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Federal Government Hispanic Outreach Proposal Contract

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Federal Government Hispanic Outreach Proposal Contract Powered By Docstoc
					                                      Request for Proposal
                                      Revised – July 2008
                                   Department of Public Health


                                         RFP # 2008 - 0913


The Connecticut Department of Public Health (DPH) is pleased to announce the availability of
funds to provide coordinated, culturally sensitive, developmentally appropriate, school based
health center (SBHC) services that include primary care, mental health, oral health care, health
promotion/risk reduction activities and outreach at ten schools in the City of Bridgeport. Services
are expected to begin on or before March 1, 2009.

Funding

A total of up to $2,933,549 in total funding is expected to be available to support this project.
Funding will be for a 28-month period beginning approximately March 1, 2009 through June 30,
2011, subject to the availability of funds and satisfactory performance. It is expected that the
following funding will be available:

Funding Source        March 1, 2009-     July 1, 2009-June July 1, 2010-June
                      June 30, 2009      30, 2010            30,2011
Base State              $397,592 (4 mos)          $1,192,777       $$1,192,777
Funding
Maternal Child              $1865 (4 mos)                 $5,596                 $5,596
Health Block Grant
Remainder of RFP          137,344 (4 mos)                     N/A                   N/A
allocation
        Total           $536,803 (4 mos)               $1,198,373            $1,198,373

Funding Restrictions

Funds are for SBHC services that may be used for personnel, fringe benefits, staff travel,
contractual services, and other direct and indirect costs associated with the operations of the clinic
and allowed in the budget. Other examples of allowable costs include purchase of clinic
equipment or supplies.

Funds cannot be used to pay for or replace school personnel (such as school nurses, counselors,
social workers), capitol improvement projects, or vehicles.

Eligibility

Applications will be accepted from public and private organizations, community-based agencies
and individuals.

Applicants must have a Connecticut address and must conduct business at a physical location in
Connecticut before the contract is awarded.



                                                   1
Closing Date

An original and five copies of the completed proposal must be received at the DPH office no later
than 3:00 p.m. on October 24, 2008.


Place Due

Department of Public Health
Public Health Initiatives Branch
410 Capitol Avenue, MS# 11MAT
P.O. Box 340308
Hartford, CT 06134-0308
Attention: Meryl Tom, Social Work Consultant, Project Manager
           Meryl.Tom@ct.gov
           Family Health Section


Further Information

Applicants who download the RFP from the DPH web site are encouraged to send written notice of
their intent to apply to the DPH. This notice can be sent using either the postal address or the e-
mail address provided under “place due” above.

To avoid giving one applicant advantage over others, all questions regarding the preparation of
proposals in response to this RFP must be submitted in writing by October 6, 2008 to the DPH
Project Manager. A copy of all written questions and responses will be provided to all applicants
who request the RFP or who send a written request for such information to the contact person
identified above. Responses to questions will be sent via e-mail to applicants who provide their e-
mail address to the contact person listed above.




                                                 2
                                  TABLE OF CONTENTS


NOTE: PAGE #’s TO CHANGE

                                                               Page

I.       Statement of Purpose                                     4

II.      Background                                               4

III.     Proposal Content Requirements                            6
         A. Applicant Information
         B. Contractor Information
         C. Services to be Provided
         D. Budget
         E. Work Plan
         F. Staffing
         G. Contract Compliance

IV.      Application Procedures                                  10

V.       Deliverables                                            11

VI.      Supervision                                             11

VII.     Review Criteria                                         12
         A. Minimum Requirements
         B. Technical Requirements
         C. Review Process

VIII.    Regulatory Compliance                                   13

IX.      Affirmative Action Notice                               14

X.       Rights Reserved to the State                            14

XI.      Attachments                                             15


            A.   Application Forms
            B.   Non-Discrimination Provisions for State of Connecticut Contracts
            C.   Preliminary Review Team Technical Review Criteria Worksheet
            D.   Minimum Requirements Checklist
            E.   City of Bridgeport-School Based Health Center Information




                                             3
I.        Statement of Purpose

      The purpose of this funding is to provide SBHC services at the ten sites located in the following
      Bridgeport Schools: Bassick High School (9-12); Central High School (9-12); Harding High
      School (9-12); Blackham Elementary School (K-8); Columbus Elementary School (PK-6);
      Dunbar Elementary School (K-8); JFK Campus Elementary School (k-8); Read Elementary
      School (K-8); Luis Munoz Marin (PK-8); and Roosevelt Elementary School (PK-8). Medical,
      mental health and dental services must be provided for students during evening hours at
      Bassick, Central and Harding High Schools during the first four months of this contract period to
      receive $137,344, the remainder of the previously issued Enhanced Services RFP funding.



II.       Background

      School Based Health Centers

      School Based Health Centers (SBHC) have served as safety net providers for medical, mental
      health and dental health care for Connecticut’s uninsured and underinsured students and their
      families dating back to the early 1980s. The Centers are located within schools or on school
      grounds and are present in elementary, middle, and high schools or in combination schools
      serving elementary and middle school students or middle and high school students in the same
      facility. Programs are designed to be accessible and integrated into the schools in which they
      operate. Education and preventive services are often offered within classrooms to become
      known entities to the students so that they can be comfortable seeking services at the SBHCs.
      The services offered to students and their families through the SBHCs are provided by a
      multidisciplinary team.

      SBHCs operate under a variety of organizations representing community health centers,
      hospitals, municipalities, boards of education and regional education councils, local health
      departments, and community based organizations. SBHC activities are supported through a
      mix of funding sources including state, federal, local and private dollars.

      Need for SBHC Services in Bridgeport

      Bridgeport is the largest city in CT with 134,750 residents according to the 2000 census. The
      Bridgeport Child Advocacy Coalition (BCAC), a network of organizations, parents and
      community leaders committed to improving the well being of Bridgeport’s children, produces a
      yearly report on the State of the Child in Bridgeport.

      According to the 2007 report, child poverty in Bridgeport is on the increase with a child poverty
      rate of nearly 30% compared to the statewide rate of 11% and rate of 18.5% nationally. More
      than half of Bridgeport children live below 200% of the federal poverty level, $34,340 for a family
      of three, the income considered necessary to meet a family’s basic costs, including food,
      housing, transportation and clothing.

      As of June 2007, there were 21,239 Bridgeport children enrolled in the HUSKY program. Even
      with HUSKY, only three in five children receive preventive health checkups, fewer than three in
      four preschoolers are immunized, and less than one in two children sees a dentist for preventive
      dental care.
                                                     4
The first SBHC was established in Bridgeport in 1983 and the first DPH funded center,
supported by an initial grant of $50,000 was established in 1985. The SBHCs in Bridgeport
currently conform to the DPH Standard Model for full time Comprehensive School Based Health
Center Level V and adheres to the National Association of School Based Health Care’s
(NASBHC) Principles and Goals for School Based Health Centers. (See Appendix E; Table 1
related to each of the funded sites, hours of operation, services offered and current staffing
models.)

The City will no longer provide funding to support the current level of personnel for the Level V
model. The City will, however, provide support by providing in-kind building support services
and routine maintenance for the SBHC during days of operation including rent, utilities, water,
and housekeeping services for each of the sites for the applicant who is awarded the funding for
this grant. The City will also provide building insurance, as the City owns each building. The
applicant awarded the contract will be responsible for negotiating an Access Agreement with the
City of Bridgeport and its Board of Education. (Please see a draft Access Agreement in the
Attachment section of the RFP for proposed terms required by the City of Bridgeport).

Comprehensive dental services have been previously provided to students at 7 of the 10 sites
(Please refer to Appendix E; Table 1). Under these circumstances, any student enrolled in the
SBHC programs from Blackham Elementary School, Harding or Central High Schools could
seek dental services at any of the other sites. It is preferred that minimally, preventive dental
services continue to be provided to students with the provision of dental examinations, dental
screenings, dental prophylaxis, sealant placement, fluoride application, and oral health
education to individual students as well as to students in-group settings. Should registered
dental hygienists provide the preventive dental services, these services must be in compliance
with Section 20-1261 of the General Statutes of Connecticut as it refers to scope of practice.

A Dental Director and two sub-contracted Dentists have also provided services; each ranging
between 14-17 hours /week. Two full time Dental Assistants have supported the dental services
provided in the SBHCs within the City of Bridgeport.

Two subcontracted child psychiatrists provide psychiatric consultation 4-7 hours/week at Central
and Harding High Schools. Psychiatric consultation has been available to all enrolled SBHC
students at all DPH funded sites.

SBHCs are fully integrated into each of the schools served. SBHC staff work closely with school
nurses, social workers, guidance counselors, administration, teachers and other school
personnel.

SBHC staff is involved with numerous community-based organizations and initiatives, including
but not limited to: the Oral Health Bridgeport Initiative (ORBIT), Bridgeport Child Advocacy
Coalition (BCAC), Community Resource Collaborative (CRC), Violence as it Relates to Children
Task Force, and the Area Advisory Council for the Department of Children and Families (DCF).

As is the requirement for all DPH-funded SBHC contractors, the Bridgeport program has
established and maintained an independent community-based SBHC advisory body that meets
a minimum of twice a year for the purpose of strengthening interagency coordination,
community support and program enhancement. It is expected that the contractor granted this
award will maintain an Advisory Board.
                                               5
       Clinical Fusion, a clinical management information system, is used to provide DPH with required
       data and reports. Clinical Fusion is the desired system of its kind and utilized by almost all DPH
       funded SBHC contractors. The license for the Clinical Fusion software will be transferable
       following the award of the RFP. There is an annual maintenance fee for the software at $250
       per single-user copy per year. The applicant awarded the contract will be responsible for
       maintenance fees. The maintenance fee includes all upgrades. Provisions will be made by
       DPH to provide a mentor to the selected contractor if they have had no prior experience using
       this data management system.

       Historically SBHC staff has collaborated with other non-funded DPH programs that have
       supported other health and well being services for students with either additional staffing or
       programs (i.e. Reconnecting Youth (RY), Promoting Alternative Thinking Strategies (PATHS),
       Families and Schools Together (FAST) and continued involvement in community-based
       activities and initiatives that focus on Bridgeport youth).

III.       Proposal Content Requirements

           Proposals must be submitted on the DPH Application Forms included in Attachment A. All
           requirements of this RFP must be met. Content requirements not addressed by the DPH
           Application Forms must be submitted in narrative form with numbered pages.

           A. Applicant Information

             The application must contain the official name, address and phone number of the
             applicant, the principal contact person for the application, and the name and signature of
             the person (or persons) authorized to execute the contract. The proposal narrative must
             be double spaced on standard 8 ½ “ x 11” paper with 1” margins and using 12-point
             Times New Roman or Arial font. Tables and charts may use 10-point font or larger.
             Each proposal shall contain the following:

             1. Background Statement- (Two page limit)
                Provide a brief description of your organization as follows:
                          a. Describe how the SBHC fits into the mission of your organization.
                          b. Describe your experience providing like services (medical, mental health
                              and oral health services) with similar mission to children and
                              adolescents over the past three years.
                          c. Describe your experience managing and supervising staff in multiple
                              clinical locations.
                          d. Describe your experience providing preventive services (e.g. nutrition,
                              substance abuse, domestic violence, teen pregnancy prevention, etc.) to
                              individuals and groups.
                          e. Describe your organization’s experience with your community and in
                              collaborative projects in the cities/towns in which you serve. Include
                              your plans to collaborate with other agencies and/or subcontractors to
                              provide comprehensive services.




                                                      6
B. Contractor Information

In order for the Branch to communicate effectively with the contractor, it is necessary to have
accurate information about contractor staff that is responsible for certain functions.

      Please provide the name, title, address, telephone and FAX number of staff persons
      responsible for the completion and submittal of:

      1. Contract and legal documents/forms
      2. Program progress reports
      3. Financial expenditure reports

Accurate information is needed by the Branch concerning the applicant’s legal status.

Please indicate whether or not the agency is incorporated, the type of agency applying for funding,
the fiscal year for the applicant agency, the agency’s federal employer ID number and/or town
code number, the applicant’s Medicaid provider status and Medicaid number, if any, and if the
applicant agency is registered as a Connecticut Minority Business Enterprise and/or Women
Business Enterprise.


      C. Services to be provided

The contractor must provide the following services and the contractor’s approach must be
addressed in the proposal:

1. Service/Program Coordination (Three page limit per site)
            a. Types of services offered and hours of operation may vary by site. The plan for
               services should address the cultural, linguistic, and ethnic needs of the targeted
               population. See
               http://www.bcacct.org/Websites/bcacct/Images/publications/SOTC_website.pdf
               for details related to the needs of the students in the City of Bridgeport. The
               applicant must describe the level of services to be offered at each and address
               the following areas:
                 1. Access: Please include hours of operation proposed for each site. The
                     proposal should include the capacity to ensure services are available during
                     the summer for children in need of services.
                 2. Proposals should include service models that include the delivery of primary
                     care, mental health and preventive dental health services at each site.
                     Please refer to Attachment E: Staffing Guidelines for reference.
                 3. Describe how you will coordinate SBHC activities with other school health
                     programs, including other health and support services for students.
                 4. Describe how you will coordinate with the school nurse, school health
                     coordinator and/or other school personnel (such as social workers, school
                     psychologist or counselors).
                 5. Describe how you will conduct community outreach and include methods to
                     be used in marketing the services to youth and families.




                                                  7
2. Implementation Plan (Three page limit per site)
           a. The applicant must include a reasonable and thorough implementation plan
               including the following:
                  1. Describe your capacity to serve a similar number of students at the ten city
                      schools. (Please refer to Table 2)
                  2. Obtaining licensure as outlined in the public health code for each site to
                      meet the established timeline.
                  3. Complying with HIPAA regulations.
                  4. Describe your staffing plan including personnel and support staff to be
                      funded at each site and identification of staff who will provide supervision,
                      oversight, and coordination of services. Identify and describe roles of staff
                      that will be utilized to provide services in your proposed model (Medical
                      Director, Nurse Practitioner, Physician Assistant, Coordinator, Medical
                      Assistant, Social Worker, Outreach worker, Dental hygienist, etc). Include
                      a plan and timeline describing how staff will be hired and trained to meet the
                      requirements of the program plan. Include appropriate job descriptions
                      and resumes of key personnel.
                  5. Describe and state the education, expertise and experience of all staff
                      positions.
                 6. Describe your plan for staff training and maintaining clinical competencies.
                 7. Describe your plan for contracting with MCO’s.
                 8. Provide your plan for a time table from March 1, 2009 through June 30,
                     2011, that specifically outlines your planned services/activities for the
                     implementation of the proposed services/activities.

3. Data/Information Management (two page limit)
             a. Health records: Describe policies and procedures developed to ensure
                confidentiality and privacy in the storage and transfer of health records (including
                electronic records), communicating health information related to referring
                students to other providers including the child’s primary care provider, or for
                additional services, and regular collaboration with a physician advisor.
             b. Describe your ability and experience with collecting and managing data that will
                manage patient information data. Include a work plan for implementing the
                Clinical Fusion data management system in all ten sites.

4. Billing (three page limit)
         The selected contractor shall bill appropriate public programs and other third party
         insurers. The selected contractor shall operate as a not-for-profit provider.
               a. Provide a description of your organization’s billing capacity, existing contracts with
                   State health insurance serving the Bridgeport community and your plan for
                   reinvesting reimbursements in the SBHC program.
               b. Include policies and procedures that minimize or eliminate co-pays.
               c. Any revenue received as a result of billing must be re-invested in the SBHC
                   program and must be identified on the end of year report.

5. Collaborations/Community Linkages (three page limit)
             a. Identify health care providers in the community willing to offer services to
                students and their families in the SBHC clinic setting and from those who agree to
                accept referrals from the SBHC. (The list should include providers to address
                acute or complex problems, as well as after-hours care needs such as for
                                                   8
                  acute care, mental health professionals, family/social services, dental health
                  Professionals, specialists, other.) Provide letters of commitment from each
                  provider willing to collaborate on this project that demonstrate past collaboration
                 and intent to provide resources.
              b. Describe your plan to establish and maintain cooperative working relationships
                  with the Board of Education, school personnel, community-based providers,
                  parents, and the community.
              c. Describe your plan to establish and maintain a broad -based diverse SBHC
                  Advisory Committee to advise and assist in the development and operation of the
                  SBHC program.

6. Quality Assurance Plan (Two page limit)

Describe your organization’s plan to measure quality, including benchmarks for participation and
outreach. The plan should include, but not be limited to, addressing faculty, student and parental
satisfaction, adherence to best practice standards in all clinical disciplines and reflect opportunities
for improvement. The plan should also reflect actions taken to resolve identified problems and
improve quality of care provided.

7. Funding

SBHC contractors are currently required to provide at least 25% matching funds to support
activities to be provided. The applicant awarded this contract will be required to provide at least
25% in-kind support to operate their center(s). This must be clearly identified in the submitted
budget.



       D. Budget

       Payments will be negotiated based on time frames and deliverables described in section V
       of this RFP. The proposal must contain the existing budget and the itemized budget with a
       detailed justification for each line item on the budget forms included in the Application in
       Attachment A. All costs (travel, printing, supplies, etc.) must be included in the contract
       price. Competitiveness of the budget will be considered as part of the proposal
       review process. Note: Please submit a separate budget for each site for the contract
       periods of 3/1/09-6/30/09, 7/1/09-6/30/10, and 7/1/10-6/30/11.


           The State of Connecticut is exempt from the payment of excise, transportation and
           sales taxes imposed by the Federal and/or state government. Such taxes must not be
           included in contract prices.

           The maximum amount of the bid may not be increased after the proposal is submitted.
           All cost estimates will be considered as “not to exceed” quotations against which time
           and expenses will be charged.

           The proposed budget is subject to change during the contract award negotiations.



                                                   9
          The selected Contractor must provide DPH with four copies of the subcontract. All
          information required of the contractor must be applied to the subcontractor as well. *

          Copies of state set aside certifications for small and/or minority business must
          also be provided.

          Payments will be negotiated based on time frames and deliverables described in
          section V of this RFP.

      E. Work plan (three page limit per site)

      A comprehensive and realistic work plan with measurable objectives describing tasks to be
      performed, deliverables and timelines, including a project start date, must be provided on
      the Application Forms included in Attachment A. SMART objectives are objectives that are
      Specific, Measurable, Achievable, Realistic, and Time-bound. The work plan must be
      consistent with the RFP and the project’s goals and objectives. The project start date will
      be considered as part of the review criteria for this RFP.

      F. Staffing

         The proposal must describe the staff assigned to this project, including the extent to
         which they have the appropriate training and experience to perform assigned duties.
         Job descriptions, hours per week, and hourly rates must be provided for all staff
         assigned to this project on the form included in Attachment A. Resumes must be
         provided for all professional staff assigned to this project.


      G. Contract Compliance

         The proposal must include a completed Notification to Bidders form (return one and
         keep one for your records) and a Workforce Analysis Questionnaire. In addition,
         proposals must include a signed statement of adherence to Assurances. These
         forms are included in Attachment A.


IV.   Application Procedures

        A. Applicants must complete their proposal using the following procedures:

           1. An original and five copies of the completed proposal must be addressed to the
              Project Manager: Meryl Tom, Social Work Consultant, Public Health Initiatives
              Branch, Family Health Section and must be received at DPH no later than, 3 p.m.
              on October 24, 2008.

           2. The proposal must be completed on the Application Forms included in
              Attachment A and additional narrative pages as needed to meet all requirements of
              this RFP.

           3. The proposal must be signed by an authorized official of the applicant
              organization.
                                                10
            4. Supplemental information will not be considered after the deadline
               submission of proposals, unless specifically requested by DPH.

            5. Notification of the outcome of proposal review will be mailed to all applicants. A
               contract will be mailed to the successful applicant on or about February 1, 2009,
               with an effective project start date on or about March 1, 2009.

V.     Deliverables

       In the course of providing the required services of this contract, several documents must be
       produced and delivered immediately upon completion to the DPH Project Manager for
       approval. These documents, along with the required services, will be the indicators for
       measuring the performance of the contractor. Development of these deliverables must be
       included as objectives in the project work plan described in Section III of this RFP (work
       plan forms are included in Attachment A). A payment schedule will be negotiated based
       upon the following deliverables:

            A. A fully executed contract with signatures from the appropriate authorized persons
            from the Connecticut Department of Public Health and the contractor’s authorized
            official.

            B. All required reporting documents: quarterly progress and expenditure reports,
            budget revisions, and annual reports.

            C. A letter of assurance or subcontract with a community-based provider stating their
            agreement to provide patient coverage and back up when the SBHC is not in
            operation. (Written agreements for provision of after-hours care and care during the
            summer and other vacation periods must be submitted annually.)

            D. Timely reporting of all contractual reporting documents.

            E. Evidence of meeting all contractual agreements under this contract.

            F. Evidence of a fully executed Access Agreement negotiated between the selected
            applicant(s) and the City of Bridgeport and Board of Education. (Please see draft
            Agreement in the Attachment section of the RFP.)

VI.    Supervision

       The DPH Project Manager within the Public Health Initiatives Branch, Family Health
       Section, will provide supervision.

VII.   Review Criteria

       Proposals submitted in response to this notice will be reviewed in two steps; first, to
       determine whether the minimum requirements have been met (see Attachment D, Minimum
       Requirements Checklist). Second, to determine the technical merit of the proposals and the
       extent to which they meet the goals and intent of the RFP.

                                                 11
   A. Minimum Requirements

      Proposals will be screened for completeness and compliance with the requirements
      specified in the RFP (see Attachment D, Minimum Requirements Checklist). Applicants
      who fail to follow instructions or to include all required elements may be deemed
      incomplete and removed from further review. In addition, applicants with long-standing,
      significant outstanding unresolved issues on current and prior year contracts with the
      Department may be removed from consideration for additional funding.

   B. Technical Requirements (Note: You are encouraged to revise this section to
      address the specific needs of your RFP)

Complete proposals will be review for technical merit based on the following criteria:

1. The extent to which the applicant has demonstrated successful experience providing similar
   services. Preference will be given to applicants who have experience providing primary
   care, mental health services and oral health in a SBHC setting.

2. The extent to which references provided support to the applicant’s success in providing
   similar services.

3. The extent to which services to be provided are described clearly and cover all requirements
   outlined in the RFP.

4. The extent to which adequate time is allocated to manage and coordinate the services to be
   provided.

5. The extent to which the profile of staff that will be working on this project is clear and
   adequate to manage the services to be provided. (Applicants are asked to consider hiring
   existing SBHC staff to help promote continuity of care with enrolled students and their
   families).

6. The extent to which a thorough work plan is presented, with measurable (SMART)
   objectives, appropriate timelines, and measurable outcomes.

7. The extent to which a cost effective budget is presented which follows budget instructions in
   Appendix A. Preference will be given to applicants who demonstrate commitment to this
   project and offer more than a 25% match in service delivery.


8. The extent to which the applicant provides evidence that it will utilize small and minority
   businesses, whenever feasible and appropriate, in the purchase of supplies and services
   funded through this contract.

9. The FISCAL COMPETEVENESS OF THE PROPOSAL. Preference will be given to
   applicants whose plan provides medical, mental health and oral health services and
   includes health promotion and prevention activities.




                                              12
    C. Review Process

        A panel of appropriate staff and outside experts will review proposals, which meet the
        minimum requirements. This panel will make recommendations concerning the selection of
        a proposal for funding. Recommendations to the Commissioner will be submitted in rank
        order based on Team Scores for each proposal. The final selection is at the discretion of
        the DPH Commissioner.

        Following the final selection, a Personal Service or Human Services Agreement will be
        developed between the applicant and the Department that details services to be provided,
        budget and reporting requirements. No financial obligation by the State can be incurred
        until a contract is fully executed.

VIII.   Regulatory Compliance

        The applicant is required to be in compliance with any applicable provisions of the
        Regulations of Connecticut State Agencies, if a current recipient of funding from DPH and
        with State Non-discrimination and Affirmative Action laws, rules and regulations.

        Moreover, in accordance with Section 4a-60 of the Connecticut General Statutes, as
        amended by Public Act 07-142, Section 9, the awardee shall agree and warrant that in the
        performance of this award, he/she will not discriminate or permit discrimination against any
        person or group of persons on the grounds of race, color, religious creed, age, marital
        status (including civil unions, per Public Act 07-245, Section 2), national origin, ancestry,
        sex, mental retardation, mental or physical disability, but not limited to, blindness unless it is
        shown by the awardee that such disability prevents performance of the work involved, in any
        manner prohibited by the laws of the United States or the State of Connecticut.

        Also, in accordance with Section 4a-60a of the Connecticut General Statutes, as amended
        by Public Act 07-142, Section 10, the awardee shall agree and warrant that in performance
        of this award, he/she will not discriminate or permit discrimination against any person or
        group of persons on the grounds of sexual orientation, in any manner prohibited by the laws
        of the United States or the State of Connecticut, and that employees are treated when
        employed without regard to their sexual orientation.

        Also, in accordance with Section 46a-81c(1) of the Connecticut General Statutes, as
        amended by Public Act 07-245, Section 3, the awardee shall agree and warrant that in
        performance of this award, he/she by him/herself or her/his agent, except in the case of a
        bona fide occupational qualification or need, will not refuse to hire or employ or bar or
        discharge from employment any individual or discriminate against such person in
        compensation or in terms, conditions, or privileges of employment, because of the person's
        sexual orientation or civil union status.

        The awardee shall further agree to provide the Commission on Human Rights and
        Opportunities with such information requested by the Commission concerning the
        employment practices and procedures of the awardee as they relate to the provisions of
        Section 4a-60 and Regulations of Connecticut State Agencies, Sections 46a-68J-2 to 46a-
        68K-8.


                                                    13
      Further, in accordance with the Contract Compliance Regulations of Connecticut State
      Agencies, the applicant will be required to complete the Notification To Bidders form
      and the Workforce Analysis Questionnaire as part of the application process
      (included in Attachment A).


IX.   Affirmative Action Notice

      DPH strongly supports the concept and implementation of affirmative action to overcome
      the present effects of past discrimination. DPH urges its bidders, suppliers, contractors and
      awardees to implement affirmative action plans and programs of their own, and hereby
      notifies all DPH bidders, suppliers, contractors and awardees that DPH will not knowingly do
      business with, or make awards to, any individual or organization excluded from participation
      in any federal or state contract program, or found to be in violation of any state or federal
      anti-discrimination law.

X.    Rights Reserved to the State

      The State reserves the right to reject any and all proposals, in whole or in part, to waive
      technical defects, irregularities and omissions if, in its judgment, the best interest of the
      State will be served.



[2008RFPTEMPLATE.doc]




                                                  14
XI. ATTACHMENTS




       15
ATTACHMENT A                                                                                                                     Page 1 of 16
APPLICATION FORMS
                                                       REQUEST FOR PROPOSAL
                                                    RFP # 2008-0913
                                 (School Based Health Center Program-City of Bridgeport)

                                                     DEPARTMENT OF PUBLIC HEALTH
                                             PUBLIC HEALTH INITIATIVES BRANCH

A. Applicant Information

Applicant Agency: __________________________________________________________________________
                                          Legal Name
_________________________________________________________________________________________
                                          Address
_________________________________________________________________________________________
                       City/Town          State              Zip Code

__________________                         _________________________                                        _________________________
   Telephone No.                                        FAX No.                                                   E-Mail Address

Contact Person: __________________________________                                    Title: ___________________________

Telephone No: ___________________________

TOTAL PROGRAM COST:                        $__________________

I certify that to the best of my knowledge and belief, the information contained in this application is true and correct.
The application has been duly authorized by the governing body of the applicant, the applicant has the legal authority
to apply for this funding, the applicant will comply with applicable state and federal laws and regulations, and that I am
a duly authorized signatory for the applicant.

          _________________________________________                                              _________________
                Signature of Authorizing Official:                                               Date

           _____________________________________________________
                      Typed Name and Title
-----------------------------------------------------------------------------------------------------------------------------------------------

The applicant agency is the agency or organization, which is legally and financially responsible and accountable for the
use and disposition of any awarded funds. Please provide the following information:

               Full legal name of the organization or corporation as it appears on the corporate seal and as registered
                with the
                Secretary of State
               Mailing address
               Main telephone number
               Fax number, if any
               Principal contact person for the application (person responsible for developing application)
               Total program cost

The funding application and all required submittals must include the signature of an officer of the applicant agency who
has the legal authority to bind the organization. The signature, typed name and position of the authorized official of the
applicant agency must be included as well as the date on which the application is signed.




                                                                             16
APPLICATION FORMS                                                                                  Page 2 of 16


                                      B. CONTRACTOR INFORMATION

PLEASE LIST THE AGENCY CONTACT PERSONS RESPONSIBLE FOR COMPLETION AND SUBMITTAL OF:

Contract and Legal Documents/Forms:

 Name                                       Title                                            Tel. No.



 Street                                     Town                                             Zip Code



 Email                                                                                       Fax No.


Program Progress Reports:

 Name                                       Title                                            Tel. No.



 Street                                     Town                                             Zip Code



 Email                                                                                       Fax No.


Financial Expenditure Reporting Forms:

 Name                                       Title                                            Tel. No.



 Street                                     Town                                             Zip Code



 Email                                                                                       Fax No,


Incorporated:         YES       NO                                     Agency Fiscal Year:


Type of Agency:             Public    Private            Other,
Explain:
                             Profit        Non-Profit

Federal Employer I.D. Number:                                          Town Code No:
Medicaid Provider Status:     YES     NO                                Medicaid Number:

Minority Business Enterprise (MBE):    YES          NO

Women Business Enterprise (MBE):       YES          NO

                                                                  17
APPLICATION FORMS                                                              Page 3 of 16

C. Services to be Provided


   1.   Describe your experience providing the kinds of services described in the “Services to be
        Provided” section of the RFP.




   2.   Provide at least two references (with their telephone numbers) that may be contacted to
        support your description of your experience in providing these services.




                                              18
APPLICATION FORMS                                                                 Page 4 of 16

  3.   Briefly describe the approach to the services you will provide as outlined in the “Services
       to be Provided” section of the RFP. Use the Workplan form to elaborate (see Section E
       of this application).




  4.   Briefly state the hours of operation of your organization and indicate the suitability of
       these hours to the Services and Deliverables required in this proposal. Include
       agreements/plans for backup coverage for medical and mental health care when the
       SBHCs are not in operation.




                                               19
APPLICATION FORMS                                                                   Page 5 of 16


A. Instructions Budget Summary 1
   I.      Personnel (lines #1 - #5) each person funded:
           a) Name of person & Title
           b) Hourly rate, # hours working per week, and # of weeks. (Calculate)
           c) Fringe benefit rate. (Calculate)
             Example:
          1.    Name & Position: John Smith, Coordinator
               Calculation: $25.00 hr X 35hrs X 45wks               $39,375
               Fringe Benefit: 26%                                  $10,238
   II.     Line #11 Contractual (Subcontracts) provide the total of all subcontracts and complete
           Subcontractor Schedule.
   III.    Lines #6 - #13 complete categories as appropriate,
   IV.     Line # 14: Other Expenses are any other types of expense that do not fit into the categories listed.
           For example: Equipment (purchasing a computer at a cost of $1,500). Please note that the state’s
           definition of equipment is tangible personal property with a normal useful life of at least one year
           and a value of at least $2,500 or more.
   V.      ***Audit Costs, the cost of audits made in accordance with OMB Circular A133 (Federal Single
           Audit) are allowable charges to Federal awards. The cost of State Single Audits (CGS 4-23 to 4-
           236) is allowable charges to State awards. Audit costs are allowable to the extent that they
           represent a pro-rata share of the cost of such audit. Audit costs charged to Department of Public
           Health contracts must be budgeted, reported and justified as an audit cost line item within
           the Administrative and General Cost category.
   VI.     Line Item #15 Administrative and General Costs, these are defined as those costs that have
           been incurred for the overall executive and administrative offices of the organization or other
           expenses of a general nature that do not relate solely to any major cost objective of the overall
           organization. Examples of A&G costs include salaries of executive directors, administrative &
           financial personnel, accounting, auditing, management information systems, proportional office
           costs such as building occupancy, telephone, equipment, and office supplies. Please review the
           OPM website on Cost Standards for more information at:
           http://www.ct.gov/opm/cwp/view.asp?a=2981&q=382994.
   VII. Administrative and General Costs must be itemized on the Budget Justification Schedule.
        Costs that have a separate line item in the Budget Summary may not be duplicated as an
        Administrative and General Cost. For example, if the Budget Summary includes an amount for
        telephone costs, this cannot also be included as an Administrative and General Cost.
   VIII. Other Income list any other program income such as in-kind contributions, fees collected, or other
         funding sources and include brief explanation on Budget Justification.
   IX.     2 Year Contracts: 2 sets of budget forms have been provided. Please do a full budget for each
           year of the contract, clearly indicating the year on each form. Assume level funding for the second
           year.

  Note: If space allowed is not sufficient for large or complex subcontract budgets, the Budget Summary
  format may be copied and used instead.




                                                       20
APPLICATION FORMS                                                                 Page 6 of 16

B. Budget Justification Schedule B
   I.   Please provide a brief explanation for each line item listed on the Budget Summary. This must
        include a detailed breakdown of the components that make up the line item and any calculation used
        to compute the amount.

        ***Please note: If Laboratory Services is a line item or subcontractor, please supply a
        justification as to why a private laboratory is being used as opposed to the Connecticut State
        Laboratory.

  II.   For contractors who have subcontracts, a brief description of the purpose of each subcontract must
        be provided. Use additional sheets as necessary.
        Example:
          Line Item (Description) Amount Justification - Breakdown of Costs
          Travel                         $730 1,659 miles @ .44 = $730.00 outreach
                                                workers going to meetings and site visits.

C. Subcontractor Schedule A--Detail
   I.  All subcontractors used by each program must be included, if it is not known who the subcontractor
       will be, an estimated amount and whatever budget detail is anticipated should be provided. (Submit
       the actual detail when it is available). A separate subcontractor schedule must be completed for
       each program included in the contract. For example: The contract is providing both a Needle
       Exchange program and an AIDS Prevention Education Program and Subcontractor “A” is providing
       services to both program there must be a separate budget for Subcontractor “A” for each.
   II. Detail of Each Subcontractor:
       Choose a category below for each subcontract using the basis by which it is paid:
            A. Budget Basis               B. Fee for Service   C. Hourly Rate.


        Provide the detail for each subcontract referencing the corresponding program of the contract.
        Detail must be provided for each subcontractor listed in the Summary.


        Example A. Budget Basis
           Outreach Educator $20/hr x 20hrs/wk x 50wks             $20,000
           Travel 590 miles @ .44 cents/mile                           260
           Supplies                                                    500
                                                     Total         $20,760
        Example B. Fee for Service:
           Develop and Produce
           500 Videos @ $10 each                                    $5,000
                                                     Total
        Example C. Hourly Rate:
           Quality Assurance Review of 200 Patient Charts
           by Nurse Clinician 200 hours @ $25/hour                  $5,000
                                                     Total          $5,000
        ***Please note: If Laboratory Services is a line item or subcontractor, please supply a
        justification as to why a private laboratory is being used as opposed to the Connecticut State
        Laboratory.



                                                     21
APPLICATION FORMS                                                            Page 7 of 16


                                   Category                                    Amount
            Personnel:
            1) Name & Position:       ,
        Calculation:
        Fringe Benefit:     %

            2) Name & Position:       ,
        Calculation:
        Fringe Benefit:     %

            3) Name & Position:       ,
        Calculation:
        Fringe Benefit:     %

            4) Name & Position:       ,
        Calculation:
        Fringe Benefit:     %

            5) Name & Position:       ,       :
        Calculation:
        Fringe Benefit:     %

            6)   Travel            per mile X      miles
            7)   Training
            8)   Educational Materials
            9)   Office Supplies
            10)  Medical Materials
            11)  Contractual (Subcontracts)***
            12)  Telephone
            13)  Advertising
            14)  Other Expenses (List Below)
                a)
                b)
                c)
                d)
                e)
                f)
            15) Administrative and General Costs
                                                           Total DPH Grant

         Other Program Income:
    *** Complete Subcontractor Schedule A
APPLICATION FORMS                                          Page 8 of 16

                     Budget Justification Schedule B

     Line Item         Amount Justification including Breakdown of Costs
     (Description)
APPLICATION FORMS                                                          Page 9 of 16

                               Subcontractor Schedule A-Detail
                                             #1
          Program:
    Subcontractor Name:
    Address:
    Telephone: (     )(     -       )
    Select One: A     Budget Basis    B     Fee-for-Service   C    Hourly Rate
    Indicate One:             MBE                    WBE                 Neither
                                   Line Item                                 Amount




                                               Total Subcontract Amount:

                                              #2
    Subcontractor Name:
    Address:
    Telephone: (     )(     -       )
    Select One: A     Budget Basis    B     Fee-for-Service   C    Hourly Rate
    Indicate One:             MBE                    WBE                 Neither
                                   Line Item                                 Amount




                                               Total Subcontract Amount:

                                              #3
    Subcontractor Name:
    Address:
    Telephone: (     )(     -       )
    Select One: A     Budget Basis    B     Fee-for-Service   C    Hourly Rate
    Indicate One:             MBE                    WBE                 Neither
                                   Line Item                                 Amount




                                               Total Subcontract Amount:
  APPLICATION FORMS                                                     Page 10 of 16

E. Workplan (make as many blank pages as needed)


    Services to be Provided     Activities         Staff         Expected Outcomes      Timetable
                                                   Position(s)   and Measures of
                                                   Responsible   Success
APPLICATION FORMS                                                                Page 11 of 16

    F. Staffing

      Profile of Staff Providing Services (see Section E of this RFP). Please provide the
      information requested below.


Professional Staff*   Name                   Title                 Hourly            Assigned
                                                                   Rate              to Project:
                                                                                     # Hrs/wk

Position 1


Position 2


Position 3


Position 4


Clerical/
Support Staff:


Position 1


Position 2



    *Attach Resumes for all Professional Staff
APPLICATION FORMS                                                                 Page 12 of 16

G.   Assurances

     Any prospective contractor must agree to adhere to the following conditions and must
     positively state such in the proposal. Please read, sign, date and return this
     statement with your proposal.

     A. Conformance with Statutes - Any contract awarded as a result of this RFP must be in
        full conformance with statutory requirements of the State of Connecticut and the Federal
        Government.

     B. Ownership of Proposals - All proposals in response to this RFP are to be the sole
        property of the State, and subject to the provisions of Sections 1-19 of the Connecticut
        General Statutes (Re: Freedom of Information).

     C. Reports and Information - The contractor shall agree to supply any information
        required by DPH: including evaluation and billing information in the time, manner and
        format directed by DPH.

        The contractor shall permit access by properly authorized DPH staff to the contractor’s
        premises, staff and participant and financial records, at any reasonable time.

        The right to publish, distribute or disseminate any and all information or reports, or any
        part thereof, shall accrue to DPH without recourse. The contractor shall maintain written
        records to substantiate costs incurred under the contract.

     D. Timing and Sequence - Timing and sequence of events resulting from this RFP will
        ultimately be determined by the State.

     E. Stability of Proposed Prices - Any price offerings from applicants must be
        valid for a period of 120 days from the due date of applicant proposals.

     F. Oral Agreements - Any alleged oral agreement or arrangement made by an
        applicant with any agency or employee will be superseded by the written
        agreement.

     G. Amending or Canceling Requests - The State reserves the right to amend or cancel
        this RFP at its discretion, prior to the due date and time, and/or at any point to the
        issuance of the written agreement, if it is in the best interests of the agency and the
        State.

     H. Rejection for Default or Misrepresentation - The State reserves the right to
        reject the proposal of any applicant which is in default of any prior contract or
        for misrepresentation.
APPLICATION FORMS                                                                   Page 13 of 16


       I.   State’s Clerical Errors in Awards - The State reserves the right to correct inaccurate
            awards resulting from its clerical errors.

       J.   Rejection of Proposals - Proposals are subject to rejection in whole or in part if they
            limit or modify any of the terms and conditions and/or specifications of the RFP.

       K.   Applicant Presentation of Supporting Evidence - An applicant, if requested, must
            be prepared to present evidence of experience, ability, service facilities, and financial
            standing necessary to satisfactorily meet the requirements set forth or implied in the
            RFP.

       L.   Changes to Proposals - No additions or changes to the original proposal will be
            allowed after submittal, unless specifically requested by DPH.

       M.   Collusion - By responding, the applicant implicitly states that the proposal is not made
            in connection with any competing applicant submitting a separate response to the
            RFP, and is in all respects fair and without collusion or fraud. It is further implied that
            the applicant did not participate in the RFP development process, had no knowledge of
            the specific contents of the RFP prior to its issuance, and that no employee of the
            agency participated directly or indirectly in the applicant’s proposal preparation.

       N.   Subcontracting - In a multi-contractor situation, DPH requires a single point of
            responsibility and accountability.


The undersigned acknowledges receiving and reading the aforementioned assurances and
agrees to these terms and conditions as set forth by the Department of Public Health.


____________________________________________            ________________________________
       Signature                                        Date


On behalf of:

____________________________________________________________________________
APPLICATION FORMS   Page 14 of 16
APPLICATION FORMS                                                                         Page 15 of 16

                                      NOTIFICATION TO BIDDERS

The contract to be awarded is subject to contract compliance requirements mandated by Sections 4a-60
and 4a-60a of the Connecticut General Statutes; and, when the awarding agency is the State, Sections
46a-71 (d) and 46a-81i (d) of the Connecticut General Statutes. There are Contract Compliance
Regulations codified at Section 46a-68j-21 through 46a-68j-43 of the Regulations of Connecticut State
agencies, which establish a procedure for the awarding of all contracts covered by Sections 4a-60 and 46a-
71 (d) of the Connecticut General Statutes.


According to Section 46a-68j-30 (9) of the Contract Compliance Regulations, every agency awarding a
contract subject to the contract compliance requirements has an obligation to “aggressively solicit the
participation of legitimate minority business enterprises as bidders, contractors, subcontractors and
suppliers of materials.” “Minority Business Enterprise” is defined in Section 4a-60 of the Connecticut
General Statutes as a business wherein fifty-one percent or more of the capital stock, or assets belong to a
person or persons: “(1) Who are active in the daily affairs of the enterprise; (2) Who have the power to
direct the management and policies of the enterprise; and, (3) Who are members of a minority, as such
term is defined in subsection (a) of Section 32-9n.” “Minority” groups are defined in Section 32-9n of the
Connecticut General Statutes as “(1) Black Americans ... (2) Hispanic Americans ... (3) Women ... (4) Asian
Pacific Americans and Pacific Islanders; or (5) American Indians.” The above definitions apply to the
contract compliance requirements by virtue of Section 46a-68j-21 (11) of the Contract Compliance
Regulations.

The awarding agency will consider the following factors when reviewing the bidder’s qualifications under the
contract compliance requirements.

       a) the bidder’s success in implementing an affirmative action plan;
       b) the bidder’s success in developing an apprenticeship program complying with Sections 46a-68-1
          to 46a-68-18 of the Connecticut General Statutes, inclusive;
       c) the bidder’s promise to develop and implement a successful affirmative action plan;
       d) the bidder’s submission of EEO-1 data indicating the composition of its workforce is at or near
          parity when compared to the racial and sexual composition of the workforce in the relevant labor
          market area; and,
       e) the bidder’s promise to set aside a portion of the contract for legitimate minority business
          enterprises. See Section 46a-68j-30 (10) (E) of the Contract Compliance Regulations.

INSTRUCTION: Bidder must sign acknowledgment below line and return acknowledgment to Awarding
Agency along with the bid proposal.



The undersigned acknowledges receiving and reading a copy of the “Notification to Bidders” form.

_______________________________________                            ___________________________
       Signature                                                                Date

On behalf of:
________________________________________________________________________________
APPLICATION FORMS                                                                                               Page 16 of 16
                                                      WORKFORCE ANALYSIS

Contractor Name:                                                             Total Number of CT employees:
Address:                                                                     Full Time:                Part Time:

Complete the following Workforce Analysis for employees on Connecticut worksites who are:
Job           Overall       White              Black              Hispanic            Asian or Pacific   American         People with
Categorie     Totals        (not of Hispanic   (not of Hispanic                       Islander           Indian or        Disabilities
s             (sum of all   Origin)            Origin)                                                   Alaskan Native
              cols. male
              & female)
                            Male     Female    Male    Female     Male       Female   Male     Female    Male    Female   Male     Female
Officials &
Managers

Professionals

Technicians
Office &
Clerical
Craft Workers
(skilled)
Operatives
(semi-skilled)
Laborers
(unskilled)

Service Workers

Totals Above

Totals 1 year Ago
FORMAL ON-THE-JOB TRAINEES (Enter figures for the same categories as are shown above)

Apprentices

Trainees
                                                                                               Employment
EMPLOYMENT FIGURES WERE OBTAINED FROM:                                   Visual Check:         Records               Other:

1. Have you successfully implemented an Affirmative Action Plan?     YES                       NO
   Date of implementation:__________________If the answer is “No”, explain.

1. a) Do you promise to develop and implement a successful Affirmative Action?
          YES       NO     Not Applicable Explanation:

2. Have you successfully developed an apprenticeship program complying with Sec. 46a-68-1 to 46a-68-18 of the
Connecticut Department of Labor Regulations, inclusive:   YES   NO      Not Applicable Explanation:

3. According to EEO-1 data, is the composition of your work force at or near parity when compared with the racial and
sexual composition of the work force in the relevant labor market area?       YES        NO Explanation:

4. If you plan to subcontract, will you set aside a portion of the contract for legitimate minority business enterprises?
         YES        NO     Explanation:


_______________________________________                                                           ________________________
      Contractor’s Authorized Signature                                                              Date
Appendix B - Non-Discrimination Provisions for State of Connecticut Contracts*

*Note: Appendix B is provided for your information only. The forms in this Appendix do not need to be
       completed for the RFP. These will be used for applicants awarded funding and requested during the
       contract development process.

The Office of the Attorney General has approved the following nondiscrimination certification forms to assist
executive branch agencies in complying with the State of Connecticut's contracting requirements, pursuant
to the Connecticut General Statutes § 4a-60(a)(1) and § 4a-60a(a)(1), as amended by Public Act 07-245
and Sections 9 and 10 of Public Act 07-142.

By law, a contractor must provide the State with documentation in the form of a company or corporate policy
adopted by resolution of the board of directors, shareholders, managers, members or other governing body
of such contractor to support the nondiscrimination agreement and warranty under C.G.S. §§ 4a-60a and
46a-68h.

The first of these forms is designed to be used by corporate or other business entities; the second is to be
used only by individuals who are to sign and perform contracts with the State in their individual capacity.
One or the other of these certifications is required for all State contracts, regardless of type, term, cost, or
value.
Pursuant to C.G.S. § 46a-56(b), State agencies may apply to the Commission on Human Rights and
Opportunities (CHRO) for a waiver from this requirement when entering into contracts with the entities listed
below:

      municipalities or other political subdivisions of the State;
      quasi-public State agencies;
      other state governments (including the District of Columbia);
      the federal government;
      U.S. territories and possessions;
      federally recognized Indian tribal governments; and
      foreign governments.

The appropriate certification must be signed by an authorized signatory of the contractor (or, in the case of
an individual contractor, by the individual) and submitted to the awarding State agency at the time of
contract execution.
The appropriate form is required for all contracts signed on and after June 25, 2007.

Non-discrimination Regarding Sexual Orientation. Unless otherwise provided by Conn. Gen. Stat. § 46a-
81p, the Contractor agrees to the following provisions required pursuant to § 4a-60a of the Connecticut
General Statutes:

(a)(1) The Contractor agrees and warrants that in the performance of the Contract such Contractor will not
        discriminate or permit discrimination against any person or group of persons on the grounds of
        sexual orientation, in any manner prohibited by the laws of the United States or of the State of
        Connecticut, and that employees are treated when employed without regard to their sexual
        orientation;

   (2) the Contractor agrees to provide each labor union or representatives of workers with which such
       Contractor has a collective bargaining agreement or other Contract or understanding and each
       vendor with which such Contractor has a Contract or understanding a notice to be provided by the
       commission on human rights and opportunities advising the labor union or workers’ representative of
       the Contractor's commitments under this section, and to post copies of the notice in conspicuous
       places available to employees and applicants for employment;
   (3) the Contractor agrees to comply with each provision of this section and with each regulation or
       relevant order issued by said commission pursuant to § 46a-56 of the Connecticut General Statutes;

   (4) the Contractor agrees to provide the commission on human rights and opportunities with such
       information requested by the commission, and permit access to pertinent books, records and
       accounts concerning the employment practices and procedures of the Contractor which relate to
       provisions of this section and § 46a-56 of the Connecticut General Statutes.

(b) The Contractor shall include the provisions of subsection (a) of this section in every subcontract or
    purchase order entered into in order to fulfill any obligation of a Contract with the state and such
    provisions shall be binding on a subcontractor, vendor or manufacturer unless exempted by regulations
    or orders of the commission. The Contractor shall take such action with respect to any such subcontract
    or purchase order as the commission may direct as a means of enforcing such provisions including
    sanctions for noncompliance in accordance with § 46a-56 of the Connecticut General Statutes provided,
    if such Contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as
    a result of such direction by the commission, the Contractor may request the State of Connecticut to
    enter into any such litigation or negotiation prior thereto to protect the interests of the state and the state
    may so enter.

Nondiscrimination and Affirmative Action Provisions in Contracts of the State and Political
Subdivisions Other Than Municipalities. The Contractor agrees to comply with provisions of § 4a-60 of the
Connecticut General Statutes:

(a) Every Contract to which the state or any political subdivision of the state other that a municipality is a
    party shall contain the following provisions:

   (1) The Contractor agrees and warrants that in the performance of the Contract such Contractor will not
       discriminate or permit discrimination against any person or group of persons on the grounds of race,
       color, religious creed, age, marital status, national origin, ancestry, sex, mental retardation or
       physical disability, including, but not limited to, blindness, unless it is shown by such Contractor that
       such disability prevents performance of the work involved, in any manner prohibited by the laws of
       the United States or of the state of Connecticut. The Contractor further agrees to take affirmative
       action to insure that applicants with job-related qualifications are employed and that employees are
       treated when employed without regard to their race, color, religious creed, age, marital status,
       national origin, ancestry, sex, mental retardation, or physical disability, including, but not limited to,
       blindness, unless it is shown by such Contractor that such disability prevents performance of the
       work involved;

   (2) the Contractor agrees, in all solicitations or advertisements for employees placed by or on behalf of
       the Contractor, to state that is an “affirmative action-equal opportunity employer” in accordance with
       regulations adopted by the commission;

   (3) the Contractor agrees to provide each labor union or representative of workers with which such
       Contractor has a collective bargaining agreement or other Contract or understanding and each
       vendor with which such Contractor has a Contract or understanding, a notice to be provided by the
       commission advising the labor union or workers’ representative of the Contractor’s commitments
       under this section, and to post copies of the notice in conspicuous places available to employees
       and applicants for employment;

   (4) the Contractor agrees to comply with each provision of this section and Conn. Gen. Stat. §§ 46a-68e
       and 46a-68f and with each regulation or relevant order issued by said commission pursuant to Conn.
       Gen. Stat. §§ 46a-56, 46a-68e and 46a-68f;
   (5) the Contractor agrees to provide the commission of human rights and opportunities with such
       information requested by the commission, and permit access to pertinent books, records and
       accounts, concerning the employment practices and procedures of the Contractor as relate to the
       provisions of this section and Conn. Gen. Stat. § 46a-56. If the Contract is a public works Contract,
       the Contractor agrees and warrants that he will make good faith efforts to employ minority business
       enterprises as subcontractors and suppliers of materials on such public works project.

(b) For the purposes of this section, “minority business enterprise” means any small Contractor or supplier
    of materials fifty-one per cent or more of capital stock, if any, or assets of which is owned by a person or
    persons:

   (1) who are active in the daily affairs of the enterprise;

   (2) who have the power to direct the management and policies of the enterprise; and

   (3) who are members of a minority, as such term is defined in subsection (a) of Conn. Gen. Stat. § 49-
       60g.

(c) For the purposes of this section, “good faith” means that degree of diligence, which a reasonable person
    would exercise in the performance of legal duties and obligations. “Good faith efforts” shall include, but
    not be limited to, those reasonable initial efforts necessary to comply with statutory or regulatory
    requirements and additional or substituted efforts when it is determined that such initial efforts will not be
    sufficient to comply with such requirements. Determinations of the Contractor’s good faith efforts shall
    include but shall not be limited to the following factors: The Contractor’s employment and subcontracting
    policies, patterns and practices; affirmative action advertising; recruitment and training; technical
    assistance activities and such other reasonable activities or efforts as the commission may prescribe
    that are designed to ensure the participation of minority business enterprises in public works projects.

(d) The Contractor shall develop and maintain adequate documentation, in a manner prescribed by the
    commission, of its good faith efforts.

(e) Contractor shall include the provisions of subsection (a) of this section in every subcontract or purchase
    order entered into in order to fulfill any obligation of a Contract with the state and such provision shall be
    binding on a subcontractor, vendor or manufacturer unless exempted by regulations or orders of the
    commission. The Contractor shall take such action with respect to any such subcontract or purchase
    order as the commission may direct as a means of enforcing such provisions including sanctions for
    noncompliance in accordance with Conn. Gen. Stat. § 46a-56; provided, if such Contractor becomes
    involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by
    the commission, the Contractor may request the state of Connecticut to enter into such litigation or
    negotiation prior thereto to protect the interests of the state and the state may so enter.
                                NONDISCRIMINATION CERTIFICATION


(By corporate or other business entity regarding support of nondiscrimination against persons on account of
their race, color, religious creed, age, marital or civil union status, national origin, ancestry, sex, mental
retardation, physical disability or sexual orientation.)


I, Non-Discrimination Provisions for State of CT Contract signer's name, signer's title, of name of entity, an

entity lawfully organized and existing under the laws of name of state or commonwealth, do hereby certify

that the following is a true and correct copy of a resolution adopted on the         day of     , 20       by

the governing body of name of entity, in accordance with all of its documents of governance and

management and the laws of name of state or commonwealth, and further certify that such resolution has

not been modified, rescinded or revoked, and is, at present, in full force and effect.


       RESOLVED: That name of entity hereby adopts as its policy to support the nondiscrimination

       agreements and warranties required under Connecticut General Statutes § 4a-60(a)(1) and § 4a-

       60a(a)(1), as amended in State of Connecticut Public Act 07-245 and sections 9(a)(1) and 10(a)(1)

       of Public Act 07-142.


WHEREFORE, the undersigned has executed this certificate this              day of        , 20    .



__________________________________
Signature


Effective June 25, 2007
                               NONDISCRIMINATION CERTIFICATION


(By individual contractor regarding support of nondiscrimination against persons on account of their race,
color, religious creed, age, marital or civil union status, national origin, ancestry, sex, mental retardation,
physical disability or sexual orientation.)


I, signer's name, of business address, am entering into a contract (or an extension or other modification of

an existing contract) with the State of Connecticut (the “State”) in my individual capacity for if available,

insert “Contract No. ___”; otherwise generally describe goods or services to be provided. I hereby certify

that I support the nondiscrimination agreements and warranties required under Connecticut General

Statutes Sections 4a-60(a)(1) and 4a-60a(a)(1), as amended in State of Connecticut Public Act 07-245 and

sections 9(a)(1) and 10(a)(1) of Public Act 07-142.



WHEREFORE, I, the undersigned, have executed this certificate this            day of       , 20       .



___________________________________
Signature


Effective June 25, 2007
ATTACHMENT C              PRELIMINARY REVIEW TEAM TECHNICAL CRITERIA WORKSHEET


_______________________________________
Applicant


Criteria:                                                             Maximum Points   Bidder’s Points

1. The extent to which applicant has demonstrated successful            (10)                  (   )
   experience providing similar services. Preference will be given to
   applicants who have experience providing primary care, mental health
   services and oral health in a SBHC setting.

2. The extent to which references support the applicant’s success           (5)               (   )
   providing similar services.

3. The extent to which services to be provided are described                ( 10 )            (   )
    clearly and cover all requirements outlined in the RFP.
     .
4. The extent to which adequate time is allocated to manage and             ( 15 )            (   )
   coordinate the services to be provided.

5. The extent to which the profile of staff who will be working on this ( 10 )                (   )
   project is clear and adequate to manage the services to be provided.

6. The extent to which a thorough workplan is presented with                ( 10 )            (   )
   measurable (SMART) objectives, appropriate timelines and
   measurable outcomes.

7. The extent to which a cost effective budget is presented which           ( 15 )            (   )
   follows eligibility guidelines. Preference will be given to applicants
    who demonstrate commitment to this project and offer more than
   minimum 25% match for service delivery.

8. The extent to which contractor provides evidence that it will utilize  ( 5 )               (   )
   small and minority businesses, whenever feasible and appropriate,
   in the purchase of supplies and services funded through this contract.

9. The fiscal competitiveness of the proposal.                              ( 20 )            (   )
   Preference will be given to applicants whose plan
   provides medical, mental health and oral health
   services and includes health promotion and prevention activities.

                                                      TOTAL                 ( 100 )           (   )
ATTACHMENT D                                       MINIMUM REQUIREMENTS CHECKLIST       *


_______________________________________
Applicant


1. Resumes provided for all professional staff assigned to this project.   __________

2. Completed Notification to Bidders form included in proposal.            __________

3. Completed Workforce Analysis Questionnaire included in proposal.        __________

4. Signed Statement of Adherence to Assurances included in proposal.       __________

5. An original and 5 copies of the completed proposal must be received
   at DPH no later than October 24, 2008.                                  __________

6. Proposal is completed on Application Forms included in Attachment A.    __________

7. The proposal is signed by an authorized official of the Applicant
   Organization.                                                           __________




[Rev. 7/2008; 2008RFPTEMPLATE]
ATTACHMENT E:

                                             City of Bridgeport
                                   School Based Health Centers 2006-2007
                                                   Table 1

     School Name          Hours of          Services       Current         Previous         # Unique      Total
                          Operation         Offered      DPH Funded       City Funded         Visits     Visits &
                                                          Positions        Positions                    Collateral
                                                                                                        Contacts
Central High School*    8:00 am – 3:30   Medical &       1 FTE Social    1 FTE Nurse      Clinic-2609       5508
                        pm               Mental Health   Worker          Practitioner
                                         Services        1 FTE Subst.
                                                         Abuse Spec.
                                                         1 FTE Medical
                                                         Asst.
Bassick High School     7:30 am – 3:00   Medical &       1FTE ORW        1 FTE Nurse      Clinic-3001       5074
                        pm               Mental Health                   Practitioner
                                         Services                        1FTE Social
                                         Oral Health                     Worker
                                                                         1 FTE Medial
                                         Services
                                                                         Asst.
Harding High School*    8:00 am – 3:30   Medical &       1 FTE Social    1 FTE Nurse      Clinic-2609       3177
                        pm               Mental Health   Worker          Practitioner
                                         Services        1 FTE Medical
                                                         Asst.
Blackham Elementary     7:45 am –3:15    Medical &       1 FTE Social    1 FTE Nurse      Clinic-2365       4993
School                  pm               Mental Health   Worker          Practitioner
                                         Services        1 FTE ORW
                                         Oral Health     1 FTE Medical
                                         Services        Asst.
JFK Campus Elementary   8:00 am – 3:30   Medical &       1 FTE Social    1 FTE Nurse      Clinic-1115       2148
School                  pm               Mental Health   Worker          Practitioner
                                         Services                        1 FTE Medial
                                         Oral Health                     Asst.
                                         Services
Dunbar Elementary       8:30 am – 3:00   Medical &       1 FTE ORW       *contracted      Clinic-841        1750
School*                 pm               Mental Health                   services with
                                         Services                        local CHC

Columbus Elementary     8:00 am – 3:30   Medical &       1 FTE Medical   1 FTE Nurse      Clinic-1097       2925
School                  pm               Mental Health   Asst.           Practitioner
                                         Services                        1 FTE Social
                                         Oral Health                     Worker
                                                                         1 FTE Outreach
                                         Services
                                                                         Worker
Roosevelt Elementary    8:00 am – 3:30   Medical &       1 FTE Social    1 FTE Nurse      Clinic-2929       5538
School                  pm               Mental Health   Worker          Practitioner
                                         Services        .5 FTE ORW      1 FTE Medial
                                         Oral Health                     Asst.
                                         Services
                                              City of Bridgeport
                                    School Based Health Centers 2006-2007
                                                    Table 1



     School Name           Hours of          Services       Current          Previous        # Visits     Total
                           Operation         Offered      DPH Funded        City Funded                  Visits &
                                                           Positions         Positions                  Collateral
                                                                                                        Contacts
Luis Munoz Marin         8:00 am – 3:30   Medical &       None             1 FTE Nurse    _________          2,196
                         pm               Mental Health                    Practitioner                 (*Information
                                          Services                         1FTE Social                    provided by
                                                                                                           the City for
                                          Oral Health                      Worker
                                                                                                            2007-2008
                                                                           1 FTE Medial
                                          Services                                                        school year)
                                                                           Asst.
                                                                           1FTE ORW
Read Elementary School   8:00 am – 3:30   Medical &       1 FTE N.P.       1 FTE Social   Clinic-1102         4029
                         pm               Mental Health   1 FTE Medical    Worker
                                          Services        Asst.
                                          Oral Health     1 FTE ORW
                                          Services
Program Administration                                    1 FTE Sup.
                                                          PA’s and ORW
                                                          1 FTE Dental
                                                          Asst.
                                                          .8 FTE Finance
                                                          Mgr
Summer hours have varied due to construction/renovation needs of the particular school.
Collateral Contacts refer to referrals, translations, calls/contact on a student’s behalf,etc.
* Represents schools without on site dental health services
ORW-refers to Outreach Worker
                                                 City of Bridgeport
                                       School Based Health Centers 2006-2007
                                                       Table 2

   School Name         Hours of               Users                Clinic                           Insurance
                       Operation                                  (unique)             Medicaid      Private       None
                                                                   Visits
Central High School   8:00 am – 3:30                    768                  2609           29.3%          27.5%      43.2%
                      pm
Bassick High          7:30 am – 3:00                    570                  3001           52.6%          15.7%      31.7%
School                pm
Harding High          8:00 am – 3:30                    358                  1774           44.7%          10.1%      45.3%
School                pm
Blackham              7:45 am –3:15                     522                  2365           45.4%          23.2%      31.4%
Elementary School     pm
JFK Campus            8:00 am – 3:30                    324                  1115           32.7%          51.5%      15.7%
Elementary School     pm
Dunbar Elementary     8:00 am – 3:30                    169                    841          59.2%          13.0%      27.8%
School                pm
Columbus              8:00 am – 3:30                    426                  1097           50.0%           8.9%      41.1%
Elementary School     pm
Roosevelt             8:00 am – 3:30                    512                  2929           72.7%           9.0%      18.4%
Elementary School     pm
Read Elementary       8:00 am – 3:30                    458                  1102           45.2%          24.0%      30.8%
School                pm
Luis Munoz Marin      8:00 am – 3:30                   *452                *2,196
School                pm                         (Information           (Information   ________      ________      ________
                                         provided by the City   provided by the City
                                           for the 2007-2008      for the 2007-2008
                                                  school year           school year)

Users having at least one visit record; n= 4105
                                    School Based Health Center
                                          Staffing Guidelines

     A.    A center coordinator/manager with training and experience in health/mental health systems
           management, supervision and administration.
     B.    At least one masters-prepared advanced practice registered nurse (APRN) with experience
           serving the target population (including age and ethnicity), with appropriate clinical
           consultation and back-up or a certified physician assistant (PA) with appropriate physician
           supervision.
     C.    At least one clinically trained masters level social worker (MSW), licensed clinical social
           worker (LCSW) preferred, or Licensed Professional Counselor (LPC) with expertise in working
           with the target population (including age and ethnicity) with LCSW supervision/consultation
           and back up. A Marriage and Family Therapist (MFT) may be considered with clearly
           demonstrated expertise in working with the target population, with LMFT clinical supervision/
           consultation and back up.
     D.    A Medical Director who must be a licensed physician with experience serving the target
           population and working with mid-level practitioners.
     E.    Support staff as needed, (i.e., clerical, receptionist, data entry professionals, etc.)
     F.    Additional health and/or allied health professionals as needed (i.e. nutritionist, substance
           prevention specialist, health educator, outreach worker, parent aid, medical assistant,
           psychologist, etc.)
     G.    If oral health/dental services are to be provided (optional), a licensed Dental Director and
           additional licensed dental providers, as needed.


V.    MINIMUM PRIMARY CARE SERVICES TO BE PROVIDED: (UTILIZATION OF
      CENTER SERVICES REQUIRES WRITTEN PARENTAL PERMISSION).


      A.    Physical Health/Medical Services: Services must be provided in accordance with nationally
            recognized and accepted standards such as the American Academy of Pediatrics, “Guidelines
            for Health Supervision” or the Maternal Child and Health Bureau, (Health Resources &
            Services Administration (HRSA) and Health Care Financing Administration (HCFA)) “Bright
            Futures, Guidelines for Health Supervision of Infants, Children and Adolescents”. Other
            nationally recognized and accepted standards may be utilized as a framework for professional
            practice with prior Department approval.
            1.       Primary health care including:
                     a.      Physical exams/health assessments/screenings for health problems.
                     b.      Diagnosis and treatment of acute illness and injury
                     c.      Diagnosis and management of chronic illness
                     d.      Immunizations
                     e.      Health promotion and risk reduction
                     f.      Nutrition and weight management
              g.     Reproductive health care
              h.     Laboratory tests
              i.     Prescription and/or dispensing of medication for treatment
          2. Referral and follow-up for specialty care that is beyond the scope of services provided
             in the SBHC.


B.   Mental Health/Social Services: Services must be provided in accordance with nationally
     recognized and accepted standards such as the Child Welfare League of America or the
     National Association of Social Workers, Inc. Other nationally recognized and accepted
     standards may be utilized as a framework for professional practice with prior Department
     approval.
     1.       Services:
              a)     Assessment, diagnosis and treatment of psychological, social and emotional
                     problems
              b)     Crisis intervention
             c)      Individual, family and group counseling or referral for same if indicated
             d)      Substance abuse and HIV/AIDS prevention
             e)      Risk reduction and early intervention services
             f)      Outreach to students at risk
             g)      Support and/or psycho-educational groups focusing on topics of importance to
                     the target population
             h)      Advocacy and referral for such services as day care, housing, employment, job
                     training, etc.
             i)      Consultation to school staff and parents regarding issues of child and adolescent
                     growth and development
     2)      Referral and follow-up for care that is beyond the scope of services provided in the
             SBHC


C.   Health Education Services: Services should be supportive of existing (Local Education
     Agency) health education activities:
     1.       Consultation to school staff regarding issues of child and adolescent growth and
              development
     2.       School staff and parent training regarding issues of importance in target population
     3.       Individual and group health education
     4.       Classroom presentations
    D.    Oral Health Services:
         1. Preventive services may include:
             a. Screenings
             b. Dental prophylaxis
             c. Fissure sealants
             d. Fluoride application
             e. Sealant placement
             f.   Education


          2. Referral and follow-up for care that is beyond the scope of services provided in the SBHC
.
                    PROPERTY ACCESS AGREEMENT (DRAFT)

      THIS AGREEMENT made as of            XXXXXXXX XX, 2008 by and between the City of
Bridgeport and the Board of Education, 45 Lyon Terrace, Bridgeport, Connecticut (“City” or
“Licensor”) and ___________________________, a _______________ organized under the laws
of the State of ________________, having a principal place of business at
_____________________________ (“Licensee”; the term Licensee shall also include
representatives, agents, employees, contractors, occupants and tenants, as applicable).

       WHEREAS, the Licensor has agreed to permit the Licensee to enter upon and perform
certain services at those certain City owned school properties identified in Exhibit A, attached
hereto and made a part hereof (collectively the “Premises”) in order to provide to Bridgeport
youths and communities with Community Healthcare Services under contract with the State of
Connecticut, Department of Public Health; and

      WHEREAS, the City has fee title ownership of the Premises, but the Board of Educations
has the care, custody and control over the Premises for as long as they are utilized for educational
purposes; and

       WHEREAS, the Licensee has proceeded to submit a proposal dated
_______________(“Proposal”) to a State of Connecticut issued Request for Proposals dated
_____________ (“RFP”), the Licensee has completed the selection process and has been chosen
as the appropriate respondent to perform the services contemplated therein and herein to provide
Community Health Services at the Premises, and

      WHEREAS the Licensee agrees to enter upon the Premises and perform those Community
Health Services in such manner and in such scope as are set forth in the RFP and Proposal, which
are attached hereto and made a part hereof as Exhibits A and B (“Scope of Activity”),
respectively at its sole expense and liability, subject to the terms and conditions set forth herein;

      NOW, THEREFORE, the Licensor and the Licensee mutually agree as follows:

      1.   Right of Entry. The Licensor hereby grants to the Licensee, its representatives,
           agents, consultants and contractors a license to enter upon the Premises at the
           Licensee’s sole risk and liability for the purposes set forth herein at the hours and times
           set forth in Exhibit C, attached hereto and made a part hereof.

      2.   Term of Access. The Premises will be available for the Scope of Activities for the days
           and times set forth in Exhibit C for a period of two years, commencing March 1, 2009.

       3. Scope of Activity. The Licensee may enter upon the Premises for the purposes of
performing the Scope of Activity. At all times of Licensee’s entry on the Premises pursuant to this
agreement, it shall comply with all laws, regulations, ordinances, and Board of Education policies
related to its entry upon and activities at the Premises.

       4. Indemnification and Insurance. A. Indemnification. The Licensee agrees to defend,
indemnify and hold harmless the City, its elected officials, officers, department heads, employees
and agents from and against any and all claims, liabilities, obligations, causes of action of
whatsoever kind and nature for damages, including but not limited to damage to the Premises or
other property, and costs of every kind and description arising from its entry upon the Premises, or
arising from work or other activities conducted thereon, alleging but not limited to bodily injury,
personal injury, property damage caused by the Licensee, except that the Licensee shall not be
responsible or obligated for claims arising out of a.) the sole proximate cause of the City, its
elected officials, officers, department heads, employees or agents, or its predecessors in interest in
the Premises, or b.) the prior existence of environmentally contaminated conditions of the
Premises.

        B. Insurance requirements: The following insurance coverage is required to be produced
to the City and maintained by the Licensee at its own expense. It is further understood that the
Licensee shall require similar coverage, as appropriate, from every contractor and subcontractor in
any tier, as the case may be, or any other person by reason of the license conferred by this
agreement that may enter onto or occupy the Premises on behalf of the Licensee. All non-
standard endorsements and provisions shall be disclosed in advance in writing to the City. The
Licensee shall procure at a minimum, present to the City, and maintain in effect for the duration of
this agreement without interruption and for one year after the Licensee’s last activity at the
Premises, the insurance coverage identified below, with deductibles approved in advance by the
City, from insurers licensed to conduct business in the State of Connecticut and having a Moody’s
or Best’s financial rating of A + 15, or coverage otherwise acceptable to the City. The Licensee will
not enter upon the Premises or commence any work or other activity until the required insurance is
purchased, submitted to and approved by the City.

      Comprehensive General Liability (occurrence form) naming the City as an additional
      insured and insuring against claims or suits brought by members of the public alleging
      bodily injury or personal injury or property damage and claimed to have arisen out of
      operations conducted under this agreement. Coverage shall be broad enough to include
      blanket contractual liability, premises and operations, contingent liability, contractual liability,
      broad form property damage and personal injury, political risk, care, custody and control,
      with limitations of $1,000,000 for each occurrence/aggregate with a combined single limit for
      bodily injury, personal injury and property damage. Exclusions for independent contractors,
      employees, and care, custody and control will be removed. The Licensee or its agent shall
      inform the City in advance of any unusual endorsements or policy provisions that may be
      part of the insurance contract(s).

      Comprehensive Automobile Liability insuring against claims or suits brought by members
      of the public alleging bodily injury, personal injury or property damage, and uninsured
      motorist and claimed to have arisen out of the use of owned, hired or non-owned vehicles in
      connection with business naming the City as an additional insured. This policy will include
      endorsements providing coverage for mobile equipment and employer equipment not
      owned and hired. Coverage will be broad enough to include contractual liability, with
      limitations of $1,000,000 for each occurrence/aggregate with a combined single limit for
      bodily injury, personal injury and property damage.

      Workers’ Compensation insuring in accordance with statutory requirements, including
      voluntary compensation, broad form all states endorsement, employer’s liability insurance
      and occupational disease insurance in order to meet obligations towards employees in the
      event of injury or death sustained directly or indirectly in the course of employment. Liability
      for employee suits shall not be less than $500,000 per claim.
Owner’s Protective Liability to the extent the work under the contract is sublet to others,
the Licensee will purchase and maintain such insurance naming the Licensor as additional
insured.

Property Damage insuring against direct damage loss to buildings, structures or
improvements covering the interest of the City, the Licensee, its contractors and
subcontractors and parties having an interest therein. The City shall be named as loss
payee as its interests may appear.

General requirements. All policies shall include the following provisions:

      Cancellation notice—The City shall be entitled to receive from the insurance carriers
      not less than 30 days’ written notice of cancellation or non-renewal to be given to the
      City at: Purchasing Agent, City of Bridgeport, City Hall, 45 Lyon Terrace, Bridgeport,
      Connecticut 06604.

      Certificates of Insurance—All policies will be evidenced by an original certificate of
      insurance on an ACORD-25S form authorized by and executed with the original
      signature or original stamp of the insurer or a properly-authorized agent or
      representative reflecting all coverage required and delivered to the City prior to any
      work or other activity commencing under this agreement.

      Additional insured—The Licensee shall ensure that the Licensee and its contractors
      and subcontractors will arrange with their respective insurance agents or brokers to
      name the City, its elected officials, officers, department heads, employees and
      agents on all policies of primary and excess insurance coverage as additional insured
      parties except for any errors and omissions insurance coverage or workers’
      compensation coverage, and shall name the City as loss payee with respect to any
      damage to property of the City, as its interests may appear. The undersigned shall
      submit to the City upon commencement of this agreement and periodically thereafter,
      but in no event less than once during each year of this agreement, evidence of the
      existence of such insurance coverage in the form of original Certificates of Insurance
      issued by reputable insurance companies licensed to do business in the State of
      Connecticut and having Best’s or Moody’s A + 15 financial ratings, or coverage
      otherwise acceptable to the City. Such certificates shall designate the City in the
      following form and manner:

      The City of Bridgeport and its Board of Education, their elected officials, officers,
      department heads, employees, agents, servants, successors and assigns ATIMA
      Attention: Purchasing Agent
      45 Lyon Terrace
      Bridgeport, Connecticut 06604

      The coverage afforded to the City shall be primary insurance. If the City has other
      insurance that is applicable to the loss, such other insurance shall be on an excess or
      contingent basis. The amount of the contractor’s liability under any insurance shall
      not be reduced by the existence of such other insurance. The coverage afforded to
      the additional insured shall not apply to the sole negligence of the additional insured.
              The cost of all deductibles on any policy of insurance to be purchased by the
              Licensee will be borne by the Licensee.

              All policies, endorsements, certificates and other evidence of insurance shall be
              subject to the review and satisfaction of the City.

       5. Remedies For Default. If, after the Licensee has entered the Premises pursuant to the
license granted by this agreement, the Licensee fails for any reason to restore the Premises to the
general condition it was in prior to Licensee’s entry immediately but in any event no later than thirty
(30) days after written notice from the Licensor, the Licensee shall be liable for all costs and
expenses, including attorneys’ fees, incurred by the Licensor in restoring the Premises.

       6. Condition of Premises. The Licensee shall not direct any deterioration or waste to be
committed at the Premises. The Licensee shall return the Premises to at least the same general
condition in which the Premises was found when the Licensee commenced its entry pursuant to
this agreement. If Licensee shall not remove itself from the Premises in accordance with this
agreement, title to all installations and improvements, if any, made by the Licensee to the
Premises, upon installation thereof, shall become the sole property of the Licensor unless
otherwise stated herein. The Licensee shall not permit any mechanic’s lien, charge, or
encumbrance to be placed upon the Premises in connection with, or during its entry of the
Premises under this agreement.

       7. Resolution of Disputes and Choice of Law. The parties agree that all disputes
between them arising under this agreement or involving its interpretation, if they cannot be first
resolved by mutual agreement, are subject to the following dispute resolution procedure:

(a)         Initiation of Dispute Resolution Process. In the event that a dispute is not resolved
            after good faith effort to arrive at a mutual agreement, either party may send written
            notice to the other, in the manner specified for giving notice in this agreement, that a
            dispute continues to exist. The party giving such notice shall also forward a copy to the
            Director, [name of Department] (“Director”), In care of the [name of Department],
            [address], Bridgeport, Connecticut 06604. The notice shall set forth the nature of the
            dispute, the notifying party’s position statement, and copies of documents supporting
            its position regarding the dispute. Within seven (7) calendar days after the date such
            notice is given, the other party shall file its position statement and supporting
            documents to the Director. Within five (5) working days after receipt of such reply, the
            Director shall review the matter, issue a written determination (“Determination”), and
            mail a copy thereof to the parties. The Director may reach a Determination with or
            without a face-to-face meeting with the parties and with or without testimony of
            witnesses, in his/her sole and absolute discretion.

(b)         Mediation. If either party objects to the Determination, such party shall commence
            non-binding mediation before the American Arbitration Association (“AAA”), or similar
            mediation organization selected by the City in the City’s sole discretion within thirty (30)
            days after the date of the Determination. The City shall determine whether such
            mediation will be conducted in accordance with AAA mediation rules then in effect or
            another entity’s mediation rules.     Such mediation will be held in Bridgeport,
            Connecticut. Each party shall bear the cost of its respective counsel and one-half of
            the administrative costs of such mediation, including but not limited to the mediator’s
            fees and expenses. Failure by either party to file for mediation within such 30-day
      period shall be deemed a waiver by both parties of their respective right to appeal such
      Determination, in which event such Determination shall be final and enforceable in any
      court having jurisdiction over the parties.

(c)   Arbitration, or Litigation at City’s Option. If mediation does not resolve the dispute,
      either party may submit such dispute to the AAA, or similar alternate dispute resolution
      entity selected by the City in the City’s sole discretion. The City shall determine
      whether such arbitration will be conducted pursuant to the AAA construction rules of
      arbitration then in effect or by the rules of another entity. Notwithstanding the parties’
      respective rights to seek arbitration of the dispute, the City shall have the independent
      right, exercisable within sixty (60) days after any arbitration is commenced, in its sole
      and absolute discretion, to seek resolution of the dispute in a court of law having
      jurisdiction over the parties, in which event, resolution of the dispute by arbitration shall
      be deemed waived by the parties, any pending arbitration shall be deemed stayed, and
      the decision of the court having jurisdiction over the parties to which the dispute is
      submitted by the City shall be final and binding upon the parties. If the City either (a)
      initiates arbitration or (b) does not move to stay an arbitration initiated by the other
      party within such 60-day period, the dispute shall be resolved by arbitration.

(d)   Arbitration Process. Arbitration shall be held before a 3-member panel of arbitrators,
      unless the parties mutually agree to a single arbitrator, all of whom shall be residents
      of, or permanently employed in, the State of Connecticut. All arbitrators must have a
      minimum of ten (10) years’ current experience in their profession or occupation, a
      minimum of ten (10) years’ of relevant demonstrated experience, and a level of dispute
      resolution training commensurate with the nature and value of the dispute. The dispute
      resolution organization shall submit one or more lists containing a minimum of fifteen
      (15) potential panelists who are duly-qualified. If the parties cannot agree to a panel
      after three (3) lists have been provided, the selection of arbitrators shall be submitted
      to the chief administrative judge of the State Superior Court located in Bridgeport,
      Connecticut for resolution. The arbitration shall be held in the City of Bridgeport and
      any award rendered shall be final and binding upon the parties and enforceable in a
      court of competent jurisdiction. Upon the request of either party, the dispute may be
      determined by any expedited procedure of the AAA then in effect or expedited
      procedure of another alternate dispute resolution entity then in effect, if the nature and
      amount of such dispute warrants resolution by an expedited procedure under the
      AAA’s or such entity’s rules. The parties shall be entitled to full and fair discovery of
      documents and information necessary for the defense or prosecution of their
      respective claims, provided that such discovery is not unduly burdensome, unduly
      costly, prejudicial or violative of a party’s right to withhold confidential information such
      as attorney/client privileged communications and work product. In the conduct of the
      proceedings, the parties may vary the selected rules of administration by mutual
      agreement, but will give due consideration of the panel’s suggestions of varying the
      procedure in the interests of expedited resolution of the dispute. The parties shall
      specify the manner and breakdown of the panel’s award. The panel shall have
      authority, in its sole discretion, to award reasonable attorneys’ fees and costs to the
      prevailing party. If the award does not contain an award of attorneys’ fees and/or
      costs, each party shall bear the cost of its respective counsel, and one-half of the
      administrative costs of such arbitration, including but not limited to the arbitrators’ fees
      and expenses (except filing fees for demands and counterclaims, which shall be borne
      by the party initiating such demand or counterclaim). THIS AGREEMENT SHALL BE
        DEEMED TO MODIFY THE ARBITRATION RULES OF THE ORGANIZATION
        SELECTED BY THE CITY, WHOSE RULES SHALL BE DEEMED SUBORDINATE TO
        THIS AGREEMENT, AND THE ARBITRATION OF THE DISPUTE SHALL BE
        GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE SUBSTANTIVE
        LAWS OF THE STATE OF CONNECTICUT.        ANY AWARD THAT IS NOT
        RENDERED IN COMPLIANCE WITH PREVAILING CONNECTICUT LAW AT THE
        TIME THE AWARD IS RENDERED SHALL BE DEEMED VIOLATIVE OF PUBLIC
        POLICY AND MAY BE APPEALED TO A COURT OF COMPETENT JURISDICTION
        OVER THE PARTIES AS AN INDEPENDENT GROUND FOR APPEAL.

(e)     Joinder in Other Proceedings. The City reserves the right to require the joinder and
        participation of the other party to this agreement in any other arbitration or litigation
        involving a claim by another party that relates to the subject matter set forth in this
        agreement and, reserves the additional right, if necessary or desirable in the City’s sole
        determination, to join or implead the other party to this agreement into such arbitration
        or litigation when doing so is deemed by the City to be in its best interests.


     THIS AGREEMENT SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE
WITH THE SUBSTANTIVE LAWS OF THE UNITED STATES AND THE STATE OF
CONNECTICUT.




                                     LICENSOR


                                     By:_______________________
                                        Name:
                                        Title:


                                     LICENSEE


                                     By:_______________________
                                        Name:
                                        Title:

				
DOCUMENT INFO
Description: Federal Government Hispanic Outreach Proposal Contract document sample