ARPA Assistance Program for the Senior Services Division

ROCKDALE COUNTY, GEORGIA PREFERRED VENDOR LIST APPLICATION #22-19 ARPA Program Senior Services For the Rockdale County General Services Department Division of Senior Services Rockdale County Finance Department 958 Milstead Avenue Conyers GA 30012 770-278-7552 re re a re re 2 Rockdale County is accepting applications for the Preferred Vendor List for the Senior Services ARPA Program. The American Rescue Plan Act (ARPA) was funded to assist persons in during or recovery from the COVID pandemic. Completing this application is not a guarantee of work. Applications will be reviewed and kept on file with Rockdale County Finance. Vendors meeting criteria will be listed on the preferred vendor list. If a project is available that fits into your indicated scope of work, you may be contacted to submit a written quote. It is very important that the applicant keep an active up to date email on file with the program as this will be the main source of communication concerning potential projects. If

selected for a specific project, the name of the technician(s) or laborer(s) assigned to the job, if different from the applicant, must be identified prior to starting work. Rockdale County provides equal opportunity for all persons or businesses and does not discriminate against any person or business because of race, color, religion, sex, national origin, and handicap or veteran status. This policy ensures all segments of the business community have access to supplying the goods and services needed by Rockdale County. PURCHASING CONTACT FOR THIS REQUEST: All questions concerning this invitation and all questions arising subsequent to award are to be addressed to the Purchasing Office at the following address: Rockdale County Finance Department Attn: Shadawna Pacley 958 Milstead Avenue Conyers, GA 30012 Phone: (770) 278-7557, Fax: (770) 278-8910 E-mail: Shadawna.Pacley2@rockdalecountyga.gov To maintain a level playing field, and to assure that all proposers receive the same information, proposers are requested NOT to contact anyone other than the contact above. Doing so could result in disqualification of the proposer. COPIES FOR EVALUATION: One (1) original hard copy of application will be required for review purposes. Applications will be received at the Rockdale County Finance Department, 958 Milstead Avenue, Conyers, GA 30012; Attn: Meagan Porch or by email to Shadawna.Pacley2@rockdalecountyga.gov. TERM: The application process is open all year and applications may be submitted at any time during the calendar year. Approved vendors will remain on the list through the end of the ARPA program. mailto:Shadawna.Pacley2@rockdalecountyga.gov mailto:Shadawna.Pacley2@rockdalecountyga.gov 3 Rockdale County Dept. of General Services Senior Services Division PREFERRED VENDOR APPLICATION for ARPA Program Senior Services INSTRUCTIONS: Print or type name exactly as it appears on your drivers license (must be 18 years of age or older to apply). APPLICANTS INFORMATION Applicant's Name (Last, First, M.I.) Full Social Security No. Drivers License Number Street Address County of Residence Date of Birth Sex/Race City State ZIP Occupation Home Telephone ( ) Cell Telephone ( ) E-Mail Business / Organization (if applicable) Business Telephone ( ) Business Mobile / Cell Telephone ( ) Business Address County of Operation City State ZIP Website URL (if applicable) Do you have any disabilities (this information is voluntary and will be used for statistical purpose only) YES NO ___________________________________________________________________________________________________________ Provide business licenses or certifications. (attach copies of licenses) ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Give two references who may have knowledge of your qualifications or work. (include name, address, phone and email) 1. Name _________________________________ Phone _____________________ Email _________________________________ Street Address ________________________________________________ City ________________ State ______ Zip __________ 2. Name _________________________________ Phone _____________________ Email _________________________________ Street Address ________________________________________________ City ________________ State ______ Zip __________ Have you ever been convicted? of a Misdemeanor (including moving violation) of a Felony YES NO (if yes, explain ________________________ _________________) YES NO (if yes, explain _______________________________ __________) I hereby certify that the statements on this application are true. I understand certification can be denied by Rockdale County if information has been falsified, misleading or incomplete. I grant permission for Rockdale County to complete a background check to verify information provided. Signature of Applicant Date 4 Rockdale County Dept. of General Services Senior Services Division PREFERRED VENDOR APPLICATION for ARPA Program Senior Services Supplemental Information Applicant Name: 1. Give a brief explanation of your interest to become a preferred vendor for this program. 2. The ARPA Program - Senior Services is expected to operate for FY 2022-2024. Indicate your availability and advanced notice needed to start a project. a) Describe your general availability: (i.e., Monday-Friday, weekends, certain times of day) b) Advance notice generally required to start a project: (i.e., one day, several days, one week, month, etc.) 3. Indicate your scope of work. (check all that apply) Deck repair Drywall and wall repair Electrical (license required) Flooring HVAC (license required) Roof repair Painting Plumbing and Water Heaters (license required) Ramp building/installation Yard clearing/cleanup (not landscaping or regular yard maintenance) General home repair Other (describe) 5