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    REQUEST FOR PROPOSAL BID NO. 397 SELF INSURED PRESCRIPTION ... REQUEST FOR PROPOSAL BID NO. 397 SELF INSURED PRESCRIPTION ... Document Transcript

    • REQUEST FOR PROPOSAL BID NO. 397 SELF INSURED PRESCRIPTION PROGRAM Monroe County School District Steve Pribramsky, District 1 Andy Griffiths, District 2, Chair R. Duncan Mathewson, District 3 John Dick, District 4 Debra Walker, District 5, Vice-Chair Mike Henriquez, Acting Superintendent July 1, 2009 Page 1
    • TABLE OF CONTENTS Page 1.0 Required Notice .......................................................................................................... 3 2.0 Introduction ................................................................................................................. 4 Compensation.............................................................................................................. 5 3.0 Calendar ...................................................................................................................... 6 4.0 Interpretations ............................................................................................................. 6 5.0 Minimum Eligibility Criteria ....................................................................................... 6 6.0 Information to be Included in the Submitted Proposals............................................... 7 7.0 Evaluation of Proposals ............................................................................................... 8 8.0 Special Conditions ...................................................................................................... 9 EXHIBITS Exhibit A – Monroe County School Board Standard Contract 15 – 24 Exhibit B – Statement of No Bid 25 Exhibit C – Debarment Certification 26 Exhibit D – Drug Free Work Place Form 27 Exhibit E – Public Entity Crime Statement 28 Exhibit F – Refusal of Standard Contract 29 Exhibit G – Business/Personal Relationship Disclosure Affidavit 30 Exhibit H – Non-Collision Affidavit 31 Page 2
    • FILE ATTACHMENTS Attachment A – Formulary Attachment B – Claim Pricing Data Attachment C – Questionnaire Attachment D – Financial Quotation Form Attachment E – Performance Guarantees Addendum 1 (See attached) Page 3
    • REQUEST FOR PROPOSAL BID NO. 397 NOTICE IS HEREBY GIVEN TO PROSPECTIVE PROPOSERS that on Wednesday, August 5, 2009 at 2:00 P.M. the School Board of Monroe County (the “School District” or “School Board”) will open sealed bids for the following: BID NO. 397 SELF INSURED PRESCRIPTION PROGRAM EMPLOYEE BENEFITS & RISK MANAGEMENT Specifications and bid documents may be requested from DemandStar by Onvia by calling 1-800-711-1712 or by going to the website www.demandstar.com. The public record document is available at the Purchasing Department, 241 Trumbo Road, 2 nd Floor, Key West, FL 33040. Questions regarding the bid should be directed to Wanda Menendez, Risk Management Specialist, 241 Trumbo Road, Key West, Fl 33040, and Telephone: 305-293-1400 Ext. 53342. All bids must be received by the Purchasing Department on or before August 5, 2009 at 2:00 P.M. No waivers shall be allowed for Bids which have not been submitted to the Purchasing Department by the deadline date. Bidders must submit two (2) signed originals and four (4) typed and bound copies and one (1) copy of the completed questionnaire and Financial Quotation Form on diskette in a format compatible with Microsoft Excel in a sealed envelope clearly marked on the outside: Bid No. 397 Self Insured Prescription Program addressed and delivered to: Purchasing Department 241 Trumbo Road Key West, FL 33040 All Bids must remain valid for a period of ninety (90) days. The School Board will automatically reject the response of any person or affiliate who appears on the convicted vendor list prepared by the Department of General Services, State of Florida, under Section 287.133(3) (d), F.S. (1997). The Monroe County School District reserves the right, at its discretion to accept or reject any and all bids and to waive informalities for irregularities when it is in the best interest of the Board to do so. Award will be by the District School Board of Monroe County to the bids(s) whose bid is deemed by the board to be in the best interest of Monroe County. Dated at Key West, Florida, this 1st Day of July, 2009. Page 4
    • 2.0 INTRODUCTION Monroe County School Board (hereinafter referred to as “MCSB”) desires to receive proposals for Third Party Administration Services for their Prescription Drug benefit only. MCSB will consider proposals offered by Pharmacy Benefit Administrators who operate with a fully transparent financial model. Proposers will be bidding on Pharmacy Benefits Administration at this time, to include pharmacy network management, claims administration for both retail and mail order prescriptions, Drug Utilization Review, reporting, formulary development, rebate processing, etc. MCSB may also consider carving out the Specialty Drug program from the Medical plan and placing it under the Pharmacy Benefit. It is critical to MCSB that a pharmacy network be accessible in the Keys. MCSB is a governmental entity including the public schools in the Florida Keys, elementary grades through high school. MCSB is located in Key West, Florida 33041. There are approximately 549 employees and 558 families covered by the plan, as well as approximately 100 Retirees. The SIC code is 8211.  MCSB presently offers their employees a self-insured medical plan that is administered by Blue Cross Blue Shield of Florida. The Pharmacy benefit is administered by PBM Plus. Stop Loss Coverage is provided by Symetra Financial.  MCSB pays for the full year over a 10 month period from September through June. Current Pharmacy Benefit: You will be required to match the current benefit design. Prescription Drugs – Calendar Year Deductible - $100.00 individual, $200.00 per family (cumulative). Copayments: Retail $ 10.00 Generic (Mandatory)* $ 25.00 Brand $ 25.00 Brand w/generic available. $ 40.00 Non-Formulary. Mail Order $ 14.00 Generic (Mandatory)* $ 40.00 Brand $ 40.00 Brand w/generic available $ 70.00 Non-Formulary The patient currently pays the lower of the contracted charge or the listed Copayment. *Retail/Mail Order Mandatory Generic benefit – If you request the Brand medication, when the Generic is available, you will pay the Brand co-pay PLUS the difference between the Brand and Generic price. Page 5
    • Compensation: Gallagher Benefit Services is acting as a consultant for MCSB and currently receives fees directly from the School Board. Beginning with the new contract period, compensation for Gallagher Benefit Services should be included in all pricing as follows at the rate of $ .50 PCPM. Florida Licensed Insurance Agent Involvement Due to the nature of group health benefits programs the School Board is publicly advertising for the benefit of other agents who may wish to propose. The School Board does not wish to pay any more than the minimum remuneration required by Florida Statute 624.428 or any other Florida Statute. Administrators are required to disclose the amounts of commission/remuneration to be paid to Florida licensed agents, whether they are inside employee agents of the insurer or outside agents and proposers are requested to explain the full extent of services to be provided to the School Board for the commission/remuneration paid. Insurance agents should recognize that the School Board will be scrutinizing the amount of remuneration in relation to the expected level of service to be received. The School Board is desirous of avoiding payment of remuneration that may appear to be excessive. It may be interested in negotiation such remuneration, especially when two or more agents have similar or identical lowest cost proposals. Proposing agents should state if they are willing to negotiate such remuneration. Background information should be furnished on proposing agents and/or other key agency personnel that will serve the School Board. Such information should include size of agency, experience to providing insurance for public entities, personnel and qualifications (particularly of the agent who will serve the School Board), references, frequency and type of contact with the county, etc. Insurers and agents should state the amount of their errors and omissions insurance, and their insurer’s name. $1,000,000 of coverage is the minimum acceptable. 3.0 CALENDAR July 8, 2009 Release of RFP July 14, 2009 Final questions due in writing July 21, 2009 Release of Addendum # 1 (if necessary) August 5, 2009 Proposals due/opening Page 6
    • 4.0 INTERPRETATIONS If necessary, Addenda will be issued. Any verbal or written information that is obtained other than by information in this RFP document or by Addenda shall not be binding on the Monroe County School Board. It is the proposer’s sole responsibility to check on the Demandstar website (www.demandstar.com) to determine if there has been a release of Addenda. 5.0 MINIMUM ELIGIBILITY CRITERIA In order to be considered eligible for this assignment, proposer must meet or exceed the following criteria: 5.1 Awardee must obtain and maintain the insurance with coverage limits as stated in Section 8.0 - SPECIAL CONDITIONS, Subsection 8.25 - Insurance Requirements, for the term of the contract. Proposer must submit a current Certificate of Insurance showing that proposer has the required level of insurance with their proposal or within three days of request. If proposer does not have the required level of insurance, include a letter from the proposer’s insurance company or agent stating that proposer is eligible to provide this level of insurance and include a statement that proposer agrees to provide this level of insurance, if awarded this RFP. 5.2 Proposer must provide evidence that they are appropriately licensed or certified to do business in the State of Florida. 5.3 Proposer for Pharmacy Benefit Administration must have access to a network of participating pharmacies in Monroe County, Florida. 5.4 The proposer must confirm that they operate in compliance with HIPAA requirements. 5.4.1 Proposer must confirm and be able to provide evidence that they operate with full transparency. Failure to submit a statement (in the format required under Section 6.0: INFORMATION TO BE INCLUDED IN THE SUBMITTED PROPOSAL) indicating full compliance with each of the requirements of this section will disqualify proposal submitted. 6.0 INFORMATION TO BE INCLUDED IN THE SUBMITTED PROPOSAL In order to maintain comparability and facilitate the review process, it is required that proposals be organized in the manner specified below. Include all information in your proposal. 6.1 Title Page: Show the subject, the name of the proposer, address, telephone number and the date. 6.2 Table of Contents: Include a clear identification of the material by section and by page number. Page 7
    • 6.3 Letter of Transmittal: Give the names of the persons who will be authorized to make representations for the proposer, their titles, addresses and telephone numbers. 6.4 Notice Provision: When any of the parties desire to give notice to the other, such notice must be in writing, sent by US Mail, postage prepaid, addressed to the party for whom it is intended at the place last specified; the place for giving notice shall remain such until it is changed by written notice in compliance with the provisions of the paragraph. This information must be submitted with the proposal or within three days of request. For the present, the parties designate the following as the respective places for giving notice: Monroe County School Board District Office Attention: Wanda Menendez Employee Benefits and Risk Management Specialist 241 Trumbo Road Key West, FL 33040 With a Copy to: ______________________________________ ______________________________________ ______________________________________ ______________________________________ Name of Proposer: ________________________________________ (Name of Proposer, Corporation and Agency) ________________________________________ ________________________________________ (Address) With a Copy to: ________________________________________ (Name and Position of Designee of Proposer, Corporation and Agency) ________________________________________ ________________________________________ (Address) 6.0 INFORMATION TO BE INCLUDED IN THE SUBMITTED PROPOSAL (Continued) 6.5 Addenda: Proposer has determined that their firm has received all Addenda released prior to their RFP submittal. 6.6 Questionnaire (Attachment C): The Questionnaire contains required information concerning the following: Page 8
    • 6.6.1 Minimum Eligibility: Proposer must provide a detailed response for each criterion stated in Section 5.0 describing how they are in compliance. 6.6.2 Experience and Qualifications of the Proposer 6.6.3 Scope of Services Provided: The services requested by MCSB in providing the benefits requested by this RFP are listed in the Questionnaire. The proposer must address each item in the questionnaire and fully describe any deviations. 6.7 Purchasing Forms: The following forms must all be executed as directed and included with each proposal: Exhibit C (Debarment Certification) Exhibit D (Drug Free Work Place Form) Exhibit E (Public Entity Crime Statement) Attachment B (Claim Pricing Data Form) Attachment C (Questionnaire) Attachment D (Financial Quotation Form) Attachment E (Performance Guarantees The following forms are to be included and executed only if applicable: Exhibit B (Statement of no Bid) Exhibit F (Refusal of Standard Contract) Any modifications or alterations to these forms shall not be accepted and proposal will be rejected. 6.8 Special Conditions: Proposer must acknowledge understanding and acceptance of the items outlined in Section 8.0 – SPECIAL CONDITIONS, as outlined or explain any deviations from these conditions. 6.9 Other Information: Please include any sample reports, documents or exhibits under this section. 7.0 EVALUATION OF PROPOSALS MCSB shall rank all proposals received that meet the Minimum Eligibility Requirements and the Submittal Requirements. MCSB reserves the right to interview proposers that respond to this RFP or to make their recommendation based solely upon the information included in the proposals submitted. MCSB may ask questions of a clarifying nature and may request a hearing or hearings with any or all proposers as part of the evaluation process. It is important to MCSB that proposers demonstrate that they will be viable partners going forward. To that end, MCSB is requesting that they demonstrate financial stability by providing financial ratings from recognized sources, with a minimum rating of A. Companies that are not rated may submit audited financial Page 9
    • statements for a minimum of three years. Please see the Questionnaire for additional details. After initial ranking on the basis of the following selection criteria, Minimum Eligibility Criteria, Experience and Qualifications, Scope of Services Provided, Cost of Services Provided and, References. MCSB reserves the right to negotiate further terms and conditions including price with the selected proposer for recommendation. If MCSB cannot reach a mutually beneficial agreement with the highest ranked proposer, MCSB reserves the right to enter into negotiations with the next highest ranked proposer. The contract will not be awarded solely on the basis of lowest cost. MCSB reserves the right to waive irregularities in proposals received. MCSB also reserves the right to award the contract on such material MCSB deems will best serve its interests. AWARD OF IDENTICAL TIE BIDS – Whenever identical bids are received, that are tied in all respects, preference shall be given to the bid certifying a drug free workplace has been implemented in accordance with Section 287.087, F.S. In order to receive preference, a signed certification of compliance must be submitted with a bid response. Preference will be given to a Florida resident vendor over an out of state vendor if both have certified a drug-free workplace. If all vendors are Florida residents, a Monroe county vendor with a drug-free workplace will receive preference. If all bids or no bids include certificate of compliance, the tie will be broken by a flip of a coin in the presence of witnesses 8.0 SPECIAL CONDITIONS 8.1 CONTRACT TERM: The purpose of this RFP is to establish a three year contract beginning January 1, 2010 and continuing through December 31, 2012. The term of the contract may, by mutual agreement between MCSB and the awardee, upon final approval of MCSB, be extended for two additional one-year periods and, if needed, 90 days beyond the expiration date of the final renewal period. MCSB, will, if considering to renew, request a letter of intent to renew from each awardee, prior to the end of the current contract period. The awardee will be notified when the recommendation has been acted upon by MCSB. All prices shall be firm for the term of the contract. The successful awardee(s) agrees to this condition by signing its proposal. 8.2 IRREVOCABILITY OF PROPOSAL: A proposer may withdraw a bid at any time before the deadline for proposal submission/opening. A proposal may not be withdrawn before the expiration of (90) days from the date of proposal opening. Bidder warrants by virtue of bidding, that prices, terms and conditions quoted in the bid will remain firm for acceptance by MCSB for a period of (90) days from the date of bid opening, unless otherwise stated by MCSB. 8.3 INFORMATION NOT IN RFP: No verbal or written information that is obtained other than by information in this document or Addenda to this Request for Proposal shall be binding on MCSB. 8.4 PROPOSAL PUBLIC RECORD: Proposer acknowledges that all information contained within their proposal is part of the public domain as defined by the State of Florida Sunshine and Public Record Laws. Page 10
    • 8.5 CONTACT AFTER PROPOSER’S SUBMITTAL: Any proposer or a lobbyist for a proposer is prohibited from having any communication concerning this RFP or any response with any representative of the MCSB, after the submittal of their proposal and prior to the contract being awarded with the exception of communications with the office of the Director of Purchasing, unless so notified by the Purchasing Department. A proposal from any firm will be disqualified when the proposer or a lobbyist for the proposer violates this condition of the RFP. 8.6 GRATUITIES: Proposers shall not offer any gratuities, favors, or anything of monetary value to any official, employee, or agent of MCSB for the purpose of influencing consideration of this proposal. 8.7 PREPARATION COST OF PROPOSAL: Proposer is solely responsible for any and all costs associated with responding to this RFP. MCSB will not reimburse any proposer for any costs associated with the preparation and submittal of any proposal, or for any travel and per diem costs that are incurred by any proposer. 8.8 JOINT VENTURES: In the event multiple proposers submit a joint proposal in response to the RFP, a single proposer shall be identified as the Prime Proposer. If offering a joint proposal, Prime Proposer must include the name and address of all parties of the joint proposal. Prime Proposer shall provide all bonding and insurance requirements, execute any Contract, have overall and complete accountability to resolve any dispute arising within this contract. Only a single contract with one proposer shall be acceptable. Prime Proposer responsibilities shall include, but not be limited to, performing of overall contract administration, preside over other proposers participating or present at meetings, oversee preparation of reports and presentations, and file any notice of protest and final protest as described herein. Prime Proposer shall also prepare and present a consolidated invoice(s) for services performed. MCSB shall issue only one check for each consolidated invoice to the Prime Proposer for services performed. Prime Proposer shall remain responsible for performing services associated with response to this RFP. 8.9.1 APPLICABLE LAW: This RFP and any agreement resulting from it shall be interpreted and construed according to the laws of the State of Florida and Monroe County. 8.9.2 GOVERNING LAW: This RFP, and any award(s) resulting from this RFP, shall be governed by and construed under the laws of the State of Florida and Monroe County. 8.9.3 LEGAL REQUIREMENTS: Federal, state, county and local laws, ordinances, rules and regulations that in any manner affect the goods or services covered herein apply. Lack of knowledge by the proposer will in no way be a cause for relief from responsibility. 8.9.4 ADVERTISING: In submitting an RFP, proposer agrees not to use the results there from as a part of any commercial advertising without prior written approval of MCSB. 8.9.5 PAYMENT: Payment will be provided only after receipt and acceptance of services. Page 11
    • 8.9.6 EXPENDITURE: No guarantee is given or implied as to the total dollar value or work as a result of this RFP. MCSB is not obligated to place any order for services performed with any awardee(s) as a result of this award. Order placement will be based upon the needs and in the best interest of MCSB. 8.9.7 CONFLICT OF INTEREST: The award of this RFP is subject to the provisions of Chapter 112, Florida Statutes, as currently enacted or as amended from time to time. All proposers must disclose with their proposal the name of any officer, director or agent who is also an employee of MCSB. Gallagher Benefit Services, Inc. will be providing consultant services to MCSB in relation to the employee benefit program. All proposers must disclose with their proposal the name of any officer, director or agent who is also an employee of Gallagher Benefit Services. 8.9.7.1 DISPUTES: In the event of a conflict between the documents, the order of priority of the documents shall be as follows: Any agreement resulting from the award of this RFP (if applicable); then Addenda released for this RFP, with the latest Addendum taking precedence; then the RFP; then awardee’s proposal. In case of any other doubt or difference of opinion, the decision of MCSB shall be final and binding on both parties. 8.9.8 HOLD HARMLESS AGREEMENT: During the term of this award, the awardee(s) shall indemnify, hold harmless, and defend MCSB, its agents, servants and employees from any and all costs and expenses, including but not limited to, attorney’s fees, reasonable investigative and discovery costs, court costs and all other sums which MCSB, its agents, servants and employees may pay or become obligated to pay on account of any, all and every claim or demand, or assertion of liability, or any claim or actions found, thereon, arising or alleged to have arisen out of the products, goods or services furnished by the awardee(s), his agents, servants or employees, or any of awardee’s equipment when such persons or equipment are on premises owned or controlled by MCSB for the purpose of performing services, delivering products or goods, installing equipment, or otherwise transacting business, whether such claim or claims be for damages, injury to person or property, including MCSB’s property, or death of any person, group or organization, whether employed by the awardee(s) or MCSB or otherwise. 8.9.9 PATENTS AND ROYALTIES: The proposer, without exception, shall indemnify and save harmless MCSB and its employees from liability of any nature or kind, including cost and expenses for or on account of any copyrighted, patented, or unpatented invention, process, or article manufactured or used in the performance of the contract, including its use by MCSB. If the proposer uses any design, device, or materials covered by letters, patent, or copyright, it is mutually understood and agreed without exception that the RFP prices shall include all royalties or cost arising from the use of such design, device or materials in any way involved in the work. Page 12
    • 8.9.10 ANTI-DISCRIMINATION: The Vendor certifies that he or she is in compliance with the non-discrimination clause contained in Section 202, Executive Order 11246, as amended by Executive Order 11375, relative to equal employment opportunity for all persons without regard to race, color, religion, sex or national origin. 8.9.11 LIABILITY, INSURANCE, LICENSES AND PERMITS: Where proposers are required to enter or go onto MCSB property to deliver materials or perform work or services as a result of award, the proposer agrees to The Hold Harmless Agreement stated herein and will assume the full duty obligation and expense of obtaining all necessary licenses, permits and insurance. The proposer shall be liable for any damages or loss to MCSB occasioned by negligence of the proposer (or agent) or any person the proposer has designated in the completion of the contract. 8.9.12 SELLING, TRANSFERRING OR ASSIGNING CONTRACT: No contract awarded under these terms, conditions and specifications shall be sold, transferred or assigned without prior written approval of MCSB. 8.9.13 CANCELLATION: MCSB reserves the right to terminate any contract resulting from this RFP at any time and for no reason, upon giving 60 days prior written notice to the other party. Purchaser reserves the right to cancel such orders, or any part thereof, without obligation, if delivery is not made at the time specified on the bid proposal form. 8.9.14 INDEMNIFICATION PROVISION: Each party agrees to be fully responsible for its acts of negligence or its agent’s acts of negligence when acting within the scope of their employment and agrees to be liable for any damages resulting from said negligence. Nothing herein is intended to serve as a waiver of sovereign immunity by any agency to which sovereign immunity may be applicable. Nothing herein shall be construed as consent by an agency or political subdivision of the State of Florida to be sued by third parties in any matter arising out of any contract. 8.10 ACCEPTANCE AND REJECTION OF PROPOSALS: 8.10.1 Acceptance: All proposals properly completed and submitted will be considered by MCSB. However, MCSB reserves the right to request additional information, reject any or all proposals that do not meet all mandatory requirements, or reject all proposals received. 8.10.2 MCSB also reserves the right to waive irregularities in any proposal received if such action is in the best interest of MCSB. However, such a waiver shall in no way modify the RFP requirements or excuse the proposer from full compliance with the RFP specifications and other contract requirements if the proposer is awarded the contract. Page 13
    • 8.25 INSURANCE REQUIREMENTS: Proof of the following insurance will be furnished by any awardee to MCSB by Certificate of Insurance or a Certified copy of the actual insurance policy within three days of notification by MCSB. Such certificate must contain a provision for notification to MCSB 45 days in advance of any material change in coverage, non-renewal or cancellation. The notification must be by return-receipt, certified mail and no other form of notification will otherwise relieve the insurance company, its agents, or its representatives of responsibility. “The Monroe County School Board, its employees and officials shall be named as “Additional Insured” as outlined. Any deviations from these General Insurance Requirements must be requested in writing. The insurance information must be submitted on a Certificate of Insurance or a Certified copy of the actual insurance policy and submitted with the proposal. 8.25.1 Contractor’s public liability shall include comprehensive general liability, contractual liability, and products and completed operations liability. Bodily injury limits of liability shall be at least $100,000 per claimant, $200,000 per occurrence. Property damage limits of liability shall be at least $100,000 per claimant, $200,000 per occurrence. Personal injury liability (a separate coverage from bodily injury) shall be required. Personal injury liability limits shall be specified in amounts of at least $100,000 per claimant, $200,000 per occurrence. MCSB shall be named as additional insured on Contractor’s public liability policy. 8.25.2 Professional Liability insurance with limits of not less than $500,000 per occurrence/$1,000,000 Aggregate. 8.25.3 Motor vehicle liability shall be required with limits of at least $100,000 per claimant, $200,000 per occurrence for both bodily injury and property damage (this coverage should include all owned, non-owned and hired vehicles used in connection with this RFP). 8.25.4 Worker's Compensation shall be in compliance with chapter 440 Florida Statutes. Workers compensation shall include employer’s liability in the amount of at least $100,000 per accident, $500,000 policy limit for disease, $100,000 per bodily injury by disease for each employee. 8.25.5 Employee Dishonesty Insurance in the amount of $100,000 per Occurrence. Prior to the commencement of any work the awardee must provide MCSB with evidence of the required insurance. 8.26 WITHDRAWAL OR REJECTION OF RFP: In the best interest of MCSB, MCSB reserves the right to withdraw this RFP at any time prior to the time and date specified for the proposal opening; to reject any and all proposals and to waive any irregularity in proposals received. Page 14
    • 8.27 DEFAULT PROVISION: In case of default by the successful bidder or contractor, MCSB may procure the items or services from other sources and hold the bidder or contractor responsible for any excess cost occasioned or incurred thereby. 8.28 SIGNED BID CONSIDERED AN OFFER: The signed bid shall be considered an offer on the part of the bidder or contractor, which offer shall be deemed accepted upon approval by MCSB and in case of default on the part of the successful bidder or contractor, after such acceptance, MCSB may take such action as it deems appropriate, including legal action, for damages or specific performance. 8.29 SPECIFICATIONS: Any omissions of detailed specifications stated herein, that would render the materials/services from use, as specified, will not relieve the bidder from responsibility. 8.30 CONTRACTS: Sample contracts must be provided. Page 15
    • EXHIBITS Page 16
    • EXHIBIT A CONTRACT FORM 2-S (REV. 9/07) THE SCHOOL DISTRICT OF MONROE COUNTY Contract for Services: Threshold Two (Equal to or in Excess of $25,000.00) W I T N E S E T H: WHEREAS, the School Board of Monroe County, Florida (“School Board” or “MCSB”), as the contracting agent for the School District of Monroe County, Florida (“School District”), has requested bids for ____________________________________________________________________________________ _______________________________________________________________________. WHEREAS, (“Contractor”) has submitted a bid, dated to provide the services sought by the School Board. WHEREAS, is duly qualified to provide the services sought by the School Board. WHEREAS, School Board, on behalf of the School District, desires to engage to provide such services for the School District and ________________________________ _____________________________ desires to provide such services for the School District. NOW, THEREFORE, in consideration of the mutual covenants and benefits hereinafter set forth, the parties herein covenant and agree as follows: 1. REQUEST FOR BIDS AND BID INCORPORATED HEREIN The terms and specifications of the Request for Bids issued by the Monroe County School District on {Date of Request for Bids and Identifying Number} , and the terms of that bid submitted by are herein incorporated by reference as if fully set forth herein, made part of this Contract and are attached hereto as Exhibits “_A_” and “__” respectively. In the event of a conflict between the terms of this Contract and any exhibit, the terms of this Contract shall control, unless otherwise agreed in writing as an amendment pursuant to the terms for such as provided herein. Page 17
    • 2. TERM The term of this Contract shall be from January 1, 2010, to December 31, 2012. This Contract may be renewed for a period that may not exceed two (2) years or the term set forth above, whichever period is longer. The compensation for the renewal term shall be determined prior to renewal of this contract and is subject to approval by the MCSB. Further, renewal of this contract is contingent upon a determination by the MCSB that the services have been satisfactorily performed, that the services are needed and upon availability of funds. 3. CONTRACTOR'S SERVICES Contractor agrees to provide the following services: ______________________________________________________________________________ ______________________________________________________________________________ ____________________________________________________________ If documentation of the specific goods/services is attached, said documentation is labeled as Exhibit “___” to this Contract and is incorporated herewith by reference. 4. COMPENSATION School Board shall pay Contractor the sum of ________________________________ for services rendered pursuant to this Contract. Payment to be made as follows: ______________________________________________________________________________ __________________________________________________________________ No payment shall be due until the School Board verifies that all services for which payment has been requested have been fully and satisfactorily performed. The School Board will make diligent efforts to verify and pay invoices within one (1) payment cycle after receipt. 5. COMPLIANCE WITH LAWS AND POLICIES Contractor agrees to comply with all current Monroe County School Board policies and all applicable local, state and federal laws, including laws pertaining to the confidentiality of student records and public records requests. Specifically, Contractor has executed a Relationship Disclosure Affidavit, attached hereto as Exhibit “_G__”. Contractor agrees that MCSB has the right to unilaterally and immediately cancel this Contract upon refusal by Contractor to allow public access to all documents, papers, letters, or other material made or received by the Contractor in conjunction with the contract, unless the records are exempt from s.24(a) of Art. I of the State Constitution and s.119.07 (1). Should cancellation be necessary under this clause, MSCB is required only to provide written notice to Contractor, effective upon receipt of notice, which shall be documented. Page 18
    • 6. INDEPENDENT CONTRACTOR STATUS Contractor is, for all purposes arising under this Contract, an independent contractor. Contractor and its officers, agents or employees shall not, under any circumstances, hold themselves out to anyone as being officers, agents or employees of the School Board, Scholl District of Monroe County, Florida, nor any department thereof. No officer, agent or employee of the Contractor or School/Department shall be deemed an officer, agent or employee of the other party. Neither Contractor or School Board, nor any officer, agent or employee thereof, shall be entitled to any benefits to which employees of the other party are entitled, including, but not limited to, overtime, retirement benefits, workers compensation benefits, injury leave, or other leave benefits. 7. BACKGROUND CHECKS/FINGERPRINTING In accordance with the legislative mandate set out in sections 1012.32, 1012.465 and 435.04, Florida Statutes (2005) as well as with the requirements of HB 1877, The Jessica Lunsford Act (2005), effective September 1, 2005, Contractor agrees that all of its employees and sub- contractors, including employees of sub-contractors, who provide or may provide services under this Contract have completed all background screening requirements through a Monroe County School Board designee pursuant to the above-referenced statutes. It is recognized and agreed that the provisions and exceptions relating to the dictates of The Jessica Lunsford Act, and codified at sections 1012.321, 1012.465, 1012.467 and 1012.468 of the Florida Statutes, shall apply to the requirements of this paragraph where so applicable. Contractor agrees to bear any and all costs associated with acquiring the required background screenings. Contractor agrees to require all affected employees and sub- contractors to sign a statement, as a condition of employment with Contractor in relation to performance under this Contract, that the employee and/or sub-contractor will abide by the terms and notify Contractor/Employer of any arrest or conviction of any offense enumerated in section 435.04, Florida Statutes within forty-eight (48) hours of their occurrence. Contractor agrees to provide MCSB with a list of all employees and/or sub- contractors who have completed background screenings as required by the above- referenced statutes and that meet the statutory requirements contained therein. Contractor agrees that it has an ongoing duty to maintain and update these lists as new employees and/or sub-contractors are hired and in the event that any previously screened employee fails to meet the statutory standards. Contractor further agrees to notify MCSB immediately upon becoming aware that one of its employees or its sub-contractor’s employees, who was previously certified as completing the background check, and meeting the statutory standards, is subsequently arrested or convicted of any disqualifying offense. Failure by Contractor to notify MCSB of such arrest or conviction within forty-eight (48) hours of being put on notice by the employee/sub-contractor and within 5 days of its occurrence shall constitute grounds for immediate termination of this contract by MCSB. The parties further agree that failure by Contractor to perform any of the duties described in their paragraph shall constitute a material breach of the contract entitling MCSB to Page 19
    • terminate this Contract immediately with no further responsibility to make payment or perform any other duties under this Contract. 8. TERMINATION A. WITHOUT CAUSE This Contract may be terminated for any reason by either party upon sixty (60) days written notice to the other party at the addresses set forth below. If said Contract should be terminated as provided in this paragraph of the Contract, the MCSB will be relieved of all obligations under said contract and the MCSB will only be required to pay that amount of the contract actually performed to the date of termination with no payment due for unperformed work or lost profits. B. TERMINATION FOR BREACH Either party may terminate this Contract upon breach by the other party of any material provision of this Contract, provided such breach continues for fifteen (15) days after receipt by the breaching party of written notice of such breach from the non-breaching party. C. IMMEDIATE TERMINATION BY MCSB School Board may terminate this Contract immediately upon written notice to Contractor (such termination to be effective upon Contractor’s/Individual’s receipt of such notice) upon occurrence of any of the following events: a. the denial, suspension, revocation, termination, restricting, relinquishment or lapse of any license or certification required to be held by the Contractor, or of any Company/Individual staff’s professional license or certification in the State of Florida; b. conduct by Contractor or any Company/Individual staff which affects the quality of services provided to the School Board or the performance of duties required hereunder and which would, in the School Board’s sole judgment, be prejudicial to the best interests and welfare of the School Board and/or its students; c. breach by Contractor or any Company/Individual staff of the confidentiality provisions of this Contract; d. failure by Contractor to maintain the insurance required by the terms of this Contract. Page 20
    • 9. ASSIGNMENT Neither Consultant nor the Monroe County School Board may assign or transfer any interest in this Contract without the prior written consent of both parties. Should an assignment occur upon mutual written consent, this Contract shall inure to the benefit of and be binding upon the parties hereto and their respective heirs, representatives, successors and assigns. 10. AMENDMENT This Contract may be amended only with the mutual consent of the parties. All amendments must be in writing and must be approved by the Monroe County School Board. 11. INDEMNIFICATION, GOVERNING LAW & VENUE Contractor shall indemnify and hold harmless the Monroe County School Board from and against any and all claims, liabilities, damages, and expenses, including, without limitation, reasonable attorneys' fees, incurred by the MCSB in defending or compromising actions brought against it arising out of or related to the acts or omissions of Contractor, its agents, employees or officers in the provision of services or performance of duties by Contractor pursuant to this Contract. This Contract shall be construed in accordance with the laws of the State of Florida. Any dispute arising hereunder is subject to the laws of Florida, venue in Monroe County, Florida. The prevailing party shall be entitled to reasonable attorney's fees and costs incurred as a result of any action or proceeding under this Contract. 12. REPRESENTATIONS & WARRANTIES Contractor represents and warrants to the Monroe County School Board, upon execution and throughout the term of this Contract that: 1) Contractor is not bound by any Contract or arrangement which would preclude it from entering into, or from fully performing the services required under the Contract; 2) None of the Contractor’s agents, employees or officers has ever had his or her professional license or certification in the State of Florida, or of any other jurisdiction, denied, suspended, revoked, terminated and/or voluntarily relinquished under threat of disciplinary action, or restricted in any way; Page 21
    • 3) Contractor has not been convicted of a public entity crime as provided in F.S. §287.133, to wit: A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid, proposal, or rely 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 on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list; and 4) Contractor and Contractor’s agents, employees and officers have, and shall maintain throughout the term of this Contract, all appropriate federal and state licenses and certifications which are required in order for Contractor to perform the functions, assigned to him or her in connection with the provisions of the Contract. 13. CONFIDENTIALITY Contractor recognizes and acknowledges that by virtue of entering into this Contract and providing services hereunder, Contractor, its agents, employees and officers may have access to certain confidential information, including confidential student information and personal health information. Contractor agrees that neither it nor any Contractor agent, employee or officer will at any time, either during or subsequent to the term of this Contract, disclose to any third party, except where permitted or required by law or where such disclosure is expressly approved by the MCSB in writing, any confidential student information, personal health information or other confidential information, and MCSB, its agents, employees and officers shall comply with all Federal and State laws and regulation and all MCSB policies regarding the confidentiality of such information. 14. INSURANCE Contractor agrees to secure and maintain at all times during the term of this Contract, at Contractor’s expense, insurance coverage, as laid out below, covering Contractor for all acts or omissions which may give rise to liability for services under this Contract. All Contractor staff is to be insured in minimum amounts acceptable to the Monroe County School Board and with a reputable and financially viable insurance carrier, naming the Monroe County School Board as an additional insured. Such insurance shall not be cancelled except upon thirty (30) days written notice to the MCSB. Contractor shall provide MCSB with a certificate evidencing such insurance coverage within five (5) days after obtaining such coverage. Contractor agrees to notify MCSB immediately of any material change in any insurance policy required to be maintained by Contractor. Page 22
    • Contractor is required to obtain the following coverage, with documentation of having obtained such coverage being attached hereto as Exhibit “ I “: _X__ General Liability Insurance As specified on 8.25.1 of the RFP. Amount: _______________ Details/Comments: (Naming the Monroe County School District as additional insured.) _____________________________________________________________ _________________________________________________ _X__ Professional Liability Insurance As specified on 8.25.2 of the RFP Amount: _______________ Details/Comments: _____________________________________________________________ _________________________________________________ _X__ Vehicle Liability Insurance As specified on 8.25.3 on the RFP. Amount: _______________ Details/Comments: _____________________________________________________________ _________________________________________________ _X__ Workers Compensation Insurance As specified on 8.25.4 on the RFP. Amount: _______________ Details/Comments: _____________________________________________________________ ________________________________________________ 15. BILLING Bills for fees or compensation under this contract shall be submitted in detail sufficient for a proper pre-audit and post-audit thereof. Further, bills for any travel expenses shall be submitted in accordance with s. 112.061 where applicable. 16. THIRD-PARTY BILLING AND PAYMENT To the extent applicable with regard to the services provided in this Contract, the Contractor shall cooperate with School Board representatives to determine the eligibility of a referred student for third-party benefits and to bill cooperatively the third-party for services provided to the referred student. Should the third-party decline to pay for billed services, or should the third-party only make partial payment for billed services, Contractor shall provide appropriate documentation to School Board and will assist the School Board in any administrative or appeals process regarding eligibility or payment as may be requested by the School Board. Contractor shall not be entitled to bill nor accept Page 23
    • third-party payment without authorization of the School Board and Contractor agrees that School Board shall not be obligated to make any payment that exceeds the rate referred to in the paragraph governing Compensation. The Contractor shall provide service documentation in accordance with professional standards and School Board criteria as requested. 17. CONTRACT RECORDS RETENTION Contactor agrees to comply with all state and federal regulations governing contracts with public entities, including but not limited to cooperation with public records requests as provided by law, cooperation with comptrollers and auditors as provided by law, and adherence to Title 34, section 80.36, which requires the retention of all records concerning a public entity contract for three (3) years after the School Board makes final payment and all other pending matters concerning the contract are closed. 18. ETHICS CLAUSE Contractor warrants that he/it has not employed, retained or otherwise had act on his/its behalf any former Monroe County School District officer or employee. For breach or violation of this provision the Monroe County School District may, in its discretion, terminate this contract without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover the full amount of any fee, commission, percentage, gift, or consideration paid to the former Monroe County School District officer or employee. 19. CONFLICT OF INTEREST The following provisions shall apply for conflict of interest. Any violation of these provisions by a School District employee may be grounds for dismissal. No contract for goods or services may be made with any business organization in which the Superintendent or a School Board member has any material financial interest unless it is a single source or clear documentation exists to show that, no other supplier can provide the identical/comparable goods/service, at a lower cost to the School Board. No School Board member or officer, or School District officer or employee, may directly or indirectly purchase or recommend the purchase of goods or services from any business organization which they or their near relative have a material interest as defined by §112.313, Florida Statutes, except as allowed by DOE Interpretative Memorandum No. A-20. No School Board member, School District employee or official may receive gifts or any preferential treatment from vendors. Such members, officers, officials or employees shall not be prohibited from participating in any activity or purchasing program that is offered to all School District employees or in School District surplus sales, provided there is no preferential treatment. Page 24
    • 20. DEBARMENT CERTIFICATION A Debarment Certification Form, attached hereto as Exhibit “_C__”, shall be executed by Contractor and is incorporated herein as part of this Contract. Contractor certifies that neither the firm, nor any person associated therewith in the capacity of owner, partner, director, officer, principal, investigator, project director, manager, auditor, and/or position is involved in the administration of federal funds. 21. SEVERABILITY The parties recognize and agree that should any clause(s) herein be held invalid by a Court of competent jurisdiction, the remaining clauses shall not be affected and shall remain of full force and effect. 22. COUNTERPARTS This Contract may be executed in one or more counterparts, all of which together shall constitute only one Contract. 23. WAIVER A waiver by either party of a breach or failure to perform hereunder shall not constitute a waiver of any subsequent breach or failure to perform. Any waiver of insurance requirements as provided by this Contract and/or the policies of the School Board does not relieve the Contractor of the indemnification provisions contained within this Contractor. 24. CAPTIONS The captions contained herein are used solely for convenience and shall not be deemed to define or limit the provisions of this Contract. 25. ENTIRE CONTRACT The parties hereto agree that this is the final Contract between the parties and supercedes any and all prior Contracts and/or assurances, be it oral or in writing. 26. NOTICES All notices required by this Contract, unless otherwise provided herein, by either party to the other shall be in writing, delivered personally, by certified or registered mail, return receipt requested, or by Federal Express or Express Mail, and shall be deemed to have been duly given when delivered personally or when deposited in the United States mail, postage prepaid, addressed as follows: Page 25
    • Monroe County School Board: Superintendent Monroe County School District 241 Trumbo Road Key West, FL 33040 With a copy to: Monroe County School District Counsel Vernis & Bowling of the Florida Keys, P.A. 81990 Overseas Hwy, 3rd Floor Islamorada, FL 33036 (“CONTRACTOR”): APPROVED: _____________________________________ __________ LEGAL DEPARTMENT (Initial Review) DATE _____________________________________ __________ RISK MANAGEMENT DATE _____________________________________ __________ PURCHASING DEPARTMENT DATE _____________________________________ __________ PERSONNEL DEPARTMENT DATE _____________________________________ __________ LEGAL DEPARTMENT (Final Review) DATE IN WITNESS WHEREOF, the parties have executed this Contract on this _____ day of _____________________ , ___________ . __________________________________ __________ SIGNATURE OF CHAIRPERSON OF THE BOARD DATE __________________________________ __________ SIGNATURE OF SUPERINTENDENT DATE ________________________________________ ____________ SIGNATURE OF CONTRACTOR/REPRESENTATIVE DATE ________________________________________ PRINT NAME AND TITLE Page 26
    • EXHIBIT B Statement of No Bid NOTE: If you do not intend to bid on this requirement/project, please return this form immediately. Thank you. School Board of Monroe County, Florida We, the undersigned have declined to submit a bid for No. _______ Specifications too “tight”, i.e. geared toward one brand/manufacturer/service only (explain below) Unable to meet time period for responding to ITB/RFP. We do not offer this product or service. Our schedule would not permit us to perform. Unable to meet specifications. Unable to meet Bond/Insurance requirement(s). Specifications unclear (explain below). Unable to Meet Insurance Requirements. Please Remove Us from Your “Bidders List”. Other (specify below). REMARKS: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ We understand that if the “No Bid” letter is not executed and returned our name may be deleted from the Bidders List of the School Board of Monroe County. Company Name: _________________________ Email: ________________________ Bidder Number: _________________________ Date: ________________________ Signature ______________________________ Fax: _________________________ Telephone: _________________________ Page 27
    • EXHIBIT C Debarment Certification “The Bidder certifies that, neither the firm nor any person associated therewith in the capacity of owner, partner, director, officer, principal, investigator, project director, manager, auditor, and/or position involving the administration of federal funds: (a) Is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions, as defined in 49 CFR s29.110(a), by any federal department or agency; (b) Has within a three-year period preceding this certification been convicted of or had a civil judgment rendered against it for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state, or local government transaction or public contract; violation of federal or state antitrust statutes; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Is presently indicted for or otherwise criminally or civilly charged by a federal, state, or local Governmental entity with commission of any of the offenses enumerated in paragraph 9(b) of this certification; and (d) Has within a three-year period preceding this certification had one or more federal, state, or local government public transactions terminated for cause or default. The Bidder certifies that it shall not knowingly enter into any transaction with any subcontractor, material supplier, or vendor who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this project by any federal agency. Dated this day of , 20 . By_______________________________________________________________ Authorized Signature/Contractor _____ _______________________________________________________________ Typed Name/Title _______________________________________________________________ Contractor's Firm Name _______________________________________________________________ Street Address _______________________________________________________________ City/State/Zip Code _______________________________________________________________ Area Code/Telephone Number Fax Number Page 28
    • EXHIBIT D DRUG FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: ________________________________________________________________ (Name of Business) 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business’s policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee’s community, or any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. Date: ______ _________________________________________ Applicant’s Signature Page 29
    • EXHIBIT E PUBLIC ENTITY CRIME STATEMENT Public Entity Crime Statement. All invitations to bid, request for proposals and any contract document shall contain a statement which reads as follows (Section 287.133 FS): “A person or affiliate who has been placed on the convicted vendor list following a conviction for 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 on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list.” PROPOSER’S SIGNATURE DATE As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. Page 30
    • EXHIBIT F THE SCHOOL DISTRICT OF MONROE COUNTY _______________, _____ (Date) _____________________________ (Name of Company/Contractor) _____________________________ (Address) _____________________________ _____________________________ Dear ________________________: Please be advised that pursuant to the policies and procedures of The Monroe County School Board (“MCSB”), all contracts between companies and/or contractors and the School District are to be documented using standard form contracts drafted by the Monroe County School Board. It is our understanding, however, that (you have/your company has) refused and/or otherwise neglected to utilize a standard form contract for goods or services. Kindly acknowledge (your or your company’s) refusal to utilize a Monroe County School Board standard form contract by signing below. Please return a signed copy of this letter to the Monroe County School Board at your earliest convenience. Should you have any questions or concerns, please do not hesitate to contact me. I am refusing or have otherwise neglected to use a Monroe County School Board standard form contract. __________________________________ Contractor or authorized designee Very truly yours, Lisa Ernst Cherry Director of Purchasing Cc: Randy Acevedo, Superintendent Legal Department Legal Department Page 31
    • EXHIBIT G THE SCHOOL DISTRICT OF MONROE COUNTY BUSINESS/PERSONAL RELATIONSHIP DISCLOSURE AFFIDAVIT (Exhibit to Standard Form Contract) I, ___________________________________, of the City/Township/Parrish of __________________________________, State of ______________________, and according to law on my oath, and under penalty of perjury, depose and say that; 1) I am the authorized representative of the company or entity making a proposal for a project described as follows: Name of company (or vendor if no company): __________________________________; and Nature of services presently being offered to School District: __________________________ 2) I have ____ have not ____, at any time, and excluding the instant proposal, had a business or personal relationship with any member of the School Board of Monroe County, Florida, and/or with any employee of the School District of Monroe County, Florida. a.) The details of my or my company’s present and/or former relationship, excluding the instant proposal, are: {include particular Board member or employee’s name(s), position held by such member or employee and relevant date(s); use reverse for space if needed} ____________________________________________________________________________________ ________________________________________________________________________ 3) The statements contained in this affidavit are true and correct, and made with full knowledge that The School Board of Monroe County, Florida, relies upon the truth of the statements contained in this affidavit in awarding contracts for the subject project. _____________________________________ Dated:_____________ (Signature of Authorized Representative) Print: ______________________________ STATE OF ____________________, COUNTY OF ___________________ PERSONALLY APPEARED BEFORE ME, the undersigned authority, _____________________________________________________, who, after first being sworn by me, affirmed that the statements made herein are true, and has affixed his/her signature in the space provided above on this ______ day of ___________________________, 2009 NOTARY PUBLIC My commission expires: _____________________________ Page 32
    • EXHITIB H NON-COLLUSION AFFIDAVIT I,____________________________________________________of the city ing to law on my oath, and under penalty of perjury, depose and say that; 1) I am_____________________________________________, the bidder making the Proposal for the project described as follows: _______________________________________________________________ 2) The prices in this bid have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor; 3) Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or indirectly, to any other bidder or to any competitor; and 4) No attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit, or not to submit, a bid for the purpose of restricting competition; 5) The statements contained in this affidavit are true and correct, and made with full knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said project. STATE OF ____________________ _________________________________ (Signature of Bidder) COUNTY OF ___________________ _________________________________ DATE PERSONALLY APPEARED BEFORE ME, the undersigned authority, __________________________________ who, after first being sworn by me, (name of individual signing) affixed his/her signature in the space provided above on this ___________ day of _______________________, 20___. _________________________________ My commission expires: NOTARY PUBLIC Page 33
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    • Exhibit A Page 35
    • Monroe County School Board (See Attached – Addendum 1) RFP Number; 397 Instructions for Claim Re-Pricing This file contains claims data from 1/1/2007 through 8/19/2008. It has been sorted in date order and contains sufficient data for you to provide pricing according to your contracts at the time of the prescription fill. The data provided should not be changed in any way and includes: Fill Date Service Provider ID (NCPDP) Product ID (NDC) Quantity Day's Supply Brand/Generic Indicator Mail/Retail Indicator Formulary Flag Compounding Code You are requested to complete the fields shaded in blue, using your standard claims processing practices based on the plan as described below and based on the fees you are proposing to MCSB. Please provide what your actual charge to the patient would be, outline any per prescription dispensing fee and any per prescription administration fee. In the column labeled Client Cost, please show the total cost to the client for each prescription. If you have recently negotiated more favorable discounts for the providers utilized and wish to demonstrate greater savings than shown with the original fill dates, you may add a supplemental Claim Pricing form with your Proposal. You must clearly identify the Supplemental form and identify the revised "fill dates" clearly. MCSB requests that you return the completed form along with your proposal in Excel format - it is not necessary to print the form. As the proposals are evaluated, MCSB will provide approximately 20 drug codes for which we will need full pricing detail. Copayments:$ $10.00 Generic (Mandatory)* $ 25.00 Brand $ 25.00 Brand w/generic available. $ 40.00 Non-Formulary. Mail Order $ 14.00 Generic (Mandatory)* $ 40.00 Brand $ 40.00 Brand w/generic available $ 70.00 Non-Formulary Patients currently pay the lower of the charge or the Copayment. Retail/Mail Order Mandatory Generic benefit-if you Request the Brand medication, when the Generic is Available, you will pay the Brand co-pay PLUS the Difference between the Brand and Generic price. Page 36 Exhibit B
    • MONROE COUNTY SCHOOL BOARD QUESTIONNAIRE May-09 Please note there are 2 tabs in this workbook. You must complete both the Requirements Tab and the General Questions Tab in order to present a complete proposal. The Requirements Tab contains items that comprise the Minimum Eligibility, Scope of Services requested, and Experience and Qualifications. The General Questions Tab contains questions about your operational abilities, pricing and discounts, reporting, and other capabilities that are of importance. Please note that space is limited in these forms and keep your answers succinct. If additional space is required, please insert a new row for the remaining response to ensure that your response will be complete. Where an item requests documentation, please provide that documentation at the end of your proposal under the tab entitled: Other Information. Please do not modify the format of these forms except to add a row for additional space. Exhibit C Page 37
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    • ATTACHMENT D - FINANCIAL QUOTATION FORM 1. PRICING - RETAIL Brand Drugs AWP minus % or MAC Estimated MAC Discount: AWP minus % Dispensing Fee $ Per Script Administrative Fee $ Per Script Generic Drugs AWP minus % or MAC Estimated MAC Discount: AWP minus % Dispensing Fee $ Per Script Administrative Fee $ Per Script 2. PRICING - MAIL ORDER Brand Drugs AWP minus % or MAC Estimated MAC Discount: AWP minus % Dispensing Fee $ Per Script Administrative Fee $ Per Script Generic Drugs AWP minus % or MAC Estimated MAC Discount: AWP minus % Dispensing Fee $ Per Script Administrative Fee $ Per Script Page 53
    • 3. PRICING - SPECIALTY PHARMACY Brand Drugs AWP minus % or MAC Estimated MAC Discount: AWP minus % Dispensing Fee $ Per Script Administrative Fee $ Per Script Generic Drugs AWP minus % or MAC Estimated MAC Discount: AWP minus % Dispensing Fee $ Per Script Administrative Fee $ Per Script 3. OTHER FEES One Time Set-Up Fee: $ Electronic Data Feeds to Medical / UR Vendor $ Per Feed Initial ID Card Packets (2 Cards) Mailed to Home: $ Per Packet Replacement ID Cards: $ Per Packet Prior Authorizations $ Per Authorization 4. REBATES Percentage of Rebates to be Paid to Plan: % Guaranteed Rebate per Retail Brand Script: $ Guaranteed Rebate per Mail Order Brand Script: $ 5. ADMINISTRATION FEE GUARANTEE Months Please list any additional fees or pricing concerns no mentioned above, including any fees for Medicare Part D related services. Page 54
    • Monroe County School Board requires the successful bidder to have sufficient confidence in its performance to warrant certain performance levels. Claims processing standards are important as well as discounts and the effective implementation of the program. Please indicate below which components of your performance you are willing to guarantee and the amount you will place at risk. Component Measure and Amount at Risk Accurate and effective implementation within X days of notification of award. Claim payment accuracy Claim payment turnaround Delivery of timely reports Transparency in operations Effective data sharing and integration across all program components Account Management Please indicate any additional program components for which you are willing to guarantee performance. Exhibit E Page 55