BIDDER S NAME Enter Bidder S Name in the Header Area Above. DSHS RFP #1713-651

[BIDDER’S NAME] Enter Bidder’s Name in the header area above. DSHS RFP #1713- 651

Attachment D - Bidder Response Form

This form is broken into the following seven (7) sections: Section D-1. Administrative Response; Section D-2. Minimum Requirements Response; Section D-3. Management, Experience and Qualifications Response; Section D-4. Technical/Functional Response; Section D-5. Outcome and Performance Measures; Section D-6. Cost Proposal; Section D-7. Bidder Letters of Commitment; and Section D-8. Bidders’ References Bidders must respond to all questions in all sections of this Attachment in the expandable space provided or as directed. If a question requires Bidder to submit additional documents, please attach them (do not imbed the document) to this document and label them clearly as part of your response to this Attachment D. If an attachment is provided, please include the name of the attachment in the Response field. Please follow instructions for each section. Failure to respond to instructions specific to any section may result in Bidder’s disqualification.

Attachment D – Bidder Response Form Page 1 of 16 SECTION D-1 – ADMINISTRATIVE RESPONSE (PASS/FAIL) Instructions: Bidder’s Response to the questions in this Section D-1, combined with the information provided in referenced required Attachments, demonstrates compliance with the Administrative Requirements of this Solicitation. While the Administrative Response is not given a numbered score, information provided as part of Bidder’s Administrative Response may cause the Bidder Response to be disqualified and may be considered in evaluating Bidder’s qualifications and experience. Please # Response Requirements Checklist: Indicate: YES/NO 1 Attachment B - Bidder’s Letter of Submittal is attached, containing required responses and signed. 2 Attachment C - Bidder’s Certification and Assurances form is signed and attached. This Attachment D – Bidder Response Form: 3 Section D-2 – Minimum Qualifications Response completed. 4 Section D-3 – Management/Experience/Qualifications Response completed. 5 Section D-4 – Technical/Functional Response completed. 6 Section D-5 – Outcome And Performance Measures completed. 7 Section D-6 – Cost Proposal completed. 8 Section D-7 – Bidder Letters of Commitment completed. 9 Section D-8 – Bidders’ References completed. [BIDDER’S NAME] Enter Bidder’s Name in the header area above. DSHS RFP #1713- 651

Attachment D - Bidder Response Form SECTION D-2 – MINIMUM QUALIFICATIONS RESPONSE (PASS/FAIL) Instructions: Bidder’s response to the questions in this Section D-2 documents how Bidder meets the Minimum Qualifications. All Minimum Qualifications must be responded to and are evaluated as Pass/Fail. Failure to respond or demonstrate how the requirements are met may cause Bidder to be deemed unresponsive and may be disqualified. Please ensure that your answer to this question includes all information that you wish DSHS to consider in determining whether you meet the Minimum Qualifications set forth in the Solicitation Document. MAXIMUM TOTAL # Minimum Qualifications: POINTS Be licensed to perform work in Washington State or commits to becoming licensed within 30 calendar days of being Pass/Fail 1 determined the Apparently Successful Bidder. For exceptions to this requirement, please go to the Washington State Business Licensing Service website more information at: http://bls.dor.wa.gov/index.aspx RESPONSE: Coalitions must be composed of one or more nonprofit, nongovernmental organizations (includes grass roots Pass/Fail 2 organizations) and one or more local governmental entities (includes tribes and tribal organizations). RESPONSE:

Attachment D – Bidder Response Form Page 3 of 16 [BIDDER’S NAME] Enter Bidder’s Name in the header area above. DSHS RFP #1713-651

Attachment D - Bidder Response Form SECTION D-3 – MANAGEMENT/ EXPERIENCE/ QUALIFICATIONS RESPONSE (SCORED) Instructions: Please describe the experiences, skills and qualifications your organization and proposed staff possesses that are relevant to an evaluation of your ability to perform the Contract that is the subject of this Solicitation. Please ensure that your answers to these questions include all information that you wish DSHS to consider in determining whether you meet the requirements and qualifications set forth in the Solicitation Document. Please include any relevant experience that distinguishes your organization or makes it uniquely qualified for the Contract. All questions must be responded to and will be scored. Failure to respond or demonstrate how the requirements/qualifications are met may cause Bidder to be deemed unresponsive and may be disqualified. FOR MAXIMUM EVALUATION TOTAL PURPOSES # Requirements/Qualifications: POINTS ONLY MANAGEMENT/ EXPERIENCE/ QUALIFICATIONS 50 Describe your organizational structure that includes your coalition partners, including member roles, and proposed staffing model for this project. Include information of any in-kind resources (e.g., staffing, goods and services, equipment) your coalition intends to contribute to help achieve 1 your project’s objectives and outcomes. If you identify as a grass-roots 20 organization, explain how you meet this definition as described in Section B. Definitions. Also, provide a Coalition organizational chart to help support an understanding of the organizational structure of the proposed project. RESPONSE: Describe how your organization and/or your partnering organizations have a demonstrated history and connection in serving the target population. 2 Include outcomes achieved and any lessons learned in implementing 20 similar projects. RESPONSE: Describe how the diversity of your key staff who will be involved in this project has the demonstrated experiences and skills to serve the target 3 population and how they are familiar with the culture and language of the 10 target population. Include any of your staff’s direct experiences with working with gang involved youths or overrepresented populations.

Attachment D - Bidder Response Form FOR MAXIMUM EVALUATION TOTAL PURPOSES # Requirements/Qualifications: POINTS ONLY RESPONSE: SECTION D-4 – TECHNICAL/ FUNCTIONAL RESPONSE (SCORED) Instructions: Please describe how your project intends to address the gang or youth violence problem affecting your community. Please ensure that your answers to these questions include all information that you wish DSHS to consider in determining whether you meet the requirements and qualifications set forth in the Solicitation Document. Please include any relevant experience that distinguishes your organization or makes it uniquely qualified for the Contract. All questions must be responded to and will be scored. Failure to respond or demonstrate how the requirements/qualifications are met may cause Bidder to be deemed unresponsive and may be disqualified. FOR MAXIMUM EVALUATION TOTAL # Requirements/Qualifications: PURPOSES POINTS ONLY TECHNICAL RESPONSE 100 Identify the gang or youth violence problem affecting your community. Describe the types of violence, other crimes and gang activity committed; how the violence and gangs impact various aspects of the 1 community; and, any known causes of the violence. Include any statistical data as support and the 15 source of this information. RESPONSE: 2 Describe the characteristics of the population that will be targeted by this project and explain why this population was selected. Include demographic information such as age, ethnicity/race, gender, socio- economic status, education level, etc., and describe the size of the target population within the project’s 10 area. RESPONSE: Define the geographical boundaries (e.g., townships, county lines, school districts, etc.) of the area that the project will 3 target. 5 RESPONSE: 4 Describe the extent of Disproportionate Minority Contact in the target population in your community and 10 any efforts to reduce racial and ethnic disparities within the local juvenile justice system. Identify if any

Attachment D - Bidder Response Form FOR MAXIMUM EVALUATION TOTAL # Requirements/Qualifications: PURPOSES POINTS ONLY specific groups of youth are over or underrepresented in the juvenile justice system when compared to the general population of at-risk youth in your community and how your project intends to address this issue. RESPONSE: Describe your proposed project and how it will implement the strategies identified in the RFP’s Project Scope to address the gang problems identified in your Statement of Need (Question #1 above). This description should be detailed enough to enable evaluators to understand the project’s design, 5 strategies, program components, outcomes, involvement of any local partnerships, and service delivery 25 methods. Identify any evidence-based programs or promising practices if they will be an integral part of your program. RESPONSE: In order to be able to assess the effectiveness of programs, JR requires the identification and reporting on activities and outcomes. JR has identified four (4) common GRIP Project outcomes all Bidders are expected to meet and report on.

In addition, Bidders must clearly identify their own program specific outcomes and provide quantitative measures that align with your project’s design.

For this response, please complete the Section 2 in Section D-5: “Outcome And Performance Measures” chart that lists the 6 GRIP Project’s common expected outcomes that Bidders are expected to meet and include your program specific outcomes 20 if they are different from the identified GRIP Project’s outcomes and measures.

Also, complete and attach a “Logic Model” diagram to help illustrate a clear connection between project objectives, corresponding program activities, and measurable outcomes. A sample Logic Model template can be found at: Logic Model Template.pdf and a Logic Model resource guide can be found at: Logic Model Workbook.pdf

RESPONSE: 7 Based upon your expected outcomes and costs, provide an estimate of the average cost per youth who will be served under 10

Attachment D - Bidder Response Form FOR MAXIMUM EVALUATION TOTAL # Requirements/Qualifications: PURPOSES POINTS ONLY this project. RESPONSE: Describe your timeline for implementing your project. The timeline should be comprehensive, carefully planned, and 8 realistic. Priority given to projects that can begin service delivery within 30 days from signed contract. 5 RESPONSE:

SECTION D-5 - OUTCOME AND PERFORMANCE MEASURES (20 Points) Instructions: Please complete the chart that lists the GRIP Project’s common expected outcomes that Bidders are expected to meet and include your program specific outcomes if they are different from the Project’s outcomes. If your program does not support any of the GRIP Project’s common expected outcomes, please indicate the reason for this. SECTION 1 - GRIP PROJECT OUTCOMES Expected Outcomes Performance Measures 1) Up to 75% of program youth will complete program • Number of youth starting the program. requirements. • Number of youth who complete program requirements If your program includes either an evidence-based program • Number of youth not completing and reason why or a promising practice, please identify this as well. 2) Up to 75% of youth known to have an offense and who did • Number of youth with offenses starting the program. not reoffend after involvement with the program. • Number of youth ending the program who did not reoffend. 3) Up to 50% of youth will demonstrate a desired change in • JR will develop and provide a client survey for distribution their targeted behavior and Program will have a client by the Program. response rate of up to 75% of the client surveys. 4) Provision of peer to peer trainings. • Number of training fulfilled. SECTION 2 - BIDDER’S PROGRAM SPECIFIC OUTCOMES Identify any additional program specific outcomes and measure below (e.g., 50 at-risk youth will receive life skills/programming services; 60 students at-risk of gang involvement will receive vocational training, reported gang-related incidents will be reduced by 50% for youth receiving case management services; school attendance rate will improve by 90% for students participating in tutoring program).

SECTION D-6 – COST PROPOSAL (SCORED) Instructions: The Bidder must provide a detailed budget by completing the Cost Proposal. The Prime Bidder may submit a single budget proposal that includes all of their Coalition Partner’s budget(s) or they may provide a separate budget Proposal for each Coalition Partner. If separate budgets are submitted, the Prime Bidder must still provide a total budget summary. The total number of available points is 30 points. A. BUDGET SUMMARY: The following table is to be completed using the totals from the budget categories A-E. Enter the totals from all expenditure categories in the application spaces. All amounts in the budget section are to be rounded to the nearest whole dollar.

Expenditure Category Total FY18 FY19 Totals Totals A. Personnel Salaries B. Personnel Benefits C. Operating Expenses D. Contractors E. Equipment Subtotal F. Administrative (maximum of 4% of subtotals from A-E) Grand Total

B. BUDGET DETAILS: This section of the budget includes a table for each major category of potential expenditure. Please itemize your proposed expenditures in each of the following categories: Personnel, Operating Expenses, Contractual, Equipment, and Administrative Expenses.

Category A – PERSONNEL Includes salaries, social security and fringe benefits for personnel required to implement the project including full or part-time staff who directly support services to the youth population served under this project (excluding contractors which should be listed in Category C).

Personne Description of Annual Salary Percentage Total l Position or Hourly Rate of Time FY18

Subtotal

Grand Total

Category B – OPERATING EXPENSES

Includes project supplies, food, travel and other operating expenses which must directly support services to youth population served under this project. Travel expenses may include mileage and/or other transportation costs. Reimbursement for travel, meals and lodging expenses cannot exceed the State of Washington’s reimbursement rate.

Operatin g Description of Expense Cost/Unit Quantity Total Expense

Subtotal FY19

Subtotal

Grand Total

Category C - CONTRACTORS

Includes contractual services such as consultants or staff training costs.

Contractors Description of Service Rate Quantity Total

Subtotal

Grand Total

Category D - EQUIPMENT

Includes equipment costs which must directly support services to youth population served under this project. DSHS may request equipment purchases be returned upon the completion of this project.

Equipmen Description of Equipment Cost/Unit Quantity Total t

Subtotal

Grand Total

Category E – ADMINISTRATIVE EXPENSES

Includes all indirect or administrative costs. These costs are the allocable portion of necessary and allowable costs that are associated with the overall management and administration of this project and which do not directly support the youth population served under this project. (Indirect or Administrative cost cannot exceed 4% of total funding).

Administrativ Description of Expenses Cost/Unit Quantity Total e Expenses

Attachment D - Bidder Response Form Subtotal

Subtotal

Grand Total

Attachment D - Bidder Response Form Category F – IN-KIND CONTRIBUTIONS

Include information of any in-kind resources (e.g., staffing, goods and services, equipment) your coalition intends to contribute to help achieve your project’s objectives and outcomes.

In-Kind Description of Contribution Cost/Unit Quantity Total

Subtotal

Grand Total

SECTION D-7 – BIDDER LETTERS OF COMMITMENT (PASS/FAIL) Instructions: Please attach signed letters of commitment for the organizations you agree will be a collaborating entity to your proposed solution and services. Also list the names and contact information for each of the members of the collaborating entity. Name, Phone # and Email. Briefly describe the services this organization will provide to the project. Entity #1

Entity #2

Entity #3

Entity #4

SECTION D-8 – BIDDERS’ REFERENCES (PASS/FAIL) Instructions: Please list three (3) names and contact information for each of the references whom JR may contact for this project. Name, Agency, Phone # and Email. Reference #1

Reference #2

Reference #3

Attachment D – Bidder Response Form Page 16 of 16