Exhibit 1 – Technical
Bid Event # EVT0005594
COBRA RFP (2019, 2020, 2021 Plan Years)
Page 28
SECTION I
Registration, Event Notice and Acknowledgement of Addenda
The Event Document as posted on the Division of Purchases web site and the acknowledgement of addenda posted for the bid event must be submitted as part of Section I of the Technical proposal.
Vendors may also submit an executive summary not to exceed two pages, explaining why they feel they are the best option for the State Employee Health Plan (SEHP).
The State of Kansas implemented a PeopleSoft Financial Management System (named SMART) in July 2010. In order to submit a response to any bid event, a vendor must be registered in SMART. It is very important for you to register your business with Procurement and Contracts, for the following reasons:
· To bid on events, registered bidders must be invited in SMART by the Procurement Officer BEFORE the bid closes.
· If invited, registered bidders will be able to receive bid event documents via e-mail.
· If not invited by the Procurement Officer, registered bidders will still receive notification of bid events based on their category code registration.
Registration may be accomplished by:
1. Identifying the category codes you would like to be associated with your bidder record. This should be completed prior to completing the bidders registration.
A full list of category codes is available at: http://www.da.ks.gov/purch/SMARTCategoryCodes.xls Note that this is a large file (5mb). It may be beneficial to identify the applicable category codes prior to beginning the registration process. The State uses the UNSPSC category code system which includes over 40,000 codes. For ease of identifying codes that may apply to your business, you may search this document by selecting Ctrl+F on your keyboard, then typing key words that may apply to your business. If you find no results, select a different key word. For example, vehicles are listed under automobiles or cars.
2. Completing the form on the following website (to include the category codes that you have selected) http://www.surveymonkey.com/s/ksbiddersurvey
3. Submitting a completed W-9 Form.
E-mail a copy of your signed and dated W-9 Form (with a signature no more than six (6) months old) to or fax it to 785-296-7240. Your bidder registration will NOT be processed until we have the W-9 Form. You may download a copy of the current W-9 Form at the IRS website: http://www.irs.gov/pub/irs-pdf/fw9.pdf
Please do not submit another application once you have registered. If you need to make changes to your bidder record (i.e. changes to contact information, address changes, add/delete commodity codes, etc.) please email those changes to . Please include your company name and taxpayer identification number to assure that the correct record is updated.
After your application has been processed, you will receive an email confirming that your application has been approved. If you have any questions regarding the bidder application, please call: 785-296-2376
Signature Sheet
Item: COBRA Administration Services for the State Employee Health Plan
Closing Date: 2:00 PM Central Time, February 14, 2018
Agency: Kansas State Employees Health Care Commission
Certification of Capabilities:
By submission of a bid and the signatures affixed thereto, the bidder certifies all products and services proposed in the bid meet or exceed all requirements of this specification as set forth in the request and that all exceptions are clearly identified.
Conflict of Interest:
I hereby certify that I (we) do not have any substantial conflict of interest sufficient to influence the bidding process on this bid. A conflict of substantial interest is one which a reasonable person would think would compromise the open competitive bid process.
Addendums to the RFP:
The undersigned acknowledges receipt of the following addenda:
#1( ) #2( ) #3( ) None ( )
Legal Name of Person, Firm or Corporation
Mailing Address City & State Zip
Toll Free Telephone Local Cell: Fax
Tax Number E-Mail
Signature Date
Typed Name Title
In the event the contact for the bidding process is different from above, indicate contact information below.
Bidding Process Contact Name
Mailing Address City & State Zip
Toll Free Telephone Local Cell: Fax
Back-up Contact Name
Mailing Address City & State Zip
Toll Free Telephone Local Cell: Fax
If awarded a contract and purchase orders are to be directed to an address other than above, indicate mailing address and telephone number below.
Mailing Address City & State Zip
Toll Free Telephone Local Cell: Fax
Vendor Contact Information
To facilitate the Request for Proposal (bid event) process, we ask that each Contractor designate a main contact person as well as an alternate contact should the main contact be unavailable. Please complete the following regarding that designated persons. The State has designated contact information listed in this document.
Primary Contact: ______
Title: ______
Address: ______
______
Phone Number: ______Fax Number: ______
Email Address: ______
Alternate Contact: ______
Title: ______
Address: ______
______
Phone Number: ______Fax Number: ______
Email Address: ______
Tax Clearance
The Health Care Commission in process of procurement per K. S. A. 75-6504, requests the Director of Purchases to review tax clearance status of all Contractors. Per KSA 75-3740-(c), the Director of Purchases may reject the bid of any bidder who is in arrears on taxes due the State of Kansas. The Division of Purchases will confirm tax status of all potential contractors and subcontractors prior to the release of a purchase order or contract award. The State of Kansas reserves the right to allow a bidder an opportunity to clear tax status within ten (10) calendar days, or to proceed with award to the next lowest responsive bidder, whichever is determined by the Director of Purchases to be in the best interest of the State.
The Secretary of Revenue is authorized to exchange such information with the Director of Purchases as is necessary to determine the bidder’s tax clearance status, notwithstanding any other provision of law prohibiting disclosure of the contents of taxpayer records or information.
Instructions on how to check Tax Clearance Status can be found at the following website:
http://www.ksrevenue.org/taxclearance.htm
Information about Tax Registration can be found at the following website:
http://www.ksrevenue.org/busregistration.htm
Contact Information: Please provide the attached contact information for use should the State of Kansas need to contact the appropriate officials within your company to discuss your tax clearance / registration status.
CONTRACTOR
Contact Person for Tax Issues:
Company Name: Tax Number:
Mailing Address
City & State Zip Code
Toll Free Telephone Local Cell: Fax
SUBCONTRACTOR(S)
Contact Person for Tax Issues:
Company Name: Tax Number:
Mailing Address
City & State Zip Code
Toll Free Telephone Local Cell: Fax
Additional pages may be added, as required, indicating the same information for multiple subcontractors. All subcontractors must be identified.
CERTIFICATION REGARDING
IMMIGRATION REFORM & CONTROL
All Contractors are expected to comply with the Immigration and Reform Control Act of 1986 (IRCA), as may be amended from time to time. This Act, with certain limitations, requires the verification of the employment status of all individuals who were hired on or after November 6, 1986, by the Contractor as well as any subcontractor or sub-subcontractor. The usual method of verification is through the Employment Verification (I-9) Form. With the submission of this bid, the Contractor hereby certifies without exception that Contractor has complied with all federal and state laws relating to immigration and reform. Any misrepresentation in this regard or any employment of persons not authorized to work in the United States constitutes a material breach and, at the State’s option, may subject the contract to termination and any applicable damages.
Contractor certifies that, should it be awarded a contract by the State, Contractor will comply with all applicable federal and state laws, standards, orders and regulations affecting a person’s participation and eligibility in any program or activity undertaken by the Contractor pursuant to this contract. Contractor further certifies that it will remain in compliance throughout the term of the contract.
At the State’s request, Contractor is expected to produce to the State any documentation or other such evidence to verify Contractor’s compliance with any provision, duty, certification, or the like under the contract.
Contractor agrees to include this Certification in contracts between itself and any subcontractors in connection with the services performed under this contract.
______
Signature, Title of Contractor date
CERTIFICATION INDIVIDUAL OR COMPANY
NOT CURRENTLY ENGAGED IN A BOYCOTT OF ISRAEL
In accordance with HB 2409, 2017 Legislative Session, the State of Kansas shall not enter into a contract with any Individual or Company to acquire or dispose of services, supplies, information technology or construction, unless such Individual or Company submits a written certification that such Individual or Company is not currently engaged in a boycott of Israel.
As an Individual or Contractor entering into a contract with the State of Kansas, it is hereby certified that the Individual or Company listed below is not currently engaged in a boycott of Israel.
______
Signature, Title of Contractor Date
______
Printed
______
Name of Company
Section II
Vendor Qualifications
If you believe that a particular question is not applicable to the services you are bidding, please briefly explain why. If you have described a program/service or other content and it applies to multiple questions, simply refer us to the prior description. Please do not repeat your answers.
2.1.1 / Provide a brief history of your organization including: date established; ownership (public, partnership, subsidiary, etc.) nature of business and any additional programs/products offered in addition to audit services.Answer:
2.1.2 / Is your organization part of a national or regional organization? If yes, provide the corporation’s name and address. Is your company affiliated with any other company? If so, describe these affiliate relationships.
Describe how this relationship impacts your operation and delivery of services.
Answer:
2.1.3 / List each subcontractor and/or sister corporation performing work on this contract and the location where the work will be done. Disclose any services under this RFP or your operations that are related to this RFP that are to be provided by workers outside of the United States.
Answer:
2.1.4 / If awarded a contract, indicate who within your organization will be assigned responsibility to manage or service the SEHP account. Provide a brief bio about each person who will be assigned responsibility for the SEHP account including their education and work experience, years with the company and areas of specialization, if any. Include within this team the persons who will be responsible for the data management functions for the SEHP. Confirm that persons to be assigned to implementation and account management will be part of any interview team.
· Account Management*
· Customer Service.
· Data
Answer:
2.1.5 / Describe any staff relocations, computer systems changes/upgrades, program changes or telephone system changes in process at this time or proposed within the next 12-24 months?
Answer:
2.1.6 / If your organization is licensed or registered with the State of Kansas, please provide a copy of the documentation.
Answer:
2.02 EXPERIENCE AND References
2.2.1 / Provide references from three current large self funded clients you have provided similar services as those proposed in this RFP. Public sector clients are preferred. . Also preferred would be clients who have worked with the audit teams to be assigned to this account. Information. Response should include:· Company Name
· Contact Person
· Address
· Office Phone #
· Mobile Phone #
· Services Provided
Answer:
2.2.2 / Provide references from three former clients (within last 4 years) to have provided similar services proposed in this RFP. Public sector clients lives are preferred. Also preferred would be former clients who have worked with the audit teams to be assigned to this account. Information. Response should include:
· Company Name
· Contact Person
· Address
· Office Phone #
· Mobile Phone #
· Services Provided
· Reason for termination
Answer:
ACKNOWLEDGE AND ACCEPT
I have reviewed the Vendor Qualifications section of the Request for Proposal and acknowledge that the document shall become part of the final contract. I hereby acknowledge and accept all of the provisions, requirements, and conditions stated in this section of Request for Proposal, subject to the modifications, conditions and limitations I have listed below.
______
Authorized Signature of Vendor
______
Printed Name of Signatory
______
Title
______
Date
SECTION III
DA-146a, Sample Contract, and Business Associate Agreement
Vendors are expected to closely read the DA-146a, sample contract and BAA and provide a binding signature of intent to comply with such terms and conditions. The DA-146 is a required part on all State of Kansas contracts. All Vendors are required to agree to these provisions without modification. Any modifications of the DA-146 will result in the rejection of your bid.
The SEHP is not obligated to negotiate the provisions of the contract or BAA and reserves the right to accept or reject any bid that has made revisions or modifications in the required language. These provisions are a standard part of all State Employee Health Plan contracts. Any requested modifications to the contract or BAA must be submitted in red-line format with the bid response. It is acceptable to use color for this purpose.
Bidders agree by submitting a proposal in response to this RFP, the SEHP will draft the contract, including the HIPAA Confidentiality Agreement or Business Associate Agreement (BAA) as appropriate. Any negotiations regarding the contract and BAA documents will occur prior to the contract award. Once a contract is awarded, the State will draft the contract and the vendor is expected to sign it within 10 business days.
Should the SEHP be prevented or enjoined from proceeding with the acquisition before or after contract execution by reason of any litigation or other reason beyond the control of SEHP, Vendor shall not be entitled to make or assess claim for damages by reason of said delay.
Note: If no edits are requested to the contract or BAA documents, please return the document marked “no edits required”