REQUEST FOR PROPOSAL JOB NO.: 06/0400
Date Due: NOVEMBER 20, 2006
Cover Sheet DUE NO LATER THAN 2:00 P.M.
LOCAL TIME IN HOUSTON, TEXAS
Proposals received later than the date
and time above will not be considered.
PROPOSAL FOR: Provide Application Development, Maintenance and Support for the Ryan
White CARE Act Title I Funded Centralized Patient Care Data Management System (CPCDMS)
for Harris County Public Health and Environmental Services.
Carefully read all instructions, requirements and Please return proposal in an appropriately sized
specifications. Fill out all forms properly and envelope or box. PACKAGE MUST SHOW THE JOB
completely. Submit your proposal with all appropriate NUMBER, DESCRIPTION AND BE MARKED
supplements and/or samples. "SEALED PROPOSAL".
RETURN PROPOSAL TO:
HARRIS COUNTY PURCHASING AGENT
1001 PRESTON AVENUE, SUITE 670
HOUSTON, TEXAS 77002
For additional information, contact Debbie Lasker @ 713-755-5743 or firstname.lastname@example.org
You must sign below in INK; failure to sign WILL disqualify the offer. All prices must be typewritten or written
Total Amount of Proposal $
City, State, Zip Code:
Taxpayer Identification Number (T.I.N.):
Telephone No. : FAX No.: e-mail:
Page 1 of 38
INTENT TO RESPOND
TO: Debbie Lasker at (713) 755-5743
FROM: _____________________________ (company name)
_____________________________ (street address)
_____________________________ (city, state, zip)
_____________________________ (contact name/phone#)
RE: Vendor’s intent to respond to Job #06/0400 RFP to Provide Application Development,
Maintenance and Support for the Ryan White CARE Act Title I Funded Centralized Patient Care
Data Management System (CPCDMS) for Harris County Public Health and Environmental
In order that Harris County may assess potential vendor’s interest in this job, please check one of the below and
fax form to (713) 755-6695. Thank you.
Our company intends to respond to this job ______________
Our company declines to respond to this job _____________
Optional: Reason for declining ________________________
Declining to respond will not eliminate the vendor from future consideration to jobs with Harris County.
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TABLE OF CONTENTS
Items checked below represent components which comprise this bid/proposal package. If the item IS NOT checked, it is NOT
APPLICABLE to this bid/proposal. Offerors are asked to review the package to be sure that all applicable parts are included. If any
portion of the package is missing, notify the Purchasing Department immediately.
It is the Offeror's responsibility to be thoroughly familiar with all Requirements and Specifications. Be sure you understand the following
before you return your bid packet.
__X__ 1. Cover Sheet
Your company name, address, the total amount of the bid/proposal, and your signature (IN INK) should appear on this
__X__ 2. Table of Contents
This page is the Table of Contents.
__X__ 3. General Requirements
You should be familiar with all of the General Requirements.
__X__ 4. Special Requirements/Instructions
This section provides information you must know in order to make an offer properly.
__X__ 5. Specifications
This section contains the detailed description of the product/service sought by the County.
__X__ 6. Pricing/Delivery Information
This form is used to solicit exact pricing of goods/services and delivery costs.
__X__ 7. Attachments
__X__ a. Residence Certification/Tax Form
Be sure to complete this form and return with packet.
_____ b. Bid Guaranty & Performance Bond Information & Requirements
This form applies only to certain bids/proposals. All public work contracts over $25,000 require a
Payment Bond and over $100,000 must also have a Performance Bond, in a form approved by the
County. Please read carefully and fill out completely.
_____ c. Bid Check Return Authorization Form
This form applies only to certain bids/proposals. Please read carefully and fill out completely.
_____ d. Vehicle Delivery Instructions
Included only when purchasing vehicles.
_____ e. Minimum Insurance Requirements
(Included in specific requirements when applicable (does not supersede ―Hold Harmless‖ section of
_____ f. Worker’s Compensation Insurance Coverage Rule 110.110
This requirement is applicable for a building or construction contract.
_____ g. Financial Statement
When this information is required, you must use this form.
_____ h. Reference Sheet
When this information is required, you must use this sheet.
_____ i. Other
From time to time other attachments may be included.
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GENERAL REQUIREMENTS FOR PROPOSALS
READ THIS ENTIRE DOCUMENT CAREFULLY. FOLLOW ALL INSTRUCTIONS. YOU ARE RESPONSIBLE
FOR FULFILLING ALL REQUIREMENTS AND SPECIFICATIONS. BE SURE YOU UNDERSTAND THEM.
General Requirements apply to all advertised requests for proposals; however, these may be superseded, whole or in part, by
the SPECIAL REQUIREMENTS/INSTRUCTIONS OTHER DATA CONTAINED HEREIN. Review the Table of Contents.
Be sure your proposal package is complete.
ACCESS TO RECORDS
In special circumstances, vendor may be required to allow duly authorized representatives of Harris County, the Harris
County Hospital District or the state and federal government access to contracts, books, documents, and records necessary
to verify the nature and extent of the cost of services provided by vendor.
When specifications are revised, the Harris County Purchasing Agent will issue an addendum addressing the nature of the
change. Offerors must sign it and include it in the returned proposal package.
The successful offeror may not assign, sell, or otherwise transfer this contract without written permission of Harris County
Harris County reserves the right to award this contract on the basis of LOWEST AND BEST OFFER in accordance with the
laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one offeror, to reject any or all
proposals. In the event the lowest dollar offeror meeting specifications is not awarded a contract, the offeror may appear
before the Commissioners Court, Hospital District Board of Managers, the Juvenile Board or other applicable governing body
and present evidence concerning his responsibility after officially notifying the Office of the Purchasing Agent of his intent to
If this proposal requires submission of proposal guarantee and performance bond, there will be a separate page explaining
those requirements. Offers submitted without the required proposal bond or Cashier's Check is not acceptable.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION INELIGIBILITY, AND VOLUNTARY
The Contractor certifies by execution of this Contract that it is not ineligible for participation in federal or state assistance
programs under Executive Order 12549, "Debarment and Suspension." The Contractor further agrees to include this
certification in all contracts between itself and any subcontractors in connection with the services performed under this
Contract. Contractor also certifies that contractor will notify Harris County in writing immediately if contractor is not in
compliance with Executive Order 12549 during the term of this contract. Contractor agrees to refund Harris County for
any payments made to the contractor while ineligible.
Harris County Commissioners Court must award the contract and the County Judge or other person authorized by the Harris
County Commissioners Court must sign the contract before it becomes binding on Harris County or the offeror. Department
heads are NOT authorized to sign agreements for Harris County. Binding agreements shall remain in effect until all products
and/or services covered by this purchase have been satisfactorily delivered and accepted.
Renewals may be made ONLY by written agreement between Harris County and the offeror. Any price escalations are
limited to those stated by the offeror in the original proposal.
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If offeror obtained the proposal specifications in digital format in order to prepare a response, the proposal must be
submitted in hard copy according to the instructions contained in this proposal package. If, in its proposal response,
offeror makes any changes whatsoever to the County's published proposal specifications, the County's proposal
specifications as published shall control. Furthermore, if an alteration of any kind to the County's published proposal
specifications is only discovered after the contract is executed and is or is not being performed, the contract is subject to
DISQUALIFICATION OF OFFEROR
Upon signing this proposal document, an offeror offering to sell supplies, materials, services, or equipment to Harris
County certifies that the offeror has not violated the antitrust laws of this state codified in §15.01, et seq., Business &
Commerce Code, or the federal antitrust laws, and has not communicated directly or indirectly the offer made to any
competitor or any other person engaged in such line of business. Any or all proposals may be rejected if the County
believes that collusion exists among the offerors. Proposals in which the prices are obviously unbalanced may be rejected.
If multiple proposals are submitted by an offeror and after the proposals are opened, one of the proposals is withdrawn, the
result will be that all of the proposals submitted by that offeror will be withdrawn; however, nothing herein prohibits a
vendor from submitting multiple offers for different products or services.
E-MAIL ADDRESSES CONSENT
Vendor affirmatively consents to the disclosure of its e-mail addresses that are provided to Harris County, the Harris
County Flood Control District, the Harris County Hospital District including its HMO, the Harris County Appraisal
District, or any agency of Harris County. This consent is intended to comply with the requirements of the Texas Public
Information Act, Tex. Gov’t Code Ann. §522.137, as amended, and shall survive termination of this agreement. This
consent shall apply to e-mail addresses provided by Vendor, its employees, officers, and agents acting on Vendor’s behalf
and shall apply to any e-mail address provided in any form for any reason whether related to this bid/proposal or otherwise.
Evaluation shall be used as a determinant as to which proposed items or services are the most efficient and/or most economical
for the County. It shall be based on all factors which have a bearing on price and performance of the items in the user
environment. All proposals are subject to negotiations by the Purchasing Agent and other appropriate departments, with
recommendation to the appropriate governing body. Compliance with all requirements, delivery and needs of the using
department are considerations in evaluating proposals. Pricing is NOT the only criteria for making a recommendation. A
preliminary evaluation by Harris County will be held and appropriate proposals will be subjected to the negotiating process.
Upon completion of the negotiations, Harris County will make an award. All proposals that have been submitted shall be
available and open for public inspection after the contract is awarded except for trade secrets or confidential information
contained in the proposals and identified as such.
A multi-year lease or lease/purchase arrangement (if requested by the specifications), or any contract continuing as a result of
an extension option, must include fiscal funding out. If, for any reason, funds are not appropriated to continue the lease or
contract, said lease or contract shall become null and void on the last day of the current appropriation of funds. After
expiration of the lease, leased equipment shall be removed by the contractor from the using department without penalty of any
kind or form to Harris County. All charges and physical activity related to delivery, installation, removal and redelivery shall
be the responsibility of the offeror.
In the event of any conflict between the terms and provisions of these requirements and the specifications, the specifications
shall govern. In the event of any conflict of interpretation of any part of this overall document, Harris County's interpretation
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This request for proposals is governed by the competitive bidding requirements of the County Purchasing Act, Texas Local
Government Code, §262.021 et seq., as amended. Offerors shall comply with all applicable federal, state and local laws and
regulations. Offeror is further advised that these requirements shall be fully governed by the laws of the State of Texas and
that Harris County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County
Attorney concerning any portion of these requirements.
Any contract entered into by the County that is to be paid from grant funds shall be limited to payment from the grant
funding and the vendor/provider understands that the County has not set aside any County funds for the payment of
obligations under a grant contract. If grant funding should become unavailable at any time for the continuation of services
paid for by the grant, and further funding cannot be obtained for the contract, then the sole recourse of the provider shall
be to terminate any further services under the contract and the contract shall be null and void.
Offeror agrees to comply with the Standards for Privacy of Individually Identifiable Health Information of the Health
Insurance Portability and Accountability Act of 1996, PL 104-191, 45 CFR Parts 160-164, as amended, and the Texas
Medical Records Privacy Act, Texas Health and Safety Code Chapter 181, as amended, collectively referred to as
"HIPAA", to the extent that the Offeror uses, discloses or has access to protected health information as defined by HIPAA.
Offeror may be required to enter a Business Associate Agreement pursuant to HIPAA.
HOLD HARMLESS AGREEMENT
Contractor, the successful offeror, shall indemnify and hold Harris County harmless from all claims for personal injury, death
and/or property damage resulting directly or indirectly from contractor's performance. Contractor shall procure and maintain,
with respect to the subject matter of this proposal, appropriate insurance coverage including, as a minimum, public liability
and property damage with adequate limits to cover contractor's liability as may arise directly or indirectly from work
performed under terms of this proposal. Certification of such coverage must be provided to the County upon request.
INSPECTIONS & TESTING
Harris County reserves the right to inspect any item(s) or service location for compliance with specifications and
requirements and needs of the using department. If an offeror cannot furnish a sample of a bid item, where applicable, for
review, or fails to satisfactorily show an ability to perform, the County can reject the bid as inadequate.
INVOICES AND PAYMENTS
Offerors shall submit an original invoice on each purchase order or purchase release after each delivery, indicating the
purchase order number. Invoices must be itemized. Any invoice which cannot be verified by the contract price and/or is
otherwise incorrect will be returned to the offeror for correction. Under term contracts, when multiple deliveries and/or
services are required, the offeror may invoice following each delivery and the County will pay on invoice. Contracts
providing for a monthly charge will be billed and paid on a monthly basis only. Prior to any and all payments made for
goods and/or services provided under this contract, the offeror should provide his Taxpayer Identification Number or social
security number as applicable. This information must be on file with the Harris County Auditor’s office. Failure to
provide this information may result in a delay in payment and/or back-up withholding as required by the Internal Revenue
Maintenance required for equipment proposed should be available in Harris County by a manufacturer-authorized
maintenance facility. Costs for this service shall be shown on the Pricing/Delivery Information. If Harris County opts to
include maintenance, it shall be so stated in the purchase order and said cost will be included. Service will commence only
upon expiration of applicable warranties and should be priced accordingly.
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MATERIAL SAFETY DATA SHEETS
Under the "Hazardous Communication Act", commonly known as the "Texas Right To Know Act", an offeror must provide to
the County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act.
Failure of the offeror to furnish this documentation will be cause to reject any bid applying thereto.
NEW MILLENIUM COMPLIANCE
All products and/or services furnished as part of this contract must be compliant for the present year and forward. This
applies to all computers including hardware and software as well as all other commodities with date sensitive embedded
POTENTIAL CONFLICTS OF INTEREST
An outside consultant or contractor is prohibited from submitting a proposal for services on a Harris County project of
which the consultant or contractor was a designer or other previous contributor, or was an affiliate, subsidiary, joint
venturer or was in any other manner associated by ownership to any party that was a designer or other previous contributor.
If such a consultant or contractor submits a prohibited proposal, that proposal shall be disqualified on the basis of conflict
of interest, no matter when the conflict is discovered by Harris County. Potential proposers are advised that they may have
disclosure requirements pursuant to Texas Local Government Code, Chapter 176. This law requires persons desiring to do
business with the County to disclose any gifts valued in excess of $250 given to any County Official or the County
Official’s family member, or employment of any County Official or the County Official’s family member during the
preceding twelve (12) month period. The disclosure questionnaire must be filed with the Harris County Clerk. Refer to
Texas Local Government Code, Chapter 176 for the details of this law.
Prices for all goods and/or services shall be negotiated to a firm amount for the duration of this contract or as agreed to in
terms of time frame. All prices must be written in ink or typewritten. Where unit pricing and extended pricing differ, unit
Fill out and return to Purchasing, ONE (1) complete proposal form in an appropriately sized envelope or box. PACKAGE
MUST SHOW THE JOB NUMBER, DESCRIPTION AND BE MARKED ―SEALED PROPOSAL.‖ An authorized
company representative should sign the Proposal Cover Sheet. Completion of these forms is intended to verify that the offeror
has submitted the proposal, is familiar with its contents and has submitted the material in accordance with all requirements.
Offerors must return all completed proposals to the office of the Harris County Purchasing Agent reception desk at 1001
Preston Avenue, Suite 670, Houston, Texas before 2:00 P.M. LOCAL TIME IN HOUSTON, TEXAS on the date
specified. Late proposals will not be accepted.
PURCHASE ORDER AND DELIVERY
The successful offeror shall not deliver products or provide services without a Harris County Purchase Order, signed by an
authorized agent of the Harris County Purchasing Agent. The fastest, most reasonable delivery time shall be indicated by the
offeror in the proper place on the proposal document. Any special information concerning delivery should also be included,
on a separate sheet, if necessary. All items shall be shipped F.O.B. INSIDE DELIVERY unless otherwise stated in the
specifications. This shall be understood to include bringing merchandise to the appropriate room or place designated by the
using department. Every tender or delivery of goods must fully comply with all provisions of these requirements and the
specifications including time, delivery and quality. Nonconformance shall constitute a breach which must be rectified prior to
expiration of the time for performance. Failure to rectify within the performance period will be considered cause to reject
future deliveries and cancellation of the contract by Harris County without prejudice to other remedies provided by law.
Where delivery times are critical, Harris County reserves the right to award accordingly.
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Harris County encourages the use of products made of recycled materials and shall give preference in purchasing to products
made of recycled materials if the products meet applicable specifications as to quantity and quality. Harris County will be the
sole judge in determining product preference application.
If any section, subsection, paragraph, sentence, clause, phrase or word of these requirements or the specifications shall be held
invalid, such holding shall not affect the remaining portions of these requirements and the specifications and it is hereby
declared that such remaining portions would have been included in these requirements and the specifications as though the
invalid portion had been omitted.
SILENCE OF SPECIFICATIONS
The apparent silence of specifications as to any detail, or the apparent omission from it of a detailed description concerning
any point, shall be regarded as meaning that only the best commercial practice is to prevail and that only material and
workmanship of the finest quality are to be used. All interpretations of specifications shall be made on the basis of this
statement. The items furnished under this contract shall be new, unused of the latest product in production to commercial
trade and shall be of the highest quality as to materials used and workmanship. Manufacturer furnishing these items shall be
experienced in design and construction of such items and shall be an established supplier of the item proposed.
Offerors are responsible for including all pertinent product data in the returned proposal package. Literature, brochures, data
sheets, specification information, completed forms requested as part of the proposal package and any other facts which may
affect the evaluation and subsequent contract award should be included. Materials such as legal documents and contractual
agreements, which the offeror wishes to include as a condition of the proposal, must also be in the returned proposal package.
Failure to include all necessary and proper supplemental materials may be cause to reject the entire proposal.
Harris County is exempt from all federal excise, state and local taxes unless otherwise stated in this document. Harris County
claims exemption from all sales and/or use taxes under Texas Tax Code §151.309, as amended. Texas Limited Sales Tax
Exemption Certificates will be furnished upon written request to the Harris County Purchasing Agent.
If the contract is intended to cover a specific time period, the term will be given in the specifications under SCOPE.
Harris County reserves the right to terminate the contract for default if Seller breaches any of the terms therein, including
warranties of offeror or if the offeror becomes insolvent or commits acts of bankruptcy. Such right of termination is in
addition to and not in lieu of any other remedies which Harris County may have in law or equity. Default may be construed
as, but not limited to, failure to deliver the proper goods and/or services within the proper amount of time, and/or to properly
perform any and all services required to Harris County's satisfaction and/or to meet all other obligations and requirements.
Harris County may terminate the contract without cause upon thirty (30) days written notice.
Harris County reserves the right to test equipment, supplies, material and goods proposed for quality, compliance with
specifications and ability to meet the needs of the user. Demonstration units must be available for review. Should the goods
or services fail to meet requirements and/or be unavailable for evaluation, the offer is subject to rejection.
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Title and Risk of Loss of goods shall not pass to Harris County until Harris County actually receives and takes possession of
the goods at the point or points of delivery. Receiving times may vary with the using department. Generally, deliveries may
be made between 8:30 a.m. and 4:00 p.m., Monday through Friday. Offerors are advised to consult the using department for
instructions. The place of delivery shall be shown under the "Special Requirements/Instructions" section of this proposal
and/or on the Purchase Order as a "Deliver To:" address.
WAIVER OF SUBROGATION
Offeror and offeror's insurance carrier waive any and all rights whatsoever with regard to subrogation against Harris County as
an indirect party to any suit arising out of personal or property damages resulting from offeror's performance under this
Offerors shall furnish all data pertinent to warranties or guarantees which may apply to items in the proposal. Offerors may
not limit or exclude any implied warranties. Offeror warrants that product sold to the County shall conform to the standards
established by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970. In the event product does
not conform to OSHA Standards, where applicable, Harris County may return the product for correction or replacement at the
offeror's expense. If offeror fails to make the appropriate correction within a reasonable time, Harris County may correct at
the offeror's expense.
VENDORS OWING TAXES
Pursuant to TX Local Government Code 262.0276, Harris County Commissioners Court has adopted a policy which
requires that vendors’ taxes be current as of the date bids/proposals are due. Bidders with delinquent taxes on the due date
will not be eligible for award. Whether or not a vendor’s taxes are delinquent will be determined by an independent review
of the Tax Office records. Vendors who believe a delinquency is reflected in error must contact the Tax Office to correct
any errors or discrepancies prior to submitting their bid in order to ensure that their bid will be considered. Tax records are
available online at the Tax Office website—www.hctax.net. Prior to submitting a bid, vendors are encouraged to visit the
Tax Office website, set up a portfolio of their accounts and make their own initial determination of the status of their tax
accounts. Furthermore, if, during the performance of this contract, a vendor’s taxes become delinquent, Harris County
reserves the right to provide notice to the Auditor or Treasurer pursuant to Texas Local Government Code §154.045. This
policy is effective for all bids due on or after May 1, 2004.
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This document is an alternative competitive proposal as specified in LGC 262.030.
All documents will be held by the County and are NOT subject to public review until the negotiating process is
completed and an award made. A preliminary evaluation by Harris County will be held. Appropriate proposals will
be subjected to review and may go through negotiating process.
After award by Commissioners Court, proposals will be made public.
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Term Contract to Provide Quality Management – CPCDMS Data System Development, Maintenance and Support.
Where these specific requirements differ from the preceding General Requirements, these specific requirements will
control. If you need additional information, contact Debbie Lasker at (713) 755-5743. Specifications are in
accordance with the requirements of the Ryan White C.A.R.E. Act.
The following statement is made in accordance with the FY 1995 Appropriations Act (P.L.103-333). All funds
being offered in this Request for Proposal (RFP) are 100% Ryan White C.A.R.E. Act funds with no contribution of
any non-Federal funds required of the vendor, although subsequent to any award made to the vendor resulting from
this RFP the vendor will be required to document, in a manner acceptable to the County, the total cost of the project,
the amount and percentage financed by federal money and the amount and percentage financed by non-governmental
A Pre-Proposal Conference will be held November 2, 2006 from 2:00 to 3:00 pm in the Harris County Public Health
and Environmental Services Building, 4th floor, Room 416, located at 2223 W. Loop South, Houston, TX 77027.
Attendance is not mandatory, however it is highly recommended that vendors attend in order to discuss and clarify
the Request for Proposal (RFP) requirements and answer vendor questions regarding the proposal review and award
process. Persons with disabilities requiring special accommodations please contact Gail LeBlanc at (713) 439-6039
I. SUBMISSION INSTRUCTIONS
Proposals must be formatted as follows:
Applications must be in English;
All copies of the proposal should be individually held together by a metal binding clip or be bound
(binding is not required);
Use standard size black font that is not smaller than 11 points nor larger than 12 points (colored font is not
Use 8.5 inch x 11 inch paper that can be photocopied;
Top, bottom, left and right margins may not be less than 1 inch each;
Text may be single or 1.5 spaced;
Do not submit double-sided copies;
Do not use photo-reduction;
Do not include photos, pamphlets, brochures, or over-sized documents;
A complete description of all the services the vendor will provide together with all the forms completed and in the
proper order, adequate documentation that the vendor meets the agency qualifications and requirements, cost for unit
of service, etc. will comprise the vendor’s proposal. All signature pages in the document must also be signed. It is
the vendor’s responsibility to adequately identify and define their qualifications and capabilities with regard to
meeting the requirements in this RFP including those that are specific to the Service Category under which the
response is submitted.
Vendor’s proposal must offer substantial assurance that all goals and requirements will be reached and maintained
by your organization. All vendors must respond to items listed below and are encouraged to supply all other
relevant information as Appendices. Narrative answers/statements must be self explanatory and understandable to
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members of the review panel who may read, evaluate and score your proposal. Assume that these individuals are
unfamiliar with your agency and its activities.
The complement of forms included with this RFP must be completed and submitted in the proper order. All vendors
should address each of the forms by filling out each one with the appropriate, detailed information required by the
form. Omission of any or all forms may be cause to reject your proposal in its entirety. If, for some reason, the
form does not apply to your response, you must note that decision on your copy of the form and include it in your
The vendor is responsible for making additional copies required in order to fulfill the RFP requirements. Original
and copies must be secured individually with a single binder clip for each. SUBMIT ONE (1) SIGNED
ORIGINAL AND FIVE (5) COPIES. All signatures for all forms throughout this package must be original
on the one (1) proposal marked, "ORIGINAL". If you need to use an envelope other than the one supplied or a
small box to submit your sealed proposal, please include the job number, due date and your company name on the
outside of the envelope or box.
Completed proposals must be clocked in at the Harris County Purchasing Department; 1001 Preston Ave., Suite
670; Houston, Texas 77002 on the date and time specified on the cover sheet. On that date, proposals will be
opened. Under the Request For Proposal process, sealed offers will be received and opened in the Purchasing
Department and considered confidential until an award is made. Neither information nor copies of proposals will
be available to anyone other than Harris County and the Review Committee until a formal award is made by
Commissioners Court. All proposals shall be available for public inspection under the Open Records Act after all
contracts are awarded. Please call the Purchasing Department to make an Open Records Act request.
II. EVALUATION CRITERIA AND AWARD PROCESS
The following guidelines will be used in the Evaluation/Award process.
A. Submit your best proposal initially. A technical review will be conducted by Harris County to ensure all
proposals contain the required documentation and are in conformance with the requirements set forth herein.
B. A Review Committee convened by Harris County HCPHES/HIV Services will score acceptable proposals
based on the information supplied in the vendor’s proposal, a vendor presentation, if requested, and the
following evaluation criteria: 100 Total Points (see point distribution below). Submission of a proposal
implies vendor’s acceptance of the evaluation criteria and vendor recognition that subjective judgments must
be made by reviewers.
C. Award of contracts shall be made to responsible vendor, whose proposal is determined to be the highest
scored proposal meeting all other requirements and best meeting the county’s needs for that service category.
D. No award or acquisition can be made until Commissioners Court approves such action. No County funds
will be expended for contracts resulting from this RFP. All contracts resulting from this RFP will be funded
contingent upon funds allocated and received by the County from HRSA under a federal grant awarded to
The Evaluation Criteria follows:
All proposals MUST be submitted in the order listed below.
A. Request For Proposal Cover Sheet (Enclosed in RFP)
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B. Residence Certification (Enclosed in RFP)
C. Signed Assurances Form I (Enclosed in RFP Forms Section)
D. Signed Certification Concerning Lobbying (Enclosed in RFP Forms Section)
E. Signed Compliance with Americans With Disabilities Act of 1990 (Enclosed in RFP
F. Assurance - Non-Construction Programs (s-424B) (Enclosed in RFP Forms
G. Respondent Certification (Enclosed in RFP Forms Section)
H. Renewal Option (Enclosed in RFP)
I. Cover Page (Enclosed in RFP Forms Section)
K. Table of Contents for Proposal (Provided by Vendor) Number all pages and list
according to this Table of Contents. Page one (1) of the proposal should be the Cover
Page (item I. Above), with all pages numbered sequentially forward.
NOTE: Sections L through M contain instructions for writing the narrative portion of the proposal and
the accompanying tables and appendices. The completed proposal must follow this outline with the
required information provided in the order shown. Please repeat each question and answer each
question separately and in order.
L. ABSTRACT – 0 Points
(Maximum of 2 pages)
1. Please provide the following information:
a. Legal Name of Organization or Individual
b. Mailing Address
c. Street Address (if different from mailing address)
d. Telephone number and contact person
e. Service Category (Quality Management – CPCDMS Data System Maintenance and
f. Title of Service (CPCDMS Data System Maintenance and Support)
2. Briefly summarize your proposed scope of work.
M. FINANCIAL CAPACITY AND BUDGET – 25 Points
Complete Table I.B. Fee-for-Service Budget Form.
The following documentation must be included in the appendices:
Copy of all signed and dated contracts with Subcontractors to be used by Proposer in the provision of
CPCDMS Application Support (if applicable).
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Include an Organizational Chart of Proposer’s firm.
N. DOCUMENTATION OF QUALIFICATIONS AND EXPERIENCE IN PROVIDING
HIV/AIDS CLIENT-LEVEL DATA SYSTEM SUPPORT – 75 Points
(Maximum of 25 pages, not including table)
1. Describe the background and mission of your organization, as well as a brief discussion of
current and past projects, with an emphasis on current and past projects and contracts for providing
application support for HIV/AIDS automated client-level data systems. How does providing the
proposed CPCDMS application support fit with your organization’s mission?
2. Describe the educational, technical and professional background of each proposed individual
application support professional, as well as other qualifications relevant to performing CPCDMS
application support and maintenance. Include detailed information about relevant training,
degrees, certifications and work history.
3. Describe your history of providing maintenance and support for automated client-level data
systems dealing with highly sensitive medical information, with an emphasis data related to the
treatment of HIV disease. Include the goal of such activities and the types of entities for which
you performed these services, Provide the same information for any subcontractors that will be
utilized to perform reviews under this contract.
4. Describe your history of developing and implementing automated HIV/AIDS client-level data
systems used to collect and store highly sensitive medical information with an emphasis on
development of systems collecting HIV/AIDS-related client-level data. Include information about
the processes used to develop, pilot-test, implement and refine such applications as appropriate.
Provide the same information for any subcontractors that will be utilized under this contract.
5. Describe your experience in supporting the collection and reporting of Office of Budget and
Management (OMB) mandated federal reports such as the HRSA-mandated CARE Act Data
Report (CADR), the federally-mandated data report for Ryan White CARE Act grantees.
6. Describe your experience and competence in developing, implementing and supporting
applications utilizing Microsoft SQL 2005 database architecture hosted in a Windows 2003
environment relying on Active Directory integration and authentication and Business Objects
10/XI (Crystal Enterprise)-based reporting software with an Internet-based user interface.
7. Describe your experience and competence in using, developing and scanning of data from
application-generated client surveys using Optical Mark Recognition (OMR)) software.
The following documentation must be included in the appendices:
Table II.A. Application Development and Support Contracts: Complete the table listing all relevant
contracts. Include at least 3 current or past customers where Proposer has provided similar work. The
table should include the scope of the referenced work, dates of work, company name, contact
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person, email address and telephone number. HCPHES/HIV Services may contact the listed entities to
verify the quality of Proposer’s work under the listed contracts.
Current resumes and/or Curriculum Vitae of all individuals to be used in performing services under
this contract (maximum of 5 pages per individual resume/CV).
O. APPLICATION CHECKLIST
Applications must be submitted in the order of the Application Checklist, including appendices. Do
not submit any material that is not stipulated on the Application Checklist.
O. OTHER REQUIREMENTS:
No proposal will be considered if, at the time the proposal is submitted or thereafter, the offeror
employs or receives consulting services or other services relating to the proposal, from a current or
former HIV Services staff member, unless the former staff member’s employment with HIV
Services terminated more than six months prior to the date the proposal is submitted.
Harris County may terminate a Contract after it is awarded if Proposer employs, in any capacity,
any person who is then currently employed by HIV Services, or who has been employed by HIV
Services within the six months immediately preceding the commencement of employment by
Proposer. For the purposes of this paragraph, the term ―employs in any capacity‖ shall mean the
receipt of services of any kind in exchange for consideration, regardless of whether the person
performs the services as an employee, consultant, agent, independent Proposer, subcontractor or in
some other capacity. The Executive Director of Harris County Public Health and Environmental
Services may waive this requirement upon written request from Proposer. The granting of a
waiver is at the discretion of the Executive Director and any such decision by the Executive
Director is final.
P APPENDIX - All required information that has been specified. Only include in your proposal
submission information specifically requested in the RFP (including any addendums which
may be issued). Do not include extraneous or unrelated documents in the appendices. Do not
use appendices to provide information that is required in the narrative or tables.
III. ADDITIONAL INFORMATION
A. SUGGESTIONS FOR COMPLETING PROPOSALS
In addition to the proposal writer, one or more individuals should review your proposal for content
and form. Have them read through this RFP, and then let them pretend that they are on the review
panel: have them read through your application, paying special attention to the narrative
information that you have provided, and using the evaluation criteria as a basis for their review and
comment. Check that the information provided on all of the forms and documents is consistent and
complete and all budget forms are consistent with other information (for example, the math is
Also, one or more individuals should review your application for completeness and format
correctness, taking the time to verify that your narrative responses conform to the physical space
limitations given for each section; that all required information has been assembled; that all pages,
including attachment(s), have been numbered sequentially; that binder clips have been used; that the
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correct number (one signed original and five copies) of the finished proposal has been prepared for delivery.
IV. DEFINITION OF SPECIAL LANGUAGE AND GUIDELINES
A. Quality Management is intended to ensure that providers have a means to control for
appropriateness and quality of services. HIV Services facilitates the HRSA-mandated Quality
Management program. Contracting agencies must comply with all applicable Quality
Management activities. Components of the Quality Management program include, but are not
1. Standards of Care have been approved by the RWPC to establish the minimal acceptable
levels of quality in service delivery and to provide a measurement of the effectiveness of
services. Each fiscal year the RWPC reviews and revises standards of care for each service
category. HIV Services monitors for compliance at site monitoring visits. Standards of Care
for those service categories applicable to the chart review activities being proposed may be
accessed at www.harriscountyhealth.com/hivservices.
2. Outcomes Evaluations assess health, quality of life, knowledge, attitudes and practices (KAP)
and cost-effectiveness measures for each Title I service category. Each fiscal year the RWPC
reviews and revises outcome measures for each service category. Contracting agencies are
required to participate fully in all evaluation activities, including but not limited to the ongoing
administration of HIV Services-developed client surveys and the submission of data to HIV
Services on a regular basis. Outcome measures for those service categories applicable to the
chart review activities being proposed may be accessed at
3. Clinical Review will be conducted on an ongoing basis to determine whether primary care,
health-related support services and case management programs meet Public Health Service
guidelines (or other relevant and established guidelines). Clinical review activities include but
are not limited to client chart/record review by appropriate and qualified professional(s)
designated by HIV Services.
4. Client Satisfaction assesses client opinion regarding the quality of services provided.
Through methods such as post-service surveys, clients should be given the opportunity to
express whether expectations were met, exceeded or not met. Areas to be assessed include but
are not limited to interactions with agency staff, accessibility of the facility, amount of time
spent on a waiting list and quality of service(s) rendered. Contracting agencies are required to
participate fully in all client satisfaction measurement activities, including but not limited to
the administration of HIV Services-developed client surveys and the submission of data to HIV
Services on a regular basis.
C. Centralized Patient Care Data Management System (CPCDMS) is the County-mandated automated
client-level reporting system. The County requires that agencies utilize the CPCDMS to determine eligibility
status for clients and enter service utilization data (including client demographic, client stage of illness and
co-morbidity data). If a funded agency chooses to send the required service utilization data in batch mode,
this must be done in accordance with Harris County CPCDMS business rules. All funded agencies will be
required to have a high speed Internet connection for all participating service sites. This high speed Internet
connection must be utilized for the CPCDMS. Funded agencies must use the County implemented
CPCDMS as a condition of award.
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D. CARE Act Data Report (CADR) is the HRSA-mandated reporting requirement that includes unduplicated
numbers of clients served per provider, client demographics (gender, ethnicity, age) regarding clients served,
relevant medical markers and co-morbidities, estimated percent of clients by transmission category, minority
composition of entity's board and/or staff, amounts and types of services provided, percent of clients who are
HIV positive and number with AIDS, amount of HIV/AIDS funding by source and information on numbers,
types and salaries of HIV/AIDS staff. This information must be summarized annually in the annual CARE
Act Data Report. The CPCDMS is the County’s primary means for collecting client-level data for the
A. The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 provides federal support
for comprehensive health and social services for people living with HIV/AIDS in the Houston Eligible
Metropolitan Area (Houston EMA). Houston EMA includes Chambers, Fort Bend, Harris, Liberty,
Montgomery, and Waller counties. Title I provides emergency relief grants to meet needs of individuals
infected and affected. CARE Act funding is intended to supplement, not supplant, existing and planned
funding for HIV/AIDS services at local and state levels.
Eligible recipients of these funds are providers of relevant services such as public or non-profit private
entities, or private for-profit entities if such entities are the only available provider of quality HIV care in the
area, including hospitals (which may include Department of Veterans Affairs facilities), community-based
organizations, hospices, ambulatory care facilities, community health centers, migrant health centers,
homeless health centers, substance abuse treatment programs, and mental health programs. For-profit
entities are eligible to compete for Program Support/Quality Management activities such as those
described in this RFP.
The Harris County Commissioners Court has appointed the Director of Harris County Public Health and
Environmental Services (HCPHES) as the Administrative Agent to the program. The Harris County
Commissioners Court, as the governing body of the grant recipient, has ultimate authority over awards of
Ryan White Title I Grant funds.
B. AVAILABLE MONIES
All awards are contingent on the amount of Harris County’s Federal Fiscal Year 2007 Ryan White
CARE Act Title I award from HRSA.
C. COMMENCEMENT OF SERVICES/FORFEITURE OF FUNDS
Each agency must demonstrate its ability to implement proposed services quickly, including hiring/training
appropriate personnel. If an agency fails to begin providing services and expending funds within 30 days
from receipt of funds, the agency may have to forfeit said funds.
D. APPLICABLE LAWS
Proposers MUST comply with all applicable federal, state, and local laws and regulations.
E. OTHER CONDITIONS/RESTRAINTS
The following conditions/restraints are imposed on all recipients of Ryan White Title I funds. Vendors are
not required to submit information concerning these issues within their proposals; however, agencies must
comply with them if they receive Ryan White Title I funds.
Not for profit and governmental agencies receiving Federal funding assistance in the aggregate
amount of $500,000.00 or more within their fiscal year must have an audit conducted in accordance
with Office of Management and Budget (OMB) Circular A-133. The audit must be submitted to the
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Harris County Auditor’s Office no later than 13 months of an agency’s fiscal year end (within 9
months for fiscal years beginning after June 30, 1998). Proprietary agencies receiving awards of
$25,000.00 or more must submit an audit of their general financial statements within 12 months of
their fiscal year end. Not for profit and governmental agencies meeting the $500,000.00 aggregate
threshold may charge OMB A-133 single audit costs proportionally to their Ryan White grants.
However, agencies who do not meet the $500,000.00 aggregate threshold may not use Federal funds
to pay for OMB A-133 single audit costs. Those agencies not meeting the $500,000.00 aggregate
threshold may use Federal funds to pay for limited scope audits, site visits, document reviews and
other monitoring activities.
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2. RENEWAL OPTION:
The County has the option of renewing contracts in specific service categories on an annual basis.
The renewal criteria are as follows:
1. The vendor must agree to the same terms, specifications, unit cost(s) and conditions of the
previous contract term (i.e., the unit cost and service definition must remain the same, the total
value of the contract may increase or decrease as necessary depending on allocations);
2. All renewals are contingent upon receipt of such funding from HRSA and Commissioners
3. All providers must agree to the renewal option.
Harris County wishes to consider two (2) annual renewal options, renewable one year at a
time, based on the same terms, conditions and pricing as the original year. If the vendor
does not wish to renew, mark ―N.A.‖ in the space for the year indicated on the pricing
page, Table I.B. If the vendor is willing to accept one or two annual renewals do not mark
the form, but include the form in your proposal. Harris County retains the option to
rebid at any time if in its best interest and is not automatically bound to renewal or
DO NOT MARK THE FORM IF VENDOR WILL ACCEPT ONE (1) OR TWO (2) ONE
YEAR RENEWALS. REGARDLESS OF CHOICE, THIS FORM MUST BE INCLUDED
IN PROPOSAL SUBMISSION.
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QM 2007-02: CPCDMS Data System Maintenance and Support.
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REQUEST FOR PROPOSAL COVER SHEET
SIGNED ADDENDUM (if applicable)
SIGNED ASSURANCES FORM I
SIGNED CERTIFICATION CONCERNING LOBBYING
SIGNED COMPLIANCE WITH AMERICANS WITH DISABILITIES
ACT OF 1990
ASSURANCE – NON-CONSTRUCTION PROGRAMS
TABLE of CONTENTS FOR PROPOSAL
FINANCIAL CAPACITY and BUDGET
Table I.B. Fee-for-Service Budget Form
DOCUMENTATION of EXPERIENCE IN PROVIDING EDUCATION
Table II.A. Current HIV/AIDS-Related Data Support Contracts
Job description of each type of personnel position (Maximum of 1 page
Resume or Curriculum Vitae of all data system support staff to be
assigned to the project (Maximum of 5 pages each)
Copies of contracts with any subcontracting firms to be used in
provision of support activities (not applicable for contracts with an
individual or sole proprietor)
Page 21 of 38
DESCRIPTION OF CATEGORY
Page 22 of 38
HRSA Service Category Title: Quality Management.
Local Category Title: Quality Management: CPCDMS Data System Maintenance and Support.
Revision Date: 09-11-06
Amount Available: To be Determined
Budget Type: Fee-For-Service
Budget Restrictions: Estimated Hours: Proposer should plan on providing 1,200 hours of
CPCDMS data system support as described below. The hourly CPCDMS support service fee
submitted by Proposer should be based on an expectation of providing 1,200 hours of technical
support during the contract term (3/1/07 – 2/28/08). Based on the needs of the County during the
contract term the total amount of the contract may be adjusted upward or downward – however the
per unit (hourly) rate will remain the same regardless of the total number of hours budgeted in the
Budget Limitation: Proposals exceeding a total cost of $168,000.00 will not be considered.
Services to be Provided: NOTE: This is not a request for obtaining any software developed or
marketed by proposing entity. This is solely a Request for Proposal (RFP) to provide professional
technical support for the County’s “proprietary” CPCDMS automated client-level data system.
Proposals seeking to sell or lease to the County any product (either software or hardware) shall be
Proposer will produce and provide the County the following services and work products:
Carry out activities to include, but not be limited to, the following:
Ensure that the implementation of the CPCDMS is carried out according to the time frames and
steps stipulated by HIV Services.
Provide development of new modules and enhancements to the CPCDMS as requested by central site
to include, but not be limited to:
Addition of new data elements required by the Health Resources Services Administration
(HRSA), including those that may be required subsequent to Reauthorization of the Ryan White
Addition of new data elements required by the Ryan White Care Act Data Report (CADR)
mandated by HRSA;
Addition of new elements required under HCPHES’s Ryan White Special Projects of National
Significance (SPNS) grant providing Outreach, Care and Prevention to Seropositive Young Men
of Color Who Have Sex With Men (YCMSM);
Addition of new reports based on any of the above new modules and data elements;
Addition of data export modules to enable CPCDMS data to be exported to the Texas
Department of State Health Services (DSHS) ARIES data system and other data systems as
determined by the County.
Provide second-tier technical support to include, but not be limited to, the following (second tier
involves a problem escalation from a first tier central site tech support representative):
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1. Provide Internet connectivity and communications trouble-shooting as needed for the
agencies receiving RW1 funding:
a. Interface with MIS staff at the approximately 30+ agency sites connected to the
b. Interface with HCPHES/HIV Services MIS staff regarding Internet connectivity and
security protocols and trouble-shooting;
c. Providing troubleshooting and trouble remedy for Business Objects XI reporting
engine for these 30+ agencies;
d. Provide support for 10+ central site Windows 2003 servers;
e. Provide support for 100+ Windows XP Professional desktop PCs.
2. Provide primary technical support for the CPCDMS to include, but not be limited to:
a. Assist in problem diagnosis/definition;
b. Maintain the 33,000+ lines of Software Code in the CPCDMS application;
c. Provide assistance and/or training for central site personnel for ad-hoc data update
requests from agencies for bulk updates/corrections or other areas as specified by HIV
3. Maintain data export process for CPCDMS for sharing data with the Ryan White Planning
Council Office of Support, The Resource Group and Title 1-funded agencies:
a. Provide and support data exports such as Microsoft Access databases for the
aforementioned, including technical support to end users to assure proper data
b. Maintain Business Objects 10/XI reporting system;
c. Development and implementation of data export process for CPCDMS for sharing
data with the Texas Department of State Health Services ARIES software platform.
4. Provide primary technical support for the quality management initiatives mandated by HRSA
for the Ryan White Care Act to include, but not be limited to the following:
a. Development/maintenance of the technical process for implementing client
satisfaction and client outcomes surveys;
b. Provides users of the CPCDMS a mechanism for printing individually tagged (bar-
c. Maintain the process for reading in scanned images of these surveys as data;
d. Develop reports based on this data;
e. Maintain and support the 52+ surveys (English/Spanish) created for Ryan White
eligible service categories;
f. Maintain Chart review sampling application module that generates a representative
sampling of a given agency client population. The current representative sampling
looks at five demographic categories: Adult Stage of Illness, Race, Ethnicity, Age
Groups and Gender.
5. Develop and update policies and procedures for CPCDMS, to include, but not be limited to,
a. HIPAA-related policy and procedures;
b. Patient confidentiality;
c. Patient Intake;
d. Data Entry;
e. System access and security;
f. Report Generation;
6. Provide on-going administrative technical support to include, but not be limited to, the
a. Assist in remote or on-site trouble-shooting of system from central site or agency;
b. Assist in system administration and/or configuration;
Page 24 of 38
7. Develop custom reports requested by central site or agencies to include, but not be limited to,
a. Development of ad-hoc or custom reports or applications based on ODBC (open
database connectivity), Microsoft Visual Basic, Business Objects 10/XI and/or
Microsoft Access for 30+ agency users, 38+ member Planning Council, HRSA,
Texas DSHS, HIV Services and others as directed by CPCDMS Project Management;
b. Maintain the 100+ existing Business Objects/Crystal Enterprise reports that have been
implemented for this project;
8. Maintain, support and develop on-learn training modules to assist system users in learning
and using the CPCDMS and Reports modules, including Learn.com on-line training
Estimated allocation of consultation hours for contract term:
Core Application Development 200
Core Maintenance 400
Quality Management-related Support 300
Report Design and Creation 300
Total Hours (estimated) 1,200
Service Unit Definition(s): One unit of service = one hour of authorized CPCDMS Application
Support and Maintenance acceptable to the County.
Vendor Qualifications: All individual(s) performing Application Support activities must have at
least three (3) years documented experience in providing professional development, implementation
and support services to Microsoft SQL-based database applications that utilize the Business Objects
XI reports platform. Documented experience in the development, implementation and maintenance
of HIV/AIDS automated client-level data collection systems is required.
Special Requirements: Due to the highly sensitive nature of HIV/AIDS data collection, all
personnel utilized by the Proposer in conjunction with this project must be approved in advance by
HCPHES/HIV Services. HIV Services shall reserve the right to require Proposer to provide alternate
individuals to support the activities described herein if, in the sole determination of HCPHES/HIV
Services, the needs of project so indicate.
Proposer must provide 24 hour, 7 day per week, 365 days per year response to HCPHES/HIV
Services requests for maintenance and support. When remote trouble-shooting and maintenance
capabilities are unable to resolve problems Proposer must be capable of providing on-site technical
support during normal and evening or weekend hours in order to maintain system assets as requested
by HCPHES/HIV Services. Proposer must respond to, and begin work on, any ad-hoc maintenance
requests from designated HIV Services CPCDMS project staff within 2 hours of such a request being
Proposer should expect to spend at least 25% of project time on-site at HIV Services or at any one of
the 30 plus agency sites in the six (6) county area of the Houston Ryan White Title I EMA. Travel
time to and from central or remote site locations is not billable. No minimum on-site charges or hour
requirements are allowable (i.e. if the on-site service call involves only 15 minutes of billable work,
then only 15 minutes may be billed). A list of current Ryan White Title I funded entities and their
addresses may be obtained from the HIV Services Website:
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FORMS & TABLES SECTION
The forms contained in this section must be inserted in the appropriate section of your proposal response.
There are three options from which you may choose to present your Table information. They are:
You may type on these forms.
You may create your own forms in the same format as those contained in this packet.
You may use the forms included in the RFP packet available for download from the Harris County
Page 26 of 38
Assurances Form I
By signing and submitting this proposal, the applicant organization certifies compliance with the following assurances in the event that
Ryan White funds are awarded:
· Assurance that applicant agency will provide services without regard to ability to pay or the current or past health condition of
an individual and in settings accessible to low-income persons; and funds awarded not be used to make payments for any item
or service to the extent that payment has been made, or can reasonably be expected to be made, by another third party benefits
program or by an entity that provides services on a prepaid basis.
· Assurance that applicant agency will provide outreach to low-income persons to inform them of the availability of services.
· Assurance that applicant agency will not discriminate against persons eligible for services on the grounds of race, creed, color,
handicap, national origin, sex, political affiliation or beliefs, or sexual orientation.
· Assurance that applicant agency will provide information to clients, either verbally or in print, on use of condoms and risk
avoidance/reduction behaviors for sharing of intravenous needles, or make referrals to other agencies that will do so.
· Assurance that drug-free workplace guidelines are or will be in place in agency at time of funding award in accordance with
Federal Regulation 45 CFR part 76.
· Assurance that applicant agency will maintain the confidentiality of client records.
· Assurance that applicant agency will comply with Federal Regulation 45 CFR part 76 regarding debarment and suspension.
· Assurance that agency understands specified restrictions on the use of grant award funds.
Date Applicant Organization
Signature and Title of Authorized Official
Page 27 of 38
Certification Concerning Lobbying
DEPARTMENT OF HEALTH AND HUMAN SERVICES
U.S. PUBLIC HEALTH SERVICE
The Undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person or
influencing organization attempting to influence an officer or employee of any agency, a member of Congress, or an
employee of a member of Congress in connection with the awarding of any Federal contract, the making of any
Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a member of Congress, or an employee of a member of
Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for all
subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative
agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of the fact upon which reliance was placed with this transaction was made or enter into.
Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S.
Code. Any persons who fail to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
Address of Organization Name and Title of Official Signing for Organization
Telephone of Organization Signature of Official
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Compliance with American With Disabilities Act of 1990
Name of Applicant Agency
guarantees and assures, with respect to the operation of the program and activities outlined in this proposal and all agreements or
arrangements to carry out such program or activities for which financial assistance may be awarded in any subsequent subcontract, that
will comply fully with the Americans with Disabilities Act of 1990 (ADA) and any and all Regulations promulgated thereunder. The
applicant agency understands that failure to comply with this requirement shall be sufficient cause to terminate any contract existing
between the applicant agency and the Harris County HIV Services Division.
Signature of Person Authorized to Represent Applicant Agency
Printed Name and Title
Page 29 of 38
ASSURANCE — NON-CONSTRUCTION PROGRAMS
Note: Certain of these assurance may not be applicable to your project or program. If you have questions,
please contact the awarding agency. Further, certain Federal awarding agencies may require applicants
to certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share of project costs) to ensure proper planning, management
and completion of the project described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State,
through any authorized representative, access to and the right to examine all records, books, papers, or
documents related to the award; and will establish a proper accounting system in accordance with generally
accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or
presents the appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the application time frame after receipt of approval of the awarding
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to prescribed
standard for merit systems for programs funding under one of the nineteen statutes of regulations specified in
Appendix A of OPM's Standards of a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6 Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color,
or national origin; (b) Title IX of the Educational Amendments of 1972, as amended (20 U.S.C. 1681-1683, and
1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of
1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits discrimination on the basis of
age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255, as amended, relating to
nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (P.L. 91-616, as amended, relating to nondiscrimination on the basis
of alcohol abuse or alcoholism; (g) 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3
and 290 ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VII of
the Civil Rights Act of 1968 (42 U.S.C. 3501 et seq.) as amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which
application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination
statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and
equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted
programs. These requirements apply to all interests in real property acquired for project purposes regardless of
Federal participation in purchases.
8. Will comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which limit the political
activities of employees whose principal employment activities are funded in whole or in part with Federal funds.
9. Will comply, as application, with the provisions of the Davis-Bacon Act (40 U.S.C. 276a to 276a-7), the
Copeland Act (40 U.S.C. 276c and 18 U.S.C 874, and the Contract Work House and Safety Standards Act (40
U.S.C. 327-333), regarding labor standards for federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-2343) which requires recipients in a special flood hazard area to participate in
the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000
Page 30 of 38
11. Will comply with environmental standards which may be prescribed pursuant to the following (a) institution of
environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of
wetlands pursuant to EO 11990; (d) evaluation of flood hazards in flood plains in accordance with EO 11988;
(e) assurance of project consistency with the approved State management program developed under the Coastal
Zone Management Act of 1972 (16 U.S.C. 1451 et seq.); (f) conformity of Federal actions to State (Clear Air)
Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. 7401 et seq.);
(g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as
amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as
amended, (P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1271 et seq.) related to protecting
components or potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and
the Archaeological and Historical Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development,
and related activities supported by this award assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.)
pertaining to the care, handling, and treatment of warm-blooded animals held for research, teaching, or other
activities supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.) which prohibits the
use of lead-based pain in the construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies
governing this program.
Signature of Authorized Certifying Title
Applicant Organization Date Submitted
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Name of Applicant Agency
I, , certify that I am the
of the corporation, committee, commission, association, partnership, or public agency named as the Applicant
Agency herein, that this proposal was duly submitted and signed for on behalf of said corporation, committee,
commission, association, or public agency by authority of its governing body and is within the scope of its legal
Signature of Person Making Certification
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FY 2007 Ryan White Title I Funds
Service Category of proposal as designated in RFP: Quality Management – CPCDMS
Data System Support and Maintenance
Code Number: QM 2007-02
Total amount requested: $
Contact Person for proposal clarifications/negotiations:
Contact person telephone number:
Identify your entity as one of the following: For -Profit _____, Non-Profit
or Public (governmental) _______.
Has your agency complied with all HRSA requirements and regulations for all
previously funded programs?
Yes_________ No___________ If no, explain
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UNIT COST (FEE FOR SERVICE) BUDGET FORM
Service Category: QM 2007-02
Title of Service: CPCDMS Data System Support and Maintenance
1. Fee Charged per Unit of Service:
One (1) hour of CPCDMS System Support Authorized
by HCPHES HIV Services: $
2. Number of Units of Service to be Provided: 1,200
3. Total Cost of these Services (#1 x #2): $
4. TOTAL REQUEST (3): $
5. Definition of Unit of Service: One unit of service = one hour of authorized CPCDMS
Application Support and Maintenance acceptable to the County.
Vendor agrees to continue this contract for the time frames stated below under the same terms and conditions and
pricing as the original contract. If vendor does not wish to renew, write ―N.A.‖ in the space provided.
Renewal Year 1 (FY 2008): ____________ 3-1-08 through 2-28-09
Renewal Year 2 (FY 2009): ____________ 3-1-09 through 2-28-10
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TABLE II.A. HIV/AIDS CLIENT-LEVEL DATA SYSTEM SUPPORT &
Complete the Contracts Table below. Use additional copies as necessary. List all HIV/AIDS-
related automated-client level data system support and maintenance contracts for which Proposer
currently, or in the recent past, has provided relevant work under. Note: The County may contact
these companies to inquire about the quality and consistency of services provided by Proposer.
Contracting Entity Contract Amount of Services Provided
Company Name Term Contract
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SAMPLE BUDGET TABLE
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UNIT COST (FEE FOR SERVICE) BUDGET FORM
TABLE I.B. (EXAMPLE)
Service Category: QM 2007-02
Title of Service: CPCDMS Data System Support and Maintenance
1. Fee Charged per Unit of Service:
One (1) hour of CPCDMS System Support Authorized
by HCPHES HIV Services: $135.00
2. Number of Units of Service to be Provided: 1,200
3. Total Cost of these Services (#1 x #2): $162,000.00
4. TOTAL REQUEST (3): $162,000.00
5. Definition of Unit of Service: One unit of service = one hour of authorized CPCDMS
Application Support and Maintenance acceptable to the County.
(Do not include in proposal)
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Job No.: 06/0400
RESIDENCE CERTIFICATION/TAX FORM
Pursuant to Texas Government Code §2252.001 et seq., as amended, Harris County requests Residence
Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of
governmental contracts; pertinent provisions of §2252.001 are stated below:
(3) "Nonresident bidder" refers to a person who is not a resident.
(4) "Resident bidder" refers to a person whose principal place of business is in this state, including a
contractor whose ultimate parent company or majority owner has its principal place of business in
I certify that is a Resident Bidder of Texas as defined in
Government Code §2252.001.
I certify that is a Nonresident Bidder as defined in
Government Code §2252.001 and our principal place of business is .
[City and State]
Taxpayer Identification Number (T. I. N.):
Company Name submitting Bid/Proposal:
If you are an individual, list the names and addresses of any partnership of which you are a general partner:
PROPERTY: List all taxable property owned by you or above partnerships in Harris County.
Harris County Tax Acct. No.* Property address or location**
* This is the property account identification number assigned by the Harris County Appraisal District.
** For real property, specify the property address or legal description. For business personal property, specify the
address where the property is located. For example, office equipment will normally be at your office, but inventory may
be stored at a warehouse or other location.
Do you carry Health Insurance on your employees? ___Yes ___No
If yes, what is the percentage of employees insured? _____%
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