1. No category

Agenda Item Cover Sheet
Agenda Item No. B-10
Meeting Date
‰ Consent Section
x Regular Section
‰
January 23, 2014
‰ Public Hearing
Subject:
Approval of Request for Proposal (RFP) No. S-0071-0-2014/CM for Self-Funded Medical Benefits
Program Administration.
Department Name: Human Resources - Professional Development
Contact Person: Lori Krieck
Sign-Off Approvals:
Contact Phone:
813 276 2758
Assistant County Administrator
01/16/2014
Date
Department Director
01/16/2014
Date
Management and Budget – Approved as to Financial Impact Accuracy
01/16/2014
Date
County Attorney – Approved as to Legal Sufficiency
01/16/2014
Date
Staff's Recommended Board Motion:
(1) Approve RFP No. S-0071-0-2014/CM for Self-Funded Group Health Benefits Program
Administration, which includes self-funded group health administration, Employee Assistance Program
(EAP), mental health and substance abuse benefits, stop loss coverage for self-funded group health
administration, Flexible Spending (FSA) administration and Consolidated Omnibus Budget
Reconciliation Act (COBRA) administration; and (2) Authorize the Business and Support Services
Department, Procurement Services, pursuant to their policies, to issue an RFP for obtaining competitive
proposals. There is no fiscal impact to the County as a result of this agenda item.
Financial Impact Statement:
There is no fiscal impact to the County as a result of this agenda item.
Background:
At present, the County contracts with Humana Insurance Company for self-funded group health plan
administration, EAP, mental health and substance abuse benefits, excess medical stop-loss coverage,
and for FSA and COBRA administration. The current contract will be up for an annual renewal (fifth
year of a six year contract) on October 1, 2014. At its July 17, 2013 regularly scheduled meeting, the
Board of County Commissioners (BOCC) directed staff to prepare a Request for Proposal (RFP) to
solicit proposals for a third party administrator to administer the County's self-funded medical benefits
program.
The Human Resources Department, with the assistance of the County's consultant, Gallagher Benefit
Services, prepared the RFP. Through the RFP, the County will solicit proposals to provide
administration not only for the County's self-funded group health plan, but also for mental health,
substance abuse and EAP benefits, stop-loss, and FSA and COBRA administration for employees and
retirees of all Hillsborough County agencies participating in the County's group medical benefits
program. Pursuant to BOCC Policy 07.04.01.01, the Hillsborough County Insurance Committee met on
January 9, 2014 and voted, unanimously, to recommend approval of the RFP to the BOCC, subject to
any procedural modifications.
The RFP is scheduled for release on or approximately January 31, 2014. Proposing vendors have until
Tuesday, March 18, 2014 to submit a sealed proposal.
At the time of release, the RFP will include the following attachments: employee census information,
full plan descriptions, current rate structures, proposer pricing pages, and a comprehensive vendor
questionnaire which includes detailed questions each proposing vendor must answer regarding selffunded group health plan administration, cost containment measures, disease and case management
programs, reporting, claims administration, customer service, account management, communication,
billing, on-line capabilities, rate guarantees, self-reported performance guarantees and associated
liquidated damages, provider network (geography and diversity) and provider contracts, negotiated
provider discounts and ease of administration for both County and employee.
Pursuant to Hillsborough County Ordinance No. 13-24, there shall be a Cone of Silence for all
procurement solicitations issued by the County in order to safeguard the integrity of the County's
procurement and protest process. (See the RFP, page IP-7).
List Attachments:
RFP No S-0071-0-2014/CM
3
HILLSBOROUGH
COUNTY
RFP NO. S-0071-0-2014/CM
REQUEST FOR PROPOSALS
FOR
SELF-FUNDED MEDICAL BENEFITS PROGRAM ADMINISTRATION SERVICES
FOR THE
HUMAN RESOURCES DEPARTMENT
BOARD OF COUNTY COMMISSIONERS
DEPARTMENT OF BUSINESS AND SUPPORT SERVICES - PROCUREMENT
J. THOMAS FESLER, DIRECTOR
CHERYL MURPHY, SENIOR PROCUREMENT ANALYST
IMPORTANT NOTICE: Hillsborough County issues its solicitations electronically through its contracted vendor,
Onvia DemandStar. All addenda to such solicitations will be issued exclusively through Onvia DemandStar. If
you have obtained this solicitation from a source other than Onvia DemandStar, you will not be listed on the
plan holders list and may not receive notification of any addenda issued. Failure to receive any issued addenda
shall not relieve the proposer from any obligation(s) contained in the addenda. To access Hillsborough County
solicitations and any resulting addenda, please go to www.demandstar.com or call 1-800-711-1712.
WEB SITE: http://www.hillsboroughcounty.org/procurementservices
EMAIL: [email protected]
601 E. KENNEDY BLVD., COUNTY CENTER, 18TH FLOOR
P. O. BOX 1110
TAMPA, FLORIDA 33601
TELEPHONE: (813) 272-5790
FAX NUMBER: (813) 272-6290
RFP-S-0071-0-2014 (CM) Self-Funded Medical Benefits Program Administration Services.doc
(Rev. 09/12/13)
4
STATEMENT OF “NO BID”
HILLSBOROUGH COUNTY
DEPARTMENT OF PROCURMENT SERVICES
P.O. Box 1110, Tampa, Florida 33601
RFP Number: S-0071-0-2014/CM
Title: SELF-FUNDED MEDICAL BENEFITS PROGRAM ADMINISTRATION SERVICES
IMPORTANT NOTICE TO VENDORS: If you do not intend to submit a bid/proposal and wish to continue to
receive notice of Hillsborough County procurements, please return this Statement of “No Bid.”
If you elect not to submit a bid/proposal, please indicate the reason below and either
Email this form to: [email protected] OR
Fax this form to: 813-272-6290 OR
Mail this form to the above address.
We do not offer this product/service or an equivalent
Our schedule would not permit us to perform
Insufficient time to respond to solicitation
Unable to meet specifications
Specifications not clear
Unable to meet bond and/or insurance requirements
Specifications “too tight”/restrictive (i.e. geared to specific brand or manufacturer)
Subcontractor (submitted bid to General Contractor)
Other (please explain):_________________________________________ _______________
________________________________________________________________________________________
________________________________________________________________________________________
Signature:_______________________________________ Date:____________________________________
Name: _______________________________________ Title: ______________________________________
Company: _______________________________________________________________________________
Address: ________________________________________________________________________________
Federal Tax Identification Number: _______________________
Telephone: _________________ Fax: _________________ E-Mail: ____________________
535-STATEMENT OF NO BID.dot
(10-01-09)
5
RFP PACKAGE: SERVICE PROJECT CHECKLIST
The Proposer is cautioned to read and become familiar with all sections of this HILLSBOROUGH COUNTY
RFP PACKAGE. Failure to do so may result in the submission of an irregular PROPOSAL by the Proposer
resulting in its possible rejection by Hillsborough County. The following itemized checklist identifies various
items of the Hillsborough County RFP Package which should be particularly examined by the Proposer. The
Proposer should carefully review the items specified in the checklist for purposes of assuring that a proper
PROPOSAL is made. No representation is made that the following checklist is a complete guide to every point
for consideration by the Proposer. The checklist merely calls attention to major problem areas experienced by
Hillsborough County relative to past irregular PROPOSALS.
PART A - INSTRUCTIONS TO PROPOSERS:
1.
PRE-PROPOSAL CONFERENCE INFORMATION: February ??, 2014
2.
THE PROPOSAL OPENING TIME: February ??, 2014
3.
THE PLACE OF THE PROPOSAL OPENING: Procurement, 18th Floor
SECTION 2.(e)
4.
The period of time that the Proposer's PROPOSAL shall remain in force after
the PROPOSAL opening
SECTION 2.(i)
5.
The Proposal Security requirements, if required
SECTION 3.
6.
The responsibility for State Sales Tax
SECTION 13.
7.
The composition of the Contract Documents
SECTION 14.
8.
The Performance Bond Requirements
SECTION 19.
9.
Pre-Proposal Conference Information
PART B – SPECIFICATIONS:
EXHIBIT I:
10.
The Performance Bond (if bonding is required). DO NOT COMPLETE these
forms when submitting your Proposal
11.
Complete all blanks and submit all information as requested
12.
Have the "Acknowledgement" notarized
EXHIBIT I:
13.
Complete the Equal Opportunity/Affirmative Action Requirements, as
appropriate
EXHIBIT II:
14.
If a Proposal Security is required, complete the Proposal Bond Form unless
an acceptable alternate form of security will be submitted with the Proposal
15.
Sign and seal the Proposal as requested
PART C – PROPOSAL:
PART D – AGREEMENT:
EXHIBIT I:
REV 03-91 RFP/CK/G
16.
AGREEMENT - PART D - DO NOT COMPLETE THIS AGREEMENT
WHEN SUBMITTING YOUR PROPOSAL
17.
INSURANCE REQUIREMENTS
1
6
HILLSBOROUGH COUNTY, FLORIDA
RFP NUMBER S-0071-0-2014/CM
Table of Contents
Description
Page
PART A:
INSTRUCTIONS TO PROPOSERS
PART B:
SPECIFICATIONS
IP 1 – 12
1. GENERAL CONDITIONS
GC 1 – 11
2. MINIMUM SPECIFICATIONS
MS 1 - 16
EXHIBIT I:
Hillsborough County’s Group Health Plan Benefits Summary
MS – 6
EXHIBIT II:
Flexible Spending Account Booklet
MS – 7
EXHIBIT II:
COBRA Booklet
MS – 8
EXHIBIT IV: Employee Assistance / Substance Abuse Program
EXHIBIT V:
Group Health Plan Monthly Rates
MS - 11
EXHIBIT VII: Pharmacy Financial Exhibit
MS - 12
EXHIBIT VIII: Employee Census (available on disc, when requested)
MS - 13
EXHIBIT IX: Excess Medical Stop Loss Rates and Claims Experience
(available on disc, when requested)
MS - 14
EXHIBIT X:
MS - 15
Rx4 Prescription Drug List
EXHIBIT I:
HILLSBOROUGH COUNTY EQUAL EMPLOYMENT
OPPORTUNITY/ AFFIRMATIVE ACTION REQUIREMENTS
EXHIBIT II:
W-9
Pricing Proposal Workbook
REV 01-24-05 RFP/TC/G
VQ - 1
PBVQ - 1
VP - 1
A1-5
AGREEMENT
EXHIBIT I:
EEO 1 - 4
W9 - 1
EXHIBIT IV: Prescription Benefits Program Vendor Questionnaire
EXHIBIT V:
MS - 16
P1-7
PROPOSAL
EXHIBIT III: Medical Benefits Program Administration Vendor
Questionnaire
PART D:
MS - 10
EXHIBIT VI: Medical, Pharmacy and High Cost Claims (available on disc,
when requested)
EXHIBIT XI: Medicare Advantage Plan Summary of Benefits
PART C:
MS - 9
INSURANCE REQUIREMENTS
TC - 1
IR 1 - 3
7
PART A
RFP NUMBER S-0071-0-2014/CM
INSTRUCTIONS TO PROPOSERS
Proposal for:
Self-Funded Medical Benefits Program Administration Services
MANDATORY Pre- Proposal Conference:
February 17, 2014, at 3:00 P.M., and/or
February 18, 2014, at 10:00 A.M.,
th
17 Floor of the County Center, Rm 1745C,
601 East Kennedy Blvd., Tampa Florida
PROPOSERS shall attend one (1) of the two available pre-proposal meetings.
Proposal Opening Time:
March 18, 2014, at 2:00 P.M.
Place Of Proposal Opening:
Department of Procurement Services
18TH Floor of the County Center, 601 East Kennedy Blvd.
Tampa, Florida
GENERAL TERMS AND PROVISIONS
1.
EXPLANATION OF COMPETITIVE SEALED PROPOSAL METHOD OF PROCUREMENT:
COMPETITIVE SEALED PROPOSALS DIFFER FROM COMPETITIVE SEALED BIDS IN SEVERAL
AREAS:
2.
(a)
All criteria for evaluation will be set forth in the proposal documents in order of importance. Only
these criteria will be used to determine the best proposal.
(b)
Discussions may be held with all responsible proposers after proposals are opened for purposes
of clarification. The County also reserves the right to request written clarifications from
Proposers after the proposals have been opened. Proposers will be given equal treatment
with respect to discussions and all information obtained is to secure the best possible offers for
the COUNTY.
(c)
Award shall be made to the responsible Proposer whose proposal is determined to be the most
advantageous to the COUNTY taking into consideration only the evaluation factors set forth in
the request for proposal.
(d)
The County reserves the right to issue one or more call(s) for Best and Final Proposals if
it is in the best interest of the County.
PROPOSALS
(a)
The herein included Instructions to Proposers (Part A); the Specifications (Part B); The Proposal
(Part C); and the Agreement (Part D); together with all the attached documents therein
identified, and Exhibits, constitute the entire "proposal package" (Contract Documents)
concerning this present proposal matter. Said proposal package must be the basis upon which
all proposals are offered and the same (the entire proposal package) must be kept together and
returned intact (sealed from public view) to the Hillsborough County Department of Procurement
Services at the time and place therein specified. The Proposer must manually sign the Proposal
(Part C) and should complete the attached document titled Equal Employment
Opportunity/Affirmative Action Requirements, attached as Exhibit I of the Proposal (Part C).
(b)
Prices (proposals) must be quoted only upon the Proposal Form (Part C) herewith provided and
no other Proposals will be accepted. Sealed Proposals may not be amended or otherwise
changed by any writing placed outside the sealed Proposal package; except however, any such
written "outside" communication by a Proposer shall be construed by Hillsborough County as
indicating a withdrawal of the proffered sealed Proposal to which the communication relates
(thereby causing the Proposer to have issued "No Proposal" for consideration by Hillsborough
County). All prices quoted are to be F.O.B. job site in Hillsborough County, Florida where
applicable.
REV 01-24-05 RFP/TC/G
IP - 1
8
(c)
As applies to this present proposal matter, the Proposer is hereby directed to cause delivery of
his proposal to the Hillsborough County Department of Procurement Services, 601 E. Kennedy
Blvd., County Center 18th Floor, Tampa, Florida 33602, prior to the proposal opening time
which is: 2:00 P.M. on March 18, 2014.
The delivery of said Proposal to the Department of Procurement Services prior to the time and
date stated in the preceding sentence is solely and strictly the responsibility of the Proposer.
For informational purposes, the Proposer is hereby advised that United States Postal
Service delivery is made to the County's Post Office Box. Such delivery is not made
directly to the Department of Procurement Services street address even if the Proposer
specifies the street address and/or even if Express Mail Service is utilized; therefore, use
of United States Postal Service may cause a delay in the receipt of said proposal.
Proposers are cautioned to plan necessary delivery time accordingly. The Director of
Procurement Services will in no way be responsible for delays caused by the United States
Postal Service or for delays caused by any other occurrence. All proposals must be manually
and duly signed by an authorized corporate officer, principal, or partner (as applicable). All
proposals must be marked:
SEALED PROPOSAL FOR: S-0071-0-2014/CM, SELF-FUNDED MEDICAL BENEFITS
PROGRAM ADMINISTRATION SERVICES
TO BE OPENED AT DEPARTMENT OF PROCUREMENT SERVICES
601 E. KENNEDY BLVD, COUNTY CENTER 18th FLOOR, TAMPA, FL 33602
Proposals must be signed by the Proposer with his signature in full. When a partnership is a
Proposer, the proposal shall be signed in the name of the firm by one or more of the partners.
When a corporation is a Proposer, the officer signing shall set out the corporate name in full
beneath which he shall sign his name and give the title of his office. The Proposal shall also
bear the seal of the corporation. Anyone signing the Proposal as agent must file with it legal
evidence of his authority to do so. Proposers who are nonresident corporations shall furnish to
the County a duly certified copy of their permit to transact business in the State of Florida along
with the Proposal. Failure to promptly submit this evidence of qualification to do business in the
State of Florida may be basis for rejection of the Proposal.
(d)
The Proposer is solely responsible for reading and completely understanding the requirements
and the specifications of the items proposed. The proposal opening time will be scrupulously
observed. Under no circumstances will proposals delivered after the delivery time specified be
considered.
(e)
Proposals may be withdrawn on written or telegraphic requests dispatched by the Proposer in
time for delivery in the normal course of business prior to the time fixed for the opening of
proposals; provided, however, that written confirmation of any telegraphic withdrawal over the
signature of the Proposer is placed in the mail and postmarked prior to the time set for the
opening of proposals. Negligence on the part of the Proposer in preparing his proposal confers
no right of withdrawal or modification of his proposal after such proposal has been opened by
Hillsborough County at the appointed time and place. Proposers may not withdraw or modify
their proposals after the appointed proposal opening time. Said Proposals shall be in force for a
period of not less than ninety (90) days after the proposal opening time. Further, said Proposal
shall continue in force after said ninety (90) day period, until thirty (30) days following the date of
receipt by County of written notice from the Proposer of his/her intent to withdraw his/her
proposal, or until the date specified in said written notice as the expiration date of the Proposal,
whichever is later. The aforementioned Proposal times will remain in effect irrespective of
whether an award has theretofore been made by Hillsborough County. Notwithstanding the
provisions of the preceding sentence, the Proposer may extend his/her Proposal at any time
prior to the scheduled expiration thereof. Proposers may not assign or otherwise transfer their
Proposals prior to or after the Proposal opening time.
(f)
At the time and place fixed for the opening of proposals (see above), every proposal properly
delivered within the time fixed for receiving proposals will be opened and publicly read aloud,
irrespective of any irregularities found therein. Proposers and other persons interested may be
present or represented.
(g)
Attorneys-in-fact who sign bonds or other surety instruments must attach with each bond or
surety instrument a certified and effectively dated copy of their power of attorney.
REV 01-24-05 RFP/TC/G
IP - 2
9
3.
(h)
No interpretation of the meaning of the plans, specifications, or other contract documents will be
made to any Proposer orally. Every request for such interpretation must be in writing,
addressed to the Hillsborough County Director of Procurement Services. To be given
consideration, such requests must be received at least ten (10) days prior to the date fixed for
the opening of Proposals. Any and all such interpretations and any supplemental instructions
will be in the form of a written addendum which, if issued, will be posted at
http://www.hillsboroughcounty.org/procurementservices, at least five (5) days prior to the date
fixed for the opening of proposals. Failure of a Proposer to receive any such addendum or
interpretation shall not relieve said Proposer from an obligation under their proposal as
submitted. All addenda so issued shall become part of the Contract Documents.
(i)
Either a certified check, a cashier's check, an irrevocable letter of credit or in the alternative,
submission of a Proposal Bond completed and signed by all required parties and submitted in
the format detailed by Exhibit II to the Proposal (Part C), will not be required to accompany
each proposal in a stated dollar amount which equals not less than five percent (5%) of the sum
of the computed total amount of the Proposal. Any submitted certified check, cashier's check, or
an irrevocable letter of credit shall be drawn on a solvent bank or trust company to the order of
Hillsborough County Board of County Commissioners and shall have all necessary documentary
revenue stamps attached, if required by law. Surety on Proposal Bonds shall be a duly
authorized surety company sanctioned to do business in the State of Florida; all such bonds
shall be issued or countersigned by a local producing agent who is a resident of the State of
Florida and satisfactory evidence of the authority of the person or persons executing such bonds
shall be submitted with the bond. Personal checks, business checks and cash deposits are not
acceptable to Hillsborough County and will render your bid nonresponsive.
(j)
Before submitting proposals, Proposers must carefully examine the site of the proposed work
and make all necessary investigations to inform themselves thoroughly as to all difficulties
involved in the completion of all services required pursuant to the mandates and requirements of
this proposal package. No pleas of ignorance of conditions or difficulties that may exist, prior to
the Proposal opening or of conditions or difficulties that may be encountered in the execution of
the services pursuant to this proposal package as a result of failure to make the necessary
examinations and investigations will be accepted as an excuse for any failure or omission on the
part of the Successful Proposer/ Contractor to fulfill, in every detail, all of the requirements of the
Contract Documents, nor will they be accepted as a basis for any claims whatsoever for extra
compensation or for any extension of time.
TAXES
For purposes of this present proposal matter, State Sales Tax and Federal Excise Taxes cannot be
included in the proposal, as Hillsborough County is tax exempt. The Director of Procurement Services
will sign exemption certificates submitted by the successful Proposer.
4.
PROPOSAL ERRORS
Where proposals have erasures or corrections, each erasure or correction must be initialed in ink by the
Proposer. In case of unit price contracts, if an error is committed in the extension of an item, the unit
price as shown in the Contract Documents will govern.
5.
DEVIATIONS
As concerns this present proposal matter, all proposals must clearly and with specificity detail all
deviations to the exact requirements imposed upon the Proposer by the Instructions to Proposers (Part
A); the Specifications (Part B); and the Agreement (Part D). Such deviations must be stated upon the
Proposal (Part C); otherwise Hillsborough County will consider the subject proposal as being made in
strict compliance with said Instructions to Proposers (Part A); the Specifications (Part B); and the
Agreement (Part D); the Proposer being held therefor accountable and responsible. Proposers are
hereby advised that Hillsborough County will only consider proposals that meet the specifications and
other requirements imposed upon them by this proposal package. In instances where a deviation is
stated upon the Proposal (Part C), said proposal will be subject to rejection by Hillsborough County in
recognition of the fact that said proposal does not meet the exact requirements imposed upon the
Proposer by the Instructions to Proposers (Part A); the Specifications (Part B); and the Agreement (Part
D); except, however, said proposal may not be subject to such rejection where, at the sole discretion of
Hillsborough County, the stated deviation is considered to be equal or better than the imposed
requirement and where said deviation does not destroy the competitive character of the request for
REV 01-24-05 RFP/TC/G
IP - 3
10
proposal process by affecting the amount of the proposal such that an advantage or benefit is gained to
the detriment of the other Proposers
6.
CONDITION OF MATERIALS AND PACKAGING
In instances where the Specifications (Part B) make this subject applicable (and unless otherwise
indicated), all goods and items offered for sale and/or shipped by the successful Proposer pursuant to
the requirements imposed upon said Proposer by this proposal package, will be NEW and in FIRST
CLASS CONDITION, all related containers being new and suitable for storage and shipment; all prices
including the cost of standard commercial packaging. Successful Proposers will be solely responsible
for making any and all claims against carriers as concerns missing or damaged items.
7.
BRAND NAMES, ETC
In instances where the Specifications (Part B) make this subject applicable, any use therein of brand
names, manufacturers' makes, trade names, information and/or catalog numbers are so used for the
purpose of providing description and for establishing acceptable quality levels. Such references are not
intended for the purpose of placing restrictions upon Proposers (other than as to quality) and Proposers
may propose and describe upon the Proposal (Part C) deviations believed to be equal or better than the
otherwise imposed requirement; provided, however, at the sole discretion of Hillsborough County, said
County may determine whether such deviations are or are not, in fact, deviations from said imposed
requirements. In instances where a deviation is stated upon the Proposal (Part C), said proposal will be
subject to rejection by Hillsborough County in recognition of the fact that said proposal does not meet
the exact requirements imposed upon the Proposer by the Instructions to Proposers (Part A), the
Specifications (Part B), and the Agreement (Part D); except, however, said Proposal may not be subject
to such rejection where, at the sole discretion of Hillsborough County, the stated deviation is considered
to be equal or better than the imposed requirement and where said deviation does not destroy the
competitive character of the request for proposal process by affecting the amount of the proposal such
that an advantage or benefit is gained to the detriment of the other Proposers.
8.
INFORMATION AND DESCRIPTIVE LITERATURE
Proposers must furnish all requested information in the spaces provided on the Proposal (Part C).
Additionally, where required pursuant to the provisions of this proposal package, Proposers must submit
with their Proposal; cuts, sketches, descriptive literature and/or complete specifications relative to the
items proposed and offered; references to previously submitted material concerned with previous
proposals not being acceptable to Hillsborough County.
9.
COMPLIANCE WITH OCCUPATIONAL SAFETY AND HEALTH ACT (O.S.H.A.)
In instances where such is applicable due to the nature of the proposal matter with which this proposal
package is concerned, all material, equipment, etc., as proposed and offered by Proposers must meet
and conform to all O.S.H.A. requirements; the Proposer's signature upon the Proposal (Part C) being by
this reference considered a certification of such fact.
10.
NO ASSIGNMENT OF CONTRACT
As concerns this present proposal matter, and unless the Specifications (Part B) indicate otherwise, no
successful Proposer may make any assignment of the resulting contractual agreement between parties,
in whole or in part, without prior written authorization as may be given at the sole discretion of
Hillsborough County.
11.
AWARD OF CONTRACT/REJECTION OF PROPOSALS
A contract will be awarded by the Board of County Commissioners of Hillsborough County to the
responsible Proposer submitting the best proposal in compliance with the Specifications (Part B) and
other requirements imposed by this proposal package, provided said proposal is considered (within the
sole discretion of said Board of County Commissioners) reasonable, and in the best interest of
Hillsborough County to accept. The Successful Proposer to whom a contract is awarded will be so
notified by Hillsborough County at the earliest practical date. The Board of County Commissioners of
Hillsborough County, however, at its sole discretion, reserves the right to reject any and all proposals
and to waive any informality concerning proposals whenever such rejection or waiver is in the best
interest of Hillsborough County and when the same is in conformance with standard competitive sealed
proposal procedures. Hillsborough County, likewise, reserves the right to reject the proposal of any
Proposer who has previously failed to perform properly or to complete on time, contracts of similar
nature; who is not in a position to perform the contract; or who has habitually and without just cause
REV 01-24-05 RFP/TC/G
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11
neglected the payment of bills or otherwise disregarded obligations to sub-contractors, materialmen or
employees. The ability of a Proposer to obtain a Performance Bond and/or Proposal Bond shall not be
regarded as the sole test of such Proposer's competency or responsibility.
12.
CONTRACT DOCUMENTS
The following constitute the Contract Documents (Title, Subtitles, Headings, Running Headlines, Table
of Contents, and Indices are used merely for convenience purposes):
Instructions to Proposers
Specifications
Proposal
Agreement
(Part A)
(Part B)
(Part C)
(Part D)
All Addenda Issued by the County prior to the Receipt of Proposals.
13.
PERFORMANCE BOND (Intentionally omitted)
14.
SECURITY FORFEITURE
If within ten days after notification by Hillsborough County of the COUNTY'S award of a contract, the
Successful Proposer/Contractor refuses or otherwise neglects to execute the required written contract
and fails to furnish the required Performance Bond, or acceptable alternative form of security as
stipulated herein, the amount of the Proposer's security (check, Proposal Bond or other) shall be
forfeited and the same shall be retained by Hillsborough County. No plea of mistake in the proposal or
misunderstanding of the conditions of forfeiture shall be available to the Proposer for the recovery of his
proposal security or as a defense to any action based upon the neglect or refusal to execute a written
contract.
15.
LAWS AND REGULATIONS
The Proposer's attention is directed to the fact that all applicable Federal and State laws, municipal and
County ordinances, and the rules and regulations of all authorities having jurisdiction over any part of the
project shall apply to the contract throughout and they will be deemed to be included in the contract the
same as though herein written.
16.
HAND SANITIZER ORDINANCE (05-8)
Pursuant to Hillsborough County Ordinance 05-8, as amended, every Portable Restroom in service in
Hillsborough County which does not have a hand washing facility located within the Portable Restroom
must have an operable hand sanitizer dispenser containing sanitation liquid affixed to the inside of the
Portable Restroom or immediately adjacent to the Portable Restroom. The Contractor is solely
responsible for ensuring that any and all Portable Restrooms owned or leased by the Contractor are in
compliance with the ordinance.
17.
SOLID WASTE COLLECTION AND DISPOSAL (SOLID WASTE ORDINANCE 96-34)
Pursuant to Hillsborough County Ordinance 96-34, as amended, all solid waste accumulated as a result
of this contract that the CONTRACTOR is required to remove and dispose, which the CONTRACTOR
chooses not to self haul, shall be removed and disposed of by one of the three authorized Hillsborough
County solid waste franchise collectors. For a list of the authorized franchise collectors, please contact
the Solid Waste Management Department at (813) 272-5680. The use of any other company or entity
for the collection and disposal of solid waste in the Hillsborough County solid waste service area may be
a violation of Hillsborough County Ordinance 96-34, as amended.
18.
APPLICABLE LAW
Unless otherwise specified, all phases and provisions of this Agreement, including but not limited to
interpretation, proposing, award, execution and implementation, shall be governed by the laws, rules,
and regulations of the State of Florida.
19.
EXECUTION OF WRITTEN CONTRACT
The successful Proposer will be required to sign a written contract which has been made a part of this
Proposal Package and identified as the Agreement (Part D). Said written contract will evidence in
written form the agreement between the parties pursuant to the award having been theretofore made by
the COUNTY to this Successful Proposer/Contractor; said signing to be accomplished within ten (10)
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days after Notice of Award. The above mentioned signing will take place at an Award Conference, the
date which will be set forth in the Notice of Award.
20.
MANDATORY PRE-PROPOSAL CONFERENCE
A Pre-Proposal Conference concerning this present proposal matter will be conducted by Hillsborough
County at:
PLACE:
Hillsborough County Center, 17th Floor Conference Room 1745C,
601 East Kennedy Blvd., Tampa, Florida
TIME:
February 17, 2014, at 3:00 P.M., and/or
February 18, 2014, at 10:00 A.M.,
PHONE NUMBER (813) 276-2728
PROPOSERS shall attend one (1) of the two available pre-proposal meetings.
21.
AFFIRMATIVE ACTION BUSINESS ENTERPRISE PROGRAM
Hillsborough County hereby notifies all Proposers that Minority Business Enterprises (MBE's),
Disadvantaged Minority Business Enterprises (DMBE's), and Disadvantaged Women Business
Enterprises (DWBE's) will be afforded a full opportunity to participate in any award made by Hillsborough
County pursuant to this present proposal matter and will not be subjected to discrimination on the basis
of race, color, sex, or national origin.
Hillsborough County prohibits any person involved in Hillsborough County contracting and procurement
activities, to discriminate on the basis of race, color, religion, sex, national origin, age, or physical
handicap.
22.
FISCAL NON-FUNDING CLAUSE
In the event sufficient budget funds are not available for a new fiscal period, the COUNTY shall notify
the vendor of such occurrence and the contract shall terminate on the last day of the current fiscal
period without penalty or expense to the COUNTY.
23.
ELECTRONIC PAYMENT SOLUTIONS
(a)
ePayables
(b)
The COUNTY has an ePayables electronic payment solution where the Proposer may choose to
be paid by a VISA credit card account. If the Proposer requests to participate in the COUNTY’S
ePayables electronic payment solution, the Proposer should indicate its acceptance in its Bid. If
the Proposer has indicated that it will accept the COUNTY’S VISA credit card for payment, then
the Proposer will be required to sign an ePayables Enrollment Form after the contract has been
awarded. The Proposer must have the capacity to accommodate/accept VISA credit card
payments in order to participate in the COUNTY’S ePayables electronic payment solution.
ePayables payments will be processed via a credit card and merchant services fees will apply.
Merchant services fees are determined by the vendor’s agreement with their Merchant Bank.
Fees are generally up to 3%.
ACH (Direct Deposit)
The COUNTY has an ACH payment solution where the Proposer may choose to be paid with
direct deposit. If the Proposer requests to participate in the COUNTY’S ACH electronic payment
solution, the Proposer should indicate its acceptance in its Bid. If the Proposer has indicated that
it will accept the COUNTY’S ACH for payment, then the Proposer will be required to sign a
Direct Deposit Authorization Form after the contract has been awarded.
For more information on both Electronic Payment Solutions, go to
www.hillsboroughcounty.org/DoingBusinesswithCounty
24.
PUBLIC ENTITY CRIMES STATEMENT
A person or affiliate who has been placed on the convicted vendor list following a conviction for a public
entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a
public entity, may not submit a bid, proposal, or reply on a contract with a public entity for the
construction or repair of a public building or public work, may not submit bids, proposals, or replies on
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leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier,
subcontractor, or consultant under a contract with any public entity, and may not transact business with
any public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes, for
CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list.
Additionally, pursuant to COUNTY policy, a conviction of a public entity crime may cause the rejection of
a bid, offer, or proposal. The COUNTY may make inquiries regarding alleged convictions of public entity
crimes. The unreasonable failure of a proposer to promptly supply information in connection with an
inquiry may be grounds for rejection of a bid, offer or proposal.
25.
DRUG FREE WORKPLACE PROGRAM
Pursuant to Section 287.087, Florida Statutes, proposers may submit a certificate certifying that they
have implemented a drug free workplace program with their proposals. If two or more proposals are
equal in price, quality, and service, preference will be given in the award process to the proposer who
has furnished such certification with their proposal. Certificate forms are available from the Department
of Procurement Services website at http://www.hillsboroughcounty.org/procurementservices
26.
BID RESULTS
Preliminary results (or listings of Proposers in the case of RFP's) are available at
http://www.hillsboroughcounty.org/procurementservices.
27.
LICENSING
Proposer shall be properly licensed for the appropriate category of work specified in this solicitation. All
Proposers are requested to submit any required license(s) with their response to this solicitation.
License(s) must be effective as of the solicitation opening date and must be maintained throughout the
life of the contract. Failure to be properly licensed as stated above will result in the rejection of the bid
as non-responsive.
28.
IRS FORM W-9, REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION
All Proposers are requested to complete and submit the attached W-9 form with their response to this
solicitation.
29.
HILLSBOROUGH COUNTY BUSINESS TAX
All Proposers are requested to submit a copy of their Hillsborough County Business Tax Receipt with
their response to this solicitation, if applicable. The Business Tax Receipt must be current as of the
opening date of this solicitation.
30.
PROPOSER’S COMPLIANCE WITH COUNTY’S PROCUREMENT POLICY AND PROCEDURES AND
HILLSBOROUGH COUNTY ORDINANCE – PROTEST PROCESS AND PROCEDURES
Proposer is advised that by submitting a Bid/Proposal, Proposer hereby agrees to comply with the
County’s Procurement Policy and Procedures, including, but not limited to, the County’s policy and
procedures regarding Bid/Proposal protests and Hillsborough County Ordinance No. 13-24. The
County’s Procurement Policy and Procedures can be found on the County’s website at:
http://www.hillsboroughcounty.org/procurementmanual
31.
CONE OF SILENCE: Pursuant to Hillsborough County Ordinance No. 13-24, there shall be a Cone of
Silence for all procurement solicitations issued by the County in order to safeguard the integrity of the
County’s procurement and protest process. The Cone of Silence shall go into effect on the date a
procurement solicitation is issued by the County and shall end on the date the contract is awarded by
the County or the date the procurement solicitation is canceled by the County. Unless otherwise
provided for in Hillsborough County Ordinance No. 13-24, during the time period the Cone of Silence is
in effect, no Proposer, interested party and/or their principals, officers, employees, attorneys or agents
shall communicate with County employees, the Hearing Master assigned to hear the applicable protest
appeal and/or members of the Board of County Commissioners, including their aides and employees
regarding a procurement solicitation and/or its related protest. The Cone of Silence does not prohibit a
Proposer from communicating with the Director of the County Department issuing the procurement
solicitation, County staff listed as contacts in the procurement solicitation, or the attorney in the County
Attorney’s office that is directly responsible for the applicable procurement solicitation (this information
can be obtained by contacting the County staff person listed as the contact in the applicable
procurement solicitation). A violation of the Cone of Silence will result in the disqualification of the
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Proposer from consideration in the award of the procurement solicitation unless it is determined that the
violation is unintentional and/or not material.
32. DISADVANTAGED MINORITY / DISADVANTAGED WOMEN BUSINESS ENTERPRISE and SMALL
BUSINESS ENTRPRISE PARTICIPATION
Disadvantaged Minority/Disadvantaged Women Business Enterprise and Small Business Enterprise
(DM/DWBE and SBE) Participation: Proposers who have 10% or more DWBE/MBE/SBE participation
can apply for bonus points. Qualified firms may receive five (5) percent of the maximum allowable
points for DM/DWBE and SBE participation. The term “DM/DWBE and SBE” shall mean a business that
is certified or registered as a bona fide DM/DWBE or SBE with Hillsborough County or has been granted
Reciprocal Certification by Hillsborough County. Provisional Reciprocal Certification shall be granted for
one six-month period to DM/DWBE firms which are principally domiciled in the State of Florida and
certified by other jurisdictions within the State. It will be the responsibility of the proposing firm to furnish
all the necessary information and documentation to the County as listed below in order to receive bonus
points.
1.
The request for bonus points shall be made on the proposing firm’s letterhead and must include
the following:
a.
The RFP number and project name; and
b.
c.
The name of the firm(s) to be utilized; and
The percentage of fees that will be subcontracted to that firm which must be 10% or more;
and
A commitment from the proposing firm stating that 10% or more of its ultimate fees will be
subcontracted to that DM/DWBE or SBE.
d.
2.
The following items should be attached to the above letter:
a.
b.
A letter of intent from the DM/DWBE or SBE on its letterhead stating its intent to perform
the services and the scope of work signed by its Chief Operating Officer. This letter must
reference the project.
A copy of the DM/DWBE current certification or the SBE’s current registration.
NOTE: FAILURE TO COMPLY WITH ANY OF THESE REQUIREMENTS MAY RESULT IN DENIAL
OF THE REQUESTED BONUS POINTS.
SPECIAL NOTE:
If the successful proposer has received bonus points, that firm will be required to submit
to the DM/DWBE & SBE Programs Section of the Economic Development Department a
copy of the executed subcontract agreement with each DM/DWBE or SBE listed in the
letter of commitment. Annual reports detailing the amount of money paid to each
DM/DWBE or SBE must also be submitted. Failure to provide this information may result
in the denial of future bonus points.
33. SPECIAL INSTRUCTIONS:
33.1 Proposers are instructed not to contact County employees regarding this Request for Proposal, except
staff from the Department of Business and Support Services - Procurement. This requirement remains
effective from the advertisement date through the date that this solicitation is awarded or otherwise
cancelled.
33.2 Members of County staff will comprise an evaluation committee and will individually review the
submitted proposals. Once the review is completed the evaluation committee will meet and score the
proposals as a group consensus. Selection will be based on the submitted proposals. In all cases, the
County will be the sole judge as to whether a Proposer’s proposal has or has not satisfactorily met the
requirements of this Request for Proposal.
33.3 Do not place County employees on any mailing, fax, telephone or e-mail list without the employee’s
express prior consent.
33.4 The evaluation process is designed to award a contract to a vendor whose Proposal is judged through
the evaluation and clarification process to be in the best interest of the County. Scores are based on the
evaluation of the Proposer’s responses to the County’s Group Health Plan requirements, County’s
questionnaire, supplemental questions and oral presentations, if any. Three-year (3) rate guarantees are
required. Preference will be given to financially sound proposers with rate guarantees beyond the
required three (3) years. Proposers must submit their best and final rates upon first submission. The
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Evaluation Committee may short list the top ranked proposers, ask for clarification, and/or require
program presentations to the Evaluation and/or Insurance Committee.
33.5 Quoted rates, administrative fees, intermediary fees, and any other fixed costs should not include
commissions, finder’s fees, etc. It is desired by the County that all rates be quoted net of commissions. If
commissions cannot be deleted from your proposal rates, indicate the amount and to whom
commissions are payable. Commissioned agents shall provide written documentation in their proposals
that grants binding authority to the agent from the Principal Insurer. The County reserves the right to
rename any agents of record at any time.
33.6 Business and Support Services, Procurement Services will provide census data upon request.
33.7 Proposers are cautioned that deviations from the preferred programs must be clearly stated and
described on the Proposal forms and on the Deviations and Exceptions forms in Part C.
33.8 Proposers are instructed that their proposal submission should contain their best proposal from a
monetary and technical standpoint.
33.9 Any proposer must notify the County if it is conducting or intends to conduct separate negotiations with
any other Participating Agency defined in this Request for Proposal.
34. MINIMUM QUALIFICATIONS
The proposer shall:
34.1 Not be presently debarred or suspended from contracting with federal, state, or local governments.
34.2 Be properly licensed by and registered with the State of Florida. Florida Statutes 626.901 and 626.902
prohibit representing or aiding any unauthorized insurer of insurance product. Proposals that include
insurance proposed by unauthorized insurers will be deemed non-responsive to the RFP.
34.3 Have the necessary organization, provider networks, operational controls, and technical skills to perform
the required work.
34.4 Have at least five (5) years experience providing administration of Group Health Benefits to a similar
Florida employer group. Similar means a group size of least 2,500 lives. The contract for the similar
group shall have been in force for at least one year. The experience period included in this and the
previous paragraph must have occurred within five (5) years prior to January, 2014.
34.5 Have an A.M. Best financial rating of A- or better. The proposer may not have been rated lower than Awithin the last two (2) years. Only the Proposer(s), which, in the opinion of the County, are financially
capable of providing the services, will be considered.
34.6 Financial responsibility of a proposing downstream or subsidiary company must be guaranteed in writing
by the parent company by endorsement of the Agreement as follows:
34.6.1 In the event that (the Proposer) is unable to pay any claim payable within the time and in accordance
with the terms and provisions set forth in the above-referenced agreement, the (Parent Company)
hereby agrees to make such payment therefore in accordance with the terms and provisions of such
agreement.”
34.7 Submit proposals that meet or exceed the requested plan of benefits being procured. If proposing an
enhanced plan design, it must be submitted separately from the requested plan of benefits being
procured. The Vendor Questionnaires, Part C, Exhibit III & Exhibit IV, will have a separate worksheet for
this purpose.
34.8 Provide rate guarantees for the first three (3) years of the contract period. Rate guarantees for years
four (4) and five (5) are desired. If rate guarantees are not offered for renewal years four (4) and five (5),
Hillsborough County would prefer that the renewal years have a maximum (cap) increase percentages
in renewal year prices as expressly identified within their proposal. If maximum percentage increases
are not provided, the County will negotiate pricing for years four (4) and five (5), if the Agreement is
renewed. Proposer must be willing to disclose all pricing components of renewal proposals, including
administrative costs and proposer’s tolerable loss ratio.
34.9 Submit a sample performance guarantee document with suggested liquidated damages associated with
each performance guarantee dimension to include standard dimensions for the benefit being requested.
The County will negotiate final performance guarantees with the successful proposer and upon
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implementation of the contract and will be self-reported on an annual basis at the anniversary of the
contract implementation
34.10 Disclose all fees associated with the administration of the County’s health plans, including, but not
limited to, capitation, spread pricing, rebate share, disease management, network rebates, subrogation,
that may show as a claim in the banking system or not readily displayed to the County.
34.11 Attend one of the scheduled pre-proposal conferences. This is a mandatory requirement and each
Proposer shall be requested to sign in on the list provided by County staff.
35. EVALUATION CRITERIA
The evaluation process is designed to award a contract to the Proposer whose proposal is judged
through the evaluation and negotiation process to be in the best interest of the County. Scores are
based on the evaluation of the Proposer’s responses to the RFP, questionnaire, and oral presentations,
if any. After careful analysis and evaluation of the proposals received, a successful proposer will be
recommended by the Insurance Committee to the Board of County Commissioners. The proposal will
be evaluated for the following criteria:
COST:
60 Points
Overall price will be based on the fixed cost and other fees as displayed in the Pricing Section of the
RFP. Gallagher Benefit Services will provide an estimated claim liability to the County based on each
proposer’s Network Discounts, Disease Management Programs, Network Efficiency, Network
Disruptions, Claim Management Tools and Resources, Wellness Program Initiatives, Prescription Drug
Plan Pricing and Model, Prescription Drug Plan Rebates, Specialty Prescription Drug Programs, and
other factors that impact the overall cost to the County.
Lowest cost acceptable in terms, as mentioned above, will be awarded the full 60 points; each more
costly proposer will have their cost divided by the lowest cost to determine the percentage of the 60
points they receive.
Points shall be awarded for price based on the following formula:
Lowest Price Proposal
Other Proposer's Price (varies
according to proposal being
scored)
x
Maximum Points
Given to Price
TECHNICAL APPROACH:
=
Score
30 Points
Includes, but is not limited to, cost containment measures, disease and case management program
administration, provider network (geography and diversity), additional rate guarantees/max caps,
reporting capabilities, claims administration, customer service, billing, electronic and online
administrative capabilities, administrative enhancements, performance guarantees and associated
liquidated damages.
QUALIFICATIONS, EXPERIENCE, RATING/FINANCIAL STABILITY
10 Points
Includes, but is not limited to, expertise and skills in providing Self-Funded Medical Benefits Program
Administration , as well as documented successful, relevant experience in groups of like size and
complexity as the County, A. M. Best Rating and Classification, or financial stability as determined by
the County, historical claims payment and problem resolution experience, and client references.
DM/DWBE Bonus Points
5 points
Total Possible Points
105 points
36. PROPOSAL FORMAT, and CONTENT
36.1 Proposers are advised that all information disclosed as part of this RFP process is considered part of
the public domain by the laws of the State of Florida and is subject to inspection by the public pursuant
to Chapter 119, Florida Statutes, unless an exception applies.
36.2 Proposers shall provide responses using the electronic RFP Excel Questionnaire provided with this
document and per access by way of the Demandstar website for this project. The Proposer response to
the RFP Questionnaire must be provided with their proposal submission on a CD or flash/jump drive and
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Proposer should provide a hard copy of the electronic RFP Questionnaire with their responses within
their Original submission binder.
36.3 The proposal shall contain complete, detailed responses to requests for information contained in this
RFP document and any subsequent addenda issued regarding this RFP. Failure to provide detailed
responses may render a proposal non-responsive by the County.
36.4 When attaching additional pages for explaining answers or describing experience, restate the number
and the short title of the requirement and write the response immediately after the short title.
Referencing material presented elsewhere in the proposal shall be clearly identified.
36.5 All proposals shall conform to the proposal structure, order, and shall incorporate information regarding
subcontractors where appropriate. Hillsborough County intends to contract directly for all the services
described in this RFP. Any capability for which the Proposer shall be relying upon the services or
assistance of a third party shall be disclosed. The Proposer should describe the nature of such
relationships, including a description of all relevant agreements between the two parties.
36.6 Except where noted to submit in electronic format, all copies of your proposal should be submitted on 8
½-inch by 11-inch typewritten or word processed paper.
36.7 Additionally, proposers are required to submit the Part C Exhibit III Rate Quote Worksheet and Exhibit III
and Exhibit IV RFP Questionnaires EXCEL Worksheet in an electronic format (Compact Disc {CD}, or a
flash/jump drive).
37. ORIGINAL BINDER DOCIMENT – ONE (1) BINDER CONTAINING:
37.1 Each proposer shall submit one (1) original of the following information in one (1) separate sealed
envelope within the Proposer’s container marked: RFP-S-0071-0-2014/cm, Self-Funded Medical
Benefits Program Administration Services and the Proposing entity name and provide at a minimum the
following documents:
37.1.1 Part C, Proposal, Pages P-1 through P-6.
37.1.2 Exhibit III, RFP Questionnaire EXCEL Worksheet in a hardcopy and an electronic format (Compact
Disc {CD}, or a flash/jump drive) Reference page VQ-1; RFP Questionnaire available for download on
Demandstar.
37.1.3 Exhibit IV, RFP Pharmacy Benefits Questionnaire EXCEL Worksheet in a hardcopy and an electronic
format (Compact Disc {CD}, or a flash/jump drive) Reference pages PBVQ-1; Questionnaire available
for download on Demandstar.
37.1.4 Exhibit V, RFP Pricing Proposal EXCEL Worksheet in a hardcopy and an electronic format (Compact
Disc {CD}, or a flash/jump drive) reference page VP1; Questionnaire available for download on
Demandstar.
37.1.5 Acknowledge all addendums issued, as applicable,
37.1.6 Acknowledge the Drug Free Workplace Form, as applicable.
37.1.7 Provide Registration to conduct business in the State of Florida.
37.1.8 Provide Business Tax License to conduct business in Hillsborough County, as applicable.
37.1.9 Provide DM/DWBE participation information in accordance with page IP-7, Item 30, as applicable.
38. DUPLICATE COPIES BINDER – SIX (6) CONTAINING:
38.1 In addition to the original documentation above, the Proposer shall also submit Six (6) exact duplicate
hard (paper) copies of the Proposer’s response to Part C, Exhibits III and IV, RFP EXCEL Questionnaire
Worksheets and provide same on a CD or flash/jump drive. Do not include copies of the price proposal
pages with the six (6) duplicate copies binders.
.
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FP NUMBER S-0071-0-2014/CM
PART B
SPECIFICATIONS
1. GENERAL CONDITIONS
ARTICLE 1
The Contract
Except for Titles, Subtitles, Headings, Running Headlines, Table of Contents, and Indices (all of which are
printed herein merely for convenience), the following, except for such portions thereof as may be specifically
excluded, constitute the Contract Documents:
PART A:
INSTRUCTIONS TO PROPOSERS
PART B:
SPECIFICATIONS
1. General Conditions
2. Minimum Specifications
3. EXHIBIT I: Hillsborough County’s Group Health Plan Benefits Summary
4. EXHIBIT II: Flexible Spending Account Booklet
5. EXHIBIT III: COBRA Booklet
6. EXHIBIT IV: Employee Assistance/ Substance Abuse Program
7. EXHIBIT V: Group Health Plan Monthly Rates
8. EXHIBIT VI: Medical, Pharmacy and High Cost Claims
9. EXHIBIT VII: Pharmacy Financial Exhibit
10. EXHIBIT VIII: Employee Census
11. EXHIBIT IX: Excess Medical Stop Loss Rates and Claims Experience
12. EXHIBIT X: Rx4 Prescription Drug List
13. EXHIBIT XI: Medicare Advantage Plan Summary of Benefits
PART C:
PROPOSAL
EXHIBIT I: EQUAL EMPLOYMENT OPPORTUNITY / AFFIRMATIVE ACTION
REQUIREMENTS
EXHIBIT II: W-9
EXHIBIT III: Medical Benefits Program Administration Vendor Questionnaire
EXHIBIT IV: Prescription Benefits Program Vendor Questionnaire
EXHIBIT V: Pricing Proposal Workbook
PART D:
AGREEMENT
EXHIBIT I: INSURANCE REQUIREMENTS
All Addenda Issued by the COUNTY Prior to the Receipt of Bids.
All Supplementary Drawings Issued After Award of the Contract.
All Provisions Required by Law to be a part of the Contract Documents, Whether Actually Inserted
Therein or Not.
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ARTICLE 2 - DEFINITIONS
The following words and expressions (or pronouns used in their stead) shall, wherever they appear in the
Contract Documents, be construed as follows unless a different meaning is clear from the context.
"Addendum" shall mean the additional contract provisions issued in writing by the COUNTY prior to the receipt
of Proposal.
"Agreement" shall mean the written agreement between the COUNTY and the CONTRACTOR covering the
Work to be performed. The Agreement will be attached to and made a part of the Contract Documents.
"Board of County Commissioners" shall mean the Board of County Commissioners of Hillsborough County,
Florida.
"Bonds" shall mean Proposal, Performance, and/or Payment Bond and other instruments of security furnished
by the CONTRACTOR and his Surety in accordance with the Contract Documents.
"Contract" or "Contract Documents" shall mean each of the various parts of the Contract referred to in Article 1
of the General Conditions both as a whole and severally.
"CONTRACTOR" shall mean the successful Proposer and vice versa, whether a corporation, partnership,
individual or any combination thereof, and its, their or his successors, personal representatives, executors,
administrators, and assignees.
"Contract Price" shall mean the total monies payable to the CONTRACTOR under the Contract Documents.
"Contract Time" shall mean the number of calendar days stated in the Agreement for the completion of the
Work.
"Contract Work" shall mean any and all obligations, duties and responsibilities necessary for the successful
completion of the project assigned to or undertaken by the CONTRACTOR under the Contract Documents,
including the furnishing of all labor, materials, equipment and other incidentals.
"COUNTY" shall mean the Board of County Commissioners, Hillsborough County, Florida, for whom the
Contract Work is being performed.
“County Administrator” shall mean the County Administrator of Hillsborough County.
"Day" shall mean one calendar day when used in the Contract Documents.
“Designee” shall mean individual appointed by County Administrator to act on their behalf.
"Minimum Specifications" shall mean the portion of the Specifications dealing with the technical requirements
of the work to be performed under this Contract including materials, equipment and workmanship.
"Modification Agreement" shall mean written order to the CONTRACTOR signed by the COUNTY authorizing
an addition, deletion, or revision in the Work or an adjustment in the Contract Price issued after execution of
the Agreement.
"Notice" shall mean a written notice for the County and the Contractor. Notice shall be served upon the
CONTRACTOR either personally or by leaving the said notice at the residence or with a designated agent in
charge of the Work, or addressed to the CONTRACTOR at the residence or place of business given in the
Proposal and deposited in a postpaid wrapper in any post box regularly maintained by the United States Post
Office.
"Notice of Award" shall mean the written notice given by the COUNTY to the successful Proposer.
"Notice to Proceed" shall mean the written notice given by the COUNTY to the CONTRACTOR of the date for
the work to start.
"Project" shall mean the entire improvement of which the Contract forms a part.
"Project Manager" shall mean the duly authorized representative of the Board of County Commissioners
during the contract period.
"Proposal" shall mean the offer or proposal of the Proposer submitted on the prescribed form setting forth the
prices for the work to be performed.
"Proposer" shall mean any person, partnership or corporation submitting a proposal for the Work.
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"Services" shall mean the improvement and/or the means or methods necessary for implementation and
prosecution of this Project.
"Site" shall mean the area upon or in which the CONTRACTOR’s operations are carried on and such other
areas adjacent thereto as may be designated as such by the COUNTY.
"Specifications" shall mean these General Conditions, any Special Conditions, and Minimum/Technical
Specifications and Plans.
"Subcontractor" shall mean any person, firm or corporation other than employees of the CONTRACTOR who
or which contracts with the CONTRACTOR to furnish, or actually furnishes labor, materials, and/or equipment
for the Project.
"Surety" shall mean any corporation that executes, as Surety, the CONTRACTOR'S Proposal, Performance,
and/or Payment Bond.
"Work" shall mean the improvement and/or the means or methods necessary for its implementation and
prosecution which constitutes this Contract.
ARTICLE 3 -STARTING THE WORK
The CONTRACTOR will start the Work on the date determined by the COUNTY.
ARTICLE 4 - INTERPRETATION AND INTENT OF CONTRACT DOCUMENTS
It is the intent of the Specifications to describe services to be performed in accordance with the Contract
Documents. The Contract Documents are complementary; what is called for by one is as binding as if called
for by all. If the CONTRACTOR finds a conflict, error or discrepancy in the Contract Documents, he will call it
to the COUNTY'S attention in writing before proceeding with the Work affected thereby. In resolving such
conflicts, errors and discrepancies, the documents shall be given preference in the following order:
Agreement; Specifications; Instructions to Proposers. Within the Specifications the order of preference shall
be as follows: Addenda; Special Conditions; General Conditions; Technical Specifications. Any work that may
reasonably be inferred from the Specifications or Drawings as being required to produce the intended result
shall be supplied whether or not it is specifically called for. Work, materials or equipment described in words
which so applied have a well known technical or trade meaning shall be deemed to refer to such recognized
standards. In case of conflict, the more stringent requirements shall take precedence.
ARTICLE 5 - BONDS AND INSURANCE
Performance Bond
When required by the Instructions to Proposers (Part A), the CONTRACTOR will execute a Performance Bond
or furnish acceptable alternative forms of security as stipulated in the Instructions to Proposers (Part A) as
security for the faithful performance of all his obligations under the Contract Documents. Each such Bond (or
acceptable alternative) shall be in an amount at least equal to the Contract Price and in such form and with
such surety as is acceptable to the County. If the Contract is increased by Modification Agreement(s), the
Performance Bond (or acceptable alternative) must be amended accordingly.
Insurance Required
Before starting and until acceptance of the Work by the COUNTY, the CONTRACTOR shall procure and
maintain insurance of the types and to limits specified in the AGREEMENT (Part D), Exhibit I, attached to the
Contract Documents as listed in the Instructions to Proposers (Part A); the Exhibit being incorporated as part
of the AGREEMENT by reference.
ARTICLE 6 - CONTRACTOR'S RESPONSIBILITIES
The CONTRACTOR will give all notices and comply with all laws, ordinances, rules and regulations applicable
to the Work. If the CONTRACTOR observes that the Specifications are at variance therewith, he will give the
COUNTY prompt written notice thereof, and any necessary changes shall be adjusted by an appropriate
modification. If the CONTRACTOR performs any Work knowing it to be contrary to such laws, ordinances,
rules and regulations and without such notice to the COUNTY, he will bear all costs arising therefrom;
however, it shall not be his primary responsibility to make certain that the Specifications are in accordance with
such laws, ordinances, rules and regulations.
Emergencies
In emergencies affecting the safety of persons, the Work or property at the site or adjacent thereto, the
CONTRACTOR, without special instruction or authorization from the COUNTY, is obligated to act at his
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discretion to prevent threatened damage, injury or loss. He will give the COUNTY prompt written notice of any
significant changes in the Work or deviations from the Contract Documents caused thereby, and a Modification
Agreement shall thereupon be issued covering the changes and deviations involved. If the CONTRACTOR
believes that additional work done by him in an emergency which arose from causes beyond his control
entitles him to an increase in the Contract Price or an extension of the Contract Time, he may make a claim
therefor; the same being included in the Modification Agreement.
ARTICLE 7 - FLORIDA PUBLIC RECORDS LAW:
In accordance with Chapter 119, Florida Statutes, and, except as may be provided by other applicable State
and Federal laws, all Proposers should be aware that this Invitation to Bid and all Bids are in the public domain
and are available for public inspection. Proposers are requested, however, to identify specifically any
information contained in their Bids which they consider confidential and/or proprietary, inclusive of trade
secrets as defined in s. 812.081, Florida Statutes, and which they believe to be exempt from disclosure, citing
specifically the applicable exempting law and including narrative explaining the applicable legal exemption as it
relates specifically to Proposer’s confidential and/or proprietary information.
All Bids received in response to this Invitation to Bid will become the property of the County and will not be
returned. In the event of an award, all documentation produced as part of the Contract will become the
exclusive property of the County.
All materials that qualify for exemption from Chapter 119, Florida Statutes or other applicable law must be
submitted in a separate envelope, clearly identified as "EXEMPT FROM PUBLIC DISCLOSURE" with
Proposer’s name and the Invitation to Bid number marked on the outside.
The County will not accept Bids when the entire Bid is labeled as exempt from public disclosure.
Be aware that the designation of an item as exempt from public disclosure by a Proposer may be challenged
in court by any person or entity. By designation of material in the Bid as exempt from public disclosure,
Proposer agrees to defend the County (and its employees, agents and elected and appointed officials)
against all claims and actions (whether or not a lawsuit is commenced) related to Proposer’s designation of
material as exempt from public disclosure and to hold harmless the County (and its employees, agents and
elected and appointed officials) for any award to a plaintiff for damages, costs and attorneys’ fees, incurred by
the County by reason of any claim or action related to Proposer’s designation of material as exempt from
public disclosure.
If, under this contract, the Contractor is providing services and is acting on behalf of the County as provided
under Section 119.011(2), Florida Statutes, the Contractor will comply with public records laws, and
specifically will:
Keep and maintain public records that ordinarily and necessarily would be required by the County in order to
perform the services being performed by the Contractor;
Provide the public with access to public records on the same terms and conditions that the County would
provide the records and at a cost that does not exceed the cost provided in chapter 119, Florida Statutes, or
as otherwise provided by law;
Ensure that public records that are exempt or confidential and exempt from public records disclosure
requirements are not disclosed except as authorized by law; and
Meet all requirements for retaining public records and transfer, at no cost, to the County all public records in
possession of the Contractor upon termination of the contract and destroy any duplicate public records that are
exempt or confidential and exempt from public records disclosure requirements. All records stored
electronically must be provided to the County in a format that is compatible with the information technology
systems of the County.
ARTICLE 8 - CONTRACTOR MUST HAVE LEGALLY AUTHORIZED WORKFORCE
CONTRACTOR is advised that the COUNTY has entered into an agreement (the IMAGE Agreement) with U.S
Immigration and Customs Enforcement (ICE) wherein the COUNTY will, in part, seek to promote the principles
of ethical business conduct, prevent knowingly hiring unauthorized workers through self-governance, and
encourage voluntary reporting of the discovery of unauthorized workers to ICE. Accordingly, by submitting its
Bid/Proposal, CONTRACTOR represents and warrants (a) that CONTRACTOR is in compliance with all
applicable federal, state and local laws, including, but not limited to, the laws related to the requirement of an
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employer to verify an employee’s eligibility to work in the United States, (b) that all of CONTRACTOR’S
employees are legally eligible to work in the United States, and (c) that the CONTRACTOR has actively and
affirmatively verified such eligibility utilizing the Federal Government’s Employment Eligibility Verification Form
(the Form I-9).
A mere allegation of CONTRACTOR’S intent to use and/or current use of unauthorized workers may not be a
basis to delay the COUNTY’S award of a contract to the CONTRACTOR unless such an allegation has been
determined to be factual by ICE prior to the date the contract is scheduled to be awarded by the COUNTY.
Legitimate claims of the CONTRACTOR’S use of unauthorized workers must be reported to both of the
following agencies:
The COUNTY’S Compliance Services hotline at (813) 272-6554; and ICE (Immigration and Customs
Enforcement) at 1-866-DHS-2-ICE (1-866-347-2423).
In the event it is discovered that the CONTRACTOR’S employees are not legally eligible to work in the United
States, then the COUNTY may, in its sole discretion, demand that the CONTRACTOR cure this deficiency
within a specified time frame, and/or immediately terminate the contract without any cost or penalty to the
COUNTY, and/or debar the CONTRACTOR from bidding on all COUNTY contracts for a period of up to 24
months, and/or take any and all legal action deemed necessary and appropriate.
CONTRACTOR is encouraged (but not required) to incorporate the following IMAGE Best Practices into its
business and, when practicable, incorporate verification requirements into its agreements with subcontractors:
1. Use the Department of Homeland Security employment eligibility verification program (E-Verify) to
verify the employment eligibility of all new hires.
2. Use the Social Security Number Verification Service and make a good faith effort to correct and verify
the names and Social Security numbers of the current workforce.
3. Establish a written hiring and employment eligibility verification policy.
4. Establish an internal compliance and training program related to the hiring and employment
verification process, to include, but not limited to, completion of Form I-9, how to detect fraudulent use
of documents in the verification process, and how to use E-Verify and the Social Security Number
Verification Service.
5. Require the Form I-9 and E-Verify process to be conducted only by individuals who have received
appropriate training and include a secondary review as part of each employee’s verification to
minimize the potential for a single individual to subvert the process.
6. Arrange for annual Form I-9 audits by an external auditing firm or a trained employee not otherwise
involved in the Form I-9 process.
7. Establish a procedure to report to ICE credible information of suspected criminal misconduct in the
employment eligibility verification process.
8. Establish a program to assess subcontractors’ compliance with employment eligibility verification
requirements. Encourage contractors to incorporate the IMAGE Best Practices contained in this
Article and, when practicable, incorporate the verification requirements in subcontractor agreements.
9. Establish a protocol for responding to letters received from Federal and State government agencies
indicating that there is a discrepancy between the agency’s information and the information provided
by the employer or employee; for example, “no match” letters received from the Social Security
Administration.
10. Establish a tip line mechanism (inbox, e-mail, etc.) for employees to report activity relating to the
employment of unauthorized workers, and a protocol for responding to employee tips.
11. Establish and maintain appropriate policies, practices, and safeguards against use of the verification
process for unlawful discrimination, and to ensure that U.S. citizens and authorized workers do not
face discrimination with respect to hiring, firing, recruitment or referral for a fee because of citizenship
status or national origin.
12. Maintain copies of any documents accepted as proof of identity and/or employment authorization for
all new hires.
ARTICLE 9 - PROJECT MANAGER'S STATUS
COUNTY's Representatives
The PROJECT MANAGER shall be the Board of County Commissioner's representative during the contract
period. The duties and responsibilities and the limitations of authority of the PROJECT MANAGER as the
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COUNTY'S representative during the contract period are set forth in these General Conditions and shall not be
extended without written consent of the Board of County Commissioners.
Rejecting Defective Work
The PROJECT MANAGER will have authority to disapprove or reject Work which is "defective" (which term is
hereinafter used to describe Work that is unsatisfactory, faulty or defective, does not conform to the
requirements of any inspection, test or approval). He will also have the authority to require special inspection
or testing of the Work.
ARTICLE 10 - CHANGES IN THE WORK
Without invalidating the Agreement, the COUNTY may at any time or from time to time order additions,
deletions or revisions in the Work the same being thereupon authorized by Modification Agreements. Only
upon receipt of a Modification Agreement, shall the CONTRACTOR be authorized to proceed with the Work
involved. All such Work shall be executed under the applicable conditions of the Contract Documents.
Additional Work performed by the CONTRACTOR without authorization of a Modification Agreement will not
entitle him to an increase in the Contract Price or an extension of the Contract Time except in the case of an
emergency as provided in Article 6. The effect of this paragraph shall remain paramount and shall prevail
irrespective of any conflicting provisions contained in these Contract Documents.
The COUNTY will execute appropriate Modification Agreements prepared by the PROJECT MANAGER
covering changes in the Work to be performed as provided in this Article, Work performed in an emergency as
provided in Article 6, and any other claim of the CONTRACTOR for a change in the Contract Time or the
Contract Price which is approved by the county.
It is the CONTRACTOR'S responsibility to notify his Surety of any changes affecting the
general scope of the Work or change of the Contract Price and the amount of the applicable
Bonds shall be adjusted accordingly.
ARTICLE 11 - CHANGES OF CONTRACT PRICE
The total compensation payable to the CONTRACTOR for performing the work in accordance with the terms
of this contract shall be based upon the following described factors:
A.
Application of unit prices to the actual quantities (as measured in the field by appropriate COUNTY
representatives of those items designated in Proposal (Part C) as being a Unit Price item;
B.
Application of unit shown in Proposal (Part C) to items designated as original plan quantity items; and,
The Proposal price shown in Proposal (Part C) represents an estimate of the total compensation due to
the CONTRACTOR under the terms of these Contract Documents which is based upon the quantities of
items listed therein. The actual total compensation paid to the CONTRACTOR for the project described
in these Contract Documents may vary from that amount stated in Proposal (Part C) due to:
(a)
Adjustments in pay quantity/quantities resulting from changes in item quantity/quantities; and/or,
(b)
Adjustments in pay quantity/quantities as otherwise permitted by these Contract Documents.
ARTICLE 12 - CHANGES OF CONTRACT TIME
The Contract Time will be extended in an amount equal to time lost due to delays beyond the control of the
CONTRACTOR if he makes a claim.
ARTICLE 13 - PAYMENT AND COMPLETION
Approval of Payments
The PROJECT MANAGER, within fifteen (15) days after receipt of each Application for Payment, will either
indicate his approval of payment or return the Application to the CONTRACTOR indicating, in writing, the
reason for refusing to approve payment. In the latter case, the CONTRACTOR may make the necessary
corrections and resubmit the Application. Within thirty (30) days of approval of an Application for Payment, the
COUNTY will pay the CONTRACTOR the amount approved.
The PROJECT MANAGER'S approval of any payment requested in an Application for Payment shall constitute
a representation by him to the COUNTY that the conditions precedent to the CONTRACTOR'S being entitled
to payment as set forth in the Article have been fulfilled.
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The PROJECT MANAGER'S approval of final payment shall constitute an additional representation by him to
the COUNTY that the conditions precedent to the CONTRACTOR'S being entitled to final payment as set forth
in the Article have been fulfilled.
The PROJECT MANAGER may refuse to approve the whole or any part of any payment if, in his opinion, he is
unable to make such representations to the COUNTY. He may also refuse to approve any such payment, or,
because of subsequently discovered evidence or the results of subsequent inspections or tests, nullify any
such payment previously approved, to such extent as may be necessary in his opinion to protect the COUNTY
from loss because:
A.
B.
C.
The Work is defective;
Claims have been filed or there is reasonable evidence indicating the probable filing thereof;
The Contract Price has been reduced because of Modification Agreements.
ARTICLE 14 - EPAYABLES ELECTRONIC PAYMENT SOLUTION
(a)
ePayables
If the CONTRACTOR is enrolled in the COUNTY’S ePayables electronic payment solution, all payments
will be made using the ePayables electronic payment solution. The CONTRACTOR will be issued a
VISA credit card account number with zero ($0) available funds until an invoice is approved by the
COUNTY for payment. Once the COUNTY has approved payment, an electronic remittance advice will
be sent to the CONTRACTOR via e-mail or fax along with approval for the CONTRACTOR to charge the
VISA credit card account for that amount. The CONTRACTOR will only have the ability to charge up to
the monetary limit available to the account. ePayables payments will be processed via a credit card and
merchant services fees will apply. Merchant services fees are determined by the vendor’s agreement
with their Merchant Bank. Fees are generally up to 3%.
Once the CONTRACTOR is enrolled in ePayables electronic payment solution and then requests to opt
out, the CONTRACTOR will not be eligible to re-enroll in ePayables for a minimum of twelve (12)
months.
(b)
ACH (Direct Deposit)
If the CONTRACTOR is enrolled in the County’s ACH electronic payment solution, all payments will be
made using the direct deposit. The CONTRACTOR’S bank account information will remain confidential
to the extent provided by law and necessary to make direct deposit payments. Once the COUNTY has
approved payment, an electronic remittance advice will be sent to the Contractor via e-mail.
ARTICLE 15 - SUSPENSION OF WORK AND TERMINATION
Upon seven (7) days written notice to the CONTRACTOR, the COUNTY may without cause and without
prejudice to any other right or remedy elect to abandon the Project and terminate the Agreement. In such
case the CONTRACTOR shall be paid for all Work executed.
ARTICLE 16 - FAILURE TO PERFORM
If, during the term of this contract, the Vendor/Contractor should refuse or otherwise fail to perform any of its
obligations under the contract, the County reserves the right to:
a)
b)
c)
d)
Obtain the goods or services from another Vendor/Contractor; and/or
Terminate the contract; and/or
Suspend/Debar the Vendor from bidding on Hillsborough County procurement/contracts for a
period of up to 24 months and/or
Pursue any and all other remedies available to the County.
ARTICLE 17 – TERMINATION FOR CONTRACTOR BEING ON THE SCRUTINIZED COMPANIES WITH
ACTIVITIES IN THE SUDAN LIST AND/OR SCRUTINIZED COMPANIES WITH ACTIVITIES IN THE IRAN
PETROLEUM ENERGY LIST
Contractor is advised that section 287.135, Florida Statutes, prohibits agencies from contracting with
companies for goods or services of One Million Dollars ($1,000,000.00) or more that are on either the
Scrutinized Companies with Activities in the Sudan List and/or the Scrutinized Companies with Activities in the
Iran Petroleum Energy List. Both lists are created pursuant to section 215.473, Florida Statutes. The County
reserves the right to terminate the Contract if the County discovers that the Contractor has submitted a false
certification regarding the Scrutinized Companies with Activities in the Sudan List and/or the Scrutinized
Companies with Activities in the Iran Petroleum Energy List, and/or if, during the Contract Period, the
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Contractor has been placed on the Scrutinized Companies with Activities in the Sudan List and/or the
Scrutinized Companies with Activities in the Iran Petroleum Energy List.
ARTICLE 18 - MISCELLANEOUS
Should the COUNTY or the CONTRACTOR suffer injury or damage to its person or property because of any
error, omission or act of the other or of any of his employees, agents or others for whose acts he is legally
liable, claim should be made in writing to the other party within a reasonable time of the first observance of
such injury or damage.
ARTICLE 19 - MAINTENANCE OF RECORDS
The CONTRACTOR will keep adequate records and supporting documentation applicable to this contractual
matter. Said records and documentation will be retained by the CONTRACTOR for a minimum of seven (7)
years from the date of termination of this contract. The COUNTY and its authorized agents shall have the right
to audit, inspect and copy all such records and documentation as often as the COUNTY deems necessary
during the period of this contract and during the period of seven (7) years thereafter. The seven (7) year time
period will be extended until audit findings are issued if an audit is initiated during the seven (7) year period.
Such activity shall be conducted only during normal business hours. The COUNTY, during the period of time
expressed by the preceding sentence, shall also have the right to obtain a copy of and otherwise inspect any
audit made at the direction of the CONTRACTOR as concerns the aforesaid records and documentation.
ARTICLE 20 - FUNDING
The award of this Proposal and continuation of resulting contract will be contingent upon the availability of
funds in Hillsborough County's Budget.
ARTICLE 21 - PAYMENT TO SUBCONTRACTORS
By submission of an Application for Payment, the prime CONTRACTOR certifies that all subcontractors and
suppliers have been paid for work and materials from previous progress payments received (less any
retainage) by the prime CONTRACTOR prior to receipt of any further progress payments. During the contract
and upon completion of the contract the COUNTY may request documentation to certify payment to
subcontractor's suppliers. This provision in no way creates any contractual relationship between any
subcontractor and the COUNTY or any liability on the COUNTY for the CONTRACTOR'S failure to make
timely payment to the subcontractor.
ARTICLE 22 - HILLSBOROUGH COUNTY EQUAL OPPORTUNITY CLAUSE
APPLICABLE TO ALL CONTRACTS AND SUBCONTRACTS IN THE AMOUNT OF $10,000 OR MORE.
During the performance of this contract, the CONTRACTOR agrees as follows:
(1)
General. The CONTRACTOR will not discriminate against any employee or applicant for employment
because of race, color, religion, sex, national origin, age, physical handicap or marital status. The
CONTRACTOR will take affirmative action to insure that applicants are employed and that employees
are treated during employment without regard to their race, color, religion, sex, national origin, age,
physical handicap or marital status. Such action shall include, but not be limited to, the following:
employment, upgrading, demotion, or transfer; recruitment advertising; layoff or termination; rates of pay
or other forms of compensation; and selection for training, including apprenticeship. The
CONTRACTOR agrees to post in conspicuous places, available to employees and applicants for
employment, notices setting forth the provisions of this non-discrimination clause.
(2)
Recruitment. The CONTRACTOR will in all solicitations or advertisements for employees placed by or
on behalf of the CONTRACTOR state that all qualified applicants will receive consideration for
employment without regard to race, color, religion, sex, national origin, age, handicap or marital status.
(3)
Unions. The CONTRACTOR will send, to each labor union or representative of workers with which he
has a collective bargaining agreement or other contract or understanding, a notice advertising the labor
union or worker's representative of the CONTRACTOR'S commitments under this assurance, and shall
post copies of the notice in conspicuous places available to employees and applicants for employment.
(4)
Compliance Reports. The CONTRACTOR will maintain records and information assuring compliance
with these requirements and shall submit to the designated Hillsborough County official timely, complete
and accurate compliance reports at such times and in such form containing such information as the
responsible official or his designee may determine to be necessary to enable him to ascertain whether
the CONTRACTOR has complied or is complying with these requirements. The CONTRACTOR will
permit access to his books, records and accounts by Hillsborough County for purposes of investigation
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to ascertain compliance with such rules, regulations and orders. In general, the CONTRACTOR and
subcontractors should have available racial and ethnic data showing the extent to which members of
minority groups are beneficiaries under these contracts.
(5)
Sanctions. In the event of the CONTRACTOR'S non-compliance with the non-discrimination clauses of
this contract or with any of such rules, regulations or orders, this contract may be cancelled, terminated
or suspended in whole or in part and the CONTRACTOR may be declared ineligible for further
Hillsborough County contracts by rule, regulation or order of the Board of County Commissioners of
Hillsborough County, or as otherwise provided by law.
(6)
Subcontractors. The CONTRACTOR will include the provisions of paragraphs (1) through (6) in every
subcontract under this contract so that such provisions will be binding upon each subcontractor. The
CONTRACTOR will take such action with respect to any subcontractor as the contracting agency may
direct as a means of enforcing such provisions including sanctions for non-compliance. In addition, the
Contractor, with regard to the work performed during the Contract Period, shall not discriminate on the
basis of familial status in the selection and retention of subcontractors, including procurements of
materials and leases of equipment.
(7)
Federal Requirements. In the event this contract is paid in whole or in part from any federal
governmental agency or source, the specific terms, regulations and requirements governing the
disbursement of these funds shall be specified herein and become a part of this clause.
APPLICABLE STATUTES, ORDERS AND REGULATIONS
FEDERAL
----Section I of the Fourteenth Amendment to the United States Constitution.
----Title VI of the Civil Rights Act of 1964.
----Title VII of the Civil Rights Act of 1964, as amended by the Equal Opportunity Act of 1972 and 1975.
----Civil Rights Acts of 1866 and 1870.
----Standards for a Merit System of Personnel Administration, 45 CFR 70.
----Revised Order Number 4, 41 CFR 60-2.10.
----Rehabilitation Act of 1973, P.L. 93-112.
----Interagency Agreement dated March 23, 1973.
----Executive Order 11914, Non-discrimination with Respect to the Handicapped in Federally Assisted Programs.
----Age Discrimination Act of 1967, P.L. 94-135
----Civil Rights Act of 1968, P.L. 90-284
----Veterans Readjustment Act.
---------------------------------------------
Section 14001 of the Consolidated Omnibus Budget Reconciliation Act of 1985, (State and Local Assistance Act
of 1972, as amended)
Office of Management and Budget Circular 102, Attachment O.
Age Discrimination in Employment Act, as amended.
Civil Rights Restoration Act of 1987.
Federal Civil Rights Act of 1991.
Americans with Disabilities Act
General Accounting Procedures, 45 CFR, Part 74 and/or Part 92
Clean Air Act, 42 USC 1857(h), section 306
Clean Water Act, 33 USC 1368, section 508
Executive Order 11738
Environmental Protection Agency Regulations, 40 CFR, Part 15
STATE
----State Constitution, Preamble and Article I, Section 2 protects citizens from discrimination because of race,
national origin, or religion, national origin, sex or physical disability.
----Florida Statutes, Chapter 112.042, requires non-discrimination in employment by counties and municipalities,
because of race, color, national origin, sex, handicap, or religious creed.
----Florida Statutes, Chapter 112.043, prohibits age discrimination in employment.
----Florida Statutes Chapter 413.08, prohibits discrimination against the handicapped in employment.
----Florida Statutes, Chapter 448.07, prohibits wage rate discrimination based on sex.
----Florida Civil Rights Act of 1992, as amended
HILLSBOROUGH COUNTY
-----
Hillsborough County Ordinance #00-37, (Human Rights Ordinance) prohibits discrimination in housing,
employment, public accommodations, and procurement and contracting.
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-----
Hillsborough County Ordinance #83-9, (Homerule Charter) Article IX, Section 9.11, provides that no person shall
be deprived or any right because of race, sex, age, national origin, religion, physical handicap, or political
affiliation.
(Rev 02-01)
ARTICLE 23 - SEVERABILITY
If any provision, or any portion thereof, contained in this agreement is held unconstitutional, invalid or
unenforceable, the remainder of this agreement, or portion thereof, shall be deemed severable, shall not be
affected and shall remain in full force and effect.
ARTICLE 24 - PATENT/COPYRIGHT INDEMNITY
The CONTRACTOR, in accepting this Contract/Agreement, agrees to indemnify the County and hold it
harmless from and against all claims, liability, loss, damage or expense, including attorneys' fees, arising from
or by reason of any actual or claimed trademark, patent or copyright infringement or litigation based thereon,
with respect to the goods or any part thereof covered by this order, and such obligation shall survive
acceptance of the goods and payment therefore by the County.
ARTICLE 25 - SUPPLEMENTAL UNILATERAL EXTENSION PERIODS
The COUNTY, through its Director of Financial Services (Procurement), has the option and reserves the right
to unilaterally extend this contract or renewal period for up to three (3) additional one (1) month periods or any
portion thereof, at the same terms and conditions. Notice of the County's intent to extend shall be provided by
the COUNTY in writing to the CONTRACTOR prior to the expiration of the contract, or the renewal period if the
contract has been previously renewed.
ARTICLE 26 - COUNTY AS INTENDED BENEFICIARY OF SUBCONTRACTS
The COUNTY shall be an intended substantial beneficiary of the written agreements between the
CONTRACTOR and its subcontractors.
ARTICLE 27 - CONTRACTOR USE OF HILLSBOROUGH COUNTY FOR MARKETING PROHIBITED
The CONTRACTOR shall in no way use any statements, whether written or oral, made by the COUNTY'S
employees to market, sell, promote or highlight the CONTRACTOR and/or the CONTRACTOR'S product(s)
and/or service(s) unless authorized to do so, in writing, by the County Administrator or his/her designee. In
addition, the CONTRACTOR shall not use subjective or perceived interpretations, even if factual, regarding
the COUNTY'S opinion of the CONTRACTOR'S performance, product(s) and/or service(s) in any document,
article, publication or press release designed to market, promote or highlight the CONTRACTOR and/or the
CONTRACTOR'S product(s) and/or service(s). This does not prevent the CONTRACTOR from including the
COUNTY on its client lists and/or listing or using the COUNTY as a reference.
ARTICLE 28 - UNILATERAL CHANGE ORDERS
Without invalidating the Contract, the COUNTY, through its Director of Procurement Services, reserves the
right to, at any time or from time to time, unilaterally issue change orders (the cumulative total of which shall
not exceed twenty-five thousand dollars ($25,000.00)) for additions, deletions, or revisions in the services to
be rendered under this Contract. Once the $25,000.00 cap is reached, all other additions, deletions, or
revisions in the services shall be valid and enforceable only when evidenced by a written modification
executed and approved by the Contractor and the COUNTY.
ARTICLE 29 - CONTRACT TERM
The term of this contract shall be a three (3) year period from the effective date of the County’s Notice to
Proceed.
29.1
Renewals. At the sole option of the COUNTY, this agreement may be renewed for Two (2) additional
one-year periods at the same terms and conditions and at no more than the guaranteed rate,
maximum cap, or a mutually agreed upon price. Renewal is contingent upon the satisfactory
performance of the CONTRACTOR during the initial term of the contract and the needs of the
COUNTY for the CONTRACTOR’S service.
29.2
Termination Endorsement. Notwithstanding any provision in the agreement(s) to the contrary, the
CONTRACTOR shall give written notice to the COUNTY at least 270 days prior to cancellation, nonrenewal, restriction of coverage, or restriction of contractual obligations.
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Agreement(s) are non-cancelable by the CONTRACTOR for any period in which rates and fixed cost
guarantees are in effect, subject to the 270 day notice requirement, for any reason other than nonpayment of premiums and other fixed costs.
Notwithstanding any provisions in the Agreement to the contrary, the COUNTY may cancel at any time
with a 7-day advance written notice delivered to the selected vendor.
ARTICLE 30 - PRICE ESCALATION/DE-ESCALATION CLAUSE – Intentionally Omitted
ARTICLE 31 - HIPAA COMPLIANCE
CONTRACTOR affirms that compliance with all applicable HIPAA rules and regulations will be maintained
during the course of the contract. Contractor must insure that its agents or sub-contractors agree to the same
restrictions and conditions.
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RFP NUMBER S-0071-0-2014/CM
PART B
SPECIFICATIONS
2. MINIMUM SPECIFICATIONS
1.
INTRODUCTION
1.1
It is the intent of Hillsborough County and its affiliated agencies (County) to contract with an
experienced, well-qualified vendor to provide administration of its self-funded Group Health Plan benefits
for the employees and retirees of Hillsborough County. Medical Plan Program Benefits means the
Employee and Retiree Group Health Plan, Mental Health and Substance Abuse, and Excess Medical
Stop Loss. In addition, the County intends to contract with the selected Group Medical Benefits Program
vendor to administer the Employee Assistance Program (EAP), Flexible Spending Accounts (FSA) and
COBRA.
1.2
Hillsborough County Board of County Commissioners and other affiliated County
Agencies/Constitutionals are located within Hillsborough County, Florida. The County employs
approximately 9,000 full time employees.
1.3
The County has retained Gallagher Benefits Services as its Consultant for the purpose of assisting the
County with the preparation of the RFP, Proposal(s), analysis, verification meetings, and the
recommendation of a Proposer that will be awarded the Agreement. Under the terms of its Agreement
with Hillsborough County, Gallagher Benefits Services acts solely in the capacity of consultant and is
remunerated directly by the County on a fee basis. No commissions are to be paid to Gallagher Benefits
Services.
1.4
The County is in the process of evaluating its Employee Benefit Program with the assistance of
Gallagher Benefit Services, its contracted Employee Benefits Consultants. It is the intent of the County
to review all programs to help to reduce the cost to the County while still providing plan participants with
the highest quality of health related services. An important part of our future may include partnering with
the selected vendor to support a Patient Centered Care model by integrating programs, services,
network providers, ancillary providers and non-affiliated service providers for the purpose of supporting
all patient care. In the event that a Patient Centered Care model is adopted by the County, the
proposing vendor needs to be capable of reacting to and supporting this model. Additionally, the County
is considering and evaluating the incorporation of On-Site Health Clinics, Incentive Based Health Plans
and Funding Plan Alternatives into our Employee Benefit Program for the benefit of our plan
participants. Also being considered is the carve-out of certain programs or services.
2.
2.1
EMPLOYEE GROUPS
Hillsborough County Government has nine (9) separate agencies that participate in the COUNTY’S
Medical Benefits Program. Each agency provides benefit programs administration to its employees.
Participating Agencies in Hillsborough County’s Self-Funded Medical Benefits Program Administration
are:
•
Administrative Offices of the Court
•
Arts Council
•
County Administrator*
•
Clerk of the Circuit Court
•
Children’s Board
•
Expressway Authority
•
Property Appraiser
•
Tampa Port Authority
(Rev 2-98) RFP/P/UP
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•
Tampa Sports Authority
*Includes all agencies for which benefits are administered by the County Administrator’s Human Resources
Department.
3.
PLAN BENEFITS, ELIGIBILITY, ENROLLMENT AND OTHER RELATED INFORMATION
3.1
Plan Benefits are described in detail in Part B, Exhibit II and Exhibit III of this RFP document.
3.2
Employees are eligible to enroll in Health Plan benefits upon employment, with benefits becoming
effective the first of the month following 60 days of employment. Health Plan benefits are a pre-tax
deduction and new employees may elect to enroll within 30 days of employment. All employees are
eligible to enroll in or make changes to the Health Plan benefits during the annual open enrollment
period.
3.3
Final numbers and distribution of participating employees and dependents will not be known prior to
enrollment. For comparison purposes, rates and fixed costs are to be proposed exactly as shown on the
Proposal pages, if applicable. Variation in actual enrollment must have no effect on rates/fixed costs
quoted, i.e. the Proposal must be valid regardless of variations in the actual enrollment mix. Proposal
must not be quoted with minimum participation requirements.
3.4
Variations of employee eligibility of 15% or less shall have no effect on rates/fixed costs quoted.
3.5
Eligible classes of employees are those who are permanent employees, occupying a regularly
established position, and who work a minimum 20 hour work week. However, Agencies, at their
discretion, may define its own benefits eligible class workweek to be greater than 20 hours but less than
full time, provided it is compliant with Eligibility for Coverage Requirements under the Patient Protection
and Affordable Care Act. It is the desire of the County to meet employees/retirees needs when it comes
to the administration of the entire Employee Benefit Package. The County Administrator may make
changes in the eligibility for coverage of employees, retirees, dependents, to include the addition of
domestic partner coverage. The County’s Employee Benefits Consultant, Gallagher Benefits Services, is
working with the County in establishing eligibility guidelines for the County programs moving forward.
Retirees are eligible to enroll in the Hillsborough County Group Health Plan following termination of
employment for the purpose of retirement.
3.6
The County may decide to sponsor a group Medicare Plan for eligible retirees in the future. The
Contractor must be able to provide Medicare Plan proposals which include at least one HMO and one
PPO plan, and at least one of these plans must include fixed prescription benefit coverage which
extends through or eliminates a donut hole. This would be a fully-insured product and wholly
administered by the Contracted vendor, to include enrollment, administration, and premium payment
collection.
3.7
All plans are to comply with federal guidelines and requirements, including but not limited to, Cafeteria
Plans pursuant to Internal Revenue Code Section 125, the Age Discrimination in Employment Act
(ADEA), Americans with Disabilities Act (ADA), as well as all Florida-mandated benefits. (If current
plan(s) does not comply, indicate the plan changes that would be required to bring the plan(s) into
compliance.)
3.8
All employees, retirees and dependents enrolled as active members as of September 30, 2014 are
eligible for selecting this coverage with no actively at work exclusion. Flexible Spending and Employee
Assistance Program are not retiree eligible benefits.
3.9
All Medicare eligible retirees and spouses of retirees who are enrolled in the County’s Group Health
Plan as of September 30, 2014 are eligible to continue the County’s Plan as secondary coverage to
Medicare parts A & B.
3.10 With respect to acts, errors or omissions in the performance of professional services, the Contractor
agrees to pay on behalf of and hold harmless, indemnify and defend the County, elected officials, and
members from and against any and all claims, actions, loss, demands, defense costs, liability or
(Rev 2-98) RFP/P/UP
MS - 2
31
consequential damages of any kinds or nature (including, but not by way of limitation, attorneys’ fees
and court costs) arising out of, or incidental to, the performance of the Agreement to be executed or
work performed thereunder.
3.11 The County desires to contract with a single Contractor and proposals will be evaluated accordingly.
3.12 The Contractor shall allow the County to self-bill on a monthly basis. All benefit plans will be
administered on a self-accounting rate and fixed cost remittance basis.
3.13 Hillsborough County is a governmental entity. The Contractor shall have no references to Employee
Retirement Income Security Act (ERISA) in its contract, certificates, or communications.
3.14 The County must to agree to the termination of any contracted provider or provider group within the
Contractor’s network of providers, if over 10% of the County plan participants have used said provider
within the preceding 12 months from the date of termination.
3.15 The Contractor must notify the County of any change in financial ratings by the A.M. Best rating service,
the Standard and Poors’ rating service or any other industry rating service by which it is rated. This
notification must be given by certified mail to the Director of Human Resources’ address no later than
ten (10) County business days after the Proposer has been apprised of such change. If no rating exists,
financial documentation acceptable to the County will be requested to determine viability.
3.16 Hillsborough County Government is a large group with a complex benefits program. The administration
complexities are such that proposers must be willing to be flexible in order to meet these needs. In
addition, the County’s primary focus is on customer service to their membership. In this regard, should
disagreement arise over matters such as the timing or details of benefits not otherwise clearly covered in
the RFP, the Contractor must be willing to comply with decisions made by the County and/or its
consultant.
3.17 Certain reports are required by the County at no additional cost. Proposer must confirm reporting
capability in the Electronic Questionnaire. Reports must be split out by each agency and then by
employees, retirees, Medicare participants regardless of age, dependents, and COBRA participants.
Plan Performance & Eligibility Reports
•
Standard Quarterly Experience Reporting Package such as the reports that Humana provides
for its administration of the County’s Self-Funded Group Health Plan
•
Quarterly Premium vs. Claims and then a cumulative annual report
•
Quarterly Plan Performance
•
Quarterly Report of Disease Management & Case Management Administration
•
Monthly Eligibility
•
Monthly Financial Recovery Report
•
Monthly Subrogation Report
•
Monthly Stop Loss Report
•
Monthly Medical Claims Payment Report
•
Monthly Dependent Ineligibility Due to Age
•
Semi-annual (minimum two) analysis by Medical Director of claims experience, cost drivers,
pharmacy usage and recommendations for cost control. Must be written report, but presented
by Medical Director to selected County Staff and, upon request, to a selected County Group
Financial Reports (Reports must reflect experience by line of coverage and also split out as indicated
above)
•
Weekly Medical Claims Utilization (if self-funding)
•
Monthly Rx Claims Utilization (if self-funding)
(Rev 2-98) RFP/P/UP
MS - 3
32
4.
•
Weekly FSA Claims
•
Monthly COBRA
•
Prepare and submit annual Retiree Drug Subsidy Cost Report to The Centers for Medicare
and Medicaid (CMS)
ADMINISTRATION PROVISIONS
4.1
All benefit plans will be administered on a self-accounting rate and fixed cost remittance basis.
Proposers must be willing to accept County-generated billing statements. These should balance as of
the same date of County’s coverage tape, that is, the carrier should “freeze” eligibility to match the
County’s Electronic Data Integration (EDI). County desires the ability to transfer invoices via modem or
electronic mail.
4.2
Upon award of the contract, the successful Proposer must provide a local account manager
(Hillsborough County area) to conduct the following (list is illustrative and not limited to):
4.3
4.4
•
Provide assistance to County staff as requested for issues such as, special reporting,
quarterly meetings on plan performance, guidance on industry standards, medical trend,
annual premium rate projections, network and/or provider issues, etc.
•
Coordinate special/unique projects that need elevation to specialized staff within the local or
corporate office. Monitor and report to County on project progress.
•
Be the liaison between County staff and specialized staff within the local or corporate office.
•
Research and resolve elevated eligibility and claim issues.
•
Attend Insurance Committee or other designated meetings (County to provide notification and
schedule).
Upon award of the contract, the successful Proposer must provide a full-time customer service
representative that will work out of the County Center office. This office must be staffed normal
business hours every day that the County offices are operational. If assigned customer service
representative is absent, proposer must provide alternate staffing. The County will provide an office,
telephone line, and computer connection for retrieval of internal emails from employees and staff. The
successful proposer must provide all other operational materials. In addition, the on-site customer
service representative shall conduct the following (list is illustrative and not limited to):
•
Administer the plan in accordance with plan document.
•
Research and resolve eligibility and claim issues.
•
Provide assistance to employees with plan coverage and provider issues.
•
Document all concerns/complaints on eligibility, claims, provider, and miscellaneous
issues, and provide a quarterly report to County.
•
Attend annual open enrollment briefings (County to provide notification and schedule).
•
Attend Insurance Committee meetings (County to provide notification and schedule).
•
Provide support as required to assist with open enrollment, health fairs, benefit briefings,
etc.
It is preferred that capability of online reporting and administrative access for each Hillsborough County
participating agency listed in these Minimum Specifications is available. The Board of County
Commissioners and the County Administrator’s Office shall have full online and administrative
capabilities, while all other agencies should only have access for its own agency’s employees. One
agency should not have access to the other. Example, the Sheriff’s Office must not have access to the
Clerk of the Circuit Court’s data and vice versa. The reporting and administrative capabilities must
include the ability to combine reports for all agencies.
(Rev 2-98) RFP/P/UP
MS - 4
33
5.
CURRENT PROGRAMS
See Exhibit I, II, III of Part B
6.
CONTRIBUTIONS
6.1
See Exhibit V of Part B and also the Electronic Questionnaire for contribution schedules for each plan
requested.
6.2
For some employees, the benefits and contribution schedules are subject to collective bargaining units
7.
IMPLEMENTATION AND COMMUNICATION SERVICES
7.1
Contractor shall prepare an implementation schedule for an October 1, 2014 effective date.
7.2
The current vendor is providing ID cards. The Contractor will provide ID cards on or before the effective
date of coverage to the home address of each participating County employee/retiree. If another method
of distributing ID cards is the Contractor’s current practice, it must be disclosed in the proposal and the
County will evaluate the distribution method and consider if the practice is a viable distribution option for
the County.
7.3
The Contractor must provide benefit booklets and Provider networks. Each must also be made available
to the County in electronic format for posting on its intra/internet sites. The electronic networks must be
updated at least monthly and sent to the County representative for updated posting on intra/internet
sites.
7.4
Contractor must provide comprehensive online capabilities, such as claims, provider search and
selection, request ID cards, etc.
7.5
The Contractor must be able to provide online access to personalized customer service information for
its membership.
7.6
An annual transfer/enrollment period is made available to all active and retired employees. The timing
of this period will be determined at the discretion of the County, but traditionally occurs in the summer
months. Contractor will coordinate with and support the County during these enrollment periods.
7.7
If any amendment to this contract shall materially affect any benefits, the Contractor will be responsible
for issuing new plan design booklets/certificates within a mutually agreed upon time frame.
7.8
Contractor (including current vendor, if selected) is to provide completed communication materials in a
sufficient quantity not to exceed 1000 prior to the start date of the contract, with additional supplies as
needed. The cost of printing communication materials for all plans requested are at no cost to the
County. Agencies, upon request, may order sufficient quality of booklets for their employees following
initial implementation of contract.
7.9
Director of Human Resources, or designee, must approve all booklets and any/all other employee
communications prior to printing and converting to a portable document format (pdf). Materials
requested shall be shipped directly to the ordering Agency.
7.10 All approved communications must be submitted to the County electronically for distribution to staff via
countywide email or for posting on intranet/internet.
7.11 Communications are necessary only in English. No translations into other languages are required;
however, Spanish would be desirable.
(Rev 2-98) RFP/P/UP
MS - 5
34
PART B
EXHIBIT I
GROUP HEALTH PLAN BENEFITS SUMMARIES
Files available for download at Demandstar
(1) EPO Open Access Plan (132 pages)
(2) CoverageFirstSM Plan (132 pages)
(3) HDHP Plan (128 pages)
(Rev 2-98) RFP/P/UP
MS - 6
35
PART B
EXHIBIT II
FLEXIBLE SPENDING ACCOUNT BOOKLET
Files available for download at Demandstar
(Rev 2-98) RFP/P/UP
MS - 7
36
PART B
EXHIBIT III
COBRA BOOKLET
Files available for download at Demandstar
(Rev 2-98) RFP/P/UP
MS - 8
37
PART B
EXHIBIT IV
EMPLOYEE ASSISTANCE PROGRAM / SUBSTANCE ABUSE PROGRAM
Files available for download at Demandstar
(Rev 2-98) RFP/P/UP
MS - 9
38
PART B
EXHIBIT V
GROUP HEALTH PLAN MONTHLY RATES
1 Page
(Rev 2-98) RFP/P/UP
MS - 10
39
PART B
EXHIBIT VI
MEDICAL, PHARMACY, HIGH COST CLAIMS
(available on disc when requested)
(Rev 2-98) RFP/P/UP
MS - 11
40
PART B
EXHIBIT VII
PHARMACY FINANCIAL EXHIBIT
(XX pages)
(Rev 2-98) RFP/P/UP
MS - 12
41
PART B
EXHIBIT VIII
EMPLOYEE & RETIREE CENSUS
(available on disc when requested)
(Rev 2-98) RFP/P/UP
MS - 13
42
PART B
EXHIBIT IX
EXCESS MEDICAL STOP LOSS RATES AND CLAIMS EXPERIENCE
(claims experience available on disc when requested)
(Rev 2-98) RFP/P/UP
MS - 14
43
PART B
EXHIBIT X
Rx4 PRESCRIPTION DRUG LIST
Files available for download at Demandstar
(Rev 2-98) RFP/P/UP
MS - 15
44
PART B
EXHIBIT XI
MEDICARE ADVANTAGE PLAN SUMMARY OF BENEFITS
Files available for download at Demandstar
(Rev 2-98) RFP/P/UP
MS - 16
45
RFP NUMBER S-0071-0-2014/CM
PART C
PROPOSAL
PROJECT NAME
SELF-FUNDED MEDICAL BENEFITS PROGRAM ADMINISTRATOR SERVICES
By signing this Proposal, the undersigned affirms that said Proposal is made without any understanding,
agreement, or connection with any other person, firm or corporation providing a Proposal for the same
purpose and that this Proposal is in all respects fair and without collusion or fraud. The undersigned
understands that this Proposal must be signed in ink and that an unsigned Proposal will be considered
incomplete and subject to rejection by Hillsborough County.
SUBJECT TO THE DEVIATIONS STATED IN PARAGRAPH 1 BELOW, THE UNDERSIGNED, BY THE
SIGNATURE EVIDENCED, REPRESENTS THAT THE PROPOSER ACCEPTS THE TERMS, CONDITIONS,
MANDATES, AND OTHER PROVISIONS OF THE FOREGOING INSTRUCTIONS TO PROPOSERS (PART
A), THE SPECIFICATIONS (PART B), AND THE SUBSEQUENT AGREEMENT (PART D), SAID
DOCUMENTS BEING THE STRICT BASIS UPON WHICH THE SAID PROPOSER MAKES THIS
PROPOSAL.
USE BLACK INK ONLY
ALL THE FOLLOWING REQUESTED INFORMATION MUST BE HEREUPON GIVEN
FOR THIS PROPOSAL TO BE CONSIDERED BY HILLSBOROUGH COUNTY
Deviations: NOTE - ANY REPRESENTATION IN PARAGRAPH 1 OF DEVIATION(S)
MAY CAUSE THIS PROPOSAL TO BE REJECTED BY HILLSBOROUGH COUNTY.
ALL PROPOSERS SHOULD CAREFULLY READ PARAGRAPH 5 OF THE
INSTRUCTIONS TO PROPOSERS (PART A).
The following represents every deviation (itemized by number) to the foregoing Instructions to Proposers (Part
A); the Specifications (Part B), and the Agreement (Part D) upon which this Proposal is based, to wit:
1.
(Rev 2-98) RFP/P/UP
P-1
RFP NUMBER: S-0071-0-2014/CM
SELF-FUNDED MEDICAL BENEFITS PROGRAM ADMINISTRATOR
THE FOLLOWING ARE SUBMITTED BY THE PROPOSER FOR THE PURPOSE OF:
A.
ARRIVING AT AN ESTIMATED TOTAL BID PRICE
B.
ESTABLISHING PRICE FACTORS TO BE UTILIZED IN ADJUSTING THE ESTIMATED TOTAL PRICE RESULTING FROM MODIFICATION(S)
ISSUED OR ANNUAL RENEWALS.
NOTE: QUANTITIES LISTED ARE ESTIMATES ONLY.
PRICING PAGES ARE LOCATED AND
AVAILABLE FOR DOWNLOAD ON DEMANDSTAR
46
REV 12-98 RFP/P/UP
P-2
47
3.
Name of Proposer
(typed or printed: firm, corporation, business or individual)
4.
Name of Contact Person
5.
Our local (to Tampa, Florida) business and mailing address is:
6.
Our primary business and mailing address is:
7.
Our present business phone number is
(_________)
Our present business fax number (if any) is: (_________)
Our e-mail address (if any) is:
8.
Our business has been in operation under its present name since:
9.
Our Federal Tax ID Number is:
10.
Proposer is currently set up with a merchant account to accept payment by VISA credit card and will
accept payment from the County by VISA account through the ePayables electronic payment solution.
Yes ______
No ______
Proposer will accept payment from the County by direct deposit through the ACH electronic payment
solution.
Yes ______
No ______
NOTE: If Proposer is already enrolled in the County’s ePayables or ACH solution for an existing
contract/award, the Proposer will automatically receive payment using their enrolled solution in the event
Proposer is the Successful Proposer.
11.
At this present time we understand all requirements and state that as a serious Proposer we will
comply with all the stipulations included in the Proposal package.
The above-named Proposer affirms and declares:
(1)
That the Proposer is of lawful age and that no other person, firm or corporation has any interest in
this Proposal or in the contract proposed to be entered into.
(2)
That this Proposal is made without any understanding, agreement, or connection with any other
person, firm or corporation making a Proposal for the same purpose, and is in all respects fair and
without collusion or fraud.
(3)
That the Proposer is not in arrears to Hillsborough County upon debt or contract and is not a
defaulter, as surety or otherwise, upon any obligation to Hillsborough County.
(4)
That no officer or employee or person whose salary is payable in whole or in part from the County
Treasury is, shall be or become interested, directly or indirectly, surety or otherwise in this
Proposal; in the performance of this Contract; in the supplies, materials, equipment, and services
or labor to which they relate; or in any portion of the profits thereof.
(5)
That the Proposer has carefully examined the site where the services are to be performed and
that, from his/her own investigations, been satisfied to the nature and location of the Project; the
character, quality and quantity of materials; the kind and extent of the equipment and other
facilities needed for the performance of the services; the general and local conditions, all
(Rev 6-13) RFP/P/UP
P-3
48
difficulties to be encountered; and all other items which may in any way affect the performance of
the services.
(6)
Proposer understands that Section 287.135, Florida Statutes, prohibits agencies and
governmental entities from contracting with companies for goods and/or services that are One
Million Dollars ($1,000,000.00) or more, that are on either the Scrutinized Companies with
Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy
Sector List. Both lists are created pursuant to section 215.473, Florida Statutes. Proposer hereby
certifies that Proposer is not listed on either the Scrutinized Companies with Activities in Sudan
List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List.
Proposer understands that pursuant to section 287.135, Florida Statutes, the submission of a false
certification may subject Proposer to civil penalties, attorney’s fees and/or costs.
(Rev 7-12) RFP/P/UP
P-4
49
IN WITNESS WHEREOF, this Proposal is hereby signed and sealed as of the date indicated.
ATTEST:
PROPOSER:
BY:
Witness
Witness
(SEAL)
(Authorized Signature in Ink)
(Printed Name of Signer)
(Title of Person Signing)
CORPORATE SEAL
(Where appropriate)
(Date Signed)
(Phone Number of Signer)
(Rev 7-12) RFP/P/UP
P-5
50
ACKNOWLEDGEMENT OF PROPOSER, IF A CORPORATION
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this
By
(Date)
(Name of officer or agent, title of officer or agent)
of
a
corporation,
(Name of corporation acknowledging)
(State or place of incorporation)
on behalf of the corporation, pursuant to the powers conferred upon said officer or agent by the corporation. He/she
personally appeared before me at the time of notarization, and is personally known to me or has produced
as identification and did certify to have knowledge of the matters stated
(Type of Identification)
in the foregoing instrument and certified the same to be true in all respects.
Subscribed and sworn to (or affirmed) before me this
(Date)
Commission Number
(Official Notary Signature and Notary Seal)
Commission Expiration Date
(Name of Notary typed, printed or stamped)
ACKNOWLEDGEMENT OF PROPOSER, IF A PARTNERSHIP
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this
By
(Date)
(Name of acknowledging partner or agent)
partner (or agent) on behalf
a partnership. He/she personally
appeared before me at the time of notarization, and is personally known to me or has produced
as identification and did certify to have knowledge of the matters stated
(Type of Identification)
in the foregoing instrument and certified the same to be true in all respects.
Subscribed and sworn to (or affirmed) before me this
(Date)
Commission Number
(Official Notary Signature and Notary Seal)
Commission Expiration Date
(Name of Notary typed, printed or stamped)
ACKNOWLEDGEMENT OF PROPOSER, IF AN INDIVIDUAL
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this
By
(Date)
(Name of acknowledging)
who personally appeared before me at the time of notarization, and is personally known to me or has produced
as identification and did certify to have knowledge of the matters stated
(Type of Identification)
in the foregoing instrument and certified the same to be true in all respects.
Subscribed and sworn to (or affirmed) before me this
(Date)
Commission Number
(Official Notary Signature and Notary Seal)
Commission Expiration Date
(Name of Notary typed, printed or stamped)
(Rev 7-12) RFP/P/UP
P-6
51
PART C
EXHIBIT I
HILLSBOROUGH COUNTY EQUAL EMPLOYMENT OPPORTUNITY REQUIREMENTS
STATEMENT OF COMPLIANCE
THE PROPOSER REPRESENTS THAT THE INFORMATION SUBMITTED HEREIN IS
TRUE AND CORRECT. THE PROPOSER ASSURES HILLSBOROUGH COUNTY OF
ITS COMPLIANCE WITH FEDERAL, STATE AND COUNTY AFFIRMATIVE ACTION
AND EQUAL EMPLOYMENT OPPORTUNITY REQUIREMENTS. THE PROPOSER
FURTHER ASSURES THAT IT AND ITS SUBCONTRACTOR'S/SUBRECIPIENT'S
FACILITIES ARE ACCESSIBLE TO THE HANDICAPPED (IF APPLICABLE).
INSTRUCTIONS
As a proposer/contractor with the County, you are urged to carefully review the Equal Employment Opportunity
Affirmative Action Questionnaire and respond to it as it relates to your own employment practices.
Please note particularly that:
1.
Where federally-assisted contracts are involved, the proposer/ contractor is bound by Revised Order No.
4 (41 CFR Part 60-2) and Executive Order 11246 of September 24, 1965 as amended, by Executive
Orders 11375 and 12086; or Title VI of the Civil Rights Act of 1964 and Federal contract Compliance
"bid conditions" in the proposal package.
2.
The proposer/contractor must complete ALL forms of this Equal Employment Opportunity Affirmative
Action Questionnaire if the total amount of the contract is equal to or exceeds $10,000.
If at any time there arises a question, problem or need for assistance in meeting the equal opportunity
requirements on County contracts, please contact Hillsborough County's Economic Development Department,
DM/DWBE & SBE Programs Section, P.O. Box 1110, Tampa, Florida 33601, (813) 914-4028.
(Rev 7-12) RFP/EEO/G
EEO - 1
52
EQUAL EMPLOYMENT OPPORTUNITY
AFFIRMATIVE ACTION QUESTIONNAIRE
PROJECT: SELF-FUNDED MEDICAL BENEFITS PROGRAM ADMINISTRATOR SERVICES
RFP NUMBER S-0071-0-2014/CM
FIRM’S CIVIL RIGHTS STATUS
All responding firms are requested to carefully review the following questions and provide responses as it
relates to the firm's own affirmative action and equal opportunity practices.
Please respond to the following:
1.
*Provide a copy of your organization's Affirmative Action Plan or Program. (If not submitted within the
past twelve (12) months.)
2.
Workforce Analysis by race/sex and EEO Category.
3.
If organization receives federal/state/local funding, please list source and dollar amount.
4.
Name of person designated as EEO representative.
5.
Is the organization receptive to on-site reviews?
6.
Does the organization have a procedure for resolving discrimination complaints?
7.
Has your firm been charged with discrimination within the past eighteen (18) months? If yes, how many
charges, nature of charge; when; and where?
8.
Do you anticipate hiring additional staff to perform this contract? If yes, please provide the number of
positions and type of positions.
9.
Please provide a copy of the company's Affirmative Action/Equal Employment Opportunity Policy
Statement, signed and dated by the Chief Executive Officer. (If not submitted within the past twelve (12)
months).
A written Affirmative Action Plan or Program is required if the firm has fifteen (15) or more
employees. If the firm has fewer than fifteen (15) employees, then an Affirmative Action Policy
Statement is required.
(Rev 8-00) RFP/EEO/G
EEO - 2
53
SANCTIONS AND PENALTIES
1.
Failure to comply with the Equal Opportunity and Affirmative Action requirements adopted by
the Board of County Commissioners of Hillsborough County may result in suspension or
debarment of the firms or individuals involved. Debarment of firms by Hillsborough County for
activity contrary to this program will be carried out according to the debarment procedures
contained in the Hillsborough County Procurement Manual. Said firm or individual will be
notified by registered mail of said suspension or debarment and may appeal suspension or
debarment through the procedure set forth in the Procurement Manual.
2.
The Board of County Commissioners encourages each proposer to submit EEO documentation
with the bid.
3.
The Board of County Commissioners also reserves the right to reject any proposals from firms
who have previously failed to perform properly and who have done so by commission or
omission of an act of such serious or compelling nature that the act indicates a serious lack of
business integrity or honesty or willingness to comply.
(Rev 2-06) RFP/EEO/G
EEO - 3
54
FIRM NAME:
JOB
CATEGORY
TOTAL
EMPLOYEES
MALE
FEMALE
MALES
WHT
BLK
HISP
FEMALES
API
AI
WHT
BLK
HISP
Officials &
Managers
Professionals
Technicians
Sales
Workers
Office &
Clerical
Craftsmen
(Skilled)
Operatives
(Semi-Skilled)
Laborers
(Unskilled)
Service
Workers
TOTAL
HISP:
API:
AI:
Hispanic
Asian/Pacific Islander
American Indian
Job categories as provided herein are those categories identified and used in EEO (1-6) reporting
requirements, required from employers by the Federal government.
(DO NOT LEAVE THIS PAGE BLANK)
(Rev 8-00) RFP/EEO/G
EEO - 4
API
AI
55
PART C
EXHIBIT II
Revised 9-27-10
W9-1
56
PART C
EXHIBIT III
MEDICAL BENEFITS PROGRAM ADMINISTRATION VENDOR QUESTIONNAIRE
To be posted on Demandstar
(XX pages)
Revised 9-27-10
VQ-1
57
PART C
EXHIBIT IV
PRESCRIPTION BENEFITS PROGRAM VENDOR QUESTIONNAIRE
To be posted on Demandstar
(XX pages)
Revised 9-27-10
PBVQ-1
58
PART C
EXHIBIT V
PRICING PROPOSAL WORKBOOK
To be posted on Demandstar
(XX pages)
(Rev 01-06) RFP/A/UP
VP - 1
59
PART D
AGREEMENT
THIS AGREEMENT is made and entered into this
day of
, 20
(award date for projects subject thereto) by and between the BOARD OF COUNTY COMMISSIONERS OF
HILLSBOROUGH COUNTY, FLORIDA, hereinafter called COUNTY; and
,
hereinafter called CONTRACTOR.
WITNESSETH THAT:
In consideration of the mutual covenants and provisions contained herein, the parties hereto agree as follows:
1.
The CONTRACTOR, being the best responsible proposer, shall provide to the COUNTY the labor,
services, materials and all appurtenances thereto per the requirements set forth in the Request for Proposal
S-0071-0-2014/CM, Self-Funded Medical Benefits Program Administration Services.
2.
PART A: INSTRUCTIONS TO PROPOSERS, PART B: SPECIFICATIONS, AND PART C: PROPOSAL
of this Request for Proposals are hereby incorporated by this reference into this Agreement.
3.
The CONTRACTOR shall furnish, at his own cost and expense, all equipment, tools, materials and labor
of every description necessary to carry out and complete said service/work in a good, firm, substantial and
workmanlike manner.
4.
This Agreement shall be in effect for the initial period beginning October 1, 2014 and ending September
30, 2016. Beginning October 1, 2016, this AGREEMENT may be renewed at the sole option of the COUNTY,
for two additional one year periods, at the same terms and conditions of the initial period, at the maximum rate
cap proposed and/or provided the rates can be agreed upon by the COUNTY and the CONTRACTOR. The
CONTRACTOR shall commence performance of services/work required hereunder on said beginning date
unless otherwise specified herein or as otherwise necessary in order to commence performance on said date.
5.
In order to provide for sufficient time to agree upon the subsequent rate for a renewal period, the
CONTRACTOR shall provide in writing its proposed rate to the COUNTY for the next annual renewal period,
no later than 270 days prior to the expiration of the AGREEMENT.
6.
Indemnification (General Liability): The CONTRACTOR shall indemnify, hold harmless, and defend the
COUNTY, their agents and employees and anyone directly or indirectly employed by either of them, from and
against any and all liabilities, losses, claims, damages, demands, expenses or actions, either at law or in
equity, including court costs and attorneys’ fees, that may hereafter at anytime be made or brought by anyone
on account of personal injury, property damage, loss of monies, or other loss, to the extent caused or incurred,
as a result of any negligent, wrongful, or intentional act or omission of, or based on any act of fraud or
defalcation by the CONTRACTOR, or anyone performing any act required of the CONTRACTOR in
connection with performance of this Agreement awarded pursuant to this RFP. The CONTRACTOR’S
indemnification obligations set forth herein shall remain in full force and effect during the performance of any
duties/responsibilities associated with this AGREEMENT, and any renewal periods; the performance of any
duties and responsibilities necessary to commence the AGREEMENT; or the performance of any duties and
responsibilities after expiration of the AGREEMENT.
7.
Including the provisions contained in this Agreement, the CONTRACTOR and the COUNTY shall
adhere to all provisions contained in the Contract Documents (as listed in the Instructions to Proposers (Part
A), the same being incorporated as part of this Agreement by reference.
8.
The COUNTY shall pay and the CONTRACTOR shall accept as full compensation for all
services/work done, materials furnished, and all costs and expenses incurred, the compensation outlined in
the response to the RFP-S-0071-0-2014/CM, Self-Funded Medical Benefits Program. The CONTRACTOR
guarantees all rates and costs as set forth in the CONTRACTOR’S response to the RFP through September
30, 2016. The rates and costs are attached as an exhibit to this AGREEMENT and incorporated by reference.
(Rev 01-06) RFP/A/UP
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60
9.
The CONTRACTOR agrees to the terms of the Performance Guarantees, which is attached as an
exhibit to this AGREEMENT and incorporated by reference.
10.
During the performance of this Agreement, the CONTRACTOR herein assures the COUNTY that said
CONTRACTOR is in compliance with Title VII of the 1964 Civil Rights Act, as amended, and the Florida Civil
Rights Act of 1992 in that the CONTRACTOR does not on the grounds of race, color, national origin, religion,
sex, age, handicap or marital status, discriminate in any form or manner against said CONTRACTOR’S
employees or applicants for employment. The CONTRACTOR understands and agrees that this Agreement is
conditioned upon the veracity of this Statement of Assurance. Furthermore, the CONTRACTOR herein
assures the COUNTY that said CONTRACTOR will comply with Title VI of the Civil Rights Act of 1964 when
Federal grant(s) is/are involved. Other applicable Federal and State laws, executive orders and regulations
prohibiting the type of discrimination as hereinabove delineated are included by this reference thereto. This
Statement of Assurance shall be interpreted to include Vietnam Era Veterans and Disabled Veterans within its
protective range of applicability.
11.
This Agreement shall be contingent upon the CONTRACTOR furnishing the COUNTY, when required,
a Certificate of Competency, Certificate of Insurance, Performance Bond, Payment Bond, Errors and
Omissions and Fidelity/Employee Honesty coverage, and any other such documents as required in this
Agreement upon execution of this Agreement and will be kept in force at all times during the performance of
this Agreement. Furthermore, CONTRACTOR warrants that it is qualified to do business in the State of
Florida and is not prohibited by its articles of incorporation, bylaws, or the law of the state under which it is
incorporated from performing the services required under this Agreement. CONTRACTOR further warrants
that it has obtained, and shall at all times maintain, any and all necessary permits or licenses to do business in
Florida, and to perform the services under this Agreement.
12.
If, for any reason, any portion of this Agreement is held invalid or unconstitutional by any court of
competent jurisdiction, such portion shall be deemed a separate, distinct, and independent provision, and such
holding shall not affect the validity of the remaining portions hereof.
13.
This Agreement may only be amended or modified by a written instrument executed by the COUNTY
and the CONTRACTOR.
14.
Unless otherwise specified, this Agreement shall be governed by the laws, rules, and regulations of
Florida, or the laws, rules, and regulations of the United States when providing services funded by the United
States government and venue shall be in Hillsborough County, Florida.
15.
The CONTRACTOR must be in full compliance with HIPAA and its rules and regulations. The
CONTRACTOR must ensure that its agents, subcontractors, subsidiaries and affiliated companies agree to
the same restrictions and conditions. Should the CONTRACTOR fail to cure any unintentional HIPAA breach
of which it has been notified, within the specified time, the COUNTY may terminate this AGREEMENT with 24
hours notice. Should the COUNTY determine that CONTRACTOR has intentionally violated any HIPAA rule
or regulation, COUNTY may terminate this AGREEMENT with 24 hours notice.
16.
Termination for breach: Unless the CONTRACTOR’S breach is waived, the COUNTY may, upon
twenty four (24) hours notice, terminate this Agreement for said breach. Waiver of a breach of any provision of
this Agreement shall not be deemed to be a waiver of any other breach nor shall it be construed to be a
modification of this Agreement.
17.
The COUNTY may terminate this AGREEMENT for any other reason not otherwise specified herein by
providing CONTRACTOR with seven (7) days written notice.
18.
All notices of termination, as well as all other notices required herein, shall be considered received by
the CONTRACTOR and the COUNTY if delivered in person with written proof thereof, or when deposited in
the U.S. Mail, certified, return receipt requested, or any other method mutually agreed to by the authorized
representative of the parties.
19.
Notice - Any notice required by this Agreement shall be given to the following representatives of the
parties unless otherwise mutually agreed to by the authorized representative of the parties:
(Rev 01-06) RFP/A/UP
A-2
61
COUNTY:
CONTRACTOR:
Director, Human Resources Dept
__________________________________
P.O. Box 1110
__________________________________
Tampa, Florida 33601
__________________________________
20. The foregoing constitutes the entire Agreement between the parties with respect to the subject matter
contained herein. In the event of a conflict, the express terms of this Agreement and all exhibits shall
supersede and control over the RFP, responses to the RFP, and any other clarifications and/or addendums to
the RFP.
(Rev 01-06) RFP/A/UP
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62
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date first written above.
ATTEST:
PAT FRANK
CLERK OF CIRCUIT COURT
BY:
COUNTY: HILLSBOROUGH COUNTY
FLORIDA
BY:
DEPUTY CLERK
CHAIRMAN, BOARD OF
COUNTY COMMISSIONERS
ATTEST:
CONTRACTOR
WITNESS
AUTHORIZED CORPORATE OFFICER - OR
INDIVIDUAL (SIGN BEFORE NOTARY PUBLIC
WITNESS
(Printed Name of Signer)
(Title)
(Phone)
(Date)
S-0071-0-2014/CM
Approval
Date
Department
Procurement Services
County Attorney’s Office
(Rev 01-06) RFP/A/UP
A-4
63
ACKNOWLEDGEMENT OF CONTRACTOR, IF A CORPORATION
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this
By
(Date)
(Name of officer or agent, title of officer or agent)
of
a
corporation,
(Name of corporation acknowledging)
(State or place of incorporation)
on behalf of the corporation, pursuant to the powers conferred upon said officer or agent by the corporation. He/she
personally appeared before me at the time of notarization, and is personally known to me or has produced
as identification and did certify to have knowledge of the matters stated
(Type of Identification)
in the foregoing instrument and certified the same to be true in all respects.
Subscribed and sworn to (or affirmed) before me this
(Date)
Commission Number
(Official Notary Signature and Notary Seal)
Commission Expiration Date
(Name of Notary typed, printed or stamped)
ACKNOWLEDGEMENT OF CONTRACTOR, IF A PARTNERSHIP
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this
By
(Date)
(Name of acknowledging partner or agent)
partner (or agent) on behalf
a partnership. He/she personally
appeared before me at the time of notarization, and is personally known to me or has produced
as identification and did certify to have knowledge of the matters stated
(Type of Identification)
in the foregoing instrument and certified the same to be true in all respects.
Subscribed and sworn to (or affirmed) before me this
(Date)
Commission Number
(Official Notary Signature and Notary Seal)
Commission Expiration Date
(Name of Notary typed, printed or stamped)
ACKNOWLEDGEMENT OF CONTRACTOR, IF AN INDIVIDUAL
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this
By
(Date)
(Name of acknowledging)
who personally appeared before me at the time of notarization, and is personally known to me or has produced
as identification and did certify to have knowledge of the matters stated
(Type of Identification)
in the foregoing instrument and certified the same to be true in all respects.
Subscribed and sworn to (or affirmed) before me this
(Date)
Commission Number
(Official Notary Signature and Notary Seal)
Commission Expiration Date
(Name of Notary typed, printed or stamped)
(Rev 3-97) RFP/A/UP
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PART D
EXHIBIT I
INSURANCE
REQUIREMENTS
Contractor's Liability Insurance:
The CONTRACTOR shall procure and maintain in force such insurance as will protect him from claims under Workers'
Compensation laws, disability benefit laws or other similar employee benefit laws; from claims for damages because of
bodily injury, occupational sickness or disease, or death of his employees including claims insured by usual personal
injury liability coverage; from claims for damages because of bodily injury, sickness or disease, or death of any person
other than his employees including claims insured by usual personal injury liability coverage; and from claims for injury
to or destruction of tangible property including loss of use resulting therefrom, any or all of which may arise out of or
result from the CONTRACTOR'S operations under the Contract Documents, whether such operations be by himself or
by any subcontractor or anyone directly or indirectly employed by any of them or for whose acts any of them may be
legally liable. This insurance shall be written for not less than any limits of liability specified in the Contract Documents
or required by law, whichever is greater, and shall include contractual liability insurance. Before starting the work, the
CONTRACTOR will file with the COUNTY certificates of such insurance, acceptable to the COUNTY; these certificates
shall contain a provision for cancellation as found in paragraph 5 of Section B immediately below.
Insurance Required:
A.
General
Before starting and until acceptance of the Work by the COUNTY, the CONTRACTOR shall procure and
maintain insurance of the types and to the limits specified in paragraphs B. (1) through (4) below. All policies of
insurance under this contract shall include as additional insured Hillsborough County and its employees. All
policies shall provide for separation of insured's interests such that the insurance afforded applies separately
to each insured against whom a claim is made or a suit is brought.
B.
Coverage
The CONTRACTOR shall procure and maintain in force during the life of this contract the following types of
insurance coverage written on standard forms and placed with insurance carriers acceptable to the County
and approved by the Insurance Department of the State of Florida. The amounts and type of insurance shall
conform to the following requirements:
1.
Worker's Compensation Insurance - The CONTRACTOR shall procure and shall maintain in force
during the life of this Contract, Workers' Compensation Insurance providing statutory benefits,
including those that may be required by an applicable federal statute, for all of his employees to be
engaged in work on the project under this Contract. In case any class of employee engaged in
hazardous work on the project under this contract is not protected under the Workers' Compensation
statute, the CONTRACTOR shall provide employer's liability insurance for all said employees.
a.
Employer's Liability:
$
$
$
2.
Limit each Accident
Limit Disease Aggregate
Limit Disease each Employee
Commercial General Liability Insurance - Coverage must be afforded on a form no more restrictive
than the latest edition of the Commercial General Liability Policy filed by the Insurance Service office
with limits of not less than those listed below and must include:
a.
REV 07-09 RFP/IR/G
General Aggregate:
Products and Completed Operations:
Personal and Advertising Injury:
Each Occurrence:
Fire Damage (anyone fire):
Specific Contract Aggregate Limits:
IR - 1
$
$
$
$
$
Same as above
65
3.
Automobile Liability Insurance - Coverage must be afforded on a form no more restrictive than the
latest edition of the Business Automobile Liability Policy filed by the Insurance Service office with limits
not less than those listed below and must include:
a.
b.
c.
d.
e.
4.
$
combined single limits each accident, for bodily injury and property damage
liability.
Owned Vehicles
Hired and Non-owned Vehicles
Employer Non-ownership
Garage Keepers Liability:
Professional Liability:
a.
b.
Minimum limits of $
per claim.
Notice of cancellation and or restrictions: The policy must be endorsed to provide the county
with forty-five days notice of cancellation and/or restrictions.
5.
Builder's Risk: [ ] is/ [X] is not required. Installation Floater: [ ] is/ [X] is not required. If required,
maximum deductible: $
. The policy should be issued for the cost of construction only.
Labor and fees should not be included in the amount of coverage.
6.
Pollution Liability: $
7.
Certificate of Insurance and Copies of Policies - Certificates of Insurance furnished by Hillsborough
County evidencing the insurance coverage specified in the previous paragraphs B. 1. through 4.
inclusive, and on request of the COUNTY certified copies of the policies required shall be filed with the
Risk Management Division of the COUNTY on a timely basis. The required Certificates of Insurance
not only shall list Hillsborough County as additional insured, for the operations of the CONTRACTOR
under this contract (excluding the worker's compensation, automobile liability, and professional liability
policies) and shall name the types of policies provided and shall refer specifically to this Contract.
per occurrence.
If the initial insurance expires prior to the completion of the Contract, renewal Certificates of Insurance shall be
furnished thirty (30) days prior to the date of their expiration.
The required limits for insurance may be achieved through a combination of primary and umbrella policies.
These policies will provide that: the insurer(s) waive their rights of subrogation against the Hillsborough County Board
of Commissioners, their officials, employees, agents, and consultants.
Cancellation - Should any of the above described policies be canceled or non-renewed before the stated expiration
date thereof, insurer will not cancel same until at least thirty (30) days prior written notice has been given to the below
named certificate holder. This prior notice provision is a part of each of the above described policies.
Project Title: S-00781-0-2014/CM, Self-Funded Medical Benefits Program Administration
Reviewed, Risk Management Division: SIGNED COPY IN FILE
DATE:
REV 07-09 RFP/IR/G
IR - 2
66
CERTIFICATE OF LIABILITY INSURANCE
Date:
Producer, Address, Telephone No.
Insurers Affording Coverage
Insurer A:
Insurer B:
Insured, Address
Insurer C:
Insurer D;
Insurer E:
This is to certify that the insurance policies listed below have been issued to the insured and are in force at this time. It is further certified that
these policies have been endorsed to provide that they will not be cancelled or changed so as to reduce the described coverages until 30
days after written notice of such cancellation or change has been delivered to the certificate holder at the address shown below.
Insr
Type of Insurance
Policy Number
Policy
Policy
Limits
Ltr
Effective
Expiration
Date
Date
General Liability
Commercial General Liability
Claims Made
Occur
General Aggregate Limit Applies per:
Policy
Project
Loc
Each Occurrence
$
Fire Damage
$
Personal & Advertising
Injury
General Aggregate
$
Products – Completed
Operations Aggregate
$
Combined Single Limit
(Each Accident)
Automobile Liability
Any Auto
All Owned Autos
Scheduled Autos
Hired Autos
Non-Owned Autos
Garage Liability
Any Auto
$
Bodily Injury
(Each Accident)
$
Property Damage
(Per Accident)
$
Auto Only – Ea Acc
$
$
$
Ea Acc
Auto Only:
Occur
Aggregate
Each Occurrence
Claims Made
Aggregate
Deductible
Retention
$
Workers’ Compensation and
Employer’s Liability
WC StatuOthtory Limits
er
E. L. Each Accident
E. L. Disease – Ea Emp
E. L. Disease – Pol Limit
Other
$
$
Bodily Injury
(Per Person)
Other than
Excess Liability
$
$
$
$
$
$
$
$
$
$
Contractual Liability Coverage is Included in listed General and Auto Liability Policies.
“Hillsborough County, a political subdivision of the State of Florida” has been named as an Additional Insured on the listed General, Auto and
Aircraft Liability Policies.
Listed General Liability Policies include a Separation of Insureds (severability of interests) provision.
Other Provisions/Limitations/Conditions: S-00781-0-2014/CM, Self-Funded Medical Benefits Program Administration
Certificate Holder:
Hillsborough County - BOCC
Risk Management Division
th
601 E. Kennedy Blvd, 26 FL
Tampa, FL 33602
ICM – 015 (09/10)
Fax No. 813-635-8284
Authorized Representative:
Signature
IR-3
_____________________________________