`` BIDS MUST BE SEALED AND ADDRESSED TO: State of Wisconsin

`` BIDS MUST BE SEALED AND ADDRESSED TO: State of Wisconsin
``
State of Wisconsin
Wis. Statutes s.16.75
DOA-3070 (R08/2003)
BIDS MUST BE SEALED AND ADDRESSED TO:
AGENCY ADDRESS:
DEPARTMENT OF CORRECTIONS
LINDA SCHAAF / PURCHASING SERVICES SECTION
3099 E WASHINGTON AVENUE
P.O. BOX 7991
MADISON, WI 53707-7991
REQUEST FOR BID
Remove from bidder list for this commodity/service. (Return this page only.)
Bid envelope must be sealed and plainly marked in lower corner with due date and Request for Bid
#LS12226. Late bids will be rejected. Bids MUST be date and time stamped by the soliciting
purchasing office on or before the date and time that the bid is due. Bids dated and time stamped in
another office will be rejected. Receipt of a bid by the mail system does not constitute receipt of a
bid by the purchasing office. Any bid which is inadvertently opened as a result of not being properly
and clearly marked is subject to rejection. Bids must be submitted separately, i.e., not included with
sample packages or other bids. Bid openings are public unless otherwise specified. Records will
be available for public inspection after issuance of the notice of intent to award or the award of the
contract. Bidder should contact person named below for an appointment to view the bid record.
Bids shall be firm for acceptance for sixty (60) days from date of bid opening, unless otherwise
noted. The attached terms and conditions apply to any subsequent award.
Bids MUST be in this office no later than
THIS IS NOT AN ORDER
BIDDER (Name and Address)
September 8, 2009 3:00 PM CT
Name (Contact for further information)
Linda Schaaf
Phone
Date
608-240-5450
August 11, 2009
Quote Price and Delivery FOB
Destination
Item
No.
Quantity
and Unit
Fax bids are not accepted
Net Price
Per Unit
Extended Net Total
Description
The Department of Corrections, Division of Community
Corrections, is requesting bids for Transitional Living
Program Services in Wautoma, Montello, and Berlin,
Wisconsin, per attached terms, conditions and specifications.
1.
2,555
Bed Days
Unit Cost Per Bed Day
(2 beds x 365 days/year = 730 annual bed days in Wautoma)
(2 beds x 365 days/year = 730 annual bed days in Montello)
(3 beds x 365 days/year = 1095 annual bed days in Berlin)
$
$
Before submitting this bid be sure to include all requirements
listed in Section 2.4 and 8.
Payment Terms Net 30
Delivery Time: per specifications
We claim minority bidder preference [Wis. Stats. s. 16.75(3m)]. Under Wisconsin Statutes, a 5% preference may be granted to CERTIFIED Minority Business Enterprises. Bidder must be
certified by the Wisconsin Department of Commerce. If you have questions concerning the certification process, contact the Wisconsin Department of Commerce, 5th Floor, 201 W. Washington
Ave., Madison, Wisconsin 53702, (608) 267-9550. Does Not Apply to Printing Bids.
We are a work center certified under Wis. Stats. s. 16.752 employing persons with severe disabilities. Questions concerning the certification process should be addressed to the Work Center
Program, State Bureau of Procurement, 6th Floor, 101 E. Wilson St., Madison, Wisconsin 53702, (608) 266-2605.
Wis. Stats. s. 16.754 directs the state to purchase materials which are manufactured to the greatest extent in the United States when all other factors are substantially equal. Materials covered in our
bid were manufactured in whole or in substantial part within the United States, or the majority of the component parts thereof were manufactured in whole or in substantial part in the United States.
Yes
No
Unknown
In signing this bid we also certify that we have not, either directly or indirectly, entered into any agreement or participated in any collusion or otherwise taken any action in restraint of free competition;
that no attempt has been made to induce any other person or firm to submit or not to submit a bid; that this bid has been independently arrived at without collusion with any other bidder, competitor or
potential competitor; that this bid has not been knowingly disclosed prior to the opening of bids to any other bidder or competitor; that the above statement is accurate under penalty of perjury.
We will comply with all terms, conditions and specifications required by the state in this Request for Bid and all terms of our bid.
Name of Authorized Company Representative (Type or Print)
Title
Signature of Above
Date
Phone
(
)
Fax
(
)
Federal Employer Identification No.
This form can be made available in accessible formats upon request to qualified individuals with disabilities.
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
STATE OF WISCONSIN
REQUEST FOR BID (RFB) # LS 2226
FOR: Transitional Living Program Services in Wautoma, Montello and Berlin, Wisconsin
TABLE OF CONTENTS
DEFINITIONS
1.0
INTRODUCTION, PURPOSE, AND SCOPE
2.0
BID PROCEDURE AND INSTRUCTIONS
3.0
BID ACCEPTANCE, EVALUATION AND AWARD
4.0
TECHNICAL REQUIREMENTS
5.0
PERFORMANCE REQUIREMENTS
6.0
SUPPORT REQUIREMENTS
7.0
STANDARD AND SUPPLIMENTAL TERMS AND CONDITIONS
8.0
REQUIRED FORMS AND ATTACHMENTS
ATTACHMENTS
EXHIBIT 1
…………………………………….
DCC Administrative Directive 01-10
EXHIBIT 2
…………………………………….
Referral for Services (DOC-1336)
EXHIBIT 3
..…………………………………..
Offender Report - Monthly (DOC-1088)
EXHIBIT 4
……….……………………………
Unit Service Monthly Report (DOC-1026)
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
DEFINITIONS:
The following definitions are used throughout the bid:
Bidder:
Firm submitting a bid in response to this Request for Bid
Contractor:
Successful vendor awarded the contract
DAI:
Division of Adult Institutions, administration of all state correctional incarceration facilities except those
juvenile facilities operated by Division of Juvenile Corrections – headquartered at DOC Central
Offices, 3099 E Washington Ave., Madison, WI 53704
DCC:
Division of Community Corrections, supervises offenders outside secure facilities
DJC:
Division of Juvenile Corrections, operates the three correctional ‘schools’ – headquartered at DOC
Central Offices, 3099 E Washington Ave., Madison, WI 53704
DOA:
Department of Administration has statutory authority [WI Stats. Chapter 16] to define, regulate and
delegate all aspects of procurement of commodities and services for state agencies.
DOC:
Department of Corrections, also referred to as the department or the DOC – headquartered at DOC
Central Offices, 3099 E Washington Ave., Madison, WI 53704
MBE:
Minority Business Enterprise
Offender:
Person under the custody or supervision of the Wisconsin Department of Corrections
P-Card:
Procurement Card (State credit card)
Purchasing: Department of Corrections’ Purchasing Services Section
RFB:
Request for Bid
State:
State of Wisconsin
Vendor:
Firm submitting a bid in response to this Request for Bid
Must:
Requirement is mandatory
Shall:
Requirement is mandatory
Should:
Desirable but not mandatory
Administrative and Fiscal Services: Tasks and responsibilities such as preparation and management of operational
budget; personnel management; program planning and evaluation; supervision and evaluation of staff;
labor/management relations; public relations; ensuring compliance with AA/CRC requirements; development,
implementation and monitoring of policies/practices for information and technology, space, staff/offender health, safety
and security.
Bed Day: One program slot for one offender per 24-hour day continuously available to DOC.
Correctional Client includes city, county, state or federal clients served in a correctional setting. The DOC will make
sole determination of who meets these criteria.
High profile/high risk (HP/HR) offender: An offender whose case management includes issues arising from media
attention, offender notoriety, or community opposition. They are often cases with an assaultive history, have mental health
problems or convictions for sex offenses. Some of these sex offenders may be sentenced under statutes that require sex
offender special bulletin notice (SBN) and/or sex offender registration with the Department of Corrections (DOC).
Program Participant: An offender referred by DCC and receiving services through the Secular Transitional Living
Program.
Secular Programming: A program that is free of religious components (Exhibit 1).
Special Bulletin Notification (SBN): The release of a sex offender's information pursuant of the 1995 Wisconsin
Statute 301.46(2m), which authorizes the Department to inform law enforcement agencies of the release of a convicted
sex offender when the release of information will enhance public safety and protection.
Type I Housing Unit: A one-(1) or two-(2) bedroom furnished apartment, which has a bathroom, common living area
and a kitchen with an operating refrigerator and stove. The number of occupants per bedroom shall not exceed one (1)
and the total occupancy per unit shall not exceed two (2) individuals of the same gender. The unit must meet all
applicable state and local codes, regulations, and requirements.
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
Type II Housing Unit: A furnished facility that can accommodate multiple same gender residents in single or double
occupancy bedrooms, with access to a congregate living area and a shared kitchen. The living room and the kitchen
must be designed to accommodate the needs of multiple occupants. The unit must meet all applicable state and local
codes, regulations, and requirements. Additionally, the facility must be a single purpose program (see section
4.1 for clarification).
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
1.0
Due Date: September 8, 2009 3:00 PM CT
INTRODUCTION, PURPOSE, AND SCOPE
1.1
PURPOSE OF THIS REQUEST FOR BID
The Department of Corrections, hereinafter referred to as the "DOC", through its Purchasing Services
Section, hereinafter referred to as "Purchasing," on behalf of Division of Community Corrections,
hereinafter referred to as "DCC," requests bids for the purchase of secular Transitional Living Program
Services in Wautoma, Montello, and Berlin, Wisconsin. The program must provide services to offenders
convicted in adult court and under the supervision of the Wisconsin Department of Corrections.
Other State agencies may use the resulting contract, if agreeable to both the DOC and the vendor, to obtain
the benefits of volume purchases and/or reduction in administrative expenses.
The Department of Corrections (DOC) supervises individuals with a need for temporary housing, basic
living skills and structure in work and leisure time activities. It is the intent of the DOC, Division of
Community Corrections (DCC) to purchase Secular Transitional Living Program services in supervised
housing units providing staff supervision via random on-site inspections.
1.1.1 PROGRAM GOALS
The Secular Transitional Living Program is intended to assist offenders in achieving:
 Maintenance of a pro-social lifestyle
 Residential stability and independent living skills
 Gainful employment
 Financial independence and responsibility
 Family reunification
1.1.2 PROGRAM PHILOSOPHY
Offenders experiencing the following transitional situations would be appropriate:
 Correctional institution to community
 County jail to community
 Alcohol and Other Drug Abuse (AODA) inpatient or halfway house programming to community
 Dependent family situations to independent living
 Offenders who are violating conditions of supervision to provide alternatives to incarceration
1.1.3 TARGET POPULATION
The program would serve male offenders with identified needs for temporary housing, basic living
skills, and structure in work and leisure time activities.
Program participants must be employed, or actively involved in job search, or have a verifiable legal
source of income.
1.2
CONTRACT TERM
The contract term will be for two year, with options to extend the contract for five additional one-year
terms. Extension(s) beyond the initial contract term is contingent upon the performance of the contractor
during the contract period and upon availability of funds. These are not automatic extensions. Contracts
will be reviewed by the DOC before a decision is made. Any extension(s) must be authorized by mutual
written agreement of the vendor and the state.
1.3
EXECUTED CONTRACT TO CONSTITUTE ENTIRE AGREEMENT
In the event of contract award, the contents of this RFB (including all attachments), RFB addenda and
revisions, and the bid of the successful bidder, and additional terms agreed to, in writing, by DOC and the
contractor shall become part of the contract. Failure of the successful bidder to accept these as a
contractual agreement may result in a cancellation of award.
The following priority for contract documents will be used if there are conflicts or disputes.
State of Wisconsin standard terms and conditions
Final Signed Contract including amendments
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
Official State of Wisconsin Purchase Order
Bidder’s written bid document
State of Wisconsin Request for Bid, including any amendments;
Other exhibits/attachments
Successful bidder(s) should retain a copy of this DOC Request for Bid document and their own response
to the RFB solicitation, as it becomes part of the awarded contract.
1.4
1.5
CANCELLATION AND TERMINATION
This Contract may be terminated for the following conditions:
1.4.1
The DOC may terminate the Contract at any time, with or without cause and without penalty by
delivering thirty (30) days written notice to the Contractor.
1.4.2
The DOC has a Vendor Performance Evaluation process for soliciting feed-back from contract
users about vendor performance and compliance with contract specifications.
Vendor
noncompliance with the terms, conditions or specifications that is persistent and/or significantly
impacts the quality and performance provided pursuant to the contract may be considered in
breach of contract. Negative Vendor Performance Evaluation Surveys may result in non-renewal
or termination of contract.
1.4.3
If at any time the Contractor performance threatens the health and/or safety of the DOC, the DOC
has the right to cancel and terminate the Contract without notice.
1.4.4
Failure to maintain the required Certificates of Insurance, Permits and Licenses shall be cause for
Contract termination. If the Contractor fails to maintain and keep in force the insurance as
provided in #23 of the Standard Terms and Conditions, the DOC has the right to cancel and
terminate the Contract without notice.
1.4.5
If at any time a petition in bankruptcy shall be filed against the Contractor and such petition is not
dismissed within 90 calendar days, or if a receiver or trustee of Contractor's property is appointed
and such appointment is not vacated within 90 calendar days, the DOC has the right, in addition to
any other rights of whatsoever nature that it may have at law or inequity, to terminate the Contract
by giving 10 calendar days notice in writing of such termination.
1.4.6
Failure of the DOC to comply with contract terms, conditions or specifications shall provide the
sole cause for which the Contractor is entitled to terminate the contract. The Contractor shall notify
the Department in writing within thirty (30) days after the Contractor becomes aware of the alleged
noncompliance with a complete description of the same. If the DOC does not, within forty-five (45)
days after its receipt of the Contractor’s notice, either (1) effect a cure or (2) if the noncompliance
is not one that can reasonably be cured within forty-five (45) days, develop a plan to cure the
noncompliance and diligently proceed according to that plan unto a cure is effected, then the
Contractor may terminate the Contract for cause by written notice to the DOC. The Contractor may
not terminate the Contract without cause unless express written consent to do so is provided by
the DOC.
VENDORNET REGISTRATION
Department of Administration and State Bureau of Procurement policies no longer require maintenance of
bidder’s lists or individual notification of vendors on bidders’ lists. In addition, there is no requirement to
post solicitations for bids/proposals in the Legal Notices of the Official State Newspaper. Vendors who fail
to register with VendorNet may not receive notification of procurement solicitations.
The State of Wisconsin’s purchasing information and vendor notification service is available to all
businesses and organizations that want to sell to the state. Anyone may access VendorNet on the
Internet at http://vendornet.state.wi.us to get information on state purchasing practices and policies,
commodities and services that the state buys, and tips on selling to the state. Vendors may use the same
Web site address for inclusion on the bidders list for commodities and services that the organization wants
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
to sell to the state. A subscription with notification guarantees the organization will receive an e-mail
message each time a state agency, including any campus of the University of Wisconsin System, posts a
request for bid or a request for proposal in their designated commodity/service area(s) with an estimated
value over $25,000. Organizations without Internet access receive paper copies in the mail. Increasingly,
state agencies also are using VendorNet to post simplified bids valued at $25,000 or less. Vendors also
may receive e-mail notices of these simplified bid opportunities.
To obtain information on the state’s bidder registration, visit the VendorNet Web site at
http://vendornet.state.wi.us or call the VendorNet Information Center (1-800-482-7813). In the Madison
area, call 608-264-7898.
Make sure to select all the appropriate NIGP (Commodity) Codes. Bid lists are generated by NIGP codes.
Consider using a generic email address that is accessed or delivered to multiple recipients (example:
[email protected]). This will insure that the bid notice is received.
2.0
BID PROCEDURES AND INSTRUCTIONS
2.1
REASONABLE ACCOMMODATIONS
The DOC will provide reasonable accommodations, including the provision of informational material in an
alternative format, for qualified individuals with disabilities upon request. If accommodations at a bid
opening/vendor conference are needed, contact Linda Schaaf via telephone at 608-240-5450 or email at
[email protected]
2.2
BID SUBMITTAL
Bidders must submit an original, marked as such, and one copy of all materials required (see
section 2.4 and 8) for acceptance of their bid. Receipt of a bid by the State mail system does not
constitute receipt of a bid by the Purchasing Services Section, for purposes of this RFB. Use one
of the options below for return of the bid.
The Bid(s) must be received at the Purchasing Services Section, at the office listed below, no later than
September 9, 2009 3:00 PM Central Time. Any bids received after that time and date will be rejected.
USPS ADDRESS
Department of Corrections
Linda Schaaf
Purchasing Services Section
PO Box 7991
Madison, WI 53707-7991
COMMON CARRIER ADDRESS
Department of Corrections
Linda Schaaf
Purchasing Services Section
3099 East Washington Ave.
Madison, WI 53704-4338
FAXING: Faxed bids are NOT accepted.
E-MAILING: Emailed bids are NOT accepted.
All bids must be packaged, sealed, and show the following information on the outside of the package:
Vendor’s Name and Address
Request for Bid Title
Request for Bid Number
Bid Due Date
2.3
CALENDAR OF EVENTS
Listed below are important dates and times by which actions related to this Request for Bid (RFB) must be
completed. In the event that the State finds it necessary to change any of these dates and times it will do
so by issuing an amendment to this RFB to be posted on VendorNet, unless the event is listed as
estimated or approximate.
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
DATE
August 11, 2009
August 18, 2009
August 20, 2009
September 8, 2009
2.4
Due Date: September 8, 2009 3:00 PM CT
EVENT
RFB posting date
Last day for submitting written questions
Answers to questions posted on VendorNet (estimated)
Bids due from vendors
FORMAT OF BID
Responses to this RFB must comply with the following format requirements (reference Section 8).
2.4.1
SIGNED REQUEST FOR BID FORM DOA-3070 – Cover sheet of this RFB
Include here the signed Request for Bid form included with the bid and those certifications
required for submittal of a bid. Bids submitted in response to this RFB must be signed by the
person in the vendor's organization who is responsible for the decision as to the prices being
offered in the bid or by a person who has been authorized in writing to act as agent for the person
responsible for the decision on prices.
2.4.2
COST SUBMITTAL INFORMATION
Bidders must submit cost on the Request for Bid form (DOA-3070), complete and sign, including
a price per unit for each item, an extended total for each item and a total price. Cost must include
labor, travel and insurance. All costs to furnish the service(s) included in the bid, in accordance
with the terms and conditions of this RFB, must be included.
2.4.3
VENDOR INFORMATION DOA-3477
Provide Vendor Company contact information as requested on the form.
2.4.4
AFFIDAVIT DOA-3476 (MBE/AMERICAN MADE)
Indicate on Affidavit if vendor company is claiming to be certified Minority Enterprise certified by
the State of Wisconsin, Department of Commerce or a Work Center certified by the State Use
Board. Sign the non-collusion clause.
2.4.5
DESIGNATION OF CONFIDENTIAL AND PROPRIETARY INFORMATION DOA-3027
Information submitted as part of the bid document which is proprietary and confidential in nature
and which qualifies as a trade secret may be kept confidential under the Wisconsin Open Records
Law – Section 19.36(5), Wis. Stats. Complete and sign the attached form.
2.4.6
WISCONSIN’S COOPERATIVE PURCHASING SERVICE DOA-3333
Vendors are encouraged to extend the contract resulting from this RFB to local governments in
Wisconsin. Indicate your willingness to allow Wisconsin municipalities to participate in this
contract by completing Form DOA-3333, Wisconsin’s Cooperative Purchasing Service.
2.4.7
VENDOR REFERENCE DOA-3478 Complete the Vendor Reference form with four vendors that
your company has done business with providing services. Include the company name, address,
contact person and telephone number along with a brief description of the service.
2.4.8
STATE OF WISCONSIN TERMS AND CONDITIONS
The standard (DOA-3054) and supplemental (DOA-3681) terms and conditions shall govern this RFB
and subsequent award. Vendor must accept these terms and conditions or submit point –by-point
exceptions along with proposed alternative or additional language for each point, including any
vendor contracts. Submission of any standard vendor contracts as a substitute for language in
the terms and conditions is not a sufficient response to this requirement and may result in
rejection of the vendor’s bid. The state reserves the right to negotiate contractual terms and
conditions other than those in the State of Wisconsin Contract when it is in the best interest of the
State to do so.
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
2.5
MULTIPLE BIDS
Multiple bids from a vendor will be permissible, however each bid must conform fully to the requirements
for bid submission. Each such bid must be separately submitted and labeled as Bid #1, Bid #2, etc. on
each page included in the response. Alternate acquisition plans do not constitute multiple bids.
2.6
INCURRING COSTS
The State of Wisconsin is not liable for any cost incurred by a vendor in the process of responding to this
RFB.
2.7
QUESTIONS, CLARIFICATIONS AND/OR REVISIONS THROUGH DESIGNATED CONTACT
All communications and/or questions regarding this request must be written and submitted via FAX, email, USPS mail or hand delivery to the Purchasing Services Section.
If a Bidder discovers any significant ambiguity, error, conflict, discrepancy, omission, or other deficiency in
this RFB, they have five (5) business days after the bid posting date to notify, in writing, the Purchasing
Agent at the address shown below of such error and request clarification of the RFB document. All written
questions will be responded to in writing and provided to all bidders.
DEPARTMENT OF CORRECTIONS
LINDA SCHAAF / PURCHASING SERVICES SECTION
PO BOX 7991
MADISON, WI 53707-7991
[email protected]
FAX: 608-240-3342
From the date of release of this RFB through the entire RFB process, all contacts with the DOC regarding
this RFB shall be made through the Purchasing Services Section. Violation of this condition may be
considered sufficient cause for rejection of a bid, irrespective of any other considerations.
In the event that it becomes necessary to provide additional clarifying data or information, or to revise any
part of this RFB, amendment(s) will be posted on VendorNet.
Each bid shall stipulate that it is predicated upon the terms and conditions of this RFB and any
amendment(s) thereof.
3.0
BID ACCEPTANCE, EVALUATION AND AWARD
3.1
BID OPENING
Bids will be opened on the date and time indicated on the Request for Bid Form (DOA-3070) at 3099 East
Washington Ave. Madison, WI 53704 Purchasing Services Section room. Names of the bidders shall be
read aloud at that time.
3.2
BID ACCEPTANCE
Bids which do not comply with instructions or are unable to comply with specifications contained in this
RFB may be rejected by the State. The State retains the right to accept or reject any or all bids, or accept
or reject any part of a bid deemed to be in the best interest of the State. The State shall be the sole judge
as to compliance with the instructions contained in this RFB.
3.3
BID EVALUATION
Bids will be evaluated by the DOC's purchasing agent and program manager to verify that they will meet
all specified requirements in this RFB. This verification may include requesting reports on the vendor's
financial stability, conducting demonstrations of the vendor's proposed service(s) and reviewing results of
past awards to the vendor by the State of Wisconsin.
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
FAILURE TO MEET A MANDATORY REQUIREMENT SHALL DISQUALIFY THE BID. However, if no
bidder is able to comply with a given specification, condition of bid or provide a specific item, Purchasing
Services reserves the right to delete that specification, condition of bid or item.
3.4
METHOD OF AWARD
Award(s) shall be made on the basis of the lowest net unit price and extended net total from a
responsive, responsible bidder meeting bid specifications and requirements, which is judged to be
in the best interest of the DOC. The DOC reserves the right to accept or reject any and all bids in whole or
in part. Bids that state the DOC shall guarantee a specific quantity or dollar amount will be disqualified.
In the event of bidder error in calculation, unit price shall prevail in award.
If a responsive, responsible State qualified work center meets the fair market price and other work center
program criteria, the award will be made to the work center (Wisconsin State Statute 16.752).
3.5
MINORITY BUSINESS ENTERPRISE
Bids from certified Minority Business Enterprises may be provided up to a five percent (5%) bid preference
in accordance with Wis. Stats. s. 16.75(3m).
3.6
NOTIFICATION OF INTENT TO AWARD
Any vendors who respond to this RFB, with a bid, will be notified in writing of the State’s intent to award
the contract(s) as a result of this RFB.
After notification of the intent to award is made, under the supervision of Department of Corrections,
copies of bids will be available for public inspection 8:30 a.m. to 3:30 p.m. at 3099 East Washington Ave.,
Madison WI. Vendors shall schedule reviews with purchasing agent to ensure that space is available for
the review.
3.7
APPEALS PROCESS
The appeals procedure applies to only those Requests For Bids for Services that are $25,000.00 or
greater. Notices of intent to protest and protests must be made in writing. Protesters should make their
protests as specific as possible and shall identify statutes and Wisconsin Administrative Code provisions
that are alleged to have been violated.
The written notice of intent to protest the Intent to Award a Contract must be filed with:
RICK RAEMISCH, SECRETARY, DEPARTMENT OF CORRECTIONS
P.O. BOX 7925
MADISON, WI 53707-7925
And be received in the office above within five (5) working days after the notice of intent to award is
issued. The written protest must be received in the office above within ten (10) working days after the
notice of intent to award is issued.
Copies of the notice of intent to protest and the written protest should be sent to the Purchasing
Section Chief at the same address.
The decision of the head of the procuring agency may be appealed to the Secretary of the Department of
Administration within five (5) working days of issuance, with a copy of such appeal filed with the procuring
agency, provided the appeal alleges a violation of statute or a provision of a Wisconsin Administrative
Code.
4.0
TECHNICAL REQUIREMENTS
The following requirements are the minimum specifications of the service(s) required. Failure by a bidder to
respond to any specific requirement or question shall be the basis for elimination from consideration. However, if
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
no bidder is able to comply with a given specification, condition of bid or provide a specific item, Purchasing
Services reserves the right to delete that specification, condition of bid or item.
Revisions to this bid, if any, will be made in the form of an official amendment(s) issued by the Department of
Corrections, Purchasing Services Section.
The Department reserves the right to adjust the number of units of service, to add or move locations, and/or add
locations outside the designated area if in its best interest.
4.1
FACILITY REQUIREMENTS
Program services are required to be located in Wautoma, Montello and Berlin, WI. The facility must meet
all applicable federal, state and local codes, regulations and requirements which will be the responsibility
of the contractor. This includes all associated fees and costs. Prior to the Department entering into a
contract, the contractor must submit written verification of compliance with all applicable state and local
codes, regulations, and requirements.
The Department reserves the right to inspect all units prior to occupancy. When the contractor negotiates a
lease for a unit under this contract, the Department reserves the rights to review each lease prior to its
execution.
4.1.1
HOUSING
The contractor shall offer housing, located in Wautoma, Montello, and Berlin, in Type I or Type II
housing unit(s) with the capacity to provide residence for a total of two (2) male offenders in Wautoma,
two (2) male offenders in Montello, and three (3) male offenders in Berlin. Type II housing must be a
single program housing space (only DCC offenders will be allowed to participate in the facility
program).
4.1.2 FURNISHING AND SUPPLIES
The contractor shall furnish the units with adequate furniture, household supplies (i.e., dishes, cooking
utensils, alarm clock, and paper products), bedding, and access to laundry facilities. The unit must
have a functional stove and refrigerator.
4.1.3 TELEPHONE SERVICES
The contractor shall supply a separate restricted private line for each bed. The service is to be used
for electronic monitoring equipment for surveillance of offenders. The telephone must be compatible
with electronic monitoring devices used by the Department of Corrections
4.1.4 TRANSPORTATION
Secular transitional housing sites shall be located in Wautoma, Montello, and Berlin and must be
accessible to community resources, job search, and employment.
4.1.5 FOOD
The contractor is not required to pay for the ongoing cost of food; however, the contractor shall furnish
a one week supply of staples for participants upon reception at the program. The contractor will
supply enough food to ensure three meals per day during that first initial week.
After the first week, the contractor shall oversee the purchase of food supplies by program participants
to assist them in meeting their nutritional needs and give opportunities to learn budgeting skills.
4.1.6 MAINTENANCE
The contractor shall be responsible for maintaining the unit/units in such a manner as to meet the
standards established for any applicable licensure and meet all state and local building codes, fire
safety, and sanitation requirements. Contractor shall change locks on entrance doors to unit when
deemed necessary by DOC. Contractor shall also supply such materials and equipment as is
necessary to maintain the living quarters in a clean, sanitary condition at all times. Contractor may
require that participants be responsible for actual cleaning of living quarters and care of sidewalks and
lawns. However, if no participant is able to comply with the cleaning, care of sidewalks, and lawns the
contractor will provide said service. DOC will be sole determining authority for participant ability.
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI

4.2
Due Date: September 8, 2009 3:00 PM CT
The bidder shall submit documentation detailing the facility location, description of housing unit(s)
and the number of blocks to access public transportation.
ORGANIZATION EXPERIENCE
The contractor agency shall have a minimum of two (2) years experience providing community-based
services to correctional clients. The contractor shall also have a minimum of one (1) year experience
operating supervised or unsupervised housing units.
Bidder must provide a list of past contracts, DOC and others, within the last year that are of a similar
service to this bid. Include service description, location of service, number of clients served, outcome
evaluation, and contact person with a phone number. DOC reserves the right to contact any or all
persons listed. Past contract quality may impact this award.

4.3
The bidder shall provide documentation demonstrating that the agency meets the experience
requirements, including past contract information with contact person and phone number.
STAFF QUALIFICATIONS AND EXPERIENCE
4.3.1 MANAGEMENT STAFF
The staff person or persons performing program management functions is required to have 1) a high
school diploma or its equivalent; 2) two years of experience providing services to correctional clients;
and, 3) the proven ability to deliver services to individuals from various racial, religious, and ethnic
backgrounds as well as individuals with a disability. Proven ability may be documented by one or more
years of job or volunteer experience and completion of sixteen (16) hours of cultural awareness or
cultural sensitivity training.

The bidder shall submit documentation that includes the name of the staff person(s) who will be
providing program management and the dates and location of their education/training/
experience. The bidder must also submit the name and phone numbers of persons who can
verify the experience of the program manager(s).
4.3.2 DIRECT SERVICE STAFF
Staff providing direct services and on-site inspections shall have three (3) year(s) experience working
with correctional clients. Staff providing services under any agreement resulting from this solicitation
may be required to participate in training in the supervision of offenders. DCC staff would provide this
training.

The bidder shall submit documentation that includes the name of the staff person(s) who will be
providing direct services/on-site inspections. The bidder must submit documentation of
experience/training requirements specified above. The bidder must also submit the name and
phone numbers of persons who can verify the experience of the staff person(s) in a
separate envelope.

If staff positions are pending hire, submit recruitment plan and job description of those
pending positions. NOTE: Any staff listed as pending hire will be required to be on staff
within 4 weeks from date of award unless otherwise authorized.
4.4 PROGRAM DESCRIPTION
4.4.1 PROGRAM RULES
The contractor agency is required to monitor the following rules. It is understood that this listing is a
minimum guideline. Additional rules may be implemented by the DOC and negotiated with the
contractor agency.
NO USE OF TOBACCO PRODUCTS IN THE BUILDING.
NO VISITORS ALLOWED UNLESS APPROVED BY AGENT.
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
NO ASSOCIATION WITH MINORS UNLESS APPROVED BY THE AGENT.
NO POSSESSION OR USE OF ALCOHOL.
NO POSSESSION OR USE OF CONTROLLED SUBSTANCES.
RESIDENTS MUST FOLLOW CURFEW AS ESTABLISHED BY THEIR AGENT.
RESIDENTS MUST SIGN IN AND SIGN OUT.
RESIDENTS WILL FOLLOW EMP/GPS SCHEDULE AS ESTABLISHED BY THEIR AGENTS.
RESIDENTS ARE NOT ALLOWED TO ENTER ANOTHER RESIDENT’S ROOM OR USE THEIR
POSSESSIONS WITHOUT PERMISSION.
RESIDENTS ARE EXPECTED TO KEEP THEIR OWN ROOMS CLEAN, AS WELL AS, THE
SHARED LIVING AREAS.
RESIDENTS CANNOT DISPLAY OR POSSESS ITEMS THAT PORTRAY WOMEN OR
MINORITIES NEGATIVELY, INCLUDING SEXUALLY EXPLICIT ITEMS.
AGENTS RESERVE THE RIGHT TO SEARCH RESIDENT’S ROOMS.
4.4.2 ON-SITE SUPERVISION
Contract staff will be required to physically inspect the inside of each unit by varying the time and
number of inspections each day/week to between 18 and 24 times per week and a minimum of 2
times per day. For bidding purposes only, figure budgetary cost of staff at the average of 21
inspections per week.
All inspections shall be documented and shall occur on a random basis with an emphasis on
inspections during late night/early morning and weekend hours. At a minimum, on-site supervision will
require contractor staff to A) Enter each unit including each individual room, B) Observe and document
any program rule violations such as contraband or unclean rooms, and C) Check resident sign in/out
register to verify entries are up to date.
If program rule violations occur during these visits, staff will contact a DOC representative to report the
violation. Site inspectors will be provided the names/telephone contact information for 24-hour
contacts if violation is observed outside of normal staff working hours.
Program rule violations and offender absence at unscheduled times will be reported promptly to the
offenders supervising agent.

At the time the bid is submitted, the bidder must provide a monthly staffing schedule showing
the varied inspections and listing staff on duty and on call. Schedule must include the
inspection steps staff will follow, a sample of the Site Inspection Log, and how/to whom
violations will be reported.
4.4.3 SPECIAL PROGRAM REQUIREMENTS
4.4.3.1 ADVISORY BOARD
The contractor, in cooperation with DCC staff, shall establish an advisory board for the
program. The “program” is considered to be inclusive of all beds identified in this document.
A separate advisory board is not required for multiple locations in the same program. The
board shall be comprised of representatives from law enforcement, the judicial system,
human services and the business community. The liaison agent shall attend board meetings
and activities, as necessary.
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
DOC may waive the advisory board requirement for programs with less than four program
beds.
4.4.3.2 COMMUNITY NOTIFICATION
The DOC is required pursuant to Wisconsin Statute 301.08(3) to provide notification to
communities prior to contracting for secular transitional housing. The contractor is required
to participate in the notification process.
4.4.3.3 HIGH PROFILE/HIGH RISK OFFENDERS
The contractor shall provide program slots for High Profile/High Risk offenders on an as
needed basis. If the supervising agent's case plan requires services or surveillance which
are not directly delivered by Secular Transitional living staff, the Department may purchase
services for the high profile/high risk offender individually from other available sources. The
bidder should not factor these individual purchases into the unit cost.
4.5 LENGTH OF PROGRAM PARTICIPATION
The contractor shall offer a program averaging 60 days in length. Participants may be involved for either longer
or shorter duration as needed to accomplish supervision and treatment objectives as approved by DOC.
4.6 NUMBER OF SERVICE UNITS
Seven (7) beds are required for 365 days annually. 2,555 total Bed Days will be purchased on a continual
basis annually, as long as the bed is made available to the Department, regardless of whether the bed is
occupied or not.
4.7 NUMBER OF PROGRAM PARTICIPANTS
Under any agreement resulting from this solicitation, it is anticipated that seven (7) beds turned over every two
(2) months will serve forty-two (42) offenders annually. This number will be dependent upon the occupied beds,
as well as any extended stay of approved program participants.
4.8 INTAKE/DISCHARGE PROCEDURES
4.8.1 INTAKE PROCEDURES
The contractor shall develop intake/referral procedures in cooperation with DCC staff. Upon offender's
admission to the program, the contractor shall participate in one intake staffing with the offender and the
referring or liaison agent to review and discuss program rules/expectations and the offender's case plan.
No offender shall be rejected for services without first consulting with DOC staff to determine if the
program can be modified to address the specific offender requirements.
4.8.2 DISCHARGE/TERMINATION
The contractor shall develop discharge/termination procedures in cooperation with DCC staff.
termination shall occur without the prior approval from DOC staff.
No
4.9 REPORTING REQUIREMENTS
4.9.1 REPORTING ON INDIVIDUAL OFFENDERS
4.9.1.1
Law Violations: The bidder shall notify the referring DOC staff or other available DOC staff
if a participant is in violation of the law. This notification must take place as soon as
possible and no later than 24 hours, subsequent to receiving information concerning the
law violation.
4.9.1.2
Serious Program Violations: Serious program rule violations, including failure to attend,
shall be reported to the referring DOC staff or other available DOC staff within one working
day.
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
4.9.1.3
4.9.2
Due Date: September 8, 2009 3:00 PM CT
Ad Hoc Reports: Upon request, the bidder shall provide to DOC staff, reports on offenders
served in the program when these reports are required by the court, for revocation
procedures and/or for other Departmental processes.
PROGRAM REPORTING
4.9.2.1
Referral for Services (DOC 1336): The bidder shall submit a completed Referral for
Services form for each offender referred by DOC for service. These forms shall be
submitted with the first DOC-1088 Offender Report Monthly following offender’s rejection or
acceptance into the program. A copy of the form is attached as Exhibit 2.
4.9.2.2
Offender Report Monthly (DOC 1088): The bidder shall submit a completed Offender
Report Monthly to report data on offenders served each month. This report shall be
submitted within 15 days of the last day of the month during which service was provided. A
copy of this form is attached as Exhibit 3.
4.9.2.3
Unit Service Monthly Report (DOC 1026): The bidder shall submit a completed Unit
Service Monthly Report to provide data on the number of units of service provided each
month. This report shall be submitted within 15 days of the last day of the month during
which service was provided. A copy of this form is attached as Exhibit 4.
4.9.2.4
Site Inspection Log: The contractor shall submit a monthly report listing date and time of
each on-site inspection conducted during the previous month. This report shall be
submitted with the Unit Service Monthly Report (DOC-1026).
4.9.2.5
Program Evaluation:
Program evaluation is intended to document program
implementation, as well as return useful information to program sites for the purpose of
program improvement. The contractor shall include a statement of their willingness to
collaborate and participate in program evaluation activities.
Contractors will be expected to collect and maintain similar data on offenders and their
participation in the treatment process in an electronic database. Requirements include
computer capabilities with internet access, e-mail, and window’s applications. Data will be
reviewed at the end of each year and submitted in a report providing details to show how
the program reduced recidivating. Evaluation report shall be submitted annually, at a
minimum, with a summary page explaining report outcomes. At minimum the report will
include  Program overview including outcome goals and relationship to reducing
recidivism.
 Number of offenders participated in the program.
 Number of offenders completing the program - 80% completion (standard).
 Offenders who do not complete the program, explain why.
 Number of offenders returning to the program including the period of time after
leaving the program.

5.0
If your organization has an existing system for documenting and managing client-level
information, please provide an overview of the system and whether it is in electronic or
paper format. Provide the name of your staff person who will be the contact person
responsible for coordinating with DOC and evaluation staff.
PERFORMANCE REQUIREMENTS
5.1
FIRM PRICES
Prices must remain firm for the initial contract term.
5.2
PRICE INCREASE REQUESTS
Price increase requests proposed after the initial Contract term must be received by Purchasing in writing
90 calendar days prior to the beginning of the next contract term for acceptance or rejection. Proposed
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
price increases are limited to fully documented cost increases submitted with the request. If Purchasing
deems cost increases are not acceptable, it reserves the right to rebid the contract in whole or part.
Acceptance of the price increases shall be in the form of an amendment to the contract. Price increases
must be labeled with the contract number and be submitted in the same format as the original RFB. Any
price increase requested that is not submitted in the proper format may be rejected.
5.3
STAFF PERFORMANCE
The contractor shall utilize, on this contract, only workers that are skilled in the tasks to which they are
assigned. The DOC retains the right to require the reassignment of an employee or employees, as the
Department may deem necessary. Reasons for this request may be but are not limited to incompetence,
carelessness, disruptive or otherwise objectionable behavior. The request for reassignment is in no way a
call for dismissal. It is just a request for the individual to be reassigned out of the State facility.
6.0 SUPPORT REQUIREMENTS
6.1
COLLECTION OF OFFENDER FEES
The provider shall collect fees from offenders participating in this program or via third party payments.
Program participants who are employed or who receive other public or private funds will be expected to
pay a minimum of $1.00 per day toward the program. Those participants who have no income or assets
will not be expected to pay fees for a specified time period consistent with plans developed with provider
staff and the supervising agent. The offender fees schedule shall be subject to DCC approval. The
amount of all collections will be reported on the Unit Service Monthly Report (DOC-1026) for the month in
which the fees were collected and deducted for the amount reimbursable to the provider by DCC.
No offender will be denied services because of inability to pay.
6.2
INVOICING / PAYMENT REQUIREMENTS
Contractor must agree that all invoices and purchasing card charges shall reflect the prices and discounts
established for the items on this contract for all orders placed by the DOC even though the contract
number and/or correct prices may not be referenced on each order.
The DOC must meet a statutory mandate to pay or reject invoices within 30 days of receipt by DOC
Accounts Payable (Note exemption of aids payments to individuals and organizations). Before payment is
made, it also must verify that all invoiced charges are correct as per this Contract. Only properly
submitted invoices will be officially processed for payment. Prompt payment requires that contractor
invoices be clear and complete in conformity with the instructions below. All invoices must be itemized
showing:








Contractor name
remit to address
purchase order number
release number if given
date of order/release
item manufacturer’s name or abbreviation (if applicable)
complete item description including catalog, model and/or stock number(s) identical to those
stated in bid
prices per the Contract
The original invoice and two copies must be sent to the DOC address listed on the Purchase Order.
Final payment may not be made until work has been accepted by the DOC.
6.3
SUBCONTRACTING
Any Contract resulting from this bid shall not be, in whole or in part, subcontracted, assigned, or otherwise
transferred to any other Contractor without prior written approval by Purchasing Services.
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
6.4
Due Date: September 8, 2009 3:00 PM CT
6.3.1
The Contractor shall be directly responsible for any subcontractor’s performance and work quality
when used by the Contractor to carry out the scope of the job.
6.3.2
Contractor must assure subcontractors abide by all terms and conditions under this Contract.
6.3.3
If subcontractors are to be used, the Contractor must clearly explain their participation.
PRIME CONTRACTOR AND MINORITY BUSINESS SUBCONTRACTORS
The prime contractor will be responsible for contract performance when subcontractors are used.
However, when subcontractors are used, they must abide by all terms and conditions of the contract. If
subcontractors are to be used, the bidder must clearly explain their participation.
The State of Wisconsin is committed to the promotion of minority business in the state's purchasing
program and a goal of placing 5% of its total purchasing dollars with certified minority businesses.
Authority for this program is found in ss. 15.107(2), 16.75(4), 16.75(5) and 560.036(2), Wisconsin
Statutes. The contracting agency is committed to the promotion of minority business in the state's
purchasing program.
The State of Wisconsin policy provides that minority-owned business enterprises certified by the
Wisconsin Department of Commerce, Bureau of Minority Business Development should have the
maximum opportunity to participate in the performance of its contracts. The supplier/contractor is strongly
urged to use due diligence to further this policy by awarding subcontracts to minority-owned business
enterprises or by using such enterprises to provide goods and services incidental to this agreement, with a
goal of awarding at least 5% of the contract price to such enterprises.
The supplier/contractor shall furnish appropriate quarterly information about its effort to achieve this goal,
including the identities of such enterprises certified by the Wisconsin Department of Commerce and their
contract amount.
Quarterly reports shall be due fifteen (15) calendar days after the end of the quarter, 9/31, 12/31, 3/31 and
6/30. The form for submitting this information is available from the VendorNet on the Contract’s Home
Page. http://vendornet.state.wi.us/vendornet/doaforms/doa-3234.doc.
The report shall be submitted even if there is no activity.
Submit to:
e-mail: [email protected]
post:
MBE PURCHASING REPORT
PO BOX 7991
MADISON, WI 53707-7991
The State reserves the right to request additional reports from the Contractor at no additional cost.
Contractor shall use every effort to provide such reports in a reasonable timeframe, but no later than thirty
(30) calendar days from the time the request was submitted. These reports shall be in a form approved in
advance in writing by the State.
A listing of certified minority businesses, as well as the services and commodities they provide, is available
from the Department of Administration, Office of the Minority Business Program, 608/267-3293. The listing
is published on the Internet at: http://www.doa.state.wi.us/mbe/minority_search.asp
6.5
AFFIRMATIVE ACTION
All contracts of more than Twenty Five Thousand Dollars ($25,000) require the submission of a written
affirmative action plan or request exemption. Contractors with an annual workforce of less than twenty-five
employees are eligible for exemption. Within fifteen (15) days after the award of the contract, the written
affirmative action plan, or statement requesting exception, shall be submitted to the Department’s
Contract Compliance Office. Address plan to:
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
DEPARTMENT OF CORRECTIONS
AFFIRMATIVE ACTION MANAGER
PURCHASING SERVICES SECTION
3099 E. WASHINGTON AVE.
PO BOX 7991
MADISON, WISCONSIN 53707-7991.
Contractors are encouraged to contact this office at, (608) 240-5419, for technical assistance on equal
opportunity.
"Affirmative Action Plan" is a written document that details an affirmative action program. Key parts of an affirmative action plan
are: (1) a policy statement pledging nondiscrimination and affirmative action employment, (2) internal and external dissemination of
the policy, (3) assignment of key employee as the equal opportunity officer, (4) a workforce analysis that identifies job classification
where representation of women, minorities and the disabled is deficient, (5) goals and timetables that are specific and measurable
and that are set to correct deficiencies and to reach a balance of work force, (6) revision of all employment practices to ensure that
they do not have discriminatory effects, (7) establishment of internal monitoring and reporting systems to measure progress
regularly.
Failure to comply appropriately with these requirements can lead to bidder being banned from doing
business with any agency of the State of Wisconsin. Additionally, failure to comply can result in
termination of this contract, or withholding of payment. On the Vendor Information Sheet provide the
requested information. For additional information see Section 19.0 of the Standard Terms and Conditions.
6.6
WISCONSIN SALES AND USE TAX REGISTRATION
The State of Wisconsin shall not enter into a contract with a vendor, and reserves the right to cancel any
existing contract if the vendor or contractor has not met or complied with the requirements of s. 77.66,
Wis. Stats., and related statutes regarding certification for collection of sales and use tax.
If you have not established a certification for Collection of Sale and Use Tax status with the Wisconsin
Department of Revenue, the DOC and any other state agency can not issue any purchase orders to your
firm. For additional information see http://www.dor.state.wi.us/html/vendlaw.html
6.7
EMPLOYEE IDENTIFICATION
All contractors’ employees, while working on DOC property, must wear a clearly displayed photo
identification badge (provided by the Contractor at the Contractor’s cost) showing they are employees of
the contractor. Badges must be available but will not be required to be worn when protective clothing and
respiratory protection is required.
6.8
CONFIDENTIALITY
The confidentiality of offender health information is protected by the federal Health Insurance Portability
and Accountability Act of 1996 (HIPAA) regulations (45 CFR, parts 160 & 164), federal Alcohol and Other
Drug Abuse Patient Information regulations (42 CFR Part 2), and by various Wisconsin laws governing the
confidentiality of medical, mental health, developmental disability, and alcohol and drug information. In
addition, the department considers all personally identifiable information relating to DOC employees or
offenders to be confidential, and such data is not to be released unless approved by the DOC.
6.9
LIQUIDATED DAMAGES
This shall be surety for fulfillment of the contract(s) including quality, performance and delivery under the
terms of this Request for Bid. Liquidated damages shall consist of the cost per bed for each day of failure
to deliver according to the requirements of this bid. Liquidated damages will be deducted from the invoice,
if the invoice is of sufficient amount to cover the liquidated damages. If the invoice is not of a sufficient
amount to cover the liquidated damages, the agency will request cancellation of the invoice and a credit to
cover the balance.
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
6.10
Due Date: September 8, 2009 3:00 PM CT
EMPLOYMENT OF CURRENT OFFENDERS AND EMPLOYMENT AND RETENTION OF
INDIVIDUALS ARRESTED, CHARGED OR CONVICTED OF CRIMINAL OFFENSE
6.10.1 Contractor shall not employ a person who is on probation, parole or an inmate who is supervised by
Intensive Sanctions for any position where the primary duties and responsibilities involve the
supervision or treatment of inmates, probationers or parolees or involve access to offenders' records
or funds.
6.10.2 Contractor will implement policies and procedures to ensure that:
Job applicants or current employees shall be dealt with as follows:
a) For a job applicant who has a pending criminal charge: Where the circumstances of said
criminal charge substantially relate to the circumstances of a particular job or licensed
activity, the applicant will not be hired for that job;
b) For a current employee who has a pending criminal charge: Where the circumstances of
said criminal charge substantially relate to the circumstances of the job or licensed
activity, the employee will not be continued in that particular job;
c) For a job applicant who is convicted of a criminal offense: Where the circumstances of
said conviction of a criminal or other offense that substantially relates to the
circumstances of a particular job or licensed activity, the applicant will not be hired for that
job; and
d) For a current employee who is convicted of a criminal offense: Where the circumstances
of said conviction of a criminal or other offense that substantially relates to the
circumstances of the current job or licensed activity, the employee will not be retained in
that particular job.
Nothing in this contract prohibits the Contractor from reassigning or suspending the employee or,
in the case of a conviction, terminating the employee.
6.10.3 In hiring and retention decisions, Contractor may consider records of pending criminal charges
and convictions when it can be demonstrated that the circumstances of the offense substantially
relate to the circumstances of the job or licensed activity. When determining whether the
circumstances of a pending charge or conviction are substantially job related, Contractor should
take into consideration elements related to the position, the offense, and the individual.
6.10.4 To make determinations on substantial relationships to the circumstances of the job, Contractor
shall have written policies on how the applicant for employment and the employee will be
reviewed. To guide the development of the policy, the Contractor may obtain a copy of Chapter
301 of the Department of Corrections Supervisor's Manual from the Contract Administrator.
6.11
FRATERNIZATION
6.11.1 Contractor agrees to have a written policy on fraternization that prohibits the forming of improper
relationships between Contractor's employees and offenders. The policy must be substantially
equivalent to the Department of Corrections' policy as expressed in Executive Directive 16, May
1991 - Revised January 1997, Further Revised August 2004. A copy of Executive Directive 16
may be obtained from the Contract Administrator.
6.11.2 Contractor shall address at the minimum the policy required in Sub. A: definitions of employee,
relationships and offender; a statement of prohibited relationships; duty of employee to inform
Contractor of unplanned contacts with offenders; a statement that Contractor-directed contacts or
those which are part of the employee's job duties are exempt from the policy; an exception
procedure which may be carried out by the Executive Director or designee; and a standard
employee statement indicating that each employee has read a copy of the Contractor's policy on
fraternization.
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
6.11.3 Contractor shall also agree to have a written policy which prohibits Contractor’s employees from
engaging in any sexual contact or sexual intercourse with offenders under the custody and control of
the Department of Corrections. The policy must be substantially equivalent to the Department of
Corrections’ policy as expressed in Executive Directive 16-A, August 2006. A copy of Executive
Directive 16-A may also be obtained from the Contractor Administrator.
6.11.4 Contractor shall maintain a copy of the signed employee statement on fraternization and sexual
contact in each employee's personnel file.
6.12
CONTRACTOR AUDIT REQUIREMENT
6.12.1 Governmental entities shall comply with the Single Audit Act of 1984, OMB Circular A-128 and the
State Single Audit Guidelines issued by the Department of Administration. They shall also comply
with the Department of Health and Family Services' Allowable Cost Policy Manual. Single audit
reports are due to the Department within 30 days from issuance of the report, but no later than
one year after the end of the audit period.
6.12.2 Non-profit agencies that have been certified under USC 501(c)(3) shall comply with OMB Circular
A-133, the Department's Contractor Agency Audit Guide, the Allowable Costs Policy Manual and
ss. 301.08. Audits are due to the Contractor within one year of the close of the contract.
6.12.3 Profit agencies shall comply with the Department's Contractor Agency Audit Guide, the Allowable
Costs Policy Manual, and ss. 301.08. Audits are due to the Contractor within one year of the
close of the contract.
6.12.4 If a Contractor agency's audit is based on a calendar rather than state fiscal year (July 1 through
June 30), the Contractor and/or auditor shall submit a worksheet which reconciles the
expenditures based on the state fiscal year and the relevant purchase orders within one year of
the close of the contract.
6.12.5 DOC shall notify Contractor within 90 days of receipt of the audit completed by the independent
certified auditor, whether or not the audit meets the requirements of DOC's audit guidelines. DOC
shall initiate resolution of audit findings with Contractor within 180 days following notification of the
audit's acceptance. If the audit is not complete or is acceptable only in part, DOC shall rely upon
the acceptable portion of the audit and any additional audit work shall build upon the work already
done.
6.12.6 DOC reserves the right to conduct an independent audit of Contractor if Contractor fails to secure
an audit covering all funds, or a follow-up review of selected areas is determined to be necessary.
In the event that Contractor fails to secure an audit, DOC's costs for completing an audit will be
charged back to Contractor.
6.12.7 Contractor agrees that it is responsible to assure that all purchase of service contracts of $25,000
or more meet the requirements of the Office of Management and Budget Circulars A-133 and A128 that pertain to sub-recipient audits.
6.13
FAITH-BASED AND CHARITABLE ORGANIZATIONS
6.13.1 A faith-based or charitable organization is eligible to be a contractor on the same basis as any
other private organization. If Contractor is a faith-based or charitable organization it shall retain its
independence from the State of Wisconsin, including without limitation Contractor’s control over
the definition, development, practice, and expression of its charitable or religious beliefs. Except
as otherwise provided by state or federal law, Purchaser shall not interpret this Contract to require
a charitable or faith-based organization to alter its form of internal governance or remove religious
art, icons, scriptures, or other symbols.
6.13.2 A religious organization does not, by contracting with the State of Wisconsin, lose the exemption
provided under Section 702 of the Civil Rights Act (42 U.S.C. 2000e-1(a)) regarding its
employment practices. Furthermore, if a faith-based or charitable organization segregates the
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
Due Date: September 8, 2009 3:00 PM CT
government funds provided under the Contract, then only the financial assistance provided by
these funds will be subject to audit.
6.13.3 Neither Purchaser’s selection of a charitable or faith-based contractor to provide the Services
described herein nor the expenditure of funds under this Contract is an endorsement of the
Contractor’s charitable or religious character, practices, or expression. The purpose of this
Contract is the provision of Services; none of Purchaser’s expenditures have as their objective the
funding of sectarian worship, instruction, or proselytization. As such, a faith-based or charitable
Contractor of Services under this Contract shall post at its place(s) of business the following
written notice and personally apprise all assisted inmates of the same:
Neither the State of Wisconsin’s selection of a Charitable or faith-based Contractor of
services or the expenditure of funds under any contract with said Contractor is an
endorsement of that Contractor’s charitable or religious character, practices, or
expression. No Contractor of services may discriminate against you on the basis of
religion, a religious belief, or your refusal to actively participate in a religious practice. If
you object to a particular Contractor because of its religious character, you may request
assignment to a different non-sectarian Contractor by contacting your Agent.
6.13.4 To ensure an inmate is informed of the foregoing, a faith-based or charitable Contractor shall
require that each inmate receiving Services under this Contract signs an acknowledgment form
prepared by the Contractor containing the aforementioned notice and verifying the offender’s
receipt of the same. A copy of all signed acknowledgment forms shall be promptly provided to
Purchaser. Finally, Purchaser will require that each inmate sign the Purchaser’s “Voluntary Choice
and Waiver” form, which will be provided by Purchaser, prior to receiving any Services from a
faith-based or charitable Contractor under this Contract. A faith-based or charitable Contractor
agrees to refrain from providing Services hereunder to an inmate until it receives a copy of a fully
executed Voluntary Choice and Waiver form from Purchaser for that respective offender.
7.0
6.14
AMERICANS WITH DISABILITY ACT
The contractor agency must complete or currently have on file a facility self-survey and a program and
policy self-evaluation to address compliance with the Americans with Disability Act. (Public Law 101-336,
July 26, 1990, 104 Stat. 327 and Title 42, U.S.C.A., ss. 12101 to 12213). During the course of the
contract, the contractor must take action to comply with the facility, program and employment provisions of
the Americans with Disability Act. Applicants may obtain information on the Americans with Disability Act
by contacting the Director of the Office of Diversity and Employee Services, Wisconsin Department of
Corrections, 3099 E. Washington Avenue, PO Box 7991, Madison, Wisconsin 53707-7991.
6.15
CONTRACTOR MAJOR STRUCTURAL CHANGE
The Contractor is required to provide the Department with a minimum of 90 days written advance notice of
any planned or potential structural change (merger, buyout, acquisition, consolidation, etc.). Contract may
not be automatically assigned to the new entity (since the underlying procurement may be affected).
STANDARD AND SUPPLEMENTAL TERMS AND CONDITIONS
The Standard Terms and Conditions (DOA-3054, R10/2005)) and Supplemental Standard Terms and Conditions for
Procurements for Services (DOA-3681, R01/2001) are made part of this RFB. The State of Wisconsin reserves the
right to incorporate standard State contract provisions into any contract negotiated with any bid submitted
responding to this RFB (Standard Terms and Conditions, DOA-3054). Failure of the successful bidder to accept
these obligations in a contractual agreement may result in cancellation of the award.
RFB # LS-2226
TLP Services in Wautoma, Montello and Berlin, WI
8.0
Due Date: September 8, 2009 3:00 PM CT
REQUIRED FORMS AND ATTACHMENTS
The following forms must be completed and submitted with the bid response.
FORMS:
Request for Bid Form (DOA-3070) - cover sheet, first page of this RFB
Vendor Information Form (DOA-3477)
MBE/ American Made Affidavit Form (DOA-3476)
Designation of Confidential and Proprietary Information Form (DOA-3027), if applicable.
Wisconsin’s Cooperative Purchasing Service Form (DOA-3333)
Vendor Reference Form (DOA-3478)
ADDITIONAL REQUIRED INFORMATION:

Documentation detailing the facility location, description of housing units and the number of blocks to
access public transportation as specified in 4.1.

Documentation of organization experience requirements, including past contract information, as
specified in 4.2.
 Documentation of management staff qualifications as specified in 4.3.1.
 Documentation of direct service staff experience and pending hire documentation, if applicable, as
specified in 4.3.2
 A monthly staffing schedule showing the varied inspections and listing staff on duty and on call in
accordance with specifications described in 4.4.2
 Copy of existing system for documenting and managing client-level information in 4.9.2.5., if applicable.
Wisconsin Department of Administration
Chs. 16, 19, 51
DOA-3054 (R10/2005)
Page 1 of 3
Standard Terms And Conditions
(Request For Bids / Proposals)
1.0
2.0
3.0
SPECIFICATIONS: The specifications in this request are
the minimum acceptable. When specific manufacturer and
model numbers are used, they are to establish a design,
type of construction, quality, functional capability and/or
performance level desired.
When alternates are
bid/proposed, they must be identified by manufacturer, stock
number, and such other information necessary to establish
equivalency. The State of Wisconsin shall be the sole judge
of equivalency. Bidders/proposers are cautioned to avoid
bidding alternates to the specifications which may result in
rejection of their bid/proposal.
DEVIATIONS AND EXCEPTIONS: Deviations and exceptions from original text, terms, conditions, or specifications
shall be described fully, on the bidder's/proposer's letterhead, signed, and attached to the request. In the absence
of such statement, the bid/proposal shall be accepted as in
strict compliance with all terms, conditions, and specifications and the bidders/proposers shall be held liable.
QUALITY: Unless otherwise indicated in the request, all
material shall be first quality. Items which are used,
demonstrators, obsolete, seconds, or which have been
discontinued are unacceptable without prior written approval
by the State of Wisconsin.
4.0
QUANTITIES: The quantities shown on this request are
based on estimated needs. The state reserves the right to
increase or decrease quantities to meet actual needs.
5.0
DELIVERY: Deliveries shall be F.O.B. destination freight
prepaid and included unless otherwise specified.
6.0
PRICING AND DISCOUNT: The State of Wisconsin qualifies for governmental discounts and its educational institutions also qualify for educational discounts. Unit prices shall
reflect these discounts.
6.1
6.2
6.3
Unit prices shown on the bid/proposal or contract
shall be the price per unit of sale (e.g., gal., cs., doz.,
ea.) as stated on the request or contract. For any
given item, the quantity multiplied by the unit price
shall establish the extended price, the unit price shall
govern in the bid/proposal evaluation and contract
administration.
Prices established in continuing agreements and
term contracts may be lowered due to general market
conditions, but prices shall not be subject to increase
for ninety (90) calendar days from the date of award.
Any increase proposed shall be submitted to the
contracting agency thirty (30) calendar days before
the proposed effective date of the price increase, and
shall be limited to fully documented cost increases to
the contractor which are demonstrated to be industrywide. The conditions under which price increases
may be granted shall be expressed in bid/proposal
documents and contracts or agreements.
In determination of award, discounts for early
payment will only be considered when all other conditions are equal and when payment terms allow at
least fifteen (15) days, providing the discount terms
are deemed favorable. All payment terms must allow
the option of net thirty (30).
7.0
UNFAIR SALES ACT: Prices quoted to the State of
Wisconsin are not governed by the Unfair Sales Act.
8.0
ACCEPTANCE-REJECTION:
The State of Wisconsin
reserves the right to accept or reject any or all
bids/proposals, to waive any technicality in any bid/proposal
submitted, and to accept any part of a bid/proposal as
deemed to be in the best interests of the State of
Wisconsin.
Bids/proposals MUST be date and time stamped by the
soliciting purchasing office on or before the date and time
that the bid/proposal is due. Bids/proposals date and time
stamped in another office will be rejected. Receipt of a
bid/proposal by the mail system does not constitute receipt
of a bid/proposal by the purchasing office.
9.0
METHOD OF AWARD: Award shall be made to the lowest
responsible, responsive bidder unless otherwise specified.
10.0
ORDERING: Purchase orders or releases via purchasing
cards shall be placed directly to the contractor by an
authorized agency.
No other purchase orders are
authorized.
11.0
PAYMENT TERMS AND INVOICING:
The State of
Wisconsin normally will pay properly submitted vendor
invoices within thirty (30) days of receipt providing goods
and/or services have been delivered, installed (if required),
and accepted as specified.
Invoices presented for payment must be submitted in
accordance with instructions contained on the purchase
order including reference to purchase order number and
submittal to the correct address for processing.
A good faith dispute creates an exception to prompt
payment.
12.0
TAXES: The State of Wisconsin and its agencies are
exempt from payment of all federal tax and Wisconsin state
and local taxes on its purchases except Wisconsin excise
taxes as described below.
The State of Wisconsin, including all its agencies, is
required to pay the Wisconsin excise or occupation tax on
its purchase of beer, liquor, wine, cigarettes, tobacco
products, motor vehicle fuel and general aviation fuel.
However, it is exempt from payment of Wisconsin sales or
use tax on its purchases. The State of Wisconsin may be
subject to other states' taxes on its purchases in that state
depending on the laws of that state. Contractors performing construction activities are required to pay state use tax
on the cost of materials.
13.0
GUARANTEED DELIVERY: Failure of the contractor to
adhere to delivery schedules as specified or to promptly
replace rejected materials shall render the contractor liable
for all costs in excess of the contract price when alternate
procurement is necessary. Excess costs shall include the
administrative costs.
14.0
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 and/or order with referenced parts and attach-
DOA-3054
Page 2of 3
ments 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.
15.0
16.0
17.0
18.0
19.0
APPLICABLE LAW AND COMPLIANCE: This contract
shall be governed under the laws of the State of Wisconsin.
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 or its
conduct. The State of Wisconsin reserves the right to
cancel this contract if the contractor fails to follow the
requirements of s. 77.66, Wis. Stats., and related statutes
regarding certification for collection of sales and use tax.
The State of Wisconsin also reserves the right to cancel
this contract with any federally debarred contractor or a
contractor that is presently identified on the list of parties
excluded from federal procurement and non-procurement
contracts.
ANTITRUST ASSIGNMENT: The contractor and the State
of Wisconsin recognize that in actual economic practice,
overcharges resulting from antitrust violations are in fact
usually borne by the State of Wisconsin (purchaser).
Therefore, the contractor hereby assigns to the State of
Wisconsin any and all claims for such overcharges as to
goods, materials or services purchased in connection with
this contract.
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 the State of
Wisconsin.
WORK CENTER CRITERIA: A work center must be certified under s. 16.752, Wis. Stats., and must ensure that
when engaged in the production of materials, supplies or
equipment or the performance of contractual services, not
less than seventy-five percent (75%) of the total hours of
direct labor are performed by severely handicapped
individuals.
Contracts estimated to be over twenty-five thousand
dollars ($25,000) require the submission of a written
affirmative action plan by the contractor. An exemption occurs from this requirement if the contractor has
a workforce of less than twenty-five (25) employees.
Within fifteen (15) working days after the contract is
awarded, the contractor must submit the plan to the
contracting state agency for approval. Instructions
on preparing the plan and technical assistance
regarding this clause are available from the
contracting state agency.
The contractor agrees to post in conspicuous places,
available for employees and applicants for employment, a notice to be provided by the contracting state
agency that sets forth the provisions of the State of
Wisconsin's nondiscrimination law.
19.3
Failure to comply with the conditions of this clause
may result in the contractor's becoming declared an
"ineligible" contractor, termination of the contract, or
withholding of payment.
20.0
PATENT INFRINGEMENT: The contractor selling to the
State of Wisconsin the articles described herein guarantees
the articles were manufactured or produced in accordance
with applicable federal labor laws. Further, that the sale or
use of the articles described herein will not infringe any
United States patent. The contractor covenants that it will
at its own expense defend every suit which shall be brought
against the State of Wisconsin (provided that such
contractor is promptly notified of such suit, and all papers
therein are delivered to it) for any alleged infringement of
any patent by reason of the sale or use of such articles, and
agrees that it will pay all costs, damages, and profits recoverable in any such suit.
21.0
SAFETY REQUIREMENTS: All materials, equipment, and
supplies provided to the State of Wisconsin must comply
fully with all safety requirements as set forth by the
Wisconsin Administrative Code and all applicable OSHA
Standards.
22.0
WARRANTY: Unless otherwise specifically stated by the
bidder/proposer, equipment purchased as a result of this
request shall be warranted against defects by the
bidder/proposer for one (1) year from date of receipt. The
equipment manufacturer's standard warranty shall apply as
a minimum and must be honored by the contractor.
23.0
INSURANCE RESPONSIBILITY: The contractor performing services for the State of Wisconsin shall:
NONDISCRIMINATION / AFFIRMATIVE ACTION: 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 as defined in s. 111.32(13m), Wis.
Stats., 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. Except with respect to sexual orientation, the
contractor further agrees to take affirmative action to
ensure equal employment opportunities.
19.1
19.2
24.0
23.1
Maintain worker's compensation insurance as
required by Wisconsin Statutes, for all employees
engaged in the work.
23.2
Maintain commercial liability, bodily injury and property damage insurance against any claim(s) which
might occur in carrying out this agreement/contract.
Minimum coverage shall be one million dollars
($1,000,000) liability for bodily injury and property
damage including products liability and completed
operations. Provide motor vehicle insurance for all
owned, non-owned and hired vehicles that are used
in carrying out this contract. Minimum coverage shall
be one million dollars ($1,000,000) per occurrence
combined single limit for automobile liability and
property damage.
23.3
The state reserves the right to require higher or lower
limits where warranted.
CANCELLATION: The State of Wisconsin reserves the
right to cancel any contract in whole or in part without
penalty due to nonappropriation of funds or for failure of the
contractor to comply with terms, conditions, and specifications of this contract.
DOA-3054
Page 3of 3
25.0
VENDOR TAX DELINQUENCY: Vendors who have a
delinquent Wisconsin tax liability may have their payments
offset by the State of Wisconsin.
26.0
PUBLIC RECORDS ACCESS: It is the intention of the
state to maintain an open and public process in the solicitation, submission, review, and approval of procurement
activities.
30.0
MATERIAL SAFETY DATA SHEET: If any item(s) on an
order(s) resulting from this award(s) is a hazardous chemical, as defined under 29CFR 1910.1200, provide one (1)
copy of a Material Safety Data Sheet for each item with the
shipped container(s) and one (1) copy with the invoice(s).
31.0
PROMOTIONAL ADVERTISING / NEWS RELEASES:
Reference to or use of the State of Wisconsin, any of its
departments, agencies or other subunits, or any state official or employee for commercial promotion is prohibited.
News releases pertaining to this procurement shall not be
made without prior approval of the State of Wisconsin.
Release of broadcast e-mails pertaining to this procurement
shall not be made without prior written authorization of the
contracting agency.
32.0
HOLD HARMLESS: The contractor will indemnify and
save harmless the State of Wisconsin and all of its officers,
agents and employees from all suits, actions, or claims of
any character brought for or on account of any injuries or
damages received by any persons or property resulting
from the operations of the contractor, or of any of its
contractors, in prosecuting work under this agreement.
33.0
FOREIGN CORPORATION: A foreign corporation (any
corporation other than a Wisconsin corporation) which
becomes a party to this Agreement is required to conform
to all the requirements of Chapter 180, Wis. Stats., relating
to a foreign corporation and must possess a certificate of
authority from the Wisconsin Department of Financial
Institutions, unless the corporation is transacting business
in interstate commerce or is otherwise exempt from the
requirement of obtaining a certificate of authority. Any
foreign corporation which desires to apply for a certificate of
authority should contact the Department of Financial
Institutions, Division of Corporation, P. O. Box 7846,
Madison, WI 53707-7846; telephone (608) 261-7577.
34.0
WORK CENTER PROGRAM:
The successful
bidder/proposer shall agree to implement processes that
allow the State agencies, including the University of
Wisconsin System, to satisfy the State's obligation to
purchase goods and services produced by work centers
certified under the State Use Law, s.16.752, Wis. Stat.
This shall result in requiring the successful bidder/proposer
to include products provided by work centers in its catalog
for State agencies and campuses or to block the sale of
comparable items to State agencies and campuses.
35.0
FORCE MAJEURE: Neither party shall be in default by
reason of any failure in performance of this Agreement in
accordance with reasonable control and without fault or
negligence on their part. Such causes may include, but are
not restricted to, acts of nature or the public enemy, acts of
the government in either its sovereign or contractual
capacity, fires, floods, epidemics, quarantine restrictions,
strikes, freight embargoes and unusually severe weather,
but in every case the failure to perform such must be
beyond the reasonable control and without the fault or
negligence of the party.
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.
27.0
28.0
PROPRIETARY INFORMATION: Any restrictions on the
use of data contained within a request, must be clearly
stated in the bid/proposal itself. Proprietary information
submitted in response to a request will be handled in
accordance with applicable State of Wisconsin
procurement regulations and the Wisconsin public records
law. Proprietary restrictions normally are not accepted.
However, when accepted, it is the vendor's responsibility to
defend the determination in the event of an appeal or
litigation.
27.1
Data contained in a bid/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 State of Wisconsin.
27.2
Any material submitted by the vendor in response to
this request that the vendor 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 on a
Designation of Confidential and Proprietary Information form (DOA-3027).
Bidders/proposers may
request the form if it is not part of the Request for
Bid/Request for Proposal package. Bid/proposal
prices cannot be held confidential.
DISCLOSURE: If a state public official (s. 19.42, Wis.
Stats.), a member of a state public official's immediate
family, or any organization in which a state 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) within a twelve (12) month
period, this contract is voidable by the state unless appropriate disclosure is made according to s. 19.45(6), Wis.
Stats., before signing the contract. Disclosure must be
made to the State of Wisconsin Ethics Board, 44 East
Mifflin Street, Suite 601, Madison, Wisconsin 53703
(Telephone 608-266-8123).
State classified and former employees and certain
University of Wisconsin faculty/staff are subject to separate
disclosure requirements, s. 16.417, Wis. Stats.
29.0
RECYCLED MATERIALS: The State of Wisconsin is
required to purchase products incorporating recycled materials whenever technically and economically feasible.
Bidders are encouraged to bid products with recycled
content which meet specifications.
State of Wisconsin
Department of Administration
Division of Agency Services
Bureau of Procurement
DOA-3681 (01/2001)
ss. 16, 19 and 51, Wis. Stats.
Supplemental Standard Terms and Conditions
For Procurements for Services
1.0
ACCEPTANCE OF BID/PROPOSAL CONTENT: The contents of the bid/proposal of the successful contractor will
become contractual obligations if procurement action ensues.
2.0
CERTIFICATION
OF
INDEPENDENT
PRICE
DETERMINATION:
By signing this bid/proposal, the
bidder/proposer certifies, and in the case of a joint
bid/proposal, each party thereto certifies as to its own organization, that in connection with this procurement:
2.1
2.2
The prices in this bid/proposal have been arrived at
independently, without consultation, communication,
or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any
other bidder/proposer or with any competitor;
Unless otherwise required by law, the prices which
have been quoted in this bid/proposal have not been
knowingly disclosed by the bidder/proposer and will
not knowingly be disclosed by the bidder/proposer
prior to opening in the case of an advertised procurement or prior to award in the case of a negotiated
procurement, directly or indirectly to any other
bidder/proposer or to any competitor; and
2.3
No attempt has been made or will be made by the
bidder/proposer to induce any other person or firm to
submit or not to submit a bid/proposal for the purpose
of restricting competition.
2.4
Each person signing this bid/proposal certifies that:
He/she is the person in the bidder's/proposer's organization responsible within that organization for the
decision as to the prices being offered herein and that
he/she has not participated, and will not participate, in
any action contrary to 2.1 through 2.3 above; (or)
3.2
4.0
DUAL EMPLOYMENT:
Section 16.417, Wis. Stats.,
prohibits an individual who is a State of Wisconsin employee
or who is retained as a contractor full-time by a State of
Wisconsin agency from being retained as a contractor by the
same or another State of Wisconsin agency where the
individual receives more than $12,000 as compensation for
the individual’s services during the same year.
This
prohibition does not apply to individuals who have full-time
appointments for less than twelve (12) months during any
period of time that is not included in the appointment. It does
not include corporations or partnerships.
5.0
EMPLOYMENT: The contractor will not engage the services
of any person or persons now employed by the State of
Wisconsin, including any department, commission or board
thereof, to provide services relating to this agreement without
the written consent of the employing agency of such person
or persons and of the contracting agency.
6.0
CONFLICT OF INTEREST: Private and non-profit corporations are bound by ss. 180.0831, 180.1911(1), and 181.0831
Wis. Stats., regarding conflicts of interests by directors in the
conduct of state contracts.
7.0
RECORDKEEPING AND RECORD RETENTION:
The
contractor shall establish and maintain adequate records of
all expenditures incurred under the contract. All records must
be kept in accordance with generally accepted accounting
procedures. All procedures must be in accordance with
federal, state and local ordinances.
He/she is not the person in the bidder's/proposer's
organization responsible within that organization for
the decision as to the prices being offered herein, but
that he/she has been authorized in writing to act as
agent for the persons responsible for such decisions
in certifying that such persons have not participated,
and will not participate in any action contrary to 2.1
through 2.3 above, and as their agent does hereby so
certify; and he/she has not participated, and will not
participate, in any action contrary to 2.1 through 2.3
above.
3.0
DISCLOSURE OF INDEPENDENCE AND RELATIONSHIP:
3.1
Prior to award of any contract, a potential contractor
shall certify in writing to the procuring agency that no
relationship exists between the potential contractor
and the procuring or contracting agency that interferes
with fair competition or is a conflict of interest, and no
relationship exists between the contractor and another
person or organization that constitutes a conflict of
interest with respect to a state contract.
The
Department of Administration may waive this provision, in writing, if those activities of the potential contractor will not be adverse to the interests of the state.
Contractors shall agree as part of the contract for
services that during performance of the contract, the
contractor will neither provide contractual services nor
enter into any agreement to provide services to a
person or organization that is regulated or funded by
the contracting agency or has interests that are
adverse to the contracting agency. The Department
of Administration may waive this provision, in writing,
if those activities of the contractor will not be adverse
to the interests of the state.
The contracting agency shall have the right to audit, review,
examine, copy, and transcribe any pertinent records or
documents relating to any contract resulting from this
bid/proposal held by the contractor. The contractor will retain
all documents applicable to the contract for a period of not
less than three (3) years after final payment is made.
8.0
INDEPENDENT CAPACITY OF CONTRACTOR:
The
parties hereto agree that the contractor, its officers, agents,
and employees, in the performance of this agreement shall
act in the capacity of an independent contractor and not as
an officer, employee, or agent of the state. The contractor
agrees to take such steps as may be necessary to ensure
that each subcontractor of the contractor will be deemed to
be an independent contractor and will not be considered or
permitted to be an agent, servant, joint venturer, or partner of
the state.
STATE OF WISCONSIN
DEPARTMENT OF ADMINISTRATION
DIVISION OF ENTERPRISE OPERATIONS
BUREAU OF PROCUREMENT
S. 16.765, WIS. STATS.
DOA-3477 (R01/08)
Bid / Proposal #
Commodity / Service
LS 2226
TLP in Wautoma, Montello
& Berlin, WI
Vendor Information
1.
BIDDING / PROPOSING COMPANY NAME
Phone
(
)
Toll Free Phone
FAX
(
)
E-Mail Address
(
)
Address
City
2.
State
Zip + 4
Name the person to contact for questions concerning this bid / proposal.
Name
Title
Phone
(
)
Toll Free Phone
FAX
(
)
E-Mail Address
(
)
Address
City
3.
State
Zip + 4
Any vendor awarded over $25,000 on this contract must submit affirmative action information to the
department. Please name the Personnel / Human Resource and Development or other person responsible
for affirmative action in the company to contact about this plan.
Name
Title
Phone
(
)
Toll Free Phone
FAX
(
)
E-Mail Address
(
)
Address
City
4.
State
Zip + 4
Mailing address to which state purchase orders are mailed and person the department may contact
concerning orders and billings.
Name
Title
Phone
(
)
Toll Free Phone
FAX
(
)
E-Mail Address
(
)
Address
City
5.
State
Zip + 4
CEO / President Name
This document can be made available in accessible formats to qualified individuals with disabilities.
State of Wisconsin
Department of Administration
DOA-3476 (R01/2000)
S. 16.75(3m) Wis. Stats.; s. 16.752
Wis. Stats.
Bid / Proposal #
LS-2226
Commodity
TLP in Wautoma,
Montello & Berlin,
WI
Affidavit
This completed affidavit must be submitted with the bid/proposal.
Proposer Preference: Please indicate below if claiming a proposer preference.
Minority Business Preference (s. 16.75(3m), Wis. Stats.) - Must be certified by the Wisconsin
Department of Commerce. If you have questions concerning the certification process, contact the
Wisconsin Department of Commerce, 8th Floor, 123 W. Washington Ave., P.O. Box 7970, Madison,
Wisconsin 53707-7970,
(608) 267-9550.
Work Center Preference (s 16.752, Wis Stats.) - Must be certified by the State of Wisconsin Use
Board. If you have questions concerning the certification process, contact the Wisconsin State Use
Board, 101 East Wilson Street, 6th Floor, PO Box 7867, Madison, Wisconsin 53707-7867 or 608/2662553.
American-Made Materials: The materials covered in our proposal were manufactured in whole or in substantial part
within the United States, or the majority of the component parts thereof were manufactured in whole or in substantial
part in the United States.
Yes
No
Unknown
Non-Collusion: In signing this proposal we also certify that we have not, either directly or indirectly, entered into any
agreement or participated in any collusion or otherwise taken any action in restraint of free trade; that no attempt
has been made to induce any other person or firm to submit or not to submit a proposal; that this proposal has been
independently arrived at without collusion with any other proposer competitor or potential competitor; that this
proposal has not been knowingly disclosed prior to opening of proposals to any other proposer or competitor; that
the above statement is accurate under penalty of perjury.
We will comply with all terms, conditions, and specifications required by the State of Wisconsin in this
Announcement of Bid/Proposal and the terms of our bid/proposal.
Authorized
Representative
Authorized
Representative
Company
Name
Title
Type or Print
Date (m/dd/ccyy)
Signature
Telephone
(
)
This document can be made available in accessible formats to qualified individuals with disabilities.
STATE OF WISCONSIN
DOA-3027 (R01/98)
DESIGNATION OF CONFIDENTIAL AND PROPRIETARY INFORMATION
The attached material submitted in response to Bid/Proposal # LS-2226-TLP in Wautoma, Montello & Berlin
includes proprietary and confidential information which qualifies as a trade secret, as provided in s.
19.36(5), Wis. Stats., or is otherwise material that can be kept confidential under the Wisconsin Open
Records Law. As such, we ask that certain pages, as indicated below, of this bid/proposal response be
treated as confidential material and not be released without our written approval.
Prices always become public information when bids/proposals are opened, and therefore
cannot be kept confidential.
Other information cannot be kept confidential unless it is a trade secret. Trade secret is defined in s.
134.90(1)(c), Wis. Stats. as follows: "Trade secret" means information, including a formula, pattern,
compilation, program, device, method, technique or process to which all of the following apply:
1. The information derives independent economic value, actual or potential, from not being generally
known to, and not being readily ascertainable by proper means by, other persons who can obtain
economic value from its disclosure or use.
2. The information is the subject of efforts to maintain its secrecy that are reasonable under the
circumstances.
We request that the following pages not be released
Section
Page #
Topic
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
IN THE EVENT THE DESIGNATION OF CONFIDENTIALITY OF THIS INFORMATION IS CHALLENGED, THE
UNDERSIGNED HEREBY AGREES TO PROVIDE LEGAL COUNSEL OR OTHER NECESSARY ASSISTANCE
TO DEFEND THE DESIGNATION OF CONFIDENTIALITY AND AGREES TO HOLD THE STATE HARMLESS
FOR ANY COSTS OR DAMAGES ARISING OUT OF THE STATE'S AGREEING TO WITHHOLD THE
MATERIALS.
Failure to include this form in the bid/proposal response may mean that all information provided as part of the
bid/proposal response will be open to examination and copying. The state considers other markings of confidential
in the bid/proposal document to be insufficient. The undersigned agrees to hold the state harmless for any
damages arising out of the release of any materials unless they are specifically identified above.
Company Name
___________________________________________
Authorized Representative
___________________________________________
Signature
Authorized Representative
___________________________________________
Date
___________________________________________
Type or Print
This document can be made available in accessible formats to qualified individuals with disabilities.
Division of State Agency Services
State Bureau of Procurement
State of Wisconsin
Department of Administration
DOA-3333 (R03/2004)
Vendor Agreement
Wisconsin’s Cooperative Purchasing Service
Wisconsin statutes (s. 16.73, Wis. Stats.) establish authority to allow Wisconsin municipalities to purchase from state
contracts. Participating in the service gives vendors opportunities for additional sales without additional bidding.
Municipalities use the service to expedite purchases. A "municipality" is defined as any county, city, village, town, school
district, board of school directors, sewer district, drainage district, vocational, technical and adult education district, or any
other public body having the authority to award public contracts (s. 16.70(8), Wis. Stats.). Federally recognized Indian tribes
and bands in this state may participate in cooperative purchasing with the state or any municipality under ss. 66.0301(1) and
(2), Wis.Stats.
Interested municipalities:

will contact the contractor directly to place orders referencing the state agency contract number; and

are responsible for receipt, acceptance, inspection of commodities directly from the contractor, and making
payment directly to the contractor.
The State of Wisconsin is not a party to these purchases or any dispute arising from these purchases and is not liable for
delivery or payment of any of these purchases.
The State of Wisconsin will determine the contractor’s participation by checking a box below.
MANDATORY: Bidders/Proposers must agree to furnish the commodities or services of this bid/proposal to
Wisconsin municipalities. Vendors should note any special conditions below.
OPTIONAL: Bidders/Proposers may or may not agree to furnish the commodities or services of this bid/proposal to
Wisconsin municipalities. A vendor’s decision on participating in this service has no effect on awarding this
contract.
A vendor in the service may specify minimum order sizes by volume or dollar amount, additional charges beyond
normal delivery areas, or other minimal changes for municipalities.
Vendor: please check one of the following boxes in response.
I Agree to furnish the commodities or services of this bid/proposal to Wisconsin municipalities with any
special conditions noted below.
I Do Not Agree to furnish the commodities or services to Wisconsin municipalities.
Special Conditions (if applicable):
Signature
Date (mm/dd/ccyy)
Name (Type or Print)
Title
Company
Telephone
(
Address (Street)
City
)
State
ZIP + 4
Commodity/Service
Request for Bid/Proposal Number
TLP in Wautoma, Montello, and Berlin, WI
LS-2226
This form can be made available in accessible formats upon request to qualified individuals with disabilities.
STATE OF WISCONSIN
Bid / Proposal #
DOA-3478 (R12/96)
LS-2226
TLP in Wautoma,Montello &
Berlin, WI
VENDOR REFERENCE
FOR VENDOR:
Provide company name, address, contact person, telephone number, and appropriate information on the
product(s) and/or service(s) used for four (4) or more installations with requirements similar to those included in this
solicitation document. If vendor is proposing any arrangement involving a third party, the named references should
also be involved in a similar arrangement.
Company Name
Address (include Zip + 4)
Contact Person
Phone No.
Product(s) and/or Service(s) Used
Company Name
Address (include Zip + 4)
Contact Person
Phone No.
Product(s) and/or Service(s) Used
Company Name
Address (include Zip + 4)
Contact Person
Phone No
Product(s) and/or Service(s) Used
Company Name
Address (include Zip + 4)
Contact Person
Phone No.
Product(s) and/or Service(s) Used
This document can be made available in accessible formats to qualified individuals with disabilities.
Page 2 of 6
EXHIBIT 1
EFFECTIVE DATE
WISCONSIN
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
July
DOC-1356 (Rev. 05/96)
PAGE 1 OF
2001
1
MANUAL REFERENCE
New
ORIGINATED BY
Administrative Directive 01-10
Replaces 99-15
x Revision
William J. Grosshans,
Administrator
Kerr v. Farrey
SUBJECT:
DISSEMINATION
X
PRIORITY
All Staff
X
Supervisory Staff Only
X
Policy / Directive
Information
Discuss at Staff Meeting
Read / Route / Post
The purpose of this directive is to ensure the Division of Community Corrections'
procedures comply with the decision of the United States 7t' Circuit Court of Appeals in
Kerr v. Farrey. 95 F.3d 472 (1996). In that decision, the court ruled that it was a violation
of the 1St Amendment of the United States Constitution to order an offender to attend a
treatment program with religious components. The court considered Alcoholics
Anonymous, for example, to be a program with a religious component since the program
refers to a "higher being" and to "God as we understand him."
An agent may order an offender to attend a specific secular (non-religious) treatment or
support program. An agent may not order an offender to attend a specific program with a
religious component. An offender may voluntarily participate in a treatment or
support program with a religious component as long as a non-religious program is
offered.
An agent may write a rule requiring an offender to attend and complete AODA treatment
without naming a specific program. An agent may also provide an offender with a list of
acceptable programs, as long as both secular and non-secular options are clearly
identified. If an offender chooses to participate in a program having a religious
component, the agent should document in the Chronological Log that a secular program
was offered.
________________________________
William J. Grosshans
Administrator
cc - DCC Administrative Directive Group
Executive Staff
EXHIBIT 2
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1336 (Rev. 11/2006)
WISCONSIN
REFERRAL FOR SERVICES
PART A
REFERRAL FOR SERVICES
To be Completed by Referral Agent
PROGRAM NAME
PROGRAM LOCATION
REFERRAL DATE (Month/Day/Year)
PROJECTED ELIGIBILITY DATE FOR SERVICES (Month/Day/Year)
AGENT NAME
AGENT ADDRESS
AGENT TELEPHONE NUMBER (Include Area Code)
AGENT AREA NUMBER
REFERRAL TYPE
ALTERNATIVE TO REVOCATION (ATR)
COURT-ORDERED CONDITION
SERVICES REQUEST (Check All That Apply)
Anger Management
AODA Group Services
AODA Aftercare Services
RESPONSE TO VIOLATION (NOT AN ATR)
PAROLE/ES CONDITION
OTHER - SPECIFY:
Domestic Violence Services
Education Services
Emergency Housing
AODA Assessment/Evaluation
AODA Intensive Nonresidential Groups
AODA Relapse Prevention/Aftercare
Case Management
Cognitive Interventions Groups
Crisis Intervention
Day Report Services
Sex Offender Treatment Group
Transitional Living Program
Other (Specify)
Employment Services
Family/Parenting Services
Halfway House (CBRF)
Sex Offender Assessment/Evaluation
Sex Offender Denial Focus Group
Sex Offender Education Group
Sex Offender Relapse Prevention/Aftercare
OFFENDER LAST NAME (As Shown on Court Order)
FIRST
DOB
SEX
MI
DOC NUMBER
RACE
Male
Female
OFFENDER CURRENT ADDRESS
OFFENDER TELEPHONE NUMBER (Include Area Code)
MARITAL STATUS
Single, never married
Married
OFFENDER STATUS AT TIME OF REFERRAL
Probation
Parole
Felony
Separated
Widow/Widower
Extended Supervision
980 Case
NGI
SUPERVISION DISCHARGE DATE
Misdemeanor
Habitual
Reentry from Jail
Deferred Prosecution
Reentry from Prison
Divorced
One Year or Less Probation
Reentry from DAI ATR
DOES INDIVIDUAL HAVE OUTSTANDING WARRANT OR PENDING CHARGES?
Yes
No - If Yes, Explain:
REASON FOR REFERRAL (List Problems Behaviors Evidenced By Offender And Specific Services Requested)
SPECIAL NEEDS (Check All Relevant Categories)
Yes
No
Alcohol Problems
Drug Problems (Specify)
Yes
No
History of Violence, attach description.
History of Committing Sexual Assaults
Health Problems (Specify)
Mental Health Problems (Specify)
Pregnant
Developmental or Learning Disabilities
Relationship Problems
OTHER (Specify)
Financial Management Problems
EXHIBIT 2
IS OFFENDER TAKING MEDICATION?
Prescription
Self-Pay
Insurance
Yes
No - If Yes , List Reason:
EDUCATIONAL ACHIEVEMENT
Highest Grade Level Achieved
THIS REFERRAL MUST INCLUDE THE FOLLOWING INFORMATION:
Authorization for Use and Disclosure of Protected Health Information (DOC-1163A)
Only required for information that involves personal health information, medical, mental health, AODA, or other confidential or services.
Court Order, Criminal Complaint and Prior Record
Social Information (DOC-179)
Violation Report(s), if applicable.
Information in Regard to Alcohol, other Drug Problems and Prior Treatment Experience, if applicable.
INSTRUCTIONS:
PART B
Attach Part A and Part B to your agency’s “Offender Report Form Monthly" (DOC-386, DOC-1088A and DOC-1088) for each new intake
and each offender who re-enters your program.
INTAKE DECISION
To Be Completed by Provider Agency for Offender Entering or Re-entering The Program
OFFENDER ACCEPTANCE / PROGRAM RETURN (Check Appropriate Box, Enter Appropriate Data)
Offender accepted as new intake
Offender returned to enter program
RECOMMENDED PROGRAM
START DATE
REJECTION
OFFENDER REJECTED - FOR WHAT REASON (Specify):
PROJECTED DISCHARGE DATE
EXHIBIT 3
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC1088 (Rev. 2/97)
WISCONSIN
OFFENDER REPORT – MONTHLY
COMMUNITY - BASED PROGRAMS and SERVICES
TELEPHONE NUMBER
AGENCY NAME
PURCHASE ORDER NUMBER
PROGRAM NAME
FEDERAL FUNDS
Yes
REPORT COMPLETED BY (Signature / Title)
DATE SIGNED
REPORT REVIEWED BY DPP STAFF (Signature)
INSTRUCTIONS: Use this form for all Community-based programs and services except Halfway House, use DOC-386 and Day Treatment, use DOC-1088A. Letters A through F must be completed; all other columns
may be required in accordance with the agency’s contract/grant agreement or at the direction of the Contract Administrator. All columns which require a code are noted by an asterisk. All codes for the completion of this form
are listed on the back of the form. If the Region needs assistance in developing the code for additional items, please contact the Adult Services Specialist at (608) 266-3989.
A
OFFENDER NAME
M Total Number of Offenders
B
OFFENDER
NUMBER
C
AGENT
AREA NO.
D
ADMISSION
DATE
N Total Units Provided*
E*
TYPE OF
SERVICE
F
SERVICE DATE OR DATES
G*
STATUS
Discharge
Date
Code
H
OFFENDER
FEES
COLLECTED
THIS MONTH
I
No
DATE SIGNED
REPORTING PERIOD
(Month/Year)
J
O Are Alcohol and Other Drug Abuse Services Provided Under This Contract/Grant
K
L
YES
NO
P Other Information
EXHIBIT 3
Discharge Codes
Used For All
These codes are used in column “G” STATUS Discharge Date / Code of all billing
Billing.
(01)
(02)
(03)
(04)
(05)
(06)
(07)
(08)
(09)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
forms including the TLP
Continues in Program.
Completed Service: Significant improvement in most or all areas has occurred and
the offender is approaching or has attained full recovery (Good).
Completed Service: Improvement in some areas has occurred but the degree of
improvement is minimal (Fair).
Completed Service: No positive change has occurred (Poor).
Referred to another agency.
Behavioral Termination: Staff / Program decision to terminate due to breaking
internal program rules.
Withdrew against staff advice.
Funding / Authorization Expired (service not completed).
Program Hold: When offender is temporarily not involved in service. Each
program hold incident must be 30 days or less.
Positive urinalysis screen, positive breathalyzer test or other indication of drugs.
Absconding
Rules Violation: Other than drug / alcohol or absconding.
New Offense
Hospitalized
Death
Other (specify in Field P “Other Information” at bottom of form.
EXHIBIT 4
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1026 (Rev. 2/97)
WISCONSIN
Wisconsin Statutes
Section 301.08
UNIT SERVICE
MONTHLY REPORT
AGENCY NAME
VENDOR ID NUMBER
PURCHASE ORDER NUMBER
PROGRAM NAME
TELEPHONE NUMBER
DOC CONTACT SIGNATURE
REPORTING PERIOD (Month / Year)
As the authorized representative of the above named agency, I request that my
agency is reimbursed for units of service provided to eligible Correctional offenders.
UNIT OF SERVICE(S) PROVIDED
UNIT
DESCRIPTION
NUMBER OF
UNITS
COST PER
UNIT
Less Billing to Other Agencies
Less Offender Fees Collected
NET REIMBURSABLE
TOTAL
=
I understand that my agency is required to submit a Offender Monthly Report within
30 days after the final day of the month for which this Unit Service Report is due.
I certify that the unit of services indicated for claiming State reimbursement are just, true and
correct in the amount stated and have not been reimbursed, and represent actual services
delivered and reimbursable under the laws, rules and regulation of the Wisconsin Department
of Corrections.
CONTRACTOR AGENCY CONTACT SIGNATURE
DISTRIBUTION:
Submit original and 2 copies to Grant/Contract Administrator
DATE SIGNED
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