4527 CBT Program Services in Burlington, Elkhorn, and Kenosh

4527 CBT Program Services in Burlington, Elkhorn, and Kenosh
State of Wisconsin
Wis. Statutes s.16.75
DOA-3070 (R08/2003)
BIDS MUST BE SEALED AND ADDRESSED TO:
AGENCY ADDRESS:
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 # TP-4527 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.
DEPARTMENT OF CORRECTIONS
TOM PIERCE / PURCHASING SERVICES SECTION
3099 E WASHINGTON AVENUE
P.O. BOX 7991
MADISON, WI 53707-7991
REQUEST FOR BID
Bids MUST be in this office no later than
THIS IS NOT AN ORDER
BIDDER (Name and Address)
April 18, 2014 3:00 PM Local Time
Name (Contact for further information)
Tom Pierce
Phone
Date
608-240-5586
February 18, 2014
Quote Price and Delivery FOB
Destination
Location
Quantity
and Unit
Description
Fax and email bids are not accepted
Price
Extended
Per Unit
Total
The Department of Corrections, Div. of Community
Corrections is requesting bids for Cognitive Behavioral
Therapy (CBT) Program Services (“Thinking for a Change” )
in Burlington, Elkhorn, and Kenosha, Wisconsin, per attached
terms, conditions and specifications.
Burlington
50 groups
CBT – Male
(2 sessions/wk x 12.5 weeks x 2 cycles = 50 groups)
$___________
$____________
Burlington
25 groups
CBT – Female
(2 sessions/wk x 12.5 weeks x 1 cycle = 25 groups)
$___________
$____________
Burlington
25 groups
CBT – Youthful Offender
(2 sessions/wk x 12.5 weeks x 1 cycle = 25 groups)
$___________
$____________
Burlington
25 groups
CBT – Sex Offender
(2 sessions/wk x 12.5 weeks x 1 cycle = 25 groups)
$___________
$____________
BURLINGTON
SUBTOTAL
$____________
.
Elkhorn
50 groups
CBT – Male
(2 sessions/wk x 12.5 weeks x 2 cycles = 50 groups)
$___________
$____________
Elkhorn
25 groups
CBT – Female
(2 sessions/wk x 12.5 weeks x 1 cycle = 25 groups)
$___________
$____________
Elkhorn
25 groups
CBT – Youthful Offender
(2 sessions/wk x 12.5 weeks x 1 cycle =25 groups)
$___________
$____________
Elkhorn
50 groups
CBT – Sex Offender
(2 sessions/wk x 12.5 weeks x 2 cycle = 50 groups)
$___________
$____________
ELKHORN
SUBTOTAL
$____________
Location
Quantity
and Unit
Description
Price
Per Unit
Extended
Total
Kenosha
100 groups
CBT – Male
(2 sessions/wk x 12.5 weeks x 4 cycle = 100 groups)
$___________
$____________
Kenosha
50 groups
CBT – Female
(2 sessions/wk x 12.5 weeks x 2 cycles = 50 groups)
$___________
$____________
Kenosha
50 groups
CBT – Youthful Offender
(2 sessions/wk x 12.5 weeks x 2 cycles = 50 groups)
$___________
$____________
Kenosha
25 groups
CBT – Special Needs
(2 sessions/wk x12.5 weeks x 1 cycle = 25 groups)
$___________
$____________
Kenosha
75 groups
CBT – Sex Offender
(2 sessions/wk x 12.5 weeks x 3 cycles 75 groups)
$___________
$____________
KENOSHA
SUBTOTAL
$____________
TOTAL BID AMOUNT
$____________
Before submitting this bid be sure to include all requirements listed in RFB Sections 2.4 and 9.
Payment Terms
Delivery Time
We claim minority bidder preference [Wis. Stats. s. 16.75(3m)]. Under Wisconsin Statutes, a 5% preference may be granted to State of Wisconsin CERTIFIED Minority-Owned Businesses.
Bidder must be certified by the Wisconsin Department of Administration Minority Business Certification Program. If you have questions concerning the certification process, contact the
Wisconsin Department of Administration, 101 E. Wilson St., Madison, Wisconsin 53703, (608) 267-9550. Does not apply to printing bids.
We claim disabled veteran-owned business preference [Wis. Stats. s. 16.75(3m)]. Under Wisconsin Statutes, a 5% preference may be granted to State of Wisconsin CERTIFIED Disabled
Veteran-Owned Businesses. Bidder must be certified by the Wisconsin Department of Administration Disabled Veteran-Owned Certification Program. If you have questions concerning the
certification process, contact the Wisconsin Department of Administration, 101 E. Wilson St., 6th Floor, Madison, Wisconsin 53703, (608) 267-9550. Does not apply to printing bids.
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
(
)
Email
Website
This form can be made available in accessible formats upon request to qualified individuals with disabilities
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 3 of 60
STATE OF WISCONSIN
REQUEST FOR BID (RFB) # TP-4527
FOR: Cognitive Behavioral Therapy (CBT) Program Services in Burlington, Elkhorn, and Kenosha, Wisconsin
TABLE OF CONTENTS
DEFINITIONS
1.0
INTRODUCTION, PURPOSE, AND SCOPE
2.0
BID PROCEDURES AND INSTRUCTIONS
3.0
BID ACCEPTANCE, EVALUATION AND AWARD
4.0
TECHNICAL REQUIREMENTS
5.0
PERFORMANCE REQUIREMENTS
6.0
SUPPORT REQUIREMENTS
7.0
COST INFORMATION
8.0
STANDARD AND SUPPLEMENTAL TERMS AND CONDITIONS
9.0
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)
EXHIBIT 5
……….……………………………
Correctional Program Checklist (CPC)
EXHIBIT 6
……….……….…………………
Program Guidelines
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 4 of 60
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 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
DVB:
Disabled Veteran-Owned Business
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 Affirmative Action requirements; development,
implementation, and monitoring of policies/practices for information and technology, space, staff/offender health,
safety and security.
ATR: An Alternative to Revocation is a written and signed agreement between DOC and the offender.
Cognitive Interventions: A program which teaches specific strategies or techniques to enable offenders to (1)
identify for themselves the specific thoughts that support their criminal behavior (self-observation); (2) see and
appreciate the pattern and consequences of their thinking; (3) utilize reasoning and problem solving, self-talk, social
interaction skills as a means of controlling and changing their thinking; (4) recognize that they have choices and can
make a conscious decision to change or not to change. The Department stresses programming that combines two
types of cognitive interventions: cognitive restructuring (changing the thinking patterns, attitudes, and beliefs that lead
persons to offend) and cognitive skills training (teaching reasoning, problem solving, social skills, modeling, active and
frequent role playing by group participants).
Cognitive Restructuring – This refers to the ability to focus on one’s beliefs and thinking in order to replace
ineffective beliefs and thinking with more effective ways; this in turn replaces anti-social values and morals with more
pro-social values and morals. Some specific skills may include: self-regulation and self-management skills, social
skills, problem solving skills and critical thinking/reasoning skills.
Cognitive Skills – This is the ability to focus and give offenders the opportunity to model and practice certain social
skills and problem solving skills that allow them to be more successful and reduce problems. Some specific social
skills may include: active listening, responding to the feelings of others, responding to anger and dealing with an
accusation. Some specific problem solving skills may include: stop and think, describe the problem, get information to
set a goal, considering choices and consequences, action planning and evaluation.
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 5 of 60
COMPAS: Northpointe COMPAS is a single statewide DOC system of risk/needs assessment and case planning for
an offender's lifecycle.
Correctional Client: City, count, state or federal clients/offenders/inmates served in a correctional setting. The DOC
will make sole determination of who meets this criterion.
Criminogenic Risk Factors: Those features that research has demonstrated are related to criminal behavior. At
least two types are recognized.
Static risk factors are offender characteristics that cannot change but are predictive of an offender’s propensity for
future criminal activity, for example, the offender’s age at the time of first offense.
Dynamic Risk Factors are offender characteristics that may be altered by effective intervention. Examples of
dynamic risk factors are substance abuse; identification with criminal companions; low tolerance for frustration;
impulsivity; conflicts with authority; poor use of leisure time; conning and manipulation; thrill seeking; egocentrism;
blaming others; dissatisfaction with conventional, mainstream activities; poor skills in identifying alternative
choices; etc.
Criminogenic Needs: Dynamic characteristics that a person presents that, if addressed, can reduce their likelihood
of recidivism. Examples include: employment, substance use, anti-social personality, anti-social attitudes, anti-social
associates, family dysfunction, poor self-control, and poor problem-solving skills.
Andrews, Bonta, and Hoge (1990:31) define criminogenic needs as a subset of risk factors consisting of dynamic
attributes of offenders and their circumstances that, when changed, are associated with changes in the chances of
recidivism.

Anti-social cognition – Programs targeting this specific criminogenic need seek to reduce anti-social cognition,
recognize risky thinking, and feelings, and adopt an alternative identity.

Anti-social companions – Programs targeting this specific criminogenic need seek to reduce association with
offenders, enhance contact with pro-social companions.

Anti-social personality or temperament – Programs targeting this specific criminogenic need seek to build
problem solving, self management, anger management, and coping skills.

Family and/or marital – Programs targeting this specific criminogenic need seek to reduce conflict, build positive
relationships and communication, and enhance monitoring/supervision.

Substance Abuse – Programs targeting this specific criminogenic need seek to reduce usage, reduce the
supports for abusive behavior, and enhance alternatives to abuse.

Employment – Programs targeting this specific criminogenic need seek to provide employment seeking and
keeping skills

Education/Vocational – Programs targeting this specific criminogenic need seek to enhance performance
rewards and satisfaction.

Leisure/Recreation – Programs targeting this specific criminogenic need seek to enhance involvement and
satisfaction in pro-social activities.
Culturally Diverse Programming: Programming which accommodates the learning styles of African American,
Hispanic, American Indian, Caucasian and other ethnic backgrounds. This is accomplished through diverse staff and
program materials.
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 6 of 60
Evidence Based Practices (EBP):
These are correctional practices in which an agency systematically finds,
appraises, and applies the most current and valid research findings as the basis for developing and implementing
targeted interventions and programming proven to reduce recidivism.
Gender Specific: Programming designed specifically to address male and female offenders’ needs and learning
styles.
Guided Self-Discovery: This methodology proposes that to take a cognitive approach and then try to argue offenders
out of their habits of thinking is ineffective and even counterproductive. Despite the fact that cognitive interventions
involve learning new beliefs and behaviors, these are not taught through lectures or preaching. In guided discovery,
questioning and exploration are used to help participants discover what they think, guide them to pinpoint the source of
their problems, assist them in seeing new perspectives, and help them find their own solutions to their problems.
When using guided discovery, facilitators model a process that offenders can use, on their own, to explore, evaluate
and challenge their beliefs and thoughts rather than continually relying upon facilitators to pinpoint the sources of their
problems and find solutions for them. Asking questions also helps the facilitator keep track of a participant’s progress
in understanding cognitive concepts and making cognitive changes.
The guided discovery approach is also used to maximize participant involvement in the group sessions. When
responding to questions, the participant is doing most of the work rather than being a passive recipient listening to
statements from the facilitator. Guiding participants to pinpoint the source of their problems and find their own
solutions also minimizes the possibility of the participant believing that the facilitator is attempting to impose his or her
own ideas on the participant. Participants often adopt new perspectives more readily when they are allowed to form
their own conclusions than when they are persuaded to adopt the facilitator's conclusions.
The facilitator’s role is to work with participants to help them recognize their cognitions and other risk factors that
cause problems for them; to test the validity of the thoughts, beliefs and assumptions that prove important; and to
make changes in both cognition and behaviors. By actively collaborating with the offender, facilitators minimize the
resistance and opposition that are often elicited by taking an authoritarian role, yet they still remain in a position to
structure each session and the overall course of the program in a way that is as efficient and effective as possible.
This methodology tends to increase feelings of self-efficacy and empowerment in participants by encouraging them to
adopt an internal focus of evaluation.
Motivational Interviewing (MI): MI is a client-centered, directive method for enhancing intrinsic motivation to change
by exploring and resolving ambivalence. A form of counseling that is more goal-directed yet less confrontational than
conventional methods.
Offender: A person convicted in adult court and under the supervision of Wisconsin DOC.
Program Evaluation: The identification of quantifiable behavioral indicators of response to the planned intervention
used to determine program efficacy.
Program Participant: The offender referred by the DCC and receiving services through the program is defined as a
program participant.
Program Statement: The written statement of a program’s philosophy and model of treatment; the research basis for
selection of the treatment model; the problem and the population to be served; the goals, objectives, and activities to
be employed to achieve the desired outcomes; and the plan for determining the efficacy of the services provided.
Punishers: Involves the application of a stimulus to decrease behavior.
Reinforcers: Involves the application of a stimulus to increase behavior.
Responsivity: Refers to the learning style and characteristics of the offender which can effect their engagement in
treatment.
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 7 of 60
Screening: The process which identifies whether an offender has an AODA problem (in this case) and if so, a
recommendation for the most appropriate type of treatment. A screening is a “first cut” done quickly, without the
detailed, in-depth, current information that would be gathered for an assessment. A screening should not be confused
with an assessment, which is a lengthier, much more definitive process.
Secular Programming: Secular programming is defined as a program that is free of religious components (Exhibit 1).
Special Populations: Offenders that may present particular characteristics such as the following – Cognitively
challenged (low functioning), non-English speaking, gay and lesbian, female perpetrators, learning challenged,
mentally ill or physically challenged (hearing/visual/mobility impaired).
Staffings: Verbal communication and information shared by DOC staff and contractor about a specific offender which
usually involves a face-to-face meeting, but may take place over the telephone. The offender may or may not be
present at the meeting or time of telephone call.
Stages of Change: Stages start with Pre-contemplation (the individual is not intending to make any changes in the
behavior in the next six months), then Contemplation (the individual is intending to take some sort of action within six
months), then Preparation (the individual is intending to take action within the next 30 days), then Action (the
individual made overt changes less than six months ago), finally Maintenance (the individual made overt changes
more than six months ago). Relapse (the individual has lapsed and needs to re-enter into the stage process.
Thinking for Change (T4C): Thinking for a Change (T4C) is an integrated, cognitive behavioral change program for
offenders that includes cognitive restructuring, social skills development, and development of problem solving skills.
Designed for delivery to small groups in 25 lessons, the T4C program can be expanded to meet the needs of specific
participant groups. T4C was developed in cooperation with the National Institute of Corrections (NIC).
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 8 of 60
1.0 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 the Division of Community Corrections
hereinafter referred to as "DCC", requests bids for the purchase of secular, non-residential Cognitive
Behavioral Therapy (CBT) Services in Burlington, Elkhorn, and Kenosha using Thinking For Change
(T4C) Curriculum. The program must provide services to offenders convicted in adult court and under the
supervision of the Wisconsin Department of Corrections (DOC) with specified program needs.
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 Wisconsin Department of Corrections (DOC) is changing its organizational culture to become a more
evidence-based organization to meet the mission of reducing recidivism. With the completion of the
statewide implementation of COMPAS ( Northpointe COMPAS), a web based risk/needs assessment and
case planning tool, the DOC now has quantitative tools for identifying those offenders with the highest risk
to re-offend. The Division of Community Corrections (DCC) will be providing as much information as
possible regarding each referred offender’s COMPAS assessment results. This COMPAS information will
guide the awarded contractor in providing the best services possible.
For some time, the DOC has strongly emphasized the importance of evidence-based practices (EBP).
The Department has worked with and trained its staff and contractors on how to implement EBP within
DCC programs. The studies that have been done on various programs delivery and curriculums serving
correctional or similar clients all support very specific steps in the program delivery, along with quality staff
and administrative support, to maintain contract fidelity. DOC is looking for EBP to be evident in the
supporting information included in your bid response. This offers you the opportunity to explain the impact
affecting the program participant by including the studies that have been done with correctional or similar
clients. In your bid response reference the specific studies rather than simply stating ‘studies have been
done’. Place the best available evidence from research at the heart of your program by including the EBP
definable outcome(s); illustrate that outcomes are measurable; and show that outcomes are practical as
they relate to the program participants. Awarded contractor and DOC shall work together in coordinating
outcome data with DOC minimum outcome requirements identified in section 4.8.4.4 Program
Evaluation of this bid.
The Corrections Program Checklist (CPC) is included as Exhibit 5 to assist bidders in understanding this
concept and its role in helping the Department move its staff and contractors together towards the main
goal of the Wisconsin Department of Corrections – reduction in recidivism.
As the Department moves forward with integrating EBP, it is important that DOC include Contractors in the
discussion. We must work together. While our goals may not always align, we all share a common goal
of helping offenders to improve their lives by remaining crime free. The Department values all of you as
our partners and we look forward to making sure our programs accomplish reduction in offender
recidivism, fewer victims, and fewer crimes.
1.1.1
PROGRAM GOALS
The goals of the Cognitive Behavioral Therapy Program are as follows:
 To teach offenders cognitive skills and cognitive restructuring as defined on
DEFINITIONS page of this RFB;
 Facilitate offender acceptance of responsibility for criminal behavior;
 To teach offenders to manage attitudes, thoughts, feelings, and emotions responsibly for
accountability and community protection; and
 To reduce crime/recidivism through cognitive restructuring, pro-social skill building, and
targeting dynamic criminogenic risk factors.
1.1.2
TARGET POPULATION
The program would serve male and female offenders who have been convicted in adult court as
referred by the Department of Corrections, and are under DOC supervision for the duration of
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 9 of 60
services. Some offenders may have identified special needs, such as learning disabilities /
cognitive limitations. Learning styles and needs may require reasonable accommodations in the
program.
Factors considered in referrals will include convicting offense behavior(s), prior record, other prior
history, indicators of imminent relapse, availability of resources, or other case contingencies. The
target population for cognitive Behavioral Therapy programming exhibit pro-criminal attitudes,
cognitive distortions, or errors in the content of their thinking, cognitive deficits in their ability to
plan, problem solve, and generate self-control strategies as well as deficits in the way they
process information. Thinking distortions are identified as a factor in the commission of crime.
Priority placement shall be given to moderate to high risk offenders based upon COMPAS/DOC
screening. DCC staff will determine priority offenders.
1.2
CONTRACT TERM
The contract term will be for one (1) year that will start upon receipt of formal contract and/or State of
Wisconsin purchase order by the awarded bidder. The Calendar of Events (Section 2.3) provides the
approximate contract start date.
Options to renew the contract are available for three additional one-year terms. Renewal(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 renewals. Contracts will be reviewed by the DOC
before a decision is made. Any renewal(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
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
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.
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 10 of 60
1.5
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
bidders’ lists or individual notification of vendors on bidder’s lists. In addition, there is no requirement to
post solicitations for bids/proposals in the Legal Notices of the Official State Newspaper. Section 16.75,
Wisconsin Statutes, allows for use of the Internet to post due notice for certain procurements:
http://publicnotices.wi.gov.
Vendors who fail to register with VendorNet or who register or change/add commodity codes after the
posting of a solicitation may not receive notification of procurement solicitations including amendments or
cancellations.
The State of Wisconsin’s purchasing information and vendor notification service, VendorNet, 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
to sell to the state. A registration 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 $50,000. Organizations without Internet access receive paper copies in the mail. Increasingly,
state agencies also are using VendorNet to post simplified bids valued at $50,000 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.
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 11 of 60
2
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 Tom Pierce via telephone at 608-240-5586 or email at
[email protected]
2.2
BID SUBMITTAL
Bidders must submit
 an original bid response (marked as such),
 one (1) additional paper copy of bid response,
 a CD-ROM of the bid response that is an exact duplicate of the above two paper copies
Bidders should see Sections 2.4 and 9 for information on what should be included in their bid
response. Bidders need to take the time to make sure that both paper copies and the CD-ROM of
the bid response all match each other.
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
April 18, 2014 3:00 PM Local Time Any bids received after that time and date will be rejected.
USPS ADDRESS
TOM PIERCE / PURCHASING SERVICES SECTION
DEPARTMENT OF CORRECTIONS
PO BOX 7991
MADISON, WI 53707-7991
*NOTE: Allow an extra day for deliveries to the PO Box address.
COMMON CARRIER ADDRESS
TOM PIERCE / PURCHASING SERVICES SECTION
DEPARTMENT OF CORRECTIONS
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.
DATE
February 18, 2014
March 10, 2014
EVENT
RFB posting date
Last day for submitting written questions
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 12 of 60
March 20, 2014
April 18, 2014
May 6, 2014
June 1, 2014
2.4
Answers to questions posted on VendorNet (estimated)
Bids due from vendors
Estimated award date
Approximate Contract Start date
FORMAT OF BID
Responses to this RFB must comply with the following format requirements (reference Section 9).
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. The
bidder may submit costs for all three locations, one location, or any combination two or
more locations listed on the Request for Bid form (DOA-3070): Burlington; Elkhorn; and
Kenosha.
For each location the bidder chooses to bid on, the bidder must provide the price per group and
extended total for each CBT group listed for that county and provide a Location Bid Total. Bidder
must provide all services requested for each location included in their bid submittal. 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
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.
2.4.5
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.
2.4.6
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.
2.4.7
ADDITIONAL INFORMATION
A listing of required forms and additional required information, including supporting
documentation, is provided in RFB Section 9 Required Forms and Attachments.
Bids that do not include all items listed on this checklist (Section 9) may be rejected.
Italics note all required documentation in the Request for Bid.
The information requested is to verify bidder can meet bid specifications.
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 13 of 60
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 proposal. 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.
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.
JOINT BID
The DOC requires each bid to have one Prime Contractor designated. See RFB Sections 8.1 and 8.2. A
bid submitted from two or more entities that intend to either share or split responsibilities under the
awarded contract may be submitted.
If submitted, the joint bid shall include requested information for each participant, as well as for the entity
(i.e., partnership, joint venture, consortium, new company, etc.) that will be the primary contact for, and
responsible to, the State and the DOC under the awarded contract.
Bidder must clearly indicate within the bid response the specifics of any division or allocation of
responsibilities for each participant.
2.7
INCURRING COSTS
The State of Wisconsin is not liable for any cost incurred by a vendor in the process of responding to this
RFB.
2.8
QUESTIONS, CLARIFICATIONS AND/OR REVISIONS THROUGH DESIGNATED CONTACT
All communications and/or questions regarding this request must be written and submitted via fax, e-mail,
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.
TOM PIERCE / PURCHASING SERVICES SECTION
DEPARTMENT OF CORRECTIONS
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.
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 14 of 60
Each bid shall stipulate that it is predicated upon the terms and conditions of this RFB and any
amendment(s) thereof.
3
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.
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.
The Department also reserves the right to negotiate price with the lowest responsive and responsible
bidder.
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).
Any award without an accepted site after one (1) month will be reviewed for status weekly for one
(1) additional month. Un-sited program or insufficient staff hires after two (2) months may be
considered for rescinding of award unless otherwise authorized by Contract Administrator.
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).
3.5
DISABLED VETERAN-OWNED BUSINESS
Bids from certified Disabled Veteran-Owned Businesses 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.
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 15 of 60
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 $50,000.00 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:
EDWARD F. WALL, 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
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.
The numbers of service units listed are for bidding purposes only.
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.
4.1
FACILITY REQUIREMENT
Program services are required to be located in Burlington, Elkhorn, and Kenosha, WI. The facility/ies shall
have appropriate physical space use plan to reasonably accommodate individual treatment, group
programming, and space to conduct offender interviews, intake and assessments. The Department of
Corrections will make sole determination of an appropriate physical space use plan. The facility in which
services are provided must meet all applicable federal, state and local codes, regulations and
requirements.
The Kenosha location must be accessible to public transportation.
As indicated in Section 3.4, any award without an accepted site after one (1) month will be reviewed for
status weekly for one (1) additional month. Un-sited program after two (2) months may be considered for
rescinding of award unless otherwise authorized by Contract Administrator.
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 16 of 60

4.2
Bidder must submit a description of the physical spaces, which details the space plans, if applicable.
BIDDER AGENCY EXPERIENCE
The bidder agency shall have experience levels that meet providing effective Cognitive Behavioral
Therapy programming to correctional clients and/or human services clients for a minimum of three (3)
years.
Bidder shall provide a list of past contracts, DOC and others, preferably within the last three (3) years 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
Bidder must provide documentation demonstrating that their organization meets the experience
requirements, including past contract information. Include service description, location of service,
number of clients served, outcome evaluation, and contact person with a phone number.
STAFF QUALIFICATIONS AND EXPERIENCE
All staff facilitating groups will have completed required training prior to providing specified services. DOC
shall have final approval of all program staff related to any contract resulting from this competition. During
the contract period, the Contractor will submit updates on all staff changes to the contract administrator
prior to any new staff providing a service.
4.3.1
ADMINISTRATIVE AND FISCAL: Staff responsible for providing administrative and fiscal
services for the program shall have 1) at least a Bachelor’s Degree in human services or business
related field and 2) a minimum of one (1) year of administrative and fiscal services experience,
AND 3) administrative staff shall have a minimum of one (1) year experience in the administration
or supervision of a correctional or human services program.
4.3.2
STAFF SUPERVISION: Person(s) providing supervision of direct-service staff shall have a
Bachelor’s Degree in a human services related field or a minimum of three (3) year(s) providing
supervision to staff in a correctional or human services program. General supervisor to staff
hours ratio 1:20.
4.3.3
DIRECT SERVICE:
Contractor staff facilitating cognitive behavioral therapy groups (including back-up staff and cofacilitator) must meet all of the following qualifications:
1. Facilitators must have a minimum of an Associates or Bachelor’s Degree in a human services
related field.
2. Training in group facilitation techniques.
3. A minimum of two (2) years experience facilitating cognitive based programming.
4. A minimum of two (2) years experience working with the correctional client.
5. A minimum of two (2) years experience facilitating cognitive based programming to
correctional clients of various racial, religious, ethnic backgrounds and individuals who have
disabilities.
6. Shall not currently be on supervision with the Department of Corrections.
7. Complete Contractor’s Boundaries and Professionalism training course, prior to facilitation, as
a first step to maintaining professional relationships with program participants.
8. Staff facilitating groups shall have successfully completed formalized training in the Thinking
for a Change (T4C) curriculum, in-house is acceptable when augmented by outside training
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 17 of 60
opportunities at conferences and other training venues. Formal training and update training
shall have occurred within the past three (3) years and shall continue with each updated
curriculum version released. Video Training of staff alone will not meet the requirement of this
Contract.
9. Trained in Motivational Interviewing (MI) Techniques and Evidence Based Practices (EBP)
with a minimum of 1 year experience to respond to/redirect negative behaviors.

Bidder must provide a list of staff and documentation demonstrating that program staff meets the
qualifications, experience, and training requirements for delivering Cognitive Behavioral Therapy
(CBT) Program Services as specified and described in this staff requirements section (RFB Section
4.3), to include submission of:
 Name(s) of staff person(s), dates and locations of experience and training, and the
names and phone numbers of persons who can verify the experience and training.
 List of staff that clearly identifies direct service staff, person(s) responsible for providing
administrative and fiscal services, person(s) providing supervision of direct staff, and
person(s) providing clinical supervision.
 Staff resumes that identify specific dates, company (including address and phone
number), position description and job responsibilities to verify all staff meets the
qualifications and experience requirements.
 Copies of current certification, licensing, insurance and/or training including supervision
plan, if applicable.

If staff positions are pending hire, Bidder must 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. As indicated in Section 3.4, insufficient staff hires after two (2) months may be
considered for rescinding of award unless otherwise authorized by Contract Administrator.
4.4
PROGRAM DESCRIPTION
The purpose of the Cognitive Behavioral Therapy (CBT) Program is to provide cognitive intervention
education to adult male and female DCC offenders. The contractor shall begin with a reviewing the
COMPAS risk assessment included with the referral (DOC-1336) to determine which dynamic risk factors
related to criminal re-offense each client most needs to focus on during the program. Assignment will be
made to a CBT group that will emphasize a cognitive behavioral approach to encouraging offender
change through motivational enhancement techniques. The expected length of offender involvement in
the program is 12 1/2 weeks; 25 sessions of group participation. All participants will be individually prescreened by the contractor before commencing programming. The cost of the pre-screening shall be
rolled into the per group cost of 25 sessions. Groups will meet twice a week.
Total number of offenders to be served during each contract period will depend on program site. The
program shall be secular in nature and open ended, based on the National Institute of Corrections (NIC)
developed and researched “Thinking for a Change” 3.0/3.1 curriculum.
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 18 of 60
DCC supervises individuals who have a history of criminal behavior. Several factors are noted to be
essential to program success as measured by the difference in recidivism between treatment and control
groups. The ultimate goal Cognitive Behavioral Therapy Program groups are to protect the community
from criminal behavior by reducing the offender’s risk of re-offense.
Participants will gain the following knowledge, skills, and abilities:
 Participants can identify irrational thoughts and antisocial thinking
 Challenge beliefs
 Replace distorted thoughts and beliefs with rational thought
 Change behavior. For example: decrease the frequency and severity of criminal behaviors in the
community setting
 Reduce recidivism and rule violations
 Increase their level of personal achievement
To accomplish these goals, the program will teach offenders cognitive restructuring techniques and
interpersonal social skills that promote:
 Movement through the stages of change.
 Modification of the beliefs and thoughts that support criminal behavior and victimization
 Increased impulse control and problem solving skills
4.4.1
GROUP REQUIREMENTS
The following provisions are required for all services:
1) At the onset of offender program participation, the contractor staff shall inform offenders of
the group facilitator’s duty to warn, and communication obligation to DOC. The facilitator shall
have the offender sign a waiver of confidentiality to allow information to be shared with DCC
or other criminal justice/social service agencies that have a need to know.
2) The contractor staff shall be willing to address community safety issues and cooperate with
DOC staff to monitor risk. The contractor shall report lapses, violations, and when the
offender is in a high-risk situation to the supervising agent within one working day.
3) The contract staff shall agree to accept subpoenas and sign admissions of service of such
subpoenas to appear at revocation and court hearings if requested by the Department of
Corrections or its employees or agents.
RFB # TP-4527
CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 19 of 60
4) For evaluation purposes, the contract staff shall be willing to have group treatment observed
and evaluated by a DOC representative.
5) All groups shall follow the characteristics consistent with program efficacy per Exhibit 6.
6) Contractor is responsible to develop strategies to address gender responsivity.
7) The contract staff shall demonstrate an ability to be assertive and non-punitive toward
offenders. Staff shall have a written policy addressing the implementation and use of
punishers and reinforcers, as well as and electronic system for tracking the delivery of the
behavioral modification methods. Staff training in the application of these behavior
modification tools shall be documented.
8) Groups will NOT be co-facilitated with a staff person from DOC.
9) Program workbooks will be retained by program participants after program completion.
10) Program groups are 2 hour sessions with a single 10 minute break which will be monitored by
contract staff.
11) Group size shall not be less than eight (8) and no more than twelve (12) participants.
Exceptions to the minimum group size requirement will require prior approval from DOC staff.
12) The program shall be open-ended to provide the ability to enroll offenders at various points
throughout the treatment group cycle. Groups will allow offender entrance at sessions 1, 6,
11 and 16. Single cycle locations may not be available to offenders entering mid-cycle.
13) Group services may be required to be offered during non-traditional business hours and on
Saturday. Actual group starting time shall be negotiated with the Contract Administrator but
changes in class dates and starting times shall not be implemented sooner than thirty (30)
days from written approval of DOC to avoid offender scheduling conflicts.
14) Accommodations may be required for specific populations of offenders based upon the
following: intelligence under IQ of 80, gender, race/ethnicity, motivation to change, and
personality or mental disorder.
15) Groups shall be comprised of only offenders supervised by DOC.
16) All participants will be individually pre-screened by the contractor staff before commencing
programming. Treatment plan will be developed based on the screening and written with
offender input.
17) All program services shall be secularly based. Program content, materials and self-help
support groups employed in the delivery of treatment to the offender must comply with the
requirements of Kerr v. Farrey, 95 f.3d 472 (1996) and DCC Administrative Directive 01-10,
attached as Exhibit 1.
18) The contractor shall prepare and provide all necessary program materials/equipment to
include, but not limited to, the following:
o TV/DVD/VCR
o Flipchart stand, paper and other office supplies
o Chalkboard or whiteboard with markers
o Lesson plans
o Copy machine and other office equipment as needed
o Computer and software to include Internet access
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CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
Page 20 of 60
19) When services are cancelled or delayed due to inclement weather or other circumstances as
deemed appropriate by DOC, contract staff shall make all reasonable efforts to notify group
participants of group cancelation prior to start time. Cancellation policy shall be approved by
Contract Administrator and provided to group participants within program rules. Groups will
not be held on official state holidays (New Year’s Day, Martin Luther King Jr. Day, Memorial
Day, July 4th, Labor Day, Thanksgiving Day, and Christmas Eve, Christmas Day and New
Year’s Eve Day) or when state offices are closed for observance of a Holiday.
20) Contractor shall have the capability to accept offender referral forms and related documents
electronically.
21) Contract Administrator or designee shall have access to all DCC Offender files and program
groups as they deem necessary. This includes both announced and unannounced visits.
4.4.2
COGNITIVE BEHAVIORAL THERAPY GROUPS – Male
The use of CBT approaches provides the offender with an opportunity to change behavior
patterns and at the same time helps reduce the risk the offender poses on society. The cognitive
approach aims to provide a meaningful opportunity for internal change (vs. external control) and
the opportunity to develop pro-social skills and consequential thinking abilities.
Fifty (50) total program hours plus pre-screening time shall be considered completion standards
for each cycle of CBT conducted. The contractor selected under this solicitation shall conduct 2
sessions each week for twelve and one-half (12 1/2) weeks. Each session will be two (2) hours in
length.
Burlington:
Two (2) cycles x 25 groups/cycle = Fifty (50) total groups anticipated annually.
Elkhorn:
Two (2) cycles x 25 groups/cycle = Fifty (50) total groups anticipated annually.
Kenosha:
Four (4) cycles x 25 groups/cycle = One-hundred (100) total groups anticipated annually.
4.4.3
COGNITIVE BEHAVIORAL THERAPY GROUPS – Female
Female groups will be augmented by gender-responsive material regarding healthy relationships,
childcare concerns, women’s health issues, and other relevant topics as reflective of participant
needs.
Fifty (50) total program hours plus pre-screening time shall be considered completion standards
for each cycle of CBT conducted. The contractor selected under this solicitation shall conduct 2
sessions each week for twelve and one-half (12 1/2) weeks. Each session will be two (2) hours in
length.
Burlington:
One (1) cycle x 25 groups/cycle = Twenty (25) total groups anticipated annually.
Elkhorn:
One (1) cycle x 25 groups/cycle = Twenty (25) total groups anticipated annually.
Kenosha:
Two (2) cycles x 25 groups/cycle = Fifty (50) total groups anticipated annually.
4.4.4
COGNITIVE BEHAVIORAL THERAPY GROUPS – Youthful Offender
Youthful Offender Groups will include DOC offenders ages 18-25. An additional emphasis will be
placed on issues of uniqueness and entitlement.
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CBT Program Services in Burlington, Elkhorn, and Kenosha, WI
Bids Due: April 18, 2014 3:00PM Local Time
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Fifty (50) total program hours plus pre-screening time shall be considered completion standards
for each cycle of CBT conducted. The contractor selected under this solicitation shall conduct 2
sessions each week for twelve and one-half (12 1/2) weeks. Each session will be two (2) hours in
length.
Burlington:
One (1) cycle x 25 groups/cycle = Twenty (25) total groups anticipated annually.
Elkhorn:
One (1) cycle x 25 groups/cycle = Twenty (25) total groups anticipated annually.
Kenosha:
Two (2) cycles x 25 groups/cycle = Fifty (50) total groups anticipated annually.
4.4.5
COGNITIVE BEHAVIORAL THERAPY GROUPS – Special Needs Population
T4C curriculum will be edited by the facilitator so that most material is presented verbally and
couched in language that is understandable to group members.
Fifty (50) total program hours plus pre-screening time shall be considered completion standards
for each cycle of CBT conducted. The contractor selected under this solicitation shall conduct 2
sessions each week for twelve and one-half (12 1/2) weeks. Each session will be two (2) hours in
length.
Kenosha:
One (1) cycle x 25 groups/cycle = Twenty-five (25) total groups anticipated annually.
4.4.6
COGNITIVE BEHAVIORAL THERAPY GROUPS – Sex Offender
Groups shall include sex offenders only and the T4C curriculum edited for special emphasis on
role of cognitive distortions and habitual pattern of behavior in relation to sexual offending and reoffense prevention.
Fifty (50) total program hours plus pre-screening time shall be considered completion standards
for each cycle of CBT conducted. The contractor selected under this solicitation shall conduct 2
sessions each week for twelve and one-half (12 1/2) weeks. Each session will be two (2) hours in
length.
Burlington:
One (1) cycle x 25 groups/cycle = Twenty (25) total groups anticipated annually.
Elkhorn:
Two (2) cycles x 25 groups/cycle = Fifty (50) total groups anticipated annually.
Kenosha:
Three (3) cycles x 25 groups/cycle = Seventy-five (75) total groups anticipated annually.
4.4.7
POSSIBLE EXPANSION OF CBT GROUP SERVICES
During the course of the resulting contract(s) it is possible that the type of CBT groups needed in
one or more of the cities of Burlington and Elkhorn locations included in this RFB may change.
DOC, at its discretion, may request that the contractor for the cities of Burlington and Elkhorn
location provide these groups. If the contractor agrees to provide CBT group services not
included on the DOA-3070 (cover page) for a specific cities of Burlington and Elkhorn location,
then the price per group cannot exceed the other CBT group rate(s) for that city location. In the
event that the city Burlington and Elkhorn location contractor is not interested/available and there
is more than one awarded contractor, then DOC, at its discretion, may consider the contractor(s)
for the other city Burlington and Elkhorn locations and those CBT group rates. However, a bidder
shall not expect that the DOC will request to expand the CBT services specified in this RFB.
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4.5
INTAKE/PROGRAM/DISCHARGE PROCEDURES
4.5.1
INTAKE PROCEDURES
The contractor shall develop referral/intake procedures in cooperation with the Contract
Administrator. The contractor staff shall conduct an individual pre-screening on all participants
before commencing programming. This pre-screening shall set the tone of the learning lessons,
direct and focus participants to the usefulness of the program in their own lives, and set
expectations that positive participation would greatly enhance their options.
If the contractor rejects an offender, this shall be discussed with DCC staff to determine if the
program can be modified to address the specific offender needs.
The contractor shall have each offender complete the necessary releases of information and shall
give each offender a copy of the program rules and expectations.
The contractor staff shall send copies of the intake summary, pre-test and recommendations to
the referring DCC staff person within 10 working days of intake interview.
4.5.2
PROGRAM RULES
Contractor shall give each offender a copy of the program rules and expectations.

Bidder must provide a copy of written program rules.
REMINDER: Bids that do not include all items listed on the Section 9 checklist may be rejected.
4.6
4.5.3
PROGRAM COMPLETION
Completion of the program will not be based on length of time spent in the program. Termination
will be defined by the offender’s progress in acquiring pro-social behaviors, attitudes, and beliefs.
Documentation of offender progress shall be through a combination of the following:
 A behavioral assessment instrument
 A checklist of behavioral/attitudinal criteria
 Completion of a detailed treatment plan
 Phase advancements
 Acquisition of new skills or behaviors while in the program
4.5.4
COMPLETION/TERMINATION
The contractor shall develop completion and termination procedures in cooperation with DCC staff
for offenders completing or exiting group services. The contractor shall inform the referring DCC
staff of the intent to “unsuccessfully” terminate an offender from treatment prior to termination.
Within ten (10) days of offenders successful and within five (5) days of offender’s unsuccessful
discharge from the program the Contractor shall provide the referring DOC staff person with a
discharge summary and post-test results.
LENGTH OF PROGRAM PARTICIPATION
All program types (4.4.2 through 4.4.6) shall have fifty (50) total program hours to be considered
completion standard for each cycle of Cognitive Behavioral Therapy Groups in addition to the Intake
Interview which will be completed outside of program hours. The contractor selected under this
solicitation shall conduct two (2) sessions each week for twelve and one-half (12 1/2) weeks, each session
will be two (2) hours in length with periodic review sessions as scheduled within the curriculum
4.7
NUMBER OF SERVICE UNITS
Under any agreement resulting from this solicitation, units of service are defined as follows:
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4.7.1
COGNITIVE BEHAVIOR THERAPY GROUP – Male
One 2 hour group session of direct service provided as defined in 4.4.2 with documentation to
referring agent/DOC liaison.
4.7.2
COGNITIVE BEHAVIOR THERAPY GROUP – Female
One 2 hour group session of direct service provided as defined in 4.4.3 with documentation to
referring agent/DOC liaison.
4.7.3
COGNITIVE BEHAVIOR THERAPY GROUP – Youthful Offender
One 2 hour group session of direct service provided as defined in 4.4.4 with documentation to
referring agent/DOC liaison.
4.7.4
COGNITIVE BEHAVIOR THERAPY GROUP – Special Needs Population
One 2 hour group session of direct service provided as defined in 4.4.5 with documentation to
referring agent/DOC liaison.
4.7.5
COGNITIVE BEHAVIOR THERAPY GROUP – Sex Offender
One 2 hour group session of direct service provided as defined in 4.4.6 with documentation to
referring agent/DOC liaison.
4.8 REPORTING AND EVALUATION REQUIREMENTS
4.8.1
PREPARATION, RECORD KEEPING, AND REPORTING
A. Agent of record, program liaison, and/or other designees must be included in distribution of
written reports
B. An individual intake interview must be completed within prior to a participants commencement
of programming.
C. Progress reports will be completed every month and submitted by the 10th of the following
month.
D. Cooperate fully in Department efforts to evaluate and improve programming (See Program
Evaluation Requirements)
E. Contractor shall provide a written, legible copy or e-mail listing of the attendance for each
group within 24 hours from the start of each group.
4.8.2
REPORTING ON INDIVIDUAL OFFENDERS
4.8.2.1 INTAKE SUMMARY
The program shall provide the referring DOC staff person with an intake summary within
10 working days of the offender’s screening.
4.8.2.2 DISCHARGE SUMMARY- The program shall provide the referring DOC staff person with
discharge summary and post-test results within ten (10) days of offenders successful and
within five (5) days of offender’s unsuccessful discharge from the program.
PROGRAM DISCHARGE SUMMARY REPORT FORMAT
a. Discharge status
b. Program entry and discharge dates
c. Brief description of program
d. Offender’s alcohol/drug use patterns, negative impact on life and prior treatment
history, if applicable
e. Identification of offender’s assets/strengths
f. Pre and post-test results
g. Account of offender’s effort and progress toward goals
h. Identification of significant problem areas not addressed in program
i. Identification of any continuing treatment needs and recommendations to address
them
j. Relapse Prevention Plan including Aftercare/Continuing Care recommendations
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k.

Prognosis/Risk for further use and criminality as a result of offender participation
Bidder must provide a copy of the format to be used for the discharge summary report which
addresses items a through j in RFB Section 4.8.2.2.
4.8.2.3 PROGRESS REPORTS- Reports will be delivered within ten (10) days after the end of
each month. The contractor shall provide a written monthly progress report beginning
after four weeks of programming for each participating offender. At a minimum, the
report shall include the documentation based on the following: (1) Demonstration of skills
based self-report (e.g. Thinking Reports) and/or in-group role plays, (2) Knowledge of
Cognitive Behavior Program concepts based on homework and/or testing, (3) Other
reports by staff, (4) Attendance, (5) Class Participation and (6) Status of Co-pay
Obligations.

4.8.3
Bidder must provide a copy of the format to be used for the progress report.
OTHER REPORTS
4.8.3.1 LAW VIOLATIONS- The contractor shall notify the referring DOC staff or other available
DOC staff if a participant is in violation of the law. This notification shall take place as
soon as possible and no later than 24 hours, subsequent to receiving information
concerning the law violation.
4.8.3.2 INCIDENT REPORTS - 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.
4.8.3.3 AD HOC REPORTS- Upon request, the contractor shall provide to DOC staff reports on
offenders served in the program when needed by the courts, for revocation procedures
and/or other Departmental processes.
4.8.3.4 FEDERAL REPORTS- Resulting contracts using Federal Block Grant funds will be
required to complete additional state and federal reports, as necessary.
4.8.4
PROGRAM REPORTING
4.8.4.1 REFERRAL FOR SERVICES (DOC 1336) - The contractor shall submit a completed
Referral for Services form for each offender referred by DOC for service. These forms
with Part B Intake Decision completed 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.
4.8.4.2 CLIENT REPORT MONTHLY (DOC 1088) - The contractor shall submit a completed
Client Report Monthly to report data on offenders served each month and their payment
of offender fees. This report shall be submitted within five (5) days of the last day of
the month during which service was provided. The form will be completed in its entirety
prior to submission. A copy of this form is attached as Exhibit 3.
4.8.4.3 UNIT SERVICE MONTHLY REPORT (DOC 1026) - The contractor shall submit a
completed Unit Service Monthly Report DOC-1026 to report and certify the number of
units of service provided each month and the amount of offender fees collected each
month. This report shall be submitted within five (5) working days of the last day of
the month during which service was provided. The form shall be completed in its entirety
prior to submission, including dated signature, or there may be a delay in processing the
form for payment of services. A copy of this form is attached as Exhibit 4.
4.8.4.4 PROGRAM EVALUATION – Program evaluation is intended to return useful information
to program sites for the purpose of program improvement.
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4.8.4.4.1
Contractors delivering services to offenders shall prepare for and cooperate
with evaluation efforts initiated by the Department including long-term results
of offenders discharged from the program. The Correctional Program
Checklist (CPC) will be used as the evaluation tool to assess the extent to
which correctional treatment programs adhere to the known principles of
effective intervention. It is designed to evaluate the integrity of a program, not
outcomes. It is not the intent of the evaluation process to terminate any
program, however, lack of improvement action may result in notice of
termination. CPC steps are attached as Exhibit 5.
4.8.4.4.2
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. Outcome reports shall be submitted every 6 months 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 referred.
 Number of offenders accepted.
 Number of offenders completing the level of program.
 Number of offenders needing no further programming
 Number of offenders who do not complete the program and why.
 Number of offenders returning to the program including the period of time
after leaving the program.
 Goals for future contract years.
 Identify obstacles contractor has that need resolution with DOC input.
Contractor is expected to survey offenders currently active in group services.
These written surveys shall be completed at least one (1) time for every cycle
of service delivered, not to include at discharge. Feedback surveys are
expected to examine (at minimum) on:
1. Targeted behaviors
2. Dynamic risk factors
3. Using validated instruments
4. Utilize the information to drive programming and add information to
dynamic case plans.
A written summary specifically addressing these requirements shall be sent to
the Department within ten (10) days of the implemented offender survey.
5.0

Bidder must indicate whether your organization has an existing system for
documenting and managing client-level information. If your organization has an
existing system for documenting and managing client-level information, bidder must
provide an overview of the system, including details on the established internal
standards of practice regarding service delivery and what pre/mid/post testing scoring
is gathered, and whether it is in electronic or paper format.

Bidder must provide the name of your staff person who will be the contact person
responsible for coordinating with DOC and evaluation staff.
PERFORMANCE REQUIREMENTS
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5.1
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 contracted program.
5.2
TRAINING OBSERVATION AND GROUP ACCESS
DOC Contract Administrator shall be allowed observation of training sessions and attendance during any
group session as deemed necessary by DOC.
6.0 SUPPORT REQUIREMENTS
6.1.
COLLECTION OF OFFENDER FEES
6.1.1 Contractor shall collect fees from program participants or via third party payments. Program
participants who are employed or who receive other public or private funds will be expected to
contribute toward program costs. Collection should take place outside of group session hours.
The DCC Contract Administrator shall provide the scale for determining the amount of offender
fees.
NO OFFENDER WILL BE DENIED SERVICES BECAUSE OF INABILITY TO PAY.
6.1.2
Offenders shall be provided written fee collection requirements at the program start including the
specific total amount of fees required while in program. Offenders shall receive a written receipt
from contract staff whenever a fee is paid and contractor will balance that fee receipt book
monthly in order to show individual monthly totals for DCC invoicing purposes.
6.1.3
The amount of these collections will be reported on the DOC-1026 Unit Service Monthly Report
(Exhibit 4), for the month in which the fee was paid, and deducted from the amount reimbursable
to the contract agency by the DCC.
6.2 INVOICING / PAYMENT REQUIREMENTS
Contractor must agree that all invoices 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 which is a funding
source for this service). 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
date of service(s)
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.
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7.0
8.0
COST INFORMATION
7.1
FIRM PRICES
Prices must remain firm for the initial contract term.
7.2
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
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.
7.3
Bidders must submit cost on the Request for Bid Form (DOA-3070). Refer to RFB Section 2.4.2 for Cost
Submittal Information.
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.
SPECIAL TERMS AND CONDITIONS
8.1
8.2
SUBCONTRACTING
Any Contract resulting from this bid shall not be, in whole or in part, subcontracted, assigned/referred, or
otherwise transferred to any other Contractor without prior written approval by Purchasing Services.
8.1.1
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.
8.1.2
Contractor must assure subcontractors abide by all terms and conditions under this Contract.
8.1.3
If subcontractors are to be used, the Contractor must clearly explain their participation.
PRIME CONTRACTOR: MINORITY BUSINESS SUBCONTACTORS AND DISABLED VETERANOWNED 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 Office of 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.
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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 Office of Business Development and
their contract amount.
The Wisconsin Office of Business Development also certifies disabled veteran-owned businesses and
supplier/contractor should also include the identities of such businesses in their quarterly information.
Quarterly reports shall be due fifteen (15) calendar days after the end of the quarter, 9/30, 12/31, 3/31 and
6/30. The form for submitting this information is available from the VendorNet Department of
Administration Forms 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, Minority Business Program, (608) 267-3293. The listing is
published on the Internet at: http://www.doa.state.wi.us/mbe/report2.asp?locid=0 .
A directory of certified disabled veteran-owned business can be accessed via this website:
http://commerce.wi.gov/BusinessDirectory/. Information about the Disabled Veteran-Owned Business
Program is available from the Department of Administration, (608) 267-3293.
8.3
AFFIRMATIVE ACTION
All contracts of more than Fifty Thousand Dollars ($50,000) require the submission of a written affirmative
action plan. Contractors with an annual workforce of less than twenty-five employees are excluded from
this requirement. 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:
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
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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.
8.4
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
8.5
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.
8.6
CONFIDENTIALITY
In addition to Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations on medical
record privacy (45 CFR, parts 160 & 164), the department considers all personally identifiable information
relating to offenders to be confidential, and such data is not to be released unless approved by the DOC.
8.7
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 contracted cost per group or line
item for each failure to deliver the program according to the mandatory requirements of the bid and
subsequent contract with statement of deliverables. Liquidated damages will be deducted from payments
on 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. All liquidated damage letters will be generated by the Contract Manager
or Purchasing designee.
8.7.1
CONTRACTOR APPEALS PROCESS
In the event liquidated damages are assessed the contractor will be given an opportunity to
appeal the damages by using the following process:
o
o
o
o
Respond to the DOC Contract Manager’s liquidated damage letter.
Contract Manager responds back after consulting with the program.
If contractor is still not satisfied, the contractor appeals to the Division Administrator.
If the contractor is not satisfied with the Division Administrator’s response, the contractor can
appeal to the State of Wisconsin Claims Board.
NOTE: Each party gets 10 business days to respond between steps unless otherwise agreed.
8.8
EMPLOYMENT OF CURRENT OFFENDERS AND EMPLOYMENT AND RETENTION OF
INDIVIDUALS ARRESTED, CHARGED OR CONVICTED OF CRIMINAL OFFENSE
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8.8.1
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.
8.8.2
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; and
e) For a job applicant who is required to use an Ignition Interlock Device (IID): Where the
circumstances of said court ordered requirement substantially relate to the circumstances
of a particular job or licensed activity, the applicant will not be hired for that job; and
f)
For a current employee who is required to use an Ignition Interlock Device (IID): Where
the circumstances of said court ordered requirement substantially relate to the
circumstances of a particular 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.
8.8.3
8.8.4
8.9
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.
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.
FRATERNIZATION
8.9.1 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.
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8.10
8.9.2
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.
8.9.3
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.
8.9.4
Contractor shall maintain a copy of the signed employee statement on fraternization and sexual
contact in each employee's personnel file.
CONTRACTOR AUDIT REQUIREMENT
8.10.1 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.
8.10.2 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.
8.10.3 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.
8.10.4 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.
8.10.5 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.
8.10.6 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.
8.10.7 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.
8.11
FAITH-BASED AND CHARITABLE ORGANIZATIONS
8.11.1 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
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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.
8.11.2 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
government funds provided under the Contract, then only the financial assistance provided by
these funds will be subject to audit.
8.11.3 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.
8.11.4 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.
8.12
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.
8.13
CONFIDENTIALITY AND HEALTH INSURANCE PORTABILITY ACCOUNTABILITY
In addition to Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations on medical
record privacy (45 CFR, parts 160 & 164), the department considers all personally identifiable information
relating to offenders to be confidential, and such data is not to be released unless approved by the DOC.
8.13.1 DEFINITIONS
Designated Record Set:
(1) A group of records maintained by or for a covered entity that is:
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(i) The medical records and billing records about individuals maintained by or for a covered health
care Contractor;
(ii) The enrollment, payment, claims adjudication, and case or medical management record systems
maintained by or for a health plan; or
(iii) Used, in whole or in part, by or for the covered entity to make decisions about individuals.
(2) For purposes of this Contract, the term record means any item, collection, or grouping of information
that includes protected health information and is maintained, collected, used, or disseminated by or for
a covered entity.
Disclosure - the release, transfer, provision of access to, or divulging in any other manner of information
outside the entity holding the information.
Incident - a use or disclosure of PHI by the Contractor or subcontractor not authorized by this Contract or
in writing by the Department. This definition includes any attempted, successful or unsuccessful,
unauthorized access, modification, or destruction of PHI, including electronic PHI, or interference with the
operation of any information system that contains PHI.
Individual - the person who is the subject of PHI or the personal representative of the individual, as defined
and provided for under applicable provisions of HIPAA.
Protected Health Information or “PHI” - Individually identifiable health information in any form or medium,
including demographic information, created, received, maintained, or transmitted by the Contractor, on
behalf of the Department, where such information relates to the past, present, or future physical or mental
health or condition of an individual, the provision of health care to an individual, or the payment for the
provision of health care to an individual, and where such information identifies the individual or provides a
reasonable basis to believe that it can be used to identify an individual.
PHI excludes individually identifiable health information in education records covered by the Family
Educational Rights and Privacy Act (FERPA) and employment records held by the Department in its role
as employer.
8.13.2 Prohibition on Unauthorized Use or Disclosure of PHI
The Contractor shall not use or disclose any PHI except as permitted or required by the Contract
or this Agreement, as permitted or required by law, or as otherwise authorized in writing by the
Department.
8.13.3 Permitted Use and Disclosure of PHI
The Contractor may use or disclose PHI only:
a. For the delivery of the services, program management, activities, or functions contracted for in
the Contract; or
b. For meeting contractual or legal obligations as established in any agreements between the
parties evidencing their business relationship; or
c. As permitted by HIPAA if such use or disclosure were made by the Department or otherwise
required by applicable law, rule or regulation; or
d. For use in the operations of the Contractor as provided in paragraph 4 of this Contract; or
e. As otherwise authorized by the Department in writing; or
f. For data aggregation for the health care operations of the Department.
8.13.4 Use of PHI in Contractor Operations
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The Contractor may use or disclose PHI as necessary for the delivery of the services or programs
provided for in the Contract, including appropriate management and administration of programs or
services, or to fulfill the contractual or legal obligations of the Contractor provided:
a. The disclosure is permitted or required by law; or
b. The Contractor obtains reasonable assurances, evidenced by a written contract, from any
person or organization to which the Contractor will disclose PHI that such person or
organization shall:
(i) Hold all PHI in confidence and use or further disclose it only for the purpose for which the
Contractor disclosed it to the person or organization, or as required by law; and
(ii) Notify the Contractor, who will in turn promptly notify the Department, of any instance of
which
the person or organization becomes aware that PHI was improperly disclosed.
8.13.5 Safeguarding and Maintenance of PHI
a. The Contractor will develop, implement, maintain, and use:
(i) Reasonable and appropriate administrative, technical, and physical safeguards to prevent
improper use or disclosure of PHI, in any form or medium; and,
(ii) Reasonable and appropriate administrative, technical, and physical security measures that
protect the confidentiality, integrity and availability of electronic PHI that it creates,
receives, maintains, or transmits on behalf of the Department.
b. The Contractor will document PHI safeguards and security measures and agrees to provide the
Department with access and review of this documentation if requested by the Department or an
agent of the Department. Security measures employed by the Contractor must be sufficient to
ensure that the Department is compliant with the HIPAA privacy and security requirements for
those covered services, activities, or functions performed on behalf of the Department on or
before the date such requirements become effective.
c. The Contractor agrees to conduct an accurate and thorough assessment of the potential risks
and vulnerabilities to the confidentiality, integrity, and availability of electronic PHI held by the
Contractor. The Contractor and the Department agree that all costs associated with
performance of these activities will be the responsibility of the Contractor unless the
Department agrees to be responsible for some or all of the costs associated with the
performance of these activities.
8.13.6 Use or Disclosure of PHI by Subcontractors and Agents of the Contractor
The Contractor agrees to require any agent, including subcontractors, to whom the Contractor
provides PHI to comply with the same restrictions and conditions applicable to the Contractor with
respect to PHI. Contractor further agrees to ensure that any agents or subcontractors, to whom
the Contractor provides PHI received from, or created or received by the Contractor on behalf of
the Department agrees to the same restrictions and conditions applicable to the Contractor with
respect to such information. This provision does not apply to the use or disclosure of PHI by
subcontractors that provide health care treatment to individuals or to other persons or
organizations that have entered into an Organized Health Care Arrangement (OHCA) as provided
for under the provisions of HIPAA.
8.13.7 Compliance with Electronic Transactions and Code Set Regulations
If the Contractor conducts any HIPAA-covered standard electronic transactions on behalf of the
Department, the Contractor will comply with the applicable provisions of HIPAA for such standard
transactions. The Contractor will likewise require any subcontractor or agent conducting any
standard electronic transactions on behalf of the Contractor, for services or programs covered by
the Contract, to comply with the applicable provisions of HIPAA relating to standard transactions.
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a. General requirements.
(i) If any entity requests the Contractor to conduct any of the standard electronic transactions,
the Contractor must comply with the request
(ii) The Contractor may not delay or reject a transaction, or otherwise adversely affect or
impact the other entity or the transaction submitted, because the transaction is a standard
electronic transaction
(iii) The Contractor may not reject a standard electronic transaction on the basis that it contains
data elements not needed or used by the Contractor (e.g., coordination of benefits data
elements)
(iv) The Contractor may not offer an incentive to a health care Contractor to conduct a covered
transaction through direct data entry rather than as a standard electronic transaction
(v) The Contractor, which is operating as a health care clearinghouse, or requiring an entity to
use a health care clearinghouse to receive, process, or transmit standard electronic
transactions, may not charge fees or impose costs in excess of the fees or costs for
normal telecommunications that
the entity incurs when it directly transmits, or
receives, a standard electronic transaction to, or
from, the Contractor.
b. The Contractor will not enter into, or permit its subcontractors or agents to enter into, any
contract related to the conducting of standard electronic transactions for or on behalf of the
Department that:
(i) Changes or modifies the definition, data condition, or use of a data element or segment in
an implementation specification; or
(ii) Adds any data elements or segments to the maximum defined data set; or
(iii) Uses any code or data elements that are marked “not used” in the implementation
specification or are not contained within the implementation specification; or
(iv) Changes the meaning or intent of any implementation specification.
c. If the Contractor receives a standard electronic transaction and coordinates benefits with
another health plan, it must store the coordination of benefits data it needs to forward the
standard electronic transaction to the other health plan.
8.13.8 Access to PHI
At the request of the Department, the Contractor agrees to provide access to PHI held by the
Contractor that the Department has determined to be part of the Designated Record Sets of the
programs covered by the Contract. Access to PHI will be provided to the Department or to an
individual as directed by the Department to comply with applicable HIPAA requirements. The
Department may delegate to the Contractor responsibility for performing any or all obligations
related to the Designated Record Set, including those activities required under HIPAA to permit an
individual to exercise his or her HIPAA privacy rights.
8.13.9 Amendment or Correction to PHI
At the direction of the Department, the Contractor agrees to amend or correct PHI that the
Department determines is included in the Designated Record Set held by the Contractor. The
Contractor agrees to complete any amendment or correction to PHI in accordance with HIPAA
requirements.
8.13.10 Reporting of Incidents to the Department by Contractor
The Contractor agrees to inform the Covered Entity of any incident covered by this Contract within
five (5) business days of becoming aware of the incident. The Department, at its discretion, may
require a written report. If the Department requests a written report, the Contractor agrees to
forward the report to the Department not more than five (5) business days after such request is
made. Written and verbal reports of incidents will include:
a. A complete description of the circumstances of the incident;
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b. The name of persons assigned to review and investigate the incident;
c. A description of all PHI used or disclosed during the incident;
d. The names of persons and organizations involved in the incident;
e. The actions the Contractor has undertaken or will undertake to mitigate any harmful effect of
the incident; and,
f. A corrective action plan that includes steps the Contractor has taken or will take to prevent
future similar incidents from occurring.
8.13.11 Mitigating Effect of Unauthorized Disclosures or Misuse of PHI
The Contractor agrees to mitigate, to the extent practicable, any harmful effect known to the
Contractor created by an improper use or disclosure of PHI by the Contractor in violation of the
requirements of this Contract.
8.13.12 Statutory Duty of the Department to Report Material Breaches by Contractor to Secretary
of United States Department of Health and Human Services (HHS)
Contractor and the Department agree that if the Contractor engages in a pattern of activity or
practice that constitutes a material breach or violation of this Contract, and the Department
becomes aware of such pattern or practice, the Department is required to take reasonable steps
to cure the breach or end the violation, as applicable, and, if such steps are not successful and
termination of the Contract is not feasible, the Department is required to report the problem to the
Secretary of HHS.
8.13.13 Tracking and Accounting of Disclosures of PHI by the Contractor
a. The Contractor agrees to track disclosures of PHI as required by the applicable provisions of
HIPAA and applicable Wisconsin laws. Specifically, the Contractor agrees that it will maintain
a record of all PHI disclosures made to third parties, except as provided for by the subsections
to this paragraph below. The Contractor agrees that the following information will be recorded:
(i) The date the PHI was disclosed;
(ii) The name and address, if known, of the person or entity that the PHI was disclosed to;
(iii) A brief description of the PHI disclosed; and
(iv) A brief statement describing the purpose for the disclosure.
b. For repetitive disclosures that the Contractor makes to the same person or entity for a single
purpose the Contractor will provide:
(i) The disclosure information as specified in paragraph 13(a)(i-iv) of this Contract for the first
of such repetitive disclosures;
(ii) The frequency, periodicity or number of such repetitive disclosures; and
(iii)The date of the most recent of such repetitive disclosures.
c. The Contractor will make the record of disclosures available to the Department within five (5)
business days after receiving a request by the Department.
d. Exceptions from Disclosure Tracking.
The Contractor is not required to track or record disclosures of PHI, or to provide an
accounting of disclosures for PHI meeting the following conditions:
(i) Disclosures of PHI that are permitted under this Contract, or otherwise expressly authorized
by the Department in writing; and
(ii) Disclosures of PHI for the following:
(1) For purposes of treatment, payment or health care operations activity of the
Department;
(2) In response to a request from an Individual who is the subject of the disclosed PHI, or
to that individual’s personal representative;
(3) Made to persons involved in health care or payment for health care of the individual;
(4) For disaster relief notification purposes;
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(5) For national security or intelligence purposes; or,
(6) To law enforcement officials or correctional institutions regarding individuals in
custodial situations.
e. Agreement to Obtain Valid Authorization or Informed Written Consent Prior to Disclosure of
PHI. Contractor agrees to obtain a valid authorization or informed written consent from the
individual that is the subject of the PHI disclosure or a personal representative of such
individual except for those exceptions listed in this Contract or otherwise required by law.
f. Disclosure Tracking Time Periods. Contractor agrees to maintain and make available to the
Department upon its request information on disclosures of PHI made by the Contractor for the
six-year period preceding the request, but not including disclosures made prior to April 2005, or
the date that the Contractor began performing covered services, activities, or functions on
behalf of the Department, whichever is later.
8.13.14 Accounting to the Department and to Government Agencies
The Contractor agrees to make its internal practices, books, and records relating to the use and
disclosure of PHI available to the Department, or to the Secretary of HHS in a time and manner
determined by the Department or the Secretary or designee, for purposes of determining
compliance by the Department with the requirements of HIPAA. Further, the Contractor agrees to
promptly notify the Department of communications with HHS regarding PHI and will provide the
Department with copies of any PHI or other information the Contractor has made available to HHS
under this provision.
8.13.15 Return or Destruction of PHI
Upon termination, cancellation, expiration or other conclusion of this Contract, the Contractor will:
a. Return to the Department or, if return is not feasible, destroy all PHI and any compilation of PHI
in any medium or form. The Contractor agrees to ensure that this provision also applies to PHI
in possession of subcontractors and agents of the Contractor provided to the agent or
subcontractor by the Contractor. The Contractor agrees that any original record or copy of PHI
in any medium is included in and covered by this provision, as are all original or copies of PHI
provided to subcontractors or agents of the Contractor by the Contractor. The Contractor
agrees to complete the return or destruction as promptly as possible, but not more than five (5)
business days after the effective date of termination of this Contract. The Contractor will
provide written documentation evidencing that return or destruction of all PHI has been
completed. Contractor agrees to extend the requirements of this provision to contracts entered
into with subcontractors and agents that create, receive, or maintain PHI on behalf of the
Contractor.
b. If the Contractor believes that the return or destruction of PHI is not feasible, the Contractor
shall provide written notification of the conditions that make return or destruction not feasible. If
the Contractor and the Department agree that return or destruction of PHI is not feasible, the
Contractor shall extend the protections of this Contract to PHI and prohibit further uses or
disclosures of the PHI of the Department without the express written authorization of the
Department. Subsequent use or disclosure of any PHI subject to this provision will be limited to
the use or disclosure that makes return or destruction not feasible.
8.14
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).
8.15
CARRYING A CONCEALED WEAPON
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Contractor agrees to have a written policy addressing the concealed carry law which prohibits the
possession of any weapon by Contractor's employees while providing services to DOC offenders. The
policy must be substantially equivalent to the Department of Corrections' policy as expressed in Executive
directive 80, signed October 31, 2011. A copy of Executive Directive 80 may be obtained from the
Contract Administrator.
9.0
A.
Contractor must maintain a copy of the signed employee statement on concealed carry in each
employee's personnel file.
B.
Contractor will prohibit firearms/weapons in any owned, leased/rented, or available location in
which program services are provided for DOC. Signs shall be posted at every public entrance.
Each sign must be at least five inches by seven inches state the restriction on carrying a firearm,
and inform people that weapons or firearms are prohibited. Sample signage will be available
through the Contract Administrator.
REQUIRED FORMS AND ATTACHMENTS
The following forms must be completed and submitted with the bid response.
Bids that do not include all items listed on this checklist may be rejected.
FORMS:
Request for Bid Form (DOA-3070) - cover sheet, first page of this RFB
Vendor Information Form (DOA-3477)
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 TO BE INCLUDED IN BID SUBMITTAL:
 Documentation of facility and physical space use plan as specified in RFB Section
4.1. If applicable, indicate distance proposed facility is from public transportation.
 Documentation of agency experience requirement with past contracts and
references as specified in RFB Section 4.2.
 Documentation of staff qualification and experience requirements and references as
specified in RFB Section 4.3. If staff positions are pending hire, submit recruitment
plan and job description of those pending positions.
 A copy of the written program rules as described in RFB Section 4.5.2
 A copy of format for the Discharge Summary Report as specified in RFB Section
4.8.2.2.
 A copy of format for Progress Report as specified in RFB Section 4.8.2.3
 Indicate whether your organization has an existing system for documenting and
managing client-level information as outlined in RFB Section 4.8.4.4. If so, provide
details on the established internal standards of practice regarding service delivery and
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assessment, what pre and post testing scoring is gathered, 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 as specified in RFB Section 4.8.4.4.
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.
TP-4527
Bid / Proposal #
DOA-3477 (R01/08)
COGNITIVE BEHAVIORAL THERAPY IN
BURLINGTON, ELKHORN, AND
KENOSHA
Commodity / Service
Vendor Information
1.
BIDDING / PROPOSING COMPANY NAME
Phone
(
)
Toll Free Phone
FAX
(
)
E-Mail Address
(
)
Address
2.
City
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
3.
City
State
Zip + 4
Any vendor awarded over $50,000 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
4.
City
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
DIVISION OF ENTERPRISE OPERATIONS
DOA-3027 (R03/2013)
S. 19.36(5), WIS. STATS
RETURN FORM TO:
STATE BUREAU OF PROCUREMENT
101 E. WILSON ST., 6TH FL
P. O. BOX 7867
MADISON, WI 53707
DESIGNATION OF CONFIDENTIAL AND PROPRIETARY INFORMATION
The attached material submitted in response to Bid/Proposal # TP-4527 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
Type or Print
Date
This document can be made available in alternate formats to individuals with disabilities upon request.
Division of State Agency Services
State Bureau of Procurement
State of Wisconsin
Department of Administration
DOA-3333 (R03/2004)
1.1.1
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
Commodity/Service
COGNITIVE BEHAVIORAL THERAPY IN BURLINGTON, ELKHORN, AND KENOSHA
State
)
ZIP + 4
Request for Bid/Proposal Number
RFB # TP-4527
This form can be made available in accessible formats upon request to qualified individuals with disabilities.
STATE OF WISCONSIN
DEPARTMENT OF ADMINISTRATION
DIVISION OF ENTERPRISE OPERATIONS
DOA-3478 (R06/2013)
STATE BUREAU OF PROCUREMENT
101 E. WILSON ST. / P. O. BOX 7867
MADISON, WI 53707-7886
(608) 266-2605 / FAX (608) 267-0600
TP-4527 COGNITIVE BEHAVIORAL
Bid / Proposal #
THERAPY IN BURLINGTON,
ELKHORN, AND KENOSHA
VENDOR REFERENCE
FOR VENDOR:
Provide information on business reference (name of company/organization/client, address, contact person, telephone
number, email address) and appropriate details on the service(s) provided for four (4) or more references 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
Email Address
Description and Dates of Service(s) Provided:
Phone No.
Company Name
Address (include Zip + 4)
Contact Person
Email Address
Description and Dates of Service(s) Provided:
Phone No.
Company Name
Address (include Zip + 4)
Contact Person
Email Address
Description and Dates of Service(s) Provided:
Phone No.
Company Name
Address (include Zip + 4)
Contact Person
Email Address
Description and Dates of Service(s) Provided:
Phone No.
This document can be made available in accessible formats to qualified individuals with disabilities.
* IMPORTANT:
References may be contacted to confirm the Bidder’s abilities, qualifications, and experience as stated in the Bidder’s
Response. The Department of Corrections may perform due diligence by contacting any applicable business reference, including
references within the Department or other state agencies. The Department of Corrections reserves the right to disqualify any Bidder
whose references do not support their stated claim of qualifications and experience in their bid response.
Exhibit 1
EFFECTIVE DATE
WISCONSIN
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
July
DOC-1356 (Rev. 05/96)
PAGE 1 OF
2001
New
ORIGINATED BY
Administrative Directive 01-10
Replaces 99-15
1.2
SUBJECT:
DISSEMINATION
X
1
MANUAL REFERENCE
1.1.1.1.1.1.1
x Revision
William J. Grosshans,
Administrator
Kerr v. Farrey
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
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1336 (Rev. 10/2013)
EXHIBIT 2
REFERRAL FOR SERVICES
PART A - REFERRAL FOR SERVICES - Completed by Referring Agent
PROGRAM NAME and LOCATION:
OFFENDER FEE PER GROUP
REFERRAL DATE
PROJECTED ELIGIBILITY DATE FOR SERVICES AGENT NAME
AGENT AREA NUMBER
AGENT TELEPHONE NUMBER (With Area Code)
AGENT EMAIL ADDRESS
AGENT STREET ADDRESS
SID NUMBER
OFFENDER NAME (As Shown on Court Order)
Last:
First:
DOC NUMBER
MI
DOB
SEX
RACE
Male
Female
OFFENDER TELEPHONE NUMBER
(With Area Code):
OFFENDER CURRENT ADDRESS
MARITAL STATUS:
Single, never married
OFFENDER STATUS AT TIME OF REFERRAL:
Felony
Misdemeanor
One Year or Less Probation
Married
Separated
Widow/Widower
Divorced
Probation
Parole
Extended Supervision
980 Case
Habitual
Deferred Prosecution
Reentry from Jail
Reentry from Prison
NGI
SUPERVISION DISCHARGE DATE
Reentry from DAI ATR
EDUCATIONAL ACHIEVEMENT: Highest Grade Level Achieved
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) :
REFERRAL TYPE (Check All That Apply)
ALTERNATIVE TO REVOCATION (ATR)
RESPONSE TO VIOLATION (NOT AN ATR)
OPERATING WHILE INTOXICATED 2nd /3rd
PAROLE/ES CONDITION
EARNED RELEASE PROGRAM (ERP)
OTHER - Specify:
COURT ORDERED CONDITION
CHALLENGE INCARCERATION PROGRAM (CIP)
COMPAS SUB-SCREENING TOOLS (If Completed )
URICA - University of Rhode Island Change Assessment - STAGE =
VASOR - Vermont Assessment of Sex Offender Risk – RISK LEVEL =
Static 99
– Risk assessment tool designed to predict risk of sexual recidivism – RISK CATEGORY =
OTHER:
ACTUAL SUPERVISION LEVEL :
COMPAS GENERAL RECIDIVISM SCORE:
Results:
Low
Medium
out of 10
High
COMPAS VIOLENT RECIDIVISM SCORE:
DISTRIBUTION: Original - Treatment Provider; Copy - Regional Program & Policy Analyst
out of 10
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1336 (Rev. 10/2013)
EXHIBIT 2
CRIMINOGENIC NEEDS IDENTIFIED IN COMPAS AND/OR CURRENT CASE PLAN [Check all that apply]:
“THE TOP FOUR”
Anti-Social Cognition (Criminal Thinking Self Report; Cognitive Behavioral; Criminal Opportunity; Social Isolation; Social Environment; Socialization
Failure; Social Adjustment Problems)
Anti-Social Companions (Criminal Associates and Peers; Cognitive Behavioral; Criminal Opportunity; Social Isolation; Social Adjustment Problems;
Socialization Failure; Social Environment)
Anti-Social Personality (Criminal personality; Criminal Opportunity, Cognitive Behavioral; Social Isolation; Socialization Failure; Social
Adjustment Problems; Anger)
Family/Marital (Family Criminality; Criminal Opportunity; Social Environment; Socialization Failure; Social Adjustment Problems)
“THE OTHER FOUR”
Substance Abuse (Substance Abuse; Social Environment; Social Isolation; Cognitive Behavioral; Leisure and Recreation)
Employment/Financial (Vocation/Education; Financial; Criminal Opportunity)
Vocational/Educational (Vocation/Education; Financial; Criminal Opportunity)
Leisure and/or Recreation (Leisure recreation; social isolation)
SERVICES REQUEST (Check All That Apply and Are Pertinent to the Case Plan)
Type
Abbreviation
Type
Key
Priority (e.g. 1, 2, 3)
Type
(Based on Risk and Need) Abbreviation
Type
Key
AM
Anger Management
DV
Domestic Violence
Programming
Antabuse
Antabuse Treatment
Employ
Employment Services
AODA
AODA (All Types of Tx)
HWH
Halfway Houses
MH
Mental Health Services
AODA Assess AODA Assessment Only
Circles
Circles of Support
Other:
Cog
Cognitive Interventions
Reentry:
CS
Community Service
RJ
Restorative Justice
SOT
Sex Offender
Treatment
PRE
Pre Treatment
Misc Day Tx Services
Day Tx
Drug Court
DC
Dual Diagnosis Programming
DD
TLP
Day Report Center
DRC
VocEd
SPECIAL NEEDS (Check All Relevant Categories)
Yes
No
Alcohol Problems
Yes
(Based on Risk and Need)
Transitional Living
Program
Vocational
Programming
No
History of Violence, attach Description.
Drug Problems - Specify:
History of Committing Sexual Assaults
Health Problems - Specify:
Pregnant
Mental Health Problems - Specify:
Relationship Problems
Developmental or Learning Disabilities
Financial Management Problems
Other - Specify:
IS OFFENDER TAKING MEDICATION (A SIGNED DOC-1163A REQUIRED TO RELEASE THIS INFORMATION)
Yes
Priority (e.g. 1, 2, 3)
No - If Yes , List Reason and Type:
Prescription
Self-Pay
Insurance
DISTRIBUTION: Original - Treatment Provider; Copy - Regional Program & Policy Analyst
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1336 (Rev. 10/2013)
EXHIBIT 2
THIS REFERRAL MUST INCLUDE THE FOLLOWING INFORMATION:
Authorization for Use and Disclosure of Protected Health Information (DOC-1163A)
Required for information that involves personal health information, medical, mental health, AODA, or other confidential or services.
Court Order, Criminal Complaint and Prior Conviction Record
Social Information (DOC-179)
Violation Report(s), if applicable (DOC-0005)
Alternative to Revocation Agreement, if applicable (DOC-250)
Information regarding Alcohol, other Drug Problems and Prior Treatment Experience, if applicable.
COMPAS Assessment Narrative and Bar Chart
Priority 1
 High Risk Level AND
 A MINIMUM of 2 of “The Top Four”
Criminogenic Needs
Priority 2
 Medium Risk Level or Higher AND
 A MINIMUM of 1 of “The Top Four”
Criminogenic Needs


Priority 3
Low Risk Level or Higher AND
A MINIMUM of 1 of “The Top Four”
Criminogenic Needs
PART B INTAKE DECISION –
Completed by Contracted Provider Agency for Offender Entering, Re-entering or Wait Listed for the Program
INSTRUCTIONS: Attach this completed form to your agency’s “Offender Report Form Monthly" (DOC-386, DOC-1088, or DOC-1088A) for each offender
who is wait listed or enters your program. These forms must be mailed to the regional Program & Policy Analyst along with the completed DOC-1088.
RECOMMENDED PROGRAM NAME/DAY OF WEEK/TIME:
START DATE:
PROJECTED DISCHARGE DATE
RECOMMENDED PROGRAM/DAY OF WEEK/TIME:
START DATE:
PROJECTED DISCHARGE DATE:
RECOMMENDED PROGRAM/DAY OF WEEK/TIME:
START DATE:
PROJECTED DISCHARGE DATE:
INSTRUCTIONS TO VENDOR/LIAISON: Program priority and placement shall be determined by considering an offender’s actual supervision level
recommendation score and criminogenic need.
OFFENDER ACCEPTANCE / PROGRAM RETURN (Check Appropriate Box, Enter Appropriate Data)
(WHEN OFFENDER IS PLACED ON WAIT LIST RETAIN A COPY OF THIS FORM AND RETURN IT WITH APPROPRIATE INFORMATION WHEN
OFFENDER IS READY TO START GROUP)
Offender Accepted as New Intake
Offender Returned to Program
Offender Rejected – Specify For What Reason:
Offender On Wait List – Specify for What Reason And Include Anticipated Start Date:
REASON:
Part B completed by (Name): ___________________________________________
Title: ________________________________________________
DISTRIBUTION: Original - Treatment Provider; Copy - Regional Program & Policy Analyst
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1336 (Rev. 10/2013)
EXHIBIT 2
Completing a DOC-1336 Referral for Services
Part A: Agent/DCC responsible for Completion
Program Name and Location:
Name of POGS contracted program and location where referral is being sent to.
Offender Fee per Group: As determined by the agent of record and/or contract language, specify how much of a
client fee per group, week, etc. the offender is responsible to pay and the vendor collect. If unable to pay, please
note WAIVED.
Referral Date:
Enter in the following format XX/XX/XXXX
Projected Eligibility Date for Services:
Agent Name:
SID#:
Enter date offender may start programming XX/XX/XXXX
Enter LAST NAME, FIRST NAME
Enter as determined
Agent Area number: Enter 5 digit number -- 12345
Agent Telephone number: (XXX)XXX-XXXX Enter direct telephone line – not office main line.
Agent email Address:
Example: [email protected]
Agent Street Address:
Enter full address to include Street, City and Zip Code
Offender LAST Name …. First ….. MI: SMITH, JOE K.
DOC Number: 000000
DOB:
Enter as 00/00/0000
Sex:
Check Male or Female
Race:
Enter Race as reported by offender
Offender telephone Number: Enter as (000)000-0000 and note if this is offenders line, family member line or if the
line will be disconnected soon. Also include alternate numbers the offender may be contacted at.
Offender Current Address: Enter street, city, zip and any additional addresses offender may be contacted at.
Marital Status: Check appropriate box.
Offender Status at Time of Referral: Check appropriate box
Supervision Discharge Date: Enter as 00/00/0000
Educational Achievement: Highest grade completed
Outstanding Warrants or Pending Charges: If known, enter Reason for Warrant, Agency that entered warrant,
contact information, Warrant/Case Number. Same info for Pending Charges.
Reason for Referral: This should be very detailed. List behaviors demonstrated, recent violations, previous
treatment attempts, case plan drivers/tasks, offender motivation and/or responsivity issues the vendor may need to
address.
Referral Type: Check appropriate box(es) Use “Other” box for ES sanction. Include release date.
COMPAS Sub-Screening Tools: Check boxes and provide Results for any screening tools completed prior to
referral.
DISTRIBUTION: Original - Treatment Provider; Copy - Regional Program & Policy Analyst
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1336 (Rev. 10/2013)
EXHIBIT 2
Actual Supervision Level: Check applicable box based upon COMPAS Results and inclusive of DCC override
procedures. Note: Check High for supervision levels such as CIP per policy, ENS, OWI 2,3, INT/SO, etc.
COMPAS General and Violent Recidivism scores: Enter in the following format (_/10) from COMPAS paperwork.
Criminogenic Needs: After COMPAS intake is complete and Case Plan has been developed, check boxes of
criminogenic needs that are actively being addressed between both the DCC Agent and offender via documented
Tasks and Activities. If no case plan exists use professional judgment to best determine needs.
The criminogenic needs from the COMPAS assessment will not directly correlate to the “Top 4” and “Other 4” needs
as listed in EBP. In fact some needs from COMPAS such as criminal opportunity appear in all of the Top 4. This is
an area where agent professional judgment and critical thinking skills are vital.
For example an offender is assessed as having a highly probably need in the area of criminal opportunity. The
agent then needs to review the Top 4 and Other 4 to determine where criminal opportunity fits in. Is it due to the
offenders lack of problem solving or coping skills? Is it due to risky thinking individually or as part of a group? Is it
perhaps due to an inability to build positive relationships in the community or with family members? The answers to
these questions will directly correlate to a Top 4 or Other 4 need.
Services Request: Check all that are pertinent to the DCC case plan and can be provided by the vendor.
Special Needs: Check as applicable and provide supporting documentation of each “YES”.
Offender Medication: Check as applicable. Agent shall secure a signed DOC-1163 in order to release information
about medications to vendor.
Include the Following information: Check all documents that are attached to the referral packet.
Priority Placement Boxes: Review “Criminogenic Needs” section of the DOC-1336. Consider all checked boxes
and determine how many of “The Top Four” are checked or otherwise listed on the current DCC Case Plan and the
offenders current supervision level to determine Priority 1,2 or 3. Same as with criminogenic needs in regard to the
case plan.
PART B: Vendor is Responsible for completion
Created 10/25/2013
DISTRIBUTION: Original - Treatment Provider; Copy - Regional Program & Policy Analyst
Exhibit 3
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1088 (Rev. 4/2010)
WISCONSIN
Error! Reference source not found.
OFFENDER REPORT – MONTHLY
COMMUNITY - BASED PROGRAMS and SERVICES
AGENCY NAME
TELEPHONE NUMBER
REPORTING PERIOD
(Month/Year)
PURCHASE ORDER NUMBER
PROGRAM NAME
FEDERAL FUNDING
Yes
REPORT COMPLETED BY (Signature/Title)
I Total Number of Offenders
L Other Information
J Total Units Provided
B6
OWI 3rd
B5
OWI 2nd
B4
CER
B3
PAT
B
OFFENDER NAME
B2
ATR
A
DOC #
REPORT REVIEWED BY DCC Staff (Signature)
DATE SIGNED
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. An asterisk notes all columns that require a
code. All codes for the completion of this form are listed on the back of the form.
B1
DOB
INSTRUCTIONS:
DATE SIGNED
No
C
AGENT
AREA #
D
ADMISSION
DATE
E*
TYPE OF
SERVICE
G*
STATUS
Discharge
F
SERVICE DATE OR DATES
Date
K Are Alcohol and Other Drug Abuse Services Provided Under This Contract/Grant
Code
Yes
H
OFFENDER FEES
COLLECTED THIS
MONTH
No
Exhibit 3
INSTRUCTIONS AND CODES FOR DOC-1088
A
Enter Offender DOC Number as given to provider on Part A, "Referral for Service Form" (DOC-1336).
B
Enter Offender Last Name, First Name and Middle Initial as given to approver agent on Part A, "Referral of Services Form"
(DOC-1336).
B1
Enter Offender Date of Birth as given by agent on Part A, "Referral of Services Form" (DOC-1336).
B2
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all that apply.
B3
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all that apply.
B4
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all that apply.
B5
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all that apply.
B6
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all that apply.
C
Enter DOC Agent Area Number as given to provider on Part A, "Referral for Services Form" (DOC-1336).
D
Enter Admission Date.
E
Enter Code number which applies. If your agency provided more than one type of service under the contract/grant during the
month, use a separate line on the form to report each type of service provided to each offender.
(507-30)
Group counseling, outpatient
(606)
Emergency housing
(507-10)
Outpatient counseling, Individual
(607-10)
Employment, on-the-job
(507-20)
Outpatient counseling, family
(607-20)
Employment - evaluation
(603)
Intake assessment
(607-30)
Employment - job placement
(604)
Evaluation
(607-40)
Employment - job preparation
(605)
Sex offender treatment
(608)
Education
F
List each separate date on which service was provided. As an example, if service was provided on May 5, 10 and 16, list 5/5,
5/10 and 5/16. Do not list a range of dates such as 5/5 through 5/10.
G
Enter Status Code for each program participant under the DOC contract or grant. If two codes apply, enter highest
code number. Enter date of Status Change for all codes except 01.
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
H
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 use or absconding
New Offense
Hospitalized
Death
Other (specify in Field L "Other Information" at bottom of form)
Enter total amount of offender fees collected this month for each offender. Total amount of fees collected are reflected as a
total monthly offender fee reduction on the “Unit Service Monthly Report” (DOC-1026).
I
Total number of offenders provided direct service this month.
J
Total units of service provided this month.
The total units provided, (for example, number of hours, days or group sessions provided) are dependent upon the
payment arrangement with the Department of Corrections.
K
Are alcohol and drug abuse services provided under this contract/grant? This is necessary to verify confidential status of form.
L
Use this space to note codes which need to be specified from Field E and Field G.
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
EXHIBIT 5
Evidence-Based
Correctional Program Checklist
The Correctional Program Checklist (CPC) is a tool developed to assess the extent to which
correctional treatment programs adhere to the known principles of effective intervention. It is
designed to evaluate the integrity of a program, not outcomes. The CPC is based on the results
of over 500 program assessments and three large outcome studies.
The CPC is divided into two basic areas: Capacity and Content.
The Capacity area is designed to measure whether a correctional program has the capability to
deliver evidence-based interventions and services for offenders. There are three domains in
the capacity area:
CAPACITY
1. Quality Assurance
2. Staff Characteristics
• Program monitoring activities
• Education of the staff
• Reassessment of offenders
• Experience of the staff
• Evaluation
• Assessment & training of the staff
3. Leadership & Development
• Involvement and qualifications of program director
• Implementation and design of the program
• Support for the program
The Content area has two domains and focuses on the substantive domains of Offender
Assessment and Treatment Characteristics, and the extent to which the program meets the
principles of risk, need, responsivity, and treatment.
CONTENT
4. Offender Assessment
• Selection of offenders
• Assessment of offenders
5. Treatment Characteristics
• Targeting of criminogenic needs
• Type of interventions used
• How treatment is delivered
• Provision of aftercare
Information is gathered through structured interviews with selected program staff and program
participants and observation of groups and staff. Other sources of information include policy
manuals, program curriculum, schedules review of case files, surveys, & other selected
program materials
There are several advantages to the CPC:
1. All of the indicators included in the CPC have been found to be correlated with
reductions in recidivism.
2. The process provides a measure of program integrity and quality; it provides insight into
the “black box” of a program, something that an outcome study alone does not provide.
3. The results can be obtained relatively quickly; usually the process takes a day or two and
a report is generated within a few weeks.
4. It identifies both the strengths and weaknesses of a program and provides
recommendations designed to improve the integrity of the program and to increase
effectiveness.
Prepared by the WI Department of Corrections
Office of Research & Project Management
Page 1 of 2
EXHIBIT 5
Evaluation Steps
1. Schedule site visit with program and program evaluators.
2. Day of site visit:
 Interview program/treatment director
 Interview staff
 Interview program participants
 Review case files
 Review program manuals and curricula
 Review assessment instruments
 Observe treatment group(s)
3. Day after the site visits the evaluation team meets to determine the final scores for the
program evaluation.
4. Within one or two weeks after the site visit a draft report detailing evaluation results and
recommendations is sent to the program.
5. Program is given 30 days to respond to the draft report in writing, noting any information that
is incorrect or that was missed.
6. Evaluation team takes program’s response into consideration, then compiles a final report
and sends it to program and anyone else who needs to see it.
7. Within 30 days, the program submits to the Department a “corrective action plan” detailing
the steps it will take to address areas needing improvement based on evaluation
recommendations.
8. A follow-up evaluation is done within one year if the program scores below the “effective”
category, within three years if it scores in the “effective” category, and within five years if it
scores in the “highly effective” category.
Prepared by the WI Department of Corrections
Office of Research & Project Management
Page 2 of 2
EXHIBIT 6
PROGRAM GUIDELINES:
Programs using evidence based curriculum for groups and training the staff in the delivery of that curriculum will
increase program fidelity. Several factors are noted to be essential to program success as measured by the
difference in recidivism between treatment and control groups. The National Institution of Correction’s curriculum
Offender Risk Reduction: Evidence Based Practice and Cognitive Behavioral Interventions Standard Operating
Procedures (Dec 2001) were used as a reference in the development of these guidelines.
Characteristics consistently associated with program efficacy:
1.
Sound Conceptual Model. Programs based on a cognitive-behavioral theoretical model were the
most beneficial when applied in appropriate dosage according to offender risk and need
measurements.
2.
Multifaceted Programming. Multifaceted programs, which incorporated a variety of techniques in
their intervention strategy, were more beneficial than those correctional programs that relied on a
single method.
3.
Targeting “criminogenic risk factors.” In successful programs, program targets were factors
linked with recidivism such as social cognitions or antisocial attitudes.
4.
Responsivity Principle. Program efficacy was dependent on matching styles and modes of
service to the learning styles, characteristics and abilities of offenders based upon identified risks
and needs.
5.
Role Playing/Modeling. In successful programs, correctional worker/agents modeled anti-criminal
attitudes and behavior. Modeling and role-playing techniques were used to train offenders in
empathy, interpersonal problem solving and social skills, which enabled them to cope pro-socially
with adverse or criminogenic environmental experiences.
6.
Social Cognitive Skills Training. Including program techniques that could have an impact on the
offender’s thinking was of critical importance.
Characteristics that make cognitive behavioral programs effective:
A. Group/Class Setup
1.
The facilitator is present; with the necessary materials adequately organized, and prepared to greet
arriving participants several minutes ahead of the scheduled group time.
2.
Attendance and tardiness are accurately and efficiently documented.
3.
Homework (as required by specific programs) is reviewed, checked, and appropriately reinforced.
4.
Each lesson is introduced so participants have an overview of the session.
5.
The introduction of each lesson should include reasons why content or process should be valued by
the
participants and should be tailored to address each participant’s perspective.
B. Specific Skill Development
1.
The facilitator should define the skill or concept being introduced.
2.
The facilitator should explain why the skill or concept is important and how it is related to other
material
previously covered.
3.
The facilitator should present the thinking and actions that make up the specific skill.
4.
The facilitator should model the skill correctly.
5.
The facilitator should ask questions and make sure all participants understand the specific skill
before moving on to a new skill.
6.
The facilitator should use examples and scenarios that are simple and easy to follow and directly
relevant
to the criminogenic (crime-producing behavior) needs of participants.
7.
The facilitator should allow participants to practice skills as much as possible and devote a
significant
portion (at least two-thirds) of a session to practice and exercises.
8.
The facilitator should provide feedback to participants with at least 80% being positive and
reaffirming.
9.
During the summary session, the facilitator should include a review of what the group is learning,
why the
information is important to participants, and in what specific situations the skills can be
used.
10.
The facilitator should always follow the lesson plan and assign homework as directed by the
curriculum.
EXHIBIT 6
C. Classroom Management
1.
The facilitator should start the session precisely on time.
2.
The facilitator should identify and address (but not judge) any pro-criminal responses and behaviors
(allowing these responses and behaviors to going on without addressing them undermines the
intent of
the curriculum).
3.
The facilitator should maintain a clearly defined set of group participation rules with simple, specific
consequences for violation.
4.
The facilitator should enforce class rules and boundaries.
5.
The facilitator should acknowledge the need for and expect a different level of performance based
on
the individual skills and abilities of the participants.
6.
The facilitator should take the necessary steps (both structural and situational) to insure each
participant
is involved in each session.
7.
The facilitator should use humor appropriately throughout each session.
8.
The facilitator should use the necessary equipment and materials (i.e., flipcharts, chalkboards,
overheads,
TV/VCR, workbook, stapler, paper clips, pens, pencils, and paper) appropriately throughout
each session in addition to access to a copy machine in preparation for sessions.
9.
The program participants should have a workbook or folder to hold loose workbook pages or
additional information, additional paper for note taking, and each participant should be provided with
a pen or pencil.
D. Participant Involvement
1.
Participants should be actively and voluntarily engaged and paying attention throughout each
session.
2.
Participants should be able to demonstrate their understanding of the content and processes used
throughout each session.
3.
Participants should provide positive and innovative input to the session.
4.
Participants should adequately complete class activities and homework assignments.
5.
Participants should demonstrate some understanding of their individual risk factors.
E.
Documentation and Accountability
The facilitator should have a clear and effective system to document the following items:
__ Intake interview process (in addition to pre-testing instrument)
__ Attendance
__ Tardiness
__ Homework (as required by specific programs)
__ Session participation levels
__ Ongoing motivation, skill and participation issues
__ Exit interview process (in addition to post-testing instrument).
F.
Standards
1.
The specific cognitive based curriculum must be followed exactly within the guidelines of that
individual program.
a.
There will be no addition or deletion of content materials.
b.
The program time frame will be adhered to: e.g., number of sessions suggested completing
the
program, and time frame regarding the specific amount of time to complete each session. If
the
program suggests twenty-two sessions at 1 1/2 to 2 hours per session, then it shall be
delivered in
that manner.
Prepared by the WI Department of Corrections
Office of Research & Project Management
Page 2 of 2
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