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Agenda 10/11/2016 Item #16E 1
16.E.1 10/11/2016 EXECUTIVE SUMMARY Recommendation to award Request for Proposal (RFP) #16-6614, "Workers' Compensation Medical Case Management Services" to Naples Physician Hospital Organization d/b/a Community Health Partners. OBJECTIVE: To provide Workers' Compensation medical case management services to injured employees under the County's Workers' Compensation insurance program. CONSIDERATION: In 1994, the Florida Legislature enacted changes to Florida Statutes Chapter 440, which directed fully insured and self insured employer/carriers to adopt managed care programs to deliver appropriate and cost effective medical care to injured employees on a local level. At that time, the NCH Healthcare System along with the Southwest Florida Physicians Association, now known as Community Health Partners, developed the "Workcare Program" to assist local employers in complying with the statute. The Workcare Program consists of a panel of contracted local physicians and healthcare providers of every specialty within a 100 mile radius of the employer; twenty-four hour nurse case management services to manage emergency care; ongoing case management services to manage the progress of care; and a reporting system to enable return to work and light duty assignments by the employer. Since 2012, the Board has contracted with the Naples Physician Hospital Organization d/b/a Community Health Partners to provide these services. The contract with Community Health Partners expires on December 31,2016. The County Manager appointed a selection committee and RFP #16-6614 was solicited on April 15, 2016 with 93 emails sent. Twenty (20) interested vendors downloaded the solicitation. Proposals were due on May 17, 2016. One vendor responded to the solicitation. The vendor was Naples Physician Hospital Organization d/b/a Community Health Partners.Due to the specialized nature of this service and the fact that the delivery of this service is geographically specific, it was not surprising that only one proposal was received. Many of these potential vendors are bundled with claims administration companies or insurance carriers and cannot unbundle their services. Further,potential vendors must have established relationships with local providers and employers and a significantly large client market to justify the placement of resources locally. However, despite this situation, staff felt it was important to release an RFP to test the market rather than to declare Community Health Partners a sole source. On June 7,2016 the selection committee met and scored the proposal. The committee unanimously voted to recommend that the Board enter into an Agreement with Naples Physician Hospital Organization d/b/a Community Health Partners for a period of three years with the opportunity for two one-year renewals. FISCAL IMPACT: The estimated annual cost for calendar year 2017 is $94,536 based upon 2,600 covered employees.The pricing is comparable to similar sized employers in the area. Sufficient funds are budgeted within Fund 518,Workers' Compensation Insurance. LEGAL CONSIDERATIONS: This item has been approved as to form and legality and requires majority vote for approval. -CMG RECOMMENDATION: That the Board of Commissioners awards RFP #16-6614 "Workers' Compensation Medical Case Management Services" to Naples Physician Hospital Organization d/b/a Community Health Partners and authorizes the Chairman to execute the attached County Attorney approved Agreement. Prepared by: Jeff Walker,CPCU,ARM,Division Director,Risk Management Packet Pg. 1583 16.E.1 10/11/2016 ATTACHMENT(S) 1.Workers'Compensation Managed Care Agreement (PDF) 2. 16-6614 Final Ranking (PDF) 3. 16-6614 Workers'Compensation-RFP Final (PDF) Packet Pg. 1584 16.E.1 10/11/2016 COLLIER COUNTY Board of County Commissioners Item Number: 16.E.1 Item Summary: Recommendation to award Request for Proposal (RFP) #16-6614, "Workers' Compensation Medical Case Management Services" to Naples Physician Hospital Organization d/b/a Community Health Partners. Meeting Date: 10/11/2016 Prepared by: Title: Division Director-Risk Management—Risk Management Name: Jeff Walker 08/09/2016 10:21 AM Submitted by: Title: Division Director-Risk Management—Risk Management Name: Jeff Walker 08/09/2016 10:21 AM Approved By: Review: Administrative Services Department Pat Pochopin Level 1 Division Reviewer Completed 08/09/2016 10:35 AM Procurement Services Lissett DeLaRosa Level 1 Purchasing Gatekeeper Completed 08/11/2016 8:23 AM Procurement Services Sandra Herrera Level 1 Purchasing Reviewer 1-4 Completed 08/11/2016 1:30 PM Procurement Services Rhonda Burns Level 1 Purchasing Reviewer 1-4 Completed 08/11/2016 2:15 PM Procurement Services Allison Kearns Level 1 Purchasing Reviewer 1-4 Completed 09/19/2016 1:20 PM County Attorney's Office Colleen Greene Level 2 Attorney Review Completed 09/20/2016 11:29 AM Administrative Services Department Len Price Level 2 Division Administrator Review Completed 09/23/2016 2:59 PM County Attorney's Office Jeffrey A.Klatzkow Level 3 County Attorney's Office Review Completed 09/26/2016 8:46 AM Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 09/26/2016 2:56 PM Office of Management and Budget Laura Wells Level 3 OMB 1st Reviewer 1-4 Completed 09/26/2016 3:11 PM County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 10/03/2016 11:30 PM Board of County Commissioners MaryJo Brock Meeting Pending 10/11/2016 9:00 AM Packet Pg. 1585 16.E.1.a AGREEMENT 16-6614 for Cs U "Workers' Compensation Medical Case Management Program" Lb- THIS AGREEMENT, made and entered into on this day of 2016, by and between Naples Physician Hospital Organization d/b/a Community Health Partners, authorized to do business in the State of Florida, whose business address is 851 N Fifth Avenue North, Suite 201, Naples FL 34102, (the "Contractor") and Collier County, a a political subdivision of the State of Florida, (the "County"): U WITNESSETH: .0 0) L 0 1. AGREEMENT TERM. The Agreement shall be for a three (3) year period, commencing on January 1, 2017, and terminating December 31, 2019, or until all CD outstanding Purchase Orders issued prior to the expiration of the Agreement period have been completed or terminated. a U- ce The County may, at its discretion and with the consent of the Contractor, renew the Agreement under all of the terms and conditions contained in this Agreement for two (2) additional one (1) year periods. The County shall give the Contractor written notice of the County's intention to renew the Agreement term prior to the end of the Agreement term then in effect. The County Manager, or his designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred and eighty (180) days. The County Manager, or his designee, shall give the Contractor written notice of the County's intention to extend the Agreement term prior to the end of d the Agreement term then in effect. 2. COMMENCEMENT OF SERVICES. The Contractor shall commence on January 1, 2017. as 3. STATEMENT OF WORK. The Contractor shall provide Workers' Compensation Medical Case Management Consulting in accordance with the terms and conditions of Request for Proposal (RFP) #16-6614, Exhibit A — Scope of Services, and the Contractor's proposal referred to herein and made an integral part of this Agreement. o This Agreement contains the entire understanding between the parties and any U modifications to this Agreement shall be mutually agreed upon in writing by the Parties, in compliance with the County's Procurement Ordinance, as amended, and Procurement Procedures in effect at the time such services are authorized. 4. THE AGREEMENT SUM. The County shall pay the Contractor for the performance of this Agreement based on the unit prices set forth in the Cost of Services, attached hereto as Exhibit B, and pursuant to the price methodology as defined in Section 4.2. Page 1 of 11 #16-6614"Workers'Compensation Medical Case Management Program" („:40 Packet Pg. 1586 16.E.1.a 4.1 Payment will be made upon receipt of a proper invoice and upon approval by the Director of Risk Management or his designee, and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act." caU 4.2 Price Methodology: Unit Price: The County agrees to pay a firm total fixed price (inclusive of all costs, including labor, materials, equipment, overhead, etc.) for a repetitive product or service 0 delivered (i.e. installation price per ton, delivery price per package or carton, etc.). The invoice must identify the unit price and the number of units received (no contractor inventory or cost verification. o U 4.3 Any County agency may utilize services under this Agreement, provided 12 sufficient funds are included in their budget(s). 4.4 Payments will be made for services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of the Agreement. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of a. "laches" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this Agreement. 5. SALES TAX. Contractor shall pay all sales, consumer, use and other similar taxes a associated with the Work or portions thereof, which are applicable during the performance of the Work. Collier County, Florida as a political subdivision of the State of Florida, is exempt from the payment of Florida sales tax to its vendors under Chapter E' 212, Florida Statutes, Certificate of Exemption # 85-8015966531C-2. c) a) 6. NOTICES. All notices from the County to the Contractor shall be deemed duly served if '6) mailed or faxed to the Contractor at the following Address: E Naples Physician Hospital Organization d/b/a Community Health Partners v 851 Fifth Avenue North, Suite 201 Naples, FL 34102 Phone: (239) 659-7700; Fax: (239) 659-7799 Attn: Kathy Jardone, Chief Operating Officer E-Mail: kjardone(c chealthpartners.com = All Notices from the Contractor to the County shall be deemed duly served if mailed or o faxed to the County to: a) Collier County Government Center Procurement Services Division 3327 Tamiami Trail, East Naples, Florida 34112 Attention: Allison Kearns, Interim Director, Procurement Services Division Telephone: 239-252-8407; Facsimile: 239-252-6480 Page 2 of 11 #16-6614"workers'Compensation Medical Case Management Programa Packet Pg. 1587 16.E.1.a The Contractor and the County may change the above mailing address at any time upon giving the other party written notification. All notices under this Agreement must be in writing. U 7. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating a partnership between the County and the Contractor or to constitute the Contractor as an agent of the County. o 8. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, F.S., all permits necessary for the prosecution of the Work shall be obtained by the Contractor. The County will not be obligated to pay for any permits obtained by Subcontractors/Subconsultants. L a) Payment for all such permits issued by the County shall be processed internally by the County. All non-County permits necessary for the prosecution of the Work shall be procured and paid for by the Contractor. The Contractor shall also be solely responsible for payment of any and all taxes levied on the Contractor. In addition, the Contractor shall comply with all rules, regulations and laws of Collier County, the State of Florida, or a the U. S. Government now in force or hereafter adopted. The Contractor agrees to comply with all laws governing the responsibility of an employer with respect to persons employed by the Contractor. 9. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any person to use in any manner whatsoever, County facilities for any improper, immoral or offensive purpose, or for any purpose in violation of any federal, state, county or municipal ordinance, rule, order or regulation, or of any governmental rule or regulation now in effect or hereafter enacted or adopted. In the event of such violation by the Contractor or if the County or its authorized representative shall deem any conduct on the part of the Contractor to be objectionable or improper, the County shall have the right to suspend the Agreement of the Contractor. Should the Contractor fail to correct any such violation, conduct, or practice to the satisfaction of the County within twenty-four (24) hours after receiving notice of such violation, conduct, or practice, such suspensionca to continue until the violation is cured. The Contractor further agrees not to commence operation during the suspension period until the violation has been corrected to the satisfaction of the County. ° 10. TERMINATION. Should the Contractor be found to have failed to perform his services in a manner satisfactory to the County as per this Agreement, the County may terminate o said Agreement for cause; further the County may terminate this Agreement for U convenience with a thirty(30) day written notice. The County shall be sole judge of non- performance. o In the event that the County terminates this Agreement, Contractor's recovery against the County shall be limited to that portion of the Agreement Amount earned through the E date of termination. The Contractor shall not be entitled to any other or further recovery against the County, including, but not limited to, any damages or any anticipated profit on portions of the services not performed. Page 3 of 11 #16-6614"Workers'Compensation Medical Case Management Program" e...40 Packet Pg. 1588 16.E.1.a 11. NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as to race, sex, color, creed or national origin. 12. INSURANCE. The Contractor shall provide insurance as follows: A. Commercial General Liability: Coverage shall have minimum limits of $1,000,000 2 Per Occurrence, $2,000,000 aggregate for Bodily Injury Liability and Property Damage o Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed. Operations and Contractual Liability. Q E B. Workers' Compensation: Insurance covering all employees meeting Statutory v Limits in compliance with the applicable state and federal laws. a) The coverage must include Employers' Liability with a minimum limit of $100,000 for each accident. CD C. Professional Liability: Shall be maintained by the Consultant to ensure its legal liability for claims arising out of the performance of professional services under this a Agreement. Consultant waives its right of recovery against County as to any claims u_ under this insurance. Such insurance shall have limits of not less than $500,000 each claim and in the aggregate. Special Requirements: Collier County Government shall be listed as the Certificate Holder and included as an Additional Insured on the Comprehensive General Liability Policy. Current, valid insurance policies meeting the requirement herein identified shall be maintained by Contractor during the duration of this Agreement. The Contractor shall provide County with certificates of insurance meeting the required insurance provisions. Renewal certificates shall be sent to the County ten (10) days prior to any expiration date. Coverage afforded under the policies will not be canceled or allowed to expire until the greater of: ten (10) days prior written notice, or in accordance with policy provisions. Contractor shall also notify County, in a like manner, within twenty-four (24) hours after receipt, of any notices of expiration, cancellation, non-renewal or material change in coverage or limits received by Consultant from its insurer, and nothing contained herein shall relieve Contractor of this requirement to provide notice. w Contractor shall ensure that all subcontractors comply with the same insurance o requirements that he is required to meet. U) Q)L 13. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Contractor shall indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, whether resulting from any claimed breach of this Agreement by Contractor, any statutory or regulatory violations, or from personal injury, property damage, direct or consequential damages, or economic loss, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Page 4 of 11 #16-6614"Workers'Compensation Medical Case Management Program" �C 9r)? Packet Pg. 1589 16.E.1.a Contractor or anyone employed or utilized by the Contractor in the performance of this Agreement. This indemnification obligation shall not be construed to negate, abridge or reduce any other rights or remedies which otherwise may be available to an indemnified N party or person described in this paragraph. rtsThis section does not pertain to any incident arising from the sole negligence of Collier 5 County. 2 13.1 The duty to defend under this Article 13 is independent and separate from the duty to indemnify, and the duty to defend exists regardless of any ultimate liability of the Contractor, County and any indemnified party. The duty to defend arises immediately t upon presentation of a claim by any party and written notice of such claim being provided v to Contractor. Contractor's obligation to indemnify and defend under this Article 13 will 12 survive the expiration or earlier termination of this Agreement until it is determined by final judgment that an action against the County or an indemnified party for the matter indemnified hereunder is fully and finally barred by the applicable statute of limitations. 14. AGREEMENT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Risk Management Division. 0- 15. 15. CONFLICT OF INTEREST. Contractor represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder. Contractor further represents that no persons having any such interest shall be employed to perform those services. 16. COMPONENT PARTS OF THIS AGREEMENT. This Agreement consists of the following component parts, all of which are as fully a part of the Agreement as if herein set out verbatim: Contractor's Proposal, Insurance Certificate(s), Exhibit A-Scope ofCD Services, Exhibit B— Cost Schedule, and RFP #16-6614, Scope of Services. 17. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between the parties herein that this Agreement is subject to appropriation by the Board of County Commissioners. _ 18. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, Collier County Ethics Ordinance No. 2004-05, as amended, and County a Administrative Procedure 5311. Violation of this provision may result in one or more of o the following consequences: a. Prohibition by the individual, firm, and/or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/or quotes; and, c. immediate termination of any Agreement held by the individual and/or firm for cause. E U .a.1 w Page 5 of 11 #16-6614"Workers'Compensation Medical Case Management Program"/-\ 90 Packet Pg. 1590 16.E.1.a 19. COMPLIANCE WITH LAWS. By executing and entering into this Agreement, the Contractor is formally acknowledging without exception or stipulation that it agrees to comply, at its own expense, with all federal, state and local laws, codes, statutes, 0 ordinances, rules, regulations and requirements applicable to this Agreement, including c) but not limited to those dealing with the Immigration Reform and Control Act of 1986 as To located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be 8 amended; taxation, workers' compensation, equal employment and safety (including, 2 but not limited to, the Trench Safety Act, Chapter 553, Florida Statutes, and the Florida o Public Records Law Chapter 119, including specifically those contractual requirements y at F.S. § 119.0701(2)(a)-(b) as stated as follows: c E IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OFc°) CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TOL PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: ° 4 Communication and Customer Relations Division 3299 Tamiami Trail East, Suite 102 th Naples, FL 34112-5746 a Telephone: (239) 252-8383 L The Contractor must specifically comply with the Florida Public Records Law to: 3 a 1. Keep and maintain public records required by the public agency to perform the N. service. 2. Upon request from the public agency's custodian of public records, provide the 1= public agency with a copy of the requested records or allow the records to be E inspected or copied within a reasonable time at a cost that does not exceed the 0 cost provided in this chapter or as otherwise provided by law. a 3. Ensure that public records that are exempt or confidential and exempt from 0 public records disclosure requirements are not disclosed except as authorized o by law for the duration of the contract term and following completion of the 0 contract if the Contractor does not transfer the records to the public agency. al 4. Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the Contractor or keep and maintain public c records required by the public agency to perform the service. If the Contractor transfers all public records to the public agency upon completion of the contract, 0 the Contractor shall destroy any duplicate public records that are exempt or a confidential and exempt from public records disclosure requirements. If the o Contractor keeps and maintains public records upon completion of the contract, 0 the Contractor shall meet all applicable requirements for retaining public in records. All records stored electronically must be provided to the public o agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. U Rf a Page 6 of 11 #16-6614"Workers'Compensation Medical Case Management Program" AQ Packet Pg. 1591 16.E.1.a If Contractor observes that the Contract Documents are at variance therewith, it shall promptly notify the County in writing. Failure by the Contractor to comply with the laws referenced herein shall constitute a breach of this Agreement and the County shall have the discretion to unilaterally terminate this Agreement immediately. U 20. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County encourages and agrees: to the successful proposer extending the pricing, terms and 2 conditions of this solicitation or resultant Agreement to other governmental entities at the o discretion of the successful proposer. N a. 21. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or otherwise unenforceable, in whole or in part, the remaining portion of this Agreement c° shall remain in effect. i 22. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to this Agreement in compliance with the Procurement Ordinance, as amended, and Procurement Procedures. CD 23. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by this Agreement to resolve disputes between the parties, the parties shall make a good u. faith effort to resolve any such disputes by negotiation. The negotiation shall be 72 attended by representatives of Contractor with full decision-making authority and by County's staff person who would make the presentation of any settlement reached during negotiations to County for approval. Failing resolution, and prior to the commencement of depositions in any litigation between the parties arising out of this Agreement, the parties shall attempt to resolve the dispute through Mediation before an agreed-upon Circuit Court Mediator certified by the State of Florida. The mediation shall be attended by representatives of Contractor with full decision-making authority and by County's staff person who would make the presentation of any settlement reached at mediation to County's board for approval. Should either party fail to submit to mediation as required hereunder, the other party may obtain a court order requiring mediation under section 44.102, Fla. Stat. 24. VENUE. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. c. 25. AGREEMENT STAFFING. The Contractor's personnel and management to be utilized for this Agreement shall be knowledgeable in their areas of expertise. The County U reserves the right to perform investigations as may be deemed necessary to ensure that 0" competent persons will be utilized in the performance of the Agreement. The Contractor's shall assign as many people as necessary to complete the required services on a timely basis, and each person assigned shall be available for an amount of time adequate to meet the required service. E r-. a-+ Page 7 of 11 #16-6614'Workers'Compensation Medical Case Management PrograrpA"N Packet Pg. 1592 16.E.1.a 26. ORDER OF PRECEDENCE. In the event of any conflict between or among the terms of any of the Contract Documents, the terms of the RFP the Contractor's Proposal, and/or the County's Board approved Executive Summary, the Contract Documents shall take precedence. 27. ASSIGNMENT. Contractor shall not assign this Agreement or any part thereof, without the prior consent in writing of the County. Any attempt to assign or otherwise transfer 2 this Agreement, or any part herein, without the County's consent, shall be void. If o Contractor does, with approval, assign this Agreement or any part thereof, it shall y require that its assignee be bound to it and to assume toward Contractor all of the obligations and responsibilities that Contractor has assumed toward the County. 0 28. SECURITY. The Contractor is required to comply with County Ordinance 2004-52, as N amended. Background checks are valid for five (5) years and the Contractor shall be Y responsible for all associated costs. If required, Contractor shall be responsible for the 8 costs of providing background checks by the Collier County Facilities Management Division for all employees that shall provide services to the County under this CD Agreement. This may include, but not be limited to, checking federal, state and local law enforcement records, including a state and FBI fingerprint check, credit reports, education, residence and employment verifications and other related records. u_ Contractor shall be required to maintain records on each employee and make them available to the County for at least four (4) years. All of Contractor's employees and subcontractors must wear Collier County Government Identification badges at all times while performing services on County facilities and °'- T properties. Contractor ID badges are valid for one (1) year from the date of issuance and can be renewed each year at no cost to the Contractor during the time period in which their background check is valid, as discussed below. All technicians shall have on their shirts the name of the contractor's business. The Contractor shall immediately notify the Collier County Facilities Management co Division via e-mail (DL-FMOPS@.colliergov.net) whenever an employee assigned to Collier County separates from their employment. This notification is critical to ensure the 0 continued security of Collier County facilities and systems. Failure to notify within four (4) hours of separation may result in a deduction of$500 per incident. 2 0 * * * * * E 0 U 0 i O N E 0 t0 Y Page 8 of 11 n #16-6614"Workers'Compensation Medical Case Management Program" O Packet Pg. 1593 16.E.1.a IN WITNESS WHEREOF, the parties hereto, have each, respectively, by an authorized person or agent, have executed this Agreement on the date and year first written above. (I) CZ U BOARD OF COUNTY COMMISSIONERS ATTEST: COLLIER COUNTY, FLORIDA Dwight E. Brock, Clerk of Courts 2 By: By: y Donna Fiala, Chairman Dated: E (SEAL) 0 L Naples Physician Hospital d/b/a Community Health Partners Contractor a. By: u_ First Witness Signature TType/print witness nameT TType/print signature and titleT Second Witness w E TType/print witness name R (- proved as to Form and Legality: 0 P Stant County Attorney Print Name a O U .N L G) I- L O 4 . E 4� Page 9 of 11 #16-6614"Workers'Compensation Medical Case Management Program' MD/ Packet Pg. 1594 16.E.1.a Exhibit A— Scope of Services The Contractor shall provide the following scope of services. R U • Employ nurse case managers who are dedicated solely to Workers' Compensation medical 73 case management. Es • The nurse case managers will attempt to contact employees who incur job related injuries or 2 illnesses requiring paid medical care within 24 hours (48 hours for Friday occurrences) of o the patient's first medical treatment. al • The nurse case managers will participate in monthly telephonic and quarterly on-site file c reviews with the County's third party administration company (TPA) and designated Countyce staff. U • The nurse case managers shall generate correspondence to authorized treating physicians N on topics that include but are not limited to major contributing cause (MCC), County return- Y to-work policies and patient's prior medical history. 8 • The nurse case managers will review daily, all medical reports received from authorized treating physicians to determine the appropriateness of the treatment and prescribed co medications with respect to the job related injury/illness for which they are treating the patient. t° • The nurse case managers will review all historical treatment records received as a result of a. medical releases supplied by patients to determine any impact they may have on the . patient's current job related medical condition. '2 • The nurse case managers will maintain daily communications with the County's TPA and a designated County staff to impart any pertinent medical findings critical to case management. 0) • The nurse case managers will communicate with providers and facilitate treatment for any patients exposed to communicable diseases. 5 • The nurse case managers will be available to attend doctor appointments, mediations, trials ? and settlement conferences at the request of the client/adjuster at no additional cost. 0 • The nurse case managers will provide in-service training to providers and their staff as a needed. w • The nurse case managers will have the capability to forward in a secured manner, medical o notes and correspondence to the client, the TPA and the client's legal counsel. • The nurse case managers will maintain a claims database that is well documented and i includes a diary program for follow up review of all open and closed claims. = • The nurse case managers will be on call 24 hours per day seven days per week, and will 2 return all phone calls in a timely fashion. o • The proposer will maintain a network of all medical and therapeutic disciplines that are N familiar with treating patients under workers' compensation statutes. c • The proposer shall maintain a toll free telephone number throughout the life of the E agreement. Q U -n Conditions: The Contractor shall maintain case management services at a location in Naples, 0 Florida. The Contractor must be able to demonstrate an ability to perform the Scope of Services o as described but shall also be able to demonstrate ongoing working relationship with local medical providers in the Naples area; an ability to develop contractual relationships with local c medical providers in the Naples, FL area; and demonstrate an ability to support and execute the 1= County's return to work program. Finally, the Contractor shall possess the required credentials 13 and licensure for medical case management firms. Page 10 of 11 #16-6614"Workers'Compensation Medical Case Management Program" O ) Packet Pg. 1595 16.E.1.a Exhibit "B" - Cost Schedule 0) cn The Contractor shall be paid on a Per Employee Per Month (PEPM) basis. PEPM shall be defined U as total full time, part time and job bank employees minus retirees for each participating constitutional agency as of the first day of each month. The amount due each month shall be calculated as PEPM multiplied by the applicable term rate. C 0 C Term Rate January 1, 2017 through December 31, 2017 $3.03 0 January 1, 2018 through December 31, 2018 2% increase of current rate to $3.09 112 January 1, 2019 through December 31, 2019 2% increase of current rate to $3.15 L Renewal Period $3.15 8 • CD a U- Ca r- w C 0) E 0) a) 6. L U d 0) R C to 2 C O N C 0) a. E O U in L a) L O 9 C E v as c+ Page 11 of 11 #16-6614"Workers'Compensation Medical Case Management Program" Packet Pg. 1596 1 = aseole @awuonsua wo3 .SJ) OM »t99 21, ]JpmMV : SIO Bmpeej @m] ti,99 a1, :uewg3 q¥ N. w k fL \ a P / E c % 0 § o 2 ku vs & CD ca§ k 2 (i) E § C z U 2 / co c ■ oo 2 _ 22 k � Ei _ 0 7 co % m CI- a)2 K C . _ a) o CU \ CO o » C I . (0 CO Cl)2 r- CO _ 0 CO \ � � ] : 3 Q3a) 0 7 Ws W / cG i2 E � 0 . . s f . > . : § E . I E ƒ � .. . . . w g E o E y O % 1 / / wq 0 e c2 2 )i! # \ E . 2 O 0- ,a. \{ © . z 7 E I:3 > 0 0 \ \% o 13- / co E \\ # f . . � : / E § / _ \§®~ u . . ~ � / \ / 2 ct z 0 E w & 16.E.1.c REQUEST FOR PROPOSAL E as as c ca Caber County co 0 Administrative Services Department co Procurement Seroces Division U_ c) 2 c O :4= cc co c COLLIER COUNTY a. 0 BOARD OF COUNTY COMMISSIONERS L a> O r Solicitation #16-6614 Workers' Compensation u, Medical Case Management Program u. ce L ca 4 v , Rhonda Burns, FCCN, CPPB, Procurement StrTIS ategist (239) 252-8941 (Telephone) a LL (239) 252-6700 (Fax) ct RhondaBurns@colliergov.net(Email) cscri @colliergov.net c m a E This proposal solicitation document is prepared in a Microsoft Word format. Any alterations to this document t°> made by the Vendor may be grounds for rejection of proposal, cancellation of any subsequent award, or any n other legal remedies available to the Collier County Government. CD 0 .14 ) ( (.0 cc to Prnc•am,rt6e,,kxsinAa r•2327 Tamiani Trail E.t•flop}.s,ft.,nda 1"1"2...9:,1•2:,.,252,;27•a.,4 I._n.,n,U,.,c...nm:,rs.r, ns c a1 E S i t r, Packet Pg. 1598 16.E.1.c Table of Contents E LEGAL NOTICE 3 EXHIBIT I: SCOPE OF WORK, SPECIFICATIONS AND RESPONSE FORMAT 4 0 EXHIBIT II: GENERAL RFP INSTRUCTIONS 10 EXHIBIT III: COLLIER COUNTY PURCHASE ORDER TERMS AND CONDITIONS 14 EXHIBIT IV: ADDITIONAL TERMS AND CONDITIONS FOR RFP 18 ATTACHMENT 1: VENDOR'S NON-RESPONSE STATEMENT 27 a) ATTACHMENT 2: VENDOR CHECK LIST 28 ATTACHMENT 3: CONFLICT OF INTEREST AFFIDAVIT 29 ATTACHMENT 4: VENDOR DECLARATION STATEMENT 30 ATTACHMENT 5: AFFIDAVIT FOR CLAIMING STATUS AS A LOCAL BUSINESS 32 ATTACHMENT 6: IMMIGRATION AFFIDAVIT CERTIFICATION 33 to ATTACHMENT 7: VENDOR SUBSTITUTE W—9 34 r ATTACHMENT 8: INSURANCE AND BONDING REQUIREMENTS 35 a. ATTACHMENT 9: REFERENCE QUESTIONNAIRE 37 EXHIBIT A-1: LOSSES BY BODY PARTS 39 EXHIBIT A-2: LOSS AND RESTRICTED WORK DAYS 40 ti C4 LL. a 0 O 0 a) 0 16-6614 RFP_Non_CCNATemplate_01202016 2 Packet Pg. 1599 16.E.1.c Collier County ° Administrative Services Department ami Procurement Seroces .:ision E N (Is Legal Notice co ° Sealed Proposals to provide Workers' Compensation Case Management Services will be received U until 2:30 PM Naples local time, on May 17, 2016 at the Collier County Government, Purchasing Department, 3327 Tamiami Trail E, Naples, FL 34112. •,"-° a� 2 c Solicitation 16-6614 Workers' Compensation Case Management Services 0 v Services to be provided may include, but not be limited to the following: medical case management serviceE L to self funded Workers' Compensation program. ° All statements shall be made upon the official proposal form which may be obtained on the Collier County Purchasing Department Online Bidding System website: w .colliergov.net/bid. o ww Collier County does not discriminate based on age, race, color, sex, religion, national origin, disability or marital status. BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA, w ti BY: /S/ Joanne Markiewicz Director, Procurement Services c ii This Public Notice was posted on the Collier County Purchasing Department website: u. www.colliergov.net/purchasinq and in the Lobby of Purchasing Building "G", Collier County Government Center on t 0 :,a N C Procrremork Swmces apt-tinsel.3327 Tantorn Trn I East•Naples.Ftcnaa 34112.4901•w,;•w.coal rgov naUpnroha sing U vs (0 0 E 16-6614 RFP_Non_CCNATemplate_01202016 3 Packet Pg. 1600 16.E.1.c Exhibit I: Scope of Work, Specifications and Response Format 0 As requested by the Collier County Risk Management Division (hereinafter, the "Division or Department"), the Collier County Board of County Commissioners Procurement Services Division (hereinafter, "County") has issued this Request for Proposal (hereinafter, "RFP")with the intent of obtaining proposals from interested and qualified Consultants in accordance with the terms, conditions and specifications stated or attached. The Consultant, at a minimum, must achieve the CIS requirements of the Specifications or Scope of Work stated. The results of this solicitation may be used by other County departments once awarded according to 15 the Board of County Commissioners Purchasing Policy. 0 ca Brief Description of Purchase Collier County, Florida is seeking a medical case management vendor to provide services to its self o funded Workers' Compensation program. Medical case management is currently administered by the Community Health Partners Work Care program out of their Naples, Florida office. i O Background .17 The program is focused on achieving the best medical outcomes for injured workers at the most reasonable cost. To accomplish this, efforts have been initiated and are on-going to partner with the a best medical providers in the local community. U. 7_ The program partners with Johns Eastern Company for TPA services. Johns Eastern works with Work Care to assure that injured employees receive timely, appropriate care and to assure compliance with the County's Return to Work Practice. Collier County has established a local network of medical providers to deliver care according to the appropriate need. Collier County also operates ti an occupational health program which is tasked with providing first injury care to injured employees who meet the appropriate criteria. In instances where care cannot be provided in-house, the occupational health nurse also provides first evaluation services and directs injured workers to the appropriate primary or specialty provider to avoid unnecessary or duplicate services. n��. Detailed Scope of Work 0 N The successful proposer must be able to provide the following scope of services. ■ Employ nurse case managers who are dedicated solely to Workers' Compensation medical 0 case management. 0) • The nurse case managers will attempt to contact employees who incur job related injuries or illnesses requiring paid medical care within 24 hours (48 hours for Friday occurrences) of the `o patient's first medical treatment. • The nurse case managers will participate in monthly telephonic and quarterly on-site file reviews with the County's third party administration company (TPA) and designated County staff. • The nurse case managers shall generate correspondence to authorized treating physicians on topics that include but are not limited to major contributing cause (MCC), County return-to- 16-6614 RFP_Non_CCNATemplate_01202016 4 Packet Pg. 1601 16.E.1.c work policies and patient's prior medical history. • The nurse case managers will review daily, all medical reports received from authorized treating physicians to determine the appropriateness of the treatment and prescribed medications with respect to the job related injury/illness for which they are treating the patient. • The nurse case managers will review all historical treatment records received as a result of m medical releases supplied by patients to determine any impact they may have on the patient's current job related medical condition. a) • The nurse case managers will maintain daily communications with the County's TPA and designated County staff to impart any pertinent medical findings critical to case management. U • The nurse case managers will communicate with providers and facilitate treatment for any patients exposed to communicable diseases. • The nurse case managers will be available to attend doctor appointments, mediations, trials and settlement conferences at the request of the client/adjuster at no additional cost. • The nurse case managers will provide in-service training to providers and their staff as 7 needed. a� • The nurse case managers will have the capability to forward in a secured manner, medical E notes and correspondence to the client, the TPA and the client's legal counsel. • The nurse case managers will maintain a claims database that is well documented and includes a diary program for follow up review of all open and closed claims. • The nurse case managers will be on call 24 hours per day seven days per week, and will return all phone calls in a timely fashion. • The proposer will maintain a network of all medical and therapeutic disciplines that are familiar �r with treating patients under workers' compensation statutes. • The proposer shall maintain a toll free telephone number throughout the life of the agreement. Conditions u. z The successful proposer shall maintain case management services at a location in Naples, Florida. The successful proposer must be able to demonstrate an ability to perform the Scope of Services as a described but shall also be able to demonstrate ongoing working relationship with local medical Tr; providers in the Naples area; an ability to develop contractual relationships with local medical providers in the Naples, Fl area; and demonstrate an ability to support and execute the county's return to work program. Finally, the successful vendor shall possess the required credentials and licensure Ta for medical case management firms. 11. 0 Claims Statistics and Network 0: Claims statistics for the past three years have been incorporated under Exhibit A-1 Losses by Body 0;_, Part and Exhibit A-2 Loss and Restricted Work Days. Q. Term of Contract The term of this contract is three (3) years with two (2) one year renewals.. Fees shall remain firm for the initial term of this contract. Requests for consideration of a fee adjustment must be made prior to the contract anniversary date, in writing, to the Procurement Director. Price adjustments are dependent upon the budget availability and program manager approval. Surcharges will not be accepted in conjunction with this contract, and such charges should be incorporated into the pricing structure. .r 16-6614 RFP_Non_CCNATemplate_01202016 5 Packet Pg. 1602 16.E.1.c 0 Projected Solicitation Timetable The following projected timetable should be used as a working guide for planning purposes only. The County reserves the right to adjust this timetable as required during the course of the RFP process. w Event Date v' Issue Solicitation Notice April 15, 2016 Last Date for Receipt of Written Questions May 10, 2016 at 4:00 PM, Naples Local Time Addendum Issued Resulting from Written Questions TBA o Solicitation Deadline Date and Time May 17, 2016, 2:30 PM, Naples Local Time ° Anticipated Evaluation of Submittals May- June 2016 0 Anticipated Completion of Contract Negotiations May—June 2016 - Anticipated Board of County Commissioner's Contract July 2016 Y Approval Date o Response Format The Vendor understands and agrees to abide by all of the RFP specifications, provisions, terms14. and conditions of same, and all ordinances and policies of Collier County. The Vendor further agrees that if it is awarded a contract, the work will be performed in accordance with the 12 provisions, terms and conditions of the contract. f° To facilitate the fair evaluation and comparison of proposals, all proposals must conform to the guidelines set forth in this RFP. Any portions of the proposal that do not comply with these guidelines must be so noted and explained in the Acceptance of Conditions section of the proposal. However, any proposal thata. �- contains such variances may be considered non-responsive. Proposals should be prepared simply and economically, providing a straightforward concise description of the Vendor's approach and ability to meet the County's needs, as stated in this c RFP. All proposals should be presented as described in this RFP in PDF or Microsoft Word format with Tabs clearly marked. If outlined in this RFP, the utilization of recycled paper for proposal submission is strongly encouraged. 0 U The items listed below shall be submitted with each proposal and should be submitted in the order shown. Each section should be clearly labeled, with pages numbered and separated by tabs. Failure by a Vendor to include all listed items may result in the rejection of its proposal. 1. Tab I, Cover Letter/ Management Summary(0 points) Provide a cover letter, signed by an authorized officer of the firm, indicating the underlying philosophy of the firm in providing the services stated herein. Include the name(s), telephone number(s) and email(s) of the authorized contact person(s) concerning proposal. Submission 16-6614 RFP_Non_CCNATemplate_01202016 4C 6 Packet Pg. 1603 16.E.1.c of a signed Proposal is Vendor's certification that the Vendor will accept any awards as a 0 result of this RFP. 2. Tab II, Ability to Comply with Scope of Services (15 points) E as In this tab, include: • Detailed plan of approach to how the goals of the Scope of Services will be met. a) • Complete the questionnaire in detail: v Questionnaire 1) Clearly identify and state any exceptions you may wish to take to the Scope of Services, CD Conditions or any part of this solicitation. 2 2) Do you currently operate a managed care workers' compensation program in Naples, FL. If o yes, please describe. N 3) Please attach your current provider listing by type and specialty for Naples, FL. 4) What is your process for attracting and retaining medical providers? 5) What has been your strategy for retaining specialist providers? 0 6) Describe your strategy for promoting and managing return to work programs? N 3. Tab III, Cost of Services to the County (20 points) In this tab, include: • Provide proposed fee schedule of staff that will be assigned to the contract (including sub- tD consultants/contractors) based upon the historical claim events as described in Exhibit A-2. coo Provide the flat fee per year payable in 1/12th increments. a u. ce 4. Tab IV, Experience and Capacity of Firm (20 points) -� In this tab, include: • Describe the ability of the firm to negotiate and deliver a local provider network with the ti breadth and expertise to provide the medical services needed. • Provide information that documents your firm's and subcontractors' qualifications to produce the required deliverables, including abilities, capacity, skill, and financial strength, and number of years of experience in providing the required services. • Provide examples of where you have done this locally. 0 5. Tab V, Specialized Expertise of Team Members (25 points) trTs N In this tab, include: Q. E 0 • Describe the ability of your firm's support with the County's return to work program and operational protocols. • Describe in detail, the firm's ability to provide Nurse Case Managers located in Naples, Florida. • Description of the proposed contract team and the role to be played by each member of the team. • Attach brief resumes of all proposed team members who will be involved in the management of the total package of services, as well as the delivery of specific services. r 16-6614 RFP_Non_CCNATemplate_01202016 7 Packet Pg. 1604 16.E.1.c • Attach resumes of any sub-consultants and attach letters of intent from stated sub- consultants must be included with proposal submission. d 6. Tab VI, References (10 points) E as In order for the vendor to be awarded any points for this tab, the County requests that the vendor submits five (5) completed reference forms from clients whose projects are of a similar nature to this solicitation as a part of their proposal. The County will only use the methodology calculations for the first five (5) references (only) submitted by the vendor in their proposal. Prior to the Selection Committee reviewing proposals, the following methodology will be applied to each vendor's information provided in this area: 2 • The County shall total each of the vendor's five reference questionnaires and create a ranking from highest number of points to lowest number of points. References marked with an N/A (or similar notation will be given the score of zero (0)). Vendors who do not turn in reference forms will be counted as zero (0). • The greatest number of points allowed in this criterion will be awarded to the vendor who has the highest score. y • The next highest vendor's number of points will be divided by the highest vendor's points which will then be multiplied by criteria points to determine the vendor's points awarded. Each subsequent vendor's point score will be calculated in the same manner. • Points awarded will be extended to the whole number per Microsoft Excel. For illustrative purposes only, see chart for an example of how these points would be distributed among the five proposers. n. LL Vendor Name Vendor Total Reference Points Awarded Score 3 Vendor ABC 445 10 Vendor DEF 435 9.77 Vendor GI-II 425 9.33 Vendor JKL 385 8.07 Vendor MNO 385 8.07 c Vendor PQR 250 4.53 Note:Sample chart reflects a 20 point reference criterion. rt The points awarded by vendor will be distributed to the Selection Committee prior to their evaluation of the proposals. The Selection Committee will review the vendor's proposal to ensure consistency and completion of all tasks in the RFP, and review the Points Awarded per vendor. The Selection Committee may, at their sole discretion, contact references, and/or modify the reference points assigned after a thorough review of the proposal and prior to final ranking by the final Selection Committee. 0 (n O 7. Tab VII, Acceptance of Conditions Indicate any exceptions to the general terms and conditions of the RFP, and to insurance requirements or any other requirements listed in this RFP. If no exceptions are indicated in this 16-6614 RFP_Non_CCNATemplate_01202016 B 8 Packet Pg. 1605 16.E.1.c tabbed section, it will be understood that no exceptions to these documents will be considered 0 after the award, or if applicable, during negotiations. Exceptions taken by a Vendor may result in evaluation point deduction(s) and/or exclusion of proposal for Selection Committee a consideration, depending on the extent of the exception(s). Such determination shall be at the sole discretion of the County and Selection Committee. c 8. Tab VIII, Required Form Submittals • Attachment 2: Vendor Check List • Attachment 3: Conflict of Interest Affidavit • Attachment 4: Vendor Declaration Statement • Attachment 5: Affidavit for Claiming Status as a Local Business • Attachment 6: Immigration Affidavit Certification • Attachment 7: Vendor Substitute W-9 • Attachment 8: Insurance and Bonding Requirements • Attachment 9: Reference Questionnaire E • Other: i.e. signed addenda, licenses or certifications, etc. ti y L Q� 0 CD 0 6f. Z L a) ti C d ce 0 N C GT a. E 0 U Un a) 0 to C 0 E S 16-6614 RFP_Non_CCNATemplate_01202016 9 Packet Pg. 1606 16.E.1.c Exhibit II: General RFP Instructions 0 1. Questions Direct questions related to this RFP to the Collier County Purchasing Department Online Bidding System website: www.colliergov.net/bid. Vendors must clearly understand that the only official answer or position of the County will be the one stated on the Collier County Purchasing Department Online Bidding System website. For general questions, please call the referenced To Procurement Strategist noted on the cover page. 40- 2. a2. Pre-Proposal Conference 2 0 The purpose of the pre-proposal conference is to allow an open forum for discussion and N questioning with County staff regarding this RFP with all prospective Vendors having an equal opportunity to hear and participate. Oral questions will receive oral responses, neither of which will be official, nor become part of the RFP. Only written responses to written questions will be 0 considered official, and will be included as part of this RFP as an addendum. All prospective Vendors are strongly encouraged to attend, as, this will usually be the only pre- proposal conference for this solicitation. If this pre-proposal conference is denoted as "mandatory", prospective Vendors must be present in order to submit a proposal response. 3. Compliance with the RFP Proposals must be in strict compliance with this RFP. Failure to comply with all provisions of the RFP may result in disqualification. - L 4. Ambiguity, Conflict, or Other Errors in the RFP v It is the sole responsibility of the Vendor if the Vendor discovers any ambiguity, conflict, discrepancy, omission or other error in the RFP, to immediately notify the Procurement Strategist, noted herein, of such error in writing and request modification or clarification of the document prior c to submitting the proposal. The Procurement Strategist will make modifications by issuing a written revision and will give written notice to all parties who have received this RFP from the Purchasing ft Department. ce 5. Proposal, Presentation, and Protest Costs ° 1113The County will not be liable in any way for any costs incurred by any Vendor in the preparation of its proposal in response to this RFP, nor for the presentation of its proposal and/or participation in E any discussions, negotiations, or, if applicable, any protest procedures. y 6. Delivery of Proposals ° All proposals are to be delivered before 2:30 PM, Naples local time, on or before May 17, 2016 to: Collier County Government �? Purchasing Department 3327 Tamiami Trail E Naples FL 34112 16-6614 ro RFP_Non_CCNATemplate_01202016 Q 10 Packet Pg. 1607 16.E.1.c Attn: Rhonda Burns, FCCN, CPPB Procurement Strategist The County does not bear the responsibility for proposals delivered to the Purchasing Department past the stated date and/or time indicated, or to an incorrect address by Consultant's personnel or by the Consultant's outside carrier. However, the Procurement Director, or designee, reserves the right to accept proposals received after the posted close time under the following conditions: • The tardy submission of the proposal is due to the following circumstances, which may include but not be limited to: late delivery by commercial carrier such as Fed Ex, UPS or courier where delivery was scheduled before the deadline. v • The acceptance of said proposal does not afford any competing firm an unfair advantage in the selection process. 2 Vendors must submit one (1) paper copy clearly labeled "Master," and 6 flash drives with one 4E-s; copy of the proposal on each flash drive in Word, Excel or PDF. List the Solicitation Number and Title on the outside of the box or envelope. 7. Validity of Proposals No proposal can be withdrawn after it is filed unless the Vendor makes their request in writing to the County prior to the time set for the closing of Proposals. All proposals shall be valid for a period of one hundred eighty(180) days from the submission date to accommodate evaluation and selection process. 8. Method of Source Selection a u. et The County is using the Competitive Sealed Proposals methodology of source selection for this procurement, as authorized by Ordinance Number 2013-69 establishing and adopting the Collier 3 County Purchasing Policy. The County may, as it deems necessary, conduct discussions with qualified Vendors determined to be in contention for being selected for award for the purpose of clarification to assure full understanding of, and responsiveness to solicitation requirements. 9. Evaluation of Proposals u_ The County's procedure for selecting is as follows: o 1. The County Manager or designee shall appoint a selection committee to review all proposals submitted. E 2. The Request for Proposal is issued. 3. Subsequent to the receipt closing date for the proposals, the Procurement professional will C) review the proposals received and verify each proposal to determine if it minimally 0) responds to the requirements of the published RFP. Y 4. Selection committee meetings will be open to the public and the Procurement professional will publicly post prior notice of such meeting(s) in the lobby of the Purchasing Building and on the County's Procurement Services Internet site. 5. Prior to the first meeting (Organization Meeting) of the selection committee, the Procurement professional will post a notice announcing the date, time and place of the meeting at least three (3)working days prior to the meeting. At the initial organization meeting, the selection committee members will receive instructions, the submitted 16-6614 {c. RFP_Non_CCNATemplate_01202016 11 Packet Pg. 1608 16.E.1.c proposals, and establish the next selection committee meeting date and time. After the first meeting, the Procurement professional will publically announce all subsequent committee meeting dates and times. The subsequent meeting dates and times will be posted with at least one (1) day advanced notice. 6. Selection committee members will independently review and score each proposal based a) on the evaluation criteria stated in the request for proposal using the Individual Selection Committee Score and Rank Form and prepare comments for discussion at the next meeting. The Individual Selection Committee Score and Rank Form is merely a tool to assist the selection committee member in their review of the proposals. U 7. At the scheduled selection meeting, the members will present their independent findings/ conclusions/comments based on their reading and interpretation of the materials CD presented to each other, and may ask questions of one another. At the conclusion of that discussion, members of the public will be offered an opportunity(not to exceed three (3) minutes)to provide comments. 8. At the conclusion of public comments (provided for in number 7), the selection committee members will individually rank order each proposer. Collier County selection committee E members may consider all the material submitted by the Proposer and other information o Collier County may obtain to determine whether the Proposer is capable of and has a history of successfully completing projects of this type, including, without limitation, additional information Collier County may request, clarification of proposer information, public comments, and/or additional credit information. 9. Once the individual ranking has been completed, the Procurement professional will direct selection committee members to read their individual ranking publically. The Procurement c professional will record individual rankings on the Final Ranking Sheet which will (a. mathematically compile into an overall selection committee rank of proposers. 10. In any of the selection committee meeting deliberations, by consensus, members may u- request to invite proposers in to clarify their proposals, ask for additional information, present materials, interview, ask questions, etc. The members may consider any and all information obtained through this method in formulating their individual ranking and subsequent selection committee overall ranking and final ranking. v 11.The selection committee's overall rank of firms in order of preference (from highest °' beginning with a rank of one (1) to the lowest) will be discussed and reviewed by the Procurement Strategist. By final consensus, and having used all information presented a (proposal, presentation, references, etc.), the selection committee members will create a final ranking and staff will subsequently enter into negotiations. Award of the contract is dependent upon the successful and full execution of a mutually agreed contract, pending the final approval by the Board of County Commissioners. 0 The County reserves the right to withdraw this RFP at any time and for any reason, and to issue such clarifications, modifications, and/or amendments as it may deem appropriate. E Receipt of a proposal by the County or a submission of a proposal to the County offers no rights upon the Vendor nor obligates the County in any manner. Acceptance of the proposal does not guarantee issuance of any other governmental approvals. 8 Proposals which include provisions requiring the granting of zoning variances shall not be considered. ta a> 16-6614 RFP_Non_CCNATemplate_01202016 12 Packet Pg. 1609 16.E.1.c 10. References The County reserves the right to contact any and all references pertaining to this solicitation and related proposal. 11. Proposal Selection Committee and Evaluation Factors a) The County Manager shall appoint a Selection Committee to review all proposals submitted. The factors to be considered in the evaluation of proposal responses are listed below. U 0 m Tab II, Ability to Comply with Scope of Services 15 points 2 Tab III, Cost of Services to the County 20 Points o Tab IV, Experience and Capacity of Firm 20 Points Tab V, Specialized Expertise of Team Members 25 Points Tab VI, References 10 Points Local Vendor Preference 10 Points o TOTAL 100 Points U) a> Tie Breaker: In the event of a tie, both in individual scoring and in final ranking, the firm with the lowest paid dollars by Collier County to the vendor (as obtained from the County's financial system) within the last five (5) years will receive the higher individual ranking. If there is a multiple firm tie in either individual scoring or final ranking, the firm with the lowest volume of work shall to receive the higher ranking, the firm with the next lowest volume of work shall receive the next c0 highest ranking and so on. a u_ 12. Acceptance or Rejection of Proposals L ca The right is reserved by the County to waive any irregularities in any proposal, to reject any or all proposals, to re-solicit for proposals, if desired, and upon recommendation and justification by Collier County to accept the proposal which in the judgment of the County is deemed the most ti advantageous for the public and the County of Collier. Any proposal which is incomplete, conditional, obscure or which contains irregularities of any kind, ;i may be cause for rejection. In the event of default of the successful Vendor, or their refusal to a. enter into the Collier County contract, the County reserves the right to accept the proposal of any c other Vendor or to re-advertise using the same or revised documentation, at its sole discretion. 0 4J ns N a) a. E 0 U 0) a, 0 Y (0 a> E r 16-6614 k a RFP_Non_CCNATemplate_01202016 13 Packet Pg. 1610 16.E.1.c Exhibit Ill: Collier County Purchase Order Terms and Conditions o c w 1. Offer and to comply with all carrier E m This offer is subject to cancellation by the regulations. Risk of loss of any goods as COUNTY without notice if not accepted by sold hereunder shall transfer to the c VENDOR within fourteen (14) days of COUNTY at the time and place of E issuance. delivery; provided that risk of loss prior o to actual receipt of the goods by the U 2. Acceptance and Confirmation COUNTY nonetheless remain with Iii This Purchase Order (including all VENDOR. o documents attached to or referenced b) No charges will be paid by the COUNTY a) therein) constitutes the entire agreement for packing, crating or cartage unless E between the parties, unless otherwise otherwise specifically stated in this o specifically noted by the COUNTY on the Purchase Order. Unless otherwise face of this Purchase Order. Each delivery provided in Purchase Order, no invoices c of goods and/or services received by the shall be issued nor payments made as o. COUNTY from VENDOR shall be deemed to prior to delivery. Unless freight and o be upon the terms and conditions contained other charges are itemized, any c) in this Purchase Order. discount will be taken on the full amount in of invoice. No additional terms may be added and c) All shipments of goods scheduled on the o Purchase Order may not be changed except same day via the same route must be by written instrument executed by the consolidated. Each shipping container v COUNTY. VENDOR is deemed to be on must be consecutively numbered and m notice that the COUNTY objects to any marked to show this Purchase Order T additional or different terms and conditions number. The container and Purchase Tt contained in any acknowledgment, invoice Order numbers must be indicated on bill a or other communication from VENDOR, of lading. Packing slips must show ec notwithstanding the COUNTY'S acceptance Purchase Order number and must be 12 or payment for any delivery of goods and/or included on each package of less than 3 services, or any similar act by VENDOR. container load (LCL) shipments and/or a with each car load of equipment. The v 3. Inspection COUNTY reserves the right to refuse or n'. All goods and/or services delivered return any shipment or equipment at =- hereunder shall be received subject to the VENDOR'S expense that is not marked Iii COUNTY'S inspection and approval and with Purchase Order numbers. G ii payment therefore shall not constitute VENDOR agrees to declare to the o. acceptance. All payments are subject to carrier the value of any shipment made Ce adjustment for shortage or rejection. All under this Purchase Order and the full defective or nonconforming goods will be invoice value of such shipment. o returned pursuant to VENDOR'S instruction d) All invoices must contain the Purchase at VENDOR'S expense. Order number and any other specific c information as identified on the m a To the extent that a purchase order requires Purchase Order. Discounts of prompt E a series of performances by VENDOR, the payment will be computed from the date c) COUNTY prospectively reserves the right to of receipt of goods or from date of L. cancel the entire remainder of the Purchase receipt of invoices, whichever is later. Order if goods and/or services provided Payment will be made upon receipt of a o early in the term of the Purchase Order are proper invoice and in compliance with non-conforming or otherwise rejected by the Chapter 218, Fla. Stats., otherwise 'a' COUNTY. known as the "Local Government Co 4. Shipping and Invoices Prompt Payment Act," and, pursuant to co a) All goods are FOB destination and must the Board of County Commissioners t- be suitably packed and prepared to Purchasing Policy. c secure the lowest transportation rates E C 16-6614 v RFP_Non_CCNATemplate_01202016 d 14 Packet Pg. 1611 16.E.1.c 0 5. Time Is Of the Essence and transportation shall conform to all Time for delivery of goods or performance of applicable laws, including but not limited to a0, services under this Purchase Order is of the the Occupational Health and Safety Act, the m essence. Failure of VENDOR to meet Federal Transportation Act and the Fair a) ca delivery schedules or deliver within a Labor Standards Act, as well as any law or c reasonable time, as interpreted by the regulation noted on the face of the Purchase 2 COUNTY in its sole judgment, shall entitle Order. N the COUNTY to seek all remedies available `a U to it at law or in equity. VENDOR agrees to 9. Advertising reimburse the COUNTY for any expenses No VENDOR providing goods and services a incurred in enforcing its rights. VENDOR to the COUNTY shall advertise the fact thato further agrees that undiscovered delivery of it has contracted with the COUNTY for nonconforming goods and/or services is not goods and/or services, or appropriate or o a waiver of the COUNTY'S right to insist make use of the COUNTY'S name or othercts upon further compliance with all identifying marks or property without the c specifications. prior written consent of the COUNTY'S ac. Purchasing Department. E 6. Changes v The COUNTY may at any time and by n written notice make changes to drawings 10. Indemnification Y and specifications, shipping instructions, VENDOR shall indemnify and hold harmless o quantities and delivery schedules within the the COUNTY from any and all claims, general scope of this Purchase Order. including claims of negligence, costs and v Should any such change increase or expenses, including but not limited to co decrease the cost of, or the time required for attorneys' fees, arising from, caused by or co performance of the Purchase Order, an related to the injury or death of any person equitable adjustment in the price and/or (including but not limited to employees and a. delivery schedule will be negotiated by the agents of VENDOR in the performance of w COUNTY and VENDOR. Notwithstanding their duties or otherwise), or damage to E the foregoing, VENDOR has an affirmative property (including property of the COUNTY d obligation to give notice if the changes will or other persons), which arise out of or are decrease costs. Any claims for adjustment incident to the goods and/or services to be Tr by VENDOR must be made within thirty(30) provided hereunder. r- days from the date the change is ordered or within such additional period of time as may 11. Warranty of Non-Infringement a be agreed upon by the parties. VENDOR represents and warrants that all i3: goods sold or services performed under this n. 7. Warranties Purchase Order are: a) in compliance with w VENDOR expressly warrants that the goods applicable laws; b) do not infringe any and/or services covered by this Purchase patent, trademark, copyright or trade secret; o Order will conform to the specifications, and c)do not constitute unfair competition. r drawings, samples or other descriptions a furnished or specified by the COUNTY, and VENDOR shall indemnify and hold harmless Q will be of satisfactory material and quality the COUNTY from and against any and all E production, free from defects and sufficient claims, including claims of negligence, costs c,) for the purpose intended. Goods shall be and expense, including but not limited to in delivered free from any security interest or attorneys' fees, which arise from any claim, Y other lien, encumbrance or claim of any third suit or proceeding alleging that the o party. These warranties shall survive COUNTY'S use of the goods and/or inspection, acceptance, passage of title and services provided under this Purchase Order T payment by the COUNTY. are inconsistent with VENDOR'S co representations and warranties in section 11 to r 8. Statutory Conformity (a). Goods and services provided pursuant to a this Purchase Order, and their production E r 16-6614 c. R RFP_Non_CCNATemplate_01202016 Q 15 Packet Pg. 1612 16.E.1.c 0 If any claim which arises from VENDOR'S beyond their control, including, but without breach of section 11 (a) has occurred, or is limitation to war, strikes, civil disturbances 0 likely to occur, VENDOR may, at the and acts of nature. When VENDOR has E COUNTY'S option, procure for the COUNTY knowledge of any actual or potential force rn 0 the right to continue using the goods or majeure or other conditions which will delay c ca services, or replace or modify the goods or or threatens to delay timely performance of E services so that they become non-infringing, this Purchase Order, VENDOR shall w (without any material degradation in immediately give notice thereof, including all f6 U performance, quality, functionality or relevant information with respects to what additional cost to the COUNTY). steps VENDOR is taking to complete 2 delivery of the goods and/or services to the i(i) 12. Insurance Requirements COUNTY. 2 The VENDOR, at its sole expense, shall o provide commercial insurance of such type 15. Assignment a and with such terms and limits as may be VENDOR may not assign this Purchase c reasonably associated with the Purchase Order, nor any money due or to become due Q. Order. Providing and maintaining adequate without the prior written consent of the o insurance coverage is a material obligation COUNTY. Any assignment made without c,> of the VENDOR. All insurance policies shall such consent shall be deemed void. L be executed through insurers authorized or 0 eligible to write policies in the State of 16. Taxes o Florida. Goods and services procured subject to this Purchase Order are exempt from Florida v 13. Compliance with Laws sales and use tax on real property, transient In fulfilling the terms of this Purchase Order, rental property rented, tangible personal (0 VENDOR agrees that it will comply with all purchased or rented, or services purchased 417 federal, state, and local laws, rules, codes, (Florida Statutes, Chapter 212), and from a. and ordinances that are applicable to the federal excise tax. cc conduct of its business. By way of non 7. - ca exhaustive example, this shall include the 17. Annual Appropriations 3 American with Disabilities Act and all The COUNTY'S performance and obligation Q prohibitions against discrimination on the to pay under this Purchase Order shall be basis of race, religion, sex creed, national contingent upon an annual appropriation of ti origin, handicap, marital status, or veterans' funds. =- status. Further, VENDOR acknowledges and without exception or stipulation shall be 18. Termination LE fully responsible for complying with the This Purchase Order may be terminated at r,. provisions of the Immigration Reform and any time by the COUNTY upon 30 days U- Control Act of 1986 as located at 8 U.S.C. prior written notice to the VENDOR. This 1324, et seq. and regulations relating Purchase Order may be terminated o thereto, as either may be amended. Failure immediately by the COUNTY for breach by m by the awarded firm(s) to comply with the VENDOR of the terms and conditions of this c laws referenced herein shall constitute a Purchase Order, provided that COUNTY has 0 breach of the award agreement and the provided VENDOR with notice of such E County shall have the discretion to breach and VENDOR has failed to cure U unilaterally terminate said agreement within 10 days of receipt of such notice. 0 immediately. Any breach of this provision Y may be regarded by the COUNTY as a 19. General o material and substantial breach of the a) This Purchase Order shall be governed contract arising from this Purchase Order. by the laws of the State of Florida. The .4' venue for any action brought to 14. Force Majeure specifically enforce any of the terms and cc Neither the COUNTY nor VENDOR shall be conditions of this Purchase Order shall responsible for any delay or failure in be the Twentieth Judicial Circuit in and c a> performance resulting from any cause for Collier County, Florida E 16-6614 0 2 r RFP_Non_CCNATemplate_01202016 Q 16 Packet Pg. 1613 16.E.1.c 0 b) Failure of the COUNTY to act associated with this Purchase Order in immediately in response to a breach of accordance with Florida Statute Chapter this Purchase Order by VENDOR shall 112.061, Per Diem and Travel not constitute a waiver of breach. Expenses for Public Officers, employees Waiver of the COUNTY by any default and authorized persons. by VENDOR hereunder shall not be e) In the event of any conflict between or 2 deemed a waiver of any subsequent among the terms of any Contract cn default by VENDOR. Documents related to this Purchase c) All notices under this Purchase Order Order, the terms of the Contract - shall be sent to the respective Documents shall take precedence over addresses on the face page by certified the terms of the Purchase Order. To the ami mail, return receipt requested, by extent any terms and /or conditions of 2 overnight courier service, or by personal this Purchase Order duplicate or overlap delivery and will be deemed effective the Terms and Conditions of the 7 upon receipt. Postage, delivery and Contract Documents, the provisions of other charges shall be paid by the the Terms and/or Conditions that are Q. sender. A party may change its address most favorable to the County and/or o for notice by written notice complying provide the greatest protection to the with the requirements of this section. County shall govern. d) The Vendor agrees to reimbursement of any travel expenses that may be o a LL Ce T. '.r h- a.a. LL O a N G 0 E O U N L L O Ts; 4. C a) E s- 16-6614 16-6614 RFP_Non_CCNATemplate_01202016 17 Packet Pg. 1614 16.E.1.c Exhibit IV: Additional Terms and Conditions for RFP 1. Insurance Requirements a) The Vendor shall at its own expense, carry and maintain insurance coverage from responsible companies duly authorized to do business in the State of Florida as set forth in the Insurance and Bonding attachment of this solicitation. The Vendor shall procure and maintain property insurance upon the entire project, if required, to the full insurable value of the scope of work. f6 The County and the Vendor waive against each other and the County's separate Vendors, U Contractors, Design Consultant, Subcontractors agents and employees of each and all of them, all damages covered by property insurance provided herein, except such rights as they may have to the proceeds of such insurance. The Vendor and County shall, where appropriate, require similar 2 waivers of subrogation from the County's separate Vendors, Design Consultants and Subcontractors and shall require each of them to include similar waivers in their contracts. Collier County shall be responsible for purchasing and maintaining, its own liability insurance. 0 Certificates issued as a result of the award of this solicitation must identify "For any and all work performed on behalf of Collier County." The General Liability Policy provided by Vendor to meet the requirements of this solicitation shall name Collier County, Florida, as an additional insured as to the operations of Vendor under this solicitation and shall contain a severability of interests provisions. CD Collier County Board of County Commissioners shall be named as the Certificate Holder. The a Certificates of Insurance must state the Contract Number, or Project Number, or specific Project u. fx description, or must read: For any and all work performed on behalf of Collier County. The "Certificate Holder" should read as follows: o Collier County Board of County Commissioners Naples, Florida The amounts and types of insurance coverage shall conform to the minimum requirements set forth in the Insurance and Bonding attachment, with the use of Insurance Services Office (ISO)forms and n endorsements or their equivalents. If Vendor has any self-insured retentions or deductibles under any of the below listed minimum required coverage, Vendor must identify on the Certificate of Insurance the nature and amount of such self- insured retentions or deductibles and provide 0 w satisfactory evidence of financial responsibility for such obligations. All self-insured retentions or deductibles will be Vendor's sole responsibility. Q E Coverage(s) shall be maintained without interruption from the date of commencement of the Work 0 until the date of completion and acceptance of the scope of work by the County or as specified in this solicitation, whichever is longer. Y 0 The Vendor and/or its insurance carrier shall provide 30 days written notice to the County of policy cancellation or non-renewal on the part of the insurance carrier or the Vendor. The Vendor shall also notify the County, in a like manner, within twenty-four(24) hours after receipt, of any notices of expiration, cancellation, non-renewal or material change in coverage or limits received by Vendor from its insurer and nothing contained herein shall relieve Vendor of this requirement to provide notice. In the event of a reduction in the aggregate limit of any policy to be provided by Vendor E 16-6614 ca RFP_Non_CCNATemplate_01202016 18 Packet Pg. 1615 16.E.1.c hereunder, Vendor shall immediately take steps to have the aggregate limit reinstated to the full extent permitted under such policy. -. Should at any time the Vendor not maintain the insurance coverage(s) required herein, the County a may terminate the Agreement or at its sole discretion shall be authorized to purchase such CD coverage(s) and charge the Vendor for such coverage(s) purchased. If Vendor fails to reimburse the County for such costs within thirty(30) days after demand, the County has the right to offset these costs from any amount due Vendor under this Agreement or any other agreement between the 2 County and Vendor. The County shall be under no obligation to purchase such insurance, nor shall it be responsible for the coverage(s) purchased or the insurance company or companies used. The decision of the County to purchase such insurance coverage(s) shall in no way be construed to be a waiver of any of its rights under the Contract Documents. If the initial or any subsequently issued Certificate of Insurance expires prior to the completion of the o scope of work, the Vendor shall furnish to the County renewal or replacement Certificate(s) of Insurance not later than ten (10) calendar days after the expiration date on the certificate. Failure of the Vendor to provide the County with such renewal certificate(s) shall be considered justification for Q the County to terminate any and all contracts. o v 2. Offer Extended to Other Governmental Entities In Collier County encourages and agrees to the successful vendor extending the pricing, terms and conditions of this solicitation or resultant contract to other governmental entities at the discretion of the successful vendor. 3. Additional Items and/or Services a u_ Additional items and / or services may be added to the resultant contract, or purchase order, in compliance with the Purchasing Policy. B 4. County's Right to Inspect Q The County or its authorized Agent shall have the right to inspect the Vendor's facilities/project site during and after each work assignment the Vendor is performing. rts L 5. Vendor Performance Evaluation LL ce The County has implemented a Vendor Performance Evaluation System for all contracts awarded in excess of $25,000. To this end, vendors will be evaluated on their performance upon completion/termination of this Agreement. 6. Additional Terms and Conditions of Contract ° Collier County has developed standard contracts/agreements, approved by the Board of County Commissioners (BCC). The selected Vendor shall be required to sign a standard Collier County contract within twenty one (21) days of Notice of Selection for Award. 8 The resultant contract(s) may include purchase or work orders issued under one, or any combination of price methodologies by the County's project manager: Lump Sum (Fixed Price): a firm fixed total price offering for a project; the risks are transferred from the County to the contractor; and, as a business practice there are no hourly or material 16-6614 a RFP_Non_CCNATemplate_01202016 19 Packet Pg. 1616 16.E.1.c invoices presented, rather, the contractor must perform to the satisfaction of the County's project manager before payment for the fixed price contract is authorized. Time and Materials: the County agrees to pay the contractor for the amount of labor time spent by the contractor's employees and subcontractors to perform the work(number of hours times hourly rate), and for materials and equipment used in the project(cost of materials plus the contractor's mark up). This methodology is generally used in projects in which it is not possible to accurately estimate the size of the project, or when it is expected that the project requirements 2 CD would most likely change. As a general business practice, these contracts include back-up ca documentation of costs; invoices would include number of hours worked and billing rate by U position (and not company(or subcontractor)timekeeping or payroll records), material or equipment invoices, and other reimbursable documentation for the project. CD2 Unit Price: the County agrees to pay a firm total fixed price (inclusive of all costs, including labor, o materials, equipment, overhead, etc.)for a repetitive product or service delivered (i.e. installation price per ton, delivery price per package or carton, etc.). The invoice must identify the unit price c and the number of units received (no contractor inventory or cost verification required). 0 The County reserves the right to include in any contract document such terms and conditions, as it deems necessary for the proper protection of the rights of Collier County. A sample copy of this contract is available upon request. The County will not be obligated to sign any contracts, maintenance and/or service agreements or other documents provided by the Vendor. The County's project manager, shall coordinate with the Vendor/Contractor the return of any surplus assets, including materials, supplies, and equipment associated with the scope or work. n. 7. Payment Method P_ Payments are made in accordance with the Local Government Prompt Payment Act, Chapter 218, Florida Statutes. Vendor's invoices must include: • Purchase Order Number • Description and quantities of the goods or services provided per instructions on the County's purchase order or contract. ii Invoices shall be sent to: a. U- Board of County Commissioners Clerk's Finance Department ATTN: Accounts Payable 3299 Tamiami Trail E Ste 700 cD Naples FL 34112 0 Or emailed to: bccapclerk( collierclerk.com. Collier County, in its sole discretion, will determine the method of payment for goods and/or services `o as part of this agreement. (173 Payment methods include: • Traditional — payment by check, wire transfer or other cash equivalent. a) 16-6614 t2 RFP_Non_CCNATemplate_01202016 eC 20 Packet Pg. 1617 16.E.1.c • Standard —payment by purchasing card. Collier County's Purchasing Card Program is supported by standard bank credit suppliers (i.e. VISA and MasterCard), and as such, is cognizant of the Rules for VISA Merchants and MasterCard Merchant Rules. The County may not accept any additional surcharges (credit card transaction fees) as a result of using the County's credit card for transactions relating to this solicitation. The County will entertain bids clearly stating pricing for standard payment methods. An additional separate discounted price for traditional payments may be provided at the initial bid submittal if it is clearly marked as an CI) "Additional Cash Discount." U Upon execution of the Contract and completion of each month's work, payment requests may be submitted to the Project Manager on a monthly basis by the Contractor for services rendered for that prior month. Services beyond sixty(60) days from current monthly invoice will not be considered for 2 payment without prior approval from the Project manager. All invoices should be submitted within o the fiscal year the work was performed. (County's fiscal year is October 1 - September 30.) N Invoices submitted after the close of the fiscal year will not be accepted (or processed for payment) unless specifically authorized by the Project Manager. Payments will be made for articles and/or services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of contract. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of "laches" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this agreement. In instances where the successful contractor may owe debts (including, but not limited to taxes or other fees) to Collier County and the contractor has not satisfied nor made arrangement to satisfy a. these debts, the County reserves the right to off-set the amount owed to the County by applying the u. amount owed to the vendor or contractor for services performed of for materials delivered in association with a contract. Invoices shall not reflect sales tax. After review and approval, the invoice will be transmitted to the Finance Division for payment. Payment will be made upon receipt of proper invoice and in compliance with Chapter 218 Florida Statutes, otherwise known as the "Local Government Prompt Payment Act." Collier County reserves the right to withhold and/or reduce an appropriate amount of any payment for work not performed or for unsatisfactory performance of Contractual requirements. a u_ 8. Environmental Health and Safety All Vendors and Sub vendors performing service for Collier County are required and shall comply with all Occupational Safety and Health Administration (OSHA), State and County Safety and Occupational Health Standards and any other applicable rules and regulations. Vendors and Sub vendors shall be responsible for the safety of their employees and any unsafe acts or conditions that o may cause injury or damage to any persons or property within and around the work site. All firewall v penetrations must be protected in order to meet Fire Codes. a) Collier County Government has authorized OSHA representatives to enter any Collier County facility, property and/or right-of-way for the purpose of inspection of any Vendor's work operations. This provision is non-negotiable by any department and/or Vendor. All new electrical installations shall incorporate NFPA 70E Short Circuit Protective Device Coordination and Arc Flash Studies where relevant as determined by the engineer. r 16-6614 ei RFP_Non_CCNATemplate_01202016 21 Packet Pg. 1618 16.E.1.c All electrical installations shall be labeled with appropriate NFPA 70E arch flash boundary and PPE Protective labels. 0 Y 9. Licenses CO E The Vendor is required to possess the correct Business Tax Receipt, professional license, and any other authorizations necessary to carry out and perform the work required by the project pursuant to all applicable Federal, State and Local Law, Statute, Ordinances,and rules and regulations of any kind. Additionally, copies of the required licenses must be submitted with the proposalCO response indicating that the entity proposing, as well as the team assigned to the County U account, is properly licensed to perform the activities or work included in the contract documents. Failure on the part of any Vendor to submit the required documentation may be grounds to deem Vendor non-responsive. A Vendor, with an office within Collier County is also 5 required to have an occupational license. o All State Certified contractors who may need to pull Collier County permits or call in inspections must complete a Collier County Contractor License registration form and submit the required fee. After registering the license/registration will need to be renewed thereafter to remain "active" in Collier 0 County. a> If you have questions regarding professional licenses contact the Contractor Licensing, Community L Development and Environmental Services at(239) 252-2431, 252-2432 or 252-2909. Questions regarding required occupational licenses, please contact the Tax Collector's Office at (239) 252- 2477. CD 10. Principals/Collusion a By submission of this Proposal the undersigned, as Vendor, does declare that the only person or persons interested in this Proposal as principal or principals is/are named therein and that no person other than therein mentioned has any interest in this Proposal or in the contract to be entered into; that this Proposal is made without connection with any person, company or parties making a Proposal, and that it is in all respects fair and in good faith without collusion or fraud. ti 11. Relation of County U. It is the intent of the parties hereto that the Vendor shall be legally considered an independent a- Vendor, and that neither the Vendor nor their employees shall, under any circumstances, be ce considered employees or agents of the County, and that the County shall be at no time legally responsible for any negligence on the part of said Vendor, their employees or agents, resulting in either bodily or personal injury or property damage to any individual, firm, or corporation. cn a) 12. Termination E 0 Should the Vendor be found to have failed to perform his services in a manner satisfactory to the County, the County may terminate this Agreement immediately for cause; further the County may terminate this Agreement for convenience with a thirty(30) day written notice. The County shall be sole judge of non-performance. P 13. Lobbying to All firms are hereby placed on NOTICE that the Board of County Commissioners does not wish to be lobbied, either individually or collectively about a project for which a firm has submitted a Proposal. 16-6614 tt3 RFP_Non_CCNATemplate_01202016 22 Packet Pg. 1619 16.E.1.c Firms and their agents are not to contact members of the County Commission for such purposes as meeting or introduction, luncheons, dinners, etc. During the process, from Proposal closing to 0 final Board approval, no firm or their agent shall contact any other employee of Collier County in E' reference to this Proposal, with the exception of the Procurement Director or his designee(s). Failure to abide by this provision may serve as grounds for disqualification for award of this contract to the cc firm. 14. Public Records Compliance ca The Vendor/Contractor agrees to comply with the Florida Public Records Law Chapter 119 (including specifically those contractual requirements at F.S. § 119.0701(2) (a)-(d) and (3)), ordinances, codes, rules, regulations and requirements of any governmental agencies. 2 c 0 15. Certificate of Authority to Conduct Business in the State of Florida (Florida Statute 607.1501) U) In order to be considered for award, firms must be registered with the Florida Department of State Divisions of Corporations in accordance with the requirements of Florida Statute 607.1501 and o provide a certificate of authority (www.sunbiz.orq/search.html) prior to execution of a contract. A copy of the document may be submitted with the solicitation response and the document number shall be identified. Firms who do not provide the certificate of authority at the time of response shall be required to provide same within five (5) days upon notification of selection for award. If the firm cannot provide the document within the referenced timeframe, the County reserves the right to award v to another firm. 16. Single Proposal a Each Vendor must submit, with their proposal, the required forms included in this RFP. Only one proposal from a legal entity as a primary will be considered. A legal entity that submits a proposal as a primary or as part of a partnership or joint venture submitting as primary may not then act as a sub- a consultant to any other firm submitting under the same RFP. If a legal entity is not submitting as a primary or as part of a partnership or joint venture as a primary, that legal entity may act as a sub- consultant to any other firm or firms submitting under the same RFP. All submittals in violation of this requirement will be deemed non-responsive and rejected from further consideration. U- 17. Survivability a. L Purchase Orders: The Consultant agrees that any Purchase Order that extends beyond the expiration date of the original Solicitation 16-6614 will survive and remain subject to the terms and 0 conditions of that Agreement until the completion or termination of this Purchase Order. N c 0 18. Protest Procedures ° 0 Any prospective vendor/ proposer who desires to protest any aspect(s) or provision(s) of the - solicitation (including the form of the solicitation documents or procedures) shall file their protest with the Procurement Director prior to the time of the bid opening strictly in accordance with the County's then current purchasing ordinance and policies. The Board of County Commissioners will make award of contract in public session. Award recommendations will be posted outside the offices of the Purchasing Department on Wednesdays and Thursdays. Any actual or prospective respondent who desires to formally protest the recommended contract award must file a notice of intent to protest with the Procurement Director 16-6614 k RFP_Non_CCNATemplate_01202016 23 Packet Pg. 1620 16.E.1.c within two (2) calendar days (excluding weekends and County holidays) of the date that the recommended award is posted. 0 Upon filing of said notice, the protesting party will have five (5) days to file a formal protest and will be a given instructions as to the form and content requirements of the formal protest. A copy of the CD "Protest Policy" is available at the office of the Procurement Director. en 19. Public Entity Crime a A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or 2 replies on leases of real property to a public entity; may not be awarded or perform work as a o contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not 7 transact business with any public entity in excess of the threshold amount provided in s. 287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted E vendor list. o U 20. Security and Background Checks 1- If required, Vendor/ Contractor/ Proposer shall be responsible for the costs of providing background checks by the Collier County Facilities Management Department, and drug testing for all employees that shall provide services to the County under this Agreement. This may include, but not be limited to, checking federal, state and local law enforcement records, including a state and FBI fingerprint check, credit reports, education, residence and employment verifications and other related records. Contractor shall be required to maintain records on each employee and make them available to the ,a� County for at least four(4) years. 21. Conflict of Interest Vendor shall complete the Conflict of Interest Affidavit included as an attachment to this RFP document. Disclosure of any potential or actual conflict of interest is subject to County staff review and does not in and of itself disqualify a firm from consideration. These disclosures are intended to �a identify and or preclude conflict of interest situations during contract selection and execution. ii: o. 22. Prohibition of Gifts to County Employees ce No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, ° service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, the current Collier County Ethics Ordinance and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by E the individual, firm, and/or any employee of the firm from contact with County staff for a specified v period of time; b. Prohibition by the individual and/or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/or quotes; and, c. 0 immediate termination of any contract held by the individual and/or firm for cause. 23. Immigration Affidavit Certification CD Statutes and executive orders require employers to abide by the immigration laws of the United States and to employ only individuals who are eligible to work in the United States. E 16-6614 RFP_Non_CCNATemplate_01202016 24 Packet Pg. 1621 16.E.1.c The Employment Eligibility Verification System (E-Verify) operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA), provides an Internet- based means of verifying employment eligibility of workers in the United States; it is not a substitute ° for any other employment eligibility verification requirements. The program will be used for Collier County formal Invitations to Bid (ITB) and Request for Proposals (RFP) including professional services and construction services. as Exceptions to the program: • Commodity based procurement where no services are provided. cu • Where the requirement for the affidavit is waived by the Board of County Commissioners Vendors / Bidders are required to enroll in the E-Verify program, and provide acceptable evidence of their enrollment, at the time of the submission of the vendor's/bidder's proposal. Acceptable 2 evidence consists of a copy of the properly completed E-Verify Company Profile page or a copy of o the fully executed E-Verify Memorandum of Understanding for the company. Vendors are also required to provide the Collier County Purchasing Department an executed affidavit certifying they shall comply with the E-Verify Program. The affidavit is attached to the solicitation documents. If the Bidder/Vendor does not comply with providing both the acceptable E-Verify evidence and the executed affidavit the bidder's /vendor's proposal may be deemed non-responsive. Un N Additionally, vendors shall require all subcontracted vendors to use the E-Verify system for all purchases not covered under the "Exceptions to the program" clause above. For additional information regarding the Employment Eligibility Verification System (E-Verify) program w visit the following website: http://www.dhs.gov/E-Verify. It shall be the vendor's responsibility to familiarize themselves with all rules and regulations governing this program. a u. Vendor acknowledges, and without exception or stipulation, any firm(s) receiving an award shall be fully responsible for complying with the provisions of the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended and with the provisions contained within this affidavit. Failure by the awarded firm(s)to comply with the laws referenced herein or the provisions of this affidavit shall constitute a breach of the award a) agreement and the County shall have the discretion to unilaterally terminate said agreement immediately. 173 24. Collier County Local Preference Policy a. Collier County provides an incentive to local business to enhance the opportunities of local businesses in the award of County contracts. In the evaluation of proposals, the County rewards ° Vendors for being a local business by granting a ten (10) points incentive in the evaluation criterion points. a E Local business means the vendor has a current Business Tax Receipt issued by the Collier County °� Tax Collector for at least one year prior to bid or proposal submission to do business within Collier i County, and that identifies the business with a permanent physical business address located within Y the limits of Collier County from which the vendor's staff operates and performs business in an area 8 zoned for the conduct of such business. A Post Office Box or a facility that receives mail, or a non- permanent structure such as a construction trailer, storage shed, or other non-permanent structure shall not be used for the purpose of establishing said physical address. In addition to the foregoing, a t° vendor shall not be considered a "local business" unless it contributes to the economic development and well-being of Collier County in a verifiable and measurable way. This may include, but not be limited to, the retention and expansion of employment opportunities, support and increase to the 16-6614 c,. RFP_Non_CCNATemplate_01202016 25 Packet Pg. 1622 16.E.1.c County's tax base, and residency of employees and principals of the business within Collier County. Vendors shall affirm in writing their compliance with the foregoing at the time of submitting their bid or proposal to be eligible for consideration as a "local business" under this section. A vendor who misrepresents the Local Preference status of its firm in a proposal or bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one year. Under this solicitation proposers desiring to receive local preference will be invited and required toca affirmatively state and provide documentation as set forth in the solicitation in support of their status as a local business. Any proposer who fails to submit sufficient documentation with their proposal offer shall not be granted local preference consideration for the purposes of that specific contract award. Except where federal or state law, or any other funding source, mandates to the U contrary, Collier County and its agencies and instrumentalities, will give preference to local Ta businesses in the following manner. For all purchases of commodities and services procured through a competitive proposal process o and not otherwise exempt from this local preference section, the solicitation shall include a weighted criterion for local preference that equals 10 percent of the total points in the evaluation criteria published in the solicitation. Purchases of professional services as defined and identified under subsection 11B.2 (which are subject to Section 287.055, F.S.) and subsection 11B.3 (which ° are subject to Section 11.45, F.S.) shall not be subject to this local preference section. U The vendor must complete and submit with their proposal response the Affidavit for Claiming Status as a Local Business which is included as part of this solicitation. Failure on the part of a vendor to submit this Affidavit with their proposal response will preclude said Vendor from being considered for local preference under this solicitation. A vendor who misrepresents the Local Preference status of its firm in a proposal or bid submitted to ft the County will lose the privilege to claim Local Preference status for a period of up to one year. ti ii 0 N a.O N a) 16-6614 ca RFP_Non_CCNATemplate_01202016 26 Packet Pg. 1623 16.E.1.c Collier County 0 Administrative Services Department F'roourement Services QI✓is(on a) E Attachment 1: Vendor's Non-Response Statement The sole intent of the Collier County Purchasing Department is to issue solicitations that are clear, concise and openly competitive. Therefore, we are interested in ascertaining reasons for prospective Vendors not wishing to respond to this solicitation. If your firm is not responding to this RFP, please U indicate the reason(s) by checking the item(s) listed below and return this form via email or fax, noted on Ta the cover page, or mail to Collier County Government, Purchasing Department, 3327 Tamiami Trail E, Naples, FL 34112. 2 We are not responding to Solicitation#16-6614 Workers' Compensation Medical Case Management Program for the following reason(s): 0. [ Services requested not available through our company. Our firm could not meet specifications/scope of work. a i 0 ❑ Specifications/scope of work not clearly understood or applicable (too vague, rigid, etc.) ❑ Project is too small. ❑ Insufficient time allowed for preparation of response. a LL ❑ Incorrect address used. Please correct mailing address: rn ti ❑ Other reason(s): U- Name of Firm: ° :a ° Address: Q. City, State, Zip: (n Telephone: Email: Representative Signature: Representative Name: Date a) E 16-6614 RFP_Non_CCNATemplate_01202016 27 Packet Pg. 1624 16.E.1.c Co lier County Administrative Services Department ;; Proauement Services Division C G) E Attachment 2: Vendor Check List IMPORTANT: THIS SHEET MUST BE SIGNED. Please read carefully, sign in the spaces a indicated and return with your Proposal. Vendor should check off each of the following items as the cis necessary action is completed: 0 Tts ❑ The Proposal has been signed. ❑ All applicable forms have been signed and included, along with licenses to complete the o requirements of the project. ❑ Any addenda have been signed and included. a 0 ❑ The mailing envelope has been addressed to: U Collier County Government a Purchasing Department 3327 Tamiami Trail E Naples FL 34112 Attn: Rhonda Burns, FCCN, CPPB, Procurement Strategist ❑ The mailing envelope must be sealed and marked with Solicitation #16-6614 Workers' Compensation Medical Case Management Program and May 17, 2016. u_ [ The Proposal will be mailed or delivered in time to be received no later than the specified due date o and time. (Otherwise Proposal cannot be considered.) a ❑ If submitting a manual bid, include any addenda (initialed and dated noting understanding and receipt). If submitting bid electronically, bidder will need to download all related documents on www.colliergov.net/bid. The system will date and time stamp when the addendum files were downloaded. n. ALL COURIER-DELIVERED PROPOSALS MUST HAVE THE RFP NUMBER AND TITLE ON THE u_ OUTSIDE OF THE COURIER PACKET. 0 Name of Firm: N Address: c City, State, Zip: Telephone: Email: Representative Signature: Representative Name: Date CD 16-6614 V. RFP_Non_CCNATemplate_01202016 28 Packet Pg. 1625 16.E.1.c Collier County Administrative Services Department �- Procurement Services division E N E tU Attachment 3: Conflict of Interest Affidavit to 2 By the signature below, the firm (employees, officers and/or agents) certifies, and hereby discloses, that, to the best of their knowledge and belief, all relevant facts concerning past, present, or currently planned U interest or activity (financial, contractual, organizational, or otherwise)which relates to the proposed work; and bear on whether the firm (employees, officers and/or agents) has a possible conflict have been fully disclosed. 5 c 0 Additionally, the firm (employees, officers and/or agents) agrees to immediately notify in writing the Procurement Director, or designee, if any actual or potential conflict of interest arises during the contract c and/or project duration. 0 Firm: L Signature and Date: 0 Print Name Title of Signatory T a State of County of a) SUBSCRIBED AND SWORN to before me this day of , 20 , by , who is personally known to me to be the for the Firm, OR who produced the following identification LL ce c 0 Notary Public My Commission Expires 0 U 16-6614 RFP_Non_CCNATemplate_01202016 29 Packet Pg. 1626 16.E.1.c olliier County 0 Administrative Services Department Procurement Services Divsior () E a) Attachment 4: Vendor Declaration Statement BOARD OF COUNTY COMMISSIONERS Collier County Government Complex U Naples, Florida 34112 V a, 2 RE: Solicitation: #16-6614 Workers' Compensation Medical Case Management Program o �a Dear Commissioners: a> a The undersigned, as Vendor declares that this proposal is made without connection or arrangement with o any other person and this proposal is in every respect fair and made in good faith, without collusion or v fraud. The Vendor agrees, if this proposal is accepted, to execute a Collier County document for the purpose of establishing a formal contractual relationship between the firm and Collier County, for the performance of c all requirements to which the proposal pertains. The Vendor states that the proposal is based upon the proposal documents listed by Solicitation: #16-6614 Workers' Compensation Medical Case Management Program. LL I- (Proposal Continued on Next Page) 1 L 63L O C" _ C� G 16-6614 RFP_Non_CCNATemplate_01202016 30 Packet Pg. 1627 16.E.1.c PROPOSAL CONTINUED IN WITNESS WHEREOF, WE have hereunto subscribed our names on this day of , 20 in the County of , in the State of • m E Firm's Legal Name: a, as c Address: `° a, U) City, State, Zip Code: f° U Florida Certificate of Authority Document Number: ° Federal Tax Identification c Number r CCR#or CAGE Code c Telephone: m E FAX: U N i Signature by: a' (Typed and written) Title: to Additional Contact Information u; Send payments to: (required if different from above) Company name used as payee LL Contact name: z Title: Address: a) ti City, State,ZIP ca Telephone: ° ii a. FAX: u- Email: 0 CO ca Office servicing Collier N c County to place orders a (required if different from above) E Contact name: o U Title: Cl) a� .x Address: ° City, State,ZIP CD ti" Telephone: Email C° C 0 E 16-6614 RFP_Non_CCNATemplate_01202016 31 Packet Pg. 1628 16.E.1.c COIiier County Administrative Services Department Procurement Sep ces Si vision C Attachment 5: Affidavit for Claiming Status as a Local Business as Solicitation: #16-6614 Workers' Compensation Medical Case Management Program (Check Appropriate Boxes Below) a m N State of Florida (Select County if Vendor is described as a Local Business c.j ❑ Collier County Ta ❑ Lee County d Vendor affirms that it is a local business as defined by the Purchasing Policy of the Collier County Board of County Commissioners and the Regulations Thereto. As defined in Section XI of the Collier County Purchasing Policy: o Local business means the vendor has a current Business Tax Receipt issued by the Collier County Tax Collector for at least one year prior to bid or proposal submission to do business within Collier County, and that identifies the business with a permanent physical business address located within the limits of Collier County from which the a vendor's staff operates and performs business in an area zoned for the conduct of such business. A Post Office Box or a facility that receives mail, or a non-permanent structure such as a construction trailer, storage shed, or ci other non-permanent structure shall not be used for the purpose of establishing said physical address. In addition to the foregoing, a vendor shall not be considered a "local business" unless it contributes to the economic a) development and well-being of Collier County in a verifiable and measurable way. This may include, but not be o limited to, the retention and expansion of employment opportunities, support and increase to the County's tax base, and residency of employees and principals of the business within Collier County. Vendors shall affirm in writing �* their compliance with the foregoing at the time of submitting their bid or proposal to be eligible for consideration as a "local business" under this section. A vendor who misrepresents the Local Preference status of its firm in a co proposal or bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one year. ft IX Vendor must complete the following information: Year Business Established in ❑Collier County or ❑ Lee County: Number of Employees(Including Owner(s)or Corporate Officers): Number of Employees Living in ❑ Collier County or❑ Lee(Including Owner(s)or Corporate Officers): ii If requested by the County, vendor will be required to provide documentation substantiating the information given in o_ this affidavit. Failure to do so will result in vendor's submission being deemed not applicable. Vendor Name: Date: Collier or Lee County Address: Signature: Title: E STATE OF FLORIDA v n COLLIER COUNTY E LEE COUNTY as Sworn to and Subscribed Before Me, a Notary Public, for the above State and County, on this Day of , 20 ° co Notary Public My Commission Expires: (AFFIX OFFICIAL SEAL) 16-6614 V co RFP_Non_CCNATemplate_01202016 32 Packet Pg. 1629 16.E.1.c Cotter County } w 0 Administrative Services Department Procurement Sery ces Dr,is:on a) E Attachment 6: Immigration Affidavit Certification Solicitation: #16-6614 Workers' Compensation Medical Case Management Program 2 ° This Affidavit is required and should be signed, notarized by an authorized principal of the firm and submitted with formal Invitations to Bid (ITB's)and Request for Proposals (RFP)submittals. Further, Vendors/ Bidders are Ta required to enroll in the E-Verify program, and provide acceptable evidence of their enrollment, at the time of the submission of the vendor's/bidder's proposal. Acceptable evidence consists of a copy of the properly completed E-Verify Company Profile page or a copy of the fully executed E-Verify Memorandum of Understanding for the company. Failure to include this Affidavit and acceptable evidence of enrollment ° in the E-Verify program, may deem the Vendor/ Bidder's proposal as non-responsive. y Collier County will not intentionally award County contracts to any vendor who knowingly employs unauthorized alien workers, constituting a violation of the employment provision contained in 8 U.S.C. Section 1324 a(e) Section 274A(e) of the Immigration and Nationality Act("INA"). U Collier County may consider the employment by any vendor of unauthorized aliens a violation of Section 274A(e) L of the INA. Such Violation by the recipient of the Employment Provisions contained in Section 274A(e)of the INA L shall be grounds for unilateral termination of the contract by Collier County. Vendor attests that they are fully compliant with all applicable immigration laws(specifically to the 1986 Immigration Act and subsequent Amendment(s))and agrees to comply with the provisions of the Memorandum of Understanding with E-Verify and to provide proof of enrollment in The Employment Eligibility Verification System co (E-Verify), operated by the Department of Homeland Security in partnership with the Social Security Administration a at the time of submission of the Vendor's/Bidder's proposal. u. Company Name Print Name Title 0, Signature Date Ct State of a County of The foregoing instrument was signed and acknowledged before me this day of ° 20_, by N who has produced as identification. (Print or Type Name) (Type of Identification and Number) Notary Public Signature Printed Name of Notary Public Notary Commission Number/Expiration co The signee of this Affidavit guarantees, as evidenced by the sworn affidavit required herein, the truth and accuracy of this affidavit to interrogatories hereinafter made. c ° .1- 16-6614 16-6614 RFP_Non_CCNATemplate_01202016 33 Packet Pg. 1630 16.E.1.c Collier County Administrative Services Department o Procurement Services D;vision +' 0 E Attachment 7: Vendor Substitute W—9 d LS) Request for Taxpayer Identification Number and Certification = co In accordance with the Internal Revenue Service regulations, Collier County is required to collect the following information for tax reporting purposes from individuals and companies who do business with the County(including social security numbers if used by the individual or company for tax reporting purposes). Florida Statute 119.071(5) require that the county notify you in writing of the reason for collecting this information, which will be a used for no other purpose than herein stated. Please complete all information that applies to your business and return with your quote or proposal. 1. General Information (provide all information) ca Taxpayer Name (as shown on income tax return) Q Business Name E (if different from taxpayer name) Address City in State Zip Telephone FAX Email -4 Order Information Remit/Payment Information Address Address CL LL City State Zip City State Zip FAX FAX Email Email `Z v rn F. 2. Company Status (check only one) Individual/Sole Proprietor Corporation Partnership U- Tax Exempt (Federal income tax-exempt entity Limited Liability Company ft under Internal Revenue Service guidelines IRC 501 (c)3) Enter the tax classification (D=Disregarded Entity, C=Corporation, P=Partnership) o 3. Taxpayer Identification Number(for tax reporting purposes only) a Federal Tax Identification Number(TIN) U (Vendors who do not have a TIN,will be required to provide a social security number prior to an award of the contract.) 4. Sign and Date Form Certification: Under penalties of perjury, I certify that the information shown on this form is correct to my knowledge. v Signature Date 4.1 Title Phone Number N E 16-6614 2 RFP_Non_CCNATemplate_01202016 34 Packet Pg. 1631 16.E.1.c Coker County o Administrative Services Department Procurement Serices 3.'sne 4.0 N E N Attachment 8: Insurance and Bonding Requirementsas c cc Insurance/Bond Type Required Limits E 1. ®Worker's Statutory Limits of Florida Statutes, Chapter 440 and all Federal Government a) Compensation Statutory Limits and Requirements 0 Ti 2. ® Employer's Liability $100,000 single limit per occurrencec.) au 3. ® Commercial General Bodily Injury and Property Damage c Liability(Occurrence Form) o patterned after the current $1,000,000 single limit per occurrence, $2,000,000 aggregate for Bodily Injury N ISO form Liability and Property Damage Liability. This shall include Premises and c Operations; Independent Contractors; Products and Completed Operations and Contractual Liability 0 0 4. ® Indemnification To the maximum extent permitted by Florida law, the L Contractor/Vendor/Consultant shall indemnify and hold harmless Collier sc County, its officers and employees from any and all liabilities, damages, o losses and costs, including, but not limited to, reasonable attorneys'fees and paralegals'fees, to the extent caused by the negligence, recklessness, or -cr' intentionally wrongful conduct of the Contractor/Vendor/Consultant or anyone co employed or utilized by the Contractor/Vendor/Consultant in the performance cc of this Agreement. This indemnification obligation shall not be construed to a negate, abridge or reduce any other rights or remedies which otherwise may it be available to an indemnified party or person described in this paragraph. This section does not pertain to any incident arising from the sole negligence L of Collier County. 4 4. ❑ Automobile Liability $ Each Occurrence; Bodily Injury&Property Damage, -4' a) Owned/Non-owned/Hired; Automobile Included r— ,. 5. X Other insurance as ❑Watercraft $ Per Occurrence Ta c noted: it United States Longshoreman's and Harborworker's Act coverage shall be a. maintained where applicable to the completion of the work. ce $ Per Occurrence 0 ❑ Maritime Coverage (Jones Act)shall be maintained where applicable to ca the completion of the work. c $ Per Occurrence 0 0 ❑Aircraft Liability coverage shall be carried in limits of not less than U $5,000,000 each occurrence if applicable to the completion of the Services 0, under this Agreement. ai $ Per Occurrence 8 ❑ Pollution $ Per Occurrence v. X Professional Liability $500,000 Per Occurrence Co • $ 500,000 each claim and in the aggregate c • $1,000,000 each claim and in the aggregate E • $2,000,000 each claim and in the aggregate ..7 r ❑ Professional Liability $ per claim and in Q the aggregate Packet Pg. 1632 16.E.1.c • $1,000,000 per claim and in the aggregate • $2,000,000 per claim and in the aggregate ❑ Valuable Papers Insurance $ Per Occurrence a) rn ❑ Employee Dishonesty/Crime $ Per Occurrence Including Employee Theft, Funds Transfer Fraud, Include a Joint Loss Payee endorsement naming Collier County. U) cu 6. ❑ Bid bond Shall be submitted with proposal response in the form of certified funds, U cashiers' check or an irrevocable letter of credit, a cash bond posted with the County Clerk, or proposal bond in a sum equal to 5%of the cost proposal. All a checks shall be made payable to the Collier County Board of County Commissioners on a bank or trust company located in the State of Florida and o insured by the Federal Deposit Insurance Corporation. 7. ❑ Performance and For projects in excess of$200,000, bonds shall be submitted with the no, Payment Bonds executed contract by Proposers receiving award, and written for 100% of the 4 Contract award amount, the cost borne by the Proposer receiving an award. The Performance and Payment Bonds shall be underwritten by a surety authorized to do business in the State of Florida and otherwise acceptable to Owner; provided, however, the surety shall be rated as "A-" or better as to general policy holders rating and Class V or higher rating as to financial size ° category and the amount required shall not exceed 5% of the reported policy holders' surplus, all as reported in the most current Best Key Rating Guide, published by A.M. Best Company, Inc. of 75 Fulton Street, New York, New York 10038. `.0 a 8. ® Vendor shall ensure that all subcontractors comply with the same insurance requirements that he is required to t meet. The same Vendor shall provide County with certificates of insurance meeting the required insurance 7_ provisions. 9. ® Collier County must be named as"ADDITIONAL INSURED"on the Insurance Certificate for Commercial General Liability where required. ti 10. ® The Certificate Holder shall be named as Collier County Board of County Commissioners, OR, Board of County 73 Commissioners in Collier County, OR Collier County Government, OR Collier County. The Certificates of Insurance c must state the Contract Number, or Project Number, or specific Project description, or must read: For any and all U. a. work performed on behalf of Collier County. 11. ® Thirty(30) Days Cancellation Notice required. Vendor's Insurance Statement u`ai a) We understand the insurance requirements of these specifications and that the evidence of insurability may be required °' within five(5)days of the award of this solicitation. U Name of Firm Date as L Vendor Signature ° Print Name co Insurance Agency Agent Name Telephone Number 16-6614 RFP_Non_CCNATemplate_01202016 36 Packet Pg. 1633 16.E.1.c Collier County Administrative Services Department a� P oouieme.nt Serv,ces ivision E Attachment 9: Reference Questionnaire Solicitation: #16-6614 Workers' Compensation Medical Case Management Program Reference Questionnaire for: (Name of Company Requesting Reference Information) U (Name of Individuals Requesting Reference Information) Name: Company: (Evaluator completing reference questionnaire) (Evaluator's Company completing reference) N Email: FAX: Telephone: Collier County is implementing a process that collects reference information on firms and their key personnel to be used E in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as U a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the y best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the Y firm/individual again)and 1 representing that you were very unsatisfied (and would never hire the firm/indivdival again). o If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored "0." Completion Date: Project Description: Project Budget: Project Number of Days: a- re Change Orders - Dollars Added : Change Orders- Days Added: co Item Citeria Score 1 Ability to manage the services provided to your firm. h- 2 2 Ability to maintain consistent personnel with minimal changes. 3 Quality of work. ii a 4 Quality of consultative advice provided for the program. u_ re 5 Professionalism and ability to manage personnel. 6 Project administration(completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) a _ E 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected program circumstances. m 9 Ability to follow policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future(customer satisfaction). TOTAL SCORE OF ALL ITEMS Please FAX this completed survey to: By 16-6614 (c, RFP_Non_CCNATemplate_01202016 37 Packet Pg. 1634