October 7, 2015

 

Re:  Medication Assisted Treatment Request For Proposal (RFP)

Dear Substance Use Provider:

Sauk County Department of Human Services and the State of Wisconsin are partnering to expand Medication Assisted Treatment (MAT) and services with a $1,000,000 grant awarded by Substance Abuse and Mental Health Services Administration (SAMHSA) within a tri-county region to include Columbia and Richland Counties.  The award is for three years.

This letter contains a request for proposal for your agency to apply to assist us to build a C.A.R.E. network for Medication Assisted Treatment—prescription drug and opioid addiction services.  We are looking for a provider to establish a service center within Sauk County to assist us in meeting the treatment requirements of the grant.  Please take a moment to consider becoming a partner with Sauk County to provide these important services.

The deadline for submission is November 2, 2015.

The RFP is available on our web site www.co.sauk.wi.us under Bids/RFPs tab.  If you have any questions, please contact Sharon Boesl at (608) 355-4206 or by email sboesl@co.sauk.wi.us. 

Sincerely,

SAUK COUNTY DEPARTMENT OF HUMAN SERVICES

 

Sharon L. Boesl, Ph. D., LMFT

Grant Administrator

 

REQUEST FOR PROPOSAL

 

BUILDING A C.A.R.E. NETWORK: MEDICATION ASSISTED TREATMENT-PRESCRIPTION DRUG AND OPIOID ADDICTION SERVICES

 

I.             Point of contact:               William H. Orth, Director

                                                       Sauk County Dept. of Human Services

                                                       505 Broadway Street

                                                       Baraboo, WI  53913

                                                       (608) 355-4212

                                                       worth@co.sauk.wi.us

               

Questions can be directed to:           Sharon L. Boesl, Grant Administrator for SCDHS

                                                       Sauk County Dept. of Human Services

                                                       505 Broadway Street

                                                       Baraboo, WI 53913

                                                       (608) 355-4206

                                                       sboesl@co.sauk.wi.us

II.            Proposal Due Date:  Original and four (4) sealed copies of the proposal must be received and date stamped no later than 4:30 p.m., Central Standard Time, November 2, 2015.   Faxes are not acceptable.  Proposals or amendments received by Sauk County after that time will not be considered.  Public Opening of RFP's will be conducted by William Orth, Director, Sauk County Department of Human Services and Dan Brattset, Deputy Director, Sauk County Department of Human Services, on Tuesday, November 3, 2015, at 10 a.m. in Room 450 of the West Square Building, 505 Broadway Street, Baraboo, Wisconsin.

 

III.           ALL PROPOSALS MUST BE ADDRESSED TO:

                                                                County Clerk

                                                                505 Broadway Street, Room 144

                                                                Baraboo, WI  53913

                                                                                               

                The words "BUILDING A C.A.R.E. NETWORK" must be marked on the opaque, sealed envelope. 

 

 

REQUEST FOR PROPOSAL

PART ONE

INTRODUCTION AND GENERAL INFORMATION

1.0          INTRODUCTION

1. This document constitutes a request for competitive, sealed proposals from qualified organizations to provide community-based, integrative, multidisciplinary substance use prevention and intervention programs of services for the Sauk County Department of Human Services.  
2. Qualified organizational staff is expected to coordinate with existing C.A.R.E. Collaborative to replicate coordinated community partnerships that enhance successful long term sobriety through expanded psychosocial options and local community support. The partnerships will include collaborating with medical professionals to increase access to medication assisted treatment with pharmacotherapies approved by the FDA. 
3. Contracted agency staff will begin job responsibilities on January 4, 2016.  Federal funding for this program is being provided by the Substance Abuse and Mental Health Services Administration (SAMSHA) which awarded funds to the Wisconsin Department of Health Services for a period of three years (through September 30, 2018). The award of funds is initially disbursed to Sauk County, however, expansion of programming will include Columbia County in year (2) two and Richland County in year (3) three.  Sauk County will remain the fiscal agent throughout the 3-year term of the award. 

2.0          ORGANIZATION

 

2.1          This document, referred to as a Request for Proposal (RFP), has been divided into the following parts for the convenience of the vendor:

                        2.1.1 Part One - Introduction and General Information

                        2.1.2 Part Two - Scope of Work

                        2.1.3 Part Three - General Requirements - Standard Terms and Conditions

                        2.1.4 Part Four - Proposal Submission Information

                        2.1.5 Part Five - Cost Proposal / Signature Page

3.0          DEFINITIONS

3.1          For the purpose of this RFP the vendor will be referred to as Contractor and Sauk County Department of Human Services will be referred to as County.

4.0          BACKGROUND INFORMATION

4.1          Sauk County is one of 72 units of county government in the State of Wisconsin and is a municipal corporation existing pursuant to the authority of Chapter 59 of the Wisconsin Statutes.  Sauk County encompasses 840 square miles including 22 towns, 14 villages, and 3 cities.  The County has an estimated population of 60, 024.  County operations include a skilled nursing facility, a human services department, a law enforcement agency, a state circuit court system, a highway department, a tax administration and collection effort, and other government related functions.  More information can be found at www.co.sauk.wi.us.

4.2          The Sauk County Department of Human Services operates a broad range of services for the residents of Sauk County in the following areas: 

The Child Protective Services Unit is responsible for investigating alleged cases of child abuse and neglect, and when necessary, placing youth in alternate care to provide them safety.

The Youth Services Unit assesses the circumstances of alleged juvenile offenders and makes recommendations to the Juvenile Court as to most appropriate disposition.

The Economic Support Unit completes applications for Medical Assistance, Food Stamps, Energy Assistance Program, Child Day Care, and the Wisconsin Works Program (W-2). 

The Mental Health and Recovery Services unit provides outpatient mental health and substance use treatment and is the designated 24 hour mobile crisis response team for Sauk County.

The Community Support Program provides intensive services to individuals with serious mental illness in order to support them in the community whenever possible.

Birth to 3/LTCS - These units are supported by the business and administration services units.  

 

 

REQUEST FOR PROPOSAL

PART TWO

SCOPE OF WORK

1.0SPECIFICATIONS AND SERVICES TO BE PROVIDED:

            1.1          Scope of Work to be performed.

Sauk County desires a qualified contractor to provide substance use services, leadership in building community partnerships, coordinate and implement a network of recovery resources, and offer services such as community outreach and substance use education.  Qualified contractor will provide these services within a location within Sauk County. Staff positions are identified as four (4) community recovery specialists (i.e., substance use certified counselor with minimum of a bachelor degree) and one (1) dual diagnosis professional (substance use and mental health certified counselor with minimum of a master’s degree).  Contracted staff will work closely with medical professionals to initiate and integrate medication assisted treatment options (i.e., have knowledge of or willingness to be trained) to promote successful, long term addiction recovery.  Applicants must also provide a staffing plan which demonstrates that they will have adequate qualified staff to cover all required activities and provide back up in case of illness or emergency absence.

The community recovery specialists will be responsible for organizing and maintaining community advisory bodies in several locations, identifying and responding to individuals seeking treatment, connecting them to comprehensive MH/SA assessment and monitoring and ensuring ongoing treatment involvement. In order to facilitate this, the specialists will need to be available 24/7 through a rotating on call schedule. The dual diagnosis professional will be responsible for providing comprehensive office or community based MH/SA assessments within 72 hours of referral, facilitating smooth and effective connection to treatment services and providing additional assessment and treatment services as needed. Clinical staff will work closely (with SCDHS and community partners) to ensure an integrated treatment plan that is person centered and team focused and reflects assessment of both psychosocial and recovery goals of the consumer and providers.  

Contracted agency staff will work with Sauk County Department of Human Services electronic health record to provide documentation of activities and information needed for billing of services. Contractor agency is required to comply with all laws and regulations pertaining to protected health information and other protected information, including but not limited to the Health Insurance Portability and Accountability Act as amended, and shall be required to enter into a business associate agreement with Sauk County.

Furthermore, contracted agency staff will work collaboratively with Sauk County Department of Human Services and the University of Wisconsin Population Health Institute to identify, track, and collect data for program evaluation and outcome measures. 

1.1.1     Contractors intending to apply for this proposal may be a certified outpatient clinic (DHS 35) and/or certified under DHS 75 (Community Substance Abuse Services Standards). We anticipate the contracted agency will have additional opportunities outside the grant for providing (and billing external sources of funding such as MA, insurance, fee for service) for treatment services such as outpatient sessions, Intensive Outpatient Programming (IOP), and various services within SCDHS’s Comprehensive Community Services program (with appropriate CCS certification). 

1.1.2      Direct service staff employed by the contractor for this proposal shall meet the following qualifications:

Preference for the position of Community Recovery Specialist will be given to individuals with a Clinical Substance Abuse Counselor as defined in s. SPS 160.02 (5) with at least a bachelor’s degree in a relevant area of education or human services and a minimum of one year of experience.

Dual diagnosis professional is defined as a Master's level clinician licensed under WI s. 457.10-457.13 to include school psychology, marriage and family therapy, rehabilitative psychology, guidance and counseling, independent or clinical social worker, practicing under a currently valid license or certificate and credentialed as a clinical substance abuse counselor as defined in s. SPS 160.02(5) and two years of experience providing substance use treatment and services.

Contracted agency shall have available a clinical director/supervisor to act as a consultant in person or by phone. The director is responsible for the quality of the services provided and shall have oversight of staff that includes direct review of cases and performance.  The clinical director (or designee) is responsible for oversight of documentation and timely submission of billing and compliance with billing procedures as required by Sauk County Department of Human Services and various insurance companies and Medical Assistance.

Agency staff are to submit the results of the caregiver background check including completed background information disclosure form for every background check conducted, and the results of any subsequent investigation related to the information obtained from the background. Contracted agency staff shall participate in at least eight (8) hours per year of in-service training on boundaries and ethics, confidentiality, cultural competency in mental health/substance use services, and current issues in client's rights and services.  All training is to be documented and available for review.

1.1.3          Documentation requirements.

Personnel:  Written documentation of qualifications, references, background checks and renewals, and training of all on-call staff workers shall be maintained by the contractor.

Clinical:  Contracted agency staff will be required to document all information into Sauk County Department of Human Services EHR information system (AVATAR).  All documentation is to meet criteria for billing as specified by private insurance companies and Medical Assistance.

Programmatic:  Contractor agrees to assist Sauk County Department of Human Services in collecting and analyzing data to ensure quality driven and cost effective delivery of services and treatment.  Contractor's staff shall participate in the Sauk County Department of Human Services advisory and review committee to ensure coordinated community plans of care.

1.2      Timeline.  The selected vendor should be prepared to begin providing services on January 1, 2016.

1.3      Scoring.  Equal weight will be given to each of the criteria in the scoring process. 

 

REQUEST FOR PROPOSAL

PART THREE

GENERAL REQUIREMENTS

STANDARD TERMS AND CONDITIONS

               

1.0          SPECIFICATIONS:  The specifications in this request are the minimum acceptable.  Sauk County shall be the sole judge of equivalency.  Contractors are cautioned to avoid bidding alternates to the specifications which may result in rejection of their proposal.

2.0          DEVIATIONS AND EXCEPTIONS:  Deviations and exceptions from terms, conditions, or specifications shall be described fully, on the contractor's letterhead, signed, and attached to the request.  In the absence of such statement, the proposal shall be accepted as in strict compliance with all terms, conditions, and specifications and the contractors shall be held liable.

3.0          ACCEPTANCE-REJECTION:  Sauk County reserves the right to accept or reject any or all proposals, to waive any technicality in any proposal submitted, and to accept any part of a proposal as deemed to be in the best interests of Sauk County.

3.1          Proposals MUST be date stamped by County Clerk, Sauk County West Square Building, 505 Broadway Street, Baraboo, Wisconsin  53913, on or before the date and time that the proposal is due.  Proposals dated and time stamped in another office will be rejected.  Receipt of a proposal by the mail system does not constitute receipt of a proposal by the County Clerk.

3.2          Proposals shall be submitted on company letterhead and signed by an officer of the company.  Mark sealed envelope "After Hours Mental Health/Substance Abuse Emergency Service".

4.0          TAXES:  Sauk County and its agencies are exempt from payment of all federal tax and Wisconsin state and local taxes on its purchases except Wisconsin excise tax on alcoholic beverages which is excepted by State Statutes.

            5.0      ENTIRE AGREEMENT:  These Standard Terms and Conditions shall apply to any contract or order awarded as a result of this request except where special requirements are stated elsewhere in the request; in such cases, the special requirements shall apply.  Further, the written contract shall constitute the entire agreement and no other terms and conditions in any document, acceptance, or acknowledgment shall be effective or binding unless expressly agreed to in writing by the contracting authority.

6.0          APPLICABLE LAW:  The contractor shall at all times comply with and observe all federal and state laws, local laws, ordinances, and regulations which are in effect during the period of this contract and which in any manner affect the work of its conduct.  The Sauk County Circuit Court shall be the court of exclusive jurisdiction for any litigation between the parties arising out of the performance of this contract.  This contract shall be interpreted in accordance with the laws of the State of Wisconsin.  It is understood that requirements of Wis. Stat. § 59.52(29) do not apply to this solicitation as the contract awarded will not involve "public work" as defined by Wisconsin law.

7.0          ASSIGNMENT:  No right or duty in whole or in part of the contractor under this contract may be assigned or delegated without the prior written consent of Sauk County.

8.0          SUBCONTRACTORS:  If subcontractors are planned to be used, this should be clearly explained in the proposal.  Sauk County reserves the right to reject any subcontractor.  However, the prime contractor will be responsible for contract performance whether or not subcontractors are used.

9.0          ARBITRATION/APPEALS PROCESS:  Notice of intent to protest and protests of any award made must be made in writing and filed with Sauk County Clerk, Sauk County West Square Building, 505 Broadway, Baraboo, Wisconsin 53913, within five (5) calendar days after discussion and recommendation of award.  The provisions of Chapter 68 of the Wisconsin Statutes shall apply.

9.1          Any dispute arising after award as to performance, quality and/or quantity shall be subject to arbitration as provided under Chapter 788 of the Wisconsin Statutes.

9.2          Sauk County reserves the right to have claims, disputes, or other matters in question decided by litigation.  If Sauk County waives its right to litigation, then the arbitration provisions shall apply.

10.0        NONDISCRIMINATION:  In connection with the performance of work under this contract, the contractor agrees not to discriminate against any employee or applicant for employment because of age, race, religion, color, handicap, sex, physical condition, developmental disability as defined in s. 51.01(5), Wis. Stats., sexual orientation or national origin.  This provision shall include, but not be limited to, the following:  employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship.

10.1        Failure to comply with the conditions of this clause may result in the contractor becoming declared an "ineligible" contractor, termination of the contract, or withholding of payment.

11.0        SAFETY REQUIREMENTS:  All materials, equipment, and supplies provided to Sauk County must comply fully with all safety requirements as set forth by the Wisconsin Administrative Code, Rules of the Industrial Commission on Safety, and all applicable OSHA Standards.

12.0        HOLD HARMLESS:  Contractor agrees to indemnify, hold harmless, and defend Sauk County, its officers, agents and employees from any and all liability including claims, demands, losses, costs, expenses and damages of every kind arising out of or in connection with services provided pursuant to this contract where such liability is founded upon or grows out of acts or omissions of any agents or employees of the contractor.

13.0        INSURANCE RESPONSIBILITY:  The contractor performing services for Sauk County shall comply with the insurance requirements contained herein.

13.1        Provide own insurance, countersigned by an insurer licensed to do business in the State of Wisconsin, covering the period of the agreement/contract indicating that Contractor is insured under professional liability insurance in an amount not less than minimum amounts reasonably necessary and sufficient within the profession.

13.2        Provide insurance certificates indicating required coverage, countersigned by an insurer licensed to do business in Wisconsin, covering the period of the agreement/contract.  The insurance certificate is required to be presented prior to the issuance of the purchase order or before commencement of the contract.

14.0        CANCELLATION:  Sauk County reserves the right to cancel any contract in whole or in part without penalty due to non-appropriation of funds, or for failure of the contractor to comply with the terms, conditions, and specifications of this contract.

15.0        AUDIT:  During the term of the contract, the contractor shall, upon the request of the Sauk County Controller, make available at reasonable times and places, such information as may be required for the purpose of auditing submitted bills for the service provided under the contract.

16.0        INDEPENDENT CONTRACTOR STATUS:  None of the officers, employees, or agents of the contractor are employees of Sauk County for any purpose, including but not limited to compensation, fringe benefits, or insurance coverage.

17.0        PUBLIC RECORDS ACCESS:  It is the intention of the county to maintain an open and public process in the solicitation, submission, review, and approval of procurement activities.

17.1        Bid/proposal openings are public unless otherwise specified.  Records may not be available for public inspection prior to issuance of the notice of intent to award or the award of the contract.

18.0        PROPRIETARY INFORMATION:  Any restrictions on the use of data contained within a request must be clearly stated in the proposal itself.  Proprietary information submitted in response to a request will be handled in accordance with applicable Sauk County procurement regulations and the Wisconsin public records law.  Proprietary restrictions normally are not accepted.  However, when accepted, it is the Contractor's responsibility to defend the determination in the event of an appeal or litigation.

18.1        Data contained in a proposal, all documentation provided therein, and innovations developed as a result of the contracted commodities or services cannot be copyrighted or patented.  All data, documentation, and innovations become the property of the Sauk County.

18.2        Any material submitted by the contractor in response to this request that the contractor considers confidential and proprietary information and which qualifies as a trade secret, as provided in s. 19.36(5), Wis. Stats., or material which can be kept confidential under the Wisconsin public records law, must be identified.  Proposal prices cannot be held confidential.

19.0        DISCLOSURE:  If a public official (s. 19.42, Wis. Stats.), a member of the public official's immediate family, or any organization in which a public official or a member of the official's immediate family owns or controls a ten percent (10%) interest, is a party to this agreement, and if this agreement involves payment of more than three thousand dollars ($3,000.00) within a twelve (12) month period, this contract is voidable by the county unless appropriate disclosure is made according to s. 19.45(6), Wis. Stats., before signing the contract.

20.0        MATERIAL SAFETY DATA SHEET:  If any item(s) on an order(s) resulting from this award(s) is a hazardous chemical, as defined under 29 CFR 1910.1200, provide one (1) copy of Material Safety Data Sheet for each item with the shipped container(s) and one (1) copy with the invoice(s).

21.0        TERMINATION FOR CONVENIENCE:  Sauk County reserves the right to terminate this contract for convenience upon 60 days’ notice.

22.0        TERMINATION FOR DEFAULT:  Sauk County reserves the right to terminate the contract for default if, after twenty days written notice to cure default, contractor fails to satisfactorily cure the default

23.0        PURCHASE OF SERVICE CONTRACT:    Sauk County Department of Human Services uses a standard Purchase of Services Contract which is attached as Exhibit A.  Contractors must be familiar with and abide by the terms of this contract.

 

 

REQUEST FOR PROPOSAL

PART FOUR

PROPOSAL SUBMISSION INFORMATION

1.0          SUBMISSION OF PROPOSALS

1.1          Proposals must be signed, sealed, and returned (with all necessary attachments) to the address on the first page of this request, by the proposal receipt date and time so specified.

1.1.1      In addition to the original proposal, the contractor should include one (1) original and six (6) copies of his/her proposal.

1.1.2      The contractor shall not submit a proposal by fax machine because only sealed proposals are acceptable in response to this RFP.

1.2          The contractor must respond to the RFP by submitting all data required herein in order for his/her proposal to be evaluated and considered for award.  Failure to submit such data shall be deemed sufficient cause for disqualification of the proposal from further consideration for award.

1.3          To facilitate the evaluation process, the contractor is encouraged to organize his/her proposal into distinctive sections that correspond with the individual evaluation categories described herein.

1.3.1      Each distinctive section should be titled with each individual evaluation category and all material related to that category should be included therein.

1.3.2      A letter constituting a signed acknowledgment of the original RFP and all signed amendments should be placed at the beginning of the contractor's proposal.

2.0          CLARIFICATION OF REQUIREMENTS

2.1          Contractors are strongly encouraged to read the "General Requirements" carefully prior to the submission of a proposal.

2.2          Any and all questions regarding specifications, requirements, competitive procurement process, etc., must be directed to the contact person as indicated on the first page of this RFP.

2.3          Contractors are cautioned not to contact the officers or employees of the County concerning this procurement during the competitive procurement and evaluation processes.

 

2.4          The contractor is advised that the only official position of Sauk County is that position which is stated in writing and issued by the contact person.  No other means of communication, whether oral or written, shall be construed as a formal or official response or statement.

3.0          SUBMISSION REQUIREMENTS

3.1          A title page, showing the name of the contractor submitting this information and proposing to perform the work on this project.

3.1.1      List the name, title and telephone number and e-mail addresses of that principal who will serve as the point of contact.   Such an individual must be empowered to speak for the contractor on policy and contractual matters and should be familiar with the programs and procedures of the contractor.

3.2          Provide a comprehensive resume of the individual who will be assigned primary responsibility to serve as project manager on this project.  Changes in the person listed here will not be allowed without permission from Sauk County, which shall not be unreasonably denied. 

3.3          Resumes of other key personnel who will be assigned to this service.

3.4          A table of contents, including a clear and complete identification of the materials submitted by section and page number, if applicable.

3.5          A letter of transmittal including the following:

3.5.1      A brief statement of understanding of the services to be provided.

3.5.2      A commitment to perform the work if awarded the contract.

3.5.3      A statement indicating the period for which the proposal is a firm and irrevocable offer.

3.5.4      A statement detailing how the tasks described in Part Two, Section 1.1 will be accomplished.

3.6          A profile of the contractor, detailing the experience of the contractor and the experience and qualifications of the persons who will primarily be responsible for the services.

3.7          List projects of similar scope and size which demonstrate the contractor's competence to perform the work required on this project.  Provide the name and telephone number of a contact person from at least three of these previous projects, if available.

3.8          A list of additional references. 

3.9          Any additional information not specifically requested that the contractor considers essential to this proposal.

4.0          EVALUATION PROCESS

4.1          After determining that a proposal satisfies the mandatory requirements stated in the Request for Proposal, the comparative assessment of the relative benefits and deficiencies of the proposal.  The award of a contract resulting from this Request for Proposal shall be based on the lowest and best proposal received in accordance with the submission requirements.

4.2          After an initial screening process, a technical question and answer conference or interview may be conducted with selected contractors, to clarify or verify the contractor's proposal and to develop a comprehensive assessment of the proposal.  Only contractors which Sauk County determines to meet its criteria will be invited to the conference and interview.

4.3          Sauk County reserves the right to consider historic information, whether gained from the contractor's proposal, question and answer conferences, references, or any other source, in the evaluation process.

4.4          The Contractor is cautioned that it is the contractor's sole responsibility to submit information and that Sauk County is under no obligation to solicit such information if it is not included with the contractor's proposal.  Failure of the Contractor to submit such information may cause an adverse impact on the evaluation of the Contractor's proposal.

4.5          Sauk County reserves the right to negotiate the terms and conditions, including the price, as proposed in a Contractor's proposal.  In addition, as part of such negotiations, Sauk County reserves the right to require supporting cost, pricing and other data from the Contractor in order to determine the reasonableness and acceptability of the proposal.

4.6          Submission of a proposal constitutes acceptance by the contractor of the conditions contained in this RFP.

4.7          There is no expressed or implied obligation for Sauk County to reimburse responding contractors for any expenses incurred in preparing proposals in response to this request.

5.0          CONTRACT AWARD

5.1          Any award of a contract resulting from this RFP will be made only by written authorization from the Sauk County Department of Human Services Director.

6.0          COST

6.1          The contractor must provide cost proposal data for the services required from this contract.  (Cost Proposal / Signature Form).

6.2          In the evaluation of the contractor's proposal, Sauk County reserves the right to consider the value of money and any other economic impact factors as deemed appropriate and in the best interests of Sauk County.

7.0          REPUTATION AND RELIABILITY

7.1          Reputation and reliability of the contractor's organization are considered in the evaluation process. Therefore, the contractor is advised to submit any information which documents successful and reliable experience in past performance related to the requirements of this RFP.

7.2          The qualifications of the personnel proposed by the contractor to perform the requirements of this RFP will be considered in the evaluation.  Therefore, the contractor should submit information related to the experience and qualifications of the staff proposed.

8.0          PROPOSED METHOD OF PERFORMANCE:

8.1          The Contractor will be expected to be extremely responsive to the programmatic needs of Sauk County Department of Human Services.   The Contractor should detail specifically how they intend to carry out the responsibilities of the contract including the Contractor's ability to work with governmental clients. 

 

 

REQUEST FOR PROPOSAL

PART FIVE

COST PROPOSAL/SIGNATURE FORM

The submission of a proposal shall be considered as a representation that the contractor has carefully investigated all conditions, has full knowledge of the scope, nature and quality of work required.

The proper submission of this form by the contractor will be considered as the contractor's offer to enter into a contract in accordance with the provisions herein set forth.

If your proposal is accepted and a contract issued, then this Request for Proposal and all documents attached hereto including any amendments, the Contractor's price proposals and any other written offers/clarifications made by the Contractor and accepted by the County, will be incorporated into the entire contract between the County and the Contractor, and it shall contain all the terms and conditions agreed on by the parties hereto, and no other agreement regarding the subject matter of this proposal shall be deemed to exist or bind any of the parties hereto.

Acceptance will take place only upon award by the County, execution of this document by the proper County officials, and delivery of the fully-executed contract to the successful Contractor.  The contract may only be amended by written agreement by the Contractor and Sauk County.

ATTACH YOUR COST PROPOSAL TO THIS FORM AND RETURN THE ORIGINAL AND FOUR COPIES IN ACCORDANCE WITH THE INSTRUCTIONS AS NOTED IN THE REQUEST FOR PROPOSAL.

 

CONTRACTOR (To be signed by the person authorized to legally bind contractor to this contract)

 

All proposal conditions and prices submitted shall remain firm for 90 calendar days following opening.

 

 

 

Contractor  _______________________________      Telephone No. (    ) ___________________

 

Address  _________________________________     Fax No. (    ) _________________________

 

City & State ______________________________       E-mail _____________________________

 

FEIN:  ___________________________________      Web Site ___________________________

 

BY: _____________________________________      Name:  ____________________________

      (Manual Signature Required)                                                                               (Typed or Printed)          

 

TITLE: ___________________________________      Date: _____________________________

 

 

 

REQUEST FOR PROPOSAL

COST PROPOSAL FOR

SAUK COUNTY DEPARTMENT OF HUMAN SERVICES

SCHEDULE OF COSTS

 

NOTE:   The Contractor guarantees these rates from _____________ to _____________.                        

               

 

Salary/Personnel Costs (List for each staff member)        $ ________________________

Supervision and Administration                                      $ ________________________

Fringe Benefit Costs                                                       $ ________________________

Equipment Costs                                                           $ ________________________

Operating Expenses                                                       $ ________________________

Supplies                                                                        $ ________________________

Mileage/Travel Expense                                                  $ ________________________

Consultant/Contractual Costs                                         $ ________________________

Training                                                                         $ ________________________

Insurance & Surety Bonds                                              $ ________________________

Space Costs                                                                    $ ________________________

Other (Specify)                                                               $ ________________________

 

Total Compensation Proposal                                     $ ________________________                      

 

 

Attach the Cost Proposal/Signature Form to this document.