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Home My WebLink AboutExhibit 5FORM A: COVER PAGE (1 page) Miami NICE Request for Qualifications 2008 M ME Name: Organization: Address: FEIN/SS# Phone: Fax: Email: 1. Type of response: I Single consultant. Web: ❑ Multiple consultants from a single organization I I Joint proposal (multiple entities) 2. Consultant positions: (Note: Response can include all four. Refer to RFO page 4 for related limitations) ❑ Success Partner ❑ Training Consultant ❑ Technical Consultant ❑ Evaluation Consultant 2(a) For Success Partner, Training, and Technical Consultants only: To which capacity areas are you responding?: I -I (1) Leadership development / Board II (5) Organizational development topics including: P1 (2) Program development ❑ Financial management ❑ Human Resources I 1 (3) Community engagement Technology Ti Planning ❑ (4) Fund development Other: 2(b) For Success Partner Consultants only: Currently, does your organization offer peer networking, training, info -sharing or other that may integrate FBCO organizations into an existing network of service providers or collaborators? Yes. Describe in your application. No or not currently n N.A. (individual, not an organization) 2(c) For all consultant positions: In which community service areas are you experienced? 7 C• hildren and youth I -I Families transitioning from welfare to work Healthy marriage initiative P Elders in need Ex -offender re-entry — Rehabilitation services for addicts or prisoners ❑ Homelessness Other: 3. Status regarding City of Miami administrative contract requirements (Attachment A): n C• urrently meet all requirements ❑ Will meet prior to contracting Ti Cannot meet 4. Other consultant "pools" in which you are currently active: Ti A• pproved vendor/The Children's Trust ❑ C-One network n Other: 5. Signature/date: CHECKLIST: Contents of this response Cover Background Qualifications Form (I page) (1 page per position*) Client List Resume Optional Original (1 page) (2 pages*) (3 pages) +2 copies *Note: If multiple staff/partners are included in this one response, include up to.five sets for up to five designated individuals. FORM B: PREVIOUS CLIENTS (2 pages) For purposes of reference checks, demonstration of similar capacity -building work, demonstration of experience with similar clients, etc. 1. Previous consultant engagements (contracts) with Miami NICE partners. n Alliance for Human Services Li Center on Nonprofit Effectiveness (C-One) ❑ City of Miami n Family and Children Faith Coalition Describe (if applicable): ❑ Miami -Dade County The Children's Trust ❑ United Way of Miami NICE 2. Other clients: Instructions: This form currently includes space for three clients. Adjust spacing in the grids provided below as needed, and include additional clients if space allows. DO NOT EXCEED TWO PAGES for Form B. If you would like to include additional client information beyond Form B, note that up to three additional pages can be added as attachments to the overall submission (refer to page 12 for details about page limitations). Client: Contact name, phone, email: Description of project; and s • ecific services you provided (information should be specific to the individual consultant, not the consultant's co-workers or firm): Description of results, achievements, outcomes, etc.: Other: Client: Contact name, phone, email: Description of project; and specific services you provided (information should be specific to the individual consultant, not the consultant 's co-workers or firm): Description of results, achievements, outcomes, etc.: Other: Client: Contact name, phone, email: Description of project; and specific services you provided (information should be specific to the individual consultant, not the consultant's co-workers. or firm): Description of results, achievements, outcomes, etc.: Other: (Adjust spacing as needed. DO NOT EXCEED TWO PAGES for Form B. See page 12 for space limitation and the opportunity to add additional, optional attachments.) ATTACHMENT A Miami NICE RFQ 2008-1 City of Miami Contracting Requirements Note to respondents Within this Attachment A, you will find information provided by the City of Miami with regard to the City's specific contracting requirements. Four major informational components are included: (1) Insurance Requirements -"Expert Consulting Agreement" (1 page) Note: Applicable to individuals, sole practitioners, and similar. (2) Insurance Requirements -"Professional Services Agreement" (2 pages) Note: Applicable to organizations and similar. (3) Corporate Resolution (1 page) Note: Applicable to organizations and similar. (4) Terms and Conditions (25 pages) Note that some requirements in parts 1, 2, and 3 apply only to individuals and some requirements apply to organizations. Information is relevant to future contracts for all four consultant positions described in the document titled Miami NICE RFQ 2008-1: Success Partner Consultants, Technical Consultants, Training Consultants, and Evaluation Consultants. For additional information, updates, revisions, or assistance, visit www.miaminice.org. INSURANCE REQUIREMENTS EXPERT CONSULTING AGREEMENT I. Personal Automobile Liability A. Limits of Liability Bodily Injury and Property Damage Liability Limits of Liability -Split Limits S100,000/300,000/50,000, or Combined S300,000 Endorsements Required City of Miami included as an "Additional Insured" II. Worker's Compensation A. Limits of Liability Statutory -State of Florida OR Provide exemption certificate from the State of Florida, Division of Workers' Compensation, and/or letter indicating number of employees, including corporate officers. For information: State of Florida Division of Workers ' Compensation wwwfldfs.com. See Division of Worker's Compensation, FAQs. III. Employer's Liability A. Limits of Liability S100,000 for bodily injury caused by an accident, each accident $100,000 for bodily injury caused by disease, each employee $500,000 for bodily injury caused by disease, policy limit IV. Professional Liability/Errors and Omissions Coverage (If Applicable) A. Limits of Liability Each Claim $ 1,000,000 General Aggregate Limit S 1,000,000 The above policies shall provide the City of Miami with written notice of cancellation or material change from the insurer not less than (30) days prior to any such cancellation or material change. Companies authorized to do business in the State of Florida, with the following qualifications, shall issue all insurance policies required above: The company must be rated no less than "A" as to management, and no less than "Class V" as to Financial Strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. All policies and /or certificates of insurance are subject to review and verification by Risk Management prior to insurance approval. For more information about insurance, contact your insurance broker, or: Brown & Brown, 1-800-877-2769, Teresa Schawb Extension 5756 INSURANCE REQUIREMENTS PROFESSIONAL SERVICES AGREEMENT I. Commercial General Liability A. Limits of Liability Bodily Injury and Property Damage Liability Each Occurrence General Aggregate Limit Personal and Adv. Injury Products/Completed Operations S 1,000,000 $ 2,000,000 $ 1,000,000 $ 1,000,000 B. Endorsements Required City of Miami included as an Additional Insured Employees included as insured Contractual Liability II. Business Automobile Liability A. Limits of Liability Bodily Injury and Property Damage Liability Combined Single Limit Owned/Scheduled Autos Including Hired, Borrowed or Non -Owned Autos Any One Accident S 1,000,000 B. Endorsements Required City of Miami included as an Additional Insurance III. Worker's Compensation A. Limits of Liability Statutory -State of Florida Waiver of Subrogation IV. Employer's Liability A. Limits of Liability $100,000 for bodily injury caused by an accident, each accident $100,000 for bodily injury caused by disease, each employee $500,000 for bodily injury caused by disease, policy limit V. Professional Liability/Errors and Omissions Coverage Combined Single Limit Each Claim S1,000,000 General Aggregate Limit $1,000,000 Deductible- not to exceed 10% The above policies shall provide the City of Miami with written notice of cancellation or material change from the insurer not less than (30) days prior to any such cancellation or material change. Companies authorized to do business in the State of Florida, with the following qualifications, shall issue all insurance policies required above: The company must be rated no less than "A" as to management, and no less than "Class V" as to Financial Strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. All policies and /or certificates of insurance are subject to review and verification by Risk Management prior to insurance approval. For more information about insurance, contact your insurance broker, or: Brown & Brown, 1-800-877-2769, Teresa Schawb Extension 575 CORPORATE RESOLUTION WHEREAS, , a Florida not for -profit corporation whose principal address is (hereinafter, the "Corporation"), desires to enter into a Agreement with the City of Miami, a copy of which is attached hereto (hereinafter, the "Agreement"); and WHEREAS, the Board of Directors of the Corporation at a duly held corporate meeting has considered the matter in accordance with the Articles and By -Laws of the Corporation, copies of which Articles and By -Laws are attached hereto; NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF DIRECTORS of the Corporation that as the President and as the Corporate Secretary are hereby authorized and instructed to enter into, to execute, and to deliver the Agreement and to undertake the duties, responsibilities and obligations as stated in such Agreement in the name of and on behalf of this Corporation with the City of Miami upon terms and conditions contained in the Agreement to which this Resolution is attached. DATED this day of , 200^. PRESIDENT (Signature) ATTEST: Print Name: CORPORATE SECRETARY (Signature) Print Name.: (CORPORATE SEAL)