rfp-2019 nwpfasd network · Web viewAuthor: Renee Little Created Date: 01/18/2019 07:17:00 Last...

Northwest Peace FASD Alberta

FASD Supports and Services

REQUEST FOR APPLICATIONJanuary 2019

April 1st, 2019 – March 31st, 2021

RFA-01-19-21 Supports and Services

Section 1.0 – TABLE OF CONTENTS

Section 1.0 – TABLE OF CONTENTS.................................................................................................3

Section 2.0 – REQUEST FOR APPLICATIONS....................................................................................4

Section 3.0 – SUBMISSION REQUIREMENTS...................................................................................5

Section 4.0 – PROPOSAL FORMAT................................................................................................ .12

Section 5.0 – PROPOSAL EVALUATION......................................................................................... 13

5.1 - EVALUATION SHEET................................................................................................. 14

5.2 - NETWORK LEADERSHIP TEAM EVALUATION SCORING SUMMARY TABLE................17

Section 6.0 FORMS

FORM A – PROPOSAL TITLE PAGE....................................................................................19

FORM B – PROPOSERS SIGNATURE PAGE.........................................................................20

FORM C - ORGANIZATIONAL INFORMATION....................................................................21

FORM D – PROPOSED SERVICE AND WORK PLAN............................................................23

FORM E- SCHEDULED COSTS..........................................................................................28

FORM F – CLIENT REFERENCE INFORMATION...................................................................29

Appendix 1- Catchment area……………………………………………………………………………………… …30

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NORTHWEST PEACE FASD SERVICE-NETWORK FASD SUPPORTS AND SERVICES

RFP-01-2019-21

Section 2.0 – REQUEST FOR PROPOSALS

The Northwest Peace FASD Board of Directors is requesting detailed and comprehensive applications until:

4:30 pm local time Tuesday February 19th, 2019 for the following project:

RFP-01-2019-21FASD SUPPORTS AND SERVICES

Documents and general information are available on the NWPFASD website

https://nwfasdnetwork.com/

or directly from the office of the Northwest Peace FASD Network.

NWFASD Support Contact- [email protected] or

Find the package on http://vendor.purchasingconnection.ca

Mailing: #204, 9805 97 St, Grande Prairie, AB T8V 8B9

Office: #204, 9805 97 St, Grande Prairie, AB T8V 8B9

Submissions may be mailed, hand delivered or emailed to [email protected]

INQUIRIES

All questions must be emailed to NW FASD Program Support, [email protected]

ISSUE DATE : January 18th,2019

Deadline : February 19 th , 2019 Tuesday at 4:30 p.m.

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mailto:[email protected]


http://vendor.purchasingconnection.ca/


https://nwfasdnetwork.com/

Section 3.0 – SUBMISSION REQUIREMENTS

The Northwest Peace FASD Alberta Services Network Society (NWPFASD) Board of Directors requests application submissions focused on addressing Fetal Alcohol Spectrum Disorder (FASD), with an emphasis on serving individuals affected by FASD over the lifespan. This RFP has been prepared in response to the Provincial Government’s FASD initiative, as described in the FASD Service Network Program Guidelines. Work at the provincial level is guided by the Alberta FASD Cross-Ministry-Committee (FASD-CMC). The NWPFASD Network is recognized by the Provincial Government as one of 12 regional networks that make up the service delivery arm for the provincial FASD initiative.

The Alberta FASD-CMC developed a Government-wide 10-year FASD Strategic Plan, (2007-2017) to improve and enhance services for individuals affected by FASD in Alberta and continue to fund services on an annual grant basis. The Provincial Government’s vision is to provide a comprehensive and coordinated provincial response to FASD by supporting the development and enhancement of FASD-related initiatives. Integral to this vision is that individuals affected by FASD receive a continuum of services that are respectful of the diversity seen throughout our communities, and that serve individuals across the lifespan.

The NWPFASD Network will support the delivery of services in the 2019- 2021 fiscal years.

Funding to successful applicants will be on a two year 2019-2020 and 2020-2021 basis dependent on Provincial funding allocations.

Please include a budget for 2019-2020 year in this proposal process. We will require a new budget for the 2020-2021 year (once funding allocations have been received from the Provincial Government).

When the successful applicants are selected, and the process moves forward to development of written contract, the contractors (successful applicants) will then be working with the NWPFASD Network office to develop the written contract. The NWPFASD Network will monitor and evaluate the contracts.

1. Scope of Work Within this Request for Proposal Process, 2019-2021 the NWPFASD Board is seeking to fund applicants in the following two pillar areas:

1. Targeted and Indicated Prevention (Parent Child Assistant Program (PCAP) and PCAP First Nations)

*First Nation (Parent Child Assistant Program) Please specify that you are applying for the PCAP First Nation Funding within the 1) Targeted and Indicated Prevention section (PCAP)

2. Supports for Individuals and Caregivers

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For the 2019 RFP for FASD Supports and Services submissions the Network Board will give priority to:

Providing FASD Supports and Services that are accessible within the geographic areas explained below (North, Central and South areas) within the Network catchment area.

This will be completed by selecting a proposal or multiple proposals that provide supports and services to the major service centers of Grande Cache, Grande Prairie, High Prairie and Peace River and their surrounding areas.

KEEP IN MIND YOUR AGENCY is not required to serve all the suggested areas. Each applicant will serve only their core areas, indicated through their proposal.

The GEOGRAPHIC AREAS included in this year’s proposal process are known as North, Central and South. Travel beyond 50km of your city/town may occur when necessary (within budget parameters). Applicants applying for the FIRST NATION Parent Child Assistance Program must be within the Northwest Peace FASD Network boundaries and must exclusively serve First Nations communities.

The North area is defined as to include areas within or surrounding the following core areas: Peace River, Manning, Grimshaw, High Prairie, and Fairview.

The Central area is defined as areas within or surrounding the areas of Grande Prairie, Sexsmith, Valleyview, Fox Creek and Hythe, Beaverlodge.

The South area includes any areas within or surrounding the core area of Grande Cache includes the communities of: Muskeg Seepee Cooperative, Susa Creek Cooperative, Grande Cache Lake Enterprise (Kamisak).

First Nation Communities includes any Reserve within the Northwest region (see map in Appendix 1 or visit http://fasd.alberta.ca/service-networks.aspx). This includes communities such as Sturgeon Lake, Horse Lake, Duncan, Drift Pile, Whitefish, Sucker Creek, etc.

MANDATORY

Training and evaluation projects, as required by the Province, will be mandatory for successfully funded agencies to participate in (e.g. FASD-ORS training).

There will also be mandatory bi – annual meetings with the Network staff. Some travel may be required for this. An annual event may be scheduled each year to give agencies a chance to network and learn from each other.

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T a rg e t ed and I n d ic a t e d Pr e v en t i o n (P-CAP)

The FASD Network is seeking to fund Parent-Child Assistant Program (PCAP) with one full time equivalent (FTE) position for each of three geographic areas of the region and two First Nation PCAP workers within different reserve populations. Each position will be funded to a maximum of $76,750.00 (inclusive of all service delivery costs). Please note, a maximum of 5% (of the budget total) may go towards Supervision, and a maximum of 10% (of the budget total) to Administration costs.

Total positions available for P-CAP

1 P-CAP – Central (Grande Prairie and Region)

1 P-CAP – North (Peace River and region)

1 P-CAP – South (Grande Cache and area)

2 P-CAP – First Nation Communities

The Parent-Child Assistant Program (PCAP) Seattle, Washington Model is an Intensive home visitation relationship-based practice model that has demonstrated successful outcomes. The PCAP program involves intensive multi-component activities, including such strategies as substance treatment, planned pregnancies and parenting programs. Training is available for P-CAP Supervisors and Mentors in Alberta through the P-CAP Council.

A Mentor should carry a caseload of 8-16.

Definition of Targeted and Indicated Prevention: prevention services educate and inform about the dangers of drinking alcohol while pregnant, the effects of FASD, and increase overall awareness about healthy pregnancy. Prevention services funded by the Network Leadership Team are for at risk populations.

• Targeted Prevention (Level 3) – Strategies targeting females of childbearing age who use substances.• Indicated Prevention (Level 4) – Strategies targeting females who have given birth to one or more children affected by FASD, and females who are known to be pregnant and consuming alcohol or other harmful substances.

Goals of PCAP Programming:• To help mothers build and maintain healthy independent family lives;• To assure that children are in safe and stable homes;• To prevent future births of substance exposed children.

The P-CAP Model

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Trained and supervised case managers provide home visitation and intervention for three years. Woman are not asked to leave the program if they relapse or experience setbacks. Case managers provide extensive practical assistance and the long-term emotional support so important to women who are making fundamental changes in their lives. There are defined program requirements to ensure success for the women and these requirements are provided for the agency during the training process.

The mentor assists clients in:• Setting goals and identifying steps to achieve them• Obtaining alcohol/drug treatment• Staying in recovery• Choosing a family planning method• Child health care/immunizations• Connecting with community services• Transportation to appointments• Solving housing, domestic violence, child custody problems• Resolving system service barriers

P-CAP First Nation program

This program will follow the criteria for the Parent Assistant program explained above. Although, this program will work with clients within a Reserve population with specific considerations of isolated locations, culture and community ideals. First Nation P-CAP workers can also find training within the PCAP training council.

The work of P-CAP First Nation programs aligns with the Truth and Reconciliation Commission’s (TRC) Calls to Action, including Call to Action number 33 regarding addressing and preventing Fetal Alcohol Spectrum Disorder (FASD).

Each Nation is only permitted to apply for one P-CAP mentor position. To effectively serve and meet the needs of the Northwest region we want to provide this opportunity to more than one community/agency.

Supports for Individuals and Caregivers

The FASD Network is seeking to fund Supports for individuals and caregivers with at least one full time equivalent (FTE) position for each of three geographic areas of the region. Each position will be funded to a maximum of $76,750.00 (inclusive of all service delivery costs). Please note, a maximum of 5% (of the budget total) may go towards Supervision, and a maximum of 10% (of the budget total) to Administration costs

Total positions available for FASD Supports

1 Supports– Central (Grande Prairie and /or area)

1 Supports – North (Peace River and/ or area)

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1 Supports – South (Grande Cache and/ or area)

Support Programs for Children & Youth with/or suspected of having FASD. Examples of types of intervention supports for youth could include coordination, advocacy, mentoring, and support groups. Integral to a youth support program must be a clear intake process followed by strategies and goals that have clear outcomes. This support program must have an evidence-based evaluation plan.

The caseload expectation is 12-22 clients.

Support Programs for Adults with/or suspected of having FASD. Examples of types of intervention supports for adults could include coordination, advocacy, mentoring, and support groups. Integral to an adult support program must be a clear intake process followed by strategies and goals that have clear outcomes. This support program must have an evidence-based evaluation plan.

The caseload expectation is 12-22 clients.

Examples of coordination and advocacy activities include the following: community supports including respite and recreation, access to detoxification and treatment, health care, education, employment, transportation, assisting with criminal or family justice issues, pregnancy and outreach programs and/or income supports and/or housing.Examples of mentoring (support and guidance) activities includes the following: assisting individuals in making healthier choices for themselves and their families, encouraging learning to increase the individuals self- advocacy skills, setting realistic and practical expectations, focusing on trust, respect and non-judgmental relationship development, adapting to the individual’s needs, using teaching strategies such as active listening and role modeling, linking individuals to resources.Support groups are facilitated, educational and/or therapeutic groups that assist with moving beyond one-on- one support and addressing issues of social isolation.Supports include programs and services that enhance protective factors and enable individuals and families affected by FASD to reach their potential in the community. Supports promote the development and well- being of individuals and caregivers; keep them safe and protected; and promote healthy communities.

2. Eligible Applicants

Eligible applicants can be:

• Not-for-Profit organizations

• Private sector companies

• First Nation Band Councils

• Applicants who agree to the terms and conditions set out in the NWPFASD Network FASD Supports & Services RFP Agreement.

Ineligible applicants:

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•Government Ministries that are on the Cross-Ministry Committee (Children Services, Alberta Health

Services, Justice, etc.).

• Network Leadership Board members

• Agencies that do not have a location within one of the geographical areas defined as North, Central or South

• Applicants submitting proposals for the sole purpose of:

o Research

o Awareness campaigns

o Capital costs related to buildings or vehicles

Any applications that do not meet the above qualifying criteria will not be given further consideration. Applications that meet all the qualifying criteria will be further assessed and ranked based on the selection criteria.

3. Selection Criteria

The evaluation and selection of service providers will be based on an evaluation of a proposal which should include detailed program, support and service delivery strategies.For the 2019 RFP for FASD Supports and Services submissions the Network Leadership Board will be giving priority to:

-Addressing needs across the lifespan without age barriers.

-Programs will focus on a developmentally sensitive approach to FASD

• Meeting identified cultural needs including indigenous and immigrant populations.

• One or a combination of applications will be selected to ensure that the NWPFASD Network offers services in service pillars of i) Targeted and Indicated Prevention (PCAP), and ii) Supports for Individuals and Caregivers (across the lifespan).

• Applicants that demonstrate a willingness to collaborate and align with the overall work of the NWPFASD Network.

• Applicants that can demonstrate organizational capacity to implement the proposed service

• Applications selected to delivery services and supports in each of the two service pillars should align with the allocated budget in the 2019 - 2020 and the expected number of clients to be served

4. Mandatory Criteria

Successful applicants must meet the following criteria:

Submission of a complete RFP package including the following components:

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o Proposed services to be delivered within the Northwest Peace FASD Service Network catchment area (see Appendix 1 for Catchment Area Map)

o Proposals are to be submitted via email, hand delivered or mailed to physical mailing address [email protected] o Applicants meet the eligible applicant criteria

Submissions should include:

• Completed forms A, B, C, D, E and F

• Project Overview Letter - a one- or two-page summary letter outlining the key features of the proposal.

• Applications are no longer than 20 pages

The submission be marked as: RFP-01-19-21 FASD SUPPORTS AND SERVICESo Certificate of incorporationo Audited financial statement or letter from a financial institution providing information pertaining to

the financial stability of the organization.

o Organizational charto Insurance certificate

o Worker’s Compensation Coverage

5. Funding Duration

The funding approved through the 2019 application for funding process will support services delivered over a period not to exceed two years. The estimated contract duration will be beginning on April 1st of 2019 and end March 31, 2021, depending on funding from the Province.

Terms and Conditions Proposals not meeting all inclusion criteria and mandatory requirements will be rejected. Submit information

on the forms provided. Proposal pages should not be altered or transformed in any way. Changing the document in any way may

warrant disqualification of acceptance. Funding requests cannot exceed the maximum funding available within each strategy and in each geographic

area. When considering proposal requests, The Northwest Peace board must be aware of the entire catchment

area which extends as far North as Manning, Ab., and West to the British Columbia border and South to Grande Cache Ab.

If proposals received through this RFP process do not meet the geographical areas highlighted or program areas required, the Network Board reserves the right to reissue the RFP or ask for a Letter of Interest pertaining to the areas not fulfilled.

Occupational Health & Safety The contractor shall comply with the provisions of the Occupational Health and Safety Act, Statues of Alberta

2000 Chapter 0-2, and amendments there to and regulations there under, and shall at all times ensure that all equipment and manpower within the work environment shall comply with the requirements of the said Act and regulations there under.

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Workers’ Compensation Board The contractor shall provide evidence to the Network Leadership Board that an account has been opened with the Workers’ Compensation board and that all fees are paid in compliance with the Board; and that the coverage is maintained for the duration of this agreement for any persons working for or employed by the contractor on this agreement.

Insurance The contractor shall provide the following insurance:Comprehensive Insurance

Comprehensive General Liability Insurance protecting the Owner, the Contractor and their respective employees against damages arising from personal injury (including death) and claims for property damage which may arise out of the operations of the Contractor and their employees under the Agreement. This insurance shall be for the amount of not less than TWO MILLION DOLLARS ($2,000,000.00) inclusive per occurrence and shall include a standard form of cross liability clause. Auto Business is required for employees that transport clients or staff.

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Section 4.0 – PROPOSAL FORMAT

The following format should be followed to provide consistency in proponent response. Applications should be no longer than 20 pages (not including charts and appendices) and should include page numbers.

Applicant Checklist

Applicant Format Requested

Form A - Proposal Title Page

Form B - Applicants Signature Page

Form C - Organizational Information

Form D - Proposed Service, Work Plan and Required Resources

Form E - Schedule of Costs (attach the Schedule B)

Form F - Client Reference Information

Appendix I Certificate of incorporation

Appendix II Audited financial statement or letter from a financial institution providing information pertaining to the financial stability of the organization.

Appendix VI Organizational chart

Appendix V Insurance certificate

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Section 5. 0 – PROPOSAL EVALUATION

5.1 Evaluation Sheet for FASD Network Board

Stage One:

Does the application meet all of the mandatory submission requirements?

Note: If the application fails d o not proceed to stage two.

Pass or Fail

Applicants meet the eligible applicant criteria.

Application was received by February 19th at 4:30 pm.

Stage Two:

The criteria below will be ranked in correspondence to the rating scale below. The Board will use this to assist scoring the proposal:

10 Not only acceptable, they have given a desired or a superior solution or answer.

7 The answer is satisfactory.

3 They have provided a portion of the answer or solution we were seeking.

0 They have not addressed the requirement or have missed the intention of the question.

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Applications that pass Stage One will be ranked on the following criteria:

SECTION I for NW Peace FASD Board

CRITERIA PointsImportance

IndexMaximum

Points

A) Applicant Qualifications

Mandate of the organization is compatible with the proposed FASD services and supports.

0-10 0.5 5

Relevant experience in performance of comparable engagements 0-10 1.0 10

Demonstrate organizational capacity to support implementation of the proposed initiative.

0-10 1.0 10

Identified the number of staff required to carry out the proposed service

0-10 0.5 5

identified staff recruitment and training strategies 0-10 1 10

B) Alignment with the Network Priorities

Process for maintaining up-to-date records and keeping information confidential

0-10 1.0 10

Process for reducing cultural barriers and address the cultural needs of the community

0-10 1.5 15

Process for addressing age-related barriers and providing services across the lifespan

0-10 1.5 15

Process for providing clients transitional services across the lifespan

0-10 1.0 10

C) Quality of Application

Application format consistent with format outline provided in the various forms

0-10 1 10

Section weight is 50%, multiply the score by 0.5. Carry forward this total to the Scoring Summary Table Section I total (A + B + C)

/100

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SECTION II NW Peace FASD Board

Applicant Plan Strategies 1 – 3

CRITERIA PointsImportance

IndexMaximum

Points

Strategy #1: Targeted and indicated Prevention services to at risk women (P-CAP and P-CAP First Nation)

Proposed service is compatible with the scope of work for the Targeted and Indicated Prevention service pillar (PCAP) as outlined in the RFP.

0-10 2.0 20

Outlined goals and proposed plan would accomplish the proposed service

0-10 1.5 15

Proposed service fills an existing service gap or enhances existing services

0 or 10Yes = 10No = 0

1.5 15

Activities align with the Provincial Government strategy 0-10 1.5 15

Outcomes match the following business planning targets for targeted andindicated prevention services to at risk women:

• Reduce incidence of FASD by reduction in pregnancies in high-risk women or reduction of substance abuse in women who are pregnant and using alcohol by utilizing a PCAP based programming model.

• Mentors & supervisors will complete the mandatory and suggested

P-CAP training. Mentorship model will include outreach services.• The mentor will connect clients and their families to a variety of

supports in their community.

0-10 220

An evaluation plan is identified that would measure the success of the proposed activities/achievement of outcomes 0-10 1.5 15

Strategy 2 Total Points /100

Section weight is 50%, multiply the score by 0.5. Carry forward this total to the Scoring Summary Table /50

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CRITERIA Points Importance Index

Maximum Points

Strategy #2: Supports for individuals affected by FASD and their caregivers.

Proposed service is compatible with the scope of work for the Supports and Service pillar as outlined in the RFP.

0-10 2.0 20

Outlined goals and proposed plan would accomplish the proposed service

0-10 1.5 15

Proposed service fills an existing service gap or enhances existing services

0 or 10

Yes = 10 1.5 15

Activities align with the Provincial Government strategy 0-10 1.5 15

Outcomes match the following business planning targets for supports for individuals and caregivers:

• Support workers will create strategies, goals and make supported referrals that address recommendations in the FASD Diagnostic report and individuals identified needs.

• Support strategies that increase client engagement and retention in programs.

• Support workers will provide supported referrals to increase access to services.

• Provide support, education, reduce social isolation and assist in development of informal networks for families/ caregivers by facilitating the development and maintenance of FASD Parent/ Caregiver support groups. 0-10 2 20

• An evaluation plan is identified that would measure the success of the proposed activities/achievement of outcomes

0-10 1.5 15

Strategy 2 Total Points /100

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Evaluation Scoring Summary Table (Board)

Proposals will have 2 scores, one for each strategy. The proposals will then be ranked according to each strategy and according to each similar geographic area.

The reason for this type of evaluation is to ensure that proposals selected is a strength-based decision (strength of the organization to provide the services) and so that the proposals selected align with the 2019-2021 Network Business Plan targets.

Strategy 1 Strategy 2

Geographic Area # 1 (North)for Proposed Service

Geographic Area # 2 (Central)or Proposed Service

Geographic Area # 3 (South)for Proposed Service

First Nation P- Cap Community within NWP FASD NW region

Section I Score /50 /50

Section II CorrespondingStrategy Score /50 /50

Total /100 /100

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Network Board Proposal Evaluation Summary Checklist

□ Proposals were ranked by defined geographic area and by strategy number

The following geographic areas are provided with services: □ North Area□ Central Area□ South AreaOr within a First Nation Area

Services are provided in each of the following service pillars: □ Prevention (limited to targeted and indicated prevention (PCAP))□ Support programs to support Individuals and Caregivers

Proposals selected provide services that:□ Address needs across the lifespan (program may be child, youth, or adult orientated)□ Meets identified cultural needs including aboriginal and immigrant populations.

Targeted and indicated prevention (PCAP and PCAP First Nations)

GeographicArea

Funding allocated to the Geographic Area

Proposals selected in this strategy

FundingRequested Clients to be Served

Total: Total: Total: Total: Total:

Network Leadership Team Proposal Evaluation Summary Checklist

A combination of proposals selected should meet the following network priorities as outlined in Section 5.0:

Supports for Individuals and Caregivers

GeographicArea

Funding allocated to the Geographic Area

Proposals selected in this strategy

FundingRequested Clients to be Served

Total: Total: Total: Total: Total:

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Section 8.0 – FORM FOR PROPOSAL

FORM A – PROPOSAL TITLE PAGE

Organization Name:

Address:

Primary Contact for Communication Purposes:

Name:

Phone:

Email:

Name of proposed service:

Geographic area(s) to be served:

Priority Area of proposed service (check one)

□ Strategy # 1 - Provide targeted and indicated prevention services (PCAP and PCAP First Nation) to at risk women. □ Strategy # 2 - Provide supports for individuals and caregivers

Summary Table

Strategy #1: Deliver targeted and indicated prevention services to at risk women.

Strategy # 2: Provide support services for individuals suspected or diagnosed withFASD of all ages and their families/ caregivers.

North Area

Central Area

South AreaFirst Nation PCAP n/a

Funding requested through NWPFASD Network (total) $

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FORM B –PROPOSERS SIGNATURE PAGE

By submitting this application, I/We agree to comply with the requirements stated in this RFP

My/Our Business License Number is:

DECLARATION

The Applicant further declares that he/she has complied in every respect with all the instructions to Applicants, that he/she has read all addenda, if any, issued prior to opening of applications, and that he/she has satisfied him/her self fully relative to all matters and conditions with respect to the general conditions of the agreement and all relevant information to which this application pertains.

ANTI-COLLUSION STATEMENT

The undersigned, as Applicant, declares, under oath that no other person has any interest in this application or in any resulting agreement to which this application pertains, that this application is not made with connection or arrangement with any other persons and without collusion or fraud.

Respectfully submitted,

Signature of Authorized Employee or Board Member Printed Name

Firm/Agency/Organization Telephone #

Address

Date

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FORM C – ORGANIZATIONAL INFORMATION

Describe the Geographic area to be served:

Provide the mandate/vision/mission of your organization:

Describe recent experience providing FASD related services and supports

Describe and demonstrate organizational capacity for the proposed initiative.

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Does your organization have a process for maintaining up-to-date records and keeping information confidential?

Does your agency have a process for reducing cultural barriers and address the cultural needs of the community?

Does your agency have a process for providing clients transitional services across the lifespan?

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FORM D - PROPOSED SERVICE AND WORK PLAN

□ Strategy #1 – Deliver targeted and indicated prevention services to at risk women (PCAP and PCAP First Nations).

Describe the Proposed Service

List Service Goals:

Does this proposed service fill an existing service gap?

□ Yes □ No

If yes, please identify the service gap and describe how you have identified this gap:

Objectives/ Key Activities to Accomplish the Proposed Service (check all that apply to your proposal)

Describe how your agency would accomplish the activities and identify the key resources that would be required.

Indicated Prevention - Provide one-on-one mentorship-based support services to females of childbearing age who use substances.

Targeted Prevention - Provide one-on-one mentorship-based support services to females who have given birth to one or more children affected by FASD, and females who are known to be pregnant and consuming alcohol or other harmful substances.

Coordinate activities to ensure mentorship and outreach services are available to rural communities within the catchment areas.

Ensure mentorship support services are modeled after the Seattle-based Parent- Child Assistance Program (P-CAP).

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Describe other objectives/key activities of the proposed service that are not listed above.


Target Population:

Number of clients to be Served (8-16):

Outline the main outcomes that are and the indicators that will be used to measure and report on progress.

Outcomes Indicators

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Evaluation Plan

Describe the means of measuring the success of the proposed activities:

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Strategy #2– Provide support services for individuals suspected or diagnosed with FASD of all ages and their families/ caregivers.

Describe the Proposed Service

List Service Goals:

Objectives/ Key Activities to Accomplish the Proposed Service (check all that apply to your proposal)


Provide supports for individuals suspected of/diagnosed with FASD of all ages and their families/ caregivers (may be either Child, Youth, or Adult focused).

Provide diagnostic follow-up support to individuals who have received a diagnosis on the spectrum. Coordinate activities to ensure needs across the lifespan and are respectful of a wide range of perspectives (including cultural diversity).

Provide creative day-to-day programming for children, youth, adults, and families affected by FASD.

Collaborate with community agencies and provide supported referrals, to address such concerns as homelessness and addictions faced by individuals affected by FASD.

Implement best-practice into the supports and services offered

Describe other objectives/key activities of the proposed service that are not listed above.



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Target Population:

Number of clients to be Served (12-22)

Outline the main outcomes that are expected and the indicators that will be used to measure and report on progress.

Outcomes Indicators

Evaluation Plan:

Describe the means of measuring the success of the proposed activities

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FORM E – SCHEDULED COSTS (FILL OUT SCHEDULE B ATTACHED)

Below is a link to the template for the Schedule B. Please click on the icon below and fill out the Schedule B template (it will open in excel). This will need to be included in the package you send in. A new budget will be required for 2020-21 before the 2nd year of service. The budget cannot exceed $76,750.00 per position. A formal Schedule B will be provided once contracts have been awarded. The Network staff will work with the successful proponent should they need support filling in the Schedule B. Please note, a maximum of 5% (of the budget total) may go towards Supervision, and a maximum of 10% (of the budget total) to Administration costs:

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FORM F- CLIENT REFERENCE INFORMATION

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Reference 1 - Company Name

Address

City/Province

Postal Code

Contact Person/Title

Phone Number

Description of work performed

Reference 2 - Company Name

Address

City/Province

Postal Code

Contact Person/Title

Phone Number

Description of work performed


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Appendix 1 – Catchment Area

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