County of Mercer
McDade Administration Building, 640 South Broad Street, P.O. Box 8068, Trenton, NJ 08650-0068
REQUEST FOR PROPOSAL
County of Mercer
For The
Department of Human Services
For
Office on Aging
Older Americans Act, Social Services Block Grant,
State of New Jersey, Peer Grouping and County Direct Funding
for the period of 1/1/16 – 12/31/17;
with the option to extend for an additional year 1/1/18 – 12/31/18
Located At
640 South Broad St.
PO Box 8068
Trenton, NJ 08650-0068
To Be Received On
October 6, 2015
Prepared By: Erica Saganowski, Assistant Executive Director
NOTICE OF RFP
The County of Mercer is soliciting proposals through the competitive contracting process in
accordance with N.J.S.A. 40A:11-4.1, et seq.
Notice is hereby given that on Tuesday, October 6, 2015 at 12:00 NOON, (Prevailing time), sealed
proposals must be received by the Mercer County Department of Human Services Contract Unit,
Room 224 in the Mercer County McDade Administration Building at which time and place proposal
applications will be opened and read in public for:
Office on Aging
Older Americans Act, Social Services Block Grant, State of New Jersey, Peer Grouping and
County Direct Funding for the period of January 1, 2016 – December 31, 2017;
with the option to extend for an additional year January 1, 2018 – December 31, 2018
$1,043,248.00 annually
Priorities of this office will ensure that services assist older individuals with greatest social and
economic needs. Services funded under this RFP are targeted specifically to Mercer County senior
citizens age 60 and over and family caregivers. A family caregiver is defined as an adult family
member, or another individual, who is an informal provider of in-home and community care to an
individual age 60 or older.
Programs and services include the following:
Legal assistance and Education; Senior Mental Health Counseling and Education; Caregiver Support
Groups and Caregiver Mental Health Education; Disease Prevention and Health Promotion;
Socialization and Recreation Services; Summer Cooling Program; Volunteer Assisted Transportation;
Volunteer Friendly Visiting; Volunteer Housekeeping; Certified Home Health Aide; In-Home Health
Care; Professional In-Home Education and Support; Respite Care; Telephone Reassurance;
Countywide Weekday Home Delivered Meals; Nutrition Counseling and Education; Kosher Nutrition
Services; State Weekend Home Delivered Meals.
Specifications and instructions to bidders may be obtained at the Mercer County Office on Aging or on
the County website at http://nj.gov/counties/mercer/departments/hs/. Proposals shall be delivered in
sealed envelopes and addressed to Mercer County Department of Human Services Contract Unit,
Room 224, 640 South Broad Street, P.O. Box 8068, Trenton, NJ 08650-0068. All proposals should be
clearly marked on the outside:
“RFP – Office on Aging Older Americans Act, Social Services Block Grant, State of New Jersey, Peer
Grouping and County Direct Funding for the period January 1, 2016 – December 31, 2017; with the
option to extend for an additional year January 1, 2018 – December 31, 2018.”
This designation must also appear on the outside of Express envelopes/packages, if sent by express
mail. Proposals may be rejected if not submitted within time, date and place designated, and if not
accompanied by any of the required documents. In addition, if the respondent’s proposal exceeds the
County allocation as per the RPF it shall be rejected.
With the exception of the United States Postal Service, express mail shall be delivered to
Mercer County Department of Human Services Contract Unit, Room 224, 640 S. Broad Street,
PO Box 8068, Trenton, New Jersey 08650-0068.
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Addenda will be issued on the website; therefore, all interested respondents shall check the website
from now through the proposal opening. It is the sole responsibility of the respondent to be
knowledgeable of all addenda related to this procurement.
Respondents shall comply with the requirements of P.L. 1975 C127 (N.J.A.C. 17:27 et seq.).
COUNTY OF MERCER, NEW JERSEY
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INTRODUCTION
The Mercer County Office on Aging is the federally designated Area Agency on Aging. As such, this
office oversees the planning of a comprehensive and coordinated service delivery system, and
promotes the effective and efficient use of resources addressing duplication, which could diminish the
positive social impact of programs and services intended by legislation (Older Americans Act of 1965,
as amended; Rules and Regulations of County Office on Aging, N.J.A.C. 5:71.). The Office on Aging
has complete authority and responsibility to plan and develop policy and programs for older people 60
years of age and older, and their caregivers, within Mercer County.
In anticipation of notice of its 2016, 2017, and 2018 Older Americans Act, Social Services Block
Grant, State of New Jersey and Mercer County Peer Grouping and County Direct allocations, the
Mercer County Office on Aging is issuing a RFP to announce the availability of funding in the amount
of $1,043,248.00 annually, for the two period of January 1, 2016 – December 31, 2017; with the
option to extend for an additional year January 1, 2018 – December 31, 2018.
The Mercer County Department of Human Services, Office on Aging is accepting proposals for the
period of January 1, 2016 – December 31, 2017; with the option to extend for an additional year
January 1, 2018 – December 31, 2018 to provide services and programs for Mercer County senior
citizens age 60 and older and their family caregivers. Priorities of this office will ensure that services
assist older individuals with greatest social and economic needs, as well as minorities, older
individuals at risk of institutional placement, older individuals residing in rural areas, older individuals
with Alzheimer’s disease and related disorders, Caregivers of older individuals with Alzheimer’s
disease and related disorders, and older individuals with severe disabilities.
The attached funding method chart should be referenced for program specific funding allocations.
Proposal budgets shall be prepared for each year; separate budgets should be submitted for
2016, 2017 and 2018. Funds for this purpose are contingent upon inclusion in and adoption of the
2016, 2017 and 2018 Federal, State, and County budgets. Levels of service should be identified in
the Proposal Attachment A for each service year as well; including the optional 2018 contract year.
Community organizations and agencies interested in submitting proposals should emphasize its ability
to address the goals of the Mercer County Office on Aging; coordinate services with the countywide
network of senior providers; and illustrate how it will specifically meet the needs of the target
population as described in the Older Americans Act, Section 306 (a)(4)(A)(iii)(III).
Programs and services include the following:
Legal assistance and Education; Senior Mental Health Counseling and Education; Caregiver Support
Groups and Caregiver Mental Health Education; Disease Prevention and Health Promotion;
Socialization, Recreation, and Community Education Services; Summer Cooling Program; Volunteer
Assisted Transportation; Volunteer Friendly Visiting; Volunteer Housekeeping; Certified Home Health
Aide; In-Home Health Care; Professional In-Home Education and Support; Respite Care; Telephone
Reassurance; Countywide Weekday Home Delivered Meals; Nutrition Counseling and Education;
Kosher Nutrition Services; Weekend Home Delivered Meals.
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ADMINISTRATIVE CONDITIONS AND REQUIREMENTS
The following items express the administrative conditions and requirements of the RFP. They will
apply to the RFP process, the subsequent contract, and the project’s production. Any proposed
change, modification, or exception to these conditions and requirements may be the basis for the
County of Mercer to determine the proposal as non-responsive to the RFP and will be a factor in the
determination of an award of contract. The contents of the proposal of the successful respondent, as
accepted by the County of Mercer, will become part of any contract awarded as a result of this RFP.
SCHEDULE
A schedule has been established for respondent proposals, proposal review, contractor selection,
project initiation, and completion. The following dates have been established:
ACTIVITY
Public notice in the Times of Trenton
Proposal-specific question in writing to Office on Aging
Response to received questions posted to County website
Proposal due
Proposal committee review
Notification of award
Project to begin
Project to end
DATE
September 9 – 10, 2015
September 14 – 25, 2015
September 16 – 30, 2015
October 6, 2015
October 13 – 19, 2015
Week of November 9, 2015
January 1, 2016
December 31, 2017
(optional 2018 contract year)
EXPRESS OR US DELIVERY
Proposals may be hand delivered or mailed; however, the County of Mercer disclaims any
responsibility for proposals received late by regular or express mail. If the proposal is sent by express
mail service, the designation must appear on the outside of the express mail envelope. Proposals
received after the designated time and date will be returned unopened – No exceptions.
PROPOSAL SUBMISSION INFORMATION
Submission Date and Time: Tuesday, October 6, 2015 at 12:00 Noon
Submit One (1) signed Original in blue ink and six (6) copies, with an additional proposal submitted on
a CD or USB Drive. In addition, submit six (6) contracts/agreements all with original signatures in
blue ink. All original signatures must be attested prior to submission. Clearly mark the submittal
package with the title of this RFP and the name of the responding firm, addressed to the County of
Mercer, Department of Human Services Contract Unit, Room 224, McDade Administration Building,
640 South Broad Street, PO Box 8068, Trenton, NJ 08650-0068.
The original proposal shall be marked to distinguish it from the copies. Responses delivered before
the submission date and time specified may be withdrawn upon written application of the respondent
who shall be required to produce evidence showing that the individual is or represents the principal(s)
involved in the proposal. After the submission date and time specified above, responses must remain
firm for a period of sixty (60) days.
LATE SUBMISSIONS WILL NOT BE ACCEPTED.
Proposals shall be rejected if not submitted within time, date and place designated, and if not
accompanied by any of the required documents.
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COUNTY REPRESENTATIVE FOR THIS SOLICITATION
The County of Mercer has designated the following personnel as its representative regarding the
RFP. Please direct all questions via email or in writing to:
Erica Saganowski
Office on Aging
County of Mercer County
PO Box 8068
640 South Broad St.
Trenton, NJ 08650-0068
esaganowski@mercercounty.org
In making requests for more information in writing either by email or postal service, any
Agency must supply an email address where communication can occur.
INTERPRETATIONS AND ADDENDA
Respondents are expected to examine the RFP with care and observe all its requirements. All
questions about the meaning or intent of this RFP and all interpretations and clarifications considered
necessary by the owner’s representative in response to such comments and questions will be posted
on the County website at http://nj.gov/counties/mercer/departments/hs/. Only comments and
questions responded to by formal written addenda will be binding. Oral interpretations, statements, or
clarifications are without legal effect. All questions must be submitted according to the schedule as
established in this RFP.
AGENCY ELIGIBILITY
For-profit, non-profit, and County and local government agencies are eligible to apply for any and all
of the above-stated categories of funding. Non-profit organizations must possess a 501(c)(3)
designation from the Internal Revenue Service and be registered as a charity under the New Jersey
Charitable Registration. For-profit agencies will be considered for funding if their proposals
demonstrate superior service provision over non-profit applicants.
Any agency with a 501(c)(3) designation must provide proof of this status, as well as include a copy of
the agency’s Certificate of Incorporation.
Should the Area Agency on Aging (AAA) choose to enter into contracts with profit-making
organizations, the AAA must adhere to the New Jersey Department of Human Services, Division of
Aging Services Waiver Policy, (91-9, III-4) and Section 212 of the Older Americans Act, which states:
None of the provisions of this Act shall be construed to prevent a recipient of a grant or contract from
entering into an agreement, subject to the approval of the state agency, with a profit-making
organization to carry out the provisions of this Act and of the appropriate State plan.
CONTRACTUAL PROVISIONS
Mercer County requires an applicant to submit six (6) original contracts signed with blue ink in addition
to its standard proposal and all other required documents. Furthermore, an applicant must type in the
name of their organization and address on page one of the contract. The date of the contract on page
one of the contract template will be completed by the County of Mercer upon execution of the Board
of Chosen Freeholders. The applicant should not enter an amount in the General Conditions of
Payment section or any other area of the contract with Mercer County. Failure to submit all required
signed documents with the applicant's proposal for funding will result in rejection of the applicant's
proposal.
Please note that the enclosed contract is conditional pending an award
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determination and Freeholder Board approval. The County will send the vendor an executed
copy of the contract upon Freeholder approval.
LOCATIONS AND ESTIMATE OF QUANTITIES
The County of Mercer reserves the right to add locations and/or increase or decrease the quantities at
the proposed costs as defined in the awarded contractor’s proposal as may be deemed reasonably
necessary or desirable to complete the work detailed by the contract. Such increase or decrease shall
in no way violate this contract, nor gives cause for liability damages.
Funding for this contract may increase beyond the original contractual amount when
additional non-contract funding becomes available (also applies to increased allocation for a
cost of living adjustment); however, the contractor must provide increased levels of service at
the unit cost referred in the proposal. The County of Mercer reserves the right to decrease or
increase the level of service based upon allocation and no minimum or maximum is implied or
guaranteed.
STATUTORY AND OTHER REQUIREMENTS
Compliance with Laws
Any contract entered into between the contractor and the owner must be in accordance with and
subject to compliance by both parties with the New Jersey Local Public Contracts Law. The contractor
must agree to comply with the non-discrimination provisions and all other laws and regulations
applicable to the performance of services there under. The respondent shall sign and acknowledge
such forms and certificates as may be required by this section.
Mandatory Affirmative Action Compliance
No firm may be issued a contract unless it complies with the Affirmative Action requirements of P. L.
1975, C. 127 as identified in the documents attached hereto.
Americans with Disabilities Act of 1990
Discrimination on the basis of disability in contracting for the delivery of services is prohibited.
Respondents are required to read Americans with Disabilities language that is part of the documents
attached hereto and agree that the provisions of Title II of the Act are made part of the contract. The
contractor is obligated to comply with the Act and hold the owner harmless.
W 9 Forms
Any agency applying to the County of Mercer for funding and is a first-time vendor must include a
copy of their most recent W 9 form. This form is required of any new vendor to expedite and ensure
payment to the agency in a timely manner. Upon receipt, the form will be forwarded to the Mercer
County Purchasing Department and will help expedite future payments.
Stockholder Disclosure Failure to provide the requested information is cause for proposal
rejection.
Proposal (reference the signature form in the required attachments section)
This is the signed proposal form and is required as the authorized signer is attesting that he/she has
read the Instructions, Affidavits and Scope of Work (Services). A proposal is not valid if it is not
signed.
STATEMENT OF CORPORATION OWNERSHIP 52:25-24.2. BIDDERS TO SUPPLY
STATEMENT OF OWNERSHIP OF 10% INTEREST IN CORPORATION OR PARTNERSHIP
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No corporation or partnership shall be awarded any contract nor shall any agreement be entered into
for the performance of any work or the furnishing of any materials or supplies, the cost of which is to
be paid with or out of any public funds, by the State, or any county, municipality or school district, or
any subsidiary or agency of the State, or of any county, municipality or school district, or by any
authority, board, or commission which exercises governmental functions, unless prior to the receipt of
the bid or accompanying the bid, of said corporation or said partnership, there is submitted a
statement setting forth the names and addresses of all stockholders in the corporation or partnership
who own 10% or more of its stock, of any class or of all individual partners in the partnership who own
a 10% or greater interest therein, as the case may be. If one or more such stockholder or partner is
itself a corporation or partnership, the stockholders holding 10% or more of that corporation's stock, or
the individual partners owning 10% or greater interest in that partnership, as the case may be, shall
also be listed. The disclosure shall be continued until names and addresses of every non-corporate
stockholder, and individual partner, exceeding the 10% ownership criteria established in this act, has
been listed.
Non-Collusion Affidavit
The Non-Collusion Affidavit, which is part of this RFP, shall be properly executed and submitted with
the RFP response.
Business Registration P.L. 2009, c.315 (For-Profit businesses/corporations only)
Reforms Business Registration Certificate (BRC) filing; permits filing prior to award of contracts if not
filed with bid. Effective with bids received and contracts awarded after January 18, 2010, this law
removes the requirement of the Local Public Contracts Law (N.J.S.A. 40A:11-23.2) that required a bid
to be rejected if the bidder failed to include a BRC with the bid, even though it may have been the
otherwise lowest responsible bid. The law now allows the BRC to be filed any time prior to award of
the contract and the bidder had to have obtained the BRC prior to receipt of bids. This permits the
BRC to be required with a bid, or submitted subsequently. If a BRC is required in a bid, but not
submitted with the bid, it would an immaterial defect; curable by being filed prior to award of the
contract. A BRC is obtained from the New Jersey Division of Revenue. Information on obtaining a
BRC is available on the internet at www.nj.gov/treasury/revenue or by phone at (609) 292-1730.
Pay to Play
Starting in January, 2007, business entities are advised of their responsibility to file an annual
disclosure statement of political contributions with the New Jersey Election Law Enforcement
Commission (ELEC) pursuant to N.J.S.A. 19:44A-20.27 if they receive contracts in excess of $50,000
from public entities in a calendar year. Business entities are responsible for determining if filing is
necessary. Additional information on this requirement is available from ELEC at 888-313-3532 or at
www.elec.state.nj.us.
CHARITABLE REGISTRATION
Charitable organizations and professional fund raisers based, operating or soliciting within New
Jersey must register with the Division of Consumer Affairs Charities Registration Section unless
specifically exempted under the provisions of the Charitable Registration and Investigation Act
(N.J.S.A. 45:17A-18 et seq.) also known as the "CRI Act." Registration renewals are required
annually within six months of the end of the charity’s fiscal year. Additional information on this
requirement is available at http://www.njconsumeraffairs.gov/charity/charfrm.htm. Copies of the most
recent registration statement must be included with the submission of this RFP.
INSURANCE AND INDEMNIFICATION
If it becomes necessary for the contractor, either as principal or by agent or employee, to enter upon
the premises or property of the owner in order to construct, erect, inspect, make delivery, or remove
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property hereunder, the contractor hereby covenants and agrees to take use, provide and make all
proper, necessary and sufficient precautions, safeguards, and protection against the occurrence of
happenings of any accident, injuries, damages, or hurt to person or property during the course of the
work herein covered and his/her sole responsibility.
The contractor further covenants and agrees to indemnify and save harmless the owner from the
payment of all sums of money or any other consideration(s) by reason of any or all such accidents,
injuries, damages, or hurt that may happen or occur upon or about such work and all fines, penalties,
and loss incurred for or by reason of the violation of any owner regulation or ordinance or the laws of
the State or the United States while said work is in progress.
The contractor shall maintain sufficient insurance to protect against all claims under Workers
Compensation as statutorily required, General Liability in the amount of $1,000,000.00 single
occurrence and $2,000,000.00 general aggregate, and Automobile Insurance in the amount of
$1,000,000.00 combined single limit. Vendors are responsible to provide updated certificates as
policies renew. Depending upon the scope of work and goods or services provided, specific types of
insurance may not be required. The Mercer County Division of Insurance and Property Management
will make this determination.
In all cases where a Certificate of Insurance is required, the County of Mercer is to be named
as an additional insured and named as the certificate holder as follows: “County of Mercer,
640 South Broad Street, P.O. Box 8068 Trenton, N.J. 08650-0068”. The Certificate shall contain
a 30-day notice of cancellation. Additionally, if the program for which your agency is applying
provides transportation to consumers and/or clients, the County of Mercer must be named as
an additional insured with the agency’s automobile insurance.
Please note: A change to the ACCORD insurance certificate precludes placing the number of days for
cancellation notification in the lower right hand box. You may fulfill the requirement for a 30-day notice
of cancellation for the insurance required to be submitted for a County of Mercer contract in any one
of the following ways:
1. Indicate a 30-day notice of cancellation in the Description of Operations box at the bottom of
the certificate.
2. Indicate a 30-day notice of cancellation on a separate page.
3. Provide a copy of the cancellation clause from the policy (you do not need to provide a copy of
the entire policy, only the page(s) referencing the cancellation clause).
AUTOMOBILE INSURANCE is required in the following situations:
 clients/consumers are being transported under your contract with the County
 you are on County property to execute your contract, including delivery of items
For most contracts the automobile insurance requirement is $1 million combined single limit.
Also, the County of Mercer shall be named as additional insured and as certificate holder. The
certificate holder address shall be as follows: County of Mercer, 640 South Broad Street, P.O.
Box 8068, Trenton, NJ 08650-0068.
WORKERS’ COMPENSATION
Vendors are required to provide proof of Workers’ Compensation coverage.
The County of Mercer requires a 30-day notice of cancellation (excluding cancellation for nonpayment) as part of its insurance requirements.
This requirement applies to workers’
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compensation policies unless you are self-insured. The certificate holder address shall be as
follows: County of Mercer, 640 South Broad Street, P.O. Box 8068, Trenton, NJ 08650-0068.
If further clarification is needed, please contact the Insurance and Property Management office at 609989-6655.
MULTIPLE PROPOSALS
More than one proposal per funding category from an individual, a firm or partnership, a corporation or
association under the same or different names shall not be considered. If an agency applies for
multiple funding categories, a separate, complete proposal and packet of forms is necessary for each
category for which are applied.
NOTICE OF AWARD
The successful respondent will be notified of the award of contract upon a favorable decision by the
County of Mercer.
PROPOSALS TO REMAIN SUBJECT TO ACCEPTANCE
RFP responses shall remain open for a period of sixty (60) calendar days from the stated submittal
date. The County of Mercer will either award the contract within the applicable time period or reject all
proposals.
The County may extend the decision to award or reject all proposals beyond the sixty (60) calendar
days when the proposals of any respondents who consent thereto may, at the request of the County,
be held for consideration for such longer period as may be agreed.
BID PROHIBITED
It is understood by the respondent that, if awarded a contract through the request for proposal
process, the prime contractor and any subcontractors utilized for these services are prohibited from
bidding the resultant goods or services required to implement the project.
FAILURE TO ENTER CONTRACT
Should the respondent, to whom the contract is awarded, fail to enter into a contract within ten (10)
days, Sundays and holidays excepted, the owner may then, at its option, accept the proposal of
another respondent.
TERMINATION OF CONTRACT
If, through any cause, the contractor shall fail to fulfill in a timely and proper manner obligations under
the contract or if the contractor violates any requirements of the contract, the owner shall thereupon
have the right to terminate the contract by giving written notice to the contractor of such termination at
least sixty (60) days prior to the proposed effective date of the termination. Such termination shall
relieve the owner of any obligation for the balances to the contractor of any sum or sums set forth in
the contract.
The contract may be terminated by either party upon sixty (60) days written notice to that effect,
forwarded to the other party desiring to terminate the contract and thereupon payments under this
contract shall be paid to the terminal date based on the expenditure reports submitted. In the event of
cancellation of this contract, the contractor agrees to furnish the County such reports as may be
requested based upon work completed under the provisions of this contract.
The contractor agrees to indemnify and hold the County of Mercer harmless from any liability to
subcontractors concerning payment for services performed arising out of the lawful termination of the
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contract by the County under this provision. In case of default by the contractor, the County may procure
the services from other sources and hold the contractor responsible for any excess cost occasioned
thereby.
CHALLENGE OF SPECIFICATIONS
Any respondent who wishes to challenge a specification shall file such challenge in writing with the
County contact no less than three (3) business days prior to the opening of the proposals. Challenges
filed after that time shall be considered void and having no impact on the owner or the award of
contract.
TRANSITIONAL PERIOD
In the event services are terminated by contract expiration or by voluntary termination by either the
contractor or the County of Mercer, the contractor shall continue all terms and conditions of said
contract for a period not to exceed thirty (30) days at the County’s request.
PAYMENT
Invoices shall specify, in detail, the period for which payment is claimed, the services performed
during the prescribed period, the amount claimed, and correlation between the services claimed.
The owner may withhold all or partial payments on account of subsequently discovered evidence
including but not limited to the following:
Deliverables not complying with the project specification;
Claims filed or responsible evidence indicating probability of filing claims;
A reasonable doubt that the Contract can be completed for the balance then unpaid.
When the above grounds are removed, payment shall be made for amounts withheld because of
them.
COST LIABILITY AND ADDITIONAL COSTS
The County of Mercer assumes no responsibility and liability for costs incurred by the respondents
prior to the issuance of an agreement. The liability shall be limited to the terms and conditions of the
contract.
Respondents will assume responsibility for all costs not stated in the proposals. All hourly rates either
stated in the proposal or used as a basis for pricing are required to be all-inclusive. Additional
charges, unless incurred for additional work performed by request of the County of Mercer, for indirect
costs, fees, postage, licensing, commissions, taxes, travel, subsistence, report preparation, meetings,
administrative tasks, administrative and clerical support, overhead, etc. are not to be billed and will not
be paid.
COST PRINCIPLES/UNALLOWED COSTS
The following are examples of unallowed costs:
 Bad Debts—Any losses arising from uncollectible accounts and other claims and related costs
are unallowable.
 Building/Renovations – Available grant funds cannot be used for building funds, renovations or
capital improvements or to supplant existing services.
 Contingencies—Contributions to a contingency reserve or any similar provision made for
unforeseen events are unallowable.
 Entertainment – Costs of amusements, social activities, and incidental costs relating thereto,
such as meals, tickets to shows, beverages, lodgings, rentals, transportation, and gratuities
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are unallowable. This does not apply to “socialization/recreation” activities for the elderly as
referred to in the Older Americans Act.
Fines and Penalties—Costs resulting from violations of or failure to comply with Federal, State
and local laws and regulations are unallowable.
Fund Raising—Costs of organized fund raising, including financial campaigns, solicitation of
gifts and bequests, and similar expenses incurred to raise capital or obtain contributions are
unallowable.
Interest and Other Financial Costs—Interest on borrowings, bond discounts, cost of
financing/refinancing operations, and legal and professional fees paid in connection therewith
are unallowable except when authorized by Federal legislation.
Non-Older Americans Act Related Expenses – Any expenses incurred that are not related as
defined in the Older Americans Act are unallowable.
Under Recovery of Costs—Any excess of cost over the maximum proposed award/contracted
amount are unallowable.
OWNERSHIP OF MATERIAL
The County of Mercer shall retain all of its rights and interest in and to any and all documents and
property both hard copy and digital furnished by the County of Mercer to the contractor, for the
purpose of assisting the contractor in the performance of this contract. All such items shall be returned
immediately to the County of Mercer at the expiration or termination of the work or completion of any
related services, pursuant thereto, whichever comes first. None of such documents and/or property
shall be disclosed, without the written consent of the County of Mercer, to others or used by the
contractor or permitted by the contractor to be used by their parties at any time in the performance of
the resulting contract.
Ownership of all data, materials, and documentation originated and prepared for the County of Mercer
pursuant to this contract shall belong exclusively to the County of Mercer. All data, reports,
computerized information, programs, and materials related to this project shall be delivered to and
become the property of the County of Mercer upon completion of the project. The contractor shall not
have the right to use, sell, or disclose the total of the interim or final work products, or make available
to third parties, without the prior written consent of the County of Mercer.
COMMENCEMENT OF WORK/TIME OF COMPLETION
The contractor agrees to commence work on the project within thirty (30) calendar days from the date
of award by the County of Mercer, unless otherwise specified.
It is hereby understood and mutually agreed, by and between the respondent and the County of
Mercer, that the date on which the service shall be substantially complete as specified in the RFP is
an ESSENTIAL CONDITION of this contract. It further is understood and agreed mutually that the
service and contract time embraced in this contract shall commence on the date specified and that the
contract shall be completed in sequence and time frame identified.
The respondent agrees that said service shall be completed regularly, diligently, and uninterruptedly
at such rate of progress as will ensure full completion therefore within the time specified. It expressly
is understood and agreed, by and between the respondent and the County, that the time of
completion of the service described herein is a reasonable time for completion of same.
GENERAL CONSIDERATIONS
Competitive Contracting is a formal procurement process governed by the New Jersey State Local
Public Contracts Law and Rules. The process utilizes an RFP containing thoroughly developed
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specifications and scope of services, criteria for evaluating proposals, and statutorily required
language and forms. Responses are ranked by a team, on the RFP criteria, using a detailed
methodology leading to a recommendation to the governing body to award a contract based on price
and other factors.
PROVIDING INFORMATION
Information will be made available at the County Division/Office during regular business hours. The
County of Mercer shall provide access, within reason, and at no cost to the Contractor, to all
information on file with the County and needed by the Contractor to complete the Project.
SUBCONTRACTORS (IF APPLICABLE)
Respondents may engage the services of Subcontractors for completion of this project. If the
proposal involves any subcontractors, full details on the nature of the work to be performed by them
and the location in which the work is to be performed must be provided. The respondent understands
that if selected, the use of subcontractors must be approved in writing by the County prior to initiating
any subcontracted work.
The most appropriate method to identify the work and quality control programs applied by
subcontractors must be clearly specified in all applicable sections of Attachment A of the proposal
when the subcontractor will be performing the work. The subcontractor’s qualifications must also be
detailed in the Agency Overview section in Attachment A section of the proposal. A project manager
must be identified for all subcontractors. Project managers are to be available for scheduled project
review meetings at the County Administration Building.
IMMIGRATION AND NATURALIZATION LAWS AND CRIMINAL BACKGROUND CHECK (AS
APPLICABLE)
The vendor must comply with all immigration and naturalization laws as are currently in force on each
potential employee to work under this contract on County of Mercer property and will not employ
individuals who are not properly registered with the United States Citizenship and Immigration
Service. Successful proposer will provide a photocopy of the Alien Registration Form or I-94
Arrival/Departure Form to the County of Mercer Office on Aging at least ten (10) days prior to any of
its employees being permitted to work under this contract on County of Mercer property.
The vendor must contact the New Jersey State Police to perform a criminal background check on
each potential employee to work under this contract on County of Mercer property. A copy of the
results of the criminal background check must be provided to the County of Mercer Office on Aging at
least ten (10) days prior to an employee being permitted access to County of Mercer property. The
County of Mercer will notify the vendor if a proposed vendor employee will not be permitted to work
under this contract within ten (10) work days following receipt of the results. If the County of Mercer
does not notify the vendor of such exclusion within ten (10) days the vendor may assign said
employee to work under the contract.
The vendor must also inform the County of Mercer of all immigration and naturalization status
changes and arrests of its employees working under this contract on County of Mercer property for
the duration of the contract. In this regard, the vendor shall make quarterly inquiry of all employees
working under this contract as to any immigration and naturalization changes and employee arrests.
Please access the following website for Instructions for obtaining a criminal history record:
http://www.state.nj.us/njsp/about/serv_chrc.html
13
The vendor must provide a photocopy of the Alien Registration Form or I-94 Arrival/Departure Form
and the results of a criminal background check on its employees working under the contract on
County of Mercer property every twelve (12) months.
EVALUATION, REVIEW AND SELECTION PROCESS
All proposals received by the deadline will be reviewed first for substantial compliance with this RFP
and for fulfillment of the mandatory requirements. Proposals that are late, non-compliant, or fail to
meet the minimum mandatory requirements will not be evaluated.
Proposals that are timely, compliant, and meet the minimum mandatory requirements will be reviewed
by an evaluation committee. Only members of the evaluation committee will grade the proposals;
however, the County reserves the right to make the final funding decision.
The County of Mercer reserves the option of awarding multiple contracts based on the evaluation
criteria and such contracts shall be awarded at the unit cost per service reflected in the contractor’s
proposal.
EVALUATION PROCESS
An evaluation team will review all proposals to determine if they satisfy the proposal requirements,
determine if a proposal should be rejected and evaluate the proposals based upon the evaluation
criteria.
UNDERSTANDING OF THE REQUESTED WORK
This will be based on the quality of the content of the RFP and the respondent’s ability to
communicate a thorough understanding of the required tasks and the approach to meet the scope of
work outlined in the RFP. The proposals will be evaluated for general compliance with the
instructions and requests issued in the RFP. Non-compliance with the significant instructions will be
grounds for disqualification of proposals.
TECHNICAL CRITERIA
The submitted proposal demonstrates a clear and concise methodology, which emphasizes an
understanding of the scope of work and related objectives. The proposal documents the use of
innovative technology and techniques and is responsive overall to the RFP requirements. All forms,
including the Proposal cover page, budget narrative and budget forms are to be typed and
complete.
KNOWLEDGE AND PROFESSIONAL COMPETENCE
This includes the ability of the Respondent to perform all of the tasks and fulfill adequately the stated
requirements. The prospective contractor will be evaluated on suitability for the tasks required.
Proposals should contain complete discussions regarding technical processes and qualifications.
Receipt of high quality service is of great importance to the County. Disregard of this directive may
disqualify the respondent from further consideration.
MANAGEMENT CRITERIA
The submitted proposal conveys a philosophy/mission statement in the agency overview. It also
demonstrates a comprehensive description of the assessment process, enrollment process, and the
length of time from referral to acceptance. Applicants must clearly define a “Unit of Service” and
provide the number of unduplicated consumers you propose to serve annually.
The submitted proposal documents a history of developing an effective plan to meet the needs of the
client population from the time of admission to discharge. The applicant must demonstrate
14
measurable and realistic time frames for evaluating the status of the client plan of service. In addition,
the applicant must establish criteria for successful completion of or negative discharge from the
program. Applicants must demonstrate sound management practices and procedures through their
proposals, to be considered for funding. Goals, objectives, number of clients, levels of service, and
outcomes for program areas are defined and measurable.
ABILITY TO COMPLETE THE PROJECT IN A TIMELY MANNER
This is based on the estimated duration of the tasks and overall schedule and the respondent’s ability
to accomplish these tasks as stated. The County of Mercer is interested in the ability of the contractor
to complete the project in a competent and expeditious manner based on the workload of the firm,
availability of qualified staff, equipment and facilities.
Respondents have the option of engaging the services of subcontractors for completion of this project.
If the proposal involves any subcontractors, provide full details on the nature of work to be performed
by them and the location in which the work is to be performed.
MANAGEMENT, EXPERIENCE, AND PERSONNEL QUALIFICATIONS
An employee of the respondent shall be identified as the project manager. Technical expertise of the
firm shall be demonstrated by past successes providing government agencies and private companies
with similar services. The project manager and other key personnel will be evaluated on knowledge,
experience, prior collaboration and successful completion of services similar to that requested in this
RFP.
In addition to relevant project experience, Respondents are asked to provide personnel qualifications
in the Proposal. The subcontractors’ qualifications (if applicable) must also be detailed in the
Agency Overview section in Attachment A of the proposal.
COST CRITERIA
Costs are reasonable and represent an effective and efficient use of public funds. Effective
coordination/integration of proposed Mercer County, State and Federal funding with existing
resources is expected. Identify the unit cost as it relates to amount of funding provided and expected
level of service.
15
SCOPE OF SERVICES
AGENCY CRITERIA:
The potential grantee must have a 501(c)(3) or equivalent tax-exempt status. Copies of the IRS
determination letter confirming status is required of contractors as part of the proposal packet. Should
the Area Agency on Aging (AAA) choose to enter into contracts with profit-making organizations, the
AAA must adhere to the New Jersey Department of Human Services, Division of Aging Services
Waiver Policy, (91-9, III-4) and Section 212 of the Older Americans Act, which states: None of the
provisions of this Act shall be construed to prevent a recipient of a grant or contract from entering into
an agreement, subject to the approval of the state agency, with a profit-making organization to carry
out the provisions of this Act and of the appropriate State plan.
The contractor must identify a senior staff member who will have overall administrative and
supervisory responsibility to the proposed program. Programs and services funded under this RFP
are to be provided free of charge to the client/participant, however voluntary donations may be
accepted. Clients unable or unwilling to provide a monetary contribution shall not be denied services
or terminated from service.
FISCAL RESPONSIBILITY
A 25 percent match is required and should be detailed on the budget pages. Grantees receiving an
allocation of $25,000.00 or more must maintain fiscal records that account for County, State and/or
Federal funds through the establishment of separate cost centers. A most recent organization-wide
audit must be attached to the proposal package. Mercer County, Federal and State funds cannot be
used to substitute existing funding.
NATIONAL AGING PROGRAM INFORMATION SYSTEMS (NAPIS) REPORTING
The Assistant Secretary of the Administration on Aging (AoA) under the Older Americans Act of 1965,
as amended, must report to the President and to Congress annually on the aging network
performance. NAPIS reporting compliance is mandated to meet federal and state programmatic and
fiscal requirements.
AoA reporting requirements are mandatory for all data collected by Area Agencies on Aging (AAA)
and all AAA funded contract service providers. Each contractor must provide, on a monthly and
quarterly basis, an accurate account of unduplicated clients and accompanying personal
characteristics, race and ethnic information. Full reporting requirements for each service will be
provided once contracts are awarded.
DATA TRACKING TECHNOLOGY – SAMS
All perspective contracting agencies will be required to utilize the Social Assistance Management
System (SAMS), a comprehensive consumer and case management system. This web based client
data tracking system will assist in recording the required NAPIS demographics and service delivery
data. Presently, licensing fees are paid for by the State of New Jersey Department of Human
Services, Division of Aging Services.
POPULATION TO BE SERVED:
Priorities of this office will ensure that services assist older individuals with greatest social and
economic needs. Services funded under this RFP are targeted specifically to Mercer County senior
citizens age 60 and over and family caregivers. A family caregiver is defined as an adult family
member, or another individual, who is an informal provider of in-home and community care to an
individual age 60 or older.
16
National Family Caregiver Support Program guidelines also allow for grandparent or relative caregiver
services to a grandparent or step-grandparent, or other relative of a child by blood or marriage, who is
55 years of age or older, and:
 Lives with a child 18 or under
 Is the primary caregiver because the biological or adoptive parents are unable/unwilling to
serve as the primary caregiver of the child; and
 Has legal custody or guardianship, or is raising the child informally.
 A “child” is defined as an individual who is not more than 18 years of age or an individual 1959 years of age who has a severe disability.
The re-authorization of the Older American’s Act has identified additional target population groups
including:
 Older individuals with limited English proficiency
 Older individuals at risk of institutional placement
 Older individuals residing in rural areas
 Older individuals with Alzheimer’s disease and related disorders
 Caregivers of older individuals with Alzheimer’s disease and related disorders
 Older individuals with severe disabilities
AVAILABLE FUNDING AND SERVICE CATEGORIES
For the 2016, 2017, and 2018 contract periods, the Mercer County Office on Aging will be funding
programs in three service categories, Community Support and Access Services, In-Home Support
Services, and Nutrition Support Services, as defined by the State of New Jersey Department of
Human Services, Division of Aging Services service taxonomy, and identified in the Mercer County
Office on Aging Area Plan Contract.
Funding will be made available through this RFP up to the approximated amounts denoted in the
funding chart. Clearly indicate for which service category and program you are applying. A proposal
must be submitted for each program in that category for which you are seeking funding. The stated
allocation per program is intended to fund one or multiple independent programs as specified.
Please reference the attached funding method chart for specific program funding amounts. Proposal
budgets should be prepared to reflect a one-year period, based upon the annual allocation identified
in the funding method chart for each year 2016, 2017 and 2018.
Funding allocations remain contingent upon the availability of funds and the passage of the 2016,
2017, and 2018 Federal, State and Mercer County Budgets, and may increase beyond the original
contractual amount when additional non-contract funding becomes available, i.e. increased allocation
for cost of living adjustment (COLA). Should this occur the contractor must provide increased levels of
services at the unit cost referenced in the proposal. The County reserves the right to decrease or
increase the levels of service based upon allocation and no minimum or maximum is implied or
guaranteed.
17
2016, 2017, 2018 FUNDING METHOD
The funding method chart should be referenced for program specific funding allocations. Proposal
budgets shall be prepared for each year (2016, 2017 and 2018). Funds for this purpose are
contingent upon inclusion in and adoption of the 2016, 2017 and 2018 Federal, State, and County
budgets.
SERVICE CATEGORY
COUNTY
STATE
FEDERAL
TOTAL
COMMUNITY SUPPORT SERVICES
LEGAL SERVICES
Assistance
Education
MENTAL HEALTH
Mental Health Counseling ( Seniors)
Mental Health Education (Seniors)
23,000.00
NATIONAL FAMILY CAREGIVER
SUPPORT PROGRAM
Mental Health Counseling ( Caregivers)
Mental Health Education (Caregivers)
PHYSICAL HEALTH
Disease Prevention/Health Promotion
SOCIALIZATION / RECREATION
SUMMER COOLING PROJECT
VOLUNTEER SERVICES
a) Assisted Transportation
b) Friendly Visitors
c) Housekeeping
61,600.00
13,659.00
18,907.00
22,000.00
117,000.00
140,000.00
42,000.00
42,000.00
36,000.00
36,000.00
21,253.00
82,853.00
20,000.00
13,659.00
18,907.00
42,000.00
IN-HOME SUPPORT SERVICES
HOME HEALTH AIDE
Certified Home Health Aide
HOME HEALTH CARE
NATIONAL FAMILY CAREGIVER
SUPPORT SERVICES
Respite Care
Professional In-Home Education & Support
TELEPHONE REASSURANCE
35,000.00
216,551.00
251,551.00
30,000.00
30,000.00
104,487.00
7,000.00
50,456.00
12,000.00
154,943.00
12,000.00
12,000.00
19,000.00
119,000.00
136,365.00
429,709.00
25,000.00
38,970.00
1,043,248.00
NUTRITION SUPPORT SERVICE
County-wide Weekday Home Delivered Meals
Home Delivered Meals
Nutrition Counseling
Nutrition Education
KOSHER NUTRITION SITE
WEEKEND HOME DELIVERED MEALS
TOTAL
17,365.00
-
25,000.00
168,931.00
38,970.00
444,608.00
18
SERVICE CATEGORIES
The goal of the Office on Aging is to foster the dignity, independence, health and well-being of Mercer
County seniors age 60 and older and their caregivers by supporting cost effective in-home and
community based support services and programs. The contractor should provide and design
programs and activities suitable for elderly participants.
SERVICE CATEGORIES AND CORRESPONDING PROGRAMS FUNDED UNDER THIS RFP
Community Support and Access Services

Legal Services
o Legal Assistance
o Legal Education

Mental Health Services
o Senior Mental Health Counseling
o Senior Mental Health Education

National Family Caregiver Support Services
o Caregiver Support Group
o Caregiver Mental Health Education

Physical Health
o Disease Prevention and Health Promotion

Socialization, Recreation and Community Education

Summer Cooling

Volunteer Services
o Assisted Transportation
o Friendly Visiting
o Housekeeping
In-Home Support Services

Home Health Aide
o Certified Home Health Aide

In-Home Health Care

National Family Caregiver Support Services
o Professional In-Home Education and Support
o Respite Care

Telephone Reassurance
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Nutrition Support Services

Countywide Weekday Home Delivered Meals
o Home Delivered Meals
o Nutrition Counseling
o Nutrition Education

Kosher Nutrition Services

Weekend Home Delivered Meals
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SERVICE CATEGORY: COMMUNITY SUPPORT and ACCESS SERVICES
Program: Legal Services
Legal Assistance
Unit:
Each hour of legal assistance
Definition: The purpose of this program is to protect and secure the rights of older people by
providing legal advice, assistance and/or representation. Services must be provided by or under the
direct supervision of a fully trained and professionally qualified attorney. The attorneys must be
qualified to practice law before the Bar Association.
Service activities should include the following components:
 Legal assistance will be provided by an attorney (or personnel supervised by an attorney) in
areas, such as public entitlements, tenants’ rights, planning for/protecting autonomy, health
care/long-term care, family/domestic cases, housing/utilities, individual rights and consumer
issues. Service priorities shall be established by the legal services provider.

Program staff will conduct a formal intake process to determine the nature of the client’s legal
difficulties and questions, what assistance is needed, and whether the program is able to
assist the client with the course of action that he/she wishes to take. An appropriate referral
should be made if the program cannot help the client.

Legal services staff will provide assistance to resolve the client’s problem that includes legal
counsel and information, legal research, preparation of legal documents and correspondence,
negotiations involving public benefits and representing clients in administrative hearings and in
court.

Providing information about other programs and services for which clients may be eligible and
referring clients to proper services as necessary.

Maintaining records, preparing reports, and other administrative efforts necessary to provide
Legal Assistance services.
Legal Assistance services shall meet or exceed the following standards:
 Legal Assistance funded by the AAA is available to residents 60 years of age and older who
have a legal problem that falls within the priorities established for the program.

All efforts of the legal assistance provider shall be designed to achieve and/or maintain the
client’s dignity and maximum level of functioning.

The Legal Assistance provider shall have the capacity to deliver legal services to
institutionalized, isolated, and homebound individuals; and have offices and/or outreach sites
which are convenient and accessible to older persons in the community.

In areas where a significant number of clients do not speak English as their principal language,
legal assistance shall be provided in the language spoken by those clients.
21

All staff providing the assistance shall be fully trained and professionally qualified. Staff
members who are not attorneys qualified to practice before the bar shall be supervised by
such an attorney.

The Legal Assistance provider shall have staff with expertise in specific areas of law affecting
older persons in economic or social need, such as public benefits, tenant issues,
abuse/neglect and Medicaid/Medicare.

It is not necessary that the supervising attorney always be present in the office, but he/she
shall be accessible for telephone consultation as necessary and should have regularly
scheduled meetings with those non-lawyers providing the legal assistance. The attorney shall
also be available to represent clients in court or further proceedings if and when necessary.

A mechanism shall be in place to enable legal assistance providers to work cooperatively with
other involved agencies as to client status and problems.

Each Legal Assistance provider shall make efforts to involve the private bar in legal services,
including groups within the private bar that furnish legal services to older persons on a pro
bono and reduced fee basis.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
22
SERVICE CATEGORY: COMMUNITY SUPPORT and ACCESS SERVICES
Program: Legal Services
Legal Education
Unit:
One session per participant
Definition: Community legal education is intended to increase client’s ability to take an active and
independent role in decision making processes affecting them as well as to increase general
awareness of problems commonly facing older adults.
Service activities should include the following components:
 Providing Community Legal Education that benefits a large number of clients cost effectively.
Individuals may learn about their legal rights and responsibilities in order to avoid legal
problems.
Individuals may be taught to represent themselves before appropriate
administrative agencies and courts.

Class/lecture content shall be determined preferably with the involvement of the older
individuals.

Community legal education may be used to increase client’s ability to take a more active
independent role in decision-making processes that affect them. In addition, it can increase
general awareness of problems facing older people.

Education events will be conducted in easily accessible congregate settings such as nutrition
sites, senior centers, and senior housing facilities for example.

Legal services staff will provide information about other programs and services for which
clients may be eligible and refer clients to proper services as necessary.
Legal Education services shall meet or exceed the following standards:
 The provider of education services shall be knowledgeable in the skill or topic to be presented
through either education, experience, or training.

Each education program shall establish linkages with local education programs in order to
maximize coordination and minimize duplication.

Education programs shall attempt to balance the content of educational sessions with the
interests, skills, and abilities of prospective participants.

In areas where a significant number of clients do not speak English as their principal language,
education programs should be provided in the language spoken by those clients.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
23
SERVICE CATEGORY: COMMUNITY SUPPORT and ACCESS SERVICES
Program: Mental Health Services
Senior Mental Health Counseling
Unit:
Each hour of mental health services
Definition: Mental health screening, assessment and treatment activities that assist older persons to
improve or maintain mental health by helping them to identify and understand their mental and
emotional health needs and secure necessary medical, preventive or mental health maintenance
services.
Service activities should include the following components:
 A mental health screening to determine overall mental health status or risk for a specific
mental health problem, such as depression.

Providing individual, marital, family, or group counseling to older adults and their families to
increase understanding about issues, problems, and community resources. Counseling may
address such issues as planning for retirement, family problems; abuse or neglect situations;
increased client dependency; preparation/planning for retirement; adjustment to disability, loss,
and death; institutionalization; alcoholism, drug dependence and abuse.

Providing information about other programs and services for which the participant may be
eligible, and referring the participant to the proper services as necessary.

Maintaining accurate client records describing the situation, services provided, and results
achieved.
Senior Mental Health services shall meet or exceed the following standards:
 Mental Health services shall be conducted by professional* staff that have been trained or
have experience working with older adults and their families. Staff should be sensitized to the
problems faced by older people that affect their mental health.
*Note: Professional staff is defined as a Masters in Social Work or related field, or a BA plus
experience working with seniors.

Mental Health services shall be aimed at enhancing the client's dignity and maximum level of
functioning.

Mental Health services should be provided in a location that is easily accessible to the older
person.

In areas where a significant number of older persons do not speak English as their principal
language, mental health services should be provided in the language spoken by these
persons.

Mental Health services shall be accessible for the well elderly population as well as those
institutionalized, isolated, and homebound. If mental health services are provided as an
in-home service, the service provider must respect the participant's right of privacy and
confidentiality to the greatest extent possible.
24

A mechanism shall be in place to enable Mental Health providers to work cooperatively with
other agencies and community caregivers, (i.e. clergy, physicians, police, attorneys, nurses,
etc.) as to client status and problems.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
25
SERVICE CATEGORY: COMMUNITY SUPPORT and ACCESS SERVICES
Program: Mental Health Services
Senior Mental Health Education
Unit:
One session per participant
Definition: Mental health education will be provided as formally structured classes, lectures or
seminars that will provide older people with opportunities to acquire knowledge and skills suited to
meet the common mental health needs associated with aging.
Service activities should include the following components:
 Program staff will determine, preferably with the involvement of older people, the content area
to be covered in the class or lecture.

Program staff will provide group instruction in content areas that promote personal enrichment
and knowledge, such as mental health and the aging process, prevention, and local resources.

Maintaining records, preparing reports, and other administrative efforts necessary to provide
Education services.
Note: Education services do not include classes, training, or lectures for AAA or other service
provider staff.
Senior Mental Health Education shall meet or exceed the following standards:
 Each education program shall establish linkages with other local education programs in order
to maximize coordination and minimize duplication.

The provider of education services shall be knowledgeable in the skill or topic to be presented
through either education, experience, or training.

Education programs shall attempt to balance the content of educational sessions with the
interests, skills, and abilities of prospective participants.

Education programs should be provided in a location that is easily accessible to the older person.

In areas where a significant number of clients do not speak English as their principal language,
education programs should be provided in the language spoken by those clients.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted and will serve to expand the programs to others in need.
26
SERVICE CATEGORY: COMMUNITY SUPPORT and ACCESS SERVICES
Program: National Family Caregiver Support Services
Caregiver Support Group
Unit:
One session per participant
Definition: A group that meets on a regular basis, formed to help relieve caregiver stress and to
provide peer support, education, and information to caregivers, both elderly and non-elderly, of older
persons.
Service activities should include the following components:
 Recruiting by qualified program staff of caregivers to participate in the support group.
Recruitment could be done selectively if the group is focused on a subset of caregivers, such
as those caring for victims of Alzheimer’s disease or stroke.

Arranging meeting times, conducting support group meetings, and determining what topics to
discuss based on the input, interest, and needs of caregivers.

Providing information about programs and services that the caregiver and/or older relative may
be eligible and providing referral to proper services as necessary.

Ongoing monitoring by the group facilitator of the caregiver’s stress level and providing
intervention or referral if appropriate.

Use of a mental health screening to determine overall mental health status or risk for a specific
mental health problem, such as depression.

Services may also include providing individual mental health counseling to help the caregiver
with the normal anger, frustration, guilt, isolation and depression associated with caregiving.

Maintaining accurate client records, preparing reports, and other administrative efforts
necessary to provide Caregiver Support Group Services.

Methods such as a sign-in sheet should be developed to obtain the name of the caregiver and
the relationship of the caregiver to the care recipient to enable the AAA to meet NAPIS
reporting requirements.
Caregiver Mental Health Counseling shall meet or exceed the following standards:
 Mental Health services shall be conducted by professional staff* that have been trained or
have experience working with older adults and their families. Staff shall be knowledgeable in
the care needs of older persons either through education, training, or experience.
*Note: Professional staff is defined as a Masters in Social Work or related field, or a BA plus
experience working with seniors.

Mental Health services shall be aimed at enhancing the client's dignity and maximum level of
functioning.
27

A mechanism or policy shall be established for the caregiver support group in order to ensure
the confidentiality of information shared within the group.

Caregiver Support Groups should be provided in a location that is easily accessible to the
older person.

Caregivers shall be provided information on the system of services available to older adults in
the community and how to access these services if necessary.

Caregiver support groups shall be limited in size to enable the discussion and support to be of
maximum benefit to the participants.

The support group may be focused by a specific disease (e.g., Alzheimer’s disease, stroke
victims) or by a general function (e.g., stress management, peer support).

In areas where a significant number of older persons do not speak English as their principal
language, Caregiver Support Groups should be provided in the language spoken by these
persons.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
28
SERVICE CATEGORY: COMMUNITY SUPPORT and ACCESS SERVICES
Program: National Family Caregiver Support Services
Caregiver Mental Health Education
Unit:
One session per participant
Definition: Mental health education will be provided as formally structured classes, lectures or
seminars that will provide caregivers with opportunities to acquire knowledge and skills that will aid
them in continuing their role of caregiving.
Service activities should include the following components:
 Program staff will determine, preferably with the involvement of the caregiver group, the
content area to be covered in the class, lecture, or seminar.

Program staff will provide group instruction in content areas that may include lectures on
caregiving strategies, accessing available resources, preserving the health of the caregiver
and decision making skills.

Maintaining records, preparing reports, and other administrative efforts necessary to provide
Caregiver Education services.

Methods, such as a sign-in sheet, should be developed to obtain the name of the caregiver
and the relationship of the caregiver to the care recipient to enable the AAA to meet NAPIS
reporting requirements.
Note: Education services do not include classes, training, or lectures for AAA or other service
provider staff.
Caregiver Mental Health Education shall meet or exceed the following standards:
 Each education program shall establish linkages with other local education programs in order
to maximize coordination and minimize duplication.

The provider of education services shall be knowledgeable in the skill or topic to be presented
through either education, experience, or training.

Education programs shall attempt to balance the content of educational sessions with the
interests, skills, and abilities of prospective participants.

Education programs should be provided in a location that is easily accessible to the older person.

In areas where a significant number of clients do not speak English as their principal language,
Education programs should be provided in the language spoken by those clients.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
29
SERVICE CATEGORY: COMMUNITY SUPPORT and ACCESS SERVICES
Program: Physical Health
Disease Prevention and Health Promotion
Unit:
Each contact
Definition: Qualified/licensed medical personnel will provide physical health screening, education,
assessment and treatment activities to assist older people in improving or maintaining physical health.
Preventive health or health maintenance services are limited to evidence based service models,
and will assist seniors in identifying and understanding their health needs and securing necessary
medical attention.
Please read the following criteria closely as funding will be contingent upon health promotion
and disease prevention programs meeting a new standard for evidence-based qualifications
beginning October 1, 2016.
Programs meeting the highest level criteria may begin at any time during the contract, however in an
effort to continue funding currently recognized programs as well as to allow providers ample time to
complete additional training to meet the needs of the new 10/1/16 requirements, the Office on Aging
will fund, for the service period January 1, 2016 – September 30, 2016 only, Title IIID disease
prevention and health promotion activities that are evidence-based as recognized by a federal
government agency as well as local programs identified as evidence-based and meeting one of the
following 3-tier criteria:
Highest-level Evidence-based Criteria
All of the below criteria, plus:
 Proven effective with older adult population, using Experimental or Quasi-Experimental
Design.
 Fully translated* in one or more community sites; and
 Includes developed dissemination products that are available to the public.
Intermediate Criteria
All of the below criteria, plus:
 Research results published in a peer-review journal; and
 Proven effective with older adult population, using some form of a control condition
(e.g. pre-post study, case control design, etc.); and
 Some basis in translation* for implementation by community level organization.
Minimal Criteria
 Demonstrated through evaluation to be effective for improving the health and wellbeing
or reducing disease, disability and/or injury among older adults; and
 Ready for translation*, implementation and/or broad dissemination by communitybased organizations using appropriately credentialed practitioners.
Beginning October 1, 2016 and beyond, to be eligible for Title IIID Federal Funds, all programs
must meet the highest level criteria of the Administration for Community Living for evidencebased programs.
Programs meeting all of the following criteria will be considered appropriate:
30





Demonstrated through evaluation to be effective for improving the health and
wellbeing or reducing disease, disability and/or injury among older adults; and
Proven effective with older adult population, using Experimental or Quasi-Experimental
Design; and
Research results published in a peer-review journal; and
Fully translated* in one or more community sites; and
Includes developed dissemination products that are available to the public.
*Note: Translated is defined as “does the program work consistently in all community settings”.
In addition, all RFP’s must include the certificate authenticating the program is an evidence based
program (or supply said certificate prior to implementing the service on 10/1/16) as well as state that
the individual named in the certificate is the same individual who will be conducting the class.
Providers should reference the approved lists identified below to verify that prospective
programs are considered evidence-based by any operating division of the U.S. Department of
Health and Human Services.





http://www.acl.gov/Programs/CPE/OPE/ADEPP.aspx
https://www.ncoa.org/center-for-healthy-aging/basics-of-evidence-based-programs/aboutevidence-based-programs/
http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html
http://www.samhsa.gov/nrepp
http://cancercontrolplanet.cancer.gov/
Service activities should include the following components:
 A complete health assessment to determine overall health or a partial assessment/screening
for individual health problems, such as hypertension, diabetes, vision or hearing deficits will be
conducted by qualified medical personnel.

Providing treatment or therapy as indicated by health assessments or from referral by
appropriate professionals. This may include vaccinations.

Offering basic health advice and information in response to screening/assessment results and
making referrals for medical intervention as indicated.

Health professionals, (registered nurse, physician, paraprofessionals* and/or volunteers)
serving as a resource person to consumers and other health professionals in regard to
information on health issues and other services for which the participant may be eligible and
referring the participant to proper services as necessary.
*Note: Paraprofessionals are defined as “A trained worker who is not a member of a given
profession but who assists a professional or one with assured competencies in a field.”

Evidence-based group education sessions can be designed to increase awareness about
proper medication usage, safety and storage issues, drug interactions, side effects and other
related information.
31

Other activities can include one-on-one medication screening and counseling sessions to
review medications, identify drug interactions, potential side effects and address individual
questions and concerns and referral to physicians.

Maintaining accurate client records describing the assessment, screening, or services
provided, and the results or outcome of health services.

Maintaining records, preparing reports, and other administrative efforts necessary to deliver
physical health services which provide for reasonable confidentiality.

Assessments, screening, and education activities will be provided in community settings like
congregate nutrition sites, senior centers, low-income/senior housing facilities and other
accessible sites conveniently located for area seniors.
Physical Health Services shall meet or exceed the following standards:

Physical Health Services shall be conducted by a registered nurse or physician, or by
paraprofessionals and/or volunteers under the supervision of a professional.

Providers of Physical Health Services shall have adequate knowledge of or be provided with
training in basic gerontology, aging and health, and common health problems of the elderly.

In areas where a significant number of older persons do not speak English as their principal
language, physical health services shall be provided in the language spoken by those persons.

Physical Health services shall be provided in a location that is easily accessible to the older
person.

A follow-up contact shall be made within a reasonable time period if an individual has been
encouraged to seek additional medical intervention. The client's choice on whether or not to
seek medical intervention should be recorded on his/her records.

If the results of tests conducted by the health professional are not readily available to the
client, then the health provider shall contact the client when the results are known. The
contact may be by phone or mail if all test results are normal, but should be by phone or in
person if one or more test results are abnormal. The purpose of this contact is either to assure
the client that the test did not indicate a health problem or to describe problem(s) that were
detected, and provide reassurance and education about how to deal with these problems.

Qualified/licensed medical personnel will provide information and education that helps older
citizens understand how to take prescription, over-the-counter (OTC), and herbal medications
in a safe and proper manner including following the regimen provided by their physician or
pharmacist.

Only evidence based service models shall be used; as described in detail above.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
32
SERVICE CATEGORY: COMMUNITY SUPPORT and ACCESS SERVICES
Program: Socialization, Recreation and Community Education
Unit:
One session per participant
Definition: Planned and structured activities and programs will be provided to well and functionally
impaired older adults in order to facilitate social contact, reduce isolation, and improve personal life
satisfaction. Services shall include formally structured classes, lectures, or seminars that provide
older persons with opportunities to acquire knowledge and skills suited to their interests.
Service activities should include the following components:
 Volunteer based socialization/recreation services offered to seniors by an established,
nonprofit community agency, and will provide the necessary support services to allow
participants to remain active and healthy throughout their lives.

In an effort to build a strong sense of community and independence for the senior citizens
involved, the socialization, recreation and community education program will be a Countywide, all-inclusive program that will include activities and educational programming for all
Mercer County seniors.

The prospective program should operate at least one location that functions as the main
program focal point. Multiple service locations throughout the county would ensure better
access for all seniors.
Socialization, Recreation, and Community Education Services shall meet or exceed the following
standards:
 The provider should be knowledgeable in the activity or program either through education,
experience, or training.

Socialization, recreation and education program shall design activity sessions for the interests,
skills, and abilities of prospective elderly participants.

Educational and leisure activities, health and safety programs as well as volunteer
opportunities should be designed to meet the interests, skills and abilities of prospective
elderly participants, and should expand the opportunities for satisfying leisure time and social
activities to foster their health and social well-being.

Program activities may include; demonstration/instruction presentations, discussion groups
and participation in arts and crafts, hobbies, travel, games, group tours, outings, educational
sessions, cultural events and other activities of a similar nature.

The service applicant may also provide meals and arrange for transportation services.

Customers of this service shall be informed that donations are accepted under this program
and such donations will serve to expand the programs to others in need.
33
SERVICE CATEGORY: COMMUNITY SUPPORT and ACCESS SERVICES
Program: Summer Cooling
Unit:
Each air conditioning unit provided
Definition: The Summer Cooling program is designed to provide older adults and/or people with
disabilities a free air conditioner or fan based on medical and financial need.
Service activities should include the following components:
 Program staff will complete an evaluation to determine an individual’s financial need, age or
disability. Required evaluation criteria include; Mercer County residence, doctor’s
note/prescription, assets under $2,000, individuals age 18+ with a disability that qualifies one
for SSI, SSD, and 200% of the Federal Poverty Status as updated annually. Participant must
have not received an air conditioning unit within the last 3 years.

The program provider will supply information about other programs and services for which the
participant may be eligible to aid in payment of higher energy costs due to the use of the air
conditioner and referral of the participant to the proper services as necessary.

Reasonable accommodations shall be made to those unable to personally pick up and/or
install the air conditioning unit.
Summer Cooling Program shall meet or exceed the following standards:
 The agency must be able to purchase, store and provide an air conditioner to the eligible
person, and evaluate program criteria.

Program staff must determine where the units will be stored and the most appropriate means
of ensuring the client or their designee receives the unit.

Agency may coordinate screening locations with other community agencies to increase
program access and awareness.

Customers of this service shall be informed that donations are accepted under this program
and such donations will serve to expand the programs to others in need.
34
SERVICE CATEGORY: COMMUNITY SUPPORT and ACCESS SERVICES
Program: Volunteer Services
Assisted Transportation
Unit:
Each one-way trip (location to location)
Definition: To provide an individualized linkage for functionally impaired or isolated older persons to
enable them to utilize community facilities and services, such as banks, stores, medical resources,
and other necessary destinations which they are unable to access due to transportation and/or health
barriers.
Service activities should include the following components:
 Program staff must determine that services are needed due to the lack of an informal support
system, family, caregiver or availability of other formal transportation systems capable of
providing assisted transportation services.

Actual transportation services will be provided by trained volunteers.

Transporting the client for food, clothes and other essentials or running essential errands, such
as picking up prescription medicines or going to the bank.

Accompanying the client to a service/facility that includes providing all necessary assistance
that the client needs in order to utilize the service/facility: such as climbing stairs, entering
doorways, crossing streets, and carrying packages.

Ongoing monitoring by the provider to detect changes in client's condition, and providing
referral to establish a necessary linkage with the appropriate agency.

Maintaining records, preparing reports, and other administrative efforts necessary to provide
escort services.
Note: In the event that clients normally using Assisted Transportation services are
occasionally unable to accompany the service provider on a regularly scheduled and essential
errand, due to illness or other circumstances, the service provider may perform the errand
without the client and may count this as a "one way trip" of Assisted Transportation Services.
Assisted Transportation shall meet or exceed the following standards:
 Services shall be structured to serve the frail, at risk, and/or homebound elderly person who,
without this help, would remain isolated from services.

Only essential errands shall be provided to enable the program to serve the greatest number
of older persons in need.

Services shall be provided in a manner to ensure that primary decision-making ability remains
with the older individual being served.

The Assisted Transportation provider/volunteer shall be trained and sensitized to the situations
and needs of the older population, including the special skills needed to aid in the service.
35

A mechanism shall be in place to enable providers to work cooperatively with other involved
agencies as to client status and problems.

Proper supervision shall be available to volunteers/workers to help resolve problems, conflicts,
and to provide additional technical assistance as needed.

Programs shall maintain adequate insurance coverage to protect volunteers/workers from the
risk inherent in the transportation of clients.

Persons performing Assisted Transportation Service shall possess a valid driver's license and
a safe driving record.

Services can be provided using mass transit, the provider's own vehicle, client's own vehicle,
or any other vehicle for which permission has been granted to be used for Assisted
Transportation.

Compensation may be paid to the provider who utilizes his/her own vehicle or a mass transit
system for the provision of Assisted Transportation.

Assisted Transportation Services should be provided in a location that is easily accessible to
the older person.

In areas where a significant number of clients do not speak English as their principal language,
Assisted Transportation services should be provided in the language spoken by those clients.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
36
SERVICE CATEGORY: COMMUNITY SUPPORT and ACCESS SERVICES
Program: Volunteer Services
Friendly Visiting
Unit:
Each visit
Definition: An organized service that provides regular visits to socially and/or geographically isolated
older individuals for purposes of providing companionship and social contact.
Service activities should include the following components:
 Visiting by paid or volunteer staff to clients to provide conversation and assist with activities,
such as letter writing, reading, household budgeting, and other similar activities.

Ongoing monitoring and early detection by the friendly visitor of changes in client's condition,
and providing referral, if necessary, to establish a linkage with the appropriate agency.

Maintaining records, preparing reports, and other administrative efforts necessary to provide
Friendly Visiting services.
Friendly Visiting shall meet or exceed the following standards:
 The program shall develop written procedures for screening prospective clients and friendly
visitors to attempt to match persons who are compatible. The screening process shall include
at least two character references for the potential friendly visitor to protect the safety of the
older person.

Friendly visitors shall receive an orientation training which covers: the needs of isolated and/or
homebound elderly persons; the function and limitations of a friendly visitor; communication
and interpersonal skills; and emergency procedures.

The program shall have a staff person designated to provide direction to friendly visitors and to
be available to contact in emergencies or problem situations.

Each friendly visitor shall agree not to solicit contributions of any kind (other than the
suggested standard OAA service contributions), attempt the sale of any merchandise or
service, or seek to encourage the acceptance of any particular belief or philosophy while
making a friendly visit.

Friendly Visiting can be provided to older individuals in their own homes or to those in long
term care facilities who are in need of social contact. Services should be provided in a
location that is easily accessible to the older person.

In areas where a significant number of clients do not speak English as their principal language,
Friendly Visiting services should be provided in the language spoken by those clients.
37
SERVICE CATEGORY: COMMUNITY SUPPORT and ACCESS SERVICES
Program: Volunteer Services
Housekeeping
Unit:
Each hour
Definition: A service provided by a volunteer or paid staff person for routine basic upkeep and
management of homes, for the purpose of enabling older persons to maintain themselves in their
place of residence by removing housekeeping barriers.
Service activities should include the following components:
 Determining that services are needed due to the fact that there is no family member or other
responsible informal caregiver available or capable of providing such services.

Light or heavy housecleaning services, such as laundry, dusting, mending, cleaning, meal
preparation, washing floors, etc., that can be provided by non-professional staff.

Performance of routine errands, such as grocery shopping or purchasing prescribed
medications.

Ongoing monitoring by housekeeping staff to detect changes in client's condition, and provide
referral, if necessary, to establish a linkage with the appropriate agency.

Maintaining records, preparing reports, and other administrative efforts necessary to provide
Housekeeping services.
Housekeeping services shall meet or exceed the following standards:
 Housekeeping services shall be provided in a manner to ensure that primary management
responsibility for the home remains with the individual being served.

Housekeeping providers shall be trained and sensitized to the situations and needs of the
older population they will be serving.

A mechanism shall be in place to enable Housekeeping providers to work cooperatively with
other involved agencies as to client status and problems.

Appropriate supervision shall be available for workers to help resolve problems or conflicts
which may result from their relationship with the client, and to provide additional technical
assistance, as needed.

In areas where a significant number of clients do not speak English as their principal language,
Housekeeping Assistance should be provided in the language spoken by those clients.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
38
SERVICE CATEGORY: IN-HOME SUPPORT SERVICES
Program: Home Health Aide
Certified Home Health Aide
Unit:
Each hour
Definition: General support by certified and professionally supervised home health aides to maintain,
strengthen, and safeguard the functioning of older individuals and families in their own homes during
periods of illness or severe instability.
Service activities should include the following components:
 Performance of daily personal care activities, such as feeding, bathing, grooming, personal
hygiene, and dressing, exercising, assisting with bed mobility and ambulation, and assisting
with self-administered medication.

Performance of light household tasks related to health maintenance services, such as cleaning
bathroom after assisting client with bath, cleaning kitchen after assisting client with meals,
changing bed linen after assisting client with bath and/or bed mobility, laundering of towels,
bed linen, etc.

Prepare and serve meals including special diets.

Performance of light housekeeping tasks, such as sweeping, dusting, ironing, and mending of
clothes, etc.

Instructions to individual or family members in home management, the care of dependent
members of the household, and in self-care.

Provision of necessary emotional and social support.

Maintaining records, preparing reports, and other administrative efforts necessary to provide
Certified Home Health Aide services.
Certified Home Health Aide services shall meet or exceed the following standards:
 Certified Home Health Aide services funded by the AAA are available only to residents 60
years of age or older or persons who are chronically physically disabled who would not
otherwise qualify for services under any other program.

Priority for service shall go to those individuals meeting the above conditions, who are
otherwise eligible for a nursing facility if they do not receive such service. In particular, priority
shall be given to referrals from hospitals, doctors, Geriatric Assessment, and Care
Management Sites, and to those individuals most socially and economically disadvantaged.

The agency shall meet and comply with all required rules, regulations, and standards set by
the cognizant accrediting agency.

All staff providing the service shall be fully trained and professionally qualified and receive
certification from the State Board of Nursing.
39

The agency shall maintain, follow, and continually update a training and supervision program
to make sure staff is fully trained and familiar with agency procedures.

All requests for service shall be processed within a reasonable time of receipt, including
identification of possible eligibility for service funded from another source other than the AAA.

Care assessments shall be started within three (3) working days after receipt of application.

A plan of care shall be developed for each new participant within five (5) working days after
enrollment.

All plans of care and other participant records shall be kept in a secure location to protect
confidentiality.

Caseloads shall be continually reviewed to ensure priority participants are being served.

Participant needs shall be reassessed every six (6) months or more frequently, with revisions
made in the plan of care as necessary; any observed changes must be immediately noted in
the participant plan of care.

Participants shall be provided with information on how other needed services (e.g., Medicare,
Medicaid, SSI, transit, housing, prosthetic or rehabilitative devices, etc.) may be obtained, and
must be provided assistance in gaining access to those services.

Participants, family members, and/or caregivers shall be informed of agency procedures for
protecting confidentiality, for reviewing progress against the plan of care, and other matters
germane to the participant's decision to accept services.

Participants, family members, and/or caregivers shall be given the opportunity to learn how to
perform the tasks performed by the Certified Home Health aide, in order to give the participant
and the informal support network a chance to function independent of agency service.

All participant records of care, service costs, sources of funds, and agency procedures shall
be reviewed regularly.

In areas where a significant number of clients do not speak English as their principal language,
Certified Home Health Aide assistance should be provided in the language spoken by those
clients.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
40
SERVICE CATEGORY: IN-HOME SUPPORT SERVICES
Program: In-Home Health Care
Unit:
Each visit
Definition: Home health care/nursing services will provide cost effective, long term, home-based
nursing services to medically underserved and impoverished seniors 60 years of age or older who
suffer from acute or chronic ill-health conditions.
Service activities should include the following components:
 Professional, skilled nurses, under the supervision of a registered nurse, will provide in-home
personal care activities, such as preventative, restorative, and/or rehabilitative nursing care,
either on a short-term or continuous basis.

Services may also include: feeding, bathing, grooming, personal hygiene, dressing, exercising,
assisting with bed mobility and ambulation, and assisting with self-administered medication,
and other personal health care needs as they arise.

An in-home assessment will be conducted, by the supervising registered nurse, for each client
to determine service needs, priority of need and eligibility for alternative and/or other
community agencies, economic conditions, medical history. Information will be utilized to
develop an individualized plan of care.

All clients will receive assistance in obtaining a request for additional services like health
education, counseling, and/or social work services needed as part of the in-home care plan.

Nursing care staff may also provide instruction and guidance to participant, family and other
caregivers on preventative health care and health maintenance, including nutrition, accident
and fall prevention, and use of health and social service resources.
Home Health Care services shall meet or exceed the following standards:
 Home Health/Nursing Services funded by the AAA is available only to residents 60 years of
age or older who would not otherwise qualify for this service under any other program. Priority
for services shall go to those individuals meeting the above definition, who are otherwise
eligible for admission to a nursing facility if they do not receive home health care/visiting nurse
services. In particular, priority shall be given to referrals from hospitals, doctors, Geriatric
Assessment and Care Management Sites, and to those individuals most socially and
economically disadvantaged.

The agency shall meet and comply with all required rules, regulations, and standards set by
the cognizant accrediting agency. All staff providing the service shall be fully trained and
professionally qualified.

The agency shall maintain, follow, and continually update a training and supervision program
to make sure staff is adequately trained and familiar with agency procedures.

All plans of care and other participant records shall be kept in a secure location to protect
confidentiality.
41
SERVICE CATEGORY: IN-HOME SUPPORT SERVICES
Program: National Family Caregiver Support Services
Professional In-Home Education and Support
Unit:
One session per participant
Definition: Professional In-Home Education and Support Services will provide individualized
education and support to unpaid caregivers in their residence in an effort to improve their ability and
effectiveness as caregivers and prolong their ability to provide care for a disabled adult, an elderly
individual, or an individual who is less than 60 and has a diagnosis of early onset dementia. Attention
to evidenced-based interventions will help ensure caregiver adherence and compliance.
Service activities should include the following components:
 The caregiver and a registered nurse will work together to assess needs and identify a written
education/support plan.

After an initial assessment, based upon the written education/support plan, the caregiver may
receive up to 5 in-home visits from professionals, including physical, occupational, and speech
therapists, registered dieticians, registered nurses, and licensed or certified social workers. A
follow-up phone call upon completion of the visits or interventions is recommended.

Education may be provided to the caregiver in such areas as special diets, speech
rehabilitation for stroke patients, safe transfer of persons from bed to toilet, information about
support groups and other services, stress management and hygiene practices for those with
lowered immune systems and evidence-based programs assisting in the care of those with
dementia.

In addition, caregivers who are caring for persons with memory loss, dementia or Alzheimer’s
disease may be referred to Skills2Care; a tailored program that combines environmental
assessment with clinical observation of the dementia process. Caregivers are assessed as to
their understanding of dementia and are encouraged to identify personal challenges and
impact the disease has on their well-being in order to create a specialized plan of
care. Through a series of 6-8 in-home sessions, the caregiver and OT meet and formulate a
plan of care that can include role playing, dementia education, home modifications and handson skill-building to assist in the day-to-day care of a person living with memory changes. At the
end of the scheduled sessions, caregivers receive up to 2 phone calls for final suggestions
and any guidance that they may need.

Maintain records, prepare reports, and other administrative tasks necessary to provide
Professional In-Home Education and Support.
In-Home Education and Support services shall meet or exceed the following standards:
 The developer of the written education/support plan shall be a registered nurse.

All professionals involved with the education/support plan, including registered nurses,
physical therapists, occupational therapists, speech therapists, registered dieticians, and
licensed or certified social workers shall be knowledgeable in the skill or topic to be presented
through education, experience, training and/or licensure, as required.
42

All professionals shall have a minimum of one year’s experience working with the geriatric or
chronically disabled population, whichever experience area is relevant to the assigned case,
and be appropriately credentialed as required by the State of New Jersey.

Occupational Therapists certified in Skills2Care will provide hands-on education to families to
enhance their abilities to manage day-to-day care.

Providers shall review and keep resumes and verification of credentials on file for all
professional staff involved in the education/support plan.

In areas where a significant number of clients do not speak English as their principal language,
Professional In-Home Education and Support should be provided in the language spoken by
those clients.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
43
SERVICE CATEGORY: IN-HOME SUPPORT SERVICES
Program: National Family Caregiver Support Services
Respite Care
Unit:
Each hour
Definition: Short term or intermittent care, provided to older persons either in their homes or in other
appropriate facilities, because of the absence or the need for relief of those persons normally
providing care.
Service activities should include the following components:
 Determining the physical and emotional status of the client and the type of supervision needed
for respite care.

Developing and maintaining individualized plans of respite care.

Implementing respite care plans that may include services such as personal care, food
preparation, helping with daily activities, and/or companionship. The duration of respite care
services may vary either being short term, e.g. 2-3 hours or long term, e.g. a weekend.

Providing information about other programs and services for which the clients might be eligible
and referring clients to proper services as necessary.

An evaluation to be completed by the client and/or caregiver after respite care has been
provided in order to monitor service.

Maintaining records, preparing reports, and other administrative efforts necessary to provide
Respite Care services.
Respite Care services shall meet or exceed the following standards:
 Respite Care funded by the AAA is available only to residents 60 years of age or older who
would not otherwise qualify for this service under any other program. Priority for respite care
shall go to those individuals who are eligible for admission to a nursing facility if they do not
receive respite care. In particular, priority shall be given to referrals from hospitals, doctors,
Geriatric Assessment and Care Management Sites, and to those individuals most socially and
economically disadvantaged.

All efforts of the Respite Care program shall be designed for maintaining the client's dignity
and health.

The Respite Care program shall, by policy, determine the maximum amount of care to be
provided to each elderly person for a set time period to ensure that the greatest number in
need is served.

Respite care provided in a centralized facility shall be determined to be compliant with all
applicable building regulations and fire, health, and safety codes.

The respite provider shall employ a trained paid or volunteer staff who shall be competent,
qualified, and sufficient in number to implement the Respite Care program.
44

Respite care workers shall receive training that includes: instruction on providing appropriate
care; communication and interpersonal skills; emergency procedures; and the physical and
emotional needs of sick and frail elderly persons.

The program shall develop procedures for screening prospective clients and respite care
workers to attempt to match persons who are compatible. The screening process shall include
contacting at least two character references for the potential respite care worker to protect the
safety of the older person.

A staff person shall be designated to be available to respite workers in case of emergencies or
problem situations.

In areas where a significant number of clients do not speak English as their principal language,
Respite Care assistance should be provided in the language spoken by those clients.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
45
SERVICE CATEGORY: IN-HOME SUPPORT SERVICES
Program: Telephone Reassurance
Unit:
Each telephone call
Definition: An organized service that provides regular telephone calls to homebound older persons
to assure their well-being and safety and to provide social interaction and psychological reassurance.
Service activities should include the following components:
 Scheduled telephoning by paid or volunteer staff to individuals to determine if they are safe
and well, and to provide social contact and conversation.

Activating an emergency plan for client(s) if a telephone call is unanswered.

Ongoing monitoring and early detection, by the callers, of changes in client's condition, and
providing referral to establish a necessary linkage with the appropriate agency.

Maintaining records, preparing reports, and other administrative efforts necessary to provide
Telephone Reassurance services.
Telephone Reassurance shall meet or exceed the following standards:

The program shall develop procedures for screening prospective clients and callers to attempt
to match persons who are compatible. The screening process should include contacting at
least two character references for the potential callers to protect the safety of the older person.

Callers shall receive an orientation training which covers: the needs of isolated and/or
homebound elderly persons; the function and limitations of a Telephone Reassurance
provider; communication and interpersonal skills; and emergency procedures.

The program shall have a staff person designated to provide direction to callers and to be
available to contact in emergencies or problem situations.

Each caller shall agree not to solicit contributions of any kind, attempt the sale of any
merchandise or service, or seek to encourage the acceptance of any particular belief or
philosophy while making a Telephone Reassurance call.

Each program shall establish and provide all callers with a copy of procedures to be followed
in emergencies or when a client does not answer (or call) as arranged. These procedures
should include:
o Provision for an immediate visit to the client's home by program staff or emergency
service personnel (i.e., police, ambulance, fire department, etc.);
o Contact of individual named to be notified in case of an emergency; and
o Verification that either subsequent contact has been made with the client or that the
client's location is identified.

In areas where a significant number of clients do not speak English as their principal language,
Telephone Reassurance should be provided in the language spoken by those clients.
46

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
47
SERVICE CATEGORY: NUTRITION SUPPORT SERVICES
Program: Countywide Weekday Home Delivered Meals
Home Delivered Meals
Unit:
Each meal
Definition: Countywide home delivered meals services will provide daily hot nutritionally adequate
meals which assure, at a minimum, one-third of the Dietary Reference Intake (DRI) to older persons in
their places of residence, daily for five days per week.
Service activities should include the following components:
 Nutritious meals, including therapeutic diets, planned by a licensed dietitian/qualified
nutritionist will be delivered five days per week.

An additional daily cold meal may be provided as well. This additional meal is provided with
the intention of supper consumption.

Home delivered meals will be provided five days a week to the homebound elderly, 60 years of
age or older between the hours of 11:00 a.m. and 1:00 p.m.
Countywide Weekday Home Delivered Meals Services shall meet or exceed the following
standards:

Persons eligible for home delivered meals are those individuals:
o Age 60 or over;
o Who are homebound;
o Incapacitated due to accident, illness, or frailty;
o Unable to prepare meals because of lack of facilities, inability to shop or cook for
self, unable to prepare meals safely, or lack knowledge and skills to prepare meals;
o Lacking support from family, friends, neighbors; health aide or other caregivers to
help secure meals;
o Who are spouses of homebound older individuals, regardless of age, if an
assessment indicates that receipt of the meal is in the best interest of the client;
o Disabled who reside at home with older eligible individuals.
*Note: Preference still must be given to serve those individuals who are 60 years and above
with the greatest economic or social need.

Client needs assessments shall be completed by qualified staff to determine eligibility and
service needs prior to or within 10 days of initiating the service, and reassessments shall be
completed within six-month intervals.

Each meal must contain at least one-third of the current Dietary Reference Intake (DRI), as
established by the Food and Nutrition Board, National Research Council, National Academy of
Sciences.

Menus for Home Delivered Nutrition programs must be certified and documented as meeting
DRI standards by a qualified nutritionist.
48

Home Delivered Nutrition Programs will provide at least one hot or other appropriate home
delivered meal, daily for five or more days per week.

Other appropriate meals may include cold, frozen, dried, canned, or supplemental foods (with
satisfactory storage life) meeting one-third DRI.

Emergency preparedness procedures must be established to cover emergency situations such
as vehicle breakdown, weather-related emergencies, etc.

When feasible and appropriate, programs should make arrangements for the availability of
meals to older persons during weather-related emergencies.

Each Home Delivered Nutrition program must bring to the attention of appropriate officials,
with the consent of the older person or his/her representative, conditions or circumstances that
place the older person or household in imminent danger.

Home Delivered Nutrition programs should assist participants in taking advantage of benefits
under other programs.

Home Delivered Nutrition programs must ensure compliance with New Jersey Standards for
the Nutrition Program for Older Americans, PM 2011-33, I-164, dated December 15, 2011.
Note: A copy of said policy memorandum will be provided pending an executed contract.

In areas where a significant number of clients do not speak English as their principal language,
Home Delivered Nutrition should be provided in the language spoken by those clients.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
49
SERVICE CATEGORY: NUTRITION SUPPORT SERVICES
Program: Countywide Weekday Home Delivered Meals
Nutrition Counseling
Unit:
One session per participant
Definition: Provision of individualized advice and guidance to older adults, who are at nutritional risk,
because of their health or nutritional history, dietary intake, medicines use, or chronic illnesses, about
options and methods for improving their nutritional status.
Service activities should include the following components:
 Qualified nutritionist (Registered Dietitian preferred) provides nutrition counseling, nutrition
assessment and nutrition screening to an older individual on a one-to-one basis. Information
may be communicated to a caregiver who is present with the client.

Individual making home visits is made aware of the NJ ADRC cross-referral process for older
adults who are in need of other services and/or assistance.

Follow-up on the progress of the client will be ensured as part of nutrition counseling
intervention.

Individuals receiving meals from Title III projects will be advised of shopping tips and foods to
select consistent with the diet for other meals that are not provided by the project.
Nutrition Counseling Services shall meet or exceed the following standards:
 Nutrition Counseling must be provided by a qualified nutritionist, (Registered Dietitian
preferred) in accordance with state law and policy.

Nutrition counseling intervention goals shall be designed to maintain the overall health of older
adults and in high-risk elders to prevent continued nutritional decline. Examples of medical
conditions which are related to increased nutritional risk include: Diabetes, Hypertension,
Cardiovascular Disease, and Osteoporosis.

Consistent and uniform written records shall be developed and maintained for reference and
documentation of service provision, including NAPIS Registered Service information.

In areas where a significant number of clients do not speak English as their principal language,
Nutrition Counseling assistance should be provided in the language spoken by those clients.

Nutrition Counseling should be provided in a location that is easily accessible to the older
person.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
50
SERVICE CATEGORY: NUTRITION SUPPORT SERVICES
Program: Countywide Weekday Home Delivered Meals
Nutrition Education
Unit: 1 session per participant (each mailing or distribution to homebound adults is counted as one
session/unit)
Definition: A program to promote better health through the provision of accurate and culturally
sensitive nutrition and health related information for homebound older adult participants of the home
delivered meals program.
Service activities should include the following components:
 Qualified individual (Registered Dietitian preferred) provides nutrition and health related
education to older adults as an educational and informative session which complements health
promotion goals for older adults.

Information provided should be checked for accuracy and reliability by the nutritionist who
oversees the provision of Nutrition Education for older adults in each nutrition program.
Nutrition Education Services shall meet or exceed the following standards:
 Nutrition Education must be overseen by a qualified nutritionist, (RD preferred). Nutritionist
should review all material distributed for Nutrition Education at group sessions and for
homebound clients for accuracy and appropriateness.

Nutrition Education material should be made available to homebound nutrition clients at least
quarterly. Each mailing is counted as one session.

Nutrition Education programs should be provided in a location that is easily accessible to the
older person.

In areas where a significant number of clients do not speak English as their principal language,
Nutrition Education should be provided in the language spoken by those clients.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
51
SERVICE CATEGORY: NUTRITION SUPPORT SERVICES
Program: Kosher Nutrition
Unit:
Each meal
Definition: Kosher nutrition funding will provide elderly residents of Mercer County, who require or
prefer a kosher diet, an opportunity to participate in a congregate meal program.
Service activities should include the following components:
 The intent of the program is to promote socialization and to reduce isolation for those
individuals who meet eligibility criteria established by the Mercer County Office on Aging.

The kosher congregate meal program will be open to people of all religions, races, and ethnic
backgrounds who prefer to observe the kosher dietary laws.
Kosher Nutrition Services shall meet or exceed the following standards:
 A qualified nutritionist employed by the nutrition program or meal provider must approve and
certify all standard menus and substitutions in advance.

Menus with documentation as to nutrient and kosher content must be kept on file by the
program for a minimum of three years.

All food service establishments must comply with all applicable licensing laws and ordinances
relating to food service operations, including Chapter 24 (N.J.A.C. 8:24) of the State Sanitary
Code, and ensure compliance with New Jersey Standards for the Nutrition Program for Older
Americans, PM 2011-33, I-164, dated December 15, 2011. Note: A copy of said policy
memorandum will be provided pending an executed contract.

Kosher Congregate Meal participants shall be given the opportunity to interact and socialize
with their peers, as well as benefit from education groups and topic speakers addressing the
issues, needs and services of the elderly.

As with all Office on Aging funded programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
52
SERVICE CATEGORY: NUTRITION SUPPORT SERVICES
Program: Weekend Home Delivered Meals
Unit:
Each meal
Definition: The provision of nutritionally adequate meals which assure, at a minimum, one-third of
the Dietary Reference Intake (DRI) to older persons in their places of residence on weekends and/or
holidays.
Service activities should include the following components:
 The weekend home delivered meal program will provide a hot meal for Saturday consumption
and a cold meal for Sunday consumption to frail/vulnerable homebound elderly, 60 years of
age or older.

The weekend home delivered meals program will maintain contact with area hospitals,
rehabilitation centers, social workers and discharge planners to inform them of services
available to elderly clients, and to increase referral sources.

Semiannually, clients will be re-evaluated in regard to continued need for weekend meal
service, in accordance with physical and/or mental limitations. The service provider will
maintain all assessment records.
Weekend Home Delivered Meals Services shall meet or exceed the following standards:
 Persons eligible for weekend home delivered meals include those individuals:
o Age 60 or over;
o Who are homebound;
o Incapacitated due to accident, illness, or frailty;
o Unable to prepare meals because of lack of facilities, inability to shop or cook for
self, unable to prepare meals safely, or lack knowledge and skills to prepare meals;
o Lacking support from family, friends, neighbors;
o Who are spouses of homebound older individuals, if an assessment indicates that
receipt of the meal is in the best interest of the client;
o Disabled who reside at home with older eligible individuals.

Client needs assessments shall be completed by qualified staff to determine participant
eligibility and service needs and reassessments shall be completed within six-month intervals

Each meal must contain at least one-third of the current Dietary Reference Intake (DRI), as
established by the Food and Nutrition Board, National Research Council, National Academy of
Sciences.

Menus for State home delivered nutrition programs must be certified and documented as
meeting DRI standards by a qualified nutritionist.

State Weekend home delivered nutrition programs will provide at least one hot or other
appropriate home delivered meal on weekends and/or holidays.
53

Other appropriate meals may include cold, frozen, dried, canned, or supplemental foods (with
satisfactory storage life) meeting one-third DRI.

Emergency preparedness procedures must be established to cover emergency situations,
such as vehicle breakdown, weather-related emergencies, etc.

When feasible and appropriate, programs should make arrangements for the availability of
meals to older persons during weather-related emergencies.

Each State Weekend Home Delivered Nutrition program must bring to the attention of
appropriate officials, with the consent of the older person or his/her representative, conditions
or circumstances which place the older person or household in imminent danger.

State Weekend Home Delivered Nutrition programs should assist participants in taking
advantage of benefits under other programs.

Home Delivered Nutrition programs must ensure compliance with New Jersey Standards for
the Nutrition Program for Older Americans, PM 2011-33, I-164, dated December 15, 2011.
Note: A copy of said policy memorandum will be provided pending an executed contract.

In areas where a significant number of clients do not speak English as their principal language,
Home Delivered Meal Programs should be provided in the language spoken by those clients.

As with all Older Americans Act programs, customers of this service shall be informed that
donations are accepted under this program and such donations will serve to expand the
programs to others in need.
54
MERCER COUNTY DEPARTMENT OF HUMAN SERVICES
Request for Proposal
PROPOSAL COVER SHEET
Agency name
Mailing address
Executive
Director/CEO
Program name
Program contact
Program address
For-Profit or
Non-Profit
E-mail address of
contact person
Telephone
number of
contact
Service
Amount
requested
Authorization
I understand that the following pages and attachments constitute part of this application.
I certify that all statements in this application are true to the best of my knowledge and I
hereby release the Mercer County Administration and the Board of Chosen Freeholders, its
employees and agents from any liability and/or responsibility concerning submission of
materials to the program. I further certify that any funds received from the Mercer County
Department of Human Services will be used exclusively for the purpose set forth in this
application.
______________________
Executive Director /CEO
______
Date
______________________
Fiscal Agent
_____
Date
PROPOSAL REQUIREMENTS
ATTACHMENT A:
Proposals should be submitted in the following format with no more than ten (10), single-spaced
narrative pages answering questions related to how programming will be achieved. The “Funding
Proposal Cover Sheet” is attached to this proposal (it is not counted as part of 10-page maximum
requirement) and should be used as the first page of your submission document. Please submit one
(1) original and six (6) copies of the proposal for review, with an additional proposal submitted on CD
or USB Drive. Please sequentially number all pages.
See the Proposal Check List at the end of this packet for clarity, as this list details how many
original and/or copies of each document that we need.
Please complete the Project/Program Description, Project/Program Administration, Evaluation of
Goals and Objectives, and the Fiscal sections (identified by Roman numerals I-IV) by answering each
of the elements identified in the outlined format. You may use additional sheets as needed for the
fiscal section. The RFP responses shall contain a narrative description of the proposed
approach to the project. Restating of the RFP will be considered an unacceptable response.
Each proposal shall include a project level of effort estimate based on, and corresponding to,
the Scope of Services provided in this RFP. The estimate shall contain a task-oriented
schedule, which identifies milestones and their proposed initiation and completion dates.
Be sure to use the appropriate headings in the same sequence as outlined below. Failure to
do so will make the review of your proposal difficult and will result in points lost. In addition, if
a heading and/or question is not applicable to your agency, please note that in your proposal.
If a section/question does not have an answer or notation that it is not applicable to your
agency, reviewers will assume that you failed to answer the question and points will be lost in
the review process.
I. PROJECT/PROGRAM DESCRIPTION:
AGENCY OVERVIEW
 Briefly describe the philosophy/mission of the applicant agency.
 Include information on the history of delivering the specific services that are the subject of this
Request for Proposal (RFP).
 Describe how the applicant/organization involves consumers in the operations, service
planning, or evaluation of services.
 All applicants are expected to collaborate with other service providers to ensure client
success. Describe how you will collaborate with other social service agencies to accomplish
the goals you will set forth in this project.
 The proposal must list the location and address of the present, active office, which will service
and manage this project.
 Please provide agency and program brochures.
SPECIFIC PROJECT/PROGRAM
 Describe the service component/project that is being purchased with the funding.
2





If requested amount of funding will augment other sources of funding for this specific
project/program, clearly indicate in percentage terms the amount supported by requested
funding in relation to entire cost of project/program.
For new projects, please include a timeline of implementation, including advertising, hiring,
start up, and program admissions.
If this program has been previously or is currently being funded by any division or Office in the
Mercer County Department of Human Services or by any other department or division of the
County of Mercer, please identify outcomes and program success from the most currently
funded year.
Specify location of program and hours of service provision.
List program service days/holiday schedule.
RATIONALE/MISSION OF PROJECT/PROGRAM
 Describe the need that is being addressed.
 Describe the methods/modalities used to implement the program design.
 Describe how the proposed program meets a need(s) identified within the community.
 Document the need by using demographic data and other local data sources.
TARGET POPULATION/ELIGIBILITY
 Describe the population that will be served.
 Describe the rationale for selecting the population(s) to be served.
 Describe the geographic service area for this project/program.
 List eligibility criteria for this project/program.
CULTURAL COMPETENCE CAPABILITY
 Describe how the proposed project meets the ethnic/cultural backgrounds and linguistic needs
of clients to be served.
 Describe how you address cultural capacity/diversity issues within your agency and program.
II. PROJECT/PROGRAM ADMINISTRATION:
ORGANIZATIONAL CHART
 Detail the supervision lines of this project/program in relationship to overall agency operation.
 Include an organizational chart with lines of supervision within the proposed program and
between the program and sponsoring agency.
 Also include all relationships to collaborating agencies, as well as subcontract agreements, if
applicable.
KEY STAFF
 Identify staff and their respective functions in implementing this program.
 Include brief job descriptions for staff paid by the grant.
STAFF DEVELOPMENT
 Describe policy for staff growth and development.
 Describe the organization’s plan for ongoing training and professional development of staff
that work in the proposed program.
ADMISSION CRITERIA
 Describe referral/enrollment process.
 Identify reports/forms/documents needed for referral/admission.
3
WAITING LIST
 Describe maintenance of a waiting list.
INTAKE
 Describe method for prioritization of intake requests.
 Describe the intake process and the type of evaluation method(s) used.
TIME TO ACCEPTANCE/ADMISSION
 What is the length of time from referral to acceptance/admission?
ACCESSIBILITY:
ACCESSIBILITY ISSUES
 Explain accessibility for the program for the target population.
 Explain accessibility for the physical plant for the target population.
 Describe limitations, if any, for people with disabilities.
 Identify barriers to access, including language, site specifics related to the physical plant, or
other existing programmatic barriers.
TRANSPORTATION
 Describe availability of public transportation.
 Does agency provide transportation to clients?
LEVELS OF SERVICE/UNITS:
UNIT OF SERVICE
 What is the agency’s definition of Unit of Service (e.g., time, face-to-face contact, bed day,
etc.)?
 How many unduplicated consumers will be served annually?
EXPECTED LOS
 What is the expected Level of Service (LOS) for each unit that will be provided annually under
this grant with your proposed funding request?
COST-PER-UNIT BREAKDOWN
 Please provide a cost-per-unit breakdown for total services that will be provided under this
grant based on the funding requested.
CLIENT SERVICE PLANNING:
CLIENT SERVICE PLAN DEVELOPMENT
 Describe how a client service plan will be developed to meet needs of consumers and their
caregivers, if applicable, from time of admission to discharge.
 Discuss the client and family involvement with service planning.
 Specify staff responsible for the plan.
SERVICE PLAN REVIEW
 What are the time frames for evaluating the status of the plan?
4
SERVICE PLAN DOCUMENTATION
 Attach a sample of the client intake/planning form, as an attachment, not as part of the
narrative.
DISCHARGE PLANNING:
DISCHARGE PROCEDURE
 Describe the procedure for discharge.
 Please include plans for family involvement, if applicable.
 Identify the staff responsible for discharge planning.
ADMINISTRATIVE DISCHARGE
 Specify the criteria for administrative discharge from the program.
 Describe the actions that are taken and how clients are assured that their needs are met, even
if your agency is not providing the service.
AFTERCARE/TRACKING/FOLLOW-UP:
AFTERCARE PLANNING
 Describe the project's role in aftercare planning.
AFTERCARE EVALUATION
 Describe the system for tracking/collection of follow-up data and time frames for that follow-up.
III. EVALUATION OF GOALS AND OBJECTIVES:
PROGRAMMATIC GOAL(S)—Goals touch on a broad spectrum by describing the program’s
intentions, and they are more general, abstract, and broad in nature than objectives are.
 Provide a broad statement of what the program is designed to accomplish.
OBJECTIVES—Objectives specify the kind and amount of change you expect to achieve for a
specific population within a given time frame for each intervention.
 Describe in detail the specific, measurable, achievable, time-specific strategies to meet the
aforementioned goal(s).
IMPLEMENTATION ACTIVITIES
 Articulate the action steps that will allow the program to reach its goals/objectives.
 Include copies of any questionnaires, diagnostic/other screening tools, surveys, etc., utilized
as part of your implementation.
MEASURABLE OUTCOMES—Measurable outcomes should be specific, measurable,
achievable, relevant, and time-specific. These should indicate the changes/benefits that will
occur in clients’ lives as a result of the program.
 Describe the expected measurable impact on the consumer or system served, regarding the
specific objectives outlined above. The proposed outcomes must be quantifiable and
measurable as to the specific benefits to the consumers served in the program. Note: Levels
of services and attendance rates will not suffice.
DATA COLLECTION - Data collection is to be completed for each client served and used for
evaluation and documentation purposes, as mandated by the Administration on Aging
reporting requirements.
 Describe client record keeping systems and method(s) of collecting NAPIS demographic
reporting data for input into the SAMS system.
5

For evidence-based programs, describe the method(s) of collecting data to be used for
evaluation purposes.
DETERMINING PROGRAM EFFECTIVENESS
 Describe the methodology for determining the project/program effectiveness.
 When using evidence-based programming, how will applicant assure fidelity to the model?
 Include copies of any questionnaires, diagnostic/other screening tools, surveys, etc., utilized
as part of your performance outcome activities.
IV. FISCAL:
ACCOUNTING PRACTICES
 Please describe your agency’s accounting practices.
MAINTAINENCE OF FINANCIAL RECORDS
 Please describe how your agency maintains fiscal records.
SOURCES OF ADDITIONAL FUNDING
 Please list additional funding sources that will support this program, including fees,
contributions, donation policy (if any), and expected revenues for the program from other
sources, and name the specific funding source.
 If the agency receives government funds, specify from which government entity,
department, division, and/or program the funds are received.
 Please do the same as the bullet point above for all private, foundation, and/or grant
funding.
 Also, describe why third-party billing is or not used and what expected revenues are (if
used).
Note: All sources of revenue described here must also be listed in Attachment B budget forms
and fully described in the Budget Narrative section of the RFP.
SLIDING SCALE FEES
 If applicable, describe the agency’s sliding scale feel system and attach the scale used to
make these determinations. This is considered an attachment, not part of the narrative
document.
SUSTAINABILITY
 Describe your plan for the program sustainability after County/State/Federal funding expires.
AUDIT
 Please include one copy of the agency’s most-recent financial audit.
 For those agencies that need to file an IRS Form 990, please submit one copy of the most upto-date form.
6
ATTACHMENT B
 BUDGET FORMS
Please submit all budget forms, even if they are not applicable to your agency. If they are not
applicable, please mark an “N/A” on them and submit them. Failure to do so will result in points
lost during the proposal review period. A budget narrative is required of all proposals.

Be sure to prepare individual budgets for each service year; 2016, 2017 and 2018.

Note: All line items should be detailed on the following budget pages. For example, do not
simply list “travel expenses”. Identify specific personnel and purpose of the travel.

All budget pages are available in a writable Excel format on the Mercer County Website:
http://nj.gov/counties/mercer/departments/hs/

Do not handwrite the budget pages.
7
ATTACHMENT B TO GRANT AGREEMENT NUMBER
COUNTY OF MERCER , DEPARTMENT OF HUMAN SERVICES, OFFICE ON AGING
(For County Use )
Standardized Back-Up Form
1. Title of Project:
Program No:
Funding Source (Please check one):
Other
C1
SSBG
C2
B
SWHDM
D
SHDM
E
2. Type (Circle one)
New
3.
Continuation
Project Director (Name, Title, Dept.,
Address-Street, City, State, Zip Code)
Revision
6. Date of:
A.
B.
Supplement
From
Through
Contract
Amount / IPS
Project
Period
Budget
Year
7. Type of Organization
Public Agency
4.
Applicant Agency ( Name, AddressStreet, City, State, Zip Code)
5.
Name, Title, Address of Official
Authorized to Sign for Applicant Agency:
8.
Private Non-Profit Agency
Payee (Specify to whom checks should be
sent. Name, Title, Address):
Total Actual Budgeted Project Cost / IPS
A. Total Project Cost
B. Project Income
C. Project Net Cost (Line A Less Line B)
D. Local Non-Federal Participation
E. Federal (State) Fund Requested (Line C Less Line D)
8
CATEGORIES
ATTACHMENT B
Budgeted
In-Kind
Total
Budgeted
Amount / Cash
1.
Project Cost
Personnel ( Name, Title, Number or Percent of
time employed)
2.
Total Personnel Cost
Consultant & Contract Services
3
Total Consultant & Contract Services Cost
Travel
4.
Total Travel Cost
Food
5.
Total Food Cost
Building Space
Total Building Space Cost
Total c/o to next page
9
CATEGORIES
ATTACHMENT B
Budgeted
Total
Budgeted
Amount / Cash
6.
In-Kind
Project Cost
Total C/O from previous page
Printing and Office Supplies
Total Printing & Office Supplies Cost
7.
Equipment
Total Equipment Cost
8
Other Costs
Total Other Cost
9.
Indirect Cost (Please Attach Justification for
indirect Rate Calculation)
Total Indirect Cost
Total Project Cost
10
ATTACHMENT B
Financial Resources (Excluding Estimated Cost)
Total
Federal Resources
Total Federal Resources
County Resources
Total County Resources
State Funds
Total State Title III Matching fund
Other Resources
Total Other Resources
Project Income
Participant Income
NSIP
Others
Total Project Income
Total Financial Resources
11
ATTACHMENT B
BUDGET NARRATIVE*
*The Budget Narrative is to be completed in Microsoft Word.
Do not leave this section blank; completion of this section is mandatory.
Please justify the need and cost calculation for each line item shown on your budget forms in
a narrative format. Indicate the number of units to be provided and the number of
unduplicated clients served.
Note: Upon review of your agency’s proposal, the County of Mercer can offer your agency a contract
with an amount that differs from what your proposal requested. If this occurs, your agency will be
asked to submit an amended budget narrative illustrating this new amount before the contract can
route to the Board of Chosen Freeholders.
12
REQUIRED ATTACHMENTS AND DOCUMENTS
NON-COLLUSION AFFIDAVIT
STATE OF NEW JERSEY
COUNTY OF MERCER SS:
I, ____________________________ of the City of___________________,
in the County of_____________________, and the State of___________________,
of full age, being duly sworn according to law on my oath depose and say that:
I am________________________________________________________
of the firm of_______________________________________________________
the vendor making the Proposal for the above named project, and that I executed the said proposal
with full authority so to do; that said vendor 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 Mercer 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
___________________________________ (Name of Vendor)
Signed: _________________________________
(also type name of affiant under signature)
Subscribed and sworn to before me
This______ day of____________, 20____.
(Signature of Notary Public)
Notary Public of_________________________
My Commission expires ____________, 20___
EEO/AFFIRMATIVE ACTION COMPLIANCE NOTICE
N.J.S.A. 10:5-31 and N.J.A.C. 17:27
GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS
All successful bidders are required to submit evidence of appropriate affirmative action compliance to
the County and Division of Public Contracts Equal Employment Opportunity Compliance. During a
review, Division representatives will review the County files to determine whether the affirmative
action evidence has been submitted by the vendor/contractor. Specifically, each vendor/contractor
shall submit to the County, prior to execution of the contract, one of the following documents:
Goods and General Service Vendors
1. Letter of Federal Approval indicating that the vendor is under an existing Federally approved or
sanctioned affirmative action program. A copy of the approval letter is to be provided by the vendor to
the County and the Division. This approval letter is valid for one year from the date of issuance.
Do you have a federally-approved or sanctioned EEO/AA program?
If yes, please submit a photostatic copy of such approval.
Yes
No
2. A Certificate of Employee Information Report (hereafter “Certificate”), issued in accordance with
N.J.A.C. 17:27-1.1 et seq. The vendor must provide a copy of the Certificate to the County as
evidence of its compliance with the regulations. The Certificate represents the review and approval of
the vendor’s Employee Information Report, Form AA-302 by the Division. The period of validity of the
Certificate is indicated on its face. Certificates must be renewed prior to their expiration date in order
to remain valid.
Do you have a State Certificate of Employee Information Report Approval? Yes
If yes, please submit a photostatic copy of such approval.
No
3. The successful vendor shall complete an Initial Employee Report, Form AA-302 and submit it to the
Division with $150.00 Fee and forward a copy of the Form and copy of the check to the County. Upon
submission and review by the Division, this report shall constitute evidence of compliance with the
regulations. Prior to execution of the contract, the EEO/AA evidence must be submitted.
The successful vendor may obtain the Affirmative Action Employee Information Report (AA302) on
the Division website www.state.nj.us/treasury/contract_compliance.
The successful vendor(s) must submit the AA302 Report to the Division of Public Contracts Equal
Employment Opportunity Compliance, with a copy to Public Agency.
The undersigned vendor certifies that he/she is aware of the commitment to comply with the
requirements of N.J.S.A. 10:5-31 and N.J.A.C. 17:27 and agrees to furnish the required forms of
evidence.
The undersigned vendor further understands that his/her bid shall be rejected as non-responsive if
said contractor fails to comply with the requirements of N.J.S.A. 10:5-31 and N.J.A.C. 17:27.
COMPANY: ____________________________ SIGNATURE: __________________________
PRINT NAME:__________________________TITLE: ________________________________
DATE: __________________
(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 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, 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.
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.
The contractor shall submit to the public agency, after notification of award but prior to
execution of a goods and services contract, one of the following three documents:
Letter of Federal Affirmative Action Plan Approval
Certificate of Employee Information Report
Employee Information Report Form AA302, electronically provided by the Division and distributed to
the public agency through the Division’s website at: www.state.nj.us/treasury/contract_compliance
The contractor and its subcontractors shall furnish such reports or other documents to the
Division of Public Contracts Equal Employment Opportunity Compliance as may be requested by the
office from time to time in order to carry out the purposes of these regulations, and public agencies
shall furnish such information as may be requested by the Division of Public Contracts Equal
Employment Opportunity Compliance for conducting a compliance investigation pursuant to
Subchapter 10 of the Administrative Code at N.J.A.C. 17:27.
COMPANY: ____________________________ SIGNATURE: __________________________
PRINT NAME:__________________________TITLE: ________________________________
DATE: __________________
SEXUAL HARASSMENT GUIDELINES
PART 1604 -- GUIDELINES ON DISCRIMINATION BECAUSE OF SEX
1604.11 Sexual Harassment
(a) Harassment on the basis of sex is a violation of Sec. 703 of Title VII (of the Civil Rights Act
of 1964). Unwelcome sexual advances, requests for sexual favors, and other verbal or physical
conduct of a sexual nature constitute sexual harassment when (1) submission to such conduct is
made either explicitly or implicitly a term or condition of an individual’s employment, (2) submission to
or rejection of such conduct by an individual, or (3) such conduct has the purpose or effect of
unreasonably interfering with an individual’s work performance or creating an intimidating, hostile or
offensive working environment.
(b) In determining whether alleged conduct constitutes sexual harassment, The Commission
(EEOC) will look at the record as a whole and at the totality of the circumstances, such as the nature
of the sexual advances and the context in which the alleged incidents occurred. The determination of
the legality of a particular action will be made from the facts, on a case by case basis.
(c) Applying general Title VII principles, an employer, employment agency, joint apprenticeship
committee or labor organization (hereinafter collectively referred to as “employer”) is responsible for
its acts and those of its agents and supervisory employees with respect to sexual harassment
regardless of whether the specific acts complained of were authorized or even forbidden by the
employer and whether the employer knew or should have known of their occurrence. The
Commission will examine the circumstances of the particular employment relationship and the job
functions performed by the individual in determining whether an individual in determining whether an
individual acts in either a supervisory or agency capacity.
(d) With respect to conduct between fellow employees, employer is responsible for acts of
sexual harassment in the workplace where the employer (or its agents or supervisory employees)
knows or should have known of the conduct, unless it can be show that it took immediate and
appropriate corrective action.
(e) An employer may also be responsible for the acts of non-employees, with respect to sexual
harassment of employees in the workplace, where the employer (or its agents or supervisory
employees) knows or should have known of the conduct and fails to take immediate and appropriate
corrective action. In reviewing these cases the Commission will consider the extent of the employer’s
control and any other legal responsibility, which the employer may have with respect to the conduct of
such non-employees.
COMPANY: ____________________________ SIGNATURE: __________________________
PRINT NAME:__________________________TITLE: ________________________________
DATE: __________________
AMERICANS WITH DISABILITIES ACT OF 1990
Equal Opportunity for Individuals with Disability
The CONTRACTOR and the County of Mercer do hereby agree that the provisions of Title II of the
Americans With Disabilities Act of 1990 (the “Act”) (42 U.S.C. S12101 et seq.), which prohibits
discrimination on the basis of disability by public entities in all services, programs and activities
provided or made available by public entities, and the rules and regulations promulgated pursuant
hereunto, are made a part of this contract. In providing any aid, benefit, or service on behalf of the
County pursuant to this contract, the CONTRACTOR agrees that the performance shall be in strict
compliance with the Act. In the event that the CONTRACTOR, its agents, servants, employees, or
subcontractors violate or are alleged to have violated the Act during the performance of this contract,
the CONTRACTOR shall defend the County in any action or administrative proceeding commenced
pursuant to this Act. The CONTRACTOR 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 or nature arising out of or claimed to arise out of the alleged violation. The
CONTRACTOR 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 grievance procedure, the CONTRACTOR 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 CONTRACTOR
shall satisfy and discharge the same at its own expense.
The County shall, as soon, practicable after a claim has been made against it, give written notice
thereof to the CONTRACTOR along with full and complete particulars of the claim. If any action or
administrative proceedings is brought against the County or any of its agents, servants, and
employees, the County shall expeditiously forward or have forwarded to the CONTRACTOR 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
CONTRACTOR pursuant to this contract will not relieve the CONTRACTOR 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 CONTRACTOR, its agents, servants, employees and subcontractors for any claim
which may arise out of their performance of this Agreement. Furthermore, the CONTRACTOR
expressly understands and agrees that the provisions of this indemnification clause shall in no way
limit the CONTRACTOR’S obligations assumed in this agreement, nor shall they be construed to
relieve the CONTRACTOR from any liability, nor preclude the County from taking any other actions
available to it under any other provisions of the Agreement or otherwise at law.
COMPANY: ____________________________ SIGNATURE: __________________________
PRINT NAME:__________________________TITLE: ________________________________
DATE: __________________
W9 FORM
Any agency applying to the County of Mercer for funding and is a first-time vendor, must include a
copy of their most recent W9 form. This form is required of any new vendor to expedite and ensure
payment to the agency in a timely manner. Upon receipt, the form will be forwarded to the Mercer
County Purchasing Department and will help expedite future payments.
Please provide a contact, addresses for Purchase Orders and Check remittance information, copy of
your W9 and forward to the County of Mercer, Department of Human Services Contract Unit, Room
224, 640 South Broad St., P.O. Box 8068, Trenton, NJ 08650-0068
CONTRACT CONTACT
COMPANY/AGENCY
PURCHASE ORDER MAILED TO:
CHECK REMITTANCE TO:
TELEPHONE
FAX
EMAIL
INSURANCE AND INDEMNIFICATION REQUIREMENTS
If it becomes necessary for the consultant, either as principal or by agent or employee, to enter upon
the premises or property of the County, the consultant hereby covenants and agrees to take use,
provide and make all proper, necessary and sufficient precautions, safeguards, and protection against
the occurrence of happenings of any accidents, injuries, damages, or hurt to person or property during
the course of the work herein covered and be his/her sole responsibility.
The consultant further covenants and agrees to indemnify and save harmless the County from the
payment of all sums of money or any other consideration(s) by reason of any, or all, such accidents,
injuries, damages, or hurt that may happen or occur upon or about such work and all fines, penalties
and loss incurred for or by reason of the violation of any County regulation, ordinance or the laws of
the State, or the United States while said work is in progress.
The consultant shall maintain sufficient insurance to protect against all claims under Workers
Compensation as statutorily required, General Liability in the amount of $1,000,000.00 single
occurrence and $2,000,000.00 general aggregate and Automobile Insurance in the amount of
$1,000,000.00 combined single limit. Vendors are responsible to provide updated certificates as
policies renew. Depending upon the scope of work and goods or services provided, specific types of
insurance may not be required. The Mercer County Division of Insurance and Property Management
will make this determination.
In all cases where a Certificate of Insurance is required, the County of Mercer is to be named
as an additional insured and named as the certificate holder as follows: “County of Mercer,
640 South Broad Street, P.O. Box 8068 Trenton, NJ 08650-0068”. The Certificate shall contain
a 30-day notice of cancellation. Additionally, if the program for which your agency is applying
provides transportation to consumers and/or clients, the County of Mercer must be named as
an additional insured with the agency’s automobile insurance.
INDEMNIFICATION AND HOLD HARMLESS CLAUSE
Contractor shall indemnify, defend and save harmless the County from and against any and all loss
cost (including attorneys’ fees), damages, expenses and liability (including statutory liability and
liability under Workers’ Compensation Laws) in connection with claims for damages as a result of
injury or death of any person or property damage to any property sustained by Contractor or all other
persons which arise from or in any manner grow out of any act or negligence on or about the said
premises by the Contractor, their partners, agents, employees, customers, invitees, contractors,
subcontractors, sub-subcontractors, vendors and the County. This indemnification clause includes
any and all claims and costs of same against the County except for the sole negligence of the County
pursuant to N.J.S.A. 2A:40A-1. Further, this indemnification clause includes any and all claims and
costs of same against the County involving environmental impairment.
(Cont’d on next page)
WAIVER OF SUBROGATION CLAUSE
Consultant, as a material part of the consideration to be rendered to the County, hereby waives all
claims against the County for damages to the goods, wares and merchandise in, upon or about said
premises, and consultant will hold the County exempt and harmless from any damage and injury to
any such person or to the goods, wares or merchandise of any such person, arising from the use of
the premises by the consultant or from failure of the consultant to keep the premises in good condition
and repair as herein provided.
______________________________________________________________________
Dated and Signed
INSURANCE CERTIFICATE
PLEASE TAKE NOTE OF THE FOLLOWING CHANGE
As you may be aware, there has been a recent change to the ACCORD insurance certificate which
precludes placing the number of days for cancellation notification in the lower right hand box. This
applies to all policies (general liability, automobile, workers’ compensation unless you are
self-insured, etc.) You may fulfill the requirement for a 30-day notice of cancellation for a County of
Mercer contract in any one of the following ways:
1. indicate a 30-day notice of cancellation in the Description of Operations box at the bottom of
the certificate
2. indicate a 30-day notice of cancellation on a separate page
3. provide a copy of the cancellation clause from the policy (you do not need to provide a copy of
the entire policy, only the page(s) referencing the cancellation clause)
AUTOMOBILE INSURANCE is required in the following situations:
-clients/consumers are being transported under your contract with the County
-you are on County property to execute your contract, including delivery of items
For most contracts the automobile insurance requirement is $1 million combined single limit. Also,
the County of Mercer shall be named as additional insured and as certificate holder. The certificate
holder address shall be as follows: County of Mercer, 640 South Broad Street, P.O. Box 8068,
Trenton, NJ 08650-0068.
If you need further clarification on this or other insurance certificate issues, please contact the
Insurance and Property Management office at 609-989-6655.
WORKERS’ COMPENSATION
Vendors are required to provide proof of Workers’ Compensation coverage.
The County of Mercer requires a 30-day notice of cancellation (excluding cancellation for nonpayment) as part of its insurance requirements.
This requirement applies to workers’
compensation policies unless you are self-insured.
The certificate holder address shall be as follows: County of Mercer, 640 South Broad Street, P.O.
Box 8068, Trenton, NJ 08650-0068.
If further clarification is needed, please contact the Insurance and Property Management office at 609989-6655.
NEW JERSEY BUSINESS REGISTRATION CERTIFICATES ACCEPTABLE BY THE
COUNTY OF MERCER
Disclosure Requirement for “Pay to Play”
P.L. 2005, Chapter 271, Section 3 Reporting
(N.J.S.A. 19:44A – 20.27)
Any business entity that has received $50,000 or more in contracts from government entities in a
calendar year will be required to file an annual disclosure report with ELEC.
At a minimum, a list of all business entities that file an annual disclosure report will be listed on
ELEC’s website at www.elec.state.nj.us. If you have any questions please contact ELEC at: 1-888313-ELEC (Toll free in NJ) or 609-292-8700. An analyst from ELEC’s Special Programs Section will
assist you.
If this requirement applies to your agency, please submit a signed copy of the appropriate forms.
STOCKHOLDER DISCLOSURE CERTIFICATION
FAILURE TO COMPLETE, SIGN AND SUBMIT THIS FORM IS CAUSE FOR REJECTION.
 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.
Check the box that represents the type of business organization:
Partnership
Corporation
Limited Partnership
Limited Liability Corporation
Subchapter S Corporation Non-Profit Corporation
Sole Proprietorship
Limited Liability Partnership
Other___________
COMPLETE IF THE BIDDER IS ONE OF THE FOUR TYPES OF CORPORATIONS:
DATE OF INCORPORATION:____________________________________________________
STATE OF INCORPORATION:___________________________________________________
BUSINESS ADDRESS:_________________________________________________________
Stockholders:
Name: ______________________________
Name: ______________________________
Address: ____________________________
Address: ____________________________
____________________________________
____________________________________
LEGAL NAME OF BIDDER:_______________________________________________
Signature________________________________ Date________________________________
Printed Name & Title___________________________________________________________
P.L. 2012 BID OR PROPOSAL PROHIBITED
C.52:32-57 “P.L. 2012, c.25 prohibits State and local public contracts with persons or entities
engaging in certain investment activities in energy or finance sectors of Iran.”
I am the duly authorized agent making certification that there has been no engagement in certain
investment activities in energy or finance sectors of Iran as prohibited by P.L. 2012, c.25. A list of
entities can be found on the following page.
NAME OF BIDDER
SIGNATURE OF AUTHORIZED REPRESENTATIVE
TITLE
____________________________________________________________________________
DATE
The following list represents entities determined, based on credible information available to
the public, to be engaged in prohibited activities in Iran pursuant to P.L. 2012, c. 25 (“Chapter
25”):
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
Bank Markazi Iran (Central Bank of Iran)
Bank Mellat
Bank Melli Iran
Bank Tejarat
National Iranian Tanker Company (NITC)
Sameh Afzar Tajak Company (SATCO)
Amona
Bank Saderat PLC
Bank Sepah
Belaz
Belneftkhim (Belarusneft)
Bharat Petroleum Corporation Ltd.
China International United Petroleum & Chemicals Co., Ltd. (Unipec)
China National Offshore Oil Corporation (CNOOC)
China National Petroleum Corporation (CNPC)
China National United Oil Corporation (ChinaOil)
China Petroleum & Chemical Corporation (Sinopec)
China Precision Machinery Import-Export Corp. (CPMIEC)
Emirates National Oil Company
Grimley Smith Associates
Indian Oil Corporation
Industrija Nafte (INA)
Kingdream PLC
Liquified Natural Gas Limited
Maire Tecnimont SpA
Naftiran Intratrade Company (NICO)
Oil and Natural Gas Corporation (ONGC)
Oil India Limited
Panyu Chu Kong Steel Pipe Company, Ltd.
Persia International Bank
PetroChina Company, Ltd.
Petroleos de Venezuela (PDVSA Petroleo, SA)
Schwing America Inc.
Shandong FIN CNC Machine Company, Ltd.
Shanghai Sunry Petroleum Equipment Company, Ltd.
Sinohydro
SK Energy
SKS Ventures
Som Petrol AS
Sonangol
Zhuhai Zhenrong Company
CONTRACT AWARD
Upon opening a Request for Proposal (RFP) application, pricing shall remain firm
for a period of sixty (60) calendar days. In the event that the award is not made
within sixty (60) calendar days, applicants may hold their pricing consideration
beyond sixty (60) calendar days or until the contract is awarded.
Check here if willing to hold the pricing consideration beyond sixty (60) calendar days
or until the contract is awarded.
Check here if not willing to hold the pricing consideration beyond sixty (60) calendar
days or until the contract is awarded.
_____________________________________________________________________
AUTHORIZED SIGNATURE
PROPOSAL
The undersigned bidder declares that he/she has read the Instructions, Affidavits and Scope of Work
and that he/she has determined the conditions affecting the bid agrees, if this proposal is accepted, to
furnish and deliver the following:
TYPE OF SERVICE AND BASIS FOR AWARD
(REQUEST UNIT COST DEFINING TYPE OF SERVICE AND TOTAL)
____________________________________________________________________________
(SIGNATURE BY AUTHORIZED REPRESENTATIVE)
The undersigned is a Corporation, Partnership or Individual under the laws of the State of
___________________ having its principal office at___________________________________
COMPANY ___________________________________________________________
ADDRESS
___________________________________________________________
ADDRESS
___________________________________________________________
FED. ID #
___________________________________________________________
NAME
___________________________________________________________
TELEPHONE ___________________________________________________________
FAX
___________________________________________________________
E-MAIL
___________________________________________________________
DATE
___________________________________________________________
COUNTY OF MERCER
Competitive Contract Provisions
(Federal/State Funding)
DEFINITIONS:
Project Name:
Act:
Older Americans Act of 1965, As Amended
(City State of NJ and/or Federal Government Act)
Authorized Appropriation:
Account Title
Account Code
Contract Period: Contract period shall mean the Term of Contract as specified in paragraph No.
1.
This CONTRACT, entered in to this 1st day of January, 20
County of Mercer hereinafter referred to as the "COUNTY", and
, by and between the
Name:
Address:
hereinafter referred to as the "CONTRACTOR"
Witnesseth That:
1. Term of Agreement. This Agreement shall be effective as of the
, 20
through the
day of
, 20
.
day of
It is understood and agreed by and between the parties hereto upon signing that this Contract
shall be deemed effective from January 1, 2016 and continuing until December 31, 2017;
with the option to extend for an additional year January 1, 2018 – December, 31 2018.
2. Compliance. The Contractor, in order to induce the COUNTY to make the within
grant for the project, agrees that it shall comply with all provisions of the authorizing
appropriation, the Act, and any regulations, requirements or guidelines which the
COUNTY may issue, whether explicitly referred to herein or not. It is further agreed that
the Contractor shall seek and develop its own sources of funding in anticipation of the
expiration of this Contract. In no event shall this Contract be construed as a commitment
by the COUNTY to expend funds beyond the termination date set forth in paragraph 1.
3. Other Funds.
The CONTRACTOR shall not use funds provided under this
Contract to replace existing or committed financial support for the same project, except
as may be provided by this Contract or with the express written approval of the
COUNTY.
4. Scope of Services.
In consideration of the contract provided by this Contract,
the CONTRACTOR shall, in a satisfactory and proper manner as determined by the
COUNTY perform all services specified in Attachment "A" (RFP response).
5. Compensation.
The COUNTY shall grant to the CONTRACTOR a sum
not to exceed $
. The CONTRACTOR shall expend project funds in
accordance with the Approved Budget as set forth on Attachment B. Except as shall be
more specifically limited on Attachment B, the amounts expended for the Personnel and
Consultants major categories may not exceed the approved amount without prior written
approval of the COUNTY. Any line item within the major cost categories of Personnel
and Consultants which shall not have been expended in accordance with Attachment B
shall be credited against and deducted from the total compensation to be paid to the
CONTRACTOR under this Contract. Except as shall be more specifically limited on
Attachment B, the amounts expended for each of the line items listed on Attachment B
with the exception of the categories of Personnel and Consultants may not exceed the
approved amount by more than 10% or $500.00, provided, however, that the total
Approved Budget is not exceeded. The express prior written approval of the COUNTY
is necessary to exceed these limitations.
6. Method of Payment.
The COUNTY shall make payments under this Contract
upon the submission of a properly executed voucher together with such other
documentation as may be required. The manner and form of such submissions shall be in
accordance with the procedures described in the issuing office’s request for proposal.
7. Books and Records.
The CONTRACTOR shall maintain such records and
accounts as are deemed necessary by the COUNTY to assure a proper accounting for all
project funds, both state and non-state shares. These records shall be available for audit
and examination by any governmental agency having an interest in the project. The
COUNTY shall have the right to conduct said audit or examination at any time during
regular working hours of this project.
Said records shall be retained for five (5) years after expiration of this Contract unless the
COUNTY in writing, specifically waives such requirement. The CONTRACTOR hereby
acknowledges that the COUNTY shall carry out such monitoring and evaluation
activities as it shall, from time to time, require for proper administration and performance
of this Contract.
8. Reports and Submissions.
The CONTRACTOR shall submit such reports
relating to the activities and the finances of the project as shall be required by the
2
COUNTY. The CONTRACTOR shall submit a final report within (30)
end of the contract period.
days after the
9. Travel Expenses. The CONTRACTOR, if a public agency, shall charge expenses for
travel in accordance with the customary practice in the government of which the agency
is a part. If the CONTRACTOR is a private agency, expenses charged for travel shall not
exceed those allowable under MERCER COUNTY Travel Regulations. In any event,
travel expenses shall not be charged in excess of the allowable budget amount.
10. Personal Property.
If personalty, including equipment costing less than one
hundred dollars ($100.00) per item is acquired and used for three (3) years from date of
acquisition for approved contract purposes, title to such property shall vest in the
CONTRACTOR. Personalty, including equipment, costing more than one hundred dollars
($100.00) or used for less than three (3) years shall be owned by the COUNTY. The
COUNTY, at its option, may, however, permit the CONTRACTOR to retain such property,
subject to reimbursement to the COUNTY of its cost minus a fair rental value for the period of
actual use.
11. Unexpended Fund Balances.
The CONTRACTOR may incur costs only
during the period set forth in paragraph No. 1 of this Contract. Expenditures made before or
after these dates shall be disallowed. Funds obligated, but not disbursed at the end of the
contract period, shall be liquidated within 30 days after the close of the contract period and
unexpended fund balance remaining shall be returned to the COUNTY with the submission of
the final report. The COUNTY at its discretion may authorize the CONTRACTOR to use the
unexpended grant funds:
(a) for approved grant purposes after the end of the contract period if the project is a
continuing activity and the COUNTY intends to enter into another contract for a
period of time immediately following the contract period.
Under such
circumstances, the amount of the subsequent contract shall be reduced by the
amount of the unexpended funds remaining at the end of the previous contract
period.
(b) for approved contract purposes if the COUNTY authorizes an extension of the
contract period.
In no event shall the CONTRACTOR use unexpended grant funds after the contract period
without the express written approval of the COUNTY.
12. Changes. The COUNTY may, from time to time, request changes in the scope of the
services of the CONTRACTOR to be performed hereunder. Such changes, including any
increase or decrease in the amount of the CONTRACTOR'S compensation, which are
mutually agreed upon by and between the COUNTY and the CONTRACTOR, must be
incorporated in written amendments to this Contract.
13. Assignability. The CONTRACTOR shall not subcontract any of the work or services
covered by this Contract, nor shall any interest in this Contract be assigned or
3
transferred, except as may be provided within the terms of this Contract or with the express
written approval of the COUNTY.
14. Discrimination Prohibited. The CONTRACTOR shall not discriminate in the performance
of this Contract because of sex, race, creed or national origin.
15. Availability of Funds. The parties hereto recognize that this Contract, made on behalf of the
COUNTY is dependent upon such funding appropriations as may be made by the COUNTY OF
MERCER, the Federal Government or other funding sources; the COUNTY shall not be held
liable for any breach of this Contract because of the absence of funding appropriations.
Funding for this contract may increase beyond the original contractual amount when additional
funding becomes available, i.e. increased allocation for cost of living adjustment (COLA).
Should this occur the contractor must provide increased levels of services at the unit cost
referenced in the proposal. The County reserves the right to decrease or increase the levels of
service based upon allocation and no minimum or maximum is implied or guaranteed.
16. Termination. The COUNTY or CONTRACTOR may, by giving written notice of sixty
(60) days specifying the effective date, terminate this Contract in whole or in part for
justifiable cause, which shall include but not be limited to:
(a) Utilization of any portion of the appropriation hereunder to employ or
otherwise compensate any person employed by the COUNTY OF MERCER who
has directly participated in the negotiation or approval of this Contract;
(b) Discovery of any pecuniary or personal interest by the CONTRACTOR, its
employees, its Officer, its Trustees, or its Directors in the project, or in any
contract emanating from the operation of this project;
(c) Failure, for any reason, of the CONTRACTOR to satisfy its obligations under
his Contract;
(d) Submission by the CONTRACTOR to the County of reports that are incorrect
or incomplete in any material respect;
(e) Any improper or inefficient use of funds provided under this Contract;
(f) Failure of the CONTRACTOR to permit the COUNTY to make an inspection
of the administrative or operational facilities of the project;
(g) Conduct or acts of the CONTRACTOR and/or its staff which are detrimental
to the objectives of this project;
(h) Any violation of the New Jersey Conflicts of Interest Law. N.J.S.A. 52:13d12 et seq.;
(i) Failure to incorporate into CONTRACTOR’S personnel policies and
procedures a system of full disclosure of all employees and applicants for
employment who have been convicted of a crime.
Upon termination of this Contract, the CONTRACTOR shall forthwith return all unexpended
proceeds and/or income of the grant to the COUNTY.
4
17. Insurance. The CONTRACTOR shall submit evidence of insurance coverage in amounts
specified by and in companies satisfactory to the COUNTY OF MERCER.
18. The CONTRACTOR agrees to save and hold harmless the COUNTY, its officers, agents,
representatives, successors and assigns, from any and all suits or actions of every nature and kind
which may be brought for/or on account of any injury, death or damage arising or growing out of
the acts or omissions of the CONTRACTOR, its officers, agents, servants or employees:
provided such acts are not attributable in any way to the negligence of the COUNTY, its officers,
agents, servants or employees.
19.
It is understood and hereby agreed by the CONTRACTOR whereupon receipt of
notification of contract award is received by the CONTRACTOR from other funding
sources which provide for funding of line items covered under this Contract, allowable
line item cost under this Contract shall cease effective the date of such contract award
notification.
20.
Publications:
The following regulations concerning publications shall be adhered to by the
CONTRACTOR:
21.
a.
Any books, reports, pamphlets, papers or articles based on activities receiving
support under Title III must contain an acknowledgment of that support.
b.
The Department of Health and Human Services, Administration on Aging,
(hereinafter called AoA) reserves the option to receive free of charge up to 12
copies of any publication published as a part of a Title III project, and two copies
of any publication based on project activities.
c.
Where a project results in a book or other copyright- able material, the author is
free to obtain a copy- right, but AoA reserves a royalty-free, non-exclusive, and
irrevocable license to reproduce, publish, or otherwise use, or authorize others to
use, all such materials.
Compliance:
a. Services of the project will be available to participants 60 years of age or older
(and their spouses) and caregivers which fit within the specific program criteria.
Moreover, the CONTRACTOR will provide services to senior citizens of greatest
social and economic need with emphasis in serving impoverished minority seniors
in at least the same proportion as the population of impoverished minority seniors
residing in the service area, and older individuals with limited English
proficiency. OAA (306) (a) (s) (A) (ii) (II) and OAA (306) (a) (s) (A) (ii) (III).
b. A sign shall be prominently displayed in all facilities operated by or in
conjunction with the project stating that the project is funded under Title III of the
Older Americans Act of 1965, as amended, through a contract by the Mercer
County Office on Aging.
5
c. In like manner, a notation of the above shall appear on all stationery, publications,
and public information relating to the project and its scope of services.
d. Monthly statistical and quarterly program (APC – NAPIS registered services),
fiscal, and narrative reports shall be filed promptly with the Mercer County Office
on Aging. The CONTRACTOR shall use SAMS for all APC data reporting and
client tracking. CONTRACTORS, sub-grantees and third parties having access to
SAMS will comply with DoAS confidentiality provisions as identified in the
Confidentiality Statement in the immediately following bullet (e).
e. In addition to any applicable HIPAA requirements, the CONTRACTOR shall
maintain the confidentiality of each Participant’s personal and confidential
information and shall not disclose such information except where disclosure is
consistent with applicable DoAS rules and policies, and the disclosure is to the
Participant, to the Participant’s legal representative, to a party upon the informed
written consent of the Participant or the Participant’s legal representative, to a
party pursuant to a court order, or if disclosure is for program monitoring by
authorized federal, State or local monitoring agencies.
f. Monthly statistical reports shall be due on or before the fifth working day of the
ensuing month being reported. Quarterly fiscal and programmatic reports, as well
as quarterly narratives shall be due on or before the fifth working day of April,
July, October, and January, covering the previous three-month period.
g. Upon adequate notice to the CONTRACTOR, the Mercer County Office on
Aging staff will perform an administrative on-site programmatic and a fiscal
monitoring of the project during the contract year. A final evaluation of the
project will be performed and form the basis of continued funding.
h. A survey of participants must be administered to clients served by the project to
solicit their views on the quality of services and to allow client input into program
activities.
i. All vehicles operated by the project shall be in accordance with New Jersey
Motor Vehicle Laws and operated by persons who:
1. Possess a valid New Jersey Driver's license; and
2. Are free from any impairing illness or disability.
j. The Project Director is required to attend quarterly Title III contractors' meetings
sponsored by the Mercer County Office on Aging.
k. The CONTRACTOR must possess a Business Continuity plan that will be
activated in the event of a disaster/state of emergency. The plan shall address
ways in which critical services are maintained for the participant and a description
of the methods to be used for communication about service continuation.
6
22.
Client Payments/Program Income:
Program income means all program income accruing to the CONTRACTOR during the
period of contract support or to a sub-contractor during the period of subsequent support.
Contributions/income received by the CONTRACTOR for the services provided under
the contract will comply with the following:
a.
b.
Opportunity to Contribute:
1.
Give each older person who receives services information about the cost
of the service.
2.
Give each older person the opportunity to contribute to part or all of the
cost of the service.
3.
Tell each older person that he or she may decide freely whether or not to
contribute and how much.
4.
Avoid the appearance of pressure to contribute.
5.
Protect the privacy of each older person with respect to his or her
contributions.
6.
Have appropriate procedures to safeguard and account for all
contributions.
Contribution Schedule:
The Area Agency on Aging allows for the CONTRACTOR to develop a
suggested contribution schedule for services provided under this part. In
developing a contribution schedule the provider must consider the income ranges
of older persons in the community and the provider's other sources of income.
c.
Failure to Contribute:
The CONTRACTOR may not deny an older person service because he/she could
or would not contribute for the service.
d.
Use of Contributions/Program Income:
1.
All income received shall be used solely for the purpose of program
continuity. In other words, income will be allocated for use in allowable
costs of the project in the current funding year or will be used in
continuing the project after contract support ends.
2.
Income received may not be used toward satisfying the CONTRACTOR'S
matching requirements as set forth within the contract.
7
e.
Monitoring of Contribution Procedures:
To assure contractor compliance with the above contribution policy, on site
monitoring and review of the CONTRACTOR'S client contribution procedures
will be performed annually by the Mercer County Office on Aging. Violations of
this policy will be documented and corrective action must be taken to assure
continued funding.
23.
Non-Discrimination Affirmation:
The contractor and the County of Mercer do hereby agree that the provisions of Title II of
the Americans with Disabilities Act of 1990 (the "Act") (42 U.S.C. 12101 ET SEQ.),
which prohibits discrimination on the basis of disability by public entities in all services,
programs, and activities provided or made available by public entities, and the rules and
regulations promulgated pursuant thereunto, are made a part of this contract. The
contractor further agrees to conduct all activities in compliance with the provisions of
Title VI of the Civil Rights Act of 1964, the Rehabilitation Act of 1973, the Age
Discrimination Act of 1975, Title IX of the Education Amendments of 1972, and the U.S.
Department of Labor's regulations at 29 CFR, Parts 31, 32, and 34.
Contractors shall cooperate with any state or federal reviews aimed at determining
compliance with nondiscrimination laws and regulations.
The contractor shall indemnify, protect and hold harmless the County, its agents,
servants, and employees from and against any and all suits, claims, losses, demands, or
damages of whatever kind or nature arising out of or claimed to arise out of the alleged
violation.
24.
Coordination of Effort:
In consideration of the contract provided by this Contract, the CONTRACTOR shall
coordinate its efforts with the Information and Assistance component of the Mercer
County Office on Aging, the County of Mercer Outreach Program, the Outreach Program
of the City of Trenton Office on Aging and other aging services within the planning and
service area.
25.
Recruitment of Personnel:
The method of staff selection by the CONTRACTOR shall reside solely with the
CONTRACTOR subject to conformity with the New Jersey Civil Service Rules and
Regulations.
26.
Bi-lingual Representation:
The CONTRACTOR agrees to provide bi-lingual services where feasible.
8
27.
Confidentiality:
The CONTRACTOR agrees to protect the client's integrity and confidentiality.
28.
Records:
The CONTRACTOR agrees to keep records as needed and make those records available
to the Mercer County Office on Aging as required. Access to these records is to be
restricted to insure the confidentiality of the client.
29. Sub-Contract Requirements:
1.
2.
Funds provided under this contract shall not be utilized in a manner, which would
contravene the Establishment Clause of the First Amendment of the United States
Constitution. Specifically, these conditions are as follows:
a.
In no event shall the provision of the services to be funded under this contract be
conditioned upon attendance at or participation in religious programs, services, or
activities;
b.
Any services to be provided under this contract shall be essentially secular in
nature and scope and in no event shall there be any religious services, counseling,
proselytizing, instruction, or other religious influence undertaken in connection
with the provision of such services; and
c.
Funds provided under this contract shall not be used for the construction,
rehabilitation, or restoration of any facility owned by a religious organization and
used, now or in the future, for any religious activity or purpose.
Each contract shall (1) specify how the provider intends to satisfy the service needs of
low income, minority individuals in the area served by the provider and (2) contain the
assurance that to the maximum extent feasible, the service provider will attempt to
provide services to low-income minority individuals in accordance with their need for
such services as described below:
a. OAA § 306(a)(4)(A)(ii)(I)); 42 U.S.C.A. § 3026(a)(4)(A)(ii)(I): provider will
specify how the provider intends to satisfy the service needs of low-income,
minority individuals, older individuals with limited English proficiency, and
older individuals residing in rural areas in the area served by the provider.
b. OAA § 306(a)(4)(A)(ii)(II); 42 U.S.C.A. § 3026(a)(4)(A)(ii)(II): provider will to
the maximum extent feasible; provide services to low-income minority individuals,
older individuals with limited English proficiency, and older individuals
residing in rural areas in accordance with their need for such services.
c. OAA § 306(a)(4)(A)(ii)(III); 42 U.S.C.A. § 3026 (a)(4)(A)(ii)(III): provider will
meet specific objectives established by the area agency on aging, for providing
9
services to low-income minority individuals, older individuals with limited
English proficiency, and older individuals residing in the planning and service
area.
3.
Each contract will include the identity of each focal point so designated (306(a)(3)(B)).
4.
Each contract made with a non-governmental entity shall include the assurance that all
sources and expenditure of funds such agency receives or expends to provide services to
older individuals will be disclosed to the Commissioner or State upon request
(306(a)(14)).
5.
Each contract shall include the assurance that language will be posted regarding a client
or participant’s right to appeal if the client/participant believes they have been improperly
denied service or they are dissatisfied with the service provided.
10
IN WITNESS WHEREOF, the COUNTY and the CONTRACTOR have executed
this Contract as of the date first above written.
COUNTY OF MERCER
BY
Name: Brian M. Hughes,
Title: County Executive
Date
BY
Name: Jerlene H. Worthy,
Date
Title: Clerk to the Board of Chosen Freeholders
CONTRACTOR
(Fill in exact name as on Page 1)
BY
Name:
Title:
Date
ATTEST:
(Secretary or Government Clerk)
Fill in below
Name
Title
Date
The aforementioned Agreement has been reviewed and approved as to form.
Arthur R., Sypek Jr.,
County Counsel
BY
Date
Please note: The parties hereto acknowledge that these supplementary provisions do not
constitute a binding contract until it is awarded and the Freeholder Board authorizes its execution
by the County Executive.
11
COUNTY OF MERCER
This contract made on this _______ day _________ of 2015
between the COUNTY OF
MERCER, a body politic of the State of New Jersey, having its principal office located at 640 South
Broad Street in the City of Trenton and State of New Jersey, herein-after referred to as the
"COUNTY", and
,
having its principal office located at
,
hereinafter referred to as the "CONTRACTOR".
WHEREAS, the County desires that the Contractor perform services of a nature hereinafter
set forth; and,
WHEREAS, the County has determined, after investigation, consultation and interview, the
Contractor is fully qualified to perform and provide such services to and for the County; and,
WHEREAS, the Contractor has acknowledged its desire to provide such services to and for
the County in a proper manner and under the terms and conditions as hereinafter set forth; now
therefore, IN CONSIDERATION, of the mutual promises herein contained, and intending to be
legally bound thereby, the parties have agreed as follows;
ARTICLE I
GENERAL CONDITIONS OF PAYMENT
In consideration of the faithful performance by the Contractor of its agreements hereunder, and in
conformity with the administrative procedures set forth herein, the County covenants and agrees to
pay to the Contractor during the term of this Contract, a maximum sum of $
.00
subject to this amount being included and approved in the 2016, 2017, and 2018 Mercer County
budget. Funding for this contract may increase beyond the original contractual amount when
additional non-county funding becomes available, i.e. increased allocation for cost of living
adjustment (COLA). Should this occur the contractor must provide increased levels of services at
the unit cost referenced in the proposal. The County reserves the right to decrease or increase the
levels of service based upon allocation and no minimum or maximum is implied or guaranteed.
Payments are to be made in prorated amounts, on a quarterly basis and on receipt of required
reports as submitted by the Contractor and approved by the County. The Contractor hereby
agrees to:
a.
Perform services described in the program specifications (RFP Response), PROGRAM
SPECIFICATIONS, hereby fully incorporated and made a part of this Contract as the
ATTACHMENT A. The Line Item Budget/Rate schedule must include how all
funds will be utilized prior to execution of this Agreement.
b.
Maintain, in accordance with practices acceptable to the County, uniform records of
services described herein and make such records available to the County any time during
the duration of the Contract of thereafter.
c.
Forward quarterly progress reports of service rendered from the inception of this Contract.
d.
Maintain adequate financial and/or personnel attendance leave records pertaining to all
services described herein as may be rendered and make said records available for
inspection by the County and any or all of its agents at any and all reasonable times during
the terms of this Contract.
e.
In order to ensure accurate fiscal reporting, all contract agencies which receive in excess of
$25,000 in a twelve (12) month period in total County funds, shall segregate the program
funded by the County by maintaining either a separate function or cost center code in their
fund accounting system. All revenue and expenses shown on the budget submission
should be charged to this account and quarterly fiscal reports should be based on these
2
figures. Where possible, County-funded programs should be shown separately in the
agency audit.
f.
Submit expenditure reporting forms as prescribed and supplied by the County not later than
the fifteenth working day of the month immediately following the end of the quarter
concerned.
g.
The Contractor shall maintain, in accordance with practices acceptable to the
County, adequate books and uniform records of services described in
ATTACHMENT A and make such records and facilities available to the County and
any persons or organizations authorized by the County to perform monitoring or
evaluation functions. This shall include provision of financial, statistical, all
professional licenses as it relates to services described in ATTACHMENT A and
program information relating to contract services for audit and inspection. All audit
examinations, inspections and visitations conducted under this agreement shall be
in confidentiality. These books and records shall be kept by the Contractor.
ARTICLE II
SPECIAL CONDITIONS
a. The Contractor's status shall be that of an independent principal and not as an agent or
employee of the County.
b. The Contractor agrees not to assign this Contract or any monies due hereunder without the
prior written approval of the County.
c. This Contract, and all rights and obligations of the parties hereto shall be construed in
accordance with the laws of the State of New Jersey.
3
d. The Contractor agrees that in the performance of this Contract it will obey, abide by and
comply with all applicable Federal and State statutes and regulations.
e. The Agency hereby covenants and agrees not to discriminate against any person who is
employed in the work covered by this Contract, or against any applicant for such
employment because of race, religion, color, age, national origin, marital status, personal
ancestry, affectional sexual orientation or disability. The Agency hereby agrees to the
requirements of Exhibit A, MANDATORY AFFIRMATIVE ACTION LANGUAGE (attached).
The Agency shall insert similar provisions in all subcontracts for service by this Contract.
f.
The Contractor and the County of Mercer do hereby agree that the provisions of Title II of
the Americans with Disabilities Act of 1990 (the "Act") (42 U.S.C. 12101 ET SEQ.), which
prohibits discrimination on the basis of disability by public entities in all services, programs
and activities provided or made available by public entities, and the rules and regulations
promulgated pursuant thereunto, are made a part of this contract. The contractor further
agrees to conduct all activities in compliance with the provisions of Title VI of the Civil
Rights Act of 1964, the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, Title
IX of the Education Amendments of 1972, and the U.S. Department of Labor's regulations
at 29 CFR, Parts 31, 32, and 34.d.
g. The Contractor shall cooperate with any Federal or state reviews aimed at determining
compliance with non- discrimination laws and regulations.
h. The Contractor hereby covenants and agrees to provide the County with a certificate of
worker's compensation insurance covering any of the Contractor's employees,
subcontractors, agents, servants, etc., who may at any time during the term of this Contract
perform any act, service, or work of any nature whatsoever by or in behalf of the
Contractor.
i.
The Contractor shall maintain sufficient insurance to protect against all claims under
Workers Compensation as statutorily required, General Liability in the amount of
4
$1,000,000.00 single occurrence and $2,000,000.00 general aggregate and Automobile
Insurance in the amount of $1,000,000.00 combined single limit. Vendors are
responsible to provide updated certificates as policies renew.
j.
Mercer County shall be included as an additional named insured on any insurance policy
applicable to this Contract.
k. The Contractor hereby covenants and agrees to render and save harmless the County
from any and all claims, causes of action, law suits, including the payment of any damages
or fines for personal injury and/or property damage or otherwise arising out of the course of
any of the activities or duties of the Contractor or their agencies, servants or employees
and that the Contractor will assume the cost, including the payment of legal fees for any
judgment arising or resulting there from and burden of providing a good and sufficient
defense or defenses, for any such claim, cause of action or law suits, if any.
l.
Any and all provisions of this Contract may be changed or modified by mutual consent of
the parties hereto but any change and/or modification shall not be binding unless reduced
to a written agreement, signed by the parties.
m. The Contract may be terminated by either party upon sixty (60) days written notice to that
effect, forwarded to the other party desiring to terminate the Contract and thereupon
payments under this Contract shall be paid to the terminal date based on the Expenditure
Reports submitted. In the event of cancellation of this Contract, the Contractor agrees to
furnish the County such reports as may be requested based upon work completed under
the provisions of this Contract
5
ARTICLE III
TERMS OF CONTRACT
It is understood and agreed by and between the parties hereto upon signing that this Contract shall
be deemed effective from January 1, 2016 and continuing until December 31, 2017; with the option
to extend for an additional year January 1, 2018 – December, 31 2018.
Please note: The parties hereto acknowledge that these supplementary provisions do not
constitute a binding contract until it is awarded and the Freeholder Board authorizes its
execution by the County Executive.
6
IN WITNESS WHEREOF, the parties hereto have executed this Contract by its duly authorized
officers.
CONTRACTOR
COUNTY OF MERCER
BY:
Name
Brian M. Hughes
Title
County Executive
ATTEST:
BY:
Jerlene H. Worthy
Clerk to the Board of
Chosen Freeholders
7
PROPOSAL CHECKLIST
The following checklist is provided as assistance to the development of the RFP Response. It in no way
supersedes or replaces the requirements of the RFP. You must initial on the lines below attesting to the
fact that you have included the documents with your RFP.
Checklist
Complete proposal packet, including Funding Proposal Cover
Sheet and Attachments A & B*
County of Mercer and/or Federal/State Contract templates*
*Signature must be attested
Agency Initials
Original in blue ink
CD or USB Drive containing all Proposal Materials*
Non-Collusion Affidavit (Complete and Notarized) *
EEO/Affirmative Action Compliance Notice *
1
1 w/ original signature
1 w/ original signature
Certificate of Employee Report or AA302*
1 w/ signature
1 original & 6 copies
6 signed originals
Originals in blue ink
*Referenced in the Affirmative Action Compliance Notice
Exhibit A: Affirmative Action Mandatory Language *
1 w/ original signature
Sexual Harassment Guidelines *
1 w/ original signature
American with Disabilities Act Language *
1 w/ original signature
W9 Form (for New Agency not previously County-funded) %
1 w/ original signature
Insurance and Indemnification – Waiver of Subrogation Clause*
Certificate of Liability Insurance*
Certificate of Automobile Insurance *
1 w/ original signature
1 w/ signature
1 w/ signature
Certificate of Workers Compensation Insurance *
1 w/ signature
Certificate of Insurance 30 –day Cancellation Time Period*
1 w/ signature
NJ Business Registration (For-Profit businesses only) *
1 w/ signature
Pay-to-Play Form (For-Profit businesses/corporations only) %
1 w/ original signature
Stockholder Disclosure Certification* FAILURE TO
COMPLETE, SIGN AND SUBMIT THIS FORM IS CAUSE FOR
REJECTION
P.L. 2012 Bid or Proposal Prohibited - Iran Certification
1 w/ original signature
Contract Award Signature Sheet*
1 w/ original signature
Proposal
1 w/ original signature
Proof of 501(c)(3) status (For Non-Profits only)*
1 w/ signature
Proof of Charitable Registration*
1 copy
Certificate of Incorporation *
1 w/ signature
Most recent audited financial statement (or Form 990 for ForProfit businesses)*
Brochures and Organizational Chart *
1 w/ original signature
1 w/original signature
6 copies
Copies of all questionnaires, diagnostic/other screening tools
6 copies
surveys, etc. utilized as part of performance outcome activities.
%
Proof of coordination (e.g., consortia/affiliation agreements,
1 copy
letters of endorsement) %
* = Required as part of proposal submission; % = Submit with proposal packet if applicable
Contract Unit