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					    Family Support Services of North Florida, Inc.

                Invitation to Negotiate


To Provide Comprehensive Post Adoption Services for
              Fiscal Year 2009 - 2010


                      Duval County

                   ITN # FSSPA09-01




                       Contact Person:
                      Juanita R. Jones
                      Contract Director
           Family Support Services of North Florida
                   4057 Carmichael Avenue
                   3000 Building, Suite 101
                 Jacksonville, Florida 32207




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                        TABLE OF CONTENTS


SECTION      TITLE                                               PAGE
1            Introduction                                        3
2            General Solicitation Information                    6
3            Programmatic Requirements                           13
4            Financial Specifications                            18
5            Instructions for Application Preparation            19
6            Evaluation Process                                  23


APPENDICES
I            Duval County Planning Districts                     25
II           Notice of Intent to Submit an Application           26
III          Required Applicants Statements and Certifications   27
IV           ITN Evaluation Tools                                34
V            FSS ITN Protest Process                             44
VI           Information System Requirements                     47
VII          Fatal Criteria                                      53
VIII         Application Summary Form                            54
IX           Authority and Requirements                          56
X            Applicant Self Evaluation                           64
XI           Sample Project Budget Detail and Instructions       74




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SECTION 1: INTRODUCTION

1.1   Background and Purpose

      Family Support Services of North Florida, Inc. a Florida non-profit corporation
      (hereinafter referred to as FSS) delivers foster care and related services
      pursuant to s.409.1671, F.S., and prevention services, while ensuring each
      child’s safety, well-being and permanency, to certain eligible persons referred by
      the State of Florida Department of Children and Families (DCF) or it’s designee,
      pursuant to contract number DJ977; hereinafter referred to as the Master
      Agreement between DCF and FSS. FSS is the Community Based Care Lead
      Agency in Duval County under the Master Agreement and is defined by
      s.409.1671, F.S. FSS is ultimately responsible under the Master Agreement
      contract with DCF to provide services through subcontracts with entities or
      individuals serving as Providers. FSS’s purpose is to contract with a Provider for
      the provision of Post Adoption services in accordance with the terms and
      conditions of the Master Agreement.

      Children need safe, permanent homes where they are free from abuse, neglect
      and other forms of mistreatment by their caregivers. Most caregivers want to
      provide a nurturing and protected environment for their children, some lack the
      required knowledge, skills, and resources to nurture and protect their children. In
      these circumstances, Family Support Services of North Florida, Inc (FSS), as
      Lead Agency pursuant to Section 409.1671, F.S. is responsible for coordinating,
      integrating, enhancing and managing a local system of supports and services for
      eligible children and their families in Duval County and Nassau County.

      Through this Invitation to Negotiate (ITN), FSS is seeking qualified organizations
      that are interested in providing comprehensive Post Adoption services in Duval
      and Nassau County.

      Consistent with the goals of the Federal Adoption and Safe Families Act (ASFA)
      and Florida’s legislative mandates, Florida’s approach to Community-Based Care
      (CBC) will:

         1. Provide for the safety of children
         2. Decrease the time it takes to achieve permanency for children
         3. Promote adoption for children when that is the best permanency option
         4. Enhance the state’s capacity and accountability for both safety and
            permanency
         5. Promote families to have enhanced capacity to provide for their
            children’s needs




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1.2   Definitions

      a. Adoption Safe Families Act (ASFA) Outcomes. ASFA outcomes are
      specific outcome measures required by the Federal Government. The measures
      are:

         Children are, first and foremost, protected from abuse and neglect.
         Children are safely maintained in their own homes whenever possible and
          appropriate.
         Children have permanency and stability in their living situations.
         Continuity of family relationships and connections is preserved for children.
         Families have enhanced capacity to provide for their children’s needs.
         Children receive appropriate services to meet their educational needs.
         Children receive adequate services to meet their physical and behavioral
          health needs.

      b. Applicant. A prospective non-profit entity that applies to become a Provider
      for Post Adoption services as defined in this ITN.

      c. Application. An application by a non-profit entity as defined in this ITN that
      applies to become a Post Adoption services provider.

      d. Best Practices. Research based and verified methodologies that address
      service strategies with conclusive, expected outcomes in the provision of the
      services.

      e. Cost Allocation Plan. A plan that describes the various support service
      components of the organization and explains how the agency identifies,
      measures, and allocates those costs to benefiting programs.

      f. Continuous Quality Improvement (CQI). Continuous internal improvements
      in service provision and administrative functions conceived, implemented and
      managed by employees. Employee teams meet quarterly to review data.
      Strategies to review data leading to the accomplishment of goals will include:
      incidents, accidents, and client grievances; customer input and satisfaction;
      performance data; peer record review data; products and/or results from quality
      improvement projects.

      g. Cultural Competence. A set of congruent behaviors, attitudes, and policies
      that allows professionals and others to work effectively in situations of different
      cultural aspects, including linguistic differences.


      h. Dependent Child. Any unmarried person under the age of 18 years who has
      not been emancipated by order of the court, and who is found by the court,



                                            4
pursuant to Chapter 39, F.S. to have been or is at substantial risk of imminent
abuse, abandonment, or neglect by the child’s parent, parents, or legal
custodian. Situations that may lead to dependency include:

    When a child has been abused, neglected or abandoned or is suffering from
     or is in imminent danger of illness or injury as a result of abuse, neglect or
     abandonment;

    When the parent or legal custodian of the child has materially violated a
     condition of placement imposed by the court; or

    When the child has no parent, legal custodian or responsible adult relative
     immediately known and available to provide supervision and care.

i. Evaluation. A process of assessment, including quality assurance and quality
improvement that takes place at a minimum annually, and encompasses external
review, compliance with set contracted standards, and accomplishment of
outcomes.

j. Family Services Counselor (FSC). The person, who coordinates all services
rendered to the child and/or family, serves as an advocate and is the single and
continuous point of contact for the child and system to the extent feasible.

k. Fiscal Year. The period from July 1 to June 30

l. Lead Agency. A non-profit community-based entity or collaborative partnership
under contract with the Florida Department of Children and Families (DCF) to
provide foster care and related services along a seamless continuum of care for
children who have been abused, abandoned or neglected and their families as
required in Section 409.1671, F.S.

m. Post Adoption Services. Services implemented to support and promote
healthy, stable families, prior to the placement of a child, through placement
transition, and after adoption finalization. Services include but are not limited to
providing referrals and linkage to community resources; individual and family
counseling; parent education classes and training; support groups; and crisis
intervention.

n. Network Provider. An individual or organization contracted to provide
services and/or materials to the Lead Agency as part of a contract with the DCF.

o. Outcome. A measure of the quantified result, impact or benefit of program
tasks on the clients, customers or users of the services.




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      p. Qualified Non-Profit Organization. An organization that is registered with the
      Florida Department of State, Division of Corporations as a non-profit corporation
      and/or is certified as tax exempt under Section 501 (c)(3) of the Internal Revenue
      Service Code.

      q. Quality Assurance (QA). Periodic external review activities conducted by the
      Department and the Lead Agency to assure that the agreed upon level of
      services is achieved and maintained by the Lead Agency and its subcontractors.
      Quality Assurance activities will assess compliance with contract requirements,
      state and federal law and associated administrative rules, regulations, and
      operating procedures, and validate quality improvement systems and findings.

      r. Unified Case Management Model. A case management model resulting in
      children and their families being assigned a single, primary FSC, who remains
      with the child and family throughout the life of the case. The FSC is responsible
      for coordinating and brokering all services provided to the child and family within
      the community-based care system and any other publicly funded systems from
      which the child and family are receiving services. Key components for success of
      this model include a coordinated, integrated provider network with formal and
      informal agreements, community participation and involvement in supporting the
      children and families served by this provider network.

      s. Utilization Management. A system of procedures integrating review and case
      management, which is designed to ensure that the services provided, to a
      specific client, at a given time, are cost-effective, appropriate, and least
      restrictive.



SECTION 2: GENERAL SOLICITATION INFORMATION

2.1   Eligible Applicants

      Non-profit organizations are invited to submit an application documenting their
      qualifications for consideration to provide identified services in Duval and Nassau
      County. The organization will be responsible for delivering and/or contracting
      for the identified services. Organizations must be accredited by a nationally
      recognized accrediting body, such as the Commission on Accreditation of
      Rehabilitation Facilities (CARF), Joint Commission on Accreditation of
      Healthcare Organizations (JCAHO), or Council on Accreditation (COA); or have a
      demonstrated plan to be accredited by a national accrediting body within two (2)
      years of executing a service contract as a result of this ITN.




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2.2   Disqualification

      Failure to sign the Statement of Assurances will automatically disqualify an
      applicant from further consideration as a qualified applicant.

      Failure to have performed any previous contractual obligations with FSS or the
      State of Florida (State) in a manner satisfactory to FSS or the State may be
      sufficient cause for disqualification. To be disqualified as an applicant under this
      provision, the applicant must have: 1) previously failed to satisfactorily perform in
      a contract with FSS or State, been notified by FSS or State of unsatisfactory
      performance, and failed to correct the unsatisfactory performance to the
      satisfaction of FSS or State; or 2) had a contract terminated by FSS or State for
      cause.

      In accordance with DCF requirements, FSS shall not sub-contract Post Adoption
      services with any person or entity which:

            is or has been barred, suspended or otherwise prohibited from doing
             business with any government entity within the last 5 years.
            is under investigation or indictment for criminal conduct or has been
             convicted of any crime which would adversely reflect on their ability to
             provide services to vulnerable populations, including, but not limited to,
             abused or neglected children, or which adversely reflects their ability to
             properly handle public funds;
            is currently involved, or has been involved within the last 5 years, with any
             litigation, regardless of whether as a plaintiff or defendant, which might
             pose a conflict of interest to DCF, the State or its subdivisions, or a
             Federal entity providing funds to the department.

2.3   FSS Sole Contact

      Any questions concerning this Invitation to Negotiate must be submitted in writing
      no later than Tuesday, April 21, 2009, 5:00 p.m. EST, to:

      Juanita R. Jones
      Contract Director
      Family Support Services of North Florida
      4057 Carmichael Avenue
      3000 Building, Suite 101
      Jacksonville, Florida 32207

      Only questions submitted in writing and pertaining to clarification of the
      ITN submission shall be answered. Inquiries will not be accepted by
      facsimile, electronic transmission, hand delivered or telephone at any time.
      All notices, decisions and intended decisions will be electronically posted via the


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      Internet on FSS website www.fssjax.org. Applicants will only communicate with
      the contact person identified above regarding this Invitation to Negotiate. With
      reference to this Invitation to Negotiate, no representations, other than those
      distributed by the contact person in writing, are binding on FSS and applicants
      are cautioned that oral responses by FSS are not binding.

2.4   Schedule of Events and Deadlines (All times are EST)

  EVENT                   DATE AND TIME*        LOCATION
  Invitation to Negotiate Thursday,
                                                FSS website www.fssjax.org
  Released                April 16, 2009
                                                Juanita R. Jones
                                                Contract Director
  Final Date to Submit                          Family Support Services of North
                          Tuesday
  Inquiries per Section                         Florida
                          April 21, 2009
  2.3                                           4057 Carmichael Avenue
                                                3000 Building, Suite 101
                                                Jacksonville, Florida 32207
  Response to Written     Friday,
                                                FSS website www.fssjax.org
  Inquiries by FSS        April 24, 2009
                                                Juanita R. Jones
                                                Contract Director
                                                Family Support Services of North
  Notice of Intent to   Tuesday
                                                Florida
  Submit an Application April 28, 2009
                                                4057 Carmichael Avenue
                                                3000 Building, Suite 101
                                                Jacksonville, Florida 32207
  EVENT                   DATE AND TIME*        LOCATION
                                                Juanita R. Jones
                                                Contract Director
                          Friday, May 15,
                                                Family Support Services of North
  Sealed Applications     2009
                                                Florida
  due to FSS              No Later Than 3:00
                                                4057 Carmichael Avenue
                          PM
                                                3000 Building, Suite 101
                                                Jacksonville, Florida 32207
                                                Family Support Services of North
                                                Florida
  ITN Application         Monday, May 18,
                                                4057 Carmichael Avenue
  Opening                 2009
                                                3000 Building, Suite 101
                                                Jacksonville, Florida 32207




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                                                Family Support Services of North
                         Wednesday, May         Florida
  Evaluation Team
                         20, 2009 – Friday,     4057 Carmichael Avenue
  Meetings Begin
                         May 22, 2009           3000 Building, Suite 101
                                                Jacksonville, Florida 32207
  Posting of Qualified   Wednesday, May
                                                FSS website www.fssjax.org
  Applicants             27, 2009
                                                Family Support Services of North
                                                Florida
  Initiation of          Monday, June 1,
                                                4057 Carmichael Avenue
  Negotiations           2009
                                                3000 Building, Suite 101
                                                Jacksonville, Florida 32207
  Notice of Contract   Monday, June 8,
                                             www.fssjax.org
  Award                2009
  Contract Effective   Wednesday, July 1,
                                             N/A
  Date                 2009
 *The dates and times listed are subject to change as deemed necessary.

2.5   Inquiries

      Inquiries must be submitted in writing to the contact person identified in Section
      2.3 of this ITN via United States Postal Express, Certified Mail, Fed Ex, DHL,
      UPS, Airborne Express services or common commercial courier, and received on
      or before the date specified in Section 2.4. Responses to all inquiries and/or
      changes to this ITN will be made available to interested parties via electronic
      posting described in Section 2.3. No questions related to this ITN will be
      accepted after the time specified in Section 2.4. Inquiries will not be accepted
      by facsimile, electronic transmission, hand delivered or telephone at any
      time.


2.6   Cost of Application Preparation

      FSS is not liable for any costs incurred by an applicant in responding to this ITN
      under any circumstances.

2.7   Withdrawal of Applications

      A written request for withdrawal, signed by the applicant may be considered if
      received by FSS within 72 hours after the application due date and time indicated
      in Section 2.4.

2.8   Notice of Intent to Submit an Application

      Notice of Intent to Submit an Application (Appendix II) must be received by FSS


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       contact person at the location specified in Section 2.3 on or before the following
       date and time specified in Section 2.4:

       Due Date:     Tuesday, April 28, 2009
                     Not later than 5:00 P.M., EST

2.9    Acceptance of Applications

       All applications, including one (1) original, one (1) electronic copy saved on a CD,
       and five (5) complete copies, must be received by the FSS contact person via
       United States Postal Express, Certified Mail, Fed Ex, DHL, UPS, Airborne
       Express services or common commercial courier, and received on or before the
       date specified in Section 2.4.

       No changes, modifications or additions to the applications submitted will be
       accepted by or be binding by FSS after the deadline for submitting applications
       has passed. Faxed or electronic submission shall not be accepted or
       considered.

       Applications not received at either the specified place or by the specified time will
       be rejected and returned unopened to the applicant. FSS will retain one
       unopened copy for use in the event of a dispute.

       FSS reserves the right to reject any and all applications, or to waive minor
       irregularities, when to do so would be in the best interest of FSS. Minor
       irregularities are defined as a variation from the ITN terms and conditions that do
       not adversely impact the delivery of services.

2.10   Rating of Applicants and Notice of Contract Award

       Eligible applicants will be rated to determine those that are qualified to enter
       negotiations with FSS that could result in a contract for services. FSS shall
       appoint an evaluation team consisting of FSS staff to participate in the rating
       process.

       Refer to Appendix IV for more information regarding applicant rating.

       FSS will identify prospective providers resulting from the ITN solicitation on FSS
       website www.fssjax.org no later than Wednesday, May 27, 2009 by 5:00 p.m.
       This information will remain posted for 72 hours thereafter. FSS may also utilize
       additional methods of notifying qualified applicants.

       On Monday, June 1, 2009, FSS will initiate contract negotiations with the most
       qualified applicants. FSS reserves the right to negotiate with more than one
       qualified applicant at a time. FSS reserves the right to assign district(s) as



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       deemed appropriate. If a contract cannot be negotiated with any of the qualified
       applicants who responded to this ITN, FSS shall have the right to issue a new
       ITN or to otherwise seek additional qualified applicants.


2.11   Protests or Disputes

       See Appendix V regarding FSS ITN Protest process.

2.12   Anticipated Contract Terms

       Contract Term

       Dependent upon the continuation of the FSS agreement with the Department of
       Children and Families the anticipated term of the contract period will be from July
       1, 2009 to June 30, 2010. Depending upon the satisfactory performance and
       continued availability of funds, the contract may be extended for one or more
       additional years.

       Contract Reports

       The provider of services under any contract resulting from this ITN shall complete
       and submit fiscal, program, and administrative reports as required by FSS on
       forms or in a manner approved by FSS.

       Record Retention Confidentiality

       All documents including consumer records, financial records, supporting
       documents, statistical records, any other documents, and electronic storage
       media, pertaining to this program proposed by this ITN shall be retained for a
       period of seven (7) years after the termination of the resulting contract or as
       required by applicable federal and/or state law. During the records retention
       period, the provider of services agrees to furnish, when requested to do so, all
       retained documents. Data files will be provided in a format readable by FSS. If
       an audit has been initiated and audit findings have not been resolved at the end
       of seven (7) years, then the records shall be retained until resolution of the audit
       findings or any resulting litigation.



       Confidentiality

       The provider of services shall comply at all times with applicable federal and
       state laws, rules, and regulations, including but not limited to 45 C.F.R. Section
       205.50 and Section 402.155 Florida Statutes regarding the confidentiality of the



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records and identity of consumers; as well as the Health Insurance Portability
and Accountability Act (42 U.S. Section 210 et seq) and all regulations
promulgated under (45 C.F.R. Parts 160, 162, and 164). The contract resulting
from this ITN will define the responsibilities of the provider of services related to
the disposition of records following termination of the contract.


Nonexpendable Property

Nonexpendable property is defined as tangible personal property of a non-
consumable nature that has an acquisition value or cost of $1,000 or more and
an expected useful life of at least one year. All computers, including all desktop
and laptop computers, regardless of the acquisition cost or value are classified
as nonexpendable property.

A formal contract amendment is required prior to the purchase of any property
item not specifically listed in the approved contract budget.

Information Technology Resources

The provider of services under a contract resulting from this ITN agrees to
receive written approval from FSS prior to the purchase of any Information
Technology Resource (ITR) made as a part of any contract resulting from this
ITN. ITR include data processing hardware, software, services and
maintenance. The applicant will not be reimbursed for any ITR purchases made
prior to obtaining FSS’s written approval.

Please refer to Appendix VI for further specifications regarding Information
Systems Requirements.

Shared Risk/Shared Reward
FSS and its provider of services share in both the financial successes and
challenges of this collaborative approach to community based care.
Consequently, contractual changes from time to time with DCF may result in
subsequent amendments to sub-contracts by either reducing or increasing the
total funding available for the project.
Hiring Preference
Providers submitting proposals for the specified services shall give a hiring
preference to existing Post Adoption staff who are qualified, currently in good
standing and who are interested in obtaining employment with the provider.

FSS Master Agreement with DCF
All applications and resulting contracts accepted or negotiated by FSS are


                                      12
        subject to the terms and conditions of FSS’s Master Agreement with DCF,
        Contract DJ031. If an applicant desires a copy of the Master Agreement, a
        written request must be submitted to the contact person identified in Section 2.3
        of this ITN within the inquiry timeframe as stated in Section 2.4.


SECTION 3: PROGRAMMATIC REQUIREMENTS

Specific service and program requirements will be negotiated in detail with the
successful applicant.

PROGRAMMATIC DESIGN

COMMUNITY BASED CARE MODEL

                                I. LEGISLATIVE INTENT

Purpose of Model

Chapter 39, F.S., 39.001(3) describes the purpose of Community Based Care in Florida.
As cited, “It is a purpose of the Legislature that the children of this state be provided
with the following protections:

   1. Protection from abuse, abandonment, neglect, exploitation, and threatened harm.
   2. A permanent and stable home.
   3. A safe and nurturing environment that will preserve a sense of personal dignity
        and integrity.
   4.   Adequate nutrition, shelter, and clothing.
   5.   Effective treatment to address physical, social, and emotional needs, regardless
        of geographical location.
   6.   Equal opportunity and access to quality and effective education, which will meet
        the individual needs of each child and to recreation and other community
        resources to develop individual abilities.
   7.   Access to preventive services.
   8.   An independent trained advocate when intervention is necessary and a skilled
        guardian or caregiver in a safe environment when alternative placement is
        necessary.

             II. COMMUNITY BASED CARE FUNDAMENTAL PRINCIPLES

A. System Beliefs

   1. Child safety. Above all else, children must be protected from abuse, neglect or
      other forms of maltreatment.



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  2. Community involvement. The State of Florida, the school system, the courts,
     Guardian Ad-Litem, law enforcement, foster parents, local governments, the child
     and family, volunteers, local businesses, donors and foundations, as well as faith
     based and other community organizations, are critical partners in achieving and
     maintaining successful outcomes.

  3. Accountability. We are held accountable for performing to a higher standard of
     care based on best practice principles and established, measurable outcomes.

  4. Resource management. We reach established outcomes when all resources are
     used in the most efficient method, i.e., human resources, fiscal resources, and
     information/technology.

  5. Responsiveness. We deliver services through a rapid and attentive approach
     that is responsive to the child and family’s needs when in crisis.

  6. Concurrent planning. Children and families are best served when we remain
     open to multiple potential solutions and goals to achieve stability and
     permanency.

  7. Single point of entry. We approach each child and family in a way that assures
     access to consistent treatment and services, and reduction in duplication of
     efforts.

  8. Individualized case planning. We assure the greatest opportunity for success
     when the service approach remains flexible and adjusts to the child and family’s
     needs as identified through an ongoing process of risk and safety assessment.

  9. Strength-based approach. We recognize and build on the strengths, resources
     and skills of each family to engage them in developing strategies to best protect
     and care for their children.

  10. Continuity of Relationship. Children and families experience higher degrees of
      safety, permanency and well-being, regardless of their service need (i.e.,
      voluntary protective services, court ordered protective supervision, foster care,
      adoption) when they have consistent and stable support, guidance and
      communication.

B. System Strengths

  1. FSS Mission Statement. To provide for the safety and stability of children and
     families by strengthening the child protection system and involving neighborhood
     networks to ensure success.




                                           14
   The mission of FSS drives a seamless system of community based care that is
   characterized by integrity in decision-making with child safety as a central focus,
   respect for the rights and dignity of children and families, and priority on
   professional responsibilities over personal interests.

   Family Support Services strives to:

      Develop a network of family foster care that is neighborhood-based and
       makes every attempt to place children in their own communities
      Reduce the number of children served in institutional and group care –
       shifting to family foster care and family-centered services
      Lessen the number of children coming into foster care
      Decrease the length of stay of children in out-of-home care
      Reunite families quickly by implementing preventive measures
      Streamline the adoption process and provide ongoing support to adoptive
       families

2. Community investiture. FSS does not work in isolation from other critical human
   service programs. On a regular and ongoing basis, we report system outcomes
   and seek direction from community stakeholders.

3. Intensity of services. We place emphasis on services from point of referral and
   assess risk to help determine level of contacts. Ongoing assessment determines
   intensity of service throughout the life of the case.

4. Team approach. We use the Family Team Conference Case Planning approach
   to create an individualized case plan. Children and families are the core of the
   team. They bring their history, experience, and strengths to their own resolution
   process. Professional staff; FSC, foster parents, Guardian Ad Litem,
   therapist/counselor and other service providers work with the family toward
   safety, permanency and well-being for the child.

5. Checks and balances. Reliance on a community-based care model, with multiple
   stakeholders and perspectives, inherently reinforces continual stimulation of
   checks and balances that ensures optimal service delivery, system integrity, and
   achievement of client outcomes.

6. Staff development system. The system deploys and relies on a well-trained and
   competent workforce. It promotes achievement of initial competencies and
   ongoing skill development through established and formal training and regular
   supervision on service delivery topics. Program specific training and
   competency expectations include foundations, indicators of maltreatment, initial
   response, interviewing, removal and placement, assessment and case planning,
   case supervision and services, and adoptions, as well as legal base, court
   systems, federal funding, and relative caregiver.


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  7. Ethical Standards. According to the highest standards of family-centered ethical
     practice, all services and interventions help the family identify its strengths,
     competencies, resources, and options for community assistance/support; help
     the family understand problems in new and more helpful ways; and help the
     family formulate solutions to specific problems. Services demonstrate respect for
     individual and family values and goals; support cultural identity and linguistic
     needs; accommodate variations in life style; and emphasize personal growth,
     development, and situational change. Clients and families are informed of their
     right to consent and participate in decisions about their care; have right of refusal
     and self-determination; have a right to privacy and confidentiality protection; and
     have the right to be heard by the organization with regard to grievances.



                        III. FSS SYSTEM OF CARE DESIGN


A. Regulatory Compliance

  1. All services are responsive to and compliant with the requirements of the ASFA.
     General requirements for all programs focus on safety, well-being and
     permanency through attention to Service Provision, Health Care Needs, Case
     Plans, Judicial Reviews, In-Home Protective Supervision, Out-of-Home Care,
     Adoption Program, Independent Living, Department of Juvenile Justice, Data
     Validation, Federal Funding Requirements, and Adoption Subsidy.

  2. All services are responsive to and compliant with required statutory and
     applicable DCF policies and administrative rules, national accreditation
     standards, and FSS policies and procedures.

B. General Best Practice Service Requirements

  Based on FSS’s system of care beliefs and strengths, services under this ITN
  will include the following:

     Services to be Provided:


     1.      General Description. The Subcontractor shall provide a comprehensive
     array of Post Adoption and related services to eligible children, families and other
     substitute caregivers as described in Chapter 409, F.S. and Chapters 65C-13,
     65C-14, and 65C-15, F.A.C. families in Duval and Nassau County. The over all
     intent is to compliment a comprehensive system of care where children are
     protected from abuse and neglect, able to live with their newly adopted families,
     achieve stability and permanency in their living situation, achieve success in


                                           16
school and become stable, gainfully employed adults. Services, service
definitions and service tasks are outlined in the Master Agreement and
Amendments hereby incorporated by reference.

2.      Service Design

 (a)    As needed children and families shall be encouraged and supported to
        access services. When families refuse or fail to follow through with
        services, the reason for their doing so will be assessed and the services
        that have been offered shall be modified or alternative services offered to
        encourage acceptance of services.

 (b)    Families shall receive individualized services based on their unique
        strengths and needs. The strengths and needs of the family shall dictate
        the type and mix of services provided; the type and mix of services
        provided shall not be dictated by what services are available. Services
        must be adapted to families; children and their families must not be
        required to adapt to inflexible, pre-existing services. When possible within
        existing resources the Subcontractor shall develop needed services when
        they are unavailable.

 (c)    Services to families shall be planned and delivered through a systematic
        plan, which will meet all Federal, State, Department and FSS
        requirements.

 (d)    The Subcontractor shall be sensitive to cultural and racial differences and
        the special needs of minority, ethnic and racial groups. Services shall be
        provided in a manner that respects these differences and attends to these
        needs.

3.      Scope of Services.

         Subcontractor will provide services not limited to but including the
     following:

        a)     A comprehensive assessment of the child and family.

        b)     As deemed appropriate, the Counselor will be participate in the
               Individualized Education Plan (IEP) with the child (ren), parents and
               school personnel to ensure the best educational placement is
               arranged and supported.

        c)     Linkage to community resources to meet special needs.

        d)     Counseling services.



                                       17
             e)     Adoption support groups.

             f)     Crisis management services on a 24 hour per day, 7 day per week
                    basis.

             g)     The Subcontractor shall fully cooperate with FSS Adoptions
                    Department in sharing and providing information to FSS for families
                    interested in pursuing adoption.

             h)     Parent education classes.


SECTION 4: FINANCIAL SPECIFICATIONS

4.1   Funding Source

      This ITN is funded through the FSS Master Agreement DJ031 and may include,
      but is not limited to the following state and federal funding:

      General Revenue, Administrative Trust Fund, Tobacco Settlement Trust Fund,
      Operations & Maintenance Trust Fund, Temporary Assistance to Needy Families
      (TANF) Maintenance of Effort (MOE), Home Visitor/High Risk Newborn, Social
      Services Block Grant (SSBG), SSBG 2, Title IV-B Child Welfare Services, Title
      IV-E Foster Care, Title IV-E Adoption Services, Medicaid Administration,
      Promoting Safe and Stable Families (PSSF), State Access & Visitation, Child
      Abuse Prevention and Treatment Act (CAPTA) and TANF.

4.2   Funding Amount

      Funding for the Post Adoption Services Function is anticipated to be
      $ 100,000.00 per fiscal year for a total of $100,000.00 for this contract term.

4.3   Allowable Costs

      Allowable costs will include those reasonable and necessary costs involved in
      providing Post Adoption services in accordance with the Office of Management
      and Budget (OMB) Circular A-122
      (http://www.whitehouse.gov/omb/circulars/a122/a122.html). Indirect costs may
      be limited and will be finalized during the contract negotiation.

4.4   Invoicing and Payment

      The successful applicant(s) shall be paid on a fixed price basis with a not-to-
      exceed maximum dollar amount, pending any approvals required from DCF,
      using an invoice format to be finalized during the contract negotiation.


                                           18
4.5   Financial Audits

      The contract resulting from this ITN will define the responsibilities of the applicant
      for complying with financial audits.

SECTION 5: INSTRUCTIONS FOR APPLICATION PREPARATION

5.1   General Information

      The applicant shall include one (1) original, one (1) electronic copy saved on a
      CD, and five (5) copies of the application, each in a separate sealed envelope
      clearly marked. Each envelope will be marked as follows: “Services ITN#
      FSSPA09-01”, applicant’s name and address. The original proposal must be
      clearly marked as such, and the copies identified and numbered (i.e., Original,
      Copy #1 of 6). The electronic copy should be included with the Original and
      clearly marked.

      Appendix VII lists Fatal Criteria that each application must satisfy. Failure to
      meet fatal criteria will automatically disqualify an application from further
      consideration.

      The narrative portion (5.2.C) must not exceed 40 pages, 12-point type, excluding
      cost application, required applicant statements and certifications, and required
      attachments, and must follow the exact sequence below. A completed application
      consists of the following:

5.2   Contents of Application

      A. Signed Application Summary Form, Executive Summary of the Application
         (see Appendix VIII).
      B. Signed Required Applicant Statements and Certifications (see Appendix III)
                Acceptance of Contract Terms and Conditions
                Statement of No Involvement
                Proof of Signature Authority
                Conflict of Interest Form
                Certification of Drug-Free Workplace
                Certification of Board of Directors Approval
                Certification of No Criminal Conduct
                Certification Regarding Corrective Action Plans Implementation
                Certification Regarding Debarment and Suspension and Other
                   Responsibility Matters Form
                Certification Regarding Lobbying Form
      C. Program Narrative (see Section 5.3)
      D. Cost Application (see Section 5.4)


                                            19
      E. Required Attachments (see Section 5.3 and 5.4)
                An Organizational Chart/Staffing Pattern
                Job descriptions for key project staff
                Most recent financial audit
                Most recent monitoring report(s) from any funding source(s)
                Accreditation documents
                Letters of Support (limit to 10)

5.3   Program Narrative

      Information is required in two (2) areas: A) organizational capacity and
      collaborative relationships and B) program design and required outcomes.

      A. Organizational Capacity, Collaborative Relationships and Staff
         Development

      This section shall contain a synopsis of the applicant’s organization and
      collaborative relationships. This section should consider service and program
      information described in Section 3 and must include:

         1.   A synopsis of the applicant’s organizational qualifications and
              experiences with state and federal funding, i.e. adoption, post adoption
              child welfare, TANF, prevention, and/or mental health. Present evidence
              that the applicant has experience managing multiple funding streams for
              a single project.

         2.   A description of the applicant’s approach to integrating the services
              detailed in this ITN with the community’s current programs and services,
              including linkages with existing community and neighborhood based
              supports. This will include, but not be limited to, linkages to full service
              schools, faith institutions, mental health professionals and health care
              providers, substance abuse and domestic violence programs, police,
              child care providers, parent groups, and neighborhood groups. Present
              evidence that the applicant has a history of community collaboration and
              a commitment to future collaboration.

         3.   A description of the experience of the applicant’s project director (if
              known) and key project staff, including their qualifications and prior
              experience with adoption and post adoption services. Additionally, the
              applicant should include an organizational chart which identifies how
              proposed staff relates to each other and the entire organization.

         4.   The applicant shall include a staffing plan for direct services and
              administrative services, including number of staff, qualifications,
              organization of staff and timelines for hiring and training new staff for this


                                            20
         project. The staffing plan will address staff turnover, future recruitment
         and how hiring issues will be managed.

    5.   The applicant shall provide a staff development and training plan which
         will address mandatory training as well as agency specific training.

    6.   The applicant will submit any/all accreditation documents.

    7.   The applicant will submit a maximum of ten (10) letters of support.

B. Program Design and Required Outcomes

This section will contain an overview of how the applicant will plan, implement
and evaluate the services to meet the system of care beliefs and complement the
existing FSS design (Section 3).

a. The applicant will address the cultural diversity of the population to be served
including plans for maintaining cultural competence of service staff.

b. The applicant will address barriers to service delivery. These barriers
include, but are not limited to, challenges such as language,
transportation, service delivery schedules and hours accessible to
clients.

c. The applicant shall describe how they will interface with other service
providers and systems, both formal and informal, in the planning district(s) when
the needs of children in the child welfare system transcend the direct authority of
the FSC. Other service providers may include, but are not limited to:

           Florida Department of Children and Families
           Department of Juvenile Justice
           Children’s Medical Services/Department of Health
           Developmental Disabilities Program
           Office of the State’s Attorney
           Child Protection Team
           Guardian Ad Litem’s Office
           Court Systems
           Law Enforcement
           Public and private school systems
           Behavioral health systems
           Other providers

d. The applicant’s quality assurance plan will include a method for assessing
need and adequately address safety issues and risk assessment.




                                      21
      e. The applicant will describe previous experience and knowledge using
      Florida Safe Families Network (FSFN).

      f. The applicant will describe its ability or history with contract compliance
      (reporting, outcomes, etc.).

              Information and further detail on Programmatic Authority (Federal), Florida
              Statutes, Florida Administrative Code (Rule), Child Welfare/ Community-
              Based Care Operating Procedures, and Miscellaneous can be found in
              Appendix IX, Authority and Requirements.


5.4   Cost Application

      Applicants should propose a 12-month project and include a discussion of
      strategies for securing additional funding that can enhance the initiative allowing
      for additional services.

      The cost application must contain three (3) parts:
          Financial Capability Statement
          Applicant Self Evaluation (Appendix X)
          Sample Budget Detail and Instructions (see Appendix XI)

      A. Financial Capability Statement

         1.   The applicant should include a statement describing the organization’s
              experience and capacity to:

               Receive and manage federal and state funds
               Provide fiscal management of current programs, including revenue
                maximization expertise, fiscal reporting and oversight
               Access funds (i.e., through cash reserves, line of credit, etc.) for
                operating costs for at least two months of service in the event
                advances from the DCF are unavailable

         2.   The applicant shall submit a cost allocation plan that describes allocation
              methodologies used by the applicant to claim costs for this project. This
              plan must also include the applicant’s indirect allocation and rate
              methodology. If the applicant has a federally approved plan, a copy may
              be submitted to FSS to support claimed costs.

      B. Applicant Self Evaluation (Appendix X)


      C. Budget Narrative and Budget Forms


                                            22
    This component of the cost application justifies the budget and the cost of
    services. The method of cost presentation will be a line-item budget and budget
    narrative per the instructions and format found in the ITN Sample Project Budget
    Detail and Instructions – Appendix XI. All requested costs shall be allowable,
    reasonable, necessary and be in compliance with OMB Circular A-122.

    The cost application shall include proposed expenditures to be used as match (if
    any). The funding source of budget items identified as match may not be another
    Federal grant or state contract.


SECTION 6: EVALUATION PROCESS

    Phase 1 – Fatal Criteria

    The contact person identified in Section 2.3 of this ITN or designee will determine
    whether each application meets the fatal criteria listed in Appendix VII. Failure to
    comply with all fatal criteria will render an applicant non-responsive and ineligible
    for further evaluation. All qualified applicants will advance to Phase 2.

    Phase 2 – Evaluation of Applicants

    The contact person identified in Section 2.3 will convene an evaluation team to
    evaluate all qualified applicants. The evaluation team will rate the responsive
    applicants using the structured evaluation tools located in Appendix IV. Each
    evaluation team member will perform an individual evaluation of assigned
    applications.

    Each evaluator rating summary (Appendix IV) will be submitted to the contact
    person identified in Section 2.3, who will average the rates. The resulting
    average will be totaled yielding the evaluation teams’ final rating for the
    application.

    Phase 3 – Report of Applications
    The contact person identified in Section 2.3 will review rating sheets for
    accuracy, and prepare a report. This report will be submitted to the CEO of FSS
    and subsequently to the FSS Board of Directors.

    The Board of Directors shall, at its absolute discretion, select the applicant or
    applicants with which further negotiations shall be conducted and provide any
    related direction to the CEO of FSS it believes warranted in that regard.

    Phase 4 – Negotiation with Applicants
    The CEO, or designee, in accordance with the direction of the Board of Directors



                                         23
shall negotiate the terms of the contract, including the award amount, with the
selected applicants prior to entering into a contract. FSS reserves the right to
negotiate with more than one applicant at a time. If a contract cannot be
negotiated with any of the ranked applicants who responded to this ITN, FSS
shall have the right to issue a new ITN or to otherwise seek additional qualified
applicants.




                                     24
                                    APPENDIX I
                            Duval County Planning Districts

Duval County has been organized into six (6) planning districts; each of these planning
districts is represented by a Citizen Planning Advisory Committee.
Statistics were obtained from FSFN, using removal location by zip code. In two
situations where the zip code overlapped the planning district boundaries, the removal
counts were added to the planning district with the largest geographical portion of the
zip code.

                          Duval County Planning Districts
                                         *
    District 1   District 2   District 3   District 4   District 5         District 6
                  Greater
     Urban       Arlington/ Southeast Southwest Northwest                    North
     Core        Beaches
     32201         32277        32257       32205         32219             32218
     32202         32211        32216       32210         32208             32226
     32206         32246        32207       32212         32209
                   32227        32250       32073         32220
                   32238        32217       32244         32254
                   32266        32240       32222         32204
                   32225        32256       32221
                   32228        32223       32243
                   32233        32258       32224
                                32255       32214




                                           25
                                       APPENDIX II
                         Notice of Intent to Submit an Application


                          Due Date: Tuesday, April 28, 2009
                               Not later than 5:00 P.M.


    To become a provider of Post Adoption Services in Duval and Nassau Counties

                                    ITN#FSSPA09-01

Applicant Name: ____________________________________________

Authorized Signature: _______________________________________

Title: ____________________________________________________

Date: ____________________________________________________

wishes to inform the Family Support Services of North Florida, Inc. of its intent to
respond to the Invitation to Negotiate for Duval and Nassau Counties.




                                            26
                                       APPENDIX III


           REQUIRED APPLICANTS STATEMENTS & CERTIFICATIONS


A. Statement of Assurances                            Appendix III.A.

   1. Acceptance of Contract Terms and Conditions     Appendix III.A.

   2. Statement of No Involvement                     Appendix III.A.

   3. Proof of Signature Authority                    Appendix III.A.

   4. Conflict of Interest Statement                  Appendix III.A.

   5. Certification of Drug-Free Workplace            Appendix III.A.

   6. Certification of Board of Directors Approval    Appendix III.A.

   7. Certification of No Criminal Conduct            Appendix III.A.

   8. Certification of Corrective Action Plan         Appendix III.A.

B. Certification Regarding Debarment,                 Appendix III.B.
   Suspension and Other Responsibility Matters Form

C. Certification Regarding Lobbying Form              Appendix III.C.




                                            27
                                     APPENDIX III.A.

Required Applicants Statements and Certifications

*As described in Section 5.2, Items 1 through 8 below are Mandatory
Requirements (Fatal Criteria).

*1. Acceptance of Contract Terms and Conditions

I, __________________________, as an authorized representative of,

_____________________________________, hereby agree that if awarded any
contract as a result of the Family Support Services of North Florida, Inc (FSS).
Invitation to Negotiate number FSSPA09-01, it will comply with the requirements,
terms and conditions stated in the Invitation to Negotiate and in FSS’s Contract with
the entity. In recognition thereof the applicant’s representative has read, understood, it
agrees to comply and any deviation from the terms and conditions set forth therein
may result, at FSS’s exclusive determination, in rejection of the application.
Type Name of Authorized Official:              Title:

Signature of Authorized Official:             Date:


*2. Statement of No Involvement

I_________________________________________________, as an authorized
representative of,

_____________________________________, certify that no member of this agency
nor any person having interest in this agency has been awarded a contract by the
Family Support Services of North Florida, Inc. on a non-competitive basis to:
   1. Develop this Invitation to Negotiate,
   2. Perform a feasibility study concerning the scope of work contained in this
         Invitation to Negotiate.

Type Name of Authorized Official:             Title:

Signature of Authorized Official:             Date:




                                            28
                               APPENDIX III.A. (continued)

Required Applicants Statements and Certifications

*3. Proof of Signature Authority
This Invitation to Negotiate shall include proof of signature authority if someone
signs the Invitation to Negotiate other than the President or Chairperson of the
Board of Directors. This proof shall be one of the following: A written statement by
the President or Chairperson of the Board delegating authority to a particular
person, a copy of the entity’s by-laws reflecting signature authority to a particular
position, a copy of the Board of Directors’ meeting minutes that shows action to
delegate signature authority to a particular person or position. If delegating
signature authority, please complete the below and include the above requested
document.
Type Name of President or Chairperson of the Board of Directors:

Type Title of Person to Whom Signature Authority is Delegated:

Type Name of Person to Whom Signature Authority is Delegated:


*4. Conflict of Interest Statement (Non-Collusion)
I hereby certify, that all persons, companies, or parties interested in the Invitation to
Negotiate as principals are named therein, that the Invitation to Negotiate is made
without collusion with any other person, persons, company, or parties submitted a
application; that it is all respect made in good faith; and as the signer of the
Invitation to Negotiate, I have full authority to legally bind the applicant to the
provisions of this application.
Type Name of Authorized Representative:                  Title:

Signature of Authorized Representative:                Date:


*5. Certification of Drug – Free Workplace Program
I hereby certify that my agency currently maintains a drug-free workplace
environment in accordance with Chapter 287.087, F.S. and will continue to promote
this policy through the implementation of that section.
Type Name of Authorized Representative:              Title:

Signature of Authorized Representative:                Date:




                                             29
*6. Certification of Board of Directors Approval
I hereby certify that my agency’s Board of Directors has given its approval for my
agency to enter into negotiations with Family Support Services of North Florida, Inc.
(FSS) to provide Comprehensive Post Adoption Services in Duval and Nassau
Counties commencing July 1, 2009.
Type Name of Authorized Representative:              Title:

Signature of Authorized Representative:               Date:


                               APPENDIX III.A. (continued)

Required Applicants Statements and Certifications

7. Certification of No Criminal Conduct
I hereby certify, that no persons or companies interested in the Invitation to
Negotiate as principals are under investigation or indictment for criminal conduct,
nor have they been convicted of any crime which would adversely reflect on their
ability to provide services to vulnerable populations, including, but not limited to,
abused or neglected children, or which adversely reflects their ability to properly
handle public funds.

If there are persons or companies under investigation or indictment for criminal
conduct, or have been convicted of any crime as described above, please provide
an explanation below.




Type Name of Authorized Representative:               Title:

Signature of Authorized Representative:               Date:




                                             30
8. Certification of Corrective Action Plan Implementation
I hereby certify that all persons, companies, or parties interested in the Invitation to
Negotiate as principals have implemented Corrective Action Plans approved by
FSS, Department of Children and Families or any governmental entity, after having
received due notice.

If there are persons or companies that have failed to implement Corrective Action
Plans as described above, please provide an explanation below.




Type Name of Authorized Representative:                Title:

Signature of Authorized Representative:                Date:


                                     APPENDIX III.B.

            CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
                    AND OTHER RESPONSIBILITY MATTERS
                         (Primary Covered Transaction)


This certification is required by the regulations implementing Executive Order 12549,
Debarment and Suspension, 29 CFR Part 98, Section 98.510, Participants’
Responsibilities. The regulations were published as Part VII of the May 26, 1988,
Federal Register (pages 19160-19211).


   1. The prospective primary participant certifies to the best of its knowledge and
      belief, that it and its principals:

       a. Are not presently debarred, suspended, proposed for debarment, declared
       ineligible, or voluntarily excluded from covered transactions by any Federal
       department or agency;

       b. Have not within a three-year period preceding this application been convicted
       of, or had a civil judgment rendered against them for commission of fraud or a
       criminal offense in connection with obtaining, attempting to obtain, or performing
       a public (Federal, State, or local) transaction or contract under a public


                                             31
     transaction; violation of Federal or State antitrust statutes or commission of
     embezzlement, theft, forgery, bribery, falsification or destruction of records,
     making false statements, or receiving stolen property;

     c. Are not presently indicted for, or otherwise criminally or civilly charged by a
     government entity (Federal, State, or local) with commission of any of the
     offenses enumerated in paragraph 1.b of this certification; and

     d. Have not within a three-year period preceding this application/application had
     one or more public transactions (Federal, State, or local) terminated for cause or
     default.

  2. Where the prospective primary participant is unable to certify to any of the
     statements in this certification, such prospective participant shall attach an
     explanation to this application.




_____________________________           ___________________________________
Name of Certifying Official                Signature             Date


____________________________________________________________________
Title                      Name of Organization


____________________________________________________________________
Address of Organization




                                           32
                                         APPENDIX III.C.

                            CERTIFICATION REGARDING LOBBYING
        (Certification For Contracts, Grants, Loans, And Cooperative Agreements)

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

1.   No Federal appropriated funds have been or will be paid, by or on behalf of the
   undersigned, to any person for influencing or attempting to influence an officer or
   employee of a Federal agency, a Member of Congress, an officer or employee 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, an officer or employee 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 fact upon which reliance was placed
when this transaction was made or entered 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 person who fails to file that 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.

_____________________________                 ___________________________________
Name of Certifying Official                      Signature      Date

_____________________________________________________________________
Title                      Name of Organization

______________________________________________________________________
Address of Organization


*Note: In these instances, “All” in the Final Rule is expected to be clarified to show that it applies
to covered contract/grant transactions over $100,000 (per OMB).


                                                 33
   APPENDIX IV




ITN Evaluation Tools




         34
                 APPENDIX IV


               FATAL CRITERIA




The Fatal Criteria form is located in Appendix VII




                       35
                                                     APPENDIX IV
                                                Rating Scale Summary




Points                    Rating Scale Summary*
         Applicant has not responded to or has poorly responded to
  0      the criterion demonstrating a lack of understanding of the     No value
         criterion addressed in the application.
         Applicant has demonstrated little or no direct capability or
  1      has not adequately addressed the criterion in the              Minimal
         application.
         Applicant has demonstrated average capability and a good
  2                                                                     Average
         approach to the criterion in the application.
         Applicant has demonstrated above average capability and         Above
  3
         approach to the criterion in the application.                  Average


  * Scoring is 0-3 unless otherwise indicated.
    Where 0 or 1 is listed as the scoring option: 0 = the criteria has not been demonstrated
                                                  1 = the criteria is supported in the documentation

  ** Scores must be whole numbers, fractions or decimals are not acceptable




                                                            36
                                                   APPENDIX IV
                                             Evaluator Rating Summary




Applicant’s Name (Agency)                                                      Date



        Reviewed By (FSS)                                                      Date



       Witnessed by (FSS)                                                      Date




         Evaluator Rating Summary:                                        Subtotal    Maximum Score:
                                                                           Score:
         5.3 A. Organizational Capacity, Collaborative Relationships                  40
                and Staff Development
         5.3 B. Program Design and Required Outcomes                                  96
         5.4. Cost Application                                                        59
                                                                                      195     (Total points possible)

 * Scoring is 0-3 unless otherwise indicated.
   Where 0 or 1 is listed as the scoring option: 0 = the criteria has not been demonstrated
                                             1 = the criteria is supported in the documentation

 ** Scores must be whole numbers, fractions or decimals are not acceptable



                                                           37
                                              APPENDIX IV
5.3 A. ORGANIZATIONAL CAPACITY, COLLABORATIVE RELATIONSHIPS AND STAFF DEVELOPMENT

              Criteria                                      Indicators                            Score    Comments
                                                                                                   (0-3)
      1. A synopsis of the            There is evidence that the applicant has
         applicant’s                   knowledge and/or experience with earning state
         organizational                and federal funding
         qualifications and           There is evidence that the applicant has
         experiences with state        experience managing multiple funding streams for
         and federal funding, i.e.     a single project
         child welfare, TANF,
         Prevention and/or
         Mental Health
      2. A description of the            Applicant has a history of community
         proposed approach to             collaboration and commitment to future
         the integration of this          community collaboration (weighed X 3)
         project with the planning       There is evidence that the applicant has linkages
         district(s) current              to various community and neighborhood based
         programs and service             services
      3. A description of the           Applicant’s project director and/or key project staff
         experience of the               have worked with this population and community
         applicant’s project             based services
         director (if known) and        Applicant includes a staffing plan for direct
         key project staff,              services and administrative services, including
         including their                 number of staff, qualifications, organization of staff
         qualifications and prior        and timelines for hiring and training new staff for
         experience with                 this project
         community-based care           Applicant includes an organizational chart which
         services                        identifies how project staff relate to each other
                                         and the entire organization
                                        Applicant addresses how staff turnover and future
                                         recruitment and hiring issues will be managed



                                                                   38
         Criteria                                Indicators                    Score          Comments
                                                                                (0-3)
 4. Applicant’s Staff         Applicant includes a Staff Development and      0 or 1
     Development and           Training Plan
     Training Plan            The plan describes agency specific training

                              The plan describes incorporation of mandated
                               training


Sub total of Organizational Capacity, Collaborative Relationships and Staff Development Section 5.3 A.:______________
                                                                                       (Total Possible Score = 40)




                                                       39
                                                           APPENDIX IV
5.3 B. Program Design and Required Outcomes

                 Criteria                                   Indicators                      Score    Comments
                                                                                             (0-3)
      1. How the applicant will         Applicant describes how it will work within the
         address the FSS                 FSS system of care model
         comprehensive system of
         care. Include any plans to     Applicant describes how it will manage service
         strengthen relationships with   linkage and coordination, including physical,
         other community service         mental and behavioral health and educational
         providers as part of the FSS    needs of the child
         system of care for children
         and families
      2. Cultural Competency            Applicant includes plans for maintaining           0 or 1
                                         cultural competence of service staff
                                        Applicant addresses cultural diversity of the      0 or 1
                                         population it serves
      3. Methods for addressing         Applicant will describe how they will address
         barriers to service delivery    the following barriers:

                                           -Language
                                           -Transportation
                                           -Service delivery schedules
                                           -Hours accessible to clients

      4. How the applicant will           Applicant includes plan to address how it will
         address achieving the             achieve the required outcomes for outcome
         required outcomes for Post        measures 5.3.Bc 1 through 9 (weighted X 3)
         Adoption Services




                                                                 40
                                                     APPENDIX IV
 Criteria                       Indicators                                              Score    Comments
                                                                                         (0-3)
5. How applicant will            Applicant describes how it may interface with
   interface with other           service providers
   service providers and
   systems when the needs        The above description of interfacing explains their
   of children in the child       approach to meeting the complex needs of
   welfare system                 children and support permanency for children with
   transcend the direct           such complex needs
   authority of the FSC
6. Applicant’s Quality           Applicant includes a Quality Assurance plan           0 or 1
   Assurance Plan related        The plan is described in detail and includes a
   to service delivery            method for assessing need on an ongoing basis
                                 Applicant has a planning process that adequately
                                  addresses safety issues and risk assessment
7. How the applicant will        Applicant describes implementation of FSS’s
   address the FSS                 prevention services function and how they will
   prevention services             meet the FSS prevention outcome measures
   function, include any         Applicant describes how it will manage prevention
   plans to strengthen            service linkage and coordination on behalf of the
   relationships with other       family
   community service
   providers as part of the
   FSS system of care
8. Applicant’s experience        Applicant describes FSFN experience and
   and knowledge with             knowledge
   FSFN
9. Applicant’s ability or        Applicant describes its ability or history with
   history with contract          contract compliance (reporting, outcomes, etc)
   compliance

                        Subtotal of Program Design and Required Outcomes Section 5.3 B.:________X2=_______________
                                          (Program Design and Required Outcomes weighted by 2 = Total Possible Score = 96)


                                                           41
                                                             APPENDIX IV
5.4 Cost Application

               Criteria                                    Indicators                          Score    Comments
                                                                                                (0-3)
     1. The applicant’s audited       The financial statements indicate the applicant has a
        financial statements           history of sound financial management (weighted X
        indicate it has sufficient     2)
        resources and                 Applicant has experience managing multiple funding
        experience to manage           streams (weighted X 2)
        this project
     2. Financial Capability          Applicant describes the organizational experience
        Statement                      and capacity to receive and manage federal and
                                       state funds
                                      Applicant describes the organizational experience
                                       and capacity to seek and receive unrestricted grants
                                       and local community support
                                      Applicant describes the organizational experience
                                       and capacity to determine and manage
                                       documentation required for federal funding
                                      Applicant describes the organizational experience
                                       and capacity to provide fiscal management of current
                                       programs including fiscal reporting and oversight
                                      Applicant describes the organizational experience
                                       and capacity to access fund for operating costs (line
                                       of credit, reserves, etc.) for at least two months
                                       should an advance not be available
     3. Applicant Self                Applicant includes a completed Applicant Self
        Evaluation                     Evaluation and the responses in the self evaluation
                                       indicate strong financial management practices are
                                       in place
     4. Budget                        Applicant used the budget format found in Appendix
                                                                                               0 or 1
                                       XI

                                                                   42
         Criteria                               Indicators                          Score        Comments
                                                                                     (0-3)
                           The application indicated all requested costs are
                            allowable, reasonable and necessary and in
                            compliance with OMB Circular A-122
                           Separate line item budgets were submitted for
                                                                                    0 or 1
                             service by planning district(s)
                           Compensation is commensurate with the types of
                                                                                    0 or 1
                             work performed (Direct Labor and Support Costs)
                           Positions are necessary to achieve the project goals
                                                                                    0 or 1
                             (Direct Labor and Support Costs)
                           Support costs that should or could be included in the
                             agency’s Indirect Cost Rate (as applicable) are not
                             also included as direct costs (i.e. CEO, CFO, COO,
                             etc.)
                           Fringe benefits are reasonable, allowable, allocable    0 or 1
Budget (continued)
                             and consistently applied
                           Fringe benefits are comparable to that of similar
                             organizations
                           Sufficient detail is provided to determine how costs
                             were derived
                           Costs are reasonable in view of actual prices
                           Travel mileage reimbursement rates do not exceed
                             the state rate
5. Cost Allocation Plan    Applicant includes a description of allocation
                            methodologies to claim costs for this contract. Also
                            includes a description of the agency’s indirect cost
                            allocation and rate methodologies
                           The Cost Allocation Plan presents an equitable
                             methodology for allocating costs to all programs
                             based on relative benefit

                                                               Sub total of Cost Application Section 5.4: _____________
                                                                                               (Total Possible Score = 59)

                                                        43
                                       APPENDIX V
                                        Protests

Purpose and Scope: Protests may be filed in response to competitive procurement
decisions.

1. Filing the Protest. Any person who or agency that has been adversely affected by a
    decision or intended decision concerning a solicitation or a notice of contract award
    may file a written notice of protest with the Family Support Services of North Florida
    Inc.’s (FSS) contact person listed in the solicitation document within three calendar
    days after the posting of the solicitation or of the notice of FSS’s decision or
    intended decision. The protest may be filed electronically and submitted to:
    juanita.jones@fssnf.org.

2.    Issues Causing Protest. Any person who or agency that has been adversely
     affected by the terms, conditions and specifications contained in this solicitation,
     including any provisions governing the methods for ranking proposal, applications,
     or replies, awarding contracts, reserving rights of further negotiation, or modifying or
     amending any contract shall file a notice of protest in writing within three calendar
     days after the posting of the notice or decision or intended decision. When filing the
     protest the following requirements must be adhered to:

       a. A formal protest must be filed with the FSS contact person after filing the
          notice of intent to protest. The formal protest must be:

              (1) In writing; and,

              (2) Filed within ten (10) business days after filing of the notice of protest.

                     a. No time will be added to the above time limits for mail service.

                     b. Failure to file a protest within the time prescribed shall constitute
                        a waiver of protest proceedings; and

              (3) Accompanied by a bond payable to FSS as described in Paragraph 3
                  at the time of filing the formal written protest.

3. Posting Bond for Protest Filed. Any person who or agency that files an action
   protesting a decision or intended decision pertaining to contracts administered by
   FSS must comply with the following requirements.

       a. When protesting a decision or intended decision the protestor must post a
           bond equal to five percent (5%) of FSS’s estimated contract amount. FSS at
           its sole discretion shall estimate the contract amount based on factors
           including, but not limited to, the following:




                                             44
             (1) The price of previous or existing contracts for similar or contractual
                 services.
             (2) The amount appropriated for the contract.
             (3) The fair market value of similar contractual services.

      b. FSS shall provide the estimated contract amount to the protestor within three
          business days after the notice of protest has been filed. The estimated
          contract amount is not subject to protest. The bond shall be conditioned upon
          the payment of all costs and charges that are adjudged against the protestor
          in any subsequent hearing in which action is brought and in any subsequent
          appellate court proceeding.

      c. The official hours of office operation for receipt of intent to protest and/or a
          petition and bond are 8:30 AM to 4:30 PM local time.


4. Content of Formal Written Notice of Protest. The formal written notice of protest
   should be printed, typewritten, or otherwise duplicated in legible form. The content of
   the formal written notice of protest should contain:

   a. The name and address of FSS contact person with whom the protest will be filed;

   b. The name and address of the agency filing the protest and an explanation of how
      its substantial interests have been affected by the solicitation or by FSS’s notice
      of intended or actual contract award;

   c. With particularity, the facts and law upon which the protest is based;

   d. A statement of all issues of disputed material facts (if there are none, the protest
      must indicate such);

   e. A concise statement of the ultimate facts alleged, as well as the rules and
      statutes which entitle the person or firm filing the protest to relief;

   f. A demand for relief to which the person or agency deems himself/itself entitled;
      and,

   g. Any other information which the agency contends is material.

5. FSS’s Response to Protest.

   a. Upon receipt of a formal written notice of protest, the solicitation process or
      contract award process must be stopped until the protest is resolved. Upon
      receipt of a protest, the FSS contact person shall immediately consult the
      appropriate legal counsel. With legal counsel, the FSS Chief Executive Officer
      must determine whether or not to accept or reject the protest.



                                           45
   b. The Board of Directors of FSS, if it is deemed necessary, may set forth in writing,
      particular facts and circumstances which may require continuance of the
      solicitation processes or the contract award process on an emergency basis
      without the above mentioned delay in order to avoid immediate and serious
      danger to public health, safety, or welfare. This written determination will
      specifically detail the facts underlying the decision and will constitute final agency
      action. In such circumstances, FSS shall use its procurement policy for
      processing emergency procurements due to disputes.

6. Resolution of the Protest.

   a. The formal written protest shall be referred to a hearing officer who shall conduct
      further proceedings. It shall be the responsibility of FSS to appoint an appropriate
      individual to serve as the hearing officer.

   b. Upon completion of the hearing process and any appellate court proceedings the
      disposition of the bond shall be as follows: If FSS prevails, it shall recover all
      costs and charges that shall be included in the final order or judgment, excluding
      attorney fees. Upon payment of such costs and charges by the agency
      protesting, the bond shall be returned to the agency.




                                            46
                                    APPENDIX VI
                          Information System Requirements

The department maintains information in the Florida Safe Families Network System,
herein after FSFN, (formerly known as HomeSafenet) and the Integrated Child Welfare
Services Information System (ICWSIS). The provider must enter data into, and retrieve
data from, these applicable systems. The provider shall have limited access to the
Florida Abuse Hotline Information System (FAHIS).

Security
The provider shall comply with all applicable laws and procedures pertaining to security
and confidentiality including, but not limited to, those listed in Appendix IX. The provider
shall comply with any naming conventions, security requirements, or other
specifications relating to any connection it may be allowed to make to the department’s
electronic information systems. The provider’s own systems and premises shall be
subject to inspection by the department’s representatives at any time to verify
compliance with security requirements. Any data communications involving the
department may also be monitored by department security or systems personnel for
compliance with these requirements or misuse of the systems.

In the event that the provider is allowed to electronically connect to any of the
department’s facilities, the department may suspend or revoke that connection at any
time without notice if the department has reason to believe that the security of the
department’s systems may be compromised by a continuation of that connection.
In the event the provider purchases, develops or maintains its own electronic
information systems to support services provided through this contract, the department
must have access to all information necessary to audit and examine such information in
its native format, using access devices (terminals, personal computers, or other devices
required) made available for this purpose by the provider. The provider must provide
the department’s representatives with the necessary system user accounts and
passwords to access all information related to this contract which may be stored in the
provider’s systems. The department may require the provider to accurately complete a
self-audit questionnaire relating to the electronic information systems the provider and
any subcontractors or affiliates participating under this contract use. Material security
violations or improper information disclosures, if found, shall constitute sufficient
grounds for a determination that the contract has been breached.

In accordance with Florida Statutes, Florida Administrative Code and departmental
standards and procedures, the provider shall be required to exercise due diligence to
ensure and maintain the accuracy, timeliness, and confidentiality of information entered
into, or retrieved from, these systems. It is expressly understood that the provider's
violation of any Florida Statute related to the confidentiality of information, or any
associated Florida Administrative Code and departmental standards and procedures
(see Appendix IX), may constitute sufficient grounds for a determination that the
contract has been breached.



                                            47
Liability for System Failure
The department is not liable to the provider for a failure of any of the department’s
systems or for the degradation or disruption of any connection or system. Provider loss
or diminution of access to the department’s systems for any reason shall not excuse the
provider from its obligations under this contract. The length of time of a department
system failure will be calculated in working days. The provider shall be held
accountable for late data input due to a department systems failure of less than one
working day. Department systems failure of more than one working day shall be
calculated as follows: For each additional working day of department systems failure the
provider shall have two working days for data input before they are held accountable for
late data input.

Integrated Child Welfare Service Information System
The provider shall enter data into ICWSIS within 48 hours to indicate changes in a
child’s living arrangements or legal status or changes made to a foster home’s status.

FSFN Requirements
FSFN is the department’s system of record for all casework. The provider specifically
agrees that FSFN will always contain the most current and the most accurate
information regardless of any other systems employed by the provider.

The provider specifically agrees to collect, enter and maintain all data to meet FSFN
requirements in accordance with FSFN policies and procedures, including timeliness
criteria.

The provider is responsible for purification of data for the planning district served by the
provider in State systems that may be necessary before any future automated
conversion of data from current systems to FSFN. This includes data entered before
the provider assumed responsibility for services. The provider is also responsible for
any manual data conversion activities required. If additional funds are made available to
the Region for this purpose, a proportionate amount will be added to this contract for a
similar level of effort.

Joint Application Development (JAD) Sessions and User Acceptance Testing. The
provider shall participate in JAD sessions and user acceptance testing during the
development and operation of FSFN. The provider shall be responsible for any travel
costs associated with attendance at these sessions.

The provider shall not have access to State owned applications, e.g., FSFN, ICWSIS,
etc., to resolve data issues, make software changes, add programming, etc.

Application Training. The provider shall participate in application training for use of
FSFN, as required during the deployment of future FSFN functionality. The provider
shall be responsible for any travel costs associated with attendance at these training
sessions.



                                             48
Site Survey. The provider agrees to allow the department to conduct a site survey to
determine needs related to the implementation of FSFN at the provider’s site(s). The
department agrees to determine the resources needed to equip the provider’s staff and
in evaluating site security requirements.

Equipment. The provider shall not use equipment provided by the department and
purchased with FSFN funds for any purpose other than to support staff providing Title
IV-E and IV-B eligible services in accordance with the department’s federally approved
cost allocation plan for FSFN. FSFN computer equipment shall not be transferred,
replaced or disposed of by the provider without prior permission of the department’s
contract manager.

Information Technology (IT) Modernization

Modernization includes the purchase of planned or directed changes in technical
sophistication application systems and equipment. The provider may purchase new or
replacement IT in accordance with policy and procedures listed in Appendix IX.
Replacement of department furnished IT necessary in the performance of this contract
shall be procured by the provider and funded against payments made under this
contract at no additional cost to the department.

The provider shall provide new or factory reconditioned parts and components when
practicable in providing maintenance and repair services as described herein. All
replacement units, parts, components and materials to be used in the maintenance and
repair of equipment shall be compatible with existing equipment on which it is to be
used and shall meet industry standards and be suitable for their intended use. If
material that meets the accepted industry standard cannot be obtained, the provider
must obtain the concurrence of the Zone’s Information Systems Director before using
alternate materials.

Annually, the provider shall provide to the Zone’s Information Systems Director a
replacement schedule of all department-furnished property. The replacement schedule
shall identify all department-furnished property by nomenclature, age, estimated useful
life, estimated replacement date, estimated replacement value, salvage value, and any
projected cost savings from replacement.

Information Technology Support
The purpose of this section is to define the areas of Information Technology (IT) support
and responsibility between the provider and the department's Region Management
Information Systems. Certain conditions based on physical location of the provider
staff, department staff, ownership of the building leases and ownership of the facility
LAN and WAN connections will impact the specific IT support for the provider.

The provider shall be responsible for their own networks and network applications, not
the department, including, but not limited to, their e-mail, network operating systems,



                                           49
MS Windows, MS Word and other like applications. The provider further agrees to
maintain a support center for their staff to call before any contact is made with the
department’s Customer Assistance Center and that provider’s support center will make
a determination that the issue is related to a State owned application, not a provider
one. State owned applications shall be defined as any application developed and
maintained by the department.

Local Area Network (LAN) issues shall be the provider’s responsibility. The provider’s
LANs and the software supporting those LANs are not State owned applications or
LANs until the provider transfers the original equipment or equipment they purchased
during the term of the contract back to the department to replace the original equipment.
Wide Area Networks (WAN) shall be the provider’s responsibility for from the PC to the
network point of presence that connects them to the State's WAN. The department or
the State shall be responsible from the point of presence to the department’s central
data processing facility.

With respect to IT support for provider staff located in a department facility,
where the Local Area Network and Wide Area Network connections are controlled
by the department, the following will be supported:

In the case of trouble or suspected trouble requiring the assistance of department
personnel, the provider will call the department’s Office of Information Systems
Customer Assistance Center in Tallahassee. The Customer Assistance Center will be
the initial contact point for support on provider network issues and to request
assistance. The provider staff will identify such calls as fault calls, so that the appropriate
level of urgency can be applied. All IT support will be documented by means of a
generated work order by the department. The provider acknowledges that abuse of this
technical support facility would lead to degradation in service to other providers and
department users. The department reserves the right to charge for Customer Assistance Center
calls that are caused by failure of provider-owned equipment outside that approved by
the department or incorrect operation of the provider’s equipment.

The department will make reasonable efforts to maintain constant access to the State’s
network and ensure that the network is available for use by the provider. The department cannot
be held responsible for accidental non-availability or outages of service, or for unforeseen
interruptions to service. The department shall not be held responsible for any loss or
damage incurred by the provider or any other person caused by any failure of any nature
on the part of third party service suppliers, to supply the provider with sufficient services
and connections, to maintain the quality of service or network that the department may be
endeavoring to supply.

Services to be provided include:
    Network Support of Core Service Switches and Routers
    Support of Core Service Firewalls
    Support of Network Management hardware and software
    Support of Dynamic Host Configuration Protocol (DHCP) services


                                              50
      Support of Domain Name Server (DNS) services Connectivity to the internet
      Support of Simple Mail Transport Protocol (SMTP) gateway e-mail services
      Review/Replacement of core service network
      Provide premise wiring installation and maintenance

Other Services:
    Network design and architecture
    Network capacity planning
    Support of wireless networking
    Wireless design
    Network change management and problem management
    Support and hosting of Network servers and associated equipment within a
      department-owned computer room.

Hours of Service Availability for access to Network Support Service available Monday –
Friday, from 7:00 a.m. – 5:00 p.m. excluding State holidays. Network monitoring will be
staffed twenty-four (24) hours per day Monday through Saturday.

Department staff will evaluate, engineer, purchase, configure, install, troubleshoot and
maintain the backbone data network switches, servers, and software as deemed
appropriate by the Zone Information Systems Director.

Department staff will troubleshoot all LAN/WAN connections. If any LAN connection
requires repair or replacement, then it is the responsibility of the department to pay for
these repairs or replacements. The Zone Information Systems Director will be
responsible for bringing in outside hardware vendors when necessary to repair or replace
defective or nonfunctional components, where cost effective. Replacements will be made
with "like" equipment. The department agrees to coordinate with the provider MIS staff
to resolve WAN access to any required State application(s).

Any new data wiring required by the provider for connectivity must be approved by the
department, through the Information Resource Request Process, and all associate
wiring costs shall be paid by the provider.

The department agrees department personnel will assume responsibility for keeping
network operating systems updated with current patches and revisions and to install and
configure appropriate device access to any required State application(s).

The department shall provide network security for State-owned applications. Example:
local area network servers, FAHIS, FSFN and Adoption Exchange. The provider shall
provide PC software and network security software products and access assistance to
provider staff for non State-owned applications, for example FSS Database/COBRIS
software.

Any installation of any type of provider Network Server on a department-owned LAN
must be approved by the department's Zone Information Systems Director.


                                             51
With respect to IT support for provider staff located in a provider facility where
the Local Area Network and Wide Area Network connections are controlled by the
provider, the following will be supported:

The department agrees to coordinate with the provider MIS staff in the installation,
configuration and security access to any state owned application(s). The department
agrees to install and configure appropriate device access to any required state
application(s). The department agrees to coordinate with the provider MIS staff to
resolve WAN access to any required state application(s).

Provider staff may optionally call the Customer Assistance Center in Tallahassee for
first line of support, or they can call their own provider network helpdesk support first. If
the provider’s staff calls the Customer Assistance Center, the provider staff will identify
such calls as fault calls, so that the appropriate level of urgency can be applied. All such IT
support will be documented by means of a generated work order by the department.
The provider acknowledges that abuse of this technical support facility would lead to degradation in
service to other providers and department users. The department reserves the right to charge for
Customer Assistance Center calls that are caused by failure of provider-owned equipment outside
that approved by the department or incorrect operation of the provider’s equipment.

Provider staff will troubleshoot all LAN/WAN connections. If any LAN connection
requires repair or replacement then it is the responsibility of the provider to pay for these
repairs or replacements.

Any new data wiring required by the provider for connectivity must be approved by the
department’s Zone Information Systems Director, through the Information Resource
Request Process, and shall be paid by the provider.

The department shall provide network security for State-owned applications. Example:
local area network servers, FAHIS, FSFN and Adoption Exchange. The provider shall
provide PC software and network security software products and access assistance to
provider staff for non State-owned applications, for example FSS Database/COBRIS.
The provider shall provide network security software products and access assistance to
the provider staff for all applications.




                                                52
                                    APPENDIX VII
                                   FATAL CRITERIA

If any of these criteria are not met, the response cannot be considered further
(shall be completed by FSS).

      Applicant’s Name (Agency):_____________________________________
                                 (Print Name)

      Reviewed By (FSS): ___________________________________________
                              (Print Name)               (Date)

      Witnessed By (FSS):___________________________________________
                              (Print Name)               (Date)

     The application was received by the time and date         ☐ YES      ☐ NO
     specified in the ITN.
     The Notice of Intent to Submit an Application was         ☐ YES      ☐ NO
     received by the time and date specified in the ITN.
     The application includes the Application Summary          ☐ YES      ☐ NO
     Form.
     The application includes a line item budget with          ☐ YES      ☐ NO
     narrative justification.
     The application includes a signed letter from the CEO     ☐ YES      ☐ NO
     committing to establish a physical presence within the
     planning district (s) if awarded a contract
     A. Statements of Assurance                                ☐ YES      ☐ NO
           1. Acceptance of Terms and Conditions               ☐ YES      ☐ NO
           2. Statement of No Involvement                      ☐ YES      ☐ NO
           3. Proof of Signature Authority                     ☐ YES      ☐ NO
           4. Conflict of Interest Statement                   ☐ YES      ☐ NO
           5. Drug Free Workplace                              ☐ YES      ☐ NO
           6. Certification of authority to enter into         ☐ YES      ☐ NO
              negotiations with FSS for specified services
           7. Certification of No Criminal Conduct             ☐ YES      ☐ NO
           8. Certification of Corrective Action Plan          ☐ YES      ☐ NO
              Implementation
     B. Certification Regarding Debarment, Suspension,         ☐ YES      ☐ NO
        and Other Matters of Responsibility Form
     C. Certification Regarding Lobbying Form                  ☐ YES      ☐ NO

If any responses are “no”, the application is disqualified from further evaluation.

FSS reserves the right to waive minor irregularities when to do so would be in the best
interest of the FSS system of care design.


                                           53
                                  APPENDIX VIII
                            Application Summary Form


Complete Name of
Applicant
Legal Name of Applicant
if Different
Address including City,
County, State and Zip
Code
Name and Title of
Contact Person
Phone Number including
Area Code
Vendor Identification
Number
(Federal Employer
Identification
Number)
Fiscal Year End Date
(Month and Day only)
If Applicable, Name and
Address of Parent
Organization
Medicaid Provider #, if
any
Minority Status         Federal Minority Business Enterprise
                        State Certified MBE               African American
                                                           Hispanic
                                                           Asian/Hawaiian
                                                           Native American
                                                           Woman
List of Board of                Name and Title                State/County of Legal
Directors:                                                         Residence




                                         54
                         APPENDIX VIII (CONTINUED)
                      Executive Summary of the Application

             Please complete a one-page summary of the application.




Applicant Name: ________________________________________

Authorized Signature: ____________________________________

Title: ________________________________________________




                                      55
                                      APPENDIX IX
                              AUTHORITY AND REQUIREMENTS

      The provider shall be knowledgeable of and fully comply with all state and federal
      laws, rules, and regulations as amended from time to time that do or may affect the
      subject areas of this contract. Authorities include, but are not limited to the following:

I. PROGRAMMATIC AUTHORITY (FEDERAL)

A. Federal foster care services: Social Security Act, Title IV-B and Title IV-E, as
   amended (42 U.S.C. 670-679a; 45 C.F.R. 1355-1357); P.L. 96-272, Adoption
   Assistance and Child Welfare Act of 1980 (42 U.S.C. 670, et seq.); P.L. 100-485,
   Family Support Act of 1988 (42 U.S.C. 602; 42 U.S.C. 1396a; 45 C.F.R. 92.32
   Uniform Requirements for Grant and Cooperative Agreements Equipment; 45 C.F.R.
   95, 204-206, 233, 234, 260); P.L. 103-382, S. 551, The Multiethnic Placement Act of
   1994 (MEPA); P.L.104-188, S. 1808, Removal of Barriers to Interethnic Adoption;
   P.L. 105-89, Adoption and Safe Families Act of 1997; P.L. 106-169, Foster Care
   Independence Act of 1999.

B. Federal child welfare services: Social Security Act, as amended; Adoption
   Assistance and Child Welfare Act of 1980 (42 U.S.C. 620-628a; 45 C.F.R. 1355-
   1357)

C. Federal family preservation and support services: Social Security Act, as amended
   (42 U.S.C. 629-629e; 45 C.F.R. 1355-1357).

D. The provider shall ensure compliance with Title IV-B of the Social Security Act, Title
   IV-E of the Social Security Act, Social Services Block Grant (SSBG), Title XIX
   (Medicaid), and Temporary Assistance for Needy Families (TANF).

E. Federal Indian Child Welfare Act of 1978, 25 U.S.C. 1901 et seq.

F. Americans with Disabilities Act of 1990, 42 U.S.C. 12101 et seq.

II.       FLORIDA STATUTES

Applicable Florida Statutes as amended from time to time including, but not by way of
limitation:

A. Child Welfare/Community-Based Care Program

CH 39        Proceedings Relating to Children
CH 61        Dissolution of Marriage; Support; Custody
CH 63        Adoption
CH 383       Maternity And Infancy Hygiene
CH 391       Children’s Medical Services



                                                56
CH 393   Developmental Disabilities
CH 402   Health And Human Services: Miscellaneous Provisions
CH 409   Social And Economic Assistance
CH 411   Handicap Or High-Risk Condition Prevention And Early Childhood Assistance
CH 414   Family Self-Sufficiency
CH 415   Adult Protective Services
CH 435   Employment Screening
CH 455   Business And Professional Regulation: General Provisions
CH 490   Psychological Services
CH 491   Clinical, Counseling, And Psychotherapy Services
CH 743   Disability Of Nonage Of Minors Removed
CH 760   Discrimination In The Treatment Of Persons; Minority Representation
CH 827   Abuse Of Children

B. Substance Abuse and Mental Health Services

CH 381   Public Health: General Provisions
CH 386   Particular Conditions Affecting Public Health
CH 394   Mental Health
CH 397   Substance Abuse Services
CH 458   Medical Practice
CH 459   Osteopathic Medicine
CH 464   Nursing
CH 465   Pharmacy
CH 499   Drug, Cosmetic, And Household Products
CH 553   Building Construction Standards
CH 893   Drug Abuse Prevention And Control

C. Department of Management Services

Section 112.061            Per diem and travel expenses of public officers, employees,
                           and authorized persons
Section 112.3185           Contractual services
CH 120                     Administrative Procedures Act
Section 215.422            Warrants, vouchers, and invoices; processing time limits;
                           dispute resolution; agency or judicial branch compliance
Section 255.0515           Bids for state contracts; substitution of subcontractors
CH 287                     Procurement Of Personal Property and Services

D. Statewide Requirements

Section 23.30, F.S.        Florida Customer Service Standards Act
CH 119                     Public Records
CH 282                     Communications and Data Processing
CH 815                     Computer-Related Crimes




                                           57
III.   FLORIDA ADMINISTRATIVE CODE (RULES)

A. Child Welfare/Community-Based Care Program

65C-6    Domestic Violence
65C-7    Specific Standards For Child Protection Teams
65C-8    Sexual Abuse Treatment Program
65C-9    Alien Children
65C-10   Child Protective Investigations
65C-11   Protective Services
65C-12   Emergency Shelter Care
65C-13   Substitute Care of Children
65C-14   Group Care
65C-15   Child-Placing Agencies
65C-16   Adoptions
65C-17   Master Trust
65C-20   Family Day Care Standards and Large Family Child Care Homes
65C-21   Subsidized Child Care
65C-22   Child Care Standards
65C-23   WAGES Hardship Exemption and Prevention Services
65C-24   Relative Caregiver
65C-25   Specialized Child Care Facilities for the Care of Mildly-Ill Children

B. Substance Abuse and Mental Health Services

65E-4 Community Mental Health Regulation
65E-5 Mental Health Act Regulation
65E-10 Psychotic and Emotionally Disturbed Children - Purchase of Residential
       Service Rules
65E-12 Public Mental Health, Crisis Stabilization Units, Short-Term Residential
       Treatment Programs
65E-14 Community Alcohol, Drug Abuse and Mental Health Services - Financial Rules
65E-15 Continuity of Care Case Management
65E-20 Forensic Client Services Act Regulation

IV.    CHILD WELFARE/COMMUNITY-BASED CARE OPERATING PROCEDURES:

The provider may develop operating procedures to be approved by the department
equivalent to the following subjects. In the interim, the provider must follow the
department’s equivalent operating procedures.

CFOP 15-12          Procedures for Releasing Selected Information Pertaining to an
                    Abuse, Neglect, Abandonment or Exploitation Report
CFOP 30-5           Cases Requiring Entry of a Final Order
CFOP 60-11          Policy On Domestic Violence, Chapter 1
CFOP 60-52          Employees as Guardians Ad Litem



                                            58
CFOP 175-15    Child Welfare Legal Services
CFOP 175-16    Avoiding Unnecessary Placements Through the Use of Substitute
               Care Funds
CFOP 175-17    Child Death Review Procedures
CFOP 175-18    Child Care Training
CFOP 175-19    Administrative Fines for False Reporting of Abuse, Neglect and
               Abandonment
CFOP 175-20    Child Protection Teams and Sexual Abuse Treatment Programs
CFOP 175-21    Investigative Response
HRSOP 175-22   Diligent Search
CFOP 175-23    Case Supervision in Initial Responses/Assessments Involving
               Shelter Care
CFOP 175-24    Predisposition Study
CFOP 175-25    Additional and Supplemental Reports
HRSOP 175-26   Confidentiality of Children and Families Records
CFOP 175-28    Allegation Matrix
CFOP 175-29    Temporary Assistance for Needy Families (TANF) Funding for
               Services
HRSOP 175-33   Out-of-Town Inquiries
CFOP 175-34    Removal and Placement of Children
CFOP 175-36    Reports and Services Involving Indian Child
CFOP 175-37    Sharing Records With Children
CFOP 175-38    Reunification
CFSOP 175-39   Change of Custody
CFOP 175-40    Consent for Medical Screening, Examination, and Treatment of
               Children in Physical or Legal Custody of the Department
CFOP 175-41    Family Assessment
CFOP 175-42    Case Chronological Documentation
CFOP 175-43    Courtesy Supervision
CFOP 175-44    Services to Refugee and Entrant Unaccompanied Minors
CFOP 175-45    Assessment of Florida Abuse Hotline Information Referrals
CFOP 175-46    Duplicate and Sequence Merges
CFOP 175-47    Termination of Services - General
CFOP 175-48    Transfer of Cases Within and Between Districts
CFOP 175-49    Reports Involving Allegations of Medical Neglect of an Infant with a
               Life Threatening Condition
CFOP 175-50    Visitation and Other Contact with Children in Shelter
CFOP 175-51    Manual Expunction of Florida Abuse Hotline Information System
               Records
CFOP 175-52    Re-licensing Child-Placing Agencies
CFOP 175-54    Interstate Compact on the Placement of Children
CFOP 175-55    Priority Placement under the Interstate Compact on the Placement
               of Children
CFOP 175-56    Reports Involving Families Residing on Federal Property
CFOP 175-57    Caller Identification
CFOP 175-58    Re-licensing of Family Foster Homes and Emergency Shelter Care



                                      59
                  Homes
CFOP 175-59       Master Trust for Benefit of Family Safety and Preservation Program
                  Clients
CFOP 175-60       State Institutional Claims for Damages Caused by
                  Shelter or Foster Child
CFOP 175-61       Exit Interviews for Children in Shelter/Foster Care
CFOP 175-62       Expediting Permanency for Abandoned Infants
CFOP 175-64       Family Foster Home Waivers
CFOP 175-67       Finalized Adoption Cases and Automated System Client Identifiers
CFOP 175-69       Hospital/Emergency Room Child Abuse Reports
CFOP 175-70       Funeral Arrangements for Children in Foster Care
CFOP 175-71       Title IV-E Foster Care and Adoption Subsidy
CFOP 175-72       New Children in Families with Active Investigations or Case
                  Services or Where Involuntary Termination of Parental Rights Has
                  Occurred in the Past
CFOP 175-76       Employees Involved in Reports of Abuse, Neglect, Abandonment or
                  Exploitation
CFOP 175-77       WAGES/Hardship Exemption - Substitute Care Review
CFOP 175-79       Relative Caregiver Program
CFOP 175-80       Independent Living Services (Ages 16 to 21)
CFOP 175-81       Subsidized Independent Living (SIL)
CFOP 175-83       Identification of Children
CFOP 175-85       Prevention, Reporting and Services To Missing Children
CFOP 175-86       Dependency Court Intervention In Cases of Abuse or Neglect by
                  Non-Custodial Parents
CFOP 175-88       The Prevention and Placement of Child Victims and Aggressors
                  Involved In Child-On-Child Sexual Abuse, Sexual Assault,
                  Seduction or Exploitation In Substitute Care
CFOP 175-89       Filing of Petition for Release of Abuse Records To The Public
CFOP 175-90       “Extraordinary Circumstances” for Extension of Case Plans
CFOP 175-91       Abuse and Neglect Clearance of Informal Child Care Providers
CFOP 175-93       TANF Uses in Family Safety
CFOP 175-94       Direct Access To Information for Background or Criminal History
                  Checks for Investigations, Emergency Placements, and Out of the
                  Ordinary Circumstances
CFOP 175-96       Coordination of Services Including Mental Health and Substance
                  Abuse Services for Youth in the Care and Custody of DCF and
                  Served by the DJJ
CFOP 215-6        Incident Reporting and Client Risk Prevention

V.    MISCELLANEOUS

A. Family Support Services of North Florida, Inc. Operating Procedures

FSSOP 15-12       Procedures Releasing Selected Information Pertaining to an Abuse,
                  Neglect, Abandonment or Exploitation Report



                                        60
FSSOP 175-01   Client Complaint Procedure
FSSOP 175-02   Client Satisfaction Survey
FSSOP 175-03   Child Resource Record (Formerly called the “Red Folder”)
FSSOP 175-15   Child Welfare Legal Services
FSSOP 175-16   Avoiding Unnecessary Placements Through the Use of Substitute
               Care Funds
FSSOP 175-17   Child Death Review Procedures
FSSOP 175-21   Investigative Response
FSSOP 175-22   Diligent Search
FSSOP 175-23   Case Supervision in Initial Responses/Assessments Involving
               Shelter Care
FSSOP 175-24   Predisposition Study
FSSOP 175-26   Confidentiality of Children & Families Records
FSSOP 175-29   TANF Funding Services for Children
FSSOP 175-32   Reasonable Efforts
FSSOP 175-33   Out-Of-Town Inquiries
FSSOP 175-34   Removal and Placement of Children
FSSOP 175-35   Termination of Parental Rights was never promulgated by DCAF*
FSSOP 175-36   Reports and Services Involving Indian Child
FSSOP 175-37   Sharing Records with Children
FSSOP 175-38   Reunification
FSSO P175-39   Change of Custody
FSSOP 175-40   Consent for Medical Screening, Examination, and Treatment of
               Children in Physical or Legal Custody of the department
FSSOP 175-41   Family Assessment
FSSOP 175-42   Case Chronological Documentation
FSSOP 175-43   Case Supervision Activities Involving Multiple Districts, Counties or
               Regions
FSSOP 175-44   Services to Refugee and Entrant Unaccompanied Minors
FSSOP 175-45   Assessment of Florida Abuse Hotline Information Referrals
FSSOP 175-47   Termination of Services-general
FSSOP 175-48   Transfer of cases Within and Between Districts
FSSOP 175-50   Visitation and other Contact with Children in Emergency Shelter
FSSOP 175-52   Re-licensing Child-Placing Agencies
FSSOP 175-53   Records Retention for Family Safely Case Records
FSSOP 175-54   Interstate Compact on the Placement of Children
FSSOP 175-55   Priority Placement under the Interstate Compact on the Placement
               of Children
FSSOP 175-58   Re-licensing of Family Foster Homes and Emergency Shelter Care
               Homes
FSSOP 175-59   Master Trust for Benefit of Family Safety and Preservation Program
               Clients
FSSOP 175-60   State Institutional Claims for Damages Caused by Shelter or Foster
               Care
FSSOP 175-61   Exit Interviews for Children in Shelter/Foster Care
FSSOP 175-62   Expediting Permanency for Abandoned Infants



                                      61
FSSOP 175-64        Family Home Waivers
FSSOP 175-70        Funeral Arrangements for Children in Foster Care
FSSOP 175-71        Title IV-E Foster Care and Adoption Subsidy
FSSOP 175-72        New Children in Families w/Active Investigations OR Case Services
                    Or Where Involuntary Termination of Parental Rights Has Occurred
                    In the Past
FSSOP 175-76        Employees Involved in Reports of Abuse, Neglect, Abandonment or
                    Exploitation
FSSOP 175-77        Wages/Hardship Exemption Substitute Care Review
FSSOP 175-78        Certification Procedure for Professional Child Protection Employees
FSSOP 175-79        Relative Caregiver Program
FSSOP 175-80        Independent Living Services (Ages 16-2!)
FSSOP 175-81        Subsidized Independent Living (SILL)
FSSOP 175-83        Identification of Children
FSSOP 175-85        Prevention of and Services To Children Who Run Away While In
                    Substitute Care
FSSOP 175-88        The Prevention And Placement Of Child Victims and aggressors
                    Involved in Child -on-Child Sexual Abuse Sexual Assault,
                    Seduction, or Exploitation in Substitute Care
FSSOP 175-90        Extraordinary Circumstances For Extension Of Case Plans
FSSOP 175-93        TANF Uses In Family Safety
FSSOP 175-94        Access To Information for Background/Criminal History Check
FSSOP 215-6         Incident Reporting and Client Risk Prevention
FSSOP 60-11         Policy On Domestic Violence, Chapter 1

B. Department of Children and Families Operating Procedures
CFOP 15-4         Records Management
CFOP 75-2         Contract Management System for Contractual Services
CFOP 75-8         Contract Monitoring
CFOP 125-1        Community Resources/Volunteer Management
CFOP 155-10       Mental Health Services for Children in the Custody of the
                  Department
CFOP 180-4        Mandatory Reporting Requirements to the Office of the Inspector
                  General

C. Information Systems Operating Procedures
CFOP 50-2         Security of Data and Information Technology Resources
CFOP 50-7          Policy on Enhanced Workstations and Statewide Office Automation
                  Standards
CFOP 50-6         Security
CFOP 50-9         Policy on Information Resource Requests

D. Federal Cost Principles (www.whitehouse/omb/circulars/index)
OMB Circular A-87     Cost Principles for State, Local and Indian Tribal
                      Governments
OMB Circular A-122    Cost Principles for Non-Profit Organizations



                                          62
OMB Circular A-133, as amended   Audits of States, Local Governments, and Non-
                                 Profit Agencies




                                   63
                                   APPENDIX X
                            APPLICANT SELF EVALUATION


Please answer all questions by checking off the applicable box. For those items that are
not applicable to your contract, check N/A. For example, if you do not have any
subcontracts, you should check N/A for each item in Section IX,
Subcontracts/Professional Agreements.

 Please provide a brief explanation for any negative response.

I.        SEGREGATION OF DUTIES

1. Someone other than the timekeeper and persons who deliver
   paychecks to employees prepares the payroll.                                Yes   No    N/A
2. The duties of record keeper are separated from any cash-related             Yes   No    N/A
   functions.
3. Check signing is limited to those authorized to make disbursements
   and whose duties exclude posting and recording of cash received.            Yes   No    N/A
4. Personnel performing the disbursement function are excluded from
   purchasing, receiving, inventory, and general ledger functions.             Yes   No    N/A
5. Mail receipts are opened and listed by someone not involved in
   posting, deposit preparation and deposit making.                            Yes   No    N/A
6. The person making the deposit is different from the person who              Yes   No    N/A
   prepares the deposit.
7. An official who is not responsible for its preparation and is outside the
   payroll department approves the payroll.                                    Yes   No    N/A

II.     POLICIES AND PROCEDURES

1.    Policies and procedures are reviewed annually and updated as
      necessary to reflect current operations.                                 Yes   No

2. Written policies and procedures address:

      a. Record retention                                                      Yes   No

      b. Travel and entertainment                                              Yes   No

      c. Purchasing                                                            Yes   No

      d. Asset acquisition, inventory, and disposal                            Yes   No    N/A

      e. Cash management (payables, receivables, deposits, petty cash,         Yes   No
         reconciliations, etc.)



                                            64
        f. Credit cards                                                      Yes   No   N/A

        g. Subcontractors                                                    Yes   No   N/A

        h. Bad debt write-offs                                               Yes   No   N/A

        i. Disaster plan, including recovery, per contractual requirements   Yes   No   N/A


        j. Personnel                                                         Yes   No

        k. Employee loans                                                    Yes   No   N/A

        l. Client trust funds                                                Yes   No   N/A

        m. Computer back-up                                                  Yes   No   N/A

         n. PRIDE                                                            Yes   No   N/A

         o. Recycling                                                        Yes   No   N/A

         p. Data Security                                                    Yes   No   N/A

III.         CASH

A. Cash Handling Procedures

1. a. All revenue is deposited into one operating account.                   Yes   No   N/A

       b. Deposits are made on a ____ daily; ____weekly; ______ other (be    Yes   No   N/A
        specific) basis.


2. The agency maintains a cash receipts journal.                             Yes   No   N/A

3. Revenue received that is not deposited on the same day is stored in
   a locked and secure location.                                             Yes   No   N/A

4. The person receiving the monthly bank statement in the mail is not
   the same person responsible for performing the monthly account
   reconciliation.                                                           Yes   No   N/A

5. The bank statements and paid checks are received unopened from
   the bank by the person reconciling the account.                           Yes   No   N/A




                                              65
6. Checks received in the mail are restrictively endorsed immediately
   upon opening the mail.                                                    Yes   No   N/A

7. Cash received from fund raising events are properly controlled,           Yes   No   N/A
   accounted, and reported.

8. Bank reconciliations are performed monthly, reviewed, and signed by
   the next level of management.                                             Yes   No

B. Petty Cash
                                                                             Yes   No   N/A
1. A specific employee is designated, in writing, as custodian.

2.    Petty cash is not commingled with other funds and is used for small,
      emergency expenses.                                                    Yes   No   N/A

3.    Cash fund is kept in a locked, secure location.                        Yes   No   N/A

4.     Payments are made through vouchers that are completely and            Yes   No   N/A
      accurately filled out.

5.    Payments are supported by invoices or receipts.                        Yes   No   N/A

6.    Payments made are under $50 (for small incidental purchases).          Yes   No   N/A

7.    Travel payments are not made from petty cash.                          Yes   No   N/A

8.    Documents are effectively canceled (marked paid) when expense is       Yes   No   N/A
      paid.

9.  Surprise audits are periodically performed and documented in             Yes   No   N/A
    writing.
10. The size of the petty cash fund is adequate to meet emergency            Yes   No   N/A
    expenses.

IV.       ACCOUNTS RECEIVABLE

1. A detailed accounts receivable aging schedule is maintained by            Yes   No   N/A
   accounting.

2. The accounts receivable aging schedule is reconciled to the general       Yes   No   N/A
   ledger monthly.




                                            66
3. The agency has established accounts receivable write off procedures
   that:
                                                                             Yes   No
     a. are properly documented

     b. are approved by the President/Chief Executive Officer and the        Yes   No
        Board of Directors

V.       ACCOUNTS PAYABLE

A. Disbursements

1. The agency maintains an accounts payable ledger (checkbook) for           Yes   No
   its operating account.

2. During the payment process, the following are verified by
   management:
                                                                             Yes   No
     a. Checks are issued in sequence

     b. Voids are clearly documented and accounted for                       Yes   No

     c. Multiple payments made to one payee during the month are             Yes   No
        researched

     d. Payments are based on original invoices                              Yes   No

     e. Payments are approved by appropriate levels of management            Yes   No

     f. Back-up is effectively canceled upon payment (help prevent           Yes   No
        duplicate payments)

     g. The check amount and invoice amount agree                            Yes   No

     h. Bills are timely paid                                                Yes   No

     i. Payments to the Executive Director are countersigned by a Board      Yes   No   N/A
        member

     j. Goods and services with a cost of $1500 or more are supported
        with a cost analysis price quotation or competitive bid unless the
        agency’s policies and procedures require another level               Yes   No


For tax exempt providers:



                                            67
    k. Sales tax is not being paid on purchases of goods or services.      Yes   No   N/A

B. Employee Expense Transactions

1. Expense reports/vouchers are utilized                                   Yes   No

2. All expenses are supported with original receipts                       Yes   No

3. The business purpose of the expenses are clearly stated                 Yes   No

4. All conference expenses are pre-authorized and supported with an        Yes   No   N/A
   agenda

5. A mileage sheet is used to calculate and reimburse mileage              Yes   No   N/A
   expenses

6. The mileage sheet contains information to include beginning and
   ending odometer readings, purpose, and destination                      Yes   No   N/A

7. All travel expenses reimbursed from state funding sources are paid in
   accordance with state rates (s. 112.061, F.S.)                          Yes   No   N/A

C. Credit Card Transactions

1. The agency maintains a listing of who has credit cards and the
   corresponding credit card numbers.                                      Yes   No   N/A

2. The agency performs monthly reconciliations of credit card              Yes   No   N/A
   statements.

3. The agency has review procedures that are used to track and pay         Yes   No   N/A
   balances.

4. The cardholder or designee is not making personal purchases.            Yes   No   N/A

5. Is there a policy that prohibits personal purchases?                    Yes   No   N/A

6. Corporate credit cards that are loaned to employees are controlled
   through a log indicating the date, person's name, purchase amount,      Yes   No   N/A
   and description.
                                                                           Yes   No   N/A
7. Original receipts support expenses charged to credit card




                                           68
     D. Tax Payments

     941s and Unemployment Compensation Taxes (UCTs) are completed,
     submitted and paid timely.                                                    Yes   No   N/A

E.    E. Advance Payment of Contract Funds / Return of Funds

     1.    If the agency received an advance under the contract and those
           funds were deposited into an interest bearing account (optional under
           s. 216.181(16)(b), F.S.), interest proceeds were returned to FSS or     Yes   No   N/A
           applied to future FSS payments to the agency.

     2. If the agency charged unallowable expenses to the contract or was          Yes   No   N/A
        otherwise overpaid, arrangements have been made to reimburse
        FSS.

     VI.        FINANCIAL REPORTING

     1. Monthly financial statements are prepared.                                 Yes   No   N/A
         These include the following:

           a. A statement of activities (income statement) listed by cost center   Yes   No   N/A

           b. A statement of financial condition/position (balance sheet)          Yes   No   N/A

           c. Budget variance report                                               Yes   No   N/A

     2. Support documentation for all journal entries made are retained.           Yes   No   N/A

     3. a. The agency performs a monthly closing and                               Yes   No   N/A
        b. Prepares/prints a complete set of accounting books (general
           ledger, accounts payable journal, accounts receivable journal,          Yes   No   N/A
           etc.)


     4. The agency maintains a current chart of accounts which:

           a. Allows for cost center accounting                                    Yes   No   N/A

           b. Tracks administration as a cost center                               Yes   No   N/A

           c. Has a methodology to allocate indirect cost including                Yes   No   N/A
           administration




                                                  69
5. An independent audit has been performed and the report submitted
   to FSS within 180 days from the agency's fiscal year end or within 30     Yes   No   N/A
   days of the agency’s receipt of the audit report, whichever occurs
   first.
                                                                             Yes   No   N/A
6. Did the provider respond to the recommendations made in the
   independent auditor’s management letter?

7. The agency has an adequate record keeping system. The records
   are kept in a central location and are neat and organized.                Yes   No

8. Agency management submits monthly financial statements to the             Yes   No   N/A
   Board of Directors.

9. The agency has an operating budget that was approved by the Board         Yes   No   N/A
   of Directors.

VII.        METHOD OF PAYMENT (INVOICING)

        Documentation supporting the number of units and dollars claimed
        on corresponding invoices are kept by the agency and are available   Yes   No
        for review and inspection.

VIII.       ASSETS AND PROPERTY

1. An annual asset inventory is taken and recorded in writing.               Yes   No   N/A

2. Property records are reconciled to the general ledger at least            Yes   No   N/A
   annually.

3. Property / capital assets are recorded on an asset ledger with the
   following information:
                                                                             Yes   No   N/A
        a. sequential item number

        b. description                                                       Yes   No   N/A

        c. funding source                                                    Yes   No   N/A

        d. purchase date and amount                                          Yes   No   N/A

        e. cost                                                              Yes   No   N/A

        f. location                                                          Yes   No   N/A




                                             70
      g. condition                                                           Yes   No   N/A

      h. asset tag number (capital assets of $1,000 or more)                 Yes   No   N/A

4. Acquisitions and disposals are documented in writing.                     Yes   No   N/A

5. If any leases for property and equipment exist, they are current and      Yes   No   N/A
   properly executed.

IX.        SUBCONTRACTS / PROFESSIONAL AGREEMENTS

If you subcontract FSS services

      1. Persons who are properly authorized to bind your organization
        and its subcontractor sign the written agreement.                    Yes   No   N/A

      2. The subcontract agreement indicates the scope of work to be         Yes   No   N/A
         performed.

      3. If any part of FSS’s contract with the agency is subcontracted,
         your organization has written documentation that indicates that
         FSS reviewed and approved of the act of subcontracting and          Yes   No   N/A
         inclusion of required flow-down clauses.

X.        LOANS

1. If loans are made to employees, formal, signed agreements are
   secured and contain the following:

      a. Date loan made, amount, and maturity                                Yes   No   N/A

      b. Terms and conditions regarding repayment                            Yes   No   N/A

      c. Approval by the President/Executive Director                        Yes   No   N/A

      d. Disclosure to the Board of Directors through an aging schedule or   Yes   No   N/A
         other report

2. If loans are being granted to officers and/or directors of the agency,
   please explain on separate attachment.                                    Yes   No   N/A

       Attachment # _________ included.                                      Yes   No




                                            71
XI.        PERSONNEL MANAGEMENT / PAYROLL

1. All personnel files contain the following:
   a. Current job description signed and dated by employee                  Yes   No

      b. I-9 forms                                                          Yes   No

      c.    W-4 forms                                                       Yes   No

      d.    Annual evaluations (if required)                                Yes   No

      e. Pay rates and changes are clearly documented and agree with        Yes   No
        the latest payroll register.

      f. Reference checks                                                   Yes   No
      g. Security agreement forms (CF 114), if applicable                   Yes   No   N/A
         (1) All employees with access to DCF data through computer-
             related media have read and signed the CF 114                  Yes   No
        (2) The custodian (NAME) for all CF 114 forms at the
             location is                                                    Yes   No
                _______________________
          (3) The forms are stored at the following sites: ______________   Yes   No

2.     a. Employees document their work hours through a time sheet or       Yes   No
      punch clock.
        b. The employee signed the time records.                            Yes   No
        c. The supervisor reviewed and signed the time records.             Yes   No

3. Non-exempt employees receive time and a half for all hours in            Yes   No
   excess of 40 per week.

4. Do any of your employees also have a contract with your agency? If
   yes, please explain in separate attachment.                              Yes   No

      Attachment # ______ included                                          Yes   No




                                               72
XII.       ALCOHOL, SUBSTANCE ABUSE AND MENTAL HEALTH
          BLOCK GRANT FUNDS

1. The agency is in full compliance with all block grant requirements.       Yes   No   N/A

2. The agency maintains a schedule indicating the amount of block
   grant funds received and expensed during the current contract             Yes   No   N/A
   period.

XIII.      SPONSORSHIP

The agency has complied with s. 286.25, F.S., requiring that any non-
governmental organization sponsoring a program financed partially by
state funds, or funds obtained from a state agency, shall use specific
statutory language recognizing the state’s sponsorship when it publicizes,   Yes   No   N/A
advertises or describes sponsorship of the program.


XIV.      LOBBYING

1. The agency has complied with s. 216.347, F.S., which prohibits the
   use of state contract funds for the purpose of lobbying the Legislature   Yes   No
   or a state agency.
2. If contracts contain federal funding in excess of $100,000 and the
   provider organization spends any money on lobbying, the provider
   has sent a Disclosure of                                                  Yes   No
   Lobbying Activities, Standard Form LLL, to the contract manager for
   federal review.


XV.       INSURANCE

1.       Agency has the capacity to furnish a performance bond in the        Yes   No
        amount of two and a half percent (2.5%) of the total estimated
        contract amount for each fiscal year to ensure full and complete
        performance of the contractual services. The Performance bond
        should be in place when contract begins.                             Yes   No

2. Ability to place FSS as a listed co-insured on all policies
                                                                             Yes   No
3. Ability to obtain liability insurance as specified in section 409.1671
   Florida Statute
   and any subsequent amendments thereto.




                                             73
                               APPENDIX XI
                  PROJECT BUDGET DETAIL AND INSTRUCTIONS


The Project Annual Budget by Month and Budget Narrative worksheets identify all costs
that are proposed to be paid by FSS. The instructions below will assist you in preparing
the Annual Budget by Month and Project Budget Detail (narrative) worksheets

A. Using the instructions provided in the ITN #FSSPA09-01 Budget Detail Appendix XI,
   Excel workbook (separate link), complete the Project Budget Detail sheets (tabs) to
   calculate project costs for all applicable budget line items and associated narrative.

      Submit a budget package (budget detail sheet by month and budget detail
       worksheet) for FSS/DCF funding.
      Separate line item budgets and narratives shall be submitted for services
       proposed for each selected district.

   In each project budget detail worksheet (narrative), identify the requested elements
   listed in the columns (i.e. Cost Per Unit, # of Months). When the unit or quantity has
   been left blank, please identify those items of unit, quantity, cost, months, etc.
   Narrative must be provided for each cost identified.

      List each personnel position individually and assign a unique position
       number to each. Identify the % of time by percent that each position will
       spend providing services under FSS/DCF Child Welfare funding.

B. List the cost of each line item as described in the Budget Detail sheets by month in
   the identified row/column on the Annual Project Budget by Month worksheet (tab).




  BUDGET FORMS ARE INCLUDED AS A SEPARATE LINK IN THE WEB SITE IN
                    MICROSOFT EXCEL FORMAT




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