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SERIAL#: PH RFP 260068 Page 1 of 50 CONTRACT PURSUANT TO PH RFP 260068 This Contract is entered into this 1st day of April 2026 by and between Maricopa County (“County”), a political subdivision of the State of Arizona, and Cartwheel Health Services, P.C., a Massachusetts corporation (“Contractor”) for the purchase of services related to SCHOOL-BASED MENTAL TELEHEALTH SERVICES. 1.0 CONTRACT TERM: 1.1 This Contract is for a term of twelve (12) months, beginning on the 1st day of April 2026 and ending the 31st day of March 2027. 1.2 The County may, at its option and with the agreement of the Contractor, renew the term of this Contract for additional terms up to a maximum of two (2) additional years, (or at the County’s sole discretion, extend the contract on a month- to-month basis for a maximum of six (6) months after expiration). The County shall notify the Contractor in writing of its intent to extend the Contract term at least sixty (60) calendar days prior to the expiration of the original contract term, or any additional term thereafter. 2.0 CONTRACT COMPLETION: The Contractor shall make all reasonable efforts for an orderly transition of its duties and responsibilities to another provider and/or to the County. This may include, but is not limited to, the preparation of a transition plan and cooperation with the County or other providers in the transition. The transition includes the transfer of all records, and other data in the possession, custody or control of Contractor required to be provided to the County either by the terms of this agreement or as a matter of law. The provisions of this clause shall survive the expiration or termination of this agreement. 3.0 PRICE ADJUSTMENTS: Any requests for reasonable price adjustments must be submitted sixty (60) calendar days prior to the Contract expiration date. Requests for adjustment in cost of labor and/or materials must be supported by appropriate documentation. The reasonableness of the request will be determined by comparing the request with the Consumer Price Index or by performing a market survey. If County agrees to the adjusted price terms, County shall issue written approval of the change and provide an updated version of the Contract. The new change shall not be in effect until the date stipulated on the Contract. 4.0 PAYMENTS: 4.1 As consideration for performance of the duties described herein, County shall pay Contractor the sum(s) stated in Exhibit “A.” 4.2 Payment shall be made upon the County’s receipt of a properly completed invoice. SERIAL#: PH RFP 260068 Page 2 of 50 4.3 INVOICES: 4.3.1 The Contractor shall submit one (1) legible copy of their detailed invoice before payment(s) will be made. Incomplete invoices will not be processed. At a minimum, the invoice must provide the following information: Company name, address, and contact information County bill-to name and contact information Contract Serial Number County purchase order number Invoice number and date Payment terms Invoice period Description of purchase or services, include: o Pricing per unit of purchase and extended price o Budget category Subtotal of each budget category Total amount due 4.3.2 Problems regarding billing or invoicing shall be directed to the Department as listed on the Purchase Order. 4.3.3 Payment shall only be made to the Contractor by Accounts Payable through the Maricopa County Vendor Express Payment Program. This is an Electronic Funds Transfer (EFT) process. After Contract Award the Contractor shall complete the Vendor Registration Form located on the County Department of Finance Vendor Registration Web Site located at https://azdom-vss-ext.hostams.com/PRDVSS2X1/Advantage4 4.3.4 Discounts offered in the contract shall be calculated on the date a properly completed invoice is received by the County. 4.3.5 EFT payments to the routing and account numbers designated by the Contractor will include the details on the specific invoices that the payment covers. The Contractor is required to discuss remittance delivery capabilities with their designated financial institution for access to those details. 5.0 APPLICABLE TAXES: 5.1 Payment of Taxes: The Contractor shall pay all applicable taxes. With respect to any installation labor on items that are not attached to real property performed by Contractor under the terms of this Contract, the installation labor cost and the gross receipts for materials provided shall be listed separately on the Contractor’s invoices. 5.2 State and Local Transaction Privilege Taxes: To the extent any State and local transaction privilege taxes apply to sales made under the terms of this Contract it is the responsibility of the seller to collect and remit all applicable taxes to the proper taxing jurisdiction of authority. 5.3 Tax Indemnification: Contractor and all subcontractors shall pay all Federal, State, and local taxes applicable to its operation and any persons employed by the Contractor. Contractor shall require all subcontractors to hold Maricopa County harmless from any responsibility for taxes, damages and interest, if applicable, contributions required under SERIAL#: PH RFP 260068 Page 3 of 50 Federal, and/or State and local laws and regulations, and any other costs including transaction privilege taxes, unemployment compensation insurance, Social Security, and Worker’s Compensation. 6.0 TAX (SERVICES): No tax shall be invoiced or paid against Contractor’s labor. It is the responsibility of the Contractor to determine any and all applicable taxes. 7.0 AVAILABILITY OF FUNDS: 7.1 The provisions of this Contract relating to payment for services shall become effective when funds assigned for the purpose of compensating the Contractor as herein provided are available to County for disbursement. The County shall be the sole judge and authority in determining the availability of funds under this Contract. County shall keep the Contractor fully informed as to the availability of funds. 7.2 If any action is taken by any State agency, Federal department, or any other agency or instrumentality to suspend, decrease, or terminate its fiscal obligations under, or in connection with, this Contract, County may amend, suspend, decrease, or terminate its obligations under, or in connection with, this Contract. In the event of termination, County shall be liable for payment only for services rendered prior to the effective date of the termination, provided that such services are performed in accordance with the provisions of this Contract. County shall give written notice of the effective date of any suspension, amendment, or termination under this Section, at least ten (10) days in advance. 9.0 STRATEGIC ALLIANCE for VOLUME EXPENDITURES (SAVE) The County is a member of the SAVE cooperative purchasing group. SAVE includes the State of Arizona, many Phoenix metropolitan area municipalities, and many K-12 unified school districts. Under the SAVE Cooperative Purchasing Agreement, and with the concurrence of the successful respondent under this solicitation, a member of SAVE may access a contract resulting from a solicitation issued by the County. If contractor does not want to grant such access to a member of SAVE, state so in contractor’s bid. In the absence of a statement to the contrary, the County will assume that contractor does wish to grant access to any contract that may result from this bid. The County assumes no responsibility for any purchases by using entities. 10.0 INTERGOVERNMENTAL COOPERATIVE PURCHASING AGREEMENTS (ICPAs): County currently holds ICPAs with numerous governmental entities. These agreements allow those entities, with the approval of the Contractor, to purchase their requirements under the terms and conditions of the County contract. It is the responsibility of the non-County government entity to perform its own due diligence on the acceptability of the contract under its applicable procurement rules, processes, and procedures. Certain governmental agencies may not require an ICPA and may utilize this contract if it meets their individual requirements. Other governmental agencies may enter into a separate Statement of Work with the Contractor to meet their own requirements. The County is not a party to any uses of this contract by other governmental entities. 11.0 DUTIES: The Contractor shall perform all duties stated in Exhibit “C”, or as otherwise directed in writing by the Procurement Officer. SERIAL#: PH RFP 260068 Page 4 of 50 12.0 TERMS AND CONDITIONS: 12.1 INDEMNIFICATION: To the fullest extent permitted by law, and to the extent that claims, damages, losses or expenses are not covered and paid by insurance purchased by the Contractor, the Contractor shall defend indemnify and hold harmless the County (as Owner), its agents, representatives, agents, officers, directors, officials, and employees from and against all claims, damages, losses, and expenses (including, but not limited to attorneys' fees, court costs, expert witness fees, and the costs and attorneys' fees for appellate proceedings) arising out of, or alleged to have resulted from the negligent acts, errors, omissions, or mistakes relating to the performance of this Contract. Contractor's duty to defend, indemnify, and hold harmless the County, its agents, representatives, agents, officers, directors, officials, and employees shall arise in connection with any claim, damage, loss, or expense that is attributable to bodily injury, sickness, disease, death or injury to, impairment of, or destruction of tangible property, including loss of use resulting there from, caused by negligent acts, errors, omissions, or mistakes in the performance of this Contract, but only to the extent caused by the negligent acts or omissions of the Contractor, a subcontractor, any one directly or indirectly employed by them, or anyone for whose acts they may be liable, regardless of whether or not such claim, damage, loss, or expense is caused in part by a party indemnified hereunder. The amount and type of insurance coverage requirements set forth herein will in no way be construed as limiting the scope of the indemnity in this paragraph. The scope of this indemnification does not extend to the sole negligence of County. 12.2 INSURANCE: 12.2.1 Contractor, at Contractor’s own expense, shall purchase and maintain the herein stipulated minimum insurance from a company or companies duly licensed by the State of Arizona and possessing a current A.M. Best, Inc. rating of B++. In lieu of State of Arizona licensing, the stipulated insurance may be purchased from a company or companies, which are authorized to do business in the State of Arizona, provided that said insurance companies meet the approval of County. The form of any insurance policies and forms must be acceptable to County. 12.2.2 All insurance required herein shall be maintained in full force and effect until all work or service required to be performed under the terms of the Contract is satisfactorily completed and formally accepted. Failure to do so may, at the sole discretion of County, constitute a material breach of this Contract. 12.2.3 Contractor’s insurance shall be primary insurance as respects County, and any insurance or self-insurance maintained by County shall not contribute to it. 12.2.4 Any failure to comply with the claim reporting provisions of the insurance policies or any breach of an insurance policy warranty shall not affect the County’s right to coverage afforded under the insurance policies. SERIAL#: PH RFP 260068 Page 5 of 50 12.2.5 The insurance policies may provide coverage that contains deductibles or self-insured retentions. Such deductible and/or self-insured retentions shall not be applicable with respect to the coverage provided to County under such policies. Contractor shall be solely responsible for the deductible and/or self-insured retention and County, at its option, may require Contractor to secure payment of such deductibles or self- insured retentions by a surety bond or an irrevocable and unconditional letter of credit. 12.2.6 The insurance policies required by this Contract, except Workers’ Compensation and Errors and Omissions, shall name County, its agents, representatives, officers, directors, officials and employees as Additional Insureds. 12.2.7 The policies required hereunder, except Workers’ Compensation and Errors and Omissions, shall contain a waiver of transfer of rights of recovery (subrogation) against County, its agents, representatives, officers, directors, officials, and employees for any claims arising out of Contractor’s work or service. 12.2.8 Commercial General Liability: Commercial General Liability insurance and, if necessary, Commercial Umbrella insurance with a limit of not less than $2,000,000 for each occurrence, $4,000,000 Products/Completed Operations Aggregate, and $4,000,000 General Aggregate Limit. The policy shall include coverage for premises liability, bodily injury, broad form property damage, personal injury, products and completed operations and blanket contractual coverage, and shall not contain any provisions which would serve to limit third party action over claims. There shall be no endorsement or modifications of the CGL limiting the scope of coverage for liability arising from explosion, collapse, or underground property damage. 12.2.9 Automobile Liability: Commercial/Business Automobile Liability insurance and, if necessary, Commercial Umbrella insurance with a combined single limit for bodily injury and property damage of not less than $2,000,000 each occurrence with respect to any of the Contractor’s owned, hired, and non-owned vehicles assigned to or used in performance of the Contractor’s work or services or use or maintenance of the premises under this Contract. 12.2.10 Workers’ Compensation: Workers’ Compensation insurance to cover obligations imposed by Federal and State statutes having jurisdiction of Contractor’s employees engaged in the performance of the work or services under this Contract; and Employer’s Liability insurance of not less than $1,000,000 for each accident, $1,000,000 disease for each employee, and $1,000,000 disease policy limit. Contractor, its contractors and its subcontractors waive all rights against Contract and its agents, officers, directors and employees for recovery of damages to the extent these damages are covered by the Workers’ Compensation and Employer’s Liability, or commercial umbrella liability insurance obtained by Contractor, its contractors and its subcontractors pursuant to this Contract. SERIAL#: PH RFP 260068 Page 6 of 50 12.2.11 Medical Malpractice: Medical Malpractice insurance and, if necessary, Commercial Umbrella insurance, which will insure and provide coverage for Medical Malpractice of the Contractor, with limits of no less than $5,000,000 for each claim. 12.2.12 Sexual Molestation and Physical Abuse: Commercial General Liability – Occurrence Form Policy shall include bodily injury, property damage and broad form contractual liability coverage. a. The policy shall be endorsed to include coverage for physical/sexual abuse and molestation. b. The policy shall be endorsed to include the following additional insured language: "(_____), its subsidiary, parent, associated and/or affiliated entities, successors, or assigns, its elected officials, trustees, employees, agents, and volunteers shall be named as additional insureds with respect to liability arising out of the activities performed by, or on behalf of the Contractor". 12.2.13 Minimum Limits: General Aggregate $2,000,000 Products/Completed Operations Aggregate $2,000,000 Each Occurrence Limit $2,000,000 Personal/Advertising Injury Sexual Abuse/Molestation $2,000,000 $2,000,000 12.2.14 Certificates of Insurance: Prior to Contract award, Contractor shall furnish the County with valid and complete certificates of insurance, or formal endorsements as required by the Contract in the form provided by the County, issued by Contractor’s insurer(s), as evidence that policies providing the required coverage, conditions and limits required by this Contract are in full force and effect. Such certificates shall identify this contract number and title. 12.2.14.1 In the event any insurance policy(ies) required by this Contract is(are) written on a claims made basis, coverage shall extend for two years past completion and acceptance of Contractor’s work or services and as evidenced by annual Certificates of Insurance. 12.2.14.2 If a policy does expire during the life of the Contract, a renewal certificate must be sent to County fifteen (15) calendar days prior to the expiration date. 12.2.15 Cancellation and Expiration Notice: Applicable to all insurance policies required within the Insurance Requirements of this Contract, Contractor’s insurance shall not be permitted to expire, be suspended, be canceled, or be materially changed for any reason without thirty (30) days prior written notice to Maricopa County. SERIAL#: PH RFP 260068 Page 7 of 50 Contractor must provide to Maricopa County, within two (2) business days of receipt, if they receive notice of a policy that has been or will be suspended, canceled, materially changed for any reason, has expired, or will be expiring. Such notice shall be sent directly to Maricopa County Office of Procurement Services and shall be mailed, or hand delivered, to 4041 N. Central Avenue, 1400, Phoenix, AZ 85012 or emailed to the Procurement Officer noted in the solicitation. 12.3 FORCE MAJEURE: 12.3.1 Neither party shall be liable for failure of performance, nor incur any liability to the other party on account of any loss or damage resulting from any delay or failure to perform all or any part of this Contract if such delay or failure is caused by events, occurrences, or causes beyond the reasonable control and without negligence of the parties. Such events, occurrences, or causes will include Acts of God/Nature (including fire, flood, earthquake, storm, hurricane or other natural disaster), war, invasion, act of foreign enemies, hostilities (whether war is declared or not), civil war, riots, rebellion, revolution, insurrection, military or usurped power or confiscation, terrorist activities, nationalization, government sanction, lockout, blockage, embargo, labor dispute, strike, interruption or failure of electricity or telecommunication service. 12.3.2 Each party, as applicable, shall give the other party notice of its inability to perform and particulars in reasonable detail of the cause of the inability. Each party must use best efforts to remedy the situation and remove, as soon as practicable, the cause of its inability to perform or comply. 12.3.3 The party asserting Force Majeure as a cause for non-performance shall have the burden of proving that reasonable steps were taken to minimize delay or damages caused by foreseeable events, that all non-excused obligations were substantially fulfilled, and that the other party was timely notified of the likelihood or actual occurrence which would justify such an assertion, so that other prudent precautions could be contemplated. 12.4 WARRANTY OF SERVICES: 12.4.1 The Contractor warrants that all services provided hereunder will conform to the requirements of the Contract, including all descriptions, specifications and attachments made a part of this Contract. County’s acceptance of services or goods provided by the Contractor shall not relieve the Contractor from its obligations under this warranty. 12.4.2 In addition to its other remedies, County may, at the Contractor's expense, require prompt correction of any services failing to meet the Contractor's warranty herein. Services corrected by the Contractor shall be subject to all the provisions of this Contract in the manner and to the same extent as services originally furnished hereunder. 12.5 INSPECTION OF SERVICES: 12.5.1 The Contractor shall provide and maintain an inspection system acceptable to County covering the services under this Contract. Complete records of all inspection work performed by the Contractor shall be maintained and made available to County during Contract performance and for as long afterwards as the Contract requires. 12.5.2 County has the right to inspect and test all services called for by the Contract, to the extent practicable at all times and places during the term of the Contract. County shall perform inspections and tests in a manner that will not unduly delay the work. SERIAL#: PH RFP 260068 Page 8 of 50 12.5.3 If any of the services do not conform to Contract requirements, County may require the Contractor to perform the services again in conformity with Contract requirements, at no cost to the County. When the defects in services cannot be corrected by re-performance, County may: 12.5.3.1 Require the Contractor to take necessary action to ensure that future performance conforms to Contract requirements; and 12.5.3.2 Reduce the Contract price to reflect the reduced value of the services performed. 12.5.4 If the Contractor fails to promptly perform the services again or to take the necessary action to ensure future performance in conformity with Contract requirements, County may: 12.5.4.1 By Contract or otherwise, perform the services and charge to the Contractor, through direct billing or through payment reduction, any cost incurred by County that is directly related to the performance of such service; or 12.5.4.2 Terminate the Contract for default. 12.6 PURCHASE ORDERS: County reserves the right to cancel Purchase Orders within a reasonable period of time after issuance. Should a Purchase Order be canceled, the County agrees to reimburse the Contractor for actual and documentable costs incurred by the Contractor in response to the Purchase Order. The County will not reimburse the Contractor for any costs incurred after receipt of County notice of cancellation, or for lost profits, shipment of product prior to issuance of Purchase Order, etc. 12.7 SUSPENSION OF WORK: The Procurement Officer may order the Contractor, in writing, to suspend, delay, or interrupt all or any part of the work of this contract for the period of time that the Procurement Officer determines appropriate for the convenience of the County. No adjustment shall be made under this clause for any suspension, delay, or interruption to the extent that performance would have been so suspended, delayed, or interrupted by any other cause, including the fault or negligence of the Contractor. No request for adjustment under this clause shall be granted unless the claim, in an amount stated, is asserted in writing as soon as practicable after the termination of the suspension, delay, or interruption, but not later than the date of final payment under the Contract. 12.8 STOP WORK ORDER: The Procurement Officer may, at any time, by written order to the Contractor, require the Contractor to stop all, or any part, of the work called for by this contract for a period of ninety (90) calendar days after the order is delivered to the Contractor, and for any further period to which the parties may agree. The order shall be specifically identified as a stop work order issued under this clause. Upon receipt of the order, the Contractor shall immediately comply with its terms and take all reasonable steps to minimize the incurrence of costs allocable to the work covered by the order during the period of work stoppage. Within a period of 90 calendar days after a stop-work is delivered to the Contractor, or within any extension of that period to which the parties shall have agreed, the Procurement Officer shall either: SERIAL#: PH RFP 260068 Page 9 of 50 12.8.1 Cancel the stop work order; or 12.8.2 Terminate the work covered by the order as provided in the Default, or the Termination for Convenience clause of this Contract. 12.8.3 The Procurement Officer may make an equitable adjustment in the delivery schedule and/or Contract price, or otherwise, and the Contract shall be modified, in writing, accordingly, if the Contractor demonstrates that the stop work order resulted in an increase in costs to the Contractor. 12.9 TERMINATION FOR CONVENIENCE: Maricopa County may terminate the Contract for convenience by providing sixty (60) calendar days advance notice to the Contractor. 12.10 TERMINATION FOR DEFAULT: The County may, by written notice of default to the Contractor, terminate this Contract in whole or in part if the Contractor fails to: 12.10.1 Deliver the supplies or to perform the services within the time specified in this Contract or any extension; 12.10.2 Make progress, so as to endanger performance of this Contract; or 12.10.3 Perform any of the other provisions of this Contract. 12.10.4 The County’s right to terminate this contract under these subparagraphs may be exercised if the Contractor does not cure such failure within ten (10) business days (or more if authorized in writing by the County) after receipt of the notice from the Procurement Officer specifying the failure. 12.11 STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST: Notice is given that pursuant to A.R.S. § 38-511 the County may cancel any Contract without penalty or further obligation within three years after execution of the Contract, if any person significantly involved in initiating, negotiating, securing, drafting or creating the Contract on behalf of the County is at any time while the Contract or any extension of the Contract is in effect, an employee or agent of any other party to the Contract in any capacity or consultant to any other party of the Contract with respect to the subject matter of the Contract. Additionally, pursuant to A.R.S § 38-511 the County may recoup any fee or commission paid or due to any person significantly involved in initiating, negotiating, securing, drafting or creating the Contract on behalf of the County from any other party to the Contract arising as the result of the Contract. 12.12 CONTRACTOR LICENSE REQUIREMENT: The Contractor shall procure all permits, insurance, licenses and pay the charges and fees necessary and incidental to the lawful conduct of his/her business, and as necessary complete any required certification requirements, required by any and all governmental or non-governmental entities as mandated to maintain compliance with and in good standing for all permits and/or licenses. SERIAL#: PH RFP 260068 Page 10 of 50 The Contractor shall keep fully informed of existing and future trade or industry requirements, Federal, State and Local laws, ordinances, and regulations which in any manner affect the fulfillment of a Contract and shall comply with the same. Contractor shall immediately notify both Office of Procurement Services and the Department of all changes concerning permits, insurance, or licenses. 12.13 SUBCONTRACTING: 12.13.1 The Contractor may not assign to another contractor or subcontract to another party for performance of the terms and conditions hereof without the written consent of the County. All correspondence authorizing subcontracting must reference the Contract Number and identify the job project. 12.13.2 The Subcontractor’s rate for the job shall not exceed that of the Prime Contractor’s rate, as bid in the pricing section, unless the Prime Contractor is willing to absorb any higher rates, or the County has approved the increase. The Subcontractor’s invoice shall be invoiced directly to the Prime Contractor, who in turn shall pass-through the costs to the County, without mark-up. A copy of the Subcontractor’s invoice must accompany the Prime Contractor’s invoice. 12.14 AMENDMENTS: All amendments to this Contract shall be in writing and approved/signed by both parties. The designated Procurement Officer shall be responsible for approving all amendments for Maricopa County. 12.15 ADDITIONS/DELETIONS OF REQUIREMENTS: The County reserves the right to add and/or delete materials and services to a Contract. If a service requirement is deleted, payment to the Contractor will be reduced proportionately to the amount of service reduced in accordance with the bid price. If additional materials or services are required from a Contract, prices for such additions will be negotiated between the Contractor and the County. 12.16 STRICT COMPLIANCE: Acceptance by County of a performance that is not in strict compliance with the terms of the Contract shall not be deemed to be a waiver of strict compliance with respect to all other terms of the Contract. 12.17 VALIDITY: The invalidity, in whole or in part, of any provision of this Contract shall not void or affect the validity of any other provision of the Contract. 12.18 SEVERABILITY: The removal, in whole or in part, of any provision of this Contract shall not void or affect the validity of any other provision of this Contract. SERIAL#: PH RFP 260068 Page 11 of 50 12.19 RIGHTS IN DATA: The County shall have the use of data and reports resulting from a Contract without additional cost or other restriction except as may be established by law or applicable regulation. Each Party shall supply to the other Party, upon request, any available information that is relevant to a Contract and to the performance thereunder. 12.20 NON-DISCRIMINATION: Contractor agrees to comply with all provisions and requirements of Arizona Executive Order 2009-09 including flow down of all provisions and requirements to any subcontractors. Executive Order 2009-09 supersedes Executive order 99-4 and amends Executive order 75-5 and may be viewed and downloaded at the Arizona State Library Research website (http://azmemory.azlibrary.gov/cdm/singleitem/collection/execorders/id/680/rec/1) which is hereby incorporated into this contract as if set forth in full herein. During the performance of this Contract, Contractor shall not discriminate against any employee, client, or any other individual in any way because of that person’s age, race, creed, color, religion, sex, disability, or national origin. 12.21 CERTIFICATION REGARDING DEBARMENT AND SUSPENSION: The undersigned (authorized official signing on behalf of the Contractor) certifies to the best of his or her knowledge and belief that the Contractor, it’s current officers and directors; 12.21.1 are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from being awarded any contract or grant by any United States Department or Agency or any state, or local jurisdiction; 12.21.2 have not within three (3) year period preceding this Contract; 12.21.2.1 been convicted of fraud or any criminal offense in connection with obtaining, attempting to obtain, or as the result of performing a government entity (Federal, State or local) transaction or contract; and 12.21.2.2 been convicted of violation of any Federal or State antitrust statues or conviction for embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property regarding a government entity transaction or contract; 12.21.2.3 are not presently indicted or criminally charged by a government entity (Federal, State or local) with commission of any criminal offenses in connection with obtaining, attempting to obtain, or as the result of performing a government entity public (Federal, State or local) transaction or contract; and are not presently facing any civil charges from any governmental entity regarding obtaining, attempting to obtain, or from performing any governmental entity contract or other transaction; and have not within a three (3) year period preceding this Contract had any public transaction (Federal, State or local) terminated for cause or default. 12.21.3 If any of the above circumstances described in the paragraph are applicable to the entity submitting a bid for this requirement, include with your bid an explanation of the matter including any final resolution. SERIAL#: PH RFP 260068 Page 12 of 50 12.21.4 The Contractor shall include, without modification, this clause in all lower tier covered transactions (i.e., transactions with Subcontractors) and in all solicitations for lower tier covered transactions related to this Contract. 12.22 VERIFICATION REGARDING COMPLIANCE WITH A.R.S. §41-4401 AND FEDERAL IMMIGRATION LAWS AND REGULATIONS: 12.22.1 By entering into the Contract, the Contractor warrants compliance with the Immigration and Nationality Act (INA using E-verify) and all other Federal immigration laws and regulations related to the immigration status of its employees and A.R.S. §23-214(A). The Contractor shall obtain statements from its subcontractors certifying compliance and shall furnish the statements to the Procurement Officer upon request. These warranties shall remain in effect through the term of the Contract. The Contractor and its subcontractors shall also maintain Employment Eligibility Verification forms (I-9) as required by the Immigration Reform and Control Act of 1986, as amended from time to time, for all employees performing work under the Contract and verify employee compliance using the E-verify system and shall keep a record of the verification for the duration of the employee’s employment or at least three (3) years, whichever is longer. I-9 forms are available for download at USCIS.GOV. 12.22.2 The County retains the legal right to inspect Contractor and subcontractor employee documents performing work under this Contract to verify compliance with paragraph 8.22.1 of this Section. Contractor and subcontractor shall be given reasonable notice of the County’s intent to inspect and shall make the documents available at the time and date specified. Should the County suspect or find that the Contractor or any of its subcontractors are not in compliance, the County will consider this a material breach of the Contract and may pursue any and all remedies allowed by law, including, but not limited to; suspension of work, termination of the Contract for default, and suspension and/or debarment of the Contractor. All costs necessary to verify compliance are the responsibility of the Contractor. 12.23 INFLUENCE: As prescribed in MC1-1203 of the Maricopa County Procurement Code, any effort to influence an employee or agent to breach the Maricopa County Ethical Code of Conduct or any ethical conduct may be grounds for Disbarment or Suspension under MC1-902. An attempt to influence includes, but is not limited to: 12.23.1 A Person offering or providing a gratuity, gift, tip, present, donation, money, entertainment or educational passes or tickets, or any type of valuable contribution or subsidy, 12.23.2 That is offered or given with the intent to influence a decision, obtain a contract, garner favorable treatment, or gain favorable consideration of any kind. If a Person attempts to influence any employee or agent of Maricopa County, the Chief Procurement Officer, or his designee, reserves the right to seek any remedy provided by the Maricopa County Procurement Code, any remedy in equity or in the law, or any remedy provided by this contract. 12.24 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND REQUIREMENT TO INFORM EMPLOYEES OF WHISTLERBLOWER RIGHTS: SERIAL#: PH RFP 260068 Page 13 of 50 12.24.1 The Parties agree that this Contract and employees working on this Contract will be subject to the whistleblower rights and remedies in the pilot program on Contractor employee whistleblower protections established at 41 U.S.C. § 4712 by section 828 of the National Defense Authorization Act for Fiscal Year 2013 (Pub. L. 112–239) and section 3.908 of the Federal Acquisition Regulation. 12.24.2 Contractor shall inform its employees in writing, in the predominant language of the workforce, of employee whistleblower rights and protections under 41 U.S.C. § 4712, as described in section 3.908 of the Federal Acquisition Regulation. Documentation of such employee notification must be kept on file by Contractor and copies provided to County upon request. 12.24.3 Contractor shall insert the substance of this clause, including this paragraph, in all subcontracts over the simplified acquisition threshold ($150,000 as of September 2013). 12.25 UNIFORM ADMINISTRATIVE REQUIREMENTS: By entering into this Contract, Contractor agrees to comply with all applicable provisions of Title 2, Subtitle A, Chapter II, PART 200—UNIFORM ADMINISTRATIVE REQUIREMENTS, COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR FEDERAL AWARDS contained in Title 2 C.F.R. § 200 et seq. 12.26 ACCESS TO AND RETENTION OF RECORDS FOR THE PURPOSE OF AUDIT AND/OR OTHER REVIEW: 12.26.1 In accordance with section MC1-371 of the Maricopa County Procurement Code the Contractor agrees to retain (physical or digital copies of) all books, records, accounts, statements, reports, files, and other records and back-up documentation relevant to this Contract for six (6) years after final payment or until after the resolution of any audit questions which could be more than six (6) years, whichever is latest. The County, Federal or State auditors and any other persons duly authorized by the Department shall have full access to, and the right to examine, copy and make use of, any and all said materials. 12.26.2 If the Contractor’s books, records, accounts, statements, reports, files, and other records and back-up documentation relevant to this Contract are not sufficient to support and document that requested services were provided, the Contractor shall reimburse Maricopa County for the services not so adequately supported and documented. 12.27 AUDIT DISALLOWANCES: If at any time it is determined by the County that a cost for which payment has been made is a disallowed cost, the County shall notify the Contractor in writing of the disallowance. The course of action to address the disallowance shall be at sole discretion of the County, and may include either an adjustment to future invoices, request for credit, request for a check or a deduction from current invoices submitted by the Contractor equal to the amount of the disallowance, or to require reimbursement forthwith of the disallowed amount by the Contractor by issuing a check payable to Maricopa County. SERIAL#: PH RFP 260068 Page 14 of 50 12.28 OFFSET FOR DAMAGES: In addition to all other remedies at Law or Equity, the County may offset from any money due to the Contractor any amounts Contractor owes to the County for damages resulting from breach or deficiencies in performance of the Contract. 12.29 PUBLIC RECORDS: Under Arizona law, all Offers submitted and opened are public records and must be retained by the Records Manager at the Office of Procurement Services. Offers shall be open to public inspection and copying after Contract award and execution, except for such Offers or sections thereof determined to contain proprietary or confidential information by the Office of Procurement Services. If an Offeror believes that information in its Offer or any resulting Contract should not be released in response to a public record request under Arizona law, the Offeror shall indicate the specific information deemed confidential or proprietary and submit a statement with its offer detailing the reasons that the information should not be disclosed. Such reasons shall include the specific harm or prejudice which may arise from disclosure. The Records Manager of the Office of Procurement Services shall determine whether the identified information is confidential pursuant to the Maricopa County Procurement Code. 12.30 PRICES: Contractor warrants those prices extended to County under this Contract are no higher than those paid by any other customer for these or similar services. 12.31 WRITTEN CERTIFICATION PURSUANT to A.R.S. § 35-393.01: If Contractor engages in for-profit activity and has 10 or more employees, and if this agreement has a value of $100,000 or more, Contractor certifies it is not currently engaged in and agrees for the duration of this agreement to not engage in, a boycott of goods or services from Israel. This certification does not apply to a boycott prohibited by 50 U.S.C. § 4842 or a regulation issued pursuant to 50 U.S.C. § 4842. 12.32 WRITTEN CERTIFICATION PURSUANT to A.R.S. § 35-394: Contractor warrants and certifies that it does not currently, and agrees for the duration of the Agreement, that it will not use: 1. the forced labor of ethnic Uyghurs in the People's Republic of China, 2. any goods or services produced by the forced labor of ethnic Uyghurs in the People's Republic of China, 3. any contractors, subcontractors or suppliers that use the forced labor or any goods or services produced by the forced labor of ethnic Uyghurs in the People's Republic of China. If Contractor becomes aware during the term of this Agreement that the Contractor is not in compliance with this paragraph, Contractor shall notify the County within five business days after becoming aware of the noncompliance. If the Contractor fails to provide a written certification to the County that the Contractor has remedied the noncompliance within 180 days after notifying the County of its noncompliance, then the agreement terminates, except that if the agreement termination date occurs before the end of the 180-day period, the agreement terminates on the agreement termination date. SERIAL#: PH RFP 260068 Page 15 of 50 12.33 RELIGIOUS ACTIVITIES: The Contractor agrees that costs, planned or claimed, including costs incurred, shall not include any expense for any religious activity. 12.34 GOVERNING LAW: This Contract shall be governed by the laws of the State of Arizona. Venue for any actions or lawsuits involving this Contract will be in Maricopa County Superior Court, Phoenix, Arizona. 12.35 ORDER OF PRECEDENCE: In the event of a conflict in the provisions of this Contract and Contractor’s proposed initial or best and final response to the solicitation, the terms of this Contract shall prevail. 12.36 UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT REGISTRATION: All Contractors must have a Unique Entity Identifier (UEI) number issued through https://sam.gov/content/entity- registration. If Contractor does not have one at time of award, they must apply for one within 30 days of contract award. Contractor must also remain current within the System for Award Management platform located at www.sam.gov throughout the term of the contract. 12.37 ADA COMPLIANCE: Contractor agrees and warrants that all of its web content services and products and all of its mobile apps services and products, covered under this contract, and in all languages provided, comply with Level A and Level AA success criteria and conformance requirements specified in the WCAG 2.1, W3C Recommendation 05 June 2018, https://www.w3.org/TR/2018/REC-WCAG21-20180605/ and https://perma.cc/UB8A-GG2F or will be modified to be compliant prior to delivery or installation to County. Contractor further agrees and warrants that all web content services and products and all mobile apps services and products, in all languages provided, shall remain in full compliance with the above WCAG success criteria and conformance requirements during the term of the contract. Contractor agrees to immediately notify County in the event it becomes aware that any web content services and products or any mobile apps services and products provided under this Contract become non-compliant with the above WCAG success criteria and conformance requirements, if applicable. In such an event, Contractor agrees it will work to remediate any identified compliance deficiencies and will notify County concerning the estimated remediation completion date. Upon request, Contractor shall provide County with documentation, including but not limited to a third-party assessment certificate, substantiating compliance of the services or products with the above WCAG success criteria and conformance requirements and any other applicable governmental regulations regarding accessibility. Non- compliance with the above WCAG success criteria and conformance requirements will be deemed a material breach of the contract and the County may immediately terminate the contract or impose other legal remedies at the County’s discretion, including suspension of services and/or products. The County reserves the right to audit Contractor’s compliance with the above WCAG success criteria and conformance requirements. The Contractor will indemnify, defend, and hold harmless the County against any third- SERIAL#: PH RFP 260068 Page 16 of 50 party claims arising from the Contractor’s non-compliance with the above WCAG success criteria and conformance requirements. 13.0 INCORPORATION OF DOCUMENTS: The following are to be attached to and made part of this Contract: 13.1.1 Exhibit A, Budget Detail and Narrative 13.1.2 Exhibit B, Scope of Work 13.1.3 Exhibit C, Office/ of Procurement Services Contractor Travel and Per Diem Policy 14.0 NOTICES: All notices given pursuant to the terms of this Contract shall be addressed to: For County: For Contractor: Maricopa County Department of Public Health Cartwheel Health Services P.C. Purchasing & Contracts Unit ATTN: Cheryl Bucalo, Procurement Officer Dr. Juliana Chen 4041 N. Central Avenue, # 1400 700 Massachusetts Ave. 3rd Floor Phoenix, AZ 85012 Cambridge, MA 02139 Cheryl.Bucalo@Maricopa.gov juliana@cartwheelcare.org (602) 506-6886 (888) 500-2067 SERIAL#: PH RFP 260068 Page 17 of 50 SERIAL#: PH RFP 260068 Page 18 of 50 SERIAL#: PH RFP 260068 Page 19 of 50 EXHIBIT A BUDGET DETAIL & NARRATIVE SERIAL#: PH RFP 260068 Page 20 of 50 SERIAL#: PH RFP 260068 Page 21 of 50 Serial # PH RFP 260068 Page 22 of 50 EXHIBIT B SCOPE OF WORK Original Intent and Scope of Work from Solicitation: 1.0 BACKGROUND: This work builds on the MCDPH Substance Use Prevention & Response Strategic Plan (2024–2028), which emphasizes early intervention, regionally responsive initiatives, and trauma-informed practices to address root causes of substance use. This plan serves as the foundation for targeted, data-driven investments in substance and tobacco-related prevention, treatment, harm reduction, and recovery initiatives. Across the country, rates of depression, anxiety, and suicidal ideation among youth have risen sharply in recent years. According to the CDC, more than 4 in 10 high school students report feeling persistently sad or hopeless, and 1 in 5 have seriously considered suicide.1 These challenges can go untreated—especially in communities with limited access to mental health services. Yet research consistently shows that timely mental health intervention can improve academic achievement, reduce school absences, and lower the likelihood of substance misuse. 2.0 INTENT: To help address community needs, the Maricopa County Department of Public Health (MCDPH) is launching a regional telehealth initiative focused on improving youth mental health in schools with an aim of reaching 50,000 students a year. MCDPH intends to award a single applicant with demonstrated success in school- based telehealth programs and will use $750,000 of funding for the initiative in the first year. Funding may be renewed for up to two (2) additional years. The selected Contractor shall deliver short-term virtual therapy sessions to students and provide referral pathways for longer-term treatment. Services should be made available during and outside of school hours, enabling students to connect with licensed providers from school or home. The awarded Contractor shall be responsible for recruiting schools, delivering services, and tracking program impact. While this funding is dedicated to students in Maricopa County, the contract will be structured to allow other government agencies across Arizona to contribute funds and expand the service in their own regions. Key priorities for this initiative include: Delivering brief, trauma-informed therapy sessions through a secure telehealth platform Collaborating directly with schools to identify and refer students in need Expanding access in rural and underserved areas where mental health services are limited Providing services that are respectful, accessible, and responsive to a range of student needs and backgrounds 1 Source: CDC Youth Risk Behavior Survey (YRBS), 2021 Serial # PH RFP 260068 Page 23 of 50 Tracking outcome measures such as improved attendance, reduced disciplinary actions, and early screening for tobacco or vaping behaviors Reducing barriers to care by providing services without copays or deductibles 2.1 ELIGIBLE ORGANIZATIONS Eligible applicants include nonprofit organizations, private organizations, and academic institutions with at least three years of experience delivering telehealth-based mental health services. Eligible applicants must: Demonstrate a minimum of three (3) years of experience providing telehealth-based mental health services within K-12 school settings. Only experience accrued after the organization’s formal establishment may be counted. Demonstrate a minimum of three (3) years of experience billing third-party insurance for mental health services, with such experience occurring after establishment as a formal organization. Have previously served at least 500,000 students. Applicants serving at least 300,000 students in the past five years may be considered if clear evidence of capacity to scale is provided. Staffing must include Arizona-licensed Behavioral health providers or a documented plan and timeline for obtaining Arizona-licensed providers prior to service delivery. Commitment of at least $100,000 in-kind contributions over the course of the year. Contributions may include staff time, technology, or other resources directly supporting service delivery. 2.2 FOCUS POPULATIONS The Telehealth services are intended to address gaps in coverage. Proposals should focus on schools, particularly those in rural or medically underserved areas of Maricopa County.2 In Maricopa County, the medically underserved areas include: Alhambra Village Avondale Buckeye Camelback East Village Central City Village El Mirage & Youngtown Estrella Village & Tolleson Fort McDowell Yavapai Nation Glendale Central Laveen Village Maryvale Village Mesa Central Mesa West North Mountain Village Salt River Pima-Maricopa Indian Community South Mountain Village & Guadalupe Surprise North & Wickenburg Tempe North 2 Arizona Medically Underserved Areas. October 2024 Biennial Report. Serial # PH RFP 260068 Page 24 of 50 If Contractor is unable to recruit schools from the specified geographic areas despite demonstrating reasonable and documented outreach efforts, they may submit a written request for an exception to the MCDPH Contract Manager. MCDPH will review the request and provide a written decision within five (5) business days. 2.3 FUNDING ACTIVITIES AND LIMITATIONS 2.3.1 Funding Activities Funded activities must relate to the delivery of trauma-informed, short-term mental health services to K–12 students through a secure telehealth platform. Telehealth services must be provided in partnership with schools and designed to meet the needs of students both in-person and in remote settings. The Contractor will also be responsible for recruiting schools, ensuring service accessibility across various geographic areas, and collaborating with Maricopa County Department of Public Health (MCDPH) on program implementation and evaluation. 2.3.2 Funding Limitations 2.3.2.1 Funds cannot be used for research studies, academic projects, or any initiative primarily aimed at generating new knowledge rather than implementing services. 2.3.2.2 Funding must be used to directly support activities outlined in the Scope of Work and align with the Maricopa County Substance Use Prevention & Response Strategic Plan. 2.3.2.3 Food and rent are not allowed. 2.3.2.4 Indirect costs may not exceed 15% of the total budget. 2.3.2.5 Travel expenses must comply with Maricopa County’s travel and per diem policies. 2.4 Required Metrics The County has invested in multiple substance use and tobacco-related initiatives. To ensure consistency and demonstrate value to taxpayers, MCDPH requires all funded programs to report outcomes using standard measures. Each agency’s final evaluation plan will include a set of MCDPH standard measures, mutually agreed upon in writing. These measures must align with MCDPH’s existing evaluation framework. MCDPH engages in program evaluation and performance measurement to learn about the anticipated and unanticipated effects of public health programs, improve public health programs, and ensure accountability. Successful proposals will be required to provide data on a quarterly basis. Proposals should describe the organization’s current data collection procedures and the feasibility of collecting the following outputs and short-term outcomes: 2.4.1 Outputs: Serial # PH RFP 260068 Page 25 of 50 2.4.1.1 Number of students referred and served 2.4.1.2 Number of therapy sessions completed 2.4.2 Short-Term Outcomes: 2.4.2.1 Completion of mental health, tobacco, and vaping screenings 2.4.2.2 Student engagement in therapy sessions 2.4.2.3 Identification of students needing additional support 2.4.2.4 Referral outcomes for long-term care If funding allows, proposals should include resources in their budgets for required data collection and reporting. 3.0 SCOPE OF WORK The selected Contractor shall be responsible for executing the following tasks: 3.1 School Partnership and Recruitment 3.1.1 Recruit a diverse mix of public schools across Maricopa County to participate in the initiative, with a focus on rural and underserved communities. 3.1.2 Establish partnership agreements with each school site outlining service delivery models, student eligibility, and consent protocols. 3.1.3 Ensure school-based points of contact are trained on referral processes and service access pathways. 3.1.4 Schools participating in this initiative must agree to provide the Contractor and MCDPH with access to relevant aggregate student data needed for program evaluation. At a minimum, this includes attendance rates and disciplinary records, reported in aggregate form. Data shall be provided in a format and frequency mutually agreed upon in writing, and consistent with FERPA and other applicable privacy laws. The Contractor shall include these data-sharing requirements in partnership agreements with schools and ensure that all reporting safeguards student privacy. 3.2 Service Delivery 3.2.1 Deliver short-term mental health therapy via telehealth using licensed professionals trained in trauma-informed care. 3.2.2 Ensure telehealth therapy sessions are accessible to students during school hours and outside of school hours, including evenings and weekends, based on student and family availability. 3.2.3 Provide telehealth services from both school-based settings and students’ homes, based on school district preferences and family circumstances. 3.2.4 Establish and maintain referral pathways to longer-term mental health providers when clinically appropriate. 3.2.5 Bill third-party insurance for all eligible services, including Medicaid and private insurers. 3.2.6 Ensure delivery of services regardless of the student's ability to pay, including waiving or covering co-payments and deductibles when necessary to ensure access. 3.3 School-based Capacity Building and Coordination Serial # PH RFP 260068 Page 26 of 50 3.3.1 Provide orientation and training to school staff on how to support students when accessing telehealth services. 3.3.2 Coordinate with family support staff, behavioral health providers, and school personnel to ensure appropriate follow-up for students in need. 3.4 Technology, Privacy, and Compliance 3.4.1 Maintain a secure telehealth platform with user-friendly access for students and families that is compliant with all rules and regulations as outlined in the Health Insurance Portability and Accountability Act (HIPAA). 3.4.2 Ensure compliance with all applicable federal, state, and local privacy regulations, including but not limited to, the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act (HIPAA). 3.4.3 Provide technical assistance to schools and families to ensure smooth access to telehealth sessions. 3.5 Data Collection and Evaluation Plan 3.5.1 Finalize an Evaluation Plan in partnership with MCDPH. This may include, but is not limited to: 3.5.1.1 Track service utilization by site, region, and student demographics, including number of sessions delivered and referral outcomes. 3.5.1.2 Collect and report data on: 3.5.1.2.1School attendance improvements 3.5.1.2.2Disciplinary action trends 3.5.1.2.3Student engagement in mental health screenings 3.5.1.2.4Screening and referral results for tobacco and other substance use, depression, and anxiety 3.5.1.2.5Student and parent customer satisfaction 3.5.2 Complete required reporting for the Evaluation Plan. 3.6 Reporting and Monitoring 3.6.1 Provide required data on a quarterly, as well as annual, basis as outlined in Section 2.4, Required Metrics. All requests for additional information to verify data quality and accuracy must be responded to within 48 hours. 3.6.1.1 Quarterly and annual reports must include at a minimum: 3.6.1.1.1 Project activities and progress 3.6.1.1.1.1 Success stories and challenges 3.6.1.1.1.2 Staffing changes 3.6.1.1.1.3 Budget updates (including explanations for overspending or underspending) 3.6.1.1.1.4 Evaluation metrics aligned with the approved evaluation plan 3.6.1.1.2Reports must be submitted electronically via MCDPH’s designated platform (e.g., Envisio, RedCap). 3.6.1.1.3Additional reporting requirements may be requested by MCDPH. 3.7 Financial and Match Requirements Serial # PH RFP 260068 Page 27 of 50 3.7.1 Submit a proposed detailed budget using the MCDPH template in Attachment A. 3.7.2 Provide at least $100,000 in in-kind contributions over the contract period, which may include technology, staffing, or other relevant support. 3.7.3 Any budget modifications over 10% require prior written approval from MCDPH. 3.8 Staffing Requirements 3.8.1 Clinician Qualifications 3.8.1.1 All clinical services must be delivered by licensed mental health professionals authorized to provide telehealth services in Arizona. Acceptable credentials include, but are not limited to: 3.8.1.1.1Licensed Professional Counselor (LPC) 3.8.1.1.2Licensed Clinical Social Worker (LCSW) 3.8.1.1.3Licensed Marriage and Family Therapist (LMFT) 3.8.1.1.4Licensed Psychologist (PhD or PsyD) 3.8.1.1.5Licensed Associate-level providers (e.g., LAC, LMSW) under direct supervision of independently licensed staff 3.8.2 Providers must have experience working with children and adolescents and demonstrate training in trauma-informed care. Documentation of licenses may be required by MCDPH. 3.8.3 Contractor must ensure adequate staffing levels to support consistent and timely access to services for all participating schools. 3.8.4 Staffing Plan 3.8.4.1 A staffing plan must be submitted as part of the proposal, detailing: 3.8.4.1.1Provider credentials and supervisory structure 3.8.4.1.2Anticipated caseloads 3.8.4.1.3Any subcontracted staff or partners involved in clinical service delivery 3.8.4.1.4Bilingual or multilingual staff are encouraged where available to support effective communication with students and families. 3.9 Budget and Financial Compliance 3.9.1 Contractor shall submit a detailed proposed budget using the MCDPH-provided template in Attachment A. 3.9.2 Indirect costs may not exceed 15% of the total budget. 3.9.3 Any budget modifications exceeding 10% of the total award require prior written approval from MCDPH. 3.9.4 All expenditures must abide by the guidance set forth in Section 2.3.2, Funding Limitations. 3.10 Invoicing 3.10.1 Submit monthly invoices requesting reimbursement to the program contact by the 15th of the following month. 3.10.2 Provide supporting documentation for all expenses listed. 3.11 Meetings and Site Visits Serial # PH RFP 260068 Page 28 of 50 3.11.1 Participate in monthly meetings with MCDPH. Meeting frequency may be adjusted upon written approval from the MCDPH Contract Manager. Changes may be made based on project needs, performance, and/or operational priorities. 3.11.2 Allow for at least one virtual site visit annually with MCDPH. MCDPH shall: 3.12 Provide technical assistance for developing evaluation plans and ongoing support for implementation of the project plan. 3.13 Establish templates and submission methods for required documentation and reporting. 3.13.1 Additionally, MCDPH shall provide training for any platforms used for reporting (ex. Envisio, RedCap). 3.14 Conduct ongoing review of project activities to ensure alignment with program goals. 3.15 Participate in conference calls, meetings, and partner discussions as needed. 3.16 Review and approve the use of any materials with the Maricopa County branding prior to dissemination. 3.17 Compensate Contractor according to approved budget and satisfactory submission of all expenditures and receipts. Serial # PH RFP 260068 Page 29 of 50 Contractor’s Response Serial # PH RFP 260068 Page 30 of 50 Serial # PH RFP 260068 Page 31 of 50 Serial # PH RFP 260068 Page 32 of 50 Serial # PH RFP 260068 Page 33 of 50 Serial # PH RFP 260068 Page 34 of 50 Serial # PH RFP 260068 Page 35 of 50 Serial # PH RFP 260068 Page 36 of 50 Serial # PH RFP 260068 Page 37 of 50 Serial # PH RFP 260068 Page 38 of 50 Serial # PH RFP 260068 Page 39 of 50 Serial # PH RFP 260068 Page 40 of 50 Serial # PH RFP 260068 Page 41 of 50 Serial # PH RFP 260068 Page 42 of 50 Serial # PH RFP 260068 Page 43 of 50 Serial # PH RFP 260068 Page 44 of 50 Contractor’s Response to Best and Final BAFO Requirements 1. Provide copies of all applicable staff certifications. Please note that updated certifications will be required annually for the duration of any resulting contract. Overview: Below is a list of Arizona-licensed clinicians currently providing services with Cartwheel and who would be available to provide services to Maricopa County students and families. We hereby attest that each clinician is in good standing with their respective Arizona licensing board. Given the large number of clinicians, we have not attached copies of every clinician’s license but have provided a link to the clinician’s active license on the website of the licensing board. If additional information about licenses or certifications is needed, we would be happy to provide it. Cartwheel Clinician Roster & Staff Certification List These lists have been redacted for privacy concerns; however, MCDPH has received sufficient information to satisfy this request. 2. Provide a copy of the assessment tool proposed for use. A youth-specific assessment tool is preferred. We propose 2 primary and 2 secondary assessment tools which will collectively support all of MCDPH’s goals. Below is a summary table. See Attachment A for copies of each tool. Primary Assessment Tools Tool What It Measures When We Use It Youth Validation PHQ-9 and GAD-7 Depression and anxiety severity Completed every therapy session by students ages 12+ PHQ-9 validated for adolescents (Richardson et al., 2010; Allgaier et al., 2012). Recommended by AHCCCS. GAD-7 validated for adolescents (Mossman et al., 2017; Tiirikainen et al., 2019). Tobacco & Vaping Screener Screens for tobacco and vaping use Included in standard intake forms for all students Aligned with MCDPH’s Substance Use Prevention & Response Strategic Plan Secondary Assessment Tools Tool What It Measures When We Use It Youth Validation Serial # PH RFP 260068 Page 45 of 50 C-SSRS (Columbia Suicide Severity Rating Scale) Suicidal ideation and behavior Completed if PHQ-9 score indicates elevated risk of suicide Youth version validated ages 6–18. Recommended by FDA, CDC, SAMHSA. SRAS (School Refusal Assessment Scale) Functional profile of school avoidance Completed at intake for students struggling with school refusal. Helps identify the primary reason behind refusal. Youth-specific instrument validated ages 5–18 (child and parent versions) How These Tools Work Together Cartwheel’s assessment tools form an integrated clinical workflow. The PHQ-9 and GAD-7 are administered at intake and readministered every session to track depression and anxiety trajectories. PHQ-9 Question 9 triggers the C-SSRS when positive. The SRAS is administered for students with attendance concerns to identify the functional driver of avoidance. This layered approach ensures that no clinical signal is missed and that every student’s treatment is guided by validated, current data. 3. Provide additional details regarding contingency plans for staff turnover, including how service continuity will be maintained. Cartwheel's national scale and care model design provide multiple layers of protection against service disruption when clinician turnover occurs. Organizational-Level Contingency Plans Contingency Plan How it Works Continuity of care When clinicians choose to leave, we encourage and incentivize them (with retention bonuses) to continue seeing current clients without taking on new clients. This gradual ramp-down reduces disruptions for families. Dedicated clinical recruiting team 8 full-time clinician recruiters enabled us to hire 30 Arizona-licensed clinicians in 30 days when scaling with the Arizona Department of Education. This capacity allows us to promptly backfill positions and maintain appropriate staffing levels. Large clinical team With nearly 50 Arizona-licensed clinicians active, the departure of any single provider does not create a service gap. Caseloads can be temporarily absorbed while recruitment proceeds. Predictive staffing Our proprietary demand forecasting algorithm projects clinical staffing needs 3–6 months in advance—allowing proactive recruitment before gaps materialize rather than reactive hiring after they occur. Student-Level Contingency Plans Contingency Plan How it Works Rapid reassignment If a family requests or needs to be assigned a new clinician, we aim to complete reassignments within 2 business days and keep students in the same scheduling slot to minimize disruption. Thoughtful handoff Our Clinical Managers work with each family to facilitate a warm handoff from the Serial # PH RFP 260068 Page 46 of 50 departing clinician to the new one. Students and families discuss options with Clinical Managers to select a clinician who fits their needs—rather than being assigned without input. For example, if a clinician takes short-term medical leave, a family may prefer to wait for their return; with a resignation, they would be reassigned to a new clinician immediately. School communication When a clinician change occurs, we also notify the referring school counselor, providing the name of the new clinician and confirming that care will continue without interruption. This keeps school staff informed and maintains trust in the partnership. Integrated care team Unlike most telehealth providers—where the therapist is the family's only point of contact—Cartwheel uses a team-based model. Many students engage with multiple providers (e.g., individual therapist, psychiatric provider). If one provider leaves, the student maintains continuity through their existing relationships with other care team members. 4. Provide additional details describing the proposed in-kind contribution, including its structure, how it will be implemented, and tracked. Component 1: Therapy Support for School Staff ($250,000 Value) Maricopa County’s school-based workforce is under extraordinary stress. Nationally, nearly half of public school teachers report frequent job-related stress—more than any other occupation (RAND, 2024). In Arizona specifically, teacher attrition rates remain among the highest in the nation, with burnout, anxiety, and compassion fatigue cited as leading causes. Caring for the mental health of the adults in the building is not a perk—it is a precondition for a stable, effective school community. Proposal: In addition to our services for students and families, we would allow all school-based personnel in participating schools to confidentially sign up for teletherapy. Services are designed to augment, not replace, existing Employee Assistance Programs (EAPs). Common use cases include: • Burnout and compassion fatigue • Anxiety and chronic stress • Depression • Grief and loss • Relationship and family challenges • Sleep disturbances • Parenting challenges • Motivation Implementation: Staff members sign up directly with Cartwheel—no school involvement required. A dedicated Care Coordinator reaches out to verify insurance, match the staff member with a licensed clinician based on clinical needs and preferences, and schedule the first session. Virtual sessions are available 8am–8pm on weekdays, weekends, and school breaks. Care is available in English, Spanish, and other languages with no waitlists, and is provided as an in-network benefit using the staff member’s health insurance plan (a copayment or deductible may apply). No session limits: We do not have a cap on sessions. Typically, staff are in care for anywhere from 2 to 6 months. Reporting: Cartwheel will report de-identified, aggregate metrics to MCDPH on a quarterly basis: ● Number of staff who self-referred ● Number of therapy sessions completed ● Utilization rates by participating district ● Staff satisfaction ratings ● Qualitative feedback from staff Serial # PH RFP 260068 Page 47 of 50 Note: All reporting is fully de-identified to protect staff confidentiality, and schools will not know which staff received services but will also have access to aggregate data. Estimated Value of $250,000: 2,500 completed staff therapy sessions at $100 per session Component 2: Professional Learning for Educators and Families ($150,000 Value) Proposal: Cartwheel delivers a monthly series of expert-led virtual workshops designed to build mental health literacy and practical skills among school staff and families. Workshops are led by Cartwheel’s clinical leadership team, including specialists with decades of experience in school-based mental health. Recordings and leave-behind resources are made available in a Resource Hub for 12 months following initial publication. Across Cartwheel’s existing programs nationally, workshops have drawn more than 10,000 attendees in the past 12 months with an average satisfaction rating of 4.9/5.0. Among participating school staff, 95% reported feeling more confident supporting student mental health after attending. Example topics for 2026-27: Workshop Topic Why This Matters for Maricopa County Chronic Absenteeism and School Refusal Maricopa County chronic absence rates exceed the state average in multiple high-need districts; attendance recovery is a stated MCDPH priority ADHD and Academic Challenges ADHD is the most common behavioral health diagnosis among school-age children in AZ and a leading driver of school-based referrals Back-to-School Anxiety Transition periods generate the highest volume of school-based mental health referrals nationally Building Positive Social Media Relationships Arizona’s youth social media legislation has elevated this as a statewide priority for educators and families Discussing Suicide with Children and Teens Suicide is the second leading cause of death among Arizona youth ages 10–24 (AZ DHS, 2023) Workshop topics can be adjusted based on feedback from MCDPH, district leadership, and participating families throughout the contract period. Implementation: Cartwheel’s Program Manager coordinates scheduling with MCDPH and participating districts to ensure workshops are accessible and relevant. Sessions are offered virtually to maximize participation, with recordings available for those unable to attend live. Reporting: Upon request, Cartwheel will provide reporting to MCDPH on the number of workshops delivered, total attendance, and satisfaction ratings from attendees. Estimated Value of $150,000: ● 10 scheduled workshops x 150 attendees per workshop x $80 per attendee = $120,000 ● 6 ad-hoc workshops provided to districts x $5,000 per workshop = $30,000 Attachment A: Assessment Tools Note: Cartwheel uses the questions below but delivers each assessment electronically and, in the client’s, preferred language PHQ-9 Questions Serial # PH RFP 260068 Page 48 of 50 GAD-7 Questions Tobacco & Vaping Questions (note: this is an excerpt from a longer intake form) Cartwheel’s intake form asks about any history of substance use. If the client marks “yes,” Cartwheel asks that they provide additional detail including the type of substance (e.g., tobacco, vaping). Columbia Suicide Severity Rating Scale (C-SSRS) Questions Example linked here: https://cssrs.columbia.edu/wp-content/uploads/Columbia_Protocol.pdf School Refusal Assessment Scale (SRAS) Questions Linked here to save space: https://sphsoutcomes.net/node/506 Serial # PH RFP 260068 Page 49 of 50 EXHIBIT C OFFICE OF PROCUREMENT SERVICES CONTRACTOR TRAVEL AND PER DIEM POLICY 1.0 All contract-related travel plans and arrangements shall be prior-approved by the County Contract Administrator. 2.0 Lodging, per diem and incidental expenses incurred in performance of Maricopa County/Special District (County) contracts shall be reimbursed based on current U.S. General Services Administration (GSA) domestic per diem rates for Phoenix, Arizona. Contractors must access the following internet site to determine rates (no exceptions): (www.gsa.gov). 2.1 Additional incidental expenses (i.e., telephone, fax, internet and copying charges) shall not be reimbursed. They should be included in the contractor’s hourly rate as an overhead charge. 2.2 The County will not (under no circumstances) reimburse for Contractor guest lodging, per diem or incidentals. 3.0 Commercial air travel shall be reimbursed as follows: 3.1 Coach airfare will be reimbursed by the County. Business class airfare may be allowed only when preapproved in writing by the County Contract Administrator as a result of the business need of the County when there is no lower fare available. 3.2 The lowest direct flight airfare rate from the Contractors assigned duty post (pre-defined at the time of contract signing) will be reimbursed. Under no circumstances will the County reimburse for airfares related to transportation to or from an alternate site. 3.3 The County will not (under no circumstances) reimburse for Contractor guest commercial air travel. 4.0 Rental vehicles may only be used if such use would result in an overall reduction in the total cost of the trip, not for the personal convenience of the traveler. Multiple vehicles for the same set of travelers for the same travel period will not be permitted without prior written approval by the County Contract Administrator. 4.1 Purchase of comprehensive and collision liability insurance shall be at the expense of the contractor. The County will not reimburse contractor if the contractor chooses to purchase this coverage. 4.2 Rental vehicles are restricted to sub-compact, compact or mid-size sedans unless a larger vehicle is necessary for cost efficiency due to the number of travelers. (NOTE: contractors shall obtain pre- approval in writing from the County Contract Administrator prior to rental of a larger vehicle.) 4.3 County will reimburse for parking expenses if free, public parking is not available within a reasonable distance of the place of County business. All opportunities must be exhausted prior to securing parking that incurs costs for the County. Opportunities to be reviewed are the DASH; shuttles, etc. that can transport the contractor to and from County buildings with minimal costs. 4.4 County will reimburse for the lowest rate, long-term uncovered (e.g. covered or enclosed parking will not be reimbursed) airport parking only if it is less expensive than shuttle service to and from the airport. 4.5 The County will not (under no circumstances) reimburse the Contractor for guest vehicle rental(s) or other any transportation costs. 5.0 Contractor is responsible for all costs not directly related to the travel except those that have been pre- approved by the County Contract Administrator. These costs include (but not limited to) the following: in- room movies, valet service, valet parking, laundry service, costs associated with storing luggage at a hotel, fuel costs associated with non-County activities, tips that exceed the per diem allowance, health club fees, Serial # PH RFP 260068 Page 50 of 50 and entertainment costs. Claims for unauthorized travel expenses will not be honored and are not reimbursable. 6.0 Travel and per diem expenses shall be capped at 15% of project price unless otherwise specified in individual contracts. 7.0 Contractor shall provide, (upon request) with their invoice(s), copies of receipts supporting travel and per diem expenses, and if applicable with a copy of the written consent issued by the Contract Administrator. No travel and per diem expenses shall be paid by County without copies of the written consent as described in this policy and copies of all receipts.