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Request for Qualifications <br />Employment and Day Program Services <br /> <br /> <br />2017 Kittitas County RFQ 16 <br /> No <br /> <br />R. Have you had any findings or reports with corrective action? <br /> Yes, explain the issue and how the problem was resolved. <br /> No <br /> <br />S. Have you/your agency or any staff of your agency been named in any civil or criminal suit related to <br />providing services? <br /> Yes, please explain <br /> No <br /> <br />T. Has your agency/business ever operated under a different name? (Include information if the current <br />director was a director of another agency.) <br /> Yes, please indicate other name: <br /> No <br /> <br />U. Within the past three years, has all staff had clear DSHS Background Central Check Unit (BCCU)? <br /> Yes, please provide copies of their most recent background checks <br /> No <br /> <br />V. Please attach a projected organization chart that shows the name, title/role, and date of hire of each staff <br />person whose work would be related to services in Kittitas County. Include all applicable service, <br />administrative and finance staff. <br /> <br />W. Please attach a narrative or documentation in response to the following questions and include them with <br />your agency’s submission materials: <br /> Please describe your agency’s capacity to provide Employment and Day Program Services to <br />individuals. <br /> Signed Debarment/Suspension Statement. <br /> Copy/copies of all job descriptions relevant to provide Employment and Day Program Services. <br /> Information on staff that will be providing services, including brief resumes of each that describe <br />education, licenses and/or certifications, and experience. <br /> A copy of your agency’s table of contents of all written policies and procedures. <br /> A copy of your Business License. <br /> Proof of your agency’s Commission on Accreditation of Rehabilitative Facilities (CARF) <br />accreditation. <br /> A copy of your agency’s current Washington State Division of Vocational Rehabilitation (DVR) <br />Contract. <br /> Attach forms and/or explain your agency’s process to successfully develop and implement a plan <br />for providing services that are based on individual needs that include: <br />• Method for gathering information; <br />• How needs are assessed; <br />• Plan implementation; and <br />• Plan outcomes <br /> Review the DDA County Guidelines and explain how your agency will provide services in <br />accordance with the DDA County Guidelines: <br />https://www.dshs.wa.gov/sites/default/files/DDA/dda/documents/c_guidelines.pdf