Community Based Organization 312 views6 applications

Country: Nigeria

Request for Application Number: RFA-001-2019

Donor Award Title: CORE Group Partners Project (CGPP)

Donor: United States Agency for International Development (USAID)-World Vision US

Releasing Date: 25 August, 2019

Closing Date: 23 September, 2019

Closing Time: 5:00pm Nigeria Time

I. OVERVIEW

International Medical Corps (IMC), an international non-governmental organization (located at 12400 Wilshire Boulevard, Suite 1500, Los Angeles, California), with a main in Abuja (Plot 882, Olu Awotesu Street off Idris Ibrahim Crescent, Jabi Abuja, FCT) and a sub-office in Maiduguri (located at Plot 87, Damboa Road, Old GRA, Maiduguri, Borno State)International Medical Corps intends to enter into a sub award/grants for the implementation of the project entitled: “INITIATIVE FOR SUPPORTING POLIO ERADICATION IN NORTHEASTERN AND NORTHWESTERN NIGERIA (ISPENN)”. To this end, International Medical Corps is seeking applications from qualified community based organizations (CBOs) interested in implementing activities described in this solicitation.

Through this Request for Applications (RFA), IMC is seeking Full Applications for competitive grants, for implementation of activities that strengthen Core Group Partners Project interventions in Borno.

Eligible organizations are invited to submit a full application, detailed budget, and budget notes that meet the requirements of this RFA, which directly relates to the INITIATIVE FOR SUPPORTING POLIO ERADICATION IN NORTHEASTERN AND NORTHWESTERN NIGERIA (ISPENN) project, whereas all proposed activities must respond to the goals and objectives of the project and contains expected outcomes and results linked to the program’s results framework. Each organization can submit only one application under this RFA. The successful organization will be awarded and will implement the sub-grant in accordance with USAID and US Government regulations governing grants under cost reimbursement agreements, as well as IMC’s internal sub-award/grant management policies.

Applicants must be Nigerians with a long time presence in Borno State, recognized as active in the State, that are legally registered and recognized under the laws of the Federal Government of Nigeria, and must be in compliance with all relevant applicable laws and regulations in accordance with Section IV of this RFA.

Faith-based organizations will receive equal opportunity for funding in accordance with the mandated guidelines laid out in ADS 303.3.28 except for faith-based organizations whose objectives are for discriminatory and religious purposes, and whose main objective of the grant is of a religious nature.

Any resulting awards will be subject to 2 CFR 200 – Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards and USAID Mandatory and Required-as-Applicable Standard Provisions for Non-US Non-Governmental Organizations.

Awarding of grants is pending funding availability. Implementation of the grants is expected to start at the beginning of January 2020.

II. PROGRAM DESCRIPTION AND SCOPE OF WORK

A. Background

International Medical Corps began its Polio programming in Kano State in March, 2015, and subsequently, expanded Polio eradication activities to Borno State in October, 2015. Despite the violent acts of the insurgents, activities succeeded, helping protect young children against Polio and lifting vaccination rates from the 20-30% range to impressive 99.96% rate in Kano and 96.8% in Borno.

The Core Group Partner Project (CGPP) continues to support the Polio Eradication Initiatives (PEI) in Nigeria through International Medical Corps (IMC), a U.S. based non-profit organization with over 30 years of humanitarian and development experience in 70 countries worldwide. International Medical Corps continues to increase acceptance of immunizations and improve the sensitivity of surveillance for Acute Flaccid Paralysis, focusing especially on Polio vaccination in 10 LGAs in Borno State (Damboa, Jere, Maiduguri Metropolitan Council (MMC), Kala Balge, Ngazai, Konduga, Abadam, Monguno, Guzamala, Ngala).

The CGPP project aims to 1) re-enforce the Ministry of Health’s (MOH) routine immunization program to improve its performance, 2) strengthen independent immunization campaign monitoring efforts, and 3) improve community mobilization in support of child immunization and Acute Flaccid Paralysis (AFP) surveillance. This strategy has led to significant improvement in the Expanded Program on Immunization (EPI) services contributing to CGPP’s goal of Polio eradication in hard-to-reach communities.

B. Overview of the current situation

Nigeria remains one of the three countries not yet declared Polio-free by the World Health Organization. Cases of Poliomyelitis and Poliovirus transmission in Nigeria resurfaced in 2016, in Borno State. This included single cases of Wild Polio Virus (WPV) in Gwoza and Jere Local Government Areas (LGAs) in August and one case of WPV-type 1 in Monguno in October, 2016. However, with efforts from partners including the World Health Organization, the Centers for Disease Control and Prevention, UNICEF, the Core Group Partner Project, and many more, Nigeria could be declared Polio-free by the end of 2019.

International Medical Corps (IMC) is implementing a 5-year project as one of the CGPP partners in Borno and Kano states. The multi-year project will enter in its third fiscal year beginning September 30, 2019.

Polio eradication activities have been successfully conducted through a partnership with community based organizations (CBO), and include supplementary immunization activities (SIA), immunization plus days (IPDs), outbreak responses (OBR), pre-campaign meetings and trainings at the state, Local Government Area (LGA), and ward levels; capacity building for CBO’s management staff including the Voluntary Community Mobilizers (VCM), Voluntary Ward Supervisors (VWS), and Local Government Area Coordinators (LGAC) at the community level, and strengthening routine immunization and continuous advocacy and meetings with local leaders and officials.

C. Scope of Work

In order to continue the implementation of interventions described above in ten (10) LGAs of Borno State (Damboa, Jere, MMC, Kala Balge, Ngazai, Konduga, Abadam, Monguno, Guzamala, and Ngala), International Medical Corps, through the Core Group Partner Project, requests applications from eligible community based organizations.

The successful sub-recipient will support the specific CGPP objectives as these relate to increasing coverage of Polio and routine immunizations to protect children from preventable diseases and disability.

Objective 1: Build effective partnerships between PVOs, NGOs, and international, national and regional organizations involved in Polio

Under this objective, the sub-recipient will:

• Conduct ward level review meetings
• Conduct monthly LGA review meetings
• Hold monthly Routine Immunization (RI) meetings

Objective 2: Support PVO/NGO efforts to strengthen national and regional immunization

systems to achieve Polio eradication

Under this objective, the sub-recipient will:

• Conduct facility/community outreaches for Polio eradication
• Conduct monthly meetings by representatives of health facility with health workers
• Conduct house-to-house mobilization to create demand for OPV uptake during campaigns.
• Support Maternal, Newborn and Child Health (MNCH) Week
• Support World Breastfeeding Week
• Conduct monthly supervisory visit in each LGA to inspect Cold Chain
• Conduct monthly meeting with Ward Development Committee (WDC) /Village Development Committee (VDC) to address issues related to RI (i.e. drop-out rate)
• Conduct RI supportive supervision for Health Facility staff, RI providers and VCMs.
• Conduct quarterly meetings with key informants (barbers, and TBAs) to strengthen RI
• Conduct award activities to outstanding VCM/VWS/LGACs

Objective 3: Support PVO/NGO involvement in national and regional planning and

implementation of supplemental Polio immunizations

Under this objective, the sub-recipient will:

• Conduct Directly Observed Polio Vaccination (DOPV) supervision during IPDs
• Conduct house-to-house visits during “in-between” rounds and during IPDs
• Conduct advocacy visits to political, traditional and religious leaders
• Conduct sensitization meetings with village leaders (pre-campaign)
• Hold sensitization meetings with ward leaders
• Hold sensitization meetings with religious leaders
• Hold Non Compliance Meeting with WFPs, Religious & Traditional Leaders
• Organize and conduct monthly meetings with Health Facility Staff/CHIPS
• Participate in planning, implementation, and evaluations for NIDs, Sub-national Immunization Days (SNID) or Mop-up campaigns;
• Identify problematic areas and develop plans and strategies to increase coverage in those areas
• Support social mobilization to increase acceptance and demand for supplemental immunizations and routine immunization
• Encourage community participation in, or contribution to, supplemental immunizations and other immunization efforts such as child health weeks.
• Organize and conduct monthly meetings with Health Facility Staff/CHIPS
• Conduct IPC skills training for CGPP technical staff
• Conduct training on PEI (microplanning, Social Mobilization, and M&E) for CGPP technical staff
• Conduct training on VVM and VCM register
• Conduct IPC skills training for religious and traditional leaders
• Support outbreak response(s)/Fractional Inactivated Poliovirus Vaccine (fIPV) through deployment of CGPP staff
• Support World Polio Day activities
• Support African Vaccination Weeks

Objective 4: Support PVO/NGO efforts to strengthen AFP case detection and reporting (and case detection of

other infectious diseases)

• Under this objective, the sub-recipient will:
• Conduct refresher training for community informants/VCMs
• Conduct AFP Surveillance Coordination meetings with LGA authorities, and religious/traditional leaders
• Review of VCMs weekly AFP Active Case Search
• Provide step-down refresher trainings for VCMs on AFP surveillance and active case search
• Conduct AFP surveillance supportive supervision to focal LGAs
• Conduct monthly meeting with community informants. /VCMs

Objective 5: Support timely documentation and use of information to continuously improve the quality of Polio eradication (and other related health) activities

Under this objective, the sub-recipient will:

• Conduct monthly compound meetings
• Conduct community dialogues
• Attend Quarterly M&E Review meetings
• Attend bi-annual sharing meetings
• Conduct community-level feedback meetings with CBO staff/Community Informants/traditional and religious leaders in focus LGAs.
• Conduct supportive supervision on data quality and reporting, including timely data extraction from VCMs registers

Crosscutting Issues

Cross cutting issues are those that should be considered by each applicant as part of their proposal:

• Vulnerable Populations: Applicants will be asked to outline how they will take vulnerable populations (pregnant women, children, elderly, disabled, poor) into account
• Gender Mainstreaming: Applicants will be asked to outline how they will ensure gender mainstreaming into account
• Hard to reach areas: Applicants will be asked which strategy they will use to avoid missed child

· Organizational Development:

In order to assist in building the organizational capacity of the CBO receiving funding, International Medical Corps and the CGPP will provide capacity assessment and development by assessing the applicant programmatic, financial, logistics and M&E capacities. The outcomes of the assessment will feed into the Organizational Development Plan (ODP) that will represent capacity building priorities supporting the partner’s technical and organizational capacities.

D. Sustainability Plan/Exit Strategy

All applications should include a sustainability plan, including an exit strategy, to illustrate how services will continue after the CGPP funding cycle. For example, continuation of sensitization of caregivers for RI uptake, etc.

III. INELIGIBLE ACTIVITIES AND GOODS

The following items cannot be purchased with grant funds. The following activities and goods are unallowable and should not be included in the proposed budget:

1. Alcoholic beverages and non-program related entertainment costs;
2. Infrastructure or construction activities;
3. Real property (land, including land improvements, structures and appurtenances thereto);
4. Goods or services restricted or prohibited under the prevailing USAID source/nationality and other regulations; or from countries or suppliers as may be identified by USAID’s consolidated list of debarred, suspended, or ineligible subcontractors at (www.sam.gov);
5. Purchases of restricted goods, such as agricultural commodities, motor vehicles, pharmaceuticals, pesticides, timber extraction or processing equipment, used equipment, and fertilizers. If procurement of these restricted goods is necessary, IMC will request approval from the contracting officer and will procure items directly and donate in kind to the grantee;
6. Prohibited goods under USAID regulations, including but not limited to: police or law enforcement equipment, abortion equipment and services, Military equipment, Surveillance equipment, weather modification equipment, luxury goods, and gambling equipment;
7. Private ceremonies, parties, celebrations, or “representation” expenses;
8. Previous obligations and/or bad debts;
9. Fines and/or penalties;
10. Creation of endowments;
11. Cash assistance to the Palestinian Authority, including local government units and employees;
12. Any purchases or activities deemed unnecessary to accomplish grant purposes as determined by IMC;
13. Other costs unallowable under USAID and/or federal regulations. Refer to 2 CFR 200 subpart E “Cost Principles”;
14. Sub-granting.

IV. ELIGIBILITY CRITERIA

Applicants must meet the following requirements in order for International Medical Corps to review their application:

1. Legally Registered

Eligibility for Applicants is limited to Nigerian community based organization, recognized as active in Borno State, that are legally registered and recognized under the laws of the Government of the Federal Republic of Nigeria. The applicant must also be legally authorized to work in Borno State. Applicants must attach a valid copy of their registration documentation. Applicant should be established and registered for at least three years prior to the date of this RFA.

1. Technical Capacity

Applicant demonstrates a respectable level of transparency and good governance. It should possess the required experience to successfully implement the grant activities, verified through past performance and reference checks. Examples of such requirements include years of operation, size of annual budget, experience working within the relevant sector, audit track record, etc. It displays sound management in the form of financial, administrative, and technical policies and procedures that are in written format and that present a system of internal controls to safeguard assets and protect against fraud, waste, and abuse. It demonstrates successful past performance in implementation of activities related to Polio eradication activities. IMC will assess this capability prior to awarding a grant

1. Fiscal responsibility

All preparation and submission costs related to the RFA are at the Applicant’s expense. Applicants who come under consideration for an award will be subject to a pre-award survey to determine fiscal responsibility, ensure adequacy of financial controls, and negotiate a budget.

1. Prohibition against Fee

Assistance sub-awards (e.g. sub-agreements, in-kind grants, simplified grants, fixed amount sub-awards) cannot charge a fee-for-profit. Applicants must not include a fee-for-profit in their application.

1. Conflict of Interest

The sub-recipient’s other relationships, associations, activities, and interests should not create a conflict of interest that could prevent full impartiality in implementation of the sub-award activities. At a later stage and before grant awarding, applicants must complete the IMC Conflict of Interest Certification, declaring that no known conflicts exist.

1. Prohibition against transactions with Ineligible or Excluded Individuals and Organizations

In accordance with International Medical Corps and USAID policies and regulations, International Medical Corps prohibits transactions with ineligible or excluded individuals and organizations. Applicants will be subject to a screening; to ensure they are not associated with terrorism. Applicants will also be asked to certify that it has not and will not promote or engage in violence or terrorism and are in full compliance with all U.S. Executive Orders, laws and regulations that prohibit transactions with, and the provision of resources and support to, individuals and organizations associated with terrorism.

1. Compliance to USAID regulations

· Applicant furnishes detailed information on key personnel in order to complete the partner vetting forms.

· For any grant award(s) resulting from this solicitation that is other than in-kind and equivalent to $25,000 USD or more, grantees will be required to obtain and provide a Data Universal Numbering System (DUNS) number at the time of award. If the applicant already has a DUNS number, it should be included in their application. Otherwise, applicants will be expected to get a DUNS number before an award is made. IMC will assist successful applicants with this process. DUNS numbers can be obtained online at http://fedgov.dnb.com/webform/pages/CCRSearch.jsp

· Comply with the Branding and Marking requirements if awarded a grant. (For more information, see USAID’s Branding and Marking requirements at the following link: http://www.usaid.gov/sites/default/files/documents/1868/320.pdf).

· Applicants must agree to sign, prior to grant negotiation, the USAID Anti-Terrorism Certification (ATC) and other required pre-award certifications as specified in ADS 303.3.8 and other USAID policies and regulations as stipulated.

· Non-U.S. sub-recipients will be subject to annual financial audits should the sub-recipients incur expenditures of federal funds totaling $750,000 or more during its fiscal year. USAID has the discretion to audit sub-recipients at a lower threshold if deemed necessary.

V. Quality Assurance Considerations

The following parameters apply to all potential grants under this RFA:

· All projects’ activities will be supported in Borno State.

· Applicants must apply for all objectives as stated in section C (Scope of Work).

· Applicant is willing to consider gender integration and equality in all stages of project. Applicant shall address the needs and interests of marginalized/vulnerable populations, including but not limited to men, women, boys, girls, individuals with disabilities, and aged people.

· Applicant shall be willing to address its capacity development needs, and agrees to conduct different types of capacity assessments as necessary.

· Applicant shall consider including Strategic Objective in their application for capacity development.

· Any single procurement action for equipment or material above $5,000 must be implemented by IMC and/or consortium partners on behalf of the grantee to assure that all USAID rules and regulations pertaining to procurement are respected and that any necessary waivers have been approved by USAID.

· The Grantee must adhere to USAID and IMC branding and marking requirements, following the IMC/USAID approved branding strategy and marking plan throughout implementation.

· IMC will retain the right to conduct an audit of grantees at any time during or after project implementation.

VI. EVALUATION CRITERIA

Applications will be evaluated by International Medical Corps and consortium partners, based on the evaluation criteria below:

No.

Evaluation Category

Max Points

1. General/Administrative Status
2. Registration with the Corporate Affairs Commission (CAC)
3. Registration with the Special Control Unit against Money Laundering (SCUML) – optional
4. Additional Registration at the State and local government levels – optional

10 Points

1. Technical Approach

· Minimum number of years of operation in Borno State

• Experience working in Polio/immunization project(s)
• Experience in report writing
• Monitoring and evaluation system

25

1. Clear considerations for gender and vulnerabilities:
2. Inclusion of gender and vulnerabilities considerations in the application.
3. Clear identification of the target-groups/beneficiaries who will be directly and positively affected by the proposed activities

10 Points

1. Management & Programmatic Capacity

· Proposed personnel

· Relevant past performance and experience in the field including examples of current and past projects

10 Points

1. Budget

· Cost efficiency/realism

· Feasibility of budget vs. project activities

10 Points

VII. AUTHORITY AND GOVERNING REGULATIONS

This RFA is issued in accordance with a cooperative agreement issued by USAID to IMC under the Foreign Assistance Act of 1961, as amended. International Medical Corps/Nigeria CGPP grants to non-U.S. organizations must adhere to certain United States Government regulations, as well as certain USAID rules and policies specific to the implementation of programs in the North-East of Nigeria. Awards made to non-U.S. organizations will adhere to guidance provided under ADS Chapter 303, “Grants and Cooperative Agreements to Non-Governmental Organizations” and will be within the terms of the USAID Standard Provisions for Non-U.S. Non-Governmental Recipients, as well as the IMC Sub-awards Manual. These provisions can be accessed through the USAID website at http://www.usaid.gov/sites/default/files/documents/1868/303.pdf. Also should adhere to: 2 CFR 200: Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (http://www.ecfr.gov/cgi-bin/text idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl.); 2 CFR 230 – Cost Principles For Non Profit Organizations (see http://www.ecfr.gov); the USAID Mandatory Standard Provisions for Non-US Nongovernmental Organizations (see http://www.usaid.gov/policy/ads/300/303mab.pdf); 22 CFR 228 – Rules for Procurement of Commodities and Services Financed by USAID (see http://www.ecfr.gov); USAID’s “No-Contact Policy”, and other USAID Notices issued from time to time (collectively available at http://transition.usaid.gov/wbg/notices.html); and the statutes and regulations governing the USAID cooperative agreement will apply to approved grants.

International Medical Corps is required to ensure that all organizations receiving USAID grant funds comply with the guidance found in these circulars, as applicable to the respective terms and conditions of their grant awards.

International Medical Corps retains the right to terminate any grant in whole or in part or to suspend payments should the recipient become insolvent during performance of the award, if the recipient materially fails to comply with the terms and conditions of the grant, or if a continuation of the grant would not be in the interest of IMC stakeholders.

VIII. FUNDING AND Award Information

All grants will be negotiated, denominated and funded in US Dollars. Grants under this RFA may not exceed $250,000 in value per grant and 9 months in duration. Payments will be made on a monthly cost reimbursement basis, following submission and approval of monthly financial and narrative reports. Rolling advances might be agreed during project negotiations. All costs funded by the grant must be allowable, allocable and reasonable.

Regarding indirect cost rate (NICRA), the following options are available to use as a means of budgeting:

• Negotiated Indirect Cost Rate Agreement (NICRA) from the U.S. Government
• De-minimis 10% Rate
• Billed Direct to the project, if this option is allowable under donor regulations
• A negotiated rate, as agreed between International Medical Corps and the sub-partner (can be discussed if partner moves to consideration phase)

Indirect costs are not to be included in this grant; however, the budget may include direct costs that will be incurred by the Applicant to provide identifiable administrative and management costs that can be directly attributable to supporting the grant objective. Grantee and/or approved third party contribution are strongly encouraged, although it is not required.

IX. REQUIRED APPLICATION FORMAT AND CONTENT

All applications must include the following format requirements:

Note: Full Application should not be more than 20 pages. All applicants must use the full application form provided along with this RFA, no other forms or templates will be accepted.

• English language only.
• Font size is 12 Times New Roman.
• Line spaced 1.5.
• Include applicant organization name, date, RFA number, and page number as a footer throughout the document.

Detail for the application components are as follows:

1) COVER PAGE

Include the following information on the cover page:

• Name of the organization
• Name of project
• Date of submission
• Contact person name, title, contact information (including phone and email address)
• Budget amount requested
• RFA number

2) PART A: NARRATIVE

Organizational Capacity and Potential: Describe why you believe your organization should be selected to receive a sub-award under this program? Describe your past experience that you will build upon in order to implement the proposed project. What are some of your organization’s key strengths that can be built upon for future growth and achievement?

Project Beneficiaries: Children under 5 for RI and children less than 1 year for OPV

Activities by Objective: Describe in detail how your organization will achieve the project objectives. Show how your activities will build upon what communities are already doing to respond to the problems, and will utilize community resources to address the problems. Show how your work will further strengthen collaboration among relevant government and civil society entities and initiatives already active in your project areas. Clearly link your activities to the appropriate objectives outlined above.

Monitoring and Reporting: Describe the activities and tools you will use to monitor project implementation. Describe how you will use monitoring information to improve project activities. Describe the process you will use to prepare good regular reports. Describe approaches you will use to use project data to improve quality.

Project Management and Structure: Identify principal staff members who will be involved in ensuring program success and accountability. Describe their responsibilities and qualifications. Describe your supervisory systems with special attention to how you will ensure quality of project activities. Discuss your strategies for managing and motivating volunteers.

3) PART C: BUDGET AND BUDGET NARRATIVE

Detailed Budget:

Provide a detailed budget according to the template provided in ATTACHMENT B, with an accompanying budget narrative which provides detail of the total costs to implement the proposed program. Include a breakdown of all costs and organize by major budget category. The detailed budget may be included in the Appendices section of the proposal if that is more convenient

Note: All costs should be presented in US dollars. In the budget narrative, state the currency conversion rate you are using.

Budget Narrative:

Include a narrative for your budget that describes, in detail, a breakdown of unit costs for each budget line item. Your budget narrative should be presented in the following format:

Salaries: Indicate each proposed staff member by position title, the percentage of time (level of effort) to be dedicated solely to this project, and proposed salary (monthly and annual).

Fringe Benefits: Describe fringe benefits that are required by local law and provided according to common practice, and your organization’s policies. Describe how benefits are calculated.

Travel: Include all estimated costs for local and regional travel to be charged to the sub-award as well as any stipends or per diems provided to staff according to your organization’s policies. Include locations of travel (to and from), as well as unit costs for airfare, lodging, per diem, and number of days. Include a brief description of the purpose of travel. This budget line also includes rental of vehicles and utilization of sub-grantee’s vehicles and include fuel costs, maintenance, licensing and registration, etc. All airfare must be coach-class. International travel will not be permitted without prior approval by International Medical Corps. Fuel costs for land travel should also be included in this section.

Equipment: Clearly indicate any equipment to be purchased under this sub-award including unit costs. “Equipment” is defined as those items having a unit price of US $5,000 or greater, and a useful life of more than one year. Include an additional line for expandable and non-expandable equipment.

Supplies: Indicate any supplies to be purchased under this sub-award including unit costs. “Supplies” are defined as those items consumed directly for the operation of the program and having a unit price less than US $5,000.

Other Direct Costs: Detail other direct costs, including office rent, utilities, banking fees, postage, courier, and other costs allocated directly to the project.

Indirect Costs (if applicable): Indirect costs (also known as administrative costs, overhead or non-project attributable costs (NPAC)) are incurred for common or joint objectives and cannot be readily identified with a particular project. Indirect costs are common costs that benefit the day-to-day operations of an organization, including categories such as salaries and expenses of executive officers, personnel administration, and accounting, or that benefit and are identifiable to more than one program or activity, such as depreciation, rental costs, operations and maintenance of facilities, and telephone expenses. In accordance with International Medical Corps policy and donor regulations, sub-recipients may allocate indirect costs on the basis of the following:

• A negotiated rate, as agreed between International Medical Corps and the applicant

Applicants must provide an explanation and supporting documentation (as applicable), to justify which method they will use to charge indirect costs, if any.

Restricted Items (if applicable): Identify any costs in your budget that are considered “restricted items” per the criteria below. The following items are restricted and will require prior approval from the donor before costs may be incurred to purchase the below items. International Medical Corps will obtain donor approval on behalf of the applicant for the items listed below:

Agricultural commodities

Motor vehicles

Pharmaceuticals

Pesticides

Rubber Compounding Chemicals and Plasticizers

Used equipment

US Government-owned excess property

Fertilizer

4) PART D: PAST PERFORMANCE REFERENCES

Please provide other past performance data for a minimum of three (3) projects implemented by the applicant.

REFERENCE ONE

Project Name:

Project Description:

Name of the Donor:

Program Period of Performance:

Award Amount (in US Dollars):

Type of Award

(Cost Reimbursement or Fixed Price; Grant/ Cooperative Agreement/ Contract; etc.)

Was your entity the prime recipient?

Choose One: Yes/No

Client Reference

(Name, Title, Email, Phone):

Results/ Key Accomplishments:

REFERENCE TWO

Project Name:

Project Description:

Name of the Donor:

Program Period of Performance:

Award Amount (in US Dollars):

Type of Award

(Cost Reimbursement or Fixed Price; Grant/ Cooperative Agreement/ Contract; etc.)

Was your entity the prime recipient?

Choose One: Yes/No

Client Reference

(Name, Title, Email, Phone):

Results/ Key Accomplishments:

REFERENCE THREE

Project Name:

Project Description:

Name of the Donor:

Program Period of Performance:

Award Amount (in US Dollars):

Type of Award

(Cost Reimbursement or Fixed Price; Grant/ Cooperative Agreement/ Contract; etc)

Was your entity the prime recipient?

Choose One: Yes/No

Client Reference

(Name, Title, Email, Phone):

Results/ Key Accomplishments:

5) APPENDICES:

The following attachments are required with the applicant’s proposal:

APPENDIX 1: Evidence of local registration status

APPENDIX 2: International Medical Corps’ Conflict of Interest Certification signed

APPENDIX 3: Past performance references

APPENDIX 4: Copy of a report to a former donor

APPENDIX 5: Organizational Chart

APPENDIX 6: Proof of Bank Account and Bank Statements (over the past 3 months) APPENDIX 7: Board of Director Profiles