worker                             $16,340.00
        (1,361.67/mo. X 12 months x 100 %)
        Responsible for planning and over-
        Seeing daily activities including but not
        Limited to daily classroom activities

        Day Care Worker                             $16,340.00
        (1,361.67/mo. X 12 months x 100 %)
        Responsible for planning and over-
        Seeing daily activities including but not
        Limited to daily classroom activities

        Day Care Worker                             $16,340.00
        (1,361.67/mo. X 12 months x 100 %)
        Responsible for planning and over-
        Seeing daily activities including but not
        Limited to daily classroom activities

        Day Care Worker                             $16,340.00
        (1,361.67/mo. X 12 months x 100 %)
        Responsible for planning and over-
        Seeing daily activities including but not
        Limited to daily classroom activities

        Day Care Worker                             $16,340.00
        (1,361.67/mo. X 12 months x 100 %)
        Responsible for planning and over-
        Seeing daily activities including but not
        Limited to daily classroom activities

        Clerical                                    $14,675.00
        (1300.00/mo. x 5 months x75 %)
        (1400.00/mo. X 7 months x100%)
        Provide clerical support to the coor-
        dinator. Maintain accurate
        Records.

        Accountant                                  $9,765.00
        (3,255.00/mo. x 12 months x 25 %)
        Provides AR/AP bookkeeping records.
        Prepares fiscal reports and audits.

Note: Use additional pages as needed.
2.   FRINGE                                                            $21,919.00
     (Total Personnel costs x TOTAL %)
              FICA                               7.65%
              State Unemployment                 2.70%
              Workers Comp.                      1.65%
              Health Insurance                             %
              Life Insurance                               %
                                                           %
                                                           %
                                                           %
             TOTAL                               12.00%

             Note: All fringe benefits must be included.

3.   TRAVEL                                                                    $4,667.00
     Local Travel                                          $4,667.00
     17,285 miles x $.27/mile

     Out of Town Travel                                    $
     (within the Houston EMA only)
                                                 :
     Transportation   $
     Lodging          $
     Per Diem/Meals   $
     TOTAL            $

                                                 :
     Transportation   $
     Lodging          $
     Per Diem/Meals   $
     TOTAL            $

4.   EQUIPMENT                                                                 $1,080.00
     Description:     1 Personal Computer                  $1,080.00
                                                           $
                                                           $

5.   SUPPLIES                                                                  $3,000.00
     General Consumable Office Supplies                    $3,000.00
     Other:                                                $
                                                           $
                                                           $
                                                           $
6.    CONTRACTUAL                                                                 $

                                                      $
      ($       /hr. x              hours)

                                                      $
      ($       /hr. x              hours)

7.    OTHER                                                                       $ 35,586.00

      Telecommunications                              $9,727.00
      Printing                                        $ 790.00
      Insurance                                       $3,100.00
      Office Space                                    $12,846.00
      Infection Control Supplies                      $ 790.00
      Van Lease                                       $8,333.00
                                                      $
                                                      $
                                                      $
                                                      $
                                                      $
                                                      $
                                                      $
                                                      $
                                                      $
                                                      $
      TOTAL                                           $35,586.00

      Note: Include all other expenses.

TOTAL DIRECT COSTS                                                        $ 248,912.00

TOTAL INDIRECT COSTS (NOT ALLOWED)                                        $       ---

TOTAL COSTS                                                               $248,912.0




                                                      EXAMPLE
                                            FEE FOR SERVICE BUDGET FORM
                                                        (Budget Form # 2)




                       You must complete this form when you are submitting a fee for service budget.

Service Category:             Day Care

Title of Service:            Child Day Care


1.       Fee Charged per Unit of Service:                                              $94.00


2.       Number of Units of Service to be Provided:                                    2648


3.       Total Cost of these Services (#1 x #2):                                       $ 248,912.00

4.       Breakdown of Fee per Unit of Service:


          Personnel                                          $68.98
          Fringe                                             $ 8.28
          Travel                                             $ 1.75
          Equipment                                          $ .41
          Supplies                                           $ 1.13
          Other                                              $13.45
          TOTAL                                              $94.00



5.        Definition of Unit of Service:

          1 unit of service =4 hours of day care service_____________________________________

								
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