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State of Wisconsin
Wis. Statutes s.16.75
DOA-3070 (R08/2003)
BIDS MUST BE SEALED AND ADDRESSED TO: Remove from bidder list for this commodity/service. (Return this page only.)
AGENCY ADDRESS: Bid envelope must be sealed and plainly marked in lower corner with due date and Request for Bid
# DJB-1166 . Late bids will be rejected. Bids MUST be date and time stamped by the
soliciting purchasing office on or before the date and time that the bid is due. Bids dated and time
Department of Corrections
stamped in another office will be rejected. Receipt of a bid by the mail system does not constitute
David Brinkmeier / Purchasing Services Section receipt of a bid by the purchasing office. Any bid which is inadvertently opened as a result of not
3099 E Washington Avenue being properly and clearly marked is subject to rejection. Bids must be submitted separately, i.e.,
P.O. Box 7991 not included with sample packages or other bids. Bid openings are public unless otherwise
Madison, WI 53707-7991 specified. Records will be available for public inspection after issuance of the notice of intent to
award or the award of the contract. Bidder should contact person named below for an appointment
to view the bid record. Bids shall be firm for acceptance for sixty (60) days from date of bid
REQUEST FOR BID opening, unless otherwise noted. The attached terms and conditions apply to any subsequent
award.
THIS IS NOT AN ORDER Bids MUST be in this office no later than
BIDDER (Name and Address) June 1, 2007 2PM CT
Name (Contact for further information)
PLEASE COMPLETE:
David Brinkmeier
Phone Date
608-240-5589 May 12, 2007
Quote Price and Delivery FOB
Destination
Fax bids are not accepted
Item Quantity Price
Description
No. and Unit Per Group Total
Intensive Outpatient Alcohol and Other Drug Abuse
(AODA) Secular Program on the north side of
Milwaukee, WI.
1 360 Intensive Outpatient Services $ $
Groups (3 groups @ 4 sessions weekly x 10 weeks = 120 Groups) price per group x 360
(120 Groups x 3 cycles = 360 Groups Annually)
Group size: 8-12 offenders
Include items listed in Section 8 – Bidders Checklist.
Payment Terms Net 30 Delivery Time: per specifications
We claim minority bidder preference [Wis. Stats. s. 16.75(3m)]. Under Wisconsin Statutes, a 5% preference may be granted to CERTIFIED Minority Business Enterprises. Bidder must be
certified by the Wisconsin Department of Commerce. If you have questions concerning the certification process, contact the Wisconsin Department of Commerce, 5th Floor, 201 W. Washington
Ave., Madison, Wisconsin 53702, (608) 267-9550. Does Not Apply to Printing Bids.
We are a work center certified under Wis. Stats. s. 16.752 employing persons with severe disabilities. Questions concerning the certification process should be addressed to the Work Center
Program, State Bureau of Procurement, 6th Floor, 101 E. Wilson St., Madison, Wisconsin 53702, (608) 266-2605.
Wis. Stats. s. 16.754 directs the state to purchase materials which are manufactured to the greatest extent in the United States when all other factors are substantially equal. Materials covered in our
bid were manufactured in whole or in substantial part within the United States, or the majority of the component parts thereof were manufactured in whole or in substantial part in the United States.
Yes No Unknown
In signing this bid we also certify that we have not, either directly or indirectly, entered into any agreement or participated in any collusion or otherwise taken any action in restraint of free competition;
that no attempt has been made to induce any other person or firm to submit or not to submit a bid; that this bid has been independently arrived at without collusion with any other bidder, competitor or
potential competitor; that this bid has not been knowingly disclosed prior to the opening of bids to any other bidder or competitor; that the above statement is accurate under penalty of perjury.
We will comply with all terms, conditions and specifications required by the state in this Request for Bid and all terms of our bid.
Name of Authorized Company Representative (Type or Print) Title
Phone ( )
Fax ( )
Signature of Above Date Federal Employer Identification No. Social Security No. if Sole
Proprietor (Voluntary)
This form can be made available in accessible formats upon request to qualified individuals with disabilities.
RFB # DJB-1166 Due Date: June 1, 2007
AODA Services Milwaukee North Page 2 of 41
STATE OF WISCONSIN
REQUEST FOR BIDS (RFB) # DJB-1166
FOR: Intensive Outpatient Alcohol and Other Drug Abuse Treatment Services Milwaukee North
TABLE OF CONTENTS
DEFINITIONS
1.0 INTRODUCTION AND PURPOSE
2.0 BID PROCEDURE AND INSTRUCTIONS
3.0 BID ACCEPTANCE, EVALUATION AND AWARD
4.0 TECHNICAL REQUIREMENTS
5.0 PERFORMANCE REQUIREMENTS
6.0 SUPPORT REQUIREMENTS
7.0 COST INFORMATION
8.0 REQUIRED FORMS
9.0 TERMS AND CONDITIONS
- SPECIAL, STANDARD AND SUPPLEMENTAL TERMS AND CONDITIONS
Attachments
EXHIBIT 1 ……………………………………. DCC Administrative Directive 01-10
EXHIBIT 2 ……………………………………. Referral for Services (DOC-1336)
EXHIBIT 3 ……………………………………. Offender Report - Monthly (DOC-1088)
EXHIBIT 4 ……….…………………………… Unit Service Monthly Report (DOC-1026)
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AODA Services Milwaukee North Page 3 of 41
DEFINITIONS:
The following definitions are used throughout the bid:
Bidder means a firm submitting a bid in response to this Request for Bid
Contractor means successful vendor awarded the contract
MBE means Minority Business Enterprise.
RFB means Request for Bid.
State/Department means State of Wisconsin/Department of Corrections
DOC means the Department of Corrections
Provider means successful vendor awarded the contract
DCC means the Division of Community Corrections
AODA Alcohol and Other Drug Abuse
Aftercare or Continuing Care: Aftercare and Continuing Care are interchangeable terms and refer to
treatment provided after the offender has completed the goals of a primary care program and no longer
requires counseling at that intensity level. Aftercare is less intensive treatment that tapers the treatment
process in order to sustain and extend the offender’s recovery by reinforcing concepts learned in the
primary program. Aftercare is usually offered on an outpatient basis for a limited time. For example, DOC
Aftercare is often twelve weeks in length.
AODA Assessment: The process and procedures by which a counselor or service identifies and
evaluates an individual’s strengths, weaknesses, problems and needs in order to develop the offender’s
individual treatment plan or to make recommendations for the offender’s continuing care.
Clinical Supervision: The documented oversight responsibility for the clinical services as they are provided
to an offender in an AODA program. It involves periodic direct observation and analytic review of ongoing
assessment, counseling, treatment plan development, implementation, discharge planning and case
management by the contractor staff with the purpose of evaluating and improving service delivery and
assuring quality of care.
Clinical Supervisor: The person designated to be responsible for the clinical supervision of the staff
delivering clinical services in an AODA treatment program. This person is knowledgeable and
experienced about the provision of substance abuse services, the change process and working with
criminal offenders.
Cognitive Interventions: Cognitive interventions is defined as a program which teaches specific strategies
or techniques to enable offenders to (1) identify for themselves the specific thoughts that support their
criminal behavior (self-observation); (2) see and appreciate the pattern and consequences of their
thinking; (3) utilize reasoning and problem solving, self-talk, social interaction skills as a means of
controlling and changing their thinking; (4) recognize that they have choices and can make a conscious
decision to change or not to change. The Department stresses programming that combines two types of
cognitive interventions: cognitive restructuring (changing the thinking patterns, attitudes, and beliefs that
lead persons to offend) and cognitive skills training (teaching reasoning, problem solving, and social
skills).
Criminogenic Risk Factors: Those features that research has demonstrated are related to criminal
behavior. At least two types are recognized. Static risk factors are offender characteristics that cannot
change but are predictive of an offender's propensity for future criminal activity, for example, the offender’s
age at the time of first offense. Dynamic risk factors are offender characteristics that may be altered by
effective intervention. Examples of dynamic risk factors are substance abuse; identification with criminal
companions; low tolerance for frustration; impulsivity; conflicts with authority; poor use of leisure time;
conning and manipulation; thrill seeking; egocentrism; blaming others; dissatisfaction with conventional,
mainstream activities; poor skills in identifying alternative choices; etc.
Culturally diverse programming: Culturally diverse programming means programming which
accommodates the learning styles of African American, Hispanic, American Indian, Caucasian and other
ethnic backgrounds. This is accomplished through diverse staff and program materials.
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Gender Specific: Gender specific programming means programming designed specifically to address
male and female offenders’ needs and learning styles.
Guided Self-Discovery: This methodology proposes that to take a cognitive approach and then try to argue
offenders out of their habits of thinking is ineffective and even counterproductive. Despite the fact that
cognitive interventions involve learning new beliefs and behaviors, these are not taught through lectures or
preaching. In guided discovery, questioning and exploration are used to help participants discover what
they think, guide them to pinpoint the source of their problems, assist them in seeing new perspectives,
and help them find their own solutions to their problems. When using guided discovery, facilitators model
a process that offenders can use, on their own, to explore, evaluate and challenge their beliefs and
thoughts rather than continually relying upon facilitators to pinpoint the sources of their problems and find
solutions for them. Asking questions also helps the facilitator keep track of a participant’s progress in
understanding cognitive concepts and making cognitive changes.
The guided discovery approach is also used to maximize participant involvement in the group sessions.
When responding to questions, the participant is doing most of the work rather than being a passive
recipient listening to statements from the facilitator. Guiding participants to pinpoint the source of their
problems and find their own solutions also minimizes the possibility of the participant believing that the
facilitator is attempting to impose his or her own ideas on the participant. Participants often adopt new
perspectives more readily when they are allowed to form their own conclusions than when they are
persuaded to adopt the facilitator's conclusions.
The facilitator’s role is to work with participants to help them recognize their cognitions and other risk
factors that cause problems for them; to test the validity of the thoughts, beliefs and assumptions that
prove important; and to make changes in both cognition and behaviors. By actively collaborating with the
offender, facilitators minimize the resistance and opposition that is often elicited by taking an authoritarian
role, yet they still remain in a position to structure each session and the overall course of the program in a
way that is as efficient and effective as possible.
This methodology tends to increase feelings of self-efficacy and empowerment in participants by
encouraging them to adopt an internal focus of evaluation.
Intake Assessment: The process by which a counselor or service contractor reviews and evaluates
offender history to include such data as the AODA assessment, Criminal Complaint, Judgment of
Conviction, Agent’s Assessment and Impressions, and offender interview to determine and report
appropriateness and level of group services to be provided.
Intensive Outpatient: A structured, non-residential AODA treatment consisting of regularly scheduled
sessions of various treatment modalities such as counseling case management, group or individual
therapy, medical services, and mental health services, as indicated, by interdisciplinary contractors for a
scheduled number of sessions per day and week. This is the most intensive level of outpatient
counseling.
Offender: Individuals who are under the supervision of the Department of Corrections (DOC).
Program Statement: The written statement of a program’s philosophy and model of treatment; the
research basis for selection of the treatment model; the problem and the population to be served; the
goals, objectives, and activities to be employed to achieve the desired outcomes; and the plan for
determining the efficacy of the services provided.
Relapse Intervention/Prevention: AODA treatment to which an offender is referred due to exhibiting signs
of relapse and / or destabilization. The goal of such a "booster" form of treatment is to re-stabilize and
return the offender to community living following a structured re-exposure to program elements designed
to address the issues the offender was having difficulty within the community. Typically, this might occur
through an alternative to revocation process with the needed elements identified in the treatment plan.
Screening: The process which identifies whether an offender has an AODA problem (in this case) and, if
so, a recommendation for the most appropriate type of treatment. A screening is a “first cut” done quickly,
RFB # DJB-1166 Due Date: June 1, 2007
AODA Services Milwaukee North Page 5 of 41
without the detailed, in-depth, current information that would be gathered for an assessment. A screening
should not be confused with an assessment, which is a lengthier, much more definitive process.
Secular Programming: Secular programming is defined as a program that is free of religious components.
Special Populations: Offenders that may present particular characteristics such as the following –
Cognitively challenged (low functioning), non-English speaking, learning challenged, mentally ill or
physically challenged (hearing/visual/mobility impaired).
1.0 INTRODUCTION AND PURPOSE
1.1 PURPOSE OF THIS REQUEST FOR BID
The purpose of this document is to provide interested parties with information to enable them to prepare
and submit a bid for Intensive Outpatient Alcohol and Other Drug Abuse (AODA) Secular Treatment
Program(s) in Milwaukee, WI. The program must provide offenders convicted in adult court and under the
supervision of the Wisconsin Department of Corrections (DOC) with specified alcohol and other drug
abuse treatment services. The targeted geographical area is to be the north side of Milwaukee, WI (North
of Canal Street and south of Capitol Drive). Contractor must have a facility within the targeted area that is
accessible by public transportation.
1.2 REASONABLE ACCOMMODATIONS
The DOC will provide reasonable accommodations, including the provision of informational material in an
alternative format, for qualified individuals with disabilities upon request. If you think you need
accommodations contact David Brinkmeier via email at david.brinkmeier@doc.state.wi.us.
1.3 SCOPE
The Department of Corrections (DOC) supervises individuals with extensive AODA treatment needs.
Non-residential or outpatient services are an integral component of the AODA treatment continuum. It is
the intent of the Division of Community Corrections (DCC) to purchase intensive outpatient groups for
offenders in Milwaukee, WI who are experiencing alcohol and/or other drug abuse problems.
1.3.1 PROGRAM GOALS
The goals and objectives of the Intensive Outpatient AODA Treatment Programs are to:
1.3.1.1 To provide a range of quality programs to meet offender's control, supervision and
treatment needs.
1.3.1.2 To provide a means to screen and assess the level of programming that would most
effectively address individual AODA treatment needs.
1.3.1.3 To provide group and/or other individual treatment for offenders that focuses on :
Promoting abstinence from mood-altering chemicals and recovery from addiction.
Promoting positive lifestyle changes to avoid further legal difficulties.
1.3.1.4 To reduce jail and prison overcrowding by providing options/diversions to offenders who
are experiencing problems as a result of their alcohol and other drug abuse.
1.3.1.5 To reduce crime/recidivism by treatment for alcohol and other drug abuse/ addiction.
1.3.2 Program Philosophy
Intensive Outpatient AODA Treatment Programs philosophy consists of the following beliefs:
An alcohol and other drug problem is an indication of a greater individual problem
Offenders can make responsible choices to change their behaviors
Treatment must address the whole person
A cognitive-behavioral treatment approach is used because research supports this
treatment model with offenders
Treatment activities are experiential to the greatest possible degree
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AODA Services Milwaukee North Page 6 of 41
1.3.3 TARGET POPULATION
The program would serve male and female offenders, in gender specific groups, with extensive
AODA needs, who have been convicted in adult court as referred by the Department of
Corrections, and are under DOC supervision for the duration of services. Some offenders may
have identified special needs, such as learning disabilities/cognitive limitations. Learning styles
and needs may require reasonable accommodations in the program. Factors considered in
referrals will include convicting offense behavior(s), prior record, other prior history, indicators of
imminent relapse, availability of resources, or other case contingencies.
1.4 OVERVIEW OF PROCURING AGENCY The DOC Purchasing Services Section performs purchasing
functions for adult, juvenile and community corrections goods and services for the State of Wisconsin.
1.5 CONTRACT TERM
General Purpose Revenue (State) will support this contract if purchased by the DOC. These funds are
allocated to the Department of Corrections, Division of Community Corrections (DCC).
Availability of funding to support this purchase is contingent upon the biennial budget process. The initial
contract is for the time period from July 1, 2007 through June 30, 2008. The Department has the option of
allowing two, one-year renewal options or portions thereof; however, funding beyond June 30, 2008 is
contingent upon the performance of the contractor during the contract period and upon the availability of
funds.
EXECUTED CONTRACT TO CONSTITUTE ENTIRE AGREEMENT
In the event of contract award, the contents of this RFB (including all attachments), RFB addenda and
revisions, and the bid of the successful bidder, and additional terms agreed to, in writing, by the
Department and the Contractor shall become part of the contract. Failure of the successful bidder to
accept these as a contractual agreement may result in a cancellation of award.
The following priority for contract documents will be used if there are conflicts or disputes.
The Final Signed Agreement and/or Official Purchase Orders
Vendor's Bid
State Request for Bid
1.6 CANCELLATION AND TERMINATION
1.6.1 Failure of Department to comply with the Agreement terms, conditions, or specifications shall
provide the sole cause for which Contractor is entitled to terminate this Agreement. Contractor
shall notify Department in writing within thirty (30) days after Contractor becomes aware of the
alleged noncompliance with a complete description of the same. If Department does not, within
forty-five (45) days after its receipt of Contractor’s notice, either (i) effect a cure or (ii) if the
noncompliance is not one that can reasonably be cured within forty-five (45) days, develop a plan
to cure the noncompliance and diligently proceed according to that plan until a cure is effected,
then Contractor may terminate this Agreement for cause by written notice to Department.
Contractor may not terminate this Agreement without cause unless express written consent to do
so is provided by Department.
1.6.2 Department may terminate this Agreement at any time, with or without cause, and without penalty
by delivering thirty (30) days’ written notice to Contractor.
1.6.3 In the event that the Agreement is terminated for any reason whatsoever, Department's liability
shall be limited to the pro rata cost of the Services approved and satisfactorily provided as of the
effective date of termination and Contractor will refund to Department, within fourteen (14) days
of the effective date of termination, all payments made hereunder by Department to Contractor
for Services not completed or not accepted by Department.
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AODA Services Milwaukee North Page 7 of 41
1.6.4 Department shall be entitled to recover all costs related to obtaining and providing replacement
Services and/or deliverables which could not be provided or completed due to either Contractor’s
termination of the Agreement for any reason prior to the expiration of the Agreement term or
Department’s termination of the Agreement due to Contractor’s failure to comply with the
Agreement. The rights and remedies of Department provided herein shall not be exclusive but are
in addition to any other rights and remedies provided by law or elsewhere in the Agreement,
including the documents incorporated herein.
1.6.5 Upon termination or expiration of this Agreement, each party shall forthwith return to the other all
papers, materials, and other properties of the other held by each for purposes of execution of this
Agreement; provided, however, Department shall be entitled to retain a copy of any completed or
partially completed Service deliverables, if any, as well as any other project records Department is
required to retain under the State of Wisconsin’s records retention requirements. In addition,
each party will assist the other party in the orderly termination of this Agreement and the transfer
of all aspects hereof, tangible or intangible, as may be necessary for the orderly, non-disrupted
business continuation of each party.
1.7 VENDORNET REGISTRATION
The State of Wisconsin’s purchasing information and vendor notification service is available to all
businesses and organizations that want to sell to the state. Anyone may access VendorNet on the
Internet at http://vendornet.state.wi.us to get information on state purchasing practices and policies,
commodities and services that the state buys, and tips on selling to the state. Vendors may use the same
Web site address for inclusion on the bidders list for commodities and services that the organization wants
to sell to the state. A subscription with notification guarantees the organization will receive an e-mail
message each time a state agency, including any campus of the University of Wisconsin System, posts a
request for bid or a request for proposal in their designated commodity/service area(s) with an estimated
value over $25,000. Organizations without Internet access receive paper copies in the mail. Increasingly,
state agencies also are using VendorNet to post simplified bids valued at $25,000 or less. Vendors also
may receive e-mail notices of these simplified bid opportunities.
To obtain information on the state’s bidder registration, please visit the VendorNet Web site at
http://vendornet.state.wi.us or call the VendorNet Information Center (1-800-482-7813). In the Madison
area, please call 264-7898.
Note: Department of Administration and State Bureau of Procurement policies no longer require
maintenance of bidder’s lists or individual notification of vendors on bidders’ lists. In addition, there is no
requirement to post solicitations for bids/proposals in the Legal Notices of the Official State Newspaper.
Vendors who fail to register with VendorNet may not receive notification of procurement solicitations.
Additional Notes:
Make sure you select the appropriate NIGP (Commodity) Codes. Registering without selecting the codes
for the commodities or services you are interested in supplying will not result in notification of bid
solicitations or place your name on a potential vendor list. Lists are generated by NIGP codes.
Consider using a generic email address that is accessed or delivered to multiple recipients (example:
bids@xyzcompany.com). This will insure that the bid notice is received.
Annually an email will be sent to renew your registration. If you do not renew your company will be
removed from the Vendornet bidders list.
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AODA Services Milwaukee North Page 8 of 41
2.0 BID PROCEDURES AND INSTRUCTIONS
2.1 METHOD OF BID
Vendors must submit an original, marked as such, and three (3) copies of all materials required for
acceptance of their bid.
Bidder must submit a price per group and a total extended price (price per group x 360).
Bids must be received in the below office by the specified time stated. All bids must be time-stamped as
accepted by the Purchasing Services Section by the stated time. Bids not so stamped will not be
accepted. Receipt of a bid by the State mail system does not constitute receipt of a bid by the
Purchasing Services Section, for purposes of this RFB. Please use one of the options below for return
of your bid.
The Bid(s) must be received at the Purchasing Services Section no later than June 1, 2007 2pm Central
Time. Any bids received after that time and date will be rejected.
USPS ADDRESS COMMON CARRIER ADDRESS
Department of Corrections Department of Corrections
David Brinkmeier / Purchasing Services Section David Brinkmeier / Purchasing Services Section
PO Box 7991 3099 East Washington Ave.
Madison, WI 53707-7991 Madison, WI 53704-4338
FAXING: Faxed bids are NOT accepted. E-MAILING: Emailed bids are NOT accepted.
All bids must be packaged, sealed, and show the following information on the outside of the package:
Vendor's Name and Address
Request for Bids Title
Request for Bids Number
Bid Due Date
2.2 CALENDAR OF EVENTS
Listed below are important dates and times by which actions related to this Request for Bids (RFB) must
be completed. In the event that the State finds it necessary to change any of these dates and times it will
do so by issuing a supplement to this RFB.
DATE EVENT
May 12, 2007 Date of issue of the RFB.
May 18, 2007 Last day for submitting written questions
May 22, 2007 Answers to written questions posted to VendorNet (estimated)
June 1, 2007 Bids due from vendors
July 1, 2007 Contract Start date
2.3 FORMAT OF BID Vendors responding to this RFB must comply with the following format requirements:
2.3.1 SIGNED REQUEST FOR BID SHEET
Include here the signed Request for Bid sheet (DOA-3070) included with the bid and those
certifications required for submittal of a bid. Bids submitted in response to this RFB must be
signed by the person in the vendor's organization who is responsible for the decision as to the
prices being offered in the bid or by a person who has been authorized in writing to act as agent
for the person responsible for the decision on prices.
By submitting a signed bid, the vendor's signatories certify that in connection with this
procurement: (a) the vendor's organization or an agent of the vendor's organization has arrived at
the prices in its bid without consultation, communication or agreement with any other respondent
or with any competitor for the purpose of restricting competition, (b) the prices quoted in the bid
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AODA Services Milwaukee North Page 9 of 41
have not been knowingly disclosed by the vendor's organization or by any agent of the vendor's
organization and will not be knowingly disclosed by same, directly or indirectly, to any other
respondent or to any competitor, and (c) no attempt has been made or will be made by the
vendor's organization or by any agent of the vendor's organization to induce any other person or
firm to submit or not to submit a bid for the purpose of restricting competition.
2.3.2 STATE OF WISCONSIN TERMS AND CONDITIONS
These standard and supplemental terms and conditions shall govern this bid and subsequent
award. Vendors must accept these terms and conditions or submit point-by-point exceptions
along with proposed alternative or additional language for each point, including any
vendor contracts. Submission of any standard vendor contracts as a substitute for
language in the terms and conditions is not a sufficient response to this requirement and
may result in rejection of the vendor's bid. The State reserves the right to negotiate
contractual terms and conditions other than those in the State of Wisconsin Contract when it is in
the best interest of the State to do so.
2.3.3 ADDITIONAL INFORMATION
A listing of required forms and supporting documents is included in Section 8. The information
requested is for verification of service meeting bid specifications. Only lowest bid envelopes will
be reviewed to ensure a responsive bidder.
Italics note all required documentation in the Request for Bid. Bids that do not include all
items listed on this checklist may be rejected.
2.4 MULTIPLE BIDS
Multiple bids from a vendor will be permissible; however each bid must conform fully to the requirements
for bid submission. Each such bid must be separately submitted and labeled as Bid #1, Bid #2, etc. on
each page included in the response. Alternate acquisition plans do not constitute multiple bids.
2.5 INCURRING COSTS
The State of Wisconsin is not liable for any cost incurred by a vendor in the process of responding to this
RFB.
2.6 QUESTIONS, CLARIFICATIONS AND/OR REVISIONS THROUGH DESIGNATED CONTACT
All communications and/or questions regarding this request must be written and submitted via FAX, e-
mail, USPS mail or hand delivery to the Purchasing Services Section.
If a Bidder discovers any significant ambiguity, error, conflict, discrepancy, omission, or other deficiency in
this RFB, they have five (5) business days after the bid posting date, in writing, Purchasing Agent at the
address shown below of such error and request modification or clarification of the RFB document. All
written questions will be responded to in writing and provided to all bidders.
Department of Corrections
David Brinkmeier / Purchasing Services Section
PO Box 7991
Madison, WI 53707-7991
david.brinkmeier@doc.state.wi.us
From the date of release of this RFB, until a Letter of Intent is issued, all contacts with the DOC regarding
this RFB shall be made through the Purchasing Services Section. Violation of this condition may be
considered sufficient cause for rejection of a bid, irrespective of any other considerations.
Each bid shall stipulate that it is predicated upon the terms and conditions of this RFB and any
supplements or revisions thereof.
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AODA Services Milwaukee North Page 10 of 41
2.7 NEWS RELEASES AND PROMOTIONAL MATERIALS
News releases pertaining to the RFB or to the acceptance, rejection, or evaluation of bids shall not be
made without the prior written approval of the State. Contractor agrees to not use promotional or
marketing material which states expressly or by fair implication that the DOC endorses either the
Contractor or any sponsor of such material.
3.0 BID ACCEPTANCE, EVALUATION AND AWARD
3.1 BID OPENING
Bids will be opened on June 1, 2007 at 3099 East Washington Ave. Madison, WI 53704 Purchasing
Services Section. Names of the bidders may be read aloud at that time.
3.2 BID ACCEPTANCE
Bids which do not comply with instructions or are unable to comply with specifications contained in this
RFB may be rejected by the State. The State may request reports on a vendor's financial stability and if
financial stability is not substantiated may reject a vendor's bid. The State retains the right to accept or
reject any or all bids, or accept or reject any part of a bid deemed to be in the best interest of the State.
The State shall be the sole judge as to compliance with the instructions contained in this RFB.
3.3 BID EVALUATION
Bids will be evaluated by the DOC's purchasing agent and program manager/staff to verify that they will
meet all specified requirements in this RFB. This verification may include requesting reports on the
vendor's financial stability, conducting demonstrations of the vendor's proposed products(s) and/or
service(s), and reviewing results of past awards to the vendor by the State of Wisconsin.
Bids from certified Minority Business Enterprises may be provided up to a five percent (5%) bid preference
in accordance with Wis. Stats. s. 16.75(3m).
3.4 METHOD OF AWARD
This contract shall be awarded to the lowest total cost of the responsive and responsible bidder meeting
bid specifications and requirements. The Department reserves the right to accept or reject any and all
bids in whole or in part. The Department also reserves the right to negotiate price with the lowest
responsive and responsible bidder. The Department reserves the right to adjust the number of units of
service, to add or move locations, and/or add locations outside the designated area if in its best interest.
3.5 NOTIFICATION OF INTENT TO AWARD
Any vendors who respond to this RFB, with a bid, will be notified in writing of the State's intent to award
the contract(s) as a result of this RFB.
After notification of the intent to award is made, and under the supervision of agency staff, copies of bids
will be available for public inspection 8:30 a.m. to 3:30 p.m., Monday through Fridays, at 3099 East
Washington Ave., Madison WI. Vendors should schedule reviews with purchasing agent to ensure that
space is available for the review.
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3.6 APPEALS PROCESS
The appeals procedure applies to only those Requests For Bids for Services that are $25,000.00 or
greater. Notices of intent to protest and protests must be made in writing. Protesters should make their
protests as specific as possible and shall identify statutes and Wisconsin Administrative Code provisions
that are alleged to have been violated.
The written notice of intent to protest the Intent to Award a Contract must be filed with:
Secretary, Department of Corrections
P.O. Box 7925
Madison, WI 53707-7925
And be received in this office within five (5) working days after the notice of intent to award is issued. The
written protest must be received in this office within ten (10) working days after the notice of intent to
award is issued.
Copies of the notice of intent to protest and the written protest should be sent to the Purchasing
Section Chief.
The decision of the head of the procuring agency may be appealed to the Secretary of the Department of
Administration within five (5) working days of issuance, with a copy of such appeal filed with the procuring
agency, provided the appeal alleges a violation of statute or a provision of a Wisconsin Administrative
Code.
4.0 TECHNICAL REQUIREMENTS
4.1 FACILITY REQUIREMENTS
Intensive Outpatient AODA treatment services are required to be located on the north side of Milwaukee,
WI (north of Canal Street and south of Capitol Drive). The location must be accessible to public
transportation. The facility in which services are provided must meet all applicable federal, state and local
codes, regulations and requirements.
4.2 AGENCY EXPERIENCE
The contractor shall have a minimum of three (3) years experience providing AODA programming to
offenders.
Bidder must provide a list of past contracts, DOC and others, within the last 3 years that are of a similar
service to this bid. Include service description, location of service, number of offenders served, outcome
evaluation, and contact person with a phone number. DOC reserves the right to contact any or all
persons listed. Past contract quality may impact this award.
The bidder shall provide documentation demonstrating that the agency meets the 3 years experience
requirement, including past contract information.
4.3 STAFF QUALIFICATIONS AND EXPERIENCE
4.3.1 STAFF QUALIFICATIONS
Agency staff delivering any of the direct AODA services are required: 1) to be certified by the
Wisconsin Certification Board, Inc. or the Department of Regulation and Licensing as a
Substance Abuse Counselor or a Marriage & Family Professional Counselor or Social Worker
with an AODA specialty per MPSW 1.09; or 2) possess a certificate as a Registered Alcohol and
Drug Counselor from the Wisconsin Certification Board or a certificate as a Substance Abuse
Counselor in-Training from the Department of Regulation and Licensing (DRL).
In all instances, a staff member with supervisory designation shall provide overall clinical
supervision to insure program integrity and a professional level of practice by treatment delivery
staff per DRL regulations on Substance Abuse Counselors. The supervisor shall be credentialed
as a Clinical Supervisor in-Training or a Clinical Supervisor or be a licensed clinical psychologist
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AODA Services Milwaukee North Page 12 of 41
or licensed clinical social worker with 3 years of experience or medical doctor knowledgeable in
psychopharmacology and addiction treatment
Access to a licensed psychologist for assistance/staff consultation regarding clinical issues must
be available as needed.
The bidder shall provide documentation to verify (1) or (2) above, to include supervision plan,
if applicable.
4.3.2 STAFF EXPERIENCE
The staff person or person(s) performing program services is required to have a minimum of: 1)
three years experience providing Intensive Outpatient AODA treatment of offenders; and 2) three
years experience delivering services to individuals from various racial, religious, and ethnic
backgrounds as well as individuals with a disability. A training plan must be submitted identifying
a minimum of 24 hours of continued education for all staff.
The bidder shall provide a list of program staff and documentation demonstrating that the
program staff meets the bid solicitation’s experience requirements in delivering AODA
treatment services as described in this section. The format for this documentation is to
include name(s) of staff person(s), dates and locations of experience, and the names and
phone numbers of persons who can verify the experience.
If staff positions are pending hire, submit recruitment plan and job description of those
pending positions.
4.4 PROGRAM DESCRIPTION
The following provisions are required for all services:
1) At the onset of offender program participation, the contracter staff shall inform offenders of the
therapist’s duty to warn, and communication obligation to DOC. The therapist shall have the offender
sign a waiver of confidentiality to allow information to be shared with DOC or other criminal
justice/social service agencies that have a need to know.
2) The contractor staff shall be willing to address community safety issues and cooperate with DOC staff
to monitor risk. The contractor must report lapses, violations, and when the offender is in a high-risk
situation to the supervising agent within one working day.
3) The contractor staff must agree to appear at revocation and court hearings if required.
4) The contractor staff must be willing to have group treatment observed and evaluated by a DOC
representative or a mutually acceptable evaluator. The staff must demonstrate an ability to be
assertive, but respectful and professional toward offenders.
5) All AODA treatment groups shall be secular and use a cognitive behavioral model of programming,
motivational interviewing techniques, and guided self-discovery. Groups are to experiential and,
minimally, shall include modeling, role-playing, a system of positive reinforcement, experiential
exercises, and involvement with appropriate collateral resources.
6) Groups shall be composed of DCC offenders only in gender specific groups. Group size shall be no
more than 12 offenders and no less than 8 offenders. Daytime and evening groups will be required.
7) Additional groups may be requested at an additional location identified by DCC.
8) Groups shall be open ended allowing for entrance into the program at various sessions.
9) All referrals will be individually screened in collaboration with DCC staff for appropriateness of the
specific group treatment. Treatment placement will be consistent with (Diagnosis and Statistical
th
Manual of Mental Disorders 4 Edition) DMS IV and (WI Uniform Placement Criteria) WI-UPC, as
applicable. Sources of information to be considered shall include offender interviews, and collateral
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AODA Services Milwaukee North Page 13 of 41
contacts with professional and significant others as appropriate. Treatment plan will be developed
based on the screening and written with offender input.
4.4.1 INTENSIVE OUTPATIENT GROUPS
Treatment and intervention strategies using a cognitive interventions approach are to include, at a
minimum: chemical dependence and substance abuse education, the effects dependency/abuse
have had on offender’s life, social skills training, self-control training, the development of a
recovery plan, and relapse prevention skills as detailed below.
The contractor selected under this solicitation shall conduct a minimum of four (4) treatment
sessions each week for ten (10) weeks, each session will be three (3) hours in length. Three (3)
cycles of three (3) groups will be conducted annually. Two (2) groups will be designated for male
offenders, one (1) group will be designated for female offenders. Number of groups may be
increased or decreased based on number of referrals and availability of funds. The groups shall
be open-ended.
(1) Program Content for Intensive Outpatient Programs
A. Within this contract period upon approval of DOC AODA Program Standards, you
may be required to submit a Program Abstract as a first step in the Department's
program approval process.
B. The services provided must have research support.
C. The services provided must target dynamic criminogenic risk factors.
D. Gender-specific programming is required. Female groups must include a focus on
relationship of trauma with addiction issues.
E. Program materials and presentations must be culturally relevant to the population
served.
F. Performance measures must be established that objectively gauges offender
treatment progress.
G. Program content, materials and self-help support groups employed in the delivery of
treatment to the offender must comply with the requirements of Kerr v. Farrey, 95 f.3d
472 (1996) and DCC Administrative Directive 01-10, attached as Exhibit 1.
(2) Core Content Required for Intensive Outpatient Programs
A. An individual intake assessment is conducted at admission and offender progress is
reviewed prior to discharge from program.
B. Alcohol and other drug education for offenders with no prior treatment experience
and, if clinically indicated, for those who have previously been involved in treatment.
C. Cognitive behavioral techniques are recommended and must meet the Departments
approval.
D. A written Individualized Treatment Plan must be developed within fourteen days of the
commencement of services and be shared with the supervising agent.
E. Relapse prevention activities and a written, detailed Personal Relapse Prevention
Plan to be shared with the supervising agent and/or (if applicable) the drug court
coordinator at program completion.
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(3) Program Completion Requirements for Intensive Outpatient Programs
A. Complete goals of the Individual Treatment Plan
B. Demonstrate increased knowledge of substance use, abuse, dependence and their
impact.
C. Complete assignments to an acceptable standard
D. Demonstrate that the skills taught have been learned
E. Pass required tests to an acceptable standard
F. Produce an acceptable relapse prevention plan
Bidder shall provide a program statement and a detailed description/curriculum of the
Intensive Outpatient Program including the process/instrument to be administered/used in
determining successful completion.
4.5 INTAKE/ TREATMENT//DISCHARGE PROCEDURES
4.5.1 INTAKE PROCEDURES
The contractor staff shall develop referral/intake procedures in cooperation with DOC staff. If the
contractor rejects an offender, this must be discussed with DOC staff to determine if the program
can be modified to address the specific offender needs. The contractor staff shall send copies of
the intake summary and recommendations to the referring DOC staff person within 10 working
days of intake interview.
The contractor shall have each offender complete the necessary releases of information and shall
give each offender a copy of the program rules and expectations.
The intake assessment shall include, but is not limited to:
A. An interview focusing on recent/current offender functioning
B. The nature and severity of drug use and impact upon offender’s life
C. Describe nature and severity of criminal history and impact upon offender’s life (i.e. physical
health, mental health, family, friends, school, work, spiritual, financial and legal)
D. Secure informed consent to treatment
E. Consider information from all sources
4.5.2 TREATMENT PLAN
The contractor shall prepare an individualized treatment plan for each offender accepted into the
program. The plan shall include measurable goals and objectives, as well as activities/services
needed to achieve successful discharge from the program.
4.5.3 TREATMENT PLAN FORMAT
Treatment plans may be reviewed and modified as needed.
A. Require offender input
B. Identify offender’s assets / strengths
C. Identify offender’s problem areas
D. Describe offender’s readiness to change
Use of the Prochaska, J.O., and Diclemente, C.C., Stages of Change Model or other
Department accepted tool.
E. Identify offender’s short / long term goals
Specify steps to be taken to achieve goal(s)
Identify time frame for each step
Identify offender responsibilities
Identify contractor responsibilities
F. Specify next progress review date
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4.5.4 DISCHARGE/TERMINATION
The contractor shall develop termination and discharge procedures in cooperation with DOC staff
for offenders completing or exiting group services. The contractor shall inform the referring DOC
staff of the intent to “unsuccessfully” terminate an offender from treatment prior to termination.
Within three (3) days of termination the contractor shall prepare a discharge summary including a
description of offender’s progress in programming which includes additional program
recommendations as well as recommendations to assist the agent in supervising the offender’s
subsequent activities.
4.6 LENGTH OF PROGRAM PARTICIPATION
4.6.1 AODA INTENSIVE OUTPATIENT COUNSELING
It is anticipated that offenders will participate in no less than 40 (4 sessions per week x 10 weeks)
group sessions. Participation for any longer or shorter period of time may be negotiated with DOC
staff based on treatment goals.
4.7 NUMBER OF SERVICE UNITS
Under any agreement resulting from this solicitation, units of service are defined as follows:
4.7.1 AODA INTENSIVE OUTPATIENT COUNSELING GROUPS
One three-hour group session of direct service to 8 to 12 offenders participating in activities as
defined in 4.5 with documentation to referring DOC staff.
4.8 REPORTING REQUIREMENTS
4.8.1 EXPECTATIONS FOR PREPARATION, RECORD KEEPING, AND REPORTING
A. Agent of record, program liaison, and/or other designees must be included in distribution of
written reports.
B. An individual intake assessment must be completed within fourteen days of referral.
C. Development of an individual treatment plan that is
1. Individualized according to assessment of each offender
2. Completed and submitted within first fourteen days of admission
3. Reviewed at least every thirty days and modified as needed
D. Quarterly progress reports completed and submitted by the 10th of the following month.
E. Written personal, detailed Relapse Prevention Plan completed and submitted within 5 days of
program completion.
F. Develop Aftercare Plan recommendations.
G. Cooperate fully in Department efforts to evaluate and improve AODA programming (See
Program Evaluation Requirements)
H. Contractor shall provide a weekly written, legible copy or e-mail listing of the attendance for
each group within 24 hours from the start of each group.
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4.8.2 REPORTING ON INDIVIDUAL OFFENDERS
4.8.2.1 PROGRESS REPORTS: The contractor shall document attendance and progress of the
offender in the Intensive Outpatient AODA groups. Documentation of offender progress
will be submitted to the referring DOC staff person on a quarterly basis.
Quarterly Progress Report Format
Progress reports must address the following areas:
1) Attendance
2) Participation
3) Homework completion
4) Demonstrate knowledge acquisition
5) Demonstrate skill in applying knowledge
6) Performance in completing treatment plan elements
7) Drug tests administered and results in past month
8) Note progress/modifications to treatment plan in past month
The bidder shall provide a copy of the format to be used for the
Progress reports.
4.8.2.2 DISCHARGE SUMMARY: The program shall provide the referring DOC staff person with
a discharge summary within ten (10) days of offenders successful and within three (3)
days of offender’s unsuccessful discharge from the program.
PROGRAM DISCHARGE SUMMARY REPORT FORMAT
A. Discharge status
B. Program entry and discharge dates
C. Brief description of program
D. Offender’s alcohol/drug use patterns, negative impact on life and prior treatment
history
E. Identification of offender’s assets/strengths
F. Account of offender’s effort and progress toward goals
G. Identification of significant problem areas not addressed in program
H. Identification of any continuing treatment needs and recommendations to address
them
I. Relapse Prevention Plan including aftercare recommendations
J. Prognosis/Risk for further use and criminality as a result of offender participation
The bidder shall provide a copy of the format to be used for the discharge summary
(see 4.5.4).
4.8.3 OTHER REPORTS
4.8.3.1 LAW VIOLATIONS: The contractor shall notify the referring DOC staff or other available
DOC staff if a participant is in violation of the law. This notification must take place as
soon as possible and no later than 24 hours, subsequent to receiving information
concerning the law violation.
4.8.3.2 SERIOUS PROGRAM VIOLATIONS: Serious program rule violations, including failure to
attend shall be reported to the referring DOC staff or other available DOC staff within
one working day.
4.8.3.3 AD HOC REPORTS: Upon request, the contractor shall provide to DOC staff reports on
offenders served in the program when needed by the courts, for revocation procedures
and/or other Departmental processes.
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4.8.4 PROGRAM REPORTING
4.8.4.1 REFERRAL FOR SERVICES (DOC 1336): The contractor shall submit a completed
Referral for Services form for each offender referred by DOC for service. These forms
shall be submitted with the first Offender Report Monthly (DOC 1088) following offender’s
rejection or acceptance into the program. A copy of the form is attached as Exhibit 2.
4.8.4.2 OFFENDER REPORT MONTHLY (DOC 1088): The contractor shall submit a completed
Offender Report Monthly to report data on offenders served each month. This report shall
be submitted within five (5) days of the last day of the month during which service was
provided. A copy of this form is attached as Exhibit 3.
4.8.4.3 UNIT SERVICE MONTHLY REPORT (DOC 1026): The contractor shall submit a
completed Unit Service Monthly Report to provide data on the number of units of service
provided each month. This report shall be submitted within five (5) working days of
the last day of the month during which service was provided. A copy of this form is
attached as Exhibit 4.
4.8.4.4 PROGRAM EVALUATION: Program evaluation is intended to return useful information
to program sites for the purpose of program improvement. Contractors delivering AODA
services to offenders must prepare for and cooperate with evaluation efforts initiated by
the Department. Contractors will be expected to collect and maintain similar data on
offenders and their participation in the treatment process in an electronic database.
Requirements include computer capabilities with internet access, e-mail, and window’s
applications.
4.9 SPECIAL SERVICE DELIVERY REQUIREMENTS
Under any agreement resulting from this solicitation, the contractor shall begin delivering services
on July 1, 2007, for offenders referred for services by DOC. Failure to meet this deadline may
result in termination of the agreement.
5.0 PERFORMANCE REQUIREMENTS
5.1 Prices must remain firm for the initial contract term.
5.2 Price increase requests proposed after the initial Contract term must be received by Purchasing in writing
90 calendar days prior to the beginning of the next contract term for acceptance or rejection. Proposed
price increases are limited to fully documented cost increases submitted with the request. If Purchasing
deems cost increases are not acceptable, it reserves the right to rebid the contract in whole or part.
Acceptance of the price increases shall be in the form of an amendment to the contract publication. Price
increases must be labeled with the contract number and be submitted in the same format as the original
RFB. Any price increase requested that is not submitted in the proper format may be rejected.
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AODA Services Milwaukee North Page 18 of 41
6.0 SUPPORT REQUIREMENTS
6.1 CONTRACTOR REIMBURSEMENT
The contractor shall be reimbursed for units of service provided each month as reported using the
Offender Report Monthly (DOC-1088) and the Unit Services Monthly Report (DOC-1026).
Contractor must agree that the Offender Report Monthly (DOC-1088) and the Unit Services Monthly
Report (DOC-1026) shall reflect the prices and discounts established for the items on this contract.
Before payment is made, the DOC also must verify that all invoiced charges are correct as per this
Contract. Only properly submitted Offender Report Monthly (DOC-1088) and Unit Services Monthly
Report (DOC-1026) will be officially processed for payment.
6.2 COLLECTION OF OFFENDER FEES
It is not anticipated that the contractor will rely on the collection of participant fees to cover a portion of the
operating expenses of the program.
If third party payments are collected, these payments will be deducted from the amount reimbursable to
the agency by DOC. The amount of these collections will be reported on the Unit Service Monthly Report
(DOC-1026) for the month in which the fee was paid, and deducted from the amount reimbursable to the
agency by the Division of Community Corrections. No offender will be denied services because of inability
to pay.
6.3 REPORTS
Reports of both programmatic and fiscal activity will be required for the purpose of documenting the
satisfactory meeting of program objectives, in accordance with the application. Reporting requirements will
be specified in the agreement between the contractor and the Department. Failure of the contractor to
accept these obligations may result in cancellation of the award.
The contractor shall, at the option of the Department, appear before Department administrators to clarify
findings and to answer any questions at any time during the contract negotiation period or after the contract is
completed.
7.0 COST INFORMATION
Bidders must submit cost on the Request For Bid form (Form DOA-3070), please complete and sign, including
price per group and total price (price per group x 360).
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AODA Services Milwaukee North Page 19 of 41
8.0 REQUIRED FORMS AND ATTACHMENTS
BIDDER'S CHECKLIST
All bids must include information requested in 8.1 through 8.2 as specified below. Requirements of 8.1 must be
submitted in a separate envelope from the items listed in 8.2. Both envelopes must be marked with the bid name, bid
number, due date and time in the lower left hand corner of the envelope.
8.1 PROGRAM SPECIFICATIONS - the following program specification detail is required to be submitted at the
time of the bid under separate cover.
8.1.1 Documentation of agency experience requirements, including past contract information (Include
service description, location of service, number of offenders served, outcome evaluation, and
contact person with a phone number), as specified in 4.2
8.1.2 Documentation of staff qualifications/training requirements as specified in 4.3.1
8.1.3 Documentation of staff experience as specified in 4.3.2
8.1.4 A detailed description of the AODA Intensive Outpatient Counseling Group component to be
delivered by the bidder in accordance with specifications described in 4.4.1
8.1.5 Copy of format used for progress report in 4.8.2.1
8.1.6 Copy of format used for discharge summary in 4.8.2.2
8.2 FORMS/SIGNATURES REQUIRED - the following forms are required to be submitted at the time of the bid
under separate cover.
8.2.1 Request for Bid (DOA-3070). Please put the following information in the lower left hand corner of the
envelope: Bid number, date and time of opening, and service description.
8.2.2 Vendor Information Form - DOA-3477
8.2.3 Affidavit Form – DOA-3476
8.2.4 Taxpayer Identification Number Form – DOA-6448
8.2.5 Designation of Confidential and Proprietary Information Form - DOA-3027
8.2.6 Vendor Agreement - WI Cooperative Purchasing Service Form – DOA-3333
STATE OF WISCONSIN Bid / Proposal # DJB-1166
DOA-3477 (R05/98)
Commodity / Service AODA SERVICES MILWAUKEE
NORTH
VENDOR INFORMATION
1. BIDDING / PROPOSING COMPANY NAME
FEIN
Phone ( ) Toll Free Phone ( )
FAX ( ) E-Mail Address
Address
City State Zip + 4
2. Name the person to contact for questions concerning this bid / proposal.
Name Title
Phone ( ) Toll Free Phone ( )
FAX ( ) E-Mail Address
Address
City State Zip + 4
3. Any vendor awarded over $25,000 on this contract must submit affirmative action information to the
department. Please name the Personnel / Human Resource and Development or other person responsible
for affirmative action in the company to contact about this plan.
Name Title
Phone ( ) Toll Free Phone ( )
FAX ( ) E-Mail Address
Address
City State Zip + 4
4. Mailing address to which state purchase orders are mailed and person the department may contact
concerning orders and billings.
Name Title
Phone ( ) Toll Free Phone ( )
FAX ( ) E-Mail Address
Address
City State Zip + 4
5. CEO / President Name
This document can be made available in accessible formats to qualified individuals with disabilities.
State of Wisconsin Bid / Proposal # DJB-1166
Department of Administration AODA Services
DOA-3476 (R01/2000) Commodity Milw. N.
S. 16.75(3m) Wis. Stats.; s. 16.752
Wis. Stats.
Affidavit
This completed affidavit must be submitted with the bid/proposal.
Proposer Preference: Please indicate below if claiming a proposer preference.
Minority Business Preference (s. 16.75(3m), Wis. Stats.) - Must be certified by the Wisconsin
Department of Commerce. If you have questions concerning the certification process, contact the
Wisconsin Department of Commerce, 8th Floor, 123 W. Washington Ave., P.O. Box 7970, Madison,
Wisconsin 53707-7970,
(608) 267-9550.
Work Center Preference (s 16.752, Wis Stats.) - Must be certified by the State of Wisconsin Use
Board. If you have questions concerning the certification process, contact the Wisconsin State Use
Board, 101 East Wilson Street, 6th Floor, PO Box 7867, Madison, Wisconsin 53707-7867 or 608/266-
2553.
American-Made Materials: The materials covered in our proposal were manufactured in whole or in substantial part
within the United States, or the majority of the component parts thereof were manufactured in whole or in substantial
part in the United States.
Yes No Unknown
Non-Collusion: In signing this proposal we also certify that we have not, either directly or indirectly, entered into any
agreement or participated in any collusion or otherwise taken any action in restraint of free trade; that no attempt
has been made to induce any other person or firm to submit or not to submit a proposal; that this proposal has been
independently arrived at without collusion with any other proposer competitor or potential competitor; that this
proposal has not been knowingly disclosed prior to opening of proposals to any other proposer or competitor; that
the above statement is accurate under penalty of perjury.
We will comply with all terms, conditions, and specifications required by the State of Wisconsin in this
Announcement of Bid/Proposal and the terms of our bid/proposal.
Authorized Title
Representative
Type or Print
Authorized Date (m/dd/ccyy)
Representative
Signature
Company Telephone ( )
Name
This document can be made available in accessible formats to qualified individuals with disabilities.
State of Wisconsin Division of Executive Budget and Finance
Department of Administration State Controller’s Office
DOA-6448 (R08/2001)
Substitute W-9 DO NOT send to IRS
Taxpayer Identification Number (TIN) Verification
Print or Type
Please see attachment or reverse for complete instructions.
This form can be made available in alternative formats to qualified individuals upon request.
Legal Name Entity Designation (check only one) Required
(as entered with IRS) If Sole Proprietorship enter your Last, First, MI
Individual / Sole Proprietor
Corporation (includes service corporations)
Trade Name Limited Liability Company - Partnership
If doing business as (D/B/A) or enter business name of Sole Proprietorship Limited Liability Company - Corporation
Government Entity
Hospital Exempt from Tax or Government
Remit Address (where check should be mailed) Owned
PO Box or Number and Street, City, State, ZIP + 4 Long Term Care Facility Exempt from Tax or
Government Owned
All Other Entities
Taxpayer Identification Number (TIN)
If you are a sole proprietor and you have an EIN,
you may enter either your SSN or EIN. However,
Order Address (where order should be mailed) using your EIN may result in unnecessary
PO Box or number and street, City, State, ZIP + 4 notices to the requester.
___ ___ ___ ___ ___ ___ ___ ___ ___
Primary Address (for return of 1099 form if different from remit Check Only One Required
address) Social Security Number (SSN)
PO Box or number and street, City, State, ZIP + 4
Employer Identification Number (EIN)
Individual Taxpayer Identification Number
for U.S. Resident Aliens (ITIN)
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number, AND
2. I am not subject to back up withholding because (a) I am exempt from backup withholding, or (b) I have not been
notified by the Internal Revenue Service (IRS) that I am subject to back up withholding as a result of a failure to report
all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.
3. I am a U.S. person (including a US resident alien).
Printed Name Printed Title Telephone Number
( )
Signature Date (mm/dd/ccyy)
For Agency Use Only
Agency Number Contact Phone Number
Change
Name Address Other (explain)
Forms may be returned by use
Department of Corrections of FAX Number: 608-240-3342
3099 East Washington Ave.
Madison, WI 53704-4338
DOA-6448 (R08/2001)
Instructions for Completing Taxpayer Identification Number Verification
(Substitute W-9)
Legal Name As entered with IRS
Individuals: Enter Last Name, First Name, MI
Sole Proprietorships: Enter Last Name, First Name, MI
All Others: Enter Legal Name of Business
Trade Name
Individuals: Leave Blank
Sole Proprietorships: Enter Business Name
All Others: Complete only if doing business as a D/B/A
Remit Address
Address where payment should be sent if different from primary address
Order Address
Address where order should be sent if different from primary address
Primary Address
Address where 1099 should be sent if different from remit address
Entity Designation
Check ONE box which describes the type of business entity.
Taxpayer Identification Number
LIST ONLY ONE: Social Security Number OR Employer Identification Number OR Individual Taxpayer Identification
Number.
If you do not have a TIN, apply for one immediately. Individuals use federal form SS-05 which can be obtained from the
Social Security Administration. Businesses and all other entities use federal form SS-04 which can be obtained from the
Internal Revenue Service.
Certification
You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does
not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions
to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not
required to sign the Certification, but you must provide your correct TIN.
Privacy Act Notice
Section 6109 requires you to furnish your correct TIN to persons who must file information returns with the IRS to report
interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of
secured property, or contributions you made to an IRA. The IRS uses the numbers for identification purposes and to help
verify the accuracy of your tax return. You must provide your TIN whether or not you are required to file a tax return.
Payers must generally withhold 31% of taxable interest, dividend, and certain other payments to a payee who does not
furnish a TIN to a payer. Certain penalties may also apply.
Taxpayer Identification Request
In order for the State of Wisconsin to comply with the Internal Revenue Service regulations, this letter is to request
that you complete the enclosed Substitute Form W-9. Failure to provide this information may result in delayed
payments or backup withholding. This request is being made at the direction of the Wisconsin State Controller in
order that the State may update its vendor file with the most current information.
Please return or FAX the Substitute Form W-9 even if you are exempt from backup withholding within (10) days of
receipt. Please make sure that the form is complete and correct. Failure to respond in a timely manner may
subject you to a 31% withholding on each payment or require the State to withhold payment of outstanding
invoices until this information is received.
We are required to inform you that failure to provide the correct Taxpayer Identification Number (TIN) / Name
combination may subject you to a $50 penalty assessed by the Internal Revenue Service under section 6723 of the
Internal Revenue Code.
Only the individual’s name to which the Social Security Number was assigned should be entered on the first line.
The name of a partnership, corporation, club, or other entity, must be entered on the first line exactly as it was
registered with the IRS when the Employer Identification Number was assigned.
DO NOT submit your name with a Tax Identification Number that was not assigned to your name. For example, a
doctor MUST NOT submit his or her name with the Tax Identification Number of a clinic he or she is associated
with.
Thank you for your cooperation in providing us with this information.
STATE OF WISCONSIN
DOA-3027 (R01/98)
DESIGNATION OF CONFIDENTIAL AND PROPRIETARY INFORMATION
The attached material submitted in response to Bid/Proposal #DJB-1166 AODA Services Milwaukee
North includes proprietary and confidential information which qualifies as a trade secret, as provided in
s. 19.36(5), Wis. Stats., or is otherwise material that can be kept confidential under the Wisconsin Open
Records Law. As such, we ask that certain pages, as indicated below, of this bid/proposal response be
treated as confidential material and not be released without our written approval.
Prices always become public information when bids/proposals are opened, and therefore
cannot be kept confidential.
Other information cannot be kept confidential unless it is a trade secret. Trade secret is defined in s.
134.90(1)(c), Wis. Stats. as follows: "Trade secret" means information, including a formula, pattern,
compilation, program, device, method, technique or process to which all of the following apply:
1. The information derives independent economic value, actual or potential, from not being generally
known to, and not being readily ascertainable by proper means by, other persons who can obtain
economic value from its disclosure or use.
2. The information is the subject of efforts to maintain its secrecy that are reasonable under the
circumstances.
We request that the following pages not be released
Section Page # Topic
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
IN THE EVENT THE DESIGNATION OF CONFIDENTIALITY OF THIS INFORMATION IS CHALLENGED, THE
UNDERSIGNED HEREBY AGREES TO PROVIDE LEGAL COUNSEL OR OTHER NECESSARY ASSISTANCE
TO DEFEND THE DESIGNATION OF CONFIDENTIALITY AND AGREES TO HOLD THE STATE HARMLESS
FOR ANY COSTS OR DAMAGES ARISING OUT OF THE STATE'S AGREEING TO WITHHOLD THE
MATERIALS.
Failure to include this form in the bid/proposal response may mean that all information provided as part of the
bid/proposal response will be open to examination and copying. The state considers other markings of confidential
in the bid/proposal document to be insufficient. The undersigned agrees to hold the state harmless for any
damages arising out of the release of any materials unless they are specifically identified above.
Company Name ___________________________________________
Authorized Representative ___________________________________________
Signature
Authorized Representative ___________________________________________
Type or Print
Date ___________________________________________
This document can be made available in accessible formats to qualified individuals with disabilities.
State of Wisconsin Division of State Agency Services
Department of Administration State Bureau of Procurement
DOA-3333 (R03/2004)
Vendor Agreement
Wisconsin’s Cooperative Purchasing Service
Wisconsin statutes (s. 16.73, Wis. Stats.) establish authority to allow Wisconsin municipalities to purchase from state
contracts. Participating in the service gives vendors opportunities for additional sales without additional bidding.
Municipalities use the service to expedite purchases. A "municipality" is defined as any county, city, village, town, school
district, board of school directors, sewer district, drainage district, vocational, technical and adult education district, or any
other public body having the authority to award public contracts (s. 16.70(8), Wis. Stats.). Federally recognized Indian tribes
and bands in this state may participate in cooperative purchasing with the state or any municipality under ss. 66.0301(1) and
(2), Wis.Stats.
Interested municipalities:
will contact the contractor directly to place orders referencing the state agency contract number; and
are responsible for receipt, acceptance, inspection of commodities directly from the contractor, and making
payment directly to the contractor.
The State of Wisconsin is not a party to these purchases or any dispute arising from these purchases and is not liable for
delivery or payment of any of these purchases.
The State of Wisconsin will determine the contractor’s participation by checking a box below.
MANDATORY: Bidders/Proposers must agree to furnish the commodities or services of this bid/proposal to
Wisconsin municipalities. Vendors should note any special conditions below.
OPTIONAL: Bidders/Proposers may or may not agree to furnish the commodities or services of this bid/proposal to
Wisconsin municipalities. A vendor’s decision on participating in this service has no effect on awarding this
contract.
A vendor in the service may specify minimum order sizes by volume or dollar amount, additional charges beyond
normal delivery areas, or other minimal changes for municipalities.
Vendor: please check one of the following boxes in response.
I Agree to furnish the commodities or services of this bid/proposal to Wisconsin municipalities with any
special conditions noted below.
I Do Not Agree to furnish the commodities or services to Wisconsin municipalities.
Special Conditions (if applicable):
Signature Date (mm/dd/ccyy)
Name (Type or Print) Title
Company Telephone
( )
Address (Street) City State ZIP + 4
Commodity/Service Request for Bid/Proposal Number
AODA Services Milwaukee North DJB-1166
This form can be made available in accessible formats upon request to qualified individuals with disabilities.
RFB # DJB-1166 Due Date: June 1, 2007
IAODA Services Milwaukee North Page 27 of 41
9.0 TERMS AND CONDITIONS
The Standard Terms and Conditions (DOA-3054) and Supplemental Standard Terms and Conditions for
Procurements for Services (DOA-3681) are by reference made a part of this RFB. The vendor is directed to the
following paragraphs of DOA-3054 in particular, as they constitute a mandatory part of any resulting contract.
2.0 Deviations and Exceptions 19.0 Nondiscrimination/Affirmative Action
23.0 Insurance Responsibility 24.0 Cancellation
Failure of the successful bidder to accept these terms may result in cancellation of the award.
SPECIAL TERMS AND CONDITIONS
9.1 PRIME CONTRACTOR AND MINORITY BUSINESS SUBCONTRACTORS
The prime contractor will be responsible for contract performance when subcontractors are used.
However, when subcontractors are used, they must abide by all terms and conditions of the contract. If
subcontractors are to be used, the bidder must clearly explain their participation.
The State of Wisconsin is committed to the promotion of minority business in the state's purchasing
program and a goal of placing 5% of its total purchasing dollars with certified minority businesses.
Authority for this program is found in ss. 15.107(2), 16.75(4), 16.75(5) and 560.036(2), Wisconsin
Statutes. The contracting agency is committed to the promotion of minority business in the state's
purchasing program.
The State of Wisconsin policy provides that minority-owned business enterprises certified by the
Wisconsin Department of Commerce, Bureau of Minority Business Development should have the
maximum opportunity to participate in the performance of its contracts. The supplier/contractor is strongly
urged to use due diligence to further this policy by awarding subcontracts to minority-owned business
enterprises or by using such enterprises to provide goods and services incidental to this agreement, with a
goal of awarding at least 5% of the contract price to such enterprises.
The supplier/contractor shall furnish appropriate quarterly information about its effort to achieve this goal,
including the identities of such enterprises certified by the Wisconsin Department of Commerce and their
contract amount.
Quarterly reports shall be due fifteen (15) calendar days after the end of the quarter, 9/31, 12/31, 3/31 and
6/30. The form for submitting this information is available from the VendorNet on the Contract’s Home
Page. http://vendornet.state.wi.us/vendornet/doaforms/doa-3234.doc.
The report shall be submitted even if there is no activity.
Submit to:
e-mail: DOCDMSPurchasing@wisconsin.gov
post: MBE Purchasing Report
PO BOX 7991
Madison, WI 53707-7991
The State reserves the right to request additional reports from the Contractor at no additional cost.
Contractor shall use every effort to provide such reports in a reasonable timeframe, but no later than thirty
(30) calendar days from the time the request was submitted. These reports shall be in a form approved in
advance in writing by the State.
A listing of certified minority businesses, as well as the services and commodities they provide, is available
from the Department of Administration, Office of the Minority Business Program, 608/267-7806. The listing
is published on the Internet at: http://www.doa.state.wi.us/deo/mbe/minority_search.asp
RFB # DJB-1166 Due Date: June 1, 2007
IAODA Services Milwaukee North Page 28 of 41
9.2 AFFIRMATIVE ACTION
All contracts of more than Twenty Five Thousand Dollars ($25,000) require the submission of a written
affirmative action plan. Contractors with an annual workforce of less than twenty-five employees are
excluded from this requirement. Within fifteen (15) days after the award of the contract, the written
affirmative action plan, or statement requesting exception, shall be submitted to the Department’s
Contract Compliance Office. Address plan to:
Ann Hommer
Department of Corrections, Purchasing Section
3099 E. Washington Ave.
PO BOX 7991
Madison, Wisconsin 53707-7991.
Contractors are encouraged to contact this office at, (608) 240-5574, for technical assistance on equal
opportunity.
"Affirmative Action Plan" is a written document that details an affirmative action program. Key parts of an affirmative action plan
are: (1) a policy statement pledging nondiscrimination and affirmative action employment, (2) internal and external dissemination of
the policy, (3) assignment of key employee as the equal opportunity officer, (4) a workforce analysis that identifies job classification
where representation of women, minorities and the disabled is deficient, (5) goals and timetables that are specific and measurable
and that are set to correct deficiencies and to reach a balance of work force, (6) revision of all employment practices to ensure that
they do not have discriminatory effects, (7) establishment of internal monitoring and reporting systems to measure progress
regularly.
Failure to comply appropriately with these requirements can lead to your company being banned from
doing business with any agency of the State of Wisconsin. Additionally, failure to comply can result in
termination of this contract, or withholding of payment. On the Vendor Information Sheet please provide
the requested information. For additional information see section 19.0 of the Standard Terms and
Conditions.
9.3 WISCONSIN SALES AND USE TAX REGISTRATION:
The State of Wisconsin shall not enter into a contract with a vendor, and reserves the right to cancel any
existing contract if the vendor or contractor has not met or complied with the requirements of s. 77.66,
Wis. Stats., and related statutes regarding certification for collection of sales and use tax.
If you have not established a certification for Collection of Sale and Use Tax status with the Wisconsin
Department of Revenue, the DOC and any other state agency can not issue any purchase orders to your
firm. For additional information see http://www.dor.state.wi.us/html/vendlaw.html
9.4 AMERICANS WITH DISABILITY ACT
The contractor must complete or currently have on file a facility self-survey and a program and policy self-
evaluation to address compliance with the Americans With Disability Act. (Public Law 101-336, July 26,
1990, 104 Stat. 327 and Title 42, U.S.C.A., ss. 12101 to 12213). During the course of the contract, the
contractor must take action to comply with the facility, program and employment provisions of the
Americans With Disability Act. Applicants may obtain information on the Americans With Disability Act by
contacting the Director, Office of Diversity and Employee Services, Wisconsin Department of Corrections,
3099 E. Washington Ave., P.O. Box 7925, Madison, Wisconsin 53707-7925.
9.5 LIQUIDATED DAMAGES:
The contractor acknowledges that damages will be incurred by the Department, in the amount of the cost
per group multiplied by the number of groups, not to exceed one-half of the total contracts, for every
program not properly provided in accordance with the mandatory requirements of this bid. This includes
the failure to start services on scheduled date.
RFB # DJB-1166 Due Date: June 1, 2007
IAODA Services Milwaukee North Page 29 of 41
9.6 EMPLOYMENT OF CURRENT OFFENDERS AND EMPLOYMENT AND RETENTION OF INDIVIDUALS
ARRESTED, CHARGED OR CONVICTED OF CRIMINAL OFFENSES.
9.6.1 Contractor may not employ a person who is on probation, parole or an inmate who is supervised
by Intensive Sanctions for any position where the primary duties and responsibilities involve the
supervision or treatment of inmates, probationers or parolees or involve access to offenders'
records or funds.
9.6.2 Contractor will implement policies and procedures to ensure that:
9.6.2.1 Job applicants or current employees shall be dealt with as follows:
9.6.2.1.1 A job applicant who has a pending criminal charge that substantially relates to
the circumstances of a particular job or licensed activity will not be hired for that job;
9.6.2.1.2 A current employee who has a pending criminal charge that substantially relates
to the circumstances of the job or licensed activity will not be continued in that particular
job;
9.6.2.1.3 A job applicant who is convicted of a criminal offense or other offense that
substantially relates to the circumstances of a particular job or licensed activity will not be
hired for that job; and
9.6.2.1.4 A current employee who is convicted of a criminal offense or other offense that
substantially relates to the circumstances of the current job or licensed activity will not be
retained in that particular job.
9.6.2.2 Nothing in this contract prohibits the Contractor from reassigning or suspending the
employee or, in the case of a conviction, terminating the employee.
9.6.3 In hiring and retention decisions, Contractor may consider records of pending criminal charges
and convictions when it can be demonstrated that the circumstances of the offense substantially
relate to the circumstances of the job or licensed activity. When determining whether the
circumstances of a pending charge or conviction are substantially job related, Contractor should
take into consideration elements related to the position, the offense, and the individual.
9.6.4 To make determinations on substantial relationships to the circumstances of the job, Contractor
must have written policies on how the applicant for employment and the employee will be
reviewed. To guide the development of the policy, the Contractor may obtain a copy of Chapter
301 of the Department of Corrections Supervisor's Manual from the Contract Administrator.
9.7 FRATERNIZATION
9.7.1 Contractor agrees to have a written policy on fraternization which prohibits the forming of improper
relationships between Contractor's employees and offenders. The policy must be substantially
equivalent to the Department of Corrections' policy as expressed in Executive directive 16, May
1991 - Revised January 1997, Further Revised August 2004. A copy of Executive Directive 16
may be obtained from the Contract Administrator.
9.7.2 Contractor must address at the minimum the policy required in Sub. A: definitions of employee,
relationships and offender; a statement of prohibited relationships; duty of an employee to inform
Contractor of unplanned contacts with offenders; a statement that Contractor-directed contacts or
those which are part of the employee's job duties are exempt from the policy; an exception
procedure which may be carried out by the Executive Director or designee; and a standard
employee statement indicating that each employee has read a copy of the Contractor's policy on
fraternization.
9.7.3 Contractor must maintain a copy of the signed employee statement on fraternization in each
employee's personnel file.
RFB # DJB-1166 Due Date: June 1, 2007
IAODA Services Milwaukee North Page 30 of 41
9.8 CONTRACTOR AUDIT REQUIREMENT
9.8.1 9.8.1.1 Governmental entities shall comply with the Single Audit Act of 1984, OMB Circular A-128
and the State Single Audit Guidelines issued by the Department of Administration. They shall also
comply with the Department of Health and Family Services' Allowable Cost Policy Manual. Single
audit reports are due to the Department within 30 days from issuance of the report, but no later
than one year after the end of the audit period.
9.8.1.2 Non-profit agencies that have been certified under USC 501(c)(3) shall comply with OMB
Circular A-133, the Department's Contractor Agency Audit Guide, the Allowable Costs Policy
Manual and ss. 301.08. Audits are due to the Contractor within one year of the close of the
contract.
9.8.1.3 Profit agencies shall comply with the Department's Contractor Agency Audit Guide, the
Allowable Costs Policy Manual, and ss. 301.08. Audits are due to the Contractor within one year
of the close of the contract.
9.8.1.4 If a Contractor agency's audit is based on a calendar rather than state fiscal year (July 1
through June 30), the Contractor and/or auditor shall submit a worksheet which reconciles the
expenditures based on the state fiscal year and the relevant purchase orders within one year of
the close of the contract.
9.8.2 Department shall notify Contractor within 90 days of receipt of the audit completed by the
independent certified auditor, whether or not the audit meets the requirements of Department's
audit guidelines. Department shall initiate resolution of audit findings with Contractor within 180
days following notification of the audit's acceptance. If the audit is not complete or is acceptable
only in part, Department shall rely upon the acceptable portion of the audit and any additional
audit work shall build upon the work already done.
9.8.3 Department reserves the right to conduct an independent audit of Contractor if Contractor fails to
secure an audit covering all funds, or a follow-up review of selected areas is determined to be
necessary. In the event that Contractor fails to secure an audit, Department's costs for
completing an audit will be charged back to Contractor.
9.8.4 Contractor agrees that it is responsible to assure that all purchase of service contracts of $25,000
or more meet the requirements of the Office of Management and Budget Circulars A-133 and A-
128 that pertain to sub-recipient audits.
RFB # DJB-1166 Due Date: June 1, 2007
IAODA Services Milwaukee North Page 31 of 41
9.9 FAITH-BASED ORGANIZATIONS
A faith-based organization is eligible to be a contractor on the same basis as any other private
organization. If Contractor is a faith-based organization it shall retain its independence from the State of
Wisconsin, including without limitation Contractor’s control over the definition, development, practice, and
expression of its religious beliefs. Except as otherwise provided by state or federal law, Department shall
not interpret this Contract to require a faith-based organization to alter its form of internal governance or
remove religious art, icons, scriptures, or other symbols.
A religious organization does not, by contracting with the State of Wisconsin, lose the exemption provided
under Section 702 of the Civil Rights Act (42 U.S.C. 2000e-1(a)) regarding its employment practices.
Furthermore, if a faith-based organization segregates the government funds provided under the Contract,
then only the financial assistance provided by these funds will be subject to audit.
Neither Department’s selection of a faith-based contractor to provide the Services described herein nor
the expenditure of funds under this Contract is an endorsement of the Contractor’s religious character,
practices, or expression. The purpose of this Contract is the provision of Services; none of Department’s
expenditures have as their objective the funding of sectarian worship, instruction, or proselytization. As
such, a faith-based Contractor of Non-secular Services under this Contract shall post at its place(s) of
business the following written notice and personally appraise all assisted offenders of the same unless its
programming is exclusively secular and it does not display conspicuous symbols of its religious character,
practices, or expression:
Neither the State of Wisconsin’s selection of a faith-based contractor of services nor the
expenditure of funds under any contract with said contractor is an endorsement of that
contractor’s religious character, practices, or expression. No contractor of services may
discriminate against you on the basis of religion, a religious belief, or your refusal to actively
participate in a religious practice. If you object to a particular contractor because of its religious
character, you may request assignment to a different non-sectarian contractor by contacting your
Agent.
To ensure an offender is informed of the foregoing, a faith-based Contractor shall require that each
offender receiving Non-secular Services or receiving secular services in a place where the organization
displays conspicuous symbols of its religious character, practices, or expression under this Contract signs
an acknowledgment form prepared by the Contractor containing the aforementioned notice and verifying
the offender’s receipt of the same. A copy of all signed acknowledgment forms shall be promptly provided
to Department. Finally, Department will require that each offender sign the Department’s “Voluntary
Choice and Waiver” form prior to receiving any non-secular services from a faith-based Contractor under
this Contract. A faith-based Contractor agrees to refrain from providing non-secular services hereunder to
an offender until it receives a copy of a fully executed Voluntary Choice and Waiver form from Department
for that respective offender.
Wisconsin Department of Administration
Chs. 16, 19, 51
DOA-3054 (R10/2005)
Page 1 of 3
Standard Terms And Conditions
(Request For Bids / Proposals)
7.0 UNFAIR SALES ACT: Prices quoted to the State of
1.0 SPECIFICATIONS: The specifications in this request are Wisconsin are not governed by the Unfair Sales Act.
the minimum acceptable. When specific manufacturer and
model numbers are used, they are to establish a design, 8.0 ACCEPTANCE-REJECTION: The State of Wisconsin
type of construction, quality, functional capability and/or reserves the right to accept or reject any or all
performance level desired. When alternates are bids/proposals, to waive any technicality in any bid/proposal
bid/proposed, they must be identified by manufacturer, stock submitted, and to accept any part of a bid/proposal as
number, and such other information necessary to establish deemed to be in the best interests of the State of
equivalency. The State of Wisconsin shall be the sole judge Wisconsin.
of equivalency. Bidders/proposers are cautioned to avoid
bidding alternates to the specifications which may result in Bids/proposals MUST be date and time stamped by the
rejection of their bid/proposal. soliciting purchasing office on or before the date and time
that the bid/proposal is due. Bids/proposals date and time
2.0 DEVIATIONS AND EXCEPTIONS: Deviations and excep- stamped in another office will be rejected. Receipt of a
tions from original text, terms, conditions, or specifications bid/proposal by the mail system does not constitute receipt
shall be described fully, on the bidder's/proposer's letter- of a bid/proposal by the purchasing office.
head, signed, and attached to the request. In the absence
of such statement, the bid/proposal shall be accepted as in 9.0 METHOD OF AWARD: Award shall be made to the lowest
strict compliance with all terms, conditions, and specifica- responsible, responsive bidder unless otherwise specified.
tions and the bidders/proposers shall be held liable.
10.0 ORDERING: Purchase orders or releases via purchasing
3.0 QUALITY: Unless otherwise indicated in the request, all cards shall be placed directly to the contractor by an
material shall be first quality. Items which are used, authorized agency. No other purchase orders are
demonstrators, obsolete, seconds, or which have been authorized.
discontinued are unacceptable without prior written approval
by the State of Wisconsin. 11.0 PAYMENT TERMS AND INVOICING: The State of
Wisconsin normally will pay properly submitted vendor
4.0 QUANTITIES: The quantities shown on this request are invoices within thirty (30) days of receipt providing goods
based on estimated needs. The state reserves the right to and/or services have been delivered, installed (if required),
increase or decrease quantities to meet actual needs. and accepted as specified.
5.0 DELIVERY: Deliveries shall be F.O.B. destination freight Invoices presented for payment must be submitted in
prepaid and included unless otherwise specified. accordance with instructions contained on the purchase
order including reference to purchase order number and
6.0 PRICING AND DISCOUNT: The State of Wisconsin quali- submittal to the correct address for processing.
fies for governmental discounts and its educational institu-
tions also qualify for educational discounts. Unit prices shall A good faith dispute creates an exception to prompt
reflect these discounts. payment.
6.1 Unit prices shown on the bid/proposal or contract 12.0 TAXES: The State of Wisconsin and its agencies are
shall be the price per unit of sale (e.g., gal., cs., doz., exempt from payment of all federal tax and Wisconsin state
ea.) as stated on the request or contract. For any and local taxes on its purchases except Wisconsin excise
given item, the quantity multiplied by the unit price taxes as described below.
shall establish the extended price, the unit price shall
govern in the bid/proposal evaluation and contract The State of Wisconsin, including all its agencies, is
administration. required to pay the Wisconsin excise or occupation tax on
its purchase of beer, liquor, wine, cigarettes, tobacco
6.2 Prices established in continuing agreements and products, motor vehicle fuel and general aviation fuel.
term contracts may be lowered due to general market However, it is exempt from payment of Wisconsin sales or
conditions, but prices shall not be subject to increase use tax on its purchases. The State of Wisconsin may be
for ninety (90) calendar days from the date of award. subject to other states' taxes on its purchases in that state
Any increase proposed shall be submitted to the depending on the laws of that state. Contractors perform-
contracting agency thirty (30) calendar days before ing construction activities are required to pay state use tax
the proposed effective date of the price increase, and on the cost of materials.
shall be limited to fully documented cost increases to
the contractor which are demonstrated to be indus- 13.0 GUARANTEED DELIVERY: Failure of the contractor to
trywide. The conditions under which price increases adhere to delivery schedules as specified or to promptly
may be granted shall be expressed in bid/proposal replace rejected materials shall render the contractor liable
documents and contracts or agreements. for all costs in excess of the contract price when alternate
procurement is necessary. Excess costs shall include the
6.3 In determination of award, discounts for early administrative costs.
payment will only be considered when all other con-
ditions are equal and when payment terms allow at 14.0 ENTIRE AGREEMENT: These Standard Terms and
least fifteen (15) days, providing the discount terms Conditions shall apply to any contract or order awarded as
are deemed favorable. All payment terms must allow a result of this request except where special requirements
the option of net thirty (30). are stated elsewhere in the request; in such cases, the
special requirements shall apply. Further, the written
contract and/or order with referenced parts and attach-
DOA-3054
Page 2of 3
ments shall constitute the entire agreement and no other
terms and conditions in any document, acceptance, or 19.2 The contractor agrees to post in conspicuous places,
acknowledgment shall be effective or binding unless available for employees and applicants for employ-
expressly agreed to in writing by the contracting authority. ment, a notice to be provided by the contracting state
agency that sets forth the provisions of the State of
15.0 APPLICABLE LAW AND COMPLIANCE: This contract Wisconsin's nondiscrimination law.
shall be governed under the laws of the State of Wisconsin.
The contractor shall at all times comply with and observe all 19.3 Failure to comply with the conditions of this clause
federal and state laws, local laws, ordinances, and may result in the contractor's becoming declared an
regulations which are in effect during the period of this "ineligible" contractor, termination of the contract, or
contract and which in any manner affect the work or its withholding of payment.
conduct. The State of Wisconsin reserves the right to
cancel this contract if the contractor fails to follow the 20.0 PATENT INFRINGEMENT: The contractor selling to the
requirements of s. 77.66, Wis. Stats., and related statutes State of Wisconsin the articles described herein guarantees
regarding certification for collection of sales and use tax. the articles were manufactured or produced in accordance
The State of Wisconsin also reserves the right to cancel with applicable federal labor laws. Further, that the sale or
this contract with any federally debarred contractor or a use of the articles described herein will not infringe any
contractor that is presently identified on the list of parties United States patent. The contractor covenants that it will
excluded from federal procurement and non-procurement at its own expense defend every suit which shall be brought
contracts. against the State of Wisconsin (provided that such
contractor is promptly notified of such suit, and all papers
16.0 ANTITRUST ASSIGNMENT: The contractor and the State therein are delivered to it) for any alleged infringement of
of Wisconsin recognize that in actual economic practice, any patent by reason of the sale or use of such articles, and
overcharges resulting from antitrust violations are in fact agrees that it will pay all costs, damages, and profits recov-
usually borne by the State of Wisconsin (purchaser). erable in any such suit.
Therefore, the contractor hereby assigns to the State of
Wisconsin any and all claims for such overcharges as to 21.0 SAFETY REQUIREMENTS: All materials, equipment, and
goods, materials or services purchased in connection with supplies provided to the State of Wisconsin must comply
this contract. fully with all safety requirements as set forth by the
Wisconsin Administrative Code and all applicable OSHA
17.0 ASSIGNMENT: No right or duty in whole or in part of the Standards.
contractor under this contract may be assigned or dele-
gated without the prior written consent of the State of 22.0 WARRANTY: Unless otherwise specifically stated by the
Wisconsin. bidder/proposer, equipment purchased as a result of this
request shall be warranted against defects by the
18.0 WORK CENTER CRITERIA: A work center must be certi- bidder/proposer for one (1) year from date of receipt. The
fied under s. 16.752, Wis. Stats., and must ensure that equipment manufacturer's standard warranty shall apply as
when engaged in the production of materials, supplies or a minimum and must be honored by the contractor.
equipment or the performance of contractual services, not
less than seventy-five percent (75%) of the total hours of 23.0 INSURANCE RESPONSIBILITY: The contractor perform-
direct labor are performed by severely handicapped ing services for the State of Wisconsin shall:
individuals.
23.1 Maintain worker's compensation insurance as
19.0 NONDISCRIMINATION / AFFIRMATIVE ACTION: In required by Wisconsin Statutes, for all employees
connection with the performance of work under this engaged in the work.
contract, the contractor agrees not to discriminate against
any employee or applicant for employment because of age, 23.2 Maintain commercial liability, bodily injury and prop-
race, religion, color, handicap, sex, physical condition, erty damage insurance against any claim(s) which
developmental disability as defined in s. 51.01(5), Wis. might occur in carrying out this agreement/contract.
Stats., sexual orientation as defined in s. 111.32(13m), Wis. Minimum coverage shall be one million dollars
Stats., or national origin. This provision shall include, but ($1,000,000) liability for bodily injury and property
not be limited to, the following: employment, upgrading, damage including products liability and completed
demotion or transfer; recruitment or recruitment advertising; operations. Provide motor vehicle insurance for all
layoff or termination; rates of pay or other forms of owned, non-owned and hired vehicles that are used
compensation; and selection for training, including appren- in carrying out this contract. Minimum coverage shall
ticeship. Except with respect to sexual orientation, the be one million dollars ($1,000,000) per occurrence
contractor further agrees to take affirmative action to combined single limit for automobile liability and
ensure equal employment opportunities. property damage.
19.1 Contracts estimated to be over twenty-five thousand 23.3 The state reserves the right to require higher or lower
dollars ($25,000) require the submission of a written limits where warranted.
affirmative action plan by the contractor. An exemp-
tion occurs from this requirement if the contractor has 24.0 CANCELLATION: The State of Wisconsin reserves the
a workforce of less than twenty-five (25) employees. right to cancel any contract in whole or in part without
Within fifteen (15) working days after the contract is penalty due to nonappropriation of funds or for failure of the
awarded, the contractor must submit the plan to the contractor to comply with terms, conditions, and specifica-
contracting state agency for approval. Instructions tions of this contract.
on preparing the plan and technical assistance
regarding this clause are available from the
contracting state agency.
DOA-3054
Page 3of 3
25.0 VENDOR TAX DELINQUENCY: Vendors who have a 30.0 MATERIAL SAFETY DATA SHEET: If any item(s) on an
delinquent Wisconsin tax liability may have their payments order(s) resulting from this award(s) is a hazardous chemi-
offset by the State of Wisconsin. cal, as defined under 29CFR 1910.1200, provide one (1)
copy of a Material Safety Data Sheet for each item with the
26.0 PUBLIC RECORDS ACCESS: It is the intention of the shipped container(s) and one (1) copy with the invoice(s).
state to maintain an open and public process in the solicita-
tion, submission, review, and approval of procurement 31.0 PROMOTIONAL ADVERTISING / NEWS RELEASES:
activities. Reference to or use of the State of Wisconsin, any of its
departments, agencies or other subunits, or any state offi-
Bid/proposal openings are public unless otherwise speci- cial or employee for commercial promotion is prohibited.
fied. Records may not be available for public inspection News releases pertaining to this procurement shall not be
prior to issuance of the notice of intent to award or the made without prior approval of the State of Wisconsin.
award of the contract. Release of broadcast e-mails pertaining to this procurement
shall not be made without prior written authorization of the
27.0 PROPRIETARY INFORMATION: Any restrictions on the contracting agency.
use of data contained within a request, must be clearly
stated in the bid/proposal itself. Proprietary information 32.0 HOLD HARMLESS: The contractor will indemnify and
submitted in response to a request will be handled in save harmless the State of Wisconsin and all of its officers,
accordance with applicable State of Wisconsin agents and employees from all suits, actions, or claims of
procurement regulations and the Wisconsin public records any character brought for or on account of any injuries or
law. Proprietary restrictions normally are not accepted. damages received by any persons or property resulting
However, when accepted, it is the vendor's responsibility to from the operations of the contractor, or of any of its
defend the determination in the event of an appeal or contractors, in prosecuting work under this agreement.
litigation.
33.0 FOREIGN CORPORATION: A foreign corporation (any
27.1 Data contained in a bid/proposal, all documentation corporation other than a Wisconsin corporation) which
provided therein, and innovations developed as a becomes a party to this Agreement is required to conform
result of the contracted commodities or services to all the requirements of Chapter 180, Wis. Stats., relating
cannot be copyrighted or patented. All data, docu- to a foreign corporation and must possess a certificate of
mentation, and innovations become the property of authority from the Wisconsin Department of Financial
the State of Wisconsin. Institutions, unless the corporation is transacting business
in interstate commerce or is otherwise exempt from the
27.2 Any material submitted by the vendor in response to requirement of obtaining a certificate of authority. Any
this request that the vendor considers confidential foreign corporation which desires to apply for a certificate of
and proprietary information and which qualifies as a authority should contact the Department of Financial
trade secret, as provided in s. 19.36(5), Wis. Stats., Institutions, Division of Corporation, P. O. Box 7846,
or material which can be kept confidential under the Madison, WI 53707-7846; telephone (608) 261-7577.
Wisconsin public records law, must be identified on a
Designation of Confidential and Proprietary Informa- 34.0 WORK CENTER PROGRAM: The successful
tion form (DOA-3027). Bidders/proposers may bidder/proposer shall agree to implement processes that
request the form if it is not part of the Request for allow the State agencies, including the University of
Bid/Request for Proposal package. Bid/proposal Wisconsin System, to satisfy the State's obligation to
prices cannot be held confidential. purchase goods and services produced by work centers
certified under the State Use Law, s.16.752, Wis. Stat.
28.0 DISCLOSURE: If a state public official (s. 19.42, Wis. This shall result in requiring the successful bidder/proposer
Stats.), a member of a state public official's immediate to include products provided by work centers in its catalog
family, or any organization in which a state public official or for State agencies and campuses or to block the sale of
a member of the official's immediate family owns or controls comparable items to State agencies and campuses.
a ten percent (10%) interest, is a party to this agreement,
and if this agreement involves payment of more than three 35.0 FORCE MAJEURE: Neither party shall be in default by
thousand dollars ($3,000) within a twelve (12) month reason of any failure in performance of this Agreement in
period, this contract is voidable by the state unless appro- accordance with reasonable control and without fault or
priate disclosure is made according to s. 19.45(6), Wis. negligence on their part. Such causes may include, but are
Stats., before signing the contract. Disclosure must be not restricted to, acts of nature or the public enemy, acts of
made to the State of Wisconsin Ethics Board, 44 East the government in either its sovereign or contractual
Mifflin Street, Suite 601, Madison, Wisconsin 53703 capacity, fires, floods, epidemics, quarantine restrictions,
(Telephone 608-266-8123). strikes, freight embargoes and unusually severe weather,
but in every case the failure to perform such must be
State classified and former employees and certain beyond the reasonable control and without the fault or
University of Wisconsin faculty/staff are subject to separate negligence of the party.
disclosure requirements, s. 16.417, Wis. Stats.
29.0 RECYCLED MATERIALS: The State of Wisconsin is
required to purchase products incorporating recycled mate-
rials whenever technically and economically feasible.
Bidders are encouraged to bid products with recycled
content which meet specifications.
State of Wisconsin Division of Agency Services
Department of Administration Bureau of Procurement
DOA-3681 (01/2001)
ss. 16, 19 and 51, Wis. Stats.
Supplemental Standard Terms and Conditions
for Procurements for Services
1.0 ACCEPTANCE OF BID/PROPOSAL CONTENT: The con- 3.2 Contractors shall agree as part of the contract for
tents of the bid/proposal of the successful contractor will services that during performance of the contract, the
become contractual obligations if procurement action ensues. contractor will neither provide contractual services nor
enter into any agreement to provide services to a
2.0 CERTIFICATION OF INDEPENDENT PRICE person or organization that is regulated or funded by
DETERMINATION: By signing this bid/proposal, the the contracting agency or has interests that are
bidder/proposer certifies, and in the case of a joint adverse to the contracting agency. The Department
bid/proposal, each party thereto certifies as to its own organi- of Administration may waive this provision, in writing,
zation, that in connection with this procurement: if those activities of the contractor will not be adverse
to the interests of the state.
2.1 The prices in this bid/proposal have been arrived at
independently, without consultation, communication, 4.0 DUAL EMPLOYMENT: Section 16.417, Wis. Stats.,
or agreement, for the purpose of restricting competi- prohibits an individual who is a State of Wisconsin employee
tion, as to any matter relating to such prices with any or who is retained as a contractor full-time by a State of
other bidder/proposer or with any competitor; Wisconsin agency from being retained as a contractor by the
same or another State of Wisconsin agency where the
2.2 Unless otherwise required by law, the prices which individual receives more than $12,000 as compensation for
have been quoted in this bid/proposal have not been the individual’s services during the same year. This
knowingly disclosed by the bidder/proposer and will prohibition does not apply to individuals who have full-time
not knowingly be disclosed by the bidder/proposer appointments for less than twelve (12) months during any
prior to opening in the case of an advertised procure- period of time that is not included in the appointment. It does
ment or prior to award in the case of a negotiated not include corporations or partnerships.
procurement, directly or indirectly to any other
bidder/proposer or to any competitor; and 5.0 EMPLOYMENT: The contractor will not engage the services
of any person or persons now employed by the State of
2.3 No attempt has been made or will be made by the Wisconsin, including any department, commission or board
bidder/proposer to induce any other person or firm to thereof, to provide services relating to this agreement without
submit or not to submit a bid/proposal for the purpose the written consent of the employing agency of such person
of restricting competition. or persons and of the contracting agency.
2.4 Each person signing this bid/proposal certifies that: 6.0 CONFLICT OF INTEREST: Private and non-profit corpora-
He/she is the person in the bidder's/proposer's organi- tions are bound by ss. 180.0831, 180.1911(1), and 181.0831
zation responsible within that organization for the Wis. Stats., regarding conflicts of interests by directors in the
decision as to the prices being offered herein and that conduct of state contracts.
he/she has not participated, and will not participate, in
any action contrary to 2.1 through 2.3 above; (or) 7.0 RECORDKEEPING AND RECORD RETENTION: The
contractor shall establish and maintain adequate records of
He/she is not the person in the bidder's/proposer's all expenditures incurred under the contract. All records must
organization responsible within that organization for be kept in accordance with generally accepted accounting
the decision as to the prices being offered herein, but procedures. All procedures must be in accordance with
that he/she has been authorized in writing to act as federal, state and local ordinances.
agent for the persons responsible for such decisions
in certifying that such persons have not participated, The contracting agency shall have the right to audit, review,
and will not participate in any action contrary to 2.1 examine, copy, and transcribe any pertinent records or
through 2.3 above, and as their agent does hereby so documents relating to any contract resulting from this
certify; and he/she has not participated, and will not bid/proposal held by the contractor. The contractor will retain
participate, in any action contrary to 2.1 through 2.3 all documents applicable to the contract for a period of not
above. less than three (3) years after final payment is made.
3.0 DISCLOSURE OF INDEPENDENCE AND RELATIONSHIP: 8.0 INDEPENDENT CAPACITY OF CONTRACTOR: The
parties hereto agree that the contractor, its officers, agents,
3.1 Prior to award of any contract, a potential contractor and employees, in the performance of this agreement shall
shall certify in writing to the procuring agency that no act in the capacity of an independent contractor and not as
relationship exists between the potential contractor an officer, employee, or agent of the state. The contractor
and the procuring or contracting agency that interferes agrees to take such steps as may be necessary to ensure
with fair competition or is a conflict of interest, and no that each subcontractor of the contractor will be deemed to
relationship exists between the contractor and another be an independent contractor and will not be considered or
person or organization that constitutes a conflict of permitted to be an agent, servant, joint venturer, or partner of
interest with respect to a state contract. The the state.
Department of Administration may waive this provi-
sion, in writing, if those activities of the potential con-
tractor will not be adverse to the interests of the state.
EXHIBIT 1
WISCONSIN EFFECTIVE DATE
DEPARTMENT OF CORRECTIONS
Division of Community Corrections July
DOC-1356 (Rev. 05/96)
2001 PAGE 1 OF 1
MANUAL REFERENCE
New x Revision
Administrative Directive 01-10 ORIGINATED BY William J. Grosshans,
Replaces 99-15 Administrator
SUBJECT: Kerr v. Farrey
DISSEMINATION PRIORITY
X All Staff X Supervisory Staff Only X Policy / Directive Information
Discuss at Staff Meeting Read / Route / Post
The purpose of this directive is to ensure the Division of Community Corrections'
procedures comply with the decision of the United States 7t' Circuit Court of Appeals in
Kerr v. Farrey. 95 F.3d 472 (1996). In that decision, the court ruled that it was a violation
of the 1St Amendment of the United States Constitution to order an offender to attend a
treatment program with religious components. The court considered Alcoholics
Anonymous, for example, to be a program with a religious component since the program
refers to a "higher being" and to "God as we understand him."
An agent may order an offender to attend a specific secular (non-religious) treatment or
support program. An agent may not order an offender to attend a specific program with a
religious component. An offender may voluntarily participate in a treatment or
support program with a religious component as long as a non-religious program is
offered.
An agent may write a rule requiring an offender to attend and complete AODA treatment
without naming a specific program. An agent may also provide an offender with a list of
acceptable programs, as long as both secular and non-secular options are clearly
identified. If an offender chooses to participate in a program having a religious
component, the agent should document in the Chronological Log that a secular program
was offered.
________________________________
William J. Grosshans
Administrator
cc - DCC Administrative Directive Group
Executive Staff
EXHIBIT 2
DEPARTMENT OF CORRECTIONS WISCONSIN
Division of Community Corrections
DOC-1336 (Rev. 11/2006)
REFERRAL FOR SERVICES
PART A REFERRAL FOR SERVICES To be Completed by Referral Agent
PROGRAM NAME PROGRAM LOCATION
REFERRAL DATE (Month/Day/Year) PROJECTED ELIGIBILITY DATE FOR SERVICES (Month/Day/Year)
AGENT NAME AGENT ADDRESS
AGENT TELEPHONE NUMBER (Include Area Code) AGENT AREA NUMBER
REFERRAL TYPE
ALTERNATIVE TO REVOCATION (ATR) RESPONSE TO VIOLATION (NOT AN ATR)
COURT-ORDERED CONDITION PAROLE/ES CONDITION OTHER - SPECIFY:
SERVICES REQUEST (Check All That Apply)
Anger Management Domestic Violence Services Sex Offender Treatment Group
AODA Group Services Education Services Transitional Living Program
AODA Aftercare Services Emergency Housing Other (Specify)
AODA Assessment/Evaluation Employment Services
AODA Intensive Nonresidential Groups Family/Parenting Services
AODA Relapse Prevention/Aftercare Halfway House (CBRF)
Case Management Sex Offender Assessment/Evaluation
Cognitive Interventions Groups Sex Offender Denial Focus Group
Crisis Intervention Sex Offender Education Group
Day Report Services Sex Offender Relapse Prevention/Aftercare
OFFENDER LAST NAME (As Shown on Court Order) FIRST MI DOC NUMBER
DOB SEX RACE
Male Female
OFFENDER CURRENT ADDRESS
OFFENDER TELEPHONE NUMBER (Include Area Code)
MARITAL STATUS
Single, never married Married Separated Widow/Widower Divorced
OFFENDER STATUS AT TIME OF REFERRAL
Probation Parole Extended Supervision 980 Case NGI
Felony Misdemeanor SUPERVISION DISCHARGE DATE
Habitual Deferred Prosecution One Year or Less Probation
Reentry from Jail Reentry from Prison Reentry from DAI ATR
DOES INDIVIDUAL HAVE OUTSTANDING WARRANT OR PENDING CHARGES?
Yes No - If Yes, Explain:
REASON FOR REFERRAL (List Problems Behaviors Evidenced By Offender And Specific Services Requested)
SPECIAL NEEDS (Check All Relevant Categories)
Yes No Yes No
Alcohol Problems History of Violence, attach description.
Drug Problems (Specify) History of Committing Sexual Assaults
Health Problems (Specify) Mental Health Problems (Specify)
Pregnant Relationship Problems
Developmental or Learning Disabilities OTHER (Specify)
Financial Management Problems
EXHIBIT 2
IS OFFENDER TAKING MEDICATION?
Yes No - If Yes , List Reason: Prescription Self-Pay Insurance
EDUCATIONAL ACHIEVEMENT
Highest Grade Level Achieved
THIS REFERRAL MUST INCLUDE THE FOLLOWING INFORMATION:
Authorization for Use and Disclosure of Protected Health Information (DOC-1163A)
Only required for information that involves personal health information, medical, mental health, AODA, or other confidential or services.
Court Order, Criminal Complaint and Prior Record
Social Information (DOC-179)
Violation Report(s), if applicable.
Information in Regard to Alcohol, other Drug Problems and Prior Treatment Experience, if applicable.
INSTRUCTIONS: Attach Part A and Part B to your agency’s “Offender Report Form Monthly" (DOC-386, DOC-1088A and DOC-1088) for each new intake
and each offender who re-enters your program.
PART B INTAKE DECISION
To Be Completed by Provider Agency for Offender Entering or Re-entering The Program
OFFENDER ACCEPTANCE / PROGRAM RETURN (Check Appropriate Box, Enter Appropriate Data)
Offender accepted as new intake
Offender returned to enter program
RECOMMENDED PROGRAM
START DATE PROJECTED DISCHARGE DATE
REJECTION
OFFENDER REJECTED - FOR WHAT REASON (Specify):
EXHIBIT 3
DEPARTMENT OF CORRECTIONS WISCONSIN
Division of Community Corrections
DOC1088 (Rev. 2/97)
OFFENDER REPORT – MONTHLY
COMMUNITY - BASED PROGRAMS and SERVICES
AGENCY NAME TELEPHONE NUMBER PURCHASE ORDER NUMBER
PROGRAM NAME FEDERAL FUNDS
Yes No
REPORT COMPLETED BY (Signature / Title) DATE SIGNED REPORT REVIEWED BY DPP STAFF (Signature) DATE SIGNED
INSTRUCTIONS: Use this form for all Community-based programs and services except Halfway House, use DOC-386 and Day Treatment, use DOC-1088A. Letters A through F must be completed; all other columns REPORTING PERIOD
may be required in accordance with the agency’s contract/grant agreement or at the direction of the Contract Administrator. All columns which require a code are noted by an asterisk. All codes for the completion of this form
are listed on the back of the form. If the Region needs assistance in developing the code for additional items, please contact the Adult Services Specialist at (608) 266-3989. (Month/Year)
A B C D E* F G* H
OFFENDER AGENT ADMISSION TYPE OF STATUS OFFENDER
I J K L
OFFENDER NAME NUMBER AREA NO. DATE SERVICE SERVICE DATE OR DATES Discharge FEES
Date Code COLLECTED
THIS MONTH
M Total Number of Offenders N Total Units Provided* O Are Alcohol and Other Drug Abuse Services Provided Under This Contract/Grant YES
NO
P Other Information
EXHIBIT 3
Discharge Codes
Used For All
These codes are used in column “G” STATUS Discharge Date / Code of all billing forms including the TLP
Billing.
(01) Continues in Program.
(02) Completed Service: Significant improvement in most or all areas has occurred and
the offender is approaching or has attained full recovery (Good).
(03) Completed Service: Improvement in some areas has occurred but the degree of
improvement is minimal (Fair).
(04) Completed Service: No positive change has occurred (Poor).
(05) Referred to another agency.
(06) Behavioral Termination: Staff / Program decision to terminate due to breaking
internal program rules.
(07) Withdrew against staff advice.
(08) Funding / Authorization Expired (service not completed).
(09) Program Hold: When offender is temporarily not involved in service. Each
program hold incident must be 30 days or less.
(10) Positive urinalysis screen, positive breathalyzer test or other indication of drugs.
(11) Absconding
(12) Rules Violation: Other than drug / alcohol or absconding.
(13) New Offense
(14) Hospitalized
(15) Death
(16) Other (specify in Field P “Other Information” at bottom of form.
EXHIBIT 4
DEPARTMENT OF CORRECTIONS WISCONSIN
Division of Community Corrections Wisconsin Statutes
DOC-1026 (Rev. 2/97) Section 301.08
UNIT SERVICE
MONTHLY REPORT
AGENCY NAME VENDOR ID NUMBER PURCHASE ORDER NUMBER
PROGRAM NAME TELEPHONE NUMBER
DOC CONTACT SIGNATURE REPORTING PERIOD (Month / Year)
As the authorized representative of the above named agency, I request that my
agency is reimbursed for units of service provided to eligible Correctional offenders.
UNIT OF SERVICE(S) PROVIDED
UNIT NUMBER OF COST PER TOTAL
DESCRIPTION UNITS UNIT
Less Billing to Other Agencies -
Less Offender Fees Collected -
NET REIMBURSABLE =
I understand that my agency is required to submit a Offender Monthly Report within
30 days after the final day of the month for which this Unit Service Report is due.
I certify that the unit of services indicated for claiming State reimbursement are just,
true and correct in the amount stated and have not been reimbursed, and represent
actual services delivered and reimbursable under the laws, rules and regulation of the
Wisconsin Department of Corrections.
CONTRACTOR AGENCY CONTACT SIGNATURE DATE SIGNED
DISTRIBUTION: Submit original and 2 copies to Grant/Contract Administrator
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