Edmund G. Brown Jr., Governor

State of CaliforniaHealth and Human Services Agency

STATE OF CALIFORNIADEPARTMENT OF REHABILITATION

ASSISTIVE TECHNOLOGY PROGRAMREQUEST FOR APPLICATION

RFA AT-18-01

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DEPARTMENT OF REHABILITATIONASSISTIVE TECHNOLOGY PROGRAMREQUEST FOR APPLICATION-AT-18-01

ContentsI. AUTHORITY 3II. BACKGROUND 3III. PURPOSE OF THIS RFA 4IV. EMPLOYMENT OF QUALIFIED INDIVIDUALS WITH DISABILITIES 5V. DESCRIPTION OF SERVICES 6VI. KEY ACTION DATES 20VII. MINIMUM QUALIFICATION FOR APPLICANTS 20VIII. RISK MANAGEMENT PLAN 23IX. WORK PLAN: 100 POINTS POSSIBLE 24X. APPLICATION SUBMISSION REQUIREMENTS 27XI. REQUIRED FORMAT FOR A APPLICATION 27XII. SUBMISSION OF REQUIRED ELECTRONIC FLASH DRIVE COPY 28XIII. REVIEW PROCESS AND CRITERIA 28XIV. APPEAL RIGHTS FOR A REVIEW 29XV. DISPOSITION OF APPLICATIONS 29XVI. AGREEMENT EXECUTION AND PERFORMANCE 30XVII. ADDITIONAL REQUIREMENTS 30ATTACHMENT 1 32ATTACHMENT 2 33ATTACHMENT 3 34ATTACHMENT 4 37ATTACHMENT 5 38

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CALIFORNIA DEPARTMENT OF REHABILITATIONREQUEST FOR APPLICATION (RFA) AT-18-01Assistive Technology Act – CFDA # 84.224A

CALIFORNIA ASSISTIVE TECHNOLOGY PROGRAM GRANT

I. AUTHORITYThe Department of Rehabilitation (DOR) administers the California Assistive Technology (AT) Program (CFDA # 84.224A), authorized by the Assistive Technology Act of 2004 (AT Act), through funding from the United States Department of Health and Human Services Administration for Community Living (ACL)( 29 USC 3006). The California Assistive Technology (AT)Program supports state efforts to improve the provision of assistive technology to individuals with disabilities of all ages through comprehensive, statewide programs that are consumer responsive. The California AT Program makes assistive technology devices and services available to individuals with disabilities and their families.The DOR administers AT Hub Activities through Social Security Reimbursement (SSR) funds (Welfare & Institutions Code Sec. 19801-06) to ensure coordination of AT services throughout the state. This funding amount is currently allocated at $210,000 per year and is separate from the AT Act funding from ACL. This funding amount and activities are reported as state leveraged funding in the mandatory annual progress report to ACL.The DOR has the authority to administer the State Loan Guarantee Program (LGP) through funding from the Rehabilitation Revolving Loan Guarantee Fund (Welfare and Institutions Code, Section 19460-19471). The State Loan Guarantee Program provides financial loans to eligible individuals, and their parents or guardians, for the purchase of modified vehicles and assistive technology devices and services to facilitate independent living and employment.

II. BACKGROUNDAssistive Technology is any item, piece of equipment, or system, whether acquired commercially, modified, or customized, that is commonly used to increase, maintain, or improve functional capabilities of individuals with disabilities. (Source: AT Act, 29 USC §3002) State and Territory Assistive Technology Programs hereafter, AT Programs authorized under Section 4 of the AT Act focus on improving the provision of assistive technology through comprehensive, statewide programs that are consumer-responsive. The goal of the AT programs is to increase availability and acquisition of assistive technology through state-level activities and state leadership activities.

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The AT Act provides federal formula grants, administered by the Administration on Community Living in the Department of Health and Human Services, to support an AT Program in each state, as well as the District of Columbia, Puerto Rico, American Samoa, Guam, the Northern Mariana Islands, and the U.S. Virgin Islands. Funds are dependent upon annual federal appropriations.In 2004, the AT Act of 1998 was amended to require a common set of activities to be provided by all AT Programs. Required state-level activities include:

financing activities, device reutilization programs, device loan programs, and device demonstration programs.

Required state leadership activities include: training and technical assistance, public awareness, information and assistance activities, and coordination and collaboration.

All the state-level activities and the state leadership activities required of the AT Contractor are described in section V. Description of Services. (link to AT Act; https://www.gpo.gov/fdsys/pkg/PLAW-108publ364/html/PLAW-108publ364.htm).Assistive technology programs are required to serve people with all types of disabilities, of all ages, in all environments, and provide a wide array of activities to meet assistive technology needs. Programs must also serve family members, service providers, educators, therapists, employers, health and rehabilitation professionals, assistive technology vendors, procurement officials, and other interested parties throughout all versions of the AT Act (Association of Assistive Technology Act Programs [ATAP], 2011).The AT Act requires specific data reporting, financial reporting, and performance measures on services provided via the required state level and leadership activities (ATAP, 2011). This data will be entered and reported through the National Assistive Technology Act Data System (NATADS). NATADS is a web-based database application used to store the records of activities performed by State AT Programs and generate the mandatory Annual Progress Report.

III. PURPOSE OF THIS RFAThrough this solicitation, the DOR is seeking applications to establish an effective and efficient program for coordination and delivery of statewide assistive

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technology services. The DOR seeks applications to continue the coordination, support and provision of existing state leadership and state level activities as well as AT Hub activities through an organization located in California to operate as the California AT Program.The DOR, with input from the Assistive Technology Advisory Committee (ATAC), intends to award one well qualified organization a grant with a maximum award of $3,445,000 for a period of 39 months with an anticipated effective date of July 1, 2018 through September 30, 2021. This 39 month period would encompass 3 state fiscal years and an additional quarter to align this grant with the federal fiscal year. This award amount is contingent on continued availability of funds and DOR reserves the right to negotiate the final amount of the award. The Grantee will be responsible for reporting activities and funding amounts for both the AT Act funds as well as the state leveraged funding from the Social Security Reimbursement (SSR) funds in the monthly, quarterly and annual progress report to ACL and DOR. The overall goal of the assistive technology program is to increase availability and acquisition of assistive technology for people with all types of disabilities and of all ages through the provision of state-level activities, state leadership activities, and AT Hub activities.

IV. EMPLOYMENT OF QUALIFIED INDIVIDUALS WITH DISABILITIESIndependent living programs are supported through funding authorized by the Rehabilitation Act of 1973, as amended (The Act). Title VII, chapter 1 of the Act states the current purpose of the program is to “promote a philosophy of independent living including a philosophy of consumer control, peer support, self-help, self-determination, equal access, and individual and system advocacy, in order to maximize the leadership, empowerment, independence, and productivity of individuals with disabilities, and the integration and full inclusion of individuals with disabilities into the mainstream of American society.” A key provision of the Act requires that 51 percent of the Board of Directors and decision making staff of the funded Independent Living Center (ILC) must be people with disabilities. Since AT Hub supports the state network of independent living programs, the DOR is encouraging potential grantees to reflect this ILC requirement in their organizational leadership and staff that will be carrying out the program under this RFA and will consider this element in scoring the Organization and Capacity portion of this RFA.Disabilities include, but are not limited to:

Physical Disabilities Intellectual Disabilities and Developmental Disabilities Sensory Disabilities Mental Health Disabilities

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V. DESCRIPTION OF SERVICESThe successful grantee will build the capacity to provide a relevant, responsive program for persons with disabilities and be able to serve people with all types of disabilities, of all ages, in all environments, and provide a wide array of activities to meet assistive technology needs. Programs must also serve family members, service providers, educators, therapists, employers, health and rehabilitation professionals, assistive technology vendors, procurement officials, and other interested parties. Programs will provide the person with disabilities and their communities with working knowledge of available assistive technology devices, services, and resources to access assistive technology. As services are better tailored to individuals and communities statewide, more will be served by the successful grantee. Program performance will be measured through required quarterly and annual reports as follows: Objective data and performance measures:

o Increased numbers of persons with disabilities served in the required program service categories reflected in annual reports as compared to previous annual reports. Prior years’ service counts can be found at http://www.catada.info/activity-summary-report

o Identify and describe in quarterly and annual reports the unmet assistive technology service needs throughout the state, the nature and location of the service needs, and the methodology used to identify these service needs.

o Describe in quarterly and annual reports the strategies implemented to address the unmet needs that have been identified, progress towards meeting these unmet needs, and how these strategies will result in increased numbers of persons with disabilities in annual reports as compared to previous annual reports. These strategies may include:

o New memorandums of understanding between local community-based entities and partner organizations aimed at increasing AT services to persons with disabilities statewide.

o Support to other local community-based entities in the development of AT services that are culturally competent and appropriate.

o Develop partnerships with Special Education Local Plan Area (SELPAs) and Local Educational Agency (LEAs).

o Partnerships with the local businesses, community living services, community-based organizations, vocational services, and other entities to increase awareness and access to AT services.

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DESCRIPTION OF SERVICES TO BE PROVIDEDThe AT Act articulates the importance of improving awareness and access to assistive technology for persons with all types of disabilities, of all ages, and in all settings. This federal law authorizes funding for statewide assistive technology services that are supported through the California AT Program at the DOR through AT Act funding and through federal Social Security Administration reimbursements to the DOR. The funded programs include statewide assistive technology activities identified by the AT Act as “state leadership” and “state level” activities.

The awardee will continue and enhance the coordination, support and provision of existing state leadership and state-level activities as well as the AT Hub activities under a single organization located in California to operate as the California AT Program to enhance and expand services within all four categories of existing statewide programs listed below. The awardee will also collaborate with and provide regular reports to the California Assistive Technology Advisory Committee (ATAC) as described in the reporting requirement of the grant provisions (Attachment 5). The ATAC is a consumer-responsive, consumer-driven committee providing advice to the State for planning of, implementation of, and evaluation of the assistive technology activities carried out through the AT program.

STATE LEADERSHIP ACTIVITIESUnder the AT Act, state leadership activities are directed to organizations, agencies, education entities, service programs, health care facilities, and businesses as well as targeted to individuals with disabilities. Activities are also targeted to public and private entities that are responsible for policies, procedures, or funding for the provision of assistive technology devices and services. Under the AT Act, no more than 40% of AT Act grant resources should be directed to state leadership activities, which are training and technical assistance, public awareness (including information and assistance), and collaboration.In California, the state leadership activities category also includes the AT Hub, to support the “Assistive Technology Network.” The AT Network members include staff and AT Advocates at twenty-eight Independent Living Centers statewide, who also receive funding authorized by California Welfare & Institution Code Sections 19801-06, and who conduct assistive technology-related public education, outreach, information and referral, service coordination, and other direct services and leadership activities. The federally approved state leadership and AT Network support activities are outlined in sections A to C below.

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State Leadership Activities: Sections A to C (total level of AT Act funding: no more than 40%)A. Training and Technical Assistance

Training activities are instructional events, usually planned in advance for a specific purpose or audience that is designed to increase participants’ knowledge, skills, and competencies regarding assistive technology. Technical assistance is focused on providing extensive assistance to state or local agencies or other entities (rather than individuals) and generally involves problem solving to achieve a mutually agreed-upon goal. Technical assistance may involve multiple contacts and interactions over an extended period of time. The Awardee will develop and disseminate training materials, conduct trainings, facilitate access to assistive technology, and provide technical assistance to facilitate access to assistive technology for students with disabilities as outlined in the Individuals with Disabilities Education Act, and to adults with disabilities transitioning to community living.Training ActivitiesTraining activities include classes and workshops with a specific focus, including (a) skill development training in assessing the need for assistive technology devices and services; (b) overview of strategies to fund assistive technology; (c) instruction to ensure the appropriate application and use of assistive technology devices and services; (d) workshops addressing the importance of multiple approaches to assessment and intervention needed to meet the individualized needs of individuals with disabilities, and (e) technical training on integrating assistive technology into the development and implementation of service plans (e.g. IEPs, ISPs, IFSPs, IPEs, IPPs, etc.). Training sessions may include instructional events that otherwise meet the definition of training and are a part of local, regional, or statewide conferences, as long as the event occurs within the state of California and approved by the state assistive technology lead agency, the DOR. Upon award, the grantee is required to conduct one (1) training in

transition, either nursing home to community or schools to post-secondary life (work, higher education, independent living), AND one (1) training for information technology (IT) professionals (e.g. web designers, web masters) in accessible information technology (e.g. instruction on web accessibility standards). In lieu of conducting the training on accessible information technology directly, the grantee may host and/or recruit California IT professionals to attend content accessibility trainings provided by the California Department of Rehabilitation Disability Access Services.

Grantees are encouraged to conduct additional trainings on topics such as assistive technology and employment, assistive technology and inclusive

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education, assistive technology for Seniors, assistive technology for infants and toddlers, and transition age youth.

In response to this RFA, the Applicant will describe the targeted number of anticipated training events it will provide to groups of individuals, including representatives of local educational agencies, other state agencies (e.g. VR district offices; county education, mental health and disabilities offices), early intervention programs, adult service programs, hospitals and other health care facilities, institutions of higher education and businesses.The Applicant will identify the percentage of federal resources it will dedicate to its training and technical assistance efforts and reflect that percentage in the Proposed Budget & Budget Narrative

B. Public AwarenessThe AT Act describes public awareness activities as those designed to provide information to targeted individuals and entities relating to the availability, benefits, appropriateness, and costs of assistive technology devices and services.

Information and Assistance (I&A)As part of public awareness activities, the awardee will provide information and assistance to people with disabilities, service providers, and other stakeholders regarding assistive technology devices and services, availability of devices and services within California, the availability of funding and other acquisition resources (including referral to the Alternative Financing Program, as appropriate), and other assistance (e.g. device troubleshooting). The awardee will also provide information on the benefits of assistive technology devices and assistive technology services with respect to enhancing the capacity of individuals with disabilities of all ages to perform activities of daily living. All information must be provided in accessible formats designed to meet the needs of targeted individuals and entities.In its response to this RFA, the Applicant will describe:

1. Its plan for assuring good “customer service” in the provision of I&A, including its target for response time (e.g. a consumer will get a return call within one business day) and coverage when the person with primary responsibility for assistive technology I&A is out of the office for any reason.

2. The strategies it will use to increase the number of I&A requests related to assistive technology from the counties and regions across the state as compared in year over year annual reports.

3. Its agreement to do the following, as a part of I&A:

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(a)Distribute applications for the State Loan Guarantee Program and other similar Alternative Financing Program for assistive technology;

(b)Offer assistance to applicants with understanding and completing the assistive technology loan application;

(c)Connect consumers with other programs and resources related to California’s Assistive Technology Lending Library, Reuse Program, telecommunications access, and other assistive technology services.

(d) Maintain the toll-free telephone line for individuals with disabilities to call for information related to the enforcement of laws related to refueling services (Business and Professions Code 13660).

Public Awareness Activities & EventsThe awardee is expected to conduct public awareness activities for targeted groups of individuals relating to the availability and benefits of assistive technology devices and services for education, employment, and community living and which provide an overview of resources and programs of the AT Network and other state-supported assistive technology-related resources in the state. Public awareness activities encompass; presentations, expos and similar events; as well as outreach activities through a variety of media (web, brochures, general press, etc.).In its response to this RFA, the Applicant will describe:

1. Describe a plan for conducting targeted outreach statewide. 2. Conduct at least three presentations in each of the major regions in

California (e.g. Northern, Central, Southern) for at least 4 of the following disability related groups and at least 2 of the following general groups:

Disability Related Group

Organizations for people with intellectual or developmental disabilities

Brain Injury Groups

Parent of children with disabilities groups

Organizations for people who are blind or have vision Loss

Organizations for people who are deaf or hard of hearing

Aging and Disability Resource Connections (ADRC)

Transition Coordinator Programs

Career or Vocational Programs10

Special Education Advisory Committees

General Groups

Senior Centers / Meals on Wheels staff

Physicians / Healthcare Providers

Human Resources departments / organizations

Educators / Libraries

PTA / Home & School

Employers / Labor Groups

Home Health Care

Veterans Organizations

Service Organizations (Lions, Rotary, etc.)

Public awareness also includes the dissemination of information about other state-supported assistive technology programs, including the availability of home modification programs, the availability of low-interest alternative financing loans (e.g. Freedom Tech) and other public sources for assistive technology.In response to this RFA, the applicant will describe its plan to promote public awareness of assistive technology and CA resources through the use of print and other media including:

Its plan to create/update a universally accessible brochure, flier, or postcard that describes its role as the CA AT Program. The brochure, flier, or postcard will give the contact information including the URL for the state AT Program (http://www.dor.ca.gov/AT/index.html) and be available in additional alternate accessible formats upon request.

The number of articles that will be submitted to the “generic” press or other accessible media.

The applicant’s own digitally accessible print or e-newsletter, and the number of articles and issues in which it will include assistive technology content.

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The proposing agency’s use of social media (e.g. Facebook page, Twitter accounts, LinkedIn, etc.) projected instances of use to promote its assistive technology activities and those of AT Network (minimum: 3 each quarter).

WebsiteThe grant awardee is expected to have a website that is fully accessible to people with various disabilities (meets or exceeds Section 508 standards) and has consistently current information related to AT Network activities.In the response to this RFA, the Applicant will describe the accessibility of its website and its plan (including timelines) to provide accurate descriptions of its programs, clearly identifying activities supported entirely or partially with assistive technology funding. The website shall include links to the state AT Program (http://www.dor.ca.gov/AT/index.html), Assistive Technology Resources (http://www.dor.ca.gov/Public/Assistive-Technology-Links.html), Assistive Technology Advisory Committee (http://www.dor.ca.gov/boards-and-committees/ATAC), California Public Utilities Commission Support Programs (http://cpuc.ca.gov/ ).

In response to this RFA, the Applicant will designate the percentage of federal resources under this subgrant for public awareness efforts, including information and assistance, public awareness events, website, and other outreach.

C. Coordination and CollaborationCoordinate activities among public and private entities that are responsible for policies, procedures, or funding for the provision of assistive technology devices and services to individuals with disabilities, service providers, and others to improve access to assistive technology devices and services for individuals with disabilities of all ages in the state. Funds may not be used to purchase assistive technology for individuals.

STATE LEVEL ACTIVITIESState level activities are primarily directed to making assistive technology available to persons with all types of disabilities, of all ages, in all settings.The federally approved state-level activities for California as reflected in the State Plan for Assistive Technology are outlined in sections D to G below.State Level Activities: Sections D to G (total level of AT Act funding: no less than 60%)D. Access: AT Device Loan Program

Through the AT Device Loan Program under the AT Act, the Grantee shall directly, or in collaboration with public or private entities, carry out device loan

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activities that provide short-term loans of AT devices to individuals, employers, public agencies, or others seeking to meet the needs of targeted individuals and entities, including others seeking to comply with the Individuals with Disabilities Education Act, the American with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973. The AT Equipment Loan Program must include a broad range of AT devices, such as but not limited to alternative augmentative communication (AAC) devices, computer access devices, electronic note takers, and assistive listening systems. Currently 12 Device Lending Libraries (DLLs) provide statewide coverage for the AT Device Loan Program. The Grantee will continue funding the existing and any newly established DLLs at a minimum of $20,000 per year. Please note: Durable Medical Equipment will be excluded from the AT Device Loan Program. In response to this RFA, the Applicant will designate the percentage of federal resources under this grant for device loan activities and:1. Describe how funds available through this grant will be used to develop

and/or enhance the Applicant’s onsite device loan program. If the Applicant already operates an onsite device loan program, provide a description of the program.

2. Estimate the number of onsite loans to be processed during the grant contract period.

3. Assure any use of federal funds for device lending supplements state-funded lending activities implemented by the Applicant. For example, the Applicant might describe its plan to use federal funds to ship onsite devices to consumers in order to facilitate a device loan, or to provide additional hours of device support to a specified number of borrowers.

4. Assure the timely and accurate entry in the NATADS database of required information for all devices the Applicant has or may acquire for onsite loans. This includes all AT devices that will be housed at the Applicant agency and available for short-term loans for any purpose, whether obtained through California Public Utilities Commission’s Program (CPUC), the Assistive Technology Device Lending Library (DLL), AT funds or other resources.

5. Applicant will develop policies and procedures for its onsite device loan program. Applicants with an existing onsite device loan program must attach copies of existing policies and procedures.

6. Describe how the Applicant will obtain and report performance measures and satisfaction from each borrower in its area region who receives a device loan from their onsite loan program.

7. Describe how the Applicant will obtain performance measures and satisfaction from a minimum of 70% of all borrowers from its region who receive a device loan through the device lending program and decreasing the number of “non-respondents”.

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8. Identify the percentage of federal resources the Applicant will dedicate to its device loan efforts and reflect that percentage in the Proposed Budget & Budget Narrative.

E. Access: AT Device DemonstrationThe purpose of a device demonstration is to assist consumers, family members, and other stakeholders in making a decision about whether or not a device is appropriate, or, of available devices, which particular model will meet the needs of the individual with a disability. In some instances, a provider will be making such a decision on behalf of a specific individual with a disability.Demonstrations are consumer-responsive, based on the requests of individuals with disabilities and/or their families. Demonstrations will benefit consumers in one of three domains: work, school, or community. Demonstrations are “hands on” and should include more than one item in a particular category, in order to provide a basis for comparison and informed decision-making. A presentation about the range and scope of AT made to providers, faculty, and students, is NOT a demonstration, even if it is held in and Applicant’s “demonstration center” (if the agency has one) and a variety of devices are shown to attendees. If such a presentation is made to consumers, it is NOT a demonstration unless the consumer(s) is participating in order to make a decision about the AT that will meet his/her needs.Demonstrations are not intended to provide instruction in order to master a device, to customize a device for individual use, or to formally evaluate or assess a consumer’s abilities in order to prescribe a device. Services related to training consumers or customizing a device are reported elsewhere (e.g. as Information and Assistance or training). In addition to demonstrations that are scheduled in response to specific requests from individuals seeking to make a decision about AT, the Applicant may also develop a plan to provide a schedule of demonstrations, and promote those events to individuals with disabilities, family members, and providers who need to make a decision about AT. For example, an agency may choose to have a demonstration of video magnifiers once a month, publish the schedule, and provide outreach to target potential participants (e.g. individuals with macular degeneration who are trying to determine if a CCTV can help).In order to provide demonstrations, the Applicant’s staff must have technical expertise or “operational competence” with relevant devices. Operational competence means the knowledge and skill to perform basic set-up, operation (including customization), and trouble-shooting, and the ability to effectively convey that information to people with disabilities, family members, and other stakeholders who are seeking to make decisions about AT. Demonstrations must be conducted by individuals who have familiarity with multiple devices within a device type, in order to compare and contrast device features.

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In response to this RFA, the Applicant will designate the percentage of federal resources under this grant for device demonstration activities and:1. Describe the targeted number of anticipated demonstrations the Applicant

will provide to persons with disabilities and family members during the contract period.

2. Identify the location(s) where device demonstrations may be conducted.3. Describe the Applicant’s plan to increase public awareness of device

demonstrations available through the agency. These efforts can include an article in the agency newsletter, listserv/email notices to consumers and providers, website, flyers distributed to providers, support groups and at presentations, exhibitions and conferences.

4. Describe the capacity of Applicant staff to conduct device demonstrations, highlighting those categories of devices with which the staff has operational competence.

5. Describe the Applicant’s strategy for fulfilling a request for a device demonstration when a demonstration is requested for a device with which the Applicant’s staff does not have operational competence. This may include facilitating a demonstration conducted by a vendor (keeping in mind the necessity to provide consumer choice and the ability to compare and contrast options), developing an agreement or subgrant with a local agency that specializes in that category of device, identifying volunteers (e.g. users of the device) who are willing to assist, or other strategies identified by the Applicant in order to meet the consumer’s need for a device demonstration.

6. Assure the timely and accurate entry in the NATADS database of required information for all devices the Applicant has or may acquire for demonstration. This includes all AT devices that will be housed at the Applicant agency and available for demonstration, whether obtained through the AT Network, the Assistive Technology Device Lending Library (DLL), AT funds or other resources.

7. Assure that the Applicant will provide at least two referrals per demonstration (e.g. a funding source and appropriate vendor).

8. Develop policies and procedures for the Applicant’s device demonstration program. Applicants with an existing device demonstration program must attach copies of existing policies and procedures.

9. Describe how the Applicant will obtain and report performance measures from the primary recipient of the demonstration, striving for 100%, with no “non-respondents”.

10. Identify the percentage of federal resources the Applicant will dedicate to its device demonstration efforts and reflect that percentage in the Proposed Budget & Budget Narrative.

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F. Acquisition: AT Reutilization ProgramThrough the AT Reutilization Program the Grantee shall directly, or in collaboration with public or private entities, carry out AT device reutilization programs that provide for the exchange, repair, recycling, or other reutilization of AT devices. The AT device reutilization programs will facilitate redistribution using a website and other means wherein the DOR does not assume liability. Other acceptable forms of redistribution include device sales, rentals, or donations. The AT device reutilization programs will include, but are not limited to, previously owned computer equipment, durable medical equipment, electronic equipment, and others.The Grantee will support the AT Reuse Coalition, which is a small committee of representatives from organizations providing AT reutilization services that work together to develop ways to collaborate and build a statewide network that increases access to used AT devices with a focus on durable medical equipment. The AT Reuse Coalition will provide recommendations to the Grantee on marketing tools and strategies to increase access to used AT for individuals with disabilities. More information on the AT Reuse Coalition is available at http://californiareuse.org/. The Grantee will collaborate with currently funded organizations that provide AT reuse and refurbishment services in the AT Program Network. The Grantee will also continue to develop best practices for AT reuse and refurbishment and to support other organizations interested in starting or expanding AT reuse and refurbishment services.Reutilization programs are solutions for individuals with disabilities who need items public sources will not pay for (including back up devices); who need a device that is no longer manufactured; or who have an acute need for a device while they pursue or wait for funding. Reutilization programs include (1) refurbishment programs, where donated devices are cleaned up, sanitized, repaired or otherwise “made ready” for new owners, (2) exchange programs, where individuals with devices to sell or donate advertise the device, and individuals in need of a device can look to see if the device they need is available and then contact the donor/seller to make the arrangements for sale and transfer of the device, (3) reassignment of new devices (e.g. donations of excess stock from a supplier) are also considered a form of reutilization and (4) open-ended loans where the consumer can continue to use the item until no longer needed (not recommended).

In response to this RFA, the Applicant will designate the percentage of federal resources under this subgrant for reutilization activities and:

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1. Describe how funds available through this grant will be used to develop and/or enhance the Applicant’s device reutilization activities. Specify the estimated number of individuals who will receive reutilized devices during the contract period.

2. If the Applicant already operates a reutilization program, provide a description of the program (refurbishment, reassignment, open-ended loan; means of operation; types of equipment; eligibility; contact information).

3. Describe how it will promote reutilization through the following activities:(a)Develop, maintain, promote, and administer an AT Exchange website

which will serve as a statewide inventory of AT available through the Applicant and program partner’s AT loan and reuse programs.

(b)Contact individuals who advertise in the Proposing agency’s newsletter or other mechanisms operated by the Applicant, to invite and facilitate consumer listings in the AT Exchange page;

(c)Promote local, regional and statewide reuse programs, including but not limited to those of the AT Network, in the proposing agency’s newsletter;

(d)Identify and maintain an annotated directory of agencies and organizations in the AT Network who conduct reuse, open-ended loan, or “classifieds” exchange activities, and a description of the characteristics of those programs in order to make referrals for reuse.

(e)Develop Memoranda of Understanding, if needed, to promote and facilitate interactions between the Applicant and reutilization programs in the state. Where agreed to by those agencies and organizations (and the sellers in their programs, if applicable), Applicant staff shall directly list items in the AT Exchange classifieds.

(f) Describe the Applicant’s ability to pick up donations or deliver equipment to recipients of reuse activities. Describe the Applicant’s strategy for picking up/delivering reused devices statewide.

(g)Maintain a current description of the Applicant’s reuse program on the NATADS online database system.

(h)Coordination and support of state emergency disaster relief.4. Develop policies and procedures for the Applicant’s device reuse program,

including policies about equipment cleaning and sanitizing, proper disposal (end-of-life), and charging fees to recipients of reassigned AT devices (including for pick up/delivery/shipping), as necessary. Applicants with an existing reutilization program must attach copies of existing policies and procedures.

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5. Assure the Applicant will obtain performance measures and satisfaction from every individual who receives an AT device from its reutilization efforts, and report them in the NATADS database.

6. By December 01, 2018, complete the Indicators of Quality for Assistive Technology Reuse (IQ-AT Reuse) survey, an interactive tool of quality indicators that looks at “promising practices” in the area of assistive technology reuse at this link: http://www.passitoncenter.org/iq_atr.php. The results of this survey are to be shared with the ATAC and must be used to develop strategies for delivery of AT Reuse services during the 3-year cycle of this grant.

7. Identify the percentage of federal resources the Applicant will dedicate to its reutilization efforts and reflect that percentage in the Proposed Budget & Budget Narrative. .

G. Alternative Financing ProgramThe Alternative Financing Program (AFP) is known in California as the State Loan Guarantee Program (LGP). The LGP is funded through a State fund called the Rehabilitation Revolving Loan Guarantee Fund. The administration of the program is funded through AT Act funds. As the LGP is a financial loan program, according to state regulations, a licensed lending institution in California needs to administer the loans. The Grantee will be responsible for the administration of the LGP directly, if eligible, or through partnering with qualified, licensed lending institution(s). The purposes of these loans are to provide increased access to, and funding for, AT devices and services. The financial institution will be responsible for providing the consumer loan payments and any defaults when applicable.Through the LGP, the Grantee, directly or in partnership with licensed lending institution(s), provides loans to eligible Californians with disabilities or their parents/guardians for the purchase of modified vehicles, durable medical equipment, adaptive aids, and other AT necessary to live independently and for employment. The program can guarantee a loan for no less than $1,000 and no more than $50,000 to any eligible applicant. A maximum of $700,000 through the Rehabilitation Revolving Loan Guarantee Fund is available for loans and is determined based on availability of funding.Individual eligibility for this program includes: 1) Adults with disabilities, parents of children with a disability and legal

guardians of children with a disability who require a modified vehicle for mobility as certified by a physician or the DOR.

2) Adults with disabilities and parents of children with disabilities who require AT to live more independently as certified by a physician or the DOR.

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3) Household income that does not exceed the level prescribed for moderate-income families by the Department of Housing and Community Development pursuant to Section 50093 of the Health and Safety Code.

4) Applicant is able to show their ability to repay the loan.H. AT Lease to Own ProgramContingent on the determination by the DOR of availability of funds in the Rehabilitation Revolving Loan Guarantee Fund, the contractor/grantee will establish an AT Lease to Own Program. The AT Lease to Own Program would provide AT to consumers on a leased arrangement and would include a lease-to-buy provision. This program model provides loans without interest rates or underwriting and can be managed through non-financial institutions such as ILCs and Device Lending Libraries. This program model is intended for financing under $2,500, to complement the LGP that supports higher amount loans. The Grantee will propose, develop, and establish an AT Lease to Own program to help alleviate some of the challenges that communities with disabilities face when obtaining AT. The AT Lease to Own program would provide AT to consumers on a leased arrangement which provides savings over a direct purchase. The lease to own option can support consumers with building their credit as well as building financial literacy skills and healthy financial habits. The Grantee will collaborate with ILCs, Device Lending Libraries, and other qualified non-profits to provide the Lease to Own Program services. The AT Lease to Own Program funding amounts for the lease to own option would be from $250 to $2,499. These funding amounts are in alignment with the California Financial Code Section 22066 for non-profit entities which states that, “The Legislature finds and declares that nonprofit organizations have an important role to play in helping individuals obtain access to affordable, credit-building small dollar loans. California law should refrain from creating statutory barriers that risk slowing the growth of these loans. This section shall be liberally construed to encourage nonprofit organizations to help facilitate the making of zero-interest, low-cost loans, through lending circles and other programs and services that allow individuals to establish and build credit histories or to improve their credit scores.” The Grantee would purchase the AT and manage the lease to own contracts with consumers. The recovery of funds will be reallocated to the AT Lease to Own Program Fund. The Grantee would also support outreach efforts for the program and respond to external inquiries for services from consumers with information and referral and monitor lease to own activity to ensure compliance with grant provisions and state and federal laws.

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VI. KEY ACTION DATES

Event Responsible Party Due DateRFA available to prospective applicants DOR February 12, 2018

Deadline to submit written questions Applicants February 23, 2018

Applicants Conference DOR and Applicant March 9, 2018

Addendum “Questions and Answers” posted to the DOR website

DOR March 16, 2018

Application Submission Applicant March 26, 2018 by 3:00 pm

RFA Screening and Evaluation DOR April 2-April 30,

2018Notice of Intent to Award DOR May 1, 2018Last date to file appeal Applicant May 31, 2018Preparation and execution of grant package

DOR and Applicant

June 1 – June 30, 2018

Grant Effective Date All July 1, 2018

VII. MINIMUM QUALIFICATION FOR APPLICANTSApplicants eligible to apply for this RFA must be a California licensed or certified organization with a demonstrated commitment to the philosophy of independent living, a history of consumer involvement, experience in the delivery of AT state leadership and state level activities, expertise in AT devices and services as well as how people with disabilities can acquire them. Applicants must serve individuals regardless of age or type of disability and must clearly articulate how they will achieve statewide reach in delivery of all required services.The applicant must demonstrate that it meets the following eligibility criteria for this RFA:

1) If the Applicant is a nonprofit organization, then the Applicant must possess and submit a determination letter as an approved nonprofit corporation confirming the agency's 501(c)(3) status with the Internal Revenue Service and the California Franchise Tax Board;

2) The Applicant has the financial stability to administer this program. In order for the DOR to make this determination, the applicant must supply the Statement of Financial Position (balance sheet) for the most recently

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completed agency fiscal year and provide a bank statement from within the last 90 days that illustrates the agency’s cash flow.

3) Proposing agency receiving funding will be required to provide insurance certificates for commercial general liability, automobile liability, and workers compensation (see Insurance Requirements in Attachment 5 section 7);

4) Must have authority to do business in California. The Applicant must submit proof of good standing (active status) with the Secretary of State. A screen print from the California Secretary of State Business Entity Detail is acceptable; and

5) Be in good standing with the Department of Rehabilitation and the State of California.

An Applicant is considered to be in good standing with the Department if it:

o Has no unpaid liabilities or unresolved debt to the Department, or is current on an agreed-upon payment plan

o Has not had a grant or contract discontinued by the Department in the last two (2) years (other than for expiration of the term or unavailability of funds by the Department).

An Applicant is NOT considered to be in good standing with the Department if it:

o Has received audit findings or findings of non-compliance from the Department and has not complied with the findings as of the final date for submission of applications, including findings that are under appeal.

6) Two letters of reference will be required from two different partner programs, such as, but not limited to, ILCs, LEAs, DSPS offices, or SELPAs that confirm the applicant’s ability to develop service delivery models for assistive technology for people with disabilities. The partner programs do not need to be agencies with which the applicant has a formal contractual agreement or relationship.

Any application that does not meet all of the minimum qualifications will be deemed non-responsive and may not be considered for review.

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A. AssurancesThe Grantee must make the following assurances, effective upon award. Additional assurances will be required as attachments to the contract (see attachment 4).

1. Materials (including web pages, PowerPoint, brochures) developed under the grant contract will acknowledge the Department of Rehabilitation funded through a grant from the Administration on Community Living, US Department of Health and Human Services. Materials should include the DOR logo (to be provided). Electronic resources (e.g. webpages) must be accessible with 508 compliance.

2. In other activities (e.g. demonstrations, reutilization, public awareness activities [presentations, expos, press releases], and training), the grantee will identify itself as a part of the California Department of Rehabilitation Assistive Technology Act Program.

3. Funding received by the grantee under this RFA will be used to supplement, not supplant, amounts available from other sources for technology-related assistance (e.g. the applicant will not use funding received under this RFA to provide direct services to consumers for which alternate funding is available through Vocational Rehabilitation, Medical Assistance, Special Education, or other public sources).

4. The grantee will ensure consumer choice in selecting providers of assistive technology devices and services (e.g. evaluation, training), especially where the grantee is also a fee-for-service AT provider.

5. The grantee’s services and programs are available to persons of all ages, regardless of nature or degree of disability.

6. The grantee is housed in a building free from architectural and communication barriers. The grantee has a working text telephone (TTY) and/or videophone on site.

7. The grantee will provide reasonable accommodations to meet the needs of individuals with disabilities seeking services of the grantee. Upon request, all materials will be available in a timely fashion in alternative formats (including braille, accessible electronic text, etc.).

8. The grantee will comply with any otherwise applicable provisions of the Americans with Disabilities Act.

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9. The grantee will comply with Section 508 of the Rehabilitation Act (access to electronic information technology). This includes the assurance of accessibility of the grantee’s website.

10. The grantee will expend all federal AT Act monies ($850,000 annually) received under this grant in accordance with the specified distribution of at least 60% for “state-level” activities and no more than 40% for “state leadership” activities, and in accordance with the distribution within “state level” and “state leadership” as proposed in its approved statement of work.

VIII. RISK MANAGEMENT PLAN A risk management plan refers to a document that addresses the process of identifying, analyzing, controlling, and mitigating risks so as to reduce the likelihood or impact of negative events a youth or person with limited cognitive ability participating in a program may be subject to.All grant applications must contain a Risk Management Plan that addresses how the applicant organization will maintain the safety of the youth or person with limited cognitive ability participating in the proposed program. In order to be awarded a grant, the Risk Management Plan must address all of the elements listed below:

1) Education and Training2) Policies and Procedures3) Reporting Systems4) Background Checks and Fingerprinting5) Employment of Individuals with Criminal Histories6) Notification of Personnel Changes7) Health and Safety Responsibilities8) Weapons

Please refer to Attachment 3 Risk Management Plan for specific instructions on how to draft a Risk Management Plan designed specifically for the applicant’s proposed program for submittal.All employees, volunteers, interns, subcontractors, and others who provide services under the grant must undergo a background check, including criminal history information based on fingerprints obtained from the California Department of Justice (DOJ) and Federal Bureau of Investigation. Applicants may find information on applying to become an applicant agency authorized to receive criminal offense record information at the DOJ’s website, Finger Print Background Check : https://oag.ca.gov/fingerprints

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IX. WORK PLAN: 100 POINTS POSSIBLEAll grant applications must contain a Work Plan that addresses how the applicant organization will carry forth this RFA per the areas outlined below. The work plan shall be in the following format:

Typed, Single sided pages, Double-spaced, Maximum of 20 pages (excluding duty statements, job announcements,

and resumes), and Arial 14 point font

The work plan must address the following areas described:A. Organizational Structure and Capacity (20 points possible)

Describe the organization’s mission, goals, values and the organization’s geographic service area and capacity to extend services statewide.

Describe the organization’s existing capacity for delivery of AT services and identifying and addressing emerging AT issues.

Describe the organization’s ability to develop and share with statewide partners the AT service models developed as the California AT Program and AT Hub.

Describe how the organizational structure will lead to effective statewide delivery of AT services.

Describe how the organization exemplifies independent living values of peer support, consumer control, civil rights, integration, equal access, and advocacy.

Describe how the organization attempts to reflect the independent living ideal that 51 percent of the organizations decision making staff must be people with disabilities.

B. Key Personnel (20 Points possible) Provide a duty statement and resume (or job announcement if the position

is vacant) for all positions (both administrative and programmatic) which are integral to providing services to persons with disabilities, particularly in the area of AT service provision and expertise with AT.

Describe how the collective duties, training, and experience of all relevant positions will result in effective program development and delivery of AT services to persons with disabilities.

Describe how the collective experience of relevant positions meet the following qualifications:

o Experience with working with persons with disabilities,o Experience with assessing the needs of persons with disabilities,

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o Experience with AT devices, AT services and how people with disabilities can acquire them,

o Experience in developing and implementing statewide service delivery models,

o Experience with working in partnership with other providers of services to persons with disabilities, such as ILCs, LEAs, Disabled Students Programs and Services (DSPS), rehabilitation services, vocational services, or health professionals, community based workers, social workers, regional centers, and;

o Experience in providing training and support to other organizations in the delivery of AT services for persons with disabilities.

C. Core Service Delivery (25 Points possible) Describe how persons with disabilities will be identified to receive AT

services, where the services will be provided, how many people will be served, and how these items were selected to maximize impact of AT services.

Describe how the AT services will be provided (individually, in a group, both, etc.) and how this approach facilitates the success of persons with disabilities.

Describe the techniques, approaches, and methods to be used in performing and successfully providing the following AT services to participants: State Level Activities

o AT Device Loan Programo AT Reutilization Programo Alternative Financing Programo Device Demonstrations

State Leadership Activitieso Training & Technical Assistanceo Public Awarenesso Coordination and Collaboration

D. Coordination of Services (15 Points possible) Describe how the organization will support, partner with, and provide

technical assistance to the AT Advocates at the 28 ILCs and 12 DLLs that make up California’s AT network.

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Describe how the organization will coordinate the collection of AT service delivery data from the AT Advocates and DLLs in California’s AT network for annual reporting requirements.

Describe how the organization will create dynamic relationships with other organizations, such as vocational rehabilitation programs, SELPAs, LEAs, regional centers, health care professionals, businesses, and ILCs in the organization’s geographic area and statewide.

Describe how the organization will collaborate with local businesses, state agencies, and community organizations serving persons with disabilities.

Describe how the organization will package and disseminate the best practices and AT service delivery models developed through this program to the broader AT and ILC Network.

E. Proposed Budget and Fiscal Planning (20 points possible) Provide an all agency budget that describes the organization’s existing

revenues, revenue sources, and allocation of revenues. Describe the activities, processes, and procedures that the organization

engages in to ensure ongoing financial solvency and safeguard against unforeseen financial hardships.

Describe how the organization will maximize use of resources for program services and minimize unnecessary administrative costs.

Provide a budget narrative line and item cost proposal worksheet that demonstrates how resources made available through this grant will be allocated.

Describe how the organization will manage and track federal AT Act funds as outlined according to the required percentages in the AT Act; i.e. no more than 40% of AT Act funds on State Leadership activities and no less than 60% of AT Act funds on State Level activities.

Applicant will include the following chart in their RFA response, showing a summary of the percent of AT Act funds that will be directed towards the required activities. NOTE: This budget summary should not include the allocated SSR state leveraged funding of $210,000 per year and should only reflect the AT Act federal funds.

Activity Percentage Allocated Budget Amount

A. Training & Technical AssistanceB. Public AwarenessC. Coordination & CollaborationSUBTOTAL STATE LEADERSHIP: 40%

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D. Device LoanE. Device DemonstrationF. ReutilizationG. Alternative Financing

ProgramSUBTOTAL LEVEL: 60%

X. APPLICATION SUBMISSION REQUIREMENTSApplicants must follow all application format instructions in providing all required information in an accessible format.Submission of a complete Application requires timely DOR receipt of both printed and accessible electronic copies.Applications that do not contain all of the required elements, or those in which the printed copy and electronic copy content do not match, or do not comply with the given instructions or criteria for the RFA will be considered non-responsive and may be disqualified from the evaluation process.

XI. REQUIRED FORMAT FOR A APPLICATIONApplications must be in accessible formats. Further information on making documents accessible is available at the following website: California Department of Rehabilitation - Making Documents Accessible. http://www.dor.ca.gov/DisabilityAccessInfo/How-do-I-Construct-Accessible-Documents.htmlThis requirement applies to all elements submitted in printed and electronic formats. Elements submitted in a non-accessible format may be considered non-responsive, and disqualified from the evaluation.To be considered for award, applications must comply with the instructions and criteria given. Each application must contain one (1) original and five (5) complete printed copies of all items being submitted, as well as one (1) accessible Word compatible electronic version on a flash drive.The application envelope must be plainly marked with the RFA number and title, your organization’s name, and the words “DO NOT OPEN,” as shown in the following format:

Department of RehabilitationRFA AT-18-01State Grant for Assistive Technology Your Organization’s NameDO NOT OPEN

Mail or deliver applications via U.S. Postal Service, United Parcel Service, Federal Express, or hand delivery, to the following address:

Department of Rehabilitation27

RFA AT-18-01Attention: Independent Living and Assistive Technology SectionAssistive Technology Program Coordinator721 Capitol Mall, 4th floorSacramento, California 95814DO NOT OPEN

Applications not submitted in a sealed envelope and marked as indicated may not be considered for contract award.

XII. SUBMISSION OF REQUIRED ELECTRONIC FLASH DRIVE COPYElectronic submissions must be made following the same schedule outlined for the hard copy application.Flash drive must be included in the envelope with the hard copy application.

XIII. REVIEW PROCESS AND CRITERIAPhase 1 – Administrative ReviewApplications will be reviewed and evaluated for timeliness and completeness of RFA specifications. In this review stage, reviewers will compare the contents of each application to the Required Documents Checklist and ensure that the minimum qualifications are met. Applications that do not contain all of the required items listed on the Required Documents Checklist may be considered non-responsive, and disqualified from the evaluation.Phase 2 – Evaluation PanelThe Evaluation Panel members are qualified employees of State of California departments and agencies who have knowledge of or experience with grant making and assistive technology related service programs in the State of California, or individuals from outside of state service who have “technical expertise” as current or former practitioners of the activities described in this RFA. The Evaluation Panel will review and score the applications in accordance with the RFA scoring criteria.

A. The DOR’s goal is to award one grant contract to ensure AT Services are available to persons with disabilities in California statewide. The DOR reserves the right to reject all applications. The DOR is not required to award any grants.

B. One (1) grant may be awarded to the highest scoring application.C. Tiebreaker: In the event there is a tie, the Evaluation Panel will break the tie

by awarding the grant to the application with the highest score in the most heavily weighted scoring category. If those scores are the same, the Evaluation Panel will break the tie by awarding the grant to the application with the highest score in the second most heavily weighted scoring category.

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If there is still no apparent winner, continue selecting the most heavily weighted scoring category to break the tie.

Rating/Scoring Criteria Maximum Possible PointsOrganizational Structure and Capacity 20Key Personnel 20Core Services 25Coordination of Services 15Proposed Budget & Budget Narrative 20

Total Possible Points 100

XIV. APPEAL RIGHTS FOR A REVIEWThe California Code of Regulations, title 9, section 7334(d) provides appeal rights for awards. Applicants who are dissatisfied with a decision of the DOR relative to an application may request a review by the DOR Grant Review Committee. The request for review must be in writing and:

Clearly identify all issues in dispute; Contain a full statement of the applicant’s position with respect to each

issue; and Contain pertinent facts and reasons in support of the applicant’s

position.The written request must be submitted to the DOR within 30 days of the release of the Notice of Intent to Award by email to: GrantappealCommittee@dor.ca.govThe DOR Grant Review Committee reviews all such requests and is appointed by the Chief Deputy Director. The DOR Grant Review Committee shall consist of up to three (3) DOR employees or appointees, selected at the Chief Deputy Director’s discretion. The DOR Grant Review Committee shall review the request and notify the requesting party in writing of the decision within 30 days of receipt of the request. The decision of the Grant Review Committee is final.

XV. DISPOSITION OF APPLICATIONSUpon application opening, all documents submitted in response to this RFA will become the property of the State of California, and will be regarded as public records under the California Public Records Act (Government Code section 6250 et seq.) and subject to review by the public.Unsuccessful or disqualified application packages may be returned upon request and at the applicant's expense.29

XVI. AGREEMENT EXECUTION AND PERFORMANCEPerformance shall start no later than 30 days, or on the express date set by DOR and the grantee, after all approvals have been obtained and the Grant Agreement is fully executed. Should the grantee fail to commence work at the agreed upon time, DOR, upon five (5) days written notice to the grantee, reserves the right to terminate the Agreement.In addition, the grantee is responsible to perform the work as described in the approved grant narrative & Budget Narrative; all unanticipated costs are the responsibility of the grantee.

XVII. ADDITIONAL REQUIREMENTSOnce grants have been awarded, grantees will be required to adhere to the following additional requirements:

A. INSURANCEI. Coverage Term – Coverage needs to be in force for the complete term of

the Grant Agreement. If insurance expires during the term of the grant, a new certificate must be received by the State at least ten (10) days prior to the expiration of this insurance. Any new insurance must still comply with the original terms of the grant.

II. Policy Cancellation or Termination and Notice of Non-Renewal – Insurance policies shall contain a provision stating coverage will not be cancelled without 30 days prior written notice to the State. In the event Grantee fails to keep in effect at all times the specified insurance coverage, the State may, in addition to any other remedies it may have, terminate this Grant upon the occurrence of such event, subject to the provisions of this Grant.

III. Deductible – Grantee is responsible for any deductible or self-insured retention contained within their insurance program.

IV. Primary Clause – Any required insurance contained in this grant shall be primary, and not excess or contributory, to any other insurance carried by the State.

V. Insurance Carrier Required Rating – All insurance companies must carry a rating acceptable to the Department of General Services Office of Risk and Insurance Management. If the Grantor is self-insured for a portion or all of its insurance, review of financial information including a letter of credit may be required.

VI. Endorsements – Any required endorsements requested by the State must be physically attached to all requested certificates of insurance and not substituted by referring to such coverage on the certificate of insurance.

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VII. Inadequate Insurance – Inadequate or lack of insurance does not negate the grantee’s obligations under the grant.

B. DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION

Federal and State agencies shall not award assistance to applicants that are debarred or suspended, or otherwise excluded from or ineligible for participation in federal assistance programs under Executive Order 12549. By signing the Agreement, grantee certifies that neither it nor its principals or sub grantees are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. (Reference website: http://www.sam.gov).

C. PROHIBITION ON TAX DELINQUENCYAny Agreement that a state agency enters into after July 1, 2012, is void if the grant is between a state agency and a grantee, or subcontractor, whose name appears on either list of the 500 largest tax delinquencies pursuant to Section 7063 or 19195 of the Revenue and Taxation Code. (Public Contract Code section 10295.4). In accordance with Public Contract Code section 10295.4, agencies are required to cancel Agreements with entities that appear on either list. Franchise Tax Board (https://www.ftb.ca.gov/aboutFTB/Delinquent_Taxpayers.shtml)Board of Equalization (http://www.boe.ca.gov/cgi-bin/deliq.cgi)

D. RISK MANAGEMENT PLAN The Grantee’s Risk Management Plan will be attached and made a part of the Grant as Exhibit F.

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ATTACHMENT 1Application Organization and Required Document Checklist

A complete application package must consist of the items identified below. Complete this checklist to confirm the items are included in your application. Place a check mark or “X” next to each item that you are submitting to the State. For your application to be responsive, all required documents listed below must be returned with bid. This checklist must also be returned with your bid package.Name/Description

_____ Required Attachment Check List (Attachment 1)

_____ Cover Sheet (Attachment 2) signed by authorized representative

_____ Application Narrative and/or Work Plan (maximum of 20 pages). (5 printed originals as well as one (1) accessible Word compatible electronic version on a flash drive.)

_____ Proposed Budget & Budget Narrative

_____ Cost Application Worksheet with breakdown of funds toward state level and state leadership activities (60% state level; 40% state leadership)

_____ Statement of Assurances (Attachment 4)

_____ Articles of Incorporation

_____ Organization’s bylaws

_____ Proof of insurance coverage

_____ Statement of Financial Position (balance sheet) for the most recently completed fiscal year and bank statement from within the last 90 days.

_____ Risk Management Plan (Attachment 3)

_____ Two Letters of Reference

_____ Staff resumes or Duty Statements for key personnel or positions identified who will provide RFA related duties during the grant period

_____ Non Profit Status Letter – Internal Revenue Service and California Franchise Tax Board (if applicable)

_____ Corporation – Proof of good standing and qualification to conduct business in the State of California

At the time of award the successful bidder will be required to submit a Payee Data Record (STD 204).32

ATTACHMENT 2Cover page sheet

1. Applicant (Organization):

______________________________________________________

Address ____________________________________________________

City___________________ County ___________ ZIP Code ___________

Tax ID Number _______________________________

2. Project Director: Name ______________________________Title ________________________________Telephone __________________________

3. Grant Administrator: Name______________________________ Title_______________________________ Telephone ___________________________

4. Contact person for application, if different than Project Director: Name _____________________________ Title _______________________________ Telephone ___________________________

The applicant certifies that, to the best of his or her knowledge and belief, the data in this application are true and correct.

Name of Authorized OfficialPrint _________________________ Signature _________________________________ Date _____________

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ATTACHMENT 3

Risk Management PlanThe specific sections identified below of the Applicant’s Risk Management Plan must be included in the application submission. All applicants will be required to submit their entire Risk Management Plan.For each of the elements listed below provide the applicable portion(s) of the Risk Management Plan that contains the information required for the element. 4.1 Education and Training of StaffIdentify the section(s) and pages(s) of the Risk Management Plan that contains the details on how staff will be trained on topics, such as protecting students and or persons with limited cognitive ability from abuse and recognizing, responding to, and reporting abuse.4.2 Policies and Procedures Attach the portion(s) of the Risk Management Plan that contain the policies and procedures that ensure:

Check in and checkout procedures (parents, conservators, and guardians authorized to pick up students, restrictions on unauthorized persons)

Supervision and services are provided with a minimum of two staff present Prohibition of one-on-one contact First Aid Plan Transportation Plans Allowable modes of transportation Standards for vehicles, drivers, training, passenger safety, and checklists Insurance coverage to ensure the health, safety, and protection during

transport for consumers Respect of privacy participants, staff, and volunteers Collection and security of health, medical, and emergency information Student confidentiality Medications and administration of medications during program hours Appropriate response to Emergencies:

o Medical, fire, evacuation, intruder, earthquake, extreme weather, emergency transportation notification to parents or legal guardians

How policies and procedures are communicated to workers who may not read or speak English

Appropriate response to media inquiries

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Program transparency, including communicating with parents, conservators and guardians who may not read or speak English.

4.3 Reporting SystemAttach the portion(s) of the Risk Management Plan that contains the reporting systems and training, including reporting incidents within organization and to DOR and to authorities pursuant to mandated reporting laws. 4.4 Background Check and FingerprintingAttach the portion(s) of the Risk Management Plan that contain details on how the bidder evaluates the results of the background checks of employees, interns, grantee, contractors, volunteers or others who will provide services or have a supervisory responsibilities over youth and/or persons with limited cognitive ability participants under this Agreement.4.5 Employment of Individuals with Criminal HistoriesAttach the portion(s) of the Risk Management Plan that contain details on the following:

a) Description of how the bidder will not either directly employ, on a contract, or volunteer basis any adult or juvenile person for a teaching or mentoring position if he or she has ever been convicted of any of the following felony offenses (the grantee is to use the background information from DOJ and FBI to make these determinations): Any crime specified in Penal Code section 290 which generally

includes offenses of a sexual nature such as rape, sodomy, child molestation and indecent exposure, and attempts to commit such crimes:o Murdero Batteryo Sexual batteryo Elder or Dependent Adult abuseo Mayhemo Kidnappingo Assault with a deadly weapon or with force by means to produce

great bodily injuryo Child abuseo Poisoning or adulterating food, drink, medicine, pharmaceutical

products; or water supplieso Spousal rapeo Intercourse based on fraudulent representation to create fear

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o Robbery

b) Details of how the bidder will ensure that they shall not employ, contract, or utilize as volunteers:

o Individuals with Criminal Histories on supervised parole or active probation, or Post Release Community Supervision;

o Individuals with Criminal Histories at any time if they are required to register as a sex offender pursuant to Penal Code section 290 or if such ex-offender has an offense history involving a “violent felony” as defined in subparagraph (c) of Penal Code section 667.5

c) Details of the applicant’s background evaluation process and criteria for all potential employees, interns, grantee, contractors, volunteers, or peer mentors including, but not limited to, criminal offense record information.

d) Details about individuals with criminal histories whose assigned duties are to involve administrative or policy decision-making; accounting, procurement, cashiering, auditing, or any other business-related administrative function shall be fully bonded to cover any potential loss to DOR and the State of California.

4.6 Notification of Personnel ChangesAttach the portion(s) of the Risk Management Plan that contain the details of the applicant’s procedures to notify DOR, in writing, of changes of any personnel hired for the purpose of providing services within

three (3) business days. Job descriptions shall be included for positions not yet staffed.4.7 Health and Safety Responsibilities

Attach the portion(s) of the Risk Management Plan that contain details on how the bidder will ensure the health and safety and protection of all Program participants to be served.

4.8 WeaponsAttach the portion(s) of the Risk Management Plan that contains the details on how the applicant will ensure program participants, interns, volunteers, employees, grantee, and contractors will not carry any weapons on site(s) where youth and/or persons with limited cognitive ability program is provided (including any fieldtrips) and will assume sole responsibility for any acts of its employees, interns, volunteers, grantee, and contractors while providing DOR services.

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ATTACHMENT 4Statement of Assurances

This form must be completed and signed by the applicant, and one copy of the below-listed required documentation must be returned with the application.

A. Corporate: 1. Copy of organization’s articles of incorporation.2. Copy of organization’s by-laws. 3. Copy of organization’s annual corporate report, as filed with the California Secretary of

State for all organizations who have completed one (1) year of fiscal operation. B. Financial Status:

An application can be rejected if, after review of the document submitted under this section, the DOR determines an applicant is not fiscally sound. 1. Copy of proof of registration with the California Franchise Tax Board for the payment of

gross receipts tax or proof of contract of an exception from payment of federal income tax pursuant to the Internal Revenue Code of 1954, 26 USC Section 501(c)(3).

C. Licensing and Certification: 1. If your organization operates a licensed health facility or facilities, attach a current copy

of the certificate(s). 2. Statement that licensing requirements have been met or are in process. 3. The organization agrees to hire, employ and sub-contract with only licensed and/or

certified personnel for the provision of all services that require such licensure and/or certification.

D. Compliance with Federal and State Regulations: The organization agrees to comply with all federal and State legal requirements, including Department of Rehabilitation policies and regulations, which apply to the services being provided.

E. Proof of Insurance: As part of your grant agreement with the Department of Rehabilitation, you are required to carry insurance coverage. An application can be rejected if, after review of the documents submitted under this section, verification of insurance is missing. You must submit applicable: 1. Professional liability insurance 2. Surety bonding for individual practitioners 3. Dishonesty bonding for organizations and group practices

I certify that the information provided throughout this application to the Department of Rehabilitation is true and correct, and I fully ensure compliance with all the requirements cited in this document. ___________________________________ _______________________Authorized Signature for Organization Date____________________________________

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Title

ATTACHMENT 5ADDITIONAL PROVISIONS

1. FEDERAL REQUIREMENTS A. The Federal Office of Management and Budget (OMB) has established unified

administrative requirements and cost principles for determining allowable costs chargeable to Federal awards. The Applicant agrees to abide by the following federal rules and regulations applicable to its organization as specifically defined in the following, except where the agreement is more restrictive.

2 CFR Part 215/34 CFR Part 74 (OMB A-110) – Administration of Grants and Agreements with Institutions of Higher Education, Hospitals, and Other Non-Profit Organizations

34 CFR Part 80 (OMB A-102) – Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments

2 CFR Part 220 (OMB A-21) - Cost Principles for Educational Institutions 2 CFR Part 225 (OMB A-87) - Cost Principles for State, Local, and Indian

Tribal Governments 2 CFR Part 230 (OMB A-122) - Cost Principles for Non-Profit Organizations OMB A-133 - Audits of States, Local Governments, and Non-Profit

OrganizationsA copy of the OMB Circulars listed above is available for download and review on the Internet at this link (www.whitehouse.gov/omb/circulars).A copy of Title 34 CFRs is available at this link (http://www.gpoaccess.gov/cfr/index.html).

2. FEDERAL FUNDING INTELLECTUAL PROPERTYA. In any agreement funded in whole or in part by the federal government, DOR

may acquire and maintain the Intellectual Property rights, title and ownership, which results directly and indirectly from the agreement. However, the federal government shall have non-exclusive, non-transferable, irrevocable, paid-up license throughout the world to use, duplicate, or dispose of such Intellectual Property throughout the world in any manner for governmental purposes and to have and permit others to do so.

B. Evaluation of Discovery or Invention: If any discovery or invention arises as a result of funded work, the Grantee must refer the discovery or invention to the DOR. The Rehabilitation Services Administration (RSA) and its

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representatives have the sole and exclusive power to determine whether or not and where a patent should be filed and the disposition of all rights, including title and license rights, which may result. RSA’s determination of these issues shall be considered final. In addition, the DOR and RSA shall acquire at least an irrevocable, non-exclusive, and royalty-free license to utilize for government purposes of any of these inventions. By signing this agreement, the Grantee agrees that determinations of rights to inventions made in the course of or under the agreement shall be made by ACL or its authorized representative.

C. Copyrights and Patents: The federal awarding agency and/or the DOR reserves a royalty-free, nonexclusive, and irrevocable license to reproduce, publish or otherwise use, and to authorize others to use, for federal government purposes:1. The copyright in any work developed under a grant, sub grant, or

agreement under a grant or sub grant; and2. Any rights of copyright to which a grantee, sub grantee or a contractor

purchases ownership with grant support.

3. DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSIONUpon acceptance and signing of grant agreement, grantee certifies that neither it nor its principals is presently debarred, suspended, proposed for department, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department of agency.

4. THIS AGREEMENT IS SUBJECT TO THE FOLLOWING PROVISIONSA. Equal Employment Opportunity--All agreements require compliance with E.O.

11246--Equal Employment Opportunity, as amended by E.O. 1137--Amending Executive Order 11246 Relating to Equal Employment Opportunity, and as supplemented by regulations at 41 CFR Part 6--Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor.

B. Clean Air Act (42 U.S.C. 7401 et seq.) and the Federal Water Pollution Control Act (33 U.S.C. 1251 et seq.), as amended--Agreements of amounts in excess of $100,000 shall require the Grantee to agree to comply with all applicable standards, orders, or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401 et seq.) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251 et seq.). Violations shall be reported to ED and the Regional Office of the Environmental Protection Agency (EPA).

C. Byrd Anti-Lobbying Amendment (31 U.S.C. 1352)--By signing this agreement, the Grantee who is awarded an agreement of $100,000 or more certifies that it will not and has not used federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee

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of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any federal contract, grant, or any other award covered by 31 U.S.C. 1352. Grantee shall also disclose any lobbying with non-federal funds that takes place in connection with obtaining any federal award.

D. All grantees shall comply with the following statutes and regulations: Subject: Discrimination on the basis of race, color, or national origin.Statute: Title VI of the Civil Rights Act of 1964 (45 U.S.C. 2000 through 2000d-4). Regulation: 34 CFR part 100. Subject: Discrimination on the basis of sexStatute: Title IX of the Education Amendments of 1972 (20 U.S.C. 1681-1683). Regulations: 34 CFR part 106. Subject: Discrimination on the basis of handicap.Statute: Section 504 of the Rehabilitation Act of 1973 (29U.S.C. 794).Regulation: 34 CFR part 104handicap.Subject: Discrimination on the basis of age.Statute: The Age Discrimination Act (42 U.S.C. 6101 et seq.).Regulation: 34 CFR part 110.

5. RETURN OF INAPPROPRIATE USE OF FUNDSUpon acceptance and signing of the grant agreement, grantee shall certify that in the event of funds used inappropriately, funds must be returned to DOR.

6. REPORTING REQUIREMENTSThe successful grantee will be assigned to a DOR Grant Contract Administrator who will provide consultation and oversight during the development of the contracted program and budget and will work closely with the successful grantee during the life of the grant agreement to provide technical assistance and monitor progress.

Quarterly Reports: Successful grantee must submit quarterly progress reports that include activities and outcomes to DOR within 30 days of the end of each quarter.

Annual Reports: Grantee must submit aggregated annual end of year reports due by August 1st following the first year and for each year thereafter under the agreement. The report must be sent by regular mail and electronically to the assigned DOR Grants Contract Administrator in the Independent Living and Assistive Technology Section. The Grantee will work collaboratively with the DOR Grants Contract Administrator to draft and finalize the Annual Progress Report due to the Administration of Community Living no later than December 15th of each year.

End of Agreement Report: At the end of the agreement, the Grantee must submit an aggregated services summary and self-analysis report within 30

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days of the end of the contract award period. The report must be sent by regular mail and electronically to the assigned DOR Contract Administrator in the Independent Living and Assistive Technology Section.

Financial monitoring and report of funds as outlined in the AT Act law federal grant guidelines as follows:

o Section 4(e)(3)(A) of the AT Act requires State AT Program to use not more than 40% of an annual award to carry out state leadership activities. Section 4(e)(3)(A) of the AT Act also requires all State AT Programs to use at least 5% of the state leadership funds for transition training or technical assistance activities.

o State AT Programs must have a mechanism in place to accurately track all AT Act expenditures by grant award fiscal year and by the state level and state leadership categories. Most direct expenditures like salaries and benefits, contractual expenses, etc. will be clearly attributable to a state level or state leadership activity. For example, expenditures for purchasing equipment for a device loan program will be state level expenses while staff salaries and travel expenses to deliver training will be state leadership. A helpful way of determining whether an activity is a state level activity or state leadership activity is to identify where the data reported in the annual progress report for an expenditure activity will be reported. Since all activities should have associated data reported, if the data is state level (state financing, reuse, device loan or device demonstration) then the activity and associated expenditure is state level. Most staff salaries and benefits can be assigned in total or in portions to state level or state leadership depending on staff job responsibilities and any time and effort logs they are required to keep for federal reporting purposes. For very generic administrative and operational expenditures, like paper or similar general office supplies, an arbitrary ratio allocation can be used such as a 50/50 split. These very generic expenditures should not be a large portion of the total fiscal year AT Act expenses especially if an indirect rate is used to cover overhead costs. The same arbitrary ratio allocation can be applied to any indirect costs claimed.

Report to the Assistive Technology Advisory Committee (ATAC): During the agreement period, the successful applicant will be required to present, in-person, a report of progress on AT to the ATAC at least twice each year.

Report to other State policy committees as requested by committee Chairs including but not limited to the State Independent Living Council, Olmstead Advisory Committee, and California’s Aging and Disability Resource Connection (ADRC) Advisory Committee.

The successful applicant is also subject to the conditions for agreements administered by the Independent Living and Assistive Technology Section, AT

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Act, the Standard Agreement, Standard Agreement Provisions, state award requirements, and applicable state and federal laws and regulations. The successful applicant must have written administrative and personnel policies and procedures for the operation of the agreement that are consistent with applicable DOR policies and must be available for review and approval by DOR.

7. INSURANCE REQUIREMENTS1. Commercial General Liability – Grantee shall maintain general liability on an

occurrence form with limits not less than $1,000,000 per occurrence for bodily injury and property damage liability combined with a $2,000,000 annual policy aggregate. The policy shall include coverage for liabilities arising out of premises, operations, independent contractors, products, completed operations, personal & advertising injury, and liability assumed under an insured Agreement. This insurance shall apply separately to each insured against whom claim is made or suit is brought subject to the Contractor’s limit of liability. The policy must include:(Agency/Department Name), The State of California, its officers, agents, employees and servants as additional insured, but only with respect to work performed under the Agreement.Endorsements must be physically attached to all requested certificates of insurance and not substituted by referring to such coverage on the certificate of insurance. The endorsement must be acceptable to the DGS Office of Risk and Insurance Management.

2. Automobile Liability (If Applicable) – For consumers being provided transportation under said Agreement, the Grantee shall maintain motor vehicle liability with limits not less than $1,000,000 combined single limit per accident. Such insurance shall cover liability arising out of a motor vehicle including owned, hired and non-owned motor vehicles to include the following additional insurance coverage below:

For non-profit organizations : Automobile Liability insurance must include Any-Auto, Hired-Autos, Non-Owned Autos, and any other auto used in performing services under the Agreement. For seating capacity of up to 15 people (includes driver) the certificate of insurance shall state a limit of liability of not less than $1,000,000 per occurrence for bodily injury and property damage liability combined. For seating capacity for 16 passengers or more the certificate of insurance shall state a limit of liability of not less than $5,000,000 per occurrence for bodily injury and property damage liability combined.

The same additional insured designation and endorsement required for general liability is to be provided for this coverage.Workers Compensation and Employers Liability – Grantee shall maintain statutory worker’s compensation and employer’s liability coverage for all its employees who will be engaged in the performance of the Agreement. Employer’s liability limits of $1,000,000 are required.

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The workers’ compensation policy shall contain a waiver of subrogation in favor of the State. The waiver of subrogation endorsement shall be provided.D. NotificationAll notices required by either party shall be in writing and sent by mail, or personally delivered to the appropriate address. Mailing addresses may be changed by written notice.F. Confidentiality1. Grantee agrees that any report or material created during the performance of

the subgrant agreement will not be released to any source except as required by this agreement or otherwise authorized by DOR.

2. Grant agrees that any information obtained in the performance of the grant agreement is confidential and shall not be published or open to public inspection in any manner, except as authorized by DOR.

3. Grantee agrees to maintain the confidentiality of any information concerning any consumers that the Grantee may obtain in the performance of the subgrant agreement and specifically agrees to comply with the provisions applicable to such information as set forth in 34 Code of Federal Regulations, Section 361.38, title 9, California code of Regulations, Section 7140 et seq., and the Information Practices Act of 1977 (California Civil Code Section 1798 et seq.)

4. Grantee agrees to report any security breach or information security incident involving consumers’ personal information to the DOR’s Grant Administrator and the DOR’s Information Security Officer. The DOR’s Information Security Officer can be contacted via e-mail at isoinfo@dor.ca.gov.

5. Security breaches or information security incidents that shall be reported include, but are not limited to:a. Inappropriate use or unauthorized disclosure of consumers’ personal

information by the Grantee or the Subcontractor’s assignees. Disclosure methods include, but are not limited to, electronic, paper, and verbal.

b. Unauthorized access to consumers’ personal information. Information can be held in medium that includes, but is not limited to, electronic and paper.

c. Loss or theft of information technology (IT) equipment, electronic devices/media, paper media, or data containing DOR consumers’ personal information. IT equipment and electronic devices/media include, but are not limited to, computers (e.g., laptop and desktop, netbooks, tablets), smartphones, cell phones, CDs, DVDs, USB flash drives, servers, printers, peripherals, assistive technology devices (e.g., note takers, videophones), and copiers. Data can be held in medium that includes, but is not limited to, electronic and paper.

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6. Grantee agrees to provide annual security and privacy training for all individuals who have access to personal, confidential, or sensitive information relating to the performance of this agreement.

7. Grantee agrees to obtain and maintain acknowledgements from all individuals to evidence their understanding of the consequences of violating California privacy laws and the contractor’s information privacy and security policies.

8. For Grantee and subcontractors(s) that do not have a security program that includes annual security and privacy training, a self-training manual is available on the DOR website under the “Providers” tab in the “Becoming a Service Provider" section under “Annual Security and Privacy Training for VR Service Providers.” The self-training manual is named “Protecting Privacy in State Government” and can be downloaded at the following link: http://www.dor.ca.gov/eps/privacytraining.htm

9. Additional training and awareness tools are available at the California Office of Information Security (OIS) website and the California Office of Privacy Protection (COPP) website. The COPP created the self-training manual, “Protecting Privacy in State Government” that DOR revised to meet its business needs.

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