Instructions - Tennessee General Assembly

Supplemental Documentation Required for Fiscal Review Committee

Revised April 2014

*Contact Name: Seannalyn Brandmeir, Benefits Administration

*Contact Phone:

615.532.4598

*Presenter’s name(s):

Laurie Lee, Executive Director; Christa Martin, Director of Financial Management and Program Integrity; Seannalyn Brandmeir, Procurement and Contracting Manager

Edison Contract Number: (if applicable)

38894 RFS Number: (if applicable)

*Original or Proposed Contract

Begin Date:

9/30/2013 *Current or Proposed End

Date:

12/31/2018

Current Request Amendment Number: (if applicable)

One

Proposed Amendment Effective Date: (if applicable)

May 1, 2017

*Department Submitting: Finance and Administration *Division: Benefits Administration

*Date Submitted: February 1, 2017 *Submitted Within Sixty (60) days: Yes

If not, explain: *Contract Vendor Name:

*Current or Proposed Maximum Liability: $3,000,000.00 *Estimated Total Spend for Commodities:

*Current or Proposed Contract Allocation by Fiscal Year: (as Shown on Most Current Fully Executed Contract Summary Sheet) FY: 2014 FY: 2015 FY: 2016 FY: 2017 FY: 2018 FY: 2019 $411,292.22 $565,103.39 $565,103.39 $565,103.39 $565,103.39 $328,294.22 *Current Total Expenditures by Fiscal Year of Contract: (attach backup documentation from Edison) FY: 2014 FY: 2015 FY: 2016 FY: 2017 FY FY $259,763.80 $553,312.10 $515,442.72 $178,676.16 $ $

IF Contract Allocation has been greater than Contract Expenditures, please give the reasons and explain where surplus funds were spent:

IF surplus funds have been carried forward, please give the reasons and provide the authority for the carry forward provision:

IF Contract Expenditures exceeded Contract Allocation, please give the

Supplemental Documentation Required for Fiscal Review Committee

Revised April 2014

reasons and explain how funding was acquired to pay the overage: *Contract Funding Source/Amount:

State:

Federal:

Interdepartmental:

$3,000,000.00 Other:

If “other” please define: If “interdepartmental” please define: Public Sector Health Plan funding Dates of All Previous Amendments

or Revisions: (if applicable) Brief Description of Actions in Previous Amendments or Revisions: (if applicable)

n/a

Method of Original Award: (if applicable) RFP *What were the projected costs of the

service for the entire term of the contract prior to contract award?

How was this cost determined?

During the RFP process, Benefits Administration estimated the cost between $3 million to $4 million. Previous contract and a RFI was conducted before the 2013 RFP was released.

*List number of other potential vendors who could provide this good or service;

efforts to identify other competitive procurement alternatives; and the

reason(s) a sole-source contract is in the best interest of the State.

n/a

Vend

orLD

Num

ber

Year

Ass

esse

dQ

uart

erAm

ount

Ass

esse

dG

uara

ntee

Asse

ssm

ent

ID

720

152Q

$1,0

00.0

0

Syst

em U

ser A

vaila

bilit

y:

The

DS

S/EI

S sh

all b

e av

aila

ble

to S

tate

us

ers n

inet

y-ni

ne p

erce

nt (9

9%) o

f th

e tim

e be

twee

n 6:

00 a

.m. a

nd 7

:00

p.m

. CST

Mon

day

thro

ugh

Satu

rday

, as

des

crib

ed in

Con

trac

t sec

tion

A.7.

d.

One

thou

sand

dol

lars

($1,

000)

for e

ach

inst

ance

the

stan

dard

is n

ot m

et.

TR

1320

152Q

$1,0

00.0

0

Repo

rtin

g:

The

Cont

ract

or sh

all

dist

ribut

e to

the

Stat

e al

l rep

orts

re

quire

d in

Con

trac

t Sec

tions

A.1

th

roug

h A.

20. a

nd C

ontr

act

Atta

chm

ent C

with

in th

e tim

e fr

ame

spec

ified

in th

e Co

ntra

ct.

Five

hun

dred

dol

lars

($50

0) fo

r eac

h re

port

not

del

iver

ed to

the

Stat

e w

ithin

th

e tim

e fr

ame

spec

ified

in th

e Co

ntra

ct.

TR

1320

161Q

$1,5

00.0

0

Repo

rtin

g:

The

Con

trac

tor s

hall

dist

ribut

e to

the

Stat

e al

l rep

orts

re

quire

d in

Con

trac

t Sec

tions

A.1

th

roug

h A.

20. a

nd C

ontr

act

Atta

chm

ent C

with

in th

e tim

e fr

ame

spec

ified

in th

e Co

ntra

ct.

Five

hun

dred

dol

lars

($50

0) fo

r eac

h re

port

not

del

iver

ed to

the

Stat

e w

ithin

th

e tim

e fr

ame

spec

ified

in th

e Co

ntra

ct.

TR

Amendment Request This request form is not required for amendments to grant contracts. Route a completed request, as one file in PDF format, via e-mail attachment sent to: [email protected]

APPROVED

CHIEF PROCUREMENT OFFICER DATE

Agency request tracking # 31786-00117

1. Procuring Agency Benefits Administration

2. Contractor

3. Edison contract ID # 38894

4. Proposed amendment # One

5. Contract’s Original Effective Date 9/30/2013

6. Current end date 12/31/2018

7. Proposed end date n/a

8. Current Maximum Liability or Estimated Liability $3,000,000.00

9. Proposed Maximum Liability or Estimated Liability n/a

10. Strategic Technology Solutions Pre-Approval Endorsement Request – information technology service (N/A to THDA)

Not Applicable Attached

11. eHealth Pre-Approval Endorsement Request – health-related professional, pharmaceutical, laboratory, or imaging Not Applicable Attached

12. Human Resources Pre-Approval Endorsement Request – state employee training service Not Applicable Attached

13. Explain why the proposed amendment is needed

Legal name change of the company from to

14. If the amendment involves a change in Scope, describe efforts to identify reasonable, competitive, procurement alternatives to amending the contract.

n/a

mailto:[email protected]

Agency request tracking # 31786-00117

Signature of Agency head or authorized designee, title of signatory, and date (the authorized designee may sign his or her own name if indicated on the Signature Certification and Authorization document)

C O N T R AC T A M E N D M E N T C O V E R S H E E T

Agency Tracking # Edison ID Contract # Amendment #

31786-00117 4354 38894 1

Contractor Legal Entity Name Edison Vendor ID

4354

Amendment Purpose & Effect(s) Legal Name Change to

Amendment Changes Contract End Date: YES NO End Date: 12/31/2018

TOTAL Contract Amount INCREASE or DECREASE per this Amendment (zero if N/A): $ 0

Funding — FY State Federal Interdepartmental Other TOTAL Contract Amount

2014 $411,292.22 $411,292.22

2015 $565,103.39 $565,103.39

2016 $565,103.39 $565,103.39

2017 $565,103.39 $565,103.39

2018 $565,103.39 $565,103.39

2019 $328,294.22 $328,294.22

TOTAL: $3,000,000.00

American Recovery and Reinvestment Act (ARRA) Funding: YES NO

Budget Officer Confirmation: There is a balance in the appropriation from which obligations hereunder are required to be paid that is not already encumbered to pay other obligations.

CPO USE

Speed Chart (optional) Account Code (optional)

AMENDMENT ONE OF CONTRACT 38894

This Amendment is made and entered by and between the State of Tennessee, State Insurance Committee, Local Education Insurance Committee, and Local Government Insurance Committee, hereinafter referred to as the ‘State” and , hereinafter referred to as the “Contractor”. For good and valuable consideration, the sufficiency of which is hereby acknowledged, it is mutually understood and agreed by and between said, undersigned contracting parties that the subject contract is hereby amended as follows:

Contractor Name. All references to “ .” shall be deleted and replaced with .

Iran Divestment Act. The requirements of Tenn. Code Ann. § 12-12-101 et.seq., addressing contracting with persons with investment activities in Iran, shall be a material provision of this Contract. The Contractor agrees, under penalty of perjury, that to the best of its knowledge and belief that it is not on the list created pursuant to Tenn. Code Ann. § 12-12-106.

Required Approvals. The State is not bound by this Amendment until it is signed by the contract parties and approved by appropriate officials in accordance with applicable Tennessee laws and regulations (depending upon the specifics of this contract, said officials may include, but are not limited to, the Commissioner of Finance and Administration, the Commissioner of Human Resources, and the Comptroller of the Treasury).

Amendment Effective Date. The revisions set forth herein shall be effective May 1, 2017. All other terms and conditions of this Contract not expressly amended herein shall remain in full force and effect.

IN WITNESS WHEREOF,

:

SIGNATURE DATE

PRINTED NAME AND TITLE OF SIGNATORY (above)

STATE INSURANCE COMMITTEE, LOCAL EDUCATION INSURANCE COMMITTEE, LOCAL GOVERNMENT INSURANCE COMMITTEE:

LARRY B. MARTIN, CHAIRMAN DATE

New Window | Help | Customize Page |

Document Approval Status

SetID: Contract ID: SHARE 0000000000000000000038894 Vendor ID: 0000004354

Review/Edit Approvers

Stage 1 DOC approval

:Approved View CommentsFinal Approval

Approved

Mitzi R Hale Document Approval 1 11/4/2013 - 10:33 AM

Approved

James R Hamdorff Document Approval 2 11/4/2013 - 11:09 AM

Approved

Andrew Kidd Document Approval 3 11/5/2013 - 10:52 AM

Approval Comment History

Mary Anne J Queen at 11/20/2013 - 2:56 PM Response accepted. Approval of the DGS CPO approved document is on behalf of the Comptroller pursuant to current signature authorization. The record is now set to On Hold. The record should remain On Hold until DGS CPO sets to Approved.

Mary Anne J Queen at 11/13/2013 - 2:05 PM Perfunctory approval to move record to CPO - Section E.18 of the contract is the ¿California Accountancy Act¿ and states that for engagements where services will be provided by the contractor at offices in California, the State acknowledges that certain of the contractor¿s personnel may not be licensed as certified public accountants. What accounting services would the contractor be providing that would otherwise require a licensed CPA to perform?

Mitzi R Hale at 11/4/2013 - 10:33 AOnly two proposals were received; Benefit was disqualified.

Sylvia D Chunn at 10/25/2013 - 4:48 PM Contract procured by RFP submitted for approval with all supporting documentation. Contract is submitted after start date due to approval by CPO on language change and F&A legal opinion of contractor changes requested. The period of implementation is from 9/30 - 12/31 and is covered by a one-time fee upon implementation and testing. Fee for services does not begin until 1-1-14.

Budget Office

:Approved View Comments

Budget Threshhold

Approved

Amy Miller Con - Budget Office Approval 11/5/2013 - 1:21 PM




Mitzi R Hale at 11/4/2013 - 10:33 A Only two proposals were received; Benefit was disqualified.


Post Budget

:Approved View CommentsPost Budget

Approved

Mary Anne J Queen Document Approval - Comptrolle 11/13/2013 - 2:06 PM

Approved

Andrew Kidd Inserted Approver 11/19/2013 - 8:33 AM

Approved

Mary Anne J Queen Inserted Approver 11/20/2013 - 2:56 PM

Approved

Sharon L Whitby Document Approval 3 11/21/2013 - 10:41 AM




Mitzi R Hale at 11/4/2013 - 10:33 AOnly two proposals were received; Benefit was disqualified.


Return to Document Management

Page 1 of 1Doc Maintenance

11/21/2013https://fs.edison.tn.gov/psc/fsprd/EMPLOYEE/ERP/c/CONTRACT_MGMT.CS_DOC_...

Instructions - Tennessee General Assembly

Documents

Transcript of Instructions - Tennessee General Assembly