C.a.R Lease Forms

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					    HARRIS COUNTY
REQUEST FOR PROPOSAL                                                JOB NO. 06/0374
      Cover Sheet                                               Date Due: November 6, 2006
                                                                     DUE NO LATER THAN 2:00 P.M.
                                                                    LOCAL TIME IN HOUSTON, TEXAS
                                                                Proposals received later than the date
                                                                and time above will not be considered.


 PROPOSAL TO: Provide Ryan White Title I Clinical Chart Review/Extraction and Data Entry for
 Harris County

                                           OFFERORS NOTE!!
Carefully read all instructions, requirements and          Please return proposal in an appropriately sized
specifications. Fill out all forms properly and            envelope or box. PACKAGE MUST SHOW THE
completely.     Submit your proposal with all              JOB NUMBER, DESCRIPTION AND BE MARKED
appropriate supplements and/or samples.                    "SEALED PROPOSAL".

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


For additional information, contact: Mary Lou Sotolongo @ (713) 755-6832.

You must sign below in INK; failure to sign WILL disqualify the offer. All prices must be typewritten or
written in ink.
                               Service Category Code _____________________________
                               Total Amount of Proposal $

Company Name:

Company Address:

City, State, Zip Code:

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

Telephone No. :                        FAX No.:                             e-mail:

Print Name:

Signature: _________________________________________________________________________


Revised 01/05
MLS/mga

                                                                                               Page 1 of 43
TABLE OF CONTENTS

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

It is the Offeror's responsibility to be thoroughly familiar with all Requirement s and Specifications. Be sure you understand the
following before you return your bid packet.
__X__ 1.           Cover Sheet
                   Your company name, address, the total amount of the bid/proposal, and your signature (IN INK) should appear on
                   this page.

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

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

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

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

__X__ 6.         Pricing/Delivery Information
                 This form is used to solicit exact pricing of goods/services and delivery co sts.

__X__ 7.         Attachments
                 __X__ a.          Residence Certification/Tax Form
                                   Be sure to complete this form and return with packet.

                 _____    b.       Bid Guaranty & Performance Bond Information & Requirements
                                   This form applies only to certain bids/proposals. All public work contracts over $25,000 require a
                                   Payment Bond and over $100,000 must also have a Performance Bond, in a form approved by the
                                   County. Please read carefully and fill out completely.

                 _____    c.       Bid Check Return Authorization Form
                                   This form applies only to certain bids/proposals. Please read carefully and fill out completely.

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

                 _____    e.       Minimum Insurance Requirements
                                   (Included in specific requirements when applicable (does not supersede ―Hold Harmless‖ section
                                   of General Requirements).

                 _____    f.       Worker’s Compensation Insurance Coverage Rule 110.110
                                   This requirement is applicable for a building or construction contract.

                 _____    g.       Financial Statement
                                   When this information is required, you must use this form.

                 _____    h.       Reference Sheet
                                   When this information is required, you must use this sheet.

                 _____    i.       Other
                                   From time to time other attachments may be included.

Revised 03/04




                                                                                                                        Page 2 of 43
                                  GENERAL REQUIREMENTS FOR PROPOSALS

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

General Requirements apply to all advertised requests for proposals; however, these may be superseded, whole or in part, by
the SPECIAL REQUIREMENTS/INSTRUCTIONS OTHER DATA CONTAINED HEREIN. Review the Table of
Contents. Be sure your proposal package is complete.

ACCESS TO RECORDS
In special circumstances, vendor may be required to allow duly authorized representatives of Harris County, the Harris
County Hospital District or the state and federal government access to contracts, books, documents, and records necessary
to verify the nature and extent of the cost of services provided by vendor.

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

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

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

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

CERTIFICATION REGARDING DEBARMENT, SUSPENSION INELIGIBILITY, AND VOLUNTARY
EXCLUSION
The Contractor certifies by execution of this Contract that it is not ineligible for participation in federal or state assistance
programs under Executive Order 12549, "Debarment and Suspension." The Contractor further agrees to include this
certification in all contracts between itself and any subcontractors in connection with the services performed under this
Contract. Contractor also certifies that contractor will notify Harris County in writing immediately if contractor is not in
compliance with Executive Order 12549 during the term of this contract. Contractor agrees to refund Harris County for any
payments made to the contractor while ineligible.

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

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


                                                                                                                 Page 3 of 43
Revised 08/06




                Page 4 of 43
DIGITAL FORMAT
If offeror obtained the proposal specifications in digital format in order to prepare a response, the proposal must be
submitted in hard copy according to the instructions contained in this proposal package. If, in its proposal response, offeror
makes any changes whatsoever to the County's published proposal specifications, the County's proposal specifications as
published shall control. Furthermore, if an alteration of any kind to the County's published proposal specifications is only
discovered after the contract is executed and is or is not being performed, the contract is subject to immediate cancellation.

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

E-MAIL ADDRESSES CONSENT
Vendor affirmatively consents to the disclosure of its e-mail addresses that are provided to Harris County, the Harris County
Flood Control District, the Harris County Hospital District including its HMO, the Harris County Appraisal District, or any
agency of Harris County. This consent is intended to comply with the requirements of the Texas Public Information Act,
Tex. Gov’t Code Ann. §522.137, as amended, and shall survive termination of this agreement. This consent shall apply to e -
mail addresses provided by Vendor, its employees, officers, and agents acting on Vendor’s behalf and shall apply to any e-
mail address provided in any form for any reason whether related to this bid/proposal or otherwise.

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

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

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



Revised 09/05




                                                                                                                 Page 5 of 43
GOVERNING LAW
This request for proposals is governed by the competitive bidding requirements of the County Purchasing Act, Texas Local
Government Code, §262.021 et seq., as amended. Offerors shall comply with all applicable federal, state and local laws and
regulations. Offeror is further advised that these requirements shall be fully governed by the laws of the State of Texas and
that Harris County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County
Attorney concerning any portion of these requirements.

GRANT FUNDING
Any contract entered into by the County that is to be paid from grant funds shall be limited to payment from the grant
funding and the vendor/provider understands that the County has not set aside any County funds for the payment of
obligations under a grant contract. If grant funding should become unavailable at any time for the continuation of services
paid for by the grant, and further funding cannot be obtained for the contract, then the sole recourse of the provider shall
be to terminate any further services under the contract and the contract shall be null and void.

HIPAA COMPLIANCE
Offeror agrees to comply with the Standards for Privacy of Individually Identifiable Health Information of the Health
Insurance Portability and Accountability Act of 1996, PL 104-191, 45 CFR Parts 160-164, as amended, and the Texas
Medical Records Privacy Act, Texas Health and Safety Code Chapter 181, as amended, collectively referred to as
"HIPAA", to the extent that the Offeror uses, discloses or has access to protected health information as defined by HIPAA.
Offeror may be required to enter a Business Associate Agreement pursuant to HIPAA.

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

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

INVOICES AND PAYMENTS
Offerors shall submit an original invoice on each purchase order or purchase release after each delivery, indicating the
purchase order number. Invoices must be itemized. Any invoice which cannot be verified by the contract price and/or is
otherwise incorrect will be returned to the offeror for correction. Under term contracts, when multiple deliveries and/or
services are required, the offeror may invoice following each delivery and the County will pay on invoice. Contracts
providing for a monthly charge will be billed and paid on a monthly basis only. Prior to any and all payments made for goods
and/or services provided under this contract, the offeror should provide his Taxpayer Identification Number or social security
number as applicable. This information must be on file with the Harris County Auditor’s office. Failure to provide this
information may result in a delay in payment and/or back-up withholding as required by the Internal Revenue Service.

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


Revised 09/05




                                                                                                                Page 6 of 43
MATERIAL SAFETY DATA SHEETS
Under the "Hazardous Communication Act", commonly known as the "Texas Right To Know Act", an offeror must provide
to the County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the
Act. Failure of the offeror to furnish this documentation will be cause to reject any bid applying thereto.

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

POTENTIAL CONFLICTS OF INTEREST
An outside consultant or contractor is prohibited from submitting a proposal for services on a Harris County project of which
the consultant or contractor was a designer or other previous contributor, or was an affiliate, subsidiary, joint venturer or was
in any other manner associated by ownership to any party that was a designer or other previous contributor. If such a
consultant or contractor submits a prohibited proposal, that proposal shall be disqualified on the basis of conflict of interest,
no matter when the conflict is discovered by Harris County. Potential proposers are advised that they may have disclosure
requirements pursuant to Texas Local Government Code, Chapter 176. This law requires persons desiring to do business
with the County to disclose any gifts valued in excess of $250 given to any County Official or the County Official’s family
member, or employment of any County Official or the County Official’s family member during the preceding twelve (12)
month period. The disclosure questionnaire must be filed with the Harris County Clerk. Refer to Texas Local Government
Code, Chapter 176 for the details of this law.

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

PROPOSAL COMPLETION
Fill out and return to Purchasing, ONE (1) complete proposal form in an appropriately sized envelope or box. PACKAGE
MUST SHOW THE JOB NUMBER, DESCRIPTION AND BE MARKED ―SEALED PROPOSAL.‖ An
authorized company representative should sign the Proposal Cover Sheet. Completion of these forms is intended to verify
that the offeror has submitted the proposal, is familiar with its contents and has submitted the material in accordance with all
requirements.

PROPOSAL RETURNS
Offerors must return all completed proposals to the office of the Harris County Purchasing Agent reception desk at 1001
Preston Avenue, Suite 670, Houston, Texas before 2:00 P.M. LOCAL TIME IN HOUSTON, TEXAS on the date
specified. Late proposals will not be accepted.

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


Revised 09/05

                                                                                                                 Page 7 of 43
RECYCLED MATERIALS
Harris County encourages the use of products made of recycled materials and shall give preference in purchasing to
products made of recycled materials if the products meet applicable specifications as to quantity and quality. Harris County
will be the sole judge in determining product preference application.

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

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

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

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

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

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

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




Revised 09/05




                                                                                                                 Page 8 of 43
TITLE TRANSFER
Title and Risk of Loss of goods shall not pass to Harris County until Harris County actually receives and takes possession of
the goods at the point or points of delivery. Receiving times may vary with the using department. Generally, deliveries may
be made between 8:30 a.m. and 4:00 p.m., Monday through Friday. Offerors are advised to consult the using department for
instructions. The place of delivery shall be shown under the "Special Requirements/Instructions" section of this proposal
and/or on the Purchase Order as a "Deliver To:" address.

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

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



                                                  VENDORS OWING TAXES
Pursuant to TX Local Government Code 262.0276, Harris County Commissioners Court has adopted a policy which requires
that vendors’ taxes be current as of the date bids/proposals are due. Bidders with delinquent taxes on the due date will not
be eligible for award. Whether or not a vendor’s taxes are delinquent will be determined by an independent review of the
Tax Office records. Vendors who believe a delinquency is reflected in error must contact the Tax Office to correct any
errors or discrepancies prior to submitting their bid in order to ensure that their bid will be considered. Tax records are
available online at the Tax Office website—www.hctax.net. Prior to submitting a bid, vendors are encouraged to visit the
Tax Office website, set up a portfolio of their accounts and make their own initial determination of the status of their tax
accounts. Furthermore, if, during the performance of this contract, a vendor’s taxes become delinquent, Harris County
reserves the right to provide notice to the Auditor or Treasurer pursuant to Texas Local Government Code §154.045. This
policy is effective for all bids due on or after May 1, 2004.




                                                                                                             Page 9 of 43
Revised 09/05




                Page 10 of 43
                                                                                                               Attachment a
                                                                                                            Job No. 06/0374

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

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

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

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

         I certify that                             is a Nonresident Bidder as defined in
                      [Company Name]
         Government Code §2252.001 and our principal place of business is                          .
                                                                             [City and State]


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

Company Name submitting Bid/Proposal:

Mailing Address:

If you are an individual, list the names and addresses of any partnership of which you are a general partner:




PROPERTY: List all taxable property owned by you or above partnerships in Harris County.

Harris County Tax Acct. No.*                 Property address or location**




* This is the property account identification number assigned by the Harris County Appraisal District.
** For real property, specify the property address or legal description. For business personal property, specify the
   address where the property is located. For example, office equipment will normally be at your office, but
   inventory may be stored at a warehouse or other location.
Do you carry Health Insurance on your employees? ___Yes ___No
If yes, what is the percentage of employees insured? _____%
Revised 08/05




                                                                                                              Page 11 of 43
                                            ATTENTION VENDORS




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

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

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




                                                                                                   Page 12 of 43
                                 SPECIAL REQUIREMENTS/INSTRUCTIONS

Term Contract To Provide Ryan White Title I Quality Management Chart Review/Extraction and Data Entry Services
for Harris County.

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

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

PRE-PROPOSAL CONFERENCE
A Pre-Proposal Conference will be held Thursday, October 19, 2006 @ 3:00 pm in the Harris County Public Health
and Environmental Services Building, 4th floor, Room 426, located at 2223 W. Loop South, Houston, TX 77027.
Attendance is not mandatory, however it is highly recommended that vendors attend in order to discuss and clarify the
Request for Proposal (RFP) requirements and answer vendor questions regarding the proposal review and award
process. Persons with disabilities requiring special accommodations please contact Gail LeBlanc at (713) 439-6039 for
arrangements.

Special Requirements

I.      SUBMISSION INSTRUCTIONS

Proposals must be formatted as follows:
    Applications must be in English;
    Submit all copies of proposal unbound, (with each individual proposal held together by a metal clip or
       sufficiently strong rubber band);
    Use standard size black font that is not smaller than 10 points nor larger than 12 points (colored font is not
       allowable);
    Use 8.5 inch x 11 inch paper that can be photocopied;
    Top, bottom, left and right margins may not be less than 1 inch each;
    Text may be single or 1.5 spaced;
    Do not submit double-sided copies;
    Do not use photo-reduction;
    Do not include photos, pamphlets, brochures, or over-sized documents;

A complete description of all the services the vendor will provide together with all the forms completed and in the
proper order, adequate documentation that the vendor meets the agency qualifications and requirements, cost for unit of
service, etc. will comprise the vendor’s proposal. All signature pages in the document must also be signed. It is the
vendor’s responsibility to adequately identify and define their qualifications and capabilities with regard to meeting the
requirements in this RFP including those that are specific to the Service Category under which the response is submitted.
                                                                                                          Page 13 of 43
Your proposal must offer substantial assurance that all goals and requirements will be reached and maintained by your
organization. All vendors must respond to items listed below and are encouraged to supply all other relevant
information as Appendices. Narrative answers/statements must be self explanatory and understandable to members of
the review panel who may read, evaluate and score your proposal. Assume that these individuals are unfamiliar with
your agency and its activities.

The complement of forms included with this RFP must be completed and submitted in the proper order. All vendors
should address each of the forms by filling out each one with the appropriate, detailed information required by the form.
Omission of any or all forms may be cause to reject your proposal in its entirety. If, for some reason, the form
does not apply to your response, you must note that decision on your copy of the form and include it in your submitted
proposal.

The vendor is responsible for making additional copies required in order to fulfill the RFP requirements. Original and
copies must be secured individually with a single binder clip for each. SUBMIT ONE (1) SIGNED ORIGINAL
AND FIVE (5) COPIES. All signatures for all forms throughout this package must be original on the one (1)
copy marked, "ORIGINAL". Copies of the original may contain copies of signatures. If you need to use an
envelope other than the one supplied or a small box to submit your sealed proposal, please include the job number, due
date and your company name on the outside of the envelope or box.

Completed proposals must be clocked in at the Harris County Purchasing Department; 1001 Preston Ave., Suite 670;
Houston, Texas 77002 on the date and time specified on the cover sheet. On that date, proposals will be opened.
Under the Request For Proposal process, sealed offers will be received and opened in the Purchasing Department
and considered confidential until an award is made. Neither information nor copies of proposals will be available to
anyone other than Harris County and the Review Committee until a formal award is made by Commissioners Court. All
proposals shall be available for public inspection under the Open Records Act after all contracts are awarded. Please
call the Purchasing Department to make an Open Records Act request.

II.     EVALUATION CRITERIA AND AWARD PROCESS
        The following guidelines will be used in the Evaluation/Award process.

A.      Submit your best proposal initially. A technical review will be conducted by Harris County to ensure all
        proposals contain the required documentation and are in conformance with the requirements set forth herein.
B.      A Review Committee convened by Harris County PHES/HIV Services will score acceptable proposals based
        on the information supplied in the vendor’s proposal, a vendor presentation, if requested, and the following
        evaluation criteria: 100 Total Points (see point distribution below). Submission of a proposal implies vendor’s
        acceptance of the evaluation criteria and vendor recognition that subjective judgments must be made by
        reviewers.

C.      Award of contracts shall be made to responsible vendor, whose proposal is determined to be the highest scored
        proposal meeting all other requirements and best meeting the county’s needs for that service category.




                                                                                                        Page 14 of 43
D.     No award or acquisition can be made until Commissioners Court approves such action. No County funds will
       be expended for contracts resulting from this RFP. All contracts resulting from this RFP will be funded
       contingent upon funds allocated and received by the County from HRSA under a federal grant awarded to the
       County.

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

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

       B.     Residence Certification (Enclosed in RFP)

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

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

       E.     Signed Compliance with Americans With Disabilities Act of 1990 (Enclosed in RFP
              Forms Section)
       F.     Assurance - Non-Construction Programs (s-424B) (Enclosed in RFP Forms
              Section)

       G.     Respondent Certification (Enclosed in RFP Forms Section)

       H.     Renewal Option (Enclosed in RFP)

       I.     Cover Page (Enclosed in RFP Forms Section)

       J.       Table of Contents for Proposal (Provided by Vendor) Number all pages and list
       according to this Table of Contents. Page one (1) of the proposal should be the Cover Page
       (item J. Above), with all pages numbered sequentially forward.

       NOTE: Sections K through M contain instructions for writing the narrative portion of the proposal and the
       accompanying tables and appendices. The completed proposal must follow this outline with the required
       information provided in the order shown. Please repeat each question and answer each question
       separately and in order.

       K.     ABSTRACT – 0 Points
              (Maximum of 2 pages)

              1. Please provide the following information:
                 a. Legal Name of Organization or Individual
                 b. Mailing Address
                 c. Street Address (if different from mailing address)
                 d. Telephone number and contact person
                                                                                                    Page 15 of 43
e. Service Category (Quality Management – Clinical Chart Review)
f. Title of Service (Clinical Chart Review)




                                                                   Page 16 of 43
     2. Briefly summarize your company’s relevant experience with conducting clinical chart review
        activities.
     3. Briefly summarize your proposed scope of work, listing project goals, objectives, activities and
        timeline.


L    FINANCIAL CAPACITY AND BUDGET – 25 Points

      1. Complete Table IB, Fee-for-Service Budget Form.

     The following documentation must be included in the appendices:

        Job description for each personnel position listed in the Documentation of Qualifications and
         Experience Section below, with a limit of one (1) page per job description.
        Copy of all signed and dated contracts with subcontractors to be used by applicant agency in the
         provision of chart review activities (if applicable).

M.   DOCUMENTATION OF QUALIFICATIONS AND EXPERIENCE IN PERFORMING CHART
     REVIEWS – 75 Points
     (Maximum of 20 pages, not including table)

     1. Describe the background and mission of your organization, as well as a brief discussion of current
     and past projects, with an emphasis on current and past projects and contracts for conducting clinical
     chart extraction and/or quality assurance/utilization review activities. Please highlight those projects
     specifically related to chart abstraction for HIV/AIDS clients. How does providing the proposed
     clinical chart review activities fit with your organization’s mission?

     2. Describe the educational and employment background of each proposed chart reviewer, as well as
     other qualifications relevant to performing medical chart extraction and/or utilization review. Include
     detailed information about relevant coursework, training, degrees, licensure, certifications and work
     history. Please highlight any experience that specifically relates to HIV/AIDS chart extraction, trainings,
     etc.

     3. Describe your history of performing medical chart extraction and/or utilization review. Include the
     goal of such reviews, the types of entities for which you performed the reviews, the type of medical
     service(s) under review, the volume of charts reviewed, the data collection period, a summary of the
     data elements collected and the outcomes of the reviews. Provide the same information for any
     subcontractors that will be utilized to perform reviews under this contract.

     4. Describe your history of developing chart extraction and/or utilization review data collection tools.
     Include information about researching and selecting the appropriate data elements and the process used
     to develop, pilot-test, and refine the tool as appropriate. Provide the same information for any
     subcontractors that will be utilized to develop chart extraction tools under this contract.


                                                                                               Page 17 of 43
         5. Describe your experience translating data collected during medical chart extraction and/or utilization
         review into an analyzable database format. Identify and describe database and reporting software
         programs used by your company in chart review data collection and analysis.

         6. Please provide a sample project management plan/timeline based on the RFP specifications. For
         example, please provide an outline of the available resources (i.e. staff) to be assigned to the project
         and the allocation of the available resources (e.g., will multiple primary care sites be reviewed
         simultaneously by more than one chart abstractor?). Please describe the proposed plan for data
         handling (e.g., compliance with HIPAA), data analysis, data quality assurance, and processes to ensure
         reliability/validity of the findings.

     The following documentation must be included in the appendices:

        Table II.A. Chart Extraction/Utilization Review/Quality Assurance Contracts: Complete the table listing
         all relevant contracts. Include at least 3 current or past customers where Proposer has provided similar
         work. The table should include the scope of the referenced work, dates of work, company name,
         contact person, email address and telephone number. HCPHES/HIV Services may contact the listed
         entities to verify the quality of Proposer’s work under the listed contracts.

        Current resumes and/or Curriculum Vitae of all individuals to be used in performing chart reviews and/or
         preparing data for submission (maximum of 5 pages per individual resume/CV).

        Current Organization Chart (not applicable for individual applicants)

        Examples of previously published reports or analysis for similar projects conducted by Proposer (limit
         30 pages, single-sided). Examples included should relate to contracts listed in Table II.A.

N        APPLICATION CHECKLIST

         Applications must be submitted in the order of the Application Checklist, including appendices. Do not
         submit any material that is not stipulated on the Application Checklist.

O.       OTHER REQUIREMENTS:

         No proposal will be considered if, at the time the proposal is submitted or thereafter, the offeror
         employs or receives consulting services or other services relating to the proposal, from a current or
         former HIV Services staff member, unless the former staff member’s employment with HIV Services
         terminated more than six months prior to the date the proposal is submitted.

         Harris County may terminate a Contract after it is awarded if Contractor employs, in any capacity, any
         person who is then currently employed by HIV Services, or who has been employed by HIV Services
         within the six months immediately preceding the commencement of employment by Contractor. For the
         purposes of this paragraph, the term ―employs in any capacity‖ shall mean the receipt of services of any
         kind in exchange for consideration, regardless of whether the person performs the services as an
         employee, consultant, agent, independent contractor, subcontractor or in some other capacity. The
                                                                                                  Page 18 of 43
       Executive Director of Harris County Public Health and Environmental Services may waive this
       requirement upon written request from Contractor. The granting of a waiver is at the discretion of the
       Executive Director and any such decision by the Executive Director is final.

P.     APPENDIX - All required information that has been specified. Only include in your proposal
       submission information specifically requested in the RFP. Do not include extraneous or unrelated
       documents in the appendices. Do not use appendices to provide information that is required in the
       narrative or tables.

III.   ADDITIONAL INFORMATION

A.     SUGGESTIONS FOR COMPLETING PROPOSALS
       In addition to the proposal writer, one or more individuals should review your proposal for content and
       form. Have them read through this RFP, and then let them pretend that they are on the review panel:
       have them read through your application, paying special attention to the narrative information that you
       have provided, and using the evaluation criteria as a basis for their review and comment. Check that the
       information provided on all of the forms and documents is consistent and complete and all budget forms
       are consistent with other information (for example, the math is correct).

       Also, one or more individuals should review your application for completeness and format correctness,
       taking the time to verify that your narrative responses conform to the physical space limitations given for
       each section; that all required information has been assembled; that all pages, including attachment(s),
       have been numbered sequentially; that binder clips have been used; that the correct number (one signed
       originals and five copies) of the finished proposal has been prepared for delivery.


IV.    DEFINITION OF SPECIAL LANGUAGE AND GUIDELINES


A.     Quality Management is intended to ensure that providers have a means to control for appropriateness
       and quality of services. HIV Services facilitates the HRSA-mandated Quality Management program.
       Contracting agencies must comply with all applicable Quality Management activities. Components of
       the Quality Management program include, but are not limited to:
       1. Standards of Care have been approved by the RWPC to establish the minimal acceptable
           levels of quality in service delivery and to provide a measurement of the effectiveness of services.
           Each fiscal year the RWPC reviews and revises standards of care for each service category. HIV
           Services monitors for compliance at site monitoring visits. Standards of Care for those service
           categories applicable to the chart review activities being proposed may be accessed at
           www.harriscountyhealth.com/hivservices.




                                                                                                 Page 19 of 43
     2. Outcomes Evaluations assess health, quality of life, knowledge, attitudes and practices (KAP)
        and cost-effectiveness measures for each Title I service category. Each fiscal year the RWPC
        reviews and revises outcome measures for each service category. Contracting agencies are
        required to participate fully in all evaluation activities, including but not limited to the ongoing
        administration of HIV Services-developed client surveys and the submission of data to HIV
        Services on a regular basis. Outcome measures for those service categories applicable to the chart
        review activities being proposed may be accessed at www.harriscountyhealth.com/hivservices.
     3. Clinical Review will be conducted on an ongoing basis to determine whether primary care, health-
        related support services and case management programs meet Public Health Service guidelines (or
        other relevant and established guidelines). Clinical review activities include but are not limited to
        client chart/record review by appropriate and qualified professional(s) designated by HIV Services.
     4. Client Satisfaction assesses client opinion regarding the quality of services provided. Through
        methods such as post-service surveys, clients should be given the opportunity to express whether
        expectations were met, exceeded or not met. Areas to be assessed include but are not limited to
        interactions with agency staff, accessibility of the facility, amount of time spent on a waiting list and
        quality of service(s) rendered. Contracting agencies are required to participate fully in all client
        satisfaction measurement activities, including but not limited to the administration of HIV Services-
        developed client surveys and the submission of data to HIV Services on a regular basis.

B.   Houston Eligible Metropolitan Area (EMA) is a six county area including Chambers, Fort Bend,
     Harris, Liberty, Montgomery and Waller in which services under this agreement must be provided. The
     Houston Health Service Delivery Area (HSDA) is a 10 county area including the 6 counties of the
     Houston EMA plus Walker, Austin, Colorado and Wharton counties.

C.   Health Resources and Services Administration (HRSA) is the Federal administrator for Ryan
     White Title I funds.


V.   OVERVIEW

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

     Eligible recipients of these funds are providers of relevant services such as public or non-profit private
     entities, or private for-profit entities if such entities are the only available provider of quality HIV care in
     the area, including hospitals (which may include Department of Veterans Affairs facilities), community-
     based organizations, hospices, ambulatory care facilities, community health centers, migrant health
     centers, homeless health centers, substance abuse treatment programs, and mental health programs.
     For-profit entities are eligible to compete for Program support activities such as those
     described in this RFP.


                                                                                                    Page 20 of 43
     The Harris County Commissioners Court has appointed the Director of Harris County Public Health
     and Environmental Services (PHES) as the Administrative Agent to the program. The Harris County
     Commissioners Court, as the governing body of the grant recipient, has ultimate authority over awards
     of Ryan White Title I Grant funds.

B.   AVAILABLE MONIES
     All awards are contingent on the amount of Harris County’s Federal Fiscal Year 2007 Ryan
     White CARE Act Title I award from HRSA.

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

D.   APPLICABLE LAWS
     Proposers MUST comply with all applicable federal, state, and local laws and regulations.

E.   OTHER CONDITIONS/RESTRAINTS
     The following conditions/restraints are imposed on all recipients of Ryan White Title I funds. Vendors
     are not required to submit information concerning these issues within their proposals; however, agencies
     must comply with them if they receive Ryan White Title I funds.
     1.      AUDIT
             Not for profit and governmental agencies receiving Federal funding assistance in the aggregate
             amount of $500,000.00 or more within their fiscal year must have an audit conducted in
             accordance with Office of Management and Budget (OMB) Circular A-133. The audit must be
             submitted to the Harris County Auditor’s Office no later than 13 months of an agency’s fiscal
             year end (within 9 months for fiscal years beginning after June 30, 1998). Proprietary agencies
             receiving awards of $25,000.00 or more must submit an audit of their general financial
             statements within 12 months of their fiscal year end. Not for profit and governmental agencies
             meeting the $500,000.00 aggregate threshold may charge OMB A-133 single audit costs
             proportionally to their Ryan White grants.         However, agencies who do not meet the
             $500,000.00 aggregate threshold may not use Federal funds to pay for OMB A-133 single
             audit costs. Those agencies not meeting the $500,000.00 aggregate threshold may use Federal
             funds to pay for limited scope audits, site visits, document reviews and other monitoring
             activities.


2.   RENEWAL OPTION:
     The County has the option of renewing contracts in specific service categories on an annual basis. The
     renewal criteria are as follows:

     1. The vendor must agree to the same terms, specifications, unit cost(s) and conditions of the previous
        contract term (i.e., the unit cost and service definition must remain the same, the total value of the
        contract may increase or decrease as necessary depending on allocations);

     2. All renewals are contingent upon receipt of such funding from HRSA and Commissioners Court
        approval;
                                                                                              Page 21 of 43
3. All providers must agree to the renewal option.

       RENEWAL OPTION
       Harris County wishes to consider two (2) annual renewal options, renewable one year at a time,
       based on the same terms, conditions and pricing as the original year. If the vendor does not
       wish to renew, mark ―N.A.‖ in the space for the year indicated. If the vendor is willing to
       accept one or two annual renewals do not mark the form, but include the form in your proposal.

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

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

       Renewal Year 1 (FY 2008):       ____________ 3-1-08 through 2-28-09

       Renewal Year 2 (FY 2009):       ____________ 3-1-09 through 2-28-10

       DO NOT MARK THE FORM IF VENDOR WILL ACCEPT ONE (1) OR TWO (2)
       ONE YEAR RENEWALS. REGARDLESS OF CHOICE, THIS FORM MUST BE
       INCLUDED IN PROPOSAL SUBMISSION.




                                                                                     Page 22 of 43
VI.   SPECIFICATIONS

SERVICE CATEGORY:

QM-01: Quality Management Clinical Chart Review/Extraction and Data Entry




                                                                        Page 23 of 43
APPLICATION CHECKLIST

   REQUEST FOR PROPOSAL COVER SHEET
   SIGNED ADDENDUM (if applicable)
   RESIDENCE CERTIFICATION
   SIGNED ASSURANCES FORM I
   SIGNED CERTIFICATION CONCERNING LOBBYING
   SIGNED COMPLIANCE WITH AMERICANS WITH DISABILITIES ACT OF
    1990
   ASSURANCE – NON-CONSTRUCTION PROGRAMS
   RESPONDENT CERTIFICATION
   RENEWAL OPTION
   COVER PAGE
   TABLE of CONTENTS FOR PROPOSAL
   ABSTRACT
   FINANCIAL CAPACITY and BUDGET
     Table I.B. Fee-for-Service Budget Form
   DOCUMENTATION of EXPERIENCE IN PROVIDING EDUCATION
     Narrative
     Table II.A. Current Chart Extraction/Quality Management/Utilization Review
       Contracts
   APPENDIX
     Job description of each type of personnel position (Maximum of 1 page each)
     Resume or Curriculum Vitae of all program staff and contract chart abstracters
       (Maximum of 5 pages each)
     Organizational Chart
     Examples of previously published reports or analysis for similar projects conducted
       by Proposer (limit 30 pages, single-sided).




                                                                          Page 24 of 43
DESCRIPTION OF CATEGORY




                          Page 25 of 43
HRSA Service Category Title: Quality Management

Local Category Title: Clinical Chart Review/Abstraction and Data Entry

Revision Date: 8-21-2006

Amount Available: To be Determined. Not to Exceed $115,000.00. Proposals exceeding a total
request greater than $115,000.00 will be disqualified.

Budget Type: Unit Cost (fee-for-service)

HRSA Service Category Definition: Activities to assess the extent to which HIV outpatient primary
medical care and health-related services provided to patients are consistent with the most recent Public
Health Service Guidelines for the treatment of HIV disease and related opportunistic infections, and to
develop strategies for ensuring that such services are consistent with the guidelines for improvement in
the access to and quality of health services.

Local Service Category Definition: Clinical chart review to assist the County in the fulfillment of the
HRSA-mandated Ryan White CARE Act Quality Management Program, namely to:

       1.     Ensure that outpatient primary medical care service providers funded through the Ryan
       White CARE Act are adhering to established HIV clinical practice standards and Public Health
       Services (PHS) guidelines for the treatment of HIV disease to the extent possible; and

       2.       Ensure that health-related services funded through the Ryan White CARE Act are
       assisting clients meet generally accepted clinical guidelines and ensure appropriate access to and
       adherence with HIV medical care.

Services to be Provided: Consultant will provide the following specific activities for the Harris County
Public Health and Environmental Services Department, HIV Services Section:

       1. Perform chart reviews and record data collection of 925 medical records at Ryan White
          CARE Act-funded provider sites designated by PHES/HIV Services.
       2. Perform data entry of chart review data element findings.
       3. Provide raw data in Microsoft Access (or other database format as approved by HIV
          Services) for delivery to the County.
       4. Provide professional consultation with HIV Services in development of Chart Review tools
          and reports. Provide consultation in conjunction with and as directed by HIV Services to
          Ryan White-funded service providers to explain chart review findings and make
          presentations to service providers and/or other stakeholders describing the process,
          activities and findings of clinical chart review activities provided by Consultant.

Consultant will perform clinical chart reviews on a randomly chosen sample of Primary Medical Care
and health-related services charts. Health-related services include Dental Care, Vision Care, Home
Health Care, Hospice Care and Rehabilitation. HIV Services may elect to include or exclude any of the
                                                                                         Page 26 of 43
aforementioned health-related services annually. HIV Services will generate the sample and provide it
to the Consultant and the service provider site prior to the scheduled review. HIV Services will
schedule the dates of chart reviews at provider sites in collaboration with the Consultant. Consultant
must have flexibility to accommodate the scheduling of chart reviews. The total number of chart reviews
to be performed will result in these activities occurring throughout the term of the contract.

Primary Medical Care
By August 2007, Consultant will perform approximately 500 clinical chart reviews of charts of
adult/non-maternity clients and 25 clinical chart reviews of charts of pediatric/youth clients (ages 6 - 17)
who have received Primary Medical Care services funded by the County’s Ryan White CARE Act Title
I grant during the preceding or current grant year. Consultant will utilize a Primary Medical Care chart
review data collection tool provided by HIV Services containing approximately 54 discrete data
elements. By September 2007 Consultant will provide the data derived from the chart reviews in an
electronic format acceptable to the County.

Dental Care
By September 2007, Consultant will perform approximately 200 clinical chart reviews of charts of
adult/non-maternity clients who have received Dental Care services funded by the County’s Ryan White
CARE Act Title I grant during the preceding 12 months. Consultant will utilize a Dental Care chart
review data collection tool provided by HIV Services containing 50 or fewer discrete data elements. By
October 2007 Consultant will provide the data derived from the chart reviews in an electronic format
acceptable to the County.

Vision Care
By November 2007, Consultant will perform approximately 110 clinical chart reviews of charts of adult,
non-maternity clients who have received Vision Care services funded by the County’s Ryan White
CARE Act Title I grant during the preceding or current grant year. Consultant will utilize a Vision Care
chart review data collection tool provided by HIV Services containing 40 or fewer discrete data
elements. By December 2007 Consultant will provide the data derived from the chart reviews in an
electronic format acceptable to the County.

Home Health Care
By December 2007, Consultant will perform approximately 30 clinical chart reviews of charts of adult,
non-maternity clients who have received Home Health Care services funded by the County’s Ryan
White CARE Act Title I grant during the preceding or current grant year. Consultant will utilize a
Home Health Care chart review data collection tool provided by HIV Services containing 45 or fewer
discrete data elements. By January 2008 Consultant will provide the data derived from the chart
reviews in an electronic format acceptable to the County.

Hospice Care
By January 2008, Consultant will perform approximately 30 clinical chart reviews of charts of adult,
non-maternity clients who have received Hospice services funded by the County’s Ryan White CARE
Act Title I grant during the preceding or current grant year. Consultant will utilize a Hospice Care chart
review data collection tool provided by HIV Services containing 45 or fewer discrete data elements.


                                                                                           Page 27 of 43
By February 2008 Consultant will provide the data derived from the chart reviews in an electronic
format acceptable to the County.




                                                                                  Page 28 of 43
Rehabilitation
By January 2008, Consultant will perform approximately 30 clinical chart reviews of adult, non-
maternity clients who have received Rehabilitation services funded by the County’s Ryan White CARE
Act Title I grant during the preceding or current grant year. Consultant will utilize a Rehabilitation chart
review data collection tool provided by HIV Services containing 45 or fewer discrete data elements.
By February 2008 Consultant will provide the data derived from the chart reviews in an electronic
format acceptable to the County.

Professional Consultation
By February 2008, Consultant will provide 80 hours of professional consultation at the direction and
approval of HIV Services for the following purposes:
a.     Meeting with Ryan White-funded service providers as directed by HIV Services to explain
       chart review findings;
b.     Presentations to HIV Services, service providers and/or other stakeholders describing the
       process, activities and findings of clinical chart review activities provided by Consultant. On-site
       presentations are limited to no more than four (4) two hour presentations per grant year.

Service Unit Definitions:
a. Primary Medical Care: One unit of service = one (1) primary medical care chart reviewed with
   data entered into the approved data collection tool and delivered in an electronic format acceptable
   to the County.
b. Health-related Services: One unit of service = one (1) primary medical care chart reviewed with
   data entered into the approved data collection tool and delivered in an electronic format acceptable
   to the County.
c. Post review consultation: One unit of service = one (1) hour of professional services provided to
   Ryan White funded primary care and health related services providers.

Chart Reviewer Minimum Qualifications:
Consultant must utilize a Registered Nurse with a master’s degree in a health-related field to perform all
Primary Medical Care, Home Health Care and Hospice Care chart reviews. Consultant must utilize a
Registered Nurse with a master’s degree in a health-related field, a Doctor of Dental Surgery or a
Registered Dental Hygienist to perform all Dental Care chart reviews. Consultant must utilize a
Registered Nurse with a master’s degree in a health-related field or a Doctor of Optometry to perform
all Vision Care chart reviews. Consultant must utilize a Registered Nurse with a master’s degree in a
health-related field, a Licensed Physical Therapist or a Registered Occupational Therapist to perform all
Rehabilitation chart reviews.

All individual(s) performing chart reviews must have at least two (2) years documented experience in
medical chart abstraction or utilization review. HIV-related chart extraction and analysis preferred.

Special Requirements:
In order to assure objectivity and eliminate potential conflict of interest Consultant and/or individual(s)
performing chart reviews may not be a recipient of Houston EMA Ryan White CARE Act Title I
funding for the provision of client services.
                                                                                           Page 29 of 43
   Consultant and/or individual(s) performing chart reviews may not be employed by, or under
    contract with, an entity that is a recipient of Houston EMA Ryan White CARE Act Title I
    funding for client services.
   Consultant and/or individual(s) performing chart reviews may not be an individual who is
    receiving services funded under any Houston EMA Ryan White CARE Act program.
   The proposer must consult with PHES/HIV Services on a regular basis regarding all aspects of
    chart review activities. Chart extraction staff must be available to meet with PHES/HIV
    Services staff at the dates and times determined by HIV Services. Meetings may be conducted
    by teleconference, video conference or in person as determined by HIV Services.




                                                                                Page 30 of 43
                                        FORMS & TABLES SECTION


The forms contained in this section must be inserted in the appropriate section of your proposal response.

There are three options from which you may choose to present your Table information. They are:

      You may type on these forms.

      You may create your own forms in the same format as those contained in this packet.

      You may use the forms included in the RFP packet available for download from the Harris County Purchasing
       Department.




                                                                                                   Page 31 of 43
                                                           Assurances Form I



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

·        Assurance that applicant agency will provide services without regard to ability to pay or the current or past health conditio n
         of an individual and in settings accessible to low-income persons; and funds awarded not be used to make payments for any
         item or service to the extent that payment has been made, or can reasonably be expected to be made, by another third party
         benefits program or by an entity that provides services on a prepaid basis.

·        Assurance that applicant agency will provide outreach to low-income persons to inform them of the availability of services.

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

·        Assurance that applicant agency will provide information to clients, either verbally or in print, on use of condoms and risk
         avoidance/reduction behaviors for sharing of intravenous needles, or make referrals to other agencies that will do so.

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

·        Assurance that applicant agency will maintain the confidentiality of client records.

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

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




                                                                    ______________________________________
         Date                                                                           Applicant Organization



                         ___________________________________________________
                                   Signature and Title of Authorized Official




                                                                                                                      Page 32 of 43
                                         Certification Concerning Lobbying

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


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

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

         (2)      If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or
                  attempting to influence an officer or employee of any agency, a member of Congress, or an employee of a member of
                  Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall
                  complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.

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

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



                                                                      _____________________________________
Date                                                                                                  Entity



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



                                                                 _________________________________________
Telephone of Organization                                                                  Signature of Official




                                                                                                                        Page 33 of 43
                            Compliance with American With Disabilities Act of 1990




_______________________________________
Name of Applicant Agency


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




_______________________________________________________
Signature of Person Authorized to Represent Applicant Agency




___________________________________________________
Printed Name and Title




____________________________________________________
Date Signed




                                                                                                                  Page 34 of 43
                             ASSURANCE — NON-CONSTRUCTION PROGRAMS


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

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

1.      Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability
        (including funds sufficient to pay the non-Federal share of project costs) to ensure proper planning,
        management and completion of the project described in this application.

2.      Will give the awarding agency, the Comptroller General of the United States, and if appropriate , the State,
        through any authorized representative, access to and the right to examine all records, books, papers, or
        documents related to the award; and will establish a proper accounting system in accordance with generally
        accepted accounting standards or agency directives.

3.      Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or
        presents the appearance of personal or organizational conflict of interest, or personal gain.

4.      Will initiate and complete the work within the application time frame after receipt of approval of the awarding
        agency.

5.      Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to prescribed
        standard for merit systems for programs funding under one of the nineteen statutes of regulations specified in
        Appendix A of OPM's Standards of a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).

6       Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a)
        Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color,
        or national origin; (b) Title IX of the Educational Amendments of 1972, as amended (20 U.S.C. 1681-1683, and
        1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973,
        as amended (29 U.S.C. 794), which prohibits discrimination on the basis of handicaps; (d) the Age
        Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits discrimination on the basis of
        age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255, as amended, relating to
        nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism
        Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616, as amended, relating to nondiscrimination
        on the basis of alcohol abuse or alcoholism; (g) 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C.
        290 dd-3 and 290 ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h)
        Title VII of the Civil Rights Act of 1968 (42 U.S.C. 3501 et seq.) as amended, relating to nondiscrimination in the
        sale, rental or financing of housing; (i) any other nondiscriminatio n provisions in the specific statute(s) under
        which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination
        statute(s) which may apply to the application.

7.      Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation
        Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and
        equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally
        assisted programs. These requirements apply to all interests in real property acquired for project purposes
        regardless of Federal participation in purchases.

8.      Will comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which limit the political
        activities of employees whose principal employment activities are funded in whole or in part with Federal
        funds.

9.      Will comply, as application, with the provisions of the Davis -Bacon Act (40 U.S.C. 276a to 276a-7), the
        Copeland Act (40 U.S.C. 276c and 18 U.S.C 874, and the Contract Work House and Safety Standards Act (40
        U.S.C. 327-333), regarding labor standards for federally assisted construction subagreements.
                                                                                                              Page 35 of 43
10.     Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster
        Protection Act of 1973 (P.L. 93-2343) which requires recipients in a special flood hazard area to participate in
        the program and to purchase flood insurance if the total cost of insurable construction a nd acquisition is
        $10,000 or more.

11.     Will comply with environmental standards which may be prescribed pursuant to the following (a) institution of
        environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and
        Executive Order (EO 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of
        wetlands pursuant to EO 11990; (d) evaluation of flood hazards in flood plains in accordance with EO 11988; (e)
        assurance of project consistency with the approved State management program developed under the Coastal
        Zone Management Act of 1972 (16 U.S.C. 1451 et seq.); (f) conformity of Federal actions to State (Clear Air)
        Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. 7401 et seq.); (g)
        protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as
        amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973,
        as amended, (P.L. 93-205).

12.     Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1271 et seq.) related to protecting
        components or potential components of the national wild and scenic rivers system.

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

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

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

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

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

18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies
    governing this program.


 Signature of Authorized Certifying                         Title
 Official


 Applicant Organization                                     Date Submitted




                                                                                                                      Page 36 of 43
RESPONDENT CERTIFICATION




________________________________________
Name of Applicant Agency




I,                                          , certify that I am the




__________________________________________
Title Printed


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

__________________________________________
Signature of Person Making Certification


_________________________________
Date Signed




                                                                                                   Page 37 of 43
                                 COVER PAGE

                  FY 2007 Ryan White Title I Funds

Proposer organization:
    ______________________________________________________________

Service Category of proposal as designated in RFP: Quality Management Clinical Chart
Review/ Extraction and Data Entry

Code Number: QM-01

Total amount requested: $

Contact Person for proposal clarifications/negotiations:
                                          ___________________________________




Title:


Contact person telephone number:

Fax number:

E-mail address:

Identify your entity as one of the following: For -Profit __________, Non-Profit


or Public (governmental) _______________.

Has your agency complied with all HRSA requirements and regulations for all previously
funded programs?
Yes_________ No___________ If no, explain




                                                                                         Page 38 of 43
                  UNIT COST (FEE FOR SERVICE) BUDGET FORM
                                   (Table I.B.)


     Service Category:      QM-01

     Title of Service:      Quality Management Clinical Chart Extraction and Data Entry


1.   Fee Charged per Unit of Service:
           a. Primary Medical Care Chart Review             $

            b. Health Related Service Chart Review                  $

            c. Professional Consultation                            $

2.   Number of Units of Service to be Provided:
          a. Primary Medical Care:      525 Chart Reviews

            b. Health Related Services:     400 Chart Reviews

            c. Professional Counseling:     80 Hours

3.   Total Cost of these Services (#1 x #2):
            a. Primary Medical Care Chart Review            $

            b. Health Related Service Chart Review                  $

            c. Post Review Consultation                             $


4.   TOTAL REQUEST (3.a + 3.b + 3.c):                               $


5.   Definitions of Units of Service:

     a. Primary Medical Care: One unit of service = one (1) primary medical care chart
        reviewed with data entered into the approved data collection tool and delivered in an
        electronic format acceptable to the County.
     b. Health-related Services: One unit of service = one (1) health-related services
        chart reviewed with data entered into the approved data collection tool and delivered
        in an electronic format acceptable to the County.
c.   Post review consultation: One unit of service = one (1) hour of professional services
        provided to HIV Services, Ryan White funded primary medical care and health-
        related service providers or other stakeholders as directed by HIV Services.
                                                                                            Page 39 of 43
Page 40 of 43
TABLE II.A. CHART EXTRACTION/UTILIZATION REVIEW/QUALITY ASSURANCE
CONTRACTS

Complete the Contracts Table below. Use additional copies as necessary. Include at least three (3)
Quality Assurance-related contracts for which the applicant currently, or in the recent past, has
provided relevant work under.

Contracting Entity          Contract        Amount of             Services Provided
Company Name                 Term           Contract
Address
Phone/Fax/Email
Contract Person/Title




                                                                                   Page 41 of 43
SAMPLE BUDGET TABLE




                      Page 42 of 43
                      UNIT COST (FEE FOR SERVICE) BUDGET FORM

                                     TABLE I.B. (EXAMPLE)


Service Category:              QM-01

Title of Service:      Quality Management Clinical Chart Extraction and Data Entry


        1.     Fee Charged per Unit of Service:
               a. Primary Medical Care Chart Review         $125.00

               b. Health Related Service Chart Review              $100.00

               c. Professional Consultation                        $100.00

         2.    Number of Units of Service to be Provided:
               a. Primary Medical Care:    525

               b. Health Related Services:    400

               c. Professional Counseling:    80 hours

         3.    Total Cost of these Services (#1 x #2):
               a. Primary Medical Care Chart Review $ 65,625.00

               b. Health Related Service Chart Review       $ 40,000.00

               c. Post Review Consultation                  $   8,000.00


         4.    TOTAL REQUEST (3.a + 3.b + 3.c):             $113,625.00



                           ****EXAMPLE ONLY****

                            (Do not include in proposal)




                                                                                     Page 43 of 43

				
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