Address Health Disparities experienced throughout the State

PROCUREMENT JUSTIFICATION FORM (PJF) This form must accompany all contract requests and sole source requisitions (RQS) over $5,000 submitted to the Division of Procurement Services. INSTRUCTIONS: Please provide the requested information in the white spaces below. All responses (except signatures) must be typed; no hand-written forms will be accepted. See the guidance document posted with this form on the Division of Procurement Services intranet site (Forms page) for additional instructions. : ARM EeSs : -. : Department Office/Division/Program: DHHS Maine Center for Disease Control and Prevention, Office of Population Health Equity Department Contract Administrator or Grant Coordinator: Chris Moiles / Melinda Farrell | nn CrP A Ee TSE SS enONrttey SRS (ff applicable) Department Reference #: | CD0-23-1570 Amount: Advantage CT / | CT 10A (Contract/Amendment/Grant) $250,000.00 RQS #: | 20230731000000000207 CONTRACT Proposed Start) 5/45/2023 Proposed End 5/31/2024 Date: Date: ee i eee it

Original Start Date: Effective Date: AMENDMENT. Previous End New End Date: Date: . . Grant Start GRANT Project Start Date: Date: Project End Date: Grant End Date: Vendor/Provider/Grantee Name, York County Community Action Program City, State: | Sanford, ME Brief Description of . was . Goods/Services/Grant To address health disparities experienced throughout the state. 2 osu Roepe al| | Mark an.*X before the justification(s) that app! CATION.FOR VENDOR SELECTION ies to. this request. (Check all that apply.) O |A. Competitive Process |G. Grant O |B. Amendment O |H. State Statute/Agency Directed & [C. Single Source/Unique Vendor Ci | 1 Federal Agency Directed | D. Proprietary/Copyright/Patents | O | J. Willing and Qualified O | . Emergency O | K. Client Choice 0 | F. University Cooperative Project [1 | L. Other Authorization REV 10/19/2021 Page 1 of 2 9/15/2023 Kathy Paquette Procurement Justification Form (PJF) Please respond to ALL of the questions in the following sections. Se egg eee ge) WiON), 4. Provide a more detailed description and explain the need for the goods, services or grant to supplement the response in Part]. The Provider shail implement programs and activities within communities that address the root causes of COVID-19 or address the social determinants of health that are unique to the community by advancing health equity, by creating the resource(s) needed to address these broader needs and by providing services in culturally relevant, linguistically appropriate, and timely ways. Providers shall also implement activities to support case management services for individuals currently in hotels or other temporary housing, including, but not limited to asylum seeker families in Southern Maine. The response should be linguistically and culturally appropriate. 2. Provide a brief justification for the selected vendor to supplement the response in Part I. Reference the RFP number, if applicable. OPHE aims to address health disparities experienced throughout the state. OPHEs theory of change centers on the idea that the organizations best positioned to impact change in communities are those whose leadership reflects the community they serve. YCCAC is the only organization prepared and ready to serve asylum seekers in York County with case management services. They are experienced in delivering case management, are able to implement the activities immediately upon contract encumbrance and are a trusted resource in York County meeting a | geographic area not currently covered by other OPHE Case Management funding. 3. Explain how the negotiated costs or rates are fair and reasonable; or how the funding was allocated to grantee. Funding determination reflects similar funds administered to Community Based Organizations working with a variety of populations in other geographic areas (Androscoggin and Cumberland Counties) and is reflective of the anticipated number of cases YCCAC will serve Scope of work reflects reasonable activities and deliverables that reflect the funding and are comparable to the case management activities other organizations are taking on as part of the Community Resilience program. 4. Describe the plan for future competition for the goods or services. The Department does not anticipate the availability of additional funding after this period. PART. a AMERICAN acres) eNom NALINI Wels & RECOVERY PLAN (MJRP) : S Does this request utilize ARPA/MJRP funds? 1 Yes If Yes, please attach the approved Business Case(s). I No If No, proceed to Part V -PART V: APPROVALS The signatures below indicate approval of this procurement request. Signature of requesting Department's Commissioner (or designee): Typed Name: Signature of DAFS Procurement Official: Typed Name: Date: REV 10/21/2021 Page 2 of 2 DocuSigned by: 41C2BA36FAF44CD... 2023-09-15T05:27:40-0700 Digitally verifiable PDF exported from www.docusign.com