Oaa - Title Iii-B
Personal Care Services and Homemaker Services Application Packet
Contents
Cover Page Information and Instructions Application VDA Service Standards for Personal Care Services and Frequently Asked Questions
Senior Services of Southeastern Virginia
Request For Application
Information & Instructions
Senior Services of Southeastern Virginia is accepting applications for provision of Title III Older Americans Act services under the Area Plan for Aging Services. Funding will be available for the period October 1, 2021 to September 30, 2022 (FY22). Proposals accepted for funding in FY22 may be renegotiated for an additional year. Programs and services funded are governed by the Older Americans Act of 1965, as amended. Copies of the Older Americans Act of 1965, as amended, and of the most recent Federal Regulations interpreting the Act are available for review. Sample copies of the agreement to be signed between Senior Services and those contractors accepted as vendors are available for review in the Senior Services Administrative offices. If you are interested in reviewing
the agreement or Older Americans Act, please contact
Brigid Miller Chief Financial Officer bmiller@ssseva.org (757) 222-4511
Providers will be selected based on the evaluation criteria shown below. You may be requested to attend interviews or to otherwise clarify your application and to submit revisions of your proposals as may result from negotiation. This application does not commit Senior Services to award a contract, to pay for any costs incurred in the preparation of the application, to respond to this request or to be bound to procure or contract for these services. The decision to award will be based on, but not
limited to the following
A. Experience and ability of the agency/organization in delivery of the service
B. Expertise in reaching the elderly in greatest economic and social need
C. Reasonableness of costs
D. Adherence to service definition and service delivery parameters
E. Availability of funds
F. Geographic area(s) to be served. We have a greater need to provide the service in the following
zip codes
Chesapeake: 23323, 23322, 23324, 23325, 23336, 23327, 23328. Virginia Beach: 23456, 23454, 23457. Suffolk: 23851, 23439, 23433, 23332, 23438, 23437, 23436
G. T he provider being a Certified State SWaM (small, woman owned and minority owned) business
Instructions
A. An original service application should be submitted to Senior Services no later than the close of the workday (4:30 p.m.) November 12, 2021. Type all information. Attach additional pages where necessary.
B. Refer to the enclosed descriptions of services defined by the Virginia Division for the Aging.
C. Services will commence as early as applications are reviewed and accepted and the project year ends September 30, 2022. Proposals ac cepted for funding in FY 22 may be renegotiated for an additional year.
D. Changes may be required in a proposed cost . If this should be the case with your application, your agency will be notified by Senior Services.
E. All contracting agencies must be equal opportunity employers and must serve the elderly without regard to race, sex, color, national or ethnic origin, or handicap.
F. Payment of funds requested from Senior Services will be made on a monthly reimbursement basis upon receipt of Senior Services’ monthly financial and programmatic reports.
Senior Services of Southeastern Virginia
Oaa
Application For Delivery Of Services To The Elderly
(where applicable, please provide your answers on separate paper)
A. General Information
1. Applicants Organization Name
A ddress
C ity/State/Zip
P hone
2. P roposed Service: Homemaker Personal Care 3. Type of Agency: (Check one) Corporation Government Agency Partnership Sole Proprietorship/Individual Tax Exempt or Non-Profit
4. R enewal Date of License
6. A
re you a Small, Women-owned, and Minority-owned Business (SWaM)? Yes No
SWaM #
7. Define the Geographic Area to be served (Please be specific; use zip codes and
neighborhoods)
8. P
roject Director, Supervisor or Coordinator
N ame
T itle
P hone
B. C Ompany Information
9. Cost of the Service per hour: _____________________
10. Principals of the Agency or Board of Directors: _____________________
11. Date of Incorporation and/or Certification: _________________________
12. State of Incorporation (if Applicable): _____________________________
13. a. Do you perform Background Checks on your employees
Yes No
b. Do you perform Random Drug and Alcohol testing
Yes No
14. Do you have written policies and procedures manual for day to day operations: Yes No
15. Is your staff covered by insurance or are they bonded in the event of theft: Yes No
16. Please provide 5 references: (include customers and business associates)
Name
Contact Person
Phone
Name
Contact Person
Phone
Name
Contact Person
Phone
Name
Contact Person
Phone
Name
Contact Person
Phone
C. Services To Be Provided
17. Describe the elderly population you presently serve in the area. Number of persons:
60 Years of age & Over 75 Years of age & Over Elderly persons living alone Elderly who are below poverty level Minority elderly (60+)
18. Define what hours and days of the week are your services available: