First 5 Contra Costa
                                                                                                Request for Qualification
                                                                                                    Evaluation Services


Auditor Legal

Contact Person:


City:                                                          State:                 Zip Code:

Phone:                                        Fax:                        Email:

Federal Tax Identification Number:

A complete qualification/proposal has no more than 25 single-sided pages with 1.5 line spacing, 12pt
font, and 8.5 x 11 inch paper with 1-inch margins plus any required Attachments and additional
information as listed below:

 A.        Cover Letter/Checklist (Attachment A) – The cover letter must be signed by an officer
            authorized to bind the proposing organization for a period of at least 90 days.
 B.        Certification of Qualifications - Return a copy of the entire completed certification properly
            executed as provided for in (Attachment B)
C.         Narrative – (maximum 25 single-sided pages)
D.         Excerpt of a few pages from a report (see page 21, #2d)
E.         Scope of Work and Budget – see example (Attachment C)
F.         Conflicts of Interest – Describe any potential conflicts of interest that your organization may
            have regarding the project.
G.         Litigation – List any lawsuit or litigation and its outcome resulting from any project undertaken
            by your organization within the last 5 years or any project where a claim or settlement was paid
            by your organization or its insurers within the last 5 years.
H.         Curriculum Vitae or resumes – for persons who will be the core team for this project.
 I.        Memoranda of Understanding – if applicable please provided for any subcontractors or
            collaborators proposed that delineate specific roles, responsibilities, and services to be
            provided by the subcontracting agency.

Name:                                                     Title:

AUTHORIZED SIGNATURE:                                                               Date:
                      First 5 Contra Costa  1485 Enea Court  Suite 1200  Concord, CA 94520
                                          (925) 771-7300 
                                                                                                            First 5 Contra Costa
                                                                                                         Request for Qualification
                                                                                                             Evaluation Services

                            CERTIFICATION OF QUALIFICATIONS TO
                                  (FIRST 5 CONTRA COSTA)

          The undersigned certifies that he/she is authorized by the Organization to submit its
         qualifications and pricing for Evaluation Services and, by doing so, agrees to furnish
         services to the Commission in accordance with the Request for Qualifications (RFQ)
         dated March 26, 2010.

         1. This Organization has carefully reviewed its qualifications and understands and
            agrees that the Commission is not responsible for any errors or omissions on the
            part of the Organization.

         2. It is understood and agreed that the Commission reserves the right to accept or
            reject any or all Organization qualifications and to waive any informality or
            irregularity in a document received by the Commission.

         3. The document includes all of the commentary, figures and data required by the
            Request for Qualifications, dated March 26, 2010.

         4. This Organization has carefully read and fully understands all of the items required
            in this RFQ. This Organization agrees to all requirements.

         5. This is an irrevocable offer and shall be valid for 90 days from May 13, 2010.

     The signature below certifies that the person signing is entitled to represent the Organization, authorized to submit
     qualifications, has understanding of the work to be done, and the qualifications and commitment to perform the
     work within the time period.

Name of

Signature of Official:




                         First 5 Contra Costa  1485 Enea Court  Suite 1200  Concord, CA 94520
                                             (925) 771-7300 
                                                                                                                      First 5 Contra Costa
                                                                                                                   Request for Qualification
                                                                                                                       Evaluation Services

                                 ATTACHMENT C – SCOPE OF WORK and BUDGET
Sample Format
The following is an example scope of work for illustrative purposes only. A submitted scope of work does not need to be
presented in this format. However, at a minimum the Scope of Work should all include activities listed on this page; activities
that the applicant does not intend to conduct should be indicated with 0 hours listed. The wording of activities may be modified
to reflect applicant’s intent, and other proposed activities may be inserted.

                                                                    Projected Hours
                                                                    Staff      Staff           Staff      Staff
  Task     Activity                                                 member     member          member     member
                                                                    A          B               C&D        E
  Initiate Contract
            Meet F5CC staff; review evaluation plan; review
  1         data collection procedures; review forms and
            databases; suggest initial changes to procedures.
  2         Meet program contractors.
  Data Collection
            Collect and enter family and providers surveys;
            review for quality and completeness.
            Collect and enter other paper forms, matching IDs
            where appropriate; review for completeness.
            Assess the need for new forms; develop forms in
  5         collaboration with F5CC staff and in consultation
            with program contractors.
            Review the program contractors’ Excel databases;
  6         review for data quality and completeness. Transfer
            data necessary for analysis.
            Work with system administrators to transfer data
  7         necessary for analysis from Persimmony (Home
            Visiting programs) and ETO (First 5 Centers).

                                First 5 Contra Costa  1485 Enea Court  Suite 1200  Concord, CA 94520
                                                    (925) 771-7300 
                                                                                 First 5 Contra Costa
                                                                              Request for Qualification
                                                                                  Evaluation Services

         Conduct interviews or other data collection, as
Data Analysis and reporting
9        Combine data sets; conduct data analysis.
         Compare findings with information external to the
10       program, such as state / national benchmarks or
         research literature.
11       Assist in the preparation of the state annual report.
         Provide F5CC Evaluation staff with subsets of (de-
         identified) data for specific in-house analysis.
         Respond to other requests by F5 Evaluation staff
         within limits.
         Prepare and present 10-12 Evaluation Reports and
         Data Summaries for each contractor.
Outcomes and Strategic Goals Report
         Collaborate with F5CC staff to develop an evaluation
         product that reports on outcomes across programs,
13       and describes program effectiveness in meeting
         outcomes, (given program intensity and focus on
         that outcome). Relate findings to Strategic Goals.
Other Activities
14       Internal meetings
15       Meetings with F5CC staff

Staff                    Staff Rates*              Total Hours   Total Cost
Staff member A           $xx / hour                              $
Staff member B           $xx / hour                              $
Staff member C & D       $xx / hour                              $
Staff member E           $xx / hour                              $
                         $xx / hour                              $
                                                                                                             First 5 Contra Costa
                                                                                                          Request for Qualification
                                                                                                              Evaluation Services

*Loaded rates include office occupancy, office operating, personnel salary/benefits/taxes, and overhead
Additional costs          Description               Amount
Travel                                              $
Duplication                                         $
Telephone                                           $
Other Cost A                                        $
Other Cost B                                        $
Total Personnel           $xx
Total Additional Costs    $xx
Total Budget              $xx

                              First 5 Contra Costa  1485 Enea Court  Suite 1200  Concord, CA 94520
                                                  (925) 771-7300 

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