LITTLETON ELEMENTARY SCHOOL DISTRICT #65...
Transcript of LITTLETON ELEMENTARY SCHOOL DISTRICT #65...
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 NOTICE OF REQUEST FOR PROPOSALS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323 623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 1 of 39
RFP Due Date: October 29, 2014 Time: 11:00 a.m., Local Time Opening Location: Littleton Elementary District No. 65 Purchasing Department
1600 S 107 Ave Avondale, AZ 85353 In accordance with School District Procurement Rules in the Arizona Administrative Code (A.A.C.) promulgated by the State Board of Education pursuant to A.R.S. 15-213, Proposals for the material or services specified will be received by the Littleton Elementary School District No. 65 (District), at the above specified location, until the time and date cited. Proposals received by the correct time and date shall be opened and only the name of the Offerors shall be publicly read and recorded. All other information contained in the Proposal shall remain confidential until award is made. If you need directions to our office, please call (623) 478-5600. Proposals shall be in the actual possession of the District, at the location indicated, on or prior to the exact time and date indicated above. Late Proposals shall not be considered. The official time will be determined by the clock designated by the District. Proposals must be submitted in a sealed envelope with the solicitation number and Offeror’s name and address clearly indicated on the envelope. All Proposals must be written legibly in ink or typewritten. Additional instructions for preparing a Proposal are provided herein. OFFERORS ARE STRONGLY ENCOURAGED TO CAREFULLY READ THE ENTIRE REQUEST FOR PROPOSAL. Questions regarding this Request for Proposal should be directed to Phyllis Kinder, Executive Director of Business Resources in writing via e-mail at [email protected]. ____________________________________________ ________________________ Phyllis Kinder Date Executive Director of Business Resources Littleton Elementary School District No. 65
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 TABLE OF CONTENTS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323 623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 2 of 39
Table of Contents
Section Page Uniform Instruction to Offerors ................................................................................................................. 3 Uniform General Terms and Conditions ................................................................................................... 9 Special Instructions, Terms and Conditions............................................................................................ 18 Scope of Work/Specifications ................................................................................................................ 26 Questionnaire…..................................................................................................................................... 28 Proposal Cost Form ............................................................................................................................... 29 Offer and Acceptance Form ................................................................................................................... 30 Acknowledgement of Addendums. ......................................................................................................... 31 Non-Collusion Statement ....................................................................................................................... 32 Performance Evaluation Survey ............................................................................................................. 33 Deviations and Exceptions Form ........................................................................................................... 34 Confidential or Proprietary Information Form .......................................................................................... 35 Familial Relationship Form .................................................................................................................... 36 No-Offer Response Form....................................................................................................................... 37 I.R.S. W-9 Form .................................................................................................................................... 38 Address Label……………………………………………………………………………………………………….39 DOCUMENTS REFERENCED: You may access a copy of the documents referenced within this Proposal at the following web addresses: Arizona Revised Statutes (A.R.S.) is available at: http://www.azleg.state.az.us/ArizonaRevisedStatutes.asp The Arizona School District Procurement Rules in the Arizona Administrative Code is available at: http://azsos.gov/public_services/Title_07/7-02.htm#Article_10 I.R.S W-9 Form (Request for Taxpayer I.D. Number) is available at: http://www.irs.gov/pub/irs-pdf/fw9.pdf
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM INSTRUCTIONS TO OFFERORS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
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1. Definition of Terms In addition to the definitions specified in Arizona Administrative Code R7-2-1001, the terms listed below are defined as follows:
A. Attachment - any item the Solicitation requires an Offeror to submit as part of the Offer.
B. Contract - the combination of the Solicitation, including the Uniform and Special Instructions to
Offerors, the Uniform and Special Terms and Conditions, and the Specifications and Statement or Scope of Work; the Offer and any Best and Final Offers; and any Solicitation Amendments or Contract Amendments; and any terms applied by law.
C. Contract Amendment - a written document signed by the Procurement Officer that is issued for the purpose of making changes in the Contract.
D. Contractor - any person who has a contract with the School District.
E. Days - calendar days unless otherwise specified.
F. Exhibit - any item labeled as an Exhibit in the Solicitation or placed in the Exhibits section of the solicitation.
G. Gratuity - payment, loan, subscription, advance, deposit of money, services, or anything of more than nominal value present or promised, unless consideration of substantially equal or greater value is received.
H. District – Littleton Elementary School District #65
I. Offer - bid, proposal or qualification.
J. Offeror - a vendor who responds to a Solicitation.
K. Procurement Officer - the person duly authorized to enter into and administer Contracts and make written determinations with respect to the Contract or his or her designee.
L. Solicitation - an Invitation for Bids (IFB), a Request for Proposals (RFP), or a Request for Qualifications (RFQ).
M. Solicitation Amendment - a written document that is authorized by the Procurement Officer and issued for the purpose of making changes to the Solicitation.
N. Subcontract - any Contract, express or implied, between the Contractor and another other party or between a subcontractor and another party delegating or assigning, in whole or in part, the making or furnishings of any material or any service required for the performance of the Contract.
2. Inquiries
A. Duty to Examine. It is the responsibility of each Offeror to examine the entire Solicitation, seek
clarification in writing, and check its Proposal for accuracy before submitting the Proposal. Lack
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM INSTRUCTIONS TO OFFERORS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
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of care in preparing a Proposal shall not be grounds for withdrawing the Proposal after the due date and time nor shall it give rise to any Contract claim.
B. Solicitation Contact Person. Any inquiry related to a Solicitation, including any requests for or inquiries regarding standards referenced in the Solicitation shall be directed solely to the Solicitation contact person. The Offeror shall not contact or direct inquiries concerning this Solicitation to any other employee unless the Solicitation specifically identifies a person other than the Solicitation contact person as a contact.
C. Submission of Inquiries. The Procurement Officer or the person identified in the Solicitation as the contact for inquires may require that an inquiry be submitted in writing. Any inquiry related to a Solicitation shall refer to the appropriate Solicitation number, page, and paragraph. Do not place the Solicitation number on the outside of the envelope containing that inquiry since it may then be identified as an Proposal and not be opened until after the Proposal due date and time.
D. Timeliness. Any inquiry shall be submitted as soon as possible and at least seven (7) days before the Proposal due date and time. Failure to do so may result in the inquiry not being answered.
E. No Right to Rely on Verbal Responses. Any inquiry that results in changes to the Solicitation shall be answered solely through a written Solicitation Amendment or Addendum. An Offeror may not rely on verbal responses to inquiries.
F. Solicitation A. The Solicitation shall only be modified by a Solicitation Amendment or Addendum. Unless otherwise stated in the Solicitation, each Solicitation Amendment or Addendum shall be acknowledged by the person signing the Offer. Failure to acknowledge a material Solicitation Amendment or Addendum or to follow the instructions for acknowledgement of the Solicitation Amendment/Addendum may result in rejection of the Offer.
G. Pre-Proposal Conference. If a Pre-Proposal Conference has been scheduled under this Solicitation, the date, time, and location appear on the Solicitation cover sheet or elsewhere in the Solicitation. An Offeror should raise any questions it may have about the Solicitation or the procurement at that time. An Offeror may not rely on any verbal responses to questions at the conference. Material issues raised at the conference that result in changes to the Solicitation shall be answered solely through a written Solicitation Amendment or Addendum.
H. Persons with Disabilities. Persons with a disability may request a reasonable accommodation, such as a sign language interpreter, by contacting the appropriate Solicitation contact person. Requests shall be made as early as possible to allow time to arrange the accommodation.
3. Proposal Preparation
A. Forms. A Proposal shall be submitted either on the forms provided in this Solicitation or their substantial equivalent. Any substitute document for the forms provided in this Solicitation will be legible and contain the same information requested on the form.
B. Typed or Ink; Corrections. The Proposal should be typed or in ink. Erasures, interlineations or other modifications in the Proposal should be initialed in ink by the person signing the Proposal. Modifications shall not be permitted after Proposals have been opened except as otherwise provided under R7-2-1030.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM INSTRUCTIONS TO OFFERORS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
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C. Evidence of Intent to be Bound. The Offer and Acceptance form within the Solicitation must be
submitted with the Offer and must include a signature by a person authorized to sign the Offer. The signature shall signify the Offeror’s intent to be bound by the Offer and the terms of the Solicitation and that the information provided is true, accurate, and complete. Failure to submit verifiable evidence of intent to be bound, such as an original signature, may result in rejection of the Offer.
D. Exceptions to Terms and Conditions. All exceptions included with the Proposal shall be submitted in a clearly identified separate section of the Proposal in which the Offeror clearly identifies the specific paragraphs of the Solicitation where the exceptions occur. Any exceptions not included in such a section shall be without force and effect in any resulting Contract unless such exception is specifically referenced by the Procurement Officer in a written statement. The Offeror’s preprinted or standard terms will not be considered as a part of any resulting Contract. All exceptions that are contained in the Offer may negatively affect the proposal evaluation criteria as stated in the Solicitation or result in rejection of the offer.
E. Subcontracts. Offeror shall clearly list any proposed subcontractors and the subcontractor’s proposed responsibilities in the Offer. Per 7 CFR §3017.200 debarment verification shall be completed on subcontracts/subcontractors. This will be completed by the subcontractor prior to contract approval.
F. Cost of Proposal Preparation. The District will not reimburse any Offeror the cost of responding to a Solicitation.
G. Federal Excise Tax. District is exempt from Federal Excise Tax on manufactured goods.
Exemption Certificates will be prepared upon request.
H. Provision of Tax Identification Numbers. Offerors are required to provide their Arizona Transaction Privilege Tax number and/or Federal Tax Identification number, if applicable, in the space provided on the Offer and Acceptance Form and provide the tax rate and amount, if applicable, on the Proposal Cost Sheet.
I. Identification of Taxes in Proposal. District is subject to all applicable state and local transaction privilege taxes. If Arizona resident Offerors do not indicate taxes on a separate item in the Proposal, the District will conclude that the price(s) offered include all applicable taxes.
J. Disclosure. If the Firm, business, or person submitting this Proposal has been debarred, suspended, or otherwise lawfully precluded from participating in any public procurement activity, including being disapproved as a subcontractor with any federal, state, or local government, or if any such preclusion from participation from any public procurement activity is currently pending, the Offeror must fully explain the circumstances relating to the preclusion or proposed preclusion in the Proposal. The Offeror shall include a letter with its Proposal setting forth the name and address of the governmental unit, the effective date of this suspension or debarment, the duration of the suspension or debarment, and the relevant circumstances relating the suspension or debarment. If suspension or debarment is currently pending, a detailed description of all relevant circumstances including the details enumerated above must be provided.
K. Solicitation Order of Precedence. In the event of a conflict in the provisions of this Solicitation and any subsequent contracts, the following shall prevail in the order set forth below:
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM INSTRUCTIONS TO OFFERORS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 6 of 39
1. Addenda/Amendments 2. Special Instructions, Terms and Conditions; 3. Uniform General Terms and Conditions; 4. Scope of Work/Specifications; 5. Attachments; 6. Exhibits; 7. Uniform Instructions to Offerors
L. Delivery. Unless stated otherwise in the Solicitation, all prices shall be F.O.B. Destination and
shall include all delivery and unloading at the destination(s).
4. Submission of Proposal A. Sealed Envelope or Package. Each Proposal shall be submitted to the location identified in this
Solicitation, in a sealed envelope or package that identifies its contents as a Proposal and the Solicitation number to which it responds. The appropriate Solicitation Number should be plainly marked on the outside of the envelope or package.
B. Electronic Submission. If determined by the District that electronic submission of proposals is advantageous, the District will include the electronic submission requirements as well as if the electronic submission is mandatory or optional in the Special Instructions, Terms and Conditions section of the RFP. Unless otherwise instructed, a facsimile or electronically submitted Proposal shall be rejected.
C. Proposal Amendment or Withdrawal. An Offeror may modify or withdraw a Proposal in writing at any time before Proposal opening if the modification or withdrawal is received before the Proposal due data and time at the location designed in the RFP. A Proposal may not be amended or withdrawn after the Proposal due date and time except as otherwise provided under R7-2-1044.
D. Public Record. Under applicable law, all Proposals submitted and opened are public records and must be retained by the District. Proposals shall be open to public inspection after Contract award, except for such Proposals deemed to be confidential by the District pursuant to R7-2-1006. If an Offeror believes that information in its Proposal contains confidential trade secrets or other proprietary data not to be disclosed as otherwise required by A.R.S. § 39-121, a statement advising the District of this fact shall accompany the submission and the information shall be so identified wherever it appears. Contract terms and conditions, pricing, and information generally available to the public are not considered confidential information under this Section.
E. Non-collusion, Employment, and Services. By signing the Offer and Acceptance form or other official contract form, the Offeror certifies that:
It did not engage in collusion or other anti-competitive practices in connection with the preparation or submission of its offer; and
It does not discriminate against any employee, applicant for employment, or person to whom it provides services because of race, color, religion, sex, sexual orientation, national origin, marital or family status, political beliefs, disability, or Vietnam status and that it complies with all applicable federal, state, and local laws and executive orders regarding employment.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM INSTRUCTIONS TO OFFERORS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
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5. Additional Proposal Information
A. Unit Price Prevails. Where applicable, in the case of discrepancy between the unit price or rate and the extension of that unit price or rate, the unit price or rate shall govern.
B. Taxes. All applicable taxes in the Proposal will be considered by the District when evaluating proposals; except when a responsive Offeror which is otherwise reasonably susceptible for award is located outside of Arizona and is not subject to a transaction privilege or use tax of a political subdivision of this state. In that event, all applicable taxes which are the obligation of Offerors in state and out of state, Offerors shall be disregarded in the Contract Award. At all times, payment of taxes and the determination of applicable taxes and rates are the sole responsibility of the awarded Offeror.
C. Late Proposals, Modifications or Withdrawals. A proposal, modification or withdrawal submitted after the exact proposal due date and time shall not be considered except under the circumstances set forth in R7-2-1044.
D. Disqualification. A Proposal from an Offeror who is currently debarred, suspended or otherwise
lawfully prohibited from any public procurement activity may be rejected.
E. Proposal Acceptance Period. An Offeror shall hold its Offer open for the number of days that is stated in the Solicitation from the Offer due date. If the Solicitation does not specifically state a number of days for the Offer acceptance, the number of days shall be ninety (90). If a Best and Final Offer is requested pursuant to a Request for Proposals, an Offeror shall hold its Offer open for ninety (90) days from the Best and Final due date.
F. Waiver and Rejection Rights. Notwithstanding any other provision of this solicitation, the District reserves the right to: 1. Waive any minor informality; 2. Reject any and all Proposals or portions thereof; or 3. Cancel a solicitation.
6. Award
A. Number or Types of Awards. Where applicable, the District reserves the right to make multiple awards or to award a Contract by individual line items, by a group of line items, or to make an aggregate award, whichever is deemed most advantageous to the District. If the Procurement Officer determines that an aggregate award to one Offeror is not in the School District’s interest, “all or none” Offers shall be rejected.
B. Contract Commencement. A Proposal does not constitute a Contract nor does it confer any rights on the Offeror to the award of a Contract. A Contract is not created until the Proposal is accepted in writing by the District with an authorized signature on the Offer and Acceptance Form. A letter or other notice of award or of the intent to award shall not constitute acceptance of the Proposal.
C. Effective Date. The effective date of this Contract shall be the date that the Procurement Officer signs the Proposal and Acceptance Form or other official contract form, unless another date is specifically stated in the Contract.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM INSTRUCTIONS TO OFFERORS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 8 of 39
D. Final acceptance. A contract will be contingent upon the approval of the District’s Governing
Board. 7. Protests
A protest shall comply with and be resolved according to Arizona Department of Education School District Procurement Code Rule A.A.C. R7-2-1141 through R7-2-1153. Protests shall be in writing and be filed with the District Representative, Ms. Phyllis Kinder, Executive Director of Business Resources. A. A protest shall include:
1. The name, addresses, and telephone number of the interested party 2. The signature of the interested party or the interested party's representative; 3. Identification of the purchasing agency and the Solicitation or Contract number; 4. A detailed statement of the legal and factual grounds of the protest including copies of
relevant documents; and 5. The form of relief requested. 6. The interested party shall supply promptly any other information requested by the District
Representative.
B. Protests based upon alleged improprieties in a solicitation that are apparent before the due date and time for responses to the solicitation, shall be filed before the due date and time for responses to the solicitation.
C. In cases other than those covered in section B of this section, the interested party shall file the
protest within 10 days after the District makes the procurement file available for public instruction.
D. The interested party may file a written request for an extension of the time limit for protest filing. The written request for an extension shall be filed with the District Representative before the expiration of the time limit and shall set forth good cause as to the specific action or inaction of the District that resulted in the interested party being unable to file the protest within the 10 days. The District Representative shall approve or deny the request in writing, state the reasons for the determination, and, if an extension is granted, set forth a new date for submission of the filing.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM GENERAL TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 9 of 39
1. Contract Interpretation
A. Arizona Law. The law of Arizona applies to this Contract including, where applicable, the Uniform Commercial Code as adopted by the State of Arizona and the Arizona School District Procurement Code, Arizona Revised Statutes (A.R.S.) 15-213, and its implementing rules, Arizona Administrative Code (A.A.C.) Title 7, Chapter 2, Articles 10 and 11.
B. Implied Contract Terms. Each Provision of law and any terms required by law to be in this
Contract are a part of this Contract as if fully stated in it. C. Relationship of Parties. The Contractor under this Contract is an independent Contractor. Neither
party to this Contract shall be deemed to be the employee agent of the other party to the Contract.
D. Severability. The provisions of this Contract are severable. Any term or condition deemed illegal
or invalid shall not affect any other term or condition of the Contract. E. No Parol Evidence. This Contract is intended by the parties as a final and complete expression of
their agreement. No course of prior dealings between the parties and no usage of the trade shall supplement or explain any terms used in this document.
F. No Waiver. Either party’s failure to insist on strict performance of any term or condition of the
Contract shall not be deemed waiver of that term or condition even if the party accepting or acquiescing in the nonconforming performance knows of the nature of the performance and fails to object to it.
2. Contract Administration and Operation
A. Records. Under A.R.S. § 35-214 and § 35-215, the Contractor shall retain and shall contractually require each Subcontractor to retain all data and other records (“records”) relating to the acquisition and performance of the Contract for a period of five years after the completion of the Contract. All records shall be subject to inspection and audit at reasonable times. Upon request, the Contractor shall produce a legible copy of any or all such records.
B. Non-Discrimination. The Contractor shall comply with State Executive Order No. 99-4, 2000-4
and all other applicable Federal and State laws, rules and regulations, including the Americans with Disabilities Act.
C. Audit. Pursuant to A.R.S. § 35-214 at any time during the term of this Contract and five (5) years
thereafter, the Contractor’s or any Subcontractor’s books and records shall be subject to audit by the District and, where applicable, the Federal Government, the extent that the books and records relate to the performance of the Contract or Subcontract.
D. Inspection and Testing. The Contractor agrees to permit access to its facilities, Subcontractor
facilities and the Contractor’s processes for producing the materials, at reasonable time for inspection of the materials and services covered under this Contract. The District shall also have the right to test at its own cost the materials to be supplied under this Contract. Neither inspection at the Contractor’s facilities nor testing shall constitute final acceptance of the materials. If the District determines non-compliance of the materials, the Contractor shall be responsible for the payment of all costs incurred by the District for testing and inspection.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM GENERAL TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 10 of 39
E. Notices. Notices to the Contractor required by this Contract shall be made by the District to the
person indicated on the Offer and Acceptance Form submitted by the Contractor unless otherwise stated in the Contract. Notices to the District required by the Contract shall be made by the Contractor to the Solicitation Contact Person indicated on the Solicitation cover sheet, unless otherwise stated in the Contract. An authorized Procurement Officer and an authorized Contractor representative may change their respective person to whom notices shall be given by written notice and an Amendment to the Contract shall not be necessary.
F. Advertising and Promotion of Contract. The Contractor shall not advertise or publish information
for commercial benefit concerning this Contract without the prior written approval of the Procurement Officer.
G. Property of the District. Any materials, including reports, computer programs and other
deliverables, created under this Contract are the sole property of the District. The Contractor is not entitled to a patent or copyright on those materials and may not transfer the patent or copyright to anyone else. The Contractor shall not use or release these materials without the prior written consent of the District.
3. Costs and Payments
A. Payments. Payments shall comply with the requirements of A.R.S. Titles 35-342 and 41, Net 30 days. Upon receipt and acceptance of goods or services, the Contractor shall submit a complete and accurate invoice for payment from the District within thirty (30) days. The Purchase Order number must be referenced on the invoice.
B. Applicable Taxes. 1. Payment of Taxes by the District. The District will pay only the rate and/or amount of taxes
identified in the Proposal and in any resulting Contract. 2. State and Local Transaction Privilege Taxes. The District is subject to all applicable state
and local transaction privilege taxes. Transaction privilege taxes apply to the sale and are the responsibility of the seller to remit. Failure to collect taxes from the buyer does not relieve the seller from its obligation to remit taxes.
3. Tax Indemnification. Contractor and all Subcontractors shall pay all federal, state, and local
taxes applicable to its operation and any persons employed by the Contractor. Contractor shall, and require all Subcontractors to hold the District harmless from any responsibility for taxes, damages and interest, if applicable, contributions required under federal, and/or state and local laws and regulations and any other costs including transaction privilege taxes, unemployment compensation insurance, Social Security and Worker’s Compensation.
4. IRS W-9. In order to receive payment under any resulting Contract, Offeror shall have a
current I.R.S. W-9 Form on file with the District.
C. Availability of Funds for the Next Fiscal Year. Funds may not presently be available for performance under this Contract beyond the current fiscal year. No legal liability on the part of the District for any payment may arise under this Contract beyond the current fiscal year until funds are made available for performance of the Contract. The District will make reasonable efforts to secure such funds.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM GENERAL TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 11 of 39
4. Contract Changes
A. Amendments. A Contract will be issued under the authority of the Executive Director for Business Resources. The Contract may be modified only through a Contract Amendment within the scope of the Contract signed by the Procurement Officer. Changes to the Contract, including the addition of work or materials, the revision of payment terms, or the substitution of work or materials, directed by an unauthorized employee or made unilaterally by the Contractor are violations or the Contract and or applicable law. Such changes, including unauthorized written Contract Amendments, shall be void and without effect, and the Contractor shall not be entitled to any claim and this Contract based on those changes.
B. Subcontracts. The Contractor shall not enter into any Subcontract under the ensuing Contract without the advance written approval of the District. The Subcontract shall incorporate by reference the terms and conditions of the Contract.
C. Assignment and Delegation. The Contractor shall not assign any right nor delegate any duty
under the Contract without the prior written approval of the District. The District shall not unreasonably withhold approval.
5. Risk and Liability
A. Risk of Loss. The Contractor shall bear all loss of conforming material covered under this Contract until received by authorized personnel at the location designated in the purchase order or Contract. Mere receipt does not constitute final acceptance. The risk of loss for nonconforming materials shall remain with the Contractor regardless of receipt.
B. General Indemnification. To the extent permitted by A.R.S. § 41-621 and § 35-154, the District
shall be indemnified and held harmless by the Contractor for its vicarious liability as result of entering into this Contract. Each party to this Contract is responsible for its own negligence.
C. Indemnification - Patent and Copyright. To the extent permitted by A.R.S. § 41-621 and § 35-
154, the Contractor shall indemnify and hold harmless the District against any liability, including costs and expenses, for infringement of any patent, trademark, or copyright arising out of Contract performance or use by the District of materials furnished or work performed under this Contract. The District shall reasonably notify the Contractor of any claim for which it may be liable under this paragraph.
D. Force Majeure.
1. Except for payment of sums due, neither party shall be liable to the other nor deemed in
default under this Contract if and to the extent that such party’s performance of this Contract is prevented by reason of force majeure. The term “force majeure” means an occurrence that is beyond the control of the party affected and occurs without its fault or negligence. Without limiting the foregoing, force majeure includes acts of God; acts of the public enemy; war; riots; strikes; mobilization; labor disputes; civil disorders; fire; flood; lockouts; injections-intervention-acts; or failures or refusals to act by government authority; and other similar occurrences beyond the control of the party declaring force majeure which such party is unable to prevent by exercising reasonable diligence.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM GENERAL TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 12 of 39
2. Force Majeure shall not include the following occurrences:
a. Late delivery of equipment or materials caused by congestion at a manufacturer’s plant or elsewhere, or an oversold condition of the market; or
b. Late performance by a Subcontractor unless the delay arises out of a force majeure occurrence in accordance with this force majeure term and condition; or
c. Inability of either the Contractor or any Subcontractor to acquire or maintain any required insurance, bonds, licenses, or permits.
3. If either party is delayed at any time in the progress of the work by force majeure, the delayed
party shall notify the other party in writing of such delay, as soon as is practicable and no later than the following working day, of the commencement thereof and shall specify the causes of such delay in such notice. Such notice shall be delivered or mailed certified-return receipt requested, and shall make a specific reference to this article, thereby invoking its provisions. The delayed party shall cause such delay to cease as soon as practicable and shall notify the other party in writing when it has done so. The time of completion shall be extended by Contract Amendment for a period of time equal to the time that results or effects of such delay prevent the delayed party from performing in accordance with this Contract.
4. Any delay or failure in performance by either party hereto shall not constitute default
hereunder or give rise to any claim for damages or loss of anticipated profits if, and that such delay or failure is caused by force majeure.
E. Third Party Antitrust Violations. The Contractor assigns to the District any claim for overcharges
resulting from antitrust violation the extent that those violations concern materials of services supplied by third parties to the Contractor toward fulfillment of this Contract.
6. Warranties
A. Liens. The Contractor warrants that the materials supplied under this Contract are free of liens. B. Quality. Unless otherwise modified elsewhere in these terms and conditions, the Contractor
warrants that for one year after acceptance by the District of the materials or services, they shall be: 1. A quality to pass without objection in the trade under the Contract description; 2. Fit for the intended purposes for which the materials or services are used; 3. Within the variations permitted by the Contract and are of even kind, quality, and quality
within each unit and among all units; 4. Adequately contained, packaged and marked as the Contract may require; and 5. Conform to the written promises or affirmations of fact made by the Contractor.
C. Fitness. The Contractor warrants that any material or service supplied to the District shall fully
conform to all requirements of the Solicitation and all representations of the Contractor, and shall be fit for all purposes and uses required by the Contract.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM GENERAL TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 13 of 39
D. Inspection/Testing. The warranties set forth in subparagraphs A through C of this paragraph are
not affected by inspection/ testing of or payment for the materials or services by the District.
E. Exclusions. Except as otherwise set forth in this Contract, there are no express or implied warranties or merchant ability fitness.
F. Compliance with Applicable Laws. The materials and services supplied under this Contract shall
comply with all applicable federal, state and local laws, and the Contract shall maintain all applicable licenses and permits.
G. Survival of Rights and Obligations after Contract Expiration or Termination.
1. Contractor’s Representations and Warranties. All representations and warranties made by the Contractor under this Contract shall survive the expiration of termination hereof. In addition, the parties hereto acknowledge that pursuant to A.R.S. § 12-510, except as provided in A.R.S. § 12-529, the District is not subject to or barred by any limitations of actions prescribed in A.R.S. Title 12, Chapter 5.
2. Purchase Orders. The Contractor shall, in accordance with all terms and conditions of the
Contract, fully perform and shall be obligated to comply with all purchase orders received by the Contractor prior to the expiration or termination hereof, unless otherwise directed in writing by the District, including, without limitation, all purchase orders received prior to but not fully performed and satisfied at the expiration or termination of this Contract.
7. District’s Contractual Remedies
A. Right to Assurance. If the District in good faith has reason to believe that the Contractor does not intend to, or is unable to perform or continue performing the Contract, the District may demand in writing that the Contractor give a written assurance of intent or ability to perform. Failure by the Contractor to provide written assurance within the number of days specified in the demand may, at the District’s option, be the basis for terminating the Contract under the Uniform General Terms and Conditions.
B. Stop Work Order.
1. The District may, at any time, by written order to the Contractor, require the Contractor to stop all or any part, of the work called for by this Contract for a period of up to ninety (90) days after the order is delivered to the Contractor, and for any further period to which the parties may agree. The order shall be specifically identified as a stop work order issued under this clause. Upon receipt of the order, the Contractor shall immediately comply with its terms and take all reasonable steps to minimize the incurrence of costs allocable to the work covered by the order during the period of work stoppage.
2. If a stop work order issued under this clause is canceled or the period of the order or any
extension expires, the Contractor shall resume work. The District shall make an equitable adjustment in the delivery schedule or Contract price, or both, and the Contract shall be amended in writing accordingly.
C. Non-exclusive Remedies. The rights and the remedies of the District under this Contract are not
exclusive.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM GENERAL TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 14 of 39
D. Nonconforming Tender. Materials supplied under this Contract shall fully comply with the
Contract. The delivery of materials or a portion of the materials in an installment that do not fully comply constitutes a breach of Contract. On delivery of nonconforming materials, the District may terminate the Contract for default under applicable termination clauses in the Contract, exercise any of its remedies under the Uniform Commercial Code, or pursue any other right or remedy available to it.
E. Right to Offset. The District shall be entitled to offset against any sums due the Contractor, any
expenses or costs incurred by the District or damages assessed by the District concerning the Contractor’s nonconforming performance or failure to perform the Contract, including expenses, costs and damages described in the Uniform General Terms and Conditions.
8. Contract Termination
A. Cancellation for Conflict of Interest. Per A.R.S. 38-511 the District may cancel this Contract within three (3) years after Contract execution without penalty or further obligation if any person significantly involved in initiating, negotiating, securing, drafting, or creating the Contract on behalf of the District is, or becomes at any time while the Contract or an extension the Contract is in effect, an employee of or a consultant to any other party to this Contract with respect to the subject matter of the Contract. The cancellation shall be effective when the Contractor receives written notice of the cancellation unless the notice specifies a later time.
B. Gratuities. The District may, by written notice, terminate this Contract, in whole or in part, if the District determines that employment or gratuity was offered or made by the Contractor or a representative of the Contractor to any officer or employee of the District for the purpose of influencing the outcome of the procurement or securing the Contract, an Amendment to the Contract, or favorable treatment concerning the Contract, including the making of any determination or decision about Contract performance. The District, in addition to any other rights or remedies, shall be entitled to recover exemplary damages in the amount of three (3) times the value of the gratuity offered by the Contractor.
C. Suspension or Debarment. The District may, by written notice to the Contractor, immediately
terminate this Contract if the District determines that the Contractor has been disbarred, suspended or otherwise lawfully prohibited from participating in any public procurement activity, including but not limited to, being disapproved as a Subcontractor of any public procurement unit or other governmental body.
D. Termination for Convenience. The District reserves the right to terminate the Contract, in whole
or in part at any time, when in the best interests of the District without penalty recourse. Upon receipt of the written notice, the Contractor shall immediately stop all work, as directed in the notice, notify all Subcontractors of the effective date of the termination and minimize all further costs to the District. In the event of termination under this paragraph, all documents, data and reports prepared by the Contractor under the Contract shall become the property of and be delivered to the District. The Contractor shall be entitled to receive just and equitable compensation for work in progress, work completed, and materials accepted before the effective date of the termination. The cost principles and procedures provided in A.A.C. R7-2-1125 shall apply.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM GENERAL TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 15 of 39
E. Termination for Default.
1. In addition to the rights reserved in the Uniform Terms and Conditions, the District reserves
the right to terminate the Contract in whole or in part due to the failure of the Contractor to comply with any term or condition of the Contract, to acquire and maintain all required insurance policies, bonds, licenses and permits, or to make satisfactory progress in performing the Contract. The District shall provide written notice of the termination and the reasons for it to the Contractor.
2. Upon termination under this paragraph, all documents, data and reports prepared by the
Contractor under the Contract shall become the property of and be delivered to the District. 3. The District may, upon termination of this Contract, procure, on terms and in the manner that
it deems appropriate, materials and services to replace those under this Contract. The Contractor shall be liable to the District for any excess costs incurred by the District re-procuring the materials or services.
F. Continuation of Performance through Termination. The Contractor shall continue to perform, in
accordance with the requirements of the Contract, up to the date of termination, as directed in the termination notice.
9. Contract Claims All Contract claims and controversies under this Contract shall be resolved according to A.R.S. Title
15-213 and AAC R7-2-1155 through R7-2-1181and rules adopted there under. 10. Gift Policy
The District will accept no gifts, gratuities or advertising products from vendors. The District has adopted a zero tolerance policy concerning vendor gifts. The District may request product samples from vendors for official evaluation with disposal of those said samples at the discretion of the Procurement Officer.
11. Integrity of Proposal By signing this Proposal, the Offeror affirms that the Offeror has not given, nor intends to give any
time hereafter any economic opportunity, future employment, gift, loan gratuity, special discount, trip favor, or service to any employee of the School District/Pubic Entity in connection with the submitted Proposal. Failure to sign the Proposal, or signing it with a false statement, shall void the submitted proposal or any resulting contract.
12. Offshore Performance
Due to security and identity protection concerns, direct services under any subsequent contract shall be performed within the borders of the United States. Any services that are described in the specifications or scope of work that directly serve the school district(s) or charter school(s) or its clients and may involve access to secure or sensitive data or personal client data or development or modification of software for the State shall be performed within the borders of the United States. Unless specifically stated otherwise in the specifications, this definition does not apply to indirect or “overhead” services, redundant back-up services or services that are incidental to the performance of the contract. This provision applies to work performed by subcontractors at all tiers.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM GENERAL TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 16 of 39
13. Contractor’s Employment Eligibility
By entering the contract, Contractor warrants compliance with A.R.S. 41-4401, A.R.S. 23-214, the Federal Immigration and Nationality Act (FINA), and all other federal immigration laws and regulations.
The District may request verification of compliance from any Contractor or Subcontractor performing work under this contract. The District reserves the right to confirm compliance in accordance with applicable laws.
Should the District suspect or find that the Contractor or any of its Subcontractors are not in compliance, the District may pursue any and all remedies allowed by law, including, but not limited to: suspension of work, termination of the contract for default, and suspension and/or debarment of the Contractor. All costs necessary to verify compliance are the responsibility of the contractor.
14. Terrorism Country Divestments
Per A.R.S. 35-392, the District is prohibited from purchasing from a company that is in violation of the Export Administration Act.
15. Fingerprint Clearance Cards
In accordance with A.R.S 15-512(H), a contractor, subcontractor or vendor or any employee of a contractor, subcontractor or vendor who is contracted to provide services on a regular basis at an individual school may be required to obtain a valid fingerprint clearance card pursuant to Title 41, Chapter 12, Article 3.1. An exception to this requirement may be made as authorized in Governing Board policy.
Contractor, subcontractors, vendors and their employees shall not provide services on District properties until authorized by the District.
Additionally, contractor shall comply with the governing body fingerprinting policies of the District.
16. Clarifications
Clarification means communication with Offeror for the sole purpose of eliminating minor irregularities, informalities, or apparent clerical mistakes in the Proposal. It is achieved by explanation or substantiation, either in a written response to an inquiry from the District or as initiated by Offeror. Clarification does not give Offeror an opportunity to revise or modify its Proposal, except to the extent that correction of apparent clerical mistakes results in a revision.
17. Confidential/Proprietary Information
A. Confidential information request: If Offeror believes that its Proposal contains trade secrets or proprietary information that should be withheld from public inspection as required by A.R.S. § 39-121, a statement advising the District of this fact shall accompany the Proposal, and the information shall be so identified wherever it appears. The District shall review the statement and shall determine in writing whether the information shall be withheld. If the District determines to disclose the information, the District shall inform Offeror in writing of such determination.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 UNIFORM GENERAL TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 17 of 39
Contract terms and conditions, pricing and information generally available to the public are not considered confidential information under this section.
B. Public record: All Proposals submitted in response to this solicitation shall become the property of the School District. They will become a matter of public record available for review, subsequent to award notification, under the supervision of the Purchasing Official at 1600 S. 107
th Ave., Avondale, AZ 85323, by appointment.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 SPECIAL INSTRUCTIONS, TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 18 of 39
Authority: This solicitation as well as any resultant contract is issued under the authority of the Governing Board. No alteration on any resultant contract may be made without the express written approval of the District Liaison in the form of an official contract amendment. Any attempt to alter any contract without such approval is a violation of the contract and the School District Procurement Rules. Any such action is subject to legal and contractual remedies available to the District inclusive of, but not limited to, contract cancellation, suspension and/or debarment of the Offeror. 1. Contract Type: Fixed Price Term.
2. Sufficient Funds: The District fully anticipates that sufficient funds will be available for this purchase, however funds are not currently available. Any contract awarded under this proposal will be conditioned upon the availability of funds.
3. Insurance: Offeror agrees to maintain such insurance as will fully protect Offeror and the District from any and all claims under any workers’ compensation statute or unemployment compensation laws, and from any and all other claims of any kind or nature for damage to property or personal injury, including death, made by anyone, that may arise from work or other activities carried on, under, or facilitated by this Agreement, either by Offeror, its employees, or by anyone directly or indirectly engaged or employed by Offeror. Offeror agrees to maintain such automobile liability insurance as will fully protect Offeror and the District for bodily injury and property damage claims arising out of the ownership, maintenance or use of owned, hired or non-owned vehicles used by Offeror or its employees, while providing services to the District.
Successful Offeror is required to provide proof of and maintain comprehensive general liability insurance with a limit of not less than $1,000,000 per occurrence and $2,000,000 aggregate coverage with a deductible of not more than $5,000 and naming LITTLETON ELEMENTARY SCHOOL DISTRICT as an additional insured party.
Successful Offeror may be required to submit proof of and maintain Worker’s Compensation and Employer’s Liability Insurance as required by law.
4. Licenses: Successful Offeror shall maintain in current status all federal, state, and local licenses and permits required by the operation of the business conducted by the Offeror.
5. No Offer Response: If you do not wish to respond to this solicitation, provide written notification of your decision by using the simple “No Bid” form found in this document. Failure to respond to two consecutive solicitations for similar items may result in deletion of your name from the District’s Offeror listing for that item. A “No Offer” will be considered a response.
6. Offer Acceptance Period: In order to allow for an adequate evaluation, the District requires an offer in response to this solicitation to be valid and irrevocable for 60 days after the opening time and date.
7. Proposal Opening: Proposals shall be opened on the date and time, and at the place designated on the cover page of this document, unless amended in writing by the District. The name of each Offeror shall be read at this time. All offers and any modifications and other information received in response to the Request for Proposals shall be shown only to the authorized District personnel having a legitimate interest in the evaluation. After contract award, the proposals and evaluation document shall be open for public inspection.
8. Response Format: All proposal responses are to be in the same form as this Request for Proposal. Address each requirement in the same order as has been requested. Include in your proposal one copy of the Operations or Procedure Manual for your system. The manual will be returned only upon request.
9. Inquiries: All questions related to this solicitation shall be in writing, directed to Phyllis Kinder, Littleton Elementary School District #65, 1600 S. 107
th Ave., Avondale, AZ 85323 or vial e-mail – [email protected]. Offerors
shall not contact or ask question of the school or department for which this requirement is being procured. Any
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 SPECIAL INSTRUCTIONS, TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 19 of 39
correspondence related to a solicitation shall refer to the appropriate solicitation number, page and paragraph number. All inquiries must be submitted no later than October 22, 2014.
10. Amendments: Any and all amendments issued by the District must be acknowledged so that the District knows you have taken the information provided in the amendment into consideration when you make your offer. An amendment acknowledgement form has been provided. All Amendments will be posted to the District
11. District Reserves The Right To:
Accept or reject any or all proposals
Waive any irregularities and technicalities and may, at its sole discretion, request a clarification or other information to evaluate any or all proposals.
Before awarding the contract, to require Offeror(s) to submit evidence of qualifications or any other information the District may deem necessary.
Prior to Governing Board approval, to cancel the RFP or portions thereof, without penalty.
Accept the proposals of any or all of the items it deems, at its sole discretion, to be in the best interest of the District.
The District reserves the right to reject any and/or all items proposed or awarded to multiple Offerors.
Further negotiate any proposal, including price, with the highest rate Offeror under the Best and Final provision. If an agreement cannot be reached with the highest rated Offeror, the District reserves the right to negotiate and recommend award to the next highest Offeror or subsequent Offeror until an agreement is reached.
12. Contract Reference: All terms and conditions of this RFP, any amendments, Offeror’s submissions and negotiated term, are incorporated into the contract by reference as set forth herein.
13. Deviations/Exceptions: Any service not provided directly by the Offeror, must be clearly indicated as such. All services must be seamless to LESD who will continue to work with the designated provider.
14. Contingencies: The total purchase of all orders to be issued against contracts is not known, and the Littleton Elementary School District #65 will not be bound to purchase a minimum quantity during any contract period. The information given is the best of our ability to project our purchases for the term of this contract.
15. Familiarity of Terms/Condition of Solicitation: Offeror should become familiar with any local conditions, which
may, in any manner, affect the services required. The Offeror(s) is/are required to carefully examine the RFP terms and to become thoroughly familiar with any and all conditions and requirements that may in any manner affect the work to be performed under the contract. No additional allowance will be made due to lack of knowledge of these conditions.
16. Term of Contract: Per A.A.C. R7-2-1042(A.3.b), it is the intent of the District to award a multi-term contract, beginning January 1, 2015 and continuing through June 30, 2015. If all conditions are met during this period of time, this contract can be extended, if funding is available, for up to an additional four one-year contracts ending June 30. 2020. However, no contract exists unless and until a purchase order is issued each fiscal year.
The contract may be terminated by either party prior to the expiration date upon thirty (30) days written notice to the other party. Cancellation of the contract shall not relieve the contractor of responsibility for satisfaction of all work that should have been done up to the last day of the contract.
17. Period of Service: The Service period will begin for all claims incurred on or after January 1, 2015. If desired by the District, administration of all claims incurred prior to that date may be included as well.
18. Award Basis: Successful Offeror(s) will be determined by evaluation criteria, including but not limited to pricing.
Awards will not be made based on price alone; however, it is a major factor.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 SPECIAL INSTRUCTIONS, TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 20 of 39
19. Lobbying: Offerors Are Hereby Advised That Lobbying Is Not Permitted With Any District Personnel Or Board
Members Related To Or Involved With This Solicitation Until The Administration's Recommendation For Award Has Been Posted In The Business Office. All Oral Or Written Inquiries Must Be Directed Through The Procurement Department.
Lobby is defined as “any action taken by an individual, firm, association, joint venture, partnership, syndicate, corporation, and all other groups who seek to influence the Governmental Decision of a Board Member or ANY District Personnel after release and prior to the award of this contract by all entities.” Any Offeror or any individuals that lobby on behalf of Offeror during the time specified will result in the rejection and disqualification of said Offer.
20. Evaluation Schedule: The District intends to use this schedule, however, it will not be held to this timeframe.
October 15, 2014 RFP Released
October 22, 2014 Final day to Submit Questions about the process due
October 29, 2014 Proposals due no later than 11:00 A.M., Local Time
November 5, 2014 Evaluation Committee Meeting to begin scoring
November 6, 2014 Written responses for clarification and, if necessary, a Best and Final due
November 18, 2014 Award made by Governing Board
January 5, 2015 Start of Contract
21. Evaluation: During the course of the selection process, all prospective companies are cautioned not to contact
School Board Members or Selection Committee Members or attempt to persuade or promote through other channels. The proposals will be initially evaluated for conforming to the requirements of the RFP by representatives of the District. All those responsible and responsive offers that meet the technical requirements will then be evaluated for pricing and specifications of services. District representatives and any outside experts the District considers necessary shall evaluate the proposals. The District reserves the right to arrange for discussions to assist in making the selection in accordance with R7-2-1047. Evaluation of the proposals will be based upon the following criteria (listed in the relative order of importance). Specific weighting may be used, but may not be required.
Up to a total of 1600 points will be awarded through the proposal evaluation process.
A Mandatory Criteria
TAB 1
1. The Firm is independent and properly licensed in the State of Arizona
2. The Firm or Firm’s representatives have not been a party of any consent judgments within the last 5 yrs.
3. The Firm must not have a record of substandard service for the last 5 years.
Must meet all three criteria for further consideration
Area of Evaluation
B TAB 2 - Profile and Qualifications
1. Provide a Letter of Interest and the firm’s understanding of services to be provided 2. Provide a description of the firm, including office size; whether the organization is local,
regional, national, or international in operations; the number of professional staff by level; and a description of the range of activities performed by the local office.
3. Affirm that the firm meets the requirements set forth in solicitation. 4. Provide a statement of the firm’s expertise in providing Workers Compensation Insurance to
school districts in Arizona.
350
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 SPECIAL INSTRUCTIONS, TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 21 of 39
5. List a description of prior experience with services of a similar like-needs or related nature of
district(s) of LESD’s size, including references. 6. Identified the senior and technical personnel to be assigned to the District. Personnel named
in the proposal may not be substituted without permission of the District.
7. Submitted a fully completed and signed Reference with current client districts.
Tab 3 – Firm’s Approach to the Services
1. Provide the claim process detailing the approach the firm intends to follow. The process should demonstrate the firm's understanding of the requirements of the RFP.
2. Identify specific case histories demonstrating the Firm’s experience in assisting School Districts with their Workers Compensation Insurance claims.
3. Provide additional information regarding ways to streamline the claims process, management, etc.
300
Tab4 - Questionnaire Submit a fully completed and signed questionnaire. All questions are to be answered.
250
Tab 5 – Transition Plan
Provide a detailed action plan with timelines to implement the new claims handling, for the transition of records and initiation of claims management for existing claims.
200
Tab 6 - Completed Required Forms (All forms must have an Authorized Signature)
Offer and Acceptance Form Addendum Acknowledgment Form (if any) Non-Collusion Form (must be notarized) Deviations and Exceptions (if any) Confidential or Proprietary Information Form Familial Relationship Form No-Bid Response Form W-9 Form Insurance Documents – Proof of all insurances required
100
C Tab 7– Fee Schedule for Services
Submit a sealed envelope that contains the all-inclusive fee for which the services will be provided. Use the Proposal Price Form enclosed with this solicitation. The fee amount should not be divulged elsewhere in the proposal. Cost is a factor is awarding the contract; however, only those proposals that meet all the mandatory criteria in the RFP will be given consideration. The contract will not be awarded solely on the basis of cost. After a composite technical score for each firm has been established, the sealed dollar cost offer will be opened. Additional points will be added to the technical score based on the price offer as outlined below. The purpose of the cost/price evaluation is to “normalize” the cost/price submittals. This is accomplished by calculating the score for each proposal by using the formula below. Initially, the price/cost proposal shall be evaluated on the total price/cost proposal. Lowest Offeror’s Cost / the firm’s cost X number of points = Score If lowest firms cost is $100 and firm “A’s” cost is $200 and the points available are 400, then the following is true for firm “A”. (100/200) x 400 = 200 points. The maximum score for price will be assigned to the firm offering the lowest price and proportional scores will be assigned to the other firms.
400
22. Discussions: In accordance with A.R.S. 41-2534, after the initial receipt of proposals, the District reserves the
option to conduct discussions with those Offerors who submit proposals determined by the District to be reasonably susceptible of being selected for award.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 SPECIAL INSTRUCTIONS, TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 22 of 39
23. Best And Finals Offers: If discussions are conducted pursuant to R7-2-1047, the District may issue a written
request for best and final offers, R7-2-1048. If the Offerors do not submit a notice of withdrawal or a best and final offer, the immediate previous offer will be construed as the best and final offer.
24. Award Basis: The successful Offeror will be determined by Evaluation Criteria including but not limited to pricing, or other incentives offered. The Littleton Elementary School District #65 reserves the right to award as many term contracts for the services as may be in the best interest of the District. Awards will not be made based on price alone.
The District reserves the right to arrange for discussions to assist in the evaluation of proposals in accordance with A.A.C. R7-2-1047.
Any deviation from the general terms and conditions or exceptions taken shall be described fully and appended to the proposal form on the Offeror's letterhead over the signature of the person signing the proposal form. Such appendages shall be considered part of the Offeror’s formal proposal. For the absence of any statements of deviation or exception, the proposal shall be accepted as in strict compliance with all terms and conditions.
If a contractor receives a proposal award, an order is placed and Offeror is unable to meet the delivery requirements, meet service requirements, or material that meets the Districts needs as outlined in this Request for Proposal, or is unable to hold proposal price, or fails to provide product or service within a reasonable period of time, AND/OR fails to provide product complying with proposal specifications, as determined by the District, the District reserves the right to go to the next lowest proposal price of equal quality which meets proposal specifications. If the proposal item delivered does not meet specifications or is received in an unsatisfactory condition and is in a damaged or unusable condition, or if service is unsatisfactory, Offeror must pick up item immediately and replace to each district’s satisfaction at no additional charge, or issue full credit, for service a return visit must be re-scheduled within 24 hours. Rejected items must be removed from the District’s premises by the Offeror upon verbal notification.
25. Contract Award: The District reserves the right to make a multiple award to more than one Offeror. The award will be limited to the least number of Offerors that the District determines is necessary to meet the needs of the District.
It is expected that the Governing Board will award this contract at its Governing Board Meeting on November 18,
2014. However, no commitment is made to this award date.
26. References: Offeror is to include a Reference List in addition to sending out a Performance Evaluation Survey (included with solicitation) to a minimum of three references (clients) preference to city school districts. The Performance Evaluation Survey is to be completed by your past and/or current clients, and they will in turn fax them to the Littleton Elementary School District #65 Procurement Department at 623-478-5620. To complete this process, fill out the top portion, (Date, To, Phone, Fax and your Firm name) of the Performance Evaluation Survey. Fax, e-mail or mail the form to your chosen clients. One reference per client. The District is requesting that a minimum of three references be sent the Performance Evaluation Survey form. A minimum of two responses must be received to receive any points associated with the evaluation of this tab. Responses should be received by the District prior to the specified due date and time.
27. Non-Collusion Statement: Each Proposal shall include a signed and notarized Non-collusion Statement. The statement is enclosed. The contractor declares, by signing and submitting a proposal, that the proposal is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the proposal is genuine and not collusive or sham; that the contractor has not directly or indirectly induced or solicited any other contractor to put in a false or sham proposal, and has not directly or indirectly colluded, conspired, connived, or agreed with any contractor or anyone else to put in a sham proposal, or that anyone shall refrain from proposing; that the contractor has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the proposal price of the contractor or any other proposer, or to fix any overhead, profit, or cost element of the proposal price, or of that of any other contractor, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 SPECIAL INSTRUCTIONS, TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 23 of 39
statements contained in the proposal are true; and, further, that the contractor has not, directly or indirectly, submitted his or her proposal price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, proposal depository, or to any member or agent thereof to effectuate a collusive or sham proposal.
28. Price Clauses: Prices shall be firm for first year of the term of the contract. Prices as stated must be complete for the services offered and shall include all associated costs, including delivery. DO NOT include sales tax on any item in the offer. Any increase in unit pricing for year two and all subsequent, must be fully documented, no greater than the amount listed on your pricing sheet, and submitted no later than 45 days prior to the renewal date. The request for increase will be reviewed by the District and a response issued within 15 days.
29. Price Reductions: Price reductions may be offered by submitting a request in writing to the District for consideration at any time during the contract period. The District at its own discretion may accept a price reduction but price increases will not be considered.
30. Examination of Records: As a successful Offeror, your firm agrees that that Director of Business Services or any duly authorized District representatives may at any time during the term of this contract, have access to and the right to examine any directly pertinent books, documents, invoices, papers and records of contracts involving transactions related to this contract.
31. Delivery of Services: Services must be received within times agreed to by the District and the Offeror. Decisions to compliance with contract services and times will be made by the District and shall be final. The items on this contract shall be delivered per the specifications and instructions.
32. Billing: Payment will be made only after submission of proper invoices as required by the District and within applicable State law and satisfactory acceptance of the services. Payment of any claim shall not preclude the District from making claim for adjustment on any services found not to have been in accordance with the general conditions. The Contractor shall be paid based on rate of actual services provided according to the rate(s) specified in the resultant contract. The Contractor shall submit itemized invoice(s) to include a record of time expended, this contract number, and work performed in sufficient detail to justify payment. The District shall process the claim for prompt payment in accordance with the standard operating procedures of the District. All billing notices must be sent to the district’s accounts payable department as shown on the purchase orders. All invoices shall identify the specific item(s) being billed. Any purchase order issued by Littleton Elementary School District #65 will refer to the RFP number on this Solicitation.
33. Affordable Care Act: Offeror understands and agrees that they shall be solely responsible for compliance with the Patient Protection and Affordable Care Act, Public Law 111-148 and the Health Care and Education Reconciliation Act, Public Law 111-152 (collectively the Affordable Care Act “ACA”). Offeror shall bear sole responsibility for providing health care benefits for its employees who provide services to the District as required by state or federal law.
34. Safety: Offeror, at its own expense and at all times, shall take all reasonable precautions to protect persons and the
District property from damage, loss or injury resulting from the activities of Offeror, its employees, its subcontractors, and/or other persons present. Offeror will comply with all specific job safety requirements promulgated by any governmental authority, including without limitation, the requirements of the Occupational Safety Health Act of 1970.
All items supplied on this contract must comply with the current applicable occupational safety and health standards of the State of Arizona Industrial Commission, the National Electric Code, and the National Fire Protection Association Standards.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 SPECIAL INSTRUCTIONS, TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 24 of 39
35. Offeror Required Contract/Agreement: If your company will require the District to sign a contract or agreement for
this service, a copy of that contract/agreement must accompany your proposal response.
After initial contract term and prior to any contract renewal, the Littleton Elementary School District #65 will review fully documented requests for price increases and may at its sole option accept any changes or cancel from the contract those items concerned. The Offeror shall likewise offer any published price reduction, during the contract period, to the District concurrent with its announcement to other customers. All price adjustments will be effective upon acceptance of the Littleton Elementary School District #65.
36. Provide information that demonstrates that all of the Mandatory Qualifications listed below have been met:
The Firm is independent and properly licensed in the State of Arizona
The Firm or Firm’s representatives have not been a party of any consent judgments within the last 5 yrs.
The Firm must not have a record of substandard service for the last 5 years
37. Proposal Format and Submittal Requirements: One original and 3 copies of the proposal shall be submitted. The original copy of the proposal should be clearly labeled “ORIGINAL.” Please conform to the format specified below. The District will make no reimbursement for the cost of developing or presenting proposals in response to the RFP. Please use the mailing label, located on the last page of this solicitation, on the outside of your return package.
They should be prepared in accordance with the proposal format requirements discussed in this RFP, and packaged in such a manner that the outer wrapping clearly indicates the RFP number.
COVER - Title Page
Identify the RFP number and title. Provide the audit firm’s name, address, and telephone number; the name and title of a contact person; and the date the proposal was submitted. The title page must also state the period the proposal is effective (non- rescindable).
1st
PAGE - Table of Contents: Include a clear and complete identification of the materials submitted by section and page number.
2nd
PAGE Letter of Transmittal: A brief letter of transmittal should that includes the following information:
A statement that the Firm and Firm’s representatives have not been a party of any consent judgments within the last five years.
The names of persons authorized to represent the firm, their titles, e-mail addresses, and telephone numbers.
Response to be tabbed to include the information requested herein:
TAB 1 – Firm’s Affirmation to Meeting Mandatory Qualifications TAB 2 – Firm’s Profile and Qualifications TAB 3 - Firm’s Approach to the Services to be provided TAB 4 – References TAB 5 – Transition Plan TAB 6 – Completed Required Forms TAB 7 – Fee Schedule for Services (Sealed Envelope)
38. Checklist:
Yes Double Checked
Did you sign the offer sheet?
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 SPECIAL INSTRUCTIONS, TERMS AND CONDITIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 25 of 39
Did you sign and notarize the Non-collusion statement?
Did you include all the necessary attachments?
Did you include firm’s in-house capabilities?
Did you acknowledge all amendments, if applicable?
Did you follow-up so that your clients responded to the survey?
Did you follow the order for submission of documents?
Did you include copies of your business licenses and proof of insurances?
Did you include one marked “original” and 3 marked “copy”?
Did you place the mailing label on the outside of your submittal box?
Did you double check that you have a signed offer sheet?
Did someone double-check all of the above?
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 SCOPE OF WORK/SPECIFICATIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 26 of 39
Purpose: The Littleton Elementary School District #65 desires to contract with qualified and experienced vendors to provide Workers Compensation Insurance Services. The services may include assistance and consulting related to risk management programs, monitoring and controlling District claims, provide training and any other services relating to reducing claims and lowering costs.
Background: The Littleton Elementary School District (District) has approximately 700 workers including substitute teachers. Approximately 60 worker’s compensation claims are filed per year. District has had an excellent E-Mod rating over the past few years that is well below the 1.0 industry standard. Injured employees are referred to US Healthworks and Banner Estrada Occupational Center for initial treatment and the District has an active return to work program established in the District. The current and past EMOD scores for LESD are:
FY 14-15: 0.59 (YTD) FY 13-14: 0.72 FY 12-13: 0.84 FY 11-12: 0.92 FY 10-11: 1.00
Quarterly reportable wages are as follow: QUARTER CLASS CODE
9101 CLASS CODE
8868 TOTALS
Qtr. 3 - July thru September 2013 $ 454,761.38 $ 4,552,382.12 $ 5,007,143.50
Qtr. 4 - October thru December 2013 $ 526,037.59 $ 5,094,145.61 $ 5,620,183.20
Qtr. 1 - January thru March 2014 $ 633,318.59 $ 5,297,704.12 $ 5,931,022.71
Qtr. 2 - April thru June 2014 $ 553,553.16 $ 5,338,990.84 $ 5,892,544.00
Totals for FY 2014 $2,167,670.72 $20,283,222.69 $ 22,459,893.41
Projected 1% Raise $ 18,341.25 $ 171,621.80 $ 189,963.05
Projected 2015 Payroll $ 22,640,856.46
The District currently has the Workers Compensation Insurance contract with CopperPoint Mutual Insurance Company. This contract expires on December 31, 2014. The District IEN Number is 86-6000508. Qualified Offerors need to provide the District with the following services:
SERVICES DESCRIPTION
Claims administration Case management and reporting to Industrial Commission of Arizona (ICA)
Payments All payments associated with a claim; medical, pharmacy, lost wages, disability, legal, et al
Communication With District, claimant, medical providers, legal, Industrial Commission of Arizona (ICA)
Maintenance of Claim File Reporting/recovery from excess carriers Case Management Litigation management, pharmacy management, bill review and re-pricing,
investigation, settlement of claims, subrogation and legal management Pharmacy claims administration Claims management and reporting to Industrial Commission of Arizona
(ICA) Bill review services Review and authorize bill payment Training
Target groups where a large of current claims occur (i.e. Special Ed), Risk Management (RMIS) Program
Added Value
Provide added value services that would decrease claims and lower costs.
Reports Reports as required by the District
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 SCOPE OF WORK/SPECIFICATIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 27 of 39
Offerors must include with their response:
1. Detailed information on how you would assist the District in managing its risk management cost, workers
compensation insurance costs and increase safety awareness.
2. Identify the approximate time frame and expected results from the assistance in #2 .
3. Provide case histories demonstrating experience in assisting districts with workers compensation insurance claims.
4. A description of how fees would be calculated for the different services offered.
5. Staff list and resumes for primary service contacts.
6. Description of customer service philosophy. If possible, please cite actual examples demonstrating your achievements in this area.
7. Three (3) current Workers’ Compensation client references similar to LESD for which the firm has provided
administration services that are considered similar to the scope of work described herein. For each client listed, state the type of service provided, years of service for the client, and name, title, telephone number and email address of the person to contact as a reference, regarding your firm’s performance. Local references are mandatory
8. Three (3) Workers’ Compensation client references that no longer use your services. For each client listed,
state the type of service provided, years of service for the client and name, title, telephone number and email address of the person to contact as a reference, regarding your firm’s performance.
9. Other information you deem beneficial to our evaluation.
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 PROPOSAL COST FORM
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 28 of 39
The District discourages overly lengthy responses, however, in order for the District to evaluate proposals fairly and completely, Offerors must answer all questions listed below and provide all information requested.
Provide replies to all requested information in accordance with the scope of services and standards and state clearly any variances. Submit:
1. Description of the firm.
2. Identify any other business services provided in addition to Workers’ Compensation claims administration.
3. List location, including any toll-free phone and/or fax numbers where claims will be administered.
4. Provide an affirmative statement that the firm meets the Mandatory Qualifications and all assigned key professional staff including the senior in charge at fieldwork are properly licensed to practice in the State of Arizona. Copy of license to be provided with your response. The Firm or Firm’s representatives have not been a party of any consent judgments within the last 5 yrs. Firm must not have a record of substandard work within the last 5 years.
5. Indicate your average turnaround time on payment of workers compensation claims.
6. Has your firm ever had to file a claim against your errors and omissions or professional liability insurance? If yes,
when? 7. Briefly explain if there have been any judgments, liens, claims, arbitration proceedings or suits filed or pending
against the Firm or its officers within the last five years? 8. Has your firm been audited or evaluated in the last 3 years? If yes, by whom? When? Were there major/minor
findings? What were the findings? Were there any recommendations? 9. What is the turnover rate of local adjusters over the past 5 years?
10. Indicate the number and type of staff you plan to dedicate to the District.
11. District anticipates a long-term relationship with the successful Firm. However, in the event of a termination of the relationship, detail how records and electronic files would be provided to the new Firm and the timeline for this transition including the costs.
12. Identify two innovative measures you have taken to control workers compensation claims costs.
13. Describe the procedure when claimants call your claim office to discuss and/or appeal processed claims.
14. Define “reasonable and customary” as your company uses it to establish allowable charges.
15 Describe the firm’s procedures in regard to claim review or disputed claims or charges in excess of the fee schedule, and those services not listed in the ICA fee schedule.
16. Do you have safety education programs? What type of training do you provide?
17. Describe the procedure taken by your firm for a claim that involved a HVAC worker falling through a roof and landing on a concrete floor (a life-long case). A claim for teacher tripping over file boxes in her classroom.
18. What is the procedure for obtaining a 2
nd opinions
19. Why should the District award a contract to your firm? What sets you apart from the firms offering the same type of
service?
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 PROPOSAL COST FORM
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 29 of 39
I/We, the undersigned, propose to provide the service necessary for the specifications/ scope of work. (Please expand spreadsheet as an attachment if additional fields for data entry are required. Note company name on each attached sheet.) I/We further declare that I/we have carefully read and examined all information to the referenced Request for Proposal. I/We agree to comply with the Districts rules, regulations and policies.
New Claim Cost Take-Over Claims Medical Only Claims: $ $ Other fees not address in the RFQ $____________ $____________ $____________ $ ___________ $____________ $____________ State the guaranteed maximum price escalation for the following contract years: Year 2____% Year 3____% Year 4____% Year 5____%
Name of Company
Date Signed
Authorized Signature/Local Representative
Telephone/Fax Number
Type Name and Position Held with Firm
E-Mail Address
Mailing Address City State Zip
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 OFFER AND ACCEPTANCE FORM
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 30 of 39
OFFER
The Undersigned hereby submits the Proposal/Proposals and agrees to furnish the material, service or construction in compliance with all
terms, conditions, specifications, and amendments in the Solicitation and any written exceptions in the Proposal/Proposals.
Arizona Transaction (Sales) Privilege Tax License No.: For clarification of this Proposal, contact:
_________________________________________________ Name: _________________________________________
Federal Employer Identification No. ____________________ Phone: _________________________________________
_________________________________________________ Fax: ___________________________________________
Tax Rate: _________________________________________% E-Mail: ________________________________________
_________________________________________________ _______________________________________________
Company Name Signature of Person Authorized to Sign Proposal
_________________________________________________ _______________________________________________
Address Printed Name
_________________________________________________ _______________________________________________
City State Zip Title
CERTIFICATION By signature in the Offer section above, the Offeror certifies:
1. The submission of the Proposal did not involve collusion or other anti-competitive practices.
2. The Offeror shall not discriminate against any employee or applicant for employment in violation of State Executive Order 99-4, 2000-4 or A.R.S. § 41-1461 through 1465.
3. The Offeror has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip,
favor, or service to a public servant in connection with the submitted Proposal. Failure to provide a valid signature affirming the stipulations required by this clause shall result
in rejection of the Proposal. Signing the Proposal with a false statement shall void the Proposal, any resulting contract and may be subject to legal remedies provided by law.
4. The Offeror warrants that it and all proposed subcontractors will maintain compliance with the Federal Immigration and Nationality Act (FINA), A.R.S. § 41-4401 and A.R.S. §
23-214 and all other Federal immigration laws and regulations related to the immigration status of its employees which requires compliance with Federal immigration laws by
employers, contractors and subcontractors in accordance with the E-Verify Employee Eligibility Verification Program.
5. In accordance with A.R.S. § 35-392, the Offeror is in compliance and shall remain in compliance with the Export Administration Act.
6. In accordance with A.R.S. § 15-512, the Offeror shall comply with fingerprinting requirements unless otherwise exempted.
7. By submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency.
8. By submission of this proposal, that no Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person for influencing or attempting
to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the
awarding of a Federal contract, the making of a Federal grant, the making of a Federal loan, the entering into a Cooperative Agreement, and the extension, continuation,
renewal, amendment, or modification of a Federal contract, grant, loan, or cooperative agreement.
ACCEPTANCE
The Proposal is hereby accepted.
The Contractor is now bound to sell the materials or services listed by the attached contract and based upon the solicitation, including all terms,
conditions, specifications, amendments, etc., and the Contractor’s Proposal as accepted by the District.
This contract shall henceforth be referred to as Contract No. __15-003-20 – Workers’ Compensation Services_____.
The Contractor has been cautioned not to commence any billable work or to provide any material or service under this contract until
Contractor receives a purchase order, contract release document, or written notice to proceed.
Awarded this ____________________ day of___________________________20________
___________________________________________________________
Authorized Signature
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 ADDENDUM ACKNOWLEDGMENT FORM
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 31 of 39
This page is used to acknowledge any and all amendments/addendums that might be issued. Any amendments/addendums issued within three days of the solicitation due date, will included a new due date to allow for addressing the addendum issues. Your signature indicates that you took the information provided in the amendments/addendums into consideration when providing your complete Offer response.
Please sign and date
AMENDMENT/ADDENDUM NO. 1 Acknowledgement ______________________________________________
Signature Date
AMENDMENT/ADDENDUM NO. 2 Acknowledgement ______________________________________________
Signature Date
AMENDMENT/ADDENDUM NO. 3 Acknowledgement ______________________________________________
Signature Date
If no amendments/addendums were issued, indicate below, sign the form and return with your response.
_____________________________________________ Firm _____________________________________________ Authorized Signature
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 NON-COLLUSION AFFIDAVIT
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 32 of 39
State of Arizona ) ) ss. County of ) ______________________________________________________________________ , affiant, the ____________________________________________________________________________
(Title) _______________________________________________________________________________
(Contractor/Offeror) the persons, corporation, or company who makes the accompanying Proposal, having first been duly worn, deposes and says:
That such Proposal is genuine and not sham or collusive, nor made in the interest of, or behalf of, any persons not herein named, and that the Offeror has not directly or indirectly induced or solicited any other Offeror to put in a sham Proposal, or any other person, firm or corporation to refrain from submitting a Proposal, and that the Offeror has not in any manner sought by collusion to secure for itself an advantage over any other Offeror.
__________________________________ __________________________________ (Title) Subscribed and sworn to before me this _________ day of _________________________ , 20 __________ Signature of Notary Public in and for the State of ______________________________________ County of ___________________________________
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 PERFORMANCE EVALUATION SURVEY
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323 623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 33 of
39
The portion below is to be completed by the RFP Offeror.
Offeror Company Name E-Mail Address
Person Completing Survey, Position Survey ID # 15-003-20 Phone # This portion is to be completed by the reference/client.
Reference Firm’s Name
Name of Contact with Reference Company Phone Number To Whom It May Concern: Our District has implemented a process that collects past information on vendors. The information will be used to assist the District in the evaluation to determine responsive and responsible procurement of the above firm. The Firm listed above has chosen to participate in this program. They have listed you as a past and/or present client that they have provided services for. Both the Firm and LESD would greatly appreciate you taking the time to complete the accompanying survey. Please evaluate and score the Performance of the Firm (10 means-you are Always satisfied and have no question about hiring them again, 5 means- you are Sometimes satisfied, and 1 means- you are very Dissatisfied and would never hire them again because of very poor performance). State “Unknown” if you do not have sufficient knowledge of their past performance in a particular area. No. Criteria Unit Score
1. Rate the services provided by this firm as it relates to Workers Compensation Insurance (1-10)
2. Rate the ability of the Firm to dig deep, discuss items, and teach to the moment (1-10)
3. Rate the ability of the Firm to react to the issues during the initial phase of the claim (1-10)
4. Was the makeup of the staff assigned to the District consistent over the contract period? (1-10)
5. Are Problems/Issues solved in a timely manner? (1-10)
6. Was the Firm able to provide consistent services? (1-10)
7. Were reports provided as required and complete by the timeline set? (1-10)
8. Were claims addressed in a timely manner? (1-10)
9 Would you hire this Firm again? (1-10)
10. How long has this Firm been your current Workers Comp. Insurance provider (in years)?
TOTAL POINTS
Thank you for your time and effort in assisting the firm in this important endeavor. Please fax this questionnaire to Littleton Elementary School District #21, Business Office 623-478-5620 by October 25, 2014.
Signature Date
Printed Name Title
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 DEVIATIONS AND EXCEPTIONS
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323 623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 34 of
39
Offerors shall indicate any and all exceptions taken to the provisions or specification in this solicitation document. Exceptions (mark one): __________ No exceptions __________ Exceptions taken – Indicate Page Number, Section number (describe –attach additional
pages if needed) _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ The Undersigned hereby acknowledges that there are no deviations/exceptions to this solicitation:
Firm
Authorized Signature
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 CONFIDENTIAL/PROPRIETARY INFORMATION FORM
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 35 of 39
Confidential/Proprietary Submittals (mark one): __________ No confidential/proprietary materials have been included with this offer __________ Confidential/Proprietary materials included. Offerors should identify below any portion of
their offer deemed confidential or proprietary (see Uniform General Terms and Conditions, page 16, #17-A). Identification in this section does not guarantee that disclosure will be prevented but that the item will be subject to review by the Offeror and the District prior to any public disclosure.
Requests to deem the entire offer or price as confidential will not be considered. Firm Name Authorized Signature Date
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 FAMILIAL RELATIONSHIP FORM
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 36 of 39
All responses to this solicitation shall be accompanied by a sworn and notarized statement disclosing any familial relationship, aka conflict of interest, which exists between the owner or any employee of the Offeror and any member of the Governing Board of the Littleton Elementary School District #65 or any employee of the Littleton Elementary School District #65. The undersigned, the owner or authorized officer of ________________________________ (the “Firm”), pursuant to the familial disclosure requirement provided in the attached solicitation, hereby represent and warrant, except as provided below, to their best knowledge that no familial relationships exist between the owner(s) or any employee of the company and any member of the Governing Board of the District, Superintendent of the Littleton Elementary School District #65 or any employee of Littleton Elementary School District #65. If such a relationship exists, provide an explanation:
(Signature of Person Authorized to Sign Offer)
(Title) Subscribed and sworn to before me this day of ,
2014
Signature of Notary Public in and for the State of
County of
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 NO-OFFER RESPONSE FORM
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 37 of 39
If you are not responding to this service/commodity, please complete and return only this form to: Littleton Elementary School District #65, 1600 S. 107
th Ave., Avondale AZ 85323 or fax it to the
attention of the Purchasing Department (623)478-5620(Please print or type, except signature) Failure to respond may result in deletion of Offeror’s name from the qualified Bidder's list for the Littleton Elementary School District #65. COMPANY NAME: ____________________________________________________________ ADDRESS: __________________________________________________________________ CITY: ___________________________________STATE: __________ZIP: ________________ CONTACT PERSON: _________________________TELEPHONE: _____________________ We, the undersigned, have declined to respond to your RFP# 15-003-20 for Workers Compensation Insurance because of the following reasons: Service/Commodity __________ Our Firm does not offer this product or the equivalent. __________There is not sufficient time to respond to this solicitation. __________ Remove our name from this list only. __________ Our Firm schedule would not permit us to perform. __________ Unable to meet all insurance requirements . __________ Other. (Specify below) REMARKS: ______________________________________________________________________________
SIGNATURE: ________________________________________ DATE: ________________
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 W-9 FORM
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 38 of 39
LITTLETON ELEMENTARY SCHOOL DISTRICT #65 ADDRESS LABEL
Purchasing Office 1600 S. 107th Ave
Avondale, AZ 85323
623-478-5602
RFP: 15-003-20 PROJECT: Workers’ Compensation Services
Page 39 of 39
CUT ALONG THE LINE AND AFFIX TO THE FRONT OF YOUR PROPOSAL RESPONSE
SEALED PROPOSAL
Submitted by:
Company Name:
Address:
City, State, Zip:
RFP # 15-003-20 WORKERS’ COMPENSATION SERVICES
Due Date: October 29, 2014 Time: 11:00 a.m., Local Time
Littleton ElementaryDistrict #65 Attn: Purchasing Department
1600 S. 107 Ave Avondale, AZ 85323
CUT ALONG THE LINE AND AFFIX TO THE FRONT OF YOUR PROPOSAL RESPONSE