RFP Homecare
SENIOR CITIZENS' SERVICES FUND BOARD
SENIOR SERVICES PROPOSAL
FOR ORGANIZATIONS In-Home Health Care Organizations
This document constitutes a proposal by the Provider, indicated below, to furnish services to persons, sixty years of age or older, who reside in Camden County, Missouri.
IMPORTANT
This proposal must be received NO LATER THAN:
TIME: 4:00 p.m.
DATE: Second Friday in November
Late proposals are subject to rejection or penalty.
Original Proposal must be securely sealed, clearly marked SENIOR SERVICES PROPOSAL, and mailed or hand-carried to:
Camden County Senior Fund Board
RFP
PO BOX 44
Sunrise Beach, MO 65079
TO BE COMPLETED BY PROVIDER
Date of Proposal: Organization Name:
Telephone: Mailing Address:
Email Address:
Organizational Status: Check whether your organization is for profit or is non-profit:   Profit   Non-Profit
The Provider hereby agrees to provide the following services for those persons, sixty years of age or older, who reside in Camden County, Missouri:
Specify the dollar amount requested: $ Indicate the Contract period:
Person to contact: Sign, then print name, and title:
Exhibit A
Detailed Budget for Proposed Service

Indicate the total number of units of service projected in Camden County and the number of units to be funded by county funds for each expense item. Indicate the dollar amount of budgeted county funds.

Expense Item Units Senior Units Only Units funded by Co. fds County Funds Requested
Advanced Personal Care
15 min.
Advanced Personal Care - RCF/ALF
15 min.
Authorized Nurse Visits
15 min.
Authorized Nurse Visits - RCF/ALF
15 min.
Basic Personal Care - Agency Model
15 min.
Basic Personal Care - RCF/ALF
15 min.
Personal Care Assistant - Consumer
15 min.
Aged and Disabled Waiver Services
Expense Item Units Senior Units Only Units funded by Co. fds County Funds Requested
Adult Day Care
15 min.
Homemaker/Chore
15 min.
Home Delivered Meals
15 min.
Respite - Basic
15 min.
Respite - Advanced
15 min.
Respite - Advanced (block)
15 min.
Respite-Advanced (daily)
15 min.
Respite - Nurse
15 min.
Respite - Basic (block)
15 min.
Independent Living Waiver Services
Expense Item Units Senior Units Only Units funded by Co. fds County Funds Requested
Personal Care Assistance
15 min.
Other Services (list and provide associated units and funding)
Expense Item Units Senior Units Only Units funded by Co. fds County Funds Requested
Total:
$
Remaining Funds from Previous Year Grant:
Projected Camden County seniors served (all):
Projected served using county funding:
Exhibit B: Year End Report
Org. Name:

Performance of Proposed Service - Provide data for Jan. 1 - Dec. 31. Camden Co. Funds received $ This Form is Due on or Before Jan 15 following the Contract Period.

Expense Item Units Senior Units Only Units funded by Co. fds County Funds Expended
Advanced Personal Care
Advanced Personal Care - RCF/ALF
Authorized Nurse Visits
Authorized Nurse Visits - RCF/ALF
Basic Personal Care - Agency Model
Basic Personal Care - RCF/ALF
Personal Care Assistant - Consumer
Other Services (list and provide associated units and funding)
Expense Item Units Senior Units Only Units funded by Co. fds County Funds Expended
Total Funds expended:
$
Unexpended Camden County Funds as of Dec. 31:
Total Camden County seniors served by your agency (regardless of funding source):
Total Camden County seniors served using county funding:
Exhibit C: Profit and Loss

Attach Profit & Loss from prior year tax return (P&L).

No P&L files uploaded.
COMMENTS - SUGGESTIONS and/or SUMMARIZE SERVICES PROVIDED
Org Name:
Comments / Summarize services provided:
SENIOR SERVICES PROPOSAL
CONTRACT

This agreement made and entered into the day of , by and between the Camden County Senior Citizens' Services Fund Board, and hereafter referred to as the Grantee.

WITNESSED:

Whereas, the Board desires to provide significant services to assist the Senior Citizens of Camden County, Missouri by and through the use of tax levy funds held by it and collected under 67.990 - 67.995 of the Revised Statutes of Missouri; and Whereas, the Board, a unit of county government, is engaging in providing services for senior persons; Now, therefore, in consideration of the mutual promises herein contained, it is agreed as follows:

  1. The Board shall recommend that the Board Treasurer pay to the Grantee the sum of $
  2. The Grantee shall;
    • a. Apply said funds to provide services for the senior citizens as stated in the RFP.
    • b. Provide the board with:
    1. Reports regarding the use of said funds.
    2. Financial information relating to the services listed in the RFP.
    3. Permit on the premises inspection of the facilities operated by the Grantee.
    4. Provide the Board with a copy of the actual operating budget for the full year Jan. 1 - Dec. 31 at the completion of the calendar year.
  3. The End of year report shall be due on or before Jan. 15 of the following year (original plus 7 copies).
  4. In Home Service Providers shall utilize the report formats provided with the RFP.

In witness whereof, the parties hereto set their signatures by their authorized representative on two original copies the day and year first above written.

Applicant Agency
Chairman, Camden County Senior Citizens Services Fund Board
Additional Uploaded Files
No additional files uploaded.