mercer county job and family services county job and family services ... ohio 45822 mercer county...

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Mercer County

Job and Family Services

Respect Care Protect

REQUEST FOR PROPOSALS

Date Issued:

March 7, 2016

Proposals Due:

11:15 A.M. March 31, 2016

Bidders must submit three (3) hard copies in a sealed envelope entitled: 2016 TANF Summer Youth Employment c/o Mercer County Commissioners Office 220 W. Livingston St. Suite 201 Celina, Ohio 45822 NOTE: Three (3) hard copies

must be received by the

submission date at the

address listed above in

order to be considered.

Faxed or emailed proposals

will not be accepted.

Bidders’ Conference 2:00 P.M.

March 17, 2016 Central Services Building 1ST Floor Conference 220 W. Livingston St. Celina, Ohio 45822

Mercer County Job and Family Services is currently soliciting proposals for providers of paid summer employment programs for low-income Mercer County youth ages 14-24 and Foster Children ages 14-18. Subsidized employment provides valuable skills and work experience for young people and serves as a stepping stone to unsubsidized employment. Programs can provide summer employment opportunities as work crew(s) or customized individual placements. Providers can place youth at government, non-profit, or private sector worksites. Summer youth program participants cannot displace or jeopardize the status of current employees. In addition, youth work experience participants should not replace the work of employees who have experienced layoffs (see 20 CFR 667.270 for non-displacement requirements).

TANF Summer Youth Employment Programs will allow eligible low income youth the opportunity to gain valuable work experience while earning a paycheck to help meet basic needs. Programs to provide additional summer employment opportunities are estimated to start May 1, 2016 and end on or before August 31, 2016 with an opportunity to transition into Comprehensive Case Management and Employment Program with Mercer County Job & Family Services. Funding is contingent upon the Ohio Department of Job and Family Services allocating TANF/PRC funds for summer youth programs. Information provided in this RFP is based upon preliminary information provided by the Ohio Department of Job and Family Services and is subject to change. Details regarding the funding are forthcoming and will be communicated as it becomes available. The 2015 TANF Summer Youth allocation was $94,045.00.

Purpose

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TABLE OF CONTENTS

Background ........................................................................................ 3

Eligible Population ............................................................................. 4

Program Requirements ...................................................................... 5

Other Program Considerations .......................................................... 6

RFP Limitations ................................................................................. 7

Contact Information ............................................................................ 8

Exhibit 1 - Proposal Contents ............................................................. 9

Exhibit 2 - Budget Template ............................................................. 12

Attachment A ................................................................................... 39

Attachment B ................................................................................... 40

Attachment C ................................................................................... 41

Attachment D ................................................................................... 42

Attachment E ................................................................................... 43

Attachment F ................................................................................... 44

Attachment G ................................................................................... 45

Proposal Scoring ............................................................................. 46

Exhibit 3 – Family Assistance Letter #152 ........................................ 49

Exhibit 4 – Sample Sub Grant Agreement ........................................ 58

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Background

Mercer County Job and Family Services administers several programs focusing on the work first philosophy and strives to provide quality employment, training and supportive services to assist individuals with obtaining and maintaining self-sufficiency. These programs incorporate a combination of supportive services, education, training, and soft skills development in order to help families transition off of public assistance and/or prevent the cycle of dependency on public assistance. Programs/funding sources include:

Ohio Works First (OWF)/Temporary Assistance for Needy Families (TANF) In October 1997, Mercer County began full implementation of the Ohio Works First

(OWF) program. As the name implies, this program emphasizes employment for families receiving public assistance. The basic philosophy encourages employment of cash recipients so families are able to transition to self-sufficiency. .

Prevention, Retention, and Contingency Program (PRC) This program is designed to provide benefits and services to income eligible families who are in need of help to obtain and/or maintain self-sufficiency. The PRC Program is funded by the Federal Temporary Assistance for Needy Families (TANF) Program through the Ohio Works First Program (OWF). The PRC Program provides counties with the opportunity to develop locally driven, flexible, responsive, and innovative services designed to meet the needs of eligible families.

Mercer County’s PRC Plan incorporates categories which allow PRC eligible individuals the opportunity to obtain assistance in order to meet TANF priorities defined by the State of Ohio, and based on Federal guidelines. The TANF Summer Youth Employment Program meets the first two purposes of TANF:

1. To provide assistance to needy families so that children may be cared for in their own home or the home of relatives;

2. End the dependence of needy parents on government benefits by promoting job preparation, work and marriage

Payment for services will be based on a reimbursement process. Start up or advanced funds are not available.

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The Summer Youth Employment Program shall only serve persons ages 14 to 24 from a PRC-eligible family and/or Foster Children ages 14 through 18 years of age. Foster children who are 18 years old must also be enrolled full time in secondary school. All summer youth participants must be a United States’ citizen or qualified alien, and resident of Mercer County. Foster Children must be in temporary or permanent custody of MCJFS or other County Department of Job & Family Services/Children Services Boards. Final eligibility is determined by Mercer County Job and Family Services. TANF/PRC Family Composition guidelines**

In order for youth to meet family composition guidelines they must meet any one of the following guidelines: a. Youth ages 14-17, as long as the youth is a minor child* in a needy family and is in

school (youth may be 18 if they are a full time student in a secondary school); b. Youth ages 18-24 as long as they are in a needy family that also has a minor child; or c. Youth ages 18-24 that have a minor child and are considered needy.

* For TANF/PRC eligibility, the definition of minor child is as follows:

An individual has not attained age eighteen(18); or An individual who is eighteen and is a full-time student in a secondary school (high

school) or enrolled in a high school level of vocational or technical training. Foster youth in the temporary or permanent custody of a County Department Job and

Family Services who are placed in a licensed foster care or kinship setting between the ages of 14 and 17 or 18 years of age and are enrolled full time in secondary school.

Eligible Population

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Program Requirements

TANF Summer Youth Employment programs can provide project based group employment (work crew) or develop individualized work sites that meet the skills and interests of the youth participants. Work site locations may include private or public non-profits, government entities, or private sector worksites. Worksites/job placements at private residences are discouraged unless work is being provided as a mobile work crew project with appropriate supervision and in collaboration with a non-profit community organization. An approved agreement with each worksite is required prior to performing work. The worksite agreement must outline job duties, responsibilities of the Program Provider (employer), worksite, and youth participant. The worksite agreement shall identify who is responsible for daily supervision of youth while at the worksite, ensure all applicable employment and wage regulations are followed and that the summer youth participant will not displace a regularly paid employee or replace employees who have been laid off. Important: The program provider will serve as the actual employer (i.e., employer of record) of the youth participants. While a third party payroll agent, such as a temporary employment agency, may be used for payroll services, the program provider must remain the employer of record. Other program requirements include but are not limited to:

Identifying and establishing projects and/or worksites for all eligible youth Developing, providing, and reviewing job descriptions of duties to be performed with

each youth participant Identifying and recruiting youth participants to be served by the proposed program Hiring and employing eligible youth Providing occupational skills and employability skills training Providing “rainy day” or alternate work when planned activities are not possible Ensuring youth participants have transportation to and from work daily or as needed.

(Transportation costs are allowable and should be included when developing a program budget.)

Pay the youth up to $10.00 per hour Providing employer functions as the employer of record including paying all payroll

expenses including Workers Compensation (worker compensation premiums and claims paid)

Responsible for youth activity coordination, direct supervision and training Ensuring that all applicable employment rules and regulations and minor wage and

safety laws are being followed (www.youthrules.dol.gov). Providing case management and supportive services as needed Communicating with job site supervisor regarding youth needs and job related

issues Completing necessary state reports and maintain fiscal records Ensuring that costs are allowable according to state and federal regulations Hiring qualified program staff and supervisors and provide appropriate background

checks for individuals working with the youth program. Youth program volunteers are expected to meet the same background standards as paid employees.

http://www.youthrules.dol.gov/

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Other Program Considerations

The following components should be considered in developing Summer Employment Activities: Summer employment may last through August 31, 2016, with youth working up to 40 hours per week or as allowed defined by safety and child labor laws (www.youthrules.dol.gov). Provider must follow the Family Assistance Letter #152 which is included as Exhibit 3. Youth still enrolled in school may need accommodations to their schedule after returning to school, working after school hours or on weekends as allowed by applicable labor laws. Mercer County JFS reserves the right to negotiate the number of paid work hours based upon the availability of funds. All programs will be required to follow all applicable Minor Labor Laws as issued by the Ohio Department of Commerce, Division of Labor and Worker Safety and the Federal Department of Labor.

Training While the TANF Summer Youth Program is mainly intended to be a work experience program designed to provide youth with an opportunity to earn a wage, gain work experience, and develop employment related skills however, ten Percent (10%) of the county’s allocation may be used for paying for soft skills training. Soft Skills training includes, but is not limited to, how to write a resume and cover letter, tips for interviewing and job etiquette. Worksites Work site development should take in consideration the age appropriateness of the activities, and should also encourage youth to help develop social skills needed to become successful employees. Employment opportunities should be meaningful and provide opportunities for youth to explore career options. Worksites should be established with employers who are committed to provide youth with the skills and supervision necessary to enhance youth job readiness. In addition, work sites should be flexible and properly informed regarding the youth’s needs and barriers, and prepared to provide supervision and guidance. The program provider/employer will be responsible to ensure youth are safe and supervised at all times. Regardless of the type of employment activity, the Provider is responsible to ensure the ratio of supervision of youth to supervisors is adequate.

Providers are encouraged to establish partnerships with local businesses. Work site agreements are required to be in place prior to youth starting employment. Summer youth program participants can not displace or jeopardize the status of current employees. In addition, youth work experience participants should not replace the work of employees who have experienced layoffs (see 20 CFR 667.270 for non-displacement requirements).

Youth Payroll Youth must be paid at least minimum wage, but reimbursement for participant wages will not exceed $10.00 per hour. The provider will be responsible to follow minor wage agreements and posting requirements, obtaining I-9 forms, parent consent forms and work permits for minors when applicable.

Payroll, associated costs*, and employer functions** are the Provider’s responsibility. The program provider will be required to administer all payroll functions and associated costs and will be reimbursed by Mercer County Job and Family Services. The vendor may use a payroll service to provide payroll functions however the program provider must retain responsibility as the employer of record. The vendor must have adequate cash flow to cover payroll/program costs for up to 30 days. The provider must be the actual employer of the youth participants.

*Associated costs for payroll administration includes but is not limited to: Medicare, Social Security (or other retirement), Federal/State/Local/School income taxes, etc. **Employer functions include but are not limited to: minor wage agreements, obtaining I-9 forms, parental consent forms, and work permits, etc. for minors 14-16 as applicable.

http://www.youthrules.dol.gov/

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RFP LIMITATIONS The provider/employer is required to maintain independent books, records, payroll, documents

accounting procedures and practices which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of this Agreement. Such records shall be subject at all reasonable times for inspection.

Reimbursement is based upon actual expenditures for the program. Provider will be expected to

have cash flow resources to sustain youth payroll and project operations for at least 30 days. Start up or advanced funds are not available.

Providers/Employers will be required to submit monthly reports of actual expenses and youth

time sheets to verify hours worked. Workers Compensation paid to a participant after the program end date is not reimbursable. Provider will be required to carry liability insurance, and to also secure the persons and

estates of eligible individuals against reasonable foreseeable torts which would cause injury or death.

Provider will be required to conduct appropriate background checks for individuals/staff

working or volunteering with the youth program.

This Request for Proposals does not commit Mercer County or the Mercer County Job and Family Services to award a contract or to pay any cost incurred in the preparation of a proposal. Mercer County/Mercer County Job and Family Services reserves the right to accept or reject any or all proposals received, to negotiate services and costs with proposers/employers, and to cancel in part or in entirety this RFP. All Proposals submitted will remain the property of Mercer County.

Funding for programs is anticipated to be available on or after May 1, 2016. Contracts will be

awarded for the provision of 2016 TANF Summer Youth Employment Programs. This RFP may be cancelled or modified at any time due to a reduction of Federal, State, or Local funds or a change in regulations. Allowable and disallowable costs for this program can be found in Exhibit 3 in this proposal.

Contracts may be amended or terminated during this period if there is a change in Federal,

State or Agency regulations that apply to the contract; a reduction of Federal, State or Local funds; unsatisfactory performance by the Provider as determined by Mercer County Job and Family Services; or upon thirty (30) days written notice by either party.

If a contract is awarded, this RFP guideline shall become a part of the contractual agreement.

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CONTACT INFORMATION

Program questions concerning this RFP may be directed to:

Elizabeth Rinderle, ERS Administrator [email protected]

Mercer County Job and Family Services (419)586-5106 ext. 524

Fiscal questions concerning this RFP may be directed to:

Anita Kremer, Fiscal Administrator [email protected]

Mercer County Job and Family Services (419)586-5106 ext. 528

OR Cindy Bittinger, Fiscal Specialist

[email protected] Mercer County Job and Family Services

(419)586-5106 ext. 540

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Exhibit 1

Proposal Contents

TANF Summer Youth Employment Program

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PROPOSAL GUIDELINES

Providers interested in being considered for TANF Summer Youth Employment Program funding for Summer 2016 must include the following information: Please number your responses accordingly

1. Cover Letter: Provider name, program name, contact person, mailing

address, phone number, fax number, email address, Federal ID# and DUNS # . Also include name, title and original signature of person submitting RFP.

2. Briefly describe your organization. Include if you are private for profit, non-profit (private or public) or government/school entity. Describe the nature of your business, the number of years you have been providing services, and any previous experience working with youth. Describe previous summer youth programming provided in the past.

3. Identify partnerships with other entities for the provision of summer work including sub-contractors (e.g. payroll processing), or any other partnerships involved with the provision of the program. Include letters of support that identify established partnerships and define partnership roles and responsibilities with the summer youth program.

4. Describe the program being proposed. Include if the program will involve mobile work crew(s)/group activities or customized worksite placement. Describe training and activities provided to develop occupational skills and work readiness. Describe how training activities will be provided, frequency, and how success will be measured.

5. Describe the specific employment activities the youth will perform, include

identified work sites or proposed worksites, job descriptions, work schedules including the number of hours worked per day, days per week, and hourly rate of pay. Describe who will be responsible to supervise the youth at each work site. Include copies of your worksite agreements if already obtained. If not, include a blank worksite agreement.

6. Describe how participants will be recruited, screened for eligibility, and referred to MCJFS for the application process. Identify the number of youth you intend to recruit and the number of youth you intend to employ in your program.

7. Describe timeline of recruitment, orientation and prospective start and end

date. List pre-employment screenings you will require such as physicals, drug tests and background checks.

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8. Describe how youth will be matched with employment activities. What assessments will be conducted (if applicable) to help with job placement?

9. Describe your payroll process. Will payroll be handled by your

organization or contracted to a third party such as a temporary agency or a payroll service? Include how frequent the youth will be paid, how hours will be tracked and how the youth be paid (direct deposit or check)?

10. Describe what other supportive services will be offered to your youth

participants-(e.g. transportation, training/certifications, safety equipment and supplies). How will the supportive services be communicated and utilized by the youth?

11. Describe your communication process with the site supervisors including frequency of site visits, expectations of the job sites to report issues and intervention process.

12. Explain how your work and break schedule will coincide with appropriate

labor regulations. Identify potential hazardous work activities/work sites and how your program will ensure appropriate safety measures are in place. Identify worksite safety protocols for injuries & accidents.

13. Identify staff positions and include job descriptions. List pre-employment

screenings you will require of staff including drug screens, criminal background checks, etc. These documents may be monitored if a contract is awarded. Describe staff roles and responsibilities.

14. Include proof of general and professional liability coverage. 15. Provider is required to issue a certificate of completion to the participating

youth who participate in the Summer Youth Program. Please provide a sample of your certificate showing the name of the program, name of the youth, the date of participation, name of the employer and include the following statement: Funding for this program was provided by The Ohio Department of Job and Family Services.

16. The following attachments and Exhibits must be completed and returned

as part of this packet: Attachment A: Assurance Form Attachment B: Americans with Disabilities Act and Compliance Statement Attachment C: Certification regarding debarment and suspension Attachment D: Affidavit in Compliance with Section 3517.13 of the ORC Attachment E: Equal Opportunity Certification Attachment F: W-9 Attachment G: Proposal Checklist Form Attachment H: Sample Sub-recipient agreement

Exhibit 2: Detailed Budget

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Exhibit 2

EXAMPLE Budget Template

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Exhibit 2: BUDGET INSTRUCTIONS AND EXAMPLE

Note: Subcontractors of the service provider must complete a separate budget to be submitted

along with the service provider’s budget.

BUDGET FACE SHEET Provider – Enter the legal name of the provider who is providing the services. Address – Enter the location where the services are provided, street number, city and zip code. Telephone & Fax Number – Enter for the location where the services are provided. Contract Period – This will be completed by MCJFS’s upon approval of contract. Budget Period – Enter the period of time upon which the budget expenditures are based. In most cases, this should be for one year. Programs – List program title for each service being proposed. Total Cost for Program – Enter the total program budget cost from the Recap of Budget Items for each program. Total Program Units – Once the budget figures are known, the agency/organization has documented numbers to reflect what it will cost to provide the program(s) service for both eligible and ineligible clients. MCJFS’s will only reimburse for eligible clients. For each service, list the total number of direct units (eligible and ineligible) of service to be provided within the proposed budget period. A unit can be per hour, per class, per participant, etc. The agency/organization must give a clear definition of a unit as described later. It is very important to be reasonable about the number of units anticipated to be served. The higher the number of units projected, the lower the unit rate will be. MCJFS’s will only reimburse actual cost for a direct billable unit not to exceed the negotiated unit rate. If the actual cost continues to exceed the negotiated unit rate on a cumulative basis, then the contract will need to be amended so that the unit rate is at a level to cover all actual cost incurred. A per hour unit would be based on one hour of billable time/action directly providing a program service to an eligible client. This shall be documented and billed in quarter hour increments.

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A per class unit would be based on one or more eligible clients being in attendance for a specific period of time when a program service is directly being provided. This time period shall be documented and billed by a number of negotiated hours, days, or weeks. A per client or participant unit would be based on one unit for an eligible client for a specific negotiated time period or as a one time only unit when a program service is directly being provided.

Direct service unit and/or direct billable unit is defined as time actually spent providing the contracted service in the following manners: either in direct or telephone contact with the eligible client(s); direct, telephone, or written contact with agencies, friends, relatives, and others directly related to assisting the eligible client in receiving the contracted service or in reaching the established goals; obtaining pertinent information, making arrangements for travel, and appointments; time spent actually transporting an eligible client to and from an agency, employer, or place directly related to assisting the eligible client in reaching the established goals. Direct service unit and/or direct billable unit must represent an action taken by the provider resulting in the eligible client(s) responding such as leaving a message requesting the eligible client return a call or make contact. A direct service unit and/or direct billable unit shall not include time spent in agency meetings, conferences, completing paperwork, dictation, reports, traveling, review of a case, or making calls and getting a busy signal. This cost is included in the budget and is covered but should not be considered when determining the number of units to be provided and/or billed for. Time spent providing a direct unit must be documented. MCJFS’s suggests that daily logs that track by quarter hour increments, with a space noting which client is being served, be used to track time and actual direct units. Please be aware that when a monitoring is done, all costs and units must be documented and available to support actual/reimbursed costs in order to prevent a finding of disallowed and non-reimbursable costs resulting in cost recovery.

Unit Costs – List the cost for each unit of service being provided (total costs for service divided by total program units). Federal regulations state that providers shall relate financial data to performance data and develop unit cost information whenever practical. Units under Contract – List total units to be purchased under this contract. This will be completed by the MCJFS’s. Amount under Contract – Compute the dollar amount of contracted units by service title (Unit cost times Units under Contract). This will be completed by the MCJFS’s. Unit Definition – Give a clear definition of each unit for each program being proposed. Describe the specific activities that will be provided to comprise each unit.

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SALARY PAGE – Position Title – List all staff positions subject to reimbursement. Filled or Vacant - Indicate if filled (F) or Vacant (v). If vacant, the salary must be prorated to reflect the date position will be filled. Salary – Enter the salary per hour.

Hours per Week – The number of hours per week the individual works to earn the listed salary.

Length of Budget – Enter the length of the Program(s) budget (days, weeks, months, and year). Allow the required amount of time to review, negotiate, and approve the contract. This information was previously discussed on Page 1. Percent of Time to Program(s) – Place the percentage of total salary relevant to the program(s) under contract. Time shown for contract services require a time study summary documentation of six to eight weeks for employees performing multiple services, unless this is for an agency/organization that has not previously contracted with MCJFS’s.

Salary Charged to the Program – Indicate the amount of salary applicable to the program(s) under contract (Salary Cost multiplied by Percent of Time to program(s).

PAYROLL RELATED EXPENSES –

Attach a worksheet if related expenses are not uniformly, or across the board, for all staff. Insert in each program heading the amount from salary page totals. Indicate the employer share of taxes and fringe benefits relevant to the salary of listed staff. These costs are to reflect actual established rates.

CONSULTATION FEES –

Attach a service agreement or fee schedule for the consultation service.

Type – Indicate the type of consulting fee (e.g. attorney, accountant, program consultant).

Rate – Enter the normal rate charged by consultant per hour or day. Hours/Days – Enter number of hours or days purchasing. Programs – Enter in the program the amount benefiting each program.

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TRAVEL –

Agency/Employee Vehicle Expense - Enter on the appropriate line the agency/employee vehicle expenses incidental to the delivery of contract programs, including the costs of transporting clients to and from their residences and provider program locations. Vehicle depreciation or lease expenses will be entered on the appropriate equipment schedule.

Mileage Reimbursement – Indicate the per mile reimbursement paid to staff, not to exceed the counties’ guidelines ($.45 per mile), the total amount of miles, and the total amount of the anticipated expenditure in the appropriate program, including client transportation.

Conferences, Meetings, etc. – Indicate the agency’s anticipated expense for this purpose. The travel shall be for official business directly related to a program(s) under contract and considered reasonable and allowable only to the extent such costs do not exceed charges normally allowed by the County’s and/or the MCJFS’s policies.

Client Purchased Transportation – Enter in the appropriate program column anticipated purchased transportation expenditures for client transportation. If the transportation is being provided by a vendor, other than the vendor this contract is with, that MCJFS’s already contracts with, the transportation rates cannot exceed the MCJFS’s current contracted rate with that provider.

CONSUMABLE SUPPLIES –

Enter in the appropriate program column the costs of consumable supplies directly related to the program. Do not enter consumable supplies that are more of a general supply used within the agency/organization that will be budgeted for as an indirect cost.

OCCUPANCY COSTS –

Rental - Enter the total square feet, monthly square foot cost, and the total square footage cost per month. Utilities - Enter the relevant utility costs per month on the appropriate line, if not included in rental charge. Depreciation or Usage Allowance – If the agency/organization owns the building, a charge for depreciation or usage allowance is an allowable cost. Both are applied to the original acquisition cost. Enter in the acquisition cost, acquisition date and useful life. Depreciation shall be by straight-line method. If the building has already been fully

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depreciated, the usage allowance method shall be applied (limited to 2% per year). Enter the depreciation or usage allowance amount and divide by twelve to calculate a monthly cost. Miscellaneous Building Expenses - Enter the anticipated miscellaneous item and costs per month. Total Monthly Occupancy Costs – Add the totals for above costs and multiply by the budget period to calculate the total occupancy costs. Apply this amount to the program(s) being provided. Use the Full Time Equivalency Rate, square footage rate, or other means of allocating to determine the allowable amount to charge and the amount to spread to each program. Records substantiating development of the means of allocating must be provided and also maintained in the agency/organization. INSURANCE COSTS - Calculate the relevant insurance cost for the program(s) budget period on the appropriate line and enter in the appropriate program column. Use the Full Time Equivalency Rate or other means of allocating to determine the allowable amount to charge and the amount to spread to each program. Records substantiating development of the means of allocating must be provided and also maintained in the agency/organization. INDIRECT COSTS - Item - Enter the indirect costs, as defined in the Allowable Operation Costs, excluding any direct costs. Calculate the relevant indirect costs for the program budget period on the appropriate line and enter in the appropriate program column. Use the Full Time Equivalency Rate or other means of allocating to determine the allowable amount to charge and the amount to spread to each program. Records substantiating development of the means of allocating indirect costs must be provided and also maintained in the agency/organization. NOTE: Indirect cost rates may be developed in any method that produces an equitable distribution. The Full Time Equivalency Rate is a suggested method of arriving at an indirect cost rate for the contract. If another method is used, describe the computation for arriving at the indicated indirect cost rate in a separate attachment.

EQUIPMENT SUBJECT TO DEPRECIATION OR USAGE ALLOWANCE – Depreciation or Usage Allowance - If the agency/organization has, or acquires for this program(s), equipment costing $5,000.00 or more with an anticipated useful life in excess of one year, a charge for depreciation or usage allowance for the equipment is an allowable cost. Both are applied to the original acquisition cost. Enter in the acquisition cost less any trade-ins, discounts, etc., acquisition date, and useful life.

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Depreciation shall be by straight-line method. If the equipment has already been fully depreciated, the usage allowance method shall be applied (limited to 6 2/3% per year). Calculate the relevant depreciation and/or usage allowance costs for the length of the program(s) on the appropriate line. Use the Full Time Equivalency Rate or other means of allocating to determine the allowable amount to charge and the amount to spread to each program. Records substantiating development of the means of allocating costs must be provided and also maintained in the agency/organization. SMALL EQUIPMENT - Item - List or categorized anticipated small equipment purchases of under $5,000.00 during the budget period. Quantity - Indicated the quantity of items to be purchased. Item Cost - Cost of listed items. Programs – Enter in the program the amount benefiting each program. LEASED AND RENTED EQUIPMENT – Equipment should only be leased and/or rented when it is feasible and the lease or rent amount does not exceed the cost to purchase the item(s).

Item - List or categorized anticipated leased and/or rented equipment of under $5,000.00 during the budget period. Equipment costing over $5,000.00 and obtained by lease/purchase agreement must be depreciated. Quantity - Indicated the quantity of items to be leased and/or rented. Rental Cost - Cost to lease and/or rent listed items. Programs – Enter in the program the amount benefiting each program. MISCELLANEOUS COSTS – Item - List or categorized anticipated miscellaneous items. Quantity - Indicate the quantity of items to be purchased. Item Cost - Cost of listed items. Programs – Enter in the program the amount benefiting each program. RECAP OF BUDGET ITEMS – This page is a summary of the costs of providing agency programs. Enter the totals for the various categories that are detailed on the attached sheets of this EXHIBIT.

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TOTAL INCOME FOR BUDGET PERIOD -

Income For Program(s) Under This Contract determines if it is necessary for MCJFS to enter into a contract to provide additional income for the program(s) being provided and if there is revenue available to support the programs and/or to support services provided to ineligible clients.

Fees from Private Consumers - Indicate the anticipated income for the budget period to supplement this program(s). Fees Generated by Contract for Recipients - Indicate the dollar value of the contract prorated to the contract period if different from the budget period. Other Federal Support of Contract Services - Indicate any other Federal support such as contracts, grants or awards for contract programs. State, County or Municipal Allocations - Indicate any state, county or municipal support of program services (i.e., levies, county general fund allocations). Contributions - Indicate private contributions in support of program services. Other Contracts – Indicate the amount of any other contracts for the programs being provided. Miscellaneous - List sources of income for contract programs not previously itemized. Total Income for Program(s) Under This Contract – Indicate total from total amounts 1 through 7. Income for Other Program(s) Services Provided by Agency Not Under This Contract determines if the agency/organization is financially sound to operate without MCJFS’s funds. From Private Consumers - Indicate other anticipated income for the budget period that does not supplement this program(s). Federal Monies (Grants or Contracts) - Indicate any other Federal support such as contracts, grants or awards for other programs. State, County or Municipal Allocations - Indicate any state, county or municipal support for other program(s) services (i.e., levies, county general fund allocations). Contributions - Indicate private contributions in support of other program(s) services. Miscellaneous - List sources of income for other programs not previously itemized. Total Other Program(s) Services – Indicate total from total amounts 1 through 5.

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Total Agency Income (Section A + B) – Indicate total from total amounts to sections A. and B.

The following example and instructions are to assist you in submitting your proposal if your agency/organization doesn’t already have an approved cost allocation plan. In order to capture all related costs and establish an equitable unit rate for the services for which you wish to contract, an allocation of costs to the program/programs must be completed and a budget established.

Example: an agency/organization may have different programs it wants to provide. It has separate direct costs for each program and other costs not directly associated with any specific program. In order to find out what it costs to provide each program and spread general and administrative expenses, a cost allocation is required. Complete the following to prepare for cost allocating. 1. Program employees who are involved in more than one activity, and who will be

performing activities for the program(s) under this contract, should participate in a minimum six to eight week time study. This would not include indirect staff such as directors, fiscal, receptionist, janitorial, etc. unless they provide direct program activities to the clients.

2. Break timings down to fifteen-minute increments with a column for each program

and one for unidentifiable time. 3. At the end of each day, add total hours timed and add totals for each column. 4. At the end of the time study period, add the totals from each time study form for

each week and transpose the numbers for each week to the TIME SUMMARY FORM. Add all totals for each column. A TIME SUMMARY FORM must be done for each employee who participated in the time study.

5. Calculate percentage of the time spent in each program from Total Hours Tracked

(THT) to determine how much of the program employee’s time benefits each program.

6. Add all TIME SUMMARY FORM’S columns individually and all those employees

who are involved in only one activity (100% of their time), if any, for each program. Must also add, in the Other Identified Programs column, all organization/agency program staff members who provide program services not included in this contract. The total of all these will give a grand total of program staff under this contract and not included in this contract. Report these totals on the FULL TIME EQUIVALENCY FORM.

7. Divide number of program employees for each program included in this contract by

the total number of program employees in the organization/agency.

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This cost allocation only benefits agencies that are currently providing services under contract with MCJFS’s. A new contractor to MCJFS’s can use this cost allocation with projected numbers based on planned or historical activity devoted to each program. These calculations will enable the organization/agency to determine how much of a specific program employee’s time benefits each program; furthermore, and just as important, it will enable the organization/agency to allocate program costs and indirect costs to each program under contract. This calculation of time is known as the Full Time Equivalency (FTE).

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TIME STUDY

Name________________________ Position______________________ Time Frame________________________

Time

Study

Program

A

Program

B

Program

C

Program

D

Other

Identified

Programs

Unidentified Total

Hours

Tracked

8:00 AM

8:15 AM

8:30 AM

8:45 AM

9:00 AM

9:15 AM

9:30 AM

9:45 AM

10:00 AM

10:15 AM

10:30 AM

10:45 AM

11:00 AM

11:15 AM

11:30 AM

11:45 AM

12:00 PM

12:15 PM

12:30 PM

12:45 PM

1:00 PM

1:15 PM

1:30 PM

1:45 PM

2:00 PM

2:15 PM

2:30 PM

2:45 PM

3:00 PM

3:15 PM

3:30 PM

3:45 PM

4:00 PM

4:15 PM

4:30 PM

4:45 PM

Total

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TIME SUMMARY FORM

Organization’s Name Time Frame

Time

Study

Program

A

Program

B

Program

C

Program

D

Other

Identified

Programs

Unidentified Total Hours

Tracked

(THT)

WEEK

1

WEEK

2

WEEK

3

WEEK

4

WEEK

5

WEEK

6

WEEK

7

WEEK

8

TOTALS

Percentage of time spent for each program (A – D, Other, and Unidentified) calculated by dividing the program total by the Total Hours Tracked (THT).

Program

A

Program

B

Program

C

Program

D

Other

Identified

Programs

Unidentified THT

(100% Or 1

Employee)

%

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FULLTIME EQUIVALENCY FORM

Program

A

Program

B

Program

C

Program

D

Other

Identified

Programs

Unidentified Total # of

Program

Employees

Employees

from all

Time

Summary

Forms

Divide number of program employees for each program column by the total number of program employees in the agency/organization and enter below.

Program

A

Program

B

Program

C

Program

D

Other

Identified

Programs

Unidentified Total # of

Program

Employees

(100%)

%

These percentage rates will enable the agency/organization to allocate program costs and indirect costs to each program under contract.

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ALLOWABLE STAFF COSTS: Salaries - Includes all remuneration, paid currently or accrued, for services rendered during the period of the contract. Salaries are allowable to the extent that the costs are reasonable for the services rendered, and are supported by documented payroll vouchers or a generally accepted method of documentation. Payroll must be supported by payroll logs, time and attendance logs, or equivalent records for individual employees. The method used should produce an equitable distribution of time and effort. Compensation for owners is allowable provided the service performed is a necessary function. Payroll Related Expenses - Employee benefits in the form of employer contributions to social security, state and municipal retirement systems, life and health insurance plans, Unemployment Insurance coverage, Worker's Compensation Insurance and pension plans are allowable if equitably distributed. Severance pay is allowable when payment is consistent with standard or approved policy.

Incentive Compensation - payments to employees based on cost reduction, efficient performance, suggestions awards, etc. are allowable to the extent that overall compensation is determined to be reasonable and such costs are paid or accrued pursuant to an established plan followed by the employer so consistently as to imply, in effect, an agreement to make such payment. Deferred Compensation - Such cost is allowable to the extent that except for past service pension and retirement costs: (1) it is for services rendered during the period of the projected budget; (2) it is, together with all other compensation paid to the employee, reasonable in amount; 3) it is paid pursuant to an agreement entered into in good faith between the agency/organization and its employees before the services are rendered, or pursuant to an established plan followed by the agency/organization so consistently as to imply, in effect, an agreement to make such payments; (4) the benefits of the plan are vested in the employees or their designated beneficiaries and no part of the deferred compensation reverts by the Internal Revenue Service, and falls within the criteria and standards of the Internal Revenue Code and the regulations of the Internal Revenue Service. Severance Pay - Commonly referred to as dismissal wages, is payment in addition to regular salaries and wages by employers to workers whose employment is being terminated. Costs of severance pay are allowable only to the extent that, in each case: it is required by law; employer/employee agreement; or established policy that constitutes, in effect, an implied agreement on the employer’s part. Only severance benefits that accrue during the period of the contract are allowable. ALLOWABLE OPERATION COSTS Consultation Fees - The reasonable cost of consultation fees, charges for the use of personal services of outside agencies or persons not on the payroll; or functions related to contract services, i.e. audit service, legal service, and specialized consultation are allowable if equitably distributed among programs and cost centers. Travel - the costs of operation, maintenance, and repairs of agency vehicles when relevant to the delivery of contract services; reasonable expenses for transportation, lodging subsistence, and related items incurred by employees who are on a travel status while on official business related to delivery of contract services, either an actual basis, or a per diem and mileage basis; expenses for meetings and conferences, if the primary purpose is the dissemination of technical information

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relating to contract services. Purchased transportation is allowable if required for the delivery of contract services. Consumable Supplies - The reasonable costs of materials and supplies are allowable. Direct charges to services should be based upon the actual price less cash discounts, trade discounts, rebates, and allowances. Consumable supplies are those items, which will be used up within one year. Occupancy Costs - Rental of Privately Owned Building - Rental cost for space is an allowable charge and should not exceed the cost of comparable space and facilities in the same locality. The lease agreement must stipulate the extent of the lessor's responsibility for renovations. Major renovations, which add to the permanent value of the property or appreciably prolong its useful life, the cost of which is borne by the provider, must be depreciated. Rental of Publicly Owned Building - The rental cost of a publicly owned building is allowable if the charge does not exceed the cost of comparable space and facilities in the same locality. The rental charge should include the costs of service, maintenance, depreciation on the building, and depreciation of major renovations. Use Allowance or Depreciation of Provider Owned Building - The computation of use allowances or depreciation will be based upon acquisition cost. The computation will exclude any cost borne by the federal government through other federal grant programs, the cost of land, and idle or excess buildings and capital improvement. Depreciation must be computed on the Straight Line Depreciation Method. If the building is fully depreciated, a use allowance for buildings and improvements may be computed at an annual rate not exceeding two percent of acquisition cost. Repair and Maintenance - Costs incurred for necessary maintenance, repair, and upkeep of property which neither add to the permanent value of the property nor appreciably prolong its useful life, but keep it in efficient operating condition, are allowable. If these expenditures add to the value or prolong the life of the property they must be depreciated as capital improvements. Utilities - Utility costs for agency facilities are allowable if equitably distributed among programs and cost centers. Insurance Costs - Cost of insurance in connection with the general conduct of activities is allowable to the extent that the cost will be in accordance with sound business practice. Employee liability insurance is allowable. Protection against liabilities for loss of assets related to the provision of contract services is allowable and should be provided, because losses incurred through the lack of available insurance coverage would not be considered an allowable cost; however, the deductible portion of insurance coverage or minor uninsurable losses is allowable. Indirect Costs - Indirect costs are those costs incurred for common or joint purpose benefiting more than one service area or cost objective. Indirect cost pools should be distributed to benefited cost objectives on bases that will produce an equitable result in consideration of relative benefits derived. The allocation distribution must be equitable. Allowable indirect costs for the indirect cost pool include, but are not limited to, the accounting and budgeting functions, disbursing services, personnel administration and payroll preparation, procurement services and general administrator's office.

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ALLOWABLE EQUIPMENT COSTS: Depreciable Equipment - Includes depreciation charges for capital equipment (any item or group of like items costing $5,000.00 or more). Computation of depreciation is based upon the acquisition cost of the item excluding; (1) any cost borne by the Federal Government through other Federal Grant Programs, and (2) any idle or excess equipment. Adequate property records must be maintained and the straight-line method of computing depreciation must be used. When equipment is replaced, the value received for the old equipment less the salvage value and any unrealized depreciation charges are deducted from the acquisition cost of the new equipment. If the equipment is fully depreciated, a use allowance for equipment may be computed at an annual rate not exceeding six and two-thirds percent of acquisition cost. Non-depreciable Equipment - Small equipment items costing less than $5,000.00 may be expensed (purchased outright during the period of the contract.) Leased Equipment - The cost of leased equipment is allowable, to the extent of its reasonableness as sound business policy. Equipment in excess of $5,000.00, obtained by lease to purchase agreement must be depreciated. MISCELLANEOUS COST: Miscellaneous - Allowable miscellaneous costs include memberships and subscriptions, reference material, printing and reproduction, mailing and postage, and any other costs incidental to the delivery of service. UNALLOWABLE COSTS: Bad Debt - Losses arising from uncollectible accounts, and other claims and related costs are unallowable. Contingencies - Contributions to a contingency reserve or any similar provision for unforeseen events are unallowable. Contributions and Donations - Outlays of cash with no prospective benefit to the contracting agency or program are unallowable. Entertainment - Costs of amusements, social activities, and related cost are unallowable. Advertising - Costs of advertising, with the exception of contract related recruitment needs, procurement of scarce items, disposal of scrap and surplus, is unallowable. All contract-related advertising must clearly disclose that the program(s) and/or service(s) are in whole or in part funded by the MCJFS’s. Advertising must only be as a direct cost and can not be designed solely to promote the MCJFS’s. Fines and Penalties - Costs resulting from violations of or failure to comply with laws and regulations are unallowable.

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Interest and Other Financial Costs - Interest on borrowings, bond discounts, or any cost of financing or refinancing operations are unallowable. Costs Borne By Other Federal or State Programs - Any costs specifically subsidized by other State or Federal dollars are unallowable and must be deducted from the applicable line items prior to unit rate computation. Cash Payments - Cash payments to eligible individuals such as a cash allowance to children in residential treatment are unallowable. Sabbatical Leave - Payment of any sabbatical leave is unallowable. Fundraising - Cost of activities to raise monies to support the provider program is unallowable. Education - Cost activities provided by the public schools that are free of charge of the general public is unallowable.

The MCJFS’S receives allocations for many different programs and services. Based on

regulations, policies, and plans of the funding source, costs may be allowable under one

program but not under another.

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PROVIDER: CONTACT PERSON:

ADDRESS:

TELEPHONE: BUDGET PERIOD:

FAX: CONTRACT PERIOD:

PROGRAMS TOTAL COST TOTAL UNITS UNIT COST CONTRACT UNITS COMPLETED BY ACDJFS

CONTRACT AMOUNT COMPLETED BY ACDJFS

PROGRAM AName________________

______________

PROGRAM BName________________

______________

PROGRAM CName________________

______________

PROGRAM DName________________

______________

PROGRAM A -

PROGRAM B -

PROGRAM C -

PROGRAM D -

UNIT DEFINITION - Please give clear definition of each unit of service for each program being proposed. A unit can be per hour, per class,

per participant, etc. Describe the specific activities that will be provided to comprise each unit.

Enter below the total cost for each program from the Budget Recap Sheet, units to be served, and unit cost.

Note: Subcontractors of the service provider must complete a separate budget to be submitted along with the service provider’s budget.

BUDGET FACE SHEET

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SALARY PAGE Budget Item Number I A.

PROGRAM A PROGRAM B PROGRAM C PROGRAM D

Name___________________ Name___________________ Name__________________ Name___________________

POSITION F SALARY HRS LENGTH

% SALARY % SALARY % SALARY % SALARY

OR or PER PER OF TO THE CHGD TO THE TO THE CHGD TO THE TO THE CHGD TO THE TO THE CHGD TO THE

TITLE V HOUR WEEK BUDGET PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM

TOTALS

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PAYROLL RELATED EXPENSES Budget Item Number I B. ATTACH WORK SHEET IF RELATED EXPENSES ARE NOT UNIFORM, OR ACROSS THE BOARD, FOR ALL STAFF


Name___________ Name___________ Name___________ Name___________

INSERT IN EACH PROGRAM THE AMOUNT FROM SALARY PAGE Amt._____________ Amt._____________ Amt._____________ Amt._____________ TOTAL

SOCIAL SECURITY 6.2%,PERS 14%,SERS ___%

MEDICARE 1.45%

WORKERS COMP ____%

RETIREMENT ____%

HOSPITALIZATION ____%

UNEMPLOYMENT ____%

OTHER (IDENTIFY

TOTAL PAYROLL RELATED EXPENSES

CONSULTATION FEES Budget Item Number I C. ATTACH SERVICE AGREEMENT OR FEE

SCHEDULE


TYPE: e.g. accountant, etc. RATE HOURS/DAYS Name___________ Name___________ Name___________ Name___________ TOTAL

TOTAL CONSULTATION FEES

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Name____________ Name____________ Name____________ Name____________ TOTAL

AGENCY/EMPLOYEES

ACTUAL VEHICLE EXPENSE

GAS & OIL

REPAIRS AND OTHER MAINTENANCE

LICENSE

INSURANCE

OTHER

MILEAGE REIMBURSEMENT @ 50 CENTS/MILE

FOR________MILES

CONFERENCE, MEETINGS, ETC.

CLIENTS

PURCHASED TRANSPORTATION:

TOTAL TRAVEL


Consumable Supplies related directly to the program(s). Name____________ Name____________ Name____________ Name____________ TOTAL

OFFICE

TRAINING

PROGRAM

OTHER (SPECIFY)______________________

TOTAL CONSUMABLE SUPPLIES

NOTE: Attach an itemized list so that MCDJFS is aware of the consumable supplies being budgeted for.

TRAVEL Budget Item Number II A.

Please see note below.

NOTE: If the service being provided requires transportation for clients and if the transportation is being provided by a vendor, other than the vendor this

contract is with, that MCDJFS already contracts with, the transportation rates can not exceed MCDJFS

CONSUMABLE SUPPLIES Budget Item Number II B.

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A. RENT (Office Space)1. Total # of

Square Feet

2. Cost per Sq.

Ft. per Month

3. Total Cost

per Month

B. UTILITIES (If Not Included In Rent)

1. HEAT

2. ELECTRICITY

3. TELEPHONE

4. WATER

5. JANITORIAL & MAINTENANCE

6. INTERNET SERVICE

7. TOTAL PER MONTH

C. DEPRECIATION OR USAGE ALLOWANCE

1. DEPRECIATION

a. Item b. Acquisition

Cost

c. Acquisition

Date

e. Useful Life

Years

f. Straight-line

Annual Dep.

2. USAGE ALLOWANCE (Limited to 2% for buildings per year)

a. Item b. Acquisition

Cost

c. Acquisition

Date

e. Useful Life

Years

f. Usage

Allowance

Amt

3. DEPRECIATION (C.1.f.) ___________ OR USAGE ALLOWANCE

( C.2.f.) ____________ DIVIDED BY 12 EQUALS

D. MISCELLANEOUS BUILDING EXPENSES1. Item 2. Cost

3. TOTAL COST PER MONTH

E.

Name___________________ Name___________________ Name___________________ Name__________________

% AMT CHGD % AMT CHGD % AMT CHGD % AMT CHGD UNRELATED

TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE

PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAMS

NOTE: USE THE FULL-TIME EQUIVELANCY RATE, SQUARE FOOTAGE RATE, OR OTHER MEANS OF ALLOCATING TO DETERMINE THE

ALLOWABLE AMOUNT TO CHARGE AND THE AMOUNT TO SPREAD TO EACH PROGRAM.


OCCUPANCY COSTS Budget Item Number II C.

TOTAL MONTHLY OCCUPANCY COSTS (A.3.+B.7.+C.3.+D.3.) ____________ X

LENGTH OF THE BUDGET _________ EQUALS TOTAL OCCUPANCY COSTS FOR

BUDGET PERIOD __________. Please see note below.

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Name____________________ Name____________________ Name____________________ Name____________________


LENGTH OF TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE

INSURANCE BUDGET PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAMS

LIABILITY See note below.

AGENCY

EMPLOYEE

BONDING

# OF EMPLOYEES

COVERED ________

OTHER _____________

TOTAL INSURANCE

NOTE: Liability Insurance covers damage done to other persons or to property other than that of contractor.

Name____________________ Name____________________ Name____________________ Name____________________


LENGTH OF TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE

ITEM BUDGET PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAMS

TOTAL INDIRECT

NOTE: Attach an itemized list so that MCDJFS is aware of the indirect costs being budgeted for.

NOTE: USE THE FULL-TIME EQUIVELANCY RATE OR OTHER MEANS OF ALLOCATING TO DETERMINE THE ALLOWABLE AMOUNT TO CHARGE AND THE AMOUNT TO SPREAD TO

EACH PROGRAM.

INSURANCE COSTS Budget Item Number II D.


INDIRECT COSTS Budget Item Number II E.

ENTER BELOW OTHER INDIRECT COSTS NOT ALREADY CAPTURED (e.g. GENERAL OFFICE SUPPLIES, ETC.)


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A. DEPRECIATION OR USAGE ALLOWANCE

1. DEPRECIATION List below the items costing $5,000.00 or more.

a. Item b.

Acquisition

Cost

c. Acquisition

Date

e. Useful Life

Years

f. Straight-line

Annual Dep.

2. USAGE ALLOWANCE (Limited to 6 2/3% for equipment per year) List below items already owned and depreciation by contractor.

a. Item b.

Acquisition

Cost

c. Acquisition

Date

e. Useful Life

Years

f. Usage

Allowance Amt

(b. X .0667)

Name___________________ Name___________________ Name___________________ Name___________________


TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE TO THE

PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAM PROGRAMS

NOTE: USE THE FULL-TIME EQUIVELANCY RATE OR OTHER MEANS OF ALLOCATING TO DETERMINE THE ALLOWABLE AMOUNT TO

CHARGE AND THE AMOUNT TO SPREAD TO EACH PROGRAM.


TOTAL PER YEAR

3. DEPRECIATION (A.1.f.) ________ + USAGE ALLOWANCE ( A.2.f.) _________ EQUALS ANNUAL DEPRECIATION

AND USAGE ALLOWANCE ____________, DIVIDED BY 12 EQUALS _________PER MONTH, X LENGTH OF

PROGRAM ______ EQUALS TOTAL EQUIPMENT DEPRECIATION AND USAGE ALLOWANC

TOTAL PER YEAR

EQUIPMENT SUBJECT TO DEPRECIATION OR USAGE ALLOWANCE Budget Item Number III A.

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ITEM PROGRAM A PROGRAM B PROGRAM C PROGRAM D

ITEM QUANTITY COST Name__________ Name__________Name__________ Name__________ TOTAL COST

TOTAL SMALL EQUIPMENT PURCHASES

RENTAL PROGRAM A PROGRAM B PROGRAM C PROGRAM D


TOTAL LEASED AND RENTED EQUIPMENT

ITEM PROGRAM A PROGRAM B PROGRAM C PROGRAM D


TOTAL MISCELLANEOUS COSTS

SMALL EQUIPMENT ( Equipment Costing Under $5,000.00) Budget Item Number III B.

LEASED AND RENTED EQUIPMENT Budget Item Number III C.

NOTE: ONLY WHEN FEASIBLE AND WHEN THE LEASE OR RENT AMOUNT DOES NOT EXCEED THE COST TO PURCHASE THE ITEM(S).

MISCELLANEOUS COSTS Budget Item Number IV

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TOTAL

PROGRAM A PROGRAM B PROGRAM C PROGRAM D BUDGET

Name___________ Name___________Name___________Name___________ AMOUNT

I STAFF COSTS

A. SALARIES

B. PAYROLL RELATED EXPENSES

C. CONSULTATION FEES

TOTAL STAFF COSTS

II OPERATIONAL COSTS

A. TRAVEL

B. CONSUMABLE SUPPLIES

C. OCCUPANCY

D. INSURANCE

E. INDIRECT COSTS

TOTAL OPERATIONAL COSTS

III EQUIPMENT COSTS

A. DEPRECIATION AND

USAGE ALLOWANCE

B. SMALL EQUIPMENT PURCHASES

C. LEASED AND RENTED EQUIPMENT

TOTAL EQUIPMENT COSTS

IV MISCELLANEOUS

TOTAL PROGRAM BUDGET FOR

PROGRAM(S) UNDER CONTRACT

RECAP OF BUDGET ITEMSEnter below the totals for the various categories which are detailed on the attached sheets of this EXHIBIT.

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Name___________ Name___________ Name___________ Name___________ TOTAL

A. INCOME FOR PROGRAM(S) UNDER THIS CONTRACT:

1. FEES FROM PRIVATE CONSUMERS

2. FEES GENERATED BY CONTRACT FOR RECIPIENTS

3. OTHER FEDERAL SUPPORT OF CONTRACTED PROGRAM(S)

4. STATE, COUNTY OR MUNICIPAL ALLOCATIONS

5. CONTRIBUTIONS

6. OTHER CONTRACTS

7. MISCELLANEOUS

TOTAL INCOME FOR PROGRAM(S) UNDER CONTRACT

B. INCOME FOR OTHER SERVICES PROVIDED BY AGENCY NOT UNDER THIS CONTRACT TOTAL

1. FROM PRIVATE CONSUMERS

2. FEDERAL MONIES (GRANTS OR CONTRACTS)

3. STATE, COUNTY OR MUNICIPAL ALLOCATIONS

4. CONTRIBUTIONS

5. MISCELLANEOUS

TOTAL OTHER PROGRAM SERVICE(S) INCOME

TOTAL AGENCY INCOME (SECTION A TOTAL + SECTION B TOTAL)

TOTAL INCOME FOR BUDGET PERIOD

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ATTACHMENT A. ASSURANCES FORM I recognize that I must give assurances for each item below. If I cannot, this proposal will be automatically rejected. The assurances are: 1. I am authorized by my Board of Directors, Trustees, other legally qualified officer, or as the owner of this agency or business to submit this proposal. 2. We are not currently on any Federal, State of Ohio, or local Debarment List. 3. We will provide records to show that we are fiscally solvent. 4. We have, or will have; all of the fiscal control and accounting procedures needed to ensure that

TANF funds will be used as required by law and contract. 6. We will meet all applicable Federal, State and Local compliance requirements. These

include, but are not limited to: * Records accurately reflect actual performance. * Maintaining record confidentiality, as required. * Reporting financial, participant, and performance data, as required. * Complying with Federal and State non-discrimination provisions. * Meeting all applicable labor laws, including Child Labor Law standards. * Drug Free Workplace

We will not:

* Place a youth in a position that will displace a current employee. * Use TANF money to assist, promote or deter union organizing. * Use funds for youth in the construction, operation or maintenance of any part of a

facility to be used for sectarian instruction or religious worship.

I hereby assure that all of the above are true. _________________________________ __________________ Signature Date ________________________________ __________________ Name (printed) Title

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ATTACHMENT B Americans with Disabilities Act and Compliance Statement

The Americans with Disabilities Act (ADA), Public Law 101-336, was signed into law on July 26, 1990

to provide a national mandate for the elimination of discrimination against individuals with disabilities.

If selected to be a contractor through Mercer County Job & Family Services, I hereby will abide by all

mandates of the ADA, Public Law 101-336 as it applies to the activities provided by the contract.

Name of Organization _________________________________________________________

Signature of agency’s responsible representative: _____________________________________

Date:_________________________________________________________________________

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Attachment C Certification Regarding debarment, suspension, ineligibility,

And voluntary exclusion lower tier covered transactions

This certification is required by the regulations implementing Executive Order 12549, Debarment and

Suspension, 20 CFR Part 98, Section 98.510, “participants’ Responsibilities”. The regulations were

published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211).

The prospective lower tier participant certifies, by submission of the proposal, that neither it nor its

principals is Debarred, suspended, proposed for debarment, declared ineligible or voluntarily

excluded from participation in this transaction by any Federal department or agency.

1. Where the prospective lower tier participant is unable to certify to any of the statements in

this certification, such prospective participant shall attach an explanation to this proposal.

Name of Organization________________________________________________________

Signature of agency’s responsible representative___________________________________

Date_______________________________

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Attachment D

AFFIDAVIT IN COMPLIANCE WITH SECTION 3517.13 OF THE OHIO REVISED CODE

STATE OF OHIO COUNTY OF MERCER SS: Personally appeared before me the undersigned, as an individual or as a representative of

_______________________________ for a contract for _____________________________________ (Name of Entity) (Type of Product or Service)

to be let by the County of Mercer, who, being duly cautioned and sworn, makes the following statement with respect to prohibited activities constituting a conflict of interest or other violations under Ohio Revised Code Section 3517.13, and further states that the undersigned has the authority to make the following representation on behalf of himself or herself or of the business entity: 1. That none of the following has individually made within the two previous calendar years and that, if awarded a contract for the purchase of goods or services in excess of $500, none of the following individually will make, beginning on the date the contract is awarded and extending until one year following the conclusion of the contract, as an individual, one or more campaign contributions totaling in excess of $1,000, to any member of the Mercer County Board of Commissioners or their individual campaign committees:

a. myself; b. any partner or owner or shareholder of the partnership (if applicable); c. any owner of more than 20% of the corporation or business trust (if applicable); d. each spouse of any person identified in (a) through (c) of this section; e. each child seven years of age to seventeen years of age of any person identified in divisions (a) through

(c) of this section (only applicable to contributions made on or after January 1, 2007). 2. That none of the following have collectively made since January 1, 2007, and that, if awarded a contract for the purchase of goods or services in excess of $500, none of the following collectively will make, beginning on the date the contract is awarded and extending until one year following the conclusion of the contract, one or more campaign contributions totaling in excess of $1,000, to any member of the Mercer County Board of Commissioners or their individual campaign committees:

a. myself; b. any partner or owner or shareholder of the partnership (if applicable); c. any owner of more than 20% of the corporation or business trust (if applicable); d. each spouse of any person identified in (a) through (c) of this section; e. each child seven years of age to seventeen years of age of any person identified in divisions (a) through

(c) of this section.

Signature _________________________________

Title: _____________________________________ Sworn to before me and subscribed in my presence this _______ day of ___________________,

______________________________, 20 ____.

Notary Public __________________________________ My Commission Expires: ________________________

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ATTACHMENT E

EQUAL OPPORTUNITY CERTIFICATION

Prior to contract award, potential contractors must assure that they are in compliance with

nondiscrimination and equal opportunity requirements. The following statements must be in all

proposals submitted and will be included in any contract with Mercer County Job & Family Services

(MCJFS).

As a condition to the award of a contract the contractor assures, with respect to the operation of

MCJFS activities, that it will fully comply with the nondiscrimination and equal opportunity provisions.

These will include:

Title IV of the Civil Rights Act of 1964, as amended

Section 504 of the Rehabilitation Act of 1975, as amended

Age Discrimination Act of 1975, as amended

Nontraditional employment for Women Act of 1991

Title IX of Education Amendments of 1972, as amended

Name of organization:________________________________________________________

Signature of Agency’s responsible representative___________________________________

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ATTACHMENT G PROPOSAL CHECKLIST FORM

Format

Three originals of proposal included

Narrative

Completed Cover Letter serving as the first page of proposal

Project Narrative

Budget Narrative

Evaluation Criteria

Understand and Agree to All Evaluation Criteria (pages 30-32)

Contract Award

Understand and Agree to Contract Award Information Forms

Attachments A-F completed and signed

Detailed Budget (may use your own format)

Proposal Checklist Form completed & attached (Attachment G)

_____________________________________________ ____________________ Proposer’s Signature Date

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Proposal Scoring

Prospective Providers are advised that an offer for a contract may be initiated after a review of the proposals. Proposals will be reviewed for acceptability with emphasis on various factors and according to the type of service to be provided. Proposals will be evaluated on the following criteria:

Provider/Employer Name_____________________

TANF Summer Youth Employment Program RFP

Y/N

Criteria

COMMENTS

1. COVER LETTER

Provider contact information and signatures

have been provided along

If no – RFP is found to be incomplete and will

not be considered for selection.

SCORING CONFLICT OF INTEREST STATEMENT

I state that I do not have a conflict of interest in scoring the attached proposal for the Mentoring Program. A conflict of interest is generally understood to exist where a person has a direct personal, organizational, or financial tie to an organization, and where that person is in a position to influence, or appears to influence, the actions of another organization for the benefit of themselves or an organization with which they have such ties. I have read the scoring conflict of Interest statement and understand that I am responsible for the information contained in it. I have had all questions answered about this statement. I understand I can refer future questions to the agency Director, to the Mercer County Prosecutor’s office or to the Ohio Ethics Commission. My signature below and my signature on the scoring sheet indicates my agreement to comply with this statement. _______________________________ __________________________ Signature Date _______________________________ __________________________ Signature Date _______________________________ ___________________________ Signature Date

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2. ORGANIZATION DESCRIPTION

Information on organization and experience

running a youth employment program

0 = Not Addressed 1 = 1-2 Years Experience 2 = 3-4 Years Experience 3 = 5 or More Years Experience

3. PARTNERSHIP

Partnership identification and letters of support

explaining the roles and responsibilities between

partners

0 = Not Addressed 1 = Addressed

4. PROGRAM PROPOSAL

Program description and how training and activities

will be provided, frequency, and how success will be

measured

0 = Not Addressed 1 = Minimally Addressed 2 = Adequately Addressed 3 = Well Planned and Thought Out

5. EMPLOYMENT ACTIVITIES

Identified proposed work sites, role of supervisor

and copy of example of worksite agreement


6. PARTICIPANT RECRUITMENT

Participant recruitment, screening, and indication of

number of youth they intend to recruit/employ


7. INTAKE AND APPLICATION

Intake and application process and pre-employment

screening requirements


8. YOUTH MATCHING

Description on how youth will be matched and

placed with employers


9. PAYROLL PROCESS

Description of payroll process and if third party

will be used, tracking of hours and payment

frequency


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10. SUPPORTIVE SERVICES

Description of supportive services that will be used and

how services will be communicated and utilized.

1 = Limited Services Available 2 = Moderate Services Available 3 = Provider Will Ensure Supportive Services are Provided As Needed

11. COMMUNICATION PROCESS

Description of communication process with site

supervisors, expectations of the job sites and

intervention process when issues arise.


12. WORKPLACE SAFETY

Description of worksite safety protocols


13. STAFF RESPONSIBILITIES

Description of staff roles and responsibilities

involved in the youth program including background

checks and screenings


14. LIABILITY INSURANCE

Proof of liability insurance provided

0 = Not Provided 1 = Requirement Met

15. CERTIFICATE OF COMPLETION

Sample provided has all required components

0 = Not Addressed 1 = Sample Provided without all Required Components 2 = Sample Provided Meets All Required Components

16. ATTACHMENTS

All required attachments (A,B,C,D,E,F,G) are

returned and completed

0 = Incomplete 1 = Completed

16. BUDGET

Detailed costs complete and accurate. 0 = Incomplete 1 = Completed

17. BUDGET/PROGRAM COST

Costs are deemed as appropriate and reasonable

0 = Contains Unallowable Charges 1 = All Charges Allowable But Some Charges Deemed Excessive 2 = All Charges Allowable and Reasonable 3 = All Charges Allowable, Reasonable and Exceeds Expectations

Maximum total score = 42

TOTAL SCORE

Questions concerning this RFP may be directed to: Questions concerning this RFP may be directed to:

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Guidance on the Use of Sub-recipients and Vendors Characteristics of a sub-recipient include:

Determines eligibility to receive Federal financial assistance

Has performance measured against whether objectives of a Federal program are met

Has responsibility for programmatic decision making

Is responsible for adherence to applicable Federal program compliance requirements

Uses Federal funds to carry out a program of the organization, as compared to providing goods or services for a

program of the pass-through entity

Characteristics of a vendor include:

Provides goods or services within normal business operations

Provides goods or services to many different purchasers

Operates in a competitive environment

Provides goods or services ancillary to the operation of the Federal program

Is not subject to compliance requirements of the Federal program

General administrative requirements to related sub-recipients are contained in 45 CFR 92.37.

Sub-grants to sub-recipients are not subject to federal procurement standards found in 45 CFR 92.36. However,

contracting with vendors is subject to these procurement rules as well as OAC 5101:9-4-07.

Further requirements for pass-through entities which provide federal funding to sub-recipients can be found in

OMB Circular A-133 Subpart D.

Advantages and Disadvantages to Using Sub-recipients and Vendors:

Advantages Disadvantages

Sub-

recipients

Handle short-term programs

quickly without hiring more

staff

Provide flexibility

Pass compliance

responsibility

Procurement not necessary

Agreement language more complex

Increased monitoring and oversight

responsibilities

Shifting current staff to monitoring

Less control over program

administration

Vendors

Keep control over the

program

Agreements usually less

complex

Less monitoring responsibility

Vendors bound to contract terms, less

discretion or ease to make changes

Keep compliance responsibility

Procurement required, time involved

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EXHIBIT 4

Mercer County Job & Family Services

Interagency Sub-grant Agreement

RECITALS:

This Sub-grant Agreement is entered into between the Mercer County Department of Job & Family Services

(hereinafter referred to as “Grantor”) and the (hereinafter referred to as “Sub-grantee”).

This Sub-grant Agreement is made pursuant to a grant award to the Grantor by the Ohio Department of Job and

Family Services (ODJFS) and is not for research and development purposes. The grant award is under the

authority of Code of Federal Domestic Assistance (CFDA) number 93.558 TANF Summer Youth Employment

Program (Temporary Assistance for Needy Families (TANF) through the Department of Health and Human

Services Office, as noted in the Fiscal Administrative Procedure Manual Transmittal Letter (FAPMTL # 152)

Exhibit( 3).

DEFINITIONS:

As used in this document, the words and phrases set forth below shall have the following meanings:

A. “Grantor” means the Mercer County Department of Job and Family Services.

B. “Sub-grantee” means

C. “Financial assistance” means all cash, reimbursements, other payments, or allocations of funds

provided by Grantor to Sub-grantee. All requirements in this Agreement related to financial assistance

also apply to any monies, including private monies and public money, as defined in section 117.01 of

the Revised Code, used by the Sub-grantee to match federal, state or county funds;

D. “Federal, state and local laws” include all federal statutes and regulations; appropriations by the Ohio

General Assembly; the Revised Code; uncodified law included in an Act, Ohio Administrative Code

(OAC) rules; any federal Office of Management and Budget (OMB) circulars including those codified

under 2-CFR-200 that a federal statute or regulation has made applicable to state and local governments;

the relevant terms and conditions of any federal awards; as well as any resolutions or policies adopted

by the Mercer County Board of County Commissioners. Federal, state and local laws also include any

Governor’s Executive Orders to the extent that they apply to counties and any ODJFS Procedure

Manuals and Guidance Letters. The term "federal, state and local laws" includes all federal, state and

local laws as listed in this paragraph and existing on the effective date of this Agreement as well as those

federal, state and local laws that are enacted, adopted, issued, effective, amended, repealed, or rescinded

on or after the effective date of this Agreement;

E. “CFDA” means the Code of Federal Domestic Assistance assigned to a federal grant.

THEREFORE, IN CONSIDERATION OF THE MUTUAL COVENANTS CONTAINED IN THIS SUB-

GRANT AGREEMENT, THE PARTIES AGREE AS FOLLOWS:

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ARTICLE I. PURPOSE OF THE SUB-GRANT/SUB-GRANT DUTIES

(A) The purpose of the Sub-award Agreement is to state the covenants and conditions under which the Sub-

recipient will provide assistance to needy families so that children may be cared for in their homes or the

homes of relatives and to end dependence of needy parents on governmental benefits by enabling low

income TANF-eligible Ohio youth participants to gain valuable work experience while earning a

paycheck to help meet basic needs.

(B) SUB-GRANTEE will report to the contact specified in Article IX, below, who may communicate specific

requests and instructions to SUB-GRANTEE concerning SUB-GRANTEE’s performance under this

Agreement. SUB-GRANTEE will comply with any instructions or requests to the satisfaction of

GRANTOR within ten (10) days after receipt of the instructions or requests. SUB-GRANTEE expressly

understands and acknowledges that any instructions are strictly necessary to ensure the successful

completion of the activities specified in this Agreement and are not intended and do not amend or alter this

Agreement or any part thereof. If SUB-GRANTEE believes that any instructions or requests would

materially alter the terms and conditions of this Agreement, SUB-GRANTEE agrees to consult the specified

contact for GRANTOR named in Article IX, below. SUB-GRANTEE agrees to consult the designated

contact for GRANTOR as necessary to ensure comprehension of Sub-grant activities and their successful

completion.

ARTICLE II. RESPONSIBILITIES OF GRANTOR

Grantor agrees to:

A. Provide funding to Sub-grantee in accordance with this Sub-grant Agreement and Federal, state and

local laws.

B. Monitor Sub-grantee to ensure the Sub-grant is used in accordance with all applicable conditions,

requirements, and restrictions.

C. Provide information on current and any subsequent changes to the terms and conditions of the grant

awards addressed in this Agreement.

D. Provide technical assistance and training to assist Sub-grantee, with the limits of available resources,

in fulfilling its obligations under this Agreement.

E. Take action to recover funds that are not used in accordance with the conditions, requirements, or

restrictions set forth in or incorporated by this Agreement.

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ARTICLE III. RESPONSIBILITIES OF SUB-GRANTEE

Sub-grantee agrees to:

A. Ensure the funds subject to this Sub-grant Agreement are used in accordance with conditions,

requirements and restrictions of federal, state and local laws, the federal terms and conditions of the

grant award, and this Sub-grant Agreement.

B. Itemized Invoices, signed by the Sub-grantee, will be sent each month to the Mercer Co. Department

of Job & Family Services, within 30 days. Sub-grantee will make reasonable efforts to include all

service provided during the service month on the invoice. With the exception of the final billing in

which Sub-grantee will make sure monitoring of any Sub-grantee(s) is completed prior to Mercer Co.

Job & Family Services processing the final payment. Final billing must be submitted to Mercer

County Job & Family Services by

C. Monitor all private and governmental entities that receive payments from Sub-grants awarded under

this Agreement to ensure that each such entity uses the funds in accordance with the applicable

federal and state laws and the terms of this Agreement.

D. Take action to recover payments that are not used in accordance with the conditions, requirements, or

restrictions set forth in this Agreement.

E. Promptly reimburse Grantor for any funds Grantor pays to any entity because of an adverse audit

finding, adverse quality control finding, final disallowance of federal financial participation, or other

sanction or penalty for which Grantor is responsible.

F. Take prompt corrective action, including paying amounts resulting from an adverse finding, sanction,

or penalty, if Grantor, ODJFS, the Ohio Auditor of State, any federal agency, or other entity

authorized by federal, state or local law to determine compliance with the conditions, requirements,

and restrictions applicable to the federal program from which this Sub-grant is awarded determines

compliance has not been achieved.

G. Keep and maintain records that are sufficient for the preparation of reports required by law and

submit all reports as requested and required by GRANTOR.

H. Make records available to Grantor, ODJFS, the Auditor of the State, federal agencies, and other

authorized governmental agencies for review, audit and investigation.

I. With this being a short term program it is anticipated to have 100% placement of eligible

participants within 10 business days, following the participant completing orientation for the

Summer Youth Employment Program. If this is not met, written documentation will need to

be provided to indicate the reason(s) for this not taking place.

J. The Sub-grantee will need to comply with data reporting as required by the State and

also will need to fully comply with any other requirements of the program as generally

set forth in Family Assistance Letter # 152 (Exhibit 3) & any additional clarifications that are issued

in regards to this funding source.

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K. The Sub-recipient shall maintain during the term of this Sub award Agreement, the applicable

insurance and bonds specified below:

a. Worker’s Compensation Insurance as required by Ohio Law.

b. Public Liability Insurance on comprehensive basis, including Contingent Liability, in amounts

not less than $100,000 per person, $ 300,000 per occurrence for bodily injury, and $ 25,000 per

occurrence for property damage.

c. Automobile Liability Insurance covering all owned, non-owned and hired vehicles used in the

performance of this contract, in the amounts as indicated in b, above.

ARTICLE IV. EFFECTIVE DATE OF THE SUB-GRANT

A. This Sub-grant Agreement will be in effect from May 1, 2016 through August 31, 2016 and all final wrap-

up cost must be incurred prior to in which to complete the program. Unless this Sub-grant Agreement

is suspended or terminated pursuant to ARTICLE VIII prior to the above termination date.

B. In addition to Section A above, it is expressly understood by both Grantor and Sub-grantee that this Sub-

grant Agreement will not be valid and enforceable until the Mercer County Auditor certifies pursuant to

Section 5705.41 (D), Revised Code, that the amount required to meet the Grantor’s obligation or, in the case

of a continuing Sub-grant Agreement to be performed in whole or in part in an ensuing fiscal year, the

amount required to meet the obligation in the fiscal year in which the Sub-grant Agreement is made, has

been lawfully appropriated for such purpose and is in the treasury or in process of collection to the credit of

an appropriate fund free from any previous encumbrances.

ARTICLE V. AMOUNT OF GRANT/PAYMENTS

A. This grant is in the total amount of ( ). This Sub-grant Agreement will be in effect from May 1, 2016

through August 31, 2016 and all final wrap-up cost must be incurred prior to in which to complete the

program.

B. Payment will be made to Sub-grantee on a cost-reimbursement basis. The total estimated cost shall be in

accordance with the budget attached as (Attachment D which will be provided by the Sub-grantee) and shall

not exceed the amount provided in Article V (A)., above. Sub-grantee may bill Grantor monthly for

reimbursement of disbursements for actual costs incurred in the performance of this Sub-grant Agreement.

Invoices shall be numbered, dated, reference this Sub-grant Agreement, show the cost incurred by budget

category (i.e., salaries, fringe benefits, equipment, travel, supplies, etc.) for the billing period and in

cumulative amount to date. All invoices must be submitted to Mercer County Department of Job & Family

Services, 220 West Livingston Street, Celina, Ohio 45822.

Grantor will make payment on all invoices submitted in accordance with the terms of this Sub-grant

Agreement. The final invoice, clearly marked “Final,” must be submitted by November 30, 2016. The final

invoice shall include certification to the effect that “Payment of this invoice constitutes complete

satisfaction of all of Grantor’s obligations under the reference Sub-grant Agreement. Sub-grantee releases

and discharges Grantor from all further claims and obligations under this Sub-grant Agreement upon

payment of this final invoice.”

C. Sub-grantee understands that availability of funds is contingent on appropriations made by the Ohio General

Assembly, ODJFS, funding sources external to the State of Ohio, such as federal funds, and appropriations

by the Mercer Board of County Commissioners. If, at any time, the Grantor Director determines that federal,

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state or local funds are insufficient to sustain existing or anticipated spending levels, the Grantor Director

may reduce, suspend, or terminate any cash, reimbursements, other payments, or allocations of funds

provided by Grantor to Sub-grantee, or other form of financial assistance as the Grantor Director determines

appropriate. If the Ohio General Assembly, ODJFS, funding sources external to the State of Ohio, such as

federal funds, or the Mercer Board of County Commissioners fails at any time to continue funding Grantor

for the payments due under this Sub-grant Agreement, this Sub-grant Agreement will be terminated as of

the date funding expires without further obligation of Grantor or Mercer County.

D. As a recipient of federal funds, SUB-GRANTEE hereby specifically acknowledges its obligations relative to

the use of, accounting of, and monitoring of, all funds provided under this Sub-grant Agreement pursuant to

federal, state and local law. Applicable requirements are set forth in 2 CFR 200 - 230 as well as 45 CFR 74-

95 (See Circulars A-21, A-87, A-102, A-110, A-122, A-133 for standards) and as otherwise required by law.

1. Standards for financial management systems: SUB-GRANTEE and its Sub-grantee(s) will comply

with the requirements of 45 CFR 74.21 or 45 CFR 92.20, as applicable, including, but not limited to:

a. Fiscal and accounting procedures;

b. Accounting records;

c. Internal control over cash, real and personal property, and other assets;

d. Budgetary control to compare actual expenditures or outlays to budgeted amounts;

e. Source documentation; and

f. Cash management.

2. Period of Availability of Funds: Pursuant to 45 CFR 74.28 or 45 CFR 92.23, as applicable,

SUB-GRANTEE and its Sub-grantee(s) may charge to the award only costs resulting from

obligations incurred during the funding period of the federal and state awards noted in the Recitals to

this Sub-grant Agreement and for the term specified in Article IV of this Sub-grant Agreement,

unless carryover of these balances is permitted. All final wrap up cost must be incurred prior to

October 31, 2016. The award must be liquidated no later than December 31, 2016, pursuant to

federal law.

3. Matching or Cost Sharing: Pursuant to 45 CFR 74.23 or 45 CFR 92.24, as applicable, matching or

cost sharing requirements applicable to the federal program must be satisfied by disbursements for

allowable costs or third-party in-kind contributions and must be clearly identified and used in

accordance with all applicable federal, state and local laws.

4. Program Income: Program income must be used and accounted for as specified in 45 CFR 74.24 or

45 CFR 92.25, as applicable to SUB-GRANTEE.

5. Real Property: If SUB-GRANTEE is authorized to use Sub-grant funds for the acquisition of real

property, title, use, and disposition of the real property will be governed by the provisions of 45 CFR

74.32 or 45 CFR 92.31. as applicable.

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6. Equipment: Title, use, management (including record keeping, internal control, and maintenance),

and disposition of equipment acquired by Sub-grantee or its Sub-grantee(s) with Sub-grant funds,

will be governed by the provisions of 45 CFR 74.34 or 45 CFR 92.32, as applicable.

7. Supplies: Title and disposition of supplies acquired by Sub-grantee or its Sub-grantee(s) with Sub-

grant funds will be governed by the provisions of 45 CFR 74.35, 92.33 and 7 CFR 3016.33 as

applicable.

E SUBAWARD INFORMATION: The following items details the specific sub award information required by

2-CFR-200. Additional information regarding the award is included as Attachment C to the sub award.

Payments for all services provided in accordance with the provisions of this contract are contingent upon the

availability of the following funds.

* Federal Award Identification: Temporary Assistance for Needy Families (TANF)

* Sub-recipient Name:

* Sub-recipient DUNS Number:

* Federal Award ID Number: 1502OHTANF

* Federal Award Date

* Sub award Period of Performance: 05/01/2016 – 8/31/2016

* Total Funding Obligated: $

* Total Amount of Federal Award $

* Federal Award Project Description: Temporary Assistance for Needy Families (TANF);

TANF Summer Youth Employment Program

Federal Awarding Agency: Department of Health and Human Services

Pass – Through Entity(s): Ohio Department of Job and Family Services;

Mercer County Department of Job and Family Services

Awarding Official: Cynthia Dungey, Director, ODJFS; Anita Kremer

Fiscal Administrator, Mercer County Board of

Commissioners

CFDA Number & Name: Temporary Assistance for Needy Families (TANF) 93.558

Mercer Co. Allocations: TANF, SYEP

Research & Development (Y/N) No

ARTICLE VI. RECORDS

A. Sub-grantee must maintain documentation conforming to all requirements prescribed by ODJFS or by

federal, state and local laws. Sub-grantee must prepare and maintain documentation to support all

transactions and to permit the reconstruction of all transactions and the proper completion of all reports

required by federal, state and local laws, and which substantiates compliance with all applicable federal, state

and local laws.

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B. Records must include sufficient detail to disclose:

1. Services provided to program participants;

2. Administrative cost of services provided to program participants;

3. Charges made and payments received for items identified in paragraphs (B) (1) and (2) of this

Article; and

4. Cost of operating the organizations, agencies, programs, activities, and functions.

C. Sub-grantee and its Sub-grantee(s) must maintain all records relevant to the administration of this Sub-grant

for a period of five (5) years after payment under this agreement. If an audit is initiated during this time

period, the Sub-grantee and its Sub-grantee(s) shall retain such records until the audit is concluded and all

issues are resolved. .

ARTICLE VII. AUDITS OF SUB-GRANTEE

A. Sub-grantee agrees to provide for timely audits as required by law (see OMB Circular A-133, and 2-

CFR200 unless a waiver has been granted by a federal agency. Subject to the threshold requirements of

45 CFR 74.26 or 45 CFR 92.26, as applicable, and 2-CFR-200 and OMB Circular A-133, Sub-grantee

must ensure that it has an audit with a scope as provided in 2-CFR-200 and OMB Circular A-133,

Subpart E, §_.500, that covers funds received under this agreement. Sub-grantee must send one (1) copy

of the final audit report to Grantor at 220 West Livingston Street, Celina, Ohio 45822 within two (2)

weeks of Sub-grantee’s receipt of any such audit report.

B. Additional responsibilities of SUB-GRANTEE as an auditee under OMB Circular A-133 ( 2-CFR-200)

include, but are not limited to:

1. Proper identification of federal awards received.

2. Maintenance of appropriate internal controls.

3. Preparation of appropriate financial statements, including s schedule of federal awards expended.

4. Proper performance and timely submission of an OMB Circular A-133 ( 2-CFR-200) audit report.

5. Follow-up on audit findings, including the preparation of a summary schedule of prior audit findings and

corrective action, if necessary, and the preparation of a corrective action plan.

C. Sub-grantee will take prompt action to correct problems identified in an audit.

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ARTICLE VIII. SUSPENSION AND TERMINATION, BREACH AND DEFAULT

A. This Sub-grant Agreement may be terminated in accordance with any of the following:

1. The parties may mutually agree to a termination by entering into a written termination agreement that is

signed by the Grantor’s Director and an authorized officer or employee of Sub-grantee. An agreement to

terminate is effective on the later of the date stated in the agreement to terminate or the date it is signed

by all parties.

2. Either party may terminate after giving ninety (90) days written notice of termination to the other party

by registered United States mail, return receipt requested. The effective date is the later of the

termination date specified in the termination notice or the 91st day following the receipt of the notice by

the other party.

3. Grantor may immediately terminate this Sub-grant Agreement if there is a loss of federal or state funds,

a disapproval of the Sub-grant Agreement by ODJFS, or illegal conduct by Sub-grantee affecting the

operation of the Sub-grant Agreement.

B. Notwithstanding the provisions of ARTICLE VIII, Section A, Grantor may suspend or terminate this Sub-

grant Agreement immediately upon delivery of a written notice to Sub-grantee, if Grantor loses funding or

discovers any illegal conduct on the part of Sub-grantee.

C. If Sub-grantee or any of its Sub-grantee(s) materially fails to comply with any term of an award, federal,

state or local laws, an assurance, a State plan or application, a notice of award, this Sub-grant Agreement, or

any other applicable rule, Grantor may take any or all of the following actions it deems appropriate in the

circumstances:

1. Temporarily withhold cash payments pending correction of the deficiency by the Sub-grantee or its Sub-

grantee(s) or more severe enforcement action;

2. Disallow all or part of the cost of the Sub-grant activity or action not in compliance;

3. Wholly or partly suspend or terminate the current award for the Sub-grantee or its Sub-grantee(s)’

Sub-grant activity;

4. Withhold further awards for the Sub-grant activity; or

5. Take any other remedies that may be legally available, including any additional remedies listed

elsewhere in this Sub-grant Agreement.

D. Sub-grantee, upon receipt of a notice of suspension or termination, will do all of the following:

1. Cease the performance of the suspended or terminated Sub-grant activities under this Sub-grant

Agreement;

2. Take all necessary steps to limit disbursements and minimize costs that include, but are not limited to,

the suspension or termination of all contracts and Sub-grants correlated to the suspended or terminated

Sub-grant activities;

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3. Prepare and furnish a report to Grantor, as of the date Sub-grantee received the notice of termination or

suspension, that describes the status of all Sub-grant activities and includes details of all Sub-grant

activities performed and the results of those activities; and

4. Perform any other tasks that Grantor requires.

E. Upon breach or default by Sub-grantee of any of the provisions, obligations, or duties embodied in this Sub-

grant Agreement, Grantor will retain the right to exercise any administrative, contractual, equitable, or legal

remedies available, without limitation. A waiver by Grantor of any occurrence of breach or default is not a

waiver of subsequent occurrences. If Grantor or SUB-GRANTEE fails to perform any obligation under this

Sub-grant Agreement and the failure is subsequently waived by the other party, the waiver will be limited to

that particular occurrence of a failure and will not be deemed to waive failures that may subsequently occur.

ARTICLE IX. NOTICES

A. Notices to Grantor from Sub-grantee that concern termination, suspension, breach, default, or other

formal notices regarding this Sub-grant Agreement will be sent to Anita Kremer, Fiscal Administrator

for Mercer County Job & Family Services 220 W. Livingston Street, Celina, Ohio 45822.

B. Notices to the Sub-grantee from Grantor that concern termination, suspension, breach, default, or other

formal notices regarding this Sub-grant Agreement will be sent to , Routine communications

from GRANTOR to SUB-GRANTEE and from SUB-GRANTEE TO GRANTOR will be between the

representatives designated in section A and B of this Article IX. Each party will retain a

written record of any such communications.

C. All notices in accordance with sections A or B of this Article IX will be in writing and will be deemed

given when received. All notices must be sent using a delivery method that documents actual delivery to

the appropriate address herein indicated (e.g., certified mail).

ARTICLE X. AMENDMENT

This document constitutes the entire agreement between Grantor and Sub-grantee with respect to all matters

herein. Except as provided in Article XI, below, this Sub-grant Agreement may be amended only a document

signed by both parties. Both Grantor and Sub-grantee agree that any amendments to laws or regulations cited

herein will result in the correlative modification of this Sub-grant Agreement without the necessity for

executing written amendments. Any written amendment to this Sub-grant Agreement will be prospective in

nature.

ARTICLE XI. ADDENDA

Grantor may elect to provide information concerning this Sub-grant Agreement in addenda hereto. Any addenda

to this Sub-grant Agreement will not need to be signed. Any claim on or draw of monies following the receipt

of the addendum will constitute acceptance of the terms and conditions contained in the addendum.

Subsequently, Grantor may modify any addendum by mailing a modified version to Sub-grantee. Any claim on

or draw of the modified addendum will constitute acceptance of the terms and conditions contained in the

modified addendum.

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ARTICLE XII. SUB-GRANTS

A. Sub-grantee must perform all duties contemplated by this Sub-grant Agreement. None of Sub-grantee’s

duties or actions pursuant to this Sub-grant Agreement may be subcontracted, nor shall this Sub-grant

Agreement be assigned, or any sub awards made by Sub-grantee, without the prior express written

authorization of Grantor.

B. Any Sub-grants made by Sub-grantee to a unit of local government, university, hospital, other nonprofit,

or commercial organization will be made in accordance with 45 CFR 74 or 45 CFR 92.37, as applicable,

and will impose upon any Sub-grantee(s) the requirements of 45 CFR 74 or 45 CFR Part 92, as applicable,

as well as federal, state and local law. Any award of a Sub-grant to another entity shall be made by means of

a Sub-grant agreement which requires the entity awarded the county Sub-grant to comply with all

conditions, requirements, and restrictions applicable to Sub-grantee regarding the grant that Sub-grantee

Sub-grants to the entity, including the conditions, requirements, and restrictions of section 5101.21 of the

Revised Code.

C. Debarment and Suspension: As provided in 45 CFR 74.13 or 45 CFR 92.35, as applicable, Sub-grantee and

its Sub-grantees must not make any award or permit any award at any time to any party that is debarred or

suspended or is otherwise excluded from or ineligible for participation in federal assistance programs.

D. Procurement: While Sub-grantee and its Sub-grantees may use their own procurement procedures,

the procedures must conform to all applicable federal, state and local laws, including, as applicable, 45 CFR

92.36 or 45 CFR 74.40 through 45 CFR 74.48. In the event of conflict between federal, state, and local

requirements, the most restrictive must be used.

E. Monitoring: Sub-grantee must manage and monitor the routine operations of Sub-grant supported activities,

including each project, program, Sub-grant, and function supported by Sub-grantee’s Sub-grant, to ensure

compliance with all applicable federal requirements, including 45 CFR 92.40. If Sub-grantee discovers that

Sub-grant funding has not been used in accordance with federal, state and local laws, Sub-grantee must take

action to recover such funding.

F. Audit: Ensure that Sub-recipients expending Five Hundred Thousand and 00/100 Dollars ($500,000) or

more in federal awards during the Sub-recipient’s fiscal year have met the audit requirements of 45 CFR

74.26 or of 45 CFR 92.26 for that fiscal year. One (1) copy of each audit report must be sent to SUB-

GRANTEE within two (2) weeks of the Sub-recipient’s receipt of any such audit report.

G. Duties as Pass-through Entity: Sub-grantee must perform those functions required under federal, state and

local laws as a Sub-recipient of Sub-grantee under this Sub-grant Agreement and as a pass-through entity of

any awards of Sub-grants to other entities, including, but not limited to:

1 Identify the federal awards made by informing each Sub-recipient of the CFDA title and number, award

name and number, award year, whether the award is for research and development, and the name of the

federal awarding agency. When some of this information is not available, the pass-through entity will

provide the best information available to describe the federal award.

2. Advise Sub-recipients of requirements imposed on them by federal laws, regulations, and the provisions

of contracts or Sub-grant agreements as well as any supplemental requirements imposed by ODJFS or by

SUB-GRANTEE.

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3. Monitor the activities of Sub-recipients as necessary to ensure that federal awards are used for authorized

purposes in compliance with all applicable federal and state laws and regulations and the provisions of

contracts or Sub-grant agreements and that all performance goals are achieved.

4. Ensure that Sub-recipients expending Five Hundred Thousand and 00/100 Dollars ($500,000) or more in

federal awards during the Sub-recipient’s fiscal year have met the audit requirements of 45 CFR 74.26 or

of 45 CFR 92.26 for that fiscal year. One (1) copy of each audit report must be sent to SUB-GRANTEE

within two (2) weeks of the Sub-recipient’s receipt of any such audit report.

5. Issue a management report on audit findings within six (6) months after receipt of a Sub-recipient’s audit

report and ensure the Sub-recipient takes appropriate and timely corrective action.

6. Consider whether audits of Sub-recipients requires adjustments of SUB-GRANTEE’S own records.

7. Require each Sub-recipient to permit ODJFS, any other state or government entity, and federal and state

auditors to have access to their records and financial statements.

ARTICLE XIII. SUB-GRANTEE CERTIFICATION OF COMPLIANCE WITH GRANT

CONDITIONS

By accepting the Sub-grant and by executing this Sub-grant Agreement, SUB-GRANTEE hereby affirms

current and continued compliance with each condition listed in this Article XIII. SUB-GRANTEE’S

certification of compliance with each of these conditions is considered a material representation of fact upon

which GRANTOR is relying in entering into this Sub-grant Agreement.

A. If, at any time, SUB-GRANTEE is not in compliance with the conditions affirmed in this Section A,

GRANTOR will consider this Sub-grant Agreement to be void ab initio and will deliver written

notice to SUB-GRANTEE. Any funds the GRANTOR paid SUB-GRANTEE for work performed

before Sub-grantee received notice that the Sub-grant Agreement is void ab initio will be

immediately repaid or GRANTOR may commence an action for recover against SUB-GRANTEE.

1. Federal Debarment Requirements: SUB-GRANTEE certifies that neither SUB-GRANTEE nor

any principals is presently debarred, suspended, proposed for debarment, declared ineligible, or

voluntarily excluded from participation in covered transactions by any Federal department or

agency, as set forth in 45 CFR 92.35 (HHS), 29 CFR 98 (DOL), or 7 CFR 3016.35 (USDA).

SUB-GRANTEE also affirms that within three (3) years preceding this agreement neither SUB-

GRANTEE nor any of its principals:

a. Have been convicted of, or had a civil judgment rendered against them for commission of

fraud or other criminal offense with obtaining, attempting to obtain, or performing a public

(federal, state, or local) transaction or contract under a public transaction; for violation of

federal or state antitrust statutes; for commission of embezzlement, theft, forgery, bribery,

falsification or destruction of records, making false statements; or for receiving stolen

property;

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b. Are presently indicted or otherwise criminally or civilly charged by a government entity

(federal, state, or local) for commission of any of the offenses listed in this paragraph and

have not had any public transactions (Federal, State, or local) terminated for cause or default.

2. Qualifications to Conduct Business: SUB-GRANTEE affirms that it has the legal authority to

apply for Federal assistance and the institutional, managerial and financial capability (including

funds sufficient to pay the non-Federal share of project cost) to ensure proper planning,

management and completion of the project described in this application.

3. Finding for Recovery: SUB-GRANTEE affirms that neither SUB-GRANTEE nor its principals

are subject to a finding for recovery under ORC 9.24, or it has taken the appropriate remedial

steps required, or otherwise qualifies under ORC 9.24 to contract with Grantor, as Grantor is a

political subdivision of the State of Ohio.

B. If at any time SUB-GRANTEE is not in compliance with the conditions affirmed in this Section B,

GRANTOR may immediately suspend or terminate this Agreement and will deliver written notice to

SUB-GRANTEE. SUB-GRANTEE will be entitled to compensation, upon submission of a proper

invoice in accordance with Article III and Article V, only for work performed during the time

SUBGRANATEE was in compliance with the provisions of this Section B. Any funds paid for

work performed during a period when SUB-GRANTEE was not in compliance with this Section B

will be immediately repaid or GRANTOR may commence an action for recovery against SUB-

GRANTEE.

1. Ethics Law: SUB-GRANTEE certifies that it and all officers, employees and agents of SUB-

GRANTEE will comply with the requirements of the Ohio ethics law and Ohio law pertaining to

offences against justice and public administration, including, but not limited to, Sections 102.03,

102.04, 2921.02, 2921.42 and 2921.43, Revised Code.

2. Nondiscrimination: SUB-GRANTEE certifies that it will comply with all Federal and State

statutes relating to nondiscrimination, non-retaliation, and non-intimidation. These include but

are not limited to:

(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the

basis of race, color or national origin.

(b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and

1685-1686), which prohibits discrimination on the basis of sex.

c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits

discrimination on the basis of handicaps.

(d) The Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits

discrimination on the basis of age.

(e) The Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to

nondiscrimination on the basis of drug abuse.

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(f) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and

Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis

of alcohol abuse or alcoholism;

(g) O.R.C. Section 125.111 which requires that in:

(1) the “hiring of employees for the performance of work under the contract or any

subcontract, no contractor or subcontractor, by reason of race, color, religion, sex, age, disability

or military status as defined in section 4112.01 of the Revised Code, national origin, or ancestry,

shall discriminate against any citizen of this state in the employment of a person qualified and

available to perform the work to which the contract relates”; and

(2) That “no contractor, subcontractor, or person acting on behalf of any contractor or

subcontractor, in any manner, shall discriminate against, intimidate, or retaliate against any

employee hired for the performance of work under the contract on account of race, color,

religion, sex, age, disability or military status as defined in section 4112.01 of the Revised Code,

national origin, or ancestry.”

3. Pro-Children: SUB-GRANTEE certifies that it will comply with the requirements of the Pro-

Children Act of 1994 (20 USC 7183) imposing restrictions on smoking in facilities where

federally funded children’s services are provided.

4. Acknowledgement of Federal Funding: SUB-GRANTEE certifies that it will acknowledge

federal funding when issuing statements, press releases, request for proposals, bid invitations, and

other documents describing projects or programs funded in whole or in part with federal funding,

including statement of the percentage and dollar amounts of the total program or project costs

financed with federal funds and the percentage and dollar amount of the total costs financed by

nongovernmental sources.

5. Limited English Proficiency: SUB-GRANTEE certifies that it will take reasonable steps to

ensure that people with limited English proficiency have meaningful access to health and social

services and there is effective communication between the service provider and individuals with

limited English proficiency.

6. Resource Conservation: SUB-GRANTEE certifies that it will comply with the Resource

Conservation and Recovery Act (42 USC 6901) in giving preference in procurement programs to

the purchase of specific products containing recycled materials identified in guidelines developed

by the EPA (40 CFR parts 247 - 254).

7. Hatch Act: SUB-GRANTEE certifies that it will comply, as applicable, with provisions of the

Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of

employees whose principal employment activities are funded in whole or in part with Federal

funds.

8. SUB-GRANTEE certifies that it will give the awarding agency, the Comptroller General of the

United States and, if appropriate, the State, through any authorized representative, access to and

the right to examine all records, books, papers, or documents related to the award; and will

establish a proper accounting system in accordance with generally accepted accounting standards

or agency directives.

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9. SUB-GRANTEE certifies that it will comply with the Intergovernmental Personnel Act of 1970

(42 U.S.C. §§4728-4763) relating to prescribed standards for merit systems for programs funded

under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a

Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).

10.SUB-GRANTEE certifies that it will cause to be performed the required financial and compliance

audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-

133, " ( 2-CFR-200)Audits of States, Local Governments, and Non-Profit Organizations."

11.SUB-GRANTEE certifies that it will comply with all applicable requirements of all other federal

laws, executive orders, regulations, and policies governing the programs funded under this Sub-

grant Agreement.

ARTICLE XIV. MISCELLANEOUS TERMS AND CONDITIONS

A. Limitation of Liability: To the extent permitted by law, Grantor agrees to be responsible for any liability

directly relating to any and all acts of negligence by Grantor. To the extent permitted by law, Sub-grantee

agrees to be responsible for any liability directly related to any and all acts of negligence by Sub-grantee. In

no event shall either party be liable for any indirect or consequential damages, even if Grantor or Sub-

grantee knew or should have known of the possibility of such damages.

B. Choice of Law; Partial Invalidity: This Sub-grant Agreement will be governed, construed, and enforced in

accordance with the laws of the State of Ohio. Should any portion of this Sub-grant Agreement be found

unenforceable by operation of statute or by administrative or judicial decision, the remaining portions of this

Sub-grant Agreement will not be affected as long as the absence of the illegal or unenforceable provision

does not render the performance of the remainder of the Sub-grant Agreement impossible.

C. Construction: Nothing in this Sub-grant Agreement is to be construed as providing an obligation for any

amount or level of funding, resources, or other commitment by Grantor to Sub-grantee that is not

specifically set forth in state and federal law. Nothing in this Sub-grant Agreement is to be construed as

providing a cause of action in any state or federal court or in an administrative forum against the State of

Ohio, ODJFS, Grantor, or any of the officers or employees of the State of Ohio, ODJFS or Grantor.

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COUNTY AUDITOR CERTIFICATE

It is hereby certified that the amount required to meet the contract agreement, obligation, payment, or

expenditure for the above has been lawfully appropriated, authorized or directed for such purpose and is in the

County Treasury or in the process of collection free from any obligation of certificate now outstanding, as

required by § 5705.41(D) of the Ohio Rev. Code.

DATED_________________

___________________________

Randy Grapner, County Auditor

Approved as to form:

_______________________________________

Amy B. Ikerd,

Assistant Prosecuting Attorney

_____________________________________________ ______________________

Date

_____________________________________________ ______________________

Mercer Co. Commissioner – Chairman Date

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