HomeMy WebLinkAboutGrant Related - New Hope DV/SABarbara Vasquez
From:
Suzi Fode
Sent:
Monday, November 23, 2020 2:59 PM
To:
BOCC Consent
Subject:
Grant Application documents- signature on BOCC Consent Agenda 12.1.2020
Attachments:
ATTACH M ENT_B_Bidder_I nformation_Fo rm.docx;
ATTACHMENT A Certifications and Assurances.docx
New Hope will be applying for funding from DSHS through the Domestic Violence Prevention; Multi -Year Domestic
Violence Prevention Projects Competitive Solicitation.
The application is due 12.9.2020 and requires 2 documents with signature. (See Attached for BOCC signature)
The funding request will be for $363,000 for a 30 month period to implement domestic violence prevention projects at
New Hope.
Thank you,
Suzi
Suzi Fode, Director
New Hope and Kids Hope
wu�C
new beginnings. better tomorrows.
311 W. Third Ave.
Moses Lake, WA 98837
1.888.560.6027
509.764.8402
Kid�llope
Wrr.n_.
€iECE I VEED
Z 3 2020
^LINTY COMMISSIONERS
ATTACHMENT A
BIDDER CERTIFICATIONS AND ASSURANCES
Bidder must sign and include the full text of this Attachment A with the Response.
Under the penalties of perjury of the State of Washington, Bidder makes the following certifications
and assurances as a required element of its Response to this Competitive Solicitation. Bidder
affirms the truthfulness of these facts and acknowledges its current and continued compliance
with these certifications and assurances as part of its Response and any resulting contract that
may be awarded by DSHS.
1. Bidder declares that all answers and statements made in Bidder's Response are true and
correct.
2. Bidder certifies that its Response is a firm offer for a period of 180 days following receipt by
DSHS, and it may be accepted by DSHS without further negotiation (except where obviously
required by lack of certainty in key terms) at any time within the 180 -day period. In the case of
a protest, the Bidder's Response will remain valid for 210 days or until the protest is resolved,
whichever is later.
3. Bidder has not been assisted by any current or former DSHS employee whose duties relate
(or did relate) to this Solicitation and who assisted in other than his or her official, public
capacity. If there are any exceptions to these assurances or if Bidder has been assisted,
Bidder will identify on a separate page attached to this document each individual by: (a) name,
(b) current address and telephone number, (c) current or former position with DSHS, (d) dates
of employment with DSHS, and (e) detailed description of the assistance provided by that
individual.
4. Bidder certifies that Bidder is not currently bankrupt or a party to bankruptcy proceedings and
has not made an assignment for benefit of creditors and authorizes DSHS to conduct a
financial assessment of Bidder in DSHS' sole discretion.
5. Bidder acknowledges that DSHS will not reimburse Bidder for any costs incurred in the
preparation of Bidder's Response. All Responses shall be the property of DSHS. Bidder
claims no proprietary right to the ideas, writings, items or samples submitted as part of its
Response.
6. Bidder acknowledges that any contract award will incorporate terms set forth in the Sample
Contract(s), including its attachments and exhibits, as set forth as Attachment A to the
Solicitation Document, or may, at DSHS' option be negotiated further. DSHS may elect to
incorporate all or any part of Bidder's Response into the Contract.
7. Bidder certifies that it has made no attempt, nor will make any attempt, to induce any other
person or firm to submit, or not submit, a Response for the purpose of restricting competition
and that the prices and/or cost data contained in Bidder's Response: (a) have been determined
independently, without consultation, communication or agreement with others for the purpose
of restricting competition or influencing bid selection, and (b) have not been and will not be
knowingly disclosed by the Bidder, directly or indirectly, to any other Bidder or competitor
before contract award, except to the extent that Bidder has joined with other individuals or
Domestic Violence Prevention FY 21-23 Page 1 of 2
ATTACHMENT A
BIDDER CERTIFICATIONS AND ASSURANCES
organizations for the purpose of preparing and submitting a joint Response or unless otherwise
required by law.
8. Bidder acknowledges that if it is awarded a contract containing Business Associate
requirements under the Health Insurance Portability and Accountability Act of 1996 (HIPAA),
or any other Data Security requirements, that Bidder will incorporate the terms of such
Business Associate or Data Security requirements into all related subcontracts.
9. Bidder acknowledges that if awarded a contract with DSHS, Bidder is required to comply with
all applicable state and federal civil rights and other laws. Failure to comply may result in
contract termination. Bidder agrees to submit additional information about its nondiscrimination
policies, at any time, if requested by DSHS.
10. Bidder certifies that it has a current Business License and agrees that it will promptly secure
and provide a copy of its Washington State Business License, unless Bidder is exempted from
being required to have one, if Bidder is awarded a contract.
11. Bidder authorizes DSHS to conduct a background check of Bidder or Bidder's employees if
DSHS considers such action necessary or advisable.
12. Bidder has not been convicted nor entered a plea of nolo contendre with respect to a criminal
offense, nor has Bidder been debarred or otherwise restricted from participating in any public
contracts.
13. Bidder certifies that Bidder is not currently bankrupt or a party to bankruptcy proceedings and
has not made an assignment for benefit of creditors and authorizes DSHS to conduct a
financial assessment of Bidder in DSHS' sole discretion.
14. Bidder acknowledges its obligation to notify DSHS of any changes in the certifications and
assurances above.
�fhl V Cindy Carter
Signature
Chair of the Board Grant County Commissioners
Title
Grant County. dba New Hope
Organization Name
December 1 2020
Date
Domestic Violence Prevention FY 21-23 Page 2 of 2
FY 21-23 DVPA PREVENTION
ATTACHMENT B
Bidder Information Form
Complete All Required Fields
Agency/Organization/Tribe/Tribal Organization Name:
Accounting Fiscal Year:
Grant County, dba New Hope
(Ex: Jan — Dec; Jul —Jun)
Jan -Dec
Address:
Did your agency expend $750,000 or more in
311 W. Third Ave.
federal funds during your past fiscal year?
® Yes ❑ No
City:
State:
ZIP:
Moses Lake
WA
98837
Applicant is:
® Local Government
❑ Federally Recognized Tribe
❑ Non-profit Organization
❑ Tribal Organization
Mailing address (if different than above): same as above
City:
State:
ZIP:
Phone: 509.764.8402
Fax: 509.766.6574
E-mail: sfode@grantcountywa.gov
Primary Contact Name/Title:
Authorized Contract Signator
Program Contact Name/Title:
Suzi Fode, Program Director
Name/Title:
Suzi Fode, Program Director
if different than primary
Board of Grant County Commissioners
Primary Contact's Phone:
Signator Contact's Phone:
Program Contact's Phone:
509.764.8402
509.754.2011
509.764.8402
Primary Contact's E-mail:
Signator Contact's E-mail:
Program Contact's E-mail:
sfode@grantcountvwa.gov
bocc-consent@grantcouj a.gov
I sfode@grantcountywa.goy
Federal Employer Identification Number (EIN):
Washington State Uniform Business Identifier (UBI) Number:
91-6001319
(if applicable): 132.001.884
Federal DUNS Number: 010202562
Registered in System for Award Management (SAM):
® Yes ❑ No Registration Expires:
Have you had any contract with the state terminated for default: ❑ Yes ® No
Explain if Yes:
I certify, under penalty of perjury as provided by the laws of the State of Washington, that all of the information
provided on this form is true and correct, and that I will notify DSHS of any changes, as needed.
Si atur
Date: 12.1.2020
Printed Name: Cindy Carter
Title: Chair, Board of Grant County Commissioners
Page 1 of 1