COVID-19 Vaccination Support Services

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. ed ea Ad Department Office/Division/Program:.| Department of Health and Human Services Department.Contract Administrator or Grant Coordinator Chris Moiles / Brianne Carrero (if applicable) Department Reference #:'| COVID-19 Vaccination Support Services Total: Amount: ; Contract/(Amendment/Grant) | Total Advantage CT /RQS #:| Multiple see table below CONTRACT _|_ Proposed Start Date: FTopoeed Fhe ee ate: : - AMENDMENT - Original Start Date:"| 2/1/2021 Effective Date: | 7/1/2022 Previous End Date:

Project:Start Date: Project End Date: Nendor/Provider/Grantee. Name, : City, State: Multiple see table below 9/30/2022 New: End:Date:)| N/A Grant:Start Date: Grant:End.Date: GRANT ol Brief. Description, of Goods/Services/Grant: Additional COVID-19 Vaccination Support Services PART li: JUSTIFICATION FOR VENDOR SELECTION Mark an *X" before the justification(s) that applies to this request. (Check all that apply.) (] |A.: Competitive Process O }:G. Grant HW +B. Amendment O /H.-:State Statute/Agency Directed O | CSingle Source/Unique Vendor O (lo-Federal-Agency Directed O |-D:: Proprietary/Copyright/Patents Ki | -J:. Willing and Qualified O Eo Emergency O |-Ke Client:-Choice O /-F.. University Cooperative Project Oj Le =Other Authorization Please respond to ALL of the questions in the following sections. REV 10/19/2021 Page 1 of 3 1/20/2023Kathy Paquette Procurement Justification Form (PJF) PART Ill: SUPPLEMENTAL INFORMATION 4. Provide a more-detailed description.and explain:the need forthe. goods, services or grant to supplement:the response in Part.|: This agreement aims to provide support for services necessary to ensure the equitable distribution and uptake for COVID-19 vaccines for underserved communities including, but not limited to, Tribes, raciai and ethnic minority groups, rural communities, individuals that identify as LGBTQ+ or people living with disabilities, and those living on the margins of the economy. Vaccine support includes assessing needs, implementing community engagement strategies to promote vaccine, increasing vaccine confidence through education and outreach, and activities to ensure the equitable distribution and administration of vaccination. The purpose of these amendments is to provide additional COVID-19 vaccination support services through 09/30/2022. 2..-Provide a brief justification for the selected vendor to-supplement the response in,Part ll. Reference the RFP. number, if applicable. The Department Commissioner's Office has determined that these providers are willing and qualified based on their ability to provide the necessary services to safely isolate and quarantine. The providers have a history of providing such services and have the capacity to meet the requirements of the deliverables. The providers are trusted in their communities to assist the Department in achieving equity in the COVID-19 vaccination program. 3.- Explain how.the negotiated costs or rates are fair'and reasonable: or:how the funding was allocated to grantee. The Department has reviewed the costs associated with these services for fairness and allowability. The funding was partly based on proposals from the organizations, including information about the number and types of outreach/education activities they will provide, the number and type of community engagement activities they will provide, and the number and kind of equitable distribution and administrative activities they will provide. The Department also considered past performance on contracts/ reporting, geography, and distribution of funds to directly impacted communities across Maine. Funds were allocated based on the organization's quarterly expenditures budget forecasting until 9/30/2022. 4. Describe the plan for future:competition forthe goods. or services. The Department does not intend to RFP these willing and qualified services. PART IV: AMERICAN RESCUE PLAN ACT (ARPA) / MAINE JOBS & RECOVERY PLAN (MJRP) Does this request utilize ARPA/MJRP. funds? O Yes If Yes, please attach the approved Business Case(s). 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): ae y Typed Name: Signature of DAFS Procurement Official: Typed Name: | ~~ Date: REV 10/21/2021 Page 2 of 3 DocuSigned by: 41C2BA36FAF44CD... Procurement Justification Form (PJF) Service Group: COVID-19 Vaccination Supports Services Start Date: 2/1/2021 End Date: ,9/30/ Le 2022 2 Contact Amendment Revised Number Advantage CT Agency Name A a Contract Value COM-21-5700D CT 410A 20210304000000002372 | Ak Health and Social Services $5,000.00 $165,075.00 COM-21-5719D CT 10A 20210304000000002393 | Gateway Community Services Maine $5,000.00 $170,706.00 COM-21-5705D CT 104 20210304000000002376 | Hand in Hand/ Mano en Mano $5,000.00 $200,648.00 COM-22-5732C CT 10A 20210909000000000628 | Healthy Acadia $5,000.00 $275,000.00 COM-21-5709D CT 10A 20210304000000002380 | Maine Association For New Americans $5,000.00 $238,608.00 COM-21-5712D CT 10A 20210304000000002384 | New England Arab American Organization $5,000.00 $169,364.00 COM-21-5713D CT 10A 20210304000000002385 | New Mainers Public Health Initiative $5,000.00 $220,843.00 COM-21-5722D CT 10A 20210319000000002507 | Sustainable Livelihoods Relief Organization $5,000.00 $41,438.00 TOTAL $40,000.00 $1,481,682.00 REV 10/21/2021 Page 3 of 3