Request for Proposals - Union County, New Jersey · Request for Proposals: Program Year 2015...

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Union County

Workforce Investment Board

Request for Proposals: Program Year 2015 WorkFirst New Jersey

Programs

RELEASE OF RFP JULY 23, 2015

RFP DUE DATE AUGUST 12, 2015 11:00AM

TENTATIVE CONTRACT/FUNDED PERIOD SEPTEMBER 1, 2015-DECEMBER 31, 2016 (subject to availability of funds)

http://ucnj.org/rfqs-rfps-rccps

http://ucnj.org/rfqs-rfps-rccps

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Request for Proposal

Program Year 2015

TABLE OF CONTENTS

1.0 Request for Proposal Instructions …………………………………………….. 5 - 10

1.1 Name of Grant Program

1.2 Purpose of Solicitation

1.3 General Information

1.4 Proposal Due Date

1.5 Eligible Applicants

1.6 Target Populations

1.7 Qualifications of Applicants

1.8 How to Obtain RFP

1.9 RFP Technical Assistance

1.10 Questions Regarding RFP

1.11 Estimated RFP Timeline

1.12 Available Funding

1.13 Funding Match Requirement

1.14 Compliance

1.15 Duplication of Services

1.16 Suspension of Program Funding

1.17 Conflict of Interest

2.0 Proposal Application Instructions …………………………………………… 11-12

2.1 Proposal Format

2.2 Protests

3.0 Requirements ……………………………………………………………………13 - 14

3.1 Administrative Requirements

3.2 Insurance

3.3 Contracting

4.0 Scope of Services …………………………………………………………… . 15 - 27

4.1 General Guidelines

4.2 TANF Clients - Requested Services & Programs

I. Core Activities

A) Job Search

B) Work Experience

i. Community Work Experience (CWEP)

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II. Non-Core Activities

-Education Directly Related to Employment (ABE/ ESL)

(Clients without a HS Diploma or GED)

-Job Skills training directly related to employment (ESL/Occupational

Cert, or Degree)

(Clients with a HS Diploma, GED, or college education)

-Satisfactory School Attendance- schooling leading to certificate of

general equivalence.

4.3 GA/SNAP Clients – Requested Services & Programs

A) Job Readiness / Life Skills

B) Work Experience - Community Work Experience Program

C) Education and Vocational Alternative Work Experience Program

4.4 Test of Adult Basic Education (TABE)

5.0 Performance Based Fee-for-Service Schedule ………………………… 28

6.0 Benchmarks for WFNJ PY 2015 Subcontracts ……………...…………… 29 - 36

7.0 Program Fundamentals and Requirements ……………………............... 37

8.0 Specific Responsibilities of the Sub-Grantee / Provider ……………… 37 - 40

9.0 Proposal Evaluation Criteria ………………………………….……..……. 40 - 41

10.0 Proposal Response …………………….…………………………………....... 42 - 45

10.1 Specification for Proposal Narrative

11.0 Proposal Compliance Assessment …………………….………...……….. 46

Attachments

A-1: Cover Page (included)

A-2: Proposal Summary Page (included)

A-3: Assurances (included)

A-4: Organization Chart (Proposer to provide)

A-5: Agency’s Current Board Membership List (Proposer to provide)

A-6: Copy of New Jersey Business Registration Certificate (Proposer to provide)

A-7: Proof of non-profit status (Proposer to provide - if applicable)

A-8: Proof of NJ Department of Labor and Workforce Development Eligible Training

Provider approval or NJDOE equivalent (Proposer to provide - if applicable)

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A-9: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion

Lower Tiered Covered Transactions (included)

A-10: Certification Regarding Lobbying for Contracts, Grants, Loans and Cooperative

Agreements (included)

A-11: Instruction for Certification (included)

A-12: Year 2014 or most recent Audited Financial Statement (Proposer to provide)

A-13: Affirmative Action Statement (included)

A-14: Americans with Disabilities Act: Equal Opportunity for Individuals with Disabilities

(included)

A-15: Stockholder Disclosure Certification (included - if applicable)

A-16: Affidavit of No Conflict of Interest (included)

A-17: Non-Collusion Affidavit (included)

A-18: Insurance Requirements (included)

A-19: Disclosure of Investment Activities in Iran (included)

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1.0 RFP INSTRUCTIONS

1.1 Name of Grant Program

Program Year 2015 WorkFirst New Jersey Programs

1.2 Purpose of Solicitation

WorkFirst New Jersey funds programs designed to provide welfare applicants, recipients, non-

custodial parents and non-cash recipients a connection to the labor market resulting in

unsubsidized employment that leads to self-sufficiency. Work experience activities provide

an individual with an opportunity to acquire the general skills, training, knowledge and work

habits necessary to obtain employment. Programs are to provide services to assist these

individuals with job placement, transitional employment and other employment related

training and support services they need to make the successful progression into long-term

unsubsidized employment. Programs should be labor market driven, and consistent with the

Union County Workforce Investment Board’s “To-Work” Consolidation Plan. Programs funded

under this RFP will assist the County of Union to exceed the federally mandated 50% TANF

Client Participation Rate.

The Union County Workforce Investment Board is seeking proposals that provide employment

preparation services to eligible WorkFirst New Jersey customers that not only support and

prepare these participants for success in employment and improved educational

achievement, but also provide intensive service strategies that have a long-term impact on a

participant’s future as members of both the community and the workforce.

Proposed programs should assist the County of Union in achieving its required Level of Service

as mandated by the NJ Department of Labor & Workforce Development. To that end, the

County shall provide the Vendor with a performance based, fee-for-service Micro Block Grant

that would enable the Vendor to voucher the County based on services provided.

This solicitation in no way implies a contractual obligation to any proposer. The award of

funds shall be contingent upon receipt of funds for these purposes from the New Jersey

Department of Labor and Workforce Development (NJLWD) and the appropriate approval of

the Union County Board of Chosen Freeholders.

1.3 General Information

The Deficit Reduction Act of 2005 maintains State flexibility and many provisions of the

Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) that

created the Temporary Assistance to Needy Families (TANF) block grant that fundamentally

reformed welfare from a cash benefits program to a program focused on work and

temporary assistance. Under TANF, adults receiving assistance are required to engage in

work activities and develop the capability to support themselves before their time-limited

assistance expires. States, and in turn, the local areas receiving TANF funding, are required to

assist recipients in making the transition to employment and also meet the federal work

participation rates, and other critical program requirements, in order to maintain full Federal

funding and avoid penalties.

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As of October 1, 2006, the Deficit Reduction Act requires consistent definitions of work activity

categories across States as well as consistent measurements of work participation. This Act

also improves verification and documentation for actual hours of participation holding States

accountable for establishing and maintaining effective internal control systems to ensure that

laws and regulations are followed: that program goals and objectives are met; that resources

are safeguarded; that reliable data is obtained, maintained and disclosed. Unsubsidized

employment is the primary goal of TANF.

The WorkFirst New Jersey services funded in this RFP include employment directed activities

for the TANF and General Assistance (GA) / Supplemental Nutrition Assistance Programs

(SNAP). The WorkFirst NJ General Assistance (GA) program provides welfare services for

individuals and couples without children. The goal of the WorkFirst New Jersey program is to

help people get off welfare, secure employment and become self-sufficient, through job

training, education and work activities.

1.4 Proposal Due Date

Proposals must be received and date-stamped by Union County Workforce Investment Board

staff no later than August 12, 2015 at 11:00 a.m. in order to be considered for funding.

Proposals shall be clearly labeled “PROPOSALS FOR COUNTY OF UNION / WORKFIRST NEW

JERSEY PROGRAMS” and submitted to:

Union County Workforce Investment Board

Administration Building, 4th Floor

10 Elizabethtown Plaza

Elizabeth, New Jersey 07207

Attention: Planner, WFNJ Programs

Respondents who hand-deliver the proposal will be issued a “Notice of Proposal Receipt”.

Hand-delivered proposals shall be accepted up to the day and time of the proposal due

date as indicated above and at the corresponding address. If the proposal is being

delivered on the due date and time, please deliver the proposal to the Union County

Administration Building, 6th Floor, Freeholders Meeting Room, 10 Elizabethtown Plaza,

Elizabeth, NJ 07207. Proposals will be marked with the time and date received by Union

County Workforce Investment Board staff. If a commercial carrier (FedEx, UPS, or USPS) is

used to submit a proposal, it is the responsibility of Respondent to ensure that they receive a

receipt of delivery from the commercial carrier. Timely submission of the proposal is the sole

responsibility of Respondent.

PROPOSALS SUBMITTED AFTER THE CLOSING DATE AND TIME

WILL NOT BE CONSIDERED FOR FUNDING AND WILL BE RETAINED UNOPENED BY THE COUNTY

1.5 Eligible Applicants

Any public or private agency/organization with demonstrated ability in the proposed

program area and:

Applicants must be a legally established non-profit entity or private for-profit

organization or school/university or government agency;

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Applicants must have a New Jersey address and be able to conduct business out of a

facility located in New Jersey; and

Applicants must be in good standing with all State and/or Federal agencies with which

the applicant has had a grant or a contractual relationship.

Respondents must be approved by NJ Department of Labor & Workforce Development or NJ

Department of Education equivalent for programs that include an occupational training

classroom component and/or a comprehensive educational component, i.e. adult basic

education, English as a Second Language, preparation for the GED, Work Readiness and

other training related courses. The program must be listed on the NJ Department of Labor &

Workforce Development Eligible Training Provider List.

Priority funding consideration will be given to agencies/organizations located in Union County

and providers who can accommodate the client’s needs for non-traditional service hours.

Agencies, organizations or consortia may propose to provide more than one service. Those

applicants applying for funds for more than one service must indicate the services in the

program description and Attachment A-2. If your programs work in conjunction with each

other, this relationship should be described completely.

Respondents are not eligible if the organization, or if 2/3 of the officers of the organization,

have been debarred from any other public agency in the United States; including, at the

time of proposal submission, those listed as “debarred, suspended, or proposed for

debarment” on the Excluded Parties List System in use by the United States General Services

Administration.

The Union County Workforce Investment Board will accept joint proposals (submitted by two

or more entities) as long as the proposal identifies a lead agency to be the fiscal agent and

responsible for the attainment of performance standards.

The Union County Workforce Investment Board will not discriminate against any firm or

individual on the grounds of race, creed, color, sex, age, handicap status or national origin in

the contract award.

1.6 Target Populations

∙ Single parent and two parent families with minor children who are eligible for, or are

receiving benefits under WorkFirst New Jersey Temporary Assistance to Needy Families

(TANF) Program.

∙ General Assistance (GA) and Supplemental Nutritional Assistance Program (SNAP)

recipients. The GA, SNAP, GA/SNAP targeted population for EDA activities must be all

employable individuals. Priority should be given to GA and GA/SNAP individuals in

receipt of assistance for 34 months or more.

The Union County Division of Social Services (UCDSS) is the referring agency for all funded

programs. However, once the funded agency receives the referral list(s) from the UCDSS, it is

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the responsibility of the funded agency to conduct outreach efforts that will increase the

likelihood that the client will arrive at their designated work activity. In addition, the funded

agency will be required to document client attendance on a daily basis.

To better serve public assistance recipients and reduce possible travel time and expense,

programs will be funded to provide services at both the eastern and western regions of the

County. The Proposal Summary Page – Attachment A-2 requires the applicant to check-off

the areas to be served by the applicant.

Eastern Union County area includes the following municipalities: Clark, Cranford, Elizabeth,

Hillside, Kenilworth, Linden, Roselle, Roselle Park, Springfield, Union and Winfield.

Western Union County area includes the following municipalities: Berkeley Heights, Fanwood,

Mountainside, Plainfield, Rahway, New Providence, Scotch Plains, Summit and Westfield.

1.7 Qualifications of Applicants in Order To Be Considered for Funding Under the Grant

Program

All grant proposals must identify a lead agency. The lead agency will be the applicant and

the legally recognized fiscal agent for the grant project and the single point of contact for

the Workforce Investment Board. The lead agency will be responsible for overseeing the

implementation of all aspects of the grant including: grant project monitoring and

reporting; outreach and recruitment; and fiscal management. It is essential that the

applicant carefully construct result-driven goals and objectives that support the

program’s stated goals and objectives, which together with the program description

provide a comprehensive plan for the successful accomplishment of the proposed

program. Proposals that do not meet the above will not be considered for the grant.

Applicants will be evaluated on the basis of quality, comprehensiveness, completeness,

accuracy and appropriateness of response to the RFP. The evaluation criteria detailed in

Section 9.0. Proposal Evaluation Criteria (page 39) will be used to review and select

applications.

Applicants under this grant program must provide a narrative describing their organizational

capacity, resources, commitment and any demonstrated ancillary program successes in

similar type of programs. Applicants must detail their experience in administering

employment directed activities for WorkFirst New Jersey clients as part of the applicant’s

“History & Expertise in Proposed Program Area” Section 2 ( p a g e 4 2 ) of this application.

All activities are to be conducted in accordance with the policy directives of the Workforce

Investment Board, NJ Department of Labor & Workforce Development and the US

Department of Health and Human Services. All successful grantees will be required to

coordinate employment directed activities with the Union County One-Stop Career Center(s)

and/or Division of Social Services for referral and reporting requirements.

1.8 How to Obtain the RFP

The RFP is available at http://ucnj.org/rfqs-rfps-rccps

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1.9 RFP Technical Assistance

It is the policy of the Local Workforce Investment Area (LWIA) to provide technical assistance

to all prospective bidders to the extent feasible that will ensure fair evaluation of all proposals

submitted.

Therefore, a Bidders Technical Assistance Conference will be held on Thursday, July 30, 2015

at 1:00 p.m. at the Union County Administration Building, 4th Floor, Training Room, 10

Elizabethtown Plaza, Elizabeth, NJ 07207.

1.10 Questions Regarding the RFP

All questions must be submitted in writing to:

Elizabeth Paskewich, Employment Service Aide





[email protected]

No questions will be answered after Friday, August 7, 2015 at 4pm.

1.11 Estimated RFP Timeline

The dates on the following timeline are tentative dates only and are subject to revision

without further notice by the Union County Workforce Investment Board:

Release of RFP July 23, 2015

Bidders Technical Assistance Conference July 30, 2015 at 1:00pm

End of Question Submittal Period August 7, 2015 at 4:00pm

RFP Due Date August 12, 2015 at 11:00am

Review and Independent Evaluation of Proposals August 13-14, 2015

Funding Recommendations – WIB Executive

Committee August 17, 2015

Award and Denial Letters Released August 18, 2015 at 4pm

Appeals Letter Due at UCWIB August 25, 2015 at 4pm

Appeals Hearing if Applicable TBD

Start of Projects September 1, 2015

1.12 Available Funding

Funding for this Request for Proposal (RFP) is made available through the PY 2015 WorkFirst

New Jersey - NJ Department of Labor & Workforce Development, (WFNJ / NJLWD)

Employment Directed Activities (EDA) Funds.

As of the date of the release of this Request for Proposal, the anticipated amount of funding

is not available. Funding will be allocated to provide services in both the eastern and

western areas of the County.

mailto:[email protected]

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Funding awards require the approval of the Union County Board of Chosen Freeholders, as

well as the funding sources WorkFirst New Jersey / NJ Department of Labor & Workforce

Development.

1.13 Funding Match Requirement – No match is required.

1.14 Compliance

All agencies must comply with the assurances and requirements of all required governmental

agencies.

1.15 Duplication of Services

All funds and services provided with the funding sources herein mentioned must not

duplicate payment or services provided by any other funding source; these funds cannot be

used to supplement services provided by any other funding source.

1.16 Suspension of Program Funding

The Union County Workforce Investment Board reserves the right to suspend program funding

if vendor cannot meet the minimum performance standards as part of the contractual

agreement between the vendor and the County of Union. The vendor will be required to

attend a special meeting with the representatives of the Union County Workforce Investment

Board to answer questions relating to non-performance.

1.17 Conflict of Interest

Each Grantee shall avoid organizational conflict of interest, and their personnel shall avoid

personal conflict of interest or the appearance of conflict of interest in receiving financial

assistance involving funds under the WIA. The “New Jersey Conflict of Interest Law” Chapter

182, P.L. 1971, as amended, shall apply. Where provisions of local laws exist, these too, shall

apply.

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2.0 PROPOSAL APPLICATION INSTRUCTIONS

2.1 Proposal Format

12-pitch size, Arial font

Single spacing

Pages numbered sequentially

a. Cumulative narrative section shall adhere to the page limit indicated for each

question. State the number and question and then provide your response.

b. Ensure all attachments are numbered and included. If questions are not applicable to

your organization indicate the reason in the attachments.

c. Proposal submission must include:

One (1) signed original

Two (2) copies

2.2 Protests

a. In the event a Respondent believes that the County’s solicitation is unfairly restrictive,

ambiguous, contains conflicting provisions, or the Respondent believes that any

resulting Contract would be commercially impractical to perform, the Respondent

must file a written protest with the Union County Workforce Investment Board.

b. An appeal of the selection process will be heard only if it is alleged that the Workforce

Investment Board has violated a statutory or regulatory provision in the awarding of a

grant. An appeal will not be heard based on a challenge to the evaluation of a

proposal. Applicants may appeal on statutory or regulatory grounds by submitting a

written request to the Union County Workforce Investment Board no later than 5 days

following receipt of funding notification. Protests should be addressed to:

Phil Kandl, Senior Planner





c. The following reasons shall be grounds for automatic rejection of an application due

to failure to conform to the requirements of the RFP:

1. Applicant did not meet the required application deadline;

2. The application is not signed in the appropriate places. Signatures on

attachments or other documents do not count as signatures on the

application;

3. Application is incomplete;

4. Non-compliance with administrative requirements, including but not limited to

absence of attachments; and

5. Application submitted in an unacceptable manner, e.g. telephone, fax, e-mail.

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d. All protests related to bid or proposal specifications must be submitted to the Union

County Workforce Investment Board no later than five (5) business days prior to the

close of the bid or proposal. Protests received after the five (5) business day deadline

will not be considered by the County.

e. In the event the protest of specifications is denied and the protester wishes to

continue in the solicitation process, they must still submit a bid prior to the close of the

solicitation in accordance with the bid/proposal submittal procedures provided in the

bid/proposal.

f. In protests related to the award of a contract, the protest must be submitted no later

than five (5) business days after the notice of the proposed contract award is

provided by the Union County Workforce Investment Board. Protests relating to a

proposed contract award which are received after the five (5) business day deadline

will not be considered by the County.

g. All protests shall be typed under the protester’s letterhead and submitted in

accordance with the provisions stated herein. All protests shall include at a minimum

the following information:

The name, address and telephone number of the protester;

The signature of the protester or the protester’s representative;

The solicitation or contract number;

A detailed statement of the legal and/or factual grounds for the protest; and

The form of relief requested.

h. In the event of a timely protest, the County shall not proceed with the solicitation or

award of the contract until the Union County Workforce Investment Board renders a

decision on the protest.

i. Upon receipt of a timely protest, a review panel will be convened to review the

information presented by all parties and the review of the protest data shall be

completed within ten (10) days from the receipt of the protest request.

j. The Union County Workforce Investment Board will within five (5) business days from

the termination of the panel review, issue a decision in writing which shall state the

reasons for the actions taken.

k. The decision of the Union County Workforce Investment Board will be final.

l. The County may, after providing written justification to be included in the

procurement file, make the determination that an immediate award of the contract is

necessary to protect the substantial interests of the County. The award of a contract

shall in no way compromise the protester’s right to the protest procedures outlined

herein.

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3.0 REQUIREMENTS

3.1 Administrative Requirements

a. Proposals that are submitted shall not be marked as confidential or proprietary.

Proposals submitted in response to this RFP process are subject to public disclosure as

permitted by the New Jersey Open Public Records Act. Additionally, all proposals

shall become the property of the County. The County reserves the right to make use

of any information or ideas in the proposals submitted.

b. All materials will be retained by the County. The County reserves the right to reject

any or all proposals and to award and contract as is in its best interest. The County

reserves the right to solicit additional information from any Respondent after the

proposals have been received, including the requesting of interviews by Respondents.

c. This RFP does not commit the Union County Workforce Investment Board or the

County to award a contract, pay any costs incurred in the preparation of a proposal

to this request, or contract for services and supplies.

d. The County reserves the right to withdraw the RFP in the event that the Union County

Workforce Investment Board determines there is a failed competition, which can be

defined by:

1. Response to RFP is insufficient to proceed;

2. Responses to RFP make it economically unfeasible to proceed;

3. Any changing circumstances in status, as determined by the Union County

Workforce Investment Board, that would negate the requirement of the RFP; or

4. Any changing circumstance, as determined by the County, which would

require postponement of the RFP.

e. The scope of services to be provided must be in accordance with all applicable

federal, State, and local laws, regulations, rules and policies, and with specifications of

this RFP.

f. Respondents will be subject to reference checks and performance information

validations. This may include, but is not limited to, a review of Respondent's

recordkeeping procedures, management systems, and accounting and

administrative systems.

g. All proposals are subject to negotiation following selection by the Union County

Workforce Investment Board. Proposals which cannot be successfully negotiated will

not be funded. Submitted proposals must be valid for a period of time no less than

one year from the date of submission.

h. A “Joint Proposal” is defined as one proposal submitted by two or more entities, with a

clearly identified lead agency. The lead agency shall be the fiscal agent and will be

responsible for the attainment of performance measures and results. The Union

County Workforce Investment Board will accept joint proposals for this RFP. The lead

agency must provide a minimum of 50% of the required services.

i. Pursuant to N.J.A.C. 17:44-2.2, the vendor shall maintain all documentation related to

products, transactions or services under this contract for a period of five (5) years from

the date of final payment. Such records shall be made available to the New Jersey

Office of the State Comptroller upon request.

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3.2 Insurance

Respondents shall refer to the Insurance Requirements Information (Attachment A-18) of this

RFP for specific requirements.

3.3 Contracting

a. The contract will be awarded through the County of Union. It is anticipated that the

contract period will be September 1, 2015 - December 31, 2016.

b. The period for client enrollment is September 1, 2015 through June 30, 2016.

c. Participants enrolled prior to July 1, 2016 shall continue to be served until the end of

their program activity. All employment directed activities must end no later than the

end of contract period: December 31, 2016.

d. The Union County Workforce Investment Board retains the right to contract with

Respondents selected for funding in the following ways:

1. Directly with each joint proposing entity individually, if it is in the best interest of

the Union County Workforce Investment Board or the County.

2. Directly with proposed subcontracted entities as identified in the proposal, if it is

in the best interest of the Union County Workforce Investment Board or the

County.

e. The Union County Workforce Investment Board retains the authority before and during

any contract period to approve proposed subcontracts or purchase agreements that

amount to $10,000 or more prior to their execution. A “Subcontractor” is defined as

any entity undertaking part of the work under the terms of the contract, by virtue of

an agreement with the Contractor.

1. The Union County Workforce Investment Board retains full authority to enforce

performance standards upon the subcontractor through the Contractor.

2. The Union County Workforce Investment Board retains full authority to direct the

Contractor in all matters pertaining to subcontractors, including cancellation of

subcontractor’s contract.

f. The Union County Workforce Investment Board will utilize performance-based

benchmarks for programs offered in this RFP. Contracts resulting from this RFP will

require monthly billing. g. Contracts will be developed as a Micro-Block Grant to have the Program Provider

offer various employment directed activities to WorkFirst New Jersey clients. The

optimal service strategy is to have the Vendor offer a menu of services the best fits the

needs of clients.

h. Contracts awarded under this RFP are subject to change based on funding

availability. Available funding (or anticipated funding) and service delivery strategies

will dictate the recommendations that are ultimately considered by the Union County

Workforce Investment Board and the County.

i. Payment is anticipated to be completed within 45-60 days upon receipt of complete

voucher with appropriate supporting documents.

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4.0 SCOPE OF SERVICES

4.1 General Guidelines

All Proposers must:

• Have an office in Union County as of September 1, 2015.

• Meet all administrative requirements of the RFP.

The County of Union is required to maintain on a monthly basis, at a minimum, the 50%

federally mandated program participation rate for recipients of WFNJ-TANF. The Participation

Rate refers to the number of mandatory participants who must be in a countable activity as a

percentage of all the TANF cases. It does not refer to the percentage of customers that must

remain in any individual program on a monthly basis. Applicants that are awarded contracts

through this funding will be expected to ensure that customers meet the required hours of

participation in their TANF programs and to meet appropriate performance goals. Activities

must allow the TANF Customer to participate 35 hours per week in order to fulfill the work

requirements.

For the purposes of this RFP, the allowable activities for TANF customers include Job Search

and Community Work Experience Program (CWEP) as stand-alone 35 hour “core” activities or

a combination of the following:

Core Activities – at minimum 20 hours per week as a service program component

- Work Experience – Community Work Experience Program (CWEP)

Non-Core Activities – 15 hours per week as a service program component

- Education Directly Related to Employment (those without a High School Diploma or

GED)

- Job Skills training directly related to employment (those with a High School Diploma or

GED)

- Satisfactory School attendance at a secondary school or course of study leading to a

certificate of general equivalence, in the case of a recipient who has not completed

secondary school

TANF Regulations focus on work through the following program requirements:

- Counting only actual hours of participation and limited scheduled hours for non-paid

work activities

- All activities used to satisfy work requirements must be supervised

- Education and training must be directly related to a specific job.

- “Job readiness activities” may count substance abuse and mental health treatment

and rehabilitation activities for only 6 weeks per year (only 4 weeks consecutive).

- Further simulate work by allowing countable participation to include actual hours with

limited excused absence.

Services provided as a result of this RFP are subject to change in accordance with Federal TANF Guidelines.

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PLEASE NOTE: Because there are differences in the regulations and policies that govern the

provision of services to the TANF and GA/SNAP populations, the information on those services

are listed separately in the following parts. Although the service titles may be the same or

similar, it is important that applicants to the RFP understand and provide responses separately

and distinctly.

4.2 TANF CLIENTS - REQUESTED SERVICES AND PROGRAMS

I. CORE ACTIVITIES

A) JOB SEARCH (JS): means the act of seeking of obtaining employment, preparation to

seek or obtain employment and includes the provision of life skills training. Job search

includes a job readiness assistance component. Job search and job readiness

assistance consists of activities designed to help an individual find employment or

improve an individual’s employment prospects.

Work activities reported under job search and job readiness are:

Job search is an up to four-week workshop directed to the individual’s needs and the

local job market conditions and will serve participants in either group or individual

activities. Job search is an appropriate up front activity for job ready recipients who

have basic workplace skills and experience applicable to the labor market. It will also

be used for individuals to successfully learn labor market skills after participating in other

work activities.

Job readiness activities will be combined with job search to enhance the effectiveness

of job search activities for those in need of additional skills development. Job readiness

activities will include an assessment to determine past work history, job interest areas,

employability strengths, marketable employment-related skills, education level, and the

identification of barriers to employment. This assessment should include screening and

testing to determine employment eligibility, exploring careers, developing a personal

portfolio and concentrating on the soft skills necessary for workplace literacy. Activities

include:

• Effective resume writing

• Interviewing techniques

• Monitored employment search

• Business writing

• Career exploration

• Returning to the workforce

• Job search techniques

• Marketing

• Realistic job goals

• Telephone etiquette

• Financial literacy

• Personal appearance

• Interest inventory

• Skill assessment testing

• Job retention

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Job Readiness Activities (JRA) must be a component of Job Search and must assist

clients to:

- be able to market themselves;

- become familiar with workplace expectations;

- develop a positive attitude toward employment to maintain successful

employment in the labor market;

- develop a resume;

- have the information necessary to initiate a job specific search plan;

- set realistic job goals;

- use the Internet to search job listings; and

- be able to fill out a job application.

Job search activities must be supervised and monitored on an ongoing basis no less

frequently than daily. Job search activities include making contact with potential

employers, whether by telephone, in person or via the Internet, to learn of suitable job

openings, applying for vacancies, and interviewing for jobs.

This program is designed to provide employment-directed activities in which

participants must remain engaged with the immediate goal of obtaining full-time

employment. Job Search activities include four (4) consecutive weeks of classroom

training focusing on job seeking and retention skills such as intensive job search, job

applications, resume writing, interviewing skills, instruction in workplace expectations

(including instruction on appropriate attire and behavior on the job), training in

effective job seeking, life skills training and post-interview follow-up. Employment Profile

Testing is also to be made available for clients to determine appropriate enrollment into

other WFNJ “To Work” activities if a job is not obtained in four (4) weeks.

Job Search (JS) must be organized, employment-related activities in which participants

engage with the immediate goal of obtaining full-time employment. Job Search is

limited to four consecutive weeks for a 12-month period. Job Search can be group or

self-directed, or a combination of both. Job Search is a stand-alone activity that will

keep the client engaged for a minimum of 35 hours per week/140 hours per month to

count for Federal participation in an activity.

Program Outcomes – Job Search (JS)

Approximately 75% of the clients enrolled will successfully complete the Job Search

objectives as stated in the Individual Responsibility Plan (IRP). When deemed

appropriate, the Job Search staff will also perform individualized job search assistance

to guide the client. This will not be limited to existing job openings, but will also include

the process of job search development to secure full-time unsubsidized employment

opportunities.

All Job Search provider sub-contracts are expected to result in a 50% employment

placement rate. Job placement may be attributed to the job search provider if

placement occurs within 30 days of the Job Search activity. This rate may be subject to

18

change based on adjustments made by the NJ Department of Labor and Workforce

Development.

State Mandated Placement Rate = 50%

B. WORK EXPERIENCE is a work activity, performed in return for public assistance that

provides an individual with an opportunity to acquire the general skills, training,

knowledge, and work habits necessary to obtain employment. The purpose of work

experience is to improve the employability of those who cannot find unsubsidized

employment due to lack of work history and/or job readiness skills. It allows customers

the opportunity to adjust to and learn how to function in an employment setting. The

activity must be supervised by an employer, work site supervisor, or other responsible

party on an ongoing basis no less frequently than daily.

i. THE COMMUNITY WORK EXPERIENCE PROGRAM (CWEP) is a core activity designed to

provide work and training experience for customers not otherwise able to obtain

employment, in order to improve their employability. CWEPs are structured

programs in which TANF recipients perform work for the direct benefit of the

community under the auspices of public or non-profit organizations. CWEP is a

program with employers who agree to provide training opportunities for customers

at approved local worksites. Sponsorship is limited to non-profit agencies, such as

federal, local, State government, and not-for-profit community based employers.

CWEP activity is limited to public service projects in fields such as health, social

services, environmental protection, education, urban development and/or re-

development, welfare, recreation, public activities, public safety, and child and

adult care (for the public good).

Providers will be responsible for developing CWEP sites at public and private non-

profit agencies, monitoring of the participants attendance/progress while enrolled

at the sites and periodic feedback on participants’ status. The CWEP sites to be

developed may be on an individual referral basis and/or small group slots consistent

with the need of the participant and the capacity of the CWEP site.

A list of Union County CWEP sites will be provided to the CWEP vendor by a NJLWD

representative who is responsible to develop and contract out sites for Union

County. All potential CWEP sites developed by program providers must be

approved by a NJLWD representative prior to client placement.

Sub-grantees should select CWEP experiences that are closely aligned with skill

development that leads to employment readiness and are tailored to match the

client’s abilities, goals, and interests to ensure the provision of meaningful and

effective work experiences for our customers. The sub-grantees will be responsible

for monitoring of customers’ attendance/progress while enrolled at the sites, and

periodic feedback on customer status. This activity will be supervised on an ongoing

basis no less frequently than daily. Periodic assessment will be integrated into this

19

activity as an ongoing tool in determining an individual’s continued program

eligibility and suitability for this work activity.

Examples of programs and activities that fit under the definition of community

service include, but are not limited to, work performed for a school (e.g. serving as a

teacher’s aide), Head Start Program (e.g. helping as a parent volunteer), church

(e.g. preparing meals for the needy), or government / non-profit agency (e.g.

providing clerical support), as well as participation in volunteer organizations such as

AmeriCorps, Volunteers in Service to America (VISTA), or private volunteer

organizations. Some examples of work experience: a receptionist at a local housing

authority, a grounds worker at a municipal park or a child care assistant at a

childcare provider. The primary purpose is to provide work experience and training

to enable participants to adjust to and learn how to function in an employment

setting.

CWEP is a stand-alone 35 hour activity. The CWEP program will be up to six (6)

months in duration that assists clients in the development of the skills necessary to

obtain unsubsidized employment. Acknowledging that a majority of the welfare

population is hard to serve, the program allows enough time to adequately assess

candidates, to identify and develop appropriate job slots and encourage the client

to actively look for employment.

Vendors are expected to identify possible barriers to employment and should strive

to place participants in positions that will enable them to gain the skills needed to

move into unsubsidized employment. The vendor is expected to act as a go-

between, working with CWEP site program operators to address issues relating to the

participant’s ability to attend work regularly and on time, and to mediate any

disputes that may arise between the participant and his/her supervisor.

The CWEP vendor will focus on two areas:

1) SITE SUPPORT

- Vendor will outreach to all existing sites to update and refine placement

information

- Vendor will make all appointments with the site manager for prospective client

placement

- Vendor will act as liaison for the site when client conflicts occur

- Vendor will open and maintain an ongoing line of communication with the site

manager to facilitate client flow and successful placements

- Vendor will report site placements and terminations to Union County Division of

Social Services

- Vendor will report activity that affects client’s eligibility to the Union County

Division of Social Services

- Vendor will maintain an accurate listing of clients currently placed in CWEP.

20

2) CLIENT SUPPORT

- Vendor will conduct face-to face pre-placement interviews with clients. At this

time, the client will have the CWEP thoroughly explained to them. They will sign a

CWEP agreement of Cooperation outlining basic generic information including

appropriate behavioral responsibilities while on site.

- Vendor will also send a CWEP client profile to the site that will briefly highlight

positive attributes such as training and education. It will also contain a schedule

of CWEP hours for the client.

- Vendor will contact the site(s) for the client to arrange for CWEP placement

interviews with the site manager.

- Vendor will collect and review attendance forms and progress reports, providing

counseling to the client as needed.

- Vendor will continually provide job leads to the client.

- Vendor will arrange for the clients to leave the site periodically, reported as an

excused absence, to actively search for employment.

- Vendor will meet with the client after job interviews to review results.

- Vendor will collect and review job search forms, counseling the client as

needed.

- Vendor will act as liaison between the client and their Division of Social Services

case manager to ensure uninterrupted client flow (ex. Problems with

transportation, childcare, emergency assistance, sanction intervention, etc.).

Vendors are encouraged to identify placements where the employer might

consider hiring the participant if the placement is a success. Work assignments

should provide participants the opportunity to develop marketable skills and the

appropriate behaviors needed in the workforce. Also, the intent of the program is to

stress the development of soft skills like teamwork, the ability to communicate

effectively with co-workers and supervisors, dependability, help participants

understand how to apply skills learned to other occupations and encourage them

to continue their job search. It is expected that clients will remain in the activity for a

minimum of two months to gain useful work experience, establish good work skills

and maintain good attendance.

After the client has successfully completed a two month minimum at the CWEP

worksite and the CWEP vendor can substantiate the ability of the client to succeed

in job search and find full-time unsubsidized employment, utilizing standardized

assessments and work history information, the vendor can recommend to referring

case manager that the client be referred to Job Search as the next activity prior to

the end of the six month program. Vendor must document good attendance and

work habits at CWEP placement site. It is up to the case manager to evaluate

vendor request utilizing job readiness criteria in consultation with client for possible

referral to next activity.

21

CWEP can be a stand-alone 35 hour activity or may be combined with another countable activity such as part-time employment or one of the non-core activities1 to meet the weekly requirement.

Because of Fair Labor Standards Act (FLSA), an individual cannot be required to

participate in a work experience for more hours than the welfare grant divided by

the minimum wage. Specific hours of participation per week will be determined on

an individual basis by the Division of Social Services.

Program components are designed around a practical strategic service strategy

that best helps a client achieve unsubsidized employment. The program includes

client assessment, community work experience, life skills and job readiness activities.

The minimum client engagement in the activity is expected to be for two months to

prepare client properly to be able to take advantage of job search activities.

Utilizing a six (6) month timeline, the vendor is expected to:

First Month – Enroll client in the program, provide program orientation and assess

client utilizing either TABE 9 / 10 or BEST+ and assessment results must be received by

referring case manager no later than by the end of the month. Vendor is

responsible to input client attendance utilizing Web-based E-Timesheet at the point

of client enrollment in the activity. In addition, vendor is responsible to forward

CWEP site placement information to referring case manager with client name and

CWEP site address.

Vendor must provide job readiness guidance in workplace expectations (including

instruction on appropriate attire and behavior on the job).

Second Month – The vendor is required to complete client progress report which

should include an assessment of client performance and evaluation of job readiness

and forward report to referring case manager by the end of the month. If the client

is doing well in the activity it is the vendor’s responsibility to procure a

recommendation letter from the CWEP site supervisor to attest to client’s good

performance and work habits. The recommendation letter is an important

reference for a prospective employer. Assistance with job preparation skill

development includes resume writing and interviewing skills.

Third through Sixth Month - The client should be better prepared to explore job

opportunities and attend job interviews having successfully participated in the CWEP

activity and having acquired valuable work experience. If the client is determined

job ready, the client should be given “excused” time to explore job opportunities

and attend job interviews (up to two (2) a week). Employment referrals and job

interview information must be in writing to document time allowed. The vendor

should confirm job interviews, and closely monitor time away from activity and

appropriate time to return to CWEP site to closely replicate real world employment

1 See Section 4.2 Part II Non-Core Activities page 23

22

expectations. The goal is to have the client placed in full-time unsubsidized

employment.

If the CWEP vendor can substantiate the ability of the client to succeed in job

search and find full-time unsubsidized employment, utilizing standardized

assessments and work history information, the vendor can recommend to referring

case manager that the client be referred to Job Search as the next activity prior to

the end of the six month program.

If the client is determined in need of more intensive services to better prepare for

employment, vendor will communicate with case-manager prior to end of activity a

recommendation for next client activity. Case manager will confer with client prior

to end of activity to determine next appropriate service/activity, i.e. ESL/ABE or

occupational training.

An exit report is required to be sent to referring case manager prior to end of the

activity. The exit report should include a detailed client assessment, a list of client

work experience(s), identification of barriers that may impede client progress, a

description of client’s performance, work habits, limitations and capabilities.

Program Time Frame

The CWEP activity will last for up to six consecutive months and 35 hours per week.

We will define hours of participation as those hours beginning with the actual start of

the activity to the end of the activity.

The CWEP may include a short-term CWEP Transitional Component designed for

immediate placement of a client in an activity and /or as a bridge between

activities. The CWEP Transitional Component has the same program requirements as

the CWEP Program but is shorter in duration: on a month by month basis.

Worksite Placement Procedures

1. The Division of Social Services refers the CWEP client to the CWEP

Vendor/Monitor.

2. The CWEP Vendor/Monitor individually interviews the client and explains the

rules and requirements of the CWEP Program.

3. The CWEP Vendor/Monitor matches the client’s skills and/or abilities with an

existing, already created site (could be a site created by NJLWD representative

for CWEP development and authorization or created by the CWEP

Vendor/Monitor). The CWEP Vendor/Monitor contacts the prospective CWEP

site to make arrangements for client referral. The client is then referred to the

site for interview and/or enrollment into the CWEP Program.

4. All potential CWEP sites developed by program providers must be approved by

a NJLWD representative prior to client placement.

23

5. The contact person for the CWEP Site and the CWEP Vendor/Monitor agree on

attendance sheet procedures and monitoring of the client through a system

established between the CWEP Site and the CWEP Vendor/Monitor.

6. The CWEP participant is instructed to report to the site and to comply with all

the rules and requirements of the CWEP Program.

7. If a CWEP site is not appropriate, or does not work out for the client, another

CWEP site should be available and ready for referral of the participant to that

site.

8. The CWEP Vendor/Monitor is responsible for the monitoring of the

attendance/progress of the CWEP participant at the CWEP activity.

Program Reporting Requirements

In addition to the LOS report required by the State, the provider agency is expected to

report the following additional requirements:

1. Total number of referrals received from Union County Division of Social

Services;

2. Total number of referrals sent back/no shows;

3. Total number of enrollments;

4. Total number of completions;

5. Total Number of terminations;

6. Total number entered employment;

7. Total number of clients place at CWEP sites; and

8. Lists of names for all of the above.

II. NON-CORE ACTIVITIES: 15 HOURS PER WEEK

1. EDUCATION DIRECTLY RELATED TO EMPLOYMENT

Education Directly Related to Employment, in the case of a recipient who has

not received a high school diploma or a certificate of high school equivalency

means education related to a specific occupation, job, or job offer.

Specific occupational skill development can be provided such as Adult Basic

Education and English as a Second Language if the individual’s career goals

require them.

2. JOB SKILLS TRAINING DIRECTLY RELATED TO EMPLOYMENT

Job skills training directly related to employment is directed to those recipients

who have received a high school diploma, GED, or higher education. Job skills

training directly related to employment includes training or education for job

skills required by an employer to provide an individual with the ability to obtain

24

employment or to advance or adapt to the changing demands of the

workplace.

Job skills training directly related to employment promotes basic skills including

English as a second language, computer and workplace literacy, work values,

occupational and transferable skills, personal career portfolio development, and

other skills necessary for the individual to obtain employment. All training and

basic skills will be targeted to a particular occupation. This activity could include

certificates that enhance occupational skills such as a Forklift Certificate or

Associate of Bachelor degree programs for specific occupational skills at State

certified colleges or Universities.

3. SATISFACTORY SCHOOL ATTENDACE AT A SECONDARY SCHOOL OR COURSE OF

STUDY LEADING TO A CERTIFICATE OF GENERAL EQUIVALENCE, IN THE CASE OF A

RECIPIENT WHO HAS NOT COMPLETED SECONDARY SCHOOL:

This activity requires regular attendance, in accordance with the requirements

of a secondary school or course of study, leading to a certificate of general

equivalence, for recipients who have not completed secondary school or

received such a certificate.

All Non-Core Activities must be supervised on an ongoing basis no less frequently than

daily. Hours of participation will be defined as those hours beginning with the actual

start of the activity to the end of the activity. Non-Core Activities may count for up to 15

hours when combined with at least 20 hours from the “core activities.” The combination

of CWEP plus a Non-Core activity has a maximum duration of three (3) months.

Documentation will include school attendance records with the following information:

- Participation in a full-time class schedule as defined and documented by the

educational institution;

- Maintaining a course/class attendance rate that meets the school’s established

standard; and

- Making satisfactory education progress as defined and documented by the school.

The State's Unified Plan for Workforce Investment requires that all training providers who

expect to receive public funds must be included on the Eligible Training Provider List. To

register a training program with the state please visit:

https://njtrainingsystems.dol.state.nj.us/ProviderLogin.aspx

4.3 GA/SNAP CLIENTS - REQUESTED SERVICES & PROGRAMS

A) JOB READINESS / LIFE SKILLS

These are employment-related activities with the immediate goal of obtaining full-time

employment. The Job Readiness / Life Skills activity is limited to four consecutive weeks per

12-month period. Job Readiness activities are combined with job search to enhance the

effectiveness of job search activities for those in need of additional skills development. Job

25

Readiness / Life Skills is a stand-alone activity and provider agency must keep the client

engaged for the required 30 hours of participation in the activity.

The ultimate goal is to prepare the client for long-term successful employment in the labor

market. Services may include, but are not limited to, life coping skills, financial

management, stress reduction, dressing for work, interviewing skills, resume writing and time

management.

The Job Readiness/Life Skills program provider shall take steps to ensure that the participant

can interpret and complete job application questions and is otherwise able to make

proper presentation for employment.

REQUIRED PROGRAM ELEMENTS

Job Readiness/Life Skills (JR/LS) must be organized, employment-related activities in which

participants engage with the immediate goal of obtaining full-time employment. Job

Readiness/Life Skills is limited to four consecutive weeks per 12-month period. Job

Readiness Activities (JRA) must assist clients in becoming familiar with work place

expectations while developing a client’s positive attitude toward employment to maintain

successful employment in the labor market.

The provider will be responsible for reviewing participation in job readiness/life skills

activities and communicate client’s progress to the Division of Social Services (DSS). If a job

has not been secured at the end of the four-week period, the job readiness/life skills

provider must recommend to case management the next appropriate work activity. The

preferred method of job search is a group activity.

State Mandated Placement Rate = 50%

B) WORK EXPERIENCE - COMMUNITY WORK EXPERIENCE PROGRAM (CWEP)

The CWEP activity for GA/SNAP customers has the same program requirements as CWEP

for TANF customers (see pages 18 – 23). The difference between the TANF and

GA/SNAP/ABAWD programs is the weekly client participation requirement: GA/SNAP/

ABAWD customers must be kept engaged in the activity for 30 hours per week as opposed

to 35 hours per week for TANF customers.

GA clients who do not successfully complete their Job Readiness/Life Skills activity may be

referred to a CWEP activity as their next activity. If clients do not have recent and/or

extensive employment or training history, the CWEP would be the most appropriate

activity.

The CWEP component may be used:

- As a training tool for participants to help them develop good work habits and basic

work skills;

- As a sheltered work environment for those participants not ready to compete in the

regular labor market and who may need close supervision.

26

The CWEP Program may include a short-term CWEP Transitional Component designed for

immediate placement of a client in an activity and /or as a bridge between activities. The

CWEP Transitional Component has the same program requirements as the CWEP Program

but is shorter in duration: on a month by month basis.

C) EDUCATIONAL AND VOCATIONAL ALTERNATIVE WORK EXPERIENCE PROGRAM (AWEP)

Educational and Vocational AWEP services address the educational or vocational needs

of WFNJ customers. This program is designed as a combination of Community Work

Experience2, for 20 hours per week, at a non-profit or public sector employer to develop

and enhance workplace competency, and a 10 hours a week job training component or

education classes for English as a Second Language (ESL), Basic Remedial Education

(BREM), and Adult Basic Education (ABE). WFNJ participants who are in AWEP are required

to continually seek employment. Priority funding consideration will be given to those

agencies/organizations proposing BREM activities which include the Secretary’s

Commission on Achieving Necessary Skills (SCANS) or comparable component in their

curriculum or scope of services.

It is the responsibility of the AWEP provider to develop and monitor CWEP slots that are

utilized by customers as part of AWEP services. A review of monitoring activities and reports

on the CWEP placements that must be completed by the AWEP provider will be a part of

the County’s monitoring of that agency’s contract.

All CWEP sites must be pre-approved by the New Jersey Department of Labor prior to

placement at the site. Proof of NJDOL site and program approval must be submitted with

the vendor’s response. The State's Unified Plan for Workforce Investment requires that all

training providers who expect to receive public funds must be included on the Eligible

Training Provider List. To register a training program with the state please visit:

https://njtrainingsystems.dol.state.nj.us/ProviderLogin.aspx.

The goal of the educational or training component of AWEP is to assist the WFNJ

participant to become work ready by helping them achieve academic or vocational

progress that will support their ability to fully utilize vocational and occupational training

services or enter unsubsidized employment.

The Alternative Work Experience Program includes program orientation and client

assessment utilizing either TABE 9 / 10 or BEST+. The AWEP program has a maximum duration

of three (3) months.

4.4 TEST OF ADULT BASIC EDUCATION (TABE)

The Test of Adult Basic Education (TABE) is a diagnostic test used to determine a person's

skill levels and aptitudes. The TABE test is used by public service agencies to help guide

program participants into meaningful activities that may include Community Work

Experience Programs, adult education programs, or going to trade school, etc. It tests skills

and aptitudes in reading, math, and English.

2 See Section 4.2 Part I Subpart B Subsection i: page 18

27

The Division of Social Services requires periodic TABE assessment services to gauge a

WorkFirst NJ participant’s skill levels. It is anticipated that 20-25 TABE assessments will be

conducted monthly.

The request for services includes the ability to provide approximately 20-25 TABE 9/10

assessments monthly on an as needed basis. The results must be submitted to the Division

of Social Services in a timely manner.

28

5.0 PERFORMANCE BASED FEE-FOR-SERVICE SCHEDULE

Please use the following as a guide to fill-out funding request information in Program

Proposal Summary: Attachment A-2

EMPLOYMENT DIRECTED ACTIVITIES BENCHMARK

1 BENCHMARK

2 BENCHMARK

3 BENCHMARK

4 BENCHMARK

5 BENCHMARK

6 TOTAL SLOT

COST

TANF Job Search $250 $250

$500

Community Work Experience Program $250 $250 $250 $250 $250 $250 $1,500

CWEP Transitional $250 $250

$500

CWEP + Education Directly Related to Employment $500 $500 $500

$1,500

CWEP + Job Skills Training Directly Related to Employment $500 $500 $500

$1,500

CWEP + Satisfactory School Attendance- CERT. OF General Equivalence $500 $500 $500 $1,500

GA/SNAP Job Readiness/Life Skills $250 $250

$500

Community Work Experience Program $250 $250 $250 $250 $250 $250 $1,500

CWEP Transitional $250 $250

$500

Alternative Work Experience Program $500 $500 $500

$1,500

TABE Testing Services $50 $50

Placement and Retention Benchmarks

Placement in Unsubsidized Employment $500

$500

Retention – 90 days $250 $250

29

6.0 Benchmarks for WFNJ PY 2015 Subcontracts

The Union County Workforce Investment Board will utilize performance-based benchmarks

for programs offered in this RFP.

The sub-contract billing process will be based upon achieved benchmarks. The sub-

grantee will be required to submit monthly: a voucher, a request for payment, a

comprehensive report and a statistical LOS report no later than the 12th calendar day

immediately following the reporting period in order to receive payment on a monthly

basis without interruption of reimbursement.

Performance Based: Under a Performance-Based contract the contractor will be

reimbursed as customers attain certain benchmarks or services.

Service Providers that place clients in unsubsidized employment will achieve the

Placement Benchmark of $500: this benchmark is achievable across all employment

directed activities. Also, service providers can achieve the 90 day employment retention

benchmark of $250 which is available to all employment directed activities.

BENCHMARKS

PROGRAM YEAR 2015

TANF

JOB SEARCH 4 WEEKS $500.00

1st Benchmark 50% Or $ 250.00

Program orientation, enrollment, at the end of 2

weeks: retention of participant in the activity for

up to 2 weeks and compliance with inputting

attendance information into the E-Timesheet

System on a weekly basis.

2nd Benchmark 50% Or $ 250.00

At the end of 2 more weeks: retention of

participant in the activity for up to 2 more

weeks and compliance with inputting



30

BENCHMARKS

PROGRAM YEAR 2015

TANF

CWEP PROGRAM 6 MONTHS $1,500.00

1st Benchmark 16.7% Or $ 250.00

At the end of one month: Assessment, enrollment in a

CWEP site; report assessment scores and CWEP site

address to DSS and compliance with inputting

attendance information into the E-Timesheet System

on a weekly basis. In addition, all assessment results

(i.e. TABE Test, Employability Assessment) must be

attached to the voucher.

2nd Benchmark 16.7% Or $ 250.00

At the end of two months: monitor client in CWEP site,

update client’s resume, send client’s

recommendation from CWEP site, progress report

and if appropriate communicate recommendation

for next activity to DSS and compliance with

inputting attendance information into the E-

Timesheet System on a weekly basis.

3rd Benchmark 16.7% Or $ 250.00

At the end of three months – retain, monitor

participant in a CWEP site (up to 1 month) and

compliance with inputting attendance information

into the E-Timesheet System on a weekly basis.

4th Benchmark 16.7% Or $ 250.00

At the end of four months – retain, monitor





At the end of five months – retain, monitor





At the end of six months – retain, monitor participant

in a CWEP site (up to 1 month) and compliance with

inputting attendance information into the E-


31

BENCHMARKS

PROGRAM YEAR 2015

TANF

CWEP TRANSITIONAL 2 MONTHS $500.00


At the end of one month: placement, retention,

monitoring of participant in the CWEP site (up to 1

month) and compliance with inputting attendance

information into the E-Timesheet System on a weekly

basis.


At the end of two months: retain, monitor participant

in the CWEP site (up to 1 month) and compliance

with inputting attendance information into the E-


BENCHMARKS

PROGRAM YEAR 2015

TANF

CWEP + EDUCATION DIRECTLY RELATED TO EMPLOYMENT

CWEP + JOB SKILLS DIRECLTY RELATED TO EMPLOYMENT

CWEP+ SATISFACTORY SCHOOL ATTENDANCE-CERT. OF GENERAL

EQUIVALENCE

3 MONTHS $1,500.00


At the end of one month – orientation, assessment,

attendance to educational/job training,

placement, retention & monitoring of participant in

a CWEP site, report assessment scores and CWEP

site address and compliance with inputting




At the end of two months – attendance to

educational/job training, retain & monitor





At the end of three months – attendance to





32

BENCHMARKS

PROGRAM YEAR 2015

GA/SNAP

JOB READINESS /LIFE SKILLS 4 WEEKS $500.00


At orientation, enrollment, at the end of 2

weeks: retention of participant in the activity

for up to 2 weeks and compliance with

having the participants provide a signature

on a sign-in sheet attesting to the clients'

presence/absence. Sign-in sheets must be

maintained on site as an audit trail.


At the end of 2 more weeks: retention of

participant in the activity for up to 2 more

weeks and compliance with having the

participants provide a signature on a sign-in

sheet attesting to the clients'

presence/absence. Sign-in sheets must be


33

BENCHMARKS

PROGRAM YEAR 2015

GA/SNAP

CWEP PROGRAM 6 MONTHS $1,500.00


At the end of one month - placement, retention,

monitoring of participant in a CWEP site (up to 1 month)

and compliance with having the participants provide a

signature on a sign-in sheet attesting to the clients’

presence/absence. Sign-in sheets must be maintained on

site as an audit trail. In addition, all assessment results

(i.e. TABE Test, Employability Assessment) must be

attached to the voucher.


At the end of two months - retain, monitor participant in a

CWEP site (up to 1 month) and compliance with having the

participants provide a signature on a sign-in sheet attesting

to the clients’ presence/absence. Sign-in sheets must be



At the end of three months - retain, monitor participant in a






At the end of four months - retain, monitor participant in a






At the end of five months - retain, monitor participant in a






At the end of six months - retain, monitor participant in a





CWEP TRANSITIONAL 2 MONTHS $500.00


At the end of one month: placement, retention, monitoring

of participant in the CWEP site (up to 1 month) and

compliance with having the participants provide a

signature on a sign-in sheet attesting to the clients’

presence/absence. Sign-in sheets must be maintained on

site as an audit trail.


At the end of two months: retain, monitor participant in the

CWEP site (up to 1 month) and compliance with having

the participants provide a signature on a sign-in sheet

attesting to the clients’ presence/absence. Sign-in sheets

must be maintained on site as an audit trail.

34

BENCHMARKS

PROGRAM YEAR 2015

GA/SNAP

ALTERNATIVE WORK EXPERIENCE PROGRAM (AWEP) 3 MONTHS $1,500.00


At the end of one month – orientation,

assessment, attendance to educational/job

training, placement, retention & monitoring

of participant in a CWEP site, report

assessment scores and CWEP site address and

compliance with having the participants

provide a signature on a sign-in sheet attesting

to the clients’ presence/absence. Sign-in

sheets must be maintained on site as an audit

trail.


At the end of two months - attendance to


participant in a CWEP site (up to 1 month)

and compliance with having the participants




trail.


At the end of three months - attendance to


participant in a CWEP site (up to 1 month)

and compliance with having the participants




trail.

BENCHMARKS

PROGRAM YEAR 2015

TEST OF ADULT BASIC EDUCATION (TABE 9/10)

Benchmark $ 50.00

Participant provided full battery of TABE 9/10

and the results submitted to Division of Social

Services

35

BENCHMARKS

PROGRAM YEAR 2015

JOB PLACEMENT AND RETENTION

PLACEMENT Benchmark $ 500.00

Placement- Full time (30 to 35 hours) unsubsidized

employment at or above the NJ minimum wage of

$8.25 per hour.

RETENTION Benchmark $ 250.00 90 Day Job Retention

36

7.0 PROGRAM FUNDAMENTALS AND REQUIREMENTS

a. Periodic contract monitoring reviews in order to assess the vendor’s compliance with

program and contract standards.

b. Providers must be in compliance with the most recent Pay-to-Play legislation.

c. The County reserves the right to modify contracts based on benchmark performance

and results obtained through the contract monitoring and compliance process.

d. Providers must attend mandated Service Provider meetings, as scheduled.

e. Periodic reviews of contracts and services will be conducted, and funds may be re-

allocated based upon customer need.

f. Services and activities approved by the County must be contracted directly with the

applicant. No third party subcontracting will be allowed without the prior written

approval of the Workforce Investment Board.

8.0 SPECIFIC RESPONSIBLITIES OF THE SUB-GRANTEE/PROVIDER

a. Program providers must document attendance daily. For all activities, vendors are

required to have the participant provide a signature on a sign-in sheet attesting to the

presence of the person on that day. These sign-in sheets must be maintained on site as

an audit trail.

In addition, sites must record attendance/absence information for each individual

each day. Form WFNJ-87, Work First New Jersey (WFNJ) Work Attendance Form must

be used to document attendance.

1) For TANF program providers, vendors must report weekly the number of hours of

participation by each individual each day using the statewide standardized WEB-

based E-TimeSheet. Each vendor must have Internet capability on site to comply with

program requirements. The program requirements include recording of attendance

and transmission of attendance records via the Internet. The Web-based “E-

TimeSheet” application must be used by the vendor to post daily

attendance/absence information and actual hours of participation for each

participant.

2) For GA/SNAP program providers, vendors must report weekly the number of hours of

participation by each individual each day using the statewide standardized WEB-

based E-TimeSheet. This information must be reported to the supervisor and case

manager at UCDSS. Providers must complete daily attendance records and forward

attendance summaries weekly to the referring case manager, UCDSS Supervisor via e-

mail and hard copy on a weekly basis.

Failure to comply would delay reimbursement of expenditures.

b. Once the provider receives the referral list from the UCDSS, it is the responsibility of the

funded agency to outreach to the client. The provider must document the outreach

effort(s) to have client arrive at their designated work activity.

37

c. All vendors must notify the Supervisor and the Case-Manager from UCDSS

immediately when:

1. The client is in non-compliance for:

i. Failure to attend activities

ii. Failure to perform – client’s performance is below a satisfactory level - in the

activity

iii. Failure to progress in the activity

iv. Inappropriate behavior in the activity

2. The client has been terminated from the designated activity

3. The client has excessive consecutive absences (3 absences) during the one (1)

month period

d. The non-compliant client must be given a written referral back to the UCDSS.

e. Report client progress weekly to the UCDSS and it is required that copies be supplied to

the UCDSS Supervisor via e-mail and hard copy on a bi-weekly basis.

f. Provide ongoing participant assessment and evaluation to the UCDSS and it is required

that copies be supplied to the UCDSS Supervisor via e-mail and hard copy on a bi-

weekly basis.

g. To keep the client engaged in the activity, and if client not engaged (missed 3 or

more consecutive days) immediately contact UCDSS to inform of non-participation

in mandated activity.

h. All providers must demonstrate, in client’s progress notes, those efforts the provider

made to outreach to clients to ensure participation and attendance in the activity.

i. Upon completion of the activity, service providers are required to complete and

share with the Case-Manager a summary of customer’s progress in the program and

it is required that copies be supplied to the UCDSS Supervisor via e-mail and hard copy.

j. Job Placement - the job placement providers must address the clients’ need to find

full-time employment, accessible transportation, childcare and other support

services and answer the requirements of limited English proficiency participants,

disabled clients [including substance abuse clients] or participants with low-level

literacy issues. Wage rates should be competitive and benefit packages reasonable

(to include sick time and vacation time) and placement should be permanent and

long-term (at least 90 days). In addition to contacting the Division of Social Services,

contractors must notify the Workforce New Jersey Office if a recipient obtains

employment.

k. All providers will be required to notify the referring UCDSS Case Manager of each

customer’s enrollment in the program and their respective start/end date.

Notification of client’s enrollment, termination, and employment must be in writing

and forwarded to the UCDSS Case Manager and it is required that copies be

supplied to the UCDSS Supervisor via e-mail and hard copy on a weekly basis.

38

l. Site Closings - It is the responsibility of the funded agency to contact the UCDSS

when their site is scheduled to be closed other than for the ten (10) state recognized

holidays regarding the WFNJ Program.

1. New Year’s Day

2. Martin Luther King’s Birthday

3. Washington’s Birthday

4. Good Friday

5. Memorial Day

6. Independence Day

7. Labor Day

8. Columbus Day

9. Veteran’s Day

10. Thanksgiving Day

Furthermore, the funded agency is required to provide appropriate

accommodations, in the event of site closings, to enable the client to meet the

required number of hours during that month in order to satisfy the work activity

requirement for federal participation purposes.

m. All providers will be required to identify and document individual performance

benchmarks for each customer, as well as provide any necessary supporting

documentation.

n. CWEP and AWEP should be based on workplace competencies.

o. AWEPs must include workplace literacy as a component.

p. All contracts must include a client flow chart.

q. Statement of participant information release is to be retained in participant file.

r. Administration, management and operation of the contracted training program.

s. Involvement with client case management and case review meetings should occur

no less frequently than bi-weekly.

t. Completion of all monitoring, evaluation, progress reports and vouchers as required.

u. Each vendor must have Internet capability on site to comply with program

requirements.

v. Individual (CWEP) Worksite Agreement

No WFNJ participant may be placed on a worksite that has not been approved with

a signed Community Work Experience Program (CWEP) Work First New Jersey/FSETP

Worksite Agreement. All items of the worksite agreement must be completed

before the worksite is approved. The CWEP worksite agreements must include the

agency’s Federal Employer Identification Number.

39

On an ongoing basis, sub-grantee staff will provide a copy of all CWEP agreements

developed to the UCDSS Case Manager. A copy should be retained by the sub-

grantee.

- Participant Attest

This form is to be read to the participant end endorsed/dated by the appropriate

parties. The original and copies should be distributed in the same manner as the

CWEP Worksite Agreement.

- State CWEP Guidelines for Implementation

A copy of the State Guidelines should be given by the sub grantee by all public

and/or private non-profit agencies to enter into a County Worksite Agreement.

- Liability Insurance

A copy of the 2/26/91 NJDHS, Division of Economic Assistance letter, governing

participant insurance liability for CWEP enrollment, is required to be given by the

sub grantee to all public and/or non-profit agencies to enter into a County

Worksite Agreement.

w. The CWEP vendor will review CWEP responsibilities with the site, including necessary

absences when the clients go on job interviews (jobs developed by provider). Time

allowed for job interviews must be recorded as an excused absence. It would also

include an understanding that the CWEP site will provide letters of recommendation

for any participant that has successfully completed this activity so that they may use

them in their job search efforts.

x. The CWEP vendor will continually mediate between the site and the client to ensure

a positive CWEP experience for both parties.

y. Provide an explanation of the Earned Income Tax Credit for all participants.

9.0 PROPOSAL EVALUATION CRITERIA

If the proposal is determined to be incomplete as per RFP guidelines, the proposal may be

administratively rejected and may not be considered for funding.

1. Compliance with Proposal Specifications (5 Points)

(Includes appropriate signatures and attachments,)

2. Agency Description / Program History (20 Points)

(Includes experience in administering workforce development / preparation programs

including efforts of job placement for clients. Satisfactory record of past performance

or placement of participants; quality of training; ability to arrange for placement,

licensure and/or support services; good retention and earning rates; satisfactory

record of integrity, business ethics and fiscal responsibility; includes the ability to

provide services that lead to achievement of competency standards. Experience in

organization, accounting and operational controls. Agency’s goals, mission and

overall agency operation.)

40

3. Program Description/Management Criteria/Program Supervision (60 Points)

(Includes ability to meet program specifications and performance goals with

reasonable costs; program oversight; technical skills to perform the work; ability to

uphold programmatic standards as described in the RFP; Evaluation Tools to be used;

Client Outreach Efforts; Curriculum)

4. Goals and Objectives of the Program (15 pts)

(Includes establishment of measurable goals for participant outcomes)

EXPLANATION OF EVALUATION CRITERIA:

Cost per Entered Employment is obtained by dividing the total dollars requested by the

total dollars requested by the total number you plan to place in unsubsidized employment

or in post-secondary education.

Average Wage at Placement will be evaluated on the actual wage at placement

proposed by the bidder.

Strategies to meet Community (Business) needs in filling positions will look at how the

needs of local business plan in the overall structure of the program.

Experience Working with Proposed Population will look at past experience serving the

same or similar populations.

Strategic Plan/Goals will be evaluated based on the information provided in the Goals

and Objectives Section. Proposer should be aware point values will not be assigned to

proposals that only reiterate the goals.

Program Design will be evaluated based on information provided in the Program

Description Section. Proposer should consider designs that are unique, innovative, and

collaborate with partners and the community at-large.

Financial/Accounting Review will be evaluated based on information in the proposal

Management Capability Section and any additional information that was requested

including audit information, cost allocation plans (if appropriate), certification of

accounting system, budget worksheets, etc. Past or current contractors will also be

reviewed on the timeliness and accuracy of financial requests.

Organizational Capacity will be evaluated based on information provide in the proposal

and any additional information that may be requested.

41

10.0 PROPOSAL RESPONSE

10.1 SPECIFICATION FOR PROPOSAL NARRATIVE

The Written Narrative will be a comprehensive snapshot of the proposed program. The

Narrative must follow the order outline. USE THE HEADINGS AS OUTLINED.

Specifications for written narrative should be submitted as follows:

Each section of the response must adhere to the specified page limit

Font: Arial

Font Size: 12-point

Spacing: single

Margins: .55 to 1-inch margins

Pagination: pages must be numbered.

The proposal shall include the following and be submitted in the order described below:

PROPOSAL COVER PAGE – Complete Attachment A-1

PROGRAM SUMMARY – Complete Attachment A-2

ASSURANCES – Complete Attachment A-3

TABLE OF CONTENTS

EXECUTIVE SUMMARY (not to exceed 2 pages)

SECTION 1. AGENCY DESCRIPTION (not to exceed 2 pages)

a. Include a brief history and services provided to this population inclusive of

geographic area, number of people served per program and client

characteristics;

b. Include the agency’s goal or the overall purpose or mission of the agency. It

encompasses all of the agency’s programmatic efforts including placement into

unsubsidized employment for applicable programs.

c. Include the name of the person and title for authorized contract signatory and

the mailing address for contract mailing and correspondence.

d. Briefly describe the success or challenges your organization has faced in the

meeting the program goals.

e. Include the following attachments after your description (does not count against

the page limit):

Organizational Chart – Attachment A-4

Agency’s Current Board Membership List - Attachment A-5

Copy of New Jersey Business Registration Certificate – Attachment A-6

Proof of non-profit status (if applicable) - Attachment A-7

42

SECTION 2. HISTORY & EXPERTISE IN EACH PROPOSED PROGRAM AREA (not to exceed 5

pages)

a. What experience does the agency have in the proposed program or service

area?

b. Provide a detailed description of the agency’s ability to work with our clientele

(public assistance recipients), and particularly the agency’s ability to motivate

the clients to attend their designated activities, keep them engaged in the

activity and to complete them.

c. Has the agency ever provided the proposed program or one similar to the

program in this proposal or service (currently or in the past)?

If yes:

Detail list of projects/programs in the past 4 years

How long has the program been in operation?

Has it been successful?

If the program ended, explain why.

SECTION 3. STATEMENT OF NEED (not to exceed 2 pages)

a. Explain why the proposed program service is needed.

b. Identify the problems or service gaps(s). The trends, studies, needs assessments,

statistics, or other information cited should be specific to Union County. If

applicable to program requested, give the occupation demand areas

appropriate to training.

SECTION 4. PROGRAM DESCRIPTION FOR EACH OF THE PROPOSED SERVICES (not to

exceed 10 pages)

Describe the program in detail:

a. Give a concise picture of the daily programmatic operations.

b. Description of overall proposed services: all training, education, supportive,

outreach, engagement, retention and related activities.

c. Indicate Curriculum Outline – Identify & list major units and hours of instruction by

subject.

d. Cite special staff training or expertise.

e. Hours of program operation.

f. Cite affiliation agreements, if applicable.

g. Describe all job development activities.

SECTION 5. GOALS & OBJECTIVES OF EACH PROPOSED PROGRAM (not to exceed 5

pages)

a. Specifically state the outcomes your agency will achieve.

43

b. Describe in detail how your agency will ensure that, at minimum, 50% of clients

referred from Division of Social Services will be enrolled, remain engaged and

complete the program.

c. What are the measurable goals for participant outcomes?

d. What are the objectives of the program?

e. If employment is a goal, list area employers you will be working with and the

types of jobs they offer.

f. For Job Search & Job Readiness Activities describe how your program will

achieve the 50% placement rate.

SECTION 6. PROGRAM SUPERVISION (not to exceed 2 pages)

a. Briefly outline a description of the overall agency operation and the people

involved in oversight and the operation of this program.

SECTION 7. PROGRAM EVALUATION (not to exceed 2 pages)

a. What internal process is in place to assess the extent to which the program is

implemented as planned?

b. Explain what the internal monitoring procedures and assessment tools will be:

Who will perform the evaluation?

How frequently will it be performed?

What are the criteria for success?

Identify the mechanism for tracking the results?

What type of report or statistics will be generated?

Who will receive the report?

SECTION 8. MANAGEMENT CAPABILITY (not to exceed 2 pages)

a. Briefly outline agency ability to establish and maintain compliance with the funding

rules, governing regulations, the assurances, certifications and general provisions as

it pertains to its subcontract if awarded.

b. Describe agency's fiscal management systems which meet the minimum generally

accepted accounting principles overall, and their relationship to the receipt and

disbursement of funds if subcontract is awarded.

c. Describe agency's fiscal management systems which meet the minimum generally

accepted accounting principles overall, and their relationship to the receipt and

disbursement of funds if subcontract is awarded.

d. Identify what measures or processes are practiced by the agency to assure fiscal

accountability.

e. Identify the individual and position title of the person the agency has delegated

as the fiscal authority.

SECTION 9. GRANT PERSONNEL QUALIFICATIONS (not to exceed 2 pages)

a. List the key personnel who will be working directly on this contract, including names

of instructors.

44

SECTION 10. SITE CLOSINGS / HOLIDAYS OBSERVED (not to exceed 2 pages)

a. List in detail all scheduled site closings. What is your organization’s plan to serve

clients in the event of regular or unexpected site closings other than the ten (10)

recognized holidays? If your agency is scheduled to close for an extended period

of time, e.g. Christmas and Thanksgiving, what accommodations will be made for

clients to fulfill their required hours of participation?

b. Cite agreements with other agencies to have available activities for clients when

agency is closed (for other than the ten (10) approved holidays).

SECTION 11. PARTNERSHIP / COORDINATION WITH INSTITUTIONS & ORGANIZATIONS

(not to exceed 2 pages)

a. Describe your organization’s experience in working as a partner within the One-

Stop system. If applicable, describe the organization’s experience as a

participant in systems that deliver educational and/or employment and training

services to this population. Also describe any partnerships that provide

temporary activities in the event of agency closing(s).

SECTION 12. REQUIRED ATTACHMENTS

Attachment A-8: Training Program Certification: If applicable, attach proof of NJ

Department of Labor and Workforce Development Eligible Training

Provider approval or NJDOE equivalent by the authorized entity for

training programs. (Please attach a printed copy of the certification

as taken from the statewide list of approved vendors at

www.njtrainingsources.org)

Attachment A-9: Certification Regarding Debarment, Suspension, Ineligibility and

Voluntary Exclusion Lower Tiered Covered Transactions

Attachment A-10: Certification Regarding Lobbying for Contracts, Grants, Loans

and Cooperative Agreements

Attachment A-11: Instruction for Certification

Attachment A-12: Year 2014 or most recent Audited Financial Statement

Attachment A-13: Affirmative Action Statement (included)

Attachment A-14: Americans with Disabilities Act: Equal Opportunity for Individuals

with Disabilities (included)

Attachment A-15: Stockholder Disclosure Certification (included - if applicable)

Attachment A-16: Affidavit of No Conflict of Interest

Attachment A-17: Non-Collusion Affidavit

Attachment A-18: Union County Insurance Requirement

Attachment A-19: Disclosure of Investment Activities in Iran

http://www.njtrainingsources.org/

45

11.0 PROPOSAL COMPLIANCE ASSESSMENT

This form will be used by Union County Workforce Investment Board staff for the initial

compliance assessment prior to submitting the proposal to the Evaluation Team for

review. Respondents may wish to use it before submitting the proposal to ensure that

all required documents have been submitted and all required elements have been

addressed. Proposals found lacking any item or section thereof may not be

considered for review.

Responsive proposal applications shall be submitted in the following manner:

Cover Page – Attachment A-1 Completed

Program Summary –Attachment A-2 Completed

Assurances – Attachment A-3 Completed

Table of Contents

Executive Summary

Section 1: Agency Description

Attachment A-4 - Organizational Chart

Attachment A-5 – Agency’s Current Board Membership List

Attachment A-6 – Copy of New Jersey Business Registration Certificate

Attachment A-7 - Proof of Non-Profit status

Section 2: History and Expertise in Each Proposed Program Area

Section 3: Statement of Need

Section 4: Program Description for Each of the Proposed Services

Section 5: Goals and Objectives of Each Proposed Program

Section 6: Program Supervision

Section 7: Program Evaluation

Section 8: Management Capability

Section 9: Grant Personnel Qualifications

Section 10: Site Closings / Holidays Observed

Section 11: Partnership / Coordination with Institutions and Organizations

Section 12: Required Attachments

Include Attachment A-8: Proof of Program Approval as an Eligible Training

Provider (if applicable)

Complete Attachment A-9: Certification Regarding Debarment, Suspension,

Ineligibility and Voluntary Exclusion Lower Tiered Covered Transactions

Complete Attachment A-10: Certification Regarding Lobbying for Contracts,

Grants, Loans and Cooperative Agreements

Include Attachment A-11: Instruction for Certification

Include Attachment A-12: Year 2014 or most recent Audited Financial Statement

Complete Attachment A-13: Affirmative Action Statement

Complete Attachment A-14: Americans with Disabilities Act

Complete Attachment A-15: Stockholder Disclosure Certification (if applicable)

Complete Attachment A-16: Affidavit of No Conflict of Interest

Complete Attachment A-17: Non-Collusion Affidavit

Include Attachment A-18: Union County Insurance Requirement

Complete Attachment A-19: Disclosure of Investment Activities in Iran

46

COUNTY OF UNION PROGRAM YEAR 2015 WORKFIRST NEW JERSEY

REQUEST FOR PROPOSALS

SECTION I A. AGENCY INFORMATION

Agency Name:

Authorized Signatory:

Mailing Address:

Telephone Number:

Fax Number:

Email:

B. AUTHORIZED TRAINING SITE:

Training Site Name:

Site Manager:

Site Address:

Telephone Number:

Fax Number:

Email:

Hours of Operation:

C. AUTHORIZED FISCAL REPRESENTATIVE

Fiscal Representative:

Title:

Address:

Telephone Number:

Fax Number:

Email:

D. TYPE OF AGENCY

Not-for-Profit 501(c)(3) Public Institution

Private for Profit Public / Government

Other (specify)

Federal ID #:_________________________________

Authorized Signatory:

(Signature Required)

Date:

COVER PAGE A-1

47

A. PROGRAM SERVICES (Check All that Apply)

B. FUNDING SUMMARY

In the “Requested Funding Columns” please indicate the amount of funding requested

per each activity / by geographical area. The total requested funding will be the basis

for the Micro-Block Grant.

TANF GA/SNAP

Job Search Job Readiness / Life Skills

Work Experience (WE) – CWEP Work Experience (WE) – CWEP

WE / CWEP + Education Directly Related

to Employment

Alternative Work Experience Program

(AWEP)

TABE Testing Services (TANF & GA/SNAP)

EMPLOYMENT DIRECTED ACTIVITIES BENCHMARK

FEE REQUESTED FUNDING

East West

TANF

Job Search $500

Community Work Experience Program $1,500

CWEP Transitional $500

CWEP + Education Directly Related to

Employment $1,500

CWEP + Job Skills Directly Related to

Employment $1,500

CWEP + Satisfactory School

Attendance- Cert. of General Equiv. $1,500

GA/SNAP

Job Readiness/Life Skills $500

Community Work Experience Program $1,500

CWEP Transitional $500

Alternative Work Experience Program $1,500

Placement and Retention Benchmarks

Placement in Unsubsidized Employment $500

Retention- 90 days $250

TABE Testing Services $50

TOTAL REQUESTED FUNDING $ $

PROPOSAL SUMMARY PAGE A-2

48

ASSURANCES A-3

I recognize that I must give assurance for each item below. If I cannot, this proposal will be

automatically rejected. The assurances are:

1. I am authorized by my Board of Directors, Trustees, other legally qualified officer, or as the

owner of this agency or business to submit this proposal on behalf of the “Proposer.”

2. The submitted proposal shall remain valid for a period of at least 120 calendar days.

3. Proposer is not currently on any Federal, State of New Jersey, or local Debarment List.

4. Proposer will provide records to show fiscal solvency, if needed.

5. Proposer has/will have all of the fiscal control and accounting procedures needed to ensure

that funds will be used as required by law and contract.

6. Proposer will meet all applicable federal, state, and local compliance requirements. These

include, but are not limited to:

• Meeting County of Union Insurance requirements (see Attachment A-18)

• Ensuring that records accurately reflect actual performance

• Maintaining record confidentiality, as required

• Reporting financial, participant, and performance data, as required

• Complying with Federal and State non-discrimination provisions

• Meeting requirements of Section 504 of the Rehabilitation Act of 1973

• Meeting all lobbying certification and disclosure of lobbying activities requirements

I hereby assure that all of the above are true.

__________________________________ ________________________________

Name Title

_______________________________ ___ ________________________________

Signature Date

49

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND

VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS A-9

This certification is required by the regulations implementing Executive Order 12549, Debarment and

Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were

published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211).

(BEFORE COMPLETING CERTIFICATION, READ ATTACHED INSTRUCTIONS WHICH ARE AN INTEGRAL

PART OF THE CERTIFICATION)

(1) The prospective recipient of Federal assistance funds certifies, by submission of this proposal,

that neither it nor its principals are presently debarred, suspended, proposed for debarment,

declared ineligible, or voluntarily excluded from participation in this transaction by any

Federal department or agency.

(2) Where the prospective recipient of Federal assistance funds is unable to certify to any of the

statements in this certification, such prospective participant shall attach an explanation to

this proposal.

Grantor/Contractor Organization Program/Title

Name of Certifying Official Signature Date

50

CERTIFICATION REGARDING LOBBYING FOR CONTRACTS, GRANTS,

LOANS AND COOPERATIVE AGREEMENTS

A-10

The undersigned certifies, to the best of his or her knowledge and belief, that:

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the

undersigned, to any person for influencing or attempting to influence an officer or

employee of an agency, a Member of Congress, an officer of employee of Congress, or an

employee of a Member of Congress in connection with the awarding of any Federal

contract, the making of any Federal grant, the making of any Federal loan, the entering

into of any cooperative agreement, and the extension, continuation, renewal,

amendment, or modification of any Federal contract, grant, loan, or cooperative

agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to

any person for influencing or attempting to influence an officer or employee of any

agency, a Member of Congress, an officer or employee of Congress, or an employee of a

Member of Congress in connection with this Federal contract, grant, loan, or cooperative

agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure

Form to Report Lobbying," in accordance with its instructions.

(3) The undersigned shall require that the language or this certification be included in the

award documents for all sub-awards at all tiers (including subcontractors, sub-grants and

contracts under grants, loans, and cooperative agreements) and that all* sub-recipients

shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when

this transaction was made or entered into. Submission of this certification is a prerequisite for

making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any

person who fails to file the required certification shall be subject to a civil penalty of not less

than $10,000 and not more than $100,000 for each such failure.

Grantor/Contractor Organization Program/Title

Name of Certifying Official Signature Date

51

INSTRUCTION FOR CERTIFICATION A-11

By signing and submitting this proposal, the prospective recipient of Federal assistance funds is

providing the certification as set out below.

1. The certification in this clause is a material representation of fact upon which reliance was placed

when this transaction was entered into. If it is later determined that the prospective recipient of Federal

assistance funds knowingly rendered an erroneous certification, in addition to other remedies available

to the Federal Government, the Department of Labor (DOL) may pursue available remedies, including

suspension and/or debarment.

2. The prospective recipient of Federal assistance funds shall provide immediate written notice to the

person to whom this proposal is submitted if at any time the prospective recipient of Federal assistance

funds learns that its certification was erroneous when submitted or has become erroneous by reason of

charged circumstances.

3. The terms "covered transaction," "debarred," "suspended," "intelligible," "lower tier covered

transactions," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily

excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of

rules implementing Executive Order 12549.

4. The prospective recipient of Federal assistance funds agrees by submitting this proposal that, should

the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier

covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily

excluded from participation in this covered transaction, unless authorized by the DOL.

5. The prospective recipient of Federal assistance funds further agrees by submitting this proposal that it

will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary

Exclusion - Lower Tier Covered Transactions" without modification, in all lower tier covered transactions

and in all solicitations for lower tier covered transactions.

6. A participant in a covered transaction may rely upon a certification of a prospective participant in a

lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from

the covered transaction, unless it knows that the certification is erroneous.

7. A participant may decide the method and frequency by which it determines the eligibility of its

principals. Each participant may but is not required to check the List of Parties Excluded from

Procurement or Non-procurement Programs.

8. Nothing contained in the foregoing shall be construed to require establishment of a system of records

in order to render in good faith the certification required by this clause. The knowledge and information

of a participant is not required to exceed that which is normally possessed by a prudent person in the

ordinary course of business dealings.

9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered

transaction knowingly enters into a lower tier covered transaction with a person who is suspended,

debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other

remedies available to the Federal Government, the DOL may pursue available remedies, including

suspension and/or debarment.

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(REVISED 4/10)

EXHIBIT A

MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE

N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127)

N.J.A.C. 17:27

GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS

During the performance of this contract, the contractor agrees as follows:

The contractor or subcontractor, where applicable, will not discriminate against any

employee or applicant for employment because of age, race, creed, color, national origin,

ancestry, marital status, affectional or sexual orientation, gender identity or expression,

disability, nationality or sex. Except with respect to affectional or sexual orientation and

gender identity or expression, the contractor will ensure that equal employment opportunity

is afforded to such applicants in recruitment and employment, and that employees are

treated during employment, without regard to their age, race, creed, color, national origin,

ancestry, marital status, affectional or sexual orientation, gender identity or expression,

disability, nationality or sex. Such equal employment opportunity 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. The contractor or subcontractor agrees

to post in conspicuous places, available to employees and applicants for employment,

notices to be provided by the Public Agency Compliance Officer setting forth provisions of

this nondiscrimination clause.

The contractor or subcontractor, where applicable will, in all solicitations or

advertisements for employees placed by or on behalf of the contractor or subcontractor,

state that all qualified applicants will receive consideration for employment without regard to

age, race, creed, color, national origin, ancestry, marital status, affectional or sexual

orientation, gender identity or expression, disability, nationality or sex.

The contractor or subcontractor will send to each labor union, with which it has a

collective bargaining agreement, a notice, to be provided by the agency contracting

officer, advising the labor union of the contractor’s commitments under this chapter and shall

post copies of the notice in conspicuous places available to employees and applicants for

employment.

The contractor or subcontractor, where applicable, agrees to comply with any

regulations promulgated by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended

and supplemented from time to time and the Americans with Disabilities Act.

The contractor or subcontractor agrees to make good faith efforts to meet targeted

county employment goals established in accordance with N.J.A.C. l7:27-5.2.

EQUAL EMPLOYMENT OPPORTUNITY / AFFIRMATIVE ACTION STATEMENT A-13

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The contractor or subcontractor agrees to inform in writing its appropriate recruitment

agencies including, but not limited to, employment agencies, placement bureaus, colleges,

universities, and labor unions, that it does not discriminate on the basis of age, race, creed,

color, national origin, ancestry, marital status, affectional or sexual orientation, gender

identity or expression, disability, nationality or sex, and that it will discontinue the use of any

recruitment agency which engages in direct or indirect discriminatory practices.

The contractor or subcontractor agrees to revise any of its testing procedures, if

necessary, to assure that all personnel testing conforms with the principles of job-related

testing, as established by the statutes and court decisions of the State of New Jersey and as

established by applicable Federal law and applicable Federal court decisions.

In conforming with the targeted employment goals, the contractor or subcontractor

agrees to review all procedures relating to transfer, upgrading, downgrading and layoff to

ensure that all such actions are taken without regard to age, race, creed, color, national

origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression,

disability, nationality or sex, consistent with the statutes and court decisions of the State of

New Jersey, and applicable Federal law and applicable Federal court decisions.

All successful vendors must submit within seven days of the notice of intent to award or

the signing of the contract one of the following:

A photocopy of your Federal Letter of Affirmative Action Plan Approval

A photocopy of your Certificate of Employee Information Report

A completed Affirmative Action Employee Information Report (AA302)

If successful vendor does not submit the affirmative action document within the seven

days the County of Union will declare the vendor as being non-responsive and award the

contract to the next lowest Proposer.

______________________________________________________

Print or type FIRM NAME here

______________________________________________________

Sign NAME and TITLE here

(Original signature only, stamped signature not accepted)

______________________________________________________

Print or type NAME and TITLE here

______________________________________________________

Print or type DATE

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AMERICANS WITH DISABILITIES ACT

EQUAL OPPORTUNITY FOR INDIVIDUALS WITH DISABILITIES

The Service Provider and the County do hereby agree that the provisions of Title II of the Americans With

disability by public entities in all services, programs, and activities provided or made available by public

entitles, and the rules and regulations promulgated pursuant thereunto, are made a part of this contract. In

providing any aid, benefit, or service on behalf of the County pursuant to this contract, the Service Provider

agrees that the performance shall be in strict compliance with the Act. In the event that the Service

Provider, its agents, servants, employees, or subcontractors violate or are alleged to have violated the Act

during the performance of this contract, the Service Provider shall defend the County in any action or

administrative proceeding commenced pursuant to this Act. The Service Provider shall indemnify, protect,

and save harmless the County, its agents, servants, and employees from and against any and all suits,

claims, losses, demands, or damages of whatever kind of nature arising out of or claimed to arise out of the

alleged violation. The Service Provider shall, at its own expense, appear, defend, and pay any and all

charges for legal services and any and all costs and other expenses arising from such action or

administrative proceeding or incurred in connection therewith. In any and all complaints brought pursuant

to the County’s grievance procedure, the Supplier agrees to abide by any decision of the County which is

rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an

award of damages against the County or if the County incurs any expense to cure a violation of the ADA

which has been brought pursuant to its grievance procedure, the Service Provider shall satisfy and

discharge the same at its own expense.

The County shall, as soon as possible after a claim has been made against it, give written notice thereof to

the Service Provider along with full and complete particulars of the claim. If any action or administrative

proceeding is brought against the County or any of its agents, servants, and employees, the County shall

expeditiously forward or have forwarded to the Service Provider every demand, complaint, notice,

summons, pleading, or other process received by the County or its representatives.

It is expressly agreed and understood that any approval by the County of the services provided by the

Service Provider pursuant to this contract will not relieve the Service Provider of the obligation to comply

with the Act and to defend, indemnify, protect, and save harmless the County pursuant to this paragraph.

It is further agreed and understood that the County assumes no obligation to indemnify or save harmless

the Service Provider, its agents, servants, employees and subcontractors for any claim which may arise out

of their performance of this Agreement. Furthermore, the Service Provider expressly understands and

agrees that the provisions of this indemnification clause shall in no way limit the Service Provider’s

obligations assumed in this Agreement, nor shall they be construed to relieve the Service Provider from any

liability, nor preclude the County from taking any other actions available to it under any other provisions of

this Agreement or otherwise by law.

Name____________________________________________________(Please print or type)

Signature_________________________________________________Date___________________

A-14

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STOCKHOLDER DISCLOSURE CERTIFICATION A-15

STOCKHOLDER DISCLOSURE CERTIFICATION N.J.S.A. 52:25-24.2 (P.L. 1977 c. 33)

Failure of the Proposer to submit the required information is cause for automatic rejection. CHECK ONE ___ I certify that the list below contains the names and home addresses of all stockholders holding 10%

or more of the issued and outstanding stock of the undersigned. OR ___ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the

undersigned. LEGAL NAME OF PROPOSER:______________________________________________________________ Check the box that represents the type of business organization: __Partnership __Corporation __Sole Proprietorship __Limited Partnership __Limited Liability Corporation __Limited Liability Partnership __Subchapter S Corporation Complete if the Proposer/respondent is one of the 3 types of corporations: Date Incorporated:_____________________ Where Incorporated:________________________ BUSINESS ADDRESS:

Street Address City State Zip Code

Telephone # Fax # Pursuant to N.J.S.A. 52:25-24.2, also referred to as P.L. 1977, c. 33, no corporation or partnership shall be awarded any contract for the performance of any work or the furnishing of any materials or supplies, unless, prior to the receipt of the Proposal or accompanying the Proposal of said corporation or partnership, there is submitted a statement setting forth the names and addresses of all stockholders in the corporation or partnership who own ten (10) percent or more of its stock of any class, or of all individual partners in the partnership who own a ten (10) percent or greater interest therein. Further, the Attorney General has concluded that the provisions of N.J.S.A. 52:25-24.2, in referring to corporations and partnerships, are intended to apply to all forms of corporations and partnerships, including, but not limited to, limited partnerships, limited liability corporations, limited liability partnerships, and Subchapter S corporations. Proposers are required to disclose whether they are a partnership, corporation or sole proprietorship. The Stockholder Disclosure Certification form shall be completed, signed and notarized. Failure of the Proposer to submit the required information is cause for automatic rejection of the Proposal.

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STOCKHOLDER DISCLOSURE CERTIFICATION - (Attachment A-15 Continued) Sign and notarize the form below, and, if necessary, complete the stockholder list below. NAME HOME ADDRESS TITLE % OF OWNERSHIP 1. 2. 3. 4. 5. If one or more of the owners of the Proposer/Respondent is itself a corporation or partnership, then for that corporation or partnership owner you must set forth the name, home address, title and percentage of ownership of every person who is an owner of that corporation or partnership.

NAME HOME ADDRESS TITLE % OF OWNERSHIP 1. 2. 3. 4. 5.

Subscribed and sworn before me this __________ day of ___________________________ , 2 __________. (Notary Public) My Commission expires: ___________, 20_____.

______________________________________

(Affiant)

_____________________________________ (Print name & title of affiant)

(Corporate Seal)

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AFFIDAVIT OF NO CONFLICT OF INTEREST A-16

AFFIDAVIT OF

NO CONFLICT OF INTEREST

State of New Jersey :

: SS:

County of :

I, , the undersigned and

(Name) (Name of Office)

of the company/firm/agency named in the within proposal, do hereby swear to the following:

I have full authority to make the representations set forth in this Affidavit; and

I am unaware of any conflict of interest that could disqualify myself or my company/firm/agency should

said company/firm/agency be selected among the list of approved vendors for the services and work by

the County of Union, and shall immediately notify said County should one arise during the term of my

contract.

SUBSCRIBED AND SWORN TO

BEFORE ME THIS DAY

OF_______________ 20_____.

____________________________________

(Print Name)

NOTARY PUBLIC OF (Signature)

MY COMMISSION EXPIRES: ___________, 20_____.

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NON-COLLUSION AFFIDAVIT A-17

NON-COLLUSION AFFIDAVIT State of New Jersey County of _________________ ss:

I, ________________________________ residing in ___________________________________ (name of affiant) (name of municipality)

in the County of _______________________________ and State of _____________________of full age, being duly sworn according to law on my oath depose and say that: I am _____________________________________ of the firm of ________________________________ (title or position) (name of firm) _____________________________________________ the Proposer making this Proposal for the RCCP entitled __________________________________________, and that I executed the said proposal with (title of proposal) full authority to do so that said Proposer has not, directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive bidding in connection with the above named project; and that all statements contained in said proposal and in this affidavit are true and correct, and made with full knowledge that the COUNTY OF UNION, NEW JERSEY relies upon the truth of the statements contained in said Proposal and in the statements contained in this affidavit in awarding the contract for the said project. I further warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon an agreement or understanding for a commission, percentage, brokerage, or contingent fee, except bona fide employees or bona fide established commercial or selling agencies maintained by _________________________________________________. Subscribed and sworn to before me this _______ day of _____________________________ Signature (Original signature only; ________________, 20______ stamped signature not accepted) ___________________________________ (Type or print name of affiant under signature) _____________________________ Notary public of the State of ____________ My Commission expires ________________

(Seal) NOTE TO NOTARY: WHEN COMPLETING THIS JURAT, ALL NOTARIES MUST: 1. Indicate date. 2. Indicate State. 3. Sign name. 4. Affix name by Printing it, typing it, using a rubber stamp, using an impression seal or using a mechanical stamp. Note to Proposer: The person who signed the Proposal form for the Proposer should sign this form also.

WARNING: IF YOU FAIL TO FULLY, ACCURATELY AND COMPLETELY FILL OUT THIS AFFIDAVIT OF NON-COLLUSION,

YOUR PROPOSAL WILL BE REJECTED.

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UNION COUNTY INSURANCE REQUIREMENTS

CONTRACTED SERVICES Commercial General Liability (CGL) Each Occurrence (4) General Liability $1,000,000.00

Personal & Adv. Injury $1,000,000.00

Med, Expense Any One Person $ 5,000.00

Damage to Premises $ 50,000.00

General Aggregate $2,000,000.00

Products – Comp/Op Aggregate $1,000,000.00

Auto Liability – Incl BI and PD (AL) (2) Any Auto $1,000,000.00

Or

All Owned $1,000,000.00

All Hired $1,000,000.00

All Non-Owned $1,000,000.00

Workers Compensation and Employee Liability Each Employee Statutory

Each Accident Statutory

(1) The per occurrence and aggregate limits for specified coverage should apply on a per location or per project basis (2) Automobile Liability is required if an automobile is used in the execution of their contract (3) $5,000,000 CSL is required if driving out of state (4) Minimum limits for small contractors, artisans, consultants can be decreased to $500,000 per occurrence (5) Liquor liability is required is supplying alcohol beverages for event

Union County Insurance Requirements continued on next page

INSURANCE REQUIREMENTS APPLICABLE TO ALL VENDORS- PAGE 1 A-18

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UNION COUNTY INSURANCE REQUIREMENTS

REQUIRED LANGUAGE NAMING THE COUNTY OF UNION AS AN ADDITIONAL INSURED

(Effective January 1, 2015) The following language is required to be added to all Certificates of Insurance provided by Vendors doing business with the County of Union. The language is as follows: “THE COUNTY OF UNION, ITS BOARD OF CHOSEN FREEHOLDERS, OFFICERS, EMPLOYEES, AGENTS, SERVANTS, (*AND THE STATE OF NEW JERSEY) ARE INCLUDED AS ADITIONAL INSURED UNDER THE GENERAL LIABILITY POLICY. THE GENERAL LIABILITY INSURANCE COVERAGE IS PROVIDED ON A PRIMARY, NON-CONTRIBUTORY BASIS, TO THE COUNTY OF UNION ET. AL. WHERE APPLICABLE, A WAIVER OF SUBROGATION IN FAVOR OF THE ABOVE-NAMED ADDITIONAL INSURED IS TO BE INCLUDED IN THOSE POLICIES OF INSURANCE WHERE PERMITTED BY LAW. SHOULD ANY OF THE ABOVE-DESCRIBED POLICIES BE CANCELLED BEFORE THEIR EXPIRATION DATES, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.”

“THE COUNTY OF UNION, ITS BOARD OF CHOSEN FREEHOLDERS, OFFICERS, EMPLOYEES, AGENTS, SERVANTS, (*AND THE STATE OF NEW JERSEY) ARE INCLUDED AS ADITIONAL INSURED UNDER THE GENERAL LIABILITY POLICY. THE GENERAL LIABILITY INSURANCE COVERAGE IS PROVIDED ON A PRIMARY, NON-CONTRIBUTORY BASIS, TO THE COUNTY OF UNION ET. AL. WHERE APPLICABLE, A WAIVER OF SUBROGATION IN FAVOR OF THE ABOVE-NAMED ADDITIONAL INSURED IS TO BE INCLUDED IN THOSE POLICIES OF INSURANCE WHERE PERMITTED BY LAW. SHOULD ANY OF THE ABOVE-DESCRIBED POLICIES BE CANCELLED BEFORE THEIR EXPIRATION DATES, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.”

INSURANCE REQUIREMENTS APPLICABLE TO ALL VENDORS- PAGE 2

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A-19

DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN

Proposer:_________________________________________________________________________ Pursuant to Public law 2012, c. 25, any person or entity that submits a bid or proposal or otherwise proposes to enter into or renew a contract must complete the certification below to attest, under penalty of perjury, that the person or entity, or one of the person or entity’s parents, subsidiaries, or affiliates, is not identified on a list created and maintained by the Department of the Treasury as a person or entity engaging in investment activities in Iran. If the Director finds a person or entity to be in violation of the principles which are the subject of the law, s/he shall take action as may be appropriate and provided by law, rule or contract, including but not limited to, imposing sanctions, seeking compliance, recovering damages, declaring the party in default and seeking debarment or suspension of the person or entity.

I certify, pursuant to Public Law 2012, c. 25, that the person or entity listed above for which I am authorized to bid/renew:

[ ] is not providing goods or services of $20,000,000 or more in the energy sector of Iran, including a person or entity that

provides oil or liquefied natural gas tankers, or products used to construct or maintain pipe lines used to transport oil or liquefied natural gas, for the energy sector of Iran, AND

[ ] is not a financial institution that extends $20,000,000 or more in credit to another person or entity, for 45 days or more, if that

person or entity will use the credit to provide goods or services in the energy sector in Iran.

In the event that a person or entity is unable to make the above certification because it or one of its parents, subsidiaries, or affiliates has engaged in the above-referenced activities, a detailed, accurate and precise description of the activities must be provided in part 2 below to the Division of Purchase under penalty of perjury. Failure to provide such will result in the proposal being rendered as non-responsive and appropriate penalties, fines and/or sanctions will be assessed as provided by law.

PART 2: PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN. You must provide, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes below. Relationship to Name_____________________________________ Bidder/Offeror_______________________________________ Description of Activities___________________________________________________________________________ Duration of Engagement____________________ Anticipated Cessation Date_____________________________ Proposer Contact Name_____________________________ Contact Phone Number_________________________________ Certification: I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. I attest that I am authorized to execute this certification on behalf of the above referenced person or entity. I acknowledge that Union County is relying on the information contained herein and hereby acknowledge that I am under a continuing obligation from the date of this certification through the completion of any contracts with the County to notify the County in writing of any changes to the answers of information contained herein. I acknowledge that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if I do so, I recognize that I am subject to criminal prosecution under the law and that it will also constitute a material breach of my agreement(s) with Union County, New Jersey and that the County at its option may declare any contract(s) resulting from this certification void and unenforceable. Full Name(Print)_________________________________________Signature__________________________________________ Title____________________________________________________Date_______________________________________________

Request for Proposals - Union County, New Jersey · Request for Proposals: Program Year 2015...

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