1 Create a ZoomGrants™ account (below) or log in to your existing account (above) 2 Select a Program to apply for, then click the Apply button to get started 3 Answer the questions and/or fill in the fields in each tab 4 If necessary, upload any requested documents 5 Submit your application and wait for a decision 6 If you are selected to receive funding, you might be required to submit invoices or reports through your application
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Orange County Health Services Department is seeking proposals from qualified organizations to provide Ending the HIV Epidemic (EHE) Early Intervention Services (EIS) to people with HIV.
By entering your initials here you certify this submission truthfully and accurately represents your application and is hereby submitted for review. Submission of this application does not, in any way, guarantee that your application will yield a favorable result.
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Summary
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Welcome to the Ending the HIV Epidemic Early Intervention Services (EIS) Grant Application.
Please Note: Proposers must have a active Employer Idenfitication Number (EIN), be registered with SAM, and have Unique Entity ID (UEI) with sam.gov prior to advancing to the next section of the grant application.
Application Title/Project Name
Amount Requested
Applicant Information
First Name
Last Name
Telephone
Email
Address 1
Address 2
City
State/Province
ZIP+4/Postal Code
Country
Organization Information
(changes to this data will be reflected on all other applications for this organization)
Create an Organization
Pre-Application
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This Pre-Application section must be submitted and Approved by the Administrator (not ZoomGrants) before you can fill out the rest of the application. Click the Submit Pre-Application button at the top or bottom of this tab to submit this section to be reviewed.
Application Questions
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Proposers must complete all sections of this application to be eligible for award.
Please note:
Failure to answer questions will result in a loss of points during the scoring process and may affect the final award.
Proposers will be unable to make changes or correct unanswered questions once the deadline has passed.
Proposals will be scored accordingly.
Proposals must score a minimum score of 70/100 to be recommended for funding. The proposal(s) with the highest ranked score will be recommended for funding.
Agency
1. Agency Information: What is your agency’s legal name and current fiscal year?
2. Agency Background: Describe your agency’s background and experience. Please address: 1. Agency Identity: Mission, vision, and years in operation. 2. Funding History: Experience managing and reporting government funds (Federal, State, Local). 3. Recent Growth: Major changes, key achievements, or significant improvements in recent years.
3. Staff and Board Development: How does your agency ensure that leadership, staff, and volunteers stay current and adapt to changes in Ryan White HIV/AIDS Program (RWHAP)/Ending the HIV Epidemic (EHE) requirements, HIV-related practices and treatment, and trends affecting people with HIV, including risk factors, demographics, and geographic locations?
4. Client Confidentiality and Grievances: How does your agency protect client rights, confidentiality, and fair treatment? Describe your policies and staff training for record security (electronic/hard copy, including HIPAA), along with your procedures for handling client grievances, complaints, and appeals.
5. Monitoring: Describe how your agency’s performance in meeting contractual standards and administrative requirements was assessed through internal reviews and/or external monitoring during the last fiscal year. If previously funded, identify the outcomes of your most recent monitoring, including any deficiencies, recommendations, corrective actions, or areas of strength. Describe how the agency addressed these results to improve performance and quality management. Previous monitoring results may be considered in the evaluation of applications for future funding opportunities.
Services
6. Service Experience: Current Services: List all services and programs currently provided, with special attention to experience providing Early Intervention Services (EIS). Detail your agency’s experience with HIV testing, outreach, linkage to HIV medical care, and re-engagement and retention in care. Provide examples of strategies used to identify, engage, and connect individuals to appropriate HIV care and supportive services. Key Positions: Summarize key staffing positions and responsibilities.
7. Client Eligibility: Describe your agency’s policies and procedures for determining and documenting client eligibility for Ryan White HIV/AIDS Program (RWHAP) Part A and Ending the HIV Epidemic (EHE) services, including verification of HIV status, eligibility criteria, required documentation, recertification processes, and compliance with all applicable RWHAP and EHE requirements.
8. Case Note Documentation: Describe your agency’s policies and procedures for case note documentation within EHE Early Intervention Services (EIS), including standards for timeliness, accuracy, confidentiality, and the systems or platforms used to document client interactions, referrals, and service delivery.
9. Client Feedback: Explain how your agency utilizes feedback to improve and modify service delivery. Summarize key results from client satisfaction surveys and/or client advisory boards.
10. Outcome Data: Describe your process for collecting, reviewing, and reporting outcome data for EHE Early Intervention Services (EIS). Include examples of metrics collected during the last year and how your agency uses outcome data to monitor performance and improve services.
11. Collaboration: Describe how your agency collaborates with community partners, healthcare providers, and other service organizations to support clients receiving EHE Early Intervention Services (EIS). Include examples of successful partnerships, referrals, and coordination of care that improve access to HIV-related services and support client engagement and retention in care, with special attention to key points of entry, including jails, hospitals, and community-based organizations providing HIV testing in the community.
12. Service Area Experience: Eligible Metropolitan Area (EMA) Service Experience: Describe your agency’s experience providing Early Intervention Services (EIS) and/or support services to people with HIV within the Eligible Metropolitan Area (Lake, Orange, Osceola, and Seminole Counties). Outline language/translation capabilities, non-discrimination practices, and physical accommodations for clients with special needs (e.g., vision/hearing impairments, mobility/wheelchair access).
13. Program Experience and Accessibility: Describe your agency’s proposed approach to providing Early Intervention Services (EIS) and/or other HIV-related support services. Outline your service delivery approach, including target populations, geographic areas served, locations/hours of operation, client access, orientation, intake and assessment, service delivery, follow-up, and staff responsibilities. Describe strategies used to ensure accessible, client-centered services and linkage to HIV care and supportive services.
14. Staffing: Please indicate the number of Early Intervention Specialists and Supervisors requested.
15. Client Capacity: Provide the estimated number of (1) total clients to be served, (2) newly diagnosed clients to be served, and (3) clients to be re-engaged in HIV care.
Financial
16. Financial Capacity: Explain how your agency maintains financial stability and ensures uninterrupted EHE–EIS program operations without relying exclusively on grant funding. Include details on other funding sources, internal financial controls, and the agency’s process for obtaining and submitting required financial statements and/or audits. (A detailed Budget must be submitted on Budget Form 101 found in the document section.)
17. Total Funding Requested: State the total amount of EHE funding your agency is requesting to provide the proposed Early Intervention Services (EIS).
18. Payer of Last Resort: Describe your agency’s policies and procedures to ensure EHE funding is used as the payer of last resort, including efforts to identify and utilize other available sources of payment or coverage before EHE funds are used.
19. Lot Selection: Please select the lot(s) for which your agency is applying for Early Intervention Services (EIS): Important: Please ensure that your responses to all application questions reflect the specific lot(s) for which your agency is applying.
Tables
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Documents Section Instructions: All required attachments must be included with the application, except for organizations that are exempt from submitting specific required documents. Organizations claiming an exemption must provide a written statement identifying the applicable exemption, along with supporting documentation verifying the exemption. These materials must be uploaded in the appropriate document section.
The online application allows applicants to upload attachments.
Please ensure:
All documents are clearly titled and easily identifiable.
Each required attachment is uploaded in the appropriate document section. Missing or incomplete documents may negatively affect the application score.
If claiming an exemption, the required written statement and supporting documentation are uploaded.
All uploaded files are complete, accurate, and final before submission. Changes cannot be made after the submission deadline.
Upload a current W-9: A completed and signed W-9 must be submitted with your proposal.
Required
Sunbiz Certificate of Corporation: Upload a printout of the Detail by Entity Name page from the Florida Department of State, Division of Corporations at sunbiz.org. The certificate must indicate that the organization is “active.”
Required
-none-
501(c)(3) Certificate / IRS Determination: Upload a current copy of your organization’s IRS 501(c)(3) determination letter verifying nonprofit status.
Required
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Proof of Certificate of Insurance: Upload a copy of your Certificate of Insurance. Refer to the Insurance Requirement Packet in the Library. Note: Coverage requirements may be adjusted based on the proposed scope of services.
Required
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Drug-Free Workplace Form: Upload a completed Drug-Free Workplace Certification form, confirming your organization’s compliance with federal and state requirements.
Download template: Drug Free Workplace Form
E-Verify Certification: Upload a completed E-Verify Certification form confirming your organization’s compliance with federal employment verification requirements.
Download template: E-Verification Certification
Required
-none-
Relationship Disclosure Form: Upload a completed form documenting relationships between the bidder, proposer, or responder and the Mayor or any member of the Orange County Board of County Commissioners.
Download template: Relationship Disclosure form
Required
-none-
Orange County Specific Project Expenditure Report: Upload a completed form documenting any expenses incurred by a lobbyist as described in Section 2-351 of the Orange County Code.
Download template: Specific Project Expenditure Form
Required
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Federal Debarment Certification Form: Upload a completed form certifying that your organization, its principals, and key personnel are not debarred, suspended, or otherwise excluded from participating in federally funded programs.
Download template: Federal Debarment Certification Form
Required
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Leased Employee Affidavit (if applicable): Upload a completed affidavit with your proposal, or submit a document justifying why your agency is “Not Applicable” if it does not apply to your organization.
Download template: Leased Employee Affidavit
Required
-none-
Joint Venture Eligibility Information (if applicable): Upload the completed information with your proposal, or a document justifying why your agency is 'Not Applicable if your organization is not part of a joint venture.
Download template: Joint Venture Eligibility Form
Schedule of Sub-contracting and Affidavit of Compliance with 2-CFR §200.321 (or 45 C.F.R. §75.330 for Health and Human Services funds) (if sub-contracting) shall be completed and submitted with your proposal.
Download template: Sub-Contracting and Affidavit of Compliance
Required
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Agent Authorization Form (if applicable): Upload the completed form with your proposal, or upload a document justifying why your agency is 'not applicable'.
Download template: Agent Authorization Form
Required
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Authorized Signatories/Negotiators Form: Upload a completed form listing all individuals authorized to sign contracts or negotiate on behalf of your organization.
Download template: Authorized Signatories/Negotiators
Required
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Grievance Procedures: Upload your organization’s Grievance Procedures outlining the process for clients or staff to report and resolve complaints.
Required
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Most Current Financial Statement or Audit: Upload the latest financial statement or audit, prepared and certified by a Certified Public Accountant (CPA).
Required
-none-
Board of Directors and Client Advisory Board: Upload a chart including ethnicity, gender, and age to demonstrate the board’s representativeness of the target population.
Required
-none-
Training and Orientation Plan: Upload your organization’s training and orientation plan detailing how staff are prepared to deliver the proposed services.
Required
-none-
Staffing Organization Chart: Upload a chart showing your organization’s staff structure, including the length of experience key staff have providing services to people with HIV.
Required
-none-
Staffing Plan: Upload a plan listing each position, summarizing duties, and indicating the percentage of time dedicated to these services. Include resumes for key staff.
Required
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References: Upload a list specifying services provided, funding source, contract reference/name/number, contract period, dollar value, number of clients served, and contact information for each reference.
Human Trafficking Affidavit: Upload the completed Human Trafficking Affidavit as required by the State of Florida, confirming compliance with state anti-human trafficking laws.
Download template: Human Traffic Affidavit
Required
-none-
Budget 101 Template: Upload the completed Budget 101 Template detailing projected costs for the proposed services.
Download template: Budget 101 Form
Required
-none-
Additional Documents (Optional): Upload any supporting documents that were not specifically requested but may help demonstrate your organization’s capacity, experience, or qualifications.
-none-
Acknowledgement of Addenda Form: If an addendum is issued for this RFP, It will be provided here. Please upload the completed form here confirming receipt and review of all addenda. If no addenda are issued, no upload is required.
-none-
* ZoomGrants™ is not responsible for the content of uploaded documents.
Extra
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add an entry to the Activity Log and request a Grant maker action.
Report
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