Project Information

Bid Title

Transportation Services -Transportation Attachment

Issuing Agency

Shelby County

Location

Tennessee

Published Date

Apr 27, 2026

Closing Date

Apr 30, 2026

Government Level

State & Local

Status

Closed

Ref. #

26-002-74

Original Source

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Project Description

Bid Title:

26-002-74 Transportation Attachment

Category:

Aging Commission

Status:

Open

Publish Date:

Monday, April 27, 2026 - 4:00pm

Close Date:

04/30/2026 - 4:00pm

Contact Person:

Candace Jackson

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Related Documents:

Transportation Attachment 1.pdf

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Attachment 1

REQUEST FOR APPLICATION OF PROPOSAL APPLICATION (RFPA)

TO DELIVER

Home and Community Based Services

Applicant Organization Name:

Mailing Address:

Office Address:

Contact:

Name & Title

E-Mail Address:

Telephone:

Emergency Contact (Name & #):

Date of Application:

. Fax:

COVER LETTER

Cover Letter – At a minimum, this letter must include the following:

• A statement that the accompanying application is in response to this RFPA.

• A statement that the applicant is willing, if selected, to execute a contract with the Area

Agency on Aging and Disability (AAAD).

• A statement identifying the individual(s) authorized to finalize a contract with the AAAD on

behalf of the Applicant.

ORGANIZATIONAL STRUCTURE AND INFORMATION

Please provide a W-9

Please identify the organizational structure of the applicant’s governing body.

Individual (sole proprietorship)

Partnership

Non-Profit Corporation

For-Profit Corporation

State University

Other (explain)

Please indicate the status of your agency (check all that apply):

minority owned/operated

small business

none of the above

women owned/operated

faith-based organization

History/Organizational Capacity

History: (Provide a brief history of the organization and its service delivery system for proposed

service.)

Governing Body: (Describe structure and responsibilities. Provide a list of the present membership

of the Board of Directors or other governing body of the applicant. The list must include each

member’s name, address, sex, race and whether he or she is a person with a disability. Also

include the method used for selecting and replacing board members.)

Organizational Chart: (For overall agency and single organization unit responsible for delivering

proposed service(s).)

Experience: (Describe within two pages organizational experience in working with older persons

and/or adults with disabilities. Include the number of years in business.)

Provide customer satisfaction rate that has been measured and documentation that 80% or more

of customers are satisfied with services.

Mission & Values: Briefly describe the approach and plans for service implementation, including:

Mission Statement

Values and/or guiding principles

Personnel:

Identify the key personnel who will be involved with the program. Please make available upon

request a resume for each of the key personnel.

Identify the supervisory structure related to proposed service delivery.

Describe the qualifications and required competencies for people who will serve as direct service

workers. Include job descriptions.

Include the proposed training approaches and curriculum to be used to keep staff current in-service

delivery and best practices in services and supports.

Policy for conducting/maintaining background checks

Financial Capacity: Provide Copies of the Following:

Most recently completed audited financial statements of submitting organization. The audited

financial statement is preferable; however, if an organization does not have this information,

IRS tax reporting forms / tax return is appropriate for the submitting organization.

A copy of the organization’s business status must be attached (i.e., 501(c), Business License,

etc.)

A copy of a valid certificate of insurance indicating liability insurance in an amount sufficient to cover

any potential liability arising as a result of a contract pursuant to this RFPA must be attached

A copy of the verification of Workers Compensation Insurance.

Copies of current signed site agreements or sight agreement template to be used for each location

[congregate, satellite, and kitchen(s)].

If an audited financial statement is available, do not complete numbers 6 and 7.

A current written bank reference, in the form of a standard business letter, indicates that the

applicant's business relationship with the financial institution is in positive standing.

Two current written positive credit references in the form of standard business letters from vendors

with which the applicant has done business, or documentation of a positive credit rating

determined by an accredited credit bureau within the last 6 months.

Organizational Conduct: (Answer each question):

Has the organization and/or any of the organization’s employees, agents, independent contractors

been convicted of, pled guilty to, or pled no contest to any contracted crime involving a public

contract?

(If the answer is yes, attach an explanation)

Has the organization and/or any of the organization’s employees, agents, independent contractors

been convicted of, pled guilty to, or pled no contest to a felony?

(If the answer is yes,

attach an explanation)

Has the organization and/or any of the organization’s employees, agents, independent contractors

been civilly liable in an action that involved fraud, misrepresentation, material omission,

misappropriation, moral turpitude, theft, or conversion?

(If the answer is yes, attach an

explanation)

Has the organization and/or any of the organization’s employees, agents, independent contractors

been relieved of responsibility by a court, employer, or client for actions involving fraud,

misrepresentation, material omission, misappropriation, moral turpitude, theft, or conversion?

(If the answer is yes, attach an explanation)

Is your organization currently under Federal or State debarment?

ASSURANCES & CERTIFICATIONS

By signing this application, the Applicant agrees:

• To certify that, under penalty of perjury, your provider organization has completed this Provider

Application independent of any outside influence which may result in your receiving privileged

information about this RFPA.

• To certify that this RFPA factually represents your administrative capabilities and proposed

services, and that if your organization is approved, you agree to abide by the terms and conditions

of the Provider Contract.

• To certify that if your organization is approved, you agree to contract with the AAAD for services

at your usual and customary charges not to exceed the maximum allowable outlined in the

contract..

• To certify that your organization will follow the specific Service Description and Standards

required by the State of Tennessee Department of Disability and Aging.for each proposed service

activity.

• To certify that your organization has written policies regarding the following:

• Personnel Policies including employee

health/sick leave policy, safety and

sanitation, fiscal management, food

service management, and food recalls.

• Affirmative Action Policy

• Non-discrimination in Hiring Policy

• Confidentiality Policy

• Non-discrimination in Service Delivery

Policy

• ADA Compliance Policy

• Drug Free Workplace Policy

• Civil Rights Compliance Policy

(Title VI and VII)

• Certification Regarding Lobbying

• To certify that your organization has secured all required licenses, certifications, permits and

accreditation (as required by the State and/or Federal governments). Attach copies including

a copy of the most recent compliance report from the Department of Health or other

regulatory entity.

IV.

SERVICE DELIVERY

1. Describe and specify the availability of funds to support the cost of providing services to

ensure service delivery continues throughout the contracted period and continuation of

services occurs until reimbursement of services is made including required match funding.

2. Describe your agency’s plan regarding weather-related emergencies. Include the following

information:

• Conditions under which the agency will be closed.

• Describe weather related emergency plans to ensure elderly clients receive services

they need during emergency situations. Submit name of contact persons.

• Plan for receiving emergency calls for assistance.

• Schedule of Holidays

3. Describe and include procedures for internal monitoring and assessment. Detail how

internal monitoring reports will be submitted to the AAAD when completed. The Internal

monitoring should be attached to this RFP and include:

•

Provide description of each of the service you are seeking funding for in the RFP

including counties you propose to serve

•

Name of the person or position responsible for monitoring and evaluating each

service.

•

Procedures for corrective action or follow-up

•

A copy of the internal monitoring tool (s) to be used.

4. Ensure compliance with Background Records Checks on employees having contact with

consumers.

5. Explain the organization’s policy process for conducting Customer Satisfaction Surveys

and attach the results of your most recent Customer Satisfaction Survey Report showing

the percentage of satisfied customers for the period.

6. Describe how information on program income and donations will be provided to program

participants and other interested parties. Include a description of procedures and

mechanisms for collection, use and management of program income and donations. All

donations must be accounted for and submitted to the AAAD as designated.

7. Identify each service you seek funding for, explain in a detailed narrative how the services

for which you request funding will be organized and delivered by your organization as

outlined in this RFP funded by state and Older Americans Act. Please include an

implementation schedule.

8. How will your organization track missed visits of authorized services?

9. If you are a current provider please provide documentation demonstrating you submitted

invoices within the contracted prescribed time frame.

10. If the service you are requesting funding for is listed on the Usual and Customary Rates

Document, please complete the form.

11. Organizations proposing to provide food boxes please propose a unit price based on the

service definition.

12. Organizations proposing to provide assistive technology should provide a comprehensive

list of technology that to be supplied, itemized costing, and a statement that the Aging

Commission of the Mid South will not be charged more than the organization’s usual and

customary rate for each service and/or item listed.

13. Organizations proposing to provide medical supplies should provide a comprehensive list

of be supplied, itemized costing, and a statement that the Aging Commission of the Mid

South will not be charged more than the organization’s usual and customary rate for each

item listed.

AUTHORIZATION FOR SUBMISSION

On this the ________________________________ day of _________________________ , 20__,

{Name of Applicant Organization)

Is submitting this application to become an approved

provider

Executive Director / CEO / President Applicant Organization

Chairman, Governing Body

Date

Date

Commodity Codes

• NAICS 484121General Freight Trucking, Long-Distance, Truckload
• NAICS 485991Special Needs Transportation
• NAICS 485999All Other Transit and Ground Passenger Transportation

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